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ARMY TAKES NEW APPROACH TO RETURNING COMBAT VETS
By KATE WILTROUT, The
Virginian-Pilot
© March 29, 2005
VIRGINIA BEACH — When the 368th Cargo Transfer Company
returned last month, thousands of well-wishers lined the road outside Fort
Story, cheering, clapping and waving flags. The gymnasium, packed with families,
exploded with noise and emotion as about 200 soldiers in desert camouflage filed
in and stood in formation.
Once, such tearful reunions would have unofficially marked the end of a deployment. After a day or two turning in equipment and filling out paperwork, troops usually went on leave. And when they resumed their duties, the focus shifted to what lay ahead, not what experiences they left behind.
No longer.
Studies – and tragedies – have convinced the Army that it must do more to prevent the possibly deadly consequences of combat stress. To help soldiers cope, the service has revamped its routine for homecoming warriors, easing them back into domestic life after the prolonged pressures of a war zone.
The new approach turns the image of the emotionally self-sufficient soldier on its head.
“Soldiers are reluctant to admit a weakness,” said Col. Kenneth Musser , the Army’s individual readiness policy division chief at the Pentagon . Now, he said, returning troops are drilled with a different message: “You are encouraged to ask for help.”
Outreach starts before soldiers reach home soil and continues with two weeks of mandatory classes and a month of voluntary counseling for issues ranging from stress and anger management to marriage enrichment. Three to four months after their deployment, the Army formally surveys how troops are doing.
The first version of the program began in May 2003 ; it has been evolving since, Musser said.
Soldiers aren’t the only ones being targeted. While family support groups have long kept spouses and children informed and in touch during deployments, now the Army teams those groups with chaplains and social workers to prepare for the stresses of reconnecting with a soldier who’s been in harm’s way.
Experts hope the changes prevent the kind of bloodshed that haunted Fort Bragg, N.C., in the summer of 2002 . Over five weeks, four soldiers – three of whom had served in Afghanistan as special operations troops – killed their wives. Two killed themselves alongside their spouses; another committed suicide while awaiting trial; the fourth is serving life in prison.
Less spectacular, but potentially more troubling, is the psychological cost of serving in combat. A report by military doctors and psychologists in July found more than 15 percent of infantry troops surveyed showed signs of major depression, generalized anxiety or post-traumatic stress disorder after returning from Iraq. Published by the New England Journal of Medicine , the study also concluded that less than 40 percent of those soldiers sought mental health care.
The 368th works in transportation, not front-line combat. But with random bombings and attacks almost daily, soldiers are in danger almost everywhere they go.
“Anything can happen at any minute of the day,” said Capt. Erik Hilberg , the company commander.
During their year long stint, the unit’s truck drivers, forklift operators and mechanics were split into groups serving in Baghdad, Fallujah, Taji and Tikrit . They came under mortar attacks, dodged sniper fire and encountered roadside bombs. Eight soldiers received Purple Hearts for combat injuries; one – Sgt. Carlos Camacho-Rivera – was killed in a rocket attack outside Fallujah in October .
To ease the transition to life stateside, Hilberg and the men and women who work for him spent their first two weeks back in half-day classes and briefings, broken up by four-day weekends.
As they do after any overseas deployment, soldiers had blood drawn and eye exams. They filled out health forms and updated life insurance policies. Classes went further, though, to include suicide prevention, combat stress and anger management.
“Most people like to focus on post-traumatic stress disorder, but there’s a wide range of stress – we’re trying to mitigate all of that,” Musser said. He compared the outreach to a patient getting a physical – the doctor doesn’t look for one symptom, but screens for a range of potential problems.
Under the expanded effort, a chaplain who had met with their families beforehand talked to the soldiers about their spouses’ expectations and needs.
“We had classes last time, but not as intensive,” said Spc. Ryan Nett , who spent six months in Kuwait in 2003.
Nett, a 23-year-old from Wisconsin , was one of 10 soldiers from the 368th selected by unit officials to talk about the adjustment process soon after coming home.
To them, some of the simplest lessons made the biggest difference.
Spc. David Smith , a 22 -year-old from Arizona , became a father for the second time while he was gone. The mechanic returned to a 3-year-old son who was wary of him and a 6-month-old daughter he barely knew. He appreciated suggestions to take his time getting reacquainted – and a tip to get down on the floor with his son, instead of towering over him.
That’s the kind of advice that works, said 11th Transportation Battalion Chaplain C. Wayne Brittian , a Baptist minister and Army major who helped families endure the deployment and led some of the soldiers’ readjustment classes.
