Combat Loss and PTSD – Part 5: When the Metal Hits the Meat

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. Click on the links below to read the previous four posts.

This post, Part 5, describes the physical, emotional, and psychological reactions of Marines to the violence of combat.

Part 1: Post 9-11 CasualtiesPart 2: The Link Between Combat and PTSDPart 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

How Infantry Marines Experience Death during Combat Operations

As we have seen, Marine training emphasizes professional detachment and desensitization when it comes to combat death: whether the death of enemy combatants or of fellow Marines. The purpose of this training is to ensure that Marines remain combat effective in order to accomplish their mission, regardless of how chaotic or bloody the battle becomes.[1] Few would disagree with the importance of this objective. But the very nature of traumatic events is that they impact the psyches of those who experience them. Training may allow a Marine to function despite experiencing trauma, but it cannot erase the traumatic experience, nor can it erase the Marine’s fundamental humanity.[2] While Marines may continue to function in combat as professional warriors, nothing can prepare them for the death of a friend. And despite their training in desensitization, many Marines report experiencing normal feelings of shock, grief, anger, and feeling helpless or out of control when a friend dies in combat. Problematically, the tempo of combat operations rarely allows Marines to fully process or integrate such feelings. The result is a heightened susceptibility to PTSD.

Fear of One’s Own Death

While training may desensitize a Marine to the death of an enemy combatant, there is always the question of one’s own mortality. Living in a combat zone where other men are actively trying to kill you creates a climate of fear for some Marines. And while this fear may not be debilitating, it can contribute to susceptibility to PTSD.[3] Chris Lyon, a Marine turret gunner in Iraq, recalls his own sense of mortality:

A Humvee damaged in combat.

A Humvee damaged in combat.

As I stood in the relative cool of the stairwell of our rarely used company barracks on the old RAF base at Habbaniyah, staring at the cool blackened steel of the “Mark” [machine gun], I wondered how I would die. I remember now that it wasn’t a question in my mind of if, but when, and where, and how. I hoped it would be quick, but I did not want it to be instant; that was clear in my mind. I wanted time in my last seconds to gather my thoughts, my loved ones in my heart, and to gather my many sins into my soul and send them all forth together, with every ounce of remorse and hope and faith I had. I did not want to die unshriven, or barring that, unknowing. These dark thoughts were spurred by what had happened to Miller and Johnson [Marines who had been killed], to be sure, but also by rumors that had been circulating about the general bounties that the AQI (Al Qaeda Iraq) had placed on turret gunners. I can’t remember, now, what the overall casualty rate for turret gunners was in OIF and OEF, or even on our own deployment. Purely by our exposed positions we were the most vulnerable to attack, especially from sniper fire. There was hardly a gunner I knew or talked to in the battalion that had not been blown up repeatedly and had numerous close calls by the end of the deployment.[4] Other

Marines with 3rd Battalion 2nd Marines patrol past the location where two Marines were killed by an IED just days before. Over the course of 2 weeks, six Marines and soldiers were killed within 200 yards of the mosque in the background. East Bidimnah, Iraq 2006

Marines with 3rd Battalion 2nd Marines patrol past the location where two Marines were killed by an IED just days before. Over the course of 2 weeks, six Marines and soldiers were killed within 200 yards of the mosque in the background. East Bidimnah, Iraq 2006

Marines describe the “pucker factor” of leaving the wire of a forward operating base in a vehicle. “Pucker” refers to the tightening feeling a Marine gets in his anal sphincter as he considers the likelihood that he could be blown up by an IED beneath his vehicle. Almost half of the casualties in Iraq and Afghanistan are the result of IEDs.[5] The fear of never knowing if you will get blown up haunts almost every Marine who goes outside the wire. This fear continues for some Marines when they return to the States and see piles of trash beside the road, which in Iraq might signify a hidden IED.

