Psyche, Science, and Society

Support our troops. Bring them home.

For Memorial Day. Don’t let more soldiers die in vain. And take care of them when they’re home.
Bruce Springsteen - Bring Them Home - San Francisco 2006:

Add comment May 25th, 2008

VA coordinator suggests avoiding PTSD diagnosis

CREW (Citizens for Responsibility and Ethics in Washington) and VoteVets.org have obtained a memo from a VA hospital’s PTSD program coordinator suggesting that they avoid giving PTSD diagnoses and instead give Adjustment Disorder R/O [rule out] PTSD. We need to find out if this is widespread.

Add comment May 15th, 2008

Fort Hood soldiers protest the war

Those of us who lived through and participated in the 1960’s and early ’70’s antiwar movement know that one of the most important aspects of those movements was the growth of the antiwar movement among active duty GIs. Most demonstrations were led by active duty soldiers, every base had its antiwar coffee house and newspaper. “Fuck the Army!” was all over the place. And discipline fell to the point where the brass knew that it was get out or get out of the way.

A friend stationed in Nam aroung 1971 described being assigned to pick up litter on the base. As he’s walking around, he smokd and three down a cigarette butt. His ergeant yelled “Pick that up!” As he tells it, he just looked at the Srage and said “F***You!” the Sergeant glowered back in rage, but kept his mouth shut, knowing that to say anything, much less discipline the soldier for insubordination, was to risk danger. an army in that shape cannot be kept in an unpopular war indefinitely.

While nowhere to that degree, there are indications that a movement of active duty soldiers is growing. A TV station in Austin Texas reports on the growth of Iraq Veterans Against the War on the base. As it quotes soldiers on base:

“The honest truth is that if the American people knew what was going on over there everyday, they would be raising their voices too. They would be saying, ‘Hey, bring those guys home,” Sgt. Selena Coppa said.

Coppa blames lawmakers in Washington for filtering the facts on the war in Iraq. She said there’s no real end in sight.

“There is a cost to this war. This war is being paid in American blood, in my soldier’s blood. And that is not okay,” Coppa said.

“We lost really good friends, really good leaders who died in Iraq. From my perspective, it didn’t make any sense, we didn’t ccomplish anything, and I talked to a lot of other soldiers who feel the same way,” Fort Hood soldier Casey Porter said.

Ronn Cantu is between Iraq deployments. He feel a need to use the opportunity to speak out:

“I honestly thought I might not live through my second tour, so I
thought, you know if I’m going to die anyway, I need to say the
things I need to say,” Cantu said.

Watch the story:

IVAW Fort Hood posts a banner — “IVAW is pro-soldier, but antiwar.”:

IVAW can be reached at ivaw.org

Add comment February 22nd, 2008

Blast trauma may act at a distance

The new Science contains an important article on current thinking on traumatic brain injury (TBI) from bomb blasts:

Shell Shock Revisited: Solving the Puzzle of Blast Trauma

Even at a distance, explosions may cause lasting damage to the brain. Such findings could have big implications for arming and compensating troops

by Yudhijit Bhattacharjee

Working at the Military Hospital in Belgrade during the brutal Balkan war of the 1990s, neurologist Ibolja Cernak encountered a medical enigma. She saw soldier after soldier with memory deficits, dizziness, speech problems, and difficulties with decision-making–but no obvious injury. Cernak recalls one 19-year-old who went to a grocery store and began to weep after he couldn’t remember how to get back home. When his mother brought him to the hospital a few days later, Cernak learned what later emerged as a common element in all these cases: The soldier had survived an explosion on the battlefield.

The strange thing was that most of these patients had not suffered a direct injury to the head. And yet, in computed tomography and magnetic resonance imaging scans, Cernak saw signs of internal damage. In some cases, the brain’s ventricles–channels that carry cerebrospinal fluid– had become enlarged; and in some, there was evidence of minor bleeding.

But when Cernak dug into the medical literature for an explanation, she came up empty. According to the available research, shock waves from an explosion injure mainly air-filled organs such as the lung and the bowel, not the brain.

With a small band of collaborators in Belgrade, China, and Sweden, Cernak undertook animal studies that eventually confirmed that blast waves can cause neuronal damage. The work drew little attention until 2 years ago when hundreds of U.S. and British soldiers began returning from Iraq with symptoms similar to those of Cernak’s patients. As roadside explosions became more common, military doctors suspected that these symptoms were the likely result of mild traumatic brain injury (TBI) sustained in blasts. Seeing her observations borne out was as if “a myth had become reality,” says Cernak, who is now a researcher at the Applied Physics Laboratory at Johns Hopkins University in Baltimore, Maryland.

How blasts affect the brain has since become an urgent question in military medicine. Last summer, the U.S. Congress gave $150 million to the Department of Defense (DOD) for the first year of research on TBI– both severe injuries that damage the skull and milder ones suspected of causing neurological deficits. The Defense Advanced Research Projects Agency (DARPA) has already launched a $9 million research program aimed specifically at understanding trauma caused by shock waves, heat, and electromagnetic radiation emanating from blasts. Another $14 million a year is going to the Defense and Veterans Brain Injury Center (DVBIC), a DOD-funded agency headquartered in Washington, D.C., for research and outreach on TBI.

This flurry of interest has focused a spotlight on Cernak’s research. There is growing consensus that blasts can produce subtle injuries in the brain as suggested by Cernak several years ago. In fact, the Department of Veterans Affairs (VA) proposed a new rule this month acknowledging blast-related TBI as a special neurological condition whose symptoms may have gone undetected in the past. The proposed rule, published in the Federal Register on 3 January, would allow for greater disability compensation to victims than is granted currently.

