Wednesday, May 17, 2006

NOT crazy...dope'em up and sent them to the field to shoot, sahoot, shoot till they drop


Copyright 2006 The Hartford Courant Company
Hartford Courant (Connecticut)

May 16, 2006 Tuesday
5 NORTHWEST CONNECTICUT/SPORTS FINAL EDITION

SECTION: MAIN; Pg. A1

LENGTH: 4358 words

HEADLINE: POTENT MIXTURE: ZOLOFT & A RIFLE;
THE MILITARY TOLD CONGRESS THAT MEDICATIONS AREN'T
USED TO KEEP SOLDIERS WITH SERIOUS MENTAL ILLNESS IN
COMBAT. BUT A COURANT INVESTIGATION REVEALS THAT DRUGS
ARE INCREASINGLY BEING HANDED OUT TO TROUBLED TROOPS
WITH LITTLE OR NO ADDITIONAL TREATMENT.

SERIES: SPECIAL REPORT: MENTALLY UNFIT, FORCED TO
FIGHT

BYLINE: LISA CHEDEKEL And MATTHEW KAUFFMAN

BODY:

When Army Sgt. 1st Class Mark C. Warren was diagnosed
with depression soon after his deployment to Iraq, a
military doctor handed him a supply of the
mood-altering drug Effexor.

Marine Pfc. Robert Allen Guy was given Zoloft to
relieve the depression he developed in Iraq.

And Army Pfc. Melissa Hobart was dutifully taking the
Celexa she was prescribed to ease the anxiety of being
separated from her young daughter while in Baghdad.

All three were given antidepressants to help them make
it through their tours of duty in Iraq -- and all came
home in coffins.

Warren, 44, and Guy, 26, committed suicide last year,
according to the military; Hobart, 22, collapsed in
June 2004, of a still-undetermined cause.

The three are among a growing number of mentally
troubled service members who are being kept in combat
and treated with potent psychotropic medications -- a
little-examined practice driven in part by a need to
maintain troop strength.

Interviews with troops, families and medical experts,
as well as autopsy and investigative reports obtained
by The Courant, reveal that the emphasis on retention
has had dangerous, and sometimes tragic, consequences.

Among The Courant's findings:

Antidepressant medications with potentially serious
side effects are being dispensed with little or no
monitoring and sometimes minimal counseling, despite
FDA warnings that the drugs can increase suicidal
thoughts.

Military doctors treating combat stress symptoms are
sending some soldiers back to the front lines after
rest and a three-day regimen of drugs -- even though
experts say the drugs typically take two to six weeks
to begin working.

The emphasis on maintaining troop numbers has led some
military doctors to misjudge the severity of mental
health symptoms.

Some of the practices are at odds with the military's
own medical guidelines, which state that certain
mental illnesses are incompatible with military
service, and some medications are not suited for
combat deployments. The practices also conflict with
statements by top military health officials, who have
indicated to Congress that psychiatric drugs are not
being used to keep service members with serious
disorders in combat.

In an interview Monday, Army Surgeon General Lt. Gen.
Kevin C. Kiley insisted that the military uses
psychiatric medications cautiously in the war zone,
saying that medical professionals may prescribe them
at low doses, ``for very mild symptoms that might
assist soldiers in transitioning through an event.''
He said the emphasis on keeping troubled troops close
to the front lines is in the service members' best
interests, because it helps them recover and avoid the
stigma of abandoning their duty.

But many outside the chain of command see it
differently.

``It's best -- for the Army,'' said Paul Rieckhoff, a
former platoon leader in Iraq who said he was
overruled when he tried to have a mentally ill soldier
evacuated. ``But find me an independent mental health
expert who thinks that that's a proper course of
action.''

Vera Sharav, president of the Alliance for Human
Research Protection, a patient advocacy group, said
retaining troops with mental disorders serious enough
to require medication is ``completely irresponsible.''

``It's really just plain dehumanizing. They are
denying these guys a humane treatment, which is to get
out of the battle,'' she said. ``The best therapy for
someone in that kind of stress is to get them out of
the stress. The worst thing is to add a drug to
this.''

Distributing Drugs

Some soldiers' advocates and medical experts criticize
the military for taking an overly pharmacological
approach to mental illness in an effort to retain
troops, without proper oversight.

Autopsy and investigative reports show that at least
three service members who killed themselves in 2005,
including Warren and Guy, were taking antidepressants.

Warren intentionally overdosed on his heart
medication, the military ruled, and a medical examiner
concluded he died of ``mixed drug intoxication,''
finding that the combination of the heart drug and the
Effexor, an antidepressant, had a ``synergistic''
effect that led to his death.

Guy was placed on Zoloft by a military doctor one
month before he locked himself in a portable toilet
and shot himself in the head, according to military
reports. An investigator concluded that Guy's suicide
was caused in part by the effects of Zoloft -- a
conclusion later rejected by a commanding general.

Zoloft, and other drugs in a class known as SSRIs,
such as Prozac, Paxil and Celexa, are the most
commonly prescribed antidepressants. But they can
worsen depression and increase suicidal thinking, and
the FDA says patients taking any antidepressant
medication should be monitored carefully when the
drugs are first prescribed -- a task that can be
difficult to accomplish in a war zone.

Families of some troops report that their loved ones
were readily prescribed SSRIs by military doctors in
Iraq, with no requirement for regular monitoring or
counseling.

Marine Lance Cpl. Nickolas D. Schiavoni, 26, of
Haverhill, Mass., earned a Purple Heart during his
first deployment to Iraq in 2004, but came home shaky
and anxious after seeing heavy combat, his parents
said. Soon after he was deployed back to Iraq for his
second tour, in September of 2005, he told his father
in an e-mail that he had been prescribed Zoloft.

``He said, `I'm real angry. I can't take anything from
anyone. They have me on Zoloft,''' David Schiavoni, of
Ware, Mass., recalled. ``I couldn't believe it -- an
antidepressant, while he's out there holding a gun? I
told him, `Get off the Zoloft because I hear bad
things about it.'''

