Cover Story: Soldier's Heart

Traumatized veterans find a health system not ready for them

Walter Coker/Folio Weekly

Spec. Joshua Peterson has punched his wife, Kristin, during nightmares about Iraq.

The first time Kristin Peterson's husband hit her, she was asleep in their bed. She awoke after Joshua's fist smashed into her face. She ran, terrified and crying, to the bathroom to wipe the blood spurting from her nose.

When she stuck her head back into the bedroom, there he was, punching at the air, muttering how she was coming after him and how he was going to kill her. Kristin started yelling but Joshua's eyes were closed. He was still asleep.

The next morning Joshua saw the dried blood on his wife.

"Oh God," she recalls him saying. "I did that."

Peterson doesn't remember the night or the nightmares.

He also can't remember punching his wife again in his sleep a few weeks later, driving her front tooth through her lip, all the while murmuring how he'd never go back.

For six months last year, Peterson, 24, helped build an oil pipeline across Iraq as a specialist in the Army's 110th Quartermaster Co. On the same highway where Pvt. Jessica Lynch was ambushed, he saw Iraqi soldiers, dead and rotting, dangling out of their tanks. One time Peterson's truck broke down and he was surrounded by a group of Iraqi children, some throwing rocks, others toting AK-47s.

"I kept thinking, 'God, I can't handle this,' " he says with a hollow laugh.

Since Peterson came back to Richmond Hill, Ga., in August 2003, these memories have turned him into a man Kristin often doesn't recognize — a man who lashes out in anger at her and their 21-month-old son, whose awful dreams tell him to beat his wife because, in his sleep, she's an Iraqi.

There are thousands of soldiers across the country like Peterson, coming home with minds twisted by what they've seen and done in Iraq.

A December 2003 Army study published in The New England Journal of Medicine found that approximately 16 percent of soldiers returning from Iraq were suffering from posttraumatic stress disorder (PTSD), a condition causing intense nightmares, paranoia and anxiety.

Now, after a particularly bloody summer and fall, many military and mental health experts predict the rate of PTSD will actually run nearly twice what the Army study found, approximately the same level suffered by Vietnam veterans. Others think it could spike even higher and note that rarely before has such a dramatic rate of PTSD manifested so early.

At the same time there is mounting concern over the system designed to help: the Department of Veterans Affairs (VA). Numerous reports show the VA doesn't have many of the essential services veterans need.

"I don't know how many people are going to be seeking treatment or whether the demand is going to be met by available resources," says Matthew Friedman, executive director of the VA's National Center for PTSD. "What I am confident is that people who come for treatment will get good treatment."

Yet the VA chronically has under-funded mental health programs and currently projects a $1.65 billion shortfall in those programs by the end of 2007.

"If we don't give the VA what it needs immediately, the consequences will be lifelong and devastating," says Steve Robinson, executive director of the National Gulf War Resource Center.

The emerging scenario is that of a generation of new veterans whose psyches are in tatters, their families scarred by the strangers their loved ones have become — and of an exhausted health care system holding its breath.

Half ready to help
"When you kill someone in combat, two things can happen," says Sgt. Walter Padilla, Charlie Co., 1st Battalion, 12th Infantry Division. "The crazy ones go crazier. Or nothing happens."

In October 2003, Padilla was commanding a Bradley fighting vehicle near the city of Kirkuk, rounding up insurgents and fending off mortar attacks. On a break one day, his company headed to a deserted area to practice their marksmanship. When gunfire rang out from a nearby village, Padilla wheeled his Bradley around to investigate. He saw two groups of armed men arguing over a pile of wood. The Bradley rumbled closer and the men began shooting.

"Everything slowed down," he says. "I lost sense of time. I saw nothing, felt nothing. Then I opened up with the machine gun."

After Padilla gripped the trigger long enough, he moved in for a closer look.

"You're walking up on something you've done with your hands," he says. "You see the back of brains blown out. You know it's either him or you. But I'd never seen anybody dying."

When Padilla's unit was shipped back to Fort Carson, Colo., in February, his life unraveled. While he was gone, his wife had filed for divorce. He began having terrible dreams about Iraq. He grew paranoid anytime he left home.

One morning, on his way to work at Fort Carson, Padilla glimpsed the lights of an Air Force jet. He swerved off the highway and grabbed his cell phone to call his commanding officer.

"I thought it was a tube flash from a mortar," he says.

While Padilla grasped at his ghosts, Washington bureaucrats were hearing about another nightmare. In March, Dr. James Scully, medical director of the American Psychiatric Association, testified to the House Appropriations Subcommittee on VA, HUD and Independent Agencies.

A Navy veteran, Scully reported a 42 percent explosion in VA patients with severe PTSD, with only a 22 percent increase in money spent on PTSD services. The discrepancy was particularly "startling," he said, because there were more vets using the VA for psychological help than ever — nearly half a million.

It was the latest blow for an institution that has struggled for decades to fulfill its mission.

By 2003, the previous decade had seen a 134 percent jump in vets seeking care with only a 44 percent increase in the budget.

