Then a weekend would go by without me dropping anything or losing my memory. My symptoms would come and go. The more I thought about it, the more I realized that this was consistent with early-onset Alzheimer’s disease. I was perplexed by all of this. I was not myself at all. But what seemed strange was that I didn’t fit the typical PTSD Vietnam veteran stereotype. I wasn’t having nightmares anymore, I didn’t drink much alcohol at all, and I wasn’t beating my wife. Yet I was clearly feeling the effects of the war. I just wasn’t right, as my wife said more than once.
One Monday morning I turned the TV in my office to CNN. Amazingly, an old colleague of mine from Walter Reed Army Medical Center was doing an interview. Dr. Deb Warden, a noted neurologist and psychiatrist, was talking about how researchers had discovered that some soldiers who had been exposed to blast injuries or extreme stress had abnormal brain scans. Dr. Warden lifted the whole world off my shoulders by explaining my symptoms to me through her CNN interview. I sat there dumbfounded but increasingly relieved as she described every symptom that plagued me: mental confusion, memory loss, rage episodes, and spontaneous stumbling while walking were now commonly seen in some veterans returning from the war. We also now know that the symptoms of soldiers who lose consciousness during a blast explosion get worse, and some never return to who they were before the war. I was lucky—I never lost consciousness. But still, I was one of those veterans who was struggling. I couldn’t hide it anymore.
I went home that night and had a long talk with Janet. She and I were relieved now, glad that at least we knew what was wrong. Dr. Warden’s interview vividly illustrated what happened to a soldier’s brain when he was blown off his feet by a bomb blast—as happened to me several times in Iraq. Dr. Warden explained that the tricky thing is that, like me, even though the soldier doesn’t crack his skull or get shot, the force from the blast still damages the brain. Put this together with the stress placed on the central nervous system from constant psychological strain of being in a combat zone, sleep deprivation, food deprivation, and the 120-degree heat, and the result can be an adverse impact on a soldier’s brain functioning and central nervous system—the new PTSD.
What was happening was that these soldiers were slipping through the cracks of the medical system, just like I did. Why? Well, soldiers like myself were never shot, never hit our heads, nor had any shrapnel from a roadside IED in us. We had two eyes, two ears, a nose, walked okay, and didn’t report any nightmares. The medical system had no reason to pay attention to us. We seemed normal when we returned home and didn’t request any assistance. The only saving grace was that, even when we didn’t seek help, for most of us the prognosis was good. Dr. Warden went on to say that most of these soldiers would return to their predeployment condition. Others—no one knew why—would never be the same.
My struggles grew less as time went on. Just when I thought I had it bad, a new patient, a new soldier walked into my world. I was in my office one day, as usual sipping on a cup of hot coffee and working on an article. My phone rang. It was my secretary. She said, “Colonel, I need your help up front, sir. There is a guy up here who needs some help.” She sounded a little odd. I said yes, that’d I’d come up front, but I didn’t understand why she was calling me with this. “Shouldn’t you be sending him to the psychiatry outpatient clinic or the emergency room?”
“Well sir, yes, I should but this soldier insists on only talking to somebody who is a combat veteran. Sir, most of our providers are civilians.”
I told her I would be right there.
Sergeant Jose Gomez was one horse of a soldier. This twenty-four-year-old specifically requested to see a psychologist who had been deployed to Iraq. Sergeant Gomez was a hard-charging, dedicated career medic. He loved being a soldier. He had a handsome Latin tan that seemed to accentuate his coal black hair and deep brown eyes. From his frame one could clearly see that this soldier dedicated at least two hours per day to the gym, with a purpose.
“What brings you in to see me, soldier?” I asked.
He responded with two words. Two words that symbolized the life, spirit, mind, and body of many soldiers upon their return home. He said, “I’m broken.”
“Son, I’m not sure I completely understand all of what you mean. What’s broken on you?” I asked.
