Thursday, March 02, 2006

A story of a soldier and PTSD

Texas Monthly's latest issue is all about Texas and the War in Iraq. There are a number of good articles which I suggest you read. The code for online access this month is Dripping Springs. Actually I suggest you read all the articles. They are from the points of view of people for whom the war is close-up and personal. Some are soldiers, some are family members. One person is a school counselor who has to deal with children losing their parents in war. For all of these people, the war matters in a way that most of us don't and can't understand. That's why I think everyone should read all of the articles offered.

There's one article I want to talk about in particular though, an article about a soldier who suffered because of the war and found he had nowhere to turn for help. It took place in 2003.

The article was about Master Sergeant James Coons, a soldier who committed suicide because of PTSD. He wasn't a combat soldier. He worked on computers, but he took his duties very seriously. After he helped in the morgue, he started having problems sleeping, and soon became dysfunctional. They sent him first to Germany, then finally to Walter Reed Medical Center, where he was undiagnosed and basically ignored. They put him on outpatient status and had him stay by himself in a local hotel. He killed himself in his room. His wife was expecting him to return on July 4th and she called his room two days earlier. She never made contact. She asked the staff to check on him, but they refused. A staff member finally checked on him on the morning of the 4th and found him hanging from a pipe in the ceiling; he had used a bedsheet.

It's a shame that he didn't receive proper treatment, but it would be one thing if anyone had at least tried to help him. His commander knew he was having problems when he overdosed on sleeping pills (Coons later said it was accidental; he had just been trying to get to sleep). But the staff at the Landsuhl Regional Medical Center assessed him as low risk for suicide. They simply arranged for outpatient care in the US and sent him back. Because he seemed in decent condition when he got there, the doctor there quickly got him out the door and into Mologne House (the hotel on the hospital grounds). That was June 29th. He was scheduled for an appointment the next day. He didn't go to it. June 29th was the last time anyone saw him alive, but he wasn't found until July 4th, even though by then he'd been missing for 6 days and his wife asked both the chaplain at the hospital and the staff at the hotel to just go to his room and knock on the door on July 2nd. Both refused.

I think this article has some important things to say. The fact of this personal tragedy is bad enough, but what's worse is that it is indicative of the kind of treatment soldiers may be getting. In Xanthippas previous post, he discusses a psychiatrist who obviously does not believe in the severity of the problem.

As Xanthippas says: "I think it's safe to say that Dr. Satel's problem is not with the mere treatment of PTSD, but the fact that the Dept. of Veterans Affairs currently errs on the side of caution, whereas she would put the burden on the veteran to show that he either did suffer PTSD, or suffered a traumatic event that could lead to PTSD."

The problem with that kind of standard is this: men like Coons do not suffer because of combat. The stress of the situation is extremely high for all the soldiers over there, and who knows what may set it off? In Coons case, it was seeing the faces of all the soldiers in the morgue when he helped set up their computer system to keep track of the bodies. Who wouldn't have trouble adjusting to that? We know he did, based on what he said to his mother later:

[...] That May he called his mother and told her that he missed her. Carol heard the strain in his voice and asked him if he was sleeping.

A long silence followed. “One or two hours a night,” he said.

“Jimmy,” said Carol, “if there’s something bothering you, why don’t you tell me?”

There was another silence. “Mama, these soldiers who are dying over here are just babies,” he said. “Just babies. I’ve seen them in the morgue.”

He told her that on one of his visits, he had seen the body of a soldier whose face had been mutilated by a bomb blast. It was hard to stop thinking about that face, he said. It was especially hard to stop thinking about the face at night, when he was lying alone in his bed.

“Now, Jimmy,” Carol told him, “you’re going to be home in about thirty days. Thirty days! When you get here, you’ll have your girls and Robin. You’ll have us. We’ll give you different things to think about. We’ll give you different memories.”

“I’m so tired,” Coons said. “I’m so tired.”

PTSD does not belong solely to men who fight in hard combat every day. PTSD is something that may afflict many of the soldiers in a war, regardless of their position.

