BAGHDAD — A military culture that values strength and a "can do" spirit is discouraging thousands of soldiers from seeking help to heal the emotional scars of war in Iraq and Afghanistan, despite top-level efforts to overcome the stigma, commanders and veterans say.
Up to one-fifth of the more than 1.7 million military members who have served in Iraq or Afghanistan are believed to have symptoms of anxiety, depression and other emotional problems. Some studies show that about half of those who need help do not seek it.
"It's a reality that for some — certainly not all, but for some — there's a stigma to stepping forward for behavioral health," said Maj. David Cabrera, who runs counseling services at a military hospital in Germany.
"Our goal is to eradicate the stigma," he said. "We're not there yet."
Encouraging more troops to seek help and training leaders to spot signs of trouble have taken on new urgency since the fatal shooting Monday of five U.S. service members at a counseling center at Baghdad's Camp Liberty.
Army Sgt. John M. Russell has been charged with five counts of murder. He was finishing his third tour in Iraq and had been ordered to seek counseling at the center, the Army said.
Sergeants on their third or fourth assignments to Iraq or Afghanistan are more than twice as likely to suffer mental health problems as those on their first assignment to a combat zone, according an Army study last year.
Combat stress is common in every war — including "battle fatigue" cases in World War II and the lasting trauma still suffered by thousands of veterans of the Vietnam conflict.
What makes the current conflicts different are the frequent, repeating rotations. Most soldiers spent just one or two assignments in Vietnam, but many American soldiers and Marines are on their third or fourth tours in Iraq and Afghanistan.
Units return home to the United States or Germany, only to soon begin preparing for their next deployment, adding strains on both the soldiers and their families.
Military officials insist they are keenly aware of the growing stress problem in the ranks and are moving quickly to expand counseling facilities not only in war zones but at bases in the U.S. and Europe for troops who return from the fighting.
Most major bases in Iraq maintain combat stress clinics, where soldiers can visit counselors and relax for a few days away from the pressures of their jobs.
"The only way we're going to keep our soldiers fit to fight, if you will, is to make sure it is a holistic approach, not just the physical but mental readiness," said Lt. Gen. Kenneth W. Hunzeker, an Iraq veteran and corps commander in Germany.
But changing attitudes in the ranks has proven a tougher challenge. Young combat soldiers don't want to seem weak in front of comrades. Sergeants who are supposed to be role models worry about endangering their careers.
Sgt. 1st Class Gary Frey, 36, on his second tour of Iraq, said the Army does not consider it a bad mark against a soldier if the soldier seeks counseling. But going to a combat stress center "may be viewed as a weakness by individuals," he said.
"We are alpha males in the infantry," he said.