Two months after that exchange, Schiavoni, who was
married with two small children, was killed by a car
bomb. David Schiavoni said he has been told that the
incident occurred after the driver of the car ignored
demands from his son's unit to stop.

``A lot of things go through my mind,'' the father
said. ``Maybe I'd rather him be angry than medicated.
Maybe if he's angry, he grabs his gun and shoots.''

Shelly Grice said her husband, Chris, a Fort Riley
soldier, was put on Zoloft and the sleep aid Ambien
after surviving an incident in February 2005 in which
his close friend was killed by an improvised explosive
device. She spent the rest of her husband's yearlong
tour worried about his mental well-being.

``His [commanding officer] said, `If I could, I would
ship you home right now,' but they lost two guys that
day and five others were injured, so they needed
him,'' Grice recounted. ``It bothers me that these
guys are just experiencing too much.''

As part of an effort to avoid evacuations out of the
war zone, the military's cadre of combat stress teams
typically treat troubled troops with a 72-hour break
from the front lines -- three hots and a cot, in
military parlance -- sometimes with drugs prescribed.
But medical experts and drug makers themselves say it
often takes weeks for SSRIs to have any therapeutic
value, while the side effects can kick in immediately.

``I have a fundamental problem with prescribing
someone an SSRI and then, with a couple days' rest,
allowing them to return to duty,'' said Dr. Stefan
Kruszewski, a Harvard-trained psychiatrist in
Harrisburg, Pa. ``If you're newly introducing a drug,
the most problematic side effects often occur right at
the beginning. So at 72 hours or at 96 hours or at
seven days, you may have more of a problem, not less,
because of a drug-related side effect.''

Dr. Jonathan Shay, an expert on combat stress who has
served as a consultant to the military on ethics and
personnel issues, said SSRIs generally do not impair a
person's ability to think clearly or react to danger.
But he said the use of such drugs should be
accompanied by counseling, and patients should be
monitored closely during the initial ``window of
danger,'' when they begin the medications.

Shay said there is no evidence that SSRIs such as
Prozac or Paxil help with acute stress or would
``protect someone in a traumatic situation'' from
developing post-traumatic stress disorder or major
depression.

``There's nothing to suppose that it helps with an
immediate trauma,'' said Shay, a Boston area
psychiatrist who counsels Vietnam veterans. ``I would
expect to see it used for a previously deployed
service member who has been diagnosed with PTSD'' or
other disorders.

Kruszewski agreed.

``It's not even a Band-Aid,'' he said. ``It might make
the doctor feel better, but the patient's not going to
benefit.''

Some Iraq war veterans say antidepressants and sleep
aids were relatively easy to obtain, with no
requirement for regular counseling or follow-up care.

Paul Scaglione, 23, an Army mechanic from the Detroit
area, said he was put on Wellbutrin in 2003 after
telling a medical worker at Tallil Air Base, ``I'm not
feeling so hot,'' and asking for ``something to keep
my mind off everything.''

``It was no big deal,'' he said. ``They just talk to
you a little and give it to you. They say you can come
back if you want, but they don't follow up or
anything.''

Kiley insisted that troops receiving medications are
afforded a balance of care, including counseling.

He characterized the use of medications in Iraq as
limited, saying some troops were allowed to deploy
``on a low-dose SSRI,'' while others who developed
problems in the war zone were placed on ``a little bit
of medication for a relatively short period of time,
to get them through something.''

He acknowledged that giving mood-altering drugs to
troops in combat could be controversial.

``There are those out in the community who would be
very concerned about that, as though you've altered
the mental capacities of a soldier by putting them on
those medications,'' he said. ``My understanding . . .
is that, in fact, is not what happens. When properly
managed and properly dosed, with evidence that the
soldiers are . . . doing well, there's no reason why
they can't do their soldierly duties.''

Fully Resolved?

Exactly how many troops are taking psychiatric drugs
remains unclear. In response to a Freedom of
Information Act request by The Courant for data on all
prescriptions dispensed in Iraq, Defense Department
officials were able to produce only limited records on
medications.

Those records, as well as the Army's own reports,
indicate that the availability and use of psychiatric
drugs in Iraq has increased steadily. A 2004 report by
a team of Army mental health professionals cited
widespread complaints from combat doctors about a lack
of psychotropic drugs, which prompted the military to
approve making antidepressants including Prozac,
Zoloft and Trazodone, and the sleep aid Ambien, more
widely available. A follow-up report 13 months later
cited far fewer complaints about access to drugs.

But in a little-noticed change a year ago, the Army
revised its deployment guidelines to include a caution
about deploying troops who are taking antidepressants
for ``moderate to severe'' depression. The guidelines
say such medications ``are not usually suitable for
extended deployments'' and ``could likely result in
adverse health consequences.''

Also, Dr. William Winkenwerder Jr., the assistant
secretary of defense for health affairs, characterized
the use of psychotropic drugs as limited when he
testified before a congressional committee last summer
that service members were being allowed to deploy on
``maintenance medication'' if their conditions had
``fully resolved.''

``For example, it is prudent to continue
antidepressants six to 18 months after an episode of
major depression has fully resolved, in order to
prevent relapse,'' he said.

How the military interprets ``fully resolved'' is in
question.

``We have seen people diagnosed within three to four
weeks [before] deployment, put on medications like
Paxil, and their deployment schedule rolls along,''
said Kathleen Gilberd, a San Diego legal counselor for
service members who heads the Military Law Task Force
of the National Lawyers Guild. ``People are being
deployed when there is no way to tell whether this
potentially serious depression will have remitted or
whether it will become a problem.''

Melissa Hobart, the East Haven native who collapsed
and died in June 2004, had enlisted in the Army in
early 2003 after attending nursing school, and
initially was told she would be stationed in Alaska,
her mother, Connie Hobart, said.

