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Reaching out to Soldiers coping with war's demons

Staff writer

When the Soldier returned from Desert Storm, he went about his Army duties without giving a second thought to the fighting and death he had seen on the frontline of the battlefield.

His wife said he had changed. He was more anxious, quicker to anger and had trouble sleeping. The Soldier - who requested anonymity for this article -- brushed his wife's concerns aside while trying on his own to bury the memories, refusing to talk to anyone about how he felt and focusing on his duties as a Soldier.

"I was in the military. It was an internal problem that I didn't want anyone to know about," he said. "I dealt with it the best way I could."

Later, after retiring as a staff sergeant, he worked in Iraq as a contractor in support of Operation Iraqi Freedom.

"It was during one of the worst periods over there," he recalled. "I was in Fallujah. We got mortared about every other day. A fellow contractor got killed while I was there. He was one of the first American civilian contractors to get killed. The experience brought back a whole lot of anxiety and other stuff that I hadn't felt since Desert Storm."

After returning from Iraq, he knew he needed help.

"You hear about the Vietnam veterans and what they went through, and you don't want that to happen to you," he said. "I was dealing with a lot of anger, a high level of anxiety and frustration with basically situations beyond my control.

"I started avoiding situations with people because they might make me erupt. I started to keep to myself a lot."

In recent years, with the Army recognizing and accepting the emotional and psychological effects of war under the definitions of Post Traumatic Stress Disorder (an anxiety disorder resulting from a traumatic event) and Traumatic Brain Disorder (physical injuries, such as a concussion, that cause brain trauma), the retired Soldier began to feel more comfortable asking for medical treatment for his problems. About eight months ago, he sought help from Fox Army Health Center. There he met Dr. David Ferguson of the Behavioral Medicine Division. He was diagnosed as suffering from PTSD and introduced to group therapy.

"Dr. Ferguson is wonderful as far as bringing out the issues amongst us veterans that we are experiencing," he said. "It's easier communicating with other veterans who have experienced the same things you have. The average citizen just doesn't understand what I've been through."

His anxiety levels are lower, his marriage is better, he is dealing better with his memories of war and he is, basically, happier and more sociable.

"The counseling I'm receiving has really helped me to deal with my anxiety and anger. That counseling along with my relationships with God and my family have really helped me wrestle the demons of war," he said.

Soldiers suffering from PTSD and TBI don't receive a Purple Heart for what Col. Mark Smith, commander of Fox Army Health Center, describes as the "signature war wound." These Soldiers are the walking wounded, often carrying their burden silently as they get on with their lives and their missions. Some turn to alcohol or drugs to lessen the pain of their memories.

"A lot of our patients have a dual diagnosis of PTSD and substance abuse because alcohol and drugs help them to cope with what they are going through," said Pat Johnson, a substance abuse counselor at Fox Army Health Center.

May is Mental Health Month. In a recent public announcement, Army chief of staff Gen. George Casey has confirmed that the Department of Defense has stated that psychological or behavioral health counseling due to service in a military combat environment or due to marital, family or grief issues will not jeopardize a Soldier's security clearance or adversely impact their military career.

"This change allows issues to be identified and addressed earlier - before psychological stress escalates to a more serious condition that may further impact the individual, the unit, families and the Army's overall readiness," Casey said in the announcement. "Helping to maintain physical and mental well-being of Soldiers and Army civilians will ensure we remain Army strong."

Armywide it is estimated that 18 percent of Soldiers who have been deployed are suffering from TBI.

At Fox, much has been done to help Soldiers suffering from PTSD or TBI. During routine checkups, doctors take a Soldier's health history and look for symptoms of the two conditions. If there is suspicion of TBI, then the Soldier is referred to a neurologist for further diagnosis. If TBI is not the source of a Soldier's symptoms, then counseling determines if PTSD is the cause.

"A neurologist or a neuropsychologist can not only determine the amount of damage that's been done to the brain to cause the TBI, but they can also determine if it is TBI or PTSD," Johnson said.

