Monday, August 21, 2006


Conclusion: Changes and After-Effects

Part 2: You Call That PTSD?

(This is belated follow-up in a multi-part series I introduced, entitled Conclusion.)

This post won’t seem to write itself, and I’m not doing much better getting it done myself.

I started with a disclaimer to what I planned on writing here, all well and good, but then it stalled right there. Lots to talk about, some reluctance I guess to pick it back up. So here goes. First, I’ll repeat a very short summary of my disclaimer to refocus.

A deployment to a combat zone – and experiencing combat first hand – changes a person forever. Yet some of our soldiers, including many Veterans of prior combat, seem quick to dismiss such thoughts from their consciousness.

Very few of our soldiers saw anything remotely like combat. Yet as leaders, we’re trained to look for, anticipate, and help our soldiers cope with inevitable effects of their deployment experiences. We try to help our soldiers deal with their experiences. If you lost something while you were there, if your mind and heart and feelings and attitudes changed, let people know. That’s a big part of what makes a MILBLOG, too, as I think about it.

So much of what we say can be twisted and used as anti-war propaganda by the usual useful idiots. But better that stuff that needs to get talked about, gets talked about. The useful idiots we will always have with us, biting ankles while the grown-ups talk things over like adults.

On the whole, most of our soldiers view their service in Iraq as an overall positive experience. Most are relieved it’s over. Here’s the bottom line up front for most: glad they went, gladder still to have it done.

I saw our Command Sergeant Major (CSM) a couple of months after our return, he wanted to talk about Iraq, our time, telling stories. He missed being in Iraq. He said so, most obviously, but even more than that, by his demeanor and expressions, I knew he missed being there. Gone was the easy (if forced) camaraderie, the shared purpose, the excitement, all the soldier and man time. Part of that was his ex-Marine self, that attraction to all things violent and combative, but there’s more to it than that.

It’s how I feel when I get a chance to slam back a few beers, play cards, tell stories, just talk smack with others who know exactly what I’m talking about. Shared experiences, but even more, shared mental states.

Sometimes it’s just some time to escape from the world of family, or work, or even just the mundane demands of the civilian day-to-day. Maybe for some, to get away from the world of women, who largely create the “nests” we men inhabit.

I think differently now about how this all works, than I thought before. During mobilization training, the focus was on preparing our soldiers physically and mentally for what we would face.

Extensive training on all phases of operations. Reports and administrative functions for headquarters staffs. Stocking spare parts and vehicle preparations, including up armoring, general motor maintenance for mechanics. Detainee operations for Tactical Human Intelligence (HUMINT) Teams (THT), leaders, really, all of us, as our Military Intelligence (MI) Battalion (BN) was to be responsible for one or more detention facilities. Defensive Lanes, Military Operations in Urban Terrain (MOUT), Convoy Operations, and Casualty handling for everybody, because you never know who’s going to use it or need it.

Above all else, medical assessment (SRC) to clear soldiers for the demands of deployment to the combat zone. Finding the men and women with chronic health problems or other limitations, and assessing whether those were severe enough to warrant being coded “Red” (Non-Deployable).

The medical staff were very responsive to both soldier and command concerns, and in my view, always tried to make the right judgment between unit mission requirements and soldier capabilities and limitations. Permanent profiles exist in wartime as well as peacetime, but some limitations can get you killed in a combat zone.

Alcoholism and heart conditions. Back problems and obesity. Psychiatric or psychological problems. Age. Overall physical health.

I worried mostly about my two time veterans, the soldiers who had served in Vietnam, or Gulf War One, or even earlier tours in Afghanistan. Some soldiers who wanted to go probably shouldn’t. Some who didn’t want to, probably could. I fought to keep those who wanted to go and I thought could handle it well, but who had limitations that potentially made them Non-Deployable. I spoke privately to the medical staff for those soldiers not willing to admit that they were having a difficult time that was sure to get worse.

It was a moment of all kinds of decisions, for leaders and Commanders, certainly, but also for men and women who rarely get to ask themselves how far they’re willing to go, who much they really want to serve, what they’re really willing to endure. How they will view themselves in the future. I’d like to think we all made the right decisions, with only 2 or 3 exceptions out of 200, mostly the result of self-deception or a willful deception of commanders by the soldiers in question.

All through the medical readiness and mobilization training period, we grew hardened, no nonsense, coldly practical about a lot of things. Some of us copped attitudes towards those who failed the screenings, or couldn’t keep up, or otherwise let the process place them outside the deployment. Many of us started using derogatory terms for those who struggled, or fell out. This made redeployment more difficult for some.

The same attitudes we left with, didn’t survive long upon our return from Iraq.

