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thedrifter
01-11-09, 08:55 AM
A general battles post-combat stress


By Nancy Montgomery, Stars and Stripes
Mideast edition, Sunday, January 11, 2009

HEIDELBERG, Germany — Just back from a year in Iraq, Gen. Carter Ham got into the car with his wife, Christi, and began a strangely silent, cross-country drive.

“I probably said three words,” Ham recently recalled of the trip four years ago from Washington state to Washington, D.C.

His time in Iraq, what the future held for them, the sites along the way — that was a lot not to talk about, Christi thought, for her usually communicative husband.

It was almost like he resented being home.

“I sensed a huge feeling on his part that there wasn’t a huge purpose to his being here (with her) and there were important things being done (in Iraq), and that he wasn’t part of it,” she said.

The trip provided the first of several signs that would eventually persuade Ham that what had happened during his year in Mosul in 2004 had left him a changed man — and that to recover, he needed to talk.

Now the commander of U.S. Army Europe, Ham, along with his wife, discussed his post-combat difficulties in an interview just before Christmas. It was the second interview the pair have given to a newspaper. Their willingness to speak publicly about the issue is rare in traditional military culture, but they appeared entirely comfortable.

“Frankly, it’s a little weird to me that people are making a big deal about it,” Ham said of the response to his openness. “Like lots of soldiers I needed a little help, and I got a little help.”

What Ham went through in Iraq was different than what sergeants or privates or captains or anyone on the line experience, he said, men and women whose lives are constantly at risk, who see close friends killed and maimed. “I wasn’t out on patrol on the streets at night … my exposure was episodic,” he said.

His Humvee was hit by a roadside bomb, though, and the gunner was badly injured.

But by far the most terrible, gruesome event was the suicide bombing in a mess tent under Ham’s command shortly before his tour ended. Twenty-two people, 14 of them U.S. troops, were killed in the Dec. 21, 2004, attack on the dining hall at Forward Operating Base Marez near Mosul.

It was devastating to Ham, the worst day of his life, and he said he has thought about it every day since.

But that wasn’t the only thing. It was also simply the burden of command. “It was the consequences every commander lives with: You issue orders that put soldiers in harm’s way,” Ham said, “and some end up killed.”

“How can you not be affected?” Christi asked.

Ham didn’t have post-traumatic stress disorder. His symptoms were more in line with what experts increasingly say are normal difficulties in post-combat adjustment: long silences, trouble sleeping, exaggerated emotions alternating with emotional detachment.

And he functioned well on the job.

“Work wasn’t a problem,” Christi said. “He could slice it that way.”

Ham said he noticed something was different when he first saw his dog, who’d been staying with his daughter during the deployment.

“The dog comes bounding out of the house and leaps up on me,” Ham said. “And I start bawling like a baby.”

One influential study indicated that about 20 percent of troops who’ve been deployed to Iraq and Afghanistan develop post-combat stress disorder. But the majority experience some adjustment problems, experts say. The Defense Department is trying to make it easier for all of them to seek help if they need it — if symptoms persist or make life difficult — often by just talking about their problems with a counselor or chaplain.

One way to get soldiers to open up is to remove the stigma that still exists within military culture to seek counsel and admit to what’s still seen — wrongly, the experts say — as a weakness.

“Reaching out and connecting — it’s a sign of strength,” said Brig. Gen. Loree Sutton, a psychiatrist and head of the Department of Defense’s Centers of Excellence for Psychological Health and Traumatic Brain Injury.

Sutton is at the center of an effort to get senior leaders to speak out about their post-combat issues — from the nearly universal sleep problems to feeling out of place, anxious and irritable, or self-medicating with alcohol — and so make it acceptable for everyone else.

But the Hams spoke out independently.

Would they have done so if he’d been a captain, a major, a lieutenant colonel and had not already reached the pinnacle of an Army career?

Ham said he didn’t know.

“I don’t think it would have made any difference,” his wife said. “Because he’s honest.”

Ham said he hopes his talking will encourage other soldiers to do the same.

“If it’s OK for this old soldier to talk about it publicly, it’s OK for you to talk about it privately,” he said.

He first acknowledged his problem years ago during an in-house session for senior leaders organized by Lt. Gen. James Dubik. Dubik encouraged frank disclosure at the session, something that was met with mixed enthusiasm. “Some were, ‘I’m OK. This is [BS],’ ” Ham said.

“It was the spouses who said, ‘You’re not OK; you’re different.’ ”

Ham calls his wife “the love of my life,” and he seeks her counsel often. Still, he said, “I wasn’t ready to talk to her.”

So, talk to someone else, she suggested.

“It wasn’t, ‘You need to go get help,’ ” he said. “It was more subtle than that.