“Sir, it’s not on me,” he said, obviously struggling to explain something that he didn’t fully understand himself. “It’s in me, Colonel. My heart . . . something . . . Sir, my mind, sir . . . My mind ain’t right, Colonel.”
Sergeant Gomez and I spent three hours together that day. He told me about how he had witnessed the carnage in Sadr City, Iraq, the worst ghetto and most dangerous place in that country. He was assigned to an armored cavalry unit. As a medic he was required to go wherever his unit went. The fighting was intense and almost daily for his unit. He saw old men, children, and his buddies get blown apart. And as a medic, he never had the option of turning away and trying to put it out of his mind. His job was to go into the worst of the carnage and try to help.
“Sir, I had to just put all my emotions in a box and not deal with this shit until I got back home,” he explained. “Colonel, I can’t sleep. I hear my dead buddies’ voices all the time. I have to drink three beers just to get to sleep at night, sir. I’m scared.”
Gomez had the more common PTSD-type symptoms. But what brought him in to see me right now?
“Sir, I threatened to choke my wife if she didn’t stop talking. Man, I was out of it this morning, Colonel. I never, ever thought about hitting my wife before.” As he told me this, Sergeant Gomez wept like a child whose mother had just died. I got his family physician to prescribe him medication for sleep and I would work with him in therapy twice a week for the next month and then each week for about six months. Sergeant Gomez got better, stayed with his wife, and rotated on to his next Army duty assignment. There were thousands of soldiers just like him.
My experience with Sergeant Gomez made me think back to a good friend, Colonel Charles Hoge, who had taken a team of researchers from Walter Reed to Iraq to conduct intensive study on the extent of mental health problems among our soldiers deployed to Iraq. I realized that Colonel Hoge and his colleagues had predicted exactly the symptoms that troubled Sergeant Gomez. The colonel and I shared a tent at Camp Victory every Saturday in August and September 2004. Charles and I would doze off to sleep at night while debating. I thought that his numbers overstated the levels of PTSD, depression, and anxiety among the troops. He, in his usually eloquent way, would disagree and say that they most likely underreported the seriousness of the problem. I had to agree now that Sergeant Gomez was neither rare nor unusual. We now know that at least 3 to 15 percent of soldiers and marines have some problems with PTSD, depression, or anxiety when they come home. We also now know that at about ninety days after a guy gets back from Iraq the numbers increase to at least 30 percent. Back at home, the loss of a job, family problems, and grief frequently combine to push many soldiers over the edge. I can’t imagine what it would have been like for me upon my return if I had learned that my wife had left me and/or my home was being foreclosed on.
On many occasions the system gets in our way of helping a soldier get the help that he needs. A reporter by the name of Lisa Chedekel published an article in the Hartford Courant on October 3, 2007, about how many soldiers who committed suicide on their return home from the war had previously been seen by an Army mental health provider. She reported that 43 percent of the soldiers who committed suicide had been prescribed psych medications before and 60 percent were seen by mental health providers before the suicide. A shocking 36 percent had been seen by an Army mental health provider within just thirty days of committing suicide.
Death always finds a soldier, either on the battlefield or at home. That thought kept going through my mind over and over as I reviewed this newspaper article. Chedekel didn’t know that the system gets in the way. Usually these soldiers get lost in the system and commit suicide not because
they receive poor treatment by the psychologist or psychiatrist, but because the soldier’s commander won’t listen to them. I wish I had a nickel for every time I said to a commander, “Captain, this guy is not doing well. You need to leave him home,” but then they made my patient deploy anyway. Well, usually they had to send the soldier back early from the deployment. This was a common battle between the mental health department and the manpower demands of the commander’s mission.
