Army’s huge culture shift: No shame in mental health help


By Gail Sheehy, Special for USA TODAY

Daniel Rodriguez joined the Army when his home life collapsed. His parents split. His father dropped from a heart attack. He was 18 and on the runty side for a high school football player, but with a dream of playing at a Division I college.

  • Pvt. Daniel Rodriguez left Iraq with a traumatic brain injury and suffered from symptoms of post-traumatic stress disorder after serving in Afghanistan.By Garrett Hubbard, for USA TODAY

    Pvt. Daniel Rodriguez left Iraq with a traumatic brain injury and suffered from symptoms of post-traumatic stress disorder after serving in Afghanistan.

By Garrett Hubbard, for USA TODAY

Pvt. Daniel Rodriguez left Iraq with a traumatic brain injury and suffered from symptoms of post-traumatic stress disorder after serving in Afghanistan.

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Three weeks after burying his father, the angry teen made his way to an Army recruitment center. Like so many of today’s volunteers, he was looking for a new home, discipline and the directions for becoming a man.

But Iraq and Afghanistan are unique in America’s wars, clouding that traditional coming-of-age road map. The invisible wounds of post-traumatic stress disorder, depression and family breakup have soared for the military there, along with repeated redeployments and a 360-degree combat-alert range. The most glaring result is the 80{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} increase in suicides, averaging nearly one a day this year — the fastest pace in the nation’s decade of war. This is the second year in a row that more active-duty soldiers have been lost to self-inflicted death than to combat.

These appalling statistics have given the Army a new mission — to treat those invisible wounds of war beforesoldiers come home with their mental composure shattered.

Pvt. Rodriguez was a prime candidate to join the epidemic of military suicides. During 12 months of walking patrols in what he calls the “concrete jungle” of Baghdad during the surge of 2007, he dodged more than 1,000 roadside bombs. But he lost a dozen of his buddies. And in Afghanistan, he was thrown together in a remote outpost with Afghan soldiers who betrayed the Americans and sided with the Taliban.

Iraq left Rodriguez with a traumatic brain injury. Afghanistan left him with classic symptoms of post-traumatic stress disorder. He came home in the fall of 2010 to a jobless economy and night terrors.

Why didn’t Rodriguez become another grim statistic?

The answer may lie at his post in Colorado, Fort Carson, where a behavioral health strategy representing a huge cultural shift in the Army has won over the Pentagon.

Two years ago, Gen. George Casey, then Army chief of staff, admitted, “We were caught flat-footed as an institution” by the dramatic spike in suicides and mental breakdowns. He committed to a massive training effort to reverse things. It was Gen. Casey who urged me to check out the unique program being tested at Fort Carson.

About the writer: Gail Sheehy is a journalist, lecturer and the best-selling author of 16 books, including “Passages in Caregiving.”

This was a change in military thinking. “Up until a few years ago,” Brig. Gen. Jim Pasquarette, then post commander, had told me, admitting mental health issues in the ranks “would have reflected weakness on our whole brigade.”

Those long-held attitudes had brought shame to Fort Carson in 2007 when 14 soldiers from the 4th Combat Brigade, back from a brutal year in Iraq, went on a string of violent rampages around Colorado Springs. All were charged or convicted in 13 murders and manslaughters.

The disgraced post turned itself inside out to reverse the Army code of silence about mental illness. Maj. Chris Ivany, Fort Carson’s battalion psychiatrist, devised a new approach: Instead of waiting until traumatized soldiers came home from combat and sought release in high-risk behavior — spousal abuse, drunken driving, drugs or suicide — why not bring behavioral health care to the combat zone?

It was one of the bloodiest battles of the war in Afghanistan that helped to earn respect for Ivany’s approach from both the leadership and the infantrymen of Fort Carson.

‘Killing at point-blank range’

Just before dawn on Oct. 3, 2009, most of the soldiers of the 4th Combat Brigade were still asleep, huddled in a remote outpost in eastern Afghanistan near the Pakistani border. They were being fired upon almost daily by Taliban rebels.

Pvt. Daniel Rodriguez, 20, had been redeployed there after a hellish year in Iraq. He was up early, writing an e-mail when the first volley of rockets screamed into the compound. He sprinted 300 meters to his post in the mortar pit, but never had a chance to fire any mortars.