When her orders were changed to Iraq, Melissa, the
mother of a 3-year-old daughter, fell into a
depression and sought help at Fort Hood, Texas,
according to her mother.

``Just before she got deployed, she said she was
getting really depressed, so I told her to go talk to
somebody,'' Connie Hobart recalled. ``She said they
put her on an antidepressant.''

Melissa, a medic, accepted her obligation to serve,
even as her mother urged her to ``go AWOL'' and come
home to Ladson, S.C., where the family had moved. But
three months into her tour in Baghdad -- and a week
before she died -- she told Connie she was feeling
lost.

``She wanted out of there. She said everybody's morale
was low,'' Connie recalled. ``She said the people over
there would throw rocks at them, that they didn't want
them there. It was making her sad.''

Around the same time, Melissa fainted and fell in her
room, she told Connie in an e-mail. She said she had
been checked out by a military doctor.

The next week, while serving on guard duty in Baghdad,
Melissa collapsed and died of what the Army has
labeled ``natural'' causes. The autopsy report lists
the cause of death as ``undetermined.''

The report notes that the only medication found in
Melissa's system was the antidepressant citalopram,
the generic name for Celexa, at what appears to be a
normal dosage level. It also suggests that because all
other causes were ruled out, a heartbeat irregularity
is a possibility.

But the report does not explore whether the medication
might have played a role in her death -- something
Connie finds troubling.

``Maybe they don't want to know how a healthy young
woman died -- but I do,'' Connie said.

Tomas Young, 26, an infantry soldier from Kansas City,
Mo., also was sent to Iraq in early 2004, from Fort
Hood, with a mental condition that was not ``fully
resolved.'' He was diagnosed with depression about
three months before he deployed, he said.

Young said a military doctor put him on Prozac and
told him to continue the medication while in combat.

``It was, `Here's the Prozac.' I didn't get counseling
or anything,'' said Young.

Young ended up forgoing the pills during his brief
deployment. He was shot within a week of arriving in
Iraq and was evacuated. He is now paralyzed from the
chest down.

Emphasis On Retention

The use of medications is just one aspect of the
military's emphasis on treating psychologically
wounded troops close to the front and returning them
to duty quickly.

Military combat-stress teams pride themselves on high
``return to duty'' rates, which are also touted in
reports by a team of military mental health experts
who were sent to Iraq after a spate of suicides in
2003.

But in 2004, top military health officials
acknowledged shortcomings with a key principle of
modern combat psychiatry, known as ``PIES,'' which
emphasizes treating troops who exhibit problems as
close to the front lines as possible, with the
expectation that they will return to duty.

``Unfortunately, the validity of these concepts has
never been demonstrated in clinical trials,'' the
group of officials acknowledged in a written report.
They also said proponents of the principle frequently
leave out its most important element -- ``respite.''
They said relief from stress ``is the primary
principle of acute combat-related behavioral and
mental health [care] in theater.''

Still, military leaders maintain faith in their
decision to treat psychiatric wounds in the field,
arguing that the approach is better for service
members than ``pathologizing'' their stress by
evacuating them to a hospital.

Col. Elspeth Ritchie, the psychiatric consultant to
the Army surgeon general, acknowledged that the
practice also serves the military.

``Historically, we've found patients evacuated out of
theater don't return,'' said Ritchie. ``In time of
great difficulty -- and there's no question the war
over there is very difficult -- sometimes anxiety and
depression may overwhelm a soldier, and they feel like
they've just got to get out of this place.

``But if they are evacuated out, they tend to have the
stigma of leaving as a psychiatric case -- and then
it's a loss of manpower for the service.''

Throughout the war, the military has evaluated the
success of its mental health programs primarily on the
basis of how many troops are retained in combat.

While Winkenwerder had assured Congress last summer
that troops with severe mental illnesses were being
sent out of the war zone, the Army's own reports
indicate that the number of soldiers evacuated from
Iraq for psychiatric problems has dropped steeply
since the first year of the war, as combat-stress
teams and medications have become more accessible.

Mental health evacuations have fallen from an average
of 75 a month in 2003 to 46 a month in 2005, according
to Army statistics. Overall, barely more than
one-tenth of 1 percent of the 1.3 million troops who
have been deployed to Iraq and Afghanistan have been
evacuated because of psychiatric problems. Meanwhile,
the mental health teams close to the front lines pride
themselves on return-to-duty rates that typically
exceed 90 percent.

But in some cases, the troubled troops who remain in
the war zone never make it home.

Army Spec. Joshua T. Brazee, 25, of Sand Creek, Mich.,
had been in Iraq for less than three months when the
military says he shot himself with his rifle in May
2005. According to his autopsy report, he had ``talked
with other soldiers about death and killing, and also
about the idea of suicide.''

His mother, Teresa Brazee, said she still has
questions about how he died, and believes there were
conflicts within his unit. She said one of Joshua's
superiors told her that his death taught him to pay
closer attention to his soldiers.

``It's a little too late for that,'' she said.

In another case, Pfc. David L. Potter was kept in the
war zone despite a diagnosis of anxiety and
depression, a suicide attempt and a psychiatrist's
recommendation that he be separated from the Army.

Potter, 22, told friends that he believed the
recommendation had been overruled, leading to a
deepening of his depression, a fellow soldier said. On
Aug 7, 2004 -- 10 days after the psychiatrist
recommended he be sent home -- Potter took a gun from
under another soldier's bed and killed himself.

The fellow soldier, who did not want his name used
because he is still in the military, said Potter was
clearly having trouble dealing with the stress of
deployment, but wasn't getting the help he needed.

``We saw what was going on,'' he said, ``but we
couldn't do anything about it.''

Ann Scheuerman knew her son Jason was having a rough
time in Iraq, but she didn't know the depth of his
despair until she awoke to a short e-mail from him
last July that left her shaking with fear.

``I'm sorry, mom, but I just can't deal with this
anymore,'' he wrote from his base in Muqdadiyah. ``I
love you, but goodbye.''

