Tuesday, October 25, 2005

PTSD

By Nathaniel Fick
The Boston Globe
August 28, 2005

IRAQ VETERAN Daniel Cotnoir learned that Baghdad rules don't apply in Lawrence (Mass.). The former Marine sergeant, who was named 2005's ''Marine of the Year" by the Marine Corps Times newspaper, was charged earlier this month with two counts of armed assault with intent to murder after firing a shotgun near a crowd of revelers outside his home. He had already reported their noise to police and, when a glass bottle shattered his bedroom window, Cotnoir allegedly feared for the safety of his wife and children. The story chilled me, not because I could have been part of the crowd, but because I imagined myself as the shooter.

As a Marine officer from 1999 to 2003, I led platoons in Afghanistan and Iraq. Following two combat tours, I left active duty to go to graduate school, thinking I could seamlessly return to normal life. But even with a loving family, supportive friends, and solid future prospects, homecoming derailed me for a year. I woke up to nightmares, shook uncontrollably during Fourth of July fireworks, and felt myself switch into ''combat mode" when challenged. After a driver cut me off on my morning commute and I envisioned gutting him with my car key, I recognized classic symptoms of post-traumatic stress disorder.

According to the American Psychiatric Association, the disorder may result when people survive events ''that involved actual or threatened death or serious injury." Combat stress disorder, in its simplest form, is the persistence into civilian life of behavior that was necessary to survive in battle: hyper-vigilance, fear of crowds, aggression.

None of us can know what Cotnoir was thinking before he pulled the trigger, but he is certainly an eligible candidate for the stress syndrome, and I see in his actions the anguish I felt after my own homecoming. What makes this so tragically significant is that Cotnoir is not alone.

A study at the Walter Reed Army Medical Center in Washington found that at least 17 percent of Iraq veterans experience anxiety, depression, or post-traumatic stress disorder. 425,000 American troops have served in Iraq since March 2003, which means that more than 70,000 may be suffering from psychological trauma. Indeed, its visible manifestations are growing. The divorce rate for Army officers has tripled in the past three years, and the National Coalition for Homeless Veterans reports that its affiliates helped 67 veterans of Afghanistan or Iraq in 2004.

My Marine training stressed that I, as an officer, had three obligations to my country: to be ready, always; to win, every time; and to return my Marines to society better than they were when I got them. The first two are military duties, and we dedicated many years and countless dollars to excelling at them. But the last cannot be done by the military alone. It is a social obligation, one too often neglected and shortchanged.

The shooting in Lawrence can have the positive effect of focusing attention on society's responsibility to our combat veterans. It has already intensified the debate in Massachusetts over whether to mandate mental health screenings for National Guardsmen returning from combat zones overseas. The screenings are only one step in the long process of reintegrating combat veterans, but mandating them would correct a dangerous oversight and better serve both veterans and the communities where they live. To have value, though, the screenings must be done right.

Members of the active-duty forces are already subject to post-deployment mental evaluation, as are the National Guards of several states. These screenings often involve little more than filling out forms.

I remember slogging through my own mental health questionnaire after leaving Iraq, answering questions such as ''Did you ever feel that your life was in imminent danger?" Yes.

Or ''Check all that apply: I saw the dead bodies of a) enemy combatants; b) American forces; c) civilians; d) all of the above." D.

Answers like mine should have prompted some sort of follow-up, but none came.

Psychological screenings in a vacuum are worse than a waste of time because they give a false sense that someone has been ''cleared." The main lesson of my experience is that the recovery process takes time, and healing only happens in community. Screenings can be gateways to those communities, both formal ones such as therapy groups and counseling sessions, and the informal networks of friends, neighbors, and colleagues with whom we live.

In a war whose burden is borne almost exclusively by the tiny minority in uniform and their families, veterans' care is one place we can all make a difference.

Nathaniel Fick is a student at Harvard's John F. Kennedy School of Government. His combat memoir, ''One Bullet Away: The Making Of A Marine Officer," will be published in October.

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