Treating Wounds You Can't See

By Linda Blum
Sunday, June 29, 2008

On the wall in my office at Fort Dix, N.J., hung a row of nature photos and some historical documents for my patients to look at: a land grant signed by James Madison, another signed by Abraham Lincoln's secretary in his name, a Lincoln campaign ballot. The soldier from Ohio studied the wall carefully. It was amazing, he said, how much the layout of those picture frames resembled the layout of the street in Tikrit that was seared in his memory; the similarity had leapt out at him the first time he came in for a session. He traced the linear space between the frames, showing me where his Humvee had turned and traveled down the block, and where the two Iraqi men had been standing, close -- too close -- to the road.

"I knew immediately something was wrong," he said. The explosion threw him out of the vehicle, with his comrades trapped inside, screaming. Lying on the ground, he returned fire until he drove off the insurgents. His fellow soldiers survived, but nearly four years later, their screams still haunted him. "I couldn't go to them," he told me, overwhelmed with guilt and imagined failure. "I couldn't help them."

That soldier from Ohio is one of the nearly 40,000 U.S. troops diagnosed by the military with post-traumatic stress disorder after serving in Iraq and Afghanistan from 2003 to 2007; the number of diagnoses increased nearly 50 percent in 2007 over the previous year, the military said this spring. I saw a number of soldiers with war trauma while working as a psychologist for the U.S. Army. In 2006, I went to Fort Dix as a civilian contractor to treat soldiers on their way to and return from those wars. I was drawn by the immediacy of the work and the opportunity to make a difference. What the raw numbers on war trauma can't show is what I saw every day in my office: the individual stories of men and women who have sustained emotional trauma as well as physical injury, people who are still fighting an arduous postwar battle to heal, to understand a mysterious psychological condition and re-enter civilian life. As I think about the soldiers who will be rotating back home from Iraq this summer as part of the "pause" in the "surge," as well as those who will stay behind, I remember some of the people I met on their long journey back from the war.

'We Are Marked'

A high-ranking noncommissioned officer had waged tank warfare during both the 1991 Persian Gulf War and the Iraq war. This soldier remains in immense distress, like many of the people I treated who needed to grieve for lives they had taken in combat. Once, after he killed at least nine people in one week, he experienced acute anxiety and depression and was taken off work for a week. "They had me pet a dog," he said.

Pet a dog? That struck me as fairly mild treatment, although association with pets has been shown to lower blood pressure and other stress indicators.

"How was that, petting the dog?" I asked.

"It was okay, I think it helped some," he said. "I don't know how it was for the dog."

* * * Another soldier, a sergeant, seemed to be living under a thick, dark cloud. He would come in every week, talk some, then periodically stare off into space. He had injured his back and shoulder and was trying to accept that many of his favorite activities were over: He couldn't run, play tennis, play basketball with his son.

He was always lucid, on point, but since his return from Iraq, he had been having auditory hallucinations in which he'd hear his name being called.

He seemed so lost in his own world that I nagged him to come to a group to try to open him up. When he finally did join us, he was transformed -- talkative, funny, smiling, strikingly different than I'd ever seen him. But later, he told me he'd hated the group: He couldn't stand hearing everyone's problems; he had felt that he had to cheer everyone up; it had been unbearable. He never went back.

Shortly before he left Fort Dix, he said to me: "We [combat vets] are marked. People see us and they know. . . . They know we're different."

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