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Still Suffering, But Redeployed
Eight months ago, Staff Sgt. Bryce Syverson was damaged goods, so unsteady that doctors at Walter Reed Army Medical Center wouldn't let him wear socks or a belt.
Syverson, 27, had landed in the psychiatric unit at Walter Reed after a breakdown that doctors traced to his 15-month tour in Iraq as a gunner on a Bradley tank. He was diagnosed with post-traumatic stress disorder and depression, and was put on a suicide watch and antidepressants, according to his family.
Today, Syverson is back in the combat zone, part of a quick-reaction force in Kuwait that could be summoned to Iraq at any time.
He got his deployment orders after being told he wasn't fit for duty.
He got his gun back after being told he was too unstable to carry a weapon.
But he hasn't quite managed to get his bearings.
"Nearly died on a PT test out here on a nice and really mild night because of the medication that I am taking,'' he wrote in a recent e-mail to his parents and brothers. "Head about to explode from the blood swelling inside, the [lightning] storm that happened in my head, the blurred vision, confusion, dizziness and a whole lot more. Not the best feeling in the entire world to have after being here for two days ...
"And I ask myself what the F*** am I doing here?''
Syverson is among a growing number of troops who are being recycled into combat after being diagnosed with PTSD or other combat-related mental disorders -- a new phenomenon that has their families worried and some mental health experts alarmed. The practice, which a top military mental health official concedes is driven partly by pressure to maintain troop levels, runs counter to accepted medical doctrine and research, which cautions that re-exposure to trauma increases the risk of serious psychiatric problems.
"I'm concerned that people who are symptomatic are being sent back, which is potentially very bad for them. That has not happened before in our country,'' said Dr. Arthur S. Blank Jr., a Yale-trained psychiatrist who helped to get PTSD recognized as a diagnosis after the Vietnam War.
"If people have received treatment for a year or two or three and the condition is completely stabilized, I could see it,'' said Blank, who was formerly director of the Department of Veterans Affairs' counseling centers. "[But] there's no study that says it's beneficial to send people back. Being re-exposed to the trauma can just intensify the symptoms.''
Although Department of Defense medical standards for enlistment into the armed forces disqualify those who have suffered from PTSD or acute reactions to stress, including combat fatigue, military officials acknowledge that they are not exempting service members who meet those criteria from going to war. Many of those who are being sent back with such symptoms, such as Syverson, are being redeployed on psychiatric medications known as SSRIs.
Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general, acknowledged that the decision to send back soldiers with symptoms or a diagnosis of PTSD was "something that we wrestle with,'' and partly driven by the military's need to retain troops because of recruiting shortfalls.
"Historically, we have not wanted to send soldiers or anybody with post-traumatic stress disorder back into what traumatized them,'' she said. "The challenge for us ... is that the Army has a mission to fight.''
Ritchie said the military looks closely at the "impairment'' level of individual service members and their response to medication before deciding whom to redeploy, and would not put any soldier at risk.
"If they're simply -- and I don't mean to minimize it -- but if they're simply having nightmares, for example, but they can do their job, then most likely they're going to deploy back with their unit,'' she said. "If they're not able to do their job and they don't respond to treatment, then we're going to probably keep them here in the States for at least a while longer.''
But whether the military can even gauge the impairment level of its veterans is in question. A newly released report by the Government Accountability Office found that nearly four in five troops returning from Iraq and Afghanistan who were found to be at risk for PTSD, based on responses to a screening questionnaire, were never referred for further evaluation or treatment. Still, top military officials continue to insist they are doing a good job of identifying and treating PTSD cases.
Dr. Matthew Friedman, director of the National Center for PTSD, an arm of the Veterans Administration, said that while he shares the concern that multiple deployments may exacerbate PTSD symptoms, he does not believe the military should take a "one size fits all'' approach to the disorder and bar all troops from deploying. Drug treatments for PTSD prove successful in some cases, he said, and some service members are more resilient than others.
"My belief is, let's look at the data'' that are being gathered by pre- and post-deployment mental health screenings, he said. "Once we have the data, we can go back and look at how people with PTSD perform.''
But some service members' families and experts say the military should not be experimenting with young men and women who have been traumatized by going to war.
"We were shocked. When somebody's put on medication and told they have PTSD, it doesn't occur to you they'd want to send them back,'' said Corrine Nieto, a Bakersfield, Calif., mother whose 24-year-old son, Chris, a Marine reservist, was redeployed to Iraq last summer after being diagnosed with PTSD. "I don't know what they're doing to these kids. I wonder if they do.''
