BAGHDAD, Iraq – Add long working days in 110 degree heat with the threat of death at the hands of insurgents. Subtract families, friends and spouses the troops' are separated from by thousands of miles. Multiply by a yearlong tour.
The result, sometimes, is battle fatigue.
When the going gets tough and the tough in the U.S. military can't get going, they call in the "Brain Rangers" (search) — an Army combat stress company that keeps an eye on troops' mental health in the field.
"Basically, we heal wounds that don't bleed," said Maj. David Rabb, commander of the 785th Medical Company (search). "Our job is to get people who aren't functioning back to duty."
The Brain Rangers are successful the vast majority of the time, helping troops manage everything from the loss of another soldier to dreaded "Dear John" letters — when spouses back home write to say they want to split up.
Rabb's 85-member company consists of Army psychiatrists, psychologists, nurses and social workers. They used to cover Iraq alone, but a surge in fighting earlier this year prompted the military to complement them with two 42-member detachments in June.
With a skeleton staff keeping watch over the mental well-being of about 140,000 U.S. troops in Iraq, four-man teams move constantly around the "theater," focusing on areas where they're most needed.
When servicemen die — as more than 1,000 have since the United States invaded Iraq last year — combat stress teams are usually notified within hours and dispatched to affected units.
They gather soldiers and take them through debriefings to get them to talk about the trauma, seen as a key step on the road to overcoming it.
The sessions last just a few hours, but the teams often stay at affected bases for days, allowing soldiers a chance to come see them privately.
"Your buddy getting killed, most people haven't trained for that. Or you shoot somebody for the first time," Rabb says. "We want people to know that their experience is a normal response to an abnormal situation. It's important that people look around and don't think of themselves as crazy, even though the situation that may be occurring externally is crazy."
About 80 percent of the Brain Rangers' effort is prevention — getting to troops in the field before serious problems, including suicide, develop. Part of that means letting them know mental health teams exist; it also means suggesting ways to combat stress, including simple things like getting enough exercise, sleep or taking time out for "guided imagery," or meditation.
Rabb's company has tried to get the word out through the toll-free military help lines, and Army radio ads, newspapers and television.
In Baghdad, troubled troops can seek help 24 hours a day at the 785th's headquarters, a two-story house in the heavily fortified Green Zone, home to Iraqi government offices and the U.S. Embassy — both frequent targets of guerrilla mortars.
Here, the Brain Rangers get about a dozen walk-in's a day, said chief psychiatrist Maj. Geoffrey Grammer, 34, of Silver Spring, Md.
The headquarters can also house a dozen live-in's at a time at a so-called "restoration center," where troops can escape their daily routines and stay for several days, sleeping on cots and playing volleyball and board games like chess, Scrabble or Monopoly.
By getting traumatized people to relax, they often open up and talk about their troubles, Rabb said. The goal is to get them back to their units as soon as possible.
"It's like a boxing ring. Sometimes you gotta go to the corner, and we're in that corner," Rabb says. "Give 'em some water, pep talk 'em and then get 'em back into the ring."
One of the biggest battles is educating people to overcome the stigma attached to seeking help.
"We've had commanders tell us to our face, 'I don't like mental health' ... they think we're there to take away their soldiers," said Staff Sgt. Will Sauder, a 24-year-old mental health specialist from Columbus, Ohio. "And we've had, three days later, them telling us, 'We're glad you came. Our soldiers are ready to go back out and do their job."'
Troops treated by mental health staff aren't even referred to as patients, but rather, "soldiers under stress," Rabb says.
Of the clients seen, less than 5 percent are sent home, usually in close consultation with their unit commanders, said Maj. Maggie Stalka from Winona, Minn., the company's executive officer and a mental health nurse.
Aside from those suffering serious combat stress, those diagnosed with major psychiatric illness like schizophrenia or serious manic depression qualify for evacuation, Grammer says.
Soldiers that can't do their job may endanger others, particularly on the battlefield.
Getting troops to overcome traumatic events before returning home — like the loss of a close friend — is key to preventing post-traumatic stress.
"Sometimes soldiers think, 'I'll deal with that when I get home, right now I just gotta do my job,"' Sauder says. "That's unfortunate, because when you get home ... no one else around you has any idea what you went through."
Or as 46-year-old Rabb, from Chicago, put it: "If you're gonna travel in life, you need to travel light. You don't need all the baggage."