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PHYSICALLY AND MENTALLY UNFIT...
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...yet forced to fight.
An Open Letter to Congress: STOP TREATING OUR SOLDIERS LIKE DOGS!!!!!!!
We demand that our soldiers are taken care of. Typically,the medically unfit soldier is:
1. examined by a military doctor or doctors, and declared medically unfit.
2. sent into battle, often in severe pain.
3. denied treatment while in combat.
4. given pain killers.
5. told to "suck it up".
6. denied access to his/her medical records.
7. given duty as heavy as anyone else's, at the risk of mistakenly harming (even killing) another soldier.
8. still denied medical treatment in more than half the cases, after their return.
9. hesitant to publicly tell their story for fear of retaliation from the military.
I have heard this time and time again from military families. It also happened exactly this way to my daughter.
Many of our soldiers will not complain, but we, their families, will. Our family members have returned with Post Traumatic Stress Disorder (PTSD), severe depression, suicidal tendencies, survivor’s guilt, and physical conditions that existed before and after combat that are still not being addressed. My own daughter is showing all these symptoms except possibly suicidal tendencies. We, their family members, are heartbroken, disappointed with our government, and angry.
Now we find that Walter Reed is allowing wounded soldiers to stay in deplorable conditions? WHY?? And why is Walter Reed blaming the wounded soldiers???
Murderers in our prisons do not deserve such cruel punishment. Why do we force it upon our soldiers??
Our message is the same as always: Please stop this insane war NOW. Please take care of our soldiers NOW.
Denise Thomas,
GA Military Families Speak Out (coordinator),
Georgia Peace and Justice Coalition
giwifegimom@netscape.net
Military Ignores Mental Illness
Associated Press | May 15, 2006
HARTFORD, Conn. - U.S. military troops with severe psychological problems have been sent to Iraq or kept in combat, even when superiors have been aware of signs of mental illness, a newspaper reported for Sunday editions.
The Hartford Courant, citing records obtained under the federal Freedom of Information Act and more than 100 interviews of families and military personnel, reported numerous cases in which the military failed to follow its own regulations in screening, treating and evacuating mentally unfit troops from Iraq.
In 1997, Congress ordered the military to assess the mental health of all deploying troops. The newspaper, citing Pentagon statistics, said fewer than 1 in 300 service members were referred to a mental health professional before shipping out for Iraq as of October 2005.
Twenty-two U.S. troops committed suicide in Iraq last year, accounting for nearly one in five of all non-combat deaths and the highest suicide rate since the war started, the newspaper said.
Some service members who committed suicide in 2004 and 2005 were kept on duty despite clear signs of mental distress, sometimes after being prescribed antidepressants with little or no mental health counseling or monitoring, the Courant reported. Those findings conflict with regulations adopted last year by the Army that caution against the use of antidepressants for "extended deployments."
"I can't imagine something more irresponsible than putting a Soldier suffering from stress on (antidepressants), when you know these drugs can cause people to become suicidal and homicidal," said Vera Sharav, president of the Alliance for Human Research Protection, a New York-based advocacy group. "You're creating chemically activated time bombs."
Although Defense Department standards for enlistment disqualify recruits who suffer from post-traumatic stress disorder, the military also is redeploying service members to Iraq who fit that criteria, the newspaper said.
"I'm concerned that people who are symptomatic are being sent back. That has not happened before in our country," said Dr. Arthur S. Blank, Jr., a Yale-trained psychiatrist who helped to get Post-Traumatic Stress Disorder recognized as a diagnosis after the Vietnam War.
The Army's top mental health expert, Col. Elspeth Ritchie, acknowledged that some deployment practices, such as sending service members diagnosed with post-traumatic stress syndrome back into combat, have been driven in part by a troop shortage.
"The challenge for us ... is that the Army has a mission to fight. And, as you know, recruiting has been a challenge," she said. "And so we have to weigh the needs of the Army, the needs of the mission, with the Soldiers' personal needs."
Ritchie insisted the military works hard to prevent suicides, but said that is a challenge because every Soldier has access to a weapon.
Commanders, not medical professionals, have final say over whether a troubled Soldier is retained in the war zone. Ritchie and other military officials said they believe most commanders are alert to mental health problems and are open to referring troubled Soldiers for treatment.
"Your average commander doesn't want to deal with a whacked-out Soldier. But on the other hand, he doesn't want to send a message to his troops that if you act up, he's willing to send you home," said Maj. Andrew Efaw, a judge advocate general officer in the Army Reserves who handled trial defense for Soldiers in northern Iraq last year.
From Military.com
Mentally Unfit, Forced To Fight - Still Suffering, But Redeployed
by LISA CHEDEKEL, The Hartford Courant
May 17th, 2006
They have post-traumatic stress and other combat-related disorders. So what are they doing back in battle?
Eight months ago, Staff Sgt. Bryce Syverson was damaged goods, so unsteady that doctors at Walter Reed Army Medical Center wouldn't let him wear socks or a belt
. Syverson, 27, had landed in the psychiatric unit at Walter Reed after a breakdown that doctors traced to his 15-month tour in Iraq as a gunner on a Bradley tank. He was diagnosed with post-traumatic stress disorder and depression, and was put on a suicide watch and antidepressants, according to his family.
Today, Syverson is back in the combat zone, part of a quick-reaction force in Kuwait that could be summoned to Iraq at any time.
He got his deployment orders after being told he wasn't fit for duty.
