By Donna St. George
Washington Post Staff Writer
Sunday, August 20, 2006
There are times when Trinette Johnson's life seems to stall, when she finds herself staring at the ceiling fan in her bedroom, watching the blades spin, her mind hung on nothing -- not her receptionist job, not her fiance, not her ailing father or her four children.
Not even the war.
The war, of course, is always there somewhere, she said, an unseen force in her life, sometimes producing moments of blank detachment, sometimes stirring up anger like nothing she has ever known.
More than two years after returning from duty in Iraq, she has found herself yelling and cursing at other drivers on the road. Panicked in crowds. Seized with fear at the sight of highway overpasses and tunnels that might suddenly explode.
Doctors gave the 32-year-old Johnson, who served in the D.C. National Guard, a diagnosis of post-traumatic stress disorder, which has plagued thousands of U.S. troops after combat in Iraq -- bringing on flashbacks, numbness, rage and anxiety and leaving many at odds with their old lives, families and jobs.
How women are affected after combat is only starting to be probed. This is the first war in which so many women have been so exposed to hostile fire, working a wider-than-ever array of jobs, for long deployments.
"This is a really unique experience, and we just don't know," said Ronald C. Kessler, a Harvard University professor and author of a landmark study of post-traumatic stress disorder.
For women who are mothers, combat-related PTSD may have added significance. Often, after war, "it's not the same mommy who left," said Yale University associate professor Laurie Harkness, who runs a Veterans Affairs mental health clinic in Connecticut. Although the same can be said for fathers, she said, "mothers in general are the emotional hub of a family."
For Johnson, it was a doctor at Walter Reed Army Medical Center who first uttered the letters P-T-S-D, a defining moment that came after she spent nine months working the bomb-blasted roads near Baghdad. Her job with the 547th Transportation Company was hauling -- troops, supplies, equipment -- and security. At one point, she helped transport dead Iraqis to their wailing relatives.
In one particularly bad period, a roadside bomb claimed the life of a 21-year-old soldier in her unit, Spec. Darryl T. Dent. Later, another bomb severely wounded Johnson's best friend, Spec. Antoinette Scott, a mother of four.
That fall in 2003, Johnson was riding in a truck with her M-16 rifle pointed out the passenger-side window. Out of nowhere came a deafening blast. Her five-ton vehicle swerved and nearly flipped. There was fire. White smoke. Flying debris. A bomb, hidden along a guardrail, had detonated.
Johnson received a Purple Heart for hearing loss in her left ear but stayed in Iraq for several more months, working the same roads. "It seemed like once every other or three days somebody was getting hit," she recalled recently.
But the enemy was elusive. She never fired her M-16.
Unexpectedly, in January 2004, she was shipped home three months early, sidelined with severe kidney stones. Later, at Walter Reed, the dreams started: violent dreams, with exploding mortars and hordes of barking dogs. She mentioned them to a doctor.
This was while she was living on the hospital grounds, seeing specialists and worrying about whether anyone in her unit had been injured or killed. She called her unit in Iraq every day. But she had not seen her kids.
A counselor prodded her to visit them -- three were being cared for by Johnson's sister in Falls Church, and one was in Richmond with the child's paternal grandmother. None of the children lived with their fathers.
"Mommy! Mommy!" her youngest daughter, then 2, shrieked during a visit in Falls Church, climbing all over her.
Johnson had been a mother since she had her son at age 14. Now she felt overwhelmed. She rose to leave.
"I can't do this," she told her sister.
In her car, she sobbed, wondering how she could feel so disconnected. "I realized that I just walked out on my babies."
* * *
In nearly 3 1/2 years of war, more than 137,000 female troops have served in Iraq and Afghanistan, some exposed to the most profound stresses of combat: ambushes, mortars, bombs, fallen comrades. They have fired M-16s and grenade launchers, killed people and been shot at.
As these women have returned home, Army researchers studying the psychological fallout of Iraq have noted a surprising trend in early studies: Women appear to be showing symptoms of post-traumatic stress disorder and other mental health troubles at roughly the same rates as men.
If this result holds true, it would stand out because women studied in the overall population show markedly higher rates of post-traumatic stress disorder than men -- about twice as much.
"It's not definitive, but it's encouraging," said Patricia A. Resick, director of the Women's Health Sciences Division of the National Center for PTSD, part of the Veterans Affairs Department. Resick said more research is needed.
While studies of the war's effects continue, one fact is clear: A generation of U.S. military women is at risk of combat-related stress disorder as never before.
A recent study showed that, overall, more than one in three U.S. troops sought mental-health care in the year after returning from Iraq. An earlier study found that about one in six showed signs of PTSD, major depression or anxiety after Iraq.
"From our data, what it looks like is that women serving in combat have the same risk as men of getting PTSD or other mental health conditions," said Charles W. Hoge of the Walter Reed Army Institute of Research.
For Johnson, treatment at Walter Reed made things better, with group sessions, art therapy and combat-stress counseling. "You're in there with other people who are going through the same things," she said, "and you kind of feel like, 'Okay, now I don't feel crazy.' "
The most wrenching day, as she remembers it, was when she was sent home: Oct. 3, 2004. No longer did she have the supportive environment of the hospital. She was on her own, medically discharged from the military because of the stress disorder.
Outwardly, Johnson looked much the same: bright eyes peering through delicate glasses, big smile, always seeming on the verge of a laugh. "Dee," everyone called her. But much had changed. "I don't even know this life," she said one day.