Shock of Combat Death

Most Marines describe the first friendly death they see in combat as a huge—and sometimes debilitating—shock.[6] When Nathan Smith served as the lieutenant of a Marine infantry platoon in Iraq, one of his foot patrols was hit by an IED. A Marine was blown apart. Smith helped the corpsman triage the casualty, then directed his attention to an aimless group of Marines standing nearby. He writes on his blog: “This is the squad that was hit by the IED and they are in shock. The squad leader stares vacantly over my right shoulder at the corpsmen bending over his bleeding friend. I have to grab his biceps and physically turn him to face me before a flicker of recognition crosses his stricken face.”[7] Lt. Col. Benjamin Busch recalls a similar incident: “The unflinching corpsman, Doc Negron, was covered with blood and looked drained as if it had been his own. The others were wide-eyed, exhausted, and silent with shock. They were huddled in a group staring at the entrance to the trauma tent, a large inflated portable triage facility. I could hear screaming and ran inside. My Marine had been sitting on the edge of his vehicle hatch when it was struck by an RPG….”[8] Officers themselves are not immune from shock upon seeing a friendly casualty. Smith recalls the first time he saw one of his

Marines from 3rd Battalion 6th Marines clear Ubaydi during Operation Steel Curtain in October and November of 2006. This was the location of the casualty described in this section.

Marines from 3rd Battalion 6th Marines clear Ubaydi during Operation Steel Curtain in October and November of 2005. This was the location of the casualty described in this section.

men who had been killed. His platoon was involved in clearing operations along the Euphrates River in western Iraq, 2005. Insurgents ambushed the unit from the town of Ubaydi. Despite his desensitizing at a local ER during IOC, Smith was unprepared for what he saw. “Some snipers attached to my platoon dragged one of our guys out of a building. He’d been shot a dozen times at close range by three insurgents with a machine gun and AK-47s. It was the most horrible thing I had ever seen – his face looked like a Halloween mask. This wasn’t supposed to happen in real life. I was incapacitated and couldn’t give any orders for what seemed like a long time, but was probably only a few seconds. Fortunately other Marines were making decisions.[9] An occasional exception to this feeling of shock is when a Marine is killed because of his own “stupidity” or when a unit continues to make the same mistake over and over. While Marines never like to see another Marine killed, there is sometimes a feeling that a Marine gets what is coming to him if he refuses to follow standard operating procedures.[10]

Helpless/Out of Control Feelings

While shock is a normal reaction to experiencing the death of a friend in combat, Marines sometimes may feel helpless or out of control as a result of the circumstances.[11] Marines who feel this way are particularly susceptible to PTSD. Dr. Hoge notes, “There are some unique situations in which warriors will acknowledge feeling helpless, and it appears that these can contribute to them developing serious PTSD symptoms on return from combat. These are situations in which warriors are unable to respond militarily, either because the enemy is elusive or because they’re constrained by the rules of engagement (ROE).”[12] Unfortunately, much of the combat in Iraq—and sometimes in Afghanistan—falls into this category. For example, the nature of the insurgency in Iraq involves hit-and-run attacks where the enemy combatants blend into the civilian population or use IEDs to inflict casualties remotely. Marines find this type of warfare maddening.[13] When a Marine unit suffers a casualty, the Marines naturally want to exact vengeance and eliminate the threat. With IEDs in particular, Marines rarely obtain this cathartic release of emotion.[14] Instead, they are left feeling helpless, victimized, and frustrated. Nathan Smith recalls that in his entire first tour in Iraq he only fired his weapon at enemy combatants once. And that was just at muzzle flashes.[15] When his dead Marine was pulled out of the building in Ubaydi, Smith recalls feeling out of control. “I felt exhausted and overwhelmed,” he says. “I instantly got a migraine which lasted for the rest of the day. I wanted to be in control—as a Marine officer you are trained to always be in control—but a dead Marine is about as out of control as you can get. Things got so bad so fast.”[16] Benjamin Busch remembers feeling helpless after one of his Marines was shot by a sniper in Iraq: “I went outside as the helicopter was being called in, and the platoon had condensed into a silent pack nearby. They seemed full of something unsettled and beyond words. I knew the feeling. They were, again, incapable of exacting revenge, unsure if they should blame the mission, the leadership, or the city…. I went over to talk to them, but they were sullen with fury and fatigue.”[17] Later, when he himself was blown up by an IED, Busch longed for revenge: “I wanted at that moment to locate the triggerman and kill him, but there was no one standing nearby waiting to confess to fighting us. Nothing but Iraq falling away in every direction, surrounding us.”[18] Given that nearly half of all casualties from Iraq and Afghanistan are from IEDs—and considering the tightened Rules of Engagement for Marines—feelings of helplessness are now a major contributing factor to the rate of PTSD in returning veterans.[19] This may be especially true for concussed Marines with traumatic brain injury or for officers who second-guess decisions they made which resulted in friendly casualties—whether a different route would have been safe, or a different plan of attack might have resulted in fewer casualties.[20] “What if” questions are a Marine officer’s secret Purgatory.[21]You can act professionally even while your soul is dying,” says former Captain Smith.[22]

