CASUALTIES OF COMBAT
Not all of America's casualties in the war on terrorism are occurring in battle - suicide among returning soldiers is a growing concern
By Jim DeBrosse and Mehul Srivastava
Dayton Daily News (OH) - Sunday, October 10, 2004
DAVID PAYNE WAS still suffering nightmares five months after his second tour of Iraq when his mother, Karen, persuaded him to call his unit leaders.
Payne, a 23-year-old Army Reservist from Norman, Okla., went into his mother's bedroom to make the call in private. `When he came out, he said, `They're going to do what they can for me, Mom. I have to go to drill duty,' ' Karen recalled. `But that was two weeks away.'
A week after the call, Payne left his mother a note saying that he loved her, that she was `the best' and that she could find him on the family's farm.
He killed himself with a handgun he'd bought that morning.
Not all of America's casualties in the war on terrorism are occurring on the battlefield, or even in Iraq and Afghanistan. A Dayton Daily News examination identified 21 soldiers serving in Operation Iraqi Freedom and Operation Enduring Freedom who committed suicide after coming home, although the actual number of suicide victims is likely much higher. And in several of the cases, family members attributed the horrific experience of war as a contributing factor in the deaths.
The mental health of America's newest soldiers in combat - before their departure,
during their deployment and after their return home - has been entrusted to a system that Congress worries is broken, that experts argue is understaffed, and that families say leaves them unable to figure out how to help their troubled spouses, children or parents when they come home.
The result was an upsurge in suicides last year among soldiers called to service in Iraq , both in the field and on the homefront. At least 24 soldiers killed themselves during Operation Iraqi Freedom from January 2003 to October 2003 - a rate of 21.2 per 100,000, or nearly double the 2002 rate for all Army personnel. The Air Force suicide rate also spiked late last year.
The suicide rate for soldiers in Iraq was roughly double the 10.7 national rate for all Americans.
Although the military does not officially collect data on suicides among returning soldiers, the Daily News compiled a list of 21 such veterans from news reports and veterans' advocate groups. The list includes two Dayton area natives who killed themselves in separate incidents over the July 4 weekend, and three former soldiers who committed murder before taking their own lives.
Several studies by the Government Accountability Office of Congress and the Army point to the failure of the Pentagon to prepare for the inevitable psychological toll of the nation's first sustained ground combat since the war in Vietnam.
`It's clear that the Department of Defense was not prepared to meet the mental health needs of soldiers,' said Steve Robinson, executive director of the National Gulf War Resource Center, an advocacy group for veterans.
Army spokeswoman Martha Rudd said the Army responded `quickly and thoroughly' to the surge in suicides among combat soldiers last summer, dispatching a team of consultants to Iraqand Kuwait in July to study the problem and then adopting most of the team's recommendations. Those included appointing a theater of operations mental health consultant, providing behavioral services to soldiers closer to their fighting units and improving the mental health care for soldiers being evacuated out of the war zone, Rudd said. The Army has created an umbrella organization, the Deployment Cycle Support System, that now coordinates mental health and wellness programs for soldiers and their families `from pre-deployment, to deployment, to post-deployment and then re-deployment,' she said.
Since the changes, the rate of soldier suicides in Iraq and Kuwait has `dropped dramatically' to two per month this year, Rudd said. Army-wide, the annual suicide rate has dropped from 12.1 suicides per 100,000 personnel to 8.1, she said.
Rudd said she can't say officially if the Army response led to the decline in suicides `because we haven't been able to determine if (last year's spike) was just a statistical anomaly or a trend. But I think it must have had some impact.'
Robinson believes it's still a case of too little, too late. `While these programs are meaningful attempts to address the problem, there are still more soldiers who need help than are being reached,' he said. `If you don't get face-to-face contact between veterans and mental health professionals with experience in treating war-time trauma, soldiers will fall through the cracks.'
Many veterans feel that the vast majority of Americans have no idea of the combat stresses in Iraq , where car bombs, hand-held rocket launchers and snipers create a front that is everywhere and make even the most routine duties perilous.
September was a record month for car bombings in Iraq - more than 30 as of Sept. 24, according to the U.S. military. On average, nearly three U.S. soldiers were killed each day last month - the highest rate since April. In August, insurgent attacks averaged 87 a day - their highest level since major combat ended in May 2003.
