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Soldiers confront the psychological cost of war

As the head of the French Army’s psychological unit, Lieutenant-Colonel François-Xavier Marchand’s job is to address mental health issues in the military. With the war raging in Afghanistan, he is a very busy man.


Lieutenant-Colonel François-Xavier Marchand has been to Afghanistan six times over the past few years. Head of the French Army’s psychological intervention unit - known by the French acronym Cispata - Marchand is about to leave for Cyprus, where he will host troops from the Army’s 126th Infantry Regiment returning from Afghanistan. A new rule passed in June makes it mandatory for all the French soldiers coming home from Afghanistan to spend three days with Cispata.

In recent years, US and British military officials have been releasing alarming figures on the state of mental health of their soldiers. According to US military statistics, approximately 20% of soldiers deployed in Iraq suffer from post traumatic stress disorder, yet 50% of them do not seek medical help.

A report published in July also shows that the suicide rate in the US military is now slightly higher than the civilian suicide rate across the country for the first time since the Vietnam War. Between Oct. 1, 2008 and Sept. 30, 2009, 160 US soldiers on duty committed suicide.

What about France? How are French soldiers - including the approximately 3,850 troops deployed in Afghanistan - doing? Since the late 1990s and especially after the war in the former Yugoslavia and the increase in overseas missions, the military has been paying careful attention to the psychological state of troops serving in an institution that has historically prided itself with getting on and getting the job done with minimum personal fuss. Lt Col. Marchand talks about the achievements and the challenges confronting his unit. What is the daily life of French soldiers in Afghanistan?

Lt. Col. Marchand: There are six-month extremely intensive missions, preceded by a year of preparation. The environment is harsh; they are in mountainous areas where it is very hot or very cold. In addition, they’re dealing with a guerrilla war, where it’s difficult to discern where is the enemy and indeed who is the enemy. We want to help the Afghans, but do they want our help? It’s a complicated situation. There’s a huge gap between how we talk about this conflict here and the reality on the ground, making the task even more difficult for the soldiers. What are some of the mental health issues that soldiers face?

Lt. Col. Marchand: We must distinguish between the daily physical injuries, which are visible, and the psychological wounds, which are invisible. You can not prepare for a confrontation with death. Of course, it’s their job, but soldiers are also human. Sometimes they go through a mission and do not develop any disorders, sometimes they develop a disorder after an injury, when they return to civilian life…

It’s not as apparent as a physical injury and we know that the sooner a physical wound is treated, the better. For psychological injuries, it’s the same thing. We must ensure that in our system, where people tend to suffer silently, that they can go ahead and seek treatment. Otherwise, you end up in a dire situation: Last week, at a military hospital in France, I met an old gentleman who was visiting for the first time with problems related to his involvement in the (1960s) Algerian war. He had never spoken about his problems before! Specifically, how do these mental health problems occur?

Lt. Col. Marchand: Generally, they appear three to six months after returning home, but sometimes they can occur after several years. Typically, there are nightmares, withdrawals, a very real sense of still being in the battlefield, hyper vigilance ... One day, for example, I was in Cyprus with an NCO when fireworks erupted. He jumped, darted under the table and curled up into a foetal position. It can also manifest itself in violence, which often starts with spousal abuse, depression, substance abuse, addictions... These behaviours can lead to social alienation, and in the worst cases, suicide. Why, unlike the US or Britain, are there no official statistics in France?

Lt. Col. Marchand: I do not know and I find it unfortunate. In my opinion, the proportion of French soldiers suffering psychological problems is the same as in the United States. However, in contrast, the number of suicides in the French Army has remained less than amongst the civilian population. What exactly is the purpose of the new rule requiring soldiers returning from Afghanistan to spend three days in Cyprus before coming home?

Lt. Col. Marchand: The goal is to have a buffer between a hostile environment with the omnipresent risk of death and daily life in a country at peace. It’s a time for them to relax and to ease their return to family life.

The soldiers are housed in a five-star hotel, which is a sign of the nation’s recognition and gratitude for their work. These are mandatory activities. It begins with a two-hour cruise with champagne and appetizers. They have the right to drink, but in moderation and at specific times. They also have relaxation sessions, cultural visits, massages ... Then there’s a group end-of-mission debriefing session. Finally, they are informed about behavioural issues that they need to watch out for: that they no longer need to be armed in France, an awareness of deviant behaviours, of adrenalin fluctuations...

Initially, the soldiers arrive in Cyprus very tense, they do not want to come, but in the end we have a 99% satisfaction rate. Has the war in Afghanistan improved the army’s awareness of mental health issues?

Lt. Col. Marchand: It’s unfortunate to say this, but Afghanistan has improved our awareness of this issue. In 2009, we developed a directive on psychological support in a combat zone, which can be applied elsewhere, not just in Afghanistan. It provides for the full-time presence of a psychologist in the theater of operation. Have these changes been readily accepted in the army?

Lt. Col. Marchand: We face enormous resistance at all levels. But today, we don’t need to justify our existence. We do not see people in hospitals, but on the ground, the very place where they face violence. We are armed, we take risks like them. They trust us because we're military and they understand that we are not here to judge or evaluate them but to help them.

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