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shadeaux63
Keeper of dreams
Posts: 1092
(2/9/05 10:40 am)
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Gaia
Here's another of the articles I wanted to send you.
A mental health crisis is emerging, with one in six returning soldiers afflicted, experts say.
November 14, 2004
By Esther Schrader, Los Angeles Times
Go to the original version of this article (may require registration).
WASHINGTON -- Matt LaBranche got the tattoos at a seedy place down the street from the Army hospital here where he was a patient in the psychiatric ward.
The pain of the needle felt good to the 40-year-old former Army sergeant, whose memories of his nine months as a machine-gunner in Iraq had left him, he said, "feeling dead inside." LaBranche's back is now covered in images, the largest the dark outline of a sword. Drawn from his neck to the small of his back, it is emblazoned with the words LaBranche says encapsulate the war's effect on him: "I've come to bring you hell."
In soldiers like LaBranche -- their bodies whole but their psyches deeply wounded -- a crisis is unfolding, mental health experts say. One out of six soldiers returning from Iraq is suffering the effects of post-traumatic stress -- and as more come home, that number is widely expected to grow.
The Pentagon, which did not anticipate the extent of the problem, is scrambling to find resources to address it.
A study by the Walter Reed Army Institute of Research found that 15.6% of Marines and 17.1% of soldiers surveyed after they returned from Iraq suffered major depression, generalized anxiety or post-traumatic stress disorder -- a debilitating, sometimes lifelong change in the brain's chemistry that can include flashbacks, sleep disorders, panic attacks, violent outbursts, acute anxiety and emotional numbness.
Army and Veterans Administration mental health experts say there is reason to believe the war's ultimate psychological fallout will worsen. The Army survey of 6,200 soldiers and Marines included only troops willing to report their problems. The study did not look at reservists, who tend to suffer a higher rate of psychological injury than career Marines and soldiers. And the soldiers in the study served in the early months of the war, when tours were shorter and before the Iraqi insurgency took shape.
"The bad news is that the study underestimated the prevalence of what we are going to see down the road," said Dr. Matthew J. Friedman, a professor of psychiatry and pharmacology at Dartmouth Medical School who is executive director of the VA's National Center for Post Traumatic Stress Disorder.
Since the study was completed, Friedman said: "The complexion of the war has changed into a grueling counterinsurgency. And that may be very important in terms of the potential toxicity of this combat experience."
Mental health professionals say they fear the system is not moving fast enough to treat the trauma. They say slowness to recognize what was happening to Vietnam veterans contributed to the psychological devastation from that war.
More than 30% of Vietnam veterans eventually suffered from the condition that more than a decade later was given the name post-traumatic stress disorder. But since their distress was not clinically understood until long after the war ended, most went for years without meaningful treatment.
"When we missed the boat with the Vietnam vets, we didn't get another chance," said Jerry Clark, director of the veterans clinic in Alexandria, Va. "When they left the service, they went away not for a month or two but for 10 years. And they came back addicted, incarcerated and all these things. We can't miss the boat again. It is imperative."
Experts on post-traumatic stress disorder say it should come as no surprise that some of the soldiers in Iraq are fighting mental illness.
Combat stress disorders -- named and renamed but strikingly alike -- have ruined lives following every war in history. Homer's Achilles may have suffered from some form of it. Combat stress was documented in the late 19th century after the Franco-Prussian War. After the Civil War, doctors called the condition "nostalgia," or "soldiers heart." In World War I, soldiers were said to suffer shell shock; in World War II and Korea, combat fatigue or battle fatigue.
But it wasn't until 1985 that the American Psychiatric Assn. finally gave a name to the condition that had sent tens of thousands of Vietnam veterans into lives of homelessness, crime or despair.
A war like the one in Iraq -- in which a child is as likely to die as a soldier and unseen enemies detonate bombs -- presents ideal conditions for its rise.
