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Frontline PTSD

interior-stress This article was published in the Sunday Herald on May 17, 2009.

John Russell showed such obvious signs of combat stress that he should have been sent home from Iraq, according to military mental health professionals. The Army Sergeant, who killed five fellow soldiers at the Camp Liberty clinic in Baghdad, was nearing the end of his third tour. That he was still in a war zone, despite his superiors knowing he presented a threat to himself and to others, is a symptom of institutional pressure to keep damaged men fighting.

Shad Meshad, Director of the National Veterans Foundation, was an “army shrink” in Vietnam. “It’s clear that this situation was escalating and sending this guy back for a third tour was just insane,” he told the Sunday Herald. “If they see any sign of breaking or snapping they need to remove soldiers completely out of the combat zone and get them into professional care. That’s the bottom line.”

John Keaveney, a Scot who joined the US Army during the Vietnam war and now runs a veterans support organisation in California, believes that unless the military improves its mental health treatment, there will be similar massacres back home. “Some other thing will happen but it’ll be in Montana or Wisconsin or Los Angeles. It’ll be a recurring thing,” he said.

“You have to understand how desperate a person has to be to seek help, leave, get a gun and go back to kill. It wasn’t on his mind when he went there to take somebody’s life, but something snapped inside of him to where his mental pain became unbearable and he thought that maybe lashing out at people would bring attention to the fact that he was injured.”

Shad Meshad

Shad Meshad counsels a soldier in Vietnam

Russell’s commanding officer had confiscated his weapon a week earlier because of concerns about his mental state, but on the way out of the clinic, he wrestled a gun from the staff Sergeant who was escorting him, returned inside and began killing, apparently indiscriminately. Two of the dead were counsellors, including a volunteer psychiatrist from the army reserve. Three others were enlisted men.

His comrades told CBS news that he was angry because his nightmares and constant anxiety were not taken seriously. His father, Wilburn Russell, claimed he had been sent to the clinic for punishment, not treatment. “They scheduled him in, and they set him up. They drove him out. I think they broke him,” he said. In an email, Russell had worried that he would be dishonourably discharged, losing his salary and his army pension, soon after taking out a large mortgage on a house in Sherman, Texas.

A career soldier with the 54th Engineering Battalion, Russell had served in Kosovo and Bosnia before going to Iraq. His specialism, salvaging robots used to destroy roadside bombs, meant that he saw “a lot of carnage and things he shouldn’t have seen,” according to his father. He lived in Germany, but on visits back to Texas he was perceptibly different, more nervous and unpredictable with each deployment. “Nobody should have to go three times. They should’ve realised that.”

The army’s own research shows that the likelihood of suffering acute combat stress increases with every tour. Soldiers with multiple deployments have 50% higher stress rates that volunteers experiencing a war zone for the first time. By the third or fourth tour, they are twice as likely to exhibit the worst symptoms. The Rand Corporation estimates that 300,000 Iraq and Afghanistan veterans have Post-Traumatic Stress Disorder or clinical depression and a further 320,000 have sustained a traumatic brain injury.

Defence Secretary Robert Gates described the shootings as “a cause for great and urgent concern.” The army has launched an investigation into whether it takes adequate care of its mentally wounded, but veterans support groups are sceptical that it will address the true scale of the problem. Admitting that one in three of the 1.7 million men and women who have fought in Iraq and Afghanistan have mental health issues, as studies have suggested, would place unbearable strain on the military.

“This war that was supposed to be six weeks is now over six years. When you put soldiers in harm’s way two, three, four, five times, the pressures are insurmountable and they start breaking,” Shad Meshad told me. The NVF receives several calls a day from veterans worried about whether they can cope with redeployment.

As a psychiatrist in Vietnam, Meshad did triage, counselling and mental health assessment, much like the doctors at Camp Liberty. “A little clinic in the combat zone is absurd, in a way, because unless they’re removed from the possibility of another catastrophe it’s really just band-aid therapy,” he said.

John Keaveney

John Keaveney in Vietnam

John Keaveney came back from Vietnam angry, out of control, with a stash of heroin sealed in the backs of Polaroid pictures. He spent years in jail, for a string of violent crimes. “I was getting locked up for assault with a deadly weapon, aggravated assault, attempted murder. I was full of hate and anger,” he told me, in a Glaswegian accent softened by half a lifetime in California.

“Wise men and theologians have talked about the adverse effects of war on the human spirit. In the first world war it was shell shock. In the second world war it was combat fatigue. After Vietnam it was Post Traumatic Stress Disorder. So they have all the data. They know that you can only subject people to a certain amount of stress before they become casualties of the situation.”

In 1982, believing he had been betrayed by the Veterans Affairs administration, he broke into Meshad’s office, held him hostage at knifepoint, cut the ribbons off his Captain’s uniform, lectured him for hours and slowly drank himself to sleep. Meshad escaped, but by the time police broke in, Keaveney was gone. He stayed on the run for a year.

When he was finally caught, he called his victim from prison, begging for forgiveness. Hearing “something in his voice which was genuine” Meshad declined to press charges and encouraged Keaveney set up New Directions, to work with other wounded soldiers. He has been helping veterans ever since and the two are now best friends.

