Healing Our Broken Heroes

    *The following is a college research paper written by a friend, Madyson Darcy, on a very timely subject: that of PTSD in our post-war soldiers returning home -- past and present.  Part of the assignment includes publication in a public forum.  Hence, it has earned a spot as a post in my blog.  Feel free to leave any commentary.

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            This is a difficult interview for Vietnam War veteran, Larry Eubanks, who has agreed to dredge up and relive horrific moments that are forever etched in his memory.  While it is hard to hear, it must be even harder to express.  His eyes flash in a face deeply cut with lines left behind by age and troubled times.  The effects of war – fighting, death, chaos – have plagued his troubled mind for years. He recalls his combat experience,  “…we couldn’t distinguish who the enemy were…frontal attacks, inside wire compound…sneak attacks, snipers, mortars, rockets, land mines, sneaky stuff  (Eubanks, 2011).”

 He went on to describe his inability to complete a second tour, “I was having nightmares, and they couldn’t have that…I was waking up screaming, that gives away your location.” He explained how he began to develop what they now call Post Traumatic Stress Disorder or PTSD, although during Vietnam it was referred to as Combat Fatigue, “I became more flaky…depression, agitation, more upset than situations were…crowds made me uncomfortable…loud noises bothered me…” For Larry, PTSD would last for years without proper treatment, leading to a troubled life filled with run-ins with the law, institutionalization, relationship problems, and a long list of medications.  Returning to civilian life continues to be a complicated, frightening and an uncertain time for thousands of men and women just like Larry who are arriving home after serving in war.  But with today’s advances in the mental health field, providing good restorative mental health care to these combat-weary warriors can diminish years of mental suffering, crime and domestic tribulations.

 Post Traumatic Stress Disorder

The complications associated with PTSD are unsettling and disruptive in the lives of people who are caught in the tumultuous ocean of emotions, such as anxiety and fear. This storm of difficulties is triggered by a traumatic event in which the person was exposed to a near death experience; serious injury or threat of both to either themselves or others and their response to these situations was extreme fear, helplessness, or horror. Often recurring intrusions in their lives is evident by interfering thoughts, frequent images of the event, dreams, nightmares, and even the feeling of reliving the moment of terror with episodes of flashbacks (American Psychiatric Association, 1994). There are also triggers that will ignite the distress such as movies, loud sounds, or reminders that represent the traumatic event.

 When these emotions and associated symptoms become overwhelming to those experiencing them, they will begin to withdraw in order to reduce the stimulus that is causing the discomfort. Some combat personnel will not discuss the event causing them the pain, they will avoid activities, and people that have too close an association with the disturbance, such as their own combat brothers. The withdrawal becomes so complete that the person will begin to exhibit diminished emotions and the inability to connect in a loving way with those around them. In addition, they will begin to have an empty regard for the future and any plans to prosper, marry, have children or experience a full long life (Center for Substance Abuse Treatment, 1993).

As a result of these signs, symptoms and triggers, soldiers are thrust into an unmanageable life, in addition to at least two of the following symptoms: trouble falling and staying asleep, irritability or angry outbursts, problems concentrating, hyper vigilance, and a hypersensitive startle response to loud noises or sounds (Center for Substance Abuse Treatment, 1993). In order for there to be a diagnosis in the true sense of the word, these symptoms would persist for more than one month and become a problem in the person’s social, professional and/or personal life.

An interview with Rob, a Scout Sniper who served two tours in Iraq, yielded a story which exemplifies the details of PTSD’s numerous symptoms and effects almost to a tee. When asked how PTSD had affected his life, Rob recalls, “Well prior to developing PTSD... I had many accomplishments in the Marine Corps: I was promoted to corporal, was high shooter in my class, and was given a certificate of accommodation for my action in Iraq. I was also given a meritorious mast for action in Kuwait prior to Iraq. I completed numerous schools, graduated top of my class in nearly all of them, and I was a scout sniper team leader. After Iraq I pretty much fell apart I didn’t care about anything. I didn’t care about being a Marine anymore (Ziarnick, 2011). ” He went on to describe the symptoms which slowly eroded his mere existence. “I began having nightmares, night sweats, paranoia, anger issues, extreme irritability, and I carried a firearm everywhere I went…I was paranoid. I didn’t feel safe.” He also spoke of having deep depression, suicidal thoughts, and intense guilt and shame over what he saw in Iraq. He stated, “I avoided most people. I tried to avoid even my closest of friends -- even guys I fought with in Iraq.”

