PTSD Among Iraq Vets

[thedrifter]

PTSD Among Iraq Vets
United Press International
June 10, 2005

WASHINGTON - New Year's Eve found 22-year old Iraq war veteran Spc. Abbie Pickett huddled in the doorway of a building, crying hysterically as fireworks exploded overhead.

The explosions brought on the adrenaline rush she had grown to associate with warfare. In Iraq those lights and noises demand a reaction. Soldiers know what to do when an attack starts. That's what their training is for.

But there were the lights and the noise and the adrenaline rush, incongruous on the peaceful street, and Pickett did not know what to do. First she hit the ground, then her alarmed friends led her to shelter until she could pull herself together.

"What is considered a bizarre (reaction) in every day life is what keeps you alive in Iraq," she said Thursday.

Pickett, of Madison, Wis., is one of the many Iraq war veterans with post-traumatic stress disorder. She returned in April 2004 from a year's duty in Iraq as a fuel truck driver attached to the Army's 4th Infantry Division with her National Guard unit. Supply convoys are among the most dangerous postings in the war since they are the frequent target of ambushes and roadside bombs. Fuel trucks are especially dangerous as they are bombs of their own if hit the right way.

Pickett's truck took small-arms fire periodically, but it was not until a night in October 2003 when her base in Baqubah came under attack that she experienced trauma. As trained, she ran into the building being shelled to help the wounded. She tended one soldier whose arm had been mangled; it would be months before she learned that her actions saved his limb. She transported four gravely injured soldiers in a truck to the hospital.

That is the experience to which she traces her depression and inability to concentrate in college or sleep. It is why she had to drop most of her classes in school and why she is on Zoloft and takes sleeping pills. Her medication is not working for her, but she is unable to get in to see a Veterans' Administration psychiatrist because they are so backed up with other cases.

"I miss Iraq," she said. "Most veterans will tell you, 'I miss Iraq.' You miss the adrenaline rush."

Many with post-traumatic stress disorder sign up to go back, she said -- back to a place where their jumpy nerves and over vigilance serves a purpose.

A 2004 study endorsed by the Veteran Administration says 18 percent of troops returning from Iraq will have post-traumatic stress disorder, the result of fearing for their lives and the lives of their friends, and the guilt of taking other lives in war.

The Afghan war yields an 11 percent likelihood a soldier will suffer the disorder. But the Iraq war is particularly difficult on troops, with the kinds of experiences that lend themselves to long-term trauma. According to the 2004 study, 94 percent of soldiers in Iraq reported receiving small-arms fire; 86 percent of reported knowing someone who was seriously injured or killed; 68 percent reported seeing dead or seriously injured Americans, and 51 percent reported handling or uncovering human remains. Most soldiers -- 77 percent -- deployed to Iraq reported shooting or directing fire at the enemy, 48 percent reported being responsible for the death of an enemy combatant, and 28 percent reported being responsible for the death of a noncombatant.

Most of those 18 percent expected to get post-traumatic stress disorder will recover, especially if they get early mental health care. But if soldiers deploy more than once - and about a third of the Iraq force is in that position -- or if new veterans who need services do not get the support they need, the lasting mental health toll could be serious.

Hawaii Democrat Sen. Daniel Akaka introduced a bill Wednesday that will require $100 million to $300 million more to be spent providing mental health care to veterans.

One of the functions of the bill is to tie health care increases in the Veterans' Administration budget to current year dollars; they are still being figured in 1996 dollars and are not keeping pace with inflation, Akaka said Thursday.

The bill, "Veterans Mental Health Care Capacity Enhancement Act of 2005" would add staff to community Veterans' Administration clinics; require in-patient, five-day detoxification programs at all primary health care facilities; and screen troops leaving the military for sexual or mental trauma to determine treatment.

Akaka praised the Veterans' Administration for the quality of its care, but warned that the care is "slipping," particularly when it comes to mental health services. More than 150,000 Iraq war veterans have entered the Veterans' Administration system, and the estimated 30,000 of those with post-traumatic stress disorder will seriously strain existing resources.

Even troops who are functioning well without observable manifestations of trauma are suffering.