By the end of the Vietnam war, so many officers had been killed by their troops that a new term – “fragging” – entered the lexicon. The Defence Department acknowledged between 800 and 1,000 such fatalities. Men in Keaveney’s unit spoke openly about blowing up their superiors, particularly after the Kent State University shootings in Ohio. Meshad assessed soldiers who were on trial for killing their own.

The Camp Liberty shooting stands out as a rarity in the current conflicts. Hasan Akbar’s murder conviction, for throwing a grenade into a tent full of sleeping soldiers in Kuwait, as they waited to invade Iraq in 2003, is the only confirmed case of fragging. Staff Sergeant Alberto Martinez was acquitted by a military court, after being accused of deliberately setting off a claymore mine that killed two officers in Tikrit, Iraq.

There are other indicators, though, that suggest dangerously high stress levels in the military. In January, more soldiers committed suicide than were killed in Iraq and Afghanistan combined. In the first four months of the year, 91 soldiers took their own lives. Last year’s total of 140 army suicides was a record, but it seems inevitable that this grim statistic will be surpassed.

The army has invested heavily in facilities like the stress clinic at Camp Liberty, so that soldiers can receive treatment for mental health problems in Iraq. A report in The National, posted on the US Army website, described the therapy that wounded soldiers receive there.

At a counselling session, Major Thomas Jarrett told volunteers that he was “fed up of hearing about” combat stress and advised them to grow from the experience. Major Kevin Gormley, who runs the centre, said “our job is to keep soldiers on the battlefield, not send them home.”

Soldiers are often reluctant to admit that they have a problem. As John Keaveney told me: “It’s hard to get PTSD treatment if you’re in a combat zone. It’s hard to admit you need help if you need to go out the next day and drive a fuel truck that could get RPG-ed. And once you let it go for a while, it’s too late. People start medicating themselves and it’s the downward spiral into mental illness.”

The online magazine Salon recently released a tape of a psychologist at Fort Carlson, Colorado, stating that the army discourages diagnoses of PTSD. The military has denied issuing any such instruction, officially or unofficially, but it certainly has good reason to do so. Confirmed PTSD entitles veterans to a disability payment worth 50% of their base salary, for life. The cost of these obligations to an estimated 300,000 people would be astronomical.

The Veterans Affairs administration has made great progress in its treatment of the condition, nonetheless. At the West Los Angeles healthcare centre, acknowledged as one of the best of its kind, Matthew Simmons runs therapy sessions at the parrot sanctuary, where sufferers are encouraged to share their traumatic experiences, as birds tweet in the background.

Simmons is a veteran of the first Iraq invasion. When he returned, he became a violent alcoholic and was eventually sent to prison for ripping a man’s eye out of its socket. “The current vets, it’s just this incredible anger,” he told me. “It comes out in all the wrong ways. When snipers are shooting at you, fear’s what you run on, but back home running on fear and anger, that dual-edged sword, gets you into a lot of trouble.”

Last year, a New York Times investigation documented 121 murders allegedly committed by veterans of the wars in Iraq and Afghanistan. Conservatives have pointed out that, per capita, this is actually fewer than the comparable age group in the general population. The US Justice Department estimates that 12% of prisoners served their country at some point, but no-one is keeping score of how many of these are veterans of the most recent wars.

Paul Sullivan, of Veterans For Common Sense, has claimed that “we may be verging on a suicide-homicide epidemic.” The statistics don’t back this up, but there is plenty of horrific anecdotal evidence .

Marine Andres Raya disappeared from Camp Pendleton between tours and instigated a shootout with police officers in his home town that left three dead. Matthew Sepi took his AK-47 to the corner shop for protection in Las Vegas and killed two gang members who tried to rob him. Private John Needham allegedly beat his girlfriend to death in California and then attacked cops who were called to the disturbance. Seth Strasburg shot a student in the face on New Year’s Eve.

All had complained about terrifying dreams, hyper-vigilance and survivor’s guilt. Only Needham had received an official diagnosis of PTSD, after he attempted suicide in Iraq. The military culture of readiness means soldiers are unlikely to own up to mental health issues in post-deployment screening, particularly when prospective employers will hear about it.

“The damage has been done for many of them. There’s a lot of walking mentally wounded in the states right now,” Meshad told me. “Violence is going to show up everywhere. It’s just pretty dramatic that it happened in Baghdad at a stress management clinic.”

Russell cannot be considered an isolated case of a warrior who was pushed beyond his limits, he said. “How many have to be killed this way? Soldiers are starting to snap, but it’s been played down because it doesn’t help in recruiting. They’ve got to replace these guys. There’s a big push for National Guard reserves at the moment because they need bodies, they need soldiers.”

When they return from combat, few PTSD sufferers will receive round the clock care they need. John Keaveney’s latest attempt to set up affordable housing for veterans in Los Angeles was blocked by local residents, concerned at the potential impact on their community. “The nation needs to wake up,” he told me. “They’re all like ‘help the vet’ but when the opportunity comes along they say not in my back yard.”