June 02, 2010
oregonlive.com

Military families are breaking under the burden of the war at home. After nine years of war on two fronts, Oregon’s military families with a veteran of Iraq or Afghanistan in the household have experienced significant increases – up to 50 percent – in divorce, mental health issues, veteran interpersonal violence and spousal abuse, and post-deployment joblessness of the primary provider. Oregon’s military families are the invisible ranks, struggling, suffering, serving in silence and social isolation. Military families need a seat at the table in Salem and a vehicle that leverages their expertise to identify and develop policies to ease their burdens, which are categorically different from the challenges facing our troops and veterans. Oregon should establish a Military Family Advisory Council.

At the recent hearing before the Legislature’s Joint Committee on Veterans’ Affairs, I made the case for creating such an advisory council, but it was the testimony of Sabena Moriarty, U.S. Marine Corps veteran, National Guard spouse and mother of eight, who told the real story:

“I wish I could sit here before you today, and tell you that having been in my husband’s shoes as a deployed service member, a deployed Marine, made my personal experience with Stephan’s first deployment easier in some way … but I can’t. Being the family member of a deployed service member is far, far more difficult than being the one deployed. …

“I was left to navigate this past deployment without a solid network of friends, no family in the area and minimal support from ever-changing Family Readiness Group representatives, who more often than not came into their positions untrained and unsupported by their own infrastructure.

“My experience here at home was a mixed bag of daily frustrations, utter exhaustion, loneliness, fear, anger, stress and confusion bordering on insanity. … I survived a high-risk pregnancy with gestational diabetes, an unexpected financial crisis that nearly [made] us homeless during the holidays [while my soldier husband was in Iraq].”

Sabena paused, struggling for composure, and then continued as tears rolled down her face:

“[A]s much as I had anticipated it, planned for it, sought out professional help for it and spent many, many sleepless nights trying to fix it, I saw each and every one of my children have extreme behavioral changes related directly to the deployment of their father, ranging from just plain acting badly and acting out, to two suicide scares by one of my children. I can honestly say, without doubt, that this was the most difficult year of my life.”

As the spouse of a National Guard two-time Iraq war veteran who is currently attached to an active-duty battalion at Joint Base Lewis-McChord, I can honestly say that this has been the most difficult decade of my life. When we are a nation at war, I understand that there will be sacrifice. But when that sacrifice is being made exclusively and repeatedly by less than 1 percent of the population, perhaps it’s more accurate to say that we are a military at war.

The military family is the first line of support for our troops, and the primary unpaid caregivers of our veterans. Mission readiness, morale, military recruitment and retention, and veteran reintegration are all directly affected by the military family. Oregon has a proud history of supporting our troops and our veterans. After nine years of war, it’s time to stand up for military families, too.

As the effects of eight years of war accumulate in Army families, a growing number of military spouses suffering stress, depression and thoughts of suicide can’t get the care they need. There is “a severe shortage of mental-health-care facilities for families, both on post and off, especially as post-behavioral health centers are already filled to capacity with soldiers,” according to Army psychiatrist Col. Kris Peterson. (Army News Service, October 13, 2009)

The Army has been closely tracking the uptick in mental health problems of soldiers, and is collaborating with the National Institute of Mental Health on “the largest study ever of suicide and mental health in the military.” (“Study to Seek Clues to Soldier Suicides.” The Washington Post, August 10, 2009) Military family members aren’t included in the study, which was announced in July, the same month that two spouses of multiply-deployed husbands were reported dead of suspected self-inflicted injuries.

One of the women was a pregnant 40-year-old Army wife in Fayetteville, North Carolina, who called 911 threatening to harm herself. When the police arrived, she was dead of an apparent self-inflicted gunshot wound. A few weeks earlier, Army officials began investigating “the recent suspected suicide of a 172nd spouse in Schweinfurt, according to Lt. Col. Eric Stetson, 172nd Infantry Brigade rear detachment commander.” (“Some seek mental health checks for spouses of multiple-deployed soldiers.” Stars and Stripes, July 5, 2009) Almost three years ago, another Fort Bragg wife committed suicide by carbon monoxide poisoning, locking herself and her young children in the family car parked in the garage with the engine running. “Her husband, a lieutenant colonel in the Army, had been deployed to Iraq just two months before, just after the birth of the couple’s daughter.” (“War’s Silent Stress: The Family at Home,” The Virginian Pilot, August 9, 2009)

In 2008, Cassy Walton, wife of Houston Army recruiter Nils Aron Andersson, an Iraq War veteran, killed herself a few days after her husband committed suicide.

During her husband’s most recent deployment, Carissa Picard, founder of Military Spouses for Change, wrote:

Here at Fort Hood, Texas … they cannot give me figures on spouse suicides but they … see so many attempted suicides in the Emergency Room that the medical staff have become quite adept at handling them. My theory is that these spouses may have reached the point of needing emergency mental health care and this is the only way to receive it.

Another Army wife said that she was hospitalized upon learning of her husband’s second deployment, due to concern that she might harm herself. Military spouse suicides typically aren’t made public, so the extent of the problem isn’t known. The Army doesn’t track suicides by military family members because most occur “off post or involve [family members of] reservists or guardsmen,” said Army spokesman Lt. Col. Christopher Garver. (Stars and Stripes, July 5, 2009)

There is some evidence indicating that spouses of citizen soldiers struggle more during deployments. Guard troops have served the longest tours in Iraq, and a study assessing the effect of deployment on military spouses revealed “Increased spousal distress and poorer coping … during deployment.” The research also found that “Longer deployment was associated with greater adverse outcomes.” (Centre for Military & Veterans’ Health, 2007) Geographic and social isolation is a major challenge for the Guard spouses who live hundreds of miles from the nearest post, armory or another military family member with a loved one at war.

Unable to attend the monthly volunteer-driven Family Readiness Groups, the only formal or informal support they receive over the course of a year-long deployment may be a single phone call from the Family Readiness Coordinator. So it’s not surprising that “68% of deployed reservists’ spouses reported increased stress [as] spouses of Guard or Reserve members may be less prepared than other active duty spouses to cope with [it].” (2008 Health Care Survey of DOD Beneficiaries)

Among active-duty spouses, a 2008 survey by the American Psychiatric Association found that 40 percent believed their mental health was hurt by their husband’s or wife’s service overseas. Approximately 25 percent reported regular problems with sleeplessness, anxiety and depression.

Earlier studies conducted on wives of deployed troops discovered a spectrum of symptoms and diagnoses, such as: depression, anxiety, insomnia, adjustment disorder, nervousness, headaches, dysphoria and changes in eating habits. (Frankel, Snowden, & Nelson, 1992; Milgram & Bar, 1993; Wood & Scarville, 1995; et. al.) “There’s a lot of research to show that partners and spouses and kids suffer from secondary PTSD [Post-Traumatic Stress Disorder],” said Tom Berger, a senior analyst for veterans’ benefits and mental health issues for the Vietnam Vets of America.

Investigations into the mental health of wives of retired veterans found that spouses of combat veterans had high levels of distress, poorer physical and psychological health over a lifetime, and greater social isolation than partners of non-combat veterans. A study on caregiver burden among partners of vets with PTSD stated that nearly half of the wives “felt as if they were on the verge of a nervous breakdown.” (Beckham, Lytle, and Feldman, 1996) Research published in The Journal of Nervous and Mental Disease stated that:

Partners [of combat veterans] endorsed high levels of psychological distress with elevations on clinical scales at or exceeding the 90th percentile. Severe levels of overall psychological distress, depression and suicidal ideation were prevalent among partners…. These findings are compelling since they demonstrate that partners of veterans with combat-related PTSD experience significant levels of emotional distress that warrant clinical attention. (Manguno-Mire, Ph.D., Sautter, Ph.D. et. al., February, 2007)

A growing number of today’s military spouses are married to active-duty veterans, and it’s likely that the psychological distress experienced by wives of combat veterans is compounded by bearing the burden of war at home during multiple deployments, but there are painfully few resources focused on serving this population. Soldiers receive training and courses to prepare them for multiple deployments, but spouses do not. Even when clinical care is available, 66 percent of the military spouses surveyed “worried that looking for assistance for their own issues would harm their loved ones’ chances of promotion.” (American Psychiatric Association, 2008)

The stigma that prevents troops from seeking mental health help also affects military spouses, some of whom believe that a wife who asks for help is weak, and “not cut out to be an Army wife.” Hypervigilant of the fact that it’s their soldier, not themselves, repeatedly putting their boots on the ground and their lives on the line, spouses learn to “suck it up,” and suffer in silence.

In the past year, however, more military wives have begun speaking out, including Sheila Casey, wife of the Army’s top soldier, Gen. George Casey, Army chief of staff. Testifying before the Senate Armed Services Committee in June, Mrs. Casey remarked, “Army families are the most brittle part of the force … [They] are sacrificing too much, and we can no longer ask them to just make the best of it.“

A Wife’s Battle
When Her Soldier Returned From Baghdad, Michelle Turner Picked Up the Burden of War

By Anne Hull and Dana Priest
Washington Post Staff Writers
Sunday, October 14, 2007; A01

ROMNEY, W.Va.

M ichelle Turner’s husband sits in the recliner with the shades drawn. He washes down his Zoloft with Mountain Dew. On the phone in the other room, Michelle is pleading with the utility company to keep their power on.

“Can’t you tell them I’m a veteran?” asks her husband, Troy, who served as an Army scout in Baghdad and came back with post-traumatic stress disorder.

“Troy, they don’t care,” Michelle says, her patience stretched.

The government’s sweeping list of promises to make wounded Iraq war veterans whole, at least financially, has not reached this small house in the hills of rural West Virginia, where one vehicle has already been repossessed and the answering machine screens for bill collectors. The Turners have not been making it on an $860-a-month disability check from the Department of Veterans Affairs.

After revelations about the poor treatment of outpatient soldiers at Walter Reed Army Medical Center earlier this year, President Bush appointed a commission to study the care of the nation’s war-wounded. The panel returned with bold recommendations, including the creation of a national cadre of caseworkers and a complete overhaul of the military’s disability system that compensates wounded soldiers.

But so far, little has been done to sort out the mess of bureaucracy or put more money in the hands of newly disabled soldiers who are fending off evictions and foreclosures.

In the Turner house, that leaves an exhausted wife with chipped nail polish to hold up the family’s collapsing world. “Stand Together,” a banner at a local cafe reminds Michelle. But since Troy came back from Iraq in 2003, the burden of war is now hers.

Michelle has spent hundreds of hours at the library researching complicated VA policies and disability regulations. “You need two college degrees to understand any of it,” she says, lacking both. She scavenges information where she can find it. A psychotic Vietnam vet she met in a VA hospital was the one who told her that Troy might be eligible for Social Security benefits.

Meanwhile, there are clothes to wash, meals to cook, kids to get ready for school and a husband who is placidly medicated or randomly explosive. Besides PTSD, Michelle suspects that Troy may have a brain injury, which could explain how a 38-year-old man who used to hunt and fish can lose himself in a three-day “Scooby-Doo” marathon on the Cartoon Network.

“He can’t deal with everyday stresses of living,” Michelle says. “He can’t make decisions. He is a worrywart. Fearful. It’s like they took Troy and put him in a different person.”

As thousands of war-wounded lug their discharge papers and pill bottles home, more than a quarter are returning with PTSD and brain trauma. Compensation for these invisible injuries is more difficult and the social isolation more profound, especially in rural communities where pastures outnumber mental health providers. Troy’s one-year war has become his wife’s endless one.

His Illness, Her Full-Time Job

The Turners live in a small rental house in the northern tip of West Virginia, surrounded by enormous blue sky and the dark spine of South Branch Mountain. There is a VFW tavern in town, but Troy doesn’t bother. After one of his distraught soldier buddies from Iraq got so drunk he wrapped his motorcycle around a tree, Troy stays away from alcohol. Still, the techniques he learned to calm his PTSD in Army and VA treatment programs — tai chi meditation and classical music — seem like distant remedies in this county of farm equipment and Ford pickups.

Michelle thinks Troy’s anxiety and depression are worsening, and she tells anyone who will listen — her pastor, doctors and counselors at VA. His speech is sometimes soupy from mood stabilizers. The meds give him tremors. He used to cut the grass and bring home a paycheck, but now he stays inside like a perpetual patient. His memory is shot, and he relies on Michelle for everything.

“What is the name of the doctor who looks at knees?” he asks one day.

Michelle takes a breath. “Orthopedic,” she says. “Troy, please try.”

At 31, her eyes are hollowed by worry and her brown hair is turning gray. The Turners live 80 miles from the Martinsburg VA Medical Center, where Troy receives his care, and sometimes they go once a week. The all-day journey requires a babysitter for the kids — ages 10 and 11, both from previous marriages — and burns $25 worth of precious gas.

“This is the part you don’t see on TV,” Michelle says.

One hot morning, they set out for Martinsburg yet again. Troy recently screened positive for possible traumatic brain injury — he was exposed to multiple blasts in Iraq — and the hospital wants him back for more comprehensive testing. Troy and Michelle are quiet on the ride into Martinsburg. A Bible rests on the back seat. The cornfields and emerald hills spread out from the two-lane highway. Troy’s pill box is between them, along with the silence.

Finally Troy says he thinks his new medication is making him less aggressive.

Michelle is skeptical. “You don’t have an ‘off’ button anymore,” she says.

Troy, in the passenger seat, keeps his eyes on the road. “They broke it off when I was over there.”

He served with the 3rd Infantry Division during the 2003 invasion of Iraq. Before that, he spent a decade with the National Guard, pulling a tour in Bosnia. A laconic country boy with a plug of tobacco in his cheek, Troy was a cavalry scout with the 3rd Battalion, 15th Infantry Regiment that pressed into Baghdad. His platoon sergeant was decapitated by a rocket-propelled grenade, and others he knew were obliterated.

Troy’s problems started after his tour. While he was on home leave from Fort Stewart one weekend, Michelle found him sitting on the bed with a bottle of pills. He said he couldn’t go back. Michelle drove him to the Martinsburg VA hospital, which shipped him to Walter Reed for three weeks of psychiatric care.

He was sent back to Fort Stewart and returned to duty, a reality he could not cope with. Twice he tried to commit suicide and was hospitalized at Winn Army Community Hospital before being medically discharged for PTSD in 2004. After 13 years in uniform, Troy got nearly the lowest disability rating possible, a $11,349 severance check and no benefits.

Michelle was dating Troy at the time. She had visited him at Walter Reed. When he asked if she wanted out of the relationship, she said she would stick by him as long as he continued to treat her well. They were married on Valentine’s Day in 2005.

For 18 months Troy worked as a truck driver until his symptoms began to worsen. He imagined he saw Army vehicles on the interstate, causing him to shake and panic. His family needed the $2,600-a-month salary, so Troy kept driving and Michelle rode in the truck with him. Finally VA doctors increased Troy’s medication, and he became too zonked to drive.

VA rated Troy’s disability level at 50 percent, resulting in $860 a month in compensation. Like many wounded soldiers, he was clobbered by a fine-print government regulation known as “concurrent receipt,” which prevents double compensation. That meant before he could receive his VA disability check, Troy had to pay back the $11,349 he received when he left the Army. For 13 months, VA withheld his check until the Army amount was reimbursed.

The Turners’ foothold in working-class America completely slid away when Michelle — who has worked as a teacher’s aide and an inventory-control specialist at Wal-Mart — developed health problems and was forced to quit her job. Now her full-time job is Troy.

His illness has eroded their marriage, but on the morning they arrive at the Martinsburg VA hospital, she leads the charge on his behalf. The concrete behemoth serves 129,000 vets from West Virginia, Maryland, Virginia and Pennsylvania. It is at once efficient and numbingly bureaucratic.

Michelle and Troy move down the hallways, passing a room near the PTSD residence where a group of young vets, some tattooed and still muscled from the desert, are playing a game of ring toss. The cafeteria smells of bleach and canned peaches.

In the small lobby of the neuropsychological department, Troy leans over the sign-in clipboard, pen in hand, staring at the sheet. Michelle tells him what day it is. They sit together on the hard chairs until Troy’s name is called.

With two hours to kill, Michelle wanders into the hallway and runs into a Vietnam vet she has befriended. A former Marine with ramrod posture, the vet has PTSD and an encyclopedic knowledge of VA procedures. “Don’t take no for an answer,” he tells Michelle. “Huntington [a VA regional office] says you are his fiduciary, right?”

“They say they need to come out and do a home study,” Michelle says.

The vet shakes his head angrily. “Don’t let these people get over on you!”

She returns to the waiting room. A flier on the bulletin board catches her eye: “Coming Soon, Help for Veterans and Families.” A door opens, and one of Troy’s doctors asks her to step into his office. When Michelle emerges 15 minutes later, she stands alone in the waiting room, twisting the handle of her purse. The doctor said Troy is getting worse.

Not knowing where else to go, Michelle heads upstairs to the PTSD offices. Troy has already done one 45-day stint in the residential program, and Michelle has been trying to get him in again. She knocks on the door of a counselor, a big, bald, friendly man who does not wave off the intrusion.

“You think he’s violent at this point?” the counselor asks.

Michelle dodges the question. “He’s not getting any counseling,” she says, leaning against the door.

The counselor explains that all 50 beds in the program are full and the waiting list is 25 deep. “I apologize for not being able to get him in right away,” he says.

Michelle’s voice breaks. “I know you are doing the best you can,” she says. “Anymore, he’s just ashamed. I wish I had a video camera set up to show the people at the VA: This is what an average day looks like.”

She goes back for Troy, who has finished his tests. He is yawning and tired. He tells Michelle how hard he tried, and she smiles and touches his arm. They go upstairs to make an appointment with Troy’s psychiatrist. The clerk tells Michelle that unfortunately the doctor is on leave for the next month. The first available slot is five weeks out, at 8:30 a.m.

“Is there anything later than 8:30?” Michelle asks, politely. “We have a three-hour drive.”

Nine o’clock is the best they can do. The appointment is for 20 minutes.

The last stop of the afternoon is the travel reimbursement office on the first floor. The government has promised to care for its wounded, but the proof is often in cramped places such as this, where disabled veterans stand in line to get their mileage reimbursed. The VA mileage rate has not changed since 1977. While a federal worker gets 48.5 cents per mile, a disabled veteran is still paid 11 cents a mile.

Michelle steps to one window and gets a receipt for $14.52. At the next window, $6 in government “deductibles” are taken out, bringing the grand total to $8.52.

On the way home, Michelle pulls into a Flying J truck stop, pumping gas in the hot breeze, watching the numbers spin higher.

‘Ain’t a Scratch on Me’

Money became so desperate this spring that Michelle contacted Operation Homefront, a national organization that gives emergency assistance to deployed service members and the returning wounded. In a sign of the deepening financial crisis faced by many back from war, Operation Homefront has provided $2 million in bailout funds to 4,300 families so far in 2007, double last year’s caseload.

The Turners received $4,500 to cover three months of late car payments, rent and various other bills, and a grocery card for food. Troy was angry and embarrassed, but Michelle told him they had no other choice. The $860 VA disability check barely covers expenses.

Michelle has been pushing to have VA reevaluate Troy in hopes of getting his disability rating raised and his compensation increased. He can’t drive, he can’t work, he can barely function without her. A Black Hawk model set is next to his recliner, a therapeutic hobby made impossible by the shaking in his left arm.

The house is small, and the blare of Nickelodeon from the TV chokes the day.

“I am at the end of my rope,” Michelle says. But at least now she has the help of an assistant officer with the West Virginia Division of Veterans Affairs in a little office in Moorefield, about 30 miles from Romney. The officer submits the right paperwork to have Troy reevaluated.

Doctors find that his condition has worsened and that his PTSD is “chronic and severe.” Michelle gets copies of the medical records and sits down with them on her living room floor. Wearing an Army T-shirt that says “Got Freedom?” she begins reading. The documents are a gold mine of information that validate what she has said all along. But instead of feeling exonerated, she feels sickened.

He has nightmares frequently, two to three times a week, in which he sees himself back in Iraq . . . and Baghdad. He sees himself fighting, sees dead bodies, parts of bodies, blood rushing from bodies. In the dreams he smells blood and burnt flesh and he hears bullets passing over his head. He is fearful and scared and wakes up in cold sweats. Flashbacks are also frequent, 2 or 3 times a week, triggered by helicopters passing over, burn flesh smell, barbecue, current Iraq news and sometimes seeing military vehicles brings flashbacks.

Michelle goes page by page. Troy is in his recliner holding the remote control. From time to time she looks up at him, then her eyes go back to the records.

