Invisible Wounds: Mental Health and the Military

October 8th, 2010 - by admin

Mark Thompson / Time Magazine – 2010-10-08 00:19:05,9171,2008886,00.html

(August 16, 2010) — US Army specialist Ethan McCord was one of the first on the scene when a group of suspected insurgents was blown up on a Baghdad street in 2007, hit by 30-mm bursts from an Apache helicopter. “The top of one guy’s head was completely off,” he recalls.

“Another guy was ripped open from groin to neck. A third had lost a leg … Their insides were out and exposed. I’d never seen anything like this before.” Then McCord heard a child crying from a black minivan caught in the barrage.

Inside, he found a frightened and wounded girl, perhaps 4. Next to her was a boy of 7 or so, soaked in blood. Their father, McCord says, “was slumped over on his side, like he was trying to protect the children, but he was just destroyed.” McCord couldn’t look away from the kids. “I started seeing images of my own two children back home in Kansas.”

Ethan McCord’s mind and thousands like his are the US Army’s third front. While its combat troops fight two wars, its mental-health professionals are waging a battle to save soldiers’ sanity when they come back, one that will cost billions long after combat ends in Baghdad and Kabul.

It is a high-intensity conflict: Army troops, TIME has learned, are seeking mental help more than 100,000 times a month. That figure reflects a growth of more than 75% from the final months of 2006 to the final months of ’09, according to Army data.

Army Lieut. General Eric Schoomaker, the surgeon general who oversees the mental and physical well-being of the nation’s soldiers, concedes he doesn’t have the doctors and therapists he needs.

“We’re in uncharted territory in respect to the strain on the force,” Schoomaker said recently. Translation: he needs help. According to the Army’s estimates of its needs, 414 psychiatrists are 20% fewer than Schoomaker should have.

A study released by the Army on July 29 concluded that “numerous critical shortages of care providers including behavioral health” personnel are hurting its efforts to curb suicides.

“The Army has been criminally negligent,” says Captain Peter Linnerooth, an Army psychologist for nearly five years until 2008, who notes that the service has had a difficult time finding psychiatrists to care for combat vets, which puts even more pressure — “and way too much burnout” — on those who stay.

Interviews with dozens of mental-health experts at Army bases tell a similar story. Even though the Army mental-health corps has increased about 60% since 9/11, demand is growing even faster.

One anonymous mental-health professional told researchers last year that he spends a quarter of his time on “really sick people who never should have been let in [the military] to begin with.”

During the past year, indeed, it has become clear that a shortage of mental-health care can be nearly as dangerous to troops as any enemy. Last November, when Army psychiatrist Major Nidal Hasan allegedly gunned down 13 people at Fort Hood, Texas, it forced the Army to ask some hard questions. Did supervisors overlook Hasan’s poor performance and alarming ideology because they are desperate for psychiatrists?

Without doubt, those in the specialty feel under pressure. Sergeant Brock McNabb, who left the Army in 2008, was a mental-health technician operating out of a base near Baghdad; he endured nearly a year of 12-hour-plus shifts without a day off.

“My marriage is going to hell. The commands aren’t listening to a lot of the things we’re saying when we’re trying to take care of these guys,” he recalls thinking. “It wasn’t any huge, dramatic thing. I just decided, ‘Yeah, today’s the day I’m going to die,’ and I was O.K. with that.” He collapsed, fully clothed, on his cot.

“I looked over at my 9 mm on this little hutch I’d made, and I started laughing hysterically,” he says. “I was so exhausted after 10 months of all the s— I’d been through, I was too tired to… reach for the 9mm and put it in my mouth.” He passed out and awoke fine the next day.

The Enduring Taboo
McCord Pulled the two kids out of the minivan — the boy was still alive — and helped get them to a hospital. The Apache gunship killed a dozen men, including a pair working for the Reuters news agency; the episode became a video sensation after WikiLeaks released footage of it in April.

Back at his base, McCord washed the children’s blood off his uniform and body armor. That night, he told his staff sergeant he needed help. “Get the sand out of your vagina,” McCord says his sergeant responded. “He told me I was being a homo and needed to suck it up.”

McCord says he never spoke to anyone about it after that because he didn’t want to get in trouble and instead did what soldiers have done forever.

“I decided to try to push it down and bottle it up,” he says. But his anger, fueled by flashbacks to that day in Baghdad, kept growing. Any misstep by one of the soldiers on his team would set him off. “It was like a light switch,” McCord says. “They’d do something wrong and I’d be screaming at them.”

Going to a psychiatrist is still seen as a sign of weakness in the Army; the chief fear is that it will work against promotion. That may be why only about half of those needing help seek care, according to a 2008 Rand Corp. study. And only half of those — 25% of the total who need help — get “minimally adequate treatment,” the Rand study found. Repeat deployments deepen the crisis.

One in every 10 soldiers who has completed a single combat deployment has a mental ailment; that rate jumps to 1 in 5 with a second deployment and nearly 1 in 3 with a third. That means that more than 500,000 troops have returned home to the US in the last decade with a mental illness.

