That Feeling of 'Aliveness' Combat Veterans Miss Most: Can it Be Recaptured in Ho-Hum Civilian Life?

A powerful post by Scott Lee, a Gulf War veteran who blogs over at PTSD, A Soldier's Perspective, arrived on Friday. We Cannot Make it Through the Confines of Our Minds Without the Help of Others is so full and rich and speaks entirely to my current research that I hope he doesn't mind my reprinting it here to share with you:

I am a Gulf War I vet, I felt the same as you when I returned home from combat. For me it was the total sense of feeling alive and being a part of my squad that I missed, although I did not figure this out until after 15 years of insanity.

In the mix, blood pounds through the veins and I received a powerful sense of completeness that I still chase today. The intensiveness of combat will never be matched in the civilian world, all the mundane things we did before seem totally a way to piss us off today. When faced with survival we let all the silly shit slough off of us and become one with the universe.

Our field of vision opens completely to encompass all within our sight, the tiny reflection in the corner of the eye becomes a sharp focus without having to direct attention its way. Time becomes suspended and we know and feel what omnipresence really means. How can anything else ever compare to this experiential endeavor?

I finally received help after 15 years, I could not drink enough alcohol, smoke enough weed, or seek out enough violence to get past the feelings of emptiness. I felt such an utterly and complete loss of self and sense of identity. We were trained to feel invincible, and it may even have seemed that way at times, but we did not get through combat without the help from the soldier next to us. We cannot make it through the confines of our minds without the help of others. We could not do it alone in combat, what makes you think that you can make it alone today?

He goes on to invite his readers to take a look at his process of returning to the fold of civilian life, learning how to deal with the changes that brings into a former combat veteran's life. Check out the rest of his postings.

I've included my response to Scott in extended.

Army Chief: Fort Bliss' Warrior Resilience Program Should be Replicated

This month marks the one year anniversary of the opening of the Fort Bliss Restoration and Resilience Center in Texas.

Back in May, Secretary of Defense Robert Gates visited the groundbreaking facility, which offered up the first test of the Army's new holistic Warrior Resilience Program, saying, "This center here is illustrative of what can be done."

The one-of-a-kind program offers its participating Afghanistan and Iraq veterans group and individual therapy sessions with meditation, yoga, acupuncture, massage therapy, chiropractic and hot-stone therapy treatments.

[Fort Bliss is not the only enlightened embrace of a more holistic approach to treating combat PTSD by the Army. A welcome progression forward of military culture occurred in March when the Army sought proposals for $4 million in grant monies to be spent investigating "spiritual ministry, transcendental meditation, yoga, bioenergies such as Qi gong, Reiki, [and] distant healing."]

Building on all of this, it's great to see that Army Chief of Staff Gen. George Casey, following a visit to Fort Bliss last week, seems to agree with the movement.

Military OneSource Offers Complimentary Combat PTSD Comic Book

Jackie Eckhart of the Virginian-Pilot is one of the lucky few to have had the opportunity to review a copy of a free comic book, "Coming Home: What to Expect, How to Deal When You Return from Combat," now being offered to service members at Military OneSource. Well, the way she tells it, the men in her life understood the value of the magazine better than she did at first:

"Coming Home: What to expect, how to deal when you return from combat" is a new project by Military OneSource. Created by comic book masters Sid Jacobson and Ernie Colon, who formerly worked at Harvey and Marvel comics, it is aimed at service members who have worn combat gear every day for a year. It's aimed at people who see potential IEDs at every intersection. It is aimed at guys who come back to the States to feel fury at traffic, and women who find that half the world thinks they're bad mothers because they had to serve overseas, and family members who can't understand why their returning soldier or Marine is drinking so darned much.

This comic is aimed to help folks who need to learn about post-traumatic stress disorder. Because I wasn't one of those people, and I wasn't sure how I felt about treating a subject as serious as combat and operational stress response in a comic book, I threw "Coming Home" into a stack of reading material to look at later.

Not a minute later my 14-year-old picked it up. Then the kindergartner. Then our houseguest, a 48-year-old former Navy helicopter pilot. "What kind of aircraft is that?" he asked, holding the cover up to the light from the sliding glass doors. Then he read the whole thing.

Connecticut Works to Understand and Support its Returning Troops

The always informative Lisa Chedekel filed another statistic-rich report for the Hartford Courant earlier this month that I've been wanting to share with you. In it, she lists the results of a recent study, a 205-question survey developed by Drs. Marc Goldstien and James Malley, conducted by the state of Connecticut examining the health and reintegration needs of their 11,000 returning troops:

A first-ever survey of returning state troops shows that at least one-quarter of them meet the diagnostic criteria for post-traumatic stress disorder, while many cite problems with a spouse or partner and difficulties "connecting emotionally with family" as major concerns.

A state mental health hot line [866-251-2913] has fielded more than 300 calls for assistance from Iraq and Afghanistan veterans and their family members in the past nine months. Recently, the state veterans' affairs commissioner has begun working with the courts to ensure that increasing numbers of recently returned troops who are arrested for domestic violence, drunken driving or other offenses are flagged and referred to counseling programs.

"There's a lot of real high risks here — not only for the military members themselves, but for their families," said Linda Schwartz, commissioner of the state Department of Veterans' Affairs. "We have people in almost every town in our state who have served deployments, and the VA is just not going to be able to get to them all. We have to do more to reach out to them … to catch them when they fall."

Comforting, Yet Discomfiting, New Clue Found in Florida Missing Iraq Veteran Case

From ABC News:

The discovery of a military-style "spider hole" that may have been used by a missing ex-Marine who is likely suffering from post-traumatic stress disorder has restored hope for the combat veteran's family that he is alive.

Eric Hall, 24, disappeared on Feb. 3 in Port Charlotte, Fla. He was staying with his grandmother when he experienced what his family and authorities have described as a "combat flashback." The Marine, who was left with a permanent limp from a 2005 bomb blast in Iraq, began walking around the house shooting an imaginary gun at imaginary enemies.

Hall then took off on his motorcycle, which later was found with engine running lying in the middle of a road in Deep Creek, near Fort Myers, on Florida's west coast.

The local sheriff's office called off its search more than a week ago, but Hall's mother, Becky, and a cadre of volunteers led in part by retired members of the military continue to look for the former Marine in an area densely covered with trees and shrubs. [pictures of the search and the spider hole they found]

WWII, Korean, Vietnam, Desert Storm and OEF/OIF Vets Chime in on Combat

An interesting look at the experiences of war veterans over the decades ran earlier this month and is still well worth a reading.

