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The trauma of war Experts fear cases of veterans with PTSD could skyrocket

Thursday, February 19, 2006
By Chris Killian and Ben Lando Kalamazoo Gazette

In World War I it was called shell shock; in World War II, battle fatigue. During the Korean War it was defined as combat neurosis; after the Vietnam War it was named post-Vietnam syndrome.

But since 1980, the often severe psychological symptoms experienced by soldiers returning from war -- including nightmares, intense anxiety and flashbacks -- have been labeled post-traumatic stress disorder, or PTSD.

The names have changed, but the symptoms have not. Much like those who served in past wars, thousands of veterans of Iraq and Afghanistan have dealt with a psychological disorder that can leave them feeling detached, irritable and depressed to the point of debilitation.

The U.S. Department of Veterans Affairs reports that between 2002 and 2005, about 19,000 soldiers who fought in Iraq and Afghanistan were treated for symptoms of PTSD.

The actual number of those who suffer from PTSD almost certainly is higher, veterans experts say, because the stigma attached to mental disorders sometimes keeps troops from acknowledging a problem or seeking treatment. Another factor that might keep reported cases deceptively low: PTSD frequently doesn't affect a person until long after he or she has suffered a traumatic experience.

A 2004 VA study of 6,201 active-duty U.S. service members, published in the New England Journal of Medicine, found that symptoms of major depression, anxiety or PTSD were reported by 16 percent to 17 percent of those who fought in Iraq and 11 percent of those who served in Afghanistan.

Of the veterans who were confirmed sufferers of PTSD, 80 percent acknowledged they had a problem, 40 percent said they wanted help, but only 26 percent reported receiving formal mental-health care.

"The human experience is always the same with regard to the trauma of war," said Jim Simmons, assistant director of the American Legion Department of Michigan Veterans Affairs & Rehabilitation.

"The stress leaves its mark on everybody, some more than others."

"Sometimes I feel like I'm back in Iraq"

Brad Kuchmek returned home to Kalamazoo in September after serving in Sadr City, Iraq, a fierce flashpoint of anti-American attitudes. He recalls live machine-gun rounds passing inches from his head, a mortar shell that landed 10 feet away and didn't detonate, and his Humvee convoy running over an improvised explosive device that didn't explode.

"There were a lot of what-ifs over there," he said. To cope with the persistently dangerous climate, "I had to tell myself that if I was killed, it was meant to be."

When he returned home five months ago, Kuchmek, 37, began having nightmares. He is nervous in large crowds and startled by loud noises. He drinks vodka to help him sleep.

Kuchmek, a soft-spoken, friendly and self-proclaimed ``peaceful guy,'' trembled through a fireworks display near his home shortly after his return.

"I can't help it," said Kuchmek, who was diagnosed with PTSD after 14 months in Iraq and currently is receiving treatment at the VA Hospital in Battle Creek, the only one in Michigan that has both in-patient and out-patient PTSD treatment programs. "Sometimes I feel like I'm back in Iraq."

Making the transition to civilian life has been difficult and sometimes dark. Kuchmek spends hours alone in his room, searching for jobs on the Internet.

Nearly half a year after he left Iraq, Kuchmek is unemployed.

A different kind of war.

Today's war usually is being fought in urban areas against an enemy utilizing guerilla-warfare tactics and suicide bombings, creating an environment of almost constant danger. There is no ``down time,'' during which to recollect; no break from the anxiety.

"We had this sort of thing in Vietnam," said Donald Jarzambek, director of the Kalamazoo County Department of Veterans Affairs. "But nowhere near what it is now. Everybody in Iraq is exposed to combat."

The stress placed on soldiers asked to serve multiple tours of duty, the constant threat of injury and the number of soldiers being exposed to that threat who were not traditionally asked to serve in combat areas -- such as National Guard troops -- are variables that experts fear could propel the number of veterans with PTSD to new heights.

More than 17,000 have come home from Iraq and Afghanistan after being wounded in combat, but many more carry the unseen scars of war.

The VA offers individual and group therapies that focus on positive coping skills. It also has shown newfound openness to using alternative techniques such as holistic therapies.

Next year, $29 million is earmarked for PTSD programs, signifying attention to a problem that is ever-growing. The resources being made available indicate a difference in attitude from that of the post-Vietnam War era.

