Combat Loss and PTSD – Part 1: Post 9-11 Casualties

This is a paper about how infantrymen in the United States Marine Corps handle combat deaths. It was researched and written by Stephen Smith, Th.M., in partial fulfillment for a seminary course on Death and Dying. While Steve has never experienced the dark side of man, his twin brother – me – has. Together, we offer this paper in eight parts. Footnotes follow at the end of each section.

Part 1: Post 9-11 Casualties

Part 2: The Link Between Combat and PTSD

Part 3: Learning to Kill

Part 4: Preparing for Death

Part 5: When the Metal Hits the Meat

Part 6: Memorials and Unit Healing

Part 7: When the War Continues – PTSD

Part 8: Conclusion and Bibliography

Part 1: Post 9-11 Casualties

The purpose of this paper is to consider how infantry Marines deal with combat death in Iraq and Afghanistan. The conclusion of this paper is that a high percentage of infantry Marines are unable to effectively process friendly casualties during combat and therefore suffer from post traumatic stress disorder (PTSD) as a result of combat trauma and non-integrated loss. This paper will argue that the nature of Marine infantry training, the exhausting and dangerous experience of combat, feelings of loss of control, and close proximity to traumatic death leads to PTSD as a common—and possibly normative—result of Marine infantry combat operations.

To reach this conclusion, we will first lay out the relevant casualty statistics from the post-9/11 wars in order to show why the incidence of PTSD among infantry Marines may be higher than official statistics indicate. We will then discuss Marine training, combat operations, and how Marines handle the aftermath of death in combat. We’ll conclude with how the Marine Corps is seeking to prevent and treat PTSD.


Combat causes casualties. The Huffington Post recently ran a column detailing U.S.

Rows of headstones shadowed by a late September sun. Arlington National Cemetery. Sept 2005

Rows of headstones shadowed by a late September sun. Arlington National Cemetery. Sept 2005

military casualties from the conflicts in Iraq and Afghanistan.[1] The figures were sobering. As of November 19, 2012, precisely 5,557 Americans had been killed in combat (including those killed by improvised explosive devices, or IEDs). More than 50,000 had been wounded. Of the wounded, 16,000 suffered severe or disabling injuries. In addition, over 250,000 personnel have been diagnosed with traumatic brain injuries. These are the physical wounds of war.

Mental and Emotional Wounds of War: PTSD and Depression

But there are further casualties of war not included in these statistics. The Department of Veterans’ Affairs (VA) has officially diagnosed 207,161 veterans with Post Traumatic Stress Disorder (PTSD) as a result of combat operations or operational stress in Iraq and Afghanistan. Such diagnoses are a result of medical screening and the use of the DSM-IV criteria for PTSD. In a separate study, the Rand Corporation, a Pentagon-funded think tank, estimates that up to 337,820 post-9/11 veterans (14% of those deployed as of 2012) may suffer from the symptoms of PTSD, and perhaps another 14% may suffer from depression. The VA concurs with these estimates.[2] War carries a heavy psychological toll.

While high, the 14% incident rate of PTSD in returning veterans cited by the Rand study fits within estimates for other recent wars.[3] The National Center for PTSD estimates that 10% of Gulf War veterans suffer from PTSD, and almost 30% of Vietnam veterans suffer from it.[4] Yet the 14% figure is not the full picture when considering the impact of war and combat death on infantry Marines. When considering the incidence of PTSD in combat troops, the 14% figure may be misleading and may result in an unintentional stigma placed on those who suffer from it.[5]

Why? Because while 14% seems like a gratifyingly small percentage if you are among the 86% who don’t have PTSD, it may seem like an embarrassingly small percentage if you are in the 14% who do suffer from PTSD. An infantryman who suffers from PTSD can easily believe that there is something wrong with him—that he was not tough enough to handle combat trauma as the other 86% of troops apparently were. That he was not man enough—not warrior enough—to deal with combat. This perception may result in significant shame and the infantryman may isolate himself or sink into depression.

Higher Incidence of PTSD among Combat Infantry Marines?

But in reality, it now appears that the very nature of Marine infantry training and combat results in a high incidence of PTSD among infantrymen. Indeed, the modern infantryman who fails to suffer from PTSD may be the exception, rather than the rule. How do we come to this conclusion?

It is important to realize that the Rand study’s 14% figure of PTSD incidence is calculated based on all deployed troops. And in both the Army and Marines, there is a high “tooth to tail” ratio among personnel. This means that while there may be a large number of troops deployed in a given theater of war, only a small fraction of those troops are actually involved in daily ground combat operations where men die and the metal meets the meat. Most of these combat troops are members of the infantry.

