Thirty Percent of Iraq War Veterans May Need Psychiatric Care

San Francisco Chronicle

Thirty Percent of Iraq War Veterans May Need Psychiatric Care

The nation’s military system is quietly preparing for one of its toughest missions in decades: ensuring that soldiers who return from Iraq get the help they need to deal with the stress and horrors of war.

Military officials and mental health providers predict that up to 30 percent of returning soldiers will require psychiatric services — a number not seen since the end of the Vietnam War.

And, after several years of double-digit increases in federal funds for veterans health care, the 2005 inflation-adjusted budget is only 1.5 percent higher than last year’s.

“The system is tremendously challenged,” said Fred Gusman, who founded the nation’s first combat stress center in 1977 and is director of the Department of Veterans Affairs’ National Center for Post-Traumatic Stress Disorder in Menlo Park.

In coming months and years, new combat veterans will struggle to adjust to life back home, to go from leading troops to managing a family, from trusting no one to confiding in someone.

There are returning soldiers who feel weakened, off balance. New veterans may go out of their way to avoid crowds. They may drive through red lights, because stopping in Iraq meant potential ambush. Most soldiers will quickly regain their footing, but others will need help, some for a lifetime. All will need time and understanding, experts say.

Gusman, who is a Vietnam veteran, said the nation should feel a deep responsibility to “those who gave their all and now might need our all.”

The Pentagon estimates that as many as 100,000 new combat veterans nationwide will suffer from mental issues ranging from depression and anxiety to the more debilitating post-traumatic stress disorder, characterized by angry outbursts, flashbacks, nightmares and hypervigilance. An estimated 900 service members have been evacuated from Iraq since the start of war due to psychological problems, according to the Defense Department.

Military hospitals and clinics will be challenged, as will the families and communities of returning soldiers.

“You can’t be in a war zone and not need readjustment when you come home, ” said Kuuipo Ordway, a trauma specialist with the Concord Vet Center.

“When they get into a combat arena, they are in a survival mode,” said Ordway, who since October 2003 has met with soldiers returning from Iraq. “The neurons in the soldier’s brain shift. When they’re in a war, the soldier has to hear and smell and do everything better. They repress a lot, but their memory is keeping track.”

Jack Stowe spent a year in Iraq, returning home May 1, 2004. Stowe, a member of a National Guard transportation unit out of San Bruno, was the commander of a company that provided convoy escorts to Army trucks around Baghdad, Tikrit and Mosul. His unit constantly came under fire from insurgents and navigated roads sometimes rigged with improvised explosive devices.

When he returned, his family was thrilled to have him home and the company where he worked installing alarms welcomed him back.

He thought he was fine. He was alive. He had all of his limbs. He was lucky, he told himself.

Soon, though, the problems began. He had nightmares. He felt numb. He couldn’t connect with his wife, daughters, or sisters. Driving to work, he would see a pile of dirt on the freeway and swerve. A bump in the asphalt made him picture insurgents setting a trap.

“Over there, you do your job, you keep feelings to yourself,” said Stowe, 37, who lives in Antioch. “You have to show you are a good leader. If you show fear, your troops will reflect that. I needed to power up to be who the Army put me in the position to be. When I got back, I just shut down.”

Katie Stowe recalls a party on the Fourth of July. Her husband’s sisters were there, as were members of her family. Kids ran around. Everyone was having fun.

“Jack couldn’t even be in the same room with the group,” Katie Stowe said. “I was kind of keeping an eye out for him. I can only imagine what it’s like trying to kill anyone who tries to kill you, being in this mode of always watching and fearing and living in dirt and sand and then coming home and you’re supposed to mow the lawn.”

She says that her husband’s numbness finally led to a call for help. “Jack was scared something was seriously wrong with him. He didn’t want me to tell anyone. He was initially very embarrassed. He said, ‘I didn’t lose a leg. I didn’t lose an arm. Why should I need help?’ ”

Since that point, the two have attended therapy and counseling sessions at the Concord Vet Center. Katie Stowe says her husband is getting better. The nightmares and night sweats persist but seem less intense.

“Jack finally told another soldier he was going to get help and the other soldier said, ‘Oh, so am I and so is so and so.’ ”

The plight of soldiers who survive war but suffer from its memories is not new. The psychological wounds have been chronicled from ancient Greece to World War II, from Vietnam to the first Gulf War. Names given to the mental traumas afflicting soldiers have included “Soldier’s heart,” during the Civil War, and “battle fatigue,” during World War II. The term post-traumatic stress disorder came about in 1985 and was used to describe the tens of thousands of struggling Vietnam veterans.

The military’s mental health system is taking steps to reduce or avert the psychological wounds of war. Soldiers are screened for psychological problems before and after deployment. Unlike in past wars, the military now has combat stress specialists in the war zone.

Sandy Moreno, a psychiatric technician who spent a year in Iraq, worked with troops in the field. She is an Army reservist who was a part of the 113th combat stress company out of Southern California.

“We dealt with a lot of home front issues,” said Moreno, who now works at a veterans center in Sacramento. “We did debriefings with people who had been in critical situations, such as when a unit got ambushed or a unit member was killed.”

She said one of the toughest things for soldiers in Iraq is the reality that there is no safety zone.

“You don’t trust anyone when you’re over there. You live by the idea that you can deal with anything, handle anything.”

Stephen Robinson, a 20-year Army veteran who is now executive director of the National Gulf War Resource Center, an advocacy group, said: “I know for a fact that the military health care system is ill prepared to deal with the psychological impact of war.”

A study published in July in the New England Journal of Medicine indicated that roughly one in six soldiers returning from the war in Iraq will need psychological counseling as a result of wartime service. Robinson believes the number will rise to one in three.

Jimmy Norris, the chief financial officer for the Department of Veterans Affairs health care system, said in an interview that the federal budget for veterans health care this year is around $30 billion — a 1.5 percent inflation-adjusted increase over 2004.

“Last year there was no anxiety over the budget,” Norris said. “We had a 10 percent year-to-year increase. That was feast time. This year we will be challenged.The bottom line is that we will continue to provide the highest quality of care for veterans. We won’t compromise that.”

Newly returned veteran Antonio Hernandez, who is 35 and lives in San Jose, said he is coping with the night and day changes in his life. He says he is not in treatment, but wouldn’t resist if he began having problems.

Hernandez, an Army reservist who spent 16 months in Iraq, was always on guard. Every day, every night, there was danger. As a convoy escort, he came under constant fire.

Now he manages a Hollywood Video store.

“I do feel lucky to be home,” he said. “But I never get rid of the gory images. I lost my ability to trust. You see cute kids coming at you in Iraq. That could be a decoy. The same with women in their burkas. My kids and wife will never understand what I went through. I’m in my homeland, but I perceive life differently. Every day, there is something that reminds me of what I have been through.”

E-mail Julian Guthrie at

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