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TOUGH NOT ALWAYS ENOUGH: SOME READJUST EASILY,

BUT MANY STRUGGLE -- "The expectation is they will

come back and be normal. They can't be normal.

They have changed."

 

 

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Tough not always enough: Some readjust easily, but many struggle

BY TIM ELFRINK AND C. DAVID KOTOK
WORLD-HERALD BUREAU

LINCOLN — When they stepped off the plane last summer, the soldiers of Troop A, 1st Squadron, 167th Cavalry were welcomed home by family, friends, comrades, even the governor.

Numbering 63 when they left and 63 when they returned, they racked up more than 1,600 combat missions — more than four a day — and saw more action than any Nebraska Army National Guard unit since World War II.

They were part of a 4,000-soldier brigade sent to the insurgent stronghold of Ramadi in western Iraq. Eighty-one of the brigade's soldiers were killed in action — the most of any National Guard brigade that has served in Iraq.

First Lt. Matt Misfeldt of Omaha, who commanded the 16 soldiers of Troop A's 1st Platoon, tracked how many times insurgents shot at him. The final tally: 92.

In their primary mission protecting Marine bomb-disposal teams, Misfeldt's platoon encountered roadside bombs — exploded and unexploded — 295 times.

Homecoming on June 22, 2006, was euphoric. For most of Troop A, the celebration lasted for months.

For some, home, family, school and jobs turned out the way they had hoped during their year in combat. Three new babies have been born, and two others are on the way; two soldiers are engaged, and several say their marriages have strengthened.

"On balance, it was a positive experience for most of the guys," said Capt. Jeff Searcey of Kearney, who commanded Troop A. "We brought the teamwork and leadership we learned over there back to our communities and workplaces."

But as that joyful return to Lincoln faded into memory, nearly every soldier also realized he'd been changed by Iraq.

Many have encountered some problems readjusting to civilian life.

They acknowledged those problems to one another last winter during a weekend drill that turned into something of a group counseling session. About half described serious problems in their lives.

At least six have been formally diagnosed with post-traumatic stress disorder; many others say they have experienced some PTSD symptoms.

Seven have been arrested for driving under the influence. Another spent a month in alcohol rehab.

At least two marriages fell apart.

One soldier spent nearly three months at Walter Reed Army Medical Center in Washington with PTSD and a traumatic brain injury inflicted by repeated roadside bombings.

Another young soldier nearly died in a motorcycle accident.

But in interviews, soldier after soldier also voiced a kinship with his comrades and said he came back from Iraq with new leadership and coping abilities.

"For the most part, the guys are doing all right. We all have been doing our best to stay in close contact and take care of our own," said Staff Sgt. Chad Rowe.

The unit's experiences illustrate the challenges faced by thousands of men and women returning from Iraq — challenges that often are more intense for National Guard citizen-soldiers, who jump from civilian lives almost directly into combat, then return home just as suddenly.

"While they were there, they have to kill, they have to be in danger," said Dr. S. Pirzada Sattar, the Omaha VA Medical Center's top expert on alcohol and drug abuse.

"The expectation is they will come back and be normal. They can't be normal. They have changed."

A look at the major problems soldiers face:

Post-traumatic stress disorder

The stress of daily life in combat leaves many at risk for developing PTSD, an anxiety disorder that affects between 15 percent and 17 percent of all soldiers, said Col. Elspeth Ritchie, a psychiatry consultant to the Army Surgeon General's Office.

The rate of PTSD in Iraq probably is similar to that of past wars, she said.

"We've known for a long time that wars produce psychological effects in soldiers, but we're measuring those effects in Iraq and Afghanistan as we've never done before," Ritchie said.

A number of risk factors influence the likelihood of developing PTSD, with the amount of combat a soldier sees the most telling.

"The likelihood of developing PTSD goes higher and higher with the frequency of trauma and the severity of it. There's no doubt about that," said Dr. Ahsan Naseem, chief of the VA's PTSD clinic in Lincoln.

By that measure, Troop A's soldiers were at high risk. Being based in Ramadi, one of Iraq's worst areas, meant they were susceptible to daily encounters with snipers, improvised explosive devices and insurgents. Mortar attacks were so frequent, they were regarded as common thunder.

Repeated deployments increase the likelihood of developing PTSD or other disorders, Ritchie said, and a family history of mental health problems usually means greater risk.

Naseem said that as a defense mechanism, the brain is hard-wired to vividly remember traumatic events. The better someone remembers a dangerous situation, the more likely he will know to seek safety if it occurs again.

"The soldier makes connections after dangerous events so they can react reflexively to things. They are such excellent leaders because they can react quickly, without thinking, on the battlefield," he said.

But the ability to minutely remember traumatic events — a firefight or a car bombing — can bring the flashbacks and nightmares common to PTSD, Naseem said.