He has a lot of guilt feelings that he could not save his sergeant.

She comes to a page that lists Troy’s problems.

Hearing loss.

Tremors.

Obesity.

PTSD.

Depressive disorder.

Michelle calls out to Troy. “They are saying your memory is extremely low,” she says. “And here’s another thing. ‘Hearing loss. Exposure to artillery and machine gun fire.’ ”

VA concludes that Troy’s worsening condition merits an increase of his disability rating to 70 percent, raising his monthly check to $1,352 a month. According to VA, he doesn’t meet the criteria for 100 percent because his impairment is not “persistent,” with “persistent delusions” or a “persistent danger of hurting himself or others.” He is still able to perform his own hygiene.

From Michelle’s point of view, Troy can hold a toothbrush, but he can’t hold a job. “Even at 70 percent, you can’t raise a family,” she says. She has a year to appeal the rating.

But there is good news: The VA hospital in Martinsburg finds a bed for Troy in the PTSD residential rehab program.

Michelle is relieved. Troy will get help and she will get a respite. Troy packs his small suitcase with resignation. He doesn’t want to go. During the intake session in Martinsburg, he is withdrawn and sullen. When the doctor asks if he has been having suicidal thoughts, he says yes. The news punches Michelle in the gut.

Troy is allowed to come home on weekends, so Michelle makes the four-hour round trip to pick him up on the first Friday night. On Sunday, he refuses to go back. He says he has been through it before. Michelle pleads with him to get in the truck but he won’t, and he loses his spot in the program.

Troy returns to his recliner. VA tells Michelle that a contract counselor who visits rural counties will be in touch to schedule time with Troy. Two weeks later, Troy has his first appointment. Whatever is discussed in the 60-minute session causes him to cry the next day.

The Turners decide to pack up and leave their $475-a-month rental house for a $450-a-month mobile home in Moorefield to save money and be near Troy’s mother for help. They are strained beyond belief. Still, there are moments of gallows humor. “I have PTSD, what’s your excuse?” Troy kids Michelle.

“I have a husband with PTSD,” she says.

Before they leave, someone from Hampshire County’s Heritage Days parade calls to see if Troy wants to ride on the veterans float. Troy declines. It’s not just the crowds.

“Other people got wounded, and all I got was a mental thing,” he says.

Michelle raises an eyebrow. “It’s still an injury.”

“I think about that doctor down there,” Troy says, referring to a psychologist at Fort Stewart who suggested he was faking it. “Plus, the fact that guys are missing arms and have bullet holes and everything else. Ain’t a scratch on me.”

To remember who Troy used to be, Michelle keeps a photo of him hidden in her camera case. In the picture he is smiling and eager, ruggedly at home in his Army fatigues. Now she looks at the man in the recliner. “It’s people like you that made our country,” Michelle says. She goes back to filling out forms, and Troy goes back to Nickelodeon.

Staff researcher Julie Tate contributed to this report.

VA care in spotlight after Iraq war veteran’s suicide

By Charles M. Sennott, Globe Staff | February 11, 2007

STEWART, Minn. — It took two years of hell to convince him, but finally Jonathan Schulze was ready.

On the morning of Jan. 11, Jonathan, an Iraq war veteran with two Purple Hearts, neatly packed his US Marine Corps duffel bag with his sharply creased clothes, a framed photo of his new baby girl, and a leather-bound Bible and headed out from the family farm for a 75-mile drive to the Veterans Affairs Medical Center in St. Cloud, Minn.

Family and friends had convinced him at last that the devastating mental wounds he brought home from war, wounds that triggered severe depression, violent outbursts, and eventually an uncontrollable desire to kill himself, could not be drowned in alcohol or treated with the array of antianxiety drugs he’d been prescribed.

And so, with his father and stepmother at his side, he confessed to an intake counselor that he was suicidal. He wanted to be admitted to a psychiatric ward.

But, instead, he was told that the clinician who prescreened cases like his was unavailable. Go home and wait for a phone call tomorrow, the counselor said, as Marianne Schulze, his stepmother, describes it.

When a clinical social worker called the next day, Jonathan, 25, told again of his suicidal thoughts and other symptoms. And then, with his stepmother listening in, he learned that he was 26th on the waiting list for one of the 12 beds in the center’s ward for post-traumatic stress disorder sufferers.

Four days later, on Jan. 16, he wrapped a household extension cord around his neck, tied it to a beam in the basement, and hanged himself.

In life, Jonathan Schulze didn’t get nearly what he needed. But in death, this tough and troubled Marine may help get something critical done.

The apparent failure of the Department of Veterans Affairs to offer him timely and necessary care has electrified the debate on the blogs and websites that connect an increasingly networked and angry veterans community. It has triggered an internal investigation by the VA into how a serviceman with such obvious symptoms faced a wait for hospital care.

And it is being cited by veterans’ advocates and their allies in Congress as a searing symbol of a system that they say is vastly unprepared and under funded to handle the onslaught of 1.5 million veterans of the wars in Iraq and Afghanistan who are returning home, an estimated one in five of them with post-traumatic stress disorder, or PTSD. One in three Iraq war veterans is seeking mental health services, according to a report by an Army panel of experts last year.

The death of Jonathan also raises questions, among veterans and in Washington, about how far the military culture still has to go in dealing with the stigma often attached to cases of mental illness. Marines, especially, just aren’t supposed to cry out for help.

My feeling is no veteran should be turned away, and definitely not a veteran who is openly saying he needs help and that he feels like taking his life,” said Jonathan ’s father, James, who is a Vietnam War veteran and comes from a family with a long tradition of military service.

“My son did his duty, he risked his life for his country, and he came home a broken person. And then the VA failed in its duty to care for him,” he said, sitting in the family home in front of a coffee table transformed into a shrine for his son, with framed photos and, folded in a neat triangle, the flag that draped his coffin.

Across the country, there are stories of veterans suffering with combat stress and PTSD, who are struggling to find help at VA facilities to deal with the problems they face, according to Steve Robinson, director of veterans affairs for the Washington-based Veterans for America, an advocacy group.

“Sadly, there are a lot of Jonathan Schulzes out there,” said Robinson, a veteran of the Gulf War who investigates cases all over the country of service members suffering from mental illness and other injuries who are struggling to get the care they deserve.

A plea for help
Jonathan’s case has prompted the US Department of Veterans Affairs , with 235,000 employees at a network of medical centers for servicemen and women, to launch an ongoing internal investigation into the details surrounding Jonathan’s death, according to Phil Budahn , a VA spokesman in Washington.

But beyond that, Budahn could say little. All patient files are confidential, he said, declining comment on any of the specifics of Jonathan’s case.

But VA officials have released 400 pages of documents on the case to the Schulze family. One document from that file showed that the VA clinical social worker, Daniel Ludderman, with whom Jonathan spoke by phone on Jan. 12 did not indicate in his notes that Jonathan had expressed suicidal thoughts.

A VA spokesman told local news organizations that there were emergency beds available in a psychiatric hold unit throughout January. But the VA has not responded to questions about why, if that was the case, Jonathan was not placed in one. Another looming question in the VA investigation is why there are only 12 beds for in-patient PTSD treatment in Minnesota. That number has remained unchanged for a decade, former state VA officials say, even as the nation has engaged in two wars, in Afghanistan and Iraq, in the past five years.

James and Marianne insist they both heard Jonathan clearly state that he was suicidal on Jan. 11. Marianne says she heard it again when Jonathan was speaking with the VA’s Ludderman on the phone the next day.

James believes the VA response thus far indicates that officials are worried more about protecting the VA’s image than in meeting the overwhelming need for more and better PTSD counseling for veterans returning from Iraq and Afghanistan.

“I heard what Jon said. They can doctor the records all they want; it is not going to change what I heard,” he said.

Major Cynthia Rasmussen, who worked for 18 years as a psychiatric nurse at the VA and who now runs the Army Reserve Combat Operational Stress Control Program at Minnesota’s Fort Snelling, said, “Jonathan’s case is classic and classically tragic.”

Rasmussen said that there are many excellent programs and treatment centers within the VA, but that effective delivery of service is spotty and inconsistent and that problems of poor communication between the military and the VA are thwarting attempts by service providers to treat those veterans who need help.

“That is what happened to Jonathan, and there are just hundreds of cases like this across the country. We are seeing them every day,” she added.

Descent into mental illness

Behind the stark details of the case is a more complex and nuanced picture of Jonathan’s descent into mental illness.
He arrived home last fall after a hellish tour of duty with Second Battalion, Fourth Marines in the Ramadi/Fallujah area of Iraq, where fighting was particularly intense in the spring of 2004. In letters home, Jonathan had described the combat deaths of 16 men he called friends. He himself was wounded by shrapnel twice.

In his neat grammar-school cursive, Jonathan described the death and danger that confronted his unit daily. He made it very clear: He was terrified.

“My heart is filled with sadness. And I ask God why,” he wrote on May 13, 2004, the day after two close friends were killed. “I pray so much and ask God to keep me out of harm’s way and get me back in one piece.”

One of his fellow Marines in the Fallujah area was 25-year-old Eric Satersmoen, who knew Jonathan from local bars in the Minneapolis area where Jonathan had worked as a bouncer. They traded news about mutual friends and the Vikings and the Minnesota Wild hockey team, and they vowed to stay in touch when they got back home.

When they did return, in the winter of 2005, they found they shared some other things: persistent nightmares, sleeplessness, anxiety, anger, and a tendency to use alcohol to numb themselves to all that.

But their experiences diverged in a critical way that underscores how the VA system sometimes succeeds and why it so often falls devastatingly short — right from the moment demobilized troops get ready to go home.

Returning Marines and soldiers are routinely asked to fill out a form in which they are told to self-evaluate their own mental health on a questionnaire about nightmares, anxiety, aggression, and suicidal thoughts.

The military says the forms are a way to highlight problems early. But veterans advocates say that all too often servicemen, eager to reunite with family and friends, give the forms short shrift . They simply check “no” to every question because they do not want to be delayed at the base with mental health appointments.

That’s what Jonathan told friends and family he did. And that’s also what his close friend Eric had done after his first tour, but was determined not to repeat this second time around.

This time he knew he had a problem. He checked “yes” to the boxes that asked about nightmares, anxiety, and violent outbursts. He was given a schedule of appointments and began to enter a long process of counseling that has allowed him to slowly heal and eventually to have in-patient treatment at the Minneapolis VA where he was given a bed in the PTSD ward.

Jonathan, meanwhile, returned home for 30 days’ leave. His family immediately saw that he was depressed and anxious. They heard him thrashing and yelling in his sleep. He was not the big, fun-loving young man he was before he went off to war, they said.

The family doctor, William Phillips, saw him and wrote a report that Jonathan appeared to be suffering classic symptoms of PTS D . He prescribed Valium and encouraged Jonathan to seek help when he returned to Camp Pendleton.

“I told him that when I came home from Vietnam, I just closed up and hardened my shell. It hurt me in life. I was a pole cat to live with, and I wanted to be sure he didn’t make the same mistake,” said his father.

After his 30 days’ home leave, Jonathan returned to Pendleton for 90 days before his final discharge notice would be given. That was when he really went off the rails. He was drinking heavily and getting in violent confrontations at local bars off the base and even with his own Marines. He had nightmares of firefights in which comrades died and civilians were caught in the crossfire. He refused to admit he suffered mental problems

“Marines don’t do weakness,” said his older brother Travis, 27, a Marine who also joined up straight out of high school. Travis served in Afghanistan in the fall of 2001 during the US-led military response to the attacks of Sept. 11, 2001. “That’s the attitude, and Jon was caught up in that world,” said Travis.

Jonathan was completely out of control. In the fall of 2004, he brutally beat a fellow Marine. He also threw a 200-pound potted tree through a plate glass window during a bar fight. He ended up spending one month in the brig. Military Police searched his locker and found steroids — he was an obsessive body builder. He was busted in rank from lance corporal to private and given a “general” rather than an “honorable” discharge.

Drinking and self-loathing

These kinds of discharges are on the rise among returning veterans, particularly among those suffering from mental trauma who veer into violence and substance abuse, according to Lieutenant Colonel Colby Vokey, who supervises the legal defense of Marines at Camp Pendleton.

For Jonathan, the “general” discharge status meant that he was ineligible for GI Bill benefits, including assistance for college tuition, and it was technically up to the discretion of the VA whether he would receive medical treatment.

The VA did accept Jonathan for treatment of his shrapnel wounds and back pain. Eric, his Marine buddy, tried to help him get assistance for his mental health issues as well. They sometimes waited the entire day for appointments and group counseling.

Through it all, Jonathan never stopped drinking. Friends and family say that every night he drank his trusted Wild Turkey by the shot glass and one beer after another to chase it down. When he was tired, he drank “Jager-bombs,” a mix of the potent German liqueur Jagermeister mixed with the energy drink Red Bull.

His friend Eric drank with him. It was not easy for either one of them when they talked about the war. Eric lost control sometimes, but nothing compared with the bouts of anger and depression and violence that he watched Jonathan go through. “Crazy Jonny,” as he called him, was on a different path.

Jonathan was wracked with feelings of self-loathing about his demotion in rank, his tainted discharge, and what he felt was a failure on his part to save his friends, several of whom were killed right by his side in Iraq. The obsession with lifting and steroids, Eric believes, were an expression of low self-esteem.

“He just never could be big enough and bad enough . . . It was like he was going to drink and lift his way through the mess,” Eric said.

Then at 8:35 p.m. on Jan. 16, Eric, who was in Florida on business, received a phone call from Jonathan, who was staying in an apartment in New Prague, Minn., that Eric owned and where he gave Jonathan a room.

Jonathan told Eric he was in the basement standing on a stool and tying a noose around his neck with an extension cord. A bottle of Captain Morgan rum, three-quarters’ full, was at his side, and he was slurring .

“I tried to stall him by being nice, and then I tried getting mad at him, telling him he was taking the easy way out. I told him, ‘What about your faith?’ I was doing everything I could,” said Eric.

“He said: ‘ The hell with it all, the Marines, the VA, the hell with religion. The hell with it all. I am doing it,’ ” said Eric.
Then, Eric said, he heard the phone fall to the floor.

A family mourns
Last week, it was 10 below zero with the windchill factor in the farming town of Stewart . Before his shift at a nearby dairy plant, Jonathan’s father crunched through dry, drifting snow toward the St. Paul’s Lutheran Church cemetery to visit his son’s grave .

Dead flowers from the funeral and a small American flag that marked the grave were disappearing beneath the drifting snow.
“This never should have happened,” said James, tears welling behind a pair of sunglasses.

“This country should have taken better care of one of its sons. They owed that to Jon.”

Soldiers say military pushes them to discharge before medical needs are met

LES BLUMENTHAL; The News Tribune
Published: July 10th, 2005 12:01 AM

The day before his 22nd birthday, a bomb hanging from a tree along a road near Fallujah exploded above Rory Dunn’s Humvee.
Dunn’s forehead was crushed from ear to ear, leaving his brain exposed. His right eye was destroyed by shrapnel; the left eye nearly so. His hearing was severely damaged.

“I remember a bright flash. The trees lit up, and the Humvee was shaking,” Dunn recalled during a recent interview while curled up in an easy chair in the living room of his mother’s Renton home.

Within minutes of the May 2004 explosion, he was strapped on a stretcher and flown by helicopter to a hospital in Baghdad – the first step in his 10-month struggle to recover.

Yet, even as Dunn fought to overcome his traumatic brain injury and other wounds, his mother, Cynthia Lefever, fought the Army to ensure her son continued to receive critical care from Army specialists. Lefever said the Army tried to pressure her son into accepting a discharge before he was ready – pressure other severely wounded soldiers say they’ve experienced, too.

Lefever and other critics say the Army’s medical system, particularly Walter Reed Medical Center in Washington, D.C., has been overwhelmed by the number of wounded returning from Iraq and Afghanistan. They accuse the Army of attempting to discharge wounded soldiers before their essential medical needs are met and transfer them to Veterans Affairs medical facilities.

“The Army tried to get rid of him,” Lefever said. “It was immoral and unethical. The Army owes these kids.”

Army officials deny they’re taking advantage of wounded soldiers.

“There are no efforts to ‘rush’ anyone out of the Army or through medical treatment and the disability system,” Col. Dan Garvey, deputy commanding officer of the Army’s Physical Disability Agency, said in an interview via e-mail.

Soldiers are discharged if they no longer can “adequately perform” their assigned duties and have received “optimum medical care,” Garvey said. The process is subjective and can last months or more than year, he said, but soldiers are informed of their rights and can appeal.

“There must be a balancing act, and the system tries very hard to maintain that,” Garvey said.

The issue has attracted attention in Congress and among veterans groups.

John Fernandez, a 27-year-old retired 1st lieutenant from New York who lost part of each leg in Iraq, told the Senate Veterans Affairs Committee this spring the Army tried to discharge him before he received the medical care he was entitled to.

Sen. Patty Murray (D-Seattle), a member of the committee, said she heard similar stories from other wounded soldiers and their families.

“I think (the Army) underestimated the number of wounded. No one predicted this,” Murray said. “I don’t know whether they are overcrowded or just trying to cut costs. No one is talking about it.”

Clinging to life

Doctors initially gave Rory Dunn little chance of survival.

As he clung to life in the Baghdad hospital, they glued his left eye back into its socket and placed him in a deep medical coma to ease brain swelling. Five days later, Dunn was flown to a hospital in Germany, where his family had gone on “imminent death orders” to say their goodbyes. If he lived, they were told, he might need full-time care for the rest of his life.

Almost six weeks after he was wounded, Dunn emerged from his coma at Walter Reed, where he had been transferred. Days later, Lefever said, the Army asked her son to begin the discharge process. She objected.

During the coming months, before his skull was rebuilt, before a cornea transplant, before speech and physical therapy, the Army made at least three attempts to get her son to accept a discharge, Lefever said. In one instance, she said a top medical officer showed up in her son’s room in Ward 58, the neuroscience ward at Walter Reed, and said Dunn needed to immediately sign papers formally starting the discharge process.

“We all understood he couldn’t return to the Army, but he hadn’t even started his treatment,” Lefever said, adding that her son had just emerged from his coma.

In the fall of 2004, roughly five months after he was wounded, Lefever said her son was told to attend a meeting without his mother. During the meeting , which Lefever insisted on attending, Dunn was given three days to sign papers starting the discharge process or the Army would do it without his authorization. At that point, Dunn had not received the surgery that would rebuild his forehead.

“I felt bullied,” Lefever said.

During a six-week period stretching into February, Lefever said the Army stepped up the pressure, at one point offering to send her son to a hospital in Palo Alto, Calif., that specializes in traumatic brain injuries – but only if he first agreed to a discharge.

“I was disgusted,” Lefever said.

Though Dunn wanted out, Lefever said he wasn’t ready and felt the Army was trying to play her son off against her. In phone calls and in meetings, Lefever said her son was repeatedly told that his discharge was “none of his mom’s business.”

“Rory left his right eye, his forehead and his blood in the dirt in Iraq because the Army sent him there,” Lefever said in one e-mail to medical officials at Walter Reed. “Rory went and did his job as ordered by the Army, and deserves so much better than to sit and wait … depressed, angry, frustrated and contemplating suicide. Rory deserves the opportunity to ‘come back’ 100 percent both physically and mentally.”

Feeling overwhelmed, Lefever said she sought assistance from a veterans group, Disabled Veterans of America, as well as Sen. Murray’s office. The veterans group assigned an advocate named Danny Soto to Dunn’s case.

Soto said lots of soldiers feel they’re being “pushed out the door.” He blames the military for failing to adequately explain to the families of wounded soldiers that there will be a “continuity” of medical care after discharge.

After a series of meetings involving Dunn, Soto, a Murray aide, Lefever and Army officials, an agreement was reached that allowed Dunn to be sent to Palo Alto for treatment, then accept a discharge.

“All I wanted was the best for my son,” said Lefever, who made her feelings known to a string of Army officials, including generals at the Pentagon and then-Deputy Secretary of Defense Paul Wolfowitz.

Lefever’s fight wasn’t unique.

‘I felt I was being rushed’

Fernandez, the retired 1st lieutenant, was injured in a friendly fire incident in Iraq in April 2003. His right leg was amputated below the knee, as was his left foot. He was fitted with eight prosthetics before he found ones that were comfortable.

A graduate of West Point, where he captained the academy’s lacrosse team, Fernandez studied the regulations and was able to “push back” and fend off the discharge for months.

“I had to fight to stay on duty,” Fernandez said, adding he didn’t want to be discharged until the Army provided him with the care he felt he deserved.

