"We Have Met the Enemy, and He Is Us"

Technorati Tags: Mental health care for Iraq war veterans

Think Progress today links to a Washington Post article about that Pentagon study on ethical standards among U.S. troops in Iraq:

The authors of the Army document argued that the strains placed on troops in Iraq are in some ways more severe than those borne by the combat forces of World War II. "A considerable number of Soldiers and Marines are conducting combat operations everyday of the week, 10-12 hours per day seven days a week for months on end," wrote Col. Carl Castro and Maj. Dennis McGurk, both psychologists. "At no time in our military history have Soldiers or Marines been required to serve on the front line in any war for a period of 6-7 months."

And although U.S. casualties in Iraq are far lower than in the Vietnam War, for example, military experts say that Iraq can be a more stressful environment. In Vietnam, there were rear areas that were considered safe, but in Iraq there are no truly secure areas outside big bases. "The front in Iraq is any place not on a base camp" or a forward operating base, the report noted.

The Army's acting surgeon general says it's normal for U.S. troops to be thinking that torture is okay, as long as they don't actually do it:

Major General Gale Pollock, the army's acting surgeon general, sought to make a distinction between soldiers' thoughts about torture and their actions.

"These men and women have been seeing their friends injured and I think that having that thought is normal," she said at a Pentagon press conference," she said

"But what it speaks to is the leadership that the military is providing, because they're not acting on those thoughts. They're not torturing the people."

Someone, remind Major General Pollock that she also said this:

"Soldiers with high levels of anger, who had experienced high levels of combat or who screened positive for mental health symptoms were nearly twice as likely to mistreat noncombatants," Major General Gale Pollock, the acting army surgeon general, told reporters at a press conference.

There are also a few other trivial little side points; namely, that even if U.S. troops are not actually committing acts of torture on Iraqi civilians, those troops are experiencing unimaginable suffering and mental torment. We are dealing with human beings here, not automatons or machines. Even if Pollock doesn't care about the emotional trauma experienced by young men and women who are in Iraq right now, she might want to spare a moment or two to consider the long-term consequences for those young people -- and their families, and the larger society -- that will surely result from the mental damage this war is doing to them.

The WaPo article gives us a glimpse into what happens when soldiers stressed to the breaking point come home:

Strains on military families also are intensifying. About 20 percent of soldiers said they were planning a divorce or separation, up from 15 percent in the previous year's survey. Marital problems seem to grow with the length of a deployment, the survey found. Ten percent of soldiers deployed for less than six months reported that infidelity was a problem in their marriage, compared with 17 percent among those who had been in Iraq longer than that.

"The story I heard from my wife and daughter a lot is, 'You're not the same person that left to go over there,' " said retired Sgt. Coby Thomas, who developed post-traumatic stress disorder after serving in Iraq. "People expect you to be like you were and pick up where you left off, and they're not prepared for the changes."

Thomas, who suffered a traumatic brain injury while protecting a convoy south of Baghdad in December 2004, agreed that the stress on soldiers is increasing with multiple tours of duty. "You're talking about fourth deployments; it's the same people going over again and again," he said.

Retired Air Force Tech. Sgt. Scott Shore said multiple deployments over a 19-year military career left him with severe post-traumatic stress disorder. His last deployment was in 2004 in Iraq's Sunni insurgent stronghold, Anbar province, where he provided medical care and saw combat.

"That seemed to be the straw that broke the camel's back," Shore said in a telephone interview from Browns Mills, N.J. Shore said he has suffered flashbacks and nightmares that contributed to the breakup of his first marriage. "I don't go into crowds, I don't like driving, I don't like doing a lot of different things because I'm always on the lookout for the next ambush, the next IED," he said.

A USA Today article published in October 2005 reported that more than 25% of U.S. troops bring the war home with them in very serious ways:

More than one in four U.S. troops have come home from the Iraq war with health problems that require medical or mental health treatment, according to the Pentagon's first detailed screening of servicemembers leaving a war zone. ...

Almost 1,700 servicemembers returning from the war this year said they harbored thoughts of hurting themselves or that they would be better off dead. More than 250 said they had such thoughts "a lot." Nearly 20,000 reported nightmares or unwanted war recollections; more than 3,700 said they had concerns that they might "hurt or lose control" with someone else.

