bettenoir 
In the wake of the 2007 scandal regarding deplorable conditions at the supposedly renowned Walter Reed Army Medical Center, the Army promised to do better by its veterans and established a program they call Warrior Transition Units (WTU). On paper, WTUs were meant to provide a therapeutic, supportive environment where injured soldiers could recuperate and return to duty or gently process out of the Army. There are currently about 7,200 soldiers at 32 transition units across the Army, with about 465 soldiers at Fort Carson’s unit. Unfortunately, the word from traumatized veterans accepted into the program is that going back to Iraq would be preferable. Needless to say, that’s a pretty powerful statement coming from Iraq veteran.
The New York Times recently interviewed Specialist Michael Crawford who served as a sniper in Iraq and came home a suicidal wreck after suffering several concussions during IED explosions and witnessing several platoon mates burn to death. Crawford’s mother recognized her son’s life-threatening distress and, together, they did what it took to get Crawford into the WTU at Fort Carson in Colorado Springs.
Once he was admitted into Fort Carson’s WTU, Crawford’s situation quickly spiraled downward until the Crawford’s worst fears were realized: Michael attempted suicide. (At least four soldiers in the Fort Carson unit have committed suicide since 2007, the most of any transition unit as of February, according to the Army).
Crawford’s treatment plan in the WTU consisted of daily handouts of medications for anxiety, nightmares, depression and headaches that made him feel listless and disoriented; and a weekly session with a nurse case manager. In addition, patients are expected to keep up a semblance of military rigor despite the fact that they are heavily drugged. The noncommissioned officers in charge of the units run them like boot camp, haranguing and disciplining patients when they arrive late to formation or violate rules.
“These guys are still soldiers, and we want to treat them like soldiers,” said Lt. Col. Andrew L. Grantham, commander of the Warrior Transition Battalion at Fort Carson. But many soldiers at Fort Carson complained that discipline and insensitive treatment by cadre members made wounded soldiers feel as if they were viewed as fakers or weaklings. In many cases, the noncommissioned officers have made it clear that they do not believe the psychological symptoms reported by the unit’s soldiers are real or particularly serious.
This recent report about a Brig. General, at Fort Campbell in Kentucky, who ordered his troops not to commit suicide, demonstrates why it may be “Mission Impossible” for the military to come up with an effective, consistent approach to mental health issues:
“FORT CAMPBELL, Ky. — Thousands of soldiers, their bald eagle shoulder patches lined up row upon row across the grassy field, stood at rigid attention to hear a stern message from their commander.”
“Brig. Gen. Stephen Townsend addressed the 101st Airborne Division with military brusqueness: Suicides at the post had spiked after soldiers started returning home from war, and this was unacceptable.”
“’It’s bad for soldiers, it’s bad for families, bad for your units, bad for this division and our Army and our country and it’s got to stop now,’ he insisted. ‘Suicides on Fort Campbell have to stop now.’”
Some might put down Michael Crawford’s experience in the Warrior Transition Unit at Fort Carson as an isolated incident involving an admittedly disturbed man, but The Times reporters that covered his story didn’t stop there, they also conducted:
“ . . . interviews with more than a dozen soldiers and health care professionals from Fort Carson’s transition unit, along with reports from other posts, [which] suggest that the units are far from being restful sanctuaries. For many soldiers, they have become warehouses of despair, where damaged men and women are kept out of sight, fed a diet of powerful prescription pills and treated harshly by noncommissioned officers. Because of their wounds, soldiers in Warrior Transition Units are particularly vulnerable to depression and addiction, but many soldiers from Fort Carson’s unit say their treatment there has made their suffering worse.”
“Some soldiers in the unit, and their families, described long hours alone in their rooms, or in homes off the base, aimlessly drinking or playing video games.”
As Spec. Crawford put it, “It’s just a very dark place.” Compounding the problem is the ever-lengthening “wait time” for a medical discharge. The services are being especially careful with discharges because of the ramifications of long-term care or disability payments that might have to be provided by the Veteran’s Administration.
In Crawford’s case, he:
“ . . . has been waiting more than a year for his medical discharge. As his anxiety and depression have worsened, so have his problems in the unit. His rank was recently reduced to private in punishment for overstaying leave and using marijuana.”
“But things are looking up, his mother believes: he will be able to stay with her in Michigan while awaiting his discharge. His mother, Sally Darrow, has already seen one son commit suicide. She believes that Michael would become the second if he had to return to Fort Carson and the transition unit.”
