Published on Friday, August 27, 2004 by the Seattle Post-Intelligencer
The Unseen Cost of War: American Minds
Soldiers can sustain psychological wounds for a lifetime
by M.L. Lyke
The soldier's eyes dart from ceiling to floor, window to door. The rough hands -- hands that poked dead animals and probed human body bags in search of enemy explosives -- wrap around a cup of high-octane buzz he doesn't need. He's wired, wound tight -- a buff, tough sergeant ready to explode inside a strip-mall Starbucks.
"I knew I had a problem in Iraq when I wanted to start machine-gunning whole towns," says the National Guardsman, who returned to Fort Lewis from active duty in late March after an extended deployment.
He landed at McChord Air Force Base, got off the plane and flamed. "I wanted to start tearing people's heads off."
Neighbors in his Bellingham block may remember the soldier. He's the one who was outside shouting "You missed me again, - - - - - - - !" on the Fourth of July.
He's the one who screamed at the television when an Arabic speaker came on.
He's the one who still jumps out of his skin when someone drops a pan in the kitchen. "My heart rate goes up to 220."
He is one of a growing number of local soldiers returning from Iraq with PTSD, post-traumatic stress disorder. It's a brain condition that has wreaked havoc on warriors' nervous systems since the first shell-shocked Johnny came marching home with a thousand-yard stare and a million-dollar question:
Will anything ever be the same?
"Those guys on the side of the road with the cardboard signs. I can see how they get there. ... I'm afraid of losing everything I came home to," said the 35-year-old Guardsman, who bitterly calls himself a poster child for PTSD.
"I've got some serious issues."
A tremendous cost
Puget Sound PTSD specialists call the disorder one of the "hidden wounds of war." It can't be stitched up, earns no Purple Heart and can fester over a lifetime.
The specialists predict the trickle of affected soldiers from Iraq now coming into clinics will turn into a flood, with serious consequences for strained Veterans Affairs budgets and for taxpayers who foot disability bills.
"We hear about the thousands of injuries -- brain injuries, leg injuries, arm injuries -- but rarely do we hear about the psychological casualties in war," said PTSD expert Dr. Evan Kanter, a neuroscientist and staff psychiatrist at the Veterans Affairs Puget Sound Health Care System in Seattle
"There will be tens of thousands of these, and the cost of that will be tremendous."
An Army survey published in the New England Journal of Medicine on July 1 said 15.6 percent to 17.1 percent of returning soldiers from Iraq exhibited signs of anxiety, major depression or other mental health problems. A new study of 1,300 Fort Bragg paratroopers who took part in the Iraq invasion echoed the findings, showing 17.4 percent exhibited PTSD symptoms.
No one is sure why one soldier is affected by a traumatic event more than another. "The boundary line between 'normal' and 'pathological' response to the extreme demands of battle is fuzzy at best," notes the Iraq War Clinician Guide, prepared by the U.S. Department of Veterans Affairs.
But PTSD specialists say reservists and National Guard soldiers appear particularly vulnerable. War is not the full-time job of the estimated 160,000 "weekend warriors" now in Iraq -- civilian soldiers who have been called up in the largest numbers since World War II. They have off-duty lives, careers and demands back home that increase stress.
Symptoms of PTSD include short tempers and erratic sleep habits. Many patients have difficulty holding onto marriages and jobs. One local counselor treats a veteran who has had 30 jobs in 30 years.
Self-medicating with booze and drugs is common. So are nightmares, flashbacks and "intensive memories.' The thwap-thwap of a news helicopter has sent more than one Vietnam vet diving for the nearest ditch. For some Iraq vets, simply slamming a door, using a nail gun or clicking a camera can unglue them.
"The body remembers. It fires up without even checking in with the cerebral part of the cortex," said Seattle clinical psychologist Thomas Wear, one of the counselors contracted to help vets through the Washington state Department of Veterans Affairs' PTSD program.
The narrowed attention, jitteriness and hypervigilance of wartime often carry over into civilian life. PTSD counselors tell of patients who walk the perimeter of their bedroom every night or sleep with their guns.
The National Guardsman with "issues" locked all his weapons away after he got home. He has learned to trust no one. Including himself.