He got his gun back after being told he was too unstable to carry a weapon.
But he hasn't quite managed to get his bearings.
"Nearly died on a PT test out here on a nice and really mild night because of the medication that I am taking," he wrote in a recent e-mail to his parents and brothers. "Head about to explode from the blood swelling inside, the [lightning] storm that happened in my head, the blurred vision, confusion, dizziness and a whole lot more. Not the best feeling in the entire world to have after being here for two days ...
"And I ask myself what the F*** am I doing here?"
Syverson is among a growing number of troops who are being recycled into combat after being diagnosed with PTSD or other combat-related mental disorders - a new phenomenon that has their families worried and some mental health experts alarmed. The practice, which a top military mental health official concedes is driven partly by pressure to maintain troop levels, runs counter to accepted medical doctrine and research, which cautions that re-exposure to trauma increases the risk of serious psychiatric problems.
"I'm concerned that people who are symptomatic are being sent back, which is potentially very bad for them. That has not happened before in our country," said Dr. Arthur S. Blank Jr., a Yale-trained psychiatrist who helped to get PTSD recognized as a diagnosis after the Vietnam War.
"If people have received treatment for a year or two or three and the condition is completely stabilized, I could see it," said Blank, who was formerly director of the Department of Veterans Affairs' counseling centers. "[But] there's no study that says it's beneficial to send people back. Being re-exposed to the trauma can just intensify the symptoms."
Although Department of Defense medical standards for enlistment into the armed forces disqualify those who have suffered from PTSD or acute reactions to stress, including combat fatigue, military officials acknowledge that they are not exempting service members who meet those criteria from going to war. Many of those who are being sent back with such symptoms, such as Syverson, are being redeployed on psychiatric medications known as SSRIs.
Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general, acknowledged that the decision to send back soldiers with symptoms or a diagnosis of PTSD was "something that we wrestle with," and partly driven by the military's need to retain troops because of recruiting shortfalls.
"Historically, we have not wanted to send soldiers or anybody with post-traumatic stress disorder back into what traumatized them," she said. "The challenge for us ... is that the Army has a mission to fight."
Ritchie said the military looks closely at the "impairment" level of individual service members and their response to medication before deciding whom to redeploy, and would not put any soldier at risk.
"If they're simply - and I don't mean to minimize it - but if they're simply having nightmares, for example, but they can do their job, then most likely they're going to deploy back with their unit," she said. "If they're not able to do their job and they don't respond to treatment, then we're going to probably keep them here in the States for at least a while longer."
But whether the military can even gauge the impairment level of its veterans is in question. A newly released report by the Government Accountability Office found that nearly four in five troops returning from Iraq and Afghanistan who were found to be at risk for PTSD, based on responses to a screening questionnaire, were never referred for further evaluation or treatment. Still, top military officials continue to insist they are doing a good job of identifying and treating PTSD cases.
Dr. Matthew Friedman, director of the National Center for PTSD, an arm of the Veterans Administration, said that while he shares the concern that multiple deployments may exacerbate PTSD symptoms, he does not believe the military should take a "one size fits all" approach to the disorder and bar all troops from deploying. Drug treatments for PTSD prove successful in some cases, he said, and some service members are more resilient than others.
"My belief is, let's look at the data" that are being gathered by pre- and post-deployment mental health screenings, he said. "Once we have the data, we can go back and look at how people with PTSD perform."
But some service members' families and experts say the military should not be experimenting with young men and women who have been traumatized by going to war.
"We were shocked. When somebody's put on medication and told they have PTSD, it doesn't occur to you they'd want to send them back," said Corrine Nieto, a Bakersfield, Calif., mother whose 24-year-old son, Chris, a Marine reservist, was redeployed to Iraq last summer after being diagnosed with PTSD. "I don't know what they're doing to these kids. I wonder if they do."
Jason Sedotal, a 21-year-old military policeman from Pierre Part, La., was diagnosed with PTSD in early 2005 after he returned from Iraq, where he was traumatized by an incident in which a Humvee he was driving rolled over a land mind, he said. His sergeant, sitting beside him, lost both legs and an arm.
Last September, Sedotal was transferred from Fort Bragg to Fort Polk, where he said doctors switched his medication from Prozac to Zoloft, and commanders deemed him ready to redeploy. He has been back in Iraq since October.
"I don't feel like myself. I can't sleep, I can't be around crowds, I'm just drinking a lot," he said during a mid-tour visit home last week. He said he had seen a doctor at Fort Polk, to ask if he could stay home and get treatment, but instead was given a higher dose of Zoloft and told he was shipping out again this week.
When he asked the doctor if his symptoms would ever go away, he said he was told, "Sure - when you get out of there."
Neither the military nor the VA has figures on the number of troops with PTSD or other combat-related disorders who have been redeployed after a diagnosis. Overall, more than 378,000 active-duty, reserve and National Guard troops have served more than one tour in Iraq or Afghanistan, including about 151,000 Army soldiers and 51,000 Marines, according to the Department of Defense's latest deployment statistics.
Recent studies indicate that at least 18 percent of returning Iraq veterans are at risk for PTSD, while 35 percent have sought mental health care in their first year home.
The Courant's research shows that at least seven troops who are believed to have committed suicide in 2005 and 2006 were serving second or third deployments. In some of those cases, according to their families, they had exhibited signs of psychological problems between deployments that went undetected by military officials, who rely largely on the self-reported questionnaires.