“It’s amazing what rolling around on the floor will do for building relationships ” with children, Brittian said.
Further wisdom; don’t try to “recreate” moments missed during deployments.
“Go out and make new memories,” Brittian said.
Some of the 368th’s soldiers said they appreciated the expanded program, but consider the best tool for coping to be a buddy in uniform.
Spc. Ashley Harris , 24, who also served in Afghanistan, said that when her two-week R&R trip home ended, she was eager to reconnect with her fellow soldiers in Iraq.
“You miss your friends,” she said. “They become family.”
Hilberg counts on that camaraderie to help him recognize who might need more help readjusting. He and the chaplain said the company is small enough, and close enough, they can ask around about how soldiers are doing.
There’s a more formal structure in place for that, too.
Unlike before, the Army now requires soldiers to fill out written surveys 90 to 120 days after returning.
“We just found that it makes sense to extend it out, to keep checking in with people,” Hilberg said. “The majority, after the first three months, it won’t be like they never left, but they’ve re-adapted.”
Soon, that practice will spread to other service branches as the Department of Defense begins requiring all troops returning from Iraq to be screened mentally and physically three months and six months after deployment.
“We learned from the Gulf War that health concerns emerge over time following return from deployment,” Air Force Col. Joyce Adkins wrote in response to questions about the pending change. Adkins works at the Department of Defense’s Deployment Health Support Directorate , managing a mental health and deployment stress program.
Research from the Persian Gulf War in 1991 – and more recently, the first rounds of deployment to Afghanistan and Iraq – confirmed that one of the most critical periods for service members is about four months after they return, Adkins said.
The 368th won’t hit that milestone until June.
So far, members said, they’ve been glad for the extra emphasis on readjusting , even if the classes kept them on base for two weeks before a long-awaited month of leave.
Few think they’ve seen their last deployment. Even on the day they returned, many said they expect to be deployed again within a year.
“We just enjoy the time that we have now,” said Spc. Lorenzo Pulliam , a 21-year-old from Kansas.
Harris said the transitions have gotten easier with each deployment. Like Pulliam, she doesn’t bother worrying about if or when she’ll go through it again.
“If you thought about it,” she said, “you’d go crazy.”
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Trauma of Iraq war haunting thousands returning home
By William M. Welch, USA TODAY
MORGANTOWN, W.Va. — Jeremy Harrison sees the warning signs in the Iraq war
veterans who walk through his office door every day — flashbacks,
inability to relax or relate, restless nights and more.
He recognizes them as symptoms of combat stress because he's trained to, as a counselor at the small storefront Vet Center here run by the U.S. Department of Veterans Affairs. He recognizes them as well because he, too, has faced readjustment in the year since he returned from Iraq, where he served as a sergeant in an engineering company that helped capture Baghdad in 2003. "Sometimes these sessions are helpful to me," Harrison says, taking a break from counseling some of the nation's newest combat veterans. "Because I deal with a lot of the same problems." As the United States nears the two-year mark in its military presence in Iraq still fighting a violent insurgency, it is also coming to grips with one of the products of war at home: a new generation of veterans, some of them scarred in ways seen and unseen. While military hospitals mend the physical wounds, the VA is attempting to focus its massive health and benefits bureaucracy on the long-term needs of combat veterans after they leave military service. Some suffer from wounds of flesh and bone, others of emotions and psyche. These injured and disabled men and women represent the most grievously wounded group of returning combat veterans since the Vietnam War, which officially ended in 1975. Of more than 5 million veterans treated at VA facilities last year, from counseling centers like this one to big hospitals, 48,733 were from the fighting in Iraq and Afghanistan. Many of the most common wounds aren't seen until soldiers return home. Post-traumatic stress disorder, or PTSD, is an often-debilitating mental condition that can produce a range of unwanted emotional responses to the trauma of combat. It can emerge weeks, months or years later. If left untreated, it can severely affect the lives not only of veterans, but their families as well. Of the 244,054 veterans of Iraq and Afghanistan already discharged from service, 12,422 have been in VA counseling centers for readjustment problems and symptoms associated with PTSD. Comparisons to past wars are difficult because emotional problems were often ignored or written off as "combat fatigue" or "shell shock." PTSD wasn't even an official diagnosis, accepted by the medical profession, until after Vietnam. There is greater recognition of the mental-health consequences of combat now, and much research has been done in the past 25 years. The VA has a program that attempts to address them and supports extensive research. Harrison is one of 50 veterans of the Iraq and Afghanistan wars hired by the VA as counselors for their fellow veterans. 