Jason Sedotal, a 21-year-old military policeman from Pierre Part, La., was diagnosed with PTSD in early 2005 after he returned from Iraq, where he was traumatized by an incident in which a Humvee he was driving rolled over a land mind, he said. His sergeant, sitting beside him, lost both legs and an arm.
Last September, Sedotal was transferred from Fort Bragg to Fort Polk, where he said doctors switched his medication from Prozac to Zoloft, and commanders deemed him ready to redeploy. He has been back in Iraq since October.
"I don't feel like myself. I can't sleep, I can't be around crowds, I'm just drinking a lot,'' he said during a mid-tour visit home last week. He said he had seen a doctor at Fort Polk, to ask if he could stay home and get treatment, but instead was given a higher dose of Zoloft and told he was shipping out again this week.
When he asked the doctor if his symptoms would ever go away, he said he was told, "Sure -- when you get out of there.''
Neither the military nor the VA has figures on the number of troops with PTSD or other combat-related disorders who have been redeployed after a diagnosis. Overall, more than 378,000 active-duty, reserve and National Guard troops have served more than one tour in Iraq or Afghanistan, including about 151,000 Army soldiers and 51,000 Marines, according to the Department of Defense's latest deployment statistics.
Recent studies indicate that at least 18 percent of returning Iraq veterans are at risk for PTSD, while 35 percent have sought mental health care in their first year home.
The Courant's research shows that at least seven troops who are believed to have committed suicide in 2005 and 2006 were serving second or third deployments. In some of those cases, according to their families, they had exhibited signs of psychological problems between deployments that went undetected by military officials, who rely largely on the self-reported questionnaires.
Jeffrey Henthorn, 25, of Choctaw, Okla., was just six weeks into his second deployment when the military says he killed himself in Iraq last year. His family said he had shown signs of psychological problems between deployments, but had not received counseling or treatment.
Similarly, Army Spec. Rusty W. Bell, 21, of Pocahontas, Ark., showed signs of combat stress after his first deployment to the Middle East in 2003 as a member of the Army National Guard, said his mother, Darlene Gee. When he came home in April 2004, he enlisted in the Army and was sent back to Iraq in early 2005.
"He saw tons of combat that first time, and I think it affected him,'' Gee said. "I never asked him about it straight-out, but he said a few things that stick with me. He said, `Mom, I wish they'd just nuke the entire place. I know I would die, but at least I would die for a reason.' I said, `Bub, don't talk like that.'
"I thought they shouldn't have sent him back so soon,'' she said. "Let him have a normal life for a while, after what he'd been through.''
An autopsy report on Bell's death concludes that he shot himself last August, with witnesses saying he was "distraught over family problems.'' Gee said she was not aware that her son, who was married, was having any significant personal problems.
The wife of a soldier who killed himself earlier this year in Iraq said she had little doubt that repeat tours had played a role.
"I know that did affect it. Absolutely I know it. A combination of fatigue and just being worn out,'' said the woman, who did not want her name used to protect her children.
Army Surgeon General Kevin C. Kiley said many troops want to go back with their units for repeat tours, and the military is willing to facilitate that, as long as they are functioning well.
"Part of sending troops back in with medications that are stable and doing very well is . . . to de-stigmatize this, to show soldiers they can do the job, they can defend the nation, they can be part of this Army, and they won't be cast aside,'' Kiley said.
In some cases, the military has pushed the point a step further.
Army Spec. Jason Gunn, of Lansdowne, Pa., was sent back to Iraq in early 2004, after being injured in an explosion and diagnosed with PTSD, because Army officials believed it would be in his best interest to "overcome his fear by facing it,'' according to the explanation provided to his mother, Pat Gunn, through a congressman.
Since he returned home and left the Army last year, Jason has drifted between odd jobs and "goes through phases where he's in a very bad place,'' Pat Gunn said. She said she worries that the military is "taking the very last breath out of these kids.''
Mental health experts said that while some troops who suffer from PTSD symptoms may be able to return to the front lines, there is no evidence to suggest that re-exposure to trauma is in any way therapeutic.
"Anybody who says it's a form of therapy to send people back into war,'' said Dr. Jonathan Shay, a Boston-based psychiatrist who counsels Vietnam veterans, "I don't know what they're smoking.''
Fear Of Avalanche
Some soldier advocates worry that the repeat deployments of troops will lead to an avalanche of PTSD cases and fuel incidents of suicide and violence.
