The first time Kristin Peterson's husband hit her, she was asleep in their bed.
She awoke that night a split second after Joshua's fist smashed into her face and ran, terrified and crying, to the bathroom to wipe the blood spurting from her nose.
When she stuck her head back into the bedroom, there he was -- punching at the air, muttering how she was coming after him and how he was going to kill her. Kristin started yelling, but Joshua's eyes were closed. He was still asleep.
The next morning Joshua saw the dried blood on his wife. "Oh God," she recalls him saying. "I did that."
Peterson doesn't remember the night or the nightmares. He also can't remember punching his wife again in his sleep a few weeks later, this time driving her front tooth through her lip.
For six months last year, Peterson helped build an oil pipeline across Iraq as a specialist in the Army's 110th Quartermaster Company. On the same highway where Private Jessica Lynch was ambushed, he saw Iraqi soldiers, dead and rotting, dangling out of their tanks. One time Peterson's truck broke down, and he was surrounded by a group of Iraqi children, some throwing rocks, others toting AK-47s. "I kept thinking, God, I can't handle this," the 24-year-old says with a hollow laugh.
Since Peterson came back to Richmond Hill, Georgia, in August 2003, these memories have turned him into a man Kristin often doesn't recognize -- a man who lashes out in anger at her and their 21-month-old son, whose awful dreams tell him to beat his wife, because in his sleep she's an Iraqi.
There are thousands of Operation Iraqi Freedom soldiers across the country like Joshua Peterson. They are coming home with minds twisted by what they've seen and done in Iraq.
A December 2003 Army study published in The New England Journal of Medicine found that approximately 16 percent of soldiers returning from Iraq were suffering from post-traumatic stress disorder (PTSD), a psychologically debilitating condition causing intense nightmares, paranoia, and anxiety. But that study is already out of date.
Now, after a particularly bloody summer and fall, many military and mental-health experts predict the rate of PTSD will actually run nearly twice what the Army study found, approximately the same level suffered by Vietnam veterans. Others think it could spike even higher and note that rarely before has such a dramatic rate of PTSD manifested itself so early.
At the same time, there is mounting concern over the government entity designed to help. Numerous reports show that the Department of Veterans Affairs does not have many of the essential services veterans desperately need.
"I don't know how many people are going to be seeking treatment or whether the demand is going to be met by available resources," acknowledges Matthew Friedman, executive director of the VA's National Center for PTSD. "What I am confident about is that people who come for treatment will get good treatment."
Yet, despite Friedman's assumption, the VA has chronically underfunded mental-health programs and projects a $1.65 billion shortfall in those programs by the end of 2007.
"If we don't give the VA what it needs immediately, the consequences will be lifelong and devastating," says Steve Robinson, executive director of the National Gulf War Resource Center.
The emerging scenario portrays a new generation of war veterans coming home with psyches in tatters -- and of an exhausted health-care system holding its breath.
"When you kill someone in combat, two things can happen," says Sergeant Walter Padilla, Charlie Company, 1st Battalion, 12th Infantry Division. "The crazy ones go crazier. Or nothing happens."
In October 2003, Padilla was commanding a Bradley Fighting Vehicle near the city of Kirkuk, rounding up insurgents and fending off mortar attacks. One day, Padilla's company headed to a deserted area a few miles from base to practice their marksmanship. When gunfire rang out from a nearby village, Padilla wheeled his Bradley around to investigate. He saw two groups of armed men arguing over a pile of wood. The Bradley rumbled closer, and the men began shooting.
"Everything slowed down. I lost sense of time. I saw nothing, felt nothing," he says. "Then I opened up with the machine gun." Afterward, Padilla moved in for a closer look.
"You're walking up on something you've done with your hands. You see the back of brains blown out. You know it's either him or you! But I'd never seen anybody dying."
When Padilla's unit was shipped back to Fort Carson, Colorado, in late February 2004, his life unraveled. While he was gone, his wife had filed for divorce. He began having terrible dreams about Iraq. He grew paranoid.
One morning, on his way to work at Fort Carson, Padilla glimpsed the lights of an Air Force jet. He swerved his car off the highway and grabbed his cell phone to call his commanding officer. "I thought it was a tube flash from a mortar," he says.
At a bar one night, he argued with a stranger over a pool table. "Doesn't this guy know I've fucking killed people?" Padilla thought incredulously.
That night, Padilla lay awake, contemplating whether he should rush out into the night and search for the stranger. He took some sleeping pills and fought to let it go. "If I'd have found him, I would have beat him over the head with a bar stool," he says.