A Marine captain who asked that he not be identified - for fear of being made fun of or losing the confidence of his troops - reports a recurring nightmare, one of the symptoms of mental trauma. He and several of his Marines have fallen asleep at a sentry position, and their guns are far away from them, locked together. He wakes up to see Iraqi insurgents sneaking up on is position, but he can't wake up his comrades or get to his gun. He wakes up as they are being shot to death.

That Marine is now on his second combat deployment in 14 months, after less than seven months at home.

Ellie

[thedrifter]

Post-traumatic Stress Disorder: Iraq is not another Vietnam
By HOLLY CECIL
The News Enterprise
June 12, 2005

"They're firing at us!"

Capt. K.C. Hughes screams in his sleep. His body thrashing, his arms flailing, he points and barks orders, grinding his teeth, flipping from one side of the bed to the other.

"He starts breathing heavy, like he's scared or fighting," said his wife, Samantha Hughes. "He's talking war talk, but it doesn't make any sense."

The 26-year-old Army captain doesn't remember his dreams. Only a concerned "Are you OK?" from his wife when he wakes lets him know something happened while he slept.

What he does remember is the real life nightmare that started it all.

It was the morning of May 27, 2003, just after midnight. Operation Iraqi Freedom was in its infancy, and Hughes and half the members of his platoon with the 3rd Armored Cavalry unit were on checkpoint duty on the west side of Fallujah in Iraq.

They had conducted hundreds of checkpoints by that time. It was a common mission.

"At the checkpoint, we're checking vehicles for weapons and contraband, enforcing the curfew and looking for bad guys," Hughes said. "It's a good way to tell who's coming in and going out of town."

They had been at the checkpoint about an hour and a half when the small pickup truck approached.

Guards had already opened fire by the time the driver pulled the pin from a grenade. Collapsing from fatal wounds, the driver let the grenade roll from his hands toward the American soldiers. But, it was the spray of machine gun fire from the truck's passenger that wounded four soldiers and killed two others within seconds. The passenger, too, died in the firefight.

Hughes called for medical evacuation, but within 20 minutes, his unit was under fire again. And then, he was shot.

He can't remember all the details of what happened.

"There are so many things going on, you just sort of go into a kind of automatic mode," Hughes said. "And especially as a leader, my actions just kind of … happen. In situations like that, you really don't have time to think about things, you just start doing things."

At some point, a bullet entered Hughes' left shoulder, ricocheted off his collarbone and traveled down his spine before exiting. He and four others were evacuated to the United States for medical care and recovery.

Two years later, he sits perfectly postured and straight-faced in his Fort Knox home marveling at the combination of grace and good luck that kept him from either being killed or quadriplegic as a result of the ambush. He has not a single neurological effect from the gunshot.

"It should have killed me in a bunch of different … it should have done a bunch of different things," Hughes said.

It's been six months since his last nightmare. The feelings of depression, hopelessness and guilt for surviving are now memories lumped together with the bad experience that caused them. He's fine, as long as he keeps talking about it. He talks about it a lot.

That's what his counselor at Fort Carson, Colo., told him to do, after telling him he had post-traumatic stress disorder.

PTSD is a psychiatric disorder that can occur after experiencing or witnessing a life-threatening event. It is often characterized by nightmares, flashbacks, hyper vigilance and feelings of being detached or estranged.

"It often affects survivors," said Jeaneen Goodhue, nurse and coordinator for the military intensive outpatient program at Lincoln Trail Behavioral Health System. "It goes along with surviving crises or critical events that happen."

What makes an event traumatic is its power to provoke fear, helplessness or horror.

As far as known causes of PTSD, combat ranks with criminal violence, such as rape, assault or torture, motor vehicle accidents, fires, earthquakes and terrorist attacks.

According to a 2004 study published in the New England Journal of Medicine, while about 7 percent of those who experience traumatic events may develop PTSD in the civilian world, the disorder affects some 15 to 17 percent of active duty military personnel who have been deployed in Iraq and 11 percent in Afghanistan. Men and women recently removed from combat were interviewed for the study.

