Society and the Soldier: Post-Traumatic Stress Disorder – Part I

Hurricane Katrina ravages the Gulf Coast in 2005 while an earthquake savages Pakistan, India and Afghanistan. In 2004, a crushing tsunami rises out of the Indian Ocean. A terrorist attack paralyzes a nation on a mid-September morning in 2001. Every two minutes, an American is raped. Over six million are involved in car accidents annually. One to three million are victims of domestic violence in our country every year. And then there are those who are sent to combat. All are susceptible to something we call PTSD: post-traumatic stress disorder.

Next month, on March 19, 2007, we arrive at the four-year mark of the start of the Iraq War. Seven months later, on October 7, 2007, six years will have passed since the war in Afghanistan began. Since then, nearly 1.5 million American men and women – representing about one half of one percent of the nation’s total population – have worn our nation’s uniform and served in Operation Iraqi Freedom and/or Operation Enduring Freedom. Nearly 3,200 have been killed in action thus far, and over 23,000 have been wounded.

In addition, nearly 150,000 have filed disability claims; over 100,000 of which have been granted, with another 30,000+ claims pending review. It is estimated that between 500 and 1,000 OEF/OIF vets are already homeless. Many have multiple deployments under their belts. For now, at least 38,000 returning troops carry invisible marks on their souls of one degree or another and are being treated by the Veterans Administration for psychological injuries once labeled nostalgia, shell shock or combat fatigue. Today we call it post-traumatic stress disorder, or PTSD.

The Allure of War

Dear God, where do we get such men? What loving God has provided, that each generation, afresh, there should arise new giants in the land. Were we to go but a single generation without such men, we should surely be both damned and doomed. -- US military leader, anonymous, from On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace

From the advent of war, the warrior has been a mythic figure in the public realm. Honored and glorified, a nation's soldiers are larger than life (and often grow even larger in death). Think WWI's Eddie Rickenbacker or WWII's Audie Murphy. Or Hollywood’s versions: John Wayne in The Sands of Iwo Jima; Robert Mitchum in Gung Ho; Steve McQueen in The Great Escape; Tom Hanks in Saving Private Ryan; or Josh Hartnett in Pearl Harbor and Black Hawk Down. The stories of our stoic protectors and their epic battles resound in the national consciousness. But while we glorify these heroes, most would also concede that conflict is an absolute soul-drenching and body-blowing enterprise for those asked to wage it and hopefully survive it.

Even so, war is alluring. It draws us in, giving its participants (and its onlookers) a literal reason for being, or a feeling that they’re part of something larger and more important than themselves. In the heat of battle, at the very moment that war equals death, to many it also equals life.

In the first American combat memoir of the 21st century, Capt. Andrew Exum points to the power of conflict in This Man’s Army: A Soldier’s Story from the Front Lines of the War on Terrorism. Biding his time and feeling rudderless in the relatively tranquil pre-September 11 era, the Army Ranger and Penn State grad looked pensively upon the opportunities his friends had, thinking, “They were all either traveling in Europe that summer before beginning medical school, law school, or Ph.D. programs, or were already working, on their way to becoming the future business tycoons of America."

Exum feared stagnation and atrophy, that the “upcoming years would be ‘lost’ years" in which he “would not accomplish anything of any value or substance." As the Infantry Officer Basic Course at Fort Benning, Ga., loomed, the southerner from Tennessee began to realize what he was longing for:

But some words I came across that summer stood out among the dozen or so books I read … and began to haunt me. In The Last Gentlemen, Walker Percy wrote:

Southerners have trouble ruling out the possible. What happens to a man to whom all things are possible and every course of action open? Nothing of course. Except war. If a man lives in the sphere of the possible and waits for something to happen, what he is waiting for is war – or the end of the world. That is why Southerners like to fight and make good soldiers. In war the possible becomes the actual through no doing of one’s own.

It was as if Percy had been writing those words directly to me. I began to believe that war might be the only answer to all my doubts. That war might validate my existence as a soldier and a man.