More than 700,000 individuals have served in Iraq, so even by the more conservative 15 percent estimate, that could mean 105,000 Iraq veterans with PTSD or other mental health conditions.

Traumatic brain injury

The combination of modern body armor and heavily armored vehicles helps U.S. soldiers survive intense bomb blasts, even at close range.

But the IEDs used by Iraqi insurgents often leave a wake of brain injuries.

Those who survive more than one explosion — and who may suffer multiple brain injuries — are more likely to have long-term symptoms, including headaches, dizziness and vision problems.

Up to 40 percent of soldiers in Iraq suffer a brain injury in combat, said Col. Jonathan Jaffin, commander of the Army's Medical Research and Materiel Command.

Most are mild — the equivalent of a high school football player "getting his bell rung," Jaffin said.

"The vast majority of football players are better again in a week or two afterward. But there are a few that aren't, that have long-term symptoms. Those are the ones we need to identify," he said.

The Army recently began training battlefield commanders to recognize symptoms of traumatic brain injury and to pull those soldiers off duty for a week or two of recovery.

"If we can figure who's had injuries — not when they get back (home), but right when they have it — we can get that guy or gal out of the line of fire and protect them for a week or so to recover," Jaffin said.

Struggling to readjust

Soldiers returning without serious mental health conditions or brain injuries still can struggle to return to a normal routine, experts say.

After dodging roadside bombs and avoiding ambushes, Capt. Searcey found himself unable to drive without speeding and weaving.

Cpl. Darin Nelson, 22, of Fremont, who was given a Bronze Star with Valor, could sleep but a few hours a night — and then only with the lights on and TV blaring.

When a summer thunderstorm rumbled over Central City, Sgt. Michael Belleci felt as though he were back in Ramadi, under mortar attack.

"I couldn't get back to sleep. I didn't want any more nightmares," said Belleci, 25, who also received a Bronze Star with Valor.

Others have argued with spouses, struggled to focus on civilian jobs or raced motorcycles down city streets.

Such common struggles can be the result of habits they acquired to help them survive, Naseem said.

In Iraq, soldiers learn not to sleep deeply, so they can awaken instantly if attacked. They drive aggressively at high speeds, to head off ambushes and avoid roadside bombs.

Alcohol abuse

One of the main side effects of readjustment struggles has been alcohol abuse among returning soldiers.

"It becomes a solution for everything. 'I can't sleep': a couple of beers. 'A headache': a couple of beers. 'Someone cuts me off': a couple of beers," said the VA's Sattar.

One in nine soldiers from Troop A has been arrested in the past year for driving under the influence. That's more than 10 times the state rate for drunken driving arrests, which Nebraska highway safety administrator Fred Zwonechek says averages around 1 per 100 licensed drivers.

Looking for excitement

Many soldiers face a more mundane struggle: Life in Nebraska can be boring after life in a combat zone.

"Over there, they're going about 90 miles per hour every day and, by comparison, we're doing about 30 back here in Nebraska," said Col. Rod Armon, a Nebraska Guard chaplain.

The solution, for some, is to seek ways to rev up the adrenaline level: drag races, risky stunts, fast motorcycles.

Nationally, the number of soldiers killed in motorcycle accidents rose for the fourth year in a row last year, accounting for 48 percent of all the Army's vehicle-related deaths.

Of the soldiers who return from Iraq and struggle with life at home, many experience more than one of these problems, experts said.

"There's usually not one single issue these guys are dealing with, but multiple issues, each with a unique challenge," said Christopher Heaney, staff psychologist at the VA's Omaha PTSD clinic.

"You've heard us talk a lot about PTSD, but there's often injuries, side medical problems, TBI (traumatic brain injury), substance abuse," he said. "All those problems combined make this a real challenge."

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Post-traumatic stress disorder

Post-traumatic stress disorder is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

It came to public attention in relation to war veterans but can result from a variety of trauma, including: mugging, rape, child abuse, car accident or natural disaster.

It affects about 7.7 million American adults but can occur at any age.

It may cause people to startle easily, become emotionally numb, lose interest in things they once enjoyed, have trouble feeling affectionate, be irritable, become more aggressive or even become violent.

It often is accompanied by depression, substance abuse or other anxiety disorders.

It can be treated effectively with certain kinds of medication and certain kinds of psychotherapy.

How common are problems?

Nationally, about 17 percent of the more than 220,000 Iraq and Afghanistan veterans who have sought VA care have been diagnosed with post-traumatic stress disorder.

In Nebraska and western Iowa, 11 percent of the Iraq and Afghanistan veterans who have received VA care (255 veterans) have been diagnosed with PTSD.

Nationally, 3.9 percent of Iraq and Afghanistan veterans enrolled with the