Your average soldiers tend to be low maintenance, tough guys and gals, who pride themselves on endurance, strength, fortitude and getting the job done. “I’m okay. I don’t need a Doctor to tell me what hurts.”

Not everybody, mind you, but for citizen soldiers in the National Guard, most of us were something else first, and several things second and third and even more, before we were soldiers. Maybe it’s the lifestyle, the ethos, but many of us were quick to cop the tough guy stance, at least on the outside. I think it’s how many of us steeled ourselves to get through a combat zone deployment and a year more or less away from our families.

Some of our soldiers had no trouble at all describing every visit to sick call, every ill or ailment, to the Veterans Affairs (VA) counselors and medical staff upon our return. We had lots of encouragement. The VA was aggressively active promoting their services and advocating for soldier care immediately upon our return, thoroughly supported and encouraged by unit commands at every level. We must have had three Post deployment health assessments within the first 6 months of our return.

But even those soldiers who found it easy to report an ache, a problem, an injury or a burden newly carried in their lives, even these soldiers most ready to self-report, still encountered something we didn’t expect, but maybe should have: Guilt.

The average soldier returning from Vietnam felt abandoned by his country and military authorities, and shunned or scorned by his fellow citizens. We who serve today know this, largely from accounts of our Vietnam Veteran comrades, but also from living in America for the past 20-25-30 years. Many felt deep guilt that they survived while buddies didn’t make it out alive. Most left and returned in ones and twos, often isolated from comrades, and in many cases, going from jungle to transit point to home station to out on the streets in as little as 48-72 hours. No adjustment, little or no services or official debriefing, or even basic preparation, other than this: “Son, you’re gonna want to take that uniform off before you hit the airport. There’s an awful lot of hate and hard feelings out there, and that uniform’s gonna make you a target.”

Today’s veterans face very different circumstances, but can still end up in the same place, mentally and emotionally. We are often overwhelmed by the support and encouragement of our fellow citizens, family, neighbors, friends and co-workers. The American people seem bound and determined to never again make the mistake of blaming the soldier. The military stresses that we not keep anything to ourselves, and the entire deployment and redeployment processes reinforce constantly that we need to look out for each other, and refer ourselves and others for services if necessary. Even if we think just to be sure, just in case, somewhere down the road, we might possibly need extra care or services.

But in our heads, we’re thinking, “suck it up. Quit yer whinin’.”

Guilt again, but this time for a different reason. “I’m no hero,” most of us say. “I didn’t have a hard time at all,” or “I never saw any action,” or even, “I never really thought I was in any danger.” Boredom, tedium, routine, and more American style services and amenities than any prior generation of soldiers could dare to imagine. Like R&R all the time. For most, but obviously not all. Like a lottery in reverse, where only the very unlucky lost. The rest of us won.

Internet cafes, nice gyms and juice bars, café latte at the Green Bean, dining facilities (DFAC) that blow away stateside, institutional facilities, regular trips to the PX, Subway, Pizza Hut, and a 4 day pass to Qatr.

We had to deal with stray mortars, rockets, and explosions from vehicle born improvised explosive devices (VBIEDs) outside the wire or even at the gates, but these were infrequent and almost entirely ineffective, unless their aim was to lull us into complacency and a feeling of invulnerability. If that was the aim at the larger forward operating bases (FOBs), then they were largely successful. Our sense of security might have been illusory, or based on “safe from harm so far,” but that’s how it was for us in Tikrit. Results varied. Small, remote bases could be more dodgy. Big FOBs were well insulated, and the insurgent teams responsible for sporadic mortar or rocket fire never had a chance to get much practice before forced “retirement.”

This had to be one of the craziest, most unreal “combat” environment in the history of war, even by modern standards. And I don’t think we will fully appreciate what it was, or was not, and how uniquely whatever it was, affected each of us as individuals.

Some soldiers grew disgusted that there wasn’t any “action.” It seemed to make them angry. Maybe they hoped to take out some of the enemy, for any of the good or bad reasons people want to do that kind of thing. Patriotism, zeal, glory, bloodlust, a violent nature, repressed, or not-at-all-repressed anger.

Some breezed through their deployments, and several wanted to stay, or follow-up for contractor positions for a very commonly anticipated 100K tax free for all manner of specialty trades and occupations.

Some soldiers seemed to develop difficulties with the start and stop, sudden changes in security posture, on and off again vigilance, even the simple after-effects of basic, low level stress.

It really had nothing to do with whether you got shot at, or rode through an IED, or witnessed first hand a mortar or rocket strike. It had most to do with what was inside of you, what made you tick, how you coped, how you pushed both the crazy mundane, and the hopped up combat rush out of your mind, just to do the next necessary thing.

