In war, killing is down; suicide is up

For the second year in a row, the U.S. military has lost more troops to suicide than it has to combat in Iraq and Afghanistan, according to Congress.org.

The reasons are complicated and the accounting uncertain, according to the website — for instance, should returning soldiers who take their own lives after being mustered out be included?

But the suicide rate is a further indication of the stress that military personnel live under after nearly a decade of war, the website states.

Figures released by the armed services last week showed an alarming increase in suicides in 2010, but those figures leave out some categories, the website says.

Overall, the services reported 434 suicides by personnel on active duty, significantly more than the 381 suicides by active-duty personnel reported in 2009, the website says.

The 2010 total is below the 462 deaths in combat, excluding accidents and illness. In 2009, active-duty suicides exceeded deaths in battle, the website says.

Darren DeGraw, Manville and PTSD

Sometimes post-traumatic-stress disorder can take years to manifest itself. For Darren DeGraw, my Point Pleasant Boro High classmate from 1985, it took 11.

Darren was 39 when he died in 2006 in Lake Worth, Fla., of possible heart failure, according to The Princeton Packet. But what happened in 1995, shortly after joining the Manville, N.J. police force, may have been what ultimately did him in.

Darren, who had also lived in Barnegat, resigned on June 30, 2005 from the Manville force because of the PTSD he suffered from following a 1995 shooting, his ex-wife, Donna DeGraw, once told The Princeton Packet.

Even as he suffered, he apparently showed the same leadership spirit he had as a high school student, hoping to revive a community that had a wrecked economy and a population that suffered from a debilitating and deadly illness.

But there is only so much a person can do to save themselves, especially when they face the tragedy of depression and trauma that not only affects those around them. Mental illness is often a force bigger than ourselves. For Darren, it was a force that - despite the good life he led - was too big to conquer.

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9/11, kids and why I may be lucky

The thought seemed so absurd that I was afraid to bring it up.

It went like this: I saw the roster of kids playing on my son's 8-year-old baseball tournament team, and I noticed that Jon was the youngest. By far. By three months. No other child was born after October 2001.

No November. No December. Just Jon in January.

Four of the 12 were in second grade. The Little League age cutoff was April 30, so every single child - except for Jon - was born within that short time frame, between May 1 and Oct. 31, 2001.

That's six months, the latter two being the months that followed the Sept. 11 attacks.

I've wondered for a while if there was a connection. I witnessed first-hand the trauma people went through at the time, and in the moments and days and weeks that followed the attacks. I remember smelling the odor of ash, burnt rubble and flesh and thinking, God, this can't be good for me, or anybody.

Frankly, when I've raised the issue, I've gotten stares and some polite acknowledgments. "Oh, that's interesting, Tom....anyway, what else is new?"

But I still think about it, from time-to-time: What kind of impact did 9/11 have on pregnancies? Did it lead to more miscarriages? Did the trauma suffered by so many cause the premature birth rate to go up?

How was it that Jon was the only one born in 2002 who was able to play on that team?

Recent studies have shown that, perhaps, the idea isn't so ridiculous and, in fact, the impact on pregnancies could be a microcosm for the stress felt by the nation as a whole.

Indeed, the studies provide what may be the most stirring and profound evidence so far that so many, and perhaps the nation as a whole, suffered from a form of Post-Traumatic Syndrome when they learned of friends and family who died in the attacks, or watched people suffer on T.V.

Pregnant women were vulnerable because of the stress they felt that was conscious and unconscious. A study released in May said the stress felt by women after the terrorist attacks may have contributed to an increase in miscarriages of male fetuses in the United States.

The BMC Public Health journal said the male fetal death rate also increased in September 2001. Miscarriages jumped 12 percent that same month.

My wife felt the stress, too, but others seemed to feel it more. I remember people going up to my wife at the time and saying, "How do you feel about having a baby in a world like this?"

I remember thinking, please, don't say that to her. We plan on seeing this pregnancy through.

PTSD certainly can also take years to develop. We may never really know what kind of long-term impact 9/11 really has had on the nation for decades, after more studies researching the same or different things come out.

But these studies, at least, provide a start.

The authors of the BMC report, for instance, suggested that communal bereavement may have prompted an increase in miscarriages of boys, because male fetuses are believed to be more sensitive than females to stress hormones.

Just the other day, I heard Annie Murphy Paul talk about it on T.V., and I felt a little more validated.

She addressed it in her recently published book: Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, where she talks about how "many our individual characteristics - our health, our intelligence, our temperaments - are influenced by the conditions we encountered before birth."

She looks at how people "gestated" during the Nazi siege of Holland in World War II and how people are still feeling its consequences decades later; how household chemicals can harm a developing fetus; and how pregnant women who experienced the 9/11 attacks "passed their trauma on to their offspring in the womb."

This isn't about me, of course. I don't care if I feel validated. I just hope there are people out there who don't forget what happened, and try to ignore the long-lasting impact that that day has had on this country.

I said in a previous article that I feel as though this nation has been in a collective funk since Sept. 11, 2001. My hope is that the more research that's done to look at how we think feel and act, the better we can handle ourselves in the future.

The studies also make me look at my son, and seeing him excel in school, sports and just about everything, and say, geez, I'm a lucky guy.

War is hell, but suicide is worse

The Army is losing its battle to stem suicides among troops serving in Afghanistan and Iraq, with a recent report showing that 32 soldiers in one year killed themselves in the war zone, according to The Hartford Courant.

The number of suicides in Afghanistan is climbing, despite multiple new efforts by military officials to improve training and education in suicide prevention and mental health, The Courant reported. Suicide was a leading cause of non-combat deaths in Iraq last year, accounting for nearly one in three non-hostile Army fatalities.

Army officials who released the report were reluctant to draw a link between combat exposure and suicide, repeating assertions made in past years that failed personal relationships, along with legal and financial problems, were the main factors driving suicides, according to The Courant. But they did acknowledge that long and repeated tours of duty were wearing down soldiers' mental resilience.

"Is it the war? It's unquestionable that the high op-tempo, the multiple deployments and long deployments put a real strain on relationships," said Col. Elspeth Ritchie, the Army's top psychiatrist, in a conference call with reporters. "There's also normal, girlfriend-boyfriend breaking up, irrespective of the war, marital difficulties that arise in both civilians and soldiers. ... We're not seeing a clear relationship between conflict increase and suicide."

Elspeth Ritchie Photo Ritchie and Brig. Gen. Rhonda L. Cornum, assistant surgeon general for force protection, said The Courant that Army leaders would continue to emphasize training programs that alert commanders and soldiers to signs of stress and that encourage troubled troops to seek professional help.

"One of the things that I believe is happening, looking at these reports, is that the Army is very, very busy, and perhaps we haven't taken care of each other as much as we'd like to," Ritchie said.

The increase in suicides in the war zone was one factor driving an overall increase in suicides among active-duty soldiers last year, The Courant reported. The Army released figures showing 115 confirmed suicides in 2007, both stateside and abroad — the highest number recorded since the Army began keeping such records in 1980. In 2006, 102 suicides were reported. The numbers do not include suicides among veterans who left the service.

The active Army suicide rate reached 18.8 suicides per 100,000 soldiers in 2007 — also the highest rate on record and an increase over the 2006 suicide rate of 17.5 per 100,000.

Army leaders said they had scrambled in recent months to hire 180 new mental-health workers to treat troops at home bases, but they did not announce plans to beef up the contingent of counselors treating troops deployed in Iraq, The Courant reported. Despite the rising suicide numbers in Iraq, the ratio of mental-health counselors to soldiers in the war zone has dropped — from one provider for every 387 troops in 2004, to one for every 734 last year.

The Army has made a number of changes to its suicide-prevention and mental-health programs in the past several years, some prompted by a Courant series in 2006 that found the military was failing to adequately screen and treat troops with psychological problems. New policies adopted since then call for closer monitoring of troops on psychiatric medications and limits on keeping troops with mental-health problems in combat zones, according to The Courant.

(This article is an update of a story written two years ago).