Yet the Army initially sent far too few psychiatrists, psychologists and social workers to combat areas, an Army study released in the summer of 2003 found. Until this year, Congress had allocated no new funds to deal with the mental health effects of the war in Iraq. And when it did earmark money, the sum was minimal: $5 million in each of the next three years.
"We're gearing ourselves up now and preparing ourselves to meet whatever the need is, but clearly this is something that could not be planned for," said Dr. Alfonso Batres, a psychologist who heads the VA's national office of readjustment counseling services.
Last year, 1,100 troops who had fought in Iraq or Afghanistan came to VA clinics seeking help for symptoms of depression or post-traumatic stress; this year, the number grew tenfold. In all, 23% of Iraq veterans treated at VA facilities have been diagnosed with post-traumatic stress disorder.
"And this is first-year data," Batres said. "Our experience is that over time that will increase."
In the red brick buildings of Walter Reed Army Medical Center, the "psych patients," as they are known, mingle, sometimes uncomfortably, with those who have lost limbs and organs.
One soldier being treated at Walter Reed, who spoke on condition of anonymity, walks the hospital campus in the bloodied combat boots of a friend he watched bleed to death.
Another Iraq veteran in treatment at Walter Reed, Army 1st Lt. Jullian Philip Goodrum, drives most mornings to nearby Silver Spring, Md., seeking the solitude of movies and the solace of friends.
He leaves early to avoid traffic -- the crush of cars makes him jumpy. On more than one occasion, he has imagined snipers with their sights on him in the streets. Diesel fumes cause flashbacks. He keeps a vial of medication in his pocket and pops a pill when he gets nervous.
"You question -- outside of dealing with your psych injury, which will affect you from one degree or another throughout your life -- you also question yourself," Goodrum said. "I trained. I was an excellent soldier, a strong character. How could my mind dysfunction?"
When it began to become clear that what the Pentagon initially believed would be a rapid, clear-cut war had transmuted into a drawn-out counterinsurgency, the Army began pushing to reach and treat distressed soldiers sooner.
The number of mental health professionals deployed near frontline positions in Iraq has been increased. Suicide prevention programs are given to soldiers in the field. According to the Pentagon, 31 U.S. troops have killed themselves in Iraq.
At more than 200 storefront clinics known as Vet Centers -- created in 1979 to reach out to Vietnam veterans -- the VA has increased the number of group therapy sessions and staff. Three months ago, the VA hired 50 Iraq war veterans to help serve as advocates at the clinics.
Officials acknowledge that is only a start. The Government Accountability Office found in a study released in September that the VA lacked the information it needed to determine whether it could meet an increased demand for services.
"Predicting which veterans will seek VA care and at which facilities is inherently uncertain," the report concluded, "particularly given that the symptoms of PTSD may not appear for years."
The Army and the VA are also trying to catalog and research the mental health effects of this war better than they have in the past. In addition to the Walter Reed study, several more are tracking soldiers from before their deployment to Iraq through their combat experiences and into the future.
If Iraq veterans can be helped sooner, they may fare better than those who fought in Vietnam, mental health experts say. And they note that the nation, although divided on the Iraq war, is more united in caring for the needs of returning soldiers than it was in the Vietnam era. And in the last decade, new techniques have proved effective in treating stress disorders, among them cognitive-behavioral therapy and drugs like Zoloft and Paxil.
Whether people like Matt LaBranche seek and receive treatment will determine how deep an effect the stress of the war in Iraq ultimately has on U.S. society.
Before the war, LaBranche was living in Saco, Maine, with his wife and children and had no history of mental illness.
He deployed to Iraq with a National Guard transportation company based in Bangor. He came home a different person.
Just three days after he was discharged from Walter Reed, he was arrested for threatening his former wife. When he goes to court Dec. 9, he could be looking at jail time.
He lies on a couch at his brother's house most days now, struggling with the image of the Iraqi woman who died in his arms after he shot her, and the children he says caught some of his bullets. His speech is pocked with obscenities.
