Bringing The War Home

December 17th, 2006  
Team Infidel

Topic: Bringing The War Home

Houston Chronicle
December 17, 2006
The nature of the Iraq conflict, with soldiers under constant strain, could mean more return with post-traumatic stress disorder than ever
By My-Thuan Tran, Houston Chronicle Washington Bureau
WASHINGTON Michael Goss' job in Iraq was to scour dirt roads for explosives. But the thought of the bombs blowing up at any time terrified him so much that he would yell at the Humvee driver to bolt past potential explosives.
Now in Corpus Christi, Goss is still racked by random fear. Searing flashbacks of seeing his buddies killed by bombs pierce his thoughts, he said, leading doctors to diagnose him with post-traumatic stress disorder.
"You feel you are always in danger out there," Goss said. "It's just one of those feelings that you can never shake."
The distinctive nature of the Iraq conflict with its improvised explosive devices, invisible snipers, suicide bombers and combatants who are indistinguishable from civilians could lead to a record proportion of soldiers returning home with PTSD, some veterans' advocates and mental health experts say.
Iraq veterans experience many of the conditions that the U.S. Department of Veterans Affairs list as likely to contribute to PTSD: high-intensity stress, unpredictable or uncontrollable circumstances and a sense of betrayal which, in military terms, is, the feeling among soldiers, justified or not, that they're being ill-served by commanding officers.
PTSD, which took on its present clinical description after the Vietnam War, is a psychological disorder caused by witnessing or experiencing a life-threatening event, according to its traditional definition. The usual symptoms include nightmares and flashbacks, feelings of estrangement and difficulty functioning in social or family settings.
In Iraq, soldiers are in mortal danger even when they are not in combat. In the refuge of heavily fortified bases, a stroll to the mess hall or a routine mail delivery could turn deadly with a rocket or mortar round.
Living with fear 24 hours a day produces an anxiety unparalleled by other wars, said Dennis Reeves, a retired Navy commander and psychologist who was in Iraq as part of a combat-stress team.
"If you cannot predict what can happen to you, it is extremely traumatic," Reeves said. "You can put up with the 24/7 stress for about six months, but after that, it makes you vulnerable to PTSD."
The unrelenting fear has made it impossible for Goss to resume a normal life, he said.
Driving along back roads in Texas reminds him of the open terrain in Iraq. His chest tightens, he said, when he envisions the "string of glitter" that spews from exploding roadside bombs.
Goss, 29, works as a bail bondsman at night while his four young children sleep. He would rather work than spend many hours reliving the memories of Iraq in his dreams.
He recently separated from his wife of seven years, partly because of frequent outbursts he said he can't control.
"PTSD is a big part of my failing in life right now," Goss said.
Goss said he cannot afford treatment and has no access to the Veterans Administration health system because he was not discharged honorably from the Army. His discharge papers did not state the reason.
More than one in three Iraq war veterans have sought mental health counseling during the first year home, according to a study conducted by Army researchers.
Nearly one in five returning soldiers has been diagnosed with mental disorders that include post-traumatic stress disorder, according to the study. Other reports estimate that between 30,000 and 50,000 Iraq war veterans have sought treatment for PTSD.
Reeves predicts there will be a "tremendous escalation" of PTSD cases as more soldiers return, possibly exceeding the aftermath of the Vietnam War, when one of every three veterans was diagnosed with it.
Compared with Vietnam (about 58,000 U.S. personnel killed) the rate of PTSD seen in Iraq war veterans is higher than expected given the lower number of deaths (almost 3,000 U.S. personnel killed), said Paul Rieckhoff, executive director of the Iraq and Afghanistan Veterans of America, a veterans advocacy group.
One possible reason for the high number of stress-disorder cases is that anxiety in the Iraq war is more sustained than in Vietnam, where soldiers could go to the rear out of harm's way or fly to Bangkok, Thailand, and Tokyo for rest and relaxation, he said.
But in Iraq, there is no safe zone. Mortar attacks and bombings have created a "360-degree threat environment," Rieckhoff said.
Jesus Bocanegra, 24, of McAllen, said that random fear has turned his civilian life into never-ending war. He could never let his guard down when he was an Army infantry scout in Iraq. Now that he is at home, he still cannot relax. He instinctively keeps his back to the wall and constantly looks over his shoulder.
"I noticed I could not turn myself off when I came home," he said. "My body still thinks it's in Iraq."
Bocanegra, diagnosed with PTSD, started drinking heavily to forget his horrific experiences, which included killing Iraqis in firefights. Flashbacks and panic attacks made concentrating in his community college classes difficult. His sleep is still interrupted with nightmares about Iraq, he said.
The Department of Defense has taken steps to halt the onset of PTSD by sending therapists to work with soldiers and Marines in Iraq. When soldiers return home, they are interviewed and given questionnaires to determine whether they need treatment for PTSD. Veterans who are diagnosed with PTSD can receive VA compensation.
Treatment for PTSD is considered far superior than in the aftermath of the Vietnam War. Bocanegra sees a psychotherapist once a month and takes medication to treat anxiety and depression.
The unremitting nature of the Iraq conflict has touched off a debate among experts over what should be considered legitimate causes of PTSD.
Reeves and other experts argue that chronic fear of being killed may not be the same as witnessing a life-threatening event, but it nonetheless is enough to trigger post-traumatic stress disorder.
Other experts adhere to the classic diagnosis, in which a single life-threatening event, such as being in a firefight or close to an explosion, defines PTSD.
When these incidents increase because of prolonged combat, the rates of PTSD rise.
The stress caused by a war without fronts in which everyone is vulnerable to sudden violence is a normal emotional reaction that would not necessarily lead to PTSD, said Richard McNally, a Harvard psychology professor and PTSD expert.
"Most people in Iraq are in a stressful-related war zone, but that's not the same thing as being shot at or having your buddies killed before your eyes," McNally said.
Research needs to settle whether anticipation of trauma can itself be the trauma that causes PTSD, said Ira Katz, deputy chief of patient mental health services for the VA.
"There is no question that more persistent, more low-level stress can have effects," such as depression, alcohol problems and panic attacks, "even if it isn't within the definition of PTSD," Katz said.

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