Jeffrey Henthorn, 25, of Choctaw, Okla., was just six weeks into his second deployment when the military says he killed himself in Iraq last year. His family said he had shown signs of psychological problems between deployments, but had not received counseling or treatment.
Similarly, Army Spec. Rusty W. Bell, 21, of Pocahontas, Ark., showed signs of combat stress after his first deployment to the Middle East in 2003 as a member of the Army National Guard, said his mother, Darlene Gee. When he came home in April 2004, he enlisted in the Army and was sent back to Iraq in early 2005.
"He saw tons of combat that first time, and I think it affected him," Gee said. "I never asked him about it straight-out, but he said a few things that stick with me. He said, `Mom, I wish they'd just nuke the entire place. I know I would die, but at least I would die for a reason.' I said, `Bub, don't talk like that.'
"I thought they shouldn't have sent him back so soon," she said. "Let him have a normal life for a while, after what he'd been through."
An autopsy report on Bell's death concludes that he shot himself last August, with witnesses saying he was "distraught over family problems." Gee said she was not aware that her son, who was married, was having any significant personal problems.
The wife of a soldier who killed himself earlier this year in Iraq said she had little doubt that repeat tours had played a role.
"I know that did affect it. Absolutely I know it. A combination of fatigue and just being worn out," said the woman, who did not want her name used to protect her children.
Army Surgeon General Kevin C. Kiley said many troops want to go back with their units for repeat tours, and the military is willing to facilitate that, as long as they are functioning well.
"Part of sending troops back in with medications that are stable and doing very well is . . . to de-stigmatize this, to show soldiers they can do the job, they can defend the nation, they can be part of this Army, and they won't be cast aside," Kiley said.
In some cases, the military has pushed the point a step further.
Army Spec. Jason Gunn, of Lansdowne, Pa., was sent back to Iraq in early 2004, after being injured in an explosion and diagnosed with PTSD, because Army officials believed it would be in his best interest to "overcome his fear by facing it," according to the explanation provided to his mother, Pat Gunn, through a congressman.
Since he returned home and left the Army last year, Jason has drifted between odd jobs and "goes through phases where he's in a very bad place," Pat Gunn said. She said she worries that the military is "taking the very last breath out of these kids."
Mental health experts said that while some troops who suffer from PTSD symptoms may be able to return to the front lines, there is no evidence to suggest that re-exposure to trauma is in any way therapeutic.
"Anybody who says it's a form of therapy to send people back into war," said Dr. Jonathan Shay, a Boston-based psychiatrist who counsels Vietnam veterans, "I don't know what they're smoking."
Fear Of Avalanche
Some soldier advocates worry that the repeat deployments of troops will lead to an avalanche of PTSD cases and fuel incidents of suicide and violence.
In Vietnam, most soldiers did a requisite one-year tour of duty and never went back. About 30 percent of them suffer from PTSD symptoms, and another 20 percent have experienced clinically serious stress-reaction symptoms, according to the National Vietnam Veterans Readjustment Survey.
Of the 1.3 million active duty, guard and reserve troops who have served in Iraq and Afghanistan, more than 28 percent already have deployed more than once.
"This is an unexplored area," said Cathleen Wiblemo, deputy director for health care for the American Legion. "How are troops going to deal with second and third deployments? Is their reaction going to be more severe?
"I think the VA can look to seeing a lot more mental health cases," she said. "They haven't gotten the full brunt of these multiple deployments yet."
So far, more than 20,600 service members who have separated from the military have received an initial diagnosis of PTSD, according to the VA. That doesn't include service members still enlisted in the military, or veterans who seek help from private doctors or other sources.
Like other parents, Larry Syverson, an environmental engineer from Richmond, Va., worries that the military is gambling with his son's mental health for the sake of maintaining troop levels.
Bryce was sent back to Kuwait in late-March, after the Army had deemed him non-deployable and left him at his base in Germany while the rest of his unit deployed. In February, he told his father that his doctors had taken him off of Zoloft and were trying another medication. He still wasn't allowed to carry a gun.
Larry Syverson isn't sure why the military abruptly deemed Bryce deployable and handed him back his weapon. In correspondence, his son has said he agreed to go back to Kuwait because commanders told him it would help his chances of re-enlisting in the Army - something Bryce, who has not known civilian life since he graduated from high school, wants to do.
"The doctors said that I will be okay to deploy and carry around my rifle ... and shoot people," Bryce wrote in an April 18 e-mail to his father. "So in a week from me and the doctors both agreeing that I will be okay to deploy. I was gone again."
"The Battalion Commander was holding a bar to re-enlist over my head if I didn't deploy. But since I have deployed, my request for re-enlistment has been denied twice."
The tone of Bryce's e-mails, as much as the content, worries Larry Syverson, who said his youngest son, once the most "even-keeled" of four brothers, now has a festering bitterness.
"It just floors us that they'd send him back," said Larry, a peace activist whose sons all have served in the military, but who opposes the Iraq war. "To be in a psychiatric hospital last summer and now back to a war zone - it's not like they didn't know Bryce's condition, because it's their hospital and their diagnosis."
Bryce's PTSD came on the same way many cases do: suddenly, starkly, several months after he had returned home in the summer of 2004. He was watching New Year's Eve fireworks in Germany, his father said, when he "got spooked" by the crowd and the sounds, which reminded him of mortar attacks. From there, he spiraled into depression, anger and an inability to concentrate.