From the Kansas City Star:

Q. Did you have any problems readjusting after you returned from war?

Joseph L. Dickerson (Korean War): I was in several pretty strong firefights, and I was wounded — shrapnel from mortar fire at night in left chest. It’s still there, close, by my heart. They see it every time they take an X-ray. I had a hard time adjusting because I saw a whole lot of dead bodies in the short time I was there. And blood. Head blown off, arm blown off.

When I got discharged I never did talk too much to anyone about it. I kept it to myself. But I knew something was wrong, because I had problems holding jobs. I think I was 21 when I got out. Battle fatigue, that’s what they called it then. I had dreams, and you become touchy sometimes.

I went in at 17, and I used to be a happy-go-lucky guy. When I got out I was a little different. I wouldn’t go to work as I was supposed to. I couldn’t take orders till after about three or four years. And dreams. I still have the dreams. I sleep with a weapon. I always have slept with a weapon after I came out of the service. You just feel safer.

Maj. Jason “Tank” Sherman (Iraq and Afghanistan): I came back, still in the reserves, and didn’t really go through anything. I didn’t see what some other people have seen.

Gary Shepard (Vietnam War): I’m still not adjusted. I mostly stay with my friends. I’m still not comfortable in restaurants, and my kids still know they don’t let me get my back to the wall, and they watch out for me. I try not to let that bother me so much anymore, but sometimes it does. I still go to sleep with a loaded pistol most of the time.

Poem: PTSD -- 1st Person

Recently, I came across the following poem by a blogger who goes by the name of Universal. The lines were written after talking with a friend coping with combat PTSD, and the links are the original ones created by the author. Thank you for letting me reprint and share it here with others, Universal.

I can't sleep, can't feel
Anything.
Time passes in chunks now --
A month passes for me
Like someone else's day.

Zombies don't have rhythms;
I go wherever my trance
Takes me.
Today I panic in a store,
Where danger doesn't lurk.

The Sacrifices and Service of our Military Medics

A stunningly written piece by the Gary Post-Tribune's Jerry Davich shares the story of a six-tours-in-Iraq medic that hits many of the notes that we've heard so much about with combat PTSD. But the song played this time is especially moving since our protagonist received his psychological wounds while saving the lives of many of our most physically wounded soldiers.

Fortunately, this military family says their local VA is doing tremendous work with them, which is absolutely wonderful to hear.

From the Post-Tribune:

David Cox didn't hesitate to answer the question.

Kim Cox choked up before her husband could reply. She knew his feelings all too well.

"Even knowing the outcome and problems I have now," Cox said, staring past Kim, "I'd do it all over again, no doubt about it."

David reached for a sip to drink. Kim reached for a Kleenex.

Since the war in Iraq began, David has served six tours of duty as a critical care nurse for the Indiana Air National Guard. He helped transport roughly 500 critical patients during 156 combat missions, body after body, death after death.

It all caught up to him earlier this year.

Click on 'Article Link' below tags for more...

In the interest of education, articles quoted from extensively.

Continuing:

Cox, a staunch supporter of the war from day one, lost 57 pounds in one month while in Iraq. That's when he stopped sending photos of himself back home to Kim. That's when he couldn't shake the nightmares and the sadness. That's when Kim knew something was wrong with her husband of 30 years but couldn't do anything from 7,500 miles away. ...

After finally arriving home in June -- he's been home only nine months in the past four years -- he went away once again, but this time for residential treatment in an out-of-state military medical facility. There he talked with other soldiers with PTSD. It helped. It healed. But it's only a start.

Davich introduced us to Cox in a July Post-Tribune piece:

Doctors call it post-traumatic stress disorder.

Maj. David Cox of Highland calls it an emotional sledgehammer.

It pounds away at the 56-year-old Indiana Air National Guard critical care nurse with repeated rounds of depression, anxiety, panic, jumpiness, agitation, you name it.

He received psychological care while in Iraq, but the constant mortar shelling and combat missions didn't help his treatment. Plus, this past 10-month tour, the last of six since the war began, was his busiest and deadliest. Back and forth from Balad to Germany, patient after patient, body after body.

In May, while aboard a flight for the United States from Qatar, his emotions ambushed him again and he had to be hospitalized there, delaying his homecoming. He finally returned here late last month.

The reporter shares his experience of the heroic, human medic:

I first wrote about Cox in 2003, just after the Iraq War began.

I first met him in 2005, soon after he returned home from his second tour of duty.

In his basement, standing in front of two American flags draping the walls, each with handwritten notations of the combat missions he has performed, I remember asking Cox how he's able to emotionally absorb all the wounded, dying, and sometimes dead U.S. soldiers he transports.

His job is to "package up" critically wounded soldiers aboard rugged C-130 Hercules transport planes -- in effect, flying intensive care units. Cox sometimes straps himself to patients' gurneys, adjusting their monitors, ventilators and medications, while wearing full body armor and a 9-mm pistol.

How, I asked him in 2005, does he deal with this, one bloody or burned body after another, over and over, mission after mission? In his calm voice and low-key demeanor, the graying father of three told me simply, "It's what I do."

Since then, Cox has always represented to me what's good about a bad war, what's right about a wrong decision, and what's best about a worst situation. Oh, and along the way he helped rescue an Air Guard record 450 soldiers during 156 combat missions.

So when Kim e-mailed me saying David was coming home last month, I didn't think anything of it. I figured the Air National Guard's true iron man, the son of a U.S. Air Force retiree, would return to the region unscathed, again, after dodging so many proverbial bullets.

Well, I was wrong.

He got hit -- in his psyche -- by all the combat tours, the human carnage, and the unspeakable images he witnessed.

"I guess it finally caught up to me," Cox told me.

Cox and his family are now busy getting their lives back together, seeking the the peace and contentment that they deserve after the many great sacrifices they've made in peace-of mind.

David spends his time getting accustomed to civilian life again. The simple pleasures of grocery shopping with Kim, drives in the car with their dog Murphy, or doing absolutely nothing but watching life's wheels go 'round and 'round.

But the couple never knows what will trigger David's PTSD -- sometimes a photo of the war, sometimes a news account, sometimes a harmless TV show showing a doctor giving a patient a shot. And sometimes the trigger comes from within -- a memory, a flashback, an unexplained sense of dread.

Kim uses the word "sickness" to describe her husband's condition. "It's a mental illness, a disability," she explained. But David doesn't use that term. He calls it a sadness. "Knowing I'm not going back helps a lot," he said. "I don't want to see sand or 130-degree heat for a long time. I don't miss it at all."