War goes on, and the soldiers go home; but the suicides keep going up

The war at home can be worse than it is in the battlefield.

As the wars in Iraq and Afghanistan rage on, tens of thousands of soldiers are still struggling to find their way once their duty is done.

In April, there there were ten potential suicides in the Army: one has been confirmed as suicide, and nine remain under investigation.

For March, the Army reported 13 potential suicides among active-duty soldiers. Since the release of the report, four have been confirmed as suicides and nine remain under investigation.

During April 2010 - among reserve soldiers who were not on active duty - there were five potential suicides. For March, among that same group, there were nine total suicides. Of those, three were confirmed as suicides and seven are pending determination of the manner of death.

"So far for 2010 we are noticing an upward trend in the number of non-active duty suicides. There are some indications that our reservists are being doubly affected with additional stress by the challenging job market, recovering economy and uncertainty" said Col. Chris Philbrick, director, Army Suicide Prevention Task Force.

Philbrick said the Army is continuing "engagement efforts" with many veteran and military service organizations, government agencies and concerned citizens "to develop innovative and comprehensive strategies to help both our active and non-active duty soldiers."

"Given the complex nature of suicide, and the different environments our soldiers serve in, and are returning to, we welcome the opportunity to develop relationships and common approaches to this national challenge. Our soldiers are representatives of our nation." he said.

Soldiers and families in need of crisis assistance can contact Military OneSource or the Defense Center of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury Outreach Center. Trained consultants are available from both organizations 24 hours a day, 7 days a week, and 365 days a year.

The Military OneSource toll-free number for those residing in the continental U.S. is 1-800-342-9647; the website address is http://www.militaryonesource.com. Overseas personnel should refer to the Military OneSource Web site for dialing instructions for their specific location.

The Army's comprehensive list of Suicide Prevention Program information is located at http://www.armyg1.army.mil/hr/suicide/default.asp.

Suicide prevention training resources for Army Families can be accessed at http://www.armyg1.army.mil/hr/suicide/training_sub.asp?sub_cat=20 (requires Army Knowledge Online access to download materials).

The DCoE Outreach Center can be contacted at 1-866-966-1020, via electronic mail at http://Resources@DCoEOutreach.org and at http://www.dcoe.health.

Information about the Army's Comprehensive Soldier Fitness Program is located at http://www.army.mil/csf.

The address for the American Foundation for Suicide Prevention is: http://www.afsp.org. The Suicide Prevention Resource Council is at: http://www.sprc.org/index.asp.

Seventy-one soldiers and counting

Seventy-one soldiers died by their own hands through March of this year, not in the the line of duty

The number was a small decline from last year, a fact that's being trumpeted by the U.S. military as a success. But it's significantly higher than the suicide rates during times of peace.

Even the military is recognizing there are nearly as many soldiers are taking their own lives as those having theirs taken away.

The Army is preparing to launch several large representative surveys of soldiers as a way of tracking and, ultimately, dealing with the indirect casualties of war, said Col. Chris Philbrick, director, Army Suicide Prevention Task Force.

The goal of the study, he said, is to provide the tools and information that will not only help the Army mitigate suicides and suicidal behavior, but will help our country address the problem of suicide among all Americans.

“The Army Suicide Prevention Task Force is completing a review of more than 600 programs related to health promotion, risk reduction and suicide prevention,” Philbrick said. "The Army intends to refine programs and focus on those that provide commanders the best tools to address the key issues that cause behavioral health concerns.”

To help commanders with local concerns regarding suicides, the Army recently established a Specialized Suicide Augmentation Response Team, Philbrick said. “This is a team of experts that can be dispatched to augment local command response to an increase, identify gaps in policies and procedures, and offer recommendations for improvement.”

Soldiers and families in need of crisis assistance can contact Military OneSource or the Defense Center of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury Outreach Center. Trained consultants are available from both organizations 24 hours a day, 7 days a week and 365 days a year.

The Military OneSource toll-free number for those residing in the continental U.S. is 1-800-342-9647; their Web site address is http://www.militaryonesource.com. Overseas personnel should refer to the Military OneSource Web site for dialing instructions for their specific location.

The DCoE Outreach Center can be contacted at 1-866-966-1020, via electronic mail at Resources@DCoEOutreach.Org and at http://www.dcoe.health.mil.

Information about the Army’s Comprehensive Soldier Fitness Program is located at http://www.army.mil/csf.

From Marlboro man to PTSD

He was the "Marlboro Man," the man who became a symbol of the Iraq. Now he's the symbol of mental illness and neglect.

James Blake Miller is now battling the demons of post-traumatic stress.

The photograph appeared Nov. 10, 2004. He was a U.S. Marine in Iraq, a cigarette dangling from his chapped lips and smeared face.

It was an instant icon, with Dan Rather calling it "the best war photograph in recent years," according to the The San Francisco Chronicle. About 100 newspapers ran the photo, dubbing the anonymous warrior the "Marlboro Man."

The man in the photograph is James Blake Miller, now around 24, and he is an icon, although in ways Rather probably never imagined, according to the Chronicle.

This is how the Chronicle reports it:

He's quieter now -- easier to anger. He turns to fight at the sound of a backfire, can't look at fireworks without thinking of fire raining down on a city. He has trouble sleeping, and when he does, his fingers twitch on invisible triggers.

The diagnosis: post-traumatic stress disorder.

His life in Kentucky, before and after the clicking shutter, says as much about hundreds of thousands of new American war veterans as his famous photograph said about that one bad day in Fallujah -- a photo Miller cannot see as an icon.

"I don't see a whole lot," he said. "I see a day I won't care to remember, but that I'll never forget."

Miller was assigned to the 1st Battalion, 8th Marine Regiment of the 2nd Marine Division, based in Camp Lejeune, N.C.

"Right before we got ready to leave for Iraq, I guess I was a little nervous. I started smoking more -- I went from about a pack-and-a-half a day to 2 1/2 packs a day," he said. "When we got to Iraq ... I was smoking 5 1/2 packs."

For a while, Iraq didn't seem all that bad. Miller and his fellow Marines settled into a routine in Anbar province in western Iraq, setting up hiding places among the palms and sand, and watching for the white pickups that insurgents would use to plant bombs and fire mortars.

There also was time for candy and laughter with the Iraqi children who came running to see the American troops. Miller felt like he was helping.

Then, on Nov. 5, 2004, in the middle of a sandstorm, the Marines got the word that they might be heading for an assault on Fallujah -- at the time, the capital of the Iraqi insurgency.

No American forces had gone inside the city in months. And now Miller would be among the first. He had been a Marine for less than two years.

"It puts butterflies in my stomach right now," he said. "I don't know if you can describe it. I don't think words can."

The night before U.S. forces went into the city, Miller gathered with his fellow Marines and led them by memory through a passage from the Bible, John 14:2-3.

"In my Father's house, there are many mansions: if it were not so, I would have told you. I leave this place and go there to prepare a place for you, so that where I may be, you may be also."

The assault on Fallujah began Nov. 8, 2004, when U.S. planes, using a combination of high explosives and burning white phosphorus, hammered the city in advance of the artillery push. Miller was under fire from the moment he stepped out of the personnel carrier.

It lasted into Nov. 9 -- the day that, for a while, would make Miller's face the most famous in Iraq.

As Miller remembers that day, he was on a rooftop taking fire and calling for support on his radio - a 20-pound piece of equipment that he had to lug around along with nine extra batteries, hundreds of extra rounds of ammunition, and a couple of cartons of cigarettes.

As insurgent bullets from a nearby building pinged off the roof, a horrified Miller heard footsteps coming up the stairs behind him. He raised his rifle -- and barely had time to halt when he saw it was embedded Los Angeles Times photographer Luis Sinco.

Miller returned to his radio, guiding two tanks to his position. When they opened fire, he said, the thunder left his body numb -- but the building housing the attackers had collapsed. Later, he said, they would find about 40 bodies in the rubble.

"I was never so happy in all my life to take that handset away from my head," Miller said. "I lit up a f -- cigarette."