But Dr. James Stockard, civilian psychiatrist at Ireland Army Community Hospital's behavioral health clinic, believes that prevalence could be lower or higher, depending on when the soldiers were interviewed.

"I would be suspicious of any single figure," Stockard said, stating it is still too early to get a firm grasp on the scope of PTSD with the Iraq War. "I'm just saying the jury is still out. PTSD is dynamic. It goes away. It gets worse. You can't take a snapshot and have the answer."

While Fort Knox doesn't deploy a lot of troops overseas directly, it has seen a number of soldiers come and go from its training installation and medical hold unit.

Soldiers and Marines from every unit or detachment at Fort Knox have participated in Operation Iraqi Freedom. At least five Hardin County soldiers and one Radcliff Marine have been killed in what is being called the most sustained ground combat operation since Vietnam.

In addition, Hardin County is the home to a large number of Reservists and National Guardsmen who either have directly or indirectly been involved in the war effort.

"You don't come back from a hot war zone exactly the same," Stockard said. Soldiers will have features and symptoms and some learned behaviors that don't fit into civilian life. As long as the symptoms don't cause dysfunction to the soldier, they can learn to adjust.

Some can't do it alone.

The Lincoln Trail clinic sees patients every day who are experiencing some form of post-traumatic or combat stress, in both acute and chronic forms. Some are in treatment for days or weeks, others longer.

Some soldiers seek help at the behavioral health clinic at Ireland hospital or the VA hospital in Louisville. Others turn to veteran centers, chaplains, family members and each other for support in dealing with the aftermath of combat-related traumatic events.

Though the average age of the combat-related stress patient for this war is 24, people experiencing PTSD run the gamut in age, gender, years of service, number of tours and other variables.

In some, it is not only the exposure to combat, but the transition back to civilian life that can be disruptive, particularly for Reservists and National Guard members who are less accustomed to being away from their families and may have more adjustment difficulties with deployment. Exactly what triggers the stress reaction in some soldiers and not others is unknown.

"We don't know why one person will develop it and another not," said Dr. Karen Grantz, coordinator of the Post-traumatic Clinical Team at Louisville VA Hospital. "It has nothing to do with psychiatric weakness or what they saw. It's important to note, almost everybody has a post-traumatic response to being in combat."

What the Army has learned is the earlier PTSD is addressed, the less its chances of becoming chronic and, in some cases, disabling.

When Hughes first noticed his depression, he talked to his girlfriend, whom he met during his recovery and soon married. She, too, had experienced PTSD.

A cancer survivor, she underwent six months of chemotherapy and radiation. Many of the patients she knew in the oncology ward of her hospital eventually succumbed to the disease.

"I had dealt with PTSD for three years," she said. The two found they had a lot in common, and that was helpful to Hughes.

When he began having nightmares, together they sought the help of a specialist who helped them deal with what was happening.

"It wasn't just affecting me anymore, it was affecting my family, and I had a little one on the way," Hughes said.

He believes because he sought help early on and learned to talk openly about his experience, he can now control it.

Though research suggests he is right, each individual deals with the effects of combat stress in different ways.

Psychological, social and psychiatric effects from combat can be immediate, acute and chronic depending on the individual, according to the Iraq War Clinician Guide 2nd Edition, published in 2004 by the Department of Veterans Affairs and the National Center for Post-traumatic Stress Disorder.

The guidebook also says that clinical assessment of Iraq war veterans is "likely to be complicated and clinically challenging … they will have difficulty sharing their thoughts and feelings about what happened and the toll those experiences have taken on their mental health."

There is more concern with the Iraq war than other conflicts since Vietnam because the frequency and intensity of combat exposure is higher than in Afghanistan, Somalia or the 1991 Persian Gulf War, according to a national Center for Post-traumatic Stress Disorder fact sheet.

In 2004, 86 percent of soldiers in Iraq reported knowing someone who was seriously injured or killed, 68 percent reported seeing dead or seriously injured Americans and 51 percent reported handling or uncovering human remains.

Nearly 77 percent of soldiers deployed in Iraq reported shooting or directing fire at the enemy, 48 percent reported being responsible for the deaths of enemy combatants and 28 percent reported being responsible for the death of a noncombatant.

