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Posts tagged ‘Veterans’

Sex and the Wounded Soldier

amps001For Veteran’s Day, I wrote a brief story for the Dart Society Reports on “sex and the wounded soldier.”  It’s about a lot of overlapping themes — my friendship with a wounded soldier (now dead) who worried a lot about war’s impact on his intimate life; an amputee dance troupe from World War II, called “The Amputettes”; the U.S. military’s long-standing awkwardness about matters of sex, heart, and family.  It all seems a bit more timely with the Petraeus love triangle (quadrangle?  pentagon? hexagon?).

The other stories in the issue are well worth reading.  Lee Hancock has an exceptional piece about the ethical minefields that come with reporting on sexual assault within the military, called “The Rape Was Not The Only Problem.” And conflict photojournalist John Moore has a photo essay on veterans recovering from major burns at the Brooke Army Medical Center in San Antonio, Texas.

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Image credits: “‘Amps’ Shake a Shapely Leg” and “’Amputees’ Present a ‘Gay 90s’ Review” clippings.  The Canham Collection. Otis Historical Archives.  National Museum of Health and Medicine.

Suicide Watch

The director of the National Institute of Mental Health says that more Iraq and Afghanistan veterans may die from suicide than from combat. So why isn’t the Pentagon protecting U.S. soldiers off the battlefield?

(As published in the New Republic.)

As the Iraq war grinds into its sixth year, policy-makers in the U.S. would do well to remember the story of Phineas Gage. For those in need of a refresher, the 25-year-old construction foreman lost a hunk of his frontal lobe back in 1848 when a three-foot iron rod shot through his left cheekbone and out the top of his head. Miraculously, Gage could walk and talk again just minutes after the accident, staying conscious on the three-quarter-mile oxcart trek into town, where doctors patched his wounds and sent him on his merry way.

But the tale didn’t end there. In his post-accident years, Gage transformed from a levelheaded foreman into a forgetful, quick-tempered roustabout. He threw fits of “the grossest profanity” and wrestled with depression. He found it difficult to keep a job, and harder still to keep a woman. In the notebooks of his physician, Dr. John Harlow, America received its very first public account of the long-term demons unleashed by traumatic brain injury (TBI).

160 years after Gage’s accident, medical experts are calling TBI the “signature wound” of the Iraq war. An astounding 60 percent of troops entering Walter Reed Army Medical Center suffer from brain trauma as their primary or secondary malady, typically the result of an improvised explosive device. The physics look something like this: A roadside bomb sets off a blast wave that travels at a speed of 1,600 feet-per-second toward a soldier’s vehicle. On impact, the blast rattles the soldier’s brain against his or her skull–often leaving no visible scratches, but prompting closed-head traumas that can be hard to diagnose: torn cerebral tissue, internal bleeding, and relentless swelling of the brain’s inner cavities.

Much like Phineas Gage, soldiers with serious TBI often suffer from irreversible forms of cognitive freefall, such as the loss of memory and language. As for emotional consequences, they also tilt towards depression, volatile moods, and all manner of creative self-destruction. The long-term behavioral consequences of TBI–an ironic byproduct of new battlefield advancements such as Kevlar helmets that protect soldiers’ lives but not always their cortical lobes–might offer the missing link in the growing debate over Iraq veterans’ unprecedented suicide rates. According to new U.S. Army statistics, five soldiers try to kill themselves each day, compared to one soldier per day before the Iraq war.

Last Monday, Dr. Thomas Insel, director of the National Institute of Mental Health, issued a controversial prognosis for the coming generation of American veterans: “It’s quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths,” he told an annual gathering of the American Psychiatric Association. “We don’t yet know how to predict who is going to be the person to be most concerned about.”

Dr. Insel’s prognosis drew on a recent 500-page study by the RAND Corporation, which concluded that among the nearly 1.7 million who have served in Iraq and Afghanistan, some 300,000 veterans suffer from Post-Traumatic Stress Disorder (PTSD) or major depression, with nearly half of all cases going untreated. The study also highlighted a less widely-covered trend: Some 320,000 troops returning from both wars are plagued by traumatic brain injuries–again, with only half seeking treatment.

I recently spent a month reporting from Iraq and a summer volunteering at Walter Reed, and Dr. Insel’s pessimism doesn’t surprise me. I’ve heard many soldiers deadpan that, “If Iraq doesn’t kill you, coming home might,” and I’ve seen how right they can be. Last June, a friend and TBI survivor named Rob Shaw–a former medic in Iraq and Afghanistan who, in his better moments, is as gallant a New England gentleman as they come–wound up in police custody after a Hollywood-style car chase, telling cops to shoot him before he shot himself. Luckily, the officers handled the situation with a sympathetic dose of grace; if they hadn’t, he might have been reduced to yet another victim of Dr. Insel’s “psychiatric mortality.”