While Padilla battled his ghosts, Washington bureaucrats were hearing about another nightmare. On March 25, Dr. James Scully, medical director of the American Psychiatric Association (APA), testified to the House Appropriations Subcommittee on VA, HUD, and Independent Agencies. Scully, a Navy veteran, reported a 42 percent growth in VA patients with severe PTSD, with only a 22 percent increase in money spent on PTSD services. The discrepancy was particularly "startling," he said, because there were more vets using the VA for psychological help than ever -- nearly half a million.
It was the latest blow for an institution that has struggled for decades to fulfill its mission. A mammoth, federally funded agency, the VA's health-care system began treating veterans in 1930, charging a sliding fee based on a variety of factors. But in the wake of the first Gulf War, the system swelled out of control. The soaring cost of civilian health insurance combined with aging World War II, Korea, and Vietnam vets pushed droves of servicepeople toward the VA, where everything was cheaper.
In 1995, the VA began realigning its health-care system and opened hundreds of outpatient clinics. Yet by 2001, only half of those clinics provided mental-health services, according to the National Mental Health Association (NMHA).
Again, funding was a factor. By 2003, the previous decade had seen a 134 percent jump in vets seeking care, with only a 44 percent increase in the budget.
In April 2003, as U.S. troops pushed toward Baghdad, Dr. Joseph T. English, chairman of psychiatry at St. Vincent's Catholic Medical Centers of New York, told a House appropriations subcommittee that veterans were waiting an average of 47 days to get into PTSD inpatient programs and up to a year at some outpatient facilities.
VA secretary Anthony Principi (who resigned as part of the Bush administration's cabinet shuffle and will leave office when his successor is confirmed by the Senate) had commanded a Navy gunboat during Vietnam and understood PTSD. He also knew that with combat-dazed vets beginning to trickle home from Iraq, he needed more resources. So he commissioned a task-force to rapidly analyze the VA's mental-health services.
In a revealing June 3rd memo to VA undersecretary for health Dr. Jonathan Perlin, Principi wrote that the task-force had discovered four major deficiencies: Mental-health services were scattered; substance-abuse programs had been reduced; the VA's mental-health leadership hadn't been diligent in overseeing the situation; and there was no coherent mental-health strategy. Principi ordered VA brass to begin plugging the holes immediately.
While the VA worked on a long-term mental-health plan to implement the reforms, the agency's special committee on PTSD delivered an October report to Congress, warning that with more soldiers with PTSD arriving home, services needed to be expanded. During the 1980s, the VA had recommended that teams of PTSD counselors be in place at all VA medical centers. Two decades later, the report noted, barely half of the 163 facilities had them. The VA plan estimated it would take $1.65 billion by 2008 to fix things.
The PTSD committee conceded that the VA couldn't be expected to treat psychologically troubled vets from Iraq and Afghanistan while still caring for those already in the system. "If the human cost of PTSD and its related disorders is staggering, so are the long-term medical costs to the VA associated with chronic PTSD," the report stated.
The House Veterans Affairs Committee urged Congress to pump an additional $2.5 billion into the Bush administration's VA health-care budget for 2005. But by November, with the budget poised for passage, it seemed unlikely, despite the warnings from veterans groups and VA doctors who sat on the PTSD committee.
These same doctors knew they could treat the disorder better than anyone. They have been on the cutting edge of PTSD since its diagnosis was born from a war whose lessons now seemed distant.
Sergeant Dave Durman did a tour in the Mekong Delta in 1969. He was 18 and had joined the Navy the minute he got his draft notice, even though some of his buddies had already died there. "I think it was because I just really loved the water," Durman says.
Durman also loved working on the supply ship where he was stationed and the pulsing adrenaline he felt whenever his unit supported the Marines on missions around the South Vietnamese coast. He stayed in the Navy for nine years. Then in 1995, he joined the Virginia National Guard's 1032nd Transportation Company, located 10 miles from his home in Kingsport, Tennessee.
In February 2003, Durman's unit was sent to Kuwait. He was 52 years old.
Two months later, the 1032nd crossed into Iraq, charged with shipping supplies from the southern city of Talil, 300 miles north to Balad. Other convoys had been attacked on the same route, so Durman and the 19-year-old soldier who rode with him slung their flak jackets protectively over the outside of the truck doors because, Durman says, "you could stab a hole through those doors with a knife."
During one August haul, Durman came upon a group of Iraqi police who had just shot two children for stripping a car on the side of the road. He drove right by their bodies. "We're told not to interfere with domestic affairs," Durman says quietly. "I didn't want to get personally close to the Iraqis, because I knew we might have to shoot them. I'd look into their eyes, and they all looked like Gooks."