“A private just out of high school who doesn’t know his rights might just go with the flow,” he said. “You are dealing with injuries that will affect you and your family for the rest of your life. It’s an emotional time. Then you get overwhelmed with all this information.”

Former Staff Sgt. Jessica Clements of Canton, Ohio, suffered a traumatic brain injury when a bomb – the military calls them “improvised explosive devices” – detonated while she was riding in a convoy near the Baghdad airport. To relieve brain swelling, Clements said, a neurosurgeon at the Baghdad hospital clipped off a piece of her skull and temporarily inserted it into her belly for safe keeping.

“I could feel it,” said Clements of the piece of skull stored in her belly for four months before it was removed and reattached.

As she lay in a bed at Walter Reed, Clements said, she received repeated telephone calls from an Army official telling her she needed to start the discharge process.

“I had no idea what was going on,” she said in an interview. “It was only two months after I was injured. I felt I was being rushed. My skull was in my stomach, and I was doing eight hours of therapy a day. It was very frustrating.”

Panel reviews each case

Army officials won’t comment on individual medical cases, but they say they try to be sensitive when discharging seriously wounded soldiers.

“We get complaints and criticisms of the process not infrequently,” said Col. James Gilman, head of the Walter Reed Health Care System. “We get complaints it takes too long and we get complaints it goes too quickly. Our goal is to take care of the soldiers.”

When it becomes apparent a wounded soldier won’t be able to return to active duty, a medical board made up of Army physicians reviews the case. The medical board review can’t be completed until it’s decided the wounded soldier has received “optimal medical care,” said Gilman. And that’s the tricky part.

“It can be very subjective,” Gilman said, adding the medical boards have some flexibility. “We don’t just follow the regulations blindly. It’s not a one-way street.”

The findings of a medical board are turned over to a Physical Evaluation Board, part of the Army’s Human Resources Command, which ultimately decides whether a soldier stays on active duty or is discharged, and what percentage of disability a soldier receives.

Some 11,300 U.S. military personnel have been evacuated due to injuries or illness since hostilities began in Afghanistan and Iraq in October 2001. Of those, 740 had been discharged as of last week, according to the Army.

Medical advances help reduce the number of deaths in wars. With more soldiers surviving near-fatal wounds, hospitals are overburdened.

Gilman said Walter Reed, where many of the wounded are initially treated when they return to the United States, has been swamped at times.

“The installation was not built to handle all the outpatients we have now,” Gilman said.

A hotel on the hospital grounds for soldiers receiving outpatient care and their families is mostly full. Some outpatients are housed at nearby hotels or government-leased apartments.

Other Army medical facilities also feel the strain, including those in the South Sound.

Barracks at Fort Lewis have been upgraded to include, among other things, wheelchair-accessible quarters to house wounded soldiers treated as outpatients at Madigan Army Hospital, the General Accountability Office told Congress earlier this year.

Veterans organizations say they are aware that the military medical system is stretched.

“It’s obvious when you go to Walter Reed,” said Cathy Wiblemo, the American Legion’s deputy director for health care. “They are running out of room.”

Wiblemo said she has no specific knowledge that the Army has moved to discharge wounded soldiers too quickly. But she said she wouldn’t be surprised.

“The Army’s medical bills are going up, and it’s encroaching on other things they have to pay for,” she said.

Murray: Dunn’s case ‘one of many’

Dunn, Fernandez and Clements have been discharged and are being treated at VA facilities or through the military’s Tri-Care System, a health plan that covers military personnel, dependents and retirees.

Murray, who has taken a personal interest in Dunn’s case and awarded him his Purple Heart in June, said she has talked with soldiers who feel the Army has tried to “push them out.”

“Rory Dunn is just one of many,” Murray said. “It strikes me as amazing that Rory needs an advocate in the U.S. Senate. He shouldn’t have to go through this.”

As Dunn’s physical scars fade, the emotional ones linger, as do the memories of that day outside Fallujah a year ago.

“It got me, boy did it get me,” Dunn said of the explosion. “The last thing I remember was stumbling around shouting, ‘Charge, charge,’ and my buddies trying to get me to sit down.”

Though his forehead has been rebuilt, Dunn covers it with a purple baseball cap that says “Combat Wounded” and has the symbol of a purple heart. With thick glasses, he can see out of his left eye. With hearing aides, he can hear.

Lefever said she was surprised when her son joined the Army about a year after high school. She remembers him as a good student who played football and basketball. She said he also had a rebellious streak and was sort of a “cowboy.”

Dunn just shrugs when asked why he joined and later volunteered for duty in Iraq.

“It was a terrible, terrible mistake,” he said. “I was a fool.”

Dunn fidgets as he talks. His attention span is short. He ducks out for a cigarette and to play with his dog Duke, a 6-month-old German shorthair. His memory is intact, as is his sense of humor. He remembers the name of the girl he took to the senior prom. He’s looking forward to getting his own apartment and a driver’s license.

He’s also angry and impatient.

“I feel better, but I wish I could get on with my life,” he said. “I lived in hospitals and rehab for a year. It was the worst thing I ever had to go through.”

Lefever said she refused to give up until her son received the care that she says Army regulations require.

“I remain angry and disgusted with them for certain things, but I am eternally grateful to them for other things,” she said.

Col. Gilman of Walter Reed said he remembers spending a lot of time with Lefever and her son.

“We are grateful for the families who are interested. The mothers, fathers, brothers and sisters,” he said. “The ones who worry me the most are the ones whose families aren’t involved.”

By Mark Benjamin
Mar 2, 2007, 15:48

They’re overmedicated, forced to talk about their mothers instead of Iraq, and have to fight for disability pay. Traumatized combat vets say the Army is failing them, and after a year following more than a dozen soldiers at Walter Reed Hospital, I believe them.

February 18, 2005 | Before he hanged himself with his bathrobe sash in the psychiatric ward at Walter Reed Army Medical Center, Spc. Alexis Soto-Ramirez complained to friends about his medical treatment. Soto-Ramirez, 43, had been flown out of Iraq five months before then because of chronic back pain that became excruciating during the war. But doctors were really worried about his mind. They thought he suffered from post-traumatic stress disorder after serving with the 544th Military Police Company, a unit of the Puerto Rico National Guard, the kind of unit that saw dirty, face-to-face combat in Iraq.

A copy of Soto-Ramirez’s medical records, reviewed by Salon, show that a doctor who treated him in Puerto Rico upon his return from Iraq believed his mental problems were probably caused by the war and that his future was in the Army’s hands. “Clearly, the psychiatric symptoms are combat related,” a clinical psychologist at Roosevelt Roads Naval Hospital wrote on Nov. 24, 2003. The entry says, “Outcome will depend on adequacy and appropriateness of treatment.” Doctors in Puerto Rico sent Soto-Ramirez to Walter Reed in Washington, D.C., to get the best care the Army had to offer. There, he was put in Ward 54, Walter Reed’s “lockdown,” or inpatient psychiatric ward, where the most troubled patients are supposed to have constant supervision.

But less than a month after leaving Puerto Rico, on Jan. 12, 2004, Soto-Ramirez was found dead, hanging in Ward 54. Army buddies who visited him in the days before his death said Soto-Ramirez was increasingly angry and despondent. “He was real upset with the treatment he was getting,” said René Negron, a former Walter Reed psychiatric patient and a friend of Soto-Ramirez’s. “He said: ‘These people are giving me the runaround … These people think I’m crazy, and I’m not crazy, Negron. I’m getting more crazy being up here.’

“Those people in Ward 54 were responsible for him. Their responsibility was to have a 24-hour watch on him,” Negron said in a telephone interview from his home in Puerto Rico. While Soto-Ramirez’s death was by his own hand, Negron and other soldiers say the hospital shares the blame.

In fact, repeated interviews over the course of one year with 14 soldiers who have been treated in Walter Reed’s inpatient and outpatient psychiatric wards, and a review of medical records and Army documents, suggest that the Army’s top hospital is failing to properly care for many soldiers traumatized by the Iraq war. As the Soto-Ramirez case suggests, inadequate suicide watch is one concern. But the problems run deeper. Psychiatric techniques employed at Walter Reed appear outmoded and ineffective compared with state-of-the-art care as described by civilian doctors. For example, Walter Reed favors group therapy over one-on-one counseling; and the group therapy is mostly administered by a rotating cast of medical students and residents, not full-fledged doctors or veterans. The troops also complain that the Army relies too much on pills; few of the soldiers took all the medication given to them by the hospital.

Perhaps most troubling, the Army seems bent on denying that the stress of war has caused the soldiers’ mental trauma in the first place. e Army to pay disability for years.) Soto-Ramirez’s medical records reveal the economical mindset of an Army doctor who evaluated him. “Adequate care and treatment may prevent a claim against the government for PTSD,” wrote a psychologist in Puerto Rico before sending him to Walter Reed.

“The Army does not want to get into the mental-health game in a real way to really help people,” said Col. Travis Beeson, who was flown to Walter Reed for psychiatric help during a second tour with one of the Army’s special operations units in Iraq. “They want to Band-Aid it. They want you out of there as fast as possible, and they don’t want to pay for it.” Indeed, some psychiatric patients at Walter Reed are given the option of signing a form releasing them from the hospital as long as they give up any future disability payments from the Army. One soldier from Pennsylvania, who was shot five times in the chest and saved by body armor, told me he would do anything to get out of Walter Reed, even relinquish disability pay. “I’ll sign anything as soon as I can get my hands on it,” he told me several days before being released from the hospital. “I loved the Army. I was obsessed with it. The Army was my life. Fuck them now.”

The conditions for traumatized vets at the Army’s flagship hospital are particularly disturbing because Walter Reed is supposed to be the best. But leading veterans’ advocate and retired Army ranger Steve Robinson, executive director of the National Gulf War Resource Center, agrees that when it comes to psychiatric care, Walter Reed doesn’t make the grade. “I think that Walter Reed is doing a great job of taking care of those suffering acute battlefield injuries — the amputees, the burn victims, and those hurt by bullets and bombs,” said Robinson, who has spent many hours visiting psychiatric patients at Walter Reed. “But they are failing the psychological needs of the returning veterans.”

Walter Reed officials declined requests for interviews, although two spoke to me on the condition of anonymity. In written statements to Salon, Walter Reed said the mental and physical health of patients is the hospital’s top priority and described its PTSD treatment regimen as being in line with modern medical standards. The hospital said patients see both “board certified” and “board eligible” psychiatrists, including medical students and residents who “participate in the clinical activities on the ward as part of their training, and as is appropriate for their level of training and needs of the soldiers.”

The hospital also cited a recent survey in which 42 out of 45 psychiatric inpatients surveyed, or 94 percent, felt that their care was either outstanding or good. “We are satisfied that there is a very high level of patient satisfaction with their treatment,” the statement read. The hospital gave few details about the inpatient survey, such as whether it was anonymous, or whether the patients surveyed were even soldiers who recently fought in Iraq. (Inpatients can include military dependents or soldiers who fought in wars decades ago.)

The high level of satisfaction among inpatients as reported by Walter Reed is completely opposite what I saw and heard while tracking soldiers there over the last year. The soldiers I interviewed invited me to their bedsides in the lockdown ward. They handed over their private medical records. They allowed me to call their buddies, their girlfriends, their mothers. All professed to loving the Army, though some said their trust in the institution had been irrevocably shattered. All said their symptoms either stayed the same or worsened while at Walter Reed; two said they made suicide attempts. While it’s true that patients’ self-reports about treatment are not always objectively based, the repeated, bitter complaints I heard over the course of more than a year, in combination with conversations with civilian experts, cast serious doubts on Walter Reed’s approach to treating PTSD sufferers. It all convinced me that something is seriously amiss at the Army’s top hospital.

“They asked me if I missed my wife. Well, shit yeah, I missed my wife. That is not the fucking problem here”

Politicians and celebrities — like Dale Earnhardt Jr., ZZ Top and President Bush — routinely visit the wounded at Walter Reed; but dignitaries don’t come to Ward 54. When I first visited the lockdown unit in February 2004, it held around 35 patients, who slept as many as six patients to a room. Most patients stay in lockdown for just a few days, then are moved to rooms in hotel-like facilities to get treatment at the Walter Reed outpatient clinic, known as Ward 53. Within the lockdown unit, doors were kept open so that the patients who padded around the linoleum floors in Army-issued slippers, pajamas and robes could be observed at all times. Patients in various states of consciousness, from alert to near catatonic, sat around a television in a communal room. Some wore bandages from what other soldiers said were self-inflicted wounds. Patients were not allowed near the twin electric doors to Ward 54; these open by a buzzer from the nurses’ station, staffed 24 hours a day.

Soldiers who have stayed in the lockdown unit say they were heavily medicated the entire time. Some remember hearing screaming, or patients being subdued on stretchers after shock therapy. “Inpatient can be a traumatic experience for anyone,” said Lt. Jullian P. Goodrum, 34, who was in Ward 54 last February after serving in Iraq. Records show Goodrum was held in the ward 13 days longer than needed while the Army decided whether to charge him as absent without leave when, after getting back from Iraq, he was earlier hospitalized by a civilian psychiatrist. He is fighting those charges.

The soldiers told me about their textbook symptoms of PTSD: sudden, ferocious bouts of rage, utter detachment, anxiety attacks accompanied by shortness of breath, and increased perspiration and rapid eye movement. They complained of relentless insomnia, racing thoughts, self-loathing, blackouts, hallucinations and the constant reliving of war through flashbacks by day and nightmares at night. Some described vivid fantasies of violence toward the Army brass in charge of patients there — slicing their throats, throwing them out windows or shooting them. One psychiatric outpatient, who watched as his best friend was blown up by a roadside bomb in Iraq, said: “It does not matter how hardcore you are. Once you go to that war and you start to see dead bodies — you see an arm over here, you see guts over there. There is no way you are ever going to erase that.”

When it is done right, PTSD treatment is a delicate task. Trust is crucial, and medications are carefully administered and monitored. Most critical is getting patients to control the powerful and destructive emotions that can follow a traumatic event like fighting a war. What bewildered the soldiers at Walter Reed, though, was that the Army seemed determined to downplay their war trauma and search for other causes for their mental health problems. In group therapy, sessions often focused more on family relationships and childhood experiences than war, the soldiers said. One outpatient soldier was so angered about this avoidance of the topic of war, he threw a chair during group therapy. Doctors promptly sent him to lockdown.

“When you get [to Walter Reed], they analyze you, break you down, and try to find anything wrong with you before you got in” the Army, said Spc. Josh Sanders, in a telephone conversation from his home in Lovington, Ill. “They started asking me questions about my mom and my dad getting divorced. That was the last thing on my mind when I’m thinking about people getting fragged and burned bodies being pulled out of vehicles,” said Sanders. “They asked me if I missed my wife. Well, shit yeah, I missed my wife. That is not the fucking problem here. Did you ever put your foot through a 5-year-old’s skull?”

Sanders, 25, served in Iraq with the 1st Brigade, 1st Armored Division, from May until December 2003. I met him in the summer of 2004 while he was getting treatment at Walter Reed in the outpatient clinic. Sanders had been evacuated from Baghdad because of the toll the war had taken on his mind. His complaints about Walter Reed were sadly typical. “Nobody hears about this. Nobody hears about what really happens when you are there getting the ‘premier’ medical treatment,” Sanders said.

Dr. Herbert Hendin, medical director of the American Foundation for Suicide Prevention spent many years studying and treating veterans with PTSD after the Vietnam War. In discussing their treatment, Hendin said, “What veterans need is not simply to be able to talk about their combat experiences but to be able to talk about them with someone who understands the context.” Hendin said a combat veteran “needs to feel an empathic connection with the treating professional.” But to the soldiers, the atmosphere in the Walter Reed psychiatric units wasn’t conducive to feeling understood, or getting better.

In Ward 54, recent combat veterans are mixed with other soldiers and even civilians suffering a wide range of mental problems. For them, coming back from Iraq and being treated alongside soldiers with schizophrenia, for example, or maybe even soldiers’ dependents with schizophrenia, makes them feel “crazy,” as opposed to having a natural reaction to combat stress. “If you are a hard-charging person, or somebody who tries to do things right, you are already taking a huge hit to your ego by being put in there,” Beeson, the Army colonel, told me. One of the two Walter Reed officials who spoke on condition of anonymity agreed that recent combat vets shouldn’t be lumped in with other psychiatric patients. Those soldiers “need to have a specialized unit,” the official said. “They are labeled goofy and crazy, and they are not crazy.”

Beeson served in Iraq with the Army’s Civil Affairs Command, part of the Army’s special-operations units. He is a 47-year-old reservist with 26 years of service under his belt, a wiry man grizzled by war. Beeson says his PTSD manifested during his second tour in Iraq. He was flown to Walter Reed. When I first met him in August 2004, heavy medication made him speak in slow, halting sentences like a drunk with a stutter. “A lot of the therapy was counterproductive to me,” Beeson said in a telephone interview from his home in Arkansas, after getting out of Walter Reed. “It was a very paranoia-inducing place. If I was not paranoid when I got there, I was paranoid when I left … To me, they need to figure out if they are going to treat people for war or be a regular hospital.”

A dead soldier hangs in his room for four days, and Walter Reed starts checking for no-show patients

Josh Sanders, like the other soldiers I spent time with, also believes he is worse off because of his treatment at Walter Reed. “I don’t trust anybody now … I wish people could understand,” he said. Sanders made two suicide attempts while under outpatient care at Ward 53. Hospital officials would not answer questions about the prevalence of suicide attempts at Walter Reed, but said two incidents that occurred there in January, one apparent fatal overdose and another suicide attempt, are under investigation. Two years ago, the case of Army Master Sgt. James Curtis Coons, also an outpatient, raised serious questions about how Walter Reed handles suicidal patients — questions that persist today.

Coons was evacuated to Walter Reed from Kuwait on June 29, 2003, after swallowing sleeping pills in an apparent suicide attempt several days earlier. When he arrived at Walter Reed, he wasn’t sent to the lockdown unit but to a room in one of the hotel-like facilities on campus. Coons, 36, promptly hanged himself. And although he had a doctor’s appointment the next day, Walter Reed officials failed to look for Coons until July 4, so his body hung and decomposed until then. “A soldier coming in from a war zone does not show up for a doctor’s appointment and they did not even check on him?” his mother, Carol Coons, said in a telephone interview from her home in Texas. “Until this is taken seriously, this is going to continue on. A psychiatric problem among those coming home from these war zones is just as deadly as a bullet.” In a statement, the hospital said it has recently “enacted more stringent policies and procedures to strengthen outpatient soldier accountability”; for example, a Walter Reed staff member is now sent to check on patients who don’t show up for appointments, the hospital said.

It’s unclear how many combat vets are in need of PTSD treatment. But data from the Department of Veterans Affairs and a published Army study show at least one out of every six soldiers coming back from Iraq may have PTSD. (Many Army bases have psychiatric clinics, but some of the most serious cases go to Walter Reed.) Congress is responding with a flurry of bills that might help keep track of and treat the mental toll Operation Iraqi Freedom is taking on U.S. troops. Illinois Democrat Rep. Lane Evans’ bill calls on the military to use state-of-the-art methods to treat psychological injuries. Sen. Russ Feingold, D-Wis., would require the Pentagon to send reports to Congress on PTSD among troops because there is so little information on psychological injury rates.

Normally, soldiers discharged from the Army seek medical treatment from the Department of Veterans Affairs, which is widely understood to do a superior job at treating soldiers with PTSD. Because of the V.A.’s good track record, Steve Robinson of the National Gulf War Resource Center is asking Congress to put the V.A. in charge of treating soldiers with PTSD even before they leave the Army. Four of the soldiers I interviewed who left Walter Reed and later got treatment at the V.A. all praised the care they received there. They finally got a chance to talk one-on-one with other veterans about war, they said. Their medications were pared down, and their disability pay has been increased.

Indeed, the Army’s system for allocating disability pay to traumatized vets is another source of their frustration and anger. An Army panel at Walter Reed, called the Physical Evaluation Board, decides what percentage of income each soldier should get from the military to compensate him if he is too ill to serve any longer. The doctors decide whether wounds are combat related, and then the board decides how much disability the Army will pay. The board’s decision is critical for soldiers trying to make a living after leaving the Army with what can be a debilitating mental condition. Fighting with the hospital about disability pay is a source of considerable stress just as these soldiers are trying to heal their minds.

