Hidden Battles on Unseen Fronts Read online

  Chris’ VA benefits hadn’t kicked in yet, and he had to find a way to support his family. He started job hunting. Personable and, at the time, highly motivated, Chris overcame his lack of a college degree and mental problems and found a job at the Union Pacific Railroad as a conductor in training. During his time in Iraq Chris had been given 80mm of Proszac a day for his PTSD, an amount that shocked the physicians at the Seattle Veterans’ hospital where he went for treatment. “Why the hell are you on a major anxiety drug?” one doctor said. “I wouldn’t give this to anyone in your condition, particularly in combat.” The doctors experimented with various cocktails of medications: Zoloft, Paxil, Efferex, Cymbalta and others, singly and in combinations. Each prescription had side effects and none really worked.

  Then, after just six weeks, the Union Pacific training program was suddenly dismantled and Chris was let go. He became depressed and anxious and withdrew into himself. “I tuned out. I’d stare at the television all day and see nothing. I had headaches and ringing in my ears, but most of all I was drowning in a black hole.” His father, an Army veteran of 32 years, couldn’t understand why his son, the youngest of four brothers, two of whom were deceased, could not get his act together. They fought. “He yelled at me, ‘The way you’re acting, you’re spitting on all your dead brothers.’ I took Kathy and the kids and left the house.” Chris moved his family to Spokane to live with his birth mother, whom he had not seen since he was two, but he was unable to find work and returned to Seattle, this time moving in with his brother’s family.

  He was accepted into “Hard Hats,” a program training military veterans to become sheet metal workers. “The problem was, I was out of shape and had gained weight and my body couldn’t take it. I’d try to lift or carry those heavy sheets of metal, and my back would just give out.” Two weeks into the job Chris told the foreman he couldn’t physically handle the work. A few weeks later he found another job, this time as a security guard at $6.00 an hour. But his depression was worsening along with disturbing new symptoms such as loss of memory. He was unable to concentrate on the simplest of tasks.

  “I got so paranoid. I was in a state of panic most of the time. I don’t think people understand the pain of what goes on in your head. You’ve lost yourself and it’s scary as shit. No one sympathized. I mean it wasn’t as though I’d lost a leg or gotten shot up. It was all in my head.” After ten minutes on the security guard job, Chris’ back, knees and legs would seize up, putting him in excruciating pain. He had to quit. “I had no money for gas so I spent a lot of time on the Internet trying to find a job. My brother didn’t understand what was going on. His wife got fed up with us and had the cable disconnected. We had a big argument and I said, ‘Okay, I guess we’re uninvited.’” Chris and his family were homeless.

  Kathy sent her oldest son, Austin, back to North Carolina to live with his father. “It was the hardest thing I’ve ever done in my life,” she says. “I’d raised him by myself, and it broke my heart to have to send him where I knew he wasn’t wanted, but we weren’t getting by and I didn’t know what else to do.” To make ends meet, Chris and Kathy sold their belongings and pawned their wedding rings. Yet a few days later they and their two sons were living out of their car. Someone told a radio station about their plight and it broadcast their story, which raised enough money to pay for a cheap motel and food for the two boys.

  “I wanted to give up so many times,” Kathy recalls, “but even at his most depressed, Chris believed we could do it.” At the end of their rope, they were rescued by the Marine Corps in the form of a final check for moving expenses for transitioning out of the military. They got their rings out of the pawnshop, packed up their few belongings and drove across country back to Raleigh, North Carolina where Kathy’s older sister lived. However, instead of improving, their lives went downhill.

  “We got Austin back and moved in with Patty. But her husband was a drunk and a month after we got there he threatened me with a shotgun. That night we packed up our bags and left. It was the worst of the worst. We’d sold all our furniture, and the souvenirs I’d brought back from my deployments. Everything we owned was in three Rubber Maid tubs. By 3 a.m. we’d been driving around Raleigh for hours.” The next morning Chris called “Marine 4 Life” asking for help. Within 24 hours the Marine 4 Life team had moved the family into a motel.

