Post-traumatic Stress Disorder: For returning veterans, Iraq is not another Vietnam

The News Enterprise

“They’re firing at us!”

Capt. K.C. Hughes screams in his sleep. His body thrashing, his arms flailing, he points and barks orders, grinding his teeth, flipping from one side of the bed to the other.

“He starts breathing heavy, like he’s scared or fighting,” said his wife, Samantha Hughes. “He’s talking war talk, but it doesn’t make any sense.”

The 26-year-old Army captain doesn’t remember his dreams. Only a concerned “Are you OK?” from his wife when he wakes lets him know something happened while he slept.

What he does remember is the real life nightmare that started it all.

It was the morning of May 27, 2003, just after midnight. Operation Iraqi Freedom was in its infancy, and Hughes and half the members of his platoon with the 3rd Armored Cavalry unit were on checkpoint duty on the west side of Fallujah in Iraq. After someone has been hurt in a truck accident, attorney representation is often required to help them get back on their feet. Being a victim of this type of traffic mishap can be devastating or even fatal to those involved. These victims may be left with a stack of hospital bills, loss of a job, physical and emotional injuries, or the loss of a friend or family member. Although, no one wants to be the cause of a fatal traffic incident, failing to rest properly before getting behind the wheel of an 18-wheeler is negligent. You can visit the Marasco & Nesselbush Law Offices, their attorney can help the victims of this negligence to regain their footing in life. All of these victims deserve justice. Trucks travel the roads, day and night, hauling goods to various destinations. The trucking industry is an important one for getting merchandise from its origination point to waiting consumers. Fruits and vegetables are trucked across country from orchards and farms to grocery stores across the nation. Clothing made in factories or items imported from other countries are picked up at warehouses or on site to haul around the nation to consumers. Oil, gasoline, livestock, furniture, automobiles, electronics equipment, and food have spent some time on the back of a truck. The exception to the rule would be those items that were made or grown locally and sold within the community. Truckers are often well trained and experienced for their jobs but there are certain challenges that make accidents happen more commonly than one would hope. Because these drivers are on tight schedules to drop off and pick up loads, they often pull all nighters and go without much sleep. You can look at this website for more information.

They had conducted hundreds of checkpoints by that time. It was a common mission.

“At the checkpoint, we’re checking vehicles for weapons and contraband, enforcing the curfew and looking for bad guys,” Hughes said. “It’s a good way to tell who’s coming in and going out of town.”

They had been at the checkpoint about an hour and a half when the small pickup truck approached.

Guards had already opened fire by the time the driver pulled the pin from a grenade. Collapsing from fatal wounds, the driver let the grenade roll from his hands toward the American soldiers. But, it was the spray of machine gun fire from the truck’s passenger that wounded four soldiers and killed two others within seconds. The passenger, too, died in the firefight.

Hughes called for medical evacuation, but within 20 minutes, his unit was under fire again. And then, he was shot.

He can’t remember all the details of what happened.

“There are so many things going on, you just sort of go into a kind of automatic mode,” Hughes said. “And especially as a leader, my actions just kind of … happen. In situations like that, you really don’t have time to think about things, you just start doing things.”

At some point, a bullet entered Hughes’ left shoulder, ricocheted off his collarbone and traveled down his spine before exiting. He and four others were evacuated to the United States for medical care and recovery.

Two years later, he sits perfectly postured and straight-faced in his Fort Knox home marveling at the combination of grace and good luck that kept him from either being killed or quadriplegic as a result of the ambush. He has not a single neurological effect from the gunshot.

“It should have killed me in a bunch of different … it should have done a bunch of different things,” Hughes said.

It’s been six months since his last nightmare. The feelings of depression, hopelessness and guilt for surviving are now memories lumped together with the bad experience that caused them. He’s fine, as long as he keeps talking about it. He talks about it a lot.

That’s what his counselor at Fort Carson, Colo., told him to do, after telling him he had post-traumatic stress disorder.