Some of the soldiers are fighting decisions by the board at Walter Reed. Out of the 14 soldiers interviewed, five have left Walter Reed. Three ended up getting zero percent of their income as disability pay, despite what they said was serious mental stress that made it more difficult or impossible to work. Even those who got a third of their pay still had trouble making ends meet. (In every case I followed, the Department of Veterans Affairs made a later determination that the soldiers deserved more. The soldiers can choose to take the higher percentage of pay from the V.A., but in some cases if they do so, they must pay back what they have received so far from the Army.)

After 26 years of service, the Army gave Col. Beeson, from the Army’s Civil Affairs Command, zero percent of his income as disability pay for his mental wounds. Luckily, he still gets some retirement pay because of his many years of service, but he says he struggles with his injuries every day. He is appealing Walter Reed’s decision.

Josh Sanders, from the 1st Armored Division, got 30 percent from the Army, but the Army also said his problems did not come from the war. “When I was over there [at Walter Reed] the PEB [Physical Evaluation Board] process was degrading. It is like pulling money from an insurance company. All my paperwork says ‘non-service connected.’ If it is non-service connected, then why am I getting 30 percent?” he asked. The V.A. recently decided to give him 70 percent disability.

One Army reservist I spent time with tried to return to his day job as a policeman after the war, but his mental state prohibited him from carrying a gun The reservist cannot go back to policing, but since the Army decided his mental problems did not come from the war, the small percentage of disability pay he got is not enough to make ends meet, he said. He’s hoping the V.A. will give him more.

René Negron, the former soldier who visited Soto-Ramirez before the suicide, was given 30 percent of his pay until February 2006, when he’ll be reevaluated. Negron was a psychiatric patient at Walter Reed after 11 months in Iraq. At one point he checked himself into the emergency room there because he thought he might kill himself. But the Physical Evaluation Board determined that “the soldier’s retirement is not based on disability from injury or disease received in the line of duty,” according to a copy of Negron’s evaluation board proceedings. “This disability did not result from a combat-related injury.”

Negron, 48, taught hair care and cosmetology before serving in Iraq as an Army specialist with the Puerto Rico National Guard. Now, he says his debilitated mental state after the war has left him unable to work. He drives two hours each way for mental health treatment at a V.A. medical center. “You think I can live on $700 a month?” Negron asked. “I can’t work. My wife is suffering. She can’t leave me alone. Sometimes I feel suicidal. Sometimes I hear voices. Sometimes I see lights. I feel like I’m being shot at. They sent me home like that. I’ve been dealing with this since I got back,” Negron said. “I left here in good condition. If I have a mental condition, they have to deal with it … I did my part. Why can’t they do their part?”

Doctors, social workers here join VA’s drive for awareness

By BILL GLAUBER
bglauber@journalsentinel.com

They survived bombs and bullets on the battlefield. But for a small number of America’s war veterans, there is one more lethal obstacle to face after returning home – suicide.

“About 50 times a day we hear from some practitioners that a veteran is thinking about killing themselves,” Richard Gibson, manager of the mental health division at Milwaukee’s Zablocki VA Medical Center, said Thursday.

Gibson was among the featured local speakers at the hospital in the first Suicide Prevention Awareness Day sponsored by the Department of Veterans Affairs.

Once a taboo subject, suicide has come out into the open as thousands of veterans return from combat in Iraq and Afghanistan. Some of the veterans of conflicts stretching back to World War II bear the mental scars of war, including post-traumatic stress disorder. And, as Gibson noted, some can have suicidal thoughts.

Overall in the U.S., nearly one out of four people who commit suicide are veterans, Jim Benson, national VA spokesman, said during a closed-circuit broadcast.

The VA is trying to come to grips with the problem, especially after several highly publicized suicides involving returning veterans. In March 2006, a Milwaukee police officer and Iraq war veteran used his police gun to commit suicide in the basement of his home.

The officer’s death prompted the local VA to establish a suicide prevention committee headed by Michelle Cornette. A suicide coordinator will soon be hired, and an electronic suicide reporting system is expected to be implemented, Cornette said.

What should the general public know about the issue?

“That a veteran status is a risk factor for suicide,” Cornette said. “Minimize the alcohol or drugs. Watch out for social isolation, not enjoying things as much as they used to and feeling ineffective. If someone has a prior (suicide) attempt history, that’s important, too.”

Local VA officials said there is not enough information to determine if the newest veterans face greater risks for suicide. But they’re not taking chances.

“We do feel we need to step up our work in this area and deal with it right away,” said Bertrand Berger, program manager of the acute mental health unit at the Zablocki VA Medical Center.

Berger said VA officials are trying to spread the message to the wider public, especially because most veterans receive medical treatment outside the VA system. He said if friends or relatives notice a “combat veteran is having difficulty,” the vet should be referred to the VA.

Charles Wolden, a team leader for the Milwaukee Vet Center, a community-based outreach center for combat vets, said people shouldn’t be afraid “to reach out, better safe than sorry.”

“I know of at least two interventions (to prevent suicide) we’ve made recently,” Wolden said.

Jean Bromley, a social work consultant at the Zablocki VA, stressed the importance of “creating a community” when a veteran from the Iraq or Afghanistan war “walks in the door” of a VA hospital.

“We have seen more than 2,300 service members since this conflict began,” she said.

By Andrea Stone, USA TODAY
SAN JUAN CAPISTRANO, Calif. – Twilight fell over the mountain camp as the group formed a circle to trade war stories: the nightmares of battle that wake them in their sleep. The fighting. The pain. The surgeries. And always, the sudden mood swings.

“Sometimes, we feel like we have to run away,” Alex Cox says.

“The military’s stupid!” Adam Briggs declares.

Alex, 13, and Adam, 12, have never been to war, but they are no strangers to the ravages it can inflict. Their fathers were injured in Iraq. Like 13 other boys and girls ages 7 to 14 at an unusual summer camp this week for children of injured troops, they are in a generation indelibly marked by war.

Nearly 19,000 U.S. children have had a parent injured in the military since Sept. 11, 2001, the Pentagon says. They are lucky compared with the 2,200 kids whose parents have been killed in Afghanistan or Iraq. But as the U.S. approaches its sixth year at war, the impact of battlefield injuries and frequent deployments on troops’ families – not just the troops themselves – is increasingly clear.

“Wounded servicemembers have wounded family members,” says Michelle Joyner of the National Military Family Association (NMFA), which runs the camp.

In some ways, the camp in the Cleveland National Forest – which includes 61 other kids whose parents are serving in the war – was like any summer camp: a place for kids to be kids. After arriving Saturday, the campers went swimming, climbed trees, rode horses, sang silly campfire songs and ate parflesnarfs, a gooey concoction of melted chocolate, marshmallows and popcorn.

But at this camp, there were shades of the military lifestyle. Cabin groups were named like military companies: Alpha, Bravo, Charley. On Monday, the kids went to a beach luau at nearby Camp Pendleton, where Marines let them climb into amphibious landing crafts and handle machine guns.

And each day, there was “quiet time,” a chance to sit and talk about the problems each child is here to escape.

Unlike at school or at home, “kids don’t have to explain themselves,” says Joyner, whose group received permission from the children’s parents for them to speak with a reporter. “They’re with a group of their peers.”

Camper Savannah Jacobs, 11, came to camp from the Marine base at Twentynine Palms, Calif. She says she is “sad” that her stepfather, Marine Sgt. Jose Ramirez, hasn’t been able to ride a bicycle with her and her sister, Sierra, 9, since he was injured in a helicopter crash in Iraq last December.

However, Savannah says, talking with other campers about “stuff that happened to their dad makes me feel like I’m not alone, and the only one who’s suffering.”

Such sentiments come pouring out again and again: the war, through the eyes of children.

To a young child whose father loses an arm in combat, that means no more playing catch or tummy tickling, says Kent Deutsch, a Marine veteran who is a family therapist and one of three counselors at the camp. Deutsch says that when parents return from war injured or having “seen and done things that go against their inner being, the child gets a parent back who wasn’t the parent who went away.”

At a time when the Pentagon says as many as one in five returning servicemembers suffer from post-traumatic stress disorder (PTSD) or other psychological problems, many of their children are struggling to grasp what happened to make their parent so different.

“What about the traumatic brain injury where before, daddy was really smart but now the 12-year-old has more intellectual functioning than dad?” says Kuuipo Ordway, a mental health therapist who works with military kids here. “How do you adjust to that? What’s the long-term effect on a child?”

Children of servicemembers who have lost limbs, spent months in rehab and undergone repeated surgeries are prone to depression and feelings of being overwhelmed, Ordway says. “They’ve become caretakers. Before, they were the ones being taken care of.”

Camper Chessa Lara, 14, says she “wasn’t a nurse – technically” for her father, “but I was always there to make sure he was OK.”

Army 1st Sgt. Peter Lara was shot in the jaw and shoulder in Iraq in 2005 and has undergone “a lot” of surgeries since then, Chessa says. He also suffers from PTSD.

Chessa, her sister Tauntiana, 13, and brother Julien, 11, arrived at camp in an RV with their parents and five dogs after a two-week drive from Fairbanks, Alaska. When camp ends today they’ll move on – as so many other military families do each summer – to their next deployment, at Fort Jackson, S.C.

The constant moves have been hard on the family, but the children say their father’s injury may have been harder. “Sometimes when he’s in pain, he cries and stuff,” Julien says through watery eyes.

Chessa says her father sobs for a buddy who died in the firefight in which he was wounded.

“I wasn’t used to seeing him cry because he’s a man. He always said dads shouldn’t cry,” says Chessa, struggling to hold back tears.

Still, she sees a silver lining.

“Now that he got injured, he says since God gave him a second chance, he wants to spend more time with us. He says he doesn’t want to lose us,” Chessa says, adding that her father’s ordeal has made her “more responsible.”

Program may expand next year

The camp for children of injured servicemembers is a pilot program that is part of the NMFA’s network of camps for military kids. The group hopes to expand it next summer.

Dubbed Operation Purple – militaryspeak referring to all branches of the armed forces – the camps will host nearly 4,000 children of servicemembers at 34 sites in 26 states this summer. Camp is free, supported by private groups, including the Sierra Club and the Michael & Susan Dell Foundation.

Little research has been done on kids of injured servicemembers, Ordway says, adding that “we’ve got to figure out their needs.”

Many military children have “anger issues” and stress over being separated from their parents, says camp director Gene Joiner, who has run Operation Purple camps in North Carolina since the program began in 2004. But the ones whose parents were hurt have additional pressures.

“The ‘wounded children,’ you can tell there’s something more,” Joiner says. “There’s a gap with these kids on how to relate to each other. They stand off a little bit more.”

Jennifer Allman of Spring Valley, Calif., says she has seen that in her children since their father, Army National Guard Staff Sgt. Corby Allman, suffered back injuries, partial vision and hearing loss and PTSD after his convoy was hit by an “improvised explosive device,” or IED, in Iraq in 2004.

Brandon Allman, 12, is “distant,” his mother says. Jacquelyn, 10, is angry and blames herself for her father’s disability. At 7, Cheyanne appears, at least for now, just happy to have her daddy home.

“It’s hard because they don’t understand why he gets upset really quick with them or why he can literally forget a whole conversation in two minutes,” Jennifer Allman says. “I wanted them to come to camp to be with other military kids, to get counseling and to know that they are not alone.”

Brandon says his father’s injuries mean “he has to relax all the time” and can’t go out to play. Brandon says he now fixes his sisters’ bicycles and reads the numbers off a credit card when his father uses it to buy things by phone, because his dad no longer can see the numbers.

Jacquelyn, who like Cheyanne came to camp with pink streaks in her hair, says their dad “gets stressed out more and gets headaches.” She says when her brother gets frustrated with his father’s condition, he yells a lot and sometimes locks himself in his room.

“There’s usually a lot of crying by family members.”

Children mimic parents

Patients with PTSD tend to be “hypervigilant, irritable and always looking for danger,” Ordway says. She says initial studies of their children show that many “model” their behavior after their parent’s and become more anxious, more depressed and less able to sleep. That can lead to shorter attention spans and behavior problems.

For some veterans who saw Iraqi or Afghan children die, it often is difficult to come home and face their young relatives.

“When he came back, he didn’t seem right,” camper Andrew Steinhoff, 12, says of his brother, Army Spec. Ryan Hice, 19, who returned to Fayetteville, N.C., from Afghanistan in April suffering from seizures that his mother, Therese, says are caused by anxiety.

“His attitude changed a lot,” Andrew says. “His whole personality is just different.”

Most painful of all, Andrew says, the big brother with whom he used to hang out now can be reluctant to be with him.

Andrew says their mother told him that “there was this kid who reminded (Ryan) of me, who died” in Afghanistan. Now, when Andrew tries to talk to Ryan, “He says, ‘Not right now, Bug,’ ” says Andrew, using his brother’s nickname for him.

In an interview, Ryan Hice says he has been diagnosed with PTSD, traumatic brain injury and seizures caused by anxiety. He says little about his time in Afghanistan but does allow that “they say you have a twin everywhere. Well, my brother had one over there.” Hice says that when he first returned home, “I wasn’t even able to look at my brother because of stuff that happened over in Afghanistan. … It’s a work in progress. I’m now able to be in the same room with him, so that’s a beginning.”

Hice adds that “I know it’s been hard” on his little brother. He hopes Andrew made friends at camp and that “maybe they can somewhat explain to him not to take it personal.”

Therese Steinhoff says her younger son has become withdrawn and feels guilty.

“He thought he did something wrong, and he didn’t,” she says. She sent Andrew to camp because “he needs to be around others who are affected by this war.”

Every kid at the camp has a military connection, but “the wounded kids don’t want to talk about the military that much,” says Katherine Joiner, 18, a counselor here.

Ordway says that as more camps for children of injured servicemembers are opened, they are likely to emphasize small group discussions to encourage kids to express their feelings.

At this camp, Alex Cox didn’t need much encouragement to speak his mind.

One of five children of Navy hospital corpsman Robert Cox from nearby Oceanside – Alex’s sister Holly, 11, and brother Nick, 14, also came to camp – Alex talked angrily about his dad’s seven deployments and problems since his shoulder was torn up in a mortar attack in Iraq in 2004.

When Ordway asked what the children would want to tell their parents, Alex yelled, “Get over it, man!”

Alex’s mother, Monica, herself a Navy veteran, says her children have suffered from “bad grades to stomach issues to anxiety and depression” because of their father’s deployments and injury.

She says Holly has become “clingy,” and Alex was suspended from school for hitting another student. Their father says Alex and Nick argue all the time.

“I’ve seen my share” of combat, says Robert Cox. But when it comes to his children, “It just tears you up. It’s a tough deal for them.”

After fighting in Iraq, some end up on streets

Jonathan Curiel, Chronicle Staff Writer
Sunday, April 15, 2007

Three years ago, when he returned from Iraq and a stint in the U.S. Army, Herold Noel thought he’d be treated as a hero. Instead, he faced a series of degradations, including learning he was ineligible for public-housing assistance.

That’s when Noel went back to the red Jeep that had become his home at night. That’s when Noel — fueled by alcohol — took out a gun. That’s when Noel fired the bullet intended to pierce his skull and kill himself instantly.

Noel misfired, then passed out. When he woke up, he realized what had happened.

“I was fed up with this situation,” he says now, speaking on the phone from New York about the housing setbacks, job rejections and other stresses that pushed him to attempt suicide. “I just felt like I’d rather die on my feet than on my knees. This country was putting me on my knees. I said I’d rather die with a little bit of pride, because they stripped me away from all that.”

Homelessness was a central factor in Noel’s desperation, just as it is for many veterans returning to cities and towns all across the United States from the conflicts in Iraq and Afghanistan.

On any given night, an estimated 100 to 300 vets who were part of Operation Iraqi Freedom or Operation Enduring Freedom (the government’s name for its Afghanistan campaign) live in transient conditions, according to organizations that help homeless ex-GIs. These men and women who once proudly represented the U.S. military now live on the street, in shelters, in their cars, with their friends — anywhere they can unload their belongings for a night or two or longer. The number may seem low, but homeless advocates worry that these wars will eventually produce tens of thousands of homeless vets, as the Vietnam War did.

Brian Dadds, a Navy veteran whose ship monitored missile strikes on Iraq in the war’s first months, now bides his time in San Francisco, where he has slept everywhere from Ocean Beach to a city-run homeless shelter. His hair much longer than in his military days, Dadds, 24, says he’ll often just “walk around town” before deciding on a place to sleep.

Swords to Ploughshares, the San Francisco organization that helps former military personnel who are homeless, has seen more than 20 Iraq War veterans. Vietnam Veterans of California, which has temporary housing sites throughout Northern California, says it has assisted more than 60 veterans of Operation Iraqi Freedom and Operation Enduring Freedom who were in need of permanent housing.

Historians often compare the Iraq war to Vietnam in terms of scope, casualties and military aims gone awry, but for homeless advocates, there’s a disturbing difference between the conflicts: The Vietnam War, which lasted more than a decade, produced a steady stream of homeless vets in the years after hostilities ended; the Iraq and Afghanistan campaigns, which are less than 6 years old, have resulted in homeless vets while hostilities are still going on.

Many of those who join today’s volunteer army, like Noel, come from economically depressed backgrounds, say homeless advocates, and when they return home, they face the same financial vulnerabilities they had before, but now they might suffer from post-traumatic stress disorder (Noel has been diagnosed with it) and might rely on alcohol or other drugs to cope with their traumas. They may also be reluctant to admit their problems to the Department of Veterans Affairs or the many nongovernmental organizations that help homeless veterans.

“What happens sometimes is that young men and women come home from Iraq and Afghanistan, and they think everything is going to be cool and that life is going to begin again,” says Cheryl Beversdorf, president of the National Coalition for Homeless Veterans in Washington. “But then things start occurring, like they begin recognizing symptoms of PTSD or depression or whatever, and some people say, ‘I’m not going to the VA — that’s where my dad went.’ Or they say, ‘There’s nothing wrong with me.’ Or they don’t know about community-based organizations (that help homeless vets).”

About 200,000 veterans are homeless in the United States, according to estimates by the Department of Veterans Affairs, with about 80,000 having been in Vietnam. About 2.8 million Americans served in Vietnam. So far 1.5 million U.S. troops have been deployed to Iraq and Afghanistan.

Judging by experience, tens of thousands of Americans who went to Iraq and Afghanistan will eventually become homeless — a number that Veterans Affairs is woefully unprepared for, says Paul Rieckhoff, a former Army lieutenant who fought in Iraq in 2003 and 2004 and now heads a group called Iraq and Afghanistan Veterans of America, which lobbies on behalf of homeless vets.

“History is repeating itself,” Rieckhoff says. “Systemwide, there’s not an adequate plan in place to deal with homelessness. … It starts with a lack of adequate transitional resources and capacity, but there’s also a lack of beds, a lack of outreach, a lack of good data. One of my biggest criticisms of the VA is that they don’t have an accurate tracking mechanism. If you ask the secretary of the VA how many people are homeless, he won’t be able to tell you adequately. He can’t even tell you how many people are dead, because there is no registry. That’s one of the legislative initiatives that we’ve been pushing for — a Department of Defense registry that tracks everyone from the moment they get home.”

After the Vietnam War, the Department of Veterans Affairs did establish homeless outreach programs around the country. VA medical centers, such as the one in San Francisco’s outer Richmond District, have coordinators who specialize in homeless services. The VA has a national director of homeless programs and a multimillion-dollar budget that, among other things, pays for temporary housing. But the staggering number of Vietnam vets still on the streets 30 years after the war ended reveals the extent of the problem, including the VA’s role, say homeless advocates.

Upon returning to the United States, veterans must register with a system already backlogged with 400,000 applications for disability benefits, a bottleneck that puts veterans at risk of homelessness, warns Linda Bilmes, a Harvard lecturer in Public Policy who is the author of a paper published in January, “Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of Providing Veterans Medical Care and Disability Benefits.”

During the long wait for their first disability check — six months or longer — “veterans, particularly those in a state of mental distress, are most at risk for serious problems, including suicide, falling into substance abuse, divorce, losing their job, or becoming homeless,” Bilmes warns in her report.

Noel was one of those vets forced to wait six months for his first disability check. At one point, he stayed in a homeless shelter in the Bronx, where he says someone stole his Iraq War medals and photos. Noel would sometimes sleep on the roof of a building. His nightmares followed him wherever he went.

During his seven months in Iraq in 2003 and 2004, Noel delivered fuel for tanks and other military vehicles. His tanker was shelled by militants, and every time he took to Iraq’s roadways, Noel feared he would be killed. During his deliveries, he carried an M16 that he fired at people he believed were trying to harm him. In other interviews he’s given after his appearance in the 2005 documentary “When I Came Home” (which is about homeless veterans), Noel has implied that he had killed eight Iraqis. He says he witnessed the deaths or dead bodies of many other people.

