Combat Fatigue

Jeanine Plant
November 10, 2006

Gordie is 25 years old and can't bear to drive a car. He's stopped shopping at Walmart because the sound of children crying and parents yelling was too disquieting. For months, when he went to bars, he couldn't stomach people standing behind him. One day while ascending the steps of a South Philadelphia subway station, he spied five women wearing burkas, broke out into a cold sweat, restrained an overwhelming anger, and had to stop walking to regain composure. Lately, he's been having trouble sleeping.

Gordie's experiences are not uncommon, however disturbing they may seem. From 2004 to 2005, he served as a sergeant in Iraq, and now believes he's suffering from Post Traumatic Stress Disorder (PTSD), the psychiatric affliction that can follow military combat or exposure to a threat of death or serious injury.

According to a March 2006 study published in the Journal of the American Medical Association, 20 percent of Iraq veterans will suffer from some sort of mental health problem when they come home. Many of these veterans -- including the youngest among them -- will experience symptoms associated with PTSD. Some will seek treatment while others will suffer in silence.

Though Gordie hasn't been diagnosed yet, he exhibits some core characteristics of the disorder. He doesn't drive a car because when he has, he says there is an "intense rush that comes back." It reminds him of the fear he felt riding a Humvee in Iraq; it was struck several times by roadside bombs.

"It was getting to the point where I was missing work, because I didn't want to drive to work," Gordie said. He's now interning with Iraq Veterans Against the War, an anti-war group based in Philadelphia, Pa., and he doesn't have to drive to get there. But he's not alone in having trouble staying employed. According to the U.S. Bureau of Labor Statistics, 15 percent of veterans aged 20 to 24 years were jobless as of November 2005.

Gordie's aversion to driving may be a symptom of "avoidance" or "unwanted remembering." His behavior in bars could be understood as "arousal" or "hypervigilance." His encounter with the Muslim women on the streets of Philadelphia precipitated what's called "physical activation."

"Irritability and anger is a common issue, but one we see universally is hypervigilance," said Greg Leskin, the acting assistant director for the National Center for PTSD, a special program in Palo Alto, Calif., within the U.S. Department of Veterans Affairs (VA).

Demond Mullins, 24, is another recent veteran who served in Iraq as part of the U.S. Army National Guard from 2004 to 2005. He has been diagnosed with PTSD and describes classic hypervigilance tendencies: "I would go out to eat with my girlfriend, and I would always want to sit in the booth so my back could be up against the wall, so I could watch people."

Hypervigilance, unwanted remembering, trouble sleeping and physical activation are just a handful of the symptoms associated with PTSD. Others include disturbing nightmares, reliving the traumatic event, avoidance -- of family, of places, of topics -- anything that might elicit the unnerving sensation of being back in Iraq. And detachment.

When Gordie came home for a 30-day leave period from Iraq, he said he isolated himself at his brother's apartment. "I just freaked out," he remembers. "I didn't want to be around family or friends. I was getting stoned all day long. Everywhere I went, I felt like I was going to freak out because I didn't have a rifle. I couldn't stand being in a crowd."

He also says he's felt estranged from his family since he's been back. When he tells them some of what he's been through, he's greeted with unsatisfying responses. "Most people just look at you," he says.

Mullins has felt the same way: "If a vet tells a civilian about his experiences, that he's killed people, either the civilian distances himself from him or praises him. Both of them are not reactions that the veteran wants him to have. On the one hand, [the veteran] wants feedback, but then he realizes how alienated he is."

The source of alienation

Gordie has seen innocent civilians arbitrarily assaulted in their homes. He's seen the deaths of fellow soldiers, a car shot up, on fire, "covered in melted flesh," and rounds of ammunition fired randomly into unknown villages. A ten-year-old boy was shot, while Gordie watched, unable to help, because he was behind a line Gordie was not allowed to cross. The young vet describes a woman whose entire face had been blown off. "That face was gone," he says, "and I can't stop thinking about it."

Mullins has also seen what he calls pure "recklessness." He says he's witnessed "kids killed, innocent people killed." And now, in retrospect, he finds himself in a stew of remorse, questioning everything. "Maybe I should have objected. Maybe it wasn't on purpose."

For 22-year-old Joshua M., who served as a medic in the airborne infantry in Iraq from 2004 to 2005, the problem is not what he's seen, but what he's still seeing.

Just the other morning he says he looked outside his college classroom windows in Manhattan, and was transported to Iraq. The faded red brick triggered the image of a pool of blood. He said his hands felt like they were covered with the stuff. He could feel his helmet and his uniform. He was returned to a fateful night when he and his unit mistook for criminals a group of "innocent [Iraqi] civilians" who had merely been racing to get home before curfew. Joshua says he saw their parents there, too. His eyes welled up with tears right there, in the middle of class.

"In adulthood, (18 to 60 years of age) core symptoms remain static," Leskin wrote via email about the differences between older and younger patients with PTSD.

"However, they get manifested in age-appropriate ways. For example, perhaps due to concentration problems secondary to PTSD, a younger person might struggle at school. Perhaps a younger person becomes more affected socially (alienation) due to anger problems. While this is certainly true for any age group, there might be particular vulnerabilities at the younger age."

Leskin says he treats his patients accordingly. For some younger, more tech-savvy patients, he says: "We are delivering psycho-education via iPod technology. We are using virtual reality therapy."