But many researchers are skeptical of Cernak’s ideas about how these injuries might occur. Cernak postulates that blast waves ripple through the victim’s torso up into the brain through the major blood vessels, leading to neurological effects that can be slow to appear. Although she has evidence from animal experiments to back up that hypothesis, she admits that more research is needed. If the mechanism is confirmed by future studies, Cernak says, it would mean that helmets do not protect the brain against blast injury.

Besides raising questions about the protection of troops currently in combat, Cernak’s suggestion that simply being exposed to an explosion might lead to long-lasting brain damage has opened a Pandora’s box, particularly for veterans. It implies that some could be suffering from neurological deficits that went undiagnosed or were mistakenly attributed to posttraumatic stress disorder (PTSD). Indeed, since the government began putting out information about blast-related TBI, veterans have been trickling in to seek treatment for mental problems that some have lived with for decades. “It may well be that blast injuries follow the pattern of Agent Orange and Gulf War syndrome,” says former VA psychiatrist David Trudeau, referring to ill-defined health problems that have lingered for years after battle.

Hidden trauma

If Cernak had been a doctor during World War I, she says, she might well have recognized mild TBI among the thousands of soldiers who suffered from what was simply called “shell shock.” But during World War I, many doctors and military commanders viewed shell shock as a transient psychological phenomenon that affected soldiers who, in their opinion, were mentally weak.

Cernak discovered something very different: that soldiers’ mental problems seemed to be driven by enduring physical changes in the brain. To test her hypothesis, she conducted a study of 1300 patients who had suffered penetrating wounds to the lower body but not the head. More than half had suffered injuries in a blast; the rest had been wounded by projectiles. Many of the blast victims complained of symptoms such as insomnia, vertigo, and memory deficits, and more than 36% in this group showed irregular patterns of electrical activity in the brain–as measured by electroencephalograms taken within 3 days of the injury– compared to only 12% in the other group. A year later, 30% of blast- injured patients still showed abnormal brain activity compared to 4% of the rest. Cernak says the findings, published in the Journal of Trauma in 1999, suggested that the mental problems of blast victims had a biological basis.

Her study wasn’t the first to make that point. A year earlier, VA researchers had found that among veterans with PTSD, individuals with a history of blast exposure were much more likely than others to have abnormal brain activity as well as cognitive and behavioral problems.

“Our evidence pointed to the possibility that blast injury was a long- lasting injury in combat veterans,” says Trudeau, who retired in 2000. He says he was disappointed by the lack of follow-up to the study, published in the August 1998 Journal of Neuropsychiatry. “The reception we got was pretty lukewarm,” he says.

For decades, Army researchers had been studying the effects of blast waves but with a different focus. They concentrated on how to protect the lungs and bowel because the pressure from an explosion is most likely to shear at the interface of these tissues, where densities differ. DOD was so confident that advanced body armor was protecting troops against lung and bowel injuries that it closed down this research program in 2003. “We thought, why spend more money on this when we’ve fixed the problem?” says Geoffrey Ling, a neurologist and a program manager at DARPA.

Then the bad news arrived. As blast survivors from Iraq were air-lifted to hospitals, U.S. Army doctors, including Ling, who was deployed in Iraq in late 2004, began to see patients whose brains had swelled markedly within hours of being close to a blast. Some had clear head injuries but many did not. Even in cases involving visible wounds, the extent of swelling was often much greater than expected, leading neurosurgeons to wonder whether blast waves had played a role in addition to penetrating shrapnel. Ling says the patterns of vascular enlargement seen across a range of patients showed a continuum of brain injury, suggesting that there could be milder versions that were less obvious.

That suspicion has grown stronger with hundreds of soldiers returning from the war zone complaining of a common cluster of cognitive and behavioral problems. Army doctors say they have encountered many patients who are unable to perform simple addition and subtraction, read more than one sentence at a stretch, or recall simple things like what they had for lunch. “The majority are individuals who lost consciousness or were dazed after a blast but did not sustain overt head injuries,” says Ronald Riechers, a neurologist at Walter Reed Army Medical Center in Washington, D.C. “Within a short time frame, they develop headaches and notice that their reaction time and concentration are not the same as before.” Based on these evaluations, DVBIC estimates that 10% to 20% of all soldiers on duty in Iraq and Afghanistan have suffered some type of TBI.

Ling says the TBI numbers prompted DOD to restart its research on blast injury, this time with a focus on the brain. DARPA is funding two main projects as part of the first basic science effort on the topic. One will study the mechanical and cellular effects of blast waves in an animal model. Another will look at the consequences of repeated exposures to low-intensity explosions among military breachers, whose job is to blast holes into buildings using shoulder-launched weapons. “Once you know for certain what in a blast is really hurting the brain and how, you can use that to develop therapies and prevention strategies,” says Ling.

A tsunami in the brain

Although it is becoming accepted that blast waves can cause TBI, Cernak’s theory about how the damage occurs is controversial, and it has implications for how best to protect troops. She hypothesizes that when blast waves strike the body, they transfer kinetic energy and cause pressure in the main blood vessels to oscillate rapidly. A pulse travels up through the neck into the brain, damaging axonal fibers and neurons in the hippocampus, brainstem, and other structures close to cerebral vessels. The shock can also injure cells farther out in the cortical regions.

