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Iraq vets' troubles appear long after return
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It started about a month after he came home, innocently enough. Staff Sgt. Frederick Johnson missed his fellow soldiers.
During a year stationed at Anaconda base in Iraq -- nicknamed "Mortaritaville" -- he says he looked after them like a father, eyes always focused on the horizon, scanning for danger.
And at night, he clutched a half-gallon bottle of any liquor he could find, emptying two or three a week.
After he returned home in December 2005, his dangerous coping methods progressed to crack cocaine. Already depressed by separating from the Ohio-based 373rd Medical Company -- the only people, he said, who could understand his war experience -- he grappled with his emerging fear of crowds, his aversion to loud noises and the horror of his nightmares. They often ended with him leaping out of bed into a low crawl position.
After a year battling addiction and the lingering effects of the post-traumatic stress disorder (PTSD), which the Army initially failed to diagnose, Sgt. Johnson, 38, is starting his life over at the VA Pittsburgh's Highland Drive Division.
He is among thousands of soldiers overlooked by previous mental health screening methods that, according to a new Army study released earlier this month, "substantially underestimate the mental health burden" of Iraq War veterans.
With increased congressional funding, the Army is trying to stop soldiers in Sgt. Johnson's situation from slipping through the cracks. The study compared results from soldiers who received only an initial mental health screening and those who received initial screening and then were reassessed after several months.
The second screening, called the Post-Deployment Health Re-Assessment, was started after preliminary data from an earlier study of the single screening indicated that soldiers were more likely to report mental health distress several months after return than right after they came home.
The single assessment approach failed to identify thousands who later developed mental illnesses -- most notably PTSD.
The study found that after a second screening, the number of soldiers referred to treatment for mental illness more than doubled from 3,925 out of 88,235 in the first to 10,288 in the second. The second screening also showed a 75 percent increase in soldiers deemed a mental health risk and a 73 percent surge in those diagnosed with PTSD.
Among the measurable symptoms, researchers said, were soldiers' reports of relationship conflicts, which quadrupled several months after coming home.
For reservists like Sgt. Johnson, the results were even more pronounced, possibly because their civilian lives lack the support network afforded full-time soldiers for dealing with post-combat stress, the study notes.
The research, believed to be the Army's first ever in-depth study of PTSD, used the information provided by soldiers returning from Iraq between June 1, 2005 and Dec. 31, 2006.
"They got a late start considering the war started in 2003," said Ramona Joyce, spokeswoman for the American Legion, a veterans advocacy group. "But better late than never."
Researchers based at Walter Reed and the U.S. Army Center for Health Promotion and Preventive Medicine published the findings in the Journal of the American Medical Association.
The results indicate the first three to six months after deployment are key to diagnosing and treating mental illness, particularly PTSD, before soldiers' lives unwind, said one of the study's lead researchers, Dr. Charles S. Milliken of the Division of Psychiatry and Neuroscience at the Walter Reed Army Institute of Research.
"Sometimes the person with the mental issue is the last to know," said Dr. Milliken. "They might not come looking for help, but if we can catch the symptoms before they become a problem, they'll be better off."
Massive health buildup
The military has hired thousands of new mental health clinicians and created a call center to track down veterans who never had a second screening. At its 10 Western Pennsylvania hospitals, the Department of Veterans Affairs has created 221 new positions in the past three years to treat mental health patients, spokeswoman Heather Frantz said.
Like all returning combat veterans, Sgt. Johnson received an initial mental health check when his deployment ended in 2005, but it failed to foretell his future problems. His mental health was never reassessed.
According to Dr. Milliken, the tough-minded, conquer-all-obstacles mentality the military teaches may make it more difficult for some soldiers to admit they have a problem.
For many soldiers, the initial euphoria of coming home may also mask problems churning below the surface. With 15 years in the Army -- three on enlisted active duty and the last 12 in the Reserves -- Sgt. Johnson said his case was a combination of the two.
Going against training
"I didn't know I was going through PTSD and depression, but I knew something was going on," he said. "And the soldier in me said, 'Suck it up and drive on.' So that's what I did."
Self-medicating and fearing sleep, he said he would stay up for days at a time, on the lookout for drugs or hunkered down alone at a corner bar stool with a double shot of Remy Martin, afraid of becoming violent if he interacted with other people. He avoided crowds, as if still in Iraq, because he remembered them as easy targets for mortar attacks. He dreaded the sound of helicopters because it reminded him of dead or wounded soldiers being flown into his medical unit.
One night, he reached a low. Now homeless, he realized he had run from one side of his hometown of Chester, Delaware County, to the other in a crack- and alcohol-hazed panic, hiding in trees and bushes along the way fearing someone was chasing him and trying to kill him.
He was hospitalized Jan. 22, having already failed an Army drug test. He said he wishes the current mental health detection methods -- the VA now sends mental health clinicians directly to the reserve unit for screening sessions soldiers are required to attend, Dr. Milliken said -- were in place after his tour of duty.
"I wish we would have had a more extensive homecoming, instead of just seeing the chaplain and turning in our gear and going home," Sgt. Johnson said. "I didn't even know what PTSD was until this year."
With the help of medication and therapy, his life has entered its rebuilding stage. A social worker in civilian life before leaving for war, he has also taken steps toward building a nonprofit organization and a Web site, www.heroestoday.org, which will aim to help homeless veterans in the Pittsburgh area.
Sgt. Johnson could soon face the prospect of a complete detachment from the military. He said he is in the process of being discharged for the failed drug tests. A spokesman for the 99th Regional Readiness Command said privacy regulations prohibit release of information about drug testing or possible pending discharges.
Sgt. Johnson's story may represent another problem soldiers experience in dealing with mental illness.
Some psychiatrists who study PTSD, like retired Brig. Gen. Stephen N. Xenakis, worry that military commanders are using drug abuse and other PTSD symptoms as reasons to discharge troubled troops slowing down their units.
"That needs to be reexamined really carefully," Dr. Xenakis said. "We're seeing that a number of soldiers are getting discharged for behavior reasons or personality disorders when they are, in fact, suffering from PTSD or blast concussions. ... We need to revisit our policies and procedures on that."
Soldiers discharged for misconduct lose their disability benefits even though "that behavior was a sign or a symptom of their underlying mental health issue," Dr. Xenakis said.
Sgt. Johnson said he's received encouragement to appeal the Army's initial decision to discharge him for misconduct. He may try to fight for his disability benefits, but he has no interest in preserving his military career.
"I don't have any fight left in me when it comes to the Army," he said. "Besides, if I fought to stay in, I would just get sent to Iraq again anyway."
First Published November 25, 2007 12:00 am