After an agonizing morning of frantic phone calls,
Scheuerman learned that officers and a chaplain had
reached Jason in time, taking away his rifle, posting
a guard and ordering a mental evaluation for the
20-year-old private first-class.

For the first time that day, Ann Scheuerman could
breathe.

But her son's problems were just beginning.

Jason got a psychological evaluation, but afterward,
he sent his mother another disturbing e-mail.

``He was very discouraged,'' said Scheuerman, of
Lynchburg, Va. ``He said, `Mom, they think that I'm
making this up and that there was nothing wrong with
me, that I needed to just be a man, be a soldier and
quit wasting the Army's time.' He said they were going
to court-martial him for treason, that sergeants said
they were tired of people making up excuses to try to
get out of combat and it wasn't fair to all the other
real soldiers.''

Jason was pulled off missions with his fellow
soldiers, assigned menial jobs around the barracks and
given his gun back.

He used the weapon three weeks later to become the
1,797th U.S. military fatality of Operation Iraqi
Freedom.

Ann Scheuerman, who, like Jason's father, is an Army
veteran, strongly supports the military. But she wants
to know how things could have gone so wrong in Jason's
case.

``The enemy should not be dressed in a United States
Army military uniform. That's not what the enemy looks
like, and should never be what our soldiers see as the
enemy,'' she said.

``If someone would have taken two or three days, if he
would have just been in the hospital for a few days,
where someone could have actually talked to him, I
think that's all it would have taken,'' she said.

Kiley, the Army surgeon general, said he believes that
mental-health professionals in Iraq are quick to
evacuate troops who are at risk of hurting themselves
or others, or who have ``risen to the level of being
moderately or severely depressed.''

Who's Helping The Troops

After the spike in suicides in 2003, military
officials said they had faith that teams of mental
health specialists deployed to Iraq and Kuwait would
be able to provide needed care to troops, and help to
break the stigma associated with mental health issues.

But with the 2005 suicide rate in Iraq climbing to the
highest level since the war began, some soldiers'
advocates are now questioning whether the specialists
have become too reliant on short-term treatments and
medications, and not enough on one-to-one counseling.

Sandy Moreno, a Sacramento, Calif.-based psychiatric
technician in the Army Reserve, was among the first
combat-stress team members in Iraq. While her team
prided itself on a return-to-duty rate of about 95
percent, she said counseling and respite -- not
medications -- were the focus in the early months of
the war.

``You can't start someone on antidepressants and then
not see them again because their unit is moving
around,'' Moreno said. ``When you put them on those
kinds of meds, a lot of times it takes six weeks
before they take effect, or they can cause side
effects. We could never keep that good track of a
soldier.''

The military has about 230 counselors dispatched in
Iraq and Kuwait for about 100,000 troops, about the
same number as in 2004, an Army spokesman said. But
there are signs that the providers themselves are
burning out.

A team of mental health experts reported in January
2005 that caregivers were experiencing ``compassion
fatigue,'' with one-third of behavioral health workers
reporting high burnout, and one in six acknowledging
that stress was hurting their ability to do their
jobs.

``If our providers are impaired,'' the team wrote,
``our ability to intervene early and assist Soldiers
with their problems may be degraded.''

Beyond burnout, military documents and interviews
reveal a culture in which mental health professionals
are constantly on the alert for troops faking mental
illness to get out of duty.

``Clinicians must always maintain a keen eye for
potential malingerers,'' instructs the Iraq War
Clinician Guide, a 200-page bible compiled by the
Department of Veterans Affairs and the Walter Reed
Army Medical Center. ``Suspicions require close
consultation with commanders to ensure proper
diagnosis and disposition.''

Some Iraq veterans say the military is too quick to
dismiss mental health complaints, and still has a
problem treating injuries to the mind the way it
treats injuries to the body.

``If you break your leg over there, you're going to
get treatment,'' said Georg-Andreas Pogany. ``When
they go for mental health services, they are
belittled, they are shoved aside, they are called
malingerers. Their experiences are completely
invalidated.''

In 2003, Pogany, a former Army interrogator, was
charged with cowardice -- a crime punishable by death
-- after suffering a panic attack and seeking
counseling because he had seen the body of an Iraqi
man who had been cut in half by American gunfire. The
charge was later dropped.

Bob Johnson, former chief of combat stress control for
an Army brigade of about 2,800 soldiers, said he would
routinely review soldiers' work and disciplinary
histories when they complained of serious mental
problems. If a soldier with a history of antisocial
behavior came in insisting he was going to shoot
himself if he wasn't sent home, ``then that's a pretty
clear-cut case of malingering,'' he said.

Johnson said he took a punitive approach to dealing
with those soldiers, taking away their guns -- which
he compared to ``losing your manhood'' -- and forcing
them to sleep at the command point, in the line of
sight of commanders.

He said he had treated one soldier who threatened to
starve himself to death, and later swallowed a handful
of pills -- both acts that Johnson deemed bogus
attempts to get out of serving.

``There's no doubt about it, the guy had mental health
issues,'' Johnson said. ``But he wasn't going to get
the treatment he wanted, which was to go home.''

``The question is, do we want to reward this behavior?
Because if we reward this behavior, more soldiers are
going to do it.''

THE PENTAGON RESPONDS: Military health officials
defend treatment of mentally troubled troops. Page A7

Sunday: Trapped

``If a man is

having serious

mental problems,

and the chain of

command knows

about it, you get

him out of there

and get him

help.'' -- Warren

Henthorn, father

of Army Spec. Jeffrey Henthorn.

Monday: Ignored

``They talked about how

he had a history of

mental problems. No

kidding. ... I mean, if

you're flat-footed, you

don't go in. So isn't

there a clause in there

if you had mental

problems?''

-- Margaret Brabazon,

mother of Army Spec. Edward W. Brabazon

Today: Drugged

``Bobby is on a

mind-altering

drug, with a

loaded rifle,

and he is

requested to

guard an Iraqi

detainee?''