"The treatment we are offering now is more expansive than it ever has been," said Scott Dreisenga, a Battle Creek VA clinical psychologist.

"A lot has changed since Vietnam."

"You just keep it bottled up."

Ian Parrish and Chris Barz show no overt signs of their time at war. The two Marine lance corporals from Plainwell, both on three-week leaves, said they don't awaken with nightmares or flashbacks to the battlefield.

"You have to be a weak-minded person to have problems outside of there (war zone)," said Parrish, a 21-year-old Allegan High School graduate who plans to be a career soldier.

Steely eyed bravado is the Marine way. But underneath the tight haircut and behind the eyes that don't quite make enough contact to exhibit comfort, these two fighters both say war has changed them.

During an interview at Old Burdick's, in downtown Kalamazoo, Parrish constantly kept watch on Michigan Avenue, peering through a wall of windows.

Parrish and Barz, a 22-year-old graduate of Plainwell High School, served seven months in Afghanistan and expect to deploy soon to Iraq for an eight-month tour.

They remember dozens of mortar attacks when they were at Camp Blessing in Pakistan. The fact that only one proved fatal, each say, was an unlikely blessing.

"You could be sitting in your room watching TV and hear the sounds of incoming mortars and think `that might happen at any time," Parrish said.

In the mountainous region near the Pakistan border where Camp Blessing is located, they were the targets of gunfire four times while on patrol together.

"You know they're out there, and we've been engaging them out there, but we've never seen them," Parrish said, adding that after firefights with the enemy, they were sent to see whether they had hit anyone.

Both say they feel a sense of achievement for providing medical care, food, clothing and school supplies to people in the impoverished Kunar province, and for providing security during last year's national election in Afghanistan.

They point to the accomplishments and downplay the horror. But they also acknowledge the experience of war never leaves them. Neither has sought treatment for PTSD because they say they don't exhibit the signs of the disorder. They also say the training that makes them good soldiers would keep them from admitting a perceived weakness.

The 2004 VA study concluded that "among the study groups there was a significant risk of mental-health problems and that the subjects reported important barriers to receiving mental-health services, particularly the perception of stigma among those most in need of such care."

"In the Marine Corps, someone who had problems wouldn't say anything about it," Parrish said.

Barz agreed. ``You just keep it bottled up,'' he said. "You don't want to come off as weak."

That's what one Marine who was stationed at Camp Blessing -- Ryan Nass, 21, of Franklin, Wis. -- did until Sept. 3, 2005, the day he couldn't take it anymore.

"I don't know if it was a mix of stress out there,'' Parrish said. ``But he shot himself right outside our little house."

It was first suspected that Nass was the victim of sniper fire. But a shell from his own weapon was found next to his body, and it was ruled a suicide.

There was no note.

"I talked to him an hour before," said Barz, who plans to leave active duty after his tour in Iraq. "He seemed fine."

After the suicide, chaplains and psychologists were made available to soldiers. Intelligence officers began investigating the incident.

"I probably talked to seven different people about it," Parrish said.

"(But) you just got to put it past you," Barz said. "If not, you can't do your job, and you put someone else in danger."

Long-term horror

The fighting in Afghanistan has been going on for more than four years, and the war in Iraq reaches the three-year mark next month. Death is a constant companion; rest, an elusive prey.

Long-term exposure to the horrors of war almost certainly is a foreshadowing of psychological difficulty. Some PTSD experts are wondering whether the reported number of veterans suffering from the disorder will grow to the point of becoming unmanageable.

Edward Tick, who wrote the book ``War and the Soul: Healing Our Nation's Veterans from Post-Traumatic Stress Disorder,'' has been counseling veterans with PTSD since 1979. He will be in Kalamazoo April 9-11 as part of the Kalamazoo Public Library's Reading Together program.

Tick has devoted much of his life to understanding and facilitating the healing process for veterans with PTSD. As the war carries on, and more veterans come home, Tick is not optimistic about their transition into society.

He envisions thousands of veterans who will be treated for PTSD, and thousands more who will deal with the symptoms on their own.

"I think we've only seen the tip of the iceberg."

Gazette staff writer Chris Killian can be reached at 388-8552 or .

Freelance writer Ben Lando is a frequent contributor to the Gazette.