In addition, with suicide bombings and other insurgent attacks, urban guerrilla warfare in Iraq creates a constant state of alert because the enemy is not clearly identifiable. There is no safe place and no safe duty. A person may begin to feel helpless in the ability to protect him or herself, Grantz said.

"But, you have to be careful," Hughes said. "It could be a family with children in the car just as easily as it could be insurgents. You have to be cautious, of course, at all times. But there are civilians all over this battlefield.

"In the grand scheme of things, what if you went over there and you did something you couldn't live with. That would be far worse. You have to think, you may survive this whole thing, but you have to go back and live the rest of your life. That's why this environment is so difficult."

While drug therapy, psychotherapy and cognitive-behavior therapy such as relaxation techniques, stress management training and coping skills are used to treat and manage PTSD, most doctors are finding group therapy or just talking about the experiences, as in Hughes' case, are key in getting PTSD symptoms under control.

"Talking in groups, actually sharing experiences, they benefit from each other," Goodhue said. "In some cases, you have to rethink everything you do every day, especially how you react to things that make you uncomfortable."

Many facilities conduct group counseling sessions in which soldiers and veterans talk openly about combat experiences and frustrations with others who have similar experiences. But, the problem remains getting those who need it most to seek help.

There exists a stigma that a person's military career or reputation may be on the line if he or she seeks help for mental health issues.

Often it's those who most need help who won't seek it, Stockard said.

"A lot of your hardcore combat vets are the least likely to want to talk - the ones who are in the thick of things," said Bill Spencer of the Disabled American Veterans.

So, instead, they suffer silently. They may withdraw from society or turn to drugs or alcohol to diminish the symptoms, "but they can actually exacerbate the symptoms," Grantz said.

continued.....

[thedrifter]

Though Hughes knows some soldiers may not want to ask for help, he's never been concerned with other people think. He knew he needed help, so he got it, with his career remaining intact.

In March, he graduated from the Armor Captain's Career Course at Fort Knox and Thursday assumes the role of commander for C Company, 1st Battalion 46th Infantry at the post.

"I think what's really important is for commanders to realize PTSD exists," Hughes said. "And, it's going to exist in their unit, whether it does now or not."

Hughes wrote an article for Armor Magazine about PTSD which is scheduled for publication in the July/August edition.

"It's very important for commanders to make it an open environment, and it's OK to ask for help," Hughes said. "The Army is perfectly set up for it. It's a way to say, 'here I am, I went through a difficult situation, and I struggled.' It's OK to struggle. It's not something that you have to hide."

Ellie

[Tegan]

PTSD is a scary and very real thing to me. My old boyfriend, USMC, came back from Iraq in january and I could tell the difference right away. I was in California for my brothers graduation at MCRD when my ex came back. He called me and I went all the way to Camp Horno (Pendleton) to meet up with him and his buddies. They drank all night long, and as soon as my ex came home, he was completely different around me. I know that he's a brother to his buddies and all, but he was completely shut down when he came home. I talked to his Mom the other day, and she said that he's stopped shaking and even stopped smoking. I guess the only thing us folks back home can do is research it the best we can, and just be there when they need us.
www.ncptsd.va.govwww.ncptsd.va.gov

[USMC200518]

My brother had one incident, where he got out of his truck, and then went to the barracks, and called us, and he was like, they got the truck, they got Sparky, they got sparky, everyones gone, they left me... i guess that was one of the guys, and i have never really experienced it before so i thought he wasnt serious. but then my mom told me hes now getting counseling. It really hits to home when your brother isnt right. really does. Scares me.

[MillRatUSMC]

http://www.ncptsd.va.gov/publications/cq/v5/n2-3/shay.html

Achilles in Vietnam: Combat Trauma and the Undoing of Character

a few exceprts;
We often hear that the death of this special friend-in-arms broke the survivor's life into unhealable halves -- everything before his death radically severed from everything after...

The emergence of rage out of intense grief may be a biological universal; long-term obstruction of grief and failure to communalize grief can imprison a person in endless swinging between rage and emotional deadness as a permanent way of being in the world...