That mechanism is entirely different from the more widely studied effects of acceleration or deceleration in a car crash. Researchers know that a crash impact can shake the brain so violently that axonal fibers are torn. Some say victims of explosions could be experiencing a similar whiplashing, in contrast to Cernak’s view–which would mean that helmets designed to dampen that effect could help. “I am very skeptical that kinetic energy could be transferred through the vascular system,” says J. Clay Goodman, a neuropathologist at Baylor College of Medicine in Houston, Texas. “It is much more reasonable to consider the blast effects directly on the cranial vault and the brain.”

Cernak says her findings show the vascular route to be more plausible. In experiments that exposed rats and rabbits to a simulated blast wave in a shock tube–a cylinder through which an air pulse is transmitted at high velocity–Cernak and her colleagues found that immobilizing the animal’s head with steel plates to prevent whiplash effects did not protect against hippocampal cell damage, as they reported in the Journal of Trauma in 2001. Cernak says the vascular-transmission theory could explain the unique combination of symptoms in blast-induced TBI, as well as why neurological symptoms are seen in soldiers wearing helmets. For example, memory deficits hint at damage to the hippocampus, whereas problems in orientation reflect injuries to the cerebellum. “What’s happening in blast injury is that these inner structures are being affected,” Cernak says, in contrast to TBIs in traffic accidents and contact sports, where the cortex bears most of the brunt.

Cernak presented unpublished results last month at the Blast Injury Conference in Tampa, Florida, showing that exposure to blast waves can trigger neurodegeneration in rat brains, fragmenting the walls of neurons in the hippocampus and other regions. Similar findings have been published by Annette Saljo, a researcher at the University of Goteborg in Sweden and a collaborator of Cernak’s. Saljo and her colleagues reported in the Journal of Neurotrauma in August 2000 that rats exposed to blasts showed a buildup of neurofilament proteins in the cortex and the hippocampus during the week following the injury. This suggests that the damage can worsen over time, like a “slow cooking under the surface,” says Cernak: “One could think of it as a horribly accelerated aging of the brain.”

If blast waves indeed cause injury by vascular transmission, new types of body armor may be needed. “We would need to develop materials that completely absorb or reflect the full range of blast-wave frequencies generated by an explosion,” says Cernak, adding that current body armor only shields against some of a blast’s kinetic energy.

Cernak has done pioneering work, says John Povlishock, a neuroanatomist at Virginia Commonwealth University in Richmond, adding that she may be right that a “rapid rise and fall in venous pressure” is what stamps the blast’s signature on the brain. But more studies are needed to validate her ideas and translate the animal results into humans: “This is a topic with great economic, military, and social implications,” he says, “and as of now, the literature is extremely limited.”

Needed: A gold standard

As blast casualties from Iraq have mounted, the U.S. military has stepped up efforts to detect TBI among troops. In July 2006, the Army Surgeon General asked all unit commanders in Iraq to request TBI screening for soldiers displaying “poor marksmanship, delayed reaction times, decreased ability to concentrate, and inappropriate behavior.”
Troops who have been in a blast are evaluated by field medics using a short questionnaire that asks, among other things, if the person lost consciousness and had trouble remembering things from just before the explosion. Depending on the severity of the symptoms, they are asked to take a day off or see a neuropsychologist.

Some veterans groups believe a more aggressive screening policy is needed, especially because the symptoms of blast injury might not show up until later and because subtle injuries might not show up in standard brain scans. The ideal option, some say, would be to use a biomarker:

“We’d like to be able to do a blood test to determine the injury,” says Colonel Robert Labutta, a neurologist at the health affairs office at DOD. But until the science of blast injury is established, officials say, it does not make sense to bring home every soldier who has been in the vicinity of an explosion.

The costs of treating TBI victims from Iraq and Afghanistan could be astronomical. At last count, nearly 25,000 soldiers had been diagnosed with TBI. One estimate of the financial burden, calculated by Harvard researchers, puts the number at $14 billion over the next 20 years. But officials seem determined not to miss any cases among troops coming
home: In April, VA mandated TBI screening for all Iraq and Afghanistan veterans who come to VA hospitals for any services, even if it’s a dental exam.

The spotlight on mild TBI has drawn the attention of older combat veterans who were exposed to blasts but were never treated for neurological symptoms. Many were diagnosed with PTSD; some of the symptoms–such as depression, irritability, and attention deficit– overlap with those of mild TBI. These cases, some reaching back to the Vietnam War, could have significant legal and financial implications, says Edward Kim, a psychiatrist with Bristol-Myers Squibb in Plainsboro, New Jersey, and author of a recent report from the American Neuropsychiatric Association on the mental health effects of TBI. “I question whether DOD and the VA really want to open this can of worms,”
he says. For example, a veteran with Alzheimer’s disease could make a claim pointing to research showing that TBI increases the risk of developing Alzheimer’s disease.

Cernak says she has been receiving e-mails and phone calls from veterans thanking her for her research and seeking more information. Last month, she got a call from a 47-year-old woman who had served in the first Gulf War. The woman had been a teacher before she went to the combat zone, where she was exposed to repeated blasts. After she returned home, she had to stop teaching because she could not remember any facts. The story reminded Cernak why she had begun studying this obscure field 2 decades ago. “Soldiers anywhere are one of the most vulnerable populations in the world,” she says. “It is a moral obligation to help them.”

2 comments January 25th, 2008

Army in denial about PT-drug abuse link?