His ear was bleeding from the sound of the tank firing -- Miller still can't hear out of his right ear. His nose bled from a nick he took when his rifle scope and radio got tangled up midfire. He looked at the sunrise and wondered how many more of those he would see.

He was vaguely aware that elsewhere on the rooftop, Sinco was taking pictures.

At a briefing the next day, Miller's gunnery sergeant walked up to him, grinning, and said: "Would you believe you're the most famous f -- Marine in the Marine Corps right now? Believe it or not, your ugly mug just went all over the U.S."

The Marines wanted to pull him out of Fallujah at that point, Miller said, not wanting the very public poster boy to die in combat. But he stayed.

He won't talk about the weeks that followed. He only mentions moments, like still frames from a film. The day his column barely survived an ambush, escaping through a broken door as bullets struck near their feet. The morning he woke up to discover that a cat had taken up residence in the open chest cavity of an Iraqi body nearby, consuming it from within.

The day he discovered that Demarkus Brown had been killed.

"When we found out, I told a couple of my buddies who were close to him, too. We just sat around, and we didn't say much at all," Miller said. "You didn't have the heart to cry."

But it wasn't those terrible benchmarks that affected him the most, Miller said. It was the daily chore of war: the times he had to raise his rifle, peer through the scope and squeeze the trigger to launch a bullet, not at a target, not at a distant white truck, but at another human being.

"It's one thing to be shot at, and you shoot a couple rounds back, just trying to suppress somebody else," Miller said. "It's another thing when you see a human being shooting a round at you, knowing that you're shooting back with the intent to kill them. You're looking through a scope at somebody. It's totally different. You can make out a guy's eyes."

When Miller returned to America, he brought back a big duffel bag packed with numerous letters and gifts from those who had seen his photo. It was only later that he discovered he'd brought home some of the war, too.

None of the Marines talked much about the strain that war puts on one's emotions, Miller said.

The "wizards" -- military psychologists -- gave the returning troops a briefing on the subject, but nobody paid much attention. Even guys who were taking antidepressants to help them sleep didn't think much about the long-term consequences.

"What the hell are those people going to do once they get out? They ride it out until they get an honorable discharge, and then they're never diagnosed with anything," Miller said. "How the hell are you going to do anything for them after that? And that's how so many of these guys are ending up on the damn streets."

Miller dismissed the early signs, too. When he and his buddies reacted to a truck backfire by dropping into a combat stance and raising imaginary rifles, well, that was to be expected. And when his wife, Jessica -- the childhood sweetheart whom Miller had married in June -- told him he was tightening his arm around her neck in the night, that was strange, but he figured it would pass. So would the nightmares he began to have about Iraq, things that had happened, things that hadn't.

Then one day, while visiting his wife at her college dorm in Pikeville, Miller looked out the window and clearly saw the body of an Iraqi sprawled out on the sidewalk. He turned away.

"I said, 'Look, honey, I just got to get out of here.' I couldn't even tell her at the time what had happened," he said. "(I thought), 'Well, that's it. That's my little spaz I'm supposed to have that the psychiatrists were talking about ... I'm glad I got it out of the way."

But he hadn't. Jessica, a psychology student, tried to help with a visualization technique. But when he looked inside himself, Miller found a kind of demonic door guarded by a twisted figure in a black cloak. Under the cloak's hood, he spotted the snarling face of the teufelhund, a Marine Corps icon -- the devil dog.

"So I come out again, without closing the door," he said. "After all this happened, my nightmares started getting a lot f -- ing worse."

Finally, Miller went to a military psychiatrist, who diagnosed him with signs of post-traumatic stress disorder. Miller thought that meant he could not be deployed. But in early September, he joined a group of Marines headed to 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 said. "We could be going into another (urban warfare) environment just like Iraq, except this would actually be U.S. citizens.

"Here we go, Fallujah 2, right here in the states."

Not long after they arrived, as Hurricane Rita bore down on them, the Marines were packed into the amphibious assault ship Iwo Jima to wait out the storm offshore. And one day, as Miller headed for the smoke deck with a Marlboro, a passing sailor made a whistling sound just like a rocket-propelled grenade.

"I don't remember grabbing him. I don't remember putting him against the bulkhead. I don't remember getting him down on the floor. I don't remember getting on top of him. I don't remember doing any of that s -- ," Miller said. "That was like the last straw."

On Nov. 10, 2005 -- the Marine Corps' 230th birthday and one year to the day after the Marlboro Man picture appeared in the Los Angeles Times, Miller was honorably discharged after a medical review. His military career was over.
Miller returned to eastern Kentucky, the place he had spent years trying to escape. He wanted the familiarity and safety of the people and land he'd known since birth.

"Maybe it made me think twice about what I had lost," he said. "What I was really missing."

In a way, though, his family is still missing Blake Miller -- the Miller who left Kentucky for Iraq a couple of years ago.

The man who left was easygoing, quick to laugh, happy to sit in a relative's house and eat and smoke and talk. The man who came back is quick to anger, they say, and is quiet. He still smiles often but does not easily laugh.

And when he takes a seat in his adoptive grandmother's home, amid her collection of ceramic Christ figurines, it is in a chair that faces the door.

Mildred Childers, who owns those figurines, sees Miller's difficulties as a crisis of faith. She still remembers Miller's call just before the assault on Fallujah, and his terrible question: "How can people go to church and be a Christian and kill people in Iraq?"

"He was raised where that's one of the Ten Commandments, do not kill," she said. "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."

Recently, some of his Marine buddies have been calling Miller up, crying drunk, and remembering their war experiences. Just like Papaw Joe Lee used to do when Miller was a boy.

"There's a lot of Vietnam vets ... they don't heal until 30, 40 years down the road," Miller said. "People bottle it up, become angry, easily temperamental, and hell, before you know it, these are the people who are snapping on you."

Jessica interrupted. "You're already like that," she said.

She recalled her own first glimpse of the Marlboro Man -- an image seen through tears of relief that he was alive, and misery at how worn he looked.

"Some people thought it was sexy, and we thought, 'Oh, my God, he's in the middle of a war, close to death.' We just couldn't understand how some people could look at it like that," she said. "But I guess for some people it was glory, like patriotism."

She looked at her quiet husband through the smoke drifting from his right hand.

"But when it comes out and there's actually a personality behind that picture, and that personality, he has to deal with all the war, and all he's done, people don't want to know how hard it actually is," she said.

"This is the dark side of the reality of war. ... People don't want to know the Marlboro Man has PTSD."

Miller stood outside his father's home in Jonancy, looking over the beaten mobile homes, the rows of corn, potatoes and cabbage. For a change, he wasn't smoking - he's down to a pack-and-a-half a day.

"There ain't a goddamn thing around here," he said. "My whole life, all I did was watch my old man bust his ass."

It was why he joined the Marines -- why part of him wishes he could go back.

"My whole life, all I've ever known is working on cars, doing body work, cutting grass, manual labor, you know? It was something different," he said. "You always hear those commercials -- it's not just a job, it's an adventure. It was, you know?"

On the other hand, Miller isn't sure he'd want to go back to combat -- nor sure he'd ever let any kid of his enlist. He has mixed feelings about the oversize copy of the Marlboro Man picture proudly displayed in the lobby of the Marine recruiting station in Pikeville.

Some of his relatives and friends are against the war; others see it as a fight against terrorism.

Miller himself seems torn -- proud of the troops fighting for freedom, but wondering whether there was a peaceful way, to find terrorists in Iraq without invading.

There was no time for such questions in Fallujah. But now, at night, when he can't sleep, Miller thinks of the men he saw through his rifle scope, and wonders: Were they terrorists fighting against America? Or men fighting to protect their homes?

"I mean, how would we feel if they came over and started something here?" he asked. "I'm glad that I fought for my country. But looking back on it, I wouldn't do it all over again."

It helps, sometimes, to talk about it -- last week, Miller did what he hopes other veterans do: He had his first visit with a Veterans Administration counselor.

"I've got my whole life ahead of me," he said. "I'm too young to lay down and quit; too young to let anything beat me."