On a recent outing with friends, he became so enraged when he saw a Muslim family that he had to take medication to calm down.
He is seeing a therapist, but only once every two weeks.
"I'm taking enough drugs to sedate an elephant, and I still wake up dreaming about it," LaBranche said. "I wish I had just freaking died over there."
And here's another:
Returning soldiers find reintegration difficult
Sufficiency of mental health services questioned
By DAVID ASEN / Aggie News Writer
Posted 12/03/2004
Within the first summer of the war in Iraq a sergeant of the U.S. Army Special Operations Command Delta Force and his wife were found dead in their home at the Fort Bragg military complex in North Carolina.
The case, largely suspected of being a murder-suicide, represented the last of a string of four similar instances that summer of returned soldiers killing their wives and then themselves.
Despite efforts at and since that time by major military figures and institutions to assign responsibility specifically to the individual soldier in question, many within the field of mental health services suggest such severe behaviors are indicative of larger issues.
According to psychiatrist and UC Davis professor Rick Maddock, the most startling of these larger issues relates to the 20 to 30 percent of soldiers who are, only after extended periods of combat, clinically diagnosed with some psychological abnormality.
"Combat is so extreme [that] it does harm on the person's understanding of how the world works," Maddock said. "It's a fragmenting of life experience [whereby] the narrative doesn't make sense any more and the [returned soldiers] can't put the first book of their life with the new chapters."
The central challenge of the veteran's reintegration becomes rediscovering a sense of purpose amid a life once so far removed. Even while the joy of returning home is immense, many veterans are overwhelmed by grief, anger, depression and guilt.
Maddock described these reactions as a direct function of the traumatic experiences of war: seeing fellow soldiers killed in combat, the challenge of distinguishing civilians from enemies, combating enemy insurgency and living up to the extreme pressures of military duty.
In any combination, these reactions recurrently lead to post-traumatic and/or acute stress disorders which in turn manifest negatively through substance addiction, homelessness, emotional and communicative numbness or physical illness.
Though no one is immune to the effects of war, some soldiers are simply better equipped for coping with painful stressors. Those who aren't too frequently go unnoticed for extended periods before and after deployment.
Ted Puntillo, a Davis city councilmember and Vietnam veteran, cited the U.S. Military's inadequate screening of these "people who can't cope" as a principal factor in the proliferation of posttraumatic psychosis.
"Half of the people I talk to who come back [from the Iraq War] have some sort of PTSD," Puntillo said.
Even Puntillo himself, who maintains a positive remembrance of his Vietnam experience, struggled for a period with episodes of hyper-vigilance -- a common symptom for nearly all newly returned soldiers.
"When I first got back I went through a shock," Puntillo admitted. "I'd be looking for dead bodies and bullet holes everywhere I went."
The predominance of guerilla-style warfare -- with no definitive front line or clearly distinguishable enemies -- intensifies the soldier's struggle to reintegrate.
Even after actively seeking discipline and self-improvement both physically and scholastically, Dan Wolrich, a UCD student and veteran sergeant with the 15th Marine Expenditure Unit in Iraq, quickly found the atmosphere of war to be "unbelievably exhausting."
"Life over there was unpleasant in every sense," Wolrich said. "War really sucks [when] you see friends suffer, [and] Iraqis suffer."
Still, Wolrich ultimately defined his military career as a Russian cryptologic linguist as "fortunate," especially in hindsight. However, much of Wolrich's good fortune and success as a veteran is due in part to the clinical attention provided to him before and after deployment -- attention not necessarily provided as readily to less specialized reservists.
Soldiers who are identified early on as having some mental health issue can take advantage of a range of social work programs in and around military bases. These programs operate under a practical paradigm of prevention and treatment of the problem through pre-deployment briefing and post-deployment therapy.
Whether out of volition or requirement, Puntillo considered that "just having someone to talk to can help."
Yet despite all that is offered, many feel that undiagnosed soldiers still slip through the cracks.