Exum’s views are mirrored in hundreds of other such accounts that fill our history books. For Exum, war was a personal odyssey. For others, more powerful forces are at play. Edward Tick Ph.D. raises this point in War and the Soul: Healing Our Nation’s Veterans from Post-traumatic Stress Disorder:

Human history seems to demonstrate that we cannot, or will not collectively surrender our devotion to the practice of warfare, given our inherited belief that God is at the center of it. Almost every culture that has ever existed has brought forth models of both war and the warrior in its mythology and history. The absence of warfare in a culture is so rare as to suggest that war is endemic to human experience.

Then, if we must war, it is also necessary to make provision for healing in its aftermath.

Grasping the Invisible

Since the dawn of conflict, visible battle wounds have been easy enough to understand and accept. Physical scars are like passports, displaying the stamps that prove their owners have passed through something dramatic and traumatic. These marks of heroism and survival educe respect and admiration, and compassion more naturally flows towards the physically injured.

In contrast, psychological injuries don’t have bruises, bumps or scars validating trials endured and battles won. Somewhat understandably, these invisible marks of war have always been more elusive for societies to appreciate and embrace.

But they’ve always been there for anyone willing to only look.

While America was still in its infancy, German, French, English, Swiss and Spanish military doctors began describing post trauma-like symptoms found in their combat veterans. They spoke of sleeplessness, anxiety, tremors, loss of appetite, fever, emotional upheaval, and depression (or ‘melancholy’). By the mid-18th century, these doctors approached the problem (calling it ‘nostalgia’) from a holistic point of view, examining the individual and his environment for diagnosis and treatment. Revolutionary.

Nostalgia quickly turned to shell shock as the 20^th century opened and increasingly lethal weapons inflicted a brutal toll on the flesh and the mind, killing in great numbers with great power and thunder and without bias.

As World War I was replaced by WWII, military psychology ever more played a role in keeping troops close to the front lines rather than sending them to the rear for combat fatigue treatment. The military had quickly learned that the closer a soldier remained to the battlefield and his mates, the sooner he’d be ready to get back into the fight.

But, despite renewed recognition of the success of forward treatment, psychiatrists had not anticipated the impact of technology and its ensuing wounds. The introduction of aircraft as a weapon, for example, created a whole new plane of warfare. No longer did death and destruction merely spring from the ground; it also rained down from the heavens above.

Some lamented this additional arena of warfare. Charles Lindbergh, the most popular figure of his day after piloting the first solo non-stop flight across the Atlantic, in his later years wrote to former Secretary of the Interior Stewart Udall:

While aircraft have brought peoples closer together in peaceful intercourse and understanding, they have more than counteracted this accomplishment through their ruthless bombardments in war. … While missiles have opened to our knowledge unexplored reaches of space, they have made our civilization subject to extermination within hours.

One can only wonder what Lindbergh would say about our world today. Yet, while so much has changed over the years, one thing remains the same: we continue to send our youngest off to battle and often neglect to fully understand just what that means to their future – and ours.

The Journey to War

Lance Corporal James Blake Miller trained at North Carolina’s Camp LeJeune with the 1st Battalion, 8^th Marine Regiment of the 2^nd Division. The Tarawa division (named for a famous WWII Marine battle in the Pacific) had participated in the Cuban Missile Crisis. In 1983, the 1-8 lost 223 members in the Marine barracks bombing in Beirut, Lebanon, the biggest Corps hit since they took Iwo Jima decades earlier.

Today’s modern 1-8 first deployed to Iraq as part of Task Force Tarawa during the initial invasion, losing 18 Marines in the taking of Nasiriyah from March 23-29, 2003. Its second deployment, in June 2004, was with the 24^th Marine Expeditionary Unit, Miller in tow.