These survey results, which have not been publicly released, were provided to USA TODAY by the Army Center for Health Promotion and Preventive Medicine. They offer a window on the war and how the ongoing insurgency has added to the strain on troops.

Overall, since the war began, about 28% of Iraq veterans — about 50,000 servicemembers this year alone — returned with problems ranging from lingering battle wounds to toothaches, from suicidal thoughts to strained marriages. The figure dwarfs the Pentagon's official Iraq casualty count: 1,971 U.S. troops dead and 15,220 wounded as of Tuesday.

A greater percentage of soldiers and Marines surveyed in 2004-05 said they felt in "great danger" of being killed than said so in 2003, after a more conventional phase of fighting. Twice as many surveyed in 2004-05 had fired a weapon in combat.

"The (wartime) deployments do take a toll," says Lt. Col. Ellen Krenke, a Pentagon spokeswoman. "We send them to austere locations, places that are extremely hot, extremely cold, very wet, very dry ... where they may also encounter an armed enemy."

The Pentagon's goal is to identify all troops in need of care in part by screening every servicemember on a wide range of issues before and after overseas duty.

Begun in 1997 and expanded in 2003, it is the most detailed health assessment of deployed troops ever. It came in response to ailments that surfaced after the 1991 Persian Gulf War. Jim Benson, a spokesman at the Department of Veterans Affairs, says comparable data from previous wars don't exist.

Are Iraq war veterans getting the mental health services they need, then?

Hell, no:

The U.S. military is putting already-strained troops at greater risk of mental health problems because of repeated deployments to Iraq and Afghanistan, a Defense Department panel says in warning of an overburdened health system.

The Defense Department's Task Force on Mental Health chaired by Navy Surgeon General Donald Arthur, issued an urgent warning, saying that more than one-third of troops and veterans currently suffer from problems such as traumatic brain injury and post-traumatic stress disorder. With an escalating Iraq war, those numbers are expected to worsen, and current staffing and money for military health care will not be able to meet the need, the group said in a preliminary report released Thursday.

"The system of care for psychological health that has evolved in recent decades is not sufficient to meet the needs of today's forces and their beneficiaries, and will not be sufficient to meet the needs in the future," the 14-member group says.

This is how the military supports the health care needs of veterans with combat-related psychological problems:

Army generals are scrambling to apologize for the scandal over poor medical care and deplorable conditions at Walter Reed Army Medical Center in Washington, D.C. But the evidence shows that the problems extend beyond the Army's flagship hospital.

Late last year, for instance, an NPR investigation found that many soldiers who returned from Iraq to Fort Carson, in Colorado, couldn't get the mental health care they needed — even when they had post-traumatic stress disorder, or PTSD. In fact, their supervisors punished them and kicked them out of the Army. Since then, NPR has received scores of e-mails and calls from soldiers and family members at other bases who say they've being neglected, too.

Some of the first cases we heard came from Fort Knox, in Kentucky.

Consider: One year ago, an Army nurse, Brenda Johnson, was helping to run a medical clinic for U.S. soldiers in Iraq. She was in the middle of her second tour there, and her first lieutenant had just given her a glowing evaluation: "Sgt. Johnson has shown time and time again," the document declares, "that she is an outstanding leader, medic and soldier."

But then, Johnson says, she started losing control. "I couldn't sleep," she told NPR. "I got real shaky. Every time I ate I got sick, just vomited everything I ate, my stomach was always in knots. Nightmares — I had a real hard time going to sleep, 'cause if I'd fall asleep, I'd wake up scared."

The Army medivacked Johnson out of Iraq and sent her to Fort Knox, where, according to Army documents, the medical staff diagnosed her with PTSD and depression. Johnson says Fort Knox never provided intensive therapy or other treatments designed to help cure her depression and PTSD. She went briefly to a private therapist, but had to quit because she couldn't afford it. A few months later, her officers discharged her from the Army, despite her protests. A document in her file states that she was "not likely" to become "a quality soldier."

Today, Johnson sounds bitter.