Lack of Time to Grieve or Integrate Feelings as a Result of Operational Tempo

While feelings of fear, shock and helplessness are normal reactions to combat or the traumatic death of a friend, Marines have little time to process such weighty emotions during combat operations.[23] The normal deployment for infantry Marines is currently seven months. During those seven months, infantry units may experience an intense operational tempo. Compounding an intense schedule of combat operations is the need to guard bases, protect convoys, and respond to unexpected threats. The very intensity of combat operations can make warriors susceptible to PTSD when they encounter a traumatic event—exhaustion is a multiplier of environmental stress.[24] Such up-tempo schedules also mean that Marines cannot take time to grieve and integrate their feelings during combat operations: they are too busy “sucking it up” and pushing through to execute the mission, just as they were trained to do. Units are often undermanned and overworked. Marines patrol out in the “ville” then return to base and man machine guns

Lt Smith's "rack" on a highway overpass in Iraq in October 2006 - the 611 Bridge. Marines cleaned themselves as best they could with baby wipes; weapons, however, were maintained meticulously. Insurgents targeted the bridge nearly every day

Lt Smith’s “rack” on a highway overpass in Iraq in October 2006 – the 611 Bridge. Marines cleaned themselves as best they could with baby wipes; weapons, however, were maintained meticulously. Insurgents targeted the bridge nearly every day

on guard towers or go out on night patrols. “We would send guys back to the base just to get a shower and hot food. Sometimes I didn’t shower for 30 days,” Nathan Smith recalls.[25] With such a rigorous combat schedule, grief takes a back seat. Smith remembers two incidents where there was no time to grieve the loss of a Marine during combat operations. After his Marine was pulled dead out of the building in Ubaydi, Smith had no chance to gather his unit together: all of the Marines in the dead Marine’s fire team had been wounded in the ambush and needed to be medevaced. “We were still in contact with the enemy at that point,” Smith recalls, “and then we had a five day clearing operation north of the river. We just kept pushing on. I remember asking the squad leader how he was handling it, but otherwise we just kept moving. There were nine guys killed on that seven day operation.[26] In the incident on his second tour when one of Smith’s foot patrols was hit with an IED, the affected squad was not functional. “They just wanted to kill people,” Smith says. “No one except me had seen a dead body before. I put them on a 7-ton truck and sent them back to the company command post. We continued the operation with the two remaining squads. For the remaining time in country we wouldn’t let the squad leader of the dead Marine out on patrols without myself or my platoon sergeant with him. He was ‘off.’ He blamed himself for the death and just wanted to shoot something.[27] In Sangin Province, Afghanistan, Marines of the 3rd Battalion, 5th Marine Regiment, suffered over 200 casualties in just a couple of months in 2010. Lance Cpl. Derek Goins, who lost two of his best friends when they were murdered by an Afghan soldier within a U.S. base, says that the only way to cope was to forget about the losses and

A wounded Marine is evacuated from a firefight in Afghanistan.

A wounded Marine is evacuated from a firefight in Afghanistan.

continue to carry out orders: “It’s a day-by-day thing and you don’t know if you’re going to be the guy to get hit the next day, so you just keep on pushing.”[28] 20-year-old Lance Cpl. James Fischer agreed. His platoon lost a Marine on their first patrol. After seeing many friends killed and wounded, Fischer said that he no longer felt emotion even when confronting gruesome scenes. “Afterward, you just don’t get that shock anymore…. You’ll have to deal with it at some point, but right now the most important thing is keeping everyone around you alive.”[29] In an up-tempo combat environment, emotional integration of the loss of a friend may not occur. This can result in feelings of numbness as Marines shove their feelings deep inside in order to continue with combat operations.[30] This can make Marines more susceptible to PTSD when they return from combat.[31]  Ideally, Marines should take time to process the death of a friend with fellow Marines.[32] Talking about the death allows Marines to process their grief with fellow warriors who understand their experience and who will provide support to them.


