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Healing the warrior
Fort Hood has been an innovator in the battle against combat stress

By Peter Slevin
Washington Post Staff Writer
Monday, November 16, 2009

FORT HOOD, TEX. -- Families from Georgia to California buried their Fort Hood dead over the weekend, but here on the nation's largest military installation, the pace of operations did not slow. Soldiers by the hundred bid tearful farewells and shipped out to war as others returned to joyous homecomings.

For those who made it back, the Nov. 5 attack that made Fort Hood a symbol of the collateral damage of two faraway conflicts is also a reminder of the battle the Army post has been waging against the mental demons unleashed by combat.

Maj. Nidal M. Hasan, the Army psychiatrist charged in the killings, was a recent arrival to a mental health corps that had won recent plaudits from the Pentagon's highest echelons for its innovative thinking about soldier health. Yet the violence he allegedly unleashed only weeks before his own deployment underscores the depths of the military's challenges and the limits of its most well-intentioned reach.

More than 75 people based at Fort Hood have committed suicide since the Iraq war began in March 2003, including 10 this year, one of the highest rates in the Army. Divorce, depression and violence are increasingly common among the thousands of soldiers who cycle through here, officials say.

Yet spaces exist for only a fraction of the soldiers who need help, officials say. For a soldier not considered in urgent psychiatric distress, it takes three to five weeks to begin counseling sessions, a senior staff psychiatrist reported. Resistance to seeking treatment can be fierce in a world where steeled emotions are typically considered a sign of strength.

To heal the corps, Fort Hood commanders are moving beyond standard commands that soldiers simply suck it up. Sending a message that to hurt is human, to seek help divine, they hope to draw returning warriors into networks of support. It is too early to know whether the programs will succeed.

For example, on the vast Army post cloaked in drab, Fort Hood's new Spiritual Fitness Center offers color. Inside, sunlight filters through stained glass of lavender and blue. Candles are surrounded in dishes of polished stones and George Winston piano solos flow from speakers above.

"We like to call this place 'listening and love,' " Lt. Col. Ira Houck, a chaplain, explained from deep in an overstuffed armchair, one week after the shootings left 13 people dead and dozens wounded.

If the concept sounds New Age, it is. The converted chapel in the heart of the newly christened Resiliency Campus offers a refuge for broken and distressed soldiers.

Yet Sgt. Matthew Spencer, a combat veteran who works as a greeter at the center, laughs when he says he and his buddies would never seek help here.

"I am from the infantry. We don't come to places like this," Spencer, 24, said above the strains of an Ennio Morricone composition. "Why don't we come? We've got each other."

"That's the battle right there," said M. David Rudd, a former Fort Hood psychologist who is studying post-combat stress for the Defense Department. He cites the military's macho culture as one reason.

Within sight of where President Obama led a memorial service for the Nov. 5 victims, psychiatrist Adam Borah, who runs the Resilience and Restoration Center, sees firsthand the difficulty in making warriors whole.

"There are issues with stigma. There are issues with feeling judged. There are issues with feeling that you are somehow less of a person if you require help," Borah said.

One of his clinics renders immediate care to soldiers who report that they are considering hurting themselves or others. He said a soldier will be seen within 45 minutes of arrival.

A prime worry for the Army is the upward trend in suicides, Borah said. In the first 10 months of the year, 133 active-duty soldiers were reported to have committed suicide, nearly as many as all of 2008.

Fort Hood and other posts distribute "suicide prevention cards" with instructions about talking with friends who may have suicidal inclinations. The acronym is "ACE," for "ask your buddy, care for your buddy, escort your buddy."

Not since Vietnam have U.S. soldiers seen so many years of sustained combat. At Fort Hood at any given time, one-third of the roughly 53,000 soldiers are deployed, one-third are returning from war and one-third are preparing to go.

Recent research suggests that warriors' repeated exposure to trauma is more likely to weaken a soldier than to build up mental immunity.

This is not a practice-makes-perfect situation," Borah said, describing wartime trauma. "This is a situation where with every successive event, a little bit more of our resiliency is utilized."

To address the fallout of war for active-duty soldiers, with the goal of returning them to the fight, Fort Hood last year established the Warrior Combat Stress Reset Program, modeled on a six-month approach at Fort Bliss, Tex. Here, soldiers devote three weeks to what Borah calls "traditional and nontraditional therapies."

That means options from one-on-one counseling, group therapy and medication to yoga, acupuncture, massage and Japanese Reiki. The results are being evaluated as they emerge. Three graduates of the program, which treats a dozen soldiers at a time, are serving in Iraq or Afghanistan.

He said Fort Hood could not meet the post's need for professional help without making referrals to civilian counselors outside the gates.

"There is no question that our demand for services is greater than our ability to supply them on Fort Hood," Borah said.

Over at the Resiliency Campus, Col. William Rabena oversees completion of a "reflection pond" complete with a pair of small, arching wooden footbridges and babbling water.

"There's no blueprint for building a Resiliency Campus. Whatever makes sense," said Rabena, a high-intensity former field artillery battalion commander whose neighbors tease that "Mr. Non-Touchy-Feely" has been given a surprising mission.

His response: "I know, I know." Rabena is very much onboard, describing the mission as a "synergy of mind, body and spirit." The Spiritual Fitness Center's focus, he said, is "an individual's self-discovery."

"We'd like to think this is something that could help anybody out. We want it make it so people want to come," he said. To that end, he is recruiting massage and aroma-therapy specialists and is converting a racquetball court into a Wii video-game arena. A putting green is coming.

"This doesn't sound very Army, does it?" he asked.

That's the point, of course. Rabena and the Fort Hood brass are following a path set by the previous base commander, Lt. Gen. Rick Lynch. Beyond the soft music and the free cookies are conventional counselors in a nearby building. Soldiers can discuss their finances and their marriages, their anger and their anxiety.

"There's something going on at Hood that I think is extraordinary that we need to emulate until we find something better," Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, told Army Times.

In the old 33rd Street chapel, where the library bookshelves hold titles from "The Brothers Karamazov" to "Haunted by Combat," Capt. David Fell said the Army is "really good" at managing immediate response to trauma, and not as good at following up.

"It's two or three months down the line when it really starts to hit home," said Fell, 40, a chaplain who has served two tours in Iraq. "People grieve at different rates and different times. It may not even show up until another event happens."

He calls the center "a step in the right direction," but said the real challenge is changing Army culture.

"It's not an individual problem. It's wider than that," Fell said. "But there's hope when leadership steps up and shows moral courage. If the leadership makes it okay for you to reach out, a higher percentage will reach out."

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