Phillip Leveque, M.D., takes on the army’s denial or deceipt about the extent of PTSD-realted drug abuse in an article in the Salem-News:

PTSD and Psychosis Among Army Psychiatrists

Dr. Phillip Leveque Salem-News.com
Phillip Leveque has spent his life as a Combat Infantryman, Physician, Toxicologist and Pharmacologist.

(MOLALLA, Ore.) - I was a combat infantryman for about 18 months in WWII where things were really crazy with various levels of officers demanding of their underlings (anyone of lower rank) that such and such a military objective be taken even if it killed every attacking soldier.

If that isn’t psychosis, what is?

I was also stationed in General Eisenhower’s headquarters for about six months. Of about 15,000 personnel, half officers, half enlisted, they acted like there wasn’t a war.

If such a psychic denial isn’t psychosis, what is?

The current seeming denial of PTSD and drug use on the highest army medical levels MUST BE a further example of psychosis.

I was absolutely flabbergasted that on ABC News 20/20 Col. Elspeth Ritchie, the psychiatry consultant to the U.S. Army Surgeon General, implied that there is no battle-induced PTSD causing drug use by soldiers, but like all other people using drugs, there were other “reasons”.

I was reminded that in WWI the Army swept it under the rug too, naming PTSD as “homesickness” or saying that the soldiers “missed their mothers”. What comes to my mind is SNAFU, FUBAR and even JANFU.

The VA’s own information says up to half of all PTSD patients treated also have a substance abuse problem.

Colonel Ritchie would only say that PTSD is a “risk factor” for the abuse of drugs and alcohol, but that the Army has not been able to quantify how strongly the two are linked. She said she was unaware of cases of soldiers turning to drugs to cope with the trauma of their experiences in Iraq.

She said, “That has not been my experience. My psychiatrists and social workers who see soldiers report to me of their experiences with soldiers all the time, and none of them are seeing that particular explanation.”

The Army actually goes so far to say there has been NO increase in the rate of illegal drug use among soldiers since the beginning of the wars in Iraq and Afghanistan.

Who do they think they’re fooling?

I presume Dr. Ritchie got her MD from a real medical school, but I have heard that the Armed Forces has its own medical school. I was embarrassed as a physician at her comments.

Was she lying to maintain her quest for one star, or was she really ignorant about PTSD? It’s hard to believe she got to where she is today without intelligence, so that leaves: CHOICE. She is choosing her future star over the welfare of our troops.

Even other army spokespersons and the VA people say to expect about 20% of battle veterans to have PTSD. Paul Sullivan, Gulf War veteran, a former project manager at VA who monitored the disability claim activity of Iraq and Afghanistan war veterans, and now is the executive director of Veterans for Common Sense (VCS), said PTSD was a big problem. His reaction to the Army psychiatrist? “Shame on her!”

Some of the most pitiful comments were given by a woman described as the director of substance abuse programs, apparently with the U.S. Army. She spoke about their success. The 20/20 program didn’t indicate her rank, or even if she was a physician, but she obviously didn’t understand that a battle-scarred PTSD veteran will use anything he can get his hands on to remove the PTSD devils from his soul and mind, even if it is heroin, booze, or at the very least, cannabis.

Ten times the number of soldiers are using drugs now compared to when the Iraq war began. That’s the military’s number, a complete contradiction to what Col Richie said.

Hundreds of veterans have told me that cannabis works better than any prescription drug. It’s about time for a serious trial of cannabis for PTSD.

Some soldiers are breaking the rules and turning to drugs to give them relief from the consequences of trauma in war. We can help them seek the best treatment by not living in the psychosis of denial.

I have also heard that many VA psychologists are trying “fake battle sounds” as treatment. God preserve us.

We PTSD guys are trying to stay as far from that as possible.

5 comments December 16th, 2007

Military prosecutes female soldier for suicide attempt

Washington Post reporters Dana Priest and Anne Hull, who broke the story on the horrors returning soldiers faced at Walter Reed Medical Center, continue their series with a truly chilling account of a model female soldier who volunteered for Iraq and broke under the strain of work and discrimination. She attempted suicide. As she was recovering she was charged in a Court Martial for her suicide attempt.

The story is too complicated to summarize, so I’ll post it below. It constitutes another piece of evidence that segments of the military cannot tolerate the concept that military conditions could lead to a mental breakdown. Any breakdown must be due to moral weakness and character flaws that need to be suppressed or punished, leading to a secondary traumatization of the already traumatized.

Here is the Post article:

‘A Soldier’s Officer’

By Dana Priest and Anne Hull

In a nondescript conference room at Walter Reed Army Medical Center, 1st Lt. Elizabeth Whiteside listened last week as an Army prosecutor outlined the criminal case against her in a preliminary hearing. The charges: attempting suicide and endangering the life of another soldier while serving in Iraq.

Her hands trembled as Maj. Stefan Wolfe, the prosecutor, argued that Whiteside, now a psychiatric outpatient at Walter Reed, should be court-martialed. After seven years of exemplary service, the 25-year-old Army reservist faces the possibility of life in prison if she is tried and convicted.

Military psychiatrists at Walter Reed who examined Whiteside after she recovered from her self-inflicted gunshot wound diagnosed her with a severe mental disorder, possibly triggered by the stresses of a war zone. But Whiteside’s superiors considered her mental illness “an excuse” for criminal conduct, according to documents obtained by The Washington Post.

At the hearing, Wolfe, who had already warned Whiteside’s lawyer of the risk of using a “psychobabble” defense, pressed a senior psychiatrist at Walter Reed to justify his diagnosis.