“The Taliban focused their fire on Afghan National Army (ANA) soldiers, as a weakness, and collapsed their position,” recalls Capt. Stony Portis, the 32-year-old troop commander. His men ran out to fight in boxers and body armor. Rodriguez saw his friend, Pvt. Kevin Thomson, dash for his observation post. Five minutes into the firefight, a bullet pierced Thomson’s head. He was dead before he hit the ground.

“We’ve got people inside our wire!!!” someone shouted. They were 60 men, surrounded from higher ground by 300 enemy fighters. . Most of the buildings were on fire. The only communications left with Bagram Air Base were by satellite radio.

“It came down to throwing hand grenades and killing at point-blank range,” Rodriguez remembers. Dodging AK fire and grenades, Rodriguez dragged his friend’s body back. “I just couldn’t get over the fact that my buddy was dead, and that they were going to get away with it.” The private had caught a bullet in his shoulder and shrapnel in both legs. “I hit that point where I knew I was going to die, and I was just going to kill as many of them before they killed me.”

Fifty soldiers formed a last nucleus of defense. They holed up in one barracks while others cut down trees to keep the last buildings from burning. “There was yelling and crying but also equanimity,” Portis learned, “a lot of self-composure because everyone realized what was at stake.”

Eight soldiers were killed. Twenty-two more were wounded. Survivors didn’t sleep for 48 hours as the battle continued. Air support was slow in coming. The first wave of helicopters was shot up so badly, the pilots had to fly back to the nearest base. At night, survivors plotted how to destroy anything of value left at the firebase.

On the third day, they were airlifted out to Forward Operating Base Bostick with nothing but the clothes on their backs. Several days later, the shaken survivors were met by a ginger-haired young woman from Dubuque with Iowa friendliness written all over her. She was not what they expected.

‘You want to get your feelings out’

“I’m Capt. Katie Kopp, the brigade psychologist,” was her typically friendly introduction. “I’m part of the combat stress team.”

A battle-hardened psychologist, Kopp is helicoptered from Bagram to remote outposts days after bloody battles. “Getting me to soldiers who have been affected is top priority,” she says.

Kopp dispels right away the image of a couch-bound shrink. With a year of combat exposure in Afghanistan behind her, she sits down with the men wearing the same shapeless camouflage suit and boots. She was so close to the men that she asked to be embedded with the same brigade for their redeployment on the border of Pakistan. Trained with a Ph.D. in psychology to debrief soldiers at risk for post-traumatic stress, she asks the men to join her in small group-therapy sessions.

Some of the soldiers connected with her right away, seeking her out to talk one-on-one. They were super-polite. Once they could tease her about her red hair or being a girl, she knew she was in.

But not everyone welcomed these early therapeutic sessions. Rodriguez says he gave Kopp the cold shoulder at first.

“I didn’t want to relive the experience. I still couldn’t believe it was real. We’d had no chance to soak it in.” He kept thinking, “She’s going to tell me why I’m having nightmares of killing somebody? You know, who are you? … You weren’t there. There’s not blood on your boots. You know, you’re not scarred. You don’t have shrapnel in your legs.”

Kopp was not surprised by this reaction.

“I don’t expect to be the first person they turn to after having a hard time,” she says. Instead, she urges soldiers first to seek “buddy aid” — to talk about what happened with their friends — and to focus not on their losses, but on their courage and teamwork.

“When all hell broke loose, you didn’t freeze. Fifty of you killed about 150 enemy fighters. And you made it out alive! You have a lot to be proud of,” she told them. (Forty valor awards were bestowed on the unit.)

For Rodriguez, it was a tough prescription. “You want to get your feelings out, but at the same time, you know they’re going to scar you for the rest of your life. It sent me on an emotional roller coaster. … My mentality was always to bottle it up, bottle it up.”

After the group session, Rodriguez vaguely remembers having one-on-one sessions with another professional.

“Those talks were helpful in kinda getting me to open up,” he told me. “But I still wanted to believe I was man enough to take all the pressures on my shoulders.”

One of those pressures, his hatred of the ANA, was sparked anew when Rodriguez and his buddies saw a searing video posted on YouTube by the Taliban a month after the siege.

