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Effects of long term combat tours

United Press International ~ June 10, 2005

WASHINGTON - New Year's Eve found 22-year old Iraq war veteran Spc. Abbie Pickett huddled in the doorway of a building, crying hysterically as fireworks exploded overhead.

The explosions brought on the adrenaline rush she had grown to associate with warfare. In Iraq those lights and noises demand a reaction. Soldiers know what to do when an attack starts. That's what their training is for.

But there were the lights and the noise and the adrenaline rush, incongruous on the peaceful street, and Pickett did not know what to do. First she hit the ground, then her alarmed friends led her to shelter until she could pull herself together.

"What is considered a bizarre (reaction) in every day life is what keeps you alive in Iraq," she said Thursday.

Pickett, of Madison, Wis., is one of the many Iraq war veterans with post-traumatic stress disorder. She returned in April 2004 from a year's duty in Iraq as a fuel truck driver attached to the Army's 4th Infantry Division with her National Guard unit. Supply convoys are among the most dangerous postings in the war since they are the frequent target of ambushes and roadside bombs. Fuel trucks are especially dangerous as they are bombs of their own if hit the right way.

Pickett's truck took small-arms fire periodically, but it was not until a night in October 2003 when her base in Baqubah came under attack that she experienced trauma. As trained, she ran into the building being shelled to help the wounded. She tended one soldier whose arm had been mangled; it would be months before she learned that her actions saved his limb. She transported four gravely injured soldiers in a truck to the hospital.

That is the experience to which she traces her depression and inability to concentrate in college or sleep. It is why she had to drop most of her classes in school and why she is on Zoloft and takes sleeping pills. Her medication is not working for her, but she is unable to get in to see a Veterans' Administration psychiatrist because they are so backed up with other cases.

"I miss Iraq," she said. "Most veterans will tell you, 'I miss Iraq.' You miss the adrenaline rush." Many with post-traumatic stress disorder sign up to go back, she said -- back to a place where their jumpy nerves and over vigilance serves a purpose.

A 2004 study endorsed by the Veteran Administration says 18 percent of troops returning from Iraq will have post-traumatic stress disorder, the result of fearing for their lives and the lives of their friends, and the guilt of taking other lives in war.

The Afghan war yields an 11 percent likelihood a soldier will suffer the disorder. But the Iraq war is particularly difficult on troops, with the kinds of experiences that lend themselves to long-term trauma. According to the 2004 study, 94 percent of soldiers in Iraq reported receiving small-arms fire; 86 percent of reported knowing someone who was seriously injured or killed; 68 percent reported seeing dead or seriously injured Americans, and 51 percent reported handling or uncovering human remains. Most soldiers -- 77 percent -- deployed to Iraq reported shooting or directing fire at the enemy, 48 percent reported being responsible for the death of an enemy combatant, and 28 percent reported being responsible for the death of a noncombatant.

Most of those 18 percent expected to get post-traumatic stress disorder will recover, especially if they get early mental health care. But if soldiers deploy more than once - and about a third of the Iraq force is in that position -- or if new veterans who need services do not get the support they need, the lasting mental health toll could be serious.

Hawaii Democrat Sen. Daniel Akaka introduced a bill Wednesday that will require $100 million to $300 million more to be spent providing mental health care to veterans. One of the functions of the bill is to tie health care increases in the Veterans' Administration budget to current year dollars; they are still being figured in 1996 dollars and are not keeping pace with inflation, Akaka said Thursday.

The bill, "Veterans Mental Health Care Capacity Enhancement Act of 2005" would add staff to community Veterans' Administration clinics; require in-patient, five-day detoxification programs at all primary health care facilities; and screen troops leaving the military for sexual or mental trauma to determine treatment.

Akaka praised the Veterans' Administration for the quality of its care, but warned that the care is "slipping," particularly when it comes to mental health services. More than 150,000 Iraq war veterans have entered the Veterans' Administration system, and the estimated 30,000 of those with post-traumatic stress disorder will seriously strain existing resources.

Even troops who are functioning well without observable manifestations of trauma are suffering. A Marine captain who asked that he not be identified - for fear of being made fun of or losing the confidence of his troops - reports a recurring nightmare, one of the symptoms of mental trauma. He and several of his Marines have fallen asleep at a sentry position, and their guns are far away from them, locked together. He wakes up to see Iraqi insurgents sneaking up on is position, but he can't wake up his comrades or get to his gun. He wakes up as they are being shot to death.

That Marine is now on his second combat deployment in 14 months, after less than seven months at home.

Down Range - To Iraq and Back
by Bridget Cantrell, Ph.D. and Chuck Dean

An Operators Manual for Combat PTSD: Essays for Coping
by Ashley B., II Hart

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