In Vietnam, most soldiers did a requisite one-year tour of duty and never went back. About 30 percent of them suffer from PTSD symptoms, and another 20 percent have experienced clinically serious stress-reaction symptoms, according to the National Vietnam Veterans Readjustment Survey.
Of the 1.3 million active duty, guard and reserve troops who have served in Iraq and Afghanistan, more than 28 percent already have deployed more than once.
"This is an unexplored area,'' said Cathleen Wiblemo, deputy director for health care for the American Legion. "How are troops going to deal with second and third deployments? Is their reaction going to be more severe?
"I think the VA can look to seeing a lot more mental health cases,'' she said. "They haven't gotten the full brunt of these multiple deployments yet.''
So far, more than 20,600 service members who have separated from the military have received an initial diagnosis of PTSD, according to the VA. That doesn't include service members still enlisted in the military, or veterans who seek help from private doctors or other sources.
Like other parents, Larry Syverson, an environmental engineer from Richmond, Va., worries that the military is gambling with his son's mental health for the sake of maintaining troop levels.
Bryce was sent back to Kuwait in late-March, after the Army had deemed him non-deployable and left him at his base in Germany while the rest of his unit deployed. In February, he told his father that his doctors had taken him off of Zoloft and were trying another medication. He still wasn't allowed to carry a gun.
Larry Syverson isn't sure why the military abruptly deemed Bryce deployable and handed him back his weapon. In correspondence, his son has said he agreed to go back to Kuwait because commanders told him it would help his chances of re-enlisting in the Army -- something Bryce, who has not known civilian life since he graduated from high school, wants to do.
"The doctors said that I will be okay to deploy and carry around my rifle ... and shoot people,'' Bryce wrote in an April 18 e-mail to his father. "So in a week from me and the doctors both agreeing that I will be okay to deploy. I was gone again.''
"The Battalion Commander was holding a bar to re-enlist over my head if I didn't deploy. But since I have deployed, my request for re-enlistment has been denied twice.''
The tone of Bryce's e-mails, as much as the content, worries Larry Syverson, who said his youngest son, once the most "even-keeled'' of four brothers, now has a festering bitterness.
"It just floors us that they'd send him back,'' said Larry, a peace activist whose sons all have served in the military, but who opposes the Iraq war. "To be in a psychiatric hospital last summer and now back to a war zone -- it's not like they didn't know Bryce's condition, because it's their hospital and their diagnosis.''
Bryce's PTSD came on the same way many cases do: suddenly, starkly, several months after he had returned home in the summer of 2004. He was watching New Year's Eve fireworks in Germany, his father said, when he "got spooked'' by the crowd and the sounds, which reminded him of mortar attacks. From there, he spiraled into depression, anger and an inability to concentrate.
PTSD has three main clusters of symptoms: re-experiencing the trauma, in the form of flashbacks or memories; retreating from life or feeling detached; and hyper-vigilance, including impaired concentration. Some troops suffer from partial symptoms. War-zone stress also can lead to depression and anxiety disorders.
Experts say short-term treatment with Zoloft or Paxil, the two drugs approved by the government for treating PTSD, are successful in putting the disorder into remission about 30 percent of the time. But the other 70 percent of cases are not so easy to control and can continue for years. Some patients never fully recover.
The practice of redeploying soldiers who continue to suffer from PTSD symptoms runs counter to statements by the military's top health official, Assistant Defense Secretary William Winkenwerder, who assured a congressional committee last summer that troops with "unremitting mental health disorders are not deployed.''
Dr. Frank M. Ochberg, a clinical professor of psychiatry at Michigan State and a founding board member of the International Society for Traumatic Stress Studies, said he would not want anyone who has "chronic'' PTSD -- symptoms lasting longer than three months -- to return to a combat situation. Deploying someone with depression, which often accompanies PTSD, also is dangerous, he said.
"My gut feeling is, it's probably OK if they've been stabilized and they haven't had a recurrence of depression in a year,'' he said. "But the problem of depression in combat is, you are of more risk to yourself and others.''
Troops fill out post-deployment questionnaires just as they return from Iraq, and then receive a follow-up screening, recently added by the military, three to six months later.
Because the screenings rely largely on self-reporting by service members, who often are reluctant to disclose problems, their usefulness is limited, mental health experts agree. That leaves families and friends of some service members convinced that post-traumatic symptoms are going undetected.
Martin Armijo, a family friend and neighbor of 22-year-old Army medic Chris Rolan of Albuquerque, N.M., said he worried about Rolan when the young man returned home last year between deployments to Iraq.