“For me, the right outlet turned out to be a chaplain. To talk to someone in whom you have confidence, where you can say, without risk, ‘Here’s what I’m feeling.’ ”

Ham got numerous e-mails and phone calls after the first newspaper story about him in USA Today. It surprised him that they were uniformly positive, he said. “I thought I would get some ‘What the hell are you still doing in command?’ ”

But his most treasured response came from the guy Ham calls his hero: his son-in-law, an Army captain and Silver Star recipient wounded in an Afghanistan ambush. He sent a note thanking his father-in-law and said he had had some issues as well.

Ellie

thedrifter
01-11-09, 08:56 AM
‘Reaching out and connecting — it’s a sign of strength’


By Nancy Montgomery, Stars and Stripes
Mideast edition, Sunday, January 11, 2009

A real warrior will always place the mission first, never accept defeat, never quit and never leave a fallen comrade, according to the U.S. Army Warrior Ethos.

But what if he does all that, then has problems when he gets back home? What if he has post-traumatic stress disorder or nightmares or feels distant from his family?

Who are the real warriors then?

Army psychiatrist Brig. Gen. Loree Sutton is hoping to persuade soldiers that the real warriors are the ones that reach out for help with post-combat psychological issues.

“Reaching out and connecting — it’s a sign of strength,” said Sutton, head of the Defense Department’s Centers of Excellence for Psychological Health and Traumatic Brain Injury.

This spring, the center intends to unveil a $2.7 million campaign designed to help remove the still pervasive stigma from seeking mental health services — and persuade soldiers that the era of the strong, silent type is over.

Called “Real Warriors, Real Battles, Real Strength,” the campaign is modeled on one the National Institute of Mental Health did some years ago to persuade more men to seek treatment for depression. That one was called “Real Men. Real Depression” and featured manly men who had sought treatment discussing how they had been helped.

Likewise, the Real Warriors campaign is to feature stories from soldiers who had post-combat issues and sought help openly — not treating it as some shameful secret. The real secret, Sutton said, is how common — and normal — post-combat psychological issues are.

“We’re not all as invulnerable as we like to think we are,” said Army Maj. Gen. David Blackledge, one in the vanguard of senior officers and enlisted who’ve already signed up to discuss their stories. “Clearly talking to someone who’s trained and can help you understand what and why (your symptoms) are happening is very helpful. But the realization that there’s nothing wrong with you — that this is a normal response — makes it OK.”

Blackledge had severe symptoms following his Iraq deployments. He was at one of the Amman, Jordan, hotels hit by suicide bombers in 2005.

Worse, though, was what happened in 2004, during an ambush in Iraq.

Blackledge’s Humvee flipped over several times, crushing his vertebrae and breaking his ribs. His interpreter was shot through the head.

Blackledge crawled out, and he and others survived a firefight by taking cover in a ditch.

When he got home, he had nightmares from which he awoke drenched in sweat, and he constantly replayed the ambush over in his mind, he said. “I’d be totally happy one minute, and then something would happen and I’d want to kill somebody,” he said.

Blackledge sought treatment for his physical and psychological pain, and doesn’t see much difference between the two. “If you broke your leg, no one would question it,” he said. “Your brain is just another part of your body that can get injured.”

Now, he still dreams about the ambush but not so often, and the dreams are less terrifying. “It’s almost hard to call them nightmares anymore,” he said.

The Real Warriors campaign is part of a larger effort to address troops’ psychological health in the face of what have been lengthy and repeated deployments, increasing risks for traumatic brain injuries and post-combat stress. But seeking psychological treatment is still often seen by troops as both a sign of weakness and a bad career move in a culture that traditionally values stoicism, and strength is seen as invulnerability.

According to a military mental health task force report in 2007, the stigma “remains a critical barrier to accessing needed psychological care.”

Sutton says she sees the campaign lasting at least three years. That would mean changing the culture, she said, so that seeking mental health services is no longer discouraged, as it still sometimes is, by what she called “toxic leadership.”

“As we transform the culture … the toxic leadership will stand out as being what it is,” she said.

So far, Sutton said, she had recruited eight soldiers willing to participate, a staff sergeant, a first sergeant and a major among them, all willing to discuss their own experiences. “I am not alone. That’s a fundamental lesson that leads the campaign,” she said.

Blackledge said he would like to see some sergeants major come forward. “I think that would be huge,” he said.

Not everyone needs to be interviewed by the press, he said. The value is really in soldiers and their spouses talking to their peers.

“I’ve got two siblings; as much as they care about me, they just don’t have the same frame of reference,” Blackledge said.

But the people in the ambush with him? They know. He was recently in contact with two of them. “One of them still has dreams about it as often as I do,” Blackledge said.

Ellie