Thousands of Marines, soldiers bear mental scars.
When he sleeps, Jesus Bocanegra sometimes dreams he is back in Iraq. In some dreams, he feels bullets piercing him. Other times, instead of shooting at insurgents, he is trying to help civilians.
March 27 2006 courtesy of http://www.marinecorpstimes.com
By Deborah Funk
Marine Corps Times staff writer
“Sometimes, you’re chasing a little kid, to pick him up, chasing a lady, trying to help them,” the former Army sergeant said. But always in these dreams, he fails.
In his waking hours, he suffers short-term memory lapses because of post-traumatic stress disorder. He keeps a list of things to do during the day to keep on track and wears his cell phone on a cord around his neck and attaches his wallet to his pants with a chain so he doesn’t lose them.
Home from Iraq for more than a year, Bocanegra, 23, still battles the mental injury he incurred there, he said.
“You come back different,” the McAllen, Texas, native said.
Bocanegra is one of thousands of veterans who have returned from the war with mental health problems.
The latest available data, through October, shows that 36,893 veterans of the wars in Afghanistan and Iraq — about 8.5 percent of the total of 433,398 returned troops — have been seen at the Department of Veterans Affairs Medical Centers and received a provisional diagnosis of a mental health condition. Some 15,927 of those received a provisional diagnosis for PTSD.
Through Feb. 11, the Defense Department evacuated 1,760 troops from war zones for mental health conditions such as anxiety, depression and acute stress.
Mike O’Rourke, assistant director of veterans’ health policy for the Veterans of Foreign Wars, said the pace of combat operations and the particularly stressful type of guerrilla warfare in which U.S. troops are involved will lead to many more suffering mental health problems.
“We’re just seeing the tip of the iceberg now,” O’Rourke said.
PTSD is a condition in which people can feel detached, have sleep problems and often relive traumatic events in flashbacks or nightmares. Often accompanied by depression, memory problems and substance abuse, it can be so disruptive that it can impair interaction with family and friends and the ability to hold a job, according to the National Center for Post Traumatic Stress Disorder, part of the VA.
About 30 percent of troops who have served in war zones will experience PTSD in their lifetimes, according to the center.
To be sure, today’s combat veterans face a different situation than veterans of previous wars. The current conflicts mark the first time large groups of people have returned from war to find the VA and the Defense Department have proven diagnostic and treatment approaches in place, said Dr. Larry Lehmann, the VA’s associate chief consultant for mental health.
VA treatment programs include specialists, outpatient teams, and inpatient and residential programs. The VA’s Veterans Readjustment and Counseling Centers are adding 100 veterans from the current wars to provide counseling. More broadly, the VA and the Pentagon have been gearing up for more PTSD patients and have jointly developed screening and treatment guidelines for doctors to use.
The VA says it is pumping $100 million into mental health services this fiscal year, after committing a similar amount last year. At the end of fiscal 2004, the VA reports, it had a total of 144 specialized PTSD programs in place, at least one in every state. Last fiscal year, it funded 31 new or expanded PTSD programs.
Playing catch-up
In some ways, however, the VA is playing catch-up, according to critics who say funding has not kept pace with demand.
“Mental health has been underfunded in the VA for quite some time,” said Ralph Ibson, vice president of the National Mental Health Association, the nation’s oldest mental health group.
The mental health needs of returning troops — those who served both in earlier conflicts and today’s wars — “is unevenly met around the country,” said Ibson, a former House Veterans’ Affairs Committee staffer who also has worked in the office of the VA general counsel.
Not all community-based VA outpatient clinics offer counseling and those that do often have limited staff, O’Rourke said.
“What they do, they do well,” he said. “Could they do more? Yes.”
Bocanegra sees a VA psychiatrist for his PTSD, but only every couple of months because, he said, more frequent appointments aren’t available.
“How is that treatment for PTSD?” he asked. He thinks the periodic visits are just to check to make sure he isn’t a danger to himself or others, he said.
But even when services are available, troops don’t always seek care.
A Pentagon study published in the New England Journal of Medicine in July 2004 found many troops did not seek care because they feared being stigmatized by their peers and command. Of the troops whose responses indicated a mental disorder, just 23 percent to 40 percent had sought professional help.