In September, Durman's unit shipped back to Virginia. It was then the nightmares started about Iraq but also about things he'd buried, such as his abusive childhood and Vietnam.
His girlfriend, Teresa A. McKay, noticed that Durman, once confident and kind, broke into random sweats and angered easily. He drank too much whiskey and bought a .357 pistol. Their sex life, McKay said, went "190 degrees different." To McKay, a former nurse who'd worked with homeless Vietnam veterans, Durman's behavior looked disquietingly familiar.
Indeed, Vietnam provides the clinical and historical framework for PTSD and Iraq. Before Vietnam, treatment of a soldier for the psychological effects of battle was not really treatment at all, even though PTSD had long been acknowledged under a variety of names.
In 1871, a former Union Army medic, J.M. Da Costa, wrote about a stress disorder caused by heavy fighting. He called it "irritable heart," a name changed shortly thereafter to "soldier's heart."
During World War I, according to VA psychiatrist Jonathan Shay, veterans returning home with soldier's heart were told by military doctors they had shell shock, or combat neurosis. After World War II, says Shay, when tens of thousands of soldiers were hospitalized with psychiatric problems, doctors diagnosed the majority with paranoid schizophrenia.
"The diagnostic spirit which prevailed was based on Plato's idea that if you had good parentage, good genes, a good education, then no bad things could shake you from the path of virtue," says Shay.
During Vietnam, that Platonic ideal began to shift. In 1970, 20 young vets from the group Vietnam Veterans Against the War (VVAW) asked psychiatrist Robert Jay Lifton to speak with them about the war. The vets didn't trust the VA or the military but knew they needed to calm the devils they'd brought home.
Lifton, who had studied Hiroshima survivors and had been an Army psychiatrist, began meeting in New York with the group in what became known as "rap sessions." He was shocked by the extent of the veterans' traumas.
"These men talked about a particular combat situation that had a level of extremity which was new, even to me," Lifton says.
Prompted by the rap sessions, VVAW opened up dozens of "storefront" counseling centers where Vietnam veterans could speak with other vets about their experiences, a crucial part of treating PTSD. Still, despite the growing number of vets clearly suffering, the VA wouldn't accept PTSD as a diagnostic condition.
"This was because many of them were talking about atrocities, and that process was associated with a political view of the war," says Lifton.
Finally, in 1979, the VA opened its own network of storefront vet centers. A year later, the American Psychiatric Association recognized PTSD as a legitimate medical diagnosis.
When the National Vietnam Veterans Readjustment Study concluded in 1988 that 30 percent of Vietnam vets suffered from PTSD, not many were surprised. By then, Lifton and individual VA psychiatrists like Matthew Friedman had become leading experts on PTSD and pushed the condition into psychiatric and public consciousness. Through group and individual therapy, and sometimes medication, the VA was helping veterans heal, though the process could take years.
But by the time U.S. soldiers touched Iraqi soil, advancements in PTSD treatment were being compromised because of the enormous growth in the number of vets seeking mental-health services and the VA's failure to adequately respond. The new conflict, which bore an uneasy resemblance to Vietnam for the doctors who knew that war's demons, would test those advancements even further.
As Crystal Luker tells it, May 5, 2004, was the day her husband's platoon ran into trouble. That afternoon, Specialist Ron Luker was patrolling a section of Baghdad with his 1st Cavalry Division platoon.
"There was a lieutenant in the first Humvee, Ron was in the second, and his platoon sergeant was in the third with a group of privates," Crystal says.
A 19-year-old specialist from Tulsa named James Marshall, whom Ron had been looking after, also rode in the third Humvee. As the convoy snaked through a teeming Baghdad street market, there was an explosion.
"The lieutenant was yelling over the radio for all of them to haul ass back to the base because they were coming under fire," Crystal says.
When Luker looked behind him, he was horrified. The third Humvee was gone. He flipped his vehicle around and hurtled back down the street. Crystal says Luker told her when they found the Humvee, the force of the blast had blown the flesh from two of the privates all over the seats. When Luker looked in the back, he saw Marshall, wrapped around the vehicle's 50-caliber gun.
"When Ron tried pulling James' body out, his hands just went right inside of him. He pulled James' flak jacket back, and his chest was gone."
Before that day, Luker had called and written home religiously, unburdening himself to the woman he'd fallen in love with at a Mariposa, California, restaurant four years earlier. But when he came home to Fort Hood, Texas, for a week in August, things changed dramatically. That first night, at a welcome-home barbecue, Luker cornered his wife in the kitchen.