[1] “Even with all of the training, preparation, and conditioning, combat is a shock to the novice. It is surreal – at first – and the screaming violence takes an immediate physical, mental, and emotional toll. But good Marines revert to the training that was performed over and over and over and over so that it has become as natural as moving an arm or taking a breath. The mind finds comfort in performing the routine and the Marine Corps has ensured that the routine is good enough to win.” Nathan Smith, The Soldier’s Load, https://thesoldiersload.com/2012/01/16/explaining-the-inexplicable/
[2] “During combat, warriors report ‘locking down’ their emotions, falling back on their training, or feeling anger.” 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 505-506). Kindle Edition.
[3] “Warriors who face life-threatening events as part of their job learn how to control fear, how to respond using their training (not helplessly), and how to control feelings of horror. Otherwise, they wouldn’t be able to function under fire. Controlling fear does not mean that a warrior doesn’t feel fear, but that they learn how to operate in the presence of it, and how to use fear as an alert signal that helps them and their buddies stay alive.” 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 507-509). Kindle Edition.
[4] From The Soldier’s Load blog, https://thesoldiersload.com/guest-columns/
[6] “Some events are so catastrophic that there isn’t anything that compares, especially losing a close buddy.” 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 464-465). Kindle Edition.
[8] Busch, Benjamin (2012-03-20). Dust to Dust: A Memoir (p. 247). Harper Collins, Inc.. Kindle Edition.
[9] From a personal interview with the author, 11/16/12.
[10] From a conversation with Nathan Smith, 10/28/12.
[11] An anonymous veteran from the Iraq war writes, “Helplessness was the worst part I think… Every time I look back at my operations… I feel helplessness was the worst part. Seeing innocent people tortured, killed, decapitated… the children… OMFG… seeing kids dead and picking them out of the drains, that was the worst stuff for me personally. Having a weapon with ROE [Rules of Engagement], then watching something occur and knowing that if we engaged them we would be the one’s [sic] going to jail… it sucked.” From http://www.mycombatptsd.com/threads/helplessness-was-the-worst-part-i-think.16/ Accessed 11/16/12.
[12] 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 514-516). Kindle Edition.
[13] During Nathan Smith’s second tour in Iraq, his unit lost a Marine killed every two weeks. “There were more of us killed than the enemy on that tour,” he says. “We never saw a dead insurgent. We just kept getting blown up by IEDs and we had to take it. There was no enemy to take revenge on. We felt completely helpless.” From a personal interview with the author, 11/16/12.
[14] “’Watching IEDs go off, locking and loading but not firing due to the ROE, left me feeling helpless.’ -Junior Enlisted Soldier, Iraq. ‘All we do is roll on missions and hope we don’t get blown up, and then when we get hit there is nothing we can do but watch my dead friends get pulled out in pieces.’ –Senior NCO, Iraq ‘The most stressful part of my job is going out every day and waiting to get blown up. When/if someone gets hit, ROE prohibits us from doing what should be done. Everyone here is “innocent.” Yeah, right. If someone dug up the road in front of YOUR house and buried a bomb there, YOU would know about it.’ -Senior NCO, Iraq.” 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 519-521). Kindle Edition.
[15] Part of this was because he was an officer, and there was usually a screen of Marines in front of him. His job was to lead and direct, not to fire his own weapon. From a personal interview with the author, 11/16/12.
[16] From a personal interview with the author, 11/16/12.
[17] Busch, Benjamin (2012-03-20). Dust to Dust: A Memoir (p. 258). Harper Collins, Inc.. Kindle Edition.
[18] Busch, Benjamin (2012-03-20). Dust to Dust: A Memoir (pp. 273). Harper Collins, Inc.. Kindle Edition.
[19] “In several assessments of warriors deployed to Iraq or Afghanistan, nearly half reported being in threatening situations where they were unable to respond due to ROE. There is evidence that this may play a role in developing mental health problems 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 523-524). Kindle Edition.