Edgy about the journey before him, Miller channeled that energy into his smoking. A pack-and-a-half habit rose to two-and-a-half packs at deployment; and once in the ‘Sandbox’ of Iraq, it shot up to five-and-a-half packs a day. The company’s medic later said of Miller’s habit, “I tried to get him to stop – the cigarettes will kill him before the war. I get on him all the time. But this guy is a true Marlboro man."

The 1-8’s first assignment was setting up lookouts for the telltale white trucks favored by the insurgents for transporting and planting their roadside bombs and firing their mortars in Anbar Province. The Marines were specifically tasked with protecting Haditha Dam, which churned out 1/5 of the country’s electricity. The duty made Miller feel like he was doing something important for the Iraqi people. For the most part the enemy remained faceless, and Miller and crew were coasting along comparatively well. They lost guys here and there to snipers or IEDs or even accidents, but they had time to pass out candy and have a few laughs with the local kids, too.

But the fairly idyllic time would soon fade to black.

When the 1-8 got its orders for the Fallujah invasion on November 5, 2004, sandstorm swirling around them, everyone knew it would be a ferocious clash. Five Iraqi interpreters bailed out. Looking back on it, Miller said, “It puts butterflies in my stomach right now. I don’t know if you can describe it." He grasped around a little more, and then gave up, “I don’t think words can." No one had stepped foot inside the Sunni stronghold in months – but they were going in.

The evening set for assault nearing, the young Marines found themselves involved in intense training exercises. Miller remembers it all as a blur. Though stressed, the gathering of men for the mission from the various companies that had been spread throughout Iraq resulted in some happy reunions.

Miller, for example, ran into Demarkus Brown, a 22-year-old friend from infantry school days. The African-American from Virginia who had jokingly introduced himself to Miller when they had first met saying, “What’s up, cracker?" was a welcome sight. Love of music and shared experience had bonded the two and ensured they would become fast friends. They were glad to see each other. It would be the last time they would share a laugh; the last time they would do anything together, for that matter. Brown, a machine gunner known for an ever-present smile and love of the Marines, would be killed by enemy action on November 19, 2004. He was 22. He joined over 100 other American troops to perish in Anbar Province that cold November.

A southerner brought up in the Christian faith, Miller was conflicted about the battle that loomed large before him. Brought up to believe killing was a sin, his orders were to destroy life in a city, ironically, famous for its 130 mosques. His company was specifically charged with pounding Al Hydra Muhammad Mosque (thought to be the insurgency’s command center). Miller phoned his adoptive grandmother on the brink of the assault, asking her, “How can people go to church and be a Christian and kill people in Iraq?" She later explained, “He was raised where that’s one of the Ten Commandments, do not kill. I think it’s hard for a soldier to go to war and have that embedded in them from small children up, and you go over there and you’ve got to do it to stay alive."

Coming Home

A lot of Vietnam vets suffered from PTSD, but nobody took the time to understand or help them. Now some of those guys are living on the street. You look at their situation, and you think about what they did for their country and where they are now … and it hurts. -- Lance Cpl. James Blake Miller

James Blake Miller left the Middle East and returned to his Kentucky home in February 2005 a hero. On the second day of the Fight for Fallujah, Miller had taken his first cigarette break following an intense nightlong rooftop fire fight. Cigarette dangling from his lips and the blood and grime of war on his face, Luis Since – an embedded photographer with the Los Angeles Times – shot a picture that would make Miller famous. His superiors had wanted to send him home, out of harm’s way, yet Miller refused to leave his friends on the field of battle.

He would be happy to be home. But in many ways, his days at war were far from over.

Almost immediately, he began having nightmares. Pumping his trigger finger repeatedly, he tried to fight off the ghosts of Iraq. Still they followed him into the daylight hours. One day, he peered out of his wife’s college dorm room window to see an Iraqi body lying on the ground. He was anxious, easy to anger and frequently “blanking out." He sought help, and a military doctor spotted the signs of PTSD.