Subsequently a person needs to be diagnosed with PTSD by a professional such as a psychiatrist, psychologist or other qualified mental health clinician. The suffering soldier would sit down with the qualified professional who will collect an extensive history, and inventory the existing signs and symptoms. This information is gathered into a report and cross-referenced with the Diagnostic and Statistical Manual of Mental Disorders 4^th Edition, or DSM-IV (American Psychiatric Association, 1994). This book contains thorough diagnostic criteria for nearly 300 mental illnesses and is the accepted medical standard for ‘official’ psychiatric diagnosis.

Broken Heroes

War has left its wounded behind on the battle field for decades upon decades, but a new battlefield is strewn with bereaved infantry, medics and other battle weary souls. The wounds of war are far reaching and often times not evident to those of us who have never been to war. Walking among us in the supermarket, gas station, library or other public forums, are the men and women who carry the images, sounds and smells of war that we will never truly know or experience. Their minds and hearts carry the lesions of war’s aftermath; a sense of danger, a heightened sense of fear, death, anxiety and the ever watchful eye looking for the enemy that wishes to take the very breath they fought to keep so they could return home.

Back at home, soldiers are returning in droves and have not been prepared for the ramifications of war.  In Fort Carson, CO., PTSD rates have risen 4,000 percent since 2002 (Edge, The Wounded Platoon, 2010). In addition, research and coverage on media outlets indicate that nearly 30 percent of men and women returning from war are experiencing PTSD, traumatic brain injury and suicidal ideation (Victor Montgomery III, 2009). A spike in criminal behavior, violent crimes, substance abuse, domestic violence, and suicides has prompted people to take notice. A recent report by Frontline called, “The Wounded Platoon,” followed the homecoming of a platoon of soldiers from Fort Carson, Colorado (Edge, The Wounded Platoon, 2010). The documentary found that a majority of those returning are so troubled by the residue of war that they have difficulty fitting back into society and end up unemployed, isolated, or worse, in prison. Reporter Christopher Buchanan takes an investigative glance at a group of forty-two Army soldiers who fought side by side in Iraq for two tours and found an astonishing trend was taking place in nearly all of these men’s lives: Post Traumatic Stress Disorder.

Buchanan realized, as he sat interviewing one of the platoon’s men, Kenneth Eastridge, that soldiers are wholly unprepared to reenter civilian life and the number of complications associated with PTSD is rising. Eastridge had been sentenced to 10 years in prison for his part in a murder of a fellow soldier upon return from Iraq and after being diagnosed with PTSD (Buchanan, 2010). Buchanan recognized that Eastridge was only one of the many examples of what happens as a result of untreated combat stress; he decided to see if the other men Eastridge fought with had similar experiences.

Buchanan’s searched netted him all but two of the men from this platoon; unfortunately, those two soldiers died in Iraq.  What he found was an astonishing array of stories from men who tried to piece their lives back together on their own, while suffering from anxiety, depression, nightmares, fear and anger. Some self-medicated with alcohol and drugs, while others isolated themselves by taking jobs which require long stints of time away from home, such as positions which follow pipelines or railroads.  Some of these men do not have homes of their own: they are staying with family or friends and cannot find employment. Still others are suicidal.

