COMBAT GENERATION: BLOODLESS TRAUMA

Military reckons with the mental wounds of war

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When Ownbey arrived at his base's aide station following the blast he immediately called Hackett, who rushed to see him and the other wounded Marines. Ownbey remembers the relieved look on his commander's face.

Later that night Hackett told his wife about the apparently unscathed survivors of the massive bomb. "They are so fricking lucky!!!" he wrote.

'Every day he deteriorated'

In late September 2007, about three weeks after the blast, Ownbey returned to Camp Lejeune, N.C., after finishing his third combat deployment. This homecoming was nothing like the first two. The Ownbeys had bought a small house near the base. On the first drive home with his wife and three children, Ownbey slammed on the brakes, stopping just short of a pothole that had been repaired.

"Why is that there?" he said pointing to the square of pavement, which resembled the holes insurgents use to plant roadside bombs.

"What do you mean?" his wife, Sandy, recalled asking him.

Ownbey jerked the wheel to the right and drove across a neighbor's lawn to avoid the patched pavement.

Sandy took her husband on a mountain getaway a few weeks later. After dinner and a few glasses of wine, Ownbey began rambling incoherently about friends killed in Iraq. "He was walking and talking as if he wasn't really there," she said.

Sandy called up one of her husband's close friends from his Iraq tour. Ownbey spent the next three hours talking and sobbing before he fell asleep with the phone cradled to his ear. The next day he sought counseling for PTSD.

As time passed, Ownbey's hands began to shake and he began to put on weight. Five months after the blast, he finally landed an appointment with a neurologist at the Camp Lejeune hospital. The military cannot fill its pre-9/11 quotas for neurologists, creating agonizingly long waits.

At the examination Ownbey couldn't remember and repeat three simple numbers. He was so twitchy that his doctor ordered him to stop driving.

In late 2008 blood clots caused by the blast injury migrated to Ownbey's lungs, leaving him so short of breath that he couldn't climb a flight of stairs. He coughed so hard that he snapped six ribs. The doctors at the Camp Lejeune hospital moved him to Bethesda in February 2009.

"Every day he deteriorated for over a year," Sandy said.

'It was three hours of hell'

In spring 2009, the top brass in the Marine Corps and the Army were seeing troubling signs that the force was starting to fray. The suicide rate in the two services was on pace to set a record. The percentage of the Army's most severely wounded troops who were suffering from PTSD or traumatic brain injury had climbed to about 50 percent, from 38 percent a year earlier.

Amos and Chiarelli ordered the military's top psychiatrists and neurologists to the Pentagon for a meeting. "We were looking for some treatments," Amos said. "Something we could do right now."

To moderate the session, the generals brought in David Hovda, a UCLA neuroscientist who had worked closely with the National Football League on concussions.

Hovda gave a 15-minute presentation on traumatic brain injury. Then the military doctors began to argue with him and among themselves, according to participants. PTSD and mild traumatic brain injury both cause a similar array of symptoms, such as migraines, sleeplessness, anxiety and memory loss. The military doctors worried that Hovda was too quick to blame repeated concussions for medical symptoms that could also be attributed to PTSD or depression.

"It's not wrong to think these symptoms could be related to concussion," said Army Col. Charles Hoge, one of the military doctors at the session. "What is wrong is to think that they are only related to concussion."

Hovda shot back that Hoge was underestimating the damage caused by repeated battlefield concussions. "I do not agree with Colonel Hoge's position at all," he wrote in an e-mail after the meeting.

Doctors say it is essential to understand what is producing the symptoms they are trying to treat. PTSD is caused by the way the brain remembers a harrowing event. Traumatic brain injury results from the jostling of the brain.

The disagreement was deeply frustrating for both Amos and Chiarelli.

"It was three hours of hell," Chiarelli said. "No one could agree on anything."

Amos and Chiarelli stormed out of the meeting angry. They worried the internal debate was slowing the effort to help suffering soldiers and Marines. At 3:51 a.m. Chiarelli fired off an e-mail to Amos and Hovda. "I am frustrated with the way we are treating, or not treating, [traumatic brain injury] and PTSD," he wrote. "There seems to be a lack of direction and so many different ideas of what right looks like."

The generals asked Hovda to invite a dozen top civilian experts on PTSD and traumatic brain injury to Washington for two days of meetings. They wanted the sessions to focus on treatments that military doctors and researchers had overlooked. To prevent the sessions from bogging down into another academic debate, Amos and Chiarelli did not invite most of the military physicians from the first session.

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