Because war really does bring a man or woman to a point of clarity, and maybe refinement, as in the way precious metals are refined by fire. Not everyone makes it through the “refiners fire,” as scripture reminds us, to be tempered like steel, or purified like gold and silver. Some end up as a lot more dross than treasure.

We had what I came to think of as “canaries,” and that’s most of who we dealt with as emergencies and situations to deal with while deployed. Canaries were the early warning soldiers, the ones who would likely have popped, in whatever way each was built to pop, when stress came. When the going got a little tough.

Canaries revealed themselves early in mobilization training. The same soldiers who were “problem children” in training, tended to be problem children overseas. Not always, but often enough that exceptions proved the rule. The canaries fell over in their cages, but things never got so bad that the rest started falling, too. Canaries fall over in their lives back home, at their jobs, with addictions or problems that were out of control when they were mobilized. Canaries were likely to make poor choices in dealing with stress, problems, or temptations, and deployment would only add to opportunity.

I often said to myself, as I tried to stay alert for warning signs, for trends, for weaknesses that would impact everybody, or symptoms that start to spread: “Keep an eye on the canaries. Judge the potential emotional and behavioral ‘casualties’ against the general population of soldiers. Once you start seeing non-canaries, you’ve got a serious problem.” I can honestly say, we pretty much only saw the canaries fall over.

One of my soldiers seemed the farthest from harm to many of us. He worked in a decidedly non-combat role. He played the clown, often, and never seemed to take very much seriously. He had a wild streak from time to time, but seemed to settle down before anything got too out of hand. He might have gone outside the wire a couple of times, traveling to the next FOB. He might have taken a drive to our more remote site once, admittedly a more dangerous ride, but as a passenger, not truck commander (TC), driver, or gunner. He worked a short, late night shift, skeleton manning in an Admin tactical operation center (TOC). Walked back to his billets by himself, which he admitted was the scariest part of his tour.

He came back, did the VA thing, ended up with a disability and a ticket to immediate, lifetime drill pay and no need to continue staying in the Guard. He also found himself out of place in his own skin, uneasy and anxious, and now finds it difficult to work his civilian job that used to be second nature. “I’m a mess,” he says, but for the first few months we thought it was just his shtick.

Those of us who had copped that hardness towards the Non-deployables, found ourselves confronting the flip side of our prejudices. The sick, the lame, the lazy. Another term that I won’t share, but starts with “broke.”

My disabled soldier carries something beyond his injuries from this deployment to Iraq. All of us want to think we did something important, that we made a difference. That we served our country, and through that service, served in some small way the people of Iraq. That we are better men and women for our experience in Iraq.

That’s pretty hard when you think your fellow soldiers think you’re a shammer, or a shirker, or a whiner, like that “broke-thing.” Harder still, when you start thinking of yourself that way.

Which is part of the change that has to happen, each in his or her own private way. Few of us saw combat in any meaningful way. Fewer still suffered casualties or witnessed death and destruction close up. Compared to any prior generation of soldiers, we had it easy. No Greatest Generation, we. No Depression through which to survive childhood. No flaming hell like Pearl, no wall of lead like Normandy, no surf of blood throughout the Pacific. Days and days of tedium, heat and boredom, punctuated by rare minutes of adrenalin, with only the slightest chance of catastrophe in any given moment. Lots worse for some, admittedly, but just about that for most of us.

We can suffer serious and long-standing injury, if we can’t make peace with our service, our changes, ourselves.

I have another soldier who struggles with the same troubles he left home with, amplified in some way now that he sits alone in an apartment. Away from his fellow soldiers, he’s suddenly away from the forced communal living that makes a kind of family. Alone before Iraq, he’s more starkly alone now. Home can’t ever feel like Iraq, thank God, but home doesn’t feel like home anymore, either.

He’s a smart one, can quote you paragraph, line or letter about what he’s going through, what makes him tick, what a mess he really was before deployment, but hadn’t needed to confront his problems. Suddenly he finds himself unable to leave his apartment. He’s too smart and well educated to believe in God, he says, but educated by life enough to know that one can still live the life of the damned, as an atheist or agnostic.

Maybe if he could just find a volleyball club of some kind, or maybe just some kind of hobby or fellowship, just not that whole church thing. Something that can get him out of the house and around other people. Sure, he wouldn’t mind if somebody checks up on him form time to time, even as he knows we have to if we’re leaders or NCOICs. “You have a responsibility to make sure I get help, so that’s what you’re doing.” And true to form, one of the NCOs threatens to tell the CSM that he said he’ll kill himself – he hasn’t said any such thing – if he doesn’t see the counselor at the VA. (And he sure doesn’t want the CSM to be the leader who feels obligated to check up on him. His immediate NCOIC and even First Sergeant sound a whole lot better to him.)