Nearly seventeen military veterans in the United States will succeed in committing suicide everyday (Victor Montgomery III, 2009). One soldier, Ryan “Doc” Krebbs, spoke of his suicide attempt after his return to civilian life, recounting his feelings of worthlessness, comparing the notion, “I was a medic over there. I had an important job. And then when I got here, life just seemed pointless, and it seemed like I was just a burden to anybody that I was important to, so I just said, ‘fuck it’ (Buchanan, 2010).” His wife was able to get him to the hospital in time to save his life. Since the attempt, he has vowed to never again attempt suicide as he recalls the pain left in the wake of the suicide of another member of his platoon -- a fellow medic and one of the deceased Buchanan was unable to find. 

Stigma

“The government is awesome at getting men ready for war, but they can’t get them back to civilian life and a humble heart,” –Junior enlisted Marine, Post Iraq (Hoge, 2010).” When building an army to fight a war, it has become essential to steel the minds and bodies of those that will step into battle in an effort to keep the front lines strong and ensure victory. Unfortunately, the government is ill equipped to deal with or understand the issues that are being faced by returning warriors. When these men become ill, overseas and at home, they are often times discouraged from seeking help. The idea behind talking about having PTSD is taboo, “The stigma from some leadership is that you just shut your mouth and keep on going”, Jim Naughten, platoon leader for the Third Platoon, Charlie Company, 1^st Battalion, 506^th Regiment, 2^nd Brigade Combat Team, 2^nd Infantry Division  (Buchanan, 2010). When this idea is so pervasive inside the ranks, it can make it difficult for anyone to want to seek help because of the fear of being labeled a “pussy,” or “coward” , thoughts that are so engrained in their minds, they override any common sense or desire to get help (Buchanan, 2010).

In a book called “Healing the Suicidal Veteran” a therapist named Victor Montgomery III. M. C, who works with suicidal veterans, has identified numerous times with men who have a macho mentality that has driven them to the edge of destruction and only with coaxing and trust does he talk them through the wall of silence. He states to a suicidal marine, “Listen to me, buddy; I understand how difficult it is for you to ask for help. Many combat warriors have thick skin and a tough constitution. You are a seasoned warrior and have learned in combat to suck it up and stuff your feelings (Victor Montgomery III, 2009).” He goes on to talk him through his fear of speaking up and allowing the Veterans Administration services to assist him in reducing his symptoms.

Vets helping vets is a good start, as the encouraging words of Vietnam veteran Larry Eubank exemplifies this motto, “…there’s a lot of other vets over there at the VA hospital check um out go to the VA play games with them go to the wise guys [who]--
are sorting stuff out, rather than something to duck. Its mental illness, there’s a stigma associated with it, [a] special stigma with vets, false pride you don’t ever want to admit you fell apart in battle, it’s hard to face, seeing other vets who go to group, the other guys are doing it they look normal to, I will go with them and hang out. It was interesting then the first groups and counseling I attended I was just there to listen I got emotional I realized I got baggage (Eubanks, 2011).” Knowing that other veterans have similar feelings can be the initial step to getting these warriors the help they need.

If these soldiers rely on feelings and pride alone to push them through the pain, fear, and anxiety, there is little chance for survival. It is only with the help of the military, civilian treatment facilities, other veterans and Veterans Administration programs that these soldiers will be able to step outside the confines of military toughness. Only then will they realize that the courage it takes to seek help is nearly as important to muster as the courage required for fighting in a war. 

 Healing

Growing concern over the mental state that some soldiers are in following their return from war has left the mental health system and military personnel with a tough job on their hands. The question then is, how do they prepare ahead for the possibility of PTSD, diagnosing those who have PTSD and treating the already suffering veterans of many past and present wars? In an effort to deal with these dilemmas professionals have joined forces and created treatment options, support groups and even an in-patient treatment facility to help these wounded warriors cope with their mental anguish. Treatments vary according to the individual’s needs however; exposure therapy, Eye Movement Desensitization Reprogramming or EMDR, group and animal therapies, along with medication are all commonly used to alleviate suffering.