Yet in early September 2005, he was reactivated and sent to recover bodies and help police New Orleans in the wake of Hurricane Katrina. “I really didn’t want to go … there was a possibility we would be shooting people," he told San Francisco Chronicle reporter Matthew B. Stannard. “We could be going into another (urban warfare) environment just like Iraq, except this would actually be U.S. citizens." It would be like “Fallujah 2, right here in the states," Miller feared.

Tensions mounted on board the USS Iwo Jima where his unit was stationed as they waited out Hurricane Rita. “I was coming out of the galley, when this sailor made a whistling noise that resembled the sound of a rocket-propelled grenade," Miller remembered. “I don’t know why he did it … but something just triggered and I flipped out." He assaulted the sailor in a blacked-out rage.

On November 10, 2005 – exactly one year to the day his famous photo made its way around the world – Miller received an honorable but early discharge from the Marine Corps. He started VA counseling and soon began speaking out about his PTSD. Throughout the first half of 2006, Miller gave interviews describing one young man’s experience of war. Once more he received the attention of a nation, but this time it was as conflicted about Iraq as he was. Letters and gifts and visits came from strangers simply wanting to tell him, “It will be all right."

June 2006 became a blur of activity. He and his wife, Jessica, who had been married with few frills a year earlier were now showered with a lavish wedding donated by a grateful community and well-wishing strangers alike. Even Luis Sinco, the Los Angeles Times photographer whose camera froze a moment and face in Fallujah, was there. It was almost a full-circle moment that provided some closure. Almost. Miller’s best man was missing as were his other Marine brothers. They were heading back to Iraq. For the Marine who would not leave his battle buddies behind when given the chance in Fallujah: another psychological burden as they returned to battle without him. And for his mates: more exposure to the trauma of war.

Within a few days, citizen Miller was on the road as well, heading off to Washington, D.C. Honored by the National Mental Health Association for speaking out candidly about his combat-related PTSD, he met with Rep. Mike Michaud [D-Maine], ranking member of the House Veterans’ Affairs Health Subcommittee. Chronicle reporter Matthew B. Stannard wrote of a conversation between the two men:

As they left, Michaud urged Miller to continue to speak out – to lawmakers, to VA officials, to his fellow veterans. "You shouldn't underestimate yourself as one individual, what you can accomplish. You telling your story is really powerful."

It's the kind of thing Miller has heard often over the past five months: that telling his story to the world is helping other vets who lack his ability to speak out despite the pain and the pride. He always appreciates the kind words, but wonders if the people who say it aren't missing the point. "It's not what I can do to help people," he would say. "It's what everybody else can do."

As Miller now works to replace the adrenaline rush of war, adapt to the complexity of civilian life, find meaning after conflict, and make peace with himself and the war he fought in, isn’t it time now for the rest of us to pick up where he left off?

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Part II of our series will more fully explore the nature of combat PTSD, including its diagnosis and prognosis, as well as prevailing treatment options used by the VA and others medical professionals to help ease the ‘soul wound’ of war.

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Resources

Support the troops through legislation

Lane Evans Veterans Health and Benefits Improvement Act

Joshua Omvig Veterans Suicide Prevention Act

Returning Servicemember VA Healthcare Insurance Act

Assist vet-friendly organizations with a small (or large) donation of time or money

ONE Freedom

VeteranLove

National Veterans Foundation Help Line

National Coalition for Homeless Vets

National Organization of Veterans Advocates

Iraq and Afghanistan Veterans of America

Veterans for America

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Bio: Ilona Meagher is a member of the CCN Troops and Vets team and editor of the online journal PTSD Combat: Winning the War Within. She has authored the upcoming book, Moving a Nation to Care: Post-Traumatic Stress Disorder and America’s Returning Troops and is a citizen journalist for ePluribus Media. Their collaboration has resulted in the PTSD Timeline -- a database of reported OEF/OIF PTSD-related incidents -- as well as the 3-part series Blaming the Veteran: The Politics of Post Traumatic Stress Disorder. She resides in Illinois and is completing a degree in journalism at Northern Illinois University.