[20] “Being knocked out in combat, even for only a few seconds (a concussion/mTBI), is strongly associated with PTSD; in one study we conducted, over 40 percent of soldiers who lost consciousness as a result of a blast experienced serious symptoms of PTSD when they came home. But this is likely due to the context-the fact that the blast that knocked them out also injured or killed their buddies-and that when they were knocked out they were helpless to respond.” 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 554-557). Kindle Edition.
[21] “Unit members who are likely to be most at risk to develop serious PTSD symptoms are those with the closest personal connection or friendship to the injured individual, those who felt directly responsible in some way for the health and welfare of the injured individual, or those who felt most helpless to intervene in preventing the tragedy.” 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 548-550). Kindle Edition.
[22] From a personal interview with the author, 11/16/12.
[23] “The higher the frequency or intensity of combat-and particularly, the more personal the trauma is-the higher the likelihood of developing PTSD. Combat is a great equalizer.” 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 546-547). Kindle Edition.
[24] Though Dr. Hoge says that “Rates of PTSD don’t go much higher than 30 percent in units that have seen the highest levels of direct combat,” as already mentioned, concussed Marines have a 40% rate of PTSD. 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 Location 539). Kindle Edition.
[25] From a personal interview with the author, 11/16/12.
[26] From a personal interview with the author, 11/16/12.
[27] From a personal interview with the author, 11/16/12.
[28] Sebastian Abbot, “Marines in deadly Afghan valley face combat stress,” http://news.yahoo.com/s/ap/20110306/ap_on_re_as/as_afghanistan_combat_stress, accessed 11/12/12.
[29] Sebastian Abbot, “Marines in deadly Afghan valley face combat stress,” http://news.yahoo.com/s/ap/20110306/ap_on_re_as/as_afghanistan_combat_stress, accessed 11/12/12.
[30] Natasha Young, a Marine who worked with an ordnance disposal team in Iraq, realized that it is normal to go numb in combat. David Wood of the Huffington Post tells her story: “Amid the carnage, Natasha went numb. It was her job to gather the dead Marines’ personal effects, make sure letters got written home to the families and that nothing got sent home with blood on it ‘because of the biohazard.’ What was that like for her? Tears welled in her eyes as she felt again the shock and grief that she had stuffed deep inside five years ago. ‘At the time … I just … functioned,’ she says. ‘I’d make a pot of coffee because I knew we’d be up for two or three days.’ Such enormous stress is the heart of war trauma — including PTSD and TBI — that causes physiological or neuro-chemical changes in the functioning of the brain, according to Rigg, the TBI director at Fort Gordon. Many of the symptoms of post-traumatic stress — nervousness, insomnia, anxiety in crowds, jumping at a sudden loud noise — are primitive, involuntary instincts necessary to survival in a combat zone. ‘I don’t use the term “post-traumatic stress disorder” because I don’t consider it a disorder,’ Rigg says. ‘I mean, you’re in a situation where people are trying to kill you!’” “Iraq, Afghanistan War Veterans Struggle With Combat Trauma” Posted 7/04/2012 by David Wood From http://www.huffingtonpost.com/2012/07/04/iraq-afghanistan-war-veterans-combat-trauma_n_1645701.html
[31] Associated Press reporter Sebastian Abbot writes of Marines in the deadliest part of Afghanistan: “Many of the Marines in Sangin say they are coping by blocking out the horrors they have seen. Psychiatrists say that behavior is normal during combat, but it could trigger post-traumatic stress disorder when the Marines go home next month.” From “Marines in deadly Afghan valley face combat stress,” http://news.yahoo.com/s/ap/20110306/ap_on_re_as/as_afghanistan_combat_stress, accessed 11/12/12.
[32] Karl Marlantes writes, “Integrating the feelings of sadness, rage, or all of the above with the action should be standard operating procedure for all soldiers who have killed face-to-face. It requires no sophisticated psychological training. Just form groups under a fellow squad or platoon member who has had a few days of group leadership training and encourage people to talk.” What it is Like to Go to War, p.32.

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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4 Responses to Combat Loss and PTSD – Part 5: When the Metal Hits the Meat

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

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

  3. Pingback: War does not End for Everyone | UWP 1: Final Portfolio

  4. Pingback: A4 – UWP 1: Final Portfolio

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