`In Iraq , you have threat 24/7, 360 degrees. You don't know who your enemy is. Violence is so random it can happen at any time, and that takes its toll,' said Staff Sgt. Georg Pogany, who drew national attention earlier this year when he became the first soldier since the Vietnam era to be charged with cowardice. The Army later dropped all charges and Pogany is seeking a medical discharge for brain-stem damage related to his service.
Few soldiers in Iraq have been able to avoid direct combat, according to a survey of four U.S. infantry units conducted by the Walter Reed Army Institute of Research and published this July in The New England Journal of Medicine. More than 90 percent of the troops reported being shot at as well as firing at the enemy. More than four in every five soldiers knew someone who had been seriously injured or killed. `Close calls, such as having been saved from being wounded by wearing body armor, were not infrequent,' researchers found.
More than 5,000 veterans of combat in Iraq and Afghanistan have been diagnosed with a mental health problem, according to an internal document prepared by the Veterans Administration to help plan for the newest war veterans. While not all of the veterans' problems can be directly linked to their war experience, at least 1,743 are suffering from post-traumatic stress disorder - whose symptoms of anxiety, depression, sleeplessness, nightmares, inability to focus and flashbacks often are linked to combat duty.
A September 2004 GAO report lists another potential outcome if post-traumatic stress is untreated: suicide.
Death on the Fourth of July
Help was too late in coming for at least two local veterans of Operation Iraqi Freedom. Justin Covert, 22, committed suicide on the Fourth of July in his Butler Twp. home after serving as a military police officer with the Marines in Iraq . Covert had enlisted in September 2000, just a few weeks after his 19th birthday. His family declined to discuss his death.
Police reports show that Covert went out with his girlfriend to a party and then to Wings Sports Bar and Grill on North Dixie Drive late on the night of July 3. He broke into a jealous tirade after overhearing his girlfriend mention her ex-boyfriend's name in a conversation on her cell phone.
At about 2 a.m. on July 4, when the couple returned to Covert's residence, the argument began again in earnest. Just as suddenly, Covert turned quiet and apologized. He then went into his bedroom, placed a 9-millimeter Smith & Wesson semi-automatic into his mouth and pulled the trigger.
There is always a combination of factors involved in any suicide, including the victim's emotional stability, his family support system and his coping skills, but the experience of war can brand its unique trauma on veterans and lower their tolerance for frustration, said Kathy Platoni, a Dayton area psychologist and Army Reserve lieutenant colonel. Platoni headed a six-person combat operations stress unit for psychological services at Guantanamo Bay military base in Cuba before returning to her Centerville home June 29. This month, the 25-year Army veteran will ship out again for a tour of duty in Iraq .
`I can understand why somebody would come back (from Iraq ) feeling like, `I made all of these sacrifices, I suffered all of these horrible things, and now the fates, or God, or society, or my girlfriend - whatever - is doing me wrong again,' ' Platoni said. `Sometimes even people with adequate coping skills will feel that way, particularly if they are suffering from post-traumatic stress disorder.'
A lowered frustration tolerance, coupled with a familiarity with firearms, can be a deadly combination for returning soldiers, she said. `When you're used to using a weapon, or dealing with problems with a weapon, or killing people with weapons, you're desensitized,' she said. `So it's not even terrifying to think of using a weapon or having one on hand in civilian life.'
Mary Tendall, a California psychotherapist who specializes in treating PTSD for the VA, said soldiers who have spent prolonged periods in combat zones develop a hyper-vigilant, `lock and load' mentality that dominates their brain chemistry for years after their return.
`Their whole existence is coming from that primitive, reptilian-like place of survival within the brain - it's flight, fight or freeze,' Tendall said. Any trigger - a nightmare, a disappointment or even a minor provocation - can inject the traumatic past into the present reality, she said. `That's translated into, `I don't like crowds' or `I don't want to go shopping.' Or they want to kill someone who just pulled in front of them in traffic,' she said.
Members of Covert's Marine Reserve unit, Military Police Charlie Company of Dayton, were shocked to learn of his death.
`We all kept second-guessing ourselves - would we have been able to help if we were nearer, was there anything we could have done?' said Maj. Quinn Auten, who had been Covert's commanding officer during the company's first tour of Iraq .
Covert had left for Iraq in March 2003. His fellow Marines say he was the kind of soldier they learned to trust.