Complicating the Army’s mental-health challenge is an increase in brain trauma. The two wars are revealing a connection between physical wounds and mental ailments. Advances in body armor protect soldiers’ bodies but have left skulls and the gray matter inside them relatively defenseless. Schoomaker says the wars’ biggest surprise is how traumatic brain injury (TBI) caused by roadside bombs has unleashed mental trauma.

Bruised brains trigger “persistent stress-hormone releases” that can cause posttraumatic stress disorder. That, in turn, can lead to suicide. The Army has been battling a rising suicide rate for the past six years; June saw 32 suspected suicides, one of the highest monthly totals in Army history. Of those, 22 had served in combat, including 10 who had deployed two or more times.

The root cause is no mystery: repeat deployments drive up cases of posttraumatic stress, which makes soldiers six times more likely to kill themselves. So, quietly, all over the world, the Army has opened 48 medical sites dedicated to treating soldiers’ injured brains. Ground zero for this is Fort Campbell, Ky., home to the 101st Airborne Division.

After 11 suicides at the base during the first five months of 2009, a top general ordered a three-day halt to all activities to discuss the problem and issued an astonishing order to the entire division: “Suicides at Fort Campbell have to stop now.”

The Army has spent $7 million building at Fort Campbell what it calls its first behavioral-health campus (soldiers call it “the mental-health mall”) with a half-dozen new clinics filled with the latest technology for diagnosing and treating posttraumatic stress disorder (PTSD) and traumatic brain injury. The fort’s mental-health staff has grown from 31 in January 2008 to 95 today. Yet suicides continued to rise.

“The way Fort Campbell deals with the soldiers are why there’s so many suicides there,” Sergeant James Kendall, now studying to be an Army nurse at Fort Sam Houston in Texas, says.

“Pretty much everyone who went to mental health said the same thing I did — they’re just shoving them out the door.” Kendall, a medic in the 101st, returned from Afghanistan in March 2009 and says he was brushed off when he initially sought help.

It was only after he downed a full bottle of Army-prescribed Vicodin, he says, that the Army took his worries seriously. (His wife resuscitated him by injecting him with an antioverdose medication he had stashed in his medic’s bag.)

Dr. Bret Logan, a psychiatrist in charge of medical hiring at Fort Campbell, says few medical professionals want to settle near the rural base — an hour north of Nashville — for far less money than they could make in a big city.

The post has hired several foreign-born doctors, which has created cultural as well as language barriers. With only four suicides so far this year, the epidemic at Fort Campbell seems to have abated. But the trend at the base remains clear; the workload per mental-health worker has nearly doubled from 2008 to 2010, jumping from 19 to 32 visits per week.

A Patchwork Solution
McCord returned to Kansas five months after rescuing the children, but the nightmares continued. He sought help, and after a two-week wait for his first appointment, he was told by his civilian Army psychologist to calm his nighttime shakes with a blanket and a scented candle. Several weeks later, he saw a civilian Army psychiatrist, who prescribed three antidepressants that McCord says turned him into a zombie.

Soon he began downing pills with whiskey and walking around his house brandishing his military knife with its 7-in. (18-cm) blade. His wife tricked him into driving to the hospital, where an Army counselor committed him to a private mental center.

Can the Army’s mental-health corps heal itself? Not soon. Schoomaker has shifted some 100 physical-health jobs to mental-health billets, and combat tours for some medical specialists, including psychiatrists, have been cut from 12 months to six.

But the Army has been forced to hire regular civilians to help, many of whom know little about the military and its culture. One soldier walked out on a civilian therapist who thought an RPG — a rocket-propelled grenade, one of which killed his buddy — was a small car.

Army mental-health providers have been receiving “provider resiliency training” since late 2008 to ward off compassion fatigue. “The Army recognized they need to take care of their staff,” says Major Chris Warner, chief of behavioral medicine at Georgia’s Fort Stewart. Psychologist Charles Figley, a former Marine sergeant in Vietnam and pioneer in the study of burnout among military counselors, credits the Army for taking some long overdue steps to help its healers.

But there is no magic formula to fix the damage to soldiers’ minds — itself the product of wars that have lasted far longer than expected and are being fought by volunteer troops. A bigger Army would mean fewer combat tours for each soldier, but that’s not going to happen.

One bright spot: as the demand for troops eases, soldiers will spend more time at home between deployments, and such “dwell time” reduces mental ailments. There is also a growing network of private counselors across the country listening to soldiers, often for free.

Barbara Van Dahlen, a Washington psychologist, launched the nonprofit Give an Hour organization in 2005 to offer free counseling to US troops and their families. “We decided to step up and help,” she says, “because these are our folks too.”

McCord got out of the mental hospital after four days and left the Army last June. His psychological turmoil, he says, played a role in his 2008 divorce. He is no longer taking antidepressants. “The Army’s attitude was, ‘Let’s give this guy drugs and hope they work because we’re overbooked and don’t have time to deal with it,'” he says. “If they had understood what I was going through, I think all of this could have been avoided.”

Treating Soldier Stress
To see photos of the behavioral-health facilities at Fort Campbell, go to

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