By then, about three months after the invasion of Baghdad, it was becoming clear to military experts that this war—with its close-up urban warfare, the elusiveness of the insurgents, the constant threat of roadside bombs, the mutilated bodies, and the high number of civilian killings—had become the perfect breeding ground for mental health problems in soldiers. Surveys taken of the first wave of troops leaving Iraq were already indicating that a fifth of the soldiers qualified as having “moderate or severe” mental health problems—a totally unexpected number.

We were not prepared for this. We don't have enough resources to handle it. While part of the blame could go to staff at both hospitals for not recognizing the severity of the problem, it must be noted that they were overwhelmed.

But a Landstuhl psychiatrist who evaluated Coons noted in his report that the master sergeant maintained a “professional demeanor.” He added that Coons’s “risk for suicide is assessed as low”—a startling conclusion considering the Neurontin overdose just four days earlier.

Perhaps the doctor believed that Coons would find some semblance of normality once he returned home to his family. Perhaps he believed that all soldiers suffer some sort of emotional trauma during wartime and that little could be done about it. Or perhaps the doctor, overwhelmed by the number of soldiers coming in each day to Landstuhl, simply had little time to evaluate Coons.


Wearing his uniform, he arrived at Walter Reed in the early morning hours of June 29 and met with a third-year resident in one of the hospital’s locked psychiatric wards. In his report, the resident made note of Coons’s excellent grooming and “appropriate military bearing.” He noted that Coons acted “surprised” to be in a psych ward and that he adamantly insisted that he had had no suicidal thoughts. But the resident may have been overwhelmed by the influx of patients. Press accounts from 2003 reported that the members of Walter Reed’s medical staff were working seventy- to eighty-hour weeks. The resident quickly released Coons to a room at the Mologne House, a hotel on the Walter Reed campus for visiting families and soldiers undergoing outpatient treatment, and told him to report the next morning to the outpatient mental health clinic.

It's no wonder he didn't get proper treatment. But it's still a shame. This is not what our soldiers deserve. Soldiers who give up their futures for the sake of America should have something more than that given back to them. When they come back shattered, either mentally or physically, we can't just forget about them.

I suggest that instead of building any new aircraft carriers or submarines, we take that money and set it aside for veteran's medical expenses. And how about we don't turn any veterans away? Would that be too much to ask. I think not.


Xanthippas said...

That poor man. To think his only choice was to end it...we owe our soldiers so much more than that. Obviously we can't help them all, but that's not the point. The point is we're not doing enough now, and as we're not doing enough we have people on the right and in the Bush administration who would have us doing less. As far as I'm concerned, what they advocate is nothing short of betrayal of these soldiers. Whether we put up the money for them shouldn't be a choice. We OWE them; we have a moral duty to help them recover from the wars we've sent them to. They did their part, now we have to do ours for them. Anything less is shameful.

Anonymous said...

I got linked here from Pandagon, where some other vets and I have been getting a hearing, and it feels damned good.
I was an interrogator in Vietnam, 1968-1969. I tried to deal with it, first by stuffing it, then using treatment to deny it, and finally to live with it. Traumatic events are not always alike, but trhey usually evoke a state of "flight or fight", not from consciuous decision, but the "lower" brain stem. In my case there's little or no consciuous memory of some events: just before and after.

I went through five career changes and more than forty jobs ("you just don't fit") before I gave up and accepted the isolation, rage, guilt, substance abuse, etc. had a common source and ground: my experience in Vietnam. I still have to endure the comments--you don't deserve it, was that from enemy action, etc.--from people who had other priorities or who learned all they'll ever know from a movie. It would be a momentary release just to kill them, but that's not the way it's done here. Sigh. Sometimes I miss Vietnam. Didn't even have to bury the fucks.

Nat-Wu said...

Glad you came to read it and I hope you feel that not all of us keyboard warriors are total idiots. We opposed the war 100% and support our troops 100%. We blog in the hopes that it influences even a single person to think from a liberal (rational) point of view. Thanks for visiting.