“’At home, with family and schoolmates, he’s dealing with things better,’ Ms. Darrow said. ‘He’s not safe there.’”
The “Suck It Up” Therapy
Several reports last year exposed military foot-dragging on medical discharge as well as committing to diagnoses of PTSD. Salon ran a report of a soldier who inadvertently taped a conversation between him and his Army therapist in which the therapist admitted that he and his colleagues were under tremendous pressure to NOT render a diagnosis of PTSD. The soldier, Sgt. X, had been given a tape recorder, by his wife, to tape the session because one of Sgt. X’s symptoms is a serious memory problem and she was unexpectedly unable to accompany her husband to his appointment. She simply wanted to have a record of the session that she could not attend as usual.
During that session, when Sgt. X repeatedly pressed his doctor, a Dr. McNinch, to explain why he didn’t believe that Sgt. X was suffering from PTSD brought on by his service in Iraq, this was his doctor’s unusually candid reply caught on tape:
“‘OK,’ McNinch told Sgt. X. ‘I will tell you something confidentially that I would have to deny if it were ever public. Not only myself, but all the clinicians up here are being pressured to not diagnose PTSD and diagnose anxiety disorder NOS [instead].’ McNinch told him that Army medical boards were “kick[ing] back” his diagnoses of PTSD, saying soldiers had not seen enough trauma to have ’serious PTSD issues.’”
“‘Unfortunately,’ McNinch told Sgt. X, ‘yours has not been the only case … I and other [doctors] are under a lot of pressure to not diagnose PTSD. It’s not fair. I think it’s a horrible way to treat soldiers, but unfortunately, you know, now the V.A. is jumping on board, saying, ‘Well, these people don’t have PTSD,’ and stuff like that.’”
Of Course, Heads Must Roll
Call it a coincidence but, on the heels of the New York Times piece came the news, on Sunday, that Noel Koch, the Deputy Undersecretary of Defense for Wounded Warrior Care and Transition policy had been relieved of that position. Koch said that he was asked to step down by Clifford Stanley, Deputy Undersecretary of Defense for Personnel.
According to Pentagon press secretary, Geoff Morrell, Defense Secretary Robert Gates has asked Stanley to do a full review of the Pentagon’s personnel and readiness office. “He was given wide latitude to make needed changes so that our men and women in uniform are better served,” said Morrell. “What you’re seeing is that the overhaul of that vitally important office is under way.”
For his part, Koch said he believes the decision was unjust and that he resigned “under duress” after Stanley told him he had no confidence in him. The Pentagon had no comment on that statement.
Problem Not Responding to Appropriations
Meanwhile, the Pentagon is “just baffled” by the fact that millions of dollars and revamped veteran’s programs have not stemmed the ever-increasing tide of military suicides. Just this morning, this report ran in Army Times:
“Troubling new data show there are (sic) an average of 950 suicide attempts each month by veterans who are receiving some type of treatment from the Veterans Affairs Department. Seven percent of the attempts are successful, and 11 percent of those who don’t succeed on the first attempt try again within nine months. The numbers, which come at a time when VA is strengthening its suicide prevention programs, show about 18 veteran suicides a day, about five by veterans who are receiving VA care.”
Something is definitely NOT working here despite whatever tweaks to programs have been tried. There are now more veterans killing themselves than are killed in battle.
The military tend to dance around the obvious “suspects” of multiple deployments and abbreviated dwell time (time spent at home between deployments); basically, because they are strapped for volunteer troops and have to deploy and redeploy to keep “boots on the ground” in multiple war zones. And whereas the Pentagon has a virtual blank check for analyzing weapons systems and planning the Long War out to 2050 and fun stuff like that, it doesn’t seem to have the time, money or inclination to do a deep dive into the suicidal troops problem.
Fortunately for the troops, someone in Washington, Sen. Benjamin Cardin (D-MD) does give a tinker’s dam and proposed an amendment to the 2010 Defense Appropriations bill for a study into the military suicide boom.
As reported in Air Force Times in July of last year, Sen. Benjamin Cardin, (D-MD) sponsored an
“By voice vote, the Senate approved a Cardin-sponsored amendment to the 2010 defense authorization bill that would order an independent study by the National Institute of Mental Health on the potential relationship between suicide or suicide attempts and the use of antidepressants, anti-anxiety and other behavior-modifying prescription drugs.”
Aha! Now there’s an interesting premise; especially given reports that the military is handing out psychotropic drugs like candy to those in combat zones as well as those returning with PTSD. In addition, many of those drugs have the well-documented side effect of increasing suicidal thoughts in teen-agers and young adults, up to 24 years of age. Sen. Cardin might be on to something here.