So he knows he came to the combat zone with pre-existing issues that somehow got bigger with deployment and redeployment. Not that the VA cares, nor should they, nor should any of us. He’s our knucklehead, he’s struggling, he’s one of our own, and we aren’t going to leave him behind.

One of our soldiers had two businesses when he deployed, and came back to neither. Bust, gone broke, nothing left but debt and obligations.

The guy who went AWOL at the start, prompted by a demanding wife, brought back in, counseled, encouraged to do the right thing. Deployed, only to find out his wife was busy making other plans in his absence. Who still wanted to cash his checks and keep his money, but use it to prepare a nest-egg with her new squeeze.

We all took turns working on him until he severed the financial ties and saved what was left. He made quite the turn around in assertiveness, seemed to make himself a new man from the experience. Re-enlisted, earned himself $15,000 tax free, then returned stateside and disappeared somewhere in Florida. Won’t return phone calls, won’t resurface, and may soon have government officials chasing after him to recover the re-enlistment bonus.

We talk about our experiences a lot during drills, during social events. We talk about those soldiers who are still on medical hold, dealing with the Army medical process for injuries while deployed. This involves huge and somewhat Byzantine paperwork, medical consultative and care management processes, beginning with that most important Line of Duty report and medical assessment.

First time and second time around Veterans talk over who seems to be doing well, who’s suffering, whose marriage went south, who needs what surgery that most will refuse, rather than let Army Doctors try out sports medicine, back, and other complex surgeries. Who stayed active duty or Active Guard Reserve (AGR), who took the plunge to Washington Agencies, either GS or contractor.

We talk over dealing with the VA. Those who know the VA from Vietnam days marvel at how much support we get, how aggressively everybody makes sure we know what help is available.

My Master Sergeant Vietnam Vet, the one I wrote about in this Profile, overhears one of our conversations, with one of our soldiers talking about difficulty sleeping, anxiety, a litany of disturbances. The soldier mentions how the VA counselor describes it as a low level kind of post-traumatic stress syndrome (PTSD).

“You call that PTSD? That ain’t PTSD,” he finally blurts out with obvious impatience. “When you wake up screaming in the middle of the night, start beating on your wife in your sleep, or run outside in your underwear at 3:00 a.m., yelling ‘incoming,’ then you can talk about PTSD.”

He’s told us about his experiences after his time in Vietnam. The months of flashbacks, night sweats, waking nightmares, and all the rest.

“It stopped after a while. I don’t get bothered much anymore.”

Maybe. I remember the many months Harry was working full time for one of our Intel missions, and we would visit him once a month at the site. He always seemed glad to see us. “I don’t really get out much, just stay in my room.” He stayed in largely empty BOQ billets. He never seemed to need much social contact, otherwise. I always thought his alone-ness, his preferred solitude was the way he was able to make peace with his wartime experiences.

In the grand scheme of things, Harry went to hell and back early in his military career. Nearer its end, he had a different kind of experience in the combat zone. His deployment to Iraq involved a different kind of stress, dealing with an HQ, officers, and a staff that included a lot of people he vows never to work with again, if he can help it. He’s gone back to working full time as a Guardsman on extended Active Duty Special Work (ADSW) orders, but he still keeps his Guard slot by coming to our drills once a month.

So for a Vietnam Vet, what we’re going through is nothing compared to what guys like him went through. In the days when they were a lot more on their on, with little support, where the best thing to do was get rid of the uniform and sneak back home in ones and twos.

And maybe in the end, with everything else we have available, what’s most valuable has been the least appreciated from the start. The memories and experiences, the heartbreak and the anger. Whatever worked for those who came before, who have been there, done that, but back in the day when doing it was one big piece of yourself you never got all the way back. Even when we have to hear it in the form of the caustic wit of a two-time combat veteran, putting it all into perspective.

I’m glad the Army made it easier on Harry this time around. For one thing, he deserved better than he got then, and the Army had a chance to make it up to him. (Other than sending him to Iraq, that is. At least that neutralized the threat he always imagined was the worst that they could do to him.)

Good for Harry that the Army does things a whole lot better nowadays. That’s good for us, too, because he’s still one ornery son of a gun to deal with now. I can only imagine how tough he’d get with us if he had to live through a Vietnam type experience twice.

And we’re the better for both of his experiences.

Linked over at Milblogs, Fuzzilicious Thinking, Bear Creek Ledger, Biting the Heads Off Gummi Bears, Some Soldier's Mom

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