Down the road, Miller hopes to start a business. For now, he is waiting for his disability benefits to kick in. Maybe then, he and Jessica can afford the big wedding they had always wanted. She already has her white wedding dress. He still intends to wear his Marine Corps blues.
Veterans and stress

Post-traumatic stress disorder is an ailment resulting from exposure to an experience involving direct or indirect threat of serious injury or death. Symptoms include recurrent thoughts of a traumatic event, reduced involvement in work or outside interests, hyper alertness, anxiety and irritability.

About 317,000 veterans diagnosed with the disorder were treated at Department of Veterans Affairs medical centers and clinics in fiscal year 2005. Nearly 19,000 veterans of the wars in Iraq and Afghanistan were seen for the disorder in veterans' medical centers and Vet Centers from fiscal year 2002 to 2005.

A recent study of soldiers and Marines who had served in Iraq and Afghanistan found that about 17 percent met criteria for post-traumatic stress disorder, depression, or generalized anxiety disorder. Of those whose responses were positive for a mental disorder, 40 percent or fewer actually received help while on active duty.

For more information, contact your local veterans facility, call (877) 222-VETS or visit one of the following Web sites:

U.S. Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder: www.ncptsd.va.gov/

This article was reprinted from 2007.

Wake Me Up When September Ends/Green Day

Summer has come and passed
The innocent can never last
Wake me up when September ends

Like my fathers come to pass
Seven years has gone so fast
Wake me up when September ends

Here comes the rain again
Falling from the stars
Drenched in my pain again
Becoming who we are

As my memory rests
But never forgets what I lost
Wake me up when September ends

Summer has come and passed
The innocent can never last
Wake me up when September ends

Ring out the bells again
Like we did when Spring began
Wake me up when September ends

Here comes the rain again
Falling from the stars
Drenched in my pain again
Becoming who we are

As my memory rests
But never forgets what I lost
Wake me up when September ends

Summer has come and passed
The innocent can never last
Wake me up when September ends

Like my fathers come to pass
Twenty years has gone so fast
Wake me up when September ends
Wake me up when September ends
Wake me up when September ends

A tough time in a tough decade

Few memories in my life could remain so vivid: Stepping off the PATH train, and walking what seemed like 20 blocks to the smoldering ruins of the Twin Towers, and breathing in the burning smell of God-knows-what.

It was Sept. 12, 2001, the day after. I was supposed to write a story on the PATH service, and how commuters were coping with the worst tragedy of their lives. Then I was to head south, and perhaps help with the news coverage down there.

But I had little interest in working. I just wanted to see Ground Zero, otherwise known as "the pile;" the day before, I saw Tower One fall, and crumble into a pile of beams and ash, as I drove north on the New Jersey Turnpike. I saw people with video cameras parked along the road, trying to squeeze some glimpse of history in between videos of their family memories.

But, on Sept. 12, as I walked down there, and I got closer, I saw images that seemed to stand out more than "the pile" ever did. I saw people walking around with posters, saying, "Please help me! Have you seen her? Please, can you help me?" They were like the people I used to see at airports who handed out brochures, saying there was "no tomorrow," and "God will be there to save us...believe in him."

To say it was surreal would be cliche. Simply, it was the most depressing thing I ever saw.

I tried to walk past the people, and get to the pile; instead, I just stood there, and saw the people walk around like zombies, holding the pictures close to their chests, or high over their heads, looking so helpless and hapless.

I somehow knew that they would never find those people; what I didn't know was that, eight years later, many of them still seem to be looking for the loved ones they lost, and they're still struggling with the idea that they'll never come back, and that their lives will never be the same.

Back then, I thought I was in another country. This was the United States, I thought, a country with bravado. This was a country that pushed the Germans back on D-Day, and eventually all the way back to Berlin. This was not a country where people look for someone to constantly reassure them, and tell them, "It's OK. Everything is OK. We'll get the bad guys. It's OK."

It's a memory I'll never lose, even as we, as a country, seem to be so detached from it now. Even last week's near-terrorist attack on a Detroit-bound jet didn't seem to ignite the feelings of vengeance that drives people's anger when they've been attacked.

But, in other ways, we're a nation that's still hurting. When we hear about talk of the economy, and we see the poll numbers showing a falling level of confidence in government, I wonder if it has more to do with nation's soul that was wounded eight years ago, and never really recovered from it.

I think that were less detached than we think from the zombie-like atmosphere that I saw in lower Manhattan eight years ago, and we're still looking for some hero to tell us, "It's OK. America will do fine. It's OK."

I've written a lot in this space about the services available for people who are suffering from post-traumatic stress disorder, particularly people who were victims of 9-11. But, in a way, I feel like we're all suffering from nationwide PTSD, and we're still looking for some something to heal ourselves, and give us a chance to move on.

I think we're still looking for some ticker-tape parade, something that will declare that not only are the wars in Afghanistan and Iraq over, but it's OK to shop again, and it's OK to buy things again, because we're no longer spending money to fight wars against terrorists we can't see.

We're looking for some finality to the worst moment of our lives. But it never came, or it hasn't come yet; indeed, it's only escalated now that President Obama has sent in another 30,000 troops to fight the terrorist war in Afghanistan. It's only continuing when someone somehow finds a way to get the components of a bomb aboard a plane, and comes within minutes of creating our worst tragedy since Sept. 11.

In my personal life, it's continuing because I lost a friend. He's not dead, but he had a business in the World Trade Center that was obliterated when Tower One fell. Rich Kelly, another old Point Pleasant Borough high school buddy of mine, was a hero that day because he ordered people to run to Battery Park, and avoid getting buried under the crush of steel and ash.

The problem, however, was that no one was there to save Rich. Afterward, he tried to recover, buying himself a Porsche and taking me on a ride through Colts Neck, N.J., speeding up to 90 mph on some of the old, two-lane roads that run through one of the state's wealthiest communities. But he ran into trouble as he tried rescue his business life.

I tried to help, but he resisted, to the point that he virtually shut off contact with me. Rich always thought he'd be a millionaire by the time he was 30. Last I heard, he was working around the clock, selling phone systems to businesses and still trying to recover that dream. Leaving him a phone message, or sending him an email is pointless. He won't return any of them.

A lot of people blame President Obama for doing little to turn the nation's confidence around. I don't fall into that category. Mostly, however, I look forward to this new year and new decade. I've heard people talk about the 1960s and 1970s, and how they looked forward to the end of those troubled times just by looking at the clock.

Perhaps time is our only ally here, and we can hope that a new decade will inspire hope. We can hope that people will find a way to get through their trauma, and that they'll find a way to move on as we move farther and farther away from 9-11. We can hope that someone can provide more services, or better services that people can use to help themselves. Or, maybe people find a way to have better access to those services, wherever they may exist.

We can hope that people like Rich can dream of being millionaires again. But if they can't, then maybe they can come to grips with who they are, and perhaps play a role that can inspire people, the same way Rich inspired people to run away from the falling tower.

More troops will mean more stress

Once President Obama announces tonight that more than 30,000 additional troops will be sent to Afghanistan, don't think of it as a solution or a Band-Aid.

Don't think that war is ever a solution to problems. At best, it's a measure of prevention; the use of force is sometimes - though rarely - necessary to secure the safety the United States.

Think this: Another 30,000 troops will eventually become veterans who will be at risk for post-traumatic stress disorder.

Remember that there will be more people who not only will be seeking assistance for their physical wounds, but also for their damaged state of mental health.

Since we've had two war fronts since 2003, we've already seen evidence of the impact.

The number of soldiers and Marines diagnosed with post-traumatic stress disorder jumped tenfold from 2003 to 2007, according to statistics released by the Army’s surgeon general, as reported by Stars and Stripes.

The military attributed the rise in the Army numbers in part to the increase in the overall number of soldiers exposed to combat, but also better record-keeping by the service. But soldiers realize that, if there was no war, the numbers would be significantly lower.

And the numbers could go up even higher since the symptoms of PTSD sometimes don't appear until 10 to 20 years after service.

There are places for veterans with mental illness to turn and find ways to escape a life of ruin and despair.