“I’m not here to play legal games,” Col. George Brandt responded angrily, according to a recording of the hearing. “I am here out of the genuine concern for a human being that’s breaking and that is broken. She has a severe and significant illness. Let’s treat her as a human being, for Christ’s sake!”

In recent months, prodded by outrage over poor conditions at Walter Reed, the Army has made a highly publicized effort to improve treatment of Iraq veterans and change a culture that stigmatizes mental illness. The Pentagon has allocated hundreds of millions of dollars to new research and to care for soldiers with post-traumatic stress disorder, and on Friday it announced that it had opened a new center for psychological health in Rosslyn.

But outside the Pentagon, the military still largely deals with mental health issues in an ad hoc way, often relying on the judgment of combat-hardened commanders whose understanding of mental illness is vague or misinformed. The stigma around psychological wounds can still be seen in the smallest of Army policies. While family members of soldiers recovering at Walter Reed from physical injuries are provided free lodging and a per diem to care for their loved ones, families of psychiatric outpatients usually have to pay their own way.

“It’s a disgrace,” said Tom Whiteside, a former Marine and retired federal law enforcement officer who lost his free housing after his daughter’s physical wounds had healed enough that she could be moved to the psychiatric ward. A charity organization, the Yellow Ribbon Fund, provides him with an apartment near Walter Reed so he can be near his daughter.

Under military law, soldiers who attempt suicide can be prosecuted under the theory that it affects the order and discipline of a unit and brings discredit to the armed forces. In reality, criminal charges are extremely rare unless there is evidence that the attempt was an effort to avoid service or that it endangered others.

At one point, Elizabeth Whiteside almost accepted the Army’s offer to resign in lieu of court-martial. But it meant she would have to explain for the rest of her life why she was not given an honorable discharge. Her attorney also believed that she would have been left without the medical care and benefits she needed.

No decision has yet been made on whether Whiteside’s case will proceed to court-martial. The commander of the U.S. Army Military District of Washington, Maj. Gen. Richard J. Rowe Jr., who has jurisdiction over the case, “must determine whether there is sufficient evidence to support the charges against Lieutenant Whiteside and recommend how to dispose of the charges,” said his spokesman.
‘A Soldier’s Officer’

A valedictorian at James Madison High School in Vienna, a wrestler and varsity soccer player, Whiteside followed in her father’s footsteps by joining the military. She enlisted in the Army Reserve in 2001 and later joined ROTC while studying economics at the University of Virginia. During her time in college, Whiteside said, she experienced periods of depression, but she graduated and was commissioned an officer in the Army Reserve.

In 2005, she received her first assignment as an officer — at Walter Reed. As an executive officer of a support company, she supervised 150 soldiers and officers, and her evaluations from that time presaged the high marks she would receive most of her career.

“This superior officer is in the top 10 percent of Officers I have worked with in my 16 years of military service,” wrote her rater, Capt. Joel Grant. She “must be promoted immediately, ahead of all peers.”

Maj. Sandra Hersh, her senior rater, added: “She’s a Soldier’s Officer. . . . She is able to get the best from Soldiers and make it look easy.”

Seeing so many casualties at Walter Reed made Whiteside feel she was not bearing her full responsibility, she said, so she volunteered for Iraq. When she left in the fall of 2006, she carried with her a gift from her father — the double-bladed buck knife he had used in Vietnam.

Whiteside was assigned as a platoon leader in the 329th Medical Company (Ground Ambulance) at the Camp Cropper detainee prison near Baghdad International Airport. The hot light from the Abu Ghraib abuse scandal still charged the atmosphere at Cropper, which housed 4,000 detainees and included high-security prisoners such as Saddam Hussein and Ali Hassan Majeed, known as “Chemical Ali,” as well as suspected terrorists and insurgents.

Whiteside, given the radio handle “Trauma Mama,” supervised nine medics who worked the night shift at the prison. She was in charge of dispatching drivers, medics and support staff to transport sick and wounded Iraqis and U.S. troops around the prison and to a small hospital inside.

“I loved our mission,” Whiteside said, “because it represented the best of America: taking care of the enemy, regardless of what they are doing to us.”

The hours were brutal. Whiteside ate one meal a day, slept in two four-hour shifts and worked seven days a week. Her superiors credited her with her unit’s success. “She has produced outstanding results in one of the most demanding and challenging Combat Zones,” her commander, Lt. Col. Darlene McCurdy, wrote in her evaluation.

But the dynamics outside her unit were rockier. From the beginning, Whiteside and some of her female soldiers had conflicts with one of the company’s male officers. They believed he hindered female promotions and undercut Whiteside’s authority with her soldiers, according to Army investigative documents.

As the tensions with the officer increased, Whiteside said, she began suffering panic attacks. She stopped sleeping, she said, and started self-medicating with NyQuil and Benadryl, but decided against seeking help from the mental health clinic because she feared that the Army would send her home, as it had recently done with a colonel.

On Dec. 30, U.S. military officials took Hussein from his cell at Camp Cropper for execution. The next day, the prison erupted. Thousands of inmates rioted, and military police used rubber bullets, flash-bang grenades and tear gas to restore order.

Whiteside took charge in the chaos, according to written statements by troops in her unit. She dispatched a pair of medics to each compound to begin triage, handed out gas masks and organized her unit to smuggle the prison’s doctors out in an ambulance.

The next day, weary from the riots, Whiteside ran into the problem officer. They had another argument.

Army investigative documents describe what happened next.

