Military reckons with the mental wounds of war

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Amos had his encounter with Ownbey at Bethesda in late August 2009, four days before the meeting with civilian doctors and scientists. The general had been pinning Purple Hearts on wounded troops when he got word that one of the patients wanted to see him.

Staff Sgt. James Ownbey in 2009 at the National Naval Hospital in Bethesda, two years after his MRAP was blown up in an IED blast in Iraq. (Photo courtesy the United States Marine Corps)

The Marine was so weak he could barely walk. Electrodes and wires were pinned to his bare, puffy chest. The 2007 blast had damaged Ownbey's pituitary gland at the base of his brain and his weight had ballooned to 240 pounds. He was 165 pounds before the injury.

Amos extended a hand to introduce himself.

"Sir, we've met before in Iraq," Ownbey said.

Sandy watched as the general slowly recognized her husband. Amos's face turned ashen. He hugged Sandy, and she began to cry. "We are going to figure out why this is happening to him," he said.

Amos opened the meeting with the civilian doctors on Sept. 1, 2009, by passing out the now two-year-old picture of himself and Ownbey posing in front of his crumpled vehicle. Then he handed out the snapshot of the Marine in his hospital bed.

"What can you do to help us with this now?" he asked the doctors.

'He just feels numb'

By early October, Chiarelli had become obsessed with the science of PTSD and traumatic brain injury. He turned an awards luncheon in Washington for the Army's 24 noncommissioned officers of the year into a half-hour seminar on the mental wounds of war.

The Army general flashed a picture of three brain scans depicting a normal brain, a patient in a deep coma and a UCLA football player who had suffered a mild concussion. The normal brain glowed red and yellow, indicating that it was actively burning glucose. Both the concussion and the coma scans were blue, a sign that the brains had shut down to heal.

The football player's brain would only return to normal if it were given a couple of weeks to heal before it was struck again, Chiarelli said, according to a transcript of the event.

Chiarelli then explained how physiological changes caused by PTSD flooded the body with chemicals and triggered a rush of fear. "Contrary to what some believe, PTSD and traumatic brain injury are not phantom conditions exhibited by weak soldiers trying to get out of a deployment," he said.

As the months passed, Chiarelli began to refer to post-traumatic stress disorder as PTS. "I drop the D because I believe it is more of an injury than a disorder," he said. "A lot of doctors agree with me, but there are some who don't."

He sent instructions urging commanders to hold full memorial services for suicide victims just as they would for other Army fatalities. Some field commanders argued passionately against the policy, insisting that it was wrong to salute troops who had shown a lack of resolve. Chiarelli overruled them.

The best way to erase the stigma of mental illness, he insisted, would be to award the Purple Heart to troops suffering from post-traumatic stress. A 2008 study ordered by Defense Secretary Robert M. Gates had concluded that it was too difficult to prove that a soldier was suffering from PTSD. By 2010 Chiarelli countered that the science had sufficiently advanced and was worth reconsidering.

Amos disagreed with Chiarelli on the Purple Heart. "We need to keep that award as pure as we possibly can," he said.

The Marine general was never particularly captivated by the science of PTSD or traumatic brain injury. But Amos was convinced by Ownbey's suffering.

The two generals worked with the civilian doctors from the meeting they had organized in Washington to develop new procedures for treating mental wounds. To prevent traumatic brain injury, the doctors recommended new rules requiring troops who experienced a concussion to rest until a doctor cleared them for duty. After three concussions troops are no longer allowed to return to combat for the rest of the tour. "We've taken away the opportunity for Marines to say they are good to go after a concussion," Amos said, "because every Marine is going to say he is fine."

To treat PTSD, the doctors recommended therapy be delivered as soon after the triggering incident as possible. Amos and Chiarelli instituted programs to train front-line medics to spot the signs of PTSD and provide immediate psychiatric first-aid. They instructed therapists to use video conferencing to screen troops who might otherwise not get help.

The generals' goal was to fix the flawed system that Ownbey and his men confronted in Iraq and when they returned home to Camp Lejeune.

Gunnery Sgt. Christopher Wellman, who was sitting behind Ownbey when their truck was launched 30 feet in the air, estimated last month that he suffered four or five concussions during his final tour in Iraq. But he never sought medical care or skipped a patrol to rest and heal. "People were dying," he said.

He returned home and began experiencing memory problems, dizziness, nightmares and migraines. Wellman spent a year on limited duty before he made it back to his engineer unit, where he lasted three months before a routine explosion at a firing range caused him to relapse. He was medically retired from the Marine Corps this summer and began work with the Defense Department in Arlington. He stopped receiving treatment when he left Camp Lejeune.

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