The Substance Abuse and Mental Health Services Administration's Center for Mental Health Services is accepting applications for the Jail Diversion and Trauma Recovery Program's "Priority to Veterans grants."

The purpose of this program is to support expansion of trauma-integrated jail diversion programs to reach the growing number of individuals with post traumatic stress disorder and trauma-related disorders involved in the justice system.

In recognition of the dramatically higher prevalence of trauma related illnesses among veterans, this program will prioritize eligibility for veterans, organizers say. Click here for more information on this grant program, along with the request for applications.

Behind every gun is a story

President Obama says we shouldn't jump to conclusions about the shooting deaths at Fort Hood. It's understandable, however, what many people's first impulses might be.

There is anger. There were calls of revenge. Worse yet, however, there are feelings of deceit.

The man who is suspected to be responsible for the killings was a psychiatrist.

This, as a result, is more than a case of potential post-traumatic stress disorder. The very kind of person who is responsible for healing the minds of beleaguered troops who have been shuffled in-and-out of war zones could do nothing to heal himself.

But it also shows that the toll of war has gone far beyond the battlefield. Casualties no longer are the "grunts," the enlisted men and women who have seen their lives turned upside-down over the past seven years. They're also the officers, the handlers and, finally, the medical practitioners who have not only suffered personally, but also suffered as a result of their work.

There is a human side to war, and it was, perhaps, best captured by a New York Times piece published this past week. We often hear of evil when we hear death and war and casualties. But behind every gun is a life.

From The New York Times:

Born and reared in Virginia, the son of immigrant parents from a small Palestinian town near Jerusalem, he joined the Army right out of high school, against his parents’ wishes. The Army, in turn, put him through college and then medical school, where he trained to be a psychiatrist.

But Maj. Nidal Malik Hasan, the 39-year-old man accused of Thursday’s mass shooting at Fort Hood, Tex., began having second thoughts about a military career a few years ago after other soldiers harassed him for being a Muslim, he told relatives in Virginia.

He had also more recently expressed deep concerns about being sent to Iraq or Afghanistan. Having counseled scores of returning soldiers with post-traumatic stress disorder, first at Walter Reed Army Medical Center in Washington and more recently at Fort Hood, he knew all too well the terrifying realities of war, said a cousin, Nader Hasan.

“He was mortified by the idea of having to deploy,” Mr. Hasan said. “He had people telling him on a daily basis the horrors they saw over there.”

The Federal Bureau of Investigation earlier became aware of Internet postings by a man calling himself Nidal Hasan, a law enforcement official said. The postings discussed suicide bombings favorably, but the investigators were not clear whether the writer was Major Hasan.

In one posting on the Web site Scribd, a man named Nidal Hasan compared the heroism of a soldier who throws himself on a grenade to protect fellow soldiers to suicide bombers who sacrifice themselves to protect Muslims.

“If one suicide bomber can kill 100 enemy soldiers because they were caught off guard that would be considered a strategic victory,” the man wrote. It could not be confirmed, however, that the writer was Major Hasan.

Major Hasan was wounded and taken into custody by the Fort Hood police after the shooting rampage, in which 12 people were killed and at least 31 others were wounded.

Though Senator Kay Bailey Hutchison of Texas reported that Major Hasan was to be deployed this month, that could not be confirmed with the Army on Thursday night.

Nader Hasan said his cousin never mentioned in recent phone calls to Virginia that he was going to be deployed, and he said the family was shocked when it heard the news on television on Thursday afternoon.

“He was doing everything he could to avoid that,” Mr. Hasan said. “He wanted to do whatever he could within the rules to make sure he wouldn’t go over.”

Some years ago, that included retaining a lawyer and asking if he could get out of the Army before his contract was up, because of the harassment he had received as a Muslim. But Nader Hasan said the lawyer had told his cousin that even if he paid the Army back for his education, it would not allow him to leave before his commitment was up.

“I think he gave up that fight and was just doing his time,” Mr. Hasan said.

Nader Hasan said his cousin’s parents had both been American citizens who owned businesses, including restaurants and a store, in Roanoke, Va. He declined to confirm reports that they were Jordanian but said the parents, who are both dead, had immigrated from a small town near Jerusalem many years ago.

His mother’s obituary, in The Roanoke Times in 2001, said she was born in Palestine in 1952. It described her as a restaurant owner “known for her ability to keep sometimes rowdy customers out of trouble and always had a warm meal for someone who otherwise would not have anything to eat that evening.”

Records show that Major Hasan received an undergraduate degree at Virginia Tech and a medical degree at the Uniformed Services University of the Health Sciences in Bethesda, Md. He did a residency at Walter Reed Medical Center and worked there for years before a transfer to the Darnall Army Medical Center at Fort Hood this year.

Major Hasan had two brothers, one in Virginia and another in Jerusalem, his cousin said. The family, by and large, prospered in the United States, Mr. Hasan said.

The former imam at a Silver Spring, Md., mosque where Major Hasan worshiped for about 10 years described him as proud of his work in the Army and “very serious about his religion.” The former imam, Faizul Khan, said that Major Hasan had wanted to marry an equally religious woman but that his efforts to find one had failed.

“He wanted a woman who prayed five times a day and wears a hijab, and maybe the women he met were not complying with those things,” the former imam said.

Mr. Hasan, 40, a lawyer in Virginia, described his cousin as a respectful, hard-working man who had devoted himself to his parents and his career.

Mr. Hasan said his cousin became more devout after his parents died in 1998 and 2001.

“His parents didn’t want him to go into the military,” Mr. Hasan said. “He said, ‘No, I was born and raised here, I’m going to do my duty to the country.’ ”

Front-line insanity

War and sanity mix like whiskey and cocaine. What's left is disaster accelerated.

As the death toll in Afghanistan rises, the government is stepping in to help many soldiers fight their worst enemies: themselves.

The U.S. Army has enlisted the National Institute of Mental Health to try and mitigate the rising number suicides among the troops.

The study has been called "unprecedented" by officials at NIMH, according to Federal News Radio.

Study director Dr. Robert Heinssen said those involved are relying on the three "R's" - rigorous study, rapid execution, and relevant targets -- to find answers.

"The Army reached out to NIMH last summer and asked us if we were aware of any research-based approaches that had been developed on the civilian side that would help the Army with the problem of a rising suicide rate."

According to NIMH, suicide is the fourth leading cause of death among 25 to 44-year-olds in the United States, Federal News Radio reported.

Historically, the agency said, the suicide rate has been lower in the military than among civilians.

In 2008, that pattern was reversed, with the suicide rate in the Army exceeding the rate in the civilian population. The Army turned to NIMH for answers.

Let's remember everybody during the holidays - including those in harm's way

As the holiday season begins, we remember not just friends and family. In this post-911 world, we remember the 140,000 men and women who are serving in harm's way in Iraq and Afghanistan.

They're the soldiers who have to worry about whether they'll see their families again when they drive on some God-forsaken road through the heart of Baghdad, where some garbage can, road sign or even a person attached to an IED could blow up in their face.

And we remember that, hopefully, they will come home from that experience and live a life that is much like the one they lived before - though, so far, evidence has pointed to the contrary.

Suicide rates among soldiers and ex-soldiers are skyrocketing. The military, to its credit, has tried its hardest to avoid a post-Vietnam situation and give soldiers post-service care as way to ward off post-traumatic stress disorder and other illnesses.

So far, that hasn't been entirely effective. This space published the photo of the "Marlboro Man" last week, whose picture became a symbol of the Iraq conflict when it ran in newspapers across America in 2004.

Now the soldier has returned home to Kentucky, where he battles the demons of post-traumatic stress, according to media reports. The man in the photograph is James Blake Miller, now 21.

So it's worthy to note that the Department of Defense recently took additional steps to review what has happened to these soldiers, and what more can be done in the future so they return home to lives of comfort - not lives of horror.

The Department of Defense has formed a congressionally-directed task force to examine matters related to mental health.

"This is an extremely important effort involving a collaboration of DoD, federal and private sector experts in mental health," said Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs.