After Iraq, Noel’s marriage collapsed in divorce. Two of his three kids lived with another family in New York, while he and one son slept in Noel’s SUV, usually parking it on the streets of Brooklyn. “Although he now can afford to rent his own apartment, Noel still has thoughts of suicide.

“We came back to a country that won’t fight for us,” Noel says. “We’re still sacrificing.” Noel, 27, says homelessness among former service members should spark as much outrage as the conditions at Walter Reed Army Medical Center, where a Washington Post probe prompted a shakeup.

The government is trying to do something about vet homelessness, says Peter Dougherty, director of homeless programs for Veterans Affairs. In the past 15 years, as the VA has boosted services to homeless vets, the number of ex-GIs who are homeless has decreased by 50,000, he says. About 300 members of the military who saw duty in Iraq and Afghanistan have stayed in VA-sponsored housing for homeless veterans, Dougherty says. Instead of being a foreboding sign, he says, the number of new veterans seeking shelter is an opportunity for the government to work with veterans in vulnerable positions — to offer assistance before problems get out of control.

“I’m of the theory that the earlier we can intervene, the better off that veteran is going to be,” Dougherty says. “Some people always ask me, ‘Isn’t it tragic that we’re seeing these veterans?’ Well, it’s tragic we’re seeing anyone. But I think the best news we have is that the earlier we see them, the more likely it is that they’re going to get better, faster, and get on with their lives.”

During this fiscal year, Washington is spending $210 million on programs directly related to helping homeless veterans, Dougherty says. Next year’s budget is scheduled to increase by $77 million. Homeless veterans who enter the doors of the San Francisco VA clinic on Third and Harrison streets have access to showers, storage lockers, and a clean place to sit with other veterans who are trying to right themselves. They can meet with counselors and medical staff, and attend group sessions on ending abuse of alcohol and drugs.

Among those who have recently visited the center, according to clinic head Bobbie Rosenthal, are an Iraq vet who lives in a van on a street near AT&T Park and another who lives with his girlfriend “on the edge” of homelessness. The ex-serviceman in the van has overcome a drinking problem, Rosenthal says, while the other man is struggling with the effects of post-traumatic stress disorder.

Dadds says he doesn’t have a drug or alcohol problem, nor is he struggling with emotional trauma from his time in the Persian Gulf. Though he learned to shoot and was assigned guard duty on his Navy ship, his main task was to work in the vessel’s computer room, he says. Since his Navy service ended in July 2003, Dadds — a native of Maryland who has lived in Florida and San Diego — has been traveling from city to city, content with living on the street if he can’t find a temporary bed to his liking. In San Diego, he slept on the street for four months. At shelters, he has met veterans who fought in the 1991 Persian Gulf War, and in the 1992-94 Somalia operation. Dadds avoids reading or watching news about the war.

“The less I see it, the less I hear about it, the less I think about it,” Dadds says.

Dadds would one day like to “settle down” into a steady job and home, but for now, he’s unconcerned about his transient lifestyle, even if it means sleeping on a mat in a strange shelter.

Compared with the tens of thousands of people who have died in the Iraq War, Noels, Dadds and other young veterans are fortunate. The reality, though, is that homelessness can be a debilitating experience, and for veterans, nothing they ever expected when they first put on a uniform.

Homeless Vet Numbers Expected to Grow
By Christian Davenport
Washington Post Staff Writer
Monday, March 5, 2007; Page B01

It was a bad week for Aaron Chesley. He talked back to the staff at a Baltimore homeless shelter, got into an argument with a fellow veteran and missed an appointment for his post-traumatic stress disorder counseling session.

“Are you still watching the news?” his counselor, Anthony Holmes, asked.

Maybe that’s what had set Chesley off. He had been showing progress since he came to the program last fall. But television footage from the war could cast him back in Iraq in an instant, back to fingering the trigger of his machine gun, scanning the horizon for insurgents. And Holmes knew it wouldn’t take much for Chesley to land back on the streets.

“No. If the news is on, I turn my back,” Chesley said.

In a homeless shelter filled with Vietnam War veterans, Chesley, 26, a former Catonsville High School honors student who joined the West Virginia Army National Guard in 2000 to help pay for college, was the only one in the facility who fought in the country’s latest conflict. But across the nation, veterans of recent combat in Iraq and Afghanistan are slowly starting to trickle into shelters, officials say.

The number of homeless veterans from recent wars is hard to gauge. From 2004 to 2006, the Department of Veterans Affairs provided shelter to 300 veterans of Iraq and Afghanistan tours, out of the tens of thousands who have served.

That figure “is not even close to accurate,” said Paul Rieckhoff, executive director of the Iraq and Afghanistan Veterans of America, because it doesn’t include the “others sleeping in buses, their cars or on the streets.”

In New York City alone, he said his organization has helped 60 homeless veterans since 2004.

As in the Vietnam War era, when thousands of vets ended up homeless, there are already signs that the recent conflicts are taking a traumatic psychological toll on some service members. Many veterans’ advocates said that despite unprecedented attempts by the military and Veterans Affairs to care for veterans, increasing numbers of the new generation of warriors are ending up homeless.

“This is something we need to be concerned about,” said Cheryl Beversdorf, president of the National Coalition for Homeless Veterans, a Washington-based nonprofit.

Not everyone agrees, however, that the wars will spark a significant uptick in homelessness. Peter H. Dougherty, director of Veteran Affairs’ Homeless Veterans programs, said that the administration is “light years ahead” of where it was during the Vietnam era. Without a draft, today’s all-voluntary military is “better physically and mentally prepared” for combat, he said. The department now also provides free health care for two years after Iraq and Afghanistan vets get out of the military, and it’s focusing on preventive services that help veterans and their families cope.

“We are continuing to expand services, but we don’t see any influx yet,” he said.

The debate comes as Army studies have found that up to 30 percent of soldiers coming home from Iraq have suffered from depression, anxiety or PTSD. A recent study found that those who have served multiple tours are 50 percent more likely to suffer from acute combat stress.

Veterans’ homeless shelters across the country, such as the Maryland Center for Veterans Education and Training in Baltimore, are bracing for increased demand. “The wave has not hit yet, but it will,” said retired Army Col. Charles Williams, MCVET’s executive director.

Nearby, the South Baltimore Station shelter is doubling the size of its program in anticipation of the Iraq war vets it expects to serve, said Woody Curry, the center’s program director. He thinks it will be several years before they start showing up in large numbers.

“Usually it takes a period of time before it surfaces — the PTSD,” he said. “And the military mentality leads you to try to tough it out and not say anything.”

He said he was particularly worried about members of the National Guard and Reserves who return to their civilian lives after their service. “A lot of these guys were just everyday working people, and then you put them in a situation like that,” he said. In Iraq, “you’re on a hyper-vigilant state all the time. You can’t turn that off. It becomes who you are.”

Meanwhile, a report by the Democratic staff of the House Veterans Affairs Committee found that from October 2005 to June 2006, the number of Iraq and Afghanistan veterans seeking services from walk-in veterans centers doubled, from 4,467 to 9,103.

“It’s clear from the report that Vet Center capacity has not kept pace with demand for services, and the administration has failed to properly plan and prepare for the mental health needs of returning veterans and their families,” U.S. Rep. Michael H. Michaud (D-Maine), a member of the committee, said in a statement.

But Dougherty said the increase shows that more veterans were receiving treatment, and that the department’s efforts to reach out them has succeeded. It has started sending letters to vets returning from Iraq and Afghanistan with the location of the nearest veterans center and “encouraging them to go,” he said.

“One of the big differences now is we’re much more in a preventative health-care mode than we were in the past,” he said. “We’re hoping by getting that early intervention we’ll be able to take care of them.”

Although many vets suffer from PTSD, “epidemiologic studies do not suggest that there is a causal connection between military service, service in Vietnam, or exposure to combat and homelessness among veterans,” according to the Veteran Affairs Web site. Rather, homelessness in veterans is cause by an amalgam of forces: family support, finances, education, mental illness — the same factors that cause homelessness in the general population.

The veterans department is going to considerable lengths to reach out to Iraq and Afghanistan veterans and their families, Dougherty said. There are also specialized services for women, who are an increasing part of the military force and are seeing combat in Iraq. Meanwhile, the total number of homeless veterans has gone down from about 250,000 10 years ago to about 194,000 this year.

The Army has increased the number of mental health professionals in Iraq and Afghanistan, and a pilot program where primary care physicians at Army bases screen patients for PTSD and other disorders is expanding. The military has also started following up on service members three to six months after they return from war to check on their overall physical and mental health.

* * *

In Iraq, Chesley’s unit provided convoy security, which meant the Army specialist was out on the roads exposed, always wondering when the next roadside bomb would explode.

He became hardened, he said, prepared to die: “It was kind of like you embrace death to stay alive. If you were going to die, you were going to die.”

When he got home in March 2005, he struggled to adapt from the first day. He was excited to be home, and he knew his family was waiting, but as he got off the plane he felt dizzy.

Once gregarious and engaging, Chesley was withdrawn and sullen. This was not the young man who was a star athlete and an honors student, whose walls were adorned with plaques and certificates, whose principal, Robert Tomback, recently remembered him as “bright, quite charming and enormously popular.”

Chesley started drinking heavily, he said, “putting coffee in my vodka just to get going in the morning.” Drinking led to drugs and that led to trouble.

He stole about $600 from his mother. He was arrested twice for DUI, once after he hit a police car, the other after he flipped the truck with the windows he tinted so no one could see him drinking and smoking pot as he drove. He ended up floating between family members’ homes.

He tried to resume his studies at West Virginia University, but he couldn’t regain his old life.

Finally, his stepfather brought him to a VA Hospital in Baltimore, and Chesley was diagnosed with PTSD and bipolar disorder. Later, he enrolled in MCVET, the nonprofit shelter that provides drug and alcohol counseling and other services.

Sitting across from Holmes at the counseling session, Chesley was a model of contrition and promise. He vowed to take his medicine, to talk to someone if he felt rage creeping up, to “work on being respectful even if I’m angry.”

Holmes finally let him go but worried.

“He’s still got a lot of anger from the war,” Holmes said after Chesley left. “He’s on thin ice. He’s on real thin ice.”

A few weeks later, Chesley left the program, and its director of student services said he didn’t know what happened to him.

Chesley’s stepfather, Bennie Price, said he recently enrolled in a veterans program in West Virginia after “hitting rock bottom again.”

Reached by phone last night, Chesley admitted he had slipped. “But I know I need help,” he vowed. “And I want to succeed.”

By Ann Scott Tyson
Washington Post Staff Writer
Saturday, June 16, 2007; Page A02

U.S. troops returning from combat in Iraq and Afghanistan suffer “daunting and growing” psychological problems — with nearly 40 percent of soldiers, a third of Marines and half of the National Guard members reporting symptoms — but the military’s cadre of mental-health workers is “woefully inadequate” to meet their needs, a Pentagon task force reported yesterday.

The congressionally mandated task force called for urgent and sweeping changes to a peacetime military mental health system strained by today’s wars, finding that hundreds of thousands of the more than 1 million U.S. troops who have served at least one war-zone tour in Iraq or Afghanistan are showing signs of post-traumatic stress disorder (PTSD), depression, anxiety or other potentially disabling mental disorders.

“Not since Vietnam have we seen this level of combat,” said Vice Adm. Donald Arthur, co-chairman of the Department of Defense Mental Health Task Force. “With this increase in . . . psychological need, we now find that we have not enough providers in our system,” he said at a Pentagon news conference yesterday unveiling the report. “Clearly, we have a deficit in our availability of mental-health providers.”

The ongoing “surge” of more than 30,000 additional U.S. troops in Iraq and Afghanistan will exacerbate this gap, as will the rapid growth in the number of soldiers, Marines and other troops — now about half a million — who have served more than one combat tour, heightening the risk of mental illnesses, the report said.

As in the aftermath of Vietnam, the costs of untreated mental illness will rise dramatically over time, the report warned. “Our nation learned this lesson, at a tragic cost,” it said. “The time for action is now.”

Defense Secretary Robert M. Gates is required by law to develop a plan of action within six months on the 95 recommendations included in the 64-page report.

The task force, composed of seven military and seven civilian professionals with expertise in military mental health, was formed in May 2006. It based its report on visits to 38 U.S. military care facilities in the United States, Europe and Asia; interviews with care providers, military personnel and their families and commanders; as well as expert testimony and research.

The task force found that 38 percent of soldiers, 31 percent of Marines, 49 percent of Army National Guard members and 43 percent of Marine reservists reported symptoms of PTSD, anxiety, depression or other problems, according to military surveys completed this year by service members 90 and 120 days after returning from deployments.

Two “signature injuries” from Iraq and Afghanistan are PTSD and traumatic brain injury, it said. Symptoms include nightmares and other sleep problems, trouble concentrating, anger, recklessness, and self-medication with drugs and alcohol.

The task force identified several barriers to care, including the stigma associated with seeking help, poor access to providers and facilities, and disruptions in care as service members move locations.

“Stigma in the military remains pervasive and often prevents service members from seeking needed care,” the report said, citing anonymous surveys that show most members with symptoms of mental health problems do not seek help.

Some soldiers underreport problems because they want to stay with their units, and military officials note that many soldiers undergoing treatment for stress or other mental problems are allowed to deploy again after a screening to determine the intensity of their symptoms or depending on what medications they are taking. Those on lithium, for example, should not deploy while those on another class of medications similar to Prozac may be able to, said Army Col. Elspeth Cameron Ritchie, who assisted the task force.

“If you have a post-traumatic stress reaction, it’s not your fault,” Arthur said. “It’s up to leadership to say to folks that post-traumatic stress reactions are an absolutely normal part of combat operations.”

Proposals by the task force to reduce stigma include embedding health-care providers with units and offering treatment at primary medical care facilities, where service members can seek psychological help without singling themselves out. An additional recommendation is for the military to begin training troops to become more psychologically resilient, in part by conditioning them mentally, much as they conduct their physical training.

“We can use virtual-reality therapy, typing smells in to create a virtual environment,” that resembles a battlefield, said Col. Jonathan H. Jaffin, commander of Army medical research.

National Guard and reserve members — who often live far from military bases and return from deployments to rural communities — face “particularly constrained” access to clinical care as well as to the military chaplains and family support networks that active-duty personnel can tap, the report said.

“The current complement of mental health professionals is woefully inadequate” to prevent and treat members of the military and their families, the report said. But it called the process for recruiting additional trained personnel — both civilian and military — “time consuming and cumbersome,” stating for example that the number who could be recruited over the next six months would be “well below” the number required to meet the needs.

The shortage is deepening as active-duty mental-health professionals, also stressed by repeated deployments and other frustrations, are leaving the military in growing numbers, the report said. The Air Force has lost 20 percent of mental health workers from 2003 to 2007, while the Navy lost 15 percent between 2003 and 2006, and the Army lost 8 percent from 2003 to 2005.

Financial resources for mental health treatment in the military are also lacking, the report found. Congress provided a boost of $600 million for PTSD and traumatic brain injury in the 2007 supplemental war funding, but more will be needed, S. Ward Casscells, assistant secretary of defense for health affairs, said at the news conference.

by Ted Rall

NEW YORK — Americans were dismayed to learn that soldiers wounded in Afghanistan and Iraq — “fallen heroes,” as network news calls them — were being warehoused in Building 18, a rat- and roach-infested satellite of the Army’s Walter Reed Medical Center.

Disbelief turned to disgust with the disclosure that injured veterans are going bankrupt and losing their homes because the Veterans Administration (V.A.) holds up their benefit checks for years on end. Surely the men and women who fight for our country deserve better. How could such a wholesale betrayal be tolerated by a nation where “support our troops” magnets account for 20 percent-plus of total auto body surface area?

The surprise is that anyone is surprised. Every generation of warriors has marched off to war based on the pledge that they would be taken care of no matter what. America has broken that promise every time.

Abandoning men who lose their limbs and sanity in battle is a tradition that goes back to America’s first war.

More than 40 years passed before Revolutionary War vets got their pensions — by which time most had died. Of the few survivors, only those who could prove they were indigent actually collected.

At the end of the Civil War, Union Army soldiers received a $250 discharge bonus, a modest sum that didn’t last long due during a postwar period of high unemployment. By 1868 New York Governor Reuben E. Fenton remarked that homeless veterans in New York State were “numbered by the thousands.”

More than 300,000 soldiers were wounded in combat during World War I, but the Veterans Bureau, predecessor of the V.A., rejected all but 47,000 claims. “The Veterans Bureau,” a columnist wrote in 1925, “has probably made wrecks of more men since the war than the war itself took in dead and maimed.”

America’s first major military defeat led to mistreatment of those who had served in the Korean War by those who said they hadn’t fought hard enough. Among other indignities, P.O.W.’s were denied their back pay of $2.50 for each day of captivity.

Thousands of Vietnam vets were discarded like used tissues, reduced to homelessness and starvation after being denied adequate medical treatment and cash benefits. As recently as 2004, according to the Christian Science Monitor, “an estimated 500,000 veterans were homeless at some time during 2004 [but] the V.A. had the resources to tend to only 100,000 of them.”

It took a decade after the fall of Hanoi before Vietnam vets began turning up on the streets, but troops who served in Afghanistan and Iraq have already become homeless. “This kind of inner city, urban guerrilla warfare that these veterans are facing probably accelerates mental-health problems,” says Yogin Ricardo Singh, director of a veterans advocacy program in Brooklyn.

“You can have all of the yellow ribbons on cars that say ‘Support Our Troops’ that you want,” adds Linda Boone of the National Coalition for Homeless Veterans. “But it’s when they take off the uniform and transition back to civilian life that they need support the most.” As usual, they’re not getting it.

Two decades ago, as now, outrage generated by media reports forced Congressional blowhards and Army brass to promise to do better. But nothing changed. As it always does, the journalistic pack moved on to other stories. Politicians, slacking off as public pressure eased, went back to slashing the V.A. budget and brushing off veterans who complained of physical and mental disabilities brought on by their service. At this writing, the Bush Administration has asked Congress to slash veterans’ benefits by a net seven percent.

A staggering 30 percent of the 700,000 soldiers who served the 1991 Gulf War have filed claims with the American Legion stating that they are afflicted by Gulf War Syndrome, an umbrella term covering an array of illnesses ranging from chronic fatigue and loss of muscle control to brain cancer and fibromyalgia. Congress paid benefits only to vets who’d become ill within two years of 1991 — eliminating 95 percent of applicants from eligibility.

Researchers suggest a myriad of possible causes for GWS — exposure to Iraqi nerve gas and burning oil wells, infectious diseases spread by parasites, a mandatory anti-anthrax vaccine — but the smart money is on exposure to radiation released by the 286 tons of depleted uranium munitions fired by the United States in Kuwait and Iraq in 1991. Twice as dense as lead, 60 percent as radioactive as naturally occurring uranium and with a half-life of 4.5 billion years, DU is extremely toxic. Reduced to a fine airborne powder, it coated everything in the Gulf: tanks and other equipment, uniforms, lungs.

Sixteen years later, the government has yet to take its stricken Gulf War vets seriously. “I’ve been working on this since ‘93 and I’ve just given up hope,” said Dan Fahey, a doctoral student at UC Berkeley and a Gulf War vet who has become a spokesman for the victims. “I’ve spoken to successive federal committees and elected officials…who then side with the Pentagon. Nothing changes.”

Now get ready for Iraq War Syndrome. The 130 tons of DU dropped on Iraq in the Second Gulf War are destroying men like Herbert Reed, who ingested the substance in Samawah in July 2003. “Since he left a bombed-out train depot in Iraq,” reported Wired last year, “his gums bleed. There is more blood in his urine, and still more in his stool. Bright light hurts his eyes. A tumor has been removed from his thyroid. Rashes erupt everywhere, itching so badly they seem to live inside his skin. Migraines cleave his skull. His joints ache, grating like door hinges in need of oil.”

Yet the Pentagon still refuses to clean up its act. Veterans poisoned by DU haven’t received a dime in compensation. DU bombs are still being dropped on Afghan villages.

“There is something massively wrong with Herbert Reed, though no one is sure what it is,” continues the Wired story. “He believes he knows the cause, but he cannot convince anyone caring for him that the military’s new favorite weapon has made him terrifyingly sick.”