-- Ann Guy,

mother of Marine Pfc. Robert Allen Guy

Wednesday: Recycled

``It just floors us that they'd send him back. To be
in a psychiatric hospital last summer and now back to
a war zone.'' -- Larry Syverson, father of Army Staff
Sgt. Bryce Syverson

GRAPHIC: PHOTO 1: COLOR, PHOTOS BY MARK MIRKO THE
HARTFORD COURANT GRAPHIC: (B&W), THE HARTFORD COURANT
PHOTO 2-4: COLOR MUGS PHOTO 5: (B&W) MUG PHOTO 6:
(B&W), PHOTOS BY MARK MIRKO THE HARTFORD COURANT
PHOTO 1: ANN AND JAMES GUY visit the grave in
Arlington National Cemetery of their son, Marine Pfc.
Robert Allen Guy, on April 21, the first anniversary
of his death. Guy committed suicide a month after he
was prescribed the antidepressant Zoloft. GRAPHIC: ``I
Make The Final Decision' LIBRARY NOTE: This graphic
was not available electronically for this database.
PHOTO 5: ARMY PFC. MELISSA HOBART PHOTO 6: 5-YEAR-OLD
Alexis McCabe holds flags planted at the gravesite of
her mother. Army Pfc. Melissa Hobart, an East Haven
native, who collapsed and died in June 2004 while on
guard duty in Iraq. Hobart had been prescribed Celexa
to ease the anxiety of being separated from her young
daughter while in Baghdad. Her cause of death, the
military says, is still undetermined.
**************************************************

Copyright 2006 The Hartford Courant Company
Hartford Courant (Connecticut)

May 17, 2006 Wednesday
5 NORTHWEST CONNECTICUT/SPORTS FINAL EDITION

SECTION: MAIN; Pg. A1

LENGTH: 3775 words

HEADLINE: STILL SUFFERING, BUT REDEPLOYED;
THEY HAVE POST-TRAUMATIC STRESS AND OTHER
COMBAT-RELATED DISORDERS. SO WHAT ARE THEY DOING BACK
IN BATTLE?

SERIES: SPECIAL REPORT: MENTALLY UNFIT, FORCED TO
FIGHT

BYLINE: LISA CHEDEKEL Courant Staff Writer Matthew
Kauffman contributed to this story.

BODY:

Eight months ago, Staff Sgt. Bryce Syverson was
damaged goods, so unsteady that doctors at Walter Reed
Army Medical Center wouldn't let him wear socks or a
belt.

Syverson, 27, had landed in the psychiatric unit at
Walter Reed after a breakdown that doctors traced to
his 15-month tour in Iraq as a gunner on a Bradley
tank. He was diagnosed with post-traumatic stress
disorder and depression, and was put on a suicide
watch and antidepressants, according to his family.

Today, Syverson is back in the combat zone, part of a
quick-reaction force in Kuwait that could be summoned
to Iraq at any time.

He got his deployment orders after being told he
wasn't fit for duty.

He got his gun back after being told he was too
unstable to carry a weapon.

But he hasn't quite managed to get his bearings.

``Nearly died on a PT test out here on a nice and
really mild night because of the medication that I am
taking,'' he wrote in a recent e-mail to his parents
and brothers. ``Head about to explode from the blood
swelling inside, the [lightning] storm that happened
in my head, the blurred vision, confusion, dizziness
and a whole lot more. Not the best feeling in the
entire world to have after being here for two days ...

``And I ask myself what the F*** am I doing here?''

Syverson is among a growing number of troops who are
being recycled into combat after being diagnosed with
PTSD or other combat-related mental disorders -- a new
phenomenon that has their families worried and some
mental health experts alarmed. The practice, which a
top military mental health official concedes is driven
partly by pressure to maintain troop levels, runs
counter to accepted medical doctrine and research,
which cautions that re-exposure to trauma increases
the risk of serious psychiatric problems.

``I'm concerned that people who are symptomatic are
being sent back, which is potentially very bad for
them. That has not happened before in our country,''
said Dr. Arthur S. Blank Jr., a Yale-trained
psychiatrist who helped to get PTSD recognized as a
diagnosis after the Vietnam War.

``If people have received treatment for a year or two
or three and the condition is completely stabilized, I
could see it,'' said Blank, who was formerly director
of the Department of Veterans Affairs' counseling
centers. ``[But] there's no study that says it's
beneficial to send people back. Being re-exposed to
the trauma can just intensify the symptoms.''

Although Department of Defense medical standards for
enlistment into the armed forces disqualify those who
have suffered from PTSD or acute reactions to stress,
including combat fatigue, military officials
acknowledge that they are not exempting service
members who meet those criteria from going to war.
Many of those who are being sent back with such
symptoms, such as Syverson, are being redeployed on
psychiatric medications known as SSRIs.

Col. Elspeth Ritchie, psychiatry consultant to the
Army surgeon general, acknowledged that the decision
to send back soldiers with symptoms or a diagnosis of
PTSD was ``something that we wrestle with,'' and
partly driven by the military's need to retain troops
because of recruiting shortfalls.

``Historically, we have not wanted to send soldiers or
anybody with post-traumatic stress disorder back into
what traumatized them,'' she said. ``The challenge for
us ... is that the Army has a mission to fight.''

Ritchie said the military looks closely at the
``impairment'' level of individual service members and
their response to medication before deciding whom to
redeploy, and would not put any soldier at risk.

``If they're simply -- and I don't mean to minimize it
-- but if they're simply having nightmares, for
example, but they can do their job, then most likely
they're going to deploy back with their unit,'' she
said. ``If they're not able to do their job and they
don't respond to treatment, then we're going to
probably keep them here in the States for at least a
while longer.''

But whether the military can even gauge the impairment
level of its veterans is in question. A newly released
report by the Government Accountability Office found
that nearly four in five troops returning from Iraq
and Afghanistan who were found to be at risk for PTSD,
based on responses to a screening questionnaire, were
never referred for further evaluation or treatment.
Still, top military officials continue to insist they
are doing a good job of identifying and treating PTSD
cases.

