Trauma Takes a Toll

The extracts below are from a front-page article in yesterday's Wall Street Journal.

Note the Army Surgeon General saying they don't want to screen for post-traumatic stress syndrome months afterwards, when many of the cases show up, because they don't have the resources to help that many more soldiers.

Trauma Takes a Toll Beset by Nightmares, Anxiety, Ranger Leaves the Army; 'I'm Not the Same Person' by Greg Jaffe October 7, 2005 In January 2003, the Army Ranger captain sat in the Capitol as the president's guest while Mr. Bush gave his State of the Union address. To the White House, Mr. Self was a symbol of American strength, resolve and success in the war on terror. Badly outgunned, the young officer led his men through a bloody 15-hour firefight against al Qaeda fighters atop a remote mountain in Afghanistan. After the battle, the Army awarded him the Silver Star, heaped praise on him and assumed he would move swiftly onto the next war. He did. In the spring of 2003, he deployed to Iraq. There, Mr. Self began to suffer from grisly nightmares, anxiety and depression. Last year the war hero came home. In November, he quietly -- and inexplicably, to his Army friends -- left the military. A few months later, he was diagnosed with severe post-traumatic stress disorder. Today, Mr. Self presents a different sort of model for the Army. He's a striking example of the emotional toll the wars in Iraq and Afghanistan are taking on soldiers and the U.S. government's incomplete efforts to respond. Just as the U.S. military underestimated many things in Iraq -- the insurgency, the need for better body armor and stronger vehicles -- it didn't anticipate the levels of emotional stress soldiers have faced, Army officials say. Of about 49,000 veterans of Afghanistan and Iraq who received care at a Department of Veterans Affairs facility between October 2003 and February 2005, 26% screened positive for a mental disorder, the VA says. Until recently, the Army only had enough counselors to screen soldiers for mental illness immediately upon their return to the U.S. That missed thousands of soldiers like Mr. Self, whose symptoms are slow to appear. One Army study of 1,000 soldiers, for example, found troops were seven times as likely to report symptoms that merited further study if they were surveyed four months after returning home. Now the Army plans to screen troops a second time, three to six months after their combat tours end. But that effort has been slowed because the Army hasn't had enough psychiatrists to provide follow-up care, officials say. "It is not appropriate to [screen troops and then] say maybe we'll get to you later," says Lt. Gen. Kevin Kiley, the Army's surgeon general. Many more don't get help because they're concerned about the stigma. Half of the troops who screened positive for a mental disorder in a study published last year in the New England Journal of Medicine believed seeking help would "harm their career." Sixty-five percent worried they would be seen as "weak" by their leaders. Mr. Self ... often thinks that if he could just rejoin the Army, slip on one of the old uniforms and slip back into the world he knew, he'd find peace. Even death wouldn't bother him. "It would make a nice end to it all -- an honorable way to go," he says in a darker moment. "It's funny, but I felt comfortable talking about the battle with everyone but the people who meant the most to me," he says. "I didn't want to desecrate their minds." Mr. Self's wife assumed he had just moved on. Gradually, he began to notice a change in himself, he says. A feeling of malaise began to set in. He uncharacteristically put on weight. He began experiencing nightmares. After learning he had a chance to finish at the top of his class, he did poorly on his final test. "I just felt stone cold, like I had lost my personality. I didn't want to succeed," he says. "I wanted to be mediocre." In March, at his wife's urging, Mr. Self finally sought counseling -- three years after the Afghan battle and five months after he left the Army. He went to the VA hospital in Waco, Texas, where a psychologist diagnosed him with severe post-traumatic stress disorder. Mr. Self says the doctor told him about programs available at the hospital and even offered to treat him personally, but because of a busy schedule could only see him once a month. "We probably don't have enough staff at the moment. But we recognize the need and are trying to get ahead of the curve," says VA spokeswoman Liz Crossan.

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