`He really was admired by most of the guys there,' said Maj. Cara Arledge, a Marine Reserves therapist who works with the company on a regular basis, and had come to know Covert well. `That's why all of those who could come were at his funeral. Had the rest of the guys not been in Iraq , they would have been at the funeral.'
Sometime during the night after Covert's death, and hundreds of miles away in Ogden, Kan., Dayton native William Neal Price, 23, went into his garage, attached a garden hose to the exhaust pipe of his 1992 Oldsmobile Cutlass and placed the other end of the hose into his car. He rolled up the windows and turned on the engine. His wife, Erin, found his body just before 10 on the morning of July 5.
A specialist in the Army's 172nd Chemical Company at nearby Fort Riley, Price had returned in March from a year of duty in Kuwait and was fighting a battle against depression. He had spent the month of June in a VA psychiatric care unit in Topeka.
Price's wife told police investigators that nothing unusual had happened the night before his death and that the couple had discussed their plans for the weekend. But she added that they `weren't getting along really well' since his return from Kuwait.
His mother, Vicki Price of Dayton, said she did not want to go into details but said she believed her son's death `had a lot to do with' his service overseas.
Too few mental health specialists
After eight years of relatively low rates of suicide among Army personnel - 11.9 per 100,000 troops - suicides spiked last year not long after the start of Operation Iraqi Freedom. From March to October, 17 soldiers deployed to Iraq and Kuwait committed suicide - including five deaths in the month of July alone.
The problem may have begun even before U.S. troops set foot in Iraq . As soldiers leave for combat, the Armed Forces are required by law to make accurate records of their health, both mental and physical. By passing the law in 1998, Congress had hoped to avoid a recurrence of the first Gulf War, when veterans complaining about a variety of health symptoms dubbed Gulf War Syndrome. Health officials found that there was no way to tell if their problems had started before or after the war.
Dr. Manning Feinleib, a professor of public health at Johns Hopkins University in Maryland, told Congress last year that the two-page screening questionnaire handed out to soldiers contained `little worthwhile data.' In September of last year, the GAO found that 40 percent of Army soldiers were missing one page of their questionnaire from their files, and 98 percent of Air Force personnel were missing either one or both pages.
In July 2003, when soldier suicides in Iraq reached their peak, the Army took the unprecedented step of sending a team of consultants to the war zone to assess the problem and make recommendations to commanders in the field.
The Army's Mental Health Advisory Team issued its report Dec. 16, but it wasn't released to the public until the following March. The majority of the 756 soldiers interviewed reported low or very low morale. Of the soldiers who screened positive for depression, anxiety or traumatic stress, fewer than one in three said they had received any help from an Army professional, including doctors and chaplains.
Cheyenne Forsythe of Killeen, Texas, who finished his Army enlistment in March after serving as a mental health specialist to the Army's Third Brigade in Iraq , said many soldiers couldn't get help in the field even if they had wanted it - there were too few specialists on hand. He said being personally responsible for the mental well-being of several thousand soldiers under combat conditions `was overwhelming.'
One team of four specialists was allotted to each brigade, each of which could total anywhere from 1,500 to 3,500 personnel, Forsythe said. `When you looked around, there just wasn't enough of us to go around. You think you're doing your job, and then someone commits suicide not more than 500 yards away, and it's too late.'
Even if help had been readily available, almost 60 percent of soldiers felt that seeking help might make them seem weak and that their superiors would then treat them differently or deny them promotions, the Army report found. Worse, nearly half of those interviewed felt their superiors would blame them if they reported a problem.
Pogany, the staff sergeant who was charged with cowardice, says his experience proves that some Army leaders discourage soldiers from seeking psychiatric help.
Last October, Pogany, 33, of Colorado Springs, Colo., was attached to the 10th Special Forces in Iraq as an interrogator `two inches away from hell' in the heart of the Sunni Triangle when he suffered a panic attack while viewing the remains of an Iraqi man killed by a 25-millimeter round to the torso.
All that night and into the next morning, Pogany suffered from sleeplessness, vomiting, diarrhea and overwhelming feelings of terror, he said. `I felt like I was having a nervous breakdown. I had no control - over my emotions, over my fear, over my anxiety. I was freaking out like there was no tomorrow.'
The next morning, Pogany said, he went to his Special Forces team leader and asked for help but was given a sleeping pill and told he should `suck it up.'
`He literally told me to get my head out of my (extremity) and get with the program,' said Pogany, who declined to identify the team leader.