The evidence linking TBI to suicide isn’t new; many cautionary studies date back to the late-1990s and early-2000s. A significant portion of the research comes from the world of professional sports, where coaches and trainers long ago spotted the tie between depression and athletes’ concussions (a consensus reflected in a front-page New York Times article last year on the post-TBI suicide of former NFL player Andre Waters: “Expert Ties Ex-Player’s Suicide to Brain Damage From Football”).

According to one 2001 study, released in the medical journal Brain Injury, “The possibility that patients who have suffered a traumatic brain injury will commit suicide is high, and in many cases clinicians tend to underestimate [it].” The authors’ data stacks up tellingly: A year and a half after TBI patients were discharged from the hospital, 48.6 percent of them suffered from depression, and 65 percent of this group were at clinical risk for suicide. A similar 2002 study in Psychological Medicine found that 35 percent of TBI patients showed “clinically significant” levels of hopelessness, 23 percent showed suicidal ideation, and 18 percent had attempted suicide in the five years following their injury.

Still, the U.S. government has been slow to draw the links between Dr. Insel’s projected spike in veteran suicides and RAND’s massive estimates of TBI. In 2006, Congress cut funding for the Defense and Veterans Brain Injury Center, a key facility devoted to treating and understanding war-related brain traumas. “Honestly, they would have loved to have funded it,” explained spokeswoman Jenny Manley of the Senate Appropriations Committee, “but there were just so many priorities.” More recently, authorities from the Department of Veterans Affairs (VA) attempted a seedy cover-up of soldiers’ astronomical suicide rates. In a February email boldly titled “Shh!”, Dr. Ira Katz, deputy chief patient care services officer at the VA, told colleagues, “Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see…. Is this something we should address ourselves in some sort of release before someone stumbles on it?”

If Washington bureaucrats aren’t connecting the dots between suicide and TBI, young soldiers certainly are. On March 5, Specialist Timothy Juneman, 25, hanged himself in his apartment after learning that he would be sent back to Iraq, despite his evident TBI and PTSD; he was the seventh veteran receiving treatment from Spokane’s VA hospital to commit suicide this year. Not long thereafter, on May 9,  Timothy K. Israel–barely 23–used the drawstring from his pants to end his life in an Indiana jail cell, where he was being held on charges of domestic battery after an argument with a former girlfriend.

America’s young veterans deserve a better future than that–and a longer life than the forlorn Phineas Gage, who died following violent seizures in his mid-thirties. Just how relentlessly must the body counts climb before the Pentagon teams up with Congress to fund overdue research into the TBI-suicide link? Rather than gutting support for the VA, they need to expand the department’s programs for lifetime TBI screening and treatment. But even the best psychiatric treatment will only help a fraction of those returning from war with these life-altering and often deadly injuries. So as our presidential candidates debate the future of our military in Iraq, they should heed Dr. Insel’s warning that the human consequences of our continued presence there are much greater than just those who die on the battlefield.

Drinking. Brawling. Hurting.

The wounds on my friend Pete Yazgier’s head come in as many colors as Cezanne’s fruit bowls.

(As published in the Washington Post.)

Cherry-hued flecks dot the left half of his skull — grim mementos of the rocket-propelled grenade that walloped his armored vehicle in Baghdad last September. A bright scar bends like a stalk of rhubarb above his left ear, the result of six surgeries to treat the brain cancer doctors found while ministering to his shrapnel wounds; they fear the tumor was caused by depleted uranium that Pete, 28, handled as an Army mechanic.

And now, a plum-like bulge on his upper right jaw ripens before my eyes. This, oddly enough, is the one that really scares me: It’s the aftermath of a Marine’s clenched fist that hurled into Pete’s face just moments ago.

Only the bar gods know exactly how the skirmish began. But I’m guessing it went something like it did just the week before:

Marine: “Hey, [fornicator], what are you staring at?”

Army guy: “I don’t know, you [fornicating] Jarhead, you tell me.”

Marine: “I think I’m staring at a [fornication-head] who’s about to get his [buttocks] kicked.”