"He said he'd seen a lot of combat. It was freaking him out seeing all these soldiers getting shot up,'' said Armijo, a Vietnam veteran. "I could tell in his eyes, he had that look like he was lost. He wasn't the Chris I knew.''
After he returned to Iraq, Rolan was charged with killing a member of his unit during an argument, in November of last year. His older brother, Robert Garcia, is at a loss to explain what happened to the young man he says was the "bright star'' of the family.
"This is so out of the blue,'' said Garcia, who declined to discuss the pending murder case. "It just doesn't fit.''
Wrestling With Symptoms
Some troops with PTSD symptoms receive counseling in Iraq, while others don't, interviews with troops and families indicate.
Jim Holmes' son, Micah, an Army mechanic, was deployed to Iraq last August. He had returned home in May 2004 from a 10-month tour in Afghanistan with symptoms of PTSD and depression, for which Army doctors prescribed Zoloft and Wellbutrin, Holmes said.
Earlier this year, while in Iraq, he told his father that he had stopped taking the drugs because they were "too hard to get,'' and that he was not receiving counseling.
"He's not getting treated there, and who knows if there'll be any treatment available when he comes home,'' said Jim Holmes, a social worker from Gaithersburg, Md. "At this point, I just want him back.''
Whether Zoloft and other drugs actually can help to buffer combat stress or prevent full-blown PTSD is not known, mental health experts said. That uncertainty led Ochberg to call the practice of medicating stressed-out troops "one hell of a research project.''
"There are people who want to do the job, and if they do the job on medication, they may be better off,'' Ochberg said. "But I have never given anyone a prescription because they're going into a combat situation.
"There's a chance that this unwitting experiment of prevention of full-blown emotional distress will be instructive,'' he added, "but it's also fraught with moral and ethical considerations.''
Among the moral considerations is that many troops with combat-stress symptoms want to go back to the war, becoming addicted to the adrenaline and sense of mission, and unable to adjust to life at home, military counselors say. Their eagerness matches the military's willingness to recycle them into combat.
"Iraq is an impossible act to follow. Everything else pales,'' said Noka Zador, a coordinator of counseling for Iraq and Afghanistan veterans at the West Haven Veterans Administration. "Part of it is, they have one foot here, one foot there. It's a sense of, `I'm still back there anyway.'''
David Beals, 26, a soldier stationed at Fort Stewart in Georgia, sometimes tells his wife, Dawn Marie, "In my head, I'm still in Iraq.'' After he returned from his second deployment to Iraq in January, he paced around the house, bored and restless, she said.
Beals had a rough first tour in Baghdad in 2003, and sunk into a depression as his second deployment approached. In January 2005, he locked himself in the bathroom of the couple's home and swallowed a bottle of Percocet. He landed in a hospital psychiatric ward and was diagnosed with PTSD and an adjustment disorder, Dawn Marie said.
He was sent back to Iraq within a few months, for the tour that ended this January. He expects to go back for a third time at the end of this year.
"He loves what he does. He loves being in the Army,'' Dawn Marie said. "For me, you just learn to adapt. ... He definitely is not the same person. It's the same person, but not the same personality.''
Military counselors say the frequency of multiple deployments has been a disincentive for troops to seek help readjusting to life at home, and has made counseling difficult.
"Some of them don't see the relevance of coming for counseling because their bags are still packed,'' said Donna Hryb, team leader at the Hartford Vet Center in Wethersfield.
Some PTSD experts also suggest that the growing public sentiment against the war can have a negative effect on the mental health of some troops shuttling back and forth to Iraq.
"If there's controversy and doubt about the validity of the war, it has a major psychological impact, for both the therapist and soldier,'' said Blank, the psychiatrist and expert on PTSD.
James Gavin, a Vietnam veteran who is team leader of the New Haven Vet Center, said military medicine has a different emphasis than civilian medicine. The military is "looking at unit cohesion and cohesiveness,'' he said. "They're not so concerned with a heightened state of alertness, or sleeplessness, or other things. They might want people on edge.''
That's what concerns Larry Syverson.
In a recent e-mail from Kuwait, his son Bryce, who is safe from combat for now, complained that some leaders of his unit "want to actually go to Ramadi,'' and had tried to "volunteer'' the battalion for the front lines of Iraq.
Larry said he isn't worried that Bryce, whom he calls a "good soldier,'' would resist.
He's worried that he wouldn't.
Courant Staff Writer Matthew Kauffman contributed to this story.