  It was then that Chris and his family first came to the attention of the Armed Forces Foundation. The Marine 4 Life team contacted the Foundation requesting financial assistance for Chris and his family while they helped him look for a job. The foundation immediately paid for the family’s lodging and food for the week. Chris interviewed with Norfolk Southern Railroad and there was a good possibility of employment. At the end of the week the Marines moved the family into the Warrior homes at Camp LeJeune, fully furnished on-base housing designated for injured veterans and their families. Better yet, during their two and a half months stay there Chris was able to get regular treatment for his PTSD symptoms. A number of organizations, including the AFF and the Semper Fi Fund, covered the family’s expenses. Chris’s paranoia and depression lessened, and the nightmares that awakened him three and four times each night began to dissipate. The worst was over.

  The position with Norfolk Southern was still iffy, so in August when Chris was offered a job as a manager trainee with the Kangaroo Pantry in Greenville he took it, even though the starting salary was miniscule and there was no health coverage until he spent a year with the company. The Semper Fi Fund helped move the family and paid their first and last month’s rent so that they could get settled into an apartment. Austin and Zachary needed to begin school. The Armed Forces Foundation contacted Aaron’s Furniture to see if they would donate furniture since the family still owned nothing but a few bundles of clothing. Aarons donated a living room suite, bunk beds and a toddler bed for the boys’ room, a bed and chest for Chris and Kathy, and a washer and a dryer. By now Chris was receiving $1,100.00 a month in Veteran’s benefits but he still couldn’t feed his family, get treatment for his PTSD, and pay the rent.

  In early October, Norfolk Southern accepted him into their conductor training program, and Chris decided to take their offer as a second chance to find the security he and his family so desperately needed. The railroad job came with medical benefits after two weeks of work, as well as higher pay. “His optimism always won me over,” Kathy says. “I remember times when we had to drop everything and leave, but I always trusted him because he never gave up. He said ‘My boys deserve better and I promise I’m going to get it for them.’” The family moved into an apartment in Norfolk, enrolled the two older boys in school, and Chris started training. They had to pawn their wedding rings a second time in February 2008 to pay their electrical and heating bills, but by the end of March Chris completed his training and became a conductor for Norfolk Southern. He had made good on his promise.

  MEDALS

  Combat Action Ribbon (Iraq), 2 Marine Corps Good Conduct Medals, Humanitarian Service Medal, 6 Sea Service Deployment Ribbon, Armed Forces Expeditionary Medal (Haiti), Iraq Campaign Medal, Global War on Terrorism Service Medal, National Defense Service Medal, 2 Navy Unit Commendations.

  “The story of Mr. Woodruff’s recovery is nothing short of a miracle. He considers himself lucky to have received incredible care. Not only did he have to go through surgery and grafts to repair the physical damage to his face and head, but needed rehabilitative for the unseen damage to his memory, thought processes and speech. In addition to his initial treatment upon returning from Iraq, he needed constant follow-up therapy to recuperate his cognitive abilities.”

  —“Brain Injured Newspaperman Speaks Out For Returning Iraq War Veterans,” Fern Cohen, www.ezinearticles.com

  2

  DECIDING WHO IS SANE ENOUGH TO FIGHT

  The Ethics of Military Medicine in a Time of War

  By Alice Psirakis, LCSW

  Specialist D, a young 20-year-old soldier, walked out of the psychiatris
t’s office and sat in the waiting room until we could get his paperwork ready. He was a mobilizing soldier, having just arrived on post one short day ago. His unit was being processed through the medical stations when a red flag popped up, sending him over to our department for an evaluation.