"I don't need to carry guns," said the sergeant, now in treatment. "I've pointed so many at so many people for so long that it's too easy to put one in someone's face and not think a thing about it."
There's a war going on inside him. He wonders why, and for what.
"It's all a game over there. It's all about politics, oil -- who the heck knows? I'm livid."
The 'Nam factor'
Anger and insomnia are common symptoms of PTSD. So is the numbness one counselor calls "a freezing of the heart."
A hardened heart may serve in battle. Back home, still numb, it creates its own kind of pain.
"The Vietnam vets, the first year they came back, would get half-loaded and go pick a fight with the biggest guy they could find, just to get some adrenaline pumping, some feeling back into a gray, meaningless life," said Wear.
Comparisons between Iraq and Vietnam are frequent in counseling circles. While an estimated 2 percent to 10 percent of veterans exposed to combat in the brief 1991 Gulf War developed combat-related PTSD, in Vietnam it was an estimated 30 percent.
Half of those Vietnam cases are resolved, half remain chronic, said Kanter, who also serves as Northwest regional director of Physicians for Social Responsibility. "We have every reason to believe this will be the case again."
One positive psychological twist for Iraq veterans is that today's soldiers, unlike Vietnam vets, are being welcomed home to cheers. Many vets from the Vietnam War -- when PTSD symptoms were often misdiagnosed as schizophrenia or bipolar disorder -- still hold harsh memories of being spit on and called "murderers" or "baby killers."
After 35 years, many still give each other a big bear hug and say "Welcome home" in greeting. "That gives you an idea of how psychologically devastating that was," said Kanter.
Other comparisons that counselors draw are more troubling:
Like other soldiers, the 21-year-old Army specialist came home still seething. "Everything in Iraq pissed me off," said the infantryman. That included his extended deployment, the smell of raw sewage dumped outside doors, friends' endless "Dear John" letters, unpalatable rations, orders to dry shave for lack of water, body armor that weighed 70 pounds in 130-degree heat, orders to kick in doors of Iraqi families based on suspect "intelligence."
"You never knew if the guy in there was innocent or not, and half the time he was," said the soldier, interviewed at a mall coffee shop in Bellevue. His voice rose as he talked. It was loud, too loud, his sentences laced with expletives. People moved away as he talked about "stupid" people at home asking him if he'd killed anyone in Iraq.
"I just told them to shut up or I'd kill them!"
Yeah, he said, he was counseled about combat stress overseas.
Almost everyone is.
Acting on lessons learned from Vietnam, the military and Department of Veterans Affairs have focused on early intervention of PTSD, sending teams of chaplains, counselors and other mental health personnel into the field to work with soldiers.
Yeah, he said, they handed him PTSD fliers, asked him if the questions applied. "I said, ---- no and tossed them."
And sure, a couple guys in the unit claimed to have PTSD.
"They were just faking it."
Persuading returning soldiers it's OK to seek mental help is its own high-stakes battle.
Certainly gains have been made since the famous episode in 1942, when Gen. George Patton accused a hospital patient suffering "shell shock" of cowardice and slapped him across the face. Patton was later upbraided by Gen. Dwight D. Eisenhower and forced to make a public apology.
More than a half-century later, clinical attitudes about PTSD have evolved dramatically. "It's no different than treating a shell-fragment wound or problems of environmental exposure," said Hunt, the VA deployment health clinic director.
Still, the suck-it-up, soldier-on, deal-with-it culture lingers.
"There's a strange pressure on these soldiers not to have any problems with what they are doing. It's that old idea that a real man and a true warrior will stand strong," said Issaquah psychologist Michael Phillips, a trauma specialist who works with vets under a joint contract with King County's veterans program and the state VA's PTSD program.
Most soldiers, said Phillips, first try to handle problems by themselves. It's not until they see a pattern, or others point it out, that they may finally seek help. Or they may not.
The New England Journal of Medicine report shows more than half the soldiers who served in Iraq and met the criteria for psychological disorders said they would not seek help. They cited fears they would be stigmatized or that their military careers would be hurt.
Interviews with soldiers point out another scenario. Many returning soldiers, they say, answer "Not me, sir," in PTSD screenings simply because they want to go home. Immediately.
"The basic thought in our unit was, 'If you say yes to any questions, you will be held back from going on leave,' " said the Army infantryman.