"The symptoms of PTSD and TBI are often similar, although TBI sometimes requires hospitalization. But both often go undiagnosed because Soldiers are trained from early on to keep pushing on. They may not realize that their headaches, irritability and difficulty with memory is because of PTSD or TBI. The symptoms can be very subtle. It may come down to a Soldier saying their edge is gone or they don't feel quite like themselves."

The military culture teaches Soldiers to ignore physical problems so they can continue the mission. That often gets in the way of treatment for TBI or PTSD.

"The military emphasis of driving ahead keeps a lot of Soldiers from taking medical care of themselves," Ferguson said. "They don't pay attention to things bothering them."

As Fox counselors work with Soldiers suffering from TBI or PTSD, they are building their own expertise in treating the two conditions.

"I have learned so much about PTSD and TBI from the Soldiers with whom I have worked," Ferguson said. "They are living through these very difficult disorders, and have had the kindness and patience to teach me much more than I learned from the books. I have been humbled by their courage and by their willingness to explore the pain of these traumas by talking about it with myself and others in our office."

DoD plans are for all Army health care facilities to set up TBI centers of excellence. Work is being done now to set up such a center at Fox.

"We've treated PTSD and TBI for years here successfully, just under different names," Smith said. "But a congressional mandate to set up centers of excellence for TBI provides a significant increase in the budget for treatment. We've been creating the vision of what we need to do for these Soldiers. Now, we have the resources to take even better care of our PTSD and TBI patients."

Soldiers suffering from PTSD or TBI may be given a mixture of treatments - group therapy, individual counseling, marital counseling, family counseling and medications - to manage and overcome their condition. New technologies and treatments, developed primarily by the Army's doctors out of necessity, will be used to care for TBI and PTSD patients. Usually, treating Soldiers with PTSD is more straightforward than treating Soldiers with TBI.

"With PTSD you are treating the emotional trauma. You are teaching people how to confront anxiety and the memories inside them," Ferguson said.

"TBI treatment is much broader because variations can be anything. They may lose their academic ability or they may have headaches. They might not be able to recall things or they can't read or write or they have times when they feel disoriented."

Recovery and the length of treatment also vary with each individual.

"If you have mild TBI, you will recover in one to one-and-a-half years," Ferguson said.

"With single event PTSD, recovery is pretty good. But combat PTSD is really different because you may have a Soldier who has been shot at 10 times in an hour nearly every day or they have some other type of recurring traumatic event. They may have a full year of living at a heightened level of anxiety so their habits for living are significantly altered. It is much harder to recover from that."

Even though the Army has a new policy concerning the treatment of Soldier PTSD and TBI, the retired Soldier suffering from PTSD doesn't know if he would have sought help for his condition during his active service years.

"There's a stigma if you know a guy who's going to group therapy," he said. "Soldiers are shunned for that. So, a lot of Soldiers cover up the problems and try to be the best Soldier they can. It's a good thing the Army is recognizing the problem. But there is still a fear of being labeled."

He said it will take time for Soldiers to be comfortable with confronting the issues of PTSD or TBI, especially since seeking help can have a negative effect on a career in a number of ways, he said.

"Counseling takes time away from your job," he said. "And, if you have a mission, you want your best Soldier to do the job. It's hard for some commanders to let their best and most experienced Soldier go off and deal with their problems and put someone else in that position who might not perform as well."

But professionals at Fox insist it is imperative that Soldiers seek help if they are suffering from PTSD or TBI. And these Soldiers deserve the best treatment the Army has to offer.

"I have never been more proud to work with a group of people than America's combat veterans," Ferguson said of the Soldiers seeking treatment for PTSD and TBI at Fox.

"They placed their lives on the line for their country. Many came back physically and emotionally injured. And every one of them said they would do it again and again if their country requested it. They are humble heroes. While they could live in bitterness and regret about their injuries, they choose to stay committed to their country and continue to get healthier."

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