For several months, while her fiance supported them, she could not bring herself to go to work. Finally, last year, she returned to her job as a receptionist in the National Guard building in Northwest Washington, which houses a museum lined with exhibits that depict combat.
The images did not bother her.
The hard thing was that in the life she returned to, almost no one seemed to understand Iraq. They did not know what it was like to live with hidden enemies and fatal explosions, to feel so far from family and become so attached to other soldiers.
Some people told her: "I couldn't have left my kids like that."
The comments upset her because they implied a choice she did not have. She was a National Guard soldier, a job she took in 1997 as a steppingstone to more financial stability at a time when she was a single mother of three. The Iraq war did not seem a possibility then. Her father had served 26 years as a guardsman without seeing battle.
In 2003, Johnson left for war as her youngest was learning to talk.
Her eldest daughter was nearly 12 when Johnson returned. The girl seemed different -- dressing in black, skipping school, no more smiles, no hugs. She wondered: Was it because of her absence?
She recalled, "I'm looking and I'm trying to figure out, 'Where is my child?' "
* * *
Even now, there are times Johnson feels uncomfortable talking about post-traumatic stress disorder. It's an invisible wound in a war with daily bloodshed. At Walter Reed, she said, she saw soldiers with missing arms or legs, paralysis, shrapnel scars.
She is not so physically injured.
Still, her diagnosis scares her.
It took her six months after she left Walter Reed to make herself go to a VA office and stay for an appointment. She put it off at first, then became overwhelmed by the sight: veterans with glazed looks, some seeming at loose ends with nothing else to do.
"I would see some of the older vets sitting there," she recalled, "and I would be like, 'Lord, have mercy. I do not want that to be me.' "
She gave up alcohol. Some veterans drink a lot, she said, and she does not want to "self-medicate," as she called it. "It doesn't make Iraq go away," she said. "But obviously, if you pass out, then there's nothing bothering you at that time."
Johnson understands the danger of alcohol partly from her fiance, Mark Branch, who was her battle buddy in Iraq. He was driving the five-ton truck the day the bomb went off along the guardrail.
After Iraq, he drank so much Rémy Martin cognac that she lined up all of his empty liquor-bottle boxes along the top of their kitchen cabinets.
"How many fifths did I go through?" he asked her one day as they thought back.
He checked into a treatment program at Walter Reed, too.
The way Branch sees it, "a lot of us, we come back, and we have to go back to work because we have families, we have jobs, we have houses." Finding time to pursue counseling seemed impossible.
"You're never going to be healed from it," he said. "They just teach you how to live with it."
In her own life, Johnson finds herself off balance in ways that have surprised her.
One day she banged up her car but could not recall how. She heard the smack, yes. But how did she get up on the curb? Did she swipe a fire hydrant? "It's almost like I'm there but I'm not there sometimes," she said.
Another day, she recalled, it was the usual Washington traffic as she drove her Chrysler Concorde with the Purple Heart license plates. Along a snarled street, a bus driver blared his horn at her.
She yelled, cursed, then hurled an empty Coke cup at the bus before she even knew what she was doing. "You don't realize what you're doing until after, or sometimes a lot after," she said, later reflecting: "My temper is on a whole other level."
Then there was the time she got stuck in traffic near a highway overpass in Prince George's County. In Iraq, overpasses could conceal bombs. She felt a crushing sense of danger -- and traffic was at a dead stop.
"I was just losing it," she recalled.
In hysterics, Johnson phoned her fiance, who told her: Put the car in park and walk away until you settle down. When the traffic starts to move, climb back in your car.
More than 2 1/2 years after her return from war, her sense of safety has not returned. She worries as never before about terrorist attacks and suicide bombers.
"I always make sure I'm armed, regardless," she said, mentioning a knife she keeps around. "I always make sure I have something to defend myself."
She has had a hard time with the VA.
She applied for disability compensation, but it took 14 months, and there are still problems. She started mental health sessions but wound up disappointed. She said the VA canceled her appointment in October. In November. In December. Each time, there was a different reason, she said. Her therapist was sick. Her name was not on the schedule. All of that, she said, has added to her stress.
"I haven't been there in four months, and they haven't even noticed," Johnson said early this year. VA officials declined to discuss her case but said that, overall, veterans get the PTSD care they need.
In February, Johnson said, her social worker made some calls and got her a 30-minute session March 8. But problems at work so consumed her that she could not remember what to tell the doctor. Usually, she makes a list of things to bring up.
Once, she asked: How long am I going to be like this?
"It could stop today, or it could go on for years," she said she was told, which brings her to this: "That's what scares me. I just get scared that I'll be one of those homeless people that you see holding the signs because I've lost my mind."
For now, her fate is nothing like that. She and her fiance bought a house this year, a brick rancher with a big back yard in Clinton. Her children seem happier, planted. Her eldest daughter is 14, an honor student and soccer-team captain.
Her youngest, now 5, is still focused on Mommy, and Johnson is glad -- though sometimes she still finds herself overwhelmed. On weekends, she and her fiance often have six or more children around, hers and his and often a niece or nephew.
After Iraq, she rarely goes out anymore -- not to clubs, not to movies. She passed up a chance to apply for a higher-paying job in her office because she felt she could not manage additional pressure.
Some days, she feels perilously close to the edge.
If she is home, she may retreat to her bedroom. There, she can collect herself. Or she may, for a moment, lose her connection to everything, as the ceiling fan turns, as her mind goes blank.