In April 2003, as U.S. troops pushed toward Baghdad, Dr. Joseph T. English, chair of St. Vincent's Catholic Medical Centers of New York, told the same House subcommittee that veterans were waiting an average of 47 days to get into PTSD in-patient programs and up to a year at some outpatient facilities.

Former VA Secretary Anthony Principi, who resigned Dec. 8, had commanded a navy gunboat during Vietnam and understood PTSD. He also knew that with combat-dazed vets beginning to trickle home from Iraq, he needed to move. He commissioned a task force to cobble together the VA's mental health services on short notice.

In a revealing June memo, Principi wrote that the task force had discovered four major deficiencies: Mental health services were scattered, substance abuse programs had been reduced, the VA's mental health leadership hadn't been diligent in overseeing the situation and there was no coherent mental health strategy. Principi ordered VA brass to begin plugging the holes immediately.

While the VA worked on a long-term mental health plan, the agency's Special Committee on PTSD delivered an October report to Congress, warning that with more soldiers with PTSD arriving home, services needed beefing up. During the 1980s the VA had recommended there be teams of PTSD counselors at all VA medical centers. Two decades later, the report noted, barely half of the 163 facilities had them.

The VA plan estimated it would take $1.65 billion by 2008 to fix things.

Similarly, the PTSD Committee conceded that the VA couldn't be expected to treat troubled vets from Iraq and Afghanistan while still caring for those already in the system.

"If the human cost of PTSD and its related disorders is staggering, so are the long-term medical costs to the VA associated with chronic PTSD," the report said.

The House Veterans Affairs Committee urged Congress to pump an additional $2.5 billion into the Bush Administration's VA health care budget for 2005. But by November, with the budget poised for passage, it seemed unlikely, despite warnings from veterans groups and VA doctors who sat on the PTSD Committee.

These same doctors knew they could treat the disorder better than anyone. They have been on the cutting edge of PTSD since its diagnosis was born from a war whose lessons now seemed distant.

'Talking about atrocities'
PTSD had long been acknowledged under a variety of names. In 1871 a former Union Army medic wrote about a stress disorder caused by heavy fighting. He called it "irritable heart," a name changed shortly thereafter to "soldier's heart." During World War I, veterans returning with soldier's heart were told by military doctors they had "shell shock" or "combat neurosis."

After World War II, when tens of thousands of soldiers were hospitalized with psychiatric problems, doctors diagnosed the majority with paranoid schizophrenia says Jonathan Shay, author of Achilles in Vietnam: combat Trauma and The Undoing of Character.

"The diagnostic spirit which prevailed was based on Plato's idea that if you had good parentage, good genes, a good education, then no bad things could shake you from the path of virtue," he says.

In 1970, 20 young vets from Vietnam Veterans Against the War (VVAW) called psychiatrist Robert Jay Lifton. The vets didn't trust the VA or the military but knew they needed to calm the devils they'd brought home.

Lifton, who had studied Hiroshima survivors and been an army psychiatrist, began meeting in New York with the group in what became known as "rap sessions." He was shocked by the extent of the veterans' traumas.

"These men talked about a particular combat situation that had a level of extremity which was new, even to me," Lifton says.

VVAW opened dozens of storefront counseling centers, where veterans could speak with other vets about their experiences, a crucial part of treating PTSD. Still, despite the growing number of vets clearly suffering, the VA wouldn't accept PTSD as a diagnostic entity.

"This was because many of them were talking about atrocities and that process was associated with a political view of the war," Lifton says.

In 1979 the VA finally opened up its own network of storefront vet centers. A year later the American Psychiatric Association recognized PTSD as a legitimate medical diagnosis.

When the National Vietnam Veterans Readjustment Study concluded in 1988 that 30 percent of Vietnam vets suffered from PTSD, not many were surprised.

By then, Lifton and VA psychiatrists like Matthew Friedman had become leading experts on PTSD. They pushed the condition into psychiatric and public consciousness.

Through group and individual therapy and sometimes medication, the VA was helping veterans heal, though the process could take years.

But by the time U.S. soldiers touched Iraqi soil, because of the VA's enormous growth and failure to catch up, the advancements in PTSD treatment were being compromised.

A new conflict, which bore an uneasy resemblance to Vietnam for the doctors who knew that war's demons, would test those advancements even further.

'Higher than anything we've seen'
As Crystal Luker tells it, May 5 was the day her husband's platoon ran into trouble. As usual, on that afternoon Spec. Ron Luker was patrolling a section of Baghdad with his 1st Cavalry Division platoon.

"There was a lieutenant in the first Humvee, Ron was in the second and his platoon sergeant was in the third with a group of privates," Crystal Luker says.

A 19-year-old specialist from Tulsa named James Marshall, who Ron had been looking after, also rode in the third Humvee. As the convoy snaked through a teeming Baghdad street market, there was an explosion.

"The lieutenant was yelling over the radio for all of them to haul ass back to the base because they were coming under fire," Crystal says.