"He asked why I'd been avoiding him and said that I didn't want to be around him," Crystal says. When Luker started cursing, some Army friends pulled him away. "You didn't come all the way home to fight with your wife," they told him.
As the week went on, there was more arguing. Crystal says her husband accused her of cheating while he was gone. He rifled through her purse, the bedroom drawers, and repeatedly listened to old phone messages, searching for proof.
"I told him, 'You're scaring me! You're not acting right, Ron!'" Crystal says.
Luker also seemed bothered around his three daughters. In an emotional revelation, he told his wife why.
"He said he'd turned into a monster in Iraq, how he couldn't bounce his kids on his knee when he'd shoved guns in women's faces and busted into houses and pushed kids on the floor. He kept saying, 'I'm just trying to remember who I was before.'"
Luker's problems mimicked those of the growing numbers of PTSD soldiers. They also signaled another trend -- soldiers experiencing PTSD early.
"This early-onset PTSD is much higher than anything we've seen in previous conflicts," VA psychologist Scott Murray says. "We anticipate the numbers are only going to keep getting higher."
Psychologist Kaye Baron currently treats some 70 active soldiers and their families in a private practice in Colorado Springs, near Fort Carson. From clinical discussions she's had with soldiers, Baron thinks the PTSD rate could spike as high as 75 percent.
Such a rate, Lifton says, is inexorably tied to the war itself. "This is a counterinsurgency being fought against an enemy which is hard to identify, and that leads to extraordinary stress," he says.
According to Shay, the issue with the most potential for psychological torment is whether soldiers feel they've been led into battle for a noble cause.
Shay, who compared the Vietnam veteran's battle experience to that of Achilles in his book Achilles in Vietnam: Combat Trauma and the Undoing of Character, wrote how the Greek hero felt betrayed by his arrogant general, Agamemnon, whose disrespect of a priest of Apollo brought down a plague on the Greeks.
"If a soldier has experienced a betrayal of what's right by those in charge, their capacity for social trust can be impaired for the rest of their lives," Shay says.
Durman says he first began feeling uncomfortable in Iraq when it became clear there were no WMD. He says his unit was furious when General Tommy Franks retired mid-war, while the rest of the National Guard and Reservists were subject to the Army's "stop-loss" policy, which extends soldiers' deployments.
That sense of betrayal translates into what Shay calls "complex PTSD": nightmares, paranoia, violence, self-hate, and a crippling distrust.
Shay, who also analogized the Vietnam veteran's homecoming to Odysseus' tortured return to Ithaca in a second book, Odysseus in America: Combat Trauma and the Trials of Homecoming, says that after Vietnam, "Vets were coming home and burning through their social capital. Everything in their life was being destroyed or used up."
Peterson's dream-induced violence, Padilla's bar fights, Durman's drinking, and Luker's accusations about his wife are powerful examples of a similar dynamic.
According to the VA, veterans with PTSD are more apt to be jobless, impoverished, homeless, addicted, imprisoned, without a stable family, and three times more likely to die before the rest of us.
Many of the soldiers Baron treats tell her they only want to get far away from their lives at home. "They just want to go off in the mountains," she says. "And be by themselves."
Joshua Peterson and Dave Durman have started therapy at the VA. They're likely getting some of the most advanced care in the world. They're also lucky. Peterson's mother-in-law knows a VA psychiatrist, and Durman was already enrolled, thanks to his time in the Navy.
Walter Padilla is trying to leave the military and says he'll get help once he's out. Ron Luker is still in Iraq, and Crystal Luker says she'll drag her husband to the VA if she has to.
These soldiers won't be alone. So far, more than 10,000 veterans from Iraq and Afghanistan have sought psychological help from the VA, and there's every indication the numbers will jump significantly.
Despite the challenges these numbers predict, Harold Kudler, co-chair of the VA's PTSD Committee, says: "We've never been so prepared" and points to unprecedented cooperation with the Department of Defense, intensified PTSD outreach, and the 206 vet centers. But some say that preparation is not enough. "You can only provide the services for which you have the resources," says psychologist Scott Murray. "There has to be significant improvement in an allocation of funds to make that occur."
On November 20th, Congress added $1 billion to the Bush administration's $27.1 billion VA health-care budget for 2005. The amount fell $1.5 billion short of what was recommended by the House Veterans Affairs Committee. And while Congress earmarked an additional $15 million for PTSD, few think that money will make much difference.
"The heads of the VA health-care networks are all trying to figure out how the hell they're going to manage," says Rick Weidman, director of government relations for Vietnam Veterans of America.
As for the VA's mental-health plan, which estimated an extra $1.65 billion was needed to fix things fully, VA spokesperson Laurie Tranter says: "We cannot comment on this now. The plan is still being finalized."