At 6:20 p.m. a soldier frantically approached Maj. Ana Luisa Ramirez, a mental health nurse at the prison, and said Whiteside was “freaking out” and wanted to see Ramirez. The nurse found Whiteside sitting on her bed, mumbling and visibly upset. Ramirez left to get some medication.

Later, she spotted Whiteside in the darkened hallway with her sweatshirt hood pulled over her head and her hands in her pockets. Ramirez asked Whiteside to come into her room and noticed what appeared to be dried blood on her neck and hands. When she tried to take a closer look, Ramirez said, Whiteside pointed her sidearm, an M9 pistol, at her and “told me to move away and she locked the door,” according to a statement Ramirez gave to the Army.

Ramirez tried to take Whiteside’s gun, but Whiteside pushed her away and expressed her hatred of the officer she thought was sabotaging her. She grew more agitated and twice fired into the ceiling.

Nurses in the hallway began yelling, and Whiteside shouted that she wanted to kill them, the report said. She opened the door and saw armed soldiers in battle gear coming her way. Slamming the door, she discharged the weapon once into her stomach.

Whiteside says she has little recollection of the events of that night. “I remember bits and pieces,” she said. She declined to comment on whether she was trying to kill herself.

The medics who responded to the shooting scene were Whiteside’s own crew.
Recovering at Walter Reed

Whiteside was still unconscious when she arrived at Walter Reed a few days later. The bullet had ripped through one of her lungs, her liver, her spleen and several other organs. Her parents and siblings kept a round-the-clock bedside vigil, and her condition gradually improved. Within two weeks an Army criminal investigator showed up in her hospital room, but a doctor shooed him away.

After a month, Whiteside was moved to Ward 54, the hospital’s lockdown psychiatric unit, where she was diagnosed with a severe major depressive disorder and a personality disorder. According to a statement by an Army psychiatrist, she was suffering from a disassociation with reality.

Tom Whiteside visited his daughter every afternoon, bringing pizza or Chinese takeout. He often noticed from the sign-in sheet that he was the only visitor on the ward. The psych patients formed a close bond and shared an overriding fear: that the Army would drum them out with no benefits.

One soldier Whiteside befriended was a 20-year-old private named Sammantha Owen-Ewing. Intelligent and funny, Owen-Ewing was training to be a nurse when she suffered mental problems and was admitted to Ward 54. She was still receiving psychiatric care at Walter Reed when the Army abruptly discharged her. According to her husband, she was dropped off at a nearby hotel with a plane ticket.

While on Ward 54, Whiteside received a package from her crew in Iraq. Inside was a silver charm, inscribed with the crew members’ names and the message: “Know that you are always loved by us. Never be forgotten and dearly missed. Your Trauma Team.” The crew also wore “Trauma Mama” bracelets in solidarity.

After being released from Ward 54, Whiteside joined the outpatient ranks just as the Army was scrambling to overhaul its system for treating wounded soldiers and President Bush ordered a commission to study military care for Iraq veterans.

At Walter Reed, the Army brought in combat-experienced officers to replace the recovering patients whom it had asked to manage the lives of the 700 outpatients on post. The new Warrior Transition Brigade and its more experienced leaders were supposed to manage more adeptly the tension between soldiering and patient recovery.

It was Whiteside’s commanders in this unit, a captain and a colonel, who drew up criminal charges against her in April. The accusations included assault on a superior commissioned officer, aggravated assault, kidnapping, reckless endangerment, wrongful discharge of a firearm, communication of a threat and two attempts of intentional self-injury without intent to avoid service.

The Army ordered Whiteside to undergo a sanity board evaluation to determine her state of mind at the time of the shooting.

Tom Whiteside said the criminal charges threatened to unglue his daughter’s already tenuous grip on recovery. “If they are doing this to her, what are they doing to those young PFCs without parents by their side?” he asked.

By early August, Elizabeth Whiteside sought an alternative to court-martial. She requested permission to resign, a measure the military often accepts.

Rowe, commander of the U.S. Army Military District of Washington, which has jurisdiction over her case, would decide whether to grant her request.

He reviewed recommendations from Whiteside’s two commanders at Walter Reed and the facility’s commander, Maj. Gen. Eric B. Schoomaker, a physician. Whiteside’s immediate commander at the hospital, a captain, recommended that she be given an “other than honorable” discharge, according to a document obtained by The Post. The captain wrote that her “defense that she suffers from a mental disease excusing her actions is just that . . . an excuse; an excuse to distract from choices and decisions made by 1LT Whiteside.”

Col. Terrence J. McKenrick, commander of the Warrior Transition Brigade, agreed: “Although the sanity board determined that at the time of the misconduct she had a severe mental disease or defect, she knowingly assaulted and threatened others and injured herself.”

Schoomaker, now the Army’s surgeon general, dissented. “This officer has a demonstrably severe depression which manifested itself . . . as a psychotic, self-destructive episode. . . . Resignation in lieu of court-martial eliminates all of the benefits of medical support this officer deserves after 7 years of credible and honorable service.”

Rowe overruled Schoomaker. He agreed to accept Whiteside’s resignation with a “general under honorable conditions” discharge that would still deprive her of most benefits, according to her pro bono civilian attorney, Matthew J. MacLean.

But then, from her battalion commander in Iraq, Whiteside learned that an investigation there had concluded that there was “insufficient evidence for any criminal action to be taken against” her. Furthermore, it had found a hostile command climate and recommended that the officer who had been her nemesis be removed from his position and “given a letter of reprimand for gender bias in assignments and use of intimidation, manipulation and hostility towards soldiers.”