The Cox family uses jokes and humor to bind them together but also to deflect the hard times these past few months. They laugh more than cry, they smile more than they frown.

"So many others came back in a lot worse shape than me," David said matter-of-factly, "with one less arm or leg or eye. I have no right to complain."

Last year, Kimberly Cox wrote the Chicago Sun-Times about her husband during the paper's 'Yellow Ribbon Week' remembrance of the third year of the Iraq War:

My husband, Maj. David Cox, is currently serving his fourth deployment in support of Operation Iraqi Freedom. He is 56 years old. We have been married 28 years. David's military career began at the tail end of Vietnam. He jokes that it is the only lottery he ever won.

After finishing college, he left the military for a civilian nursing career. The military never left his thoughts, and in 1998, he decided to come back in, joining the Air National Guard. He received his commission and is based with the 122nd out of Fort Wayne.

They knew on 9/11 that their lives would be changed forever:

David's alert started that day.

When he was deployed the first time, we didn't know what to expect. I don't really want to say that we are used to it by now, but we do know what to expect. We know that sacrifices have to be made, and we both feel our sacrifices are small compared to what others have had to give.

In the past four years we have had only one holiday season together. This past year was the first time we were together in three years for our anniversary. When our daughter got married, we didn't know until two weeks before her wedding if her dad would be there to walk her down the aisle. He left two days after her wedding. He was not here when our first grandchild was born.

That being said, we feel blessed to be a part of helping the spread of democracy in the world. We both truly believe in our country's missions in Iraq and Afghanistan.

It is difficult to be apart so much. I think the hardest thing is just not being able to talk to each other whenever you feel like it. I miss my husband, but I try very hard to act with dignity and support him. He can't do his job correctly if he has to worry about me falling apart. That could endanger his life and the lives of those entrusted to his care.

Kathie Costos over at Wounded Times wrote a thoughtful intro to the Post-Tribune piece when she shared it with her readers tonight:

I keep trying to tell veterans that PTSD does not care if they support the mission they were given or not, support Bush or not, because in the end, that really doesn't matter. What matters is they were a human willing to serve. PTSD only cares that it can feed off of trauma and it doesn't get more traumatic, more horrific than combat. It doesn't know if the person held a gun, had the gun pointed at them or cleaned up after the shooting and blowing up stopped. ...

David Cox served six tours as a nurse in Iraq. Even now as you will read, he would go back if he could. So please stop letting people get away with attacking combat veterans with PTSD as being cowards, being lazy, being "un-patriotic" or all just being against Bush. Don't pass them off as if no one pays attention to them because people do. It has nothing to do with character, being brave or anything else because it comes to people from all sides. It is nothing to be ashamed of because they are wounded humans who survived an abnormal situation. Can you get more abnormal than combat?

They do not all end up with the same level of PTSD and they do not all end up snapping or committing suicide. Sadly they do not all heal either. Some never seek the help they need. They just need someone to reach out to them as one human to another human. No politics and no judgments. Just help.

Sending my very best wishes to the entire Cox family. And a big thank you to the great reporting of the Post-Tribune.

Journey Home with the Soldiers of Troop A, 1st Squadron, 167th Cavalry

Today's Omaha World-Herald delivers a rich piece of journalism, recounting the adjustments that local troops have had to make after returning home from Iraq one year ago.

Numbering 63 when they left and 63 when they returned, they racked up more than 1,600 combat missions — more than four a day — and saw more action than any Nebraska Army National Guard unit since World War II.

They were part of a 4,000-soldier brigade sent to the insurgent stronghold of Ramadi in western Iraq. Eighty-one of the brigade's soldiers were killed in action — the most of any National Guard brigade that has served in Iraq.

First Lt. Matt Misfeldt of Omaha, who commanded the 16 soldiers of Troop A's 1st Platoon, tracked how many times insurgents shot at him. The final tally: 92.

In their primary mission protecting Marine bomb-disposal teams, Misfeldt's platoon encountered roadside bombs — exploded and unexploded — 295 times.

Homecoming on June 22, 2006, was euphoric. For most of Troop A, the celebration lasted for months.

While most have been succeeding at adjusting to civilian life again and living with families vs. battle buddies, others have had a harder time of it. Click on 'Article Link' below tags for more...

Continuing:

But as that joyful return to Lincoln faded into memory, nearly every soldier also realized he'd been changed by Iraq. Many have encountered some problems readjusting to civilian life. They acknowledged those problems to one another last winter during a weekend drill that turned into something of a group counseling session. About half described serious problems in their lives.

At least six have been formally diagnosed with post-traumatic stress disorder; many others say they have experienced some PTSD symptoms. Seven have been arrested for driving under the influence. Another spent a month in alcohol rehab. At least two marriages fell apart.

One soldier spent nearly three months at Walter Reed Army Medical Center in Washington with PTSD and a traumatic brain injury inflicted by repeated roadside bombings. Another young soldier nearly died in a motorcycle accident.

But in interviews, soldier after soldier also voiced a kinship with his comrades and said he came back from Iraq with new leadership and coping abilities. "For the most part, the guys are doing all right. We all have been doing our best to stay in close contact and take care of our own," said Staff Sgt. Chad Rowe.

The unit's experiences illustrate the challenges faced by thousands of men and women returning from Iraq — challenges that often are more intense for National Guard citizen-soldiers, who jump from civilian lives almost directly into combat, then return home just as suddenly. "While they were there, they have to kill, they have to be in danger," said Dr. S. Pirzada Sattar, the Omaha VA Medical Center's top expert on alcohol and drug abuse. "The expectation is they will come back and be normal. They can't be normal. They have changed."

The remainder of the piece gives a brief but thorough explanation of the following challenges returning troops face:

• Post-traumatic stress disorder (PTSD)
  
• Traumatic brain injury (TBI)
  
• Struggling to readjust
  
• Alcohol abuse
  
• Looking for excitement

Please head over to learn more about each of them. And consider thanking the World-Herald for covering this important issue with such grace and class.

Wisconsin's Returning Troops

Reporter Nathan Comp of Madison's excellent Isthmus paper delivers a comprehensive piece on how local vets are transitioning back to life at home and dealing with the VA. Latest combat PTSD stats, too.

Comp also makes note of the work that ePluribus Media and I have been doing on the PTSD Timeline -- work difficult to cheer, but that we are pleased to see being used to inform others.

Hard to choose which grafs to highlight; here are a few:

Slowly, very slowly, Thomas Staskal is coming to grips with things he saw and did in Iraq. He is depressed, anxiety-prone and has an acute fear of crowds. Since returning home to the Green Bay area in November 2005, the 25-year-old Army reservist has lost three jobs and flunked out of college. Common things, like a flash of lightning, can induce the shakes.