PTSD has three main clusters of symptoms: re-experiencing the trauma, in the form of flashbacks or memories; retreating from life or feeling detached; and hyper-vigilance, including impaired concentration. Some troops suffer from partial symptoms. War-zone stress also can lead to depression and anxiety disorders.
Experts say short-term treatment with Zoloft or Paxil, the two drugs approved by the government for treating PTSD, are successful in putting the disorder into remission about 30 percent of the time. But the other 70 percent of cases are not so easy to control and can continue for years. Some patients never fully recover.
The practice of redeploying soldiers who continue to suffer from PTSD symptoms runs counter to statements by the military's top health official, Assistant Defense Secretary William Winkenwerder, who assured a congressional committee last summer that troops with "unremitting mental health disorders are not deployed."
Dr. Frank M. Ochberg, a clinical professor of psychiatry at Michigan State and a founding board member of the International Society for Traumatic Stress Studies, said he would not want anyone who has "chronic" PTSD - symptoms lasting longer than three months - to return to a combat situation. Deploying someone with depression, which often accompanies PTSD, also is dangerous, he said.
"My gut feeling is, it's probably OK if they've been stabilized and they haven't had a recurrence of depression in a year," he said. "But the problem of depression in combat is, you are of more risk to yourself and others."
Troops fill out post-deployment questionnaires just as they return from Iraq, and then receive a follow-up screening, recently added by the military, three to six months later.
Because the screenings rely largely on self-reporting by service members, who often are reluctant to disclose problems, their usefulness is limited, mental health experts agree. That leaves families and friends of some service members convinced that post-traumatic symptoms are going undetected.
Martin Armijo, a family friend and neighbor of 22-year-old Army medic Chris Rolan of Albuquerque, N.M., said he worried about Rolan when the young man returned home last year between deployments to Iraq.
"He said he'd seen a lot of combat. It was freaking him out seeing all these soldiers getting shot up," said Armijo, a Vietnam veteran. "I could tell in his eyes, he had that look like he was lost. He wasn't the Chris I knew."
After he returned to Iraq, Rolan was charged with killing a member of his unit during an argument, in November of last year. His older brother, Robert Garcia, is at a loss to explain what happened to the young man he says was the "bright star" of the family.
"This is so out of the blue," said Garcia, who declined to discuss the pending murder case. "It just doesn't fit."
Wrestling With Symptoms
Some troops with PTSD symptoms receive counseling in Iraq, while others don't, interviews with troops and families indicate.
Jim Holmes' son, Micah, an Army mechanic, was deployed to Iraq last August. He had returned home in May 2004 from a 10-month tour in Afghanistan with symptoms of PTSD and depression, for which Army doctors prescribed Zoloft and Wellbutrin, Holmes said.
Earlier this year, while in Iraq, he told his father that he had stopped taking the drugs because they were "too hard to get," and that he was not receiving counseling.
"He's not getting treated there, and who knows if there'll be any treatment available when he comes home," said Jim Holmes, a social worker from Gaithersburg, Md. "At this point, I just want him back."
Whether Zoloft and other drugs actually can help to buffer combat stress or prevent full-blown PTSD is not known, mental health experts said. That uncertainty led Ochberg to call the practice of medicating stressed-out troops "one hell of a research project."
"There are people who want to do the job, and if they do the job on medication, they may be better off," Ochberg said. "But I have never given anyone a prescription because they're going into a combat situation.
"There's a chance that this unwitting experiment of prevention of full-blown emotional distress will be instructive," he added, "but it's also fraught with moral and ethical considerations."
Among the moral considerations is that many troops with combat-stress symptoms want to go back to the war, becoming addicted to the adrenaline and sense of mission, and unable to adjust to life at home, military counselors say. Their eagerness matches the military's willingness to recycle them into combat.
"Iraq is an impossible act to follow. Everything else pales," said Noka Zador, a coordinator of counseling for Iraq and Afghanistan veterans at the West Haven Veterans Administration. "Part of it is, they have one foot here, one foot there. It's a sense of, `I'm still back there anyway.'"
David Beals, 26, a soldier stationed at Fort Stewart in Georgia, sometimes tells his wife, Dawn Marie, "In my head, I'm still in Iraq." After he returned from his second deployment to Iraq in January, he paced around the house, bored and restless, she said.
Beals had a rough first tour in Baghdad in 2003, and sunk into a depression as his second deployment approached. In January 2005, he locked himself in the bathroom of the couple's home and swallowed a bottle of Percocet. He landed in a hospital psychiatric ward and was diagnosed with PTSD and an adjustment disorder, Dawn Marie said.
He was sent back to Iraq within a few months, for the tour that ended this January. He expects to go back for a third time at the end of this year.
"He loves what he does. He loves being in the Army," Dawn Marie said. "For me, you just learn to adapt. ... He definitely is not the same person. It's the same person, but not the same personality."
Military counselors say the frequency of multiple deployments has been a disincentive for troops to seek help readjusting to life at home, and has made counseling difficult.
"Some of them don't see the relevance of coming for counseling because their bags are still packed," said Donna Hryb, team leader at the Hartford Vet Center in Wethersfield.
Some PTSD experts also suggest that the growing public sentiment against the war can have a negative effect on the mental health of some troops shuttling back and forth to Iraq.
"If there's controversy and doubt about the validity of the war, it has a major psychological impact, for both the therapist and soldier," said Blank, the psychiatrist and expert on PTSD.
