Save Our Vets Newspage 2

Battling the Effects of War
Combat can wound the mind. New science helps
vets from Iraq to cope
By Peg Tyre
Newsweek
Dec. 6, 2004 issue - It wasn't the gunshot wound in the arm that bothered Jose Hernandez when he returned
home to Cincinnati after serving in Iraq. It was the lock on the front door. He couldn't relax until he secured it twice,
three times and sometimes more. Even then he was still on edge. "I kept thinking about the things I saw over there—
shooting on the streets, dead bodies and the terror in people's eyes. I couldn't get it out of my mind," says Hernandez,
who served in the Army's 101st Airborne Division. He stopped sleeping, withdrew from friends and dropped plans to go
back to college. His girlfriend finally demanded that he get help. A Veterans Administration psychiatrist diagnosed
Hernandez with post traumatic stress disorder, or PTSD, a potentially crippling mental condition caused by extreme
stress.
Hernandez says he was one of the lucky ones. With a combination of anti-anxiety medication and talk therapy, his
symptoms have begun to fade. Many of the 170,000 men and women now returning from Iraq and Afghanistan may not
be as fortunate. When they get home, tens of thousands of them will be grappling with psychological problems such as
PTSD, anxiety, mood disorders and depression. Though scientists are learning just how trauma affects the brain—and
how best to help patients heal—there are still many obstacles to getting the treatment to the people who need it most.
For starters, no one knows how many soldiers will be affected or how serious their problems will become.
Early in the war the Army surveyed 3,671 returning Iraq veterans and found that 17 percent of the soldiers
were already suffering from depression, anxiety and symptoms of PTSD.

Experts say those numbers are likely to grow. A study of Vietnam veterans conducted in 1980 found that 30 percent
suffered from an anxiety condition later dubbed PTSD. Experts say the protracted warfare in Iraq—with its
intense urban street fighting, civilian combatants and terrorism—could drive PTSD rates even higher.
National Guard members, who make up 40 percent of the fighting force, with less training and less
cohesive units, may be more vulnerable to psychological injuries than regular soldiers. Last year 5,100
soldiers who fought in Iraq or Afghanistan sought treatment in VA clinics for PTSD. That figure is expected
to triple.
PTSD, a specific diagnosis, is not the only psychological damage soldiers can sustain. And experts say that mental
disorders can make the already rugged transition from military to civilian life a harrowing one. Soldiers can experience
depression, hyper-vigilance, insomnia, emotional numbing, recurring nightmares and intrusive thoughts. And in many
cases, the symptoms worsen with time, leaving the victims at higher risk for alcohol and drug abuse, unemployment,
homelessness and suicide. Sometimes families can become collateral damage. Christine Hansen, executive director of
the Miles Foundation, which runs a hot line for domestic-violence victims in the military, says that since start of the Iraq
war, calls have jumped from 50 to more than 500 a month.
Without treatment, some conditions such as chronic PTSD can be lethal. Five years after the Vietnam War,
epidemiologist's studying combat veterans found that they were nearly twice as likely to die from motor-vehicle
accidents and accidental poisoning than veterans who didn't see combat. In a 30-year follow up, published in the
Archives of Internal Medicine this year, the same combat vets continued to die at greater rates and remained
especially vulnerable to drug overdose and accidental poisoning. "We had the John Wayne syndrome," says Vietnam
veteran Greg Helle, who grappled with severe PTSD for decades. "We were men, we'd been to war. We thought we
could tough it out." Doctors hadn't developed effective treatment for PTSD and besides, says Helle, seeking help was
an admission of weakness.
Doctors now know that PTSD is the product of subtle biological changes that occur in the brain in response to extreme