On October 19, 2007, USA Today published an article saying that mental illness was the number two complaint among soldiers when they returned home. The numbers are simply staggering. Since 2006 they increased by 20,000, which was about a 70 percent increase over the twelve previous months. According to this article, one out of every seven returning veterans reports a problem with PTSD, depression, or alcohol. Most of the reports just don’t know that these numbers are a gross underestimate. Like me when I returned back from the war, I was not going to say “yes” or “true” to any questions on any medical/mental health screening form. Why? Well, the answer was simple. If I said yes to any questions, that meant that I would be kept at a regional hospital for another month or two, perhaps maybe five or ten months until everything was diagnosed and treated. Soldiers want to go home to their wives, just like I did.
Also, I felt the screening questions to be a violation of my privacy. I did not ask to be evaluated and I wanted to deal with my PTSD symptoms in my own way. As a result of these dynamics, we missed a lot of soldiers like myself. I honestly felt emotionally harmed by the screening process. Just when I would neatly tuck the emotional pain away, some medical general would get an idea to have us screened again. The nightmares returned every time after they forced me to dredge up those memories. Or we would be forced to attend some bullshit seminar on combat battle fatigue taught by an officer who had never deployed anywhere. That was usually an immediate turnoff. Soldiers who have deployed a lot, including myself, find it difficult to take advice or orders from those who have never deployed. On one occasion I was ordered to attend a seminar at Tripler Army Medical Center with two hundred of my closest friends who had all deployed. At Tripler, an Army psychologist who thought he knew it all told us, “You will have nightmares, get drunk a lot, have PTSD, beat your wife, and threaten people.” This enraged me. How dare this ignoramus tell me I’m going to do all those things just because I was in combat?
Given the staggering amount of data documenting the prevalence of mental health problems among the troops, I reflected on my fight with Colonel Kerry Matson when I was down range at Abu Ghraib, trying to convince her that the soldiers at Abu Ghraib needed mental health care on site, not a dangerous convoy trip away. The fact that I even needed to make that argument to her was amazing and awful. I also thought of the warrant officer and interrogator Betty Patterson, who often talked with me about how she had seen two interrogators blown apart by a mortar attack. Her words rang in my ears as I wondered how she was doing, probably home from Iraq by now: “Sir, they died right there in front of my eyes . . . One of their body parts were laying on the ground. I stood there dazed when the medics picked them up and put them in a body bag. After a while, I couldn’t do my work and I just cried a lot. Sir, we didn’t have no psychologists, no chaplains or anybody to help us deal with this. Colonel, sir, it was shameful how they just left us there with no help.”
No human being should have to see that amount of death and feel that amount of pain. I was sent into hell and asked to fix it, I said to myself. Did I? God, I hope I really made a difference.
The global war on terrorism will go on for many years to come. But I was coming to realize that, yes, I had survived, psychologically and physically. And I was beginning to realize that I had made a difference. Many of the positive changes I recommended are still in place at Army detention facilities around the world, and that is one of my proudest achievements.
Another morning found me in my favorite Old Navy pajamas, hot coffee in hand, kicked back in my favorite chair upstairs with the TV tuned to a movie on HBO. I could hear Janet and Judy downstairs, happily making breakfast. Unlike the recent, shameful episode in which I lashed out at my sweet grandchild, this time I was truly relaxed and felt whole again. But still, as I sipped my coffee and enjoyed the quiet of the morning, my thoughts drifted away for a few moments, back to the death ceremony when we loaded the soldier’s flag-draped coffin onto the C-130 cargo plane on the flight line in Kuwait. I could see myself standing there in 130-degree heat, saluting as the honor guard marched by with my fellow soldier’s coffin. I did not know that soldier’s name. All I knew was that this soldier had given his or her life in service to our country, fighting evil on a foreign soil. And this soldier was somebody’s brother, sister, mother, father, son, husband, and America was a better place because of him, his deeds, his dedication to duty for us.
As I heard my granddaughter’s laugh again, I snapped back into the present. I smiled to myself and took comfort in knowing that my rage had faded away, as well as my many hauntings in the night. But then again, the image of the soldier’s coffin being carried on board the C-130 I would always hold on to. I decided to never allow myself to forget this image, my sense of gratitude for those who volunteer for the fight and pay the ultimate price. This image over the years would serve to provide me with a sense of comfort knowing that America has many great men and women willing to make the ultimate sacrifice for its safety, and the fight against evil, tyranny, and terror.