“The Department of Defense takes the position that you can eat [DU] for breakfast and it poses no threat at all,” says Steve Robinson of the National Gulf War Resource Center.

Once again, politicians and their media mouthpieces will make big promises. But they’ll break them. They always do.

Don’t Americans who risk their lives to serve in the military deserve the same consideration as those who smoke cigarettes? Military propaganda — television commercials, posters, video games and recruitment offices, Fox News — ought to be plastered with a large, bold-faced notice:

WARNING: Military Service Causes Death, Mutilation, Poverty, Homelessness, and Complicated Feelings of Having Been Suckered.

Ted Rall is the author of “America Gone Wild,” a collection of his Bush-era cartoons featuring a lengthy foreword about his most controversial work.

By Kelly Kennedy – Staff writer
Posted : Tuesday Feb 27, 2007 13:39:03 EST
The Army is deliberately shortchanging troops on their disability retirement ratings to hold down costs, according to veterans’ advocates, lawyers and services members, and the Inspector General has identified 87 problems in the system that need fixing.

Read about the IG report

“These people are being systematically underrated,” said Ron Smith, deputy general counsel for Disabled American Veterans. “It’s a bureaucratic game to preserve the budget, and it’s having an adverse affect on service members.”

The numbers of people approved for permanent or temporary disability retirement in the Navy, Marine Corps and Air Force have stayed relatively stable since 2001.

But in the Army – in the midst of a war – the number of soldiers approved for permanent disability retirement has plunged by more than two-thirds, from 642 in 2001 to 209 in 2005, according to a Government Accountability Office report last year. That decline has come even as the war in Iraq has intensified and the total number of soldiers wounded or injured there has soared above 15,000.

The Army denies there is any intentional effort to push wounded troops off the military rolls. But critics say many troops being evaluated for possible disability retirement accept the first rating they are offered during their first informal board – but that if they were to request a formal board, and then appeal the decision of that board, they would receive higher ratings.

The system is complicated – “unduly so,” the Rand Corp. think tank said in a 2005 report – and the counselors who advise troops often have insufficient training or experience. Service members also assume that after months spent in a war zone, the military will look out for them, critics say.

Those who try to navigate the process beyond their initial evaluation – to include hundreds of combat veterans in limbo at Walter Reed Army Medical Center in Washington – face long waits, lost paperwork and months or even years away from home as they try to complete the process. If they receive a rating of above 30 percent, they receive disability retirement pay, medical benefits, and commissary privileges. Those rated under 30 percent receive severance pay and no benefits.

Many eventually give up and take their chances with the Department of Veterans Affairs, which may give a higher rating for the same disability.

But under the separate disability payment systems of the Defense Department and the VA, a higher VA rating does not necessarily translate into more money – and forgoing military disability retirement also means giving up lifetime commissary and exchange privileges, military health care and other benefits.

While the number of soldiers placed on permanent disability retirement has declined in the past five years, the number placed on temporary disability retirement – with medical conditions that officials rule might improve so they can return to work over time or worsen to the point that they must be permanently retired – has increased more than fourfold, from 165 in 2001 to 837 in 2005.

Troops on temporary disability leave convalesce for 18 months while receiving reduced basic pay. After 11/2 years, they are reevaluated and either returned to duty, or rated for separation or permanent disability retirement, or sent back to temporary disability for another 18 months – up to five years.

Along with paying them reduced wages during that time, the eventual reevaluation often leads to downward revisions in their disability ratings – and lower disability payments.

Service members’ conditions must be deemed stable before they receive a permanent disability rating, unless they are rated at less than 30 percent. In that case, they are discharged with severance pay – whether they are in stable condition or not. If their conditions then worsen, they’ll receive no more money from the military.

Compared to the overall size of the defense budget, disability retirement costs are relatively small. In 2004, the military paid more than $1.2 billion in permanent and temporary disability benefits to 90,000 people, the GAO said.

That does not include the costs of lump-sum severance pay – up to 24 months of basic pay – given to 11,174 disabled troops that year in lieu of disability retirement pay. The Pentagon was unable to provide data on severance costs, the GAO said.

Officials with the Army’s Physical Disability Agency say there is no ploy to save money and that troops going through the process are treated well.

“There is absolutely no attempt on the part of the Army or this agency to deny soldiers any disability benefits or to push them off on the VA,” said Col. Andy Buchanan, the agency’s deputy commander.

Adjudicators “are committed to ensuring all disability decisions are made fairly and accurately and based on the evidence in the soldier’s medical record,” he said. “We have never received any guidance, official or otherwise, from anywhere within DoD to limit findings for budgetary or other reasons.”

In 2005, Ellen Embrey, deputy assistant secretary of defense for force health protection and readiness, told House lawmakers the reason for the comparatively large numbers of troops placed on temporary disability was actually to keep end strength up. A premature medical evaluation board decision, she said, “may negatively impact the individual’s ability to continue serving.”

‘I COULDN’T BELIEVE IT’
Smith said he began hearing tales about two years ago of service members who said they were not getting proper disability ratings based on the VA Schedule for Rating – the document used by both the military services and the VA to determine percentage ratings for disabilities, which in turn sets compensation rates.

“I finally decided to take on a case myself,” Smith said. “It’s been a while since I took a case.”

He found an Army captain whose radial nerve in his right arm had been destroyed in Iraq – the same injury that has left Bob Dole, the World War II veteran and former Kansas senator, unable to use his arm to do more than hold a pen.

Smith followed the captain through the physical evaluation board process. He said that under the ratings schedule, this was an easy call: 70 percent disability. But at his first informal medical evaluation board, the captain initially was offered just 30 percent, and he had to fight to raise it to 60 percent through a subsequent formal evaluation board and then a final appeal.

“His first offer … I couldn’t believe it,” Smith said. “I was just incensed.”

Many troops accept the first rating offered them at their initial informal evaluation board, Smith said. “Soldiers are trained. When the evaluation board says, ‘This is what you get,’ the soldiers say, ‘Yes sir.’ A lot of people don’t appeal.”

Dennis Brower, legal advisor for the Army’s Physical Disability Agency, acknowledged as much, saying only 10 percent of soldiers request a formal board.

But when the Army wouldn’t budge on raising the captain’s rating above 60 percent, Smith took the case a step beyond where most soldiers can go.

“I called the adjutant general and said I wanted a meeting,” Smith said – and added that if he didn’t get one, he was “going to Congress.’ ”

That was in January. He got his meeting. He has demanded that the Army’s Physical Disability Agency look for patterns of incremental increases in disability ratings as troops move through the process, and how closely their ratings match what the VA schedule mandates.

Smith is still waiting to hear back, but suspects the pattern will show that a large proportion of troops with less than 20 years of service – who don’t already qualify for retirement – are rated at under 30 percent, the threshold for being considered for disability retirement pay and all other military benefits that come with it. Many of those troops instead receive one-time, lump-sum disability severance pay that is much lower in value than lifetime retirement compensation.

Pentagon spokesman Marine Maj. Stewart Upton said the disability retirement process is being looked at.

“We are in the midst of a business-process review that will generate improvements to program effectiveness, including timeliness goals for processing cases and standard definitions of start and end points as well as other metrics to ensure that progress can be accurately measured over time against common metrics,” Upton said.

“We are especially concerned with a balance of what constitutes prompt adjudication, while maintaining reasonable flexibility within the system to ensure recoveries are not inappropriately rushed.”

FIT FOR DUTY?
Army Lt. Col. Mike Parker was diagnosed with reactive arthritis, which causes painful swelling and eventual calcification of the joints. He was put on drugs that suppress his immune system, but kept on active duty – even though his medication must be refrigerated and he must remain near specialized medical care.

Without a suppressed immune system, there is no chance of him being deployed, much less to a combat zone. “If I get shot, it’s not good,” he said.

Though pleased that he could continue to serve, he wondered how a medical evaluation board could find him fit. After he talked to a dozen other service members from all branches with similar diagnoses of reactive arthritis or ankylosing spondylitis, he realized they were all evaluated based on different criteria. He produced hundreds of pages of medical records, letters and rulings to support his claims.

Some were handed disability ratings that would provide them with the $20,000 in drugs that they would need for the rest of their lives, while others were told they had preexisting conditions and given no benefits. Still others – including some with medical evidence proving otherwise – were told that because their diseases had improved and would not worsen, their disability ratings were based on the idea that they had improved from chronic illnesses that, in reality, could worsen.

Parker began making calls – to lawmakers, doctors, veterans’ groups and the media. He sought out troops having problems and offered to help them through the process, piecing together medical paperwork to make sure people got what they deserved.

He said he has seen case after frustrating case of the services ignoring their own rules. For example, an evaluation board is supposed to provide “clear and unerring evidence” for a ruling that a particular condition was preexisting – but Parker said that often does not happen.

He cited a Marine who had received a 10 percent disability rating for post-traumatic stress disorder from a Navy physical evaluation board – and was later rated at 50 percent for the same condition by the VA, using the same ratings schedule and the same medical records.

UNRELATED TO SERVICE
In May 2003, Army Cpl. Richard Twohig was thrown from an armored personnel carrier in Iraq. The 82nd Airborne Division paratrooper landed on his head, said his lawyer, Mark Waple, of Fayetteville, N.C.

Twohig suffers headaches at least once a week that last up to 14 hours, as well as short-term memory loss, and is dependent on pain medication.

“This is well substantiated by his doctors – Army medical doctors,” Waple said.

But his physical evaluation board rated him only 10 percent disabled for another injury because he had no substantive proof the headaches were a result of the accident – even though regulations call for evaluation boards to give troops the benefit of the doubt in such instances.

“I believe it is budget-related,” Waple said. “I believe that there is a feeling the service member should turn to the VA for both their health care and their veterans’ benefits.”

Twohig can’t work because of the disabling headaches, and even if he receives VA benefits, his family has lost its medical insurance. And if a physical evaluation board rules that injuries are not related to service or were preexisting conditions, troops are not eligible for VA benefits, either.

Waple said he began helping soldiers through the physical evaluation board process in the 1970s while he was still an Army lawyer, and he said he has watched the system change since the wars began in Iraq and Afghanistan.

The system “has become less friendly toward service members with compensable decisions on disability” in the past few years, especially since the war in Iraq began, Waple said.

“I think there is a definite bias on the physical evaluation board to medically separate service members with a zero-, 10- or 20-percent disability rating when it … should be medical retirement.”

Waple said he has about a dozen cases out of Fort Bragg, N.C., similar to Twohig’s.

Army Spc. Ruben Villalpando, who was featured in the Military Times coverage of the problems at Walter Reed, said that since the stories were published, contractors have fixed the elevator in Building 18 – the facility where troops on “medical hold” are housed – and have inspected each room to determine what needs to be fixed.

But more importantly to him, a Judge Advocate General lawyer looked at his case after he filed a complaint that he received no disability rating because his depression was ruled to have existed prior to his enlisting.

Villalpando said he became depressed because his cousin, a Marine, was electrocuted while they were both serving in Iraq. He has been at Walter Reed for just over a year.

“The JAG wanted to know how they knew it was existing prior to service if they didn’t have my medical records,” Villalpando said.

He has appealed that decision, and his appeal is still pending. “I’m keeping my fingers crossed,” he said.

A COMPLICATED PROCESS
Brower, the Army disability agency’s legal advisor, said part of the problem is that service members don’t understand how the process works. For example, he said a soldier who carries a notepad because of short-term memory loss will not be rated for that disability because he can function. But if he loses a foot, he would be rated for that.

“There’s no need to compensate” for the short-term memory loss because it “didn’t end your military career,” he said. “The foot did. We compensate for the loss of a career.”

And Upton said soldiers have plenty of opportunity to appeal.

“Service members are afforded due process to ensure their cases and concerns can be fairly considered whichever direction they choose,” he said. “Service members also have rights of appeal at specific points in the process should they disagree with their rating.”

Buchanan, the Army Physical Disability Agency’s deputy commander, said the system is not as bad as government reports have led people to believe.

“It really is a fair process,” he said. “It’s wide open. We have nothing to hide.”

Buchanan also said he had “no visibility” on the costs related to disability retirement pay, so he doesn’t know if the budget is going up or down.

He said he gives medical evaluation board adjudicators one instruction:

“Do the right thing. That’s the guidance I give them.”

By John Cory
t r u t h o u t | Guest Contributor

Thursday 22 February 2007

What the hell can you say? Veterans tossed aside like broken toys, discarded in the schoolyard of war. And everyone shouts, “This can’t happen in America,” when they should be shouting, “This can’t happen in America – again!” There it is.

See, the dead are at peace, buried and gone. But the maimed wander the streets forever, reminding us of our sins. Support the troops over there so we don’t have to support them over here.

That’s the thing about survival; you’ve committed the ultimate sin and returned, dragging the dusty ghosts of war around your ankles and behind your eyes. Your lips taste of the cordite and sulfur and worse yet, you smell of need.

And now you’re a stranger in a strange land. Everyone speaks a foreign language while your native tongue is Grunt. You speak security perimeters, RPGs and IEDs and how to “light ‘em up.” The System speaks bureaucrat, flinging form names and numbers that translate to deny, decline and delay. Counselors and “advisers” speak in acronym sentences that obfuscate and avoid. A grateful nation – sort of.

Then you wander into your previous life, where they speak of things that you have no clue about. Their language is familiar but alien at the same time. Lives have continued while yours was suspended somewhere between the duffle bag rag and death takes a holiday. They kept living forward while you spent ages every day living your life backward, remembering yesterday just to have a reason for making it into tomorrow.

A war veteran. That’s what you are now. Don’t mean nothin’. A pawn for politicians, a piece of your former self. Your songs are silent syllables and your dreams are closed doors without handles. Out there you rely on your Six, you trust the Point Man, and you know “Abilene” and “Racine Bob” have your back. But here – here, they shake your hand with a smile that measures you for out-of-sight shelf space. The discount rack. Your name, to be whispered when the children are not around. And you hear the phrases: “Oh, he hasn’t been the same since he got back, just drifting and distant. Not the friendly guy he used to be. Not the same.” Like a poor, crazy relative come to visit, to be tolerated until it’s time to leave.

And still others want to know what it was like? Must have been hell, huh?

Hell? No. Hell is a dark room shared with rats and cockroaches while praying someone will come by and roll you over so you don’t keep getting bedsores. Hell is counting the flakes of peeling paint on the wall just to kill time, to take your mind off the pain. Hell is paperwork in triplicate requiring proof that you did not intentionally run into that bullet in your spine but can provide the name and description of the alleged enemy who allegedly shot you. Hell, my friend, is hearing that your spouse and high-school-age kids working three and four part-time jobs make just enough money to disqualify you from financial aid, but not enough to make ends meet. There’s a war on, you know. Budget cuts and tax breaks for the wealthy; that’s what fuels the war effort. You act as though you’ve given an arm or a leg for your country. But if you do get disability pay – Buy Bonds! After taxes, of course.

Cowboy up, man! A little gunfire never hurt anybody.

They’ll glue you like a hood ornament to the front of a parade float to raise money for politicians or make stirring pious patriotic speeches and then turn away with embarrassment while you gyrate and hobble and scootch into your wheelchair. They’ll try to hide it, but you can see that look: it’s pity, not patriotic pride. It’s that “oh poor thing” blush while whispering thanks to the gods that it’s you instead of them.

A war veteran. One night alone is too many, and a hundred nights alone is not enough. Try putting that into words that others can understand. Try explaining why the Fourth of July takes you back to Haifa Street or Vin Loc or the Ashau Valley or any of a thousand little villages in a thousand days of war. Offer up a tale of how the last explosion blew someone apart so powerfully that it embedded bone fragments through the metal roof of a truck. Then watch the reaction. Lost in translation, man. Watch the eyes go blank and hear the rush of rationalization, “It’s over. Let it go and just get on with life. At least you’re alive.”

Don’t you get it, Vet? You make them uncomfortable. You remind them their kin is safe and clean while they blow the trumpets of glorious war. You are the face, the name, the body offered up on this sacrilegious altar of lies and doom. You’re the truth, the in-your-face reality of every falsehood uttered between their lips. You dared survive and now they must be held accountable. And all they can do is squirm.

Here’s the deal, and it is simple.

Every Congressional office should be flooded with phone calls and email demanding not only an investigation, but also immediate funding and corrective action of the treatment of our veterans. Viewers should require every media outlet that has dedicated untold hours and resources to the Anna Nicole Smith story to cover the failure of this administration to prioritize the healing and medical support of our troops and the wounded and their families. ABC, so willing to air slanderous 9/11 material, should send their Extreme Makeover Teams to every VA hospital and regional center in the country to show their support of the American military and veterans. And every multinational corporation that has profited from the war, or will reap ludicrous benefits from tax cuts, should be inundated by consumers to donate time, money, and material to the very souls who have paid for their greedy lobbying. And every Democratic candidate must utilize each and every public appearance to speak out on behalf of veterans and push Congress to pass immediate legislative solutions. Surely the five-day workweek could be enforced long enough to take care of our most precious resource – our fellow American citizens, our friends and our family.

Veterans are not looking for anything special, just the decency of a promise kept. No one owes anything more or less. A promise kept – duty, honor, and country.

Let us plant gardens of stone
In this sandbox of war
And irrigate the furrows with tears.
Let us grind marrow to meal
Between bullets and pavement
And moisten the noonday soil with blood.
Let us whisper their names on the wind
Then watch them swirl like orphans
Blown by devils and dust.
Let us speak in silence
Let us turn away
Never make us face them
Please just let us pray.
We’ve paid no price
But feel their pain
Now let us pray
Just to forget.
Oh no, my friend
Let us pray
For our souls
Shamed by our sins of omission.
It is they who have paid the price
With a pound of flesh
And a ton of pain
So go ahead and pray
Just pray
That you never forget.
Amen.

By Ami Albernaz

As military deployments overseas continue, a Massachusetts-based program that is helping families left back home is looking to expand.

SOFAR, or Strategic Outreach to Families of All Reservists, is a group of 70 psychotherapists who volunteer their services to Army reservists and National Guard members serving in Iraq, Afghanistan and Kuwait, as well as their families. For the past 15 months, SOFAR has operated as a pilot program offering individual counseling and organizing family readiness groups and school programs. Now, the program’s founders are hoping to extend SOFAR throughout New England, and ultimately, nationwide.

“What we’re hoping to do is to address issues around secondary trauma that family members may be experiencing and to help increase resilience so that families can cope more effectively,” says Kenneth Reich, Ed.D., co-founder of SOFAR and president of the Psychoanalytic Couple and Family Institute, which has served as a base for SOFAR. “If a soldier is a parent, it means the family back home becomes a single-parent family, with the stresses that we know these families have to operate under. We hear a lot of stories about soldiers, but far fewer stories about the families who are the invisible casualties of war. They’re not facing dangers like soldiers in a war theatre, but they face other complicated difficulties that separation brings up.”

SOFAR is one of the few programs that works with families as well as returning soldiers, says co-founder Jaine Darwin, Psy.D. While reservists and their dependents are eligible for limited psychological care, their parents, siblings and other family members are not. In addition to helping returning soldiers reintegrate into their families and civilian life, SOFAR volunteers work with family members experiencing depression, anxiety and guilt while their loved one is deployed, mainly through support groups and break-out groups at grassroots events. “We find that it’s been incredibly helpful in giving language for [family members'] feelings, when they feel they can’t suck it up and feel like they’re failing,” Darwin says.

SOFAR has also developed a pamphlet for teachers in helping children cope with the absence of a family member who has been deployed and is now planning to develop a trauma workshop that teachers can conduct in the classroom. “We know that with children, if trauma is not treated, about a third of the time it can be transmitted to [those children's] children,” Reich says.

“What we learned from Vietnam is to prevent intergenerational trauma,” Darwin adds. Statistics bear out the importance of SOFAR and other programs that provide services to soldiers. A recent study in the Journal of the American Medical Association says more than one-third of soldiers and Marines who served in Iraq sought mental health services, while a 2004 study in the New England Journal of Medicine found more than one out of six soldiers who experienced combat in Iraq showed symptoms of major depression, anxiety or posttraumatic stress disorder. SOFAR volunteers follow returning soldiers and their families for six months after reunion; for soldiers exhibiting symptoms of distress, the time frame is one year.

Before SOFAR launched in January 2005, Darwin and Reich negotiated with the military for two years, building a relationship of trust and respect, Reich says. “No one had ever proposed a project like this to the Army. We were non-profit offering pro bono services and there was some caution on the part of the military. But what developed was a relationship between two different cultures: mental health professionals and the military. We developed alliances around trust and respect.”