With this news, Whiteside asked that her letter of resignation be withdrawn. She would fight the charges.

In an e-mail exchange, the prosecutor, Wolfe, told MacLean that even if Whiteside won in court she would probably end up stigmatized and in a mental institution, just like John Hinckley, the man who shot President Ronald Reagan.

Wolfe suggested that the military court might not buy the mental illness defense. “Who doesn’t find psycho-babble unclear . . . how many people out there believe that insanity should never be a defense, that it is just, as he said, an ‘excuse.’ ”
Awaiting a Decision

Whiteside lived with other outpatient soldiers in a building on the grounds of Walter Reed. She kept her quarters neat and orderly. As her preliminary hearing approached, she often went to bed at 8 p.m. to sleep away her impending reality. She attended morning formation and medical appointments. On weekends she hung out with her clique from Ward 54, “my little posse of crazy soldiers,” as Whiteside called them.

She still had the innate ability to motivate soldiers. To pass time one recent Sunday, Whiteside drove a small group of outpatients to go bowling at the National Naval Medical Center in Bethesda. “You can do better,” she told a young private who was a terrible bowler. “We’ll pool our energy together and get a strike.”

Whiteside also offered encouragement over the phone to her friend Sammantha Owen-Ewing, the soldier she befriended on Ward 54 who had been abruptly dismissed from the Army. Sammantha was waiting to see if she could receive her care from the Department of Veterans Affairs.

Whiteside feared the same fate.

At the hearing, the testimony focused on Whiteside’s state of mind at the time of her shooting. The hearing officer would have seven days to make a recommendation on whether to dismiss the charges, offer a lesser punishment or go to court-martial. The final decision will be Rowe’s.

A psychiatrist who performed Whiteside’s sanity board evaluation testified that he found the lieutenant insane at the time of the shooting. One of the doctors said that Whiteside had a “severe mental disease or affect” and that she “did not appreciate the nature and quality of her actions.” Brandt, chief of Behavioral Health Services in Walter Reed’s Department of Psychiatry, testified that Whiteside was “grappling with holding on to her sanity,” adding: “She was right on the edge, and she fell off.”

Wolfe made his argument for a court-martial. “These are very serious charges,” he said. “The more serious the crime, the higher level it must be disposed of. . . . The government’s position is it should be a court-martial.”

When the hearing ended, Whiteside walked outside into the cold. Her phone buzzed with a text message from the husband of her friend Sammantha, asking Whiteside to call right away.

Sammantha had hung herself the night before.

On Friday, Whiteside and her father flew to Utah for the funeral. Yesterday, after a service at a small Mormon church, Sammantha Owen-Ewing was buried.

Grief-stricken by the death of her friend and bitter at the Army, Whiteside awaits the Army’s decision this week.

“I can fight them,” she said, “because I’m alive.”

1 comment December 2nd, 2007

Claims military overmedicating soldiers

ABC News reports that the military, presumably in a rush to get soldiers back in the field, is overmedicating them. ABC News claims that this reliance on drugs can teach soldiers to rely on other drugs, including illegal ones, leading to a rising addiction rate.

Instead of providing proper counseling and care for Iraq war veterans suffering from physical and psychological pain, too often the U.S. military is trying to medicate the problem away, according to drug counselors and therapists.

Andrew Pogany, who works with service members nationwide as an investigator with the veterans advocacy group Veterans for America, said overmedicating veterans is a common problem.

“Pretty much every person in my caseload is medicated, heavily medicated,” said Pogany. “There’s potential for them to become addicted.”

According to Pogany, a reliance on prescription drugs often leads veterans to reach for other coping mechanisms — illegal drugs such as marijuana, cocaine and crystal meth.

The report attributes the overmedication to a lack of counseling resources.

 But Andrew Pogany said the reason why vets suffering from PTSD are not afforded better psychiatric care is clear — a lack of resources on the part of the military.

“Do they have enough trained providers to provide individual care? The answer is no,” he told ABC News.

And the military apparently agrees. Results from the DOD (Department of Defense) Task Force on Mental Health released in June 2007 find that “the military system does not have enough resources, funding or personnel to adequately support the psychological health of service members.”

“Handing somebody a bag of medication and then seeing them once a month for a half-hour appointment, that’s not adequate,” said Pogany.

Another factor that may contribute I’ve heard about from some vets, and from reporters investigating the issue is that military commanders simply cannot accept that military experience could lead to trauma, as in PTSD. These sources feel that the pervasive denial contributes to some of the abuses os soldiers and vets that have recently been reported in several media sources.

2 comments December 2nd, 2007

Editorial: Personality disorder discharges save money, sacrifice soldiers

I have reported previously on the military’s use of personality disorder diagnoses to deny claims from disabled soldiers who served years before their “preexisting” diagnosis was “discovered.” The Anchorage Daily News has editorialized against this disgusting practice:

This is betrayal
Personality disorder discharges save money, sacrifice soldiers

(Published: October 2, 2007)

Let’s put ourselves in these shoes for a moment, if we can:

You’ve honorably served in the Army for seven years. You’ve won commendations. You re-enlisted after your first hitch. You’re in Ramadi, Iraq, in 2004 when a rocket hits the building you’re in and leaves you unconscious in rubble. Eventually doctors pull shrapnel from your neck and ear canals. You lose 75 percent of your hearing, suffer depression and nightmares.

