Till a few months back, the Allied forces and President Saddam Hussein’s regime were engaged in a struggle for the control of Iraq’s future. Political and defence experts were busy analysing the various ramifications of that war, as were the economic pundits who were  looking into the global financial implications. Anti-war activists and peace workers, as also the U.N., the Red Cross and other humanitarian organizations, continued to be concerned with the ethical, rehabilitative and human dimensions of Gulf War II. All these were no doubt highly important issues which deserved our attention. One another dimension, which we should not miss in this whole picture, was the psychopathological sequelae of this war in particular, as indeed of war and strife in general. A brief peep into the psychiatric disturbances in the aftermath of the terrorist attack on the World Trade Center in 2001, and the Gulf War of 1990-91, may provide us with some insight into what we may expect in Gulf War II.

The terrorist attack of September 11, 2001, which destroyed the World Trade Center in New York City and damaged the Pentagon in Washington, resulted in over 3500 deaths and injuries. It also traumatized a nation. Many American citizens required psychiatric treatment. A National Survey of 540 US adults, taken three to five days after the event and published in The New England Journal of Medicine, 2001, found definite evidence of psychiatric disturbances in these adults and their children (Schuster, Stein and Jaycox et al, 2001). Forty four percent adults reported one or more substantial stress symptoms. These included insomnia, nightmares, fearfulness, irritability and distressing recollections of the event. Thirty five percent of children had one or more stress symptoms. One interesting fact which emerged was that the level of stress was associated with television viewing of the disaster. So much for live coverage of such large scale disasters. (However, greater chance of psychiatric disturbances were found in those with a past history of psychiatric disorder, or those who had suffered significant stress in the recent past. A brief note of caution to that effect during live T.V. coverage of such events may help reduce distress to some extent.)

 Most of us know that psychiatrists describe a syndrome that\ develops after a person sees, or is involved in, or hears of, an extreme traumatic stressor. The person reacts to this experience with fear and helplessness, persistently relives the event and tries to avoid being reminded of it. These symptoms significantly affect important areas of his life, like family and work. This syndrome is called Post-traumatic Stress Disorder (PTSD), or Acute Stress Disorder (if it occur within 4 week of the event and remits within 2 days to 4 weeks). These disorders arise from experiences in war, torture, natural catastrophes, assaults, rape, serious accidents, fire to buildings etc. In our country India, we see this phenomenon as an aftermath of communal riots as well. The latest example of a fresh crop of PTSDs was after the post -Godhra riots which rocked Gujarat State in 2002.

 But let us continue with the WTC terrorist attack. The New England Journal of Medicine in 2002 published a study of a later survey of Manhattan residents conducted 5-8 weeks after the World Trade Center collapse (Galea, Ahern and Resnick et al, 2002). 7.5 % residents had PTSD and 9.7 % had depression. This meant 67,000 people had PTSD and approximately 87,000 had depression during the time of the study.Even allowing for estimated prevalence of current psychopathology, nearly half the estimated sample, that is, more than 75,000 South Manhattan residents suffered psychological disorders due to that one terrorist attack alone*.

Higher rates for all these conditions were found in those living close to the disaster site and those exposed to prior but unrelated traumatic events. Thus, geographic proximity and stressful life events correlated closely with development of PTSD. This can become an important guideline for any subsequent work planned for such victims.

Gulf War Syndrome

So much for the Sept. 11, 2001, attack. Let us go back a little in history to Gulf War I. This war against Iraq, which began in 1990 and ended in 1991, involved 6,97,000 American soldiers, 45,000 soldiers from Great Britain and 4,500 soldiers from Canada. More than 1,00,000 US veterans reported a number of health problems on returning from war. These included irritability, muscle  and joint pain, migraine headache, shortness of breath, digestive disturbances, hair loss, rashes, forgetfulness and difficulty with concentration. Collectively, these symptoms were called the Gulf War Syndrome. After the recent Gulf War, there is bound to be a fresh crop of victims of this syndrome.

Many veterans believed this disorder was caused due to exposure to biological and chemical agents, fumes from burning oil wells, and landfills or mustard or other nerve gases. The US Defense Department acknowledged that upto 20,000 troops may have been exposed to chemical weapons but denied that those complaining of the syndrome were suffering because of the effects of chemical exposure.* Claims submitted by Gulf War veterans seeking disability payments were denied in over 90 % cases. The morale of thousands of affected Gulf War veterans got seriously eroded. Confidence in the U.S. Defense Department’s concern for illness amongst soldiers was compromised in the public mind as a result. The repercussions of a fresh crop of war veterans with similar symptoms which will no doubt result after Gulf War II is anybody’s guess. This is not to hold any brief for the despotic Iraqi regime but only to highlight the enormous psychopathological consequences of war that power wielders force on the unsuspecting public and the loyal troops.

 There is incontrovertible evidence of organic brain damage emerging in peer - reviewed literature. Haley and colleagues, using clinical tests and Magnetic Resonance Spectroscopy (MRS) , demonstrated extensive and comprehensive neurological damage with significant biochemical changes in the brains of Gulf War veterans (Haley, Marshall and McDonald et. al., 2000)**. Damage to the basal ganglia and subsequent neurotransmitter dysfunction can result according to another study (Haley, Fleckenstein and Marshall There is i n c o n t r o v e r t i b l e evidence of organic brain damage emerging in peer - reviewed literature. Haley and colleagues, using clinical tests and Magnetic Resonance Spectroscopy (MRS), d e m o n s t r a t e d extensive and c o m p r e h e n s i v e neurological damage with significant biochemical changes in the brains of Gulf War veterans (Haley, Marshall and McDonald et. al.,2000). as can Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig’s disease, thought to be due to genetic mutations, according to a third (Charatan, 2002). To be fair, the US Defense Department did agree to pay compensation to veterans who developed ALS. The vast majority of others are still waiting for the benevolent gaze of bureaucrats and leaders who never tire of waxing eloquent about the loyalty and patriotism of their troops when they send them to war.

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*May be, we can take solace in the fact that bureaucratic callousness in not limited to India alone.

** Whether the hippocampus also plays a role in PTSD remains a controversial issue, although it has occupied the attention of some researchers ( Bremner, 2001 ; Pitman, 2001).The average volume of the hippocampal region is found lowered in soldiers involved in combat operations. How specific is this change is an area of challenging future enquiry.