The Mental Health Task Force is comprised of seven DOD members and seven non-DOD members. It has already made assessments for improving the efficacy of mental health services provided to service members.

"High on the list will be steps for improving the awareness of the potential mental health conditions among service personnel and ways to improve the access and efficacy of our existing programs," Winkenwerder said.

Let's hope they do.

War is hell, but post-traumatic stress is worse

Veterans with mental illness can find ways to escape a life of ruin and despair.

The Substance Abuse and Mental Health Services Administration's Center for Mental Health Services is accepting applications for the Jail Diversion and Trauma Recovery Program's "Priority to Veterans grants."

The purpose of this program is to support expansion of trauma-integrated jail diversion programs to reach the growing number of individuals with post traumatic stress disorder and trauma-related disorders involved in the justice system.

In recognition of the dramatically higher prevalence of trauma related illnesses among veterans, this program will prioritize eligibility for veterans, organizers say. Click here for more information on this grant program, along with the request for applications.

The big battle of Iraq has yet to begin - at home, not abroad

The number of dead soldiers in Iraq continues to climb. Others lose their limbs when yet another IED blast blows up their transport vehicles as they move in and out of war-torn Baghdad.

The potential after-effects that soldiers may suffer from this war, however, has become one big ticking time-bomb that could explode the military's already fragile morale - if nothing is ever done about it.

And post-traumatic stress disorder has the potential to tear apart families already burdened by the roller-coaster ride of National Guard soldiers being called in-and-out of duty that they thought would simply help pay their college tuition.

Already, this PTSD enemy looks firmly entrenched: A recent report showed that 32 soldiers killed themselves in the war zone last year - a record high since the war began five years ago, according to The Hartford Courant.

The number of suicides in Iraq in 2007 climbed 18 percent from 2006, despite efforts by military officials to improve training and education in suicide prevention and mental health, The Courant reported.

The number of Army troops suffering from severe combat stress is "skyrocketing," rising from just over 1,000 new cases in 2003 to more than 28,000 soldiers today diagnosed with PTSD, according to The Baltimore Sun.

Yet, no one who has, or may have the power to do something - that being Congress, the Pentagon, Barack Obama, John McCain, President Bush and on and on - has come out with a clear-cut battle-plan for tackling post-traumatic stress disorder on a large scale.

On his website, Obama talks about recruiting more health professionals, improving screening, offering more support to families and making PTSD benefits claims fairer.

McCain, a former Vietnam POW, has advocated for disability benefits to veterans with cancer and other health problems caused by Agent Orange, and also treatment for tobacco-related illnesses and substance abuse problems. He's sponsored legislation to cover mental health care in military retiree health plans, according to his website.

But all those ideas lacks specifics. Finding out how they stand is also difficult; each candidate addresses PTSD only in hard-to-find places that are buried in their websites. PTSD is missing from their bombastic, speech-driven rhetoric.

On the Pentagon's website, there is little-to-no talk of casulties of the psychological kind - perhaps sending the message that the only way a soldier can be wounded is either by a bullet or a bomb.

Even the Army seems to recognize the obvious omission. Lt. Gen. Eric B. Schoomaker, the Army's top medical officer, has said he does not know how many additional soldiers suffer from symptoms of combat stress - such as hyper-vigilance, sleeplessness and irrational anger - and he does not know how many of these soldiers are receiving treatment, according to The Baltimore Sun.

"As a nation, our mental health capability is not adequate to the need," and the Army suffers from the same problem, Schoomaker recently told defense reporters.

He also said the Army needs 300 more top mental health professionals to care for the growing numbers of soldiers suffering from severe stress, according to the Sun. But the Army has filled only 180 of those positions.

Anyone who is familiar with the tragedy of the Vietnam era or, at the very least, how it was portrayed in history books, newspaper reports and movies, should know that PTSD has the next potential to be the wound that, for many soldiers, never goes away.

Indeed, symptoms of PTSD often don't show up right away, according to the National Institute of Mental Health. Many Vietnam veterans, in fact, didn't report signs of illness until 10, or even 20 years after they served.

What's amazing is that signs of Iraq-related PTSD were first reported by The Associated Press four years ago, when the Army's first study of the mental health of troops who fought in Iraq found that about one in eight reported symptoms of post-traumatic stress disorder.

This was long before troop divisions that were shuffled out after the fall of Baghdad were forced to return and then, quite possibly, return again. Families who waited months for their loved ones to return were forced to, yet again, wait.

This was before the public really began to lose faith in the war, and then started to lose faith in President Bush, whose popular rating has fallen to Richard Nixon levels.

Whether troops leave Iraq sooner or later, managing PTSD is the battle that, for many, needs to begin now.

This article appeared in The Huffington Post on June 10, 2008.

War is hell, but suicide is worse

The Army is losing its battle to stem suicides among troops serving in Iraq, with a new report showing that 32 soldiers killed themselves in the war zone last year — a record high since the war began five years ago, according to The Hartford Courant.

The number of suicides in Iraq in 2007 climbed 18 percent from 2006, despite multiple new efforts by military officials to improve training and education in suicide prevention and mental health, The Courant reported. Suicide was a leading cause of non-combat deaths in Iraq last year, accounting for nearly one in three non-hostile Army fatalities.

Army officials who released the report were reluctant to draw a link between combat exposure and suicide, repeating assertions made in past years that failed personal relationships, along with legal and financial problems, were the main factors driving suicides, according to The Courant. But they did acknowledge that long and repeated tours of duty were wearing down soldiers' mental resilience.

"Is it the war? It's unquestionable that the high op-tempo, the multiple deployments and long deployments put a real strain on relationships," said Col. Elspeth Ritchie, the Army's top psychiatrist, in a conference call with reporters. "There's also normal, girlfriend-boyfriend breaking up, irrespective of the war, marital difficulties that arise in both civilians and soldiers. ... We're not seeing a clear relationship between conflict increase and suicide."

Elspeth Ritchie Photo Ritchie and Brig. Gen. Rhonda L. Cornum, assistant surgeon general for force protection, said The Courant that Army leaders would continue to emphasize training programs that alert commanders and soldiers to signs of stress and that encourage troubled troops to seek professional help.

"One of the things that I believe is happening, looking at these reports, is that the Army is very, very busy, and perhaps we haven't taken care of each other as much as we'd like to," Ritchie said.

The increase in suicides in the war zone was one factor driving an overall increase in suicides among active-duty soldiers last year, The Courant reported. The Army released figures showing 115 confirmed suicides in 2007, both stateside and abroad — the highest number recorded since the Army began keeping such records in 1980. In 2006, 102 suicides were reported. The numbers do not include suicides among veterans who left the service.

The active Army suicide rate reached 18.8 suicides per 100,000 soldiers last year — also the highest rate on record and an increase over the 2006 suicide rate of 17.5 per 100,000.

Army leaders said they had scrambled in recent months to hire 180 new mental-health workers to treat troops at home bases, but they did not announce plans to beef up the contingent of counselors treating troops deployed in Iraq, The Courant reported. Despite the rising suicide numbers in Iraq, the ratio of mental-health counselors to soldiers in the war zone has dropped — from one provider for every 387 troops in 2004, to one for every 734 last year.

The Army has made a number of changes to its suicide-prevention and mental-health programs in the past several years, some prompted by a Courant series in 2006 that found the military was failing to adequately screen and treat troops with psychological problems. New policies adopted since then call for closer monitoring of troops on psychiatric medications and limits on keeping troops with mental-health problems in combat zones, according to The Courant.

The Army finally admits it: Soldiers suffer stress while in combat

Hard to believe that the Army once considered post-traumatic stress disorder to be a made-up malady. Now the armed services uses terms such as "skyrocketing" to describe PTSD.

The number of Army troops suffering from severe combat stress is skyrocketing, rising from just over 1,000 new cases in 2003 to more than 28,000 soldiers today diagnosed with post-traumatic stress disorder, the Army surgeon general said in the Associated Press.