Last May over a dozen members of Congress addressed this growing concern in a signed letter to Secretary of Defense Donald Rumsfeld demanding more ample mental-health services for active-duty and reserve personnel and their families.
Since then, two programs in particular, Courage to Care and Operation Comfort, have established both actual and web-based mental health services: networking psychiatrists, therapists and other such professionals in the mental health field.
These programs strive to achieve stable-minded veterans like Puntillo and Wolrich.
"When I graduate I hope to get a job that really matters," Wolrich said. "If there's something I can do to help prevent suffering, it is definitely high on my list."
Edited by: shadeaux63 at: 2/9/05 10:48 am
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shadeaux63
Keeper of dreams
Posts: 1093
(2/9/05 10:54 am)
Reply
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Re: Gaia
I found this one,and think it applies more to what you hope to be able to do with Kirk.I hope it helps.
For Anguished Vets, the Listening Cure
By Paula J. Caplan
Sunday, September 5, 2004; Page B02
In 1996, in his late twenties, Robert joined the Army Reserve to get help with college tuition. The reserve's demands weren't much of a hardship -- until 9/11, when his life was turned upside down. First assigned to full-time duty as an airport guard, he was sent to Kabul eight months later. In Afghanistan, he counted the minutes until he could get back home. But when he did, half a year later, he found himself "all at sea." The people around him, he felt, "acted like I'd never left. For them, nothing was different." His feelings of turmoil were exacerbated by an uneasy sense that he had no right to them, as his unit had been shot at only once.
When he couldn't shake feelings of depression after nearly a year at home, his sister finally suggested that he see a therapist. It seemed like the obvious solution to her, and I can see why. After all, we sent many Vietnam and Gulf War vets behind psychotherapists' doors to deal with their anguish, and we've come to think it's the best thing to do. Unfortunately, in our over-psychologized society, we've also come to think that it's the only thing to do.
The fear factor: We must reassure soldiers back from war, the author says. (Michael Robinson-Chavez -- The Washington Post)
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We've failed to learn what the vets of previous wars have taught us -- that although therapists clearly help some soldiers, there is only so much emotional damage from war they can fix. Leaving this work to psychotherapists alone may be not only harmful to the soldiers but also dangerous for us as a nation, because it helps hide the consequences of combat, making it easier for us to go to war again the next time.
Simply sending frightened, angry soldiers off to therapists conveys disturbing messages: that we don't want to listen, that we're afraid we're not qualified to listen, and that they should talk to someone who gets paid to listen. The implication is that their devastation is abnormal, that it is a mental illness, and this only adds to their burdens. Yet since there's intense debate even among experts about the definition of mental illness, it's all the more important for the rest of us to let returnees know that we don't consider them weak or crazy for having problems.
According to U.S. Army reports, the suicide rate for American soldiers in Iraq is 17.3 per 100,000, nearly five times the rate for the Gulf War and 11 percent higher than for Vietnam. As of March this year, seven soldiers had committed suicide after returning from Iraq. Clearly, the emotional casualties of this war are already extremely high, and it is likely that the longer troops remain in Iraq and Afghanistan, the worse they will get.
Many soldiers' first instinctive response to witnessing the horrors of war is to repress their feelings and never talk about them. Traditional prescriptions for men to be tough intensify the expectation that, no matter how soldiers suffer, they should handle it alone. As more women take on combat roles, the same expectations now also apply to them. So, having seen a buddy blown to bits or realizing that they have killed an Iraqi child, many soldiers choose to suffer in silence. Some do so to protect their loved ones. Others fear the pain of telling their stories and not being understood.
That's what happened to one soldier serving in Iraq with whom I talked. He described how hard it was to sympathize with his fiancee in Dubuque when she wrote about daily frustrations like her car overheating, even as he was reeling from the shock of being reviled as an invader and occupier by the Iraqis around him. "It's hard to have any long-distance relationship," he told me, "but from Dubuque to the war in Iraq is impossible." After a three-week leave, he was headed back to the war zone, his engagement ended.