Defense officials say they are striving to erase the perceived stigma from mental health care. Combat stress experts have been sent to the war zones for quick intervention; chaplains and others offer counseling; and a militarywide program has been created that offers six free and confidential counseling sessions with civilian providers.
Preventive health assessments inquire about mental health, as do post-deployment assessments done immediately before, or just after, troops return home. And in a follow-on health reassessment to be administered three to six months after troops come home, no fewer than half the questions home in on possible mental health problems. That initiative began throughout the military this year.
“This is going to be a process,” said retired Navy Capt. (Dr.) Michael Kilpatrick, deputy director of the Pentagon’s Deployment Health Support Directorate. “It has to be proven one leader at a time.”
Some scars slow to heal
Mike, a Marine Corps reservist who helped train an Iraqi army unit, is one of those who fears being stigmatized. He agreed to be interviewed on the condition that his last name and rank not be used. He fears that disclosing his identity could damage his military career and his chances with future civilian employers.
“Physically, I’m back,” he said. “But mentally, spiritually, part of me is still in Iraq. We saw a lot of combat ... a lot of close calls.”
He’s quick to startle and anger. He’s hyperattentive; he said he may swerve his car if he sees something on the side of the road, a vestige of dealing with roadside bombs in Iraq.
He suffers short-term memory loss.
“I lose time. I’ll be standing in line, and I don’t remember how I got from point A to point B,” he said.
In November 2004, during the assault on Fallujah, shrapnel from a rocket-propelled grenade hit Mike’s right shoulder, but he declined evacuation. His journal records 81 separate firefights and 36 instances of indirect fire. In the city, he saw dungeons, torture rooms and slaughterhouses.
“It doesn’t get any worse than Fallujah,” he said.
In January 2005, while still in Iraq, Mike finally saw a combat-stress expert, without telling his command. The doctor offered him medication, which he said he refused. When his Iraq tour ended and he returned home, he again was offered medication and was diagnosed with PTSD. Still, he declined the drugs.
Finally, a bum shoulder landed him at the VA in August, where a case manager picked up on his adjustment issues. In November, he agreed to take prescribed drugs: Zoloft and a sleep aid. He now says he should have done that sooner, because it’s helping.
But he said he still feels out of synch with American life and, at times, feels as if he has more in common with the Iraqis he left behind. “It’s almost like you’re ... straddling both worlds,” he said. “But if you try to be in two places at once, you go nowhere.”
Grass-roots efforts
Air Force Col. Bob Ireland, program director for mental health policy in the Defense Department’s Office of Health Affairs, said the military is above its authorized levels of mental health experts — psychiatrists, psychologists, social workers and psychiatric nurses. Besides 3,300 active-duty officer and enlisted personnel, there are also civilian providers in the Tricare network, family support centers and other sources of support, he said.
But some still say significant gaps exist in the government’s ability to help combat veterans with mental health issues.
“There is a serious lack of urgency in Washington to deal with ... issues of mental health,” said Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, a grass-roots advocacy group. Reickhoff, a first lieutenant in the New York National Guard, was in Iraq from April 2003 to February 2004.
Shortfalls remain in the war zones as well, some say. Army Maj. (Dr.) Jon Dubose of the North Carolina National Guard, who volunteered for four 90-day tours in Iraq, said the forward operating bases where he served were in areas so dangerous that even combat-stress teams would not venture to them. His unit had one combat-stress expert who routinely counseled three to four soldiers a day, and another who came intermittently for two weeks at a time.
Dubose said a more permanent presence is needed for experts to develop a relationship with troops who are hurting.
“Nobody wants to talk to you about combat stress,” Dubose said. “To get a soldier to sit there and open up and tell you they’re wigging out is kind of difficult.”
Bocanegra is trying to move forward, but he said it’s tough. Seeing his sister’s children, for example, sparked memories of an incident in which he saw Iraqi kids injured when a helicopter opened fire on a house believed to be stocking weapons, he said.
But he plans to soon start job training at a local automotive school. He also continues to receive occasional VA psychiatric care and talks informally with other Iraq war veterans.
“I don’t want to stay like this for the rest of my life,” he said.