James Gavin, a Vietnam veteran who is team leader of the New Haven Vet Center, said military medicine has a different emphasis than civilian medicine. The military is "looking at unit cohesion and cohesiveness," he said. "They're not so concerned with a heightened state of alertness, or sleeplessness, or other things. They might want people on edge."
That's what concerns Larry Syverson.
In a recent e-mail from Kuwait, his son Bryce, who is safe from combat for now, complained that some leaders of his unit "want to actually go to Ramadi," and had tried to "volunteer" the battalion for the front lines of Iraq.
Larry said he isn't worried that Bryce, whom he calls a "good soldier," would resist.
He's worried that he wouldn't.
Courant Staff Writer Matthew Kauffman contributed to this story.
Copyright 2006, Hartford Courant
Mentally Unfit, Forced To Fight - Potent Mixture:
Zoloft & A Rifle
by LISA CHEDEKEL And MATTHEW KAUFFMAN, Hartford Courant
May 16th, 2006
The military told Congress that medications aren't used to keep soldiers with serious mental illness in combat. But a Courant investigation reveals that drugs are increasingly being handed out.
When Army Sgt. 1st Class Mark C. Warren was diagnosed with depression soon after his deployment to Iraq, a military doctor handed him a supply of the mood-altering drug Effexor.
Marine Pfc. Robert Allen Guy was given Zoloft to relieve the depression he developed in Iraq.
And Army Pfc. Melissa Hobart was dutifully taking the Celexa she was prescribed to ease the anxiety of being separated from her young daughter while in Baghdad.
All three were given antidepressants to help them make it through their tours of duty in Iraq - and all came home in coffins.
Warren, 44, and Guy, 26, committed suicide last year, according to the military; Hobart, 22, collapsed in June 2004, of a still-undetermined cause.
The three are among a growing number of mentally troubled service members who are being kept in combat and treated with potent psychotropic medications - a little-examined practice driven in part by a need to maintain troop strength.
Interviews with troops, families and medical experts, as well as autopsy and investigative reports obtained by The Courant, reveal that the emphasis on retention has had dangerous, and sometimes tragic, consequences.
Among The Courant's findings:
• Antidepressant medications with potentially serious side effects are being dispensed with little or no monitoring and sometimes minimal counseling, despite FDA warnings that the drugs can increase suicidal thoughts.
• Military doctors treating combat stress symptoms are sending some soldiers back to the front lines after rest and a three-day regimen of drugs - even though experts say the drugs typically take two to six weeks to begin working.
• The emphasis on maintaining troop numbers has led some military doctors to misjudge the severity of mental health symptoms.
Some of the practices are at odds with the military's own medical guidelines, which state that certain mental illnesses are incompatible with military service, and some medications are not suited for combat deployments. The practices also conflict with statements by top military health officials, who have indicated to Congress that psychiatric drugs are not being used to keep service members with serious disorders in combat.
In an interview Monday, Army Surgeon General Lt. Gen. Kevin C. Kiley insisted that the military uses psychiatric medications cautiously in the war zone, saying that medical professionals may prescribe them at low doses, "for very mild symptoms that might assist soldiers in transitioning through an event." He said the emphasis on keeping troubled troops close to the front lines is in the service members' best interests, because it helps them recover and avoid the stigma of abandoning their duty.
But many outside the chain of command see it differently.
"It's best - for the Army," said Paul Rieckhoff, a former platoon leader in Iraq who said he was overruled when he tried to have a mentally ill soldier evacuated. "But find me an independent mental health expert who thinks that that's a proper course of action."
Vera Sharav, president of the Alliance for Human Research Protection, a patient advocacy group, said retaining troops with mental disorders serious enough to require medication is "completely irresponsible."
"It's really just plain dehumanizing. They are denying these guys a humane treatment, which is to get out of the battle," she said. "The best therapy for someone in that kind of stress is to get them out of the stress. The worst thing is to add a drug to this."
Distributing Drugs
Some soldiers' advocates and medical experts criticize the military for taking an overly pharmacological approach to mental illness in an effort to retain troops, without proper oversight.
Autopsy and investigative reports show that at least three service members who killed themselves in 2005, including Warren and Guy, were taking antidepressants.
Warren intentionally overdosed on his heart medication, the military ruled, and a medical examiner concluded he died of "mixed drug intoxication," finding that the combination of the heart drug and the Effexor, an antidepressant, had a "synergistic" effect that led to his death.
Guy was placed on Zoloft by a military doctor one month before he locked himself in a portable toilet and shot himself in the head, according to military reports. An investigator concluded that Guy's suicide was caused in part by the effects of Zoloft - a conclusion later rejected by a commanding general.
Zoloft, and other drugs in a class known as SSRIs, such as Prozac, Paxil and Celexa, are the most commonly prescribed antidepressants. But they can worsen depression and increase suicidal thinking, and the FDA says patients taking any antidepressant medication should be monitored carefully when the drugs are first prescribed - a task that can be difficult to accomplish in a war zone.
Families of some troops report that their loved ones were readily prescribed SSRIs by military doctors in Iraq, with no requirement for regular monitoring or counseling.
Marine Lance Cpl. Nickolas D. Schiavoni, 26, of Haverhill, Mass., earned a Purple Heart during his first deployment to Iraq in 2004, but came home shaky and anxious after seeing heavy combat, his parents said. Soon after he was deployed back to Iraq for his second tour, in September of 2005, he told his father in an e-mail that he had been prescribed Zoloft.