“I used to have dreams where I was chased by the people I had to kill in Iraq,” he says, over doughnuts and milk at his east-side Madison apartment. “I no longer wake up from the nightmares, but the panic attacks are getting worse. One of the problems is that I’m angry, but I don’t know at what.”

Rarely is a soldier’s return seamless, but for battle-weary vets like Staskal, post-traumatic stress disorder can crash their landing in the civilian world. ... Staskal and his girlfriend moved to Madison in August, just before the start of the new school year. When he tried enrolling at the local VA hospital, he learned that transferring his file from Appleton would take 30 days. After that, he’d be put on the waiting list. Meanwhile, time was running out on the two years of VA benefits that reservists are given.

“If you are on active duty, there’s a lot more help,” says Staskal. “The reservists get shafted. I don’t function 100% and the Army should help me, but they’re not. You can’t just use us then leave us out to dry, which seems to be what’s happening.”

High recommendation to read the whole piece. Thx, Nathan.

Frederick News-Post Covers Combat PTSD

Alison Walker-Baird of Maryland's Frederick News-Post offers two well-written articles on combat PTSD today. The paper's Karen Gardner files another, too. Well done, News-Post!

From Walker-Baird's Stress Wounds:

The face of Post Traumatic Stress Disorder is changing. Far from the misguided stereotype of a wheelchair-bound, unemployed, middle-aged man, today's veteran with PTSD looks more like Spc. Christopher Clayton of Hagerstown, like your next-door neighbor. The 29-year-old Maryland Army National Guardsman returned from Iraq in May after 18 months in combat, greeted with hugs and beaming smiles from wife, Erika, and two young daughters.

He works full time and is pursuing a career in nursing. But a year and a half of constantly being on edge left this loving husband and father with depression and mood swings, and a diagnosis of PTSD. He's getting help. More than 400,000 veterans from the wars in Iraq and Afghanistan are expected to do the same.

Solid information, including stats and personal accounts, in all three pieces. Click on 'Article Link' below tags for more...

Continuing from Stress Wounds:

People with PTSD often don't experience symptoms until months or years after the traumatic experience. Despite the predicted flood of veterans needing mental health services, significantly fewer troops have served in Iraq and Afghanistan than in past conflicts such as the Vietnam war.

The U.S. Census Bureau estimates 8.2 million veterans served in Vietnam, making up more than 30 percent of all U.S. veterans, and about 3 million served in the Persian Gulf War. Studies have estimated from 19 percent to 31 percent of Vietnam veterans developed PTSD at some point, with between 9 percent and 15 percent still having the disorder by the end of the 1980s.

Among Gulf War veterans, 1997 and 2003 studies found 2 percent to 10 percent were still suffering from PTSD a decade after returning from deployment.

Plenty of stats on the relationship between injuries and the heightening of PTSD risk:

For every service member who dies in Iraq, nine have been wounded but survived. While more troops in Iraq and Afghanistan are surviving injuries that would have killed them in past wars, they are at risk of developing PTSD. Being wounded in a traumatic experience puts one at a significantly greater risk of developing PTSD than someone who was not injured, several recent studies found.

In the Vietnam and Persian Gulf wars, 24 percent of the wounded died. About 1 in 10 troops injured in Iraq has died, the lowest rate of any U.S. war.

They have survived with the help of better equipment and medical care than in past wars, but the weapons used in Iraq today leave many with lifetime disabilities or disfigurement. Pentagon data show more than half of troops injured are hurt so badly they can't return to war.

Military surgeons reported a high incidence of blindness, multiple amputations, burns and significant brain damage, according to Dr. Atul Gawande's study on modern war casualties published in the New England Journal of Medicine in December 2004.

Roadside bombs have caused about half of U.S. troops' injuries and deaths in Iraq, the Department of Defense's Defense Manpower Data Center reported.

Walker-Baird's second piece, Soldier faces new battle with PTSD, is an inside look into one solider's journey home from combat:

He spent 18 months in Iraq, constantly wound up and never letting his guard down. When the veteran returned home to his family, the stress didn't disappear as easily as changing into civilian clothes.

For this Hagerstown man, the wake-up call was his 3-year-old daughter telling her dad he was too angry. Spc. Christopher Clayton was living with Post Traumatic Stress Disorder.

Spc. Clayton, a member of the Frederick-based Alpha Company in the 1-115th Infantry Regiment of the Maryland Army National Guard, didn't experience symptoms of the disorder until several months after he came home.

Gardner contributes another personal account in The strength to find help: A Vietnam veteran takes steps toward healing:

Curtis Callender served in Vietnam. He went on to serve in the Army for an additional 25 years, retiring 15 years ago. It wasn't until less than a year ago, however, that he was diagnosed with Post Traumatic Stress Disorder.

Mr. Callender, 62, a native of Texas, works for the Military Amputee Research Program at Fort Detrick. After Vietnam, he became a medic in the Army and retired as a sergeant major. But something wasn't right. "I cried if I saw anything war related," he said. "I thought it was a weakness in my personality."

War movies, war stories, just about any reminder of war set him off. And as he got older, the tears came more often. He had been to see George Kauffman, the Veterans Service Officer for the Maryland Department of Veterans Affairs, at his Frederick office. "George is the one who thought I should get checked," he said.

Please read the rest, and then consider thanking the Frederick News-Post for this important coverage. Way to go!

Combat Stress Causes Brain Changes

From the El Paso Times:

[R]eaction to the extremes of combat cause physical changes in the brain, [Dr. John Fortunato with Beaumont Army Medical Center] said. A part of the brain responsible for the "fight or flight" response can grow in size by as much as 8 percent, while the part of the brain that takes time to analyze a threatening situation can shrink by as much as 12 percent.

The longer a person is exposed to an environment where they must be hypervigilant to stay alive, the more pronounced the changes, he said. That may explain, in part, why the British, who serve six-month tours, suffer only about a 5 percent rate of PTSD compared to 18 to 20 percent for U.S. soldiers, he said, adding, "Of course, they don't do some of the heavy duty tasks our soldiers do."

The good news, Fortunato said, is that the brain can normalize over time.

The article itself is about a cavalry unit sent to Iraq as part of a combat stress-genetic link study. More >>

Former Sen. Max Cleland Treated for PTSD

Heartbreaking. From WSBTV News - Atlanta:

[Former Senator Max] Cleland has revealed that he's suffering from Post Traumatic Stress Disorder and getting help from those same counseling programs he helped create. Cleland, who lost three limbs in the war, said he didn't get much help for his own psychological wounds when he returned from battle.