"It kind of hurts when you give somebody eight years of your life, and they just kind of kick you to the curb," she says. Officials at Fort Knox haven't answered our request for comment.

Blaming the messenger is also a good way to go:

The Pentagon's top medical officer yesterday contested the conclusions of a Government Accountability Office report that questioned whether service members returning from Iraq and Afghanistan are getting appropriate mental health care.

Although the report said only 22 percent of service members identified as at risk for post-traumatic stress disorder (PTSD) on a post-deployment questionnaire were referred for a mental health examination, that did not account for troops who were referred to primary care physicians or other treatment providers for mental health care, said William Winkenwerder Jr., assistant secretary of defense for health affairs.

"Many people are referred and were referred in this process not to a mental health professional but to a primary care professional, their doctor," said Winkenwerder in an interview. "They were referred to group counseling sessions, or a [confidential counseling] service or a chaplain.

"The fact that 22 percent were referred to a psychiatrist or a psychologist is not an indication the [others] did not get the support or help they needed," he said.

The issue of PTSD care in the military has become the subject of controversy. Democrats and several veterans groups have charged the administration with short-changing returning service members who are in distress, but the Pentagon has insisted that the quality of care being provided is historically unparalleled.

The Pentagon could not make a knowledgeable official available to comment on the GAO report Wednesday evening after The Washington Post obtained a draft. The final report, with the Pentagon's official response, was made public Thursday.

That response broadly concurred with the report's conclusions and recommendations -- including a call for better explanations of why some service members who were found to be at risk, but not others, were referred to mental health professionals. But the Pentagon said it disagreed with the GAO's contention that "reasonable assurance is not available to support that [Iraq and Afghanistan] service members receive referrals when needed."

"Many of these people got help," Winkenwerder said. "Probably most. We don't know the exact number, and neither does the GAO."

He sounds like he gives a shit, doesn't he?

The Voice of America raises a related concern:

The ongoing wars in Iraq and Afghanistan have generated concern about strain on the U.S. military and how long the United States can continue to keep large forces in combat. Among the concerns is that combat units are so overworked and so focused on fighting insurgencies that they may not be prepared to fight other conflicts that may break out around the world. VOA's Al Pessin reports from the Pentagon.

The United States has had troops in combat in Afghanistan since 2001 and in Iraq since 2003. Aside from the thousands of dead and wounded, and hundreds of billions of dollars spent, there is growing concern that the strain on the force could have implications for the future of U.S. military readiness.

The top U.S. military officer, General Peter Pace, says it is something he watches closely.

"I think we must pay attention to that every single day, because it's not a precise point on a curve where we can say when you get to this point, something good or bad is going to happen," he said.

General Pace and other senior officers acknowledge that the deployment schedule is putting a strain on U.S. troops, particularly combat soldiers and marines. Last month, the Defense Department announced it would lengthen the tours of duty for soldiers serving in Iraq and Afghanistan from 12 months to 15 months, with 12 months of vacation and training between deployments. The marines spend seven months at a time in combat, with six months at home.

Former Clinton Administration defense department official Michelle Flournoy says the operational tempo has already left U.S. ground forces in a precarious position.

"We're already at the point today where we do not have a reserve of ground forces that is adequate to respond to the full range of contingencies that we might face elsewhere in the world," she said.

Flournoy, who is now an analyst at the Center for a New American Security, also worries that during their time at home, troops are only training to return to Iraq or Afghanistan and fight an insurgency, sacrificing training on other basic and potentially essential military skills.

"The training is so focused on the tasks that are being conducted in Iraq that a lot of the other war-fighting tasks may be neglected. And I'll give you an example. You can find members of artillery units in both the army and the Marine Corps who've never fired artillery because every tour they've gone on since their enlistments has been in Iraq and they've been focused on counterinsurgency," she said.

Current and former military officers have expressed similar worries.

Among them is retired Major General John Batiste, who served in Iraq and has become an outspoken critic of the Bush Administration's war policy.

"At this operational tempo, we are going to seriously damage our army and Marine Corps. Every army brigade is either deployed, preparing to deploy or redeploying. There is no strategic reserve," he said.

Cross-posted at Shakesville.