Psychiatric nurse Maj. Madeline Belarde commands the 1835th.
Photo courtesy of Madeline Belarde, R.N., M.S.
On most days of most years, Madeline Belarde, R.N., M.S., is a psychiatric
nurse in charge of two wards at the Colorado Mental Health Institute in
Pueblo. But on occasional weekends at home, and for longer stretches in Iraq,
she's Maj. Belarde, commander of the 1835th Medical Detachment Combat Stress
Belarde has already served one tour of duty in the war, and her unit
completed training and left for Iraq at the end of April. The 43 soldiers in
her unit include psychologists, social workers, occupational therapists,
nurses, nurse practitioners, 68Xs—the Army's code for mental health
technicians—and one psychiatrist, APA member Matthew Goodwin, M.D.
Goodwin, a forensic psychiatrist, works with Belarde at the Colorado Mental
Health Institute. He served as an enlisted soldier in the Army from 1976 to
1979. He then went to medical school, was a physician in the Colorado National
Guard, and joined the Reserves in 2006. He spent four months in Iraq from
December 2006 to April 2007.
Army Reserve Maj. Matthew Goodwin of Pueblo, Colo., leaves soon for Iraq
to join the 1835th Medical Detachment Combat Stress Control team. On a
previous tour in Iraq, the psychiatrist served on his unit's prevention and
fitness teams and assisted the battalion aid station with psychiatric and
medical care to Iraqi villagers outside Mamudiyah.
Photo courtesy of Matthew Goodwin, M.D.
Combat stress control teams have their roots in U.S. Army practices
developed in World War I and elaborated during major conflicts ever since.
Their goal is to lessen the chances of combat stress occurring or deal with it
close to where soldiers fight to get them back to duty as quickly as possible.
Current Army doctrine recognizes that the pressures of combat are unavoidable
but says they can be mitigated by good leadership, proper training, and
services provided by combat stress control teams when needed.
Stress induced by war is "a normal reaction to abnormal
conditions," in the Army's view, but that doesn't mean it is primarily a
medical problem. Military bearing and roles remain the standard for everyone at the team's base of operations. In fact, "Soldiers are never labeled as patients or clients during such treatment," according to the Army surgeon general's Web site.
Belarde's role as a commander is not unusual. Psychiatric nurses headed all three combat stress detachments sent to Iraq in 2005-2006.
Belarde divides her team into two functional units, in the field, although individuals may move between the two units. A detachment like the 1835th ordinarily supports a division or its equivalent "The fitness team sets up a clinic and the prevention teams embed with combat units on nearby bases," she explained to Psychiatric News. Individually or in small classes, they offer a range of mental health interventions.
Enlisted members of the team are crucial to its success. They often can
elicit candid emotional reactions to events from peers who might hesitate to
open up to an officer. Even the cook and the mechanic attached to the team get
combat stress control training, said Belarde. "They can serve as a
referral and a resource for the soldiers they work with. It's like having
everyone know CPR."
The team's varied professionals tailor their interventions to fit each
"We really respect everyone's level of stress," said Belarde."
We offer whatever for ongoing, preexisting conditions like ADHD,
obsessive-compulsive disorder, or depression," he said in an interview."
It's strange that in the midst of a war, we're doing regular
Of course, there's an added, less benign, dimension that is lost on no one
in the unit.
"We also help people who have just lost a close friend or have been
through a life-threatening, near-death experience when an explosive device
goes off," he said. "Here in the U.S., you work with people you've
diagnosed, evaluate their medications, do therapy with them, and hope they do
better. But in Iraq, your patients are going back and being exposed to the
same stressors that produced their symptoms."
Goodwin has also served on the prevention side of the team, traveling to
small battle positions manned by 12 or 15 soldiers who are always focused on
preparing for the next combat patrol or rehashing the last one.
"Sometimes I'll spend the day just talking or eating meals with them,
to build trust," said Goodwin. "But I also see and hear a lot of
things the soldiers are experiencing."
Besides helping individual soldiers, Goodwin and Belarde work up and down
the chain of command. "Some of the most rewarding work we do is
consulting with everyone from sergeants to battalion commanders, helping them
do their jobs better," said Goodwin. "It's a little like family
The team trains one weekend a month in Colorado on basic "soldier
skills" such as operating radios, handling weapons, and surviving in a
combat theater, said Goodwin. Only occasionally do they get a refresher course
on combat-stress reactions. Most of their clinical knowledge draws on their
civilian jobs or prior experience in Iraq.
Last year's Army survey of mental health issues in the war zone also noted
the stresses that people like Belarde, Goodwin, and their colleagues face
after months in Iraq—personnel shortages, inadequate equipment, and a
never-ending task before them.
But burnout isn't limited to her career in the service, said Belarde. The
strains of military medicine are reflected in nursing shortages in the
civilian world too. She is preparing her team to adapt as best as possible in
"Our unit is made up of volunteers," she said. "They know
what to expect, but it's important that we take care of ourselves
Information about the U.S. Army's combat stress control program is