'It takes you back there' Post-traumatic stress was defined in 1980, partly based on the experiences of soldiers and victims of war. It produces a wide range of symptoms in men and women who have experienced a traumatic event that provoked intense fear, helplessness or horror. (Related story: Iraq injuries differ from past wars) The events are sometimes re-experienced later through intrusive memories, nightmares, hallucinations or flashbacks, usually triggered by anything that symbolizes or resembles the trauma. Troubled sleep, irritability, anger, poor concentration, hypervigilance and exaggerated responses are often symptoms. Individuals may feel depression, detachment or estrangement, guilt, intense anxiety and panic, and other negative emotions. They often feel they have little in common with civilian peers; issues that concern friends and family seem trivial after combat. Harrison says they may even hit their partners during nightmares and never know it. Many Iraq veterans have returned home to find the aftermath of combat presents them with new challenges: • Jesus Bocanegra was an Army infantry scout for units that pursued Saddam Hussein in his hometown of Tikrit. After he returned home to McAllen, Texas, it took him six months to find a job. He was diagnosed with PTSD and is waiting for the VA to process his disability claim. He goes to the local Vet Center but is unable to relate to the Vietnam-era counselors. "I had real bad flashbacks. I couldn't control them," Bocanegra, 23, says. "I saw the murder of children, women. It was just horrible for anyone to experience." Bocanegra recalls calling in Apache helicopter strikes on a house by the Tigris River where he had seen crates of enemy ammunition carried in. When the gunfire ended, there was silence. But then children's cries and screams drifted from the destroyed home, he says. "I didn't know there were kids there," he says. "Those screams are the most horrible thing you can hear." At home in the Rio Grande Valley, on the Mexico border, he says young people have no concept of what he's experienced. His readjustment has been difficult: His friends threw a homecoming party for him, and he got arrested for drunken driving on the way home. "The Army is the gateway to get away from poverty here," Bocanegra says. "You go to the Army and expect to be better off, but the best job you can get (back home) is flipping burgers. ... What am I supposed to do now? How are you going to live?" • Lt. Julian Goodrum, an Army reservist from Knoxville, Tenn., is being treated for PTSD with therapy and anti-anxiety drugs at Walter Reed Army Medical Center in Washington. He checked himself into a civilian psychiatric hospital after he was turned away from a military clinic, where he had sought attention for his mental problems at Fort Knox, Ky. He's facing a court-martial for being AWOL while in the civilian facility. Goodrum, 34, was a transportation platoon leader in Iraq, running convoys of supplies from Kuwait into Iraq during the invasion. He returned to the USA in the summer of 2003 and experienced isolation, depression, an inability to sleep and racing thoughts. "It just accumulated until it overwhelmed me. I was having a breakdown and trying to get assistance," he says. "The smell of diesel would trigger things for me. Loud noises, crowds, heavy traffic give me a hard time now. I have a lot of panic. ... You feel like you're choking." • Sean Huze, a Marine corporal awaiting discharge at Camp Lejeune, N.C., doesn't have PTSD but says everyone who saw combat suffers from at least some combat stress. He says the unrelenting insurgent threat in Iraq gives no opportunity to relax, and combat numbs the senses and emotions. "There is no 'front,' " Huze says. "You go back to the rear, at the Army base in Mosul, and you go in to get your chow, and the chow hall blows up." Huze, 30, says the horror often isn't felt until later. "I saw a dead child, probably 3 or 4 years old, lying on the road in Nasiriyah," he says. "It moved me less than if I saw a dead dog at the time. I didn't care. Then you come back, if you are fortunate enough, and hold your own child, and you think of the dead child you didn't care about. ... You think about how little you cared at the time, and that hurts." Smells bring back the horror. "A barbecue pit — throw a steak on the grill, and it smells a lot like searing flesh," he says. "You go to get your car worked on, and if anyone is welding, the smell of the burning metal is no different than burning caused by rounds fired at it. It takes you back there instantly." • Allen Walsh, an Army reservist, came back to Tucson 45 pounds lighter and with an injured wrist. He was unable to get his old job back teaching at a truck-driving school. He started his own business instead, a mobile barbecue service. He's been waiting nearly a year on a disability claim with the VA. Walsh, 36, spent much of the war in Kuwait, attached to a Marine unit providing force protection and chemical decontamination. He says he has experienced PTSD, which he attributes to the constant threat of attack and demand for instant life-or-death decisions. "It seemed like every day you were always pointing your weapon at somebody. It's something I have to live with," he says. At home, he found he couldn't sleep more than three or four hours a night. When the nightmares began, he started smoking cigarettes. He'd find himself shaking and quick-tempered. "Any little noise and I'd jump out of bed and run around the house with a gun," he says. "I'd wake up at night with cold sweats." 'A safe environment' A recent Defense Department study of combat troops returning from Iraq found that soldiers and Marines who need counseling the most are least likely to seek it because of the stigma of mental health care in the military.