Help for traumatized troops must really begin on the battlefront. Yet the military's response has been largely inadequate, even misguided. When soldiers have breakdowns in combat, military therapists give them a little rest and a chance to talk with a counselor, then send them back into the fray, rationalizing that this helps prevent "survivor guilt." But sending psychologically fragile soldiers back into combat is wrongheaded; they'll likely feel guilt no matter what. Instead, therapists should advise commanding officers that these are the last people who should be sent back into battle. They should also seek ways to help the soldiers handle survivor guilt, such as pointing out that their deaths would not guarantee that others would live.
One military program, called Operational Stress Control and Readiness, or OSCAR, provides treatment in combat zones that includes antidepressant medication, usually Prozac. Though no one would begrudge a soldier anything that might dull the terror of combat, the truth is that the feelings they experience don't disappear and will have to be dealt with eventually. And there's something Brave-New-World-like about sending people into situations where they're endangered and feel helpless, and then when they crack, giving them drugs to change their brain chemistry so that they can return to battle.
The military also touts its debriefings for soldiers heading home. With these programs, which often last 10 days or fewer, it hopes to decrease the violent behavior some soldiers exhibit when they get back home. The Army increased its counseling after three soldiers back from fighting in Afghanistan were accused of killing their wives in 2002. Returnees are alerted that they may have nightmares and short tempers, reminded that their wives have been making all the decisions and may not want to give up that power, and warned that their young children might not recognize them. That's a good beginning, but for many, the debriefings are inadequate, and their very brevity can imply that this should be all they need to "get over it."
But even with forewarning, the reality of having your child fail to recognize you can be devastating. Some counseling may work for some soldiers, but other advice -- buy some flowers for the wife, take the kids to Chuck E. Cheese -- may fail to smooth the troubled waters of homecoming. It's no easy matter to know what will help, but even though the answers are neither simple nor obvious, the ongoing project of seeking them is a social responsibility.
Every one of us needs to shoulder a bit of the burden of helping our soldiers and our returning civilians with their reentry into ordinary life back in the United States. In June, I was at the bank when I heard a customer with red crew cut hair boast, "We were with the 82nd that got Saddam." When the bank teller expressed awe, the soldier retreated a little, saying, "Well, I didn't actually see him. But some of our guys did." Another customer said, "Thanks for keeping us safe," and the soldier straightened up and boomed out that he was headed for Afghanistan soon. "Gonna get bin Laden," he declared loudly.
As he walked past me on his way out, I remarked quietly that I was frightened for him. His straight-as-a-board posture vanished, and he said, "I got stabbed in Iraq. We're sitting ducks. And it's weird being home. Can't stop watching my back." Given a chance to voice anything other than the expected bravado, out came his natural feelings of vulnerability. We need to let returnees say they were scared and let them know that's not crazy. We must also allow them to tell proud war stories when they want to. When they wish to talk, we must find non-psychiatric, non-pathologizing opportunities for them to do so openly, while also supporting them if they choose to see a therapist. And when they need silence, we must respect that, too.
In any case, a recent study in the New England Journal of Medicine revealed that enormous numbers of soldiers won't see therapists. It showed that 38 percent of soldiers thought to be mentally ill did not trust therapists, 50 percent worried that seeing one could harm their careers and a full 65 percent feared being seen as weak. Realistically, these barriers to therapy won't be overcome anytime soon.
So we citizens must accept the social responsibility of telling returnees not only that we will listen but that we will listen for as long as they want to talk about how it felt to be over there and how it feels to be back. We need to tell them not to censor themselves for fear of upsetting us, offending our sensibilities, making us feel helpless to help them or making us angry at them. If we fail to do this, then we become complicit in concealing some of war's most devastating consequences. And to refuse to face these fully is to increase the chances that we will go to war again.
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