Often they cannot remember the names or faces of anyone else with whom they served after that particular person was killed...

n my wildest thoughts I never expected or wanted to return home alive, and emotionally never have...

What was true for Vietnam, is now true for Iraq.
I hope that you might get a copy of Achilles in Vietnam: Combat Trauma and the Undoing of Character.
Because once being in combat will "forever change you".

Semper Fidelis/Semper Fi
Ricardo

[Joseph P Carey]

Perhaps, I had the best of up-bringing, and the worst of up-bringing all in one. It is strange to say something like this, but it is probably why I was never much effected by PTSD when I came home from Vietnam.

My Dad, who was a Marine in the Second World War was an FO for Artillary, and as usual, he was embedded with a line outfit upon the landings. I asked him how many landings he made during the war, when I was a kid, and he would only say 'too many.'

I went into the Marines on my Seventeenth Birthday, and I headed for Vietnam a year and a half later to join Kilo Company 3rd Battalion 7th Marines at Chu Lai.

My Dad sat me down, when I told him what my orders read, and he told me stories about what he had experienced during many of those landings and the counter attacks that the Japanese had thrown at the units he was with. He told me that it was enough to make a grown man go crazy, if they dwelled on it for a long time, and he said that I would experience much the same thing, if I were to see very much combat.

That day, during that conversation, he gave me the best advice that one Marine could ever give another. He told me, that whatever the orders are, carry them out no matter what I thought of the orders. He said, no matter what I had to do to do my job to do it. He told me not to make friends that could last forever, because, in battle, people die quickly and in bunches, and each friend that dies is another piece of you that dies. He said, shoot your enemy, and shoot them well, because, if you do not, he will surely shoot you. He said, don't be a hero, but don't ever run from the enemy, because you can kill more of them while facing them than with your back to the enemy, and, no matter how bad the situation may be, take all your bullets in the front, and stand like a Marine. And, when it is all over, and your last shot is fired, and there is no more shooting, forget everything that has happened, everything you have done, and everything you have seen, and come home.

I was in the Naval Hospital at St Albans for almost a year for my last wound, and each night I heard men cry, or scream in their sleep over things they did, or things they should have done, or friends that were no more, and some for the shame of what they feared they had done or did not do well.

The strange thing was that I could see the faces of the enemy I had killed. They were boys, and they were men, and they were the same age as was I; they were all human beings, but they were the enemy, and I was able to live with that, and I slept peacefully through the night after adjusting for the pain from my wounds.

I think the only thing that ever bothered me was seeing the villagers that were killed by the VC Political teams. The children the women, the old and the young. They were killed not for what they had done, but for what a relative did, or because they talked with US troops, or maybe because one of the villagers wanted what they had, and they found the best way too it was to accuse them of being with the Americans.

Those dreams, or nightmares, have long since left, but the memory still remains. Not everything is easy to forget so completely. It is too bad that many of the men that go into combat did not have a Dad like mine was to me.

When I said my up-bringing was the best and the worst. A mixture of the worst and the best was being there, and the best and the worst was forgetting what I could, but, while it was good that I went, it was bad what I saw, and it was good that I could forget, because I listened to my Dad. I knew what to expect in battle, and PTSD has not effected me.

The best thing you can tell a Marine going into combat is the truth, and they have to know that not all will make the walk out unharmed. Prepare them for the blood, and the guts, and the killing, after all they are Marines, and that is their job.

[Tegan]

wow, that is a very moving story that brought a tear to my eye. And what you said at the end ( "The best thing you can tell a Marine going into combat is the truth, and they have to know that not all will make the walk out unharmed. Prepare them for the blood, and the guts, and the killing, after all they are Marines, and that is their job") it is so true. I know that my Marines know that, and I believe they have good heads on their shoulders. ( I say my Marines, because i have a brother, boyfriend, ex bf, friend in iraq, and my brothers buddies i became close with, and they are all Marines)

[Phantom Blooper]

June 13,2005 <br />
CHRIS MAZZOLINI <br />
DAILY NEWS STAFF <br />
A Camp Lejeune Marine surrendered to Jacksonville police Sunday morning after a six-hour standoff at his New River Drive residence during which he...