stress. Using sophisticated imaging techniques, researchers now believe that extreme stress alters the way memory is
stored. During a major upheaval, the body releases massive doses of adrenaline which speeds up the heart, quickens
the reflexes and, over several hours, burns vivid memories that are capable of activating the amygdala, or fear center,
in the brain. People can get PTSD, doctors say, when that mechanism works too well. Instead of creating protective
memories (ducking at the sound of gunfire), says Dr. Roger Pitman, a psychiatry professor at Harvard Medical School,
"the rush of adrenaline creates memories that intrude on everyday life and without treatment, can actually hinder
survival."
Why some people get PTSD and others don't remains a mystery. Recent studies suggest that a predisposition to the
disorder may be genetic and that previous traumatic experiences can make soldiers more vulnerable to it. Once a
soldier has it, though, says Dr. Matthew Friedman, executive director of the Department of Veterans Affairs National
Center for PTSD, the good news is that the medical community now knows that "PTSD is very real and very treatable."
The challenge, says Friedman, is getting help—counseling or drug treatment—to veterans who need it most. As the
Iraq war continues, officials at the Department of Defense and the VA are scrambling. After a rash of suicides among
soldiers, they've increased the number of psychiatrists and psychologists in combat areas. Social workers trained to
spot PTSD and other mental disorders are assigned to military hospitals around the country. Primary-care physicians
at VA clinics and hospitals are now able to access combat records to see if their patients might be at risk for PTSD.
Doctors are issued wallet-size reminders on how to spot PTSD and refer patients for further treatment. The VA has
recently hired about 50 veterans from Iraq and Afghanistan to do outreach in the Vet Centers, a system of 206
community-based mental-health clinics around the country. But their resources are limited: Congress has set aside an
additional $5 million a year for three years to deal with the new mental-health problem.
VA officials admit they're not catching everyone who needs help. National Guard members often do many tours and
can be exposed to more combat than regular soldiers. But instead of rotating back to military bases where they can be
monitored, they often return to their hometowns where readjustment problems can become a family crisis. If they begin
to exhibit signs of PTSD or other psychological problems, they need to get help quickly. The VA will provide mental-
health benefits for them for only two years following their service. Regular soldiers get mental-health benefits
indefinitely.
Help came too late for Marine reservist Jeffrey Lucey. In July 2003, he returned home to Belchertown, Mass., from Iraq
and gradually sank into a deep depression. His family looked on in anguish as he began drinking too much and
isolating himself from their close-knit clan. By spring of 2004, he'd stopped sleeping, eating and attending college.
When his sister Debra Lucey tried to have a heart-to-heart, "he'd describe the terrible things he'd seen and done,"
she says, "and he'd always end by saying 'You'll never be able to understand'." Frantic, family members had him
committed to a psychiatric hospital but he was soon released. A few weeks later he crashed the family car, and the
following month a neighbor found him wandering the streets in the middle of the night dressed in full camouflage with
two battle knives he'd been issued in Iraq. Last June, Jeffrey Lucey hanged himself in the basement of his family home.
Shortly before he died, Lucey talked to an Iraq vet turned counselor at his local Vet Center. "He said he'd
found someone who could really understand," says Debra. But before he could keep his next
appointment, his demons took hold. Now Debra is telling her brother's story in the hope that others find
the help they need in time. Psychological problems, she says, are an enemy that no soldier should face
alone.
© 2005 Newsweek, Inc.