Lame invectives turn to blows. Soused onlookers hustle to their buddies’ defense. Only when a huge bouncer enters the fray do flying fists cease and desist — Marines head for the front exit, Army guys to the bar. As I search for ice to press against Pete’s busted cheek, the cops appear, looking downright bored by the redundancy of the mayhem.

Yes, sir, it’s another Friday night at R.J. Bentley’s Filling Station, a cozy bar in College Park, where wounded Iraq and Afghanistan veterans being treated at Walter Reed Army Medical Center come to fuel up on Coronas, honky-tonk dance and the “Rocky”-style pummelings I’ve seen on half a dozen visits this summer.

Venture here around dinnertime, and you’ll find University of Maryland professors eating fettuccine with their kids. But stay until the floors start getting sticky — say, around 11 p.m. — and it’s a different world altogether: a chance to brush up against college football hunks and thin girls in slinky tube tops, and also, perhaps, to witness some of the raw consequences of two faraway wars brought home.

Half a decade into the “war on terror,” America’s bars have become our barometers: instruments that measure the extent to which our veterans have been left to wrestle alone with substance abuse, anxiety disorders and other mental health problems after long tours in Iraq and Afghanistan.

The men and women who come back from the traumas of war “are often hyper-alert, quick to respond and susceptible to a loss of impulse control,” says clinical psychologist Jeffrey Jay of the Center for Post-Traumatic Stress Studies in Washington. “The brain is actually altered by these experiences — it’s part of a survival mechanism, and it’s very confusing for them.”

It’s similarly confusing for watering holes such as R.J. Bentley’s, where Pete likes to go because it’s the only bar around that occasionally plays the kind of country music he loves. “We’ve seen a massive rise in customers, thanks to Walter Reed,” one bouncer at Bentley’s told me. “But we’ve also seen a rise in fights.”

Police and news reports corroborate that fighting has been mounting in nightclubs, restaurants and bars near military bases nationwide: places such as McDonough’s Restaurant & Lounge near Fort Stewart, Ga.; O’Blarney’s Irish Pub south of Fort Lewis, Wash.; the entire “Strip” near Nellis Air Force Base in Las Vegas. Drunken driving and bar brawls so plagued the area around Fort Carson, Colo., that a National Guard unit was put on “lockdown status” after returning from Afghanistan in June. In the District, the Hawk ‘n’ Dove, a Capitol Hill bar, has banned Marines without female dates.

In Massachusetts, meanwhile, the Norfolk County district attorney’s office has begun an initiative called “Beyond the Yellow Ribbons” to prepare police and others to deal with struggling vets and the stigmas they face. District Attorney William R. Keating says he has received requests for the program’s training video from organizations in more than 20 states, because “the federal government simply isn’t providing enough guidance on how to deal with this.”

Perhaps that’s because the Bush administration’s $500 billion-plus “global struggle against violent extremism” has so far proved to be one of the most socially and economically quarantined conflicts in U.S. history. Whereas 12 percent of the population served in World War II and 4 percent in the Vietnam War, less than half of one percent of Americans are engaged in active duty in Iraq or Afghanistan. Translation: Only a sliver of my generation has been exposed to war’s dirty psychological laundry.

But with a growing number of troops returning home from multiple tours, more Americans like me — a 23-year-old occasional volunteer at Walter Reed and the girlfriend of a soldier serving in Iraq — are getting our first unsettling glimpse.

On a recent night at R.J. Bentley’s, I perched near a young man nursing a flask of whiskey who told me he’d been ordered to collect his best friend’s body parts from the crater of an improvised explosive device, and an older vet with darting eyes who said he’d tried to slit his wrists in Kuwait rather than return to Fallujah. And if you agree that trauma begets trauma, the evening’s trajectory won’t surprise you: Mix equal parts broken bodies and frayed minds, stir in college kids who couldn’t tell an IED from an iPod, add alcohol, and things are bound to get explosive.

I suspect these aren’t just the sort of routine bar fights that have typified military culture since George Washington’s troops sneaked their first swigs of moonshine. Strike Pete Yazgier, and you may slice your knuckles on his titanium skull. Toss an elbow at the man in the corner, and you could get a shin-kick from his $26,000 motorized foot, an emblem of the spectacular violence that new technologies are helping today’s troops survive.

The rough-and-tumble encounters jibe with national statistics on the effects of longer, repeated tours of duty. Soldiers who’ve deployed to Iraq more than once have a 50 percent higher rate of combat stress, according to one Army study, and soldiers with a higher rate of combat stress exhibit approximately a 10 percent increase in anger-management issues. Simple diagnoses such as “post-traumatic stress disorder” and “generalized anxiety disorder” collapse under the weight of it.