When Luker looked behind him, the third Humvee was gone. He flipped his vehicle around and hurtled back down the street. When they found the Humvee, the force of the blast had blown the flesh from two of the privates all over the seats. When Luker looked in the back, he saw Marshall, wrapped around the vehicle's 50-caliber gun.

"When Ron tried pulling James' body out, his hands just went right inside of him," Crystal Luker says. "He pulled James' flack jacket back, and his chest was gone."

Before that day, Luker called and wrote home religiously, unburdening himself to the woman he'd fallen in love with at a Mariposa, Cal., restaurant four years earlier. But when he came home to Fort Hood, Texas, for a week in August, things changed dramatically. That first night, at a "welcome home" barbecue, Luker cornered his wife in the kitchen.

"He asked why I'd been avoiding him and said that I didn't want to be around him," Crystal Luker says.

When Luker started cursing, some army friends pulled him away.

"You didn't come all the way home to fight with your wife," they told him.

As the week went on, there was more arguing. Crystal Luker says her husband accused her of cheating while he was gone. He rifled through her purse and bedroom drawers and repeatedly listened to old phone messages, searching for proof.

"I told him, 'You're scaring me. You're not acting right, Ron,' " Crystal Luker says.

Luker also seemed bothered around his three daughters. In an emotional revelation, he told his wife why.

"He said he'd turned into a monster in Iraq," Crystal Luker says. "How he couldn't bounce his kids on his knee when he'd shoved guns in women's faces and busted into houses and pushed kids on the floor. He kept saying 'I'm just trying to remember who I was before.' "

Luker's problems fit into those of the growing numbers of PTSD soldiers. They also signal another trend — soldiers experiencing PTSD early. VA psychiatrist Scott Murray says many vets won't feel PTSD's symptoms until 15 months from now.

"This early on, PTSD is much higher than anything we've seen in previous conflicts," Murray says. "We anticipate the numbers are only going to keep getting higher."

Psychologist Kaye Baron treats some 70 soldiers and their families in a private practice in Colorado Springs, near Fort Carson. From clinical discussions she's had with soldiers, Baron thinks the PTSD could spike as high as 75 percent.

Such a rate, Lifton says, is inexorably tied to the war itself.

"This is a counterinsurgency being fought against an enemy which is hard to identify, and that leads to extraordinary stress," he says.

The issue with the most potential for psychological torment is whether soldiers feel they've been led into battle for a noble cause, according to Shay.

"If a soldier has experienced a betrayal of what's right by those in charge, their capacity for social trust can be impaired for the rest of their lives," Shay says.

Indeed, Dave Durman says he first began feeling uncomfortable in Iraq when it became clear there were no weapons of mass destruction. He says his unit was furious when Gen. Tommy Franks retired mid-war while the rest of National Guard and reservists were subject to the Army's stop-loss policy, extending their deployments.

Padilla and Luker were outraged when they saw Iraqi children playing in sewage gurgling through the streets while the Army did nothing.

"I thought we were here to help these people," Padilla says.

That sense of betrayal translates into what Shay calls "complex PTSD": nightmares, paranoia, violence, self-hate and a crippling distrust.

Many of the soldiers Baron treats tell her they only want to get far away from their lives at home.

"They just want to go off in the mountains and be by themselves," she says.

In the end, a bullet
So far more than 10,000 veterans from Iraq and Afghanistan have sought psychological help from the VA, and every indication is the numbers will jump significantly.

Despite the challenges these numbers predict, Harold Kudler, co-chair of the VA's PTSD Committee, says, "We've never been so prepared." He points to unprecedented cooperation with the Department of Defense, intensified PTSD outreach and the 206 vet centers.

But some say that preparation is not enough.

"You can only provide the services for which you have the resources," says VA psychiatrist Scott Murray. "There has to be significant improvement in an allocation of funds to make that occur."

On Nov. 20 Congress added $1 billion to the Bush administration's $27.1 billion VA health care budget for 2005. The amount fell $1.5 billion short of what was recommended by the House Veterans Affairs Committee. While Congress earmarked an additional $15 million for PTSD, few think that money will make much difference.

"The heads of the VA health care networks are all trying to figure out how the hell they're going to manage," says Rick Weidman, director of government relations for Vietnam Veterans of America.

In 1968, a young soldier named Lewis Puller came back from Vietnam without his legs and hands, blown off by a Viet Cong land mine. Puller, the son of the most decorated Marine in American history, soon became a veterans' rights advocate and later a Pentagon lawyer.

He married a politician, had two children and in 1991 wrote a Pulitzer Prize winning book, Fortunate Son: The Healing of a Vietnam Vet. Popular on Capitol Hill and among veterans, he had seemingly risen from the wounds and the depression and alcoholism that haunted him for years.

On May 11, 1994, 26 years after returning home, Puller shot himself. In the end, the soldier's heart hurt too much.

Dan Frosch is a New York-based freelance writer. Barbara Solow with the Independent Weekly in Durham, N.C. contributed reporting to this story.

Editor's Note: The Association of Alternative Newsweeklies commissioned Dan Frosch's story on returning Iraq vets, and 40 alt weeklies around the country are publishing it this week along with local reporting on the issue.

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