The wounds are hard to see,
and soldiers often try to hide them.
In the field with combat-stress teams
By Rod Nordland and T. Trent Gegax
Newsweek

Capt. Glenn Palmer's worst moment came when he was giving mouth-to-mouth resuscitation to a wounded officer who
had been shot by a sniper while riding in the back seat of a Humvee. Palmer, who had been driving the vehicle, kept
trying to blow, even after he felt his own breath whistling out of a hole in the victim's head. "I still can't get the taste out
of my mouth," says Palmer, an Army chaplain.
Like soldiers in every war, American men and women in Iraq have seen things they'll never be able to discuss easily.
Some feel damaged in a way that can't be repaired; some will find that nightmares begin only many years later. In
World War I, the condition was called shell shock, and doctors treated it in psychiatric hospitals. World War II's
psychologists termed it battle fatigue, and Vietnam's shrinks coined the terms traumatic stress and post-traumatic
stress disorder (PTSD). Today, the preferred term is combat stress, and the military has an official policy for dealing
with it—in the field, as close as possible to the fighting.
Combat-stress units are deployed throughout Iraq, staffed by professionals who give soldiers counseling and advice.
The military hopes that by easing soldiers' troubles in real time, and teaching them how to deal with the horrors of the
job, it will reduce the wave of psychological fallout that always follows a war. Yet combat-stress teams are
controversial. Some soldiers feel stigmatized when offered treatment in the field, and some officers believe it gives
soldiers a psychobabble excuse for malingering. The Marine Corps will field its first permanent combat-stress units in
the coming months.
War-related stress has many symptoms: irritability, frequent urination, diarrhea, tingling in extremities, sudden reaction
to loud noises, insomnia, weight loss, even balding. And the basic treatment in the field is simple, best expressed as
"three hots and a cot." Counselors recommend that stressed soldiers check into special "fitness centers" with real
beds, hot food and 24-hour counseling—where they are encouraged to sleep and relax as much as they want for
three days. After that, most soldiers are ready to go back to work.
It certainly helped in Sergeant Eimers's case. "Before it was the stress of the heat, and then it was the stress of the
mortars—we've had 90 since October," she says. The one that hit near her mess hall, a structure with a fabric roof,
sparked a panic as soldiers jammed into one another trying to get out the doors. She wasn't sure she could go on
soldiering after that. During counseling, Eimers was relieved simply to know that she wasn't alone in feeling anxious.
Sometimes, stressed GI's get more than just therapy and advice. Capt. Robert Ruxin, a stress-team psychiatrist, says
in about a quarter of cases antidepressants are prescribed. The drugs of choice in Iraq are Celexa and Trazodone.
Army Sgt. Janice Smith, who is stationed in one of the hottest areas of the Sunni Triangle, says she takes anti-anxiety
pills to help her cope. "I don't know if I will ever be able to live a normal life again," she says. "It's very hard for us not to
be stressed out when soldiers are dying every day around you."
Some cases cannot be treated in the field. In all, a total of 538 soldiers in Iraq have been "sectioned out," or sent
home for treatment of psychological problems. (The military says many of them had pre-existing mental disorders.)
Still, although the Army will not divulge the overall number of GI's who have received counseling in Iraq, combat-stress
treatment does seem to help keep soldiers on duty. At the 528th Combat Stress Detachment, counselors see from two
to 20 people a day. In Balad, the 113th Medical Company's fitness center typically has a caseload of four soldiers in
the three-hots-and-a-cot program, plus a couple of dozen soldiers who get walk-in treatment every day. Half a dozen
other combat-stress teams are deployed around Iraq.
Some stress-reduction doctrine does have a touchy-feely aspect—talk of "identifying stressors," and therapy that
includes breathing and relaxation exercises—that seems to clash with the standard military ethos. Capt. Robert
DeCarlo, a counselor in Baqubah, says his advice to soldiers is often as simple as doing something familiar. "I like to
bake a cake ... getting a homemade cake really makes people happy." So his C-Hut looks like a Betty Crocker ad,
stacked with cake mixes sent by friends and family through the military postal service. He shares his creations with his
clients. The combat-stress team at Camp Warhorse actively promoted Christmas decorations as a morale booster, with
a DVD player as a prize for the best-decorated hooch.
In a "normal" war, only 10 percent of the Army's forces would be in frontline combat roles—the others would have
support duties and be far from harm's way. Yet in Iraq, all U.S. forces are effectively in combat roles. Typically, 25
percent of frontline soldiers will suffer from combat stress, experts say. Not all of those will go on to get full-blown post-
traumatic stress disorder. But even in Gulf War I, studies put the number of PTSD victims at 5 percent to 10 percent. In
Iraq, with a much longer engagement and nearly all troops potentially in harm's way, the rate could be much higher.
Lt. Col. Daniel Lonnquist, an Army Reserve psychiatrist who works with the stress teams in Baqubah, says he feels a
strong sense of deja vu there. In his civilian practice, he works for the Veterans Administration, counseling Vietnam
vets. At 58, he's also a Vietnam veteran himself, a rarity among troops in Iraq. "There's a lot of macho attitude here,"
he says. Among the Vietnam vets he sees back home, some "took 15 years to deal with their feelings about killing
somebody," he says. "We have vets who for years said 'counseling is not for me' and then had to eat humble pie." In
some respects, he thinks this war will be worse; a greater proportion of the soldiers are exposed to risk, many more
are reservists and, unlike Vietnam, there's been a great deal of uncertainty about how long their tours will last. "I tell
these guys, 'Talk about it with your buddies here because they'll understand ... no one else will'."
Captain Palmer has memories he'll never be able to purge. "I have buried babies caught in the cross-fire and held the
hand of wounded soldiers while the doctor tries to save their eyes and legs," he says. But the hardest was trying to
resuscitate that fellow officer, who died in the field. Palmer called on the combat-stress team for counseling, both for
himself and for other soldiers involved. The initial interview is called a critical-event debrief, or CED; the idea is to get
soldiers talking about what they experienced, and to leave a door open for future counseling. Within a day Captain
Palmer was back in the field himself—doing CEDs for other anxious soldiers.
Within the military, a big selling point for the combat-stress teams is that they keep soldiers fighting; in military
parlance, frontline psychologists are a "force multiplier." The soldiers themselves sense a Catch-22 in that: getting
stress relief so you can experience more stress. Lt. Marivic Fields was giving a combat-stress-prevention class for the
51st Transportation Company at Camp Anaconda recently, in a tent darkened to prevent targeting by enemy mortars.
The assembled soldiers were convoy truckers; their jobs are among the most dangerous in Iraq now. "This deployment
too shall pass," Fields told the group. "Like a kidney stone, it'll hurt, but it'll pass."
"Hey, lieutenant," called one of the soldiers in the back. "You want to get rid of our stress, send us home!"
"Hooah!" they all yelled.
© 2005 Newsweek, Inc.

