PTSD: Private Battles

{ Photo by Sam Dean | The Roanoke Times }

Sunday, October 23, 2011

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Related story: After the battle, Mike Sword's war within

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By Beth Macy | The Roanoke Times | 981-3435

THEIR STORIES DON'T USUALLY MAKE the front page, but many local veterans have struggled after returning from Afghanistan and Iraq.

A Roanoke veteran retreated into the national forest for a year, taking only a tent and his guns, hunting his own food, and threatening to kill himself.

A guardsman living in Franklin County spent a night drunk in a ditch, hiding from deputies who'd chased him the night before. He thought he was back in Afghanistan, under attack.

A former drill sergeant instructor now living in Roanoke County tried to kill himself in 2008 — but his wife intervened, called police and had him committed.

It's been a nearly a decade since Western Virginia sent the first of some 6,670 troops to Iraq and Afghanistan, most of them from National Guard and Reserve units. Lacking the support of a military base when they return, local veterans have been particularly hard hit: A 2010 Virginia Tech study commissioned by the Virginia Wounded Warrior Program showed higher rates of incarceration, homelessness, post-traumatic stress disorder and other mental health problems among the region's veterans.

Statewide, two-thirds of the surveyed Iraq and Afghanistan veterans reported suffering from some form of depression.

Because many troops faced multiple deployments, some veterans returned to find they'd lost their jobs. "Their employers can say they had to downsize because of the economy," adding stress on top of stress, said study author Mary Beth Dunkenberger.

Nearly all who end up in crisis wait until they hit rock bottom before asking for help.

"They know the right and the wrong answers to give on their post-deployment screenings," said Lisa Yost, regional coordinator for the Virginia Wounded Warrior Program, a state-funded program that offers support and service coordination for veterans and their families. "The wrong answers mean you have to stay longer; the right ones mean you go home to your family."

Veterans always choose their families, Yost said, even if it means lying on the form.

Trouble with the law

While the severest cases make headlines — the 2008 police shootout that ended in Mike Sword's death, for instance — many more veteran-involved incidents are showing up on police blotters, local mental health care providers say.

"So many of the guys with PTSD end up in trouble with the police — domestic issues, DUI, drunk in public, reckless driving, fighting in bars," Yost said. "The worst are suicidal. They haven't slept in days, and they're talking about killing themselves or about hurting someone else."

Across the Roanoke and New River valleys, police and other first responders are being trained to deal with people in mental health crises, including PTSD sufferers. Officers learn to thank veterans for their service, ask for their rank and where they served — anything to build rapport. They're taught to distract people in crisis by offering gum, water or a cigarette.

"We're seeing more and more veterans interface with the criminal justice system," said Patrick Halpern, executive director of the New River Valley Mental Health Association.

The two most insidious injuries of the current wars, Halpern says, are PTSD and traumatic brain injury. Both conditions can foster low impulse control and substance abuse that can lead to inter­actions with law enforcement, he added.

"Most of the people I know coming here for PTSD treatment, men and women, they've had some kind of problem with the law, either drinking-related or violence or something like that," said James Lugamira, a retired Special Forces soldier who receives weekly counseling at the Salem VA for PTSD.

Ron McCracken, a Tidewater Army veteran, says he's fought anger issues since 1975, when he returned from Vietnam. His first week home, in fact, he was so anxious and sleep-deprived that he assaulted a police officer, beginning decades of VA treatment for PTSD and substance abuse.

Sgt. Ken Asbury kept an eye out for insurgent activity during his National Guard tour in Ghazni province, Afghanistan, in 2004-05. Asbury, of Rockbridge County, has been treated for pain, spinal injuries and PTSD in the wake of his service and now attends weekly anger-management group therapy sessions at the Roanoke Vet Center. (Photo by Sam Dean | The Roanoke Times)

"The Defense Department has learned a lot since I got out," he said outside the Salem VA, where he was at the tail end of a 28-day inpatient substance abuse program — his 20th. "The things they didn't do for us they're doing for the younger guys: teaching them the signs, more programs, making safe places for them to congregate."

Nearly all his fellow patients faced similar issues, he said, including one younger veteran who'd been arrested with an assault rifle and 300 rounds of ammunition.

Yost, who sees between three and four suicidal veterans a month, says many begin their journeys into the judicial system with DUI and reckless driving charges.

"They see a piece of trash on the side of the road and think it's an IED [improvised explosive device]," she said.

VA counselors often accompany veterans to court, where judges tend to be more treatment-oriented with them, Yost and other veterans advocates say. With grant funding from the state Department of Criminal Justice, Yost and Halpern have been training judges, probation officers and prosecutors about veterans' mental health issues.

"We're not giving them a get-out-of-jail-free card," Yost said. "There are still consequences, but we are trying to get them the help they need so it won't happen in the future, or progress from a DUI to something even worse."

More places to find help

With some military reports estimating that 18 veterans commit suicide every day in the United States, VA officials have beefed up outreach efforts, offering 24-hour crisis hotlines and Internet chat counseling and following up by phone when veterans fail to show up for counseling appointments, said Laura Clevinger, suicide prevention coordinator at the Salem VA.

In the 10 months between October 2010 and July 2011, the VA National Suicide Prevention Hotline referred 8,459 callers in Virginia, North Carolina and West Virginia for crisis-intervention care at their regional medical centers. The Salem VA alone treated 770 new cases of PTSD in fiscal year 2011. During that time, 3,312 total patients were seen for mental health services, including PTSD.

While suicides among active-duty soldiers dropped in 2010 for the first time in five years, the number of Army reservists and National Guard members who killed themselves nearly doubled, according to a recent Pentagon report, which cited "failed relationships" as the most common factor.

"What's made this war so unique is these guys didn't do 12-month tours like in Vietnam," said Jerry Gilmore, the Salem VA's associate chief for mental health. "They've been deployed repeated times, for years on end, with very little time at home in between to recover.

"It's the perfect storm."

Having numbed themselves to endure the constant heightened state of vigilance required by war, soldiers find it hard to turn their emotions back on when they return to their families, explained Radford University criminologist Isaac Van Patten. "They tend to go from being almost devoid of emotion to an extreme emotional state," he said.

Having studied Mike Sword's case, he suspects the airman felt trapped by the loss of his career, which exacer­bated financial and family stresses. "Pretty quickly, you're backed into a corner, and you just want the pain to stop, but your values won't allow you to stop it.

"I think he delayed the situation [killing himself] until an opportunity arose," baiting police into shooting him.

With his hyperarousal syndrome triggered by the police chase, he probably shifted into flashback mode, unable to process the commands officers were shouting or to fully comprehend his own actions, Van Patten said.

Even with therapy and medication, "the signs are just not always clear," Gilmore added. "Sometimes a suicide leaves people wondering ‘What did I miss?' when they didn't miss anything; there was nothing to be seen."

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