In both the Army and Marines, the infantry makes up only about 12-20% of the total forces deployed. The other 80 to 88% of troops are involved in logistical support of one kind or another: truck drivers, cooks, clerks, military police, etc. Many of these logistical troops remain “inside the wire” on large, heavily guarded bases. And while in asymmetrical

Machine gunners with Company K, 3d Battalion 2d Marines in Iraq.

Machine gunners with Company K, 3d Battalion 2d Marines in Iraq.

warfare (a war with no established battle lines, such as the insurgency in Iraq) even logistical troops may encounter firefights or indirect fire (mortars, for example), usually the fighting is done by the infantry. It is the infantryman who encounters the enemy at close range and kills him. It is the infantryman who must make instantaneous life-or-death choices. It is the infantryman who chambers a round, kicks down a door, and decides who dies or lives. And it is the infantryman who watches his fellow troops suffer and die.

To put this in perspective for the Marine Corps, since September 11, 2001, over 2.4 million Americans have deployed to either Iraq or Afghanistan.[6] Approximately 1/8 of them (300,000) have been Marines. Roughly half of those Marines have deployed multiple times.[7] And of those Marines who deployed, only 12-15% were classified as infantrymen.[8] This should raise an obvious question: is there a correlation between the 14% of overall deployed troops diagnosed with PTSD, and the actual 12-15% who are classified as infantry and do most of the fighting?

(Next Post: Part 2 – The Link Between Combat and PTSD)

[1] “U.S. Wounded In Iraq, Afghanistan Includes More Than 1,500 Amputees.” Huffington Post, 11/8/12, by David Wood. Accessed 11/16/12.

[2] “Iraq, Afghanistan Veterans Struggle with War Trauma.” Huffington Post, 7/4/12, by David Wood. Accessed 11/15/12.

[3] “The DoD and VA acknowledged at the beginning of the wars in Afghanistan and Iraq that there would be substantial psychological costs. No prior war has had as much research conducted on the mental health impact while the war is going on. Congress and news organizations took special interest in PTSD in part because of a paper my research team and I wrote that was published in the New England Journal of Medicine in 2004, showing that 12 to 20 percent of soldiers and marines who had participated in the initial ground invasion of Iraq had serious symptoms of PTSD three to four months after coming home.” – Charles W. Hoge M.D.. Once a Warrior–Always a Warrior: Navigating the Transition from Combat to Home–Including Combat Stress, PTSD, and mTBI (Kindle Locations 266-270). Kindle Edition.

[5] Veterans who suffer from PTSD may believe that they are weak. This is a lie. Former Marine Captain Nathan Smith writes: “The bravest and most competent combat veterans that I know suffer from PTSD. One friend is a Marine officer who was shot through the shoulder by an insurgent sniper during a firefight in Iraq. Picking himself up from the ground and dripping blood onto the radio handset, he calmly called in his own medevac. He was—and is—a tough, personally courageous man.” From The Soldier’s Load blog,

[6] “Iraq, Afghanistan Veterans Struggle with War Trauma.” Huffington Post, 7/4/12, by David Wood. Accessed 11/15/12.

[7] Michelle Tan, Marine Corps Times, 12/18/09. Accessed 11/18/12.

[8] “In 2011, 30 percent of graduating TBS lieutenants listed infantry in their top three requested MOSs. Of those 30 percent, only 47 percent were given the MOS.” Captain Katie Petronio, “Get Over It: We Are Not All Created Equal” Marine Corps Gazette Accessed 11/19/12. Anyone in the Marines who has an “03XX” Military Occupational Specialty (MOS) is technically classified as infantry. This means that only about 15% of graduating Marine lieutenants were given infantry billets in 2011. This percentage seems to run true overall in the Marine Corps, meaning that only about 15% of Marines are technically infantry.

About Nate

A 2003 graduate of the Virginia Military Institute and former Marine infantry officer, Nate is the Chief Operating Officer of Hire Heroes USA, a nonprofit organization that helps veterans get jobs. He holds a Master's in Public Administration from the University of Georgia. Nate lives with his wife and dog in Alpharetta, Georgia.
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6 Responses to Combat Loss and PTSD – Part 1: Post 9-11 Casualties

  1. Pingback: Combat Loss and PTSD – Part 2: The Link Between Combat and PTSD | The Soldier's Load

  2. Pingback: Combat Loss and PTSD – Part 3: Learning to Kill | The Soldier's Load

  3. Pingback: Combat Loss and PTSD – Part 4: Preparing for Death | The Soldier's Load

  4. Pingback: Combat Loss and PTSD – Part 5: When the Metal Meets the Meat | The Soldier's Load

  5. Pingback: Combat Loss and PTSD – Part 6: Memorials and Healing | The Soldier's Load

  6. Pingback: Combat Loss and PTSD – Part 7: When the War Continues – PTSD | The Soldier's Load

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