The former U.S. Senator from Georgia described his symptoms to Channel 2 Action News reporter Alison Burns. He said he feels depressed, has developed a sense of hyper-vigilance about his security and has difficulty sleeping. He believes the Iraq war has, in part, triggered his condition.

"I realize my symptoms are avoidance, not wanting to connect with anything dealing with the [Iraq] war, tremendous sadness over the casualties that are taken, a real identification with that.....I've tried to disconnect and disassociate from the media. I don't watch it as much. I'm not engrossed in it like I was," he said.

Wishing him peace and better days ahead.

Click on 'Article Link' below tags for related posts...


Related Posts

• Iraq War: Deadly Trigger for Previous Wars' Veterans
  
• The Longevity of War's Wounds
  
• Today's War Can Be Difficult for Prior Veterans
  
• Vietnam Vets' PTSD Experience Helping Today's Troops

PTSD Combat News Roundup: June 28-July 9, 2006

Another collection of news and commentary on issues important to veterans and their families -- especially those coping with PTSD.

Women in Combat: Females and PTSD

According to the Department of Defense (DoD), 11% of those serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are women. Officially, they are restricted to non-combat roles; however, in wars such as that being waged in Iraq, there are no front lines. Combat roles or not -- they are in the thick of things.

Last week, the Chicago Tribune covered how war has lingered with some of the women returning home. I'll round things out by reposting a related January commentary of mine which appeared online before PTSD Combat was up and running.

New Combat PTSD Cases May Total 15,000 in 2006

From yesterday's Kansas City Star:

The number of troops back this year from Iraq and Afghanistan with post-traumatic stress disorder could be five times higher than the Department of Veterans Affairs predicted. Instead of 2,900 new cases that it reported in February to a veterans advocate in Congress, the increase could be 15,000 or more, according to the VA. [emphasis mine]

Just as this figure suggests, the article continues with more sobering information for us to examine, digest -- and act on.

Click on 'Article Link' below tags for more...

Continuing from the Kansas City Star:

At the Kansas City VA Medical Center, only nine vets from current combat were diagnosed with PTSD in 2004. Last year, it was 58. In just the first three months of fiscal 2006, the hospital saw 72. “It’s absolutely incredible,” said Kathy Lee, at the Missouri Veterans of Foreign Wars.

A former Army nurse in Vietnam who works at the hospital, Lee said, “Every single Iraq vet who comes in, I give them a list and say, ‘How many of these (PTSD) symptoms do you have?’ It’s almost nine out of 10.”

Compared to the Vietnam era, the VA is doing a better job in treating the natural psychological wounds some of our veterans return home with. Yesterday, AP reported:

The VA says it is more prepared to deal with returning veterans than it was after Vietnam, when an estimated 17.5 percent of veterans returned with mental or emotional problems. The agency has more than 160 programs for the treatment of PTSD and a $29 million dollar budget to provide services for military men and women returning from Iraq and Afghanistan. "If we don't get intervention within the first five years, the veteran is set up for a lifetime of problems," John Wilson, a psychology professor at Cleveland State University, told The (Cleveland) Plain Dealer for story published Sunday.

Wilson helped the VA design its first counseling program in the late 1970s. Now all veterans undergo a required post-deployment screening program, including a mental health assessment.

Although these programs are a step in the right direction, they are far from the magic bullet to cure all reintegration ills.

Despite expanded services and better post-deployment screening, some critics still wonder if the VA is prepared to deal with an influx of veterans coming home after multiple deployments in the Middle East. Larry Scott, who founded a Web site scrutinizing the VA, said that while the system has improved greatly, he worries the VA is still too understaffed and underfunded.

Wilson agreed there is cause for concern since repeated deployments can take an even greater mental toll on soldiers. "Iraq is a nonstop, 24-seven, hostile environment, so what happens is that these guys are incredibly wired all the time," he said. "One of the things we learned from Vietnam is that once that hyper arousal response develops, it doesn't go off."

Back to the Kansas City Star piece, we find a cautionary warning:

John Baugh, who attends a PTSD support group at the Kansas City VA Medical Center, said many soldiers still in combat zones are suffering from the disorder. “They think that the numbers are high right now,” said Baugh, 31, a former driver for an Army construction battalion in Iraq. “Wait until those guys get out and try to start functioning in the civilian world. There’s going to be hell to pay.”

The miscalculation on PTSD echoes last year’s underestimation by the Bush administration of how many Iraq and Afghanistan veterans would need medical treatment. It had underfunded VA health care by $1 billion, despite assurances to Congress that the department had enough money. Congress subsequently added $1.5 billion to the VA’s budget, but money problems still loom.

“They’re going to be short and they’re going to be playing catch-up,” Cathy Wiblemo, deputy director for health care at the American Legion, said of the VA’s PTSD treatment. “They’re not going to have the money, and the waiting list will grow.”

As the VA budget last year needed an infusion of $1.5 billion to meet its needs, many say the President's 2007 VA budget as it currently stands is insufficient to meet the needs of our returning veterans.

The White House asked for $80.6 billion in 2007 for the VA, including $3.2 billion for mental health programs. But Rep. Michael Michaud, a Maine Democrat on the House Committee on Veterans Affairs, said the VA would need more, sooner. “What’s going to happen is unless we give added resources, they’re going to have to start rationing care,” Michaud said. “It’s going to have to start pitting veterans against veterans.”

Jeff Schrade, a spokesman for Sen. Larry Craig, an Idaho Republican and chairman of the Senate Veterans Affairs Committee, said Craig was unhappy over the VA’s botched estimates on health care last year. Congress now requires quarterly budget reports, which Schrade said show that VA’s budgeting appears to be on track. “What concerns us is they’re seeing a lot more patients than they anticipated,” he said.

The VA’s contradictory estimates on PTSD surfaced in February. Prior to a Capitol Hill budget hearing, the agency replied to written questions from Rep. Lane Evans of Illinois, ranking Democrat on the House VA panel.

Asked about the need for mental health services, the VA told Evans that it expected to see 2,900 new cases in fiscal 2006, which began Oct. 1 and ends Sept. 30. A week later, the agency issued its latest quarterly report on use of the VA by Iraq and Afghanistan veterans. The numbers indicated it had diagnosed 4,711 possible cases just from October through December — more in the first three months than it told Evans to expect over the entire fiscal year.