One in six troops questioned in the study admitted to symptoms of severe depression, PTSD or other problems. Of those, six in 10 felt their commanders would treat them differently and fellow troops would lose confidence if they acknowledged their problems. A report this month by the Government Accountability Office said the VA "is a world leader in PTSD treatment." But it said the department "does not have sufficient capacity to meet the needs of new combat veterans while still providing for veterans of past wars." It said the department hasn't met its own goals for PTSD clinical care and education, even as it anticipates "greater numbers of veterans with PTSD seeking VA services." Harrison, who was a school counselor and Army Reservist from Wheeling, W.Va., before being called to active duty in January 2003, thinks cases of PTSD may be even more common than the military's one-in-six estimate. He is on the leading edge of the effort to help these veterans back home. Harrison and other counselors invite Iraq and Afghanistan veterans to stop in to talk. Often, that leads to counseling sessions and regular weekly group therapy. If appropriate, they refer the veterans to VA doctors for drug therapies such as antidepressants and anti-anxiety medications. "First of all, I let them talk. I want to find out all their problems," he says. "Then I assure them they're not alone. It's OK." Fifty counselors from the latest war is a small number, considering the VA operates 206 counseling centers across the country. Their strategy is to talk with veterans about readjustment before they have problems, or before small problems become big ones. The VA also has staff at 136 U.S. military bases now, including five people at Walter Reed, where many of the most grievously injured are sent. The toughest part of helping veterans, Harrison says, is getting them to overcome fears of being stigmatized and to step into a Vet Center. "They think they can handle the situation themselves," he says. Vet Centers provide help for broader issues of readjustment back to civilian life, including finding a job, alcohol and drug abuse counseling, sexual trauma counseling, spouse and family counseling, and mental or emotional problems that fall short of PTSD. More than 80% of the staff are veterans, and 60% served in combat zones, says Al Batres, head of the VA's readjustment counseling service. "We're oriented toward peer counseling, and we provide a safe environment for soldiers who have been traumatized," he says. "A Vietnam veteran myself, it would have been so great if we'd had this kind of outreach," says Johnny Bragg, director of the Vet Center where Harrison works. "If you can get with the guys who come back fresh ... and actually work with their trauma and issues, hopefully over the years you won't see the long-term PTSD." In all cases, the veteran has to be the one who wants to talk before counselors can help. "Once they come through the door, they usually come back," Harrison says. "For them, this is the only chance to talk to somebody, because their families don't understand, their friends don't understand. That's the big thing. They can't talk to anyone. They can't relate to anyone." |
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PTSD & Spirituality
We encourage you to visit the North American Association of Christians in Social Work website. Below is a sample of the types of instructions offered by them.
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Description This audio conference, presented by Hope Haslam Straughan, Ph.D., will first present a bio-psycho-social-spiritual approach to social work practice. Various ways of thinking about development theories in general & spiritual development in specific will be reviewed, including a segment in which the participants will consider his/her own spiritual journey, development, and identity. Finally, spiritual assessment tools will be presented and discussed in order to further one possible application of inclusion of spirituality within social work practice. Overall, the focus will be on the integration of openness to acknowledging the possible strengths, concerns, and impacts of a persons’ spirituality within the helping relationship. |
Learning Objectives
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We also encourage you to visit some of the links posted below:
Department of Veterans Affairs on PTSD & Spirituality
Spirituality & Trauma Treatment by the National Center for PTSD
Spirituality & PTSD - The Vietnam Veterans of America
PTSD & Spirituality by Vietnam Veteran Ministers
The Spiritual Costs of Being In Combat
Questions & Answers on Health and Spirituality
Spirituality & Faith in Anxiety Disorders
Spiritual Alienation: Life After the Vietnam War
Science & Theology: What Ministers Need to Know about PTSD
The Role of Religion & Spirituality in Understanding and Promoting Mental Health
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WE APPRECIATE YOUR SUGGESTIONS AND FEEDBACK
Matt 8:8-10
I know, because I am under the authority of my superior officers and I have
authority over my soldiers, and I say to one, 'Go,' and he goes, and to another,
'Come,' and he comes, and to my slave boy, 'Do this or that,' and he does it.
And I know you have authority to tell his sickness to go-and it will go!" 10
Jesus stood there amazed! Turning to the crowd he said, "I haven't seen faith
like this in all the land of Israel!
TLB