To Heal a Shattered
Treatment for PTSD
By Arieh Y. Shalev, M.D., and Michael Craig Miller, M.D.
Newsweek

Dec. 6, 2004 issue - We can count the dead. We can see physical injuries. But in soldiers returning home, it's hard
to see the psychological damage among those who have witnessed the blood, heard the screaming, felt the
shattering blast and smelled the burning flesh. Unless they make sense of what they saw and felt under fire, they'll
continue to relive the experiences of war. Fortunately, the human brain—which evolved in an environment of
constant physical threat—is so resilient that horror is usually contained. Most soldiers do not require professional
help. But when coping fails, so does recovery.
In the first three months after a trauma, survivors need to be reassured that they will recover. By talking about their
memories with family and friends, soldiers can begin to find meaning in their experience. They discover the pride in
their sacrifice and they grieve their losses. Talking should be encouraged, but some veterans prefer not to be
pushed, and that wish should usually be respected.

Unfortunately the natural healing process sometimes fails. When survivors become depressed, angry, guilt-ridden or
emotionally distant—all possible symptoms of posttraumatic stress disorder—treatment is critical. Drug therapy often
includes antidepressants, which can alleviate the core anxiety symptoms of PTSD. Stress can exacerbate almost any
mental disorder, so a psychiatrist may also prescribe a mood stabilizer such as lithium or an antipsychotic such as
risperidone. Anxiety-muting benzodiazepines such as lorazepam and clonazepam may actually raise the risk of
chronic PTSD if taken continuously.

Talk therapy, especially cognitive behavioral therapy, also has a role. A psychotherapist may cautiously encourage
the trauma victim to confront ideas and situations, both real and imagined, that trigger symptoms. Treatment may
even include virtual-reality devices that re-create the experience of combat. Talk therapists often encourage patients
to manage their anxiety with relaxation methods, such as meditation or breathing exercises, and with distraction
techniques that shift attention away from distressing thoughts. Ultimately the survivor must come to terms with how
the trauma has changed his or her self-concept, relationships and aspirations.
We may never be able to expunge memories selectively from consciousness, but some researchers are investigating
ways of helping the brain soothe the pain of recollection. Beta blockers, which blunt the adrenaline response to
stress, may reduce the intensity of emotions associated with traumatic memories. And a technique called repetitive
transcranial magnetic stimulation seems to activate the prefrontal cortex, a brain region believed to be responsible
for putting memories in context.
Still, the best treatment is a successful reintegration into civilian life. Storytelling can help turn traumatic alarm signals
into tolerable autobiographical memories. And when the dreadful memories are accompanied—as is likely—by
memories of loyal friends loved and honorable tasks completed, emotional distress can be transformed into
emotional growth.
Shalev is head of psychiatry at Hadassah University Hospital in Jerusalem. MILLER is editor in chief of the Harvard
Mental Health Letter (health.harvard.edu/NEWSWEEK).

Tampa Vet Center is the VA's frontline for returning soldiers.
Dec 15, 2004

The warrior is always in hope that there will be no more wars." --Steve Fletcher, team leader at the Tampa Vet
Center

Sitting in his office at the Tampa Vet Center, it´s all Steve Fletcher can do to speak softly. He whispers, but not like a
kid with a secret. Steve Fletcher whispers like a kid who has done something so great he doesn´t quite know how to
tell you what it was.

Fletcher is about as nondescript as the storefront he works out of. Wearing a pair of jeans and a green ¨Vet Center¨
golf shirt, he doesn´t want to be mistaken for a doctor. And the Center, which sits well off the street in a one-story
brick office building at 8900 N. Armenia in Tampa, doesn´t want to be mistaken for a hospital. That´s the point. The
Tampa Vet Center (TVC) is a place where vets can go for help without having to deal with white coats and
paperwork.

The TVC, which sees an average of 400 clients a month, is a modern-day version of the community centers that
began popping up around the country in the wake of the Vietnam War. These centers, now a part of the Department
of Veterans Affairs, led the way in recognizing and counseling PTSD sufferers. Though TVC works in tandem with
Tampa Bay´s two largest VA hospitals, its mission is still to offer an alternative to the hospitals´ long lines, crowded
parking lots and endless paperwork.

It is a small operation; four combat vets sitting in a quiet office, willing to talk. And as veterans suffering from PTSD
begin to pour out of Iraq, Fletcher and the TVC often act as first responders.

Fletcher -- who, like many VA counselors, is a Vietnam vet -- ....... At his desk, he folds a worn black-and-white
photocopy in half to try and explain what it´s like to come home from war. On one side of the fold is a photograph of
half of a young man´s face. He´s a clean-shaven civilian.

Fletcher flips the picture over, revealing the other half of the same man´s face -- only this time he´s a soldier, his
face stubbled and dirty.

Then Fletcher unfolds the whole picture, revealing the striking image of a man clearly caught in two worlds at once.
¨We want to find this guy again,¨ he says, pointing to the civilian. Then he points to the soldier. ¨But we know this
guy is never going to leave.¨

He knows because Steve Fletcher, the soldier, never left either.