Lt. Gen. Eric B. Schoomaker, the Army's top medical officer, said that he does not know how many additional soldiers suffer from lesser symptoms of combat stress, such as hyper-vigilance, sleeplessness and irrational anger, and does not know how many of these soldiers are receiving treatment, according to the AP.

Schoomaker also said that the Army has inadequate facilities and too few mental health care providers.

"As a nation, our mental health capability is not adequate to the need," and the Army suffers from the same problem, Schoomaker told defense reporters. He said the Army recognizes it needs 300 more top mental health professionals to care for the growing numbers of soldiers suffering from severe stress. It has filled only 180 of those positions, according to the AP.

Military will address health care; will mental health be part of the strategy?

The Department of Defense says it's trying finalize its 2008 plans for ensuring top quality healthcare for all service members and beneficiaries.

Noticeably left out of that declaration is any discussion of mental health - despite the fact that thousands of veterans of Iraq and Afghanistan are likely to develop symptoms for post-traumatic stress disorder within the next decade.

"Earlier this year, Secretary of Defense Gates charged me with being the guarantor of quality healthcare for service members, retirees and their families," said Dr. S. Ward Casscells, assistant secretary of defense for health affairs. "Quality healthcare is the Secretary's top goal, apart from the war itself."

The DOD first discussed its "MHS Strategic Plan" at a Washington D.C. conference in January. All of the presentations for the conference were aligned with the plan's goals and objectives, Pentagon officials said, including:

• Enhance deployable medical capability, force medical readiness and homeland defense ,including humanitarian missions;
• Sustain the military health benefit through top quality patient-centered care and long-term patient partnerships with a focus on prevention;
• Provide globally accessible, real time, health information that enables medical surveillance and evidence-based health care;
• Provide incentives to achieve quality in everything;
• Build and sustain the best hospitals and clinics; nurture a caring environment.

Casscells and conference organizers also expect to raise awareness among military and civilian communities worldwide regarding the value of military medicine - not only in combat care, but in research, education, international healthcare and humanitarian relief, the Pentagon said.

"The conference agenda is ambitious," Casscells said. "But it's the right event at the right time to energize our commitment to quality care throughout the entire enterprise."

In the military, the battle against mental health awareness continues

Fort Drum, a U.S. Army base in northern New York state, has become the epicenter of the military's mental-health ignorance.

A critical report on the mental health care provided at Fort Drum highlighted previously identified shortcomings and incorrectly characterized other facets of support being provided to soldiers, according to The Associated Press.

The report released Wednesday by Veterans for America cited problems with understaffing, a reliance on self-reporting of mental health problems and a prevailing attitude at the company level that treats mental health issues in an atmosphere of secrecy.

It also claimed that some soldiers had to wait up to two months before they were seen by doctors, according to The Associated Press.

"Are our processes as effective as we would like? No, but we're working hard and we remain fully committed as an Army and post to address our soldiers and family needs," Maj. Gen. Michael Oates, the division commander, told the wire service. "Helping our soldiers overcome the challenges of continued service in a time of war remains one of our top priorities."

Among its recommendations, the report urged Fort Drum to establish more proactive mental health screening and treatment capabilities, according to The Associated Press.

Oates noted that the post has a permanent mental health staff of four psychiatrists, six psychologists, three registered psychiatric nurses and four licensed clinical social workers.

The report was based on interviews with a dozen unnamed soldiers.

"While we don't believe 12 random soldiers represent a valid sample of our entire population, we do agree that our soldiers are having challenges," Lt. Col. Paul Swiergosz, the division spokesman, told The Associated Press. "We welcome the opinions of outside interest groups, but we're more interested in well-researched solutions to these problems."

Hey, Woodstock alumni: The "brown acid" actually may be good for you

Dude - psychedelic drugs are back. But not in the traditional drop-in, drop-out sense.

David Jay Brown wrote in the December issue of Scientific American that LSD and magic mushrooms and other drugs that "blew minds in the 1960s" may soon may be used to treat mental ailments.

Scientists say they have "therapeutic potential" because they could ease a variety of difficult-to-treat mental illnesses, such as chronic depression, post-traumatic stress disorder and drug or alcohol dependency, Brown wrote.

Clinical trials are underway - so start lining up, hippies. This time they are being explored in labs for their therapeutic applications rather than being used illegally, Brown wrote.

"The past 15 years have seen a quiet resurgence of psychedelic drug research as scientists have come to recognize the long-underappreciated potential of these drugs," Brown wrote. "In the past few years, a growing number of studies using human volunteers have begun to explore the possible therapeutic benefits of drugs such as LSD [and] psilocybin."

Much remains unclear, but scientists do believe they have somewhat similar psychoactive effects that make them potential "therapeutic tools," Brown wrote.

Though still in their preliminary stages, studies in humans suggest that the day when people can schedule a psychedelic session with their therapist to overcome a serious psychiatric problem may not be that far off.

Crosby Stills Nash & Young - Long Time Gone Lyrics

It's been a long time comin'
It's goin' to be a Long Time Gone.
And it appears to be a long,
Appears to be a long,
Appears to be a long
Time, yes, a long, long, long ,long time before the dawn.

Turn, turn any corner.
Hear, you must hear what the people say.
You know there's something that's goin' on around here,
The surely, surely, surely won't stand the light of day.
And it appears to be a long,
Appears to be a long,
Appears to be a long
Time, yes, a long, long, long ,long time before the dawn.

Speak out, you got to speak out against the madness,
You got to speak your mind,
If you dare.
But don't no don't now try to get yourself elected
If you do you had better cut your hair.
`Cause it appears to be a long,
Appears to be a long,
Appears to be a long,
Time, such a long long long long time before the dawn.

It's been a long time comin'
It's goin' to be a long time gone.
But you know,
The darkest hour is always
Always just before the dawn.
And it appears to be a long, appears to be a long,
Appears to be a long
Time before the dawn.

PTSD is not just a "war thing."

Post-traumatic stress has a long reach.

But one of its most misunderstood qualities is that it only applies to soldiers who have served in the battlefield.

In fact, it can affect people of any age and stripe - including teenagers and young adults who live in the peaceful fields of suburbia.

And anyone can encounter the kind of heartache and mental anguish that many soldiers feel when they struggle in their return to civilian life.

This is the story of Jill Manges, as reported by insidehighered.com:

Jill Manges guesses that if she’d suffered an epileptic seizure that day in class, she’d still be enrolled at Eastern Illinois University. But Manges, who has post-traumatic stress disorder, instead suffered a flashback during French history that led her to shout and sob uncontrollably.

“I can’t deny the fact that what happened was disruptive,” says Manges, who was sentenced to a year-long suspension by the university judicial board last month for violating two sections of the student conduct code barring the disruption of university functions and the academic environment in particular (see standards Id. and IVa. of this document).

“But I wonder if they would do this to someone who had an epileptic seizure in class or had a hangover in class or had an asthma attack, because that’s disruptive too.”

In a letter to Manges dated September 17, Eastern Illinois’ assistant director of judicial affairs writes that given Manges’ admission that she violated the two code of conduct standards prohibiting disruptive behavior during the September 5 “incident” (in other words, the in-class flashback), and “the seriousness with which the board viewed this incident, it is their recommendation that you be suspended from the university, effective immediately, for a minimum of an academic year through the Spring Semester, 2008, during which you would be prohibited from being on the campus without prior permission of the vice president for student affairs or his designee.”

“This was a very difficult decision for the board because they recognize that you have made progress in dealing with the situation but the board is concerned about your well-being as well as the well-being of the greater EIU community. Therefore, the board encourages you to seek a medical withdrawal from the university,” the letter continues, indicating that should that be Manges’ choice, the board would not submit its suspension recommendation to campus leadership.

“In consequence, as a condition of your readmission to the university,” the letter says, “you will need to provide documentation as evidence of your continued improvement and ability to keep your condition under control....”

Eastern Illinois officials won’t comment on the specifics of Manges’ case. But speaking more broadly about how they handle mental health issues on campus, they stress that they always have students’ best interests at heart.

“Since we’re in such a rural area and some of our services are limited, we realize this may not be the best environment to really serve all students and we also recognize that sometimes a student may not be good in this environment for other students,” says Heather Webb, director of judicial affairs at the university.