Still, all the money and services in the world will not solve the pain of PTSD for some.
In 1968, a young soldier named Lewis Puller came back from Vietnam without his legs and parts of his hands, blown off by a Viet Cong landmine. Puller, the son of the most decorated Marine in American history, soon became a veterans' rights advocate and later a Pentagon lawyer. He married a politician, had two children, and, in 1991, wrote a Pulitzer Prize-winning book called Fortunate Son: The Healing of a Vietnam Vet. Popular on Capitol Hill and among veterans, Puller had seemingly risen from the physical wounds and the depression and alcoholism which haunted him for years to live a remarkable life. On May 11, 1994, 26 years after returning home, Puller shot himself. In the end, the soldier's heart hurt too much.
Amidst an outpouring of grief, one Vietnam vet wrote an e-mail to Shay, which Shay published in Odysseus in America. "I get real tired of hidin' and runnin' from the demons," the vet wrote. "Am I the only one? Has it crossed anyone else's mind? You think maybe Lew was right? Is it the only real escape? I got questions. I'm out of answers."
Thirty years from now, one wonders how many veterans from the Iraq War will ponder those words. •
Dan Frosch is a former staff writer for The Santa Fe Reporter. He is currently a New York-based freelance writer for The Nation, In These Times, and other publications. Barbara Solow with the Independent Weekly in Durham, N.C., contributed to this story.
The Local Angle
by Janel Davis
post-traumatic-stress-disorder assistance for
Last year a group of combat veterans was assembled in front of Memphis' Veterans Affairs Medical Center for a photo. Just before the shutter clicked, a passing car backfired and VA public affairs director Willie Logan had an epiphany. "All of the men in that group had some kind of reaction to that backfire," he says. "Some of them ducked down and some of them actually hit the ground. I had worked with these men for years, but right then it hit me: These guys have been to war."
The veterans' reaction is quite common, says Dr. Norman VonButtler of the VA. "We realize that the war must have been horrible for them to still react in this way. The reactions are not fun for [the veterans]." VonButtler leads the hospital's post-traumatic-stress-disorder (PTSD) unit, one of two facilities serving veterans in West Tennessee, northern Mississippi, and eastern Arkansas. The soldiers in that photo group exhibited at least one of the symptoms of PTSD: exaggerated startle reaction.
The Department of Veterans Affairs estimates there are 1,100 soldiers in the Mid-South who have returned from Operation Iraqi Freedom. Of those, about 260 have been seen for various reasons at the Memphis VA hospital. Half that number have exhibited symptoms of PTSD, says VonButtler.
Like most treatment facilities, the Memphis VA employs group therapy in dealing with the PTSD. During his three years heading the program and his 10 years of PTSD-related work, VonButtler has developed a method which includes five treatment modules of 10 sessions each. Ten to 12 patients meet each week for a total of 50 weeks. Some exhibit symptoms severe enough to necessitate attending all 50 sessions; others who feel well enough leave sooner.
The treatment process begins by giving the veterans an understanding of basic psychological issues such as stress and anxiety. Soldiers are then taught how to deal with tension and excessive anger and how to handle the complications of normal life. The most difficult stage of the process is learning to deal with guilt issues, says VonButtler. The memory of ending someone's life eventually affects all soldiers who have done so.
"When they tell me they are okay, they can leave the program," says VonButtler. "We take them at their word." Hospital staffers also meet with soldiers' spouses and evaluate their progress from the weekly sessions.
VonButtler says soldiers returning from Iraq have had interactions with civilians in combat similar to those experienced by Vietnam veterans. "When you are in a village and see a woman in a long dress running toward you, you are always on edge because that person could be hiding a gun underneath," he says. "Some of the things these soldiers have had to do to people can only be shared with others who have done the same things."
Before veterans enter VonButtler's program, they are evaluated at the hospital's field office in Whitehaven, where they meet in a group setting for mental and physical screenings. The program's success garnered national attention this summer when Tennessee congressman Harold Ford Jr. introduced a bill that would require the Memphis program be used as a national VA model.
Ford's legislation included an allocation of $100 million to supplement the Department of Veterans Affairs with additional medical staff. Whether or not that bill passes, the government will have to allocate more resources to existing programs as more and more soldiers return from Iraq and other combat zones. Also included in those services should be more assistance to soldiers' spouses and families, VonButtler says. •
Editor's note: The Association of Alternative Newsweeklies commissioned this story for its member newspapers. The Flyer is publishing "Soldier's Heart" this week, along with 15 other AAN papers around the U.S. -- Bruce VanWyngarden