PTSD is a psychiatric disorder that can occur after experiencing or witnessing a life-threatening event. It is often characterized by nightmares, flashbacks, hyper vigilance and feelings of being detached or estranged.

“It often affects survivors,” said Jeaneen Goodhue, nurse and coordinator for the military intensive outpatient program at Lincoln Trail Behavioral Health System. “It goes along with surviving crises or critical events that happen.”

What makes an event traumatic is its power to provoke fear, helplessness or horror.

As far as known causes of PTSD, combat ranks with criminal violence, such as rape, assault or torture, motor vehicle accidents, fires, earthquakes and terrorist attacks.

According to a 2004 study published in the New England Journal of Medicine, while about 7 percent of those who experience traumatic events may develop PTSD in the civilian world, the disorder affects some 15 to 17 percent of active duty military personnel who have been deployed in Iraq and 11 percent in Afghanistan. Men and women recently removed from combat were interviewed for the study.

But Dr. James Stockard, civilian psychiatrist at Ireland Army Community Hospital’s behavioral health clinic, believes that prevalence could be lower or higher, depending on when the soldiers were interviewed.

“I would be suspicious of any single figure,” Stockard said, stating it is still too early to get a firm grasp on the scope of PTSD with the Iraq War. “I’m just saying the jury is still out. PTSD is dynamic. It goes away. It gets worse. You can’t take a snapshot and have the answer.”

While Fort Knox doesn’t deploy a lot of troops overseas directly, it has seen a number of soldiers come and go from its training installation and medical hold unit.

Soldiers and Marines from every unit or detachment at Fort Knox have participated in Operation Iraqi Freedom. At least five Hardin County soldiers and one Radcliff Marine have been killed in what is being called the most sustained ground combat operation since Vietnam.

In addition, Hardin County is the home to a large number of Reservists and National Guardsmen who either have directly or indirectly been involved in the war effort.

“You don’t come back from a hot war zone exactly the same,” Stockard said. Soldiers will have features and symptoms and some learned behaviors that don’t fit into civilian life. As long as the symptoms don’t cause dysfunction to the soldier, they can learn to adjust.

Some can’t do it alone.

The Lincoln Trail clinic sees patients every day who are experiencing some form of post-traumatic or combat stress, in both acute and chronic forms. Some are in treatment for days or weeks, others longer.

Some soldiers seek help at the behavioral health clinic at Ireland hospital or the VA hospital in Louisville. Others turn to veteran centers, chaplains, family members and each other for support in dealing with the aftermath of combat-related traumatic events.

Though the average age of the combat-related stress patient for this war is 24, people experiencing PTSD run the gamut in age, gender, years of service, number of tours and other variables.

In some, it is not only the exposure to combat, but the transition back to civilian life that can be disruptive, particularly for Reservists and National Guard members who are less accustomed to being away from their families and may have more adjustment difficulties with deployment. Exactly what triggers the stress reaction in some soldiers and not others is unknown.

“We don’t know why one person will develop it and another not,” said Dr. Karen Grantz, coordinator of the Post-traumatic Clinical Team at Louisville VA Hospital. “It has nothing to do with psychiatric weakness or what they saw. It’s important to note, almost everybody has a post-traumatic response to being in combat.”

What the Army has learned is the earlier PTSD is addressed, the less its chances of becoming chronic and, in some cases, disabling.

When Hughes first noticed his depression, he talked to his girlfriend, whom he met during his recovery and soon married. She, too, had experienced PTSD.

A cancer survivor, she underwent six months of chemotherapy and radiation. Many of the patients she knew in the oncology ward of her hospital eventually succumbed to the disease.

“I had dealt with PTSD for three years,” she said. The two found they had a lot in common, and that was helpful to Hughes.

When he began having nightmares, together they sought the help of a specialist who helped them deal with what was happening.