The blur of home
If "yes" is a hard word to say, the words that follow can be excruciating.
PTSD counselors say their new patients are raw, fragile, prone to emotional outbursts and still barely able to talk about what's happening to them as the fog of war becomes the blur of home.
"I used to not be able to talk about it at all. My blood pressure would escalate, my throat would close up and I would have an anxiety attack," says a young Marine reservist, a scholar of history and ancient languages who left studies at Western Washington University to serve in Iraq.
Activated in January 2003, his unit was one of the first into Iraq, and faced gunfire and missile attacks as soldiers set up water and fuel lines to supply battalions moving into Baghdad.
The reservist experienced his first PTSD symptoms in August 2003, two months after he returned. It took him another six months to call the VA and get help.
In his Bellingham apartment, the mild-mannered 22-year-old does talk to a reporter -- haltingly, thoughtfully, apologizing when he can't go on.
Over there, he said, soldiers joked that they'd all go nuts. Now it's not so funny.
The lance corporal, who signed up with the reserves out of high school to pay for college, has had several breakdowns, struggled with sleep, lost his temper, lost his appetite, turned to booze, started fights in bars. "My friends had to pull me off, calm me down."
Nothing's the same now. Especially him.
It's hard to concentrate in class. He walked out of a lecture on the Iraq war; the history teacher was a liberal, he says.
When someone brings up the war at a party, a casual conversation can quickly morph into an ugly situation. "I get more and more involved, it builds and builds, then they cut me off because I've freaked them out."
If a battle scene from Iraq rolls on the TV news, he freezes. "I know I should change the channel, get away, but I can't move."
Pictures of Iraq wind and rewind in his mind: the starving children crawling out from beneath homes of old rubble and debris as U.S. troops roll in; the cheers for Americans with water systems and food supplies, come to make everything OK; the warnings from commanding officers that any villager could be armed with explosives.
"These people are happy to see you, they're cheering, and you're wondering if the same guy cheering for you might blow you up," he says.
It's a complicated past, tied to an unreadable future.
"I just don't want all of it to be for nothing," says the Marine reservist. "This took a big chunk of my life away -- and I want it to count for something."
His head falls into his hands. When he looks up, there are tears welling in his eyes.
"Sorry," he says softly. "I'm sorry."
No one understands. And he can't translate.GETTING HELP
Veterans Affairs medical centers throughout Washington offer confidential mental health care for returning soldiers. Washington's Department of Veterans Affairs has 19 contractors in a PTSD outpatient program throughout the state, plus eight contractors funded through the King County veterans program.
For information about services and referrals, call state VA PTSD Program Director Tom Schumacher at 360-586-1076 or 800-562-2308.
A complete list of state VA PTSD providers, their locations, and contact information can be found at www.dva.wa.gov; click on "PTSD."
The VA Medical Center in Seattle has a special deployment health clinic to handle mental and physical post-combat evaluation and treatment, as well as counseling on family issues, VA benefits and other issues. Early intervention in PTSD, say administrators, is key. "It's a little like anemia. It can creep up on your over time and affect your life profoundly," says director Steve Hunt. Call 206-764-2636.
The 24-hour line to call for help at the VA center is 206-762-1010.
Federal vet centers offering readjustment and bereavement counseling in storefront locations around the region include: Tacoma 253-565-7038, Spokane 509-444-8387, Bellingham 360-733-9226
HISTORY AND SYMPTOMS
In the Civil War, veterans with psychological combat disorders were diagnosed with "soldier's heart." In World War I, the term was "shell shock" and in World War II "combat fatigue." The term "post traumatic stress disorder" was added to official Veterans Affairs' diagnostic codes in the early 1980s.
The brain disorder affects the body's nervous system to varying degrees. Symptoms include:
For some soldiers, "three hots and a cot" in the field will relieve symptoms. For others, problems may fade with the return to families and routines. PTSD specialists say that if symptoms last longer than a month, soldiers should consider seeking help.
ABOUT THE SOLDIERS
All the soldiers in these stories have served in Iraq. Most asked that their name not be used, for fear of repercussions. They agreed to talk in hope it would help others serving in uniform. Those diagnosed with PTSD and PTSD symptoms are all in treatment.
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