BAGRAM, Afghanistan — Kemp's wife has left him, a month after the miscarriage of their child, and he feels ready to explode with frustration and anger.
Rather than let his rage boil up inside, the staff sergeant is venting his woes to Lt. John Fellion, a psychiatric nurse at the field hospital on the Bagram base, the U.S. military's main staging area in Afghanistan. It's his fourth visit in the last week.
"It's helped. If I hadn't come in and talked, it would have turned into an ugly situation. I might have said some mean and spiteful things," said Kemp, visibly tense and on the verge of tears. His last name can't be published because of Army policy. "This has helped me let off steam."
Kemp is one of hundreds of soldiers at Bagram receiving care and attention they might not have had three months ago, before a string of domestic murders at North Carolina's Ft. Bragg Army base led to sweeping changes in the armed forces' psychological screening and treatment procedures.
Of the five murder cases that rocked the giant base this summer, three involved troops returning home from Afghanistan.
Shaken by the killings, the Army brass sent a special team to Ft. Bragg to conduct an inquiry of "physical, behavioral and any possible pharmaceutical aspects" that may have been factors in the violence. The team completed its inquiry this month but has not released its findings.
One reported focus of the probe is the anti-malarial drug that the soldiers are required to take as a precaution for Afghanistan duty. The medication has on rare occasion caused psychosis and violent side effects.
Without ruling out the effects of anti-malarial or other drugs, medical staff members here say that stress disorders are more likely being caused by the unusually uncertain and open-ended nature of the U.S.-declared war on terrorism than by pharmaceuticals.
The harsh conditions at the isolated, dust-blown and tightly secured base at Bagram also are factors in stress levels here. Soldiers work long hours but are generally not allowed off base for security reasons. Temperatures that often exceeded 100 degrees over the summer didn't help. In any case, the military already has instituted psychological screening and treatment procedures designed to discern soldiers' stress disorders before they erupt in violence.
Under new procedures, all home-bound soldiers must undergo tests for anger, depression, drug and alcohol abuse or suicidal tendencies. Soldiers who finish high on the tests then undergo lengthy debriefing and counseling at Bagram and, when warranted, compulsory follow-up treatment at home.
On their return to the U.S., soldiers deemed to be in precarious mental health are escorted to a mental health facility to start treatment before meeting their families.
"If any soldier shows obvious signs of anger or depression, we bring them in," said Lt. Col. Thomas Hicklin, who is leading the testing here. "Some tell us things like they'd be better off dead or that they get so angry they break things and they are automatically debriefed here."
Hicklin, a member of the Army Reserve's 113th Medical Company who is an assistant professor of clinical psychiatry at USC's Keck School of Medicine in civilian life, said soldiers are specifically asked how they feel about their reunions with wives or significant others.
The Ft. Bragg murders have caused widespread concern not just among the Army leadership but also among families back home. Hicklin said he had been told that many Army wives at Ft. Bragg with husbands in Afghanistan are concerned for their own safety.
And soldiers at Bagram are worried about the possibility of their behavior turning violent. "Soldiers have asked me, 'Do I take the anti-malarial medicine and risk strangling my wife, or not take it and risk contracting malaria?' " said Lt. Col. Ansar Haroun, a psychiatrist here.
Hicklin and others on the medical staff at Bagram say the incidence of stress disorders such as extreme anger and depression is running high. Even as there has been less action than many soldiers expected in confronting remnants of the former Taliban regime and Al Qaeda terrorist network, soldiers are being told that their duty here could stretch out for months and, in some cases, years.
"The soldiers are proud to be here, but the operations have gone slowly and that's frustrating not being able to do more to eliminate Al Qaeda and the Taliban. It's partly a waiting game here," Hicklin said. "It makes it hard for them to measure success."
Haroun, a reservist who in civilian life is a forensic psychiatrist for the San Diego County Superior Court system, said the lack of a concrete "end point" for the war has put many in uniform on edge.
"There is a tension between soldiers wanting to do the right thing and make the world safe from terrorism and how and when they will accomplish that," Haroun said. "In Desert Storm, they knew that once Iraq surrendered, they go home. Here, it's not clear."
Also a source of frustration is the clampdown on information. Noncombat personnel--the vast majority of the 8,000 U.S. troops here--have little or no idea how the war is going, said Army Reserve Maj. Valvincent Reyes, a social worker and probation officer from Torrance in civilian life.
"The chances of a soldier being a psychiatric casualty here," Hicklin said, "is much higher than becoming a physical casualty."