Three days later, after being placed in isolation and put on suicide watch, Pogany was permitted to see a chaplain, who referred him to Forsythe, a member of the Combat Stress Control Team. Forsythe, whose recommendation was backed by an Army psychologist, said that Pogany had suffered a normal stress reaction and that he should be permitted to get on-site treatment and work it through.
The commander rejected that idea. Instead, Pogany was sent back to the States to face court-martial charges, and the death penalty, for cowardice. `When I got back (to base), I was treated like the worst outcast, like a criminal,' he said. `I was separated from my unit, patted down and taken under guard back to the post.'
Pogany fought the cowardice charge, which the Army later downgraded to dereliction of duty. In July, the Army dropped all charges after a Navy doctor diagnosed him with brain-stem and balance problems likely caused by the anti-malarial drug, Lariam, taken by thousands of U.S. soldiers in Iraq .
Pogany is convinced that Lariam, a pill which he was required to take weekly during his tour of duty, had much to do with his reaction to stress in Iraq . Side effects of the drug can include anxiety, panic attacks, paranoia, vomiting, diarrhea and even hallucinations.
`I pretty much experienced all those things,' he said.
The Pentagon announced in February that it is investigating whether there is a link between the drug and any soldier suicides. However, the military continues to defend Lariam, known generically as mefloquine, as both highly effective and safe for soldiers to take.
`Yeah it was scary'
While study after study has shown a need for more mental health services, there's an obstacle: Many soldiers and veterans who suffer from disorders don't seek help.
More than half of the soldiers in the Walter Reed study who screened positive for mental distress indicated no interest in getting help. And as few as one in four of those reporting problems said they had gotten mental health treatment in the last year.
Spc. David Payne was one of those soldiers who had never sought help, even after his return home. Karen Payne, his mother, suspects that Lariam was a factor in her son's suicide, but she also knows that David carried the scars of war within him. `The families were never counseled as to what they should be doing to support them,' she said.
As a military policeman in Baghdad, Payne had organized soccer games with the children living in the orphanage sponsored by his Army unit, she said. `It was his way of reaching out to people where there might be a language barrier.'
Payne's most horrific memories of the war also involved children - the small bodies he found piled in an Iraqi political prison when his unit first arrived in Baghdad, she said.
Payne twice withdrew from his studies in zoology at the University of Oklahoma to serve his country in the Army Reserves, first in 2001 and again in 2003.
Payne's military police unit in Iraq stopped looters, chased after carjackers and conducted raids on the homes of suspected criminals, including counterfeiters, said Sgt. 1st Class John Marshall, the non-commissioned officer in charge of the unit, the 812th Military Police Company in Baghdad.
As in Vietnam, separating friend from foe, and the guilty from the innocent, isn't always possible in Iraq , Marshall said.
`We'd get into shoot-outs, and some of my guys actually killed a child a couple of times,' he said. `You had people running checkpoints all the time. The facts of when and where - sometimes I have to think really hard to remember which is which.
`We'd get blown up (by a car bomb) and we'd clear the area and take the people to get cared for medically. Yeah, it was scary. We didn't want to get blown up or shot. But we went right back on the street and continued the job.'
Such intense military action, for prolonged periods of time, carries a psychological toll. Of 13,855 medical evacuations from Iraq between July 2003 and August 2004, 850 - or about 6 percent - were for psychiatric reasons, according to the Army.
After Payne returned to Oklahoma in January, months of nightmares and sleeplessness spurred him to call his Army Reserve unit in April, his mother said.
Marshall said he took a call from Payne the week before his death but said that Payne declined his offers of help.
Payne's biggest concern, Marshall said, appeared to be whether he would be deployed a third time to Iraq . The sergeant said he assured Payne that wouldn't happen because he had reached the limit of 24 months of service in a war zone.
`We were talking about whether he was going to stay in the unit or not and he said, `Well, I just have some problems right now I need to work out,' ' Marshall said. `I asked, `Is there anything I can do to help? Can I get anybody to talk to you?' He said, `No, no, no. It's nothing like that. Just some stuff I have to work out on my own.' ' Payne's case points to a stress factor unique to the war on terror - the uncertainty of service for many soldiers, both in the duration of their duty and the possibility that they might be called up more than once, said Marlene Davis-Pierce, the coordinator of services for Persian Gulf veterans at the Dayton VA Medical Center.