"He said, `I'm real angry. I can't take anything from anyone. They have me on Zoloft,'" David Schiavoni, of Ware, Mass., recalled. "I couldn't believe it - an antidepressant, while he's out there holding a gun? I told him, `Get off the Zoloft because I hear bad things about it.'"
Two months after that exchange, Schiavoni, who was married with two small children, was killed by a car bomb. David Schiavoni said he has been told that the incident occurred after the driver of the car ignored demands from his son's unit to stop.
"A lot of things go through my mind," the father said. "Maybe I'd rather him be angry than medicated. Maybe if he's angry, he grabs his gun and shoots."
Shelly Grice said her husband, Chris, a Fort Riley soldier, was put on Zoloft and the sleep aid Ambien after surviving an incident in February 2005 in which his close friend was killed by an improvised explosive device. She spent the rest of her husband's yearlong tour worried about his mental well-being.
"His [commanding officer] said, `If I could, I would ship you home right now,' but they lost two guys that day and five others were injured, so they needed him," Grice recounted. "It bothers me that these guys are just experiencing too much."
As part of an effort to avoid evacuations out of the war zone, the military's cadre of combat stress teams typically treat troubled troops with a 72-hour break from the front lines - three hots and a cot, in military parlance - sometimes with drugs prescribed. But medical experts and drug makers themselves say it often takes weeks for SSRIs to have any therapeutic value, while the side effects can kick in immediately.
"I have a fundamental problem with prescribing someone an SSRI and then, with a couple days' rest, allowing them to return to duty," said Dr. Stefan Kruszewski, a Harvard-trained psychiatrist in Harrisburg, Pa. "If you're newly introducing a drug, the most problematic side effects often occur right at the beginning. So at 72 hours or at 96 hours or at seven days, you may have more of a problem, not less, because of a drug-related side effect."
Dr. Jonathan Shay, an expert on combat stress who has served as a consultant to the military on ethics and personnel issues, said SSRIs generally do not impair a person's ability to think clearly or react to danger. But he said the use of such drugs should be accompanied by counseling, and patients should be monitored closely during the initial "window of danger," when they begin the medications.
Shay said there is no evidence that SSRIs such as Prozac or Paxil help with acute stress or would "protect someone in a traumatic situation" from developing post-traumatic stress disorder or major depression.
"There's nothing to suppose that it helps with an immediate trauma," said Shay, a Boston area psychiatrist who counsels Vietnam veterans. "I would expect to see it used for a previously deployed service member who has been diagnosed with PTSD" or other disorders.
Kruszewski agreed.
"It's not even a Band-Aid," he said. "It might make the doctor feel better, but the patient's not going to benefit."
Some Iraq war veterans say antidepressants and sleep aids were relatively easy to obtain, with no requirement for regular counseling or follow-up care.
Paul Scaglione, 23, an Army mechanic from the Detroit area, said he was put on Wellbutrin in 2003 after telling a medical worker at Tallil Air Base, "I'm not feeling so hot," and asking for "something to keep my mind off everything."
"It was no big deal," he said. "They just talk to you a little and give it to you. They say you can come back if you want, but they don't follow up or anything."
Kiley insisted that troops receiving medications are afforded a balance of care, including counseling. He characterized the use of medications in Iraq as limited, saying some troops were allowed to deploy "on a low-dose SSRI," while others who developed problems in the war zone were placed on "a little bit of medication for a relatively short period of time, to get them through something."
He acknowledged that giving mood-altering drugs to troops in combat could be controversial.
"There are those out in the community who would be very concerned about that, as though you've altered the mental capacities of a soldier by putting them on those medications," he said. "My understanding . . . is that, in fact, is not what happens. When properly managed and properly dosed, with evidence that the soldiers are . . . doing well, there's no reason why they can't do their soldierly duties."
Fully Resolved? Exactly how many troops are taking psychiatric drugs remains unclear. In response to a Freedom of Information Act request by The Courant for data on all prescriptions dispensed in Iraq, Defense Department officials were able to produce only limited records on medications.
Those records, as well as the Army's own reports, indicate that the availability and use of psychiatric drugs in Iraq has increased steadily. A 2004 report by a team of Army mental health professionals cited widespread complaints from combat doctors about a lack of psychotropic drugs, which prompted the military to approve making antidepressants including Prozac, Zoloft and Trazodone, and the sleep aid Ambien, more widely available. A follow-up report 13 months later cited far fewer complaints about access to drugs.
But in a little-noticed change a year ago, the Army revised its deployment guidelines to include a caution about deploying troops who are taking antidepressants for "moderate to severe" depression. The guidelines say such medications "are not usually suitable for extended deployments" and "could likely result in adverse health consequences."
Also, Dr. William Winkenwerder Jr., the assistant secretary of defense for health affairs, characterized the use of psychotropic drugs as limited when he testified before a congressional committee last summer that service members were being allowed to deploy on "maintenance medication" if their conditions had "fully resolved."
"For example, it is prudent to continue antidepressants six to 18 months after an episode of major depression has fully resolved, in order to prevent relapse," he said.
How the military interprets "fully resolved" is in question.
"We have seen people diagnosed within three to four weeks [before] deployment, put on medications like Paxil, and their deployment schedule rolls along," said Kathleen Gilberd, a San Diego legal counselor for service members who heads the Military Law Task Force of the National Lawyers Guild. "People are being deployed when there is no way to tell whether this potentially serious depression will have remitted or whether it will become a problem."