Dr. Matthew Friedman, director of the National Center
for PTSD, an arm of the Veterans Administration, said
that while he shares the concern that multiple
deployments may exacerbate PTSD symptoms, he does not
believe the military should take a ``one size fits
all'' approach to the disorder and bar all troops from
deploying. Drug treatments for PTSD prove successful
in some cases, he said, and some service members are
more resilient than others.

``My belief is, let's look at the data'' that are
being gathered by pre- and post-deployment mental
health screenings, he said. ``Once we have the data,
we can go back and look at how people with PTSD
perform.''

But some service members' families and experts say the
military should not be experimenting with young men
and women who have been traumatized by going to war.

``We were shocked. When somebody's put on medication
and told they have PTSD, it doesn't occur to you
they'd want to send them back,'' said Corrine Nieto, a
Bakersfield, Calif., mother whose 24-year-old son,
Chris, a Marine reservist, was redeployed to Iraq last
summer after being diagnosed with PTSD. ``I don't know
what they're doing to these kids. I wonder if they
do.''

Jason Sedotal, a 21-year-old military policeman from
Pierre Part, La., was diagnosed with PTSD in early
2005 after he returned from Iraq, where he was
traumatized by an incident in which a Humvee he was
driving rolled over a land mind, he said. His
sergeant, sitting beside him, lost both legs and an
arm.

Last September, Sedotal was transferred from Fort
Bragg to Fort Polk, where he said doctors switched his
medication from Prozac to Zoloft, and commanders
deemed him ready to redeploy. He has been back in Iraq
since October.

``I don't feel like myself. I can't sleep, I can't be
around crowds, I'm just drinking a lot,'' he said
during a mid-tour visit home last week. He said he had
seen a doctor at Fort Polk, to ask if he could stay
home and get treatment, but instead was given a higher
dose of Zoloft and told he was shipping out again this
week.

When he asked the doctor if his symptoms would ever go
away, he said he was told, ``Sure -- when you get out
of there.''

Neither the military nor the VA has figures on the
number of troops with PTSD or other combat-related
disorders who have been redeployed after a diagnosis.
Overall, more than 378,000 active-duty, reserve and
National Guard troops have served more than one tour
in Iraq or Afghanistan, including about 151,000 Army
soldiers and 51,000 Marines, according to the
Department of Defense's latest deployment statistics.

Recent studies indicate that at least 18 percent of
returning Iraq veterans are at risk for PTSD, while 35
percent have sought mental health care in their first
year home.

The Courant's research shows that at least seven
troops who are believed to have committed suicide in
2005 and 2006 were serving second or third
deployments. In some of those cases, according to
their families, they had exhibited signs of
psychological problems between deployments that went
undetected by military officials, who rely largely on
the self-reported questionnaires.

Jeffrey Henthorn, 25, of Choctaw, Okla., was just six
weeks into his second deployment when the military
says he killed himself in Iraq last year. His family
said he had shown signs of psychological problems
between deployments, but had not received counseling
or treatment.

Similarly, Army Spec. Rusty W. Bell, 21, of
Pocahontas, Ark., showed signs of combat stress after
his first deployment to the Middle East in 2003 as a
member of the Army National Guard, said his mother,
Darlene Gee. When he came home in April 2004, he
enlisted in the Army and was sent back to Iraq in
early 2005.

``He saw tons of combat that first time, and I think
it affected him,'' Gee said. ``I never asked him about
it straight-out, but he said a few things that stick
with me. He said, `Mom, I wish they'd just nuke the
entire place. I know I would die, but at least I would
die for a reason.' I said, `Bub, don't talk like
that.'

``I thought they shouldn't have sent him back so
soon,'' she said. ``Let him have a normal life for a
while, after what he'd been through.''

An autopsy report on Bell's death concludes that he
shot himself last August, with witnesses saying he was
``distraught over family problems.'' Gee said she was
not aware that her son, who was married, was having
any significant personal problems.

The wife of a soldier who killed himself earlier this
year in Iraq said she had little doubt that repeat
tours had played a role.

``I know that did affect it. Absolutely I know it. A
combination of fatigue and just being worn out,'' said
the woman, who did not want her name used to protect
her children.

Army Surgeon General Kevin C. Kiley said many troops
want to go back with their units for repeat tours, and
the military is willing to facilitate that, as long as
they are functioning well.

``Part of sending troops back in with medications that
are stable and doing very well is . . . to
de-stigmatize this, to show soldiers they can do the
job, they can defend the nation, they can be part of
this Army, and they won't be cast aside,'' Kiley said.

In some cases, the military has pushed the point a
step further.

Army Spec. Jason Gunn, of Lansdowne, Pa., was sent
back to Iraq in early 2004, after being injured in an
explosion and diagnosed with PTSD, because Army
officials believed it would be in his best interest to
``overcome his fear by facing it,'' according to the
explanation provided to his mother, Pat Gunn, through
a congressman.

Since he returned home and left the Army last year,
Jason has drifted between odd jobs and ``goes through
phases where he's in a very bad place,'' Pat Gunn
said. She said she worries that the military is
``taking the very last breath out of these kids.''

Mental health experts said that while some troops who
suffer from PTSD symptoms may be able to return to the
front lines, there is no evidence to suggest that
re-exposure to trauma is in any way therapeutic.

``Anybody who says it's a form of therapy to send
people back into war,'' said Dr. Jonathan Shay, a
Boston-based psychiatrist who counsels Vietnam
veterans, ``I don't know what they're smoking.''

Fear Of Avalanche

Some soldier advocates worry that the repeat
deployments of troops will lead to an avalanche of
PTSD cases and fuel incidents of suicide and violence.

In Vietnam, most soldiers did a requisite one-year
tour of duty and never went back. About 30 percent of
them suffer from PTSD symptoms, and another 20 percent
have experienced clinically serious stress-reaction
symptoms, according to the National Vietnam Veterans
Readjustment Survey.