Sure enough, according to an article in TIME, the historic level of suicide in the military just happens to be running concurrent with another “first” in military history:
“For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army’s fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.”
“The Army estimates that authorized drug use splits roughly fifty-fifty between troops taking antidepressants — largely the class of drugs that includes Prozac and Zoloft — and those taking prescription sleeping pills like Ambien.”
The rationale for all this doping?
“Using drugs to cope with battlefield traumas is not discussed much outside the Army, but inside the service it has been the subject of debate for years. “No magic pill can erase the image of a best friend’s shattered body or assuage the guilt from having traded duty with him that day,” says Combat Stress Injury, a 2006 medical book edited by Charles Figley and William Nash that details how troops can be helped by such drugs. “Medication can, however, alleviate some debilitating and nearly intolerable symptoms of combat and operational stress injuries” and “help restore personnel to full functioning capacity.”
“Which means that any drug that keeps a soldier deployed and fighting also saves money on training and deploying replacements. But there is a downside: the number of soldiers requiring long-term mental-health services soars with repeated deployments and lengthy combat tours. If troops do not get sufficient time away from combat — both while in theater and during the “dwell time” at home before they go back to war — it’s possible that antidepressants and sleeping aids will be used to stretch an already taut force even tighter. ‘This is what happens when you try to fight a long war with an army that wasn’t designed for a long war,’ says Lawrence Korb, Pentagon personnel chief during the Reagan Administration.”
“Nearly 40% of Army suicide victims in 2006 and 2007 took psychotropic drugs — overwhelmingly, selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft. While the Army cites failed relationships as the primary cause, some outside experts sense a link between suicides and prescription-drug use — though there is also no way of knowing how many suicide attempts the antidepressants may have prevented by improving a soldier’s spirits. ‘The high percentage of U.S. soldiers attempting suicide after taking SSRIs should raise serious concerns,’ says Dr. Joseph Glenmullen, who teaches psychiatry at Harvard Medical School. ‘And there’s no question they’re using them to prop people up in difficult circumstances.’”
From the “Irony of Ironies” Department: military recruiters turn away prospective enlistees that are currently taking a prescription for anti-depressants. In order to be reconsidered for military service, they must be off of the drug for one year and have a doctor certify that they are functioning normally without anti-depressant drugs.
Adding a Degree of Difficulty
Suicide is one danger here but it’s easy to imagine others when combat troops are drugged. Here’s how one veteran put it:
“LeJeune, who spent 15 months in Iraq before returning home in May 2004, says many more troops need help — pharmaceutical or otherwise — but don’t get it because of fears that it will hurt their chance for promotion. ‘They don’t want to destroy their career or make everybody go in a convoy to pick up your prescription,’ says LeJeune, now 34 and living in Utah. ‘In the civilian world, when you have a problem, you go to the doctor, and you have therapy followed up by some medication. In Iraq, you see the doctor only once or twice, but you continue to get drugs constantly.’ LeJeune says the medications — combined with the war’s other stressors — created unfit soldiers. ‘There were more than a few convoys going out in a total daze.’”
Now, I know, from personal experience, that drugs like Zoloft and similar SSRI anti-depressants require rigorous consistency on the part of the patient and regular follow-up by the prescribing physician. Doses need to be carefully titrated, over time, to the ideal dose and take upward of two months to produce a therapeutic result. It can be disastrous to discontinue such anti-depressants abruptly; patients must be carefully weaned from them. All in all, this class of anti-depressant is not a great candidate for a highly unstable environment where supply will almost certainly be sporadic and where many patients are young, naïve and stressed and likely to use drugs in un-prescribed ways.
Looking at all of that, I can’t avoid wondering if some of our troops odd behavior, (to include some collateral damage) that has been reported in Iraq and Afghanistan might not have some connection to the haphazard drugging of soldiers compounding the death and destruction that our troops are inflicting on themselves and their families and loved ones. One thing is fairly certain from my own Vietnam generation, these mental health problems don’t go away by themselves in the short-term or the very long-term for the veterans, their families, loved ones, friends and communities. Now is the time to deal with it, if it’s not already too late . . .
[tags]military suicide rate, anti-depressants, anti-anxiety drugs, Ambien, Zoloft, Clonazepam, Veteran’s Administration, PTSD, Pentagon, Noel Koch, Michael Crawford[/tags]