VA spokesman Jim Benson said the estimate of 2,900 cases was based on earlier data. The latest quarterly numbers were still in the draft stage at the time of the hearing, he said, and VA officials stuck with the earlier data because trying to explain “would be more challenging and perhaps more confusing.”

The unnerving news continues:

VA officials also had at the time of the February budget hearing a report from the department’s Special Committee on Post-Traumatic Stress Disorder. It warned that the VA was unable handle services to new combat veterans as well as survivors of past wars, saying: “We can’t do both jobs at once within current resources.” Most of the PTSD cases the VA sees involve veterans from earlier conflicts, primarily Vietnam.

Baugh of Kansas City won’t talk much about his Iraq deployment because it triggers bad memories. But when he returned home in 2004, he couldn’t escape them. “I was jumpy, angry, irritated, sleeping one-two hours a night,” Baugh said. “I was totally worn out. I’d drink and drink and drink just to shut the memories down and the nightmares.” His wife pushed him to get help. Baugh said he’ll “jump through the ceiling” if she drops a frying pan. The clattering of kids skateboarding down his street sounds just like “gunfire in the distance: kack-kack-kack-kack.”

Joshua Lansdale knows about nightmares and noises, too. A 23-year-old veteran from Kansas City, North, he spent 11 months in the Sunni Triangle as a firefighter and emergency medical technician with the Army Reserve’s 487th Engineer Detachment. “It was a pretty hot zone,” he said. “We took a lot of mortar fire, IEDs, car bombs, saw a lot of helicopter crashes and worked the UN embassy bombing. I dragged a lot of people out of burning buildings, cars, motorcycle wrecks and explosions.” Back home, Lansdale was diagnosed with PTSD and joined a support group at the VA hospital. He predicted that returning troops would overrun the VA.

“A third of all soldiers are seeking help,” he said. “Do we have the capability of treating all those soldiers? I don’t think we do.”

The better informed we are, the more we can achieve.

As halting as these figures and assessments may be, we mustn't let them paralyze us; rather, we must use this data to energize us and our fight to get our returning troops and their families the support they need. They -- and our nation -- deserve nothing less.


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MSNBC's Hardball Reports on Combat PTSD

Posttraumatic stress disorder continues to get some much-needed national media attention. Monday's Hardball is the latest example. Host Chris Matthews opened the the segment with the story of Marine Lance Corporal Blake Miller, an Iraq veteran who received international notoriety when a photograph snapped of him in Fallujah was printed far and wide. He's now returned to the states, and is coping with PTSD.

Click on 'Article Link' below tags for more...

From the Hardball transcript (scroll down 2/3 of the page):

MATTHEWS: Welcome back to HARDBALL. For many American troops fighting in Iraq and Afghanistan, getting home is only half the battle. Once back with their family and friends, they face the new challenge of coping with their sometimes traumatizing memories of war, the condition known as post traumatic stress disorder or PTSD. MSNBC‘s Norah O‘Donnell has more. (BEGIN VIDEOTAPE)

NORAH O‘DONNELL, MSNBC CHIEF WASHINGTON CORRESPONDENT (voice-over):

Remember this picture? It is one of the most iconic images from the Iraq war. Marine Lance Corporal Blake Miller went from Fallujah to the front pages of newspapers and was called The Marlboro Man. Now, almost two years later, Miller is at home in Kentucky a changed man.

BLAKE MILLER, ‘MARLBORO MARINE‘: You can put something aside, but as far as trying to forget it, it doesn‘t work.

O‘DONNELL: Miller now suffers from post traumatic stress disorder or PTSD.

Miller is 21, honorably discharged, and can't find employment. He's having trouble sleeping, he's bogged down by nervous ticks and an aversion to crowds. The video piece closed with comments made by Charles Engle, a Walter Reed psychiatrist, and Jay Nicholson, Secretary of Veterans Affairs stating that the VA is taking care of the needs of our returning veterans.

Following O'Donnell's opening report, Chris Matthews introduces his guests: Gordon Mansfield, deputy secretary for Veterans Affairs, and General Barry McCaffrey. Before he begins the debate in the studio, he asks O'Donnell the following question:

MATTHEWS: Norah, is there any deniers out there who say there‘s no such thing as PTSD?

O‘DONNELL: I did not speak to any who believe there is, because in every war from the Civil War, it was called soldier‘s heart, after Vietnam, it was called shell shock, and now we have this more clinical term called post traumatic stress disorder. So we know many our soldiers throughout America‘s history have suffered from some sort of mental illness, but of course all mental illness has been difficult to talk about until recently.

Blake Miller spoke to us, this very heroic soldier, because he says that by speaking out he hopes that other troops will feel more comfortable talking about some of the problems they‘re experiencing and there is help available from Veterans Affairs.

He asks the same question of his guests:

MATTHEWS: Mr. Secretary, thank you for joining us. Just to repeat the question, there‘s no doubt this exists?

GORDON MANSFIELD, DEPUTY SECRETARY OF VETERANS AFFAIRS: There‘s no doubt in my mind or in the V.A.‘s mind that it does exist.

Perhaps someone needs to tell Oliver North, or Sally Satel, MD, or Christina Hoff Sommers, or Mackubin T. Owens, or George F. Will, or...oh, you get the picture. PTSD is a political and financial liability, so there are a lot of people who might rather gloss over it.

Back to Hardball:

MATTHEWS: General McCaffrey, I was struck by the difficulty that soldier had, The Marlboro Man they called him, who appeared with the cigarette in that famous picture, talking about the casualties he inflicted. You‘ve been in a lot of combat. Is that something you‘ve seen from your fellow troops?

GEN. BARRY MCCAFFREY, U.S. ARMY (RET): Well, you know, first of all, let me start off by saying, there‘s no question that this PTSD is real. We‘ve always known you can take soldiers, Marines, push them over the edge.

A lot of artillery mortar fire, extreme cold, malnutrition, extreme heat. Don‘t tell them when they‘re going to come home from combat. There‘s all sorts of reasons why any combat soldier can reach his limit.

This young Marine obviously saw a lot of heavy combat. Having said that, Chris, let me just offer a balancing viewpoint. Most young soldiers and Marines that fought in heavy combat like Fallujah, as much fighting as we‘ve done since for God‘s sakes Aurora Pocket. That was high intensity battle. Most of them come home strengthened by it, not weakened. They‘re grateful for the comradeship, the valor of their fellow soldiers and Marines. They are grateful for hot water at night, grateful for freedom and safety here in America. Most of them aren‘t damaged by this experience.

MATTHEWS: Mr. Secretary, can you be that positive?