In Pueblo, Colorado an in-patient treatment facility called Havens Behavioral War Hero Hospital at St. Mary Corwin opened its doors to veterans of Iraq and Afghanistan who have run into problems within their daily lives due to the effects of PTSD. Travis Waters, a Psychiatric Physicians Assistant who is employed at the facility recently retired from the military after 20 years of service in the Air Force and found himself drawn to the aid of these fellow men and women suffering from PTSD (Waters, 2011). He spent his last 7 years as a Captain serving medical needs of fellow service men and women. When asked what prompted him to work with soldiers with Post Traumatic Stress Disorder, he expressed the sadness of seeing men and women who worked in his medical unit, returning from Iraq with PTSD symptoms. He added, “…the medical unit saw the people that were injured and they saw people’s faces mortared, it wasn’t the front line but they still got exposed to it (Waters, 2011).” So when the opportunity came, he stepped in to work at the only in-patient PTSD treatment facility in the nation.

            His main responsibility at Haven is providing for the medical needs of patients. He stated, “The hospital currently serves twenty-three patients; five are women and most suffer from PTSD, although there are some with Traumatic Brain Injury or TBI, anti-social issues, psychosis, mood disorder, schizophrenia and behavior issues.” He said that many of the patients suffer from nightmares, which are treated with sleep aides such as; Mini Press at 1 to 12 mg depending on the severity. Other symptoms include agitation, anxiety, nervousness, and sensitivity to loud noises.

When asked what treatment was like at the hospital and how many hours they spend in treatment, he stated, “They spend 20 to 30 hours a week on different group therapies and individuals therapies.” He mentioned the main treatments used are Cognitive Behavior Therapy, Eye Movement Desensitization Reprogramming, and In vivo Exposure Therapy. These types of treatments are done by asking the sufferer to relive a traumatic event over and over in their mind, until they become desensitized to its jarring effects or they can see past the pain and live through the memory more calmly. Each person is also asked to spend time writing about events that present him or her with the most difficulty in dealing with memories, they then are asked to share this with the group and in individual therapy. One truly unique aspect of treatment is the “therapy dog program” which provides dogs for many of the men and women suffering with PTSD and the like. Travis stated, “I have seen the guys do really well with it, it tempers their anger. The dog is a queue; it gives them the idea to take care of ‘dog’ and calm down.”

            Generally these soldiers are referred by their command or by their mental health facility at their base or host station. Although acute patients only stay for one to two weeks, with the average length of stay being 28 days. It can be extended further if they uncover issues that need additional work. Mr. Waters pointed out that some patients do try to avoid returning to their units because they know they will be shipped out again or face separation from their units. If separation occurs, the men and women are put through what is called the Warrior Transition Unit; where they will receive job training work-shops, debriefing and are discharge however the military sees fit (Buchanan, 2010). This type of separation is extremely hard for someone who has spent the last 2-3 years learning how to be a soldier and now have to realize they will never do this again.

            A sad point Mr. Waters brought out in the interview, was that these men and women are often exemplary soldiers prior to trauma, when they are diagnosed, treated and sent back they are often times separated from service without benefits because their symptoms had created disruptive behavior. The defense department does not want to provide provisions for these broken warriors, nor do they want to admit they were partly to blame for their being broken.

There are also support groups offered by local Veterans organizations along with help from the more than 153 Veterans Administration Centers or VA Centers located around the United States, which connect those with PTSD symptoms with counselors and doctors who then may prescribe medication to reduce anxiety and help with sleep (Buchanan, 2010). Veterans Suicide Hotlines are teaming up with Psychiatrists, Psychologists, and other mental health providers to assure that these heroes do not fall through the cracks.

Hope

The transition from a war zone to a domestic life can be a confusing contradiction for some returning heroes (Hoge, 2010). The days of adrenaline rushes, near death experiences, loud bombs, gunfire, and constant stress are now over, although reminding the body can be a difficult task. If these military warriors can be given the approval to ask for help, which will diminish the shame they feel for thinking they are not strong enough, they can get the care they need and have a more suiting welcome home. With help from caring professionals, an alert military transition unit and a more willing role of self-recognition; suffering can be reduced with treatment and we can heal our broken heroes.