Of the 1.3 million active duty, guard and reserve
troops who have served in Iraq and Afghanistan, more
than 28 percent already have deployed more than once.

``This is an unexplored area,'' said Cathleen Wiblemo,
deputy director for health care for the American
Legion. ``How are troops going to deal with second and
third deployments? Is their reaction going to be more
severe?

``I think the VA can look to seeing a lot more mental
health cases,'' she said. ``They haven't gotten the
full brunt of these multiple deployments yet.''

So far, more than 20,600 service members who have
separated from the military have received an initial
diagnosis of PTSD, according to the VA. That doesn't
include service members still enlisted in the
military, or veterans who seek help from private
doctors or other sources.

Like other parents, Larry Syverson, an environmental
engineer from Richmond, Va., worries that the military
is gambling with his son's mental health for the sake
of maintaining troop levels.

Bryce was sent back to Kuwait in late-March, after the
Army had deemed him non-deployable and left him at his
base in Germany while the rest of his unit deployed.
In February, he told his father that his doctors had
taken him off of Zoloft and were trying another
medication. He still wasn't allowed to carry a gun.

Larry Syverson isn't sure why the military abruptly
deemed Bryce deployable and handed him back his
weapon. In correspondence, his son has said he agreed
to go back to Kuwait because commanders told him it
would help his chances of re-enlisting in the Army --
something Bryce, who has not known civilian life since
he graduated from high school, wants to do.

``The doctors said that I will be okay to deploy and
carry around my rifle ... and shoot people,'' Bryce
wrote in an April 18 e-mail to his father. ``So in a
week from me and the doctors both agreeing that I will
be okay to deploy. I was gone again.''

``The Battalion Commander was holding a bar to
re-enlist over my head if I didn't deploy. But since I
have deployed, my request for re-enlistment has been
denied twice.''

The tone of Bryce's e-mails, as much as the content,
worries Larry Syverson, who said his youngest son,
once the most ``even-keeled'' of four brothers, now
has a festering bitterness.

``It just floors us that they'd send him back,'' said
Larry, a peace activist whose sons all have served in
the military, but who opposes the Iraq war. ``To be in
a psychiatric hospital last summer and now back to a
war zone -- it's not like they didn't know Bryce's
condition, because it's their hospital and their
diagnosis.''

Bryce's PTSD came on the same way many cases do:
suddenly, starkly, several months after he had
returned home in the summer of 2004. He was watching
New Year's Eve fireworks in Germany, his father said,
when he ``got spooked'' by the crowd and the sounds,
which reminded him of mortar attacks. From there, he
spiraled into depression, anger and an inability to
concentrate.

PTSD has three main clusters of symptoms:
re-experiencing the trauma, in the form of flashbacks
or memories; retreating from life or feeling detached;
and hyper-vigilance, including impaired concentration.
Some troops suffer from partial symptoms. War-zone
stress also can lead to depression and anxiety
disorders.

Experts say short-term treatment with Zoloft or Paxil,
the two drugs approved by the government for treating
PTSD, are successful in putting the disorder into
remission about 30 percent of the time. But the other
70 percent of cases are not so easy to control and can
continue for years. Some patients never fully recover.

The practice of redeploying soldiers who continue to
suffer from PTSD symptoms runs counter to statements
by the military's top health official, Assistant
Defense Secretary William Winkenwerder, who assured a
congressional committee last summer that troops with
``unremitting mental health disorders are not
deployed.''

Dr. Frank M. Ochberg, a clinical professor of
psychiatry at Michigan State and a founding board
member of the International Society for Traumatic
Stress Studies, said he would not want anyone who has
``chronic'' PTSD -- symptoms lasting longer than three
months -- to return to a combat situation. Deploying
someone with depression, which often accompanies PTSD,
also is dangerous, he said.

``My gut feeling is, it's probably OK if they've been
stabilized and they haven't had a recurrence of
depression in a year,'' he said. ``But the problem of
depression in combat is, you are of more risk to
yourself and others.''

Troops fill out post-deployment questionnaires just as
they return from Iraq, and then receive a follow-up
screening, recently added by the military, three to
six months later.

Because the screenings rely largely on self-reporting
by service members, who often are reluctant to
disclose problems, their usefulness is limited, mental
health experts agree. That leaves families and friends
of some service members convinced that post-traumatic
symptoms are going undetected.

Martin Armijo, a family friend and neighbor of
22-year-old Army medic Chris Rolan of Albuquerque,
N.M., said he worried about Rolan when the young man
returned home last year between deployments to Iraq.

``He said he'd seen a lot of combat. It was freaking
him out seeing all these soldiers getting shot up,''
said Armijo, a Vietnam veteran. ``I could tell in his
eyes, he had that look like he was lost. He wasn't the
Chris I knew.''

After he returned to Iraq, Rolan was charged with
killing a member of his unit during an argument, in
November of last year. His older brother, Robert
Garcia, is at a loss to explain what happened to the
young man he says was the ``bright star'' of the
family.

``This is so out of the blue,'' said Garcia, who
declined to discuss the pending murder case. ``It just
doesn't fit.''

Wrestling With Symptoms

Some troops with PTSD symptoms receive counseling in
Iraq, while others don't, interviews with troops and
families indicate.

Jim Holmes' son, Micah, an Army mechanic, was deployed
to Iraq last August. He had returned home in May 2004
from a 10-month tour in Afghanistan with symptoms of
PTSD and depression, for which Army doctors prescribed
Zoloft and Wellbutrin, Holmes said.

Earlier this year, while in Iraq, he told his father
that he had stopped taking the drugs because they were
``too hard to get,'' and that he was not receiving
counseling.

``He's not getting treated there, and who knows if
there'll be any treatment available when he comes
home,'' said Jim Holmes, a social worker from
Gaithersburg, Md. ``At this point, I just want him
back.''