MANSFIELD: I would...

MATTHEWS: That combat doesn‘t generally hurt a person‘s psyche.

GORDON: Well, combat is not the ordinary way of life. It‘s an uncommon situation. So the question is what happens in that uncommon situation? What happens with the camaraderie of the unit that person serves in? And how that person is returned to the United States and how they can adapt to being back in the United States.

MATTHEWS: But all the guys that came back from World War II—you know, you talk about Tom Brokaw and the greatest generation. All of these guys came back, and I grew up with them as friends of mine—or father‘s of friends of mine. You know, Knights of Columbus guys, regular guys. And only later did I realize that these guys had been to hell and back, so many of them.

And they seem to be totally normal. They had a beer and a cigarette. They raised a family. They seemed to enjoy life, turned on the tube at night, watch Phil Silvers. You know, they seem to enjoy life, so many of them.

MANSFIELD: Your correspondent referred though to the term of shell shock and combat fatigue, and those two terms come out of basically World War I and World War II. And really I think they mean almost the same thing as PTSD means.

MATTHEWS: But they‘re the odd case or the familiar case?

MANSFIELD: Well, right now if you look at the total number of troops that have been in Iraq, that total is around 500,000. Out of that 500,000, we in the V.A. have seen about 145,000.

MATTHEWS: A third.

MANSFIELD: And out of those, 20,638 are being treated right now for PTSD or mental health problems. So that‘s 14 percent or 15 percent of the lesser number.

The Deputy Secretary, who was entirely sympathetic in my view, went on to explain some of what the VA is doing to help these thousands who are in need of help. Mental health assessments of all troops when they return home, as well as 6 months later (this new review, the PDHRA, has only recently been implemented), etc.

Now, it's nitpicking time. The problem I had with the Hardball segment was the choice of guests:

• We had an official advocating for the VA.
  
• We had an official advocating the hardline military 'rah-rah' view.
  
• We had the pro-Bush administration host.
  
• Anyone missing from this picture?

Why was there not a chair at the table for a representative from Veterans for Common Sense or any other veterans organization -- even someone from the more traditional/conservative AMVETS or American Legion?

Could the producers of Hardball not find anyone who directly represents and advocates solely for the veterans to sit at the table?


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Lifelines Online PTSD Video Series for Military Families

As our troops continue to stream home to us, families are having to deal with a variety of adjustment issues. Soldiers, sailors, airmen, and Marines are likely coping with combat stress or post-traumatic stress disorder; and so, Navy hospitals have been reaching out to help their service members and families via traditional counseling and online videos to assist families in understanding some of the reintegration issues they'll be facing.

Click on 'Article Link' below tags for more...

[UPDATE Apr 09 2007]: View videos below.

From AP:

Sgt. Milton Caples made it home to his wife and daughter after a year as a security convoy driver in Iraq, but thoughts of suicide bombers and mortar attacks haunted him, nearly costing him his former life. Driving on the rural roads near his home, he would flashback to the streets of Balad and Tikrit, speed up and try to out run other drivers. "I would know I was doing crazy stuff. It would seem like I was driving but I wasn't there. I was looking at myself doing stuff in a video game or something," he said. "In some cases, I'm glad the police didn't see me because they would have taken my license away."

He spent his nights doing security patrols of the family home - repeatedly checking to see if doors and windows were locked, if anyone was prowling around outside. His anger ate away his relationship with his wife and daughter, who struggled to reach the fun-loving man they once knew.

Three years into the Iraq war and almost five years after the invasion of Afghanistan, American families like the Capleses are increasingly becoming part of its collateral damage. Learning from the mistakes of Vietnam, the military has long encouraged returning soldiers to seek counseling. Now its leaders are trying something different - reaching out to the soldiers' families.

Although treatment and medication have evolved since Vietnam, the warrior mentality still prevents most returning soldiers from getting the help they need, said Rick Weidman of Vietnam Veterans of America. "Real men don't eat quiche and they don't have problems like this - hooah," he said, giving the shout soldiers make.

To counteract this attitude, Navy hospitals have begun advertising their counseling programs as well as pointing families to their online PTSD video series.

The videos were designed not for service members, but their families. "The goal was to bring in the family in hopes that if the individual wouldn't come in on their own, we would reach them through the family. We made thousands of copies and distributed them to all kinds of places," said retired Navy Capt. Jennifer Morse, the San Diego Naval Hospital psychiatrist featured on the videos. The Navy began producing the videos in 2004 and is releasing a re-edited version of the project in the coming months.

"The intent is to get people help, not to fix them over the Internet. (To tell them that) they shouldn't be ashamed of their feelings after they have served in these situations," said Bill Hendrix the Navy's Pentagon-based coordinator of the Lifelines video project. The videos have been so successful that the Air Force and the Army are also using them to encourage families to seek counseling for veterans of both Iraq and Afghanistan, Hendrix said.

Weidman, of the Washington-based Vietnam veterans group, applauded the efforts to reach troops by reaching out to families. "The military, under significant pressure, has made some significant efforts," he said. Vietnam Veterans of America has long pushed the Department of Defense to develop such programs, he said.

But Capt. Jeffrey Weyeneth, a psychiatrist at Pensacola Naval Hospital, estimates continued counseling programs still reach only 10 percent of troops returning from Iraq and Afghanistan. "A lot of guys, they see it as a nick in their armor, 'If I want to do 20 (years) or more, I don't want to be seen as a nut case'. And confidentiality is difficult with the military because mental health can affect your ability to function in the military so confidentiality is not as absolute as it is in the civilian world," he said.

Returning soldiers who go without treatment often hide their stress from co-workers to avoid ruining their careers and instead take their problems out on their families, Weyeneth said. "A lot of these guys come back from war but never get out of the combat, the enemy just changes. They direct their anger at other people," he said.

You may access the full Lifelines video series online.

[One technical note: For some reason, this link wouldn't open the video page in my Firefox browser; Internet Explorer, however, downloaded it just fine, making the programs available for viewing.]

The videos have been made available on YouTube:

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Acoustic Startle: Experimental PTSD Assessment Tool to be Studied in WI

The Wisconsin State Journal explores a new, experimental tool that researchers at Madison's Veterans Hospital are currently testing to gauge the effectiveness of posttraumatic stress disorder treatments. Called acoustic startle, the study will monitor eye flinch reactions, heart rate, and sweat production to sudden, loud sound to determine how severe the patient's PTSD is.

Click on 'Article Link' below tags for more...