“Once they overran our base, we saw the ANA handing their AKs over to them and cheering them on, giving them the thumbs up,” Rodriguez told me. “I’m thinking, ‘My friends died on behalf of your cowardice? Why should I fight side by side with people so worthless they won’t even fight to save their country?’ ”

The hatred boiled up inside him. It soured into depression. Night terrors came on. Rodriguez wouldn’t sleep through the night for the next year.

‘Just grit it out’

Homecomings at Fort Carson used to mean soldiers hit the tarmac, turned in their weapons, picked up their pay and then went off on a month’s leave. They were expected to ratchet down from the hypervigilance of a shoot-first, perpetual war mentality and embrace the natural boredom of a sleepy mountain town. It was a transition that defied human behavior.

In June 2011, when Rodriquez was returning to Fort Carson, the reintegration was dramatically different. Each returnee was seen by a psychological professional; a full evaluation was completed by their commanders. Had they seen heavy combat? Any drug use? Had a buddy died? A divorce at home?

Soldiers coded “green” were good to go. The “reds” — 23 soldiers who were deemed unstable or without any support at home — were met at the tarmac, where a professional would speak with them.

The 400 to 500 others designated “amber” — with symptoms such as sleeplessness, depression, panic attacks, alcohol or substance abuse — were recommended for more consultations. Rodriguez was an amber.

“We do 12- to 15-month tours,” Rodriguez explained. “You come home after a year and haven’t had a sip of alcohol. Your tolerance is down. Your emotions are high. Your testosterone’s pumping from the warfare that you just saw. You put all of these boiling points in a person’s life … and it’s just like, chaos.”

Rodriguez picked his way carefully through the questioning. “Who will be at your house?” No one. “Are there any weapons in your home?” No, all his stuff was in storage. Any question where a “yes” might raise a red flag, he gave a no.

He flew home to Stafford, Va., to cocoon himself in the house where he grew up. Rodriguez said nothing to his sister about the night terrors. Two calls came in from the behavioral health team and he was given contact numbers if he needed to talk. He didn’t call.

Rodriguez was promoted to sergeant and decorated with three medals for valor. No one let him forget about post-traumatic stress disorder. “Everyone in the military now makes a big deal about it.” He knew he had the classic symptoms, but he told himself, “Just grit it out, day by day.”

Sitting on a couch and staring into space was the toughest part. He was enrolled in Germanna Community College, but classes wouldn’t start until January. The emotional overload crashed down. Visions of his father’s death bled into faces of the 20 buddies he lost in Iraq and the weight of eight body bags he helped to load on the plane in Afghanistan. He heard about a friend who killed himself. Another one overdosed and died.

The only way he could escape the night terrors was a grueling schedule of calisthenics. Six hours a day of one-arm push-ups, gravity-defying leaps, a 40-yard dash in 4.5 seconds, throwing a football while lying on his back to the top of a three-story wall. He is now 5-foot-8, 175 pounds, sheathed in muscle.

Last December, he posted a YouTube video to show how these moves can train even a small body to become a powerhouse on the football field. In February, he was called by the head coach at Clemson University, offering him the chance to earn a starting position. His scholastic record at Germanna recently earned him a letter of acceptance from the South Carolina college.

“It was tough for me to go to counseling,” Rodriguez told me last week. “But as I opened up more and more, it helped me to get my feelings out and understand it’s OK to talk about it to other people, my friends, my mom — don’t bottle it up.”

From stress to ‘post-traumatic growth’

“This soldier,” Kopp says, “is a prime example of the ultimate goal of Fort Carson’s behavioral health care approach — to replace post-traumatic stress with post-traumatic growth. … If you can ride out the roller coaster, it is really worth it in the end.”

The Fort Carson statistics support this conclusion. The number of behavioral health consults has more than doubled since 2009, from 44,000 to a projected 92,000 in 2012. High-risk behaviors have been cut in half. Suicides at Fort Carson are down to three this year. “More people are seeking or accepting treatment,” says Sam Preston, the division psychiatrist. “Taking the secrecy out of it makes it a normal part of recovery.”

The initiator, Ivany, has been called to the Pentagon to roll out a similar program to the 43 American brigades. Already, every brigade combat team in the Army has had an increase in the number of behavioral health care providers.

The leadership at Fort Carson talks today more like social workers than John Wayneclones. “What we’re seeing here is the stigma begins to vanish,” Maj. Preston says. “This is not a military problem, this is an American problem.”

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