An assault on mental health: the struggles of a war psychologist

"Rule Number Two: Lessons I Learned in a Combat Hospital"

by Dr. Heidi Squier Kraft

Little, Brown, 241 pp., $23.99

"Session terminated due to incoming rockets," writes Dr. Heidi Kraft in her conclusion to progress notes for a patient. She practices in a cracked cement basement at an isolated air base in Iraq, with frequent power outages, sandbagged windows and 130-degree heat, an environment inducing, not reducing, stress. Business dress is fatigues accented with Kevlar.

With 11 days' notice, Kraft, a clinical psychologist with the U.S. Navy, got orders to leave her stateside practice and her life as a Marine wife and mother of 15-month-old twins. Joining other medical personnel at Al Asad Airfield, Kraft is one of four members of the redundantly named Combat Stress Platoon, charged with ministering to the invisible but crippling psychological wounds of thousands of combat Marines.

"Rule Number Two" offers no in-depth psychological analysis, but simple stories of individual struggles seen through the eyes of a practitioner who endures the same assaults on sanity as those she treats, underscoring the truth that even those escaping physical harm in combat do not return whole. Neither patient nor provider is spared, a truth reflected in the book's title, taken from dialogue in a "M*A*S*H" episode. "Rule number one is that young men die. Rule number two is that doctors can't change rule number one," Kraft tells a colleague. Cases run the diagnostic spectrum, from depression and survivors' guilt to psychotic behaviors and thoughts of suicide. A commanding officer breaks down outside the operating room of one of his seriously wounded men. A lance corporal barricades herself in a bathroom stall, pointing the barrel of an M16 at her forehead. Kraft faces the rifle of a delusional patient who talks to his ka-bar, a Marine-issued knife.

In group therapy with members of the Mortuary Affairs Unit, whose only job is recovery and processing of the dead, a corporal agonizes over finding a fetal ultrasound picture in the pocket of a dead soldier. Kraft herself is haunted by the heroic death of a young Marine who purposely falls on an enemy grenade to save his unit.

With frequent e-mail dispatches from her family, Kraft keeps informed of milestones for her twins, Brian and Megan, who start day care and master the art of eating with spoons, but happiness at the news is tempered by maternal guilt at missing these events.

Weeks into her deployment, a rocket attack leaves Kraft sleepless, pondering her mortality and acknowledging the crippling effect of her conflicting roles. "And I knew at that instant I would be unable to function in Iraq if my children stayed at the forefront of my consciousness on a day like today. In a world where rockets exploded randomly nearby, I decided I could not be a combat psychologist and a mother at the same time. It had to be one or the other. I had no choice. I put their pictures away," she writes.

Kraft and her colleagues support each other, watching episodes of "The Sopranos" and relishing weekly corn dogs in the chow hall. "Who's the shrink for the shrink in the combat zone, right?" she questions. "The shrink for a shrink, I realized, was simply that person who understood at any given moment."

Returning home is difficult for Kraft. "My return to seeing regular patients ... could only be described as torture," she writes.

"Rule number one might now state that war damages people," she writes. "Rule number two, of course, would be unchanged. I was certain of one truth, though... : War damages doctors too. They are damaged by rule number two."