You try to kill yourself by dropping a hair dryer in your bath water. The dryer short-circuits. You seek medical help at your Army post.

Eventually, the Army discharges you because you had a “pre-existing personality disorder” before you joined the service.

And what does that mean?

• You can’t get disability pay. That requires a medical board evaluation, and a soldier who signs a personality disorder discharge gets no medical board.

• You can’t get VA medical care — you can’t be treated for post-traumatic stress syndrome — because the VA treats only those wounds and conditions suffered in service. “Pre-existing condition” is the Pentagon’s way of saying the Ramadi rocket had nothing to do with the soldier’s troubles.

• You must pay back part of your re-enlistment bonus for the time you won’t serve because of the personality-disorder discharge.

All of this happened to former Spc. Jon Town of Findlay, Ohio. This spring and summer, with reports in The Nation and ABC News, Mr. Town became a symbol for veterans groups, because he’s not alone.

The military has mustered out about 22,000 service people in the last six years with personality-disorder discharges. It appears that a lot of them were flat-out bogus, as in the case of Mr. Town, or at least contestable.

There’s a gut-reaction word for what happened to Mr. Town, but we can’t use it in a family newspaper.

Why are the services doing this?

Money.

The departments of Defense and Veterans Affairs save money if they don’t have to pay benefits.

God almighty, let us take a deep breath.

A bipartisan group of senators led by Barack Obama of Illinois and Christopher Bond of Missouri has introduced a provision in the defense bill to stop the personality-disorder discharges pending investigations by the General Accountability Office (the GAO already is looking into the practice at Fort Carson, Kan.) and impose tougher standards and limits on such discharges.

Good for the senators.

Where’s the commander in chief? A few words from the White House lawn — strong words, Mr. President, leader’s words — would go far to end this kind of nonsense.

Some personality-disorder discharges are no doubt valid, and those no longer able to function in a theater of war shouldn’t be there. But any soldier who has served in Iraq or Afghanistan should get the benefit of the doubt. Soldiers subject to personality-disorder discharges must be fully informed of their rights and all the consequences of such a discharge before signing one.

You don’t have to be a psychiatrist or a soldier to understand that rockets, IEDs and sniper rounds are not pre-existing conditions. One god-awful argument to justify personality-disorder discharges was that dormant pre-existing conditions surface under the stress of combat; hence such soldiers don’t qualify for treatment of post traumatic stress disorder.

In response, we refer to that word we can’t print in a family newspaper.

The United States has a solemn obligation to those among us who were asked to wage war in Iraq and Afghanistan. Let’s keep it.

BOTTOM LINE: Let’s take care of our wounded troops — not look for ways to deny care.

1 comment October 5th, 2007

The exhaustion of the soldiers

Soldiers in Iraq are suffering exhaustion on a daily basis, the Guardian reports:

The Americans he commands, like the other men at Sullivan - a combat outpost in Zafraniya, south east Baghdad - hit their cots when they get in from operations. But even when they wake up there is something tired and groggy about them. They are on duty for five days at a time and off for two days. When they get back to the forward operating base, they do their laundry and sleep and count the days until they will get home. It is an exhaustion that accumulates over the patrols and the rotations, over the multiple deployments, until it all joins up, wiping out any memory of leave or time at home. Until life is nothing but Iraq.

Hanna and his men are not alone in being tired most of the time. A whole army is exhausted and worn out. You see the young soldiers washed up like driftwood at Baghdad’s international airport, waiting to go on leave or returning to their units, sleeping on their body armour on floors and in the dust.

Where once the war in Iraq was defined in conversations with these men by untenable ideas - bringing democracy or defeating al-Qaeda - these days the war in Iraq is defined by different ways of expressing the idea of being weary. It is a theme that is endlessly reiterated as you travel around Iraq. ‘The army is worn out. We are just keeping people in theatre who are exhausted,’ says a soldier working for the US army public affairs office who is supposed to be telling me how well things have been going since the ’surge’ in Baghdad began.

They are not supposed to talk like this. We are driving and another of the public affairs team adds bitterly: ‘We should just be allowed to tell the media what is happening here. Let them know that people are worn out. So that their families know back home. But it’s like we’ve become no more than numbers now.’

This exhaustion has implications for the troops, and for the Iraqis. The troops will suffer the short- and long-term consequences: divorces, illness, mental illness, botyh in Iraq and long after they return. The Iraqis, however, will suffer the consequences of poor decision-making by the troops: quicker firing at roadblocks, less accurate aim, more rage during home searches, overwhelming firepower called in quicker, and a general increase in the daily brutality of occupation.

US decision-makers, of course, care about neither consequence. For them the US troops, primarily working class, matter no more than do the Iraqis they attempt to control. Their all just pawns in a game of control and of image. To these decision-makers, looking strong is more important than any number of lives.

Add comment August 12th, 2007

Annoyed former sailor on use of personality disorder diagnoses to deny benefits

Promoted from comments on my March 23 post on the military’s use of personality disorder diagnoses to avoid paying benefits to traumatized Iraq vets:

The military uses personality disorder as a way to get rid of people they don’t want to deal with (for a number of reasons) by other means. They don’t do proper evaluations or make proper diagnoses and as such anyone with a PD diagnosis in the military should not believe it unless it is confirmed by a professional opinion, not the hacks they have in the military. I know of *many* people who have been discharged with PD and they are fully functioning people, not history of or signs of PD. It is a terrible thing that the military can do this is such immunity from being held accountable from their mistakes.

annoyed former sailor

Add comment May 28th, 2007