Reich and Darwin believe those alliances have placed them in a better position to take the program to a larger scale. Another key to SOFAR’s efficacy is that volunteers have gradually earned the trust of soldiers’ families. “When it comes to mental health, soldiers and families tend not to reach out easily,” Reich says. “What we’ve learned is we need to provide all kinds of ways to be helpful in a group format. As that’s happened, individual referrals have begun to happen.” The founders hope to see SOFAR spread during the next six to nine months, with training for chapters throughout the country already underway.

And as this expansion happens, the program will need more volunteers. Darwin says that among psychotherapists who have joined thus far, the experience has been eye-opening.

“From a therapists’ point of view, you can feel very helpless. Psychologists feel very gratified to be a part of this program,” she says. “It’s a fascinating experience – many of them had marched and picketed their way through Vietnam. But we’re not political, and there’s no question that the soldiers need and deserve support.”

To learn more about SOFAR, visit www.sofarusa.org. To contact Ken Reich or Jaine Darwin, write to help@sofarusa.org.

By Mary Tendall and Jan Fishler

Secondary Post Traumatic Stress Disorder, PTSD: (Not a defined mental disorder within the DSM-IV) occurs when a person has an indirect exposure to risk or trauma, resulting in many of the same symptoms as a full-blown diagnosis of PTSD.

Based on the many letters we have received, we know our readers can relate to the issues that post traumatic stress disorder, PTSD, raises among veterans and their families. While it is clear that combat veterans who have witnessed or experienced severe trauma are the primary recipients of this disorder, family members can also be affected by this condition. Although PTSD is not contagious like a bad cold or the flu, it can also affect the mental health and life satisfaction of partners. Over time, without intervention, it can become a vicious cycle. Here is an example of how this cycle might occur.

Although he knows it agitates him, Gary,* a combat veteran, watches the news every night at 6 o’clock. The news about the war in Iraq is upsetting, and by the time the program is over, Gary is angry and agitated. His wife, who has been in the kitchen making dinner, has no idea what her husband has just witnessed. She knows only that he is detached and uninterested in talking to her during their meal. When she asks if something is wrong, Gary accuses her of nagging him, leaves the table, and spends the rest of the evening in his shop, where he continues to have intrusive thoughts about the war. His wife, on the other hand, is upset by behavior she does not understand. If this situation continues, several things might occur: Gary’s wife could become depressed, alienated, and betrayed by her husband’s lack of communication; she could start drinking before dinner to numb her feelings of despair; or she might constantly be on the lookout for various cues and triggers that bring on her husband’s reactivity. Eventually, her behavior – especially her hyper vigilance – could become a stressor to Gary. The result is a dysfunctional and unhappy couple.

For the past 29 years, Darlene* has lived with Bob,* a Vietnam veteran diagnosed with PTSD. She describes this time as “walking on eggshells, never knowing when he’ll blow.” Over the years, to deal with her husband’s reactivity, Darlene has increased her own vigilance. She says that when her children were little, she often sided with them against Bob – especially when he had unrealistic expectations of them. Many times she had to leave public gatherings due to her husband’s confrontations. As their marriage progressed, Darlene’s continual vigilance took its toll, leaving her with many of the same symptoms as her husband. Her anticipation of “a blowup at any moment” created distance in her relationships – not only with family members, but also with friends. She complains that she has had no social life.

Because this aspect of trauma is not commonly addressed, Darlene and Bob were unable to take the necessary steps to communicate safely and act in ways that could have created a healthy family dynamic. Instead, they focused on blaming each other, and their marriage and their children suffered.

As one wife of a combat veteran who has attended several support groups over the years explained, “A few months ago, my husband told me he felt like he was ‘walking on eggshells,’ and I had to laugh. Apparently, my secondary PTSD had affected him.”

Secondary PTSD is not a defined mental disorder within the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV), published by the American Psychiatric Association and serving as the main diagnostic reference used by mental health professionals in the United States. However, the condition does occur when a person has an indirect exposure to risk or trauma, resulting in many of the same symptoms as a full-blown diagnosis of PTSD. These symptoms can include depression, suicidal thoughts and feelings, substance abuse, feelings of alienation and isolation, feelings of mistrust and betrayal, anger and irritability, or severe impairment in daily functioning.

Many Vietnam veterans grew up in households with fathers who had served in combat. Consequently, some veterans entered combat already having PTSD symptoms. After treatment, these veterans often acquire a new awareness about their parents, and it is not uncommon to hear statements such as, “Now I understand why my dad was so demanding. He was a workaholic and had no friends. I am like that, too!”

Secondary PTSD symptoms are not limited to spouses of combat veterans. In work with families who have relatives currently deployed in the Middle East, it has been observed that the mere thought of a distant, at-risk loved one generates fear that repeatedly sets family members on edge. Television coverage offers images that fuel the existing fears. The fear of a catastrophic event, coupled with the fear of losing a loved one, tricks the primitive part of the brain into believing that it has already happened. As a result, family members exhibit many of the symptoms of PTSD – increased irritability, increased self-medication with alcohol or drugs, sleeplessness and nightmares, social isolation (“I don’t want people asking about my son/daughter.”), poor concentration, and relationship issues. As one mother of an American soldier in Iraq shared, “I haven’t relaxed since Sharon was deployed.”

The mind has the power to create states that affect the body in both negative and positive ways. If negative thoughts and fears can cause irritability, angry outbursts, loss of interest, and hyper-vigilance, just imagine what positive thoughts might do. While it is common to blame a spouse or to become a victim, it is much more productive to take an honest look at issues and learn how to create a healthy environment. Rather than get fixated on the reactivity of the person identified with PTSD, it is more productive to view PTSD as a family matter – one that can be resolved if everyone takes time to work on his or her own issues.

At this point, you might be wondering if you or your family members have secondary PTSD. If you are close to someone who suffers from an untreated trauma, or fear for someone’s well-being who is at a sustained risk, it is important to do some self-assessment. Ask yourself: Is my sleep worse? Am I more on edge or irritable much of the time? Do I avoid social engagements more often? Am I self-medicating with alcohol or drugs? Have I developed unhealthy, distracting activities? Do I eat a less-healthy diet and exercise less? If many of the above are true, it is important to take the necessary healthy steps to calm the nervous system and create a more accurate perspective.
• Take a warm bath or shower an hour before sleep, and go to bed at the same time each night.
• Take long, deep breaths when you find yourself feeling irritable or depressed. This will give your nervous system the message that you are okay.
• Force yourself into healthy social events with good friends. Isolation adds to depression when it is based on avoidance. Socialization will bring smiles and necessary connection with others.
• Assess your use of alcohol and/or drugs. Very moderate use of alcohol is the only way to indulge. Eliminate drugs as a means of escape, unless used as prescribed.
• Create activities that are safe and that bring satisfaction. If you don’t know of any, check the newspaper for ongoing activities in your area. Taking a walk routinely with a friend is a very healthy and safe activity, and your friends will enjoy it, too.
• Eat a healthy diet and make time to exercise. Just do it! You will feel better and have more energy in a matter of days. Make it a new habit.

Another variable to consider in healing PTSD and secondary PTSD is communication. In times of combat, communication is one of the essential tools for survival, but in a non-combat environment, the rules for communication change. Where ordering, advising, lecturing, interrogating, and silence can be life-saving behaviors in a combat zone, they are roadblocks to healthy communications among friends and family members.
Positive thinking and positive self-talk are also important components of healthy communication. Because
the brain responds to constructive thoughts, thinking pleasant thoughts and making beneficial statements can go a long way to improve the atmosphere in the home. Instead of criticizing yourself or blaming yourself or others, tell yourself that you are doing the best you can.

Taking a communication class together or reading the same book about communication can be extremely helpful in lowering the anxiety level between couples. One combat veteran and his wife did both. They signed up for a weekend communication class and also bought a book on the same topic. As a result, the couple reached a new level of understanding and intimacy because they had the tools to communicate in a way that was non-threatening and non-defensive.

Whether you have PTSD or secondary PTSD, it might be comforting to know that you are not alone and that there is help. While therapy and medication are often used to heal trauma that results from extreme stressors, there are things you can do to help yourself. Join a support group where you can talk about problems in a safe environment and learn more about the disorder. Avoid alcohol or illicit drugs, and learn everything you can about the condition. Remember – PTSD and secondary PTSD are treatable. In recent years as a result of improved information, a solid support system and additional help when necessary, many families have reported improved communication and relief from symptoms.

*Names and some situations in this article have been changed.

Mary Tendall has worked for almost 14 years with combat veterans as a licensed marriage and family counselor, specializing in PTSD.

Jan Fishler is a freelance writer, trainer, and video producer who is married to a Vietnam veteran.

With all eyes on the troops in Iraq, their families–a huge and growing segment of the population–are suffering largely in media silence

by Peter Gorman

Lynn Jeffries is a single mother from Lubbock, Texas, whose son Nathan was deployed to Iraq in late 2003. A registered nurse who worked for years in an emergency room at a Lubbock hospital, Jeffries says that shortly after her son was deployed, she found herself unable to take care of trauma patients and left the emergency room for work as a hospice nurse. “I just started crying at everything,” she says. “I was so angry about this war, but at the same time I felt like I couldn’t fight against it without betraying my son. It just ate at me every day, more and more.”

Jeffries’ depression grew until, she says “at one point I thought of taking my own life in order to get my son home. It’s just made me a little crazy. I’ve never felt so helpless in my life–there are days I could not even leave the house.”

Jeffries’ son was home on leave when she spoke with this reporter, and she said she was feeling a little better–but having difficulty facing that her son is scheduled for redeployment to Iraq early in 2005. “What will happen the day I have to put him back on the plane to go back? I would do anything to have him go to Canada, but he says his friends need him and he can’t leave them.”

Teri Wills Allison of Austin, is a mother of two boys–one of whom is deployed in Iraq. She says that the depressions she began to have after her son left for Iraq got so bad that “though I’d never taken pills before I’ve needed Xanax just to get through the day since my son’s deployment.”

Jeffries and Wills Allison are not unique. They are part of a growing number of military families who find themselves dealing with what psychologists are beginning to recognize as Secondary Traumatic Stress Disorder. Like the better-known Post-Traumatic Stress Disorder, Secondary TSD can clearly be debilitating.

Says Wills Allison: “We, the mothers and fathers of the boys in Iraq–we’re getting by, but barely. Some of them tell me they need a six-pack before bed to fall asleep. Others can’t leave the house for fear they’ll come home to have that call from the military waiting on the machine. Some families are just torn apart by this.”

Some more than others. In late November, Marine Lance Cpl. Charles Hanson Jr., was killed in a roadside bombing of his convoy in Iraq. One week later, on Nov. 30, his stepdad, 39-year-old Mike Barwick, entertained guests at his Crawfordville, FL, home with stories of the stepson he loved so much. Three days later, just hours before guests were coming for a viewing at the home Barwick shared with Hanson’s mother, Dana Hanson, Barwick shot and killed himself. Family members were quoted in the local newspapers as saying it was clear he simply couldn’t live with the pain.

Misha ben-David, a drug and trauma counsellor in Austin, says he remembers his family being torn apart when his father went to Vietnam, and is beginning to fear the same thing will happen now that his son is being deployed to Iraq. “The stress on the family is unbearable,” he says. “I can already hear my ex-wife starting to freak out, retreating into a ‘rah-rah, do you love your son or not?’ frame of mind. We’ve got so much pressure on us from people like the Fox network to see this as a black-and-white issue–either you’re for the war and a patriot or you’re a no good, liberal, anti-American. Add to that stress that it’s your child that might be killed, or wounded, or permanently maimed and you’ve got a lot of family members going crazy out there.”

“Every member of every family who has ever sent a loved one to war has suffered,” says Nancy Lessin from Massachusetts, whose stepson, Joe Richardson, served in Iraq during the invasion and is expected to be called back for a second deployment there any day. “But this one is different. The stresses are different.”

Lesson is a co-founder, with her husband, Charlie Richardson and a friend, Jeffrey McKenzie, of an organization called Military Families Speak Out. MFSO was started in November, 2002, after Joe Richardson and Jeffrey McKenzie’s son–who is scheduled for a second tour in Iraq in 2005–was initially deployed to Iraq. “We realized we had no place to turn, no one to talk to about our anger at this war, about the feeling of helplessness we had, about our outrage over our sons being used in this unjust war. So we started our own organization.” Since its inception, MFSO has grown to over 2,000 members, most of whom are against the war in Iraq.

Lesson was asked why she thinks the suffering of families is different in this war than in other wars. “Because this is a war that didn’t have to happen. This is a war built on lies. We were told that this war was about weapons of mass destruction, about Iraq’s ties to al-Qaeda and the Twin Towers horror. But there were no weapons of mass destruction, no ties to al-Qaeda. We were told ‘Mission Accomplished’ when Saddam Hussein fell, but there was no mission accomplished.”

Lesson portrays a betrayal of the government’s most fundamental commitment to its soldiers. “All of our loved ones signed up to protect our country and our country’s constitution. They took a vow to give their lives, if necessary. But the assumption was that they would be fighting for a just cause. And if this were a just war–while Charlie and I would still have been terrified of that knock on the door or that telephone message telling us that Joe had died–we would have been able to move on. But in this war, a war for oil markets and corporate interests, a war in which every reason given for fighting it has proven to have been a lie, I don’t know that we would ever be able to move on if that knock on the door came. And what that has done to the families of the men and women fighting this war is horrible.”

There is also the added stress–not just on the soldiers, but on the family members as well–of involuntary tour extensions, multiple deployments, shortages of both body and vehicle armor. “Put it all together, and what you’ve created is an emotionally explosive situation,” says ben-David.

This is also the first war in which soldiers have access to the internet, intended by the military to keep morale up by giving soldiers regular contact with their families. But there have been unintended consequences to such regular contact as well. Says Lessin: “It’s not a letter every couple of weeks, where parents can try to imagine that everything is OK. With the internet we’re learning that our loved ones don’t have enough food or water or weapon replacements or armored vests, things that leave us feeling helpless.”

“Don’t even get me started on that,” says Sharon Allen, a single mother from Fort Worth, whose son is in Germany preparing for a second deployment to Iraq. “While he was in Iraq the first time, my son wrote me that the Halliburton people who were hired to bring things like mail and water and parts for the troops said it was too dangerous to go where my son was, and that the company would have to send people to a safer place to get what they needed. They were in the middle of a war, and they couldn’t. My son said the only way he kept his tank going was to steal parts from another tank. Can you imagine giving that choice to a 22-year-old? I’m a wreck knowing he’s going back.”

Wills Allison eloquently described her feelings of helplessness in an essay she wrote titled “A Mother’s View”, that initially appeared on the internet. “A just war there may be, but there is no such thing as a good war. And the burdens of an unjust war are insufferable. I know something about the costs of an unjust war, for my son, Nick–an infantryman in the US Army–is fighting one in Iraq… First, the minor stuff: my constant feelings of dread and despair; the sweeping rage that alternates with petrifying fear; the torrents of tears that accompany a maddening sense of helplessness and vulnerability… I feel like a mother lion in a cage, my grown cub in danger, and all I can do is throw myself furiously against the bars, impotent to protect him.”

One of the worst aspects of this war, wrote Wills Allison, is the wedge it’s driven between her and much of her family. “They don’t see this war as one based on lies. They’ve become evangelical believers in a false faith, swallowing Bush’s fear-mongering, his chicken-hawk posturing and strutting, and cheering his ‘bring ‘em on’ attitude as a sign of strength and resoluteness… These are the same people who have known my son since he was a baby, who have held him and loved him and played with him, who have bought him birthday presents and taken him fishing. I don’t know them anymore.”

The military offers social services and family counseling for husbands, wives and children of servicemen and women deployed overseas. But the services are only available to those who live on base. As few parents do, they have almost nowhere to turn for support.

There are a couple of exceptions. In August, 2003, under the watch of Lt Col Anthony Baker, Sr., the National Guard began working with Guard families in crisis situations, sometimes in a one-to-one setting. The Tragedy Assistance Program for Survivors (TAPS)–a non-profit with strong ties to the Department of Defense and the Dept. of Veterans’Affairs–primarily provides services to those who have lost a loved one while serving in the armed forces. But director Bonnie Carroll says the people who staff the 24-hour hotline (1-800-959-8277) will try to help anyone in a crisis situation resulting from the stress of a loved one deployed in Iraq.

“We’ll try the best we can,” Carroll says. But for most families, MFSO.org and a few other internet forums are the only places filling the void. “It’s the only place I can go at 4 AM when I can’t sleep, even with the Xanax, to talk with people who feel like I do,” says Wills Allison. “One of my friends has a son who returned home with such PTSD that he had flashbacks of the smell of burning flesh, of the sight of dead people torn to bits on the side of the road.” While home on leave, Allison says, he crawled to his mother’s bed every night to cry and fall asleep. “And then he was redeployed. His mother is barely holding on. There’s no-one in the military there for her.”

Cathy Wiblemo, deputy director for health care at the American Legion, the veterans’ organization that serves as a watchdog on the Veteran’s Administration, says there is simply no funding to provide services for the families of deployed or returning soldiers. “We do have a hotline [1-800-5040-4098] referral service for family members where we try to find them the services they need in their local community, but in terms of paying for those, they’re on their own.

She takes a stark view of the situation. “The truth is that the VA is not ready to supply the services that are going to be needed for the returning vets. And if we can’t even provide those services for soldiers, how could they possibly be available to family members?”

Unfortunately, because the phenomenon of Secondary Traumatic Stress Disorder is just beginning to be recognized, there are no studies on the numbers of people severely affected to the point where they are functioning less well than normal. It might be thousands; it might be tens of thousands. It’s also unknown how long the stress will last even after the family members return home.

“We’ll find out as we go along,” says ben-David. Until we do, they’re on their own–just incidental collateral damage.

RESOURCES:

Military Families Speak Out

Tragedy Assistance Program for Survivors

——————-

Special to WORLD WAR 4 REPORT, Jan. 17, 2005
Reprinting permissible with attribution

WW4Report.com

Military families are urged to face facts: Soldiers will be different when they return

By Peter Schworm, Globe Staff | August 27, 2006

Cathy Carney dreams of her husband’s return from Iraq in loving detail. He steps through a door, and she runs toward him, leaping into his arms for a deep kiss and tearful embrace. He doesn’t say much, just “Hi, Cath,” but smiles ear to ear, the way he did on their wedding day. All around them, mothers are hugging their sons, and fathers are scooping up daughters, but she sees only him. She clings to him and, for the longest time, doesn’t let go.

During Jack Carney’s year long deployment in Iraq, she has replayed the scene in her mind over and over again. She turns to it when she misses him the most, even if it sometimes makes her miss him more.

But, at a recent meeting of a family readiness group at an Army Reserve Center in Brockton, a program trainer cautioned against such idyllic images of soldiers’ homecomings. After the initial joy of the reunion, reservists and their families often struggle to pick up the threads of their shared lives, he warned. Many soldiers returning from war experience a rocky transition to civilian life, and that strain can permeate entire families. Couples, in particular, find it hard to regain their footing, and shouldn’t be disappointed if the old magic doesn’t return overnight.

“Don’t expect perfect in the reunion process,” said Richard Croucher, the director of family programs for the 94th Regional Readiness Command, which oversees readiness groups across New England. “To think you’re both going to continue just the way you were, it’s not going to happen. You’re both different people.”

Family readiness groups are volunteer support networks for relatives of service members who typically meet monthly to share experiences and advice, both on coping with soldiers’ absences and preparing for their return.

The Brockton group is affiliated with the Army Reserve’s 220th Transportation Company, a unit based in Keene, N.H., that was deployed to Iraq a year ago. The unit is poised to return home from Iraq soon, possibly within two weeks, and relatives are counting the days until the homecoming.

The hardships military families endure during deployment receive more attention, but the difficulties they encounter when soldiers return are often just as profound, military and civilian counselors say. Taken together, the toll of the wars in Afghanistan and Iraq are potentially causing “secondary trauma” for millions of Americans on the home front, said Kenneth Reich , codirector of a group of volunteer therapists called SOFAR that has partnered with the Army Reserve to counsel families of several reserve units, including the 220th.

“The scope is staggering,” said Reich, president of the Psychoanalytic Couple and Family Institute of New England, SOFAR’s umbrella organization. “There’s a real ripple effect on the families.”

Reich started SOFAR — it stands for Strategic Outreach to Families of All Reservists — last year after extensive negotiations with the military, and is now coordinating with groups of mental health professionals across the country to broaden the effort. SOFAR, whose members usually meet with small groups of reservists’ relatives, including children, is scheduled to begin working with the Massachusetts National Guard in October, and is also developing a program to train teachers to help children of men and women in the services.