Melissa Hobart, the East Haven native who collapsed and died in June 2004, had enlisted in the Army in early 2003 after attending nursing school, and initially was told she would be stationed in Alaska, her mother, Connie Hobart, said.
When her orders were changed to Iraq, Melissa, the mother of a 3-year-old daughter, fell into a depression and sought help at Fort Hood, Texas, according to her mother.
"Just before she got deployed, she said she was getting really depressed, so I told her to go talk to somebody," Connie Hobart recalled. "She said they put her on an antidepressant."
Melissa, a medic, accepted her obligation to serve, even as her mother urged her to "go AWOL" and come home to Ladson, S.C., where the family had moved. But three months into her tour in Baghdad - and a week before she died - she told Connie she was feeling lost.
"She wanted out of there. She said everybody's morale was low," Connie recalled. "She said the people over there would throw rocks at them, that they didn't want them there. It was making her sad."
Around the same time, Melissa fainted and fell in her room, she told Connie in an e-mail. She said she had been checked out by a military doctor.
The next week, while serving on guard duty in Baghdad, Melissa collapsed and died of what the Army has labeled "natural" causes. The autopsy report lists the cause of death as "undetermined."
The report notes that the only medication found in Melissa's system was the antidepressant citalopram, the generic name for Celexa, at what appears to be a normal dosage level. It also suggests that because all other causes were ruled out, a heartbeat irregularity is a possibility.
But the report does not explore whether the medication might have played a role in her death - something Connie finds troubling.
"Maybe they don't want to know how a healthy young woman died - but I do," Connie said.
Tomas Young, 26, an infantry soldier from Kansas City, Mo., also was sent to Iraq in early 2004, from Fort Hood, with a mental condition that was not "fully resolved." He was diagnosed with depression about three months before he deployed, he said.
Young said a military doctor put him on Prozac and told him to continue the medication while in combat.
"It was, `Here's the Prozac.' I didn't get counseling or anything," said Young.
Young ended up forgoing the pills during his brief deployment. He was shot within a week of arriving in Iraq and was evacuated. He is now paralyzed from the chest down.
Emphasis On Retention
The use of medications is just one aspect of the military's emphasis on treating psychologically wounded troops close to the front and returning them to duty quickly.
Military combat-stress teams pride themselves on high "return to duty" rates, which are also touted in reports by a team of military mental health experts who were sent to Iraq after a spate of suicides in 2003.
But in 2004, top military health officials acknowledged shortcomings with a key principle of modern combat psychiatry, known as "PIES," which emphasizes treating troops who exhibit problems as close to the front lines as possible, with the expectation that they will return to duty.
"Unfortunately, the validity of these concepts has never been demonstrated in clinical trials," the group of officials acknowledged in a written report. They also said proponents of the principle frequently leave out its most important element - "respite." They said relief from stress "is the primary principle of acute combat-related behavioral and mental health [care] in theater."
Still, military leaders maintain faith in their decision to treat psychiatric wounds in the field, arguing that the approach is better for service members than "pathologizing" their stress by evacuating them to a hospital.
Col. Elspeth Ritchie, the psychiatric consultant to the Army surgeon general, acknowledged that the practice also serves the military.
"Historically, we've found patients evacuated out of theater don't return," said Ritchie. "In time of great difficulty - and there's no question the war over there is very difficult - sometimes anxiety and depression may overwhelm a soldier, and they feel like they've just got to get out of this place.
"But if they are evacuated out, they tend to have the stigma of leaving as a psychiatric case - and then it's a loss of manpower for the service."
Throughout the war, the military has evaluated the success of its mental health programs primarily on the basis of how many troops are retained in combat.
While Winkenwerder had assured Congress last summer that troops with severe mental illnesses were being sent out of the war zone, the Army's own reports indicate that the number of soldiers evacuated from Iraq for psychiatric problems has dropped steeply since the first year of the war, as combat-stress teams and medications have become more accessible.
Mental health evacuations have fallen from an average of 75 a month in 2003 to 46 a month in 2005, according to Army statistics. Overall, barely more than one-tenth of 1 percent of the 1.3 million troops who have been deployed to Iraq and Afghanistan have been evacuated because of psychiatric problems. Meanwhile, the mental health teams close to the front lines pride themselves on return-to-duty rates that typically exceed 90 percent.
But in some cases, the troubled troops who remain in the war zone never make it home.
Army Spec. Joshua T. Brazee, 25, of Sand Creek, Mich., had been in Iraq for less than three months when the military says he shot himself with his rifle in May 2005. According to his autopsy report, he had "talked with other soldiers about death and killing, and also about the idea of suicide."
His mother, Teresa Brazee, said she still has questions about how he died, and believes there were conflicts within his unit. She said one of Joshua's superiors told her that his death taught him to pay closer attention to his soldiers.
"It's a little too late for that," she said.
In another case, Pfc. David L. Potter was kept in the war zone despite a diagnosis of anxiety and depression, a suicide attempt and a psychiatrist's recommendation that he be separated from the Army.
Potter, 22, told friends that he believed the recommendation had been overruled, leading to a deepening of his depression, a fellow soldier said. On Aug 7, 2004 - 10 days after the psychiatrist recommended he be sent home - Potter took a gun from under another soldier's bed and killed himself.