Joshua keeps his intrusive thoughts at bay Lithium and Paxil and speaks to a social worker for 45 minutes every week, a service that is covered through the VA for two years.

Mullins sought help from the VA last November, after being home for two months, but was largely disappointed. He visited with a social worker who dredged up his family life prior to the war, which compounded his level of frustration. "I think that it is very possible that she was trying to touch on something else to attribute all of my frustration to that, rather than to my experience in the war."

Mullins' social-worker sessions lasted all of three weeks. "Talking to a civilian wasn't working for me," Mullins recalls. "This woman had absolutely no point of reference." Fortunately, in the last six months, he's found that his symptoms have subsided.

Gordie, on the other hand, still feels debilitated in many ways. But when he sought assistance from the VA, he became impatient with their protocols. "You go from one line to another," he says. While sitting in one waiting room, Gordie says he saw vets from other wars, "men with canes," and became so unhinged, he left. "You are sitting in a hospital, and you think, this is what I am going to end up being in 20 years."

"Right now I find that as long as I am around other soldiers from Iraq," Gordie says, "then I feel okay." He's found the camaraderie he craves in groups like Vets4Vets, a national outreach group created by Iraqi vets to help build community, and in Iraq Veterans Against the War. But he says he does plan to return to the VA to apply for disability.

"To get diagnosed and compensated [for] PTSD, the claims process could take a year or two," says Ilona Meagher, the editor of the PTSD Combat Blog, and author of the upcoming book "Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops." But she says it's hard to point fingers at the VA. "Every [geographical] area, every unit is different," she says.

Not everyone agrees. According to a 2005 Government Accountability Office (GAO) Report commissioned by Rep. Lane Evans, D-Ill., a member of the Committee on Veterans Affairs, the VA "has failed to implement key recommendations offered by its own Special Advisory Committee on Post Traumatic Stress Disorder to improve mental health care for service members returning from Iraq and Afghanistan."

The GAO focused on the 24 of the advisory committee's recommendations -- related to clinical care and education -- and reported that the VA is not fully equipped to address the needs of veterans from Iraq and Afghanistan while providing for veterans from past wars.

The VA disputes the GAO's findings, and says that the GAO's report is a misrepresentation of their ability to provide care to Iraqi Vets.

But some vets are dubious. In the new documentary, The Ground Truth, directed by Patricia Foulkrod, for instance, one Iraqi veteran alleged to be a victim of PTSD claims to have been misdiagnosed with a personality disorder. He suspects it is done to deprive him of the full disability compensation package.

Dealing with the VA bureaucracy might be only part of the problem, says Ilona Meagher, who adds that, "some of these people are having the hardest time working through the stigma."

In fact, according to the July 2004 study, Combat Duty in Iraq and Afghanistan, Mental Health Problems and Barriers to Care, published by the New England Journal of Medicine, the perceived stigma of appearing mentally weak among members of the military is an "important barrier to receiving mental health services." After issuing an anonymous survey to members of four U.S. combat infantry units, the NEJM found that only 23 percent to 40 percent of those attesting to signs of mental disorder ever sought mental health care. And those who admitted to experiencing symptoms of mental illness were twice as likely to report concern about possible stigmatization.

The report's authors also urge more studies on the "all volunteer force deployed to Iraq and Afghanistan," as "the type of warfare conducted in these regions are very different from those involved in past wars."

The devastating consequences

The PTSD Timeline, created and compiled by members of the ePluribus Media community (including Ms. Meagher), keeps a record of what "some of our troops are experiencing" after they've come back from Iraq or Afghanistan. And the amount of incidents listed -- arrests, sexual assaults, homicides and suicides -- are staggering.

In the war zone, it's even more disturbing.

In May 2006, the Hartford Courant reported the U.S. Military has kept Iraqi soldiers in combat even after superiors have been notified of suicidal tendencies or other signs of mental illness. In 2005, the suicide rate among troops in Iraq "reached an all-time high," according to the report. Twenty-two soldiers killed themselves in 2005 alone.

When Gordie came back from Iraq, he wrote up part of his story in a first-person narrative for the Concord Monitor, a New Hampshire newspaper. He wrote, "war is hell, and it takes the kindest men and turns them into monsters."

In the piece, he relates the story about two boys would stand and stare at the U.S. troops and arouse suspicion. "I told my gunner not to worry about them -- they were kids and there was nothing to fear from them," he wrote.

Well, "one day a roadside bomb hit a unit on that route," and Gordie and his platoon were required to question everyone in the immediate vicinity. As it happened, a soldier noticed the young boys were trying to hide something, and "found a notebook filled with information on all the U.S. convoys that had traveled the highway in the past month." The boys were selling "the information to men from Baghdad" to feed their families.

Many soldiers secretly suffer from PTSD because they can't accept the implied message it would send. According to Jose Vasquez, of the New York chapter of IVAW, soldiers don't want to go from being "heroes" to being "victims" or "monsters." As for Gordie, though, the experience with the two young boys sparked an epiphany: "It was a demoralizing thing to realize that they are fighting to survive, that I am the foreigner in Iraq, that I'm the one screwing things up."


Jeanine Plant is a frequent contributor to WireTap and a freelance writer. She lives in Brooklyn, New York.


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The last sentence in this article is crap-o-la. All the troops I have talked to feel they are accomplishing something and are part of the solution, not the problem. They want to accomplish their mission period.

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