Whether Zoloft and other drugs actually can help to
buffer combat stress or prevent full-blown PTSD is not
known, mental health experts said. That uncertainty
led Ochberg to call the practice of medicating
stressed-out troops ``one hell of a research
project.''

``There are people who want to do the job, and if they
do the job on medication, they may be better off,''
Ochberg said. ``But I have never given anyone a
prescription because they're going into a combat
situation.

``There's a chance that this unwitting experiment of
prevention of full-blown emotional distress will be
instructive,'' he added, ``but it's also fraught with
moral and ethical considerations.''

Among the moral considerations is that many troops
with combat-stress symptoms want to go back to the
war, becoming addicted to the adrenaline and sense of
mission, and unable to adjust to life at home,
military counselors say. Their eagerness matches the
military's willingness to recycle them into combat.

``Iraq is an impossible act to follow. Everything else
pales,'' said Noka Zador, a coordinator of counseling
for Iraq and Afghanistan veterans at the West Haven
Veterans Administration. ``Part of it is, they have
one foot here, one foot there. It's a sense of, `I'm
still back there anyway.'''

David Beals, 26, a soldier stationed at Fort Stewart
in Georgia, sometimes tells his wife, Dawn Marie, ``In
my head, I'm still in Iraq.'' After he returned from
his second deployment to Iraq in January, he paced
around the house, bored and restless, she said.

Beals had a rough first tour in Baghdad in 2003, and
sunk into a depression as his second deployment
approached. In January 2005, he locked himself in the
bathroom of the couple's home and swallowed a bottle
of Percocet. He landed in a hospital psychiatric ward
and was diagnosed with PTSD and an adjustment
disorder, Dawn Marie said.

He was sent back to Iraq within a few months, for the
tour that ended this January. He expects to go back
for a third time at the end of this year.

``He loves what he does. He loves being in the Army,''
Dawn Marie said. "For me, you just learn to adapt. ...
He definitely is not the same person. It's the same
person, but not the same personality.''

Military counselors say the frequency of multiple
deployments has been a disincentive for troops to seek
help readjusting to life at home, and has made
counseling difficult.

``Some of them don't see the relevance of coming for
counseling because their bags are still packed,'' said
Donna Hryb, team leader at the Hartford Vet Center in
Wethersfield.

Some PTSD experts also suggest that the growing public
sentiment against the war can have a negative effect
on the mental health of some troops shuttling back and
forth to Iraq.

``If there's controversy and doubt about the validity
of the war, it has a major psychological impact, for
both the therapist and soldier,'' said Blank, the
psychiatrist and expert on PTSD.

James Gavin, a Vietnam veteran who is team leader of
the New Haven Vet Center, said military medicine has a
different emphasis than civilian medicine. The
military is ``looking at unit cohesion and
cohesiveness,'' he said. ``They're not so concerned
with a heightened state of alertness, or
sleeplessness, or other things. They might want people
on edge.''

That's what concerns Larry Syverson.

In a recent e-mail from Kuwait, his son Bryce, who is
safe from combat for now, complained that some leaders
of his unit ``want to actually go to Ramadi,'' and had
tried to ``volunteer'' the battalion for the front
lines of Iraq.

Larry said he isn't worried that Bryce, whom he calls
a ``good soldier,'' would resist.

He's worried that he wouldn't.

Sunday: Trapped

"If a man is

having serious

mental

problems, and

the chain of

command

knows about

it, you get him

out of there

and get him help." -- Warren Henthorn, father of Army
Spec. Jeffrey Henthorn

Monday: Ignored

``They talked

about how he

had a history of

mental problems.

No kidding. ... I

mean, if you're

flat-footed, you

don't go in. So

isn't there a

clause in there if you had mental problems?'' --
Margaret Brabazon, mother of Army Spec. Edward W.
``Crazy Eddie'' Brabazon

Tuesday: Drugged

``Bobby is on a

mind-altering

drug, with a

loaded rifle,

and he is

requested to

guard an Iraqi

detainee?''

-- Ann Guy,

mother of Marine Pfc. Robert Allen Guy

Today: Recycled

``It just floors

us that they'd

send him back.

To be in a

psychiatric

hospital last

summer and

now back to

a war zone.''

-- Larry Syverson, father

of Army Staff Sgt. Bryce Syverson

On The Web: Larry Syverson, father of Army Staff Sgt.
Bryce Syverson, worries about his son who is in
Kuwait. Bryce was diagnosed with post-traumatic stress
disorder after 15 months in Iraq, and spent one month
in Walter Reed Army Medical Center. In this video,
Larry shares e-mails and voice mails from Bryce. To
view the video, previous installments, and to share
your thoughts on this investigative report in our
online forum, visit www.courant.com/soldiers

GRAPHIC: PHOTO 1: COLOR, MARK MIRKO / THE HARTFORD
COURANT PHOTO 2-5: (B&W) MUGS PHOTO 6-7: (B&W)
PHOTO 1: A WHITE HOUSE security officer and his dog
walk behind Larry Syverson, whose son, Army Staff Sgt.
Bryce Syverson, was redeployed to Kuwait despite being
diagnosed with post-traumatic stress disorder. Larry
Syverson went to Washington on May 1, the third
anniversary of President Bush's announcement that
major combat had ended in Iraq, against the backdrop
of a banner reading ``Mission Accomplished.'' PHOTO 6:
STAFF SGT. BRYCE SYVERSON sits on a throne in one of
Saddam Hussein's palaces in Iraq, in this undated
photo supplied by Larry Syverson, his father. After a
15-month tour in Iraq, Bryce has post-traumatic stress
disorder and depression, and was put on a suicide
watch and antidepressants. He has been redeployed to
the Middle East. PHOTO 7: BRYCE SYVERSON, in a family
photo supplied by his father, is shown in the
psychiatric unit at Walter Reed Army Medical Center,
where he was sent after a breakdown that doctors
traced to his tour in Iraq.

2 Comments:

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At 6:26 AM, Blogger Arthur said...

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