From the Wisconsin State Journal:

Doctors at the Veterans Hospital are preparing for a new generation of veterans returning from Iraq and Afghanistan who might develop PTSD. They are researching new therapies for the disease that might make the condition more manageable for newly returned soldiers than it has been for many Vietnam veterans. The doctors are also looking at a new way of assessing the effectiveness of PTSD treatment.

The experimental assessment tool, called acoustic startle, is based on the flinch of a patient's eye muscles. It's a reflex to a sudden sound that can be measured by the contraction of the obicularis oculi, the muscle that gives people of a certain age bags under their eyes.

As with most psychological disorders, doctors now use questionnaires to rate symptoms of PTSD and determine whether medications or psychotherapies help patients get better. But sufferers of PTSD, many of them men who have been in combat, can be reluctant to acknowledge their symptoms, doctors say. Improvements in irritability, detachment, nightmares and flashbacks can be subtle.

In a study about to begin at the VA, electrodes will be placed below the eyes and on the arms and hands of veterans with and without PTSD. The subjects will wear headphones through which piercing tones will randomly ring. During 10-minute sessions of loud beeps, their eye muscle contraction, along with heart rate and production of sweat, will be measured. Some participants will have recently started detox for alcohol abuse.

The goal is to see if acoustic startle is a useful way of quantifying the severity of PTSD - and to learn if some patients, likely those who react most to sudden noise, "self-medicate" by drinking.

More clinical information on startle response from the National Center for PTSD:

Historical and contemporary records provide evidence that an important symptom seen in combat veterans diagnosed with Shell Shock, Combat Fatigue or Post Traumatic Stress Disorder has been, and continues to be, an exaggerated startle reflex. (6-9) Clinical observations of exaggerated startle in distressed combat veterans were so common by mid-century, some psychiatric authorities argued that increased startle was cardinal symptom of combat fatigue (10). While not considered the cardinal symptom of PTSD today, exaggerated startle remains tightly linked to trauma related psychological illness. In fact, according to DSM-IV, PTSD is now the only anxiety disorder in which hyperstartle is listed as a core symptom.

Investigators have had various motivations for studying the acoustic startle reflex in humans and especially in those suffering from PTSD. Some have been interested in finding out whether or not exaggerated startle is a marker (or sign) indicating, or helping to provide a reliable diagnosis of PTSD. The idea of an objective test for PTSD remains extraordinarily appealing to many clinicians and forensic specialists. It is felt that such a test would enhance discrimination between individuals who do and who do not have PTSD.

For other investigators, startle has been less interesting as test for PTSD, and more interesting as a probe in examining central nervous system reactivity in individuals with PTSD. Because so much is known about the neuroanatomical pathways of, and neurotransmitters involved in the startle reflex, several studies have used startle to gain an understanding of neurohormonal functioning in PTSD. Finally, several investigators have used startle as an objective measure of the emotional states of anxiety and fear and have used startle as a tool to elucidate the neural mechanisms involved in the learning and extinction of fear and anxiety.

The startle reflex is one that is shared by very nearly all animals. In basic terms, it is the rapid motor twitch or jump that occurs when an animal or human is exposed to a sudden stimulus (such as a touch, a noise, or a visual image or light). The term acoustic startle reflex refers to the startle response to loud or sudden sounds. In humans, the most consistent and easy way to measure the acoustic startle reflex is to record the speed and intensity of the eye-blink that occurs after someone hears the noise.

The Madison Veterans Hospital is also conducting other PTSD experiments, including:

"Imagery rehearsal therapy" to reduce nightmares - and, sometimes, other symptoms. "You practice a dream and change the ending," said researcher Tracey Smith.

The short-term use of steroids to boost cortisol, a stress hormone. Some patients with PTSD have low levels of cortisol, perhaps because a sudden rush of it following a traumatic event has blunted production. A two-week dose of steroids "could help normalize that system," said researcher Catherine Johnson.

Use of the drugs risperidone and quetiapine, both antipsychotics developed for schizophrenia, in addition to the antidepressants typically given to patients with PTSD.

Researchers are also testing the use of prazosin, a blood pressure medication that slows down the sympathetic nervous system, commonly known as the "fight or flight" response to danger.

Great to see these studies moving forward.

PTSD Documentary Airs Today

New England Cable News (NECN) is set to air a new documentary, Hidden Wounds, detailing the struggle of three local soldiers who've returned from Iraq with post-traumatic stress. If you're in the viewing area, you can catch it today at 10:00AM and 7:00PM. NECN will re-broadcast the special throughout the week [times/dates - scroll down]. For those not in the viewing area, the Boston Globe has an article out today and online clips are available.

Click on 'Article Link' below tags for more...

The pop of a firecracker in a parking lot was all it took to send Nate Fick back to Iraq. That sound had him ducking behind the nearest car, grabbing for the pistol holstered on his thigh. Except his gun wasn't there. The former Marine was in Maryland with his sister and it was July Fourth, about a month after his return from Iraq. "I stood up a few seconds later, and said, 'Man, I'm out of my mind,'" Fick said in an interview this week. ...

"Hidden Wounds," which debuts Sunday at 10 a.m. and 7 p.m., tells the stories of Fick, currently a Harvard graduate student, Sgt. Russell Anderson, a longtime military man from Norton, and Jeff Lucey, a Marine who killed himself several months after returning to Belchertown. "These are three very different men," said Iris Adler, the film's producer and writer. "In spite of their differences, they all come home with post-traumatic stress disorder."

About one in six soldiers from Iraq and Afghanistan are suffering from post-traumatic stress disorder and depression, according to studies cited in the documentary. The soldiers in the film believe that the percentage is much higher, but a stigma prevents others from admitting the struggle. "There's a lot more people out there than you think like me," Anderson, 55, said this week.

Anderson's and Lucey's experiences are briefly outlined before returning to Fick's story:

Fick, a Dartmouth graduate, joined the military to test himself and because he believed members of the privileged class should serve. In Iraq, he led a reconnaissance unit to Baghdad. Carnage became commonplace, and the pressure of making life and death decisions was relentless. When he returned home, Fick fell into deep depression. He found relief writing about his experiences, an exercise that became the book, "One Bullet Away."

Fick said he hoped telling his story makes post-traumatic stress disorder real to people who don't know a soldier. People returning from Iraq are going to have serious problems, he said, and society needs ensure they get proper care, unlike so many Vietnam veterans. "Their problems have endured the 30-40 years since they came back," Fick said. "I don't want to see that repeated."

Don't forget to view the online clips if you're outside of the viewing area; and take a moment to thank NECN for their efforts at getting more to understand the plight of those troops coping with PTSD.


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