My granddaughter came up the stairs, jumped on my lap, and took a big swig from my coffee cup. I hugged Judy tight and felt a warm satisfaction in this quiet moment with one of God’s sweetest creations.
I look forward to the day when I can sit at Café Du Monde in New Orleans, have a café au lait with Judy, and tell her the story of the great men and women I served with in Iraq, Cuba, and Afghanistan. I want to tell her how I was a part of the fight to help save our humanity.
12
Go to the Basement
May 2005
Even though I felt that I was getting back to normal, smiling and laughing like my old self, my brain and my psychomotor skills still sometimes showed some of the aftermath of my time in Abu Ghraib. With no warning, my brain would involuntarily go on pause. To cope, I busied myself with administrative matters of the department while my colleagues, staff, friends, and students attempted on many occasions to get me to talk about what happened at Abu Ghraib. It wasn’t until May 2005, while I was teaching a psychology workshop to a group of young Army captains in our training program, that I seemed to come out of the mental fog. In my time away from classroom instruction, I started organizing my thoughts on Abu Ghraib, trying to bring some order to my memories and to find the lessons that might help other soldiers and psychologists. I was reluctant to talk with anyone about those experiences and what I had learned, but I knew that it was important to document them.
One day I was about halfway through my planned classroom discussion when I asked if anyone had any questions. A young Army captain by the name of Jessica Schuster from Minnesota surprised me and spoke up. Captain Schuster was like many young female Army officers. She was a former goalie on a girls’ hockey team, frequently lifted weights, and she had a get-down-to-business approach and style.
“Sir, I got an e-mail from one of my professors back at Minnesota and he told me that you were the guy sent to Abu Ghraib to put procedures in place to fix that horrible tragedy,” she said. “Colonel James, our year here is winding down. Sir . . . so, even though you haven’t talked about this much, my question is . . . sir, what leadership principles did you take away from Abu Ghraib?”
It wasn’t the first time I had been asked this question, of course, and I was used to just brushing it off. I could have easily demurred and returned to the day’s lesson, but for some reason my mind was receptive when the query came from Captain Schuster. At that moment, my brain and my memory seemed to start working again and in a very fluid way I was able to organize my thoughts
. I felt like I was finally ready to tell someone about Abu Ghraib. I felt I finally understood it enough that I could offer some useful lessons. I don’t know why it happened at that moment, but it did, and I decided to answer the captain’s question.
I thought for a moment about the notes I had been making on lessons from Abu Ghraib, and then I turned, looked Captain Schuster right in the eyes, and whispered, “Schuster, you got to be there.”
She responded in a kind of a confused way. “Sir, what did you say? I didn’t hear you, sir.”
I repeated myself, louder, so the whole group could hear. “You have to be there. Captain Schuster, as a leader you need to always remember to be there. Never allow yourself to be a vacant, distant, and emotionally detached leader.”
I explained that there were many reports of the brigade commander, the post commander, and the task force commanding general of Abu Ghraib as simply being vacant leaders. They weren’t there.
“Sir, forgive me for asking something stupid and dumb, but Colonel, I really need to get in the weeds of it because when I graduate from here, I may never have another chance to talk with you about this again, sir,” she continued, speaking with an intensity I had not heard from her before. “Sir, why is this so important?”
“Well, Schuster, if I’m not there as a leader that will leave a message to my subordinates that I’m gone, not only physically but most importantly it sends the message that I left the mission, and I don’t care about the mission,” I told her. “When that happens we may as well pack up our shit and go home.”
She looked stunned, like she didn’t expect such a strong answer from me.
“Captain Schuster, you and your student colleagues need to hear what I’m about to say next,” I said, glancing around to the other attendees, who were now paying attention. “You gotta go to the basement.”
Fixing Hell Page 21