  The soldier had informed the medical provider that he was on Depakote, a medicine used for bipolar disorder or, sometimes, as an overall mood stabilizer. Anytime a soldier revealed that he was on any psychotropic medication, an instant referral to Behavioral Health was generated for clearance to continue mobilizing. In this soldier’s case, the psychiatrist did not feel comfortable clearing him because he would most likely be unable to get blood work done in theater (Iraq) to monitor his Depakote levels. It was dangerous to deploy someone who was on Depakote or Lithium because of the extreme heat, so those medications were automatic disqualifiers.

  But when I handed the soldier the paperwork containing the information that would generate the process to return him back home, I felt a piercing inside me. The soldier looked at me, about to break down. He was heartbroken as though we had just crushed his dream. Whenever I used to tell my dad about grandiose plans I had and he would ask me a thousand logistical questions, I’d always say to him in an exasperated tone, “Dad, you’re such a dream-squasher.”

  In that moment, I felt like a dream-squasher. He looked at me with such a look of devastation that I felt sorry for him almost as if we were responsible for doing something cruel to him. Imagine that—I felt guilty for not sending someone to war. What had my world come to? The existence of that type of guilt itself seemed warped.

  And yet, I felt it.

  Sergeant K was a tall, husky, 49-year-old Army Reservist who was mobilizing for the third time to a combat zone—one tour in Afghanistan and one in Iraq had earned him the diagnosis of Post Traumatic Stress Disorder (PTSD). He suffered from nightmares, intrusive memories and emotional numbing. Yet here he was, having volunteered to deploy once again—a phenomenon all too common. He came through our doors as a self-referral, with a primary complaint of insomnia. After an extensive psychosocial history it was clear that SGT K was suffering from PTSD. During a session in which I encouraged him to discuss his intrusive memories, he told me about a young Afghan girl who was killed. SGT K broke down, sobbing as he remembered this, feeling that he was somehow responsible for her death. But SGT K was insistent on being redeployed. He had not come to Behavioral Health to get sent back home—he just needed to sleep. He told me, “If I could just sleep I’ll feel better. My guys need me.” I couldn’t argue with him about that.

  But I also remember telling him that I thought this third deployment was going to be the psychological death of him. SGT K agreed.

  Yet Sergeant K had been training effectively with his unit over the past few months. He was mission-oriented, taking care of his lowerenlisted soldiers the way an NCO (Non-Commissioned Officer) is supposed to. He had a vast supply of knowledge and experience to contribute that only a seasoned combat veteran could have. He hadn’t frozen or panicked at all during any simulated fire and training exercises. Other than his insomnia, none of his other PTSD symptoms seemed to be affecting his training at this current time—this current time being the operative phrase. He wanted to deploy. He felt a responsibility toward his younger, less experienced soldiers who were counting on him during this deployment.

  And the truth was, no concerning training or behavioral issues had been observed or reported by his leadership thus far. Considering the circumstances, SGT K was functioning extremely well.

  After a short-term treatment regimen combining brief psychotherapy and medication management, we decided to deploy SGT K on antidepressants, with instructions to follow up at Combat Stress Control once he got to Iraq.

  While I served as the Chief of Behavioral Health Services at one of the largest Army deployment installations from 2004 to 2007, that was my entire life. Day in and day out, my staff and I were tasked with deciding who went to war, who returned home, who would deploy at a later date to the combat zone, who could redeploy and who couldn’t. The military refers to this as Fitness for Duty Evaluations. Thousands of soldiers walked through our doors awaiting a disposition that, no doubt, would alter the course of their lives.

  I was a New York State-licensed clinical social worker; a member of the National Association of Social Workers, whose code of ethics highlights values such as client self-determination (the client is ultimately responsible for his own course of action and decision-making). I had spent years working as a community-based public health social worker. But I was also a Captain in the United States Army. I was a medical officer whose corps motto was “To Conserve the Fighting Strength.” Years ago, I had sworn to protect my country and serve as a personal reflection of the Army’s core values. My warrior ethos talked about things like, “I will always place the mission first.” And so here I was—a social worker plucked out of the civilian world and now mobilized to carry out the Army’s mission.