As the war in Iraq has dragged on, what began as six months of active duty for most soldiers, including their pre- and post-deployment time, soon became six months in combat, then a full year and, most recently, up to 18 months at a time.
Total service in Iraq has been capped at 24 months.
Unlike the war in Vietnam, Davis-Pierce said, many of those being called up for duty in Iraq and Afghanistan are `weekend warriors' - National Guard troops and Reservists - `older people in their 30s and 40s who have jobs, who have families. A lot of these people (in Operation Iraqi Freedom) signed up to get their educational benefits and all that, and they never dreamed that they would be made active.'
A persistent enemy
Because of the `intensity of warfare,' a GAO study says, mental health experts predict 15 percent or more of the servicemen returning from Iraq and Afghanistan will develop post-traumatic stress disorder - a rate roughly equal to that of Vietnam War veterans.
The tragic parallels between the two wars are not lost on 78-year-old Ray Seeley of Canton, N.C.
Seeley's son, Zane, descended into mental illness and homelessness following his service in Vietnam, and the family lost touch with him for more than four years. He suddenly reappeared in Canton last week, Seeley said. `He was living under a bridge in Mississippi, down on the coast - a gathering place for the homeless, I guess.'
In January, Zane's son, Jeremy, committed suicide at age 28 after his return from Operation Iraqi Freedom.
`There's no definite reason we could understand for that happening,' Seeley said. `I talked to some of his buddies who were with him when he was over there. They said he did his job really well and didn't show any signs of this.'
Seeley himself served in the Navy during World War II on a destroyer escort, protecting Allied convoys from enemy submarines.
`I saw a good deal of that during World War II - people who just lost it,' Seeley said. `Of course, there was no help then. We had too much to do. So we just transferred them off the ship to something else.'
Jeremy Seeley was found dead Jan. 17 - three years to the day after his enlistment in the Army - at the Shoney's Inn in Clarksville, Tenn., not far from the 101st Airborne Division's base at Ft. Campbell, Ky.
Behind the bolted door, Seeley had drunk a fatal concoction of Pepsi, antifreeze and Drain Pro.
Ray Seeley said his family didn't even know Jeremy had returned to the States.
`I was four years in the Navy in World War II, and you know, men do strange things like that after every war, like the boys were doing after 'Nam,' he said. `It just seems like they lose interest in everything' Dr. David L. Kurtz, an Air Force psychiatrist based at Wright-Patterson Air Force Base, believes suicide is a cyclical problem that arises whenever the Armed Forces let down their guard.
Kurtz was dispatched to Kuwait late last year to help the Army strengthen its suicide prevention efforts.
`What we found is that the Army had enough mental health assets, but not in the right places,' Kurtz said. `They needed more presence in northern Kuwait' because that's the gateway to and from Iraq .
Army Medical Command estimates it has 80 to 90 psychiatrists and psychologists operating in Iraq , plus another 100 to 130 mental health specialists.
Those numbers have not changed significantly since last summer, said Army spokesman Jaime Cavazos.
While the Army was asking for help from other military branches, the Air Force, too, saw an increase in suicides.
Twenty-five active duty personnel committed suicide between October of last year and Feb. 24, 2004. As a result, the Air Force went from having the lowest suicide rate among all services in calendar 2003 - 10.5 per 100,000 people - to one of the highest in 2004, with a rate of 18.1 per 100,000.
`I think what we have found in the Air Force is that every time we turn our attention to something else, the suicide rate goes up again,' Kurtz said.
The Air Force is now busy making sure that suicide prevention is a `command issue' among all of its leaders - speeding up the timing of its briefings on the subject from every 20 months to every six months, he said.
Supervisors must monitor the daily quality of life among military personnel and look for the very early warning signs of suicide - family and relationship stresses, financial and legal problems and alcohol and drug abuse, Kurtz said.
`Any one of these individual problems signals that things are bigger and that they need to be addressed.'
Ray Seeley said he hopes the military will now keep a closer watch on its soldiers and veterans.
`I'm 78 years old. I'm beyond hope. I'm a mountain man who lives in the mountains. I just wake up every morning and look around and thank God for all the beauty I can see,' he said. `But my hope and prayer is that something good will come out of all of this. I hope something can be done for our boys.'
Assistant Director of News Research Phillip Elam contributed to this report. Contact Jim DeBrosse at 225-2437 and Mehul Srivastava at 225-2432.