“It wasn’t just affecting me anymore, it was affecting my family, and I had a little one on the way,” Hughes said.

He believes because he sought help early on and learned to talk openly about his experience, he can now control it.

Though research suggests he is right, each individual deals with the effects of combat stress in different ways.

Psychological, social and psychiatric effects from combat can be immediate, acute and chronic depending on the individual, according to the Iraq War Clinician Guide 2nd Edition, published in 2004 by the Department of Veterans Affairs and the National Center for Post-traumatic Stress Disorder.

The guidebook also says that clinical assessment of Iraq war veterans is “likely to be complicated and clinically challenging … they will have difficulty sharing their thoughts and feelings about what happened and the toll those experiences have taken on their mental health.”

There is more concern with the Iraq war than other conflicts since Vietnam because the frequency and intensity of combat exposure is higher than in Afghanistan, Somalia or the 1991 Persian Gulf War, according to a national Center for Post-traumatic Stress Disorder fact sheet.

In 2004, 86 percent of soldiers in Iraq reported knowing someone who was seriously injured or killed, 68 percent reported seeing dead or seriously injured Americans and 51 percent reported handling or uncovering human remains.

Nearly 77 percent of soldiers deployed in Iraq reported shooting or directing fire at the enemy, 48 percent reported being responsible for the deaths of enemy combatants and 28 percent reported being responsible for the death of a noncombatant.

In addition, with suicide bombings and other insurgent attacks, urban guerrilla warfare in Iraq creates a constant state of alert because the enemy is not clearly identifiable. There is no safe place and no safe duty. A person may begin to feel helpless in the ability to protect him or herself, Grantz said.

“But, you have to be careful,” Hughes said. “It could be a family with children in the car just as easily as it could be insurgents. You have to be cautious, of course, at all times. But there are civilians all over this battlefield.

“In the grand scheme of things, what if you went over there and you did something you couldn’t live with. That would be far worse. You have to think, you may survive this whole thing, but you have to go back and live the rest of your life. That’s why this environment is so difficult.”

While drug therapy, psychotherapy and cognitive-behavior therapy such as relaxation techniques, stress management training and coping skills are used to treat and manage PTSD, most doctors are finding group therapy or just talking about the experiences, as in Hughes’ case, are key in getting PTSD symptoms under control.

“Talking in groups, actually sharing experiences, they benefit from each other,” Goodhue said. “In some cases, you have to rethink everything you do every day, especially how you react to things that make you uncomfortable.”

Many facilities conduct group counseling sessions in which soldiers and veterans talk openly about combat experiences and frustrations with others who have similar experiences. But, the problem remains getting those who need it most to seek help.

There exists a stigma that a person’s military career or reputation may be on the line if he or she seeks help for mental health issues.

Often it’s those who most need help who won’t seek it, Stockard said.

“A lot of your hardcore combat vets are the least likely to want to talk — the ones who are in the thick of things,” said Bill Spencer of the Disabled American Veterans.

So, instead, they suffer silently. They may withdraw from society or turn to drugs or alcohol to diminish the symptoms, “but they can actually exacerbate the symptoms,” Grantz said.

Though Hughes knows some soldiers may not want to ask for help, he’s never been concerned with other people think. He knew he needed help, so he got it, with his career remaining intact.

In March, he graduated from the Armor Captain’s Career Course at Fort Knox and Thursday assumes the role of commander for C Company, 1st Battalion 46th Infantry at the post.

“I think what’s really important is for commanders to realize PTSD exists,” Hughes said. “And, it’s going to exist in their unit, whether it does now or not.”

Hughes wrote an article for Armor Magazine about PTSD which is scheduled for publication in the July/August edition.

“It’s very important for commanders to make it an open environment, and it’s OK to ask for help,” Hughes said. “The Army is perfectly set up for it. It’s a way to say, ‘here I am, I went through a difficult situation, and I struggled.’ It’s OK to struggle. It’s not something that you have to hide.”

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