  And I was responsible for placing the mission first.

  Very few people understand the cognitive dissonance that begins to take place here, and the potential ethical conflict that starts brewing between what I may think a soldier needs and what the Army needs. As a military social worker serving in a time of war, sometimes it was unclear to me who I worked for. In my civilian life the answer was easy—the client of course! In the military the answer was much more blurred. Who was I responsible to? Where did my clinical loyalties lie? Did I work for the individual soldier? Or did I work for the collective Army as a whole?

  The reality, I discovered, was that I worked for both simultaneously—a balancing act which would prove to be a huge challenge over the course of my tenure at Fort Dix. I knew in my heart that client-self determination was a paramount part of my professional ethos, but that was not a value to be emphasized in the Army. It didn’t matter if someone wanted to go to war; they just had to. And we had to figure out if they could. However, I need to make something clear here: neither I, nor the team that I supervised, ever operated in any unethical ways. When my team and I made a decision whether or not to deploy a soldier, we struggled and struggled to make the right one. While I understand that civilians who read this may judge the clinical decisions I made as compromising, my hope is to offer an insider’s perspective and expose them to the intricacies of the military mental health system during a time of war.

  When we deployed SGT K we were not saying that he did not have Post Traumatic Stress Disorder—quite the contrary. We were deploying him with PTSD. To many, that is simply disturbing, and I can understand and respect that. But allow me to explain how that is even possible in the world of military medicine. The secret is this: It all came down to level of functioning.

  The last criterion in the DSM IV-TR diagnostic guide for almost all psychological disorders asks: how severely do these symptoms impact the person’s current social and psychological level of functioning? In other words, how distressing is this condition/illness to the person in their interpersonal relationships, in their place of work, at school, in how they interact with the world in general? Taking this into consideration, we recognized how two people with a diagnosis of PTSD may have very different symptom manifestations of it. Some are completely incapacitated, while others exhibit fewer symptoms, causing them lesser distress.

  There were so many other factors that guided my decision-making: where was this soldier deploying? Would he be “outside the wire” and thus potentially exposed to violence if not combat most of the time? What was his MOS (Military Occupation Specialty); in other words, what was his job? Was he a computer technician who would be inside the wire fixing computers most of the day or was he a gunner going on several patrols a week, probably engaging in live fire exchanges? Was he an administrative clerk who was helping out the Executive Officer all day or was he a truck driver, going back and forth to different bases in Iraq? How savvy was his command about mental health issues, and could we trust him to
take care of his soldiers if he observed behavior that concerned him?

  Was there a combat stress team deploying with his unit? Could the soldier receive his psychotropic medication while in theater (the combat zone)? What was the soldier’s previous level of traumatic exposure? What would his potential level of traumatic exposure be in the combat zone this time around? How was he reacting during training here in the States? Was he freezing up during the simulated mortar attacks? Was he withdrawing and isolating himself from his comrades? Was he unable to work as a team player? Did he run for cover every time the cannon went off at 1700hours daily on post? How disruptive was his hypervigilance to his everyday functioning? The list goes on and on…

  It is very difficult to predict human behavior and psychological deterioration in general, much less in a combat zone. And on some level, that is what I was being asked to do. The reality is, not everyone is built and wired the same way. We don’t really know why some people will break down while others don’t. We don’t really know why some people will get PTSD when others, having endured similar trauma, won’t. We have some ideas, but we don’t truly know. And the truth of the matter is, on some level, as clinicians, we took a risk answering these questions and hoped that our clinical expertise, coupled with a prayer here and there, would prove to be the right answer.

  The front cover of the June 16, 2008 issue of Time magazine was titled, “America’s Medicated Army, bringing to light the controversy of deploying soldiers on medication or giving them meds to assist them with symptoms while in combat. I never saw that as unethical—I saw it as practical, a necessary evil almost. In a rose-colored glasses world, that would not be the case. But the reality of war dictates otherwise.