“Everything is done on a case-by-case basis,” says Sandra Cox, the director of the counseling center. “Usually when information goes out there, [people] only have a very small portion of the truth, they have a very small portion of the behaviors that are brought up. They have a very small portion of the whole picture.”

A Flashback and its Fall-Out

While enrolled at Eastern Illinois, Manges says she saw a private counselor off campus to deal with her diagnosis of PTSD — a result of the sexual abuse she experienced from 1999 through 2000, when someone she knew not only abused her but also collected money from other men who did the same.

She was sitting in French history class September 5 when she could feel a flashback coming. Trying to leave but unable to exit the room in time, she collapsed before reaching the hallway.

“I don’t remember what happened because I was disassociating, but what witnesses said, what my professor said, is that I started sobbing uncontrollably, shouting, screaming. I was unresponsive; I was just lying on the floor,” Manges says.

For the 10 to 15 minutes the episode lasted (of the 50-minute Wednesday afternoon class), the other 15 students “responded by sitting quietly and letting those of us who needed to act do so,” says David Smith, the professor teaching the course. “I was extremely proud of how the students responded.”

An ambulance came, and Manges declined to go to the hospital. She says it’s her understanding that at least two classes, including her French history class, were canceled, and one other was moved. There were six or seven classrooms on the hall, Smith says, and other professors came into the hallway to see what was going on.

Manges experiences such severe flashbacks – which she describes as akin to reliving a traumatizing event – once every two weeks or so. This was the first time one happened in a public academic setting at Eastern Illinois, she says, although she had a similar experience in a classroom at a community college that she previously attended (she transferred to Eastern Illinois in January of this year).

Upon returning to her room on September 5, Manges says she had two voice-mail messages waiting: one from judicial affairs, asking her to see a campus counselor, and one from the counseling center. Wanting to comply, she called the judicial affairs official, who met Manges to walk her over to the counseling center. The next day, Manges met with judicial affairs for a meeting, and her parents came to the university for a second meeting the day after. “Pretty much the gist of it was she told me how much of a disruption I had caused,” Manges says.

Smith, who says that he was interviewed by several college officials about the incident, adds that in his conversations, judicial affairs staff focused on the flashback and the disruption of classes.

After a hearing September 13, Manges says she learned of the year-long suspension and her option to accept a medical withdrawal. She chose the latter so her family could get her tuition money back. Because of that, she says she can’t appeal the judicial board’s decision. She’s living in her off-campus apartment, with plans to get a job, move to Boston in January and apply to finish college there. She was a junior history major and writing minor at Eastern Illinois. She has no plans to sue, saying she has neither the money nor the time.

Manges says she had come up on judicial affairs’ radar screen once previously, back in the spring when she spoke with a professor about experiencing suicidal thoughts. Manges says she was asked by college officials at that time to sign a behavioral contract agreeing to continue psychological treatment and keep up her academic coursework. Manges, who says she is not suicidal now, signed the contract.

She says that she upheld it and that the contract — and the suicidal ideation she experienced in the spring — did not come up during her judicial board hearing, which focused on the PTSD. She says that a letter from her therapist certifies that she is not a threat to herself or others.

And as Gary Pavela, author of Questions and Answers on College Student Suicide: A Law and Policy Perspective (2006: College Administration Publications), points out, “Research indicates that the odds that a student with suicidal ideation will actually commit suicide are 1,000 to one.” Several national reports following the 1999 Columbine High School shooting show that “it is inadvisable to create the impression that there is some kind of automatic, hair-trigger response to behavior that is viewed as disruptive or that falls outside of the area of disruptive into suicidal ideation,” Pavela says, as the perception of harsh penalties can prevent students from seeking help.

“I don’t know what we can do except to make students aware that this is happening at the campus,” says Manges, who describes a general lack of awareness of mental health issues. “Honestly, because there’s not a lot of knowledge about mental illness, mental illness still has a huge stigma. People don’t understand it; people are scared of it because they don’t understand it.”

“I was certainly disappointed at the outcome,” says Smith, the professor of the French history course. He testified on Manges’ behalf at the judicial board hearing.

“I certainly hoped that the student would be returning to the class, wanted her to come back” — as, he says, did the other students in the course.

“I would hope that in the wake of terrible tragedies like at Virginia Tech that universities don’t close themselves off as places where students can deal with difficult issues.”

Psychology and Behavior

Eastern Illinois administrators say they make a concerted effort to help students deal with their problems while staying on campus. “Whenever possible, we try to work with the student to help them through their mental illness,” says Webb, the judicial affairs director. She mentions the behavioral contracts cited by Manges as one example. A number of situations, including excessive alcohol consumption and suicidal ideation, could result in students being asked to sign a contract, which outline a set of expectations.

“It doesn’t say we expect you not to experience mental health issues. We expect that,” Cox of the counseling center says. “What we look for are changes in behavior.”

Webb says that, whenever it’s appropriate, she contacts the counseling center to see if a voluntary withdrawal might be an option for a student facing charges in the judicial system. In fact, when asked whether there were any inaccuracies in a student newspaper story outlining Manges’ take on what happened, officials clarified a policy stipulating that when mental illness is impacting student behavior, the possibility of a voluntary medical withdrawal is always discussed prior to judicial proceedings.

“[What’s been] put out there is that Eastern has suspended students based on mental health reasons. And that is incorrect,” says Cox. But, she adds, “if there are long-term or consistent behaviors that are in violation of the student conduct code…then we have to look to see, do we have the services for someone who is struggling to a significant extent?”

While Cox says she processes a handful of voluntary withdrawals per week at the university of about 12,000 students, not once in her 11 years at Eastern Illinois has the university had to complete its mandatory withdrawal process for psychological reasons, reserved for the most extreme cases involving threats to the self or others and an inability to take care of oneself.

Yet, while Manges technically signed a voluntary withdrawal form, to her it might as well have been mandatory. “I was between a rock and a hard place. I chose a hard place,” she says. “I’ve always been under the impression that people who take a medical withdrawal do it for themselves. For me, it was something that I was pretty much forced into doing.”

The Bigger Picture

While what Manges says happened at Eastern Illinois may not be common, nor are such experiences uncommon, says Karen Bower, a senior staff attorney at the Judge David L. Bazelon Center for Mental Health Law. Bower says she routinely (more than once a month) gets calls from students who are forced to leave college for mental health reasons.

“They all feel very betrayed by the school and say that being out of school isn’t going to help them,” says Bower, who was involved with recent lawsuits on similar issues against George Washington University and Hunter College of the City University of New York that both ended in settlements.

“We have urged that schools not use disciplinary action for behavior that’s a result of mental illness,” Bower says — echoing Professor Smith’s sentiment that a judicial board hearing didn’t seem like an appropriate venue for addressing his student’s situation.

“I am concerned that judicial affairs as a body is designed to handle certain kinds of cases that this kind of event — when someone is not operating in a voluntary manner — they’re not well-equipped to deal with,” says Smith.

In its model policy, the Bazelon Center recommends that involuntary leave only be used in a situation where an individualized assessment determines that a student is a direct threat to the self or others. Under the Americans with Disabilities Act, Bower adds, colleges are required to provide reasonable accommodations for students. That could mean, in this case, she says, waiving the rule about class disruptions for Manges, or mitigating any sentence.

“I think they think it’s objective, but discrimination based on conduct that’s the result of disability is the same as discrimination based on disability,” Bower says. “The use of the disciplinary system as a whole is really a way of removing students from an environment instead of finding out what kinds of supports and services they need to stay in school and be successful.”

Although college leaders say they have the students’ interests at heart — in addition to the interests of other students — when advocating medical withdrawals, Manges says in her case, at least, the time off won’t be helpful.

“Being in school is extremely important to me and it is part of the healing process. It is my way of reclaiming my life; it is my way of getting back what was stolen from me when I was younger,” says Manges.

“I can’t do anything right now. I can work, I can go to therapy, but I was going to therapy while I was in school.”