With so many combat soldiers returning from Iraq with serious psychological problems, millions of their loved ones are dealing with the repercussions. Reich said he is struck by the depth of military families’ resilience, but also of their hardships. “The tail of trauma is a long one,” he said.

Croucher and Reich said there is a growing recognition that military families, particularly those of reservists, need counseling before and during soldiers’ return to ease the often-jarring reentry to their former lives. A National Military Family Association survey released in March found that military families experience high levels of anxiety, fatigue, and stress, and called for increased assistance to help families adjust after deployments.

Jaine Darwin, a Cambridge psychoanalyst and SOFAR codirector, said that while the public commonly perceives soldiers’ returns as “VE Day in Times Square,” the post deployment transition is usually daunting.

Essentially, a new father or mother is coming home to a family that has also changed, she said. “You can’t take someone whose life has been in constant danger, drop them back home, and expect everything to be rosy right away.”

Darwin said that families’ daily exposure to intense stress — the nightmares, erratic behavior, and emotional distance — can be traumatizing, and hopes that counseling families will help prevent soldiers’ children from incurring “intergenerational trauma.” SOFAR plans to continue counseling family members for several months after units have returned.

Mel Tapper , the returning combat veteran coordinator for the Boston area, who also works with National Guard readiness groups, said that families who pray each day for their soldier’s safe return find it hard to think of anything beyond that point.

“But, after the initial euphoria, you have to deal with the reality,” he said.

Matt Cary , president of the Washington-based advocacy group, Veterans and Military Families for Progress, said he is lobbying for expanded services for military families after deployment, noting high divorce rates among military couples.

Nancy Lessin , a Boston resident who cofounded Military Families Speak Out, which opposes the war, said that reunions are invariably bittersweet because soldiers return fundamentally changed.

“No one comes back from this war safe and sound,” she said. “Our loved ones who left do not come back.”

In Brockton, a strong kinship pervades the room at the Army Reserve Center as members share smiles, empathetic looks, and nervous laughs. No one mentions the war, except to ask how a loved one is doing, and whether they’ve been able to get through on the phone. They want nothing more than to have their spouses and children safely beside them again, but they understand that reconnecting will take time.

“When they get back, it’s wonderful, but everything’s changed,” said Lillian Connolly , the wife of an Army staff sergeant, Joseph Connolly Jr., and the readiness group leader. “They don’t know what the kids eat, what their bedtime is. You adjust to them being gone and suddenly it’s, “ `Hi, honey, I’m home.’

SOFAR and the group plan to keep meeting after the unit returns. When the unit returned from its first tour, families felt unprepared to handle the anxiety, paranoia, and restlessness many soldiers experienced. This time, relatives believe they will be able to spot the warning signs and have fewer illusions that their lives will resume without a hitch.

Connolly said members started preparing for the unit’s return “as soon as they left,” to minimize the readjustment, and Croucher, who suffered post traumatic stress disorder after serving in Vietnam, counsels patience.

“It takes at least as long as the deployment for you both to get your nervous system back to normal,” Croucher told the group. Many soldiers return home wary and withdrawn, hesitant to show affection, he said.

“They’re still soldiers,” he said. “They’re not husbands and parents yet.”

Carney, a 44-year-old Canton resident, said she is relieved the group will continue its meetings, and that she has tried to remain “cautious about my expectations” despite her excitement that a year that has “felt like five” is nearly over.

As the meeting wrapped up, Croucher urged the group to call if they see signs of erratic behavior.

“Only time will bring your soldier back to you. Remember that.”

Thursday, September 1, 2005

MANHATTAN — Serving in combat can affect the relationship satisfaction of military couples, according to preliminary results of a study by a Kansas State University professor.

Briana Nelson Goff, associate professor of marriage and family therapy in K-State’s School of Family Studies and Human Services, has conducted surveys and interviews during the last year with 47 military couples from Fort Riley and Fort Leavenworth. The majority of the participating couples are married, while the others have been dating for at least a year. In each case, the male member of the couple has served in the war in Iraq or in Afghanistan.

Nelson Goff said her research is the first comprehensive study to compare the similarities between couples who are dealing with the aftereffects of war and those who deal with other similar types of traumatic experiences. Her survey was designed to find and gauge the level of individual trauma symptoms related to the war experience and if they are affecting the couples’ relationship.

All of the men reported war trauma and other traumatic experiences, Nelson Goff said. “The wives didn’t have direct war-related trauma but some have had other traumatic experiences from their past such as childhood abuse, rape or domestic violence, and many reported their husband’s deployment as traumatic to them,” she said.

“What we’re finding is that the individual symptoms of the soldiers and their partners are negatively affecting their relationship satisfaction. The more individual symptoms they are reporting, the less satisfied they are with their relationship,” Nelson Goff said.

The most common individual symptoms of the study’s participants are depression and anxiety, as well as dissociation and re-experiencing the traumatic events.

“It’s actually symptoms of anxiety in the soldiers and their spouses that are most affecting their relationships,” she said. “These aren’t just general symptoms of anxiety; they are specific to the traumatic experiences members of each couple have had,” she said.

“The feelings of anxiety and the re-experiencing of events by the soldiers are specifically related to their trauma symptoms and could be related to their deployment or to other traumatic experiences they have had,” she said. “In the wives, their anxiety may be related to their experiences with the deployment, but that’s not something we know for sure. We will have to get into our interview data to determine this more specifically.”

A large majority of the soldiers identified their deployment as their most traumatic event, Nelson Goff said.

“We found that 82 percent of the soldiers reported that their deployment to Iraq or Afghanistan or an experience related to their deployment was the most traumatic experience they have had,” she said. “Related to that, 24 percent of the wives said that their husband’s deployment has been their most traumatic experience. I think it is quite interesting that nearly one in four of the wives also identified the deployment as their most traumatic experience.”

Her findings about deployment run counter to a 2003 military study taken to assess the mental health of soldiers returning from Iraq or Afghanistan. “That study found soldiers were reporting very low stress related to their deployment,” she said.

Her survey data also suggest that a spouse’s individual symptoms can affect their partner’s symptoms, which is known as secondary trauma.

“The spouses, particularly the husbands’ individual symptoms, are affecting the wives,” Nelson Goff said. “In addition, a spouse’s individual trauma symptoms can predict the other spouse’s individual symptoms. So, one partner’s depression and anxiety can be related to the other partner’s symptoms of depression or anxiety or individual stress symptoms.”

Data from the interview component of her study will be assessed next and should help to enhance her study’s findings, Nelson Goff said. The study has been conducted with some support from the University Small Research Grant program and from the College of Human Ecology.

Nelson Goff, a licensed clinical marriage and family therapist, has dedicated her research to examining post-traumatic stress disorder and the effects of traumatic stress on couple and family systems. A K-State faculty member since 1998, she has spent time in Bosnia-Herzegovina researching how war affects children. She also spent time there working in children’s homes and has sent graduate students from K-State to aid orphans as well. At the state level, she is project coordinator for the Kansas All-Hazards Behavioral Health Program and is in charge of developing and coordinating a state plan for disaster mental health.

Volunteer psychologists and other providers are helping relatives of National Guard and Army Reserve troops in Afghanistan and Iraq cope with the wars’ effects.

By Zak Stambor
Monitor Staff
Print version: page 48

In 1969, Mary Ann Meigs was a new bride whose husband Montgomery, an Army captain, had just been deployed to Vietnam. Soon after he left, she developed a bedtime routine to cope with her separation and anxiety.

“I would lie in bed and reassure myself that today there was no knock on the door,” she recalls. “And that meant that he was one day closer to coming home.”

During the Gulf War 22 years later, Meigs’ 16-year-old son, Matthew, developed his own war-related reaction after Montgomery, now an Army Colonel, took him aside shortly before his deployment to Saudi Arabia. Meigs listed what he expected from his son if he did not return from the Persian Gulf.

Although Mary Ann noticed that her son slept a lot and spoke little of the deployment, she did not learn of the conversation for more than 10 years.

“I had no idea of the burden that he was carrying,” she says.

Her family may have adjusted to the war’s stressors better, she says, had therapy or family support groups been available.

That’s why Mary Ann and Montgomery Meigs, who retired as a four-star general, were founding advisory board members for SOFAR (Strategic Outreach to Families of All Reservists), a group of more than 70 psychologist volunteers offering free individual or family therapy as well as support groups for families of Army Reserve and National Guard members who are stationed in or returning from Afghanistan, Iraq and Kuwait. The group’s goal is to help them cope with the stresses of the war.

Secondary trauma

The Meigs’ experiences as Army family members are not unique, says psychologist Kenneth Reich, EdD, co-founder of SOFAR and president of the Psychoanalytic Couple and Family Institute of New England, SOFAR’s umbrella organization. Indeed, the “secondary trauma” associated with war is extremely far-reaching, Reich says. Separation and anxiety put stress on troops’ marriages and relationships, and often make children resentful or wary of their deployed parents, he notes.

Add to that the experience of war itself: More than one in six soldiers in Iraq who experienced combat exhibited symptoms of major depression, serious anxiety or post-traumatic stress disorder, according to a July 2004 New England Journal of Medicine study (Vol. 351, No. 1, pages 13-22). When those statistics are combined with the difficulties that families of reservists and guardsmen have-few outlets or resources for support or care-their situation can be particularly trying and isolating, Reich says.

SOFAR aims to address those problems by providing a range of psychological services that cultivate the stability of troops’ family networks, encourage families to develop contingency plans and help them effectively manage sensitive problems as they occur.

Between October 2001 and November 2005, nearly 1.19 million troops have deployed to Iraq and Afghanistan, according to Defense Department spokesman Maj. Todd Vician.

Assuming that each of those troops has seven immediate family members-such as parents, spouses, siblings and children-the wars have closely affected more than 8.3 million people, Reich says. Add in neighbors, friends and in-laws, and the two wars may have affected nearly 50 million Americans, he says.

“As people’s loved ones go to war, everyone can figure out what the soldiers encounter in combat,” he says. “[Though] the civilians that are left behind don’t show scars, they suffer enormously.”

Providing relief

To help mitigate some of that secondary trauma, Reich and SOFAR co-founder Jaine Darwin, PhD, a former Div. 39 (Psychoanalysis) president, pitched the SOFAR pilot program to the Army Reserves. After two years of negotiations with the military, the pilot launched last April. The psychologists are working with the Family Readiness Group of the Army Reserves’ 883rd Medical Company, 220th Transportation Company and other units to help families throughout the troops’ deployment alert, mobilization and reunion. SOFAR volunteers provide individual and family therapy and lead support groups on topics like stress management, anger management and general coping skills.

During the Family Readiness Group’s monthly meetings, Darwin or other SOFAR volunteers lead a 20-minute discussion group focused on common emotional stresses and overview SOFAR’s services. They then divide the participants into four breakout groups-parents, spouses, significant others and children-to focus on the specific needs of each group.

The impact of the breakout groups has been enormous, says Rick Croucher, civilian director of New England’s 94th Regional Readiness Command.

“Everyone feels like they get the individual help that they need,” he says. “And it’s helping people direct their emotions in a positive way.”

SOFAR has seen an upsurge in calls for services since the 883rd had its second deployment in October and the 220th had its second deployment in November. Many, Darwin says, are unsure how to cope.

For instance, one soldier’s wife refused to bring their children along to say goodbye on the day he deployed. She said that she couldn’t stand to see them say one more goodbye.

Building an effective model

One of the keys to SOFAR’s success, says Croucher, is the lack of red tape needed to procure services. Since the services are free and do not require health-care coverage, SOFAR requires families to sign only one consent form before they perform services.

Since SOFAR began working within the family briefings last April, Croucher has seen a significant increase in the number of families attending.

“The families feel as though they are getting the personal services they need,” he says.

Although Reich and Darwin say the work has been trying, they both consider SOFAR to be a success. That’s why they aim to expand the program nationwide this year with the assistance of APA Div. 39, the American Psychoanalytic Association and national social work and psychiatry organizations.

“We have a terrific opportunity to intervene and make a difference,” Reich says.

For more information about SOFAR, visit www.pcfine.org/sofarandguard/volunteers.html. To become a local volunteer or make a referral, call (617) 266-2611 or e-mail Jaine Darwin or Kenneth Reich.
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By Peter Gorman, AlterNet
Posted on March 18, 2005, Printed on June 22, 2007

http://www.alternet.org/story/21534/

Lynn Jeffries is a single mother from Lubbock, Texas whose 23-year-old son Nathan was deployed to Iraq in late 2003. A registered nurse who worked for years in an emergency room at a hospital in Lubbock, Jeffries soon found herself unable to take care of trauma patients and left the emergency room for work as a hospice nurse.

“I just started crying at everything,” she says. “I was so angry about this war, but at the same time I felt like I couldn’t fight against it without betraying my son. It just ate at me every day, more and more.”

Jeffries’ depression grew until, she says “at one point I thought of taking my own life in order to get my son home. It’s just made me a little crazy. I’ve never felt so helpless in my life-there are days I could not even leave the house.”

Jeffries’ son was home on leave when she spoke with AlterNet, and she said she was feeling a little better, but was already dreading her son’s redeployment to Iraq (scheduled for early in 2005). “What will happen the day I have to put him back on the plane to go back?” she asks in despair. “I would do anything to have him go to Canada, but he says his friends need him and he can’t leave them.”

Teri Wills Allison, who lives in Austin and is the mother of two boys-one of whom is deployed in Iraq-says that the depression she sank into after her son left for Iraq got so bad that “though I’d never taken pills before, I’ve needed Xanax just to get through the day.”

Secondary Traumatic Stress Disorder

Jeffries and Wills Allison are not unique. They are part of a growing number of military families who find themselves dealing with what psychologists are beginning to recognize as Secondary Traumatic Stress Disorder. Not unlike PTSD, Secondary TSD can clearly be debilitating.

Says Wills Allison: “We, the mothers and fathers of the boys in Iraq, we’re getting by, but barely. Some of them tell me they need a six-pack before bed to fall asleep. Others can’t leave the house for fear they’ll come home to have that call from the military waiting on the machine. Some families are just torn apart by this.”

Some more than others.

During late November, 2004, Marine Lance Cpl. Charles Hanson Jr., was killed in a roadside bombing of his convoy in Iraq. One week later, on Nov. 30, his stepdad, 39-year-old Mike Barwick, entertained guests at his Crawfordville, Fla. home with stories of the stepson he loved so much. Three days later, just hours before guests were scheduled to arrive for a viewing at the home Barwick shared with Hanson’s mother, Dana Hanson, Barwick shot and killed himself. Family members quoted in the local newspapers said it was clear that he simply couldn’t live with the pain.

Misha ben-David, a trained trauma counselor, says he remembers his family growing up being torn apart when his father went to Vietnam. He is reliving the tragedy now that his son is being deployed to Iraq. “The stress on the family is unbearable,” he says. “I can already hear my ex-wife starting to freak out, retreating into a ‘rah-rah, do you love your son or not?’ frame of mind.”

The internal rifts are intensified by the media coverage of the war. “We’ve got so much pressure on us from people like the Fox network to see this as a black and white issue-either you’re for the war and a patriot or you’re a no good, liberal, anti-American,” he says. “Add to that stress that it’s your child that might be killed, or wounded, or permanently maimed and you’ve got a lot of family members going crazy out there.”

The Pentagon’s treatment of its own soldiers – the involuntary tour extensions, multiple deployments, shortages of both body and vehicle armor – don’t help either. And thanks to e-mail, parents are no longer protected from the daily struggles of their children. “It’s not a letter every couple of weeks, where parents can try to imagine that everything is okay,” Lessin says. “With the internet we’re learning that our loved ones don’t have enough food or water or weapon replacements or armored vests, things that leave us feeling helpless.”

“Don’t even get me started on that,” says Sharon Allen, a single mother from Fort Worth, Texas, whose son is in Germany preparing for a second deployment. “While he was in Iraq the first time, my son wrote me that the Halliburton people – who were hired to bring things like mail and water and parts for the troops – said it was too dangerous to go where my son was,” says Allen. “My son said the only way he kept his tank going was to steal parts from another tank. Can you imagine giving that choice to a 22-year-old?”

Wills Allison is just as angry at the Pentagon. “One of my friends has a son who returned home with such PTSD that he had flashbacks of the smell of burning flesh, of the sight of dead people torn to bits on the side of the road,” she says. While home on leave, he crawled to his mother’s bed every night to cry and fall asleep. “And then he was redeployed. His mother is barely holding on. There’s no one in the military there for her,” she says.

Fighting an Unjust War

“Every member of every family who has ever sent a loved one to war has suffered,” says Nancy Lessin from Massachusetts, whose stepson, Joe Richardson, served in Iraq during the invasion and is expected to be called back for a second deployment there any day.

Lessin is a co-founder, with her husband, Charlie Richardson and a friend, Jeffrey McKenzie, of an organization called Military Families Speak Out (MFSO). They started MFSO in November, 2002, after Joe Richardson and Jeffrey McKenzie’s son-who is also scheduled for a second tour in Iraq in 2005-were initially deployed to Iraq. Since its inception, MFSO has grown to include over 2,000 member families-nearly 100 of whom are from Texas.

“We realized we had no place to turn, no one to talk to about our anger at this war, about the feeling of helplessness we had, about our outrage over our sons being used in this unjust war,” Lessin says. “So we started our own organization.”

Lesson, however, thinks the suffering of families is different in this war than in other wars. “The stresses are different,” she says, “because this is a war that didn’t have to happen. This is a war built on lies.” It’s that much harder to accept the price of war when each of the reasons given by the Bush administration – weapons of mass destruction, ties to al Qaeda – have proved to be false.

“They know their sons and daughters, husbands and wives are in harm’s way for nothing, for a war that should never have happened. But they feel terrible guilt about feeling that way. And they know that their sons and daughters, husbands and wives are killing people who didn’t have to die either,” Lessin says. “This is a level of stress that is on top of the normal stress of a loved one being in a war that is justified. And it is beyond almost what a family can take.”

In an essay titled “A Mother’s View,” Wills Allison describes the wedge the war has driven between her and much of her family:

They don’t see this war as one based on lies. They’ve become evangelical believers in a false faith, swallowing Bush’s fear mongering, his chicken-hawk posturing and strutting, and cheering his ‘bring ‘em on’ attitude as a sign of strength and resoluteness … These are the same people who have known my son since he was a baby, who have held him and loved him and played with him, who have bought him birthday presents and taken him fishing. I don’t know them anymore.
Yet speaking out against the war can feel just as difficult: “How can I hate this war so much, how can I fight against it and not betray my son. I feel like I’m betraying him just talking with you,” Lynn Jeffries says.

No Help for the Grieving

The military offers social services and family counseling for husbands, wives and children of servicemen and women deployed overseas. But the services are only available to those who live on base – not many parents do. As a result, they have almost nowhere to turn for support.

There are, however, a couple of exceptions. In August, 2003, under the watch of Lt. Col. Anthony Baker, Sr., who heads the Family Programs of the National Guard, began working with families in crisis situations, sometimes in a one-to-one setting. The Tragedy Assistance Program for Survivors (TAPS)-a non-profit with strong ties to the Department of Defense and the Department of Veterans’ Affairs-primarily provides services to those who have lost a loved one while serving in the armed forces. But director Bonnie Carroll says the people who man the 24-hour hotline (1-800-959-8277) will try to help anyone in a crisis situation resulting from the stress of a loved one deployed in Iraq.

But for most families, MFSO and a few other internet forums are the only places that help fill the void. “It’s the only place I can go at 4 a.m. when I can’t sleep, even with the Xanax, to talk with people who feel like I do,” says Allison.

The military is aware of the stress the Iraq war is having on family members but is unable to do anything for them. Cathy Wiblemo, deputy director for health care at the American Legion, a Veteran’s Administration watchdog group, says that while the VA and the American Legion are very concerned about the issues facing the families of deployed or returning vets, there is simply no funding to provide them services. “We do have a hotline (1-800-504-4098) referral service for family members where we try to find them the services they need in their local community, but in terms of paying for those, they’re on their own,” Wiblemo says.

As Wiblemo points out, the VA is already struggling to do right by the soldiers themselves. “The truth is that the VA is not ready to supply the services that are going to be needed for the returning vets,” she says. “And if we can’t even provide those services for soldiers, how could they possibly be available to family members?”

Peter Gorman is former editor-in-chief of High Times magazine.

© 2007 Independent Media Institute. All rights reserved.