The fellow soldier, who did not want his name used because he is still in the military, said Potter was clearly having trouble dealing with the stress of deployment, but wasn't getting the help he needed.
"We saw what was going on," he said, "but we couldn't do anything about it."
Ann Scheuerman knew her son Jason was having a rough time in Iraq, but she didn't know the depth of his despair until she awoke to a short e-mail from him last July that left her shaking with fear.
"I'm sorry, mom, but I just can't deal with this anymore," he wrote from his base in Muqdadiyah. "I love you, but goodbye."
After an agonizing morning of frantic phone calls, Scheuerman learned that officers and a chaplain had reached Jason in time, taking away his rifle, posting a guard and ordering a mental evaluation for the 20-year-old private first-class.
For the first time that day, Ann Scheuerman could breathe.
But her son's problems were just beginning.
Jason got a psychological evaluation, but afterward, he sent his mother another disturbing e-mail.
"He was very discouraged," said Scheuerman, of Lynchburg, Va. "He said, `Mom, they think that I'm making this up and that there was nothing wrong with me, that I needed to just be a man, be a soldier and quit wasting the Army's time.' He said they were going to court-martial him for treason, that sergeants said they were tired of people making up excuses to try to get out of combat and it wasn't fair to all the other real soldiers."
Jason was pulled off missions with his fellow soldiers, assigned menial jobs around the barracks and given his gun back.
He used the weapon three weeks later to become the 1,797th U.S. military fatality of Operation Iraqi Freedom.
Ann Scheuerman, who, like Jason's father, is an Army veteran, strongly supports the military. But she wants to know how things could have gone so wrong in Jason's case
. "The enemy should not be dressed in a United States Army military uniform. That's not what the enemy looks like, and should never be what our soldiers see as the enemy," she said.
"If someone would have taken two or three days, if he would have just been in the hospital for a few days, where someone could have actually talked to him, I think that's all it would have taken," she said.
Kiley, the Army surgeon general, said he believes that mental-health professionals in Iraq are quick to evacuate troops who are at risk of hurting themselves or others, or who have "risen to the level of being moderately or severely depressed."
Who's Helping The Troops
After the spike in suicides in 2003, military officials said they had faith that teams of mental health specialists deployed to Iraq and Kuwait would be able to provide needed care to troops, and help to break the stigma associated with mental health issues.
But with the 2005 suicide rate in Iraq climbing to the highest level since the war began, some soldiers' advocates are now questioning whether the specialists have become too reliant on short-term treatments and medications, and not enough on one-to-one counseling.
Sandy Moreno, a Sacramento, Calif.-based psychiatric technician in the Army Reserve, was among the first combat-stress team members in Iraq. While her team prided itself on a return-to-duty rate of about 95 percent, she said counseling and respite - not medications - were the focus in the early months of the war.
"You can't start someone on antidepressants and then not see them again because their unit is moving around," Moreno said. "When you put them on those kinds of meds, a lot of times it takes six weeks before they take effect, or they can cause side effects. We could never keep that good track of a soldier."
The military has about 230 counselors dispatched in Iraq and Kuwait for about 100,000 troops, about the same number as in 2004, an Army spokesman said. But there are signs that the providers themselves are burning out.
A team of mental health experts reported in January 2005 that caregivers were experiencing "compassion fatigue," with one-third of behavioral health workers reporting high burnout, and one in six acknowledging that stress was hurting their ability to do their jobs.
"If our providers are impaired," the team wrote, "our ability to intervene early and assist Soldiers with their problems may be degraded."
Beyond burnout, military documents and interviews reveal a culture in which mental health professionals are constantly on the alert for troops faking mental illness to get out of duty.
"Clinicians must always maintain a keen eye for potential malingerers," instructs the Iraq War Clinician Guide, a 200-page bible compiled by the Department of Veterans Affairs and the Walter Reed Army Medical Center. "Suspicions require close consultation with commanders to ensure proper diagnosis and disposition."
Some Iraq veterans say the military is too quick to dismiss mental health complaints, and still has a problem treating injuries to the mind the way it treats injuries to the body.
"If you break your leg over there, you're going to get treatment," said Georg-Andreas Pogany. "When they go for mental health services, they are belittled, they are shoved aside, they are called malingerers. Their experiences are completely invalidated."
In 2003, Pogany, a former Army interrogator, was charged with cowardice - a crime punishable by death - after suffering a panic attack and seeking counseling because he had seen the body of an Iraqi man who had been cut in half by American gunfire. The charge was later dropped.
Bob Johnson, former chief of combat stress control for an Army brigade of about 2,800 soldiers, said he would routinely review soldiers' work and disciplinary histories when they complained of serious mental problems. If a soldier with a history of antisocial behavior came in insisting he was going to shoot himself if he wasn't sent home, "then that's a pretty clear-cut case of malingering," he said.
Johnson said he took a punitive approach to dealing with those soldiers, taking away their guns - which he compared to "losing your manhood" - and forcing them to sleep at the command point, in the line of sight of commanders.
He said he had treated one soldier who threatened to starve himself to death, and later swallowed a handful of pills - both acts that Johnson deemed bogus attempts to get out of serving.
"There's no doubt about it, the guy had mental health issues," Johnson said. "But he wasn't going to get the treatment he wanted, which was to go home."
"The question is, do we want to reward this behavior? Because if we reward this behavior, more soldiers are going to do it."
...also see:
Mentally Unfit, Forced To Fight