Consider Jonathan Schulze, an Iraq vet with two Purple Hearts who got drunk at a Minnesota bar in January, then went home and hanged himself from an electrical cord wrapped around a beam in his basement. The tragedy unfolded only after the Marine machine-gunner returned from Ramadi with deep psychological wounds, threw a 200-pound potted tree through a window during a brawl, and beseeched the local Veterans Affairs Department for help, only to be told that his suicidal confessions put him 26th on the waiting list for assistance. (According to a recent Pentagon report, suicide rates are 35 percent higher for Iraq veterans than for the general population.)

Then there are cases like that of Spec. Richard Davis, who survived “shock and awe” in Baghdad only to be stabbed to death by his fellow soldiers in 2003 after celebrating his homecoming at a Hooters restaurant and a topless bar near Fort Benning, Ga.

Institutional ignorance isn’t the problem. In January, the Pentagon released a survey cautioning that the rate of binge drinking in the Army skyrocketed 30 percent between 2002 and 2005, hurting combat readiness. Even so, the best response the Defense Department could muster was a Web-based campaign called “That Guy,” which goofily implores soldiers to “Turn your speakers on, dude!” so that they can hear cartoon-animated warnings about how guzzling beer might hurt their sex lives by causing them to puke in their date’s purse.

Perhaps the $2 million this cost would have been better spent on comprehensive treatment programs for servicemen and women of the sort that are sorely lacking at Walter Reed, where the renowned PTSD program accepts a paltry average of 65 patients a year and a typical mental health regimen involves, according to a report in The Washington Post, random screenings of movies such as “The Devil Wears Prada” and a dearth of one-on-one therapy with trained clinicians.

In my own small way, I’ve seen the price of this negligent government policy, coupled with the military stigma against seeking help for psychological distress. I’ve sat outside the hospital with Pete’s friends as they drank heavily, talked about friends’ corpses, compared R.I.P. tattoos and fed their psych meds to the squirrels to pass the slow-drip nights. I’ve held the forehead of my courageous boyfriend, Robert, as he shivered on the cold tile floor of our hotel room, vomiting Scotch, on our last vacation in January, before his most recent deployment. We laughed at his New Year’s resolution — “Don’t get blown up” — but all the while my brain screamed, “This can’t be normal!” because, well, my heart knew it wasn’t, and because I sensed the deeper pain his jokes masked.

“You don’t get the option to not be scarred by war,” he recently wrote me from Iraq. “You don’t get to shed your uniform and go home like nothing’s different. You forever carry the seeds of violence inside.”

Those seeds are sprouting like strangle-weed as the rest of America bustles along, debating the fates of Posh Spice and Harry Potter, as if war were just a pixilated thing that happens to far-away Muggles. Some of these weeds can be uprooted: More than 45,000 vets overcame the stigma of PTSD to seek medical help in the first quarter of 2007, and national legislation such as the Wounded Warriors Act promises to funnel more resources toward vets’ mental health, if it ever escapes congressional molasses.

But much of the current wars’ noxious overgrowth is proving ineradicable, coiling stealthily around our bars, jails, businesses and private lives.

One damning manifestation is traumatic brain injury (TBI), the unforeseen consequence of modern military technologies and equipment such as Kevlar helmets. Sixty percent of all injured vets entering Walter Reed suffer from TBI as a primary or secondary injury, according to the Defense and Veterans Brain Injury Center.

Three of the four most notorious troublemakers I’ve gotten to know at R.J. Bentley’s are victims of TBI — a silent disability that receives little of the public sympathy afforded the war’s more visible amputees. And there’s no snazzy Web site or government program that will undo cranial nerve damage or recover a personality that has fallen off the tip of its own tongue — slow to remember, quick to violent outbursts, unrecognizable to loved ones.

On a recent night, I loaded up the car with TBI-afflicted friends, including Pete (who, for the record, is funny and smart and kind), and drove to a happy-go-lucky bar in Adams Morgan in the District, where the drinks come with cheerful pink umbrellas.

Approaching the bar, we saw a blond guy with a cast on his wrist. “Hey, you were in Iraq, too?” asked Pete’s friend Zach, tapping the cast. The kid looked befuddled. “No — I just fell at the pool.”

The exchange was a perfect reflection of how the true costs of war have been outsourced to a very few Americans, and a great many Iraqis. But it also reminded me that full-scale containment of the wreckage is impossible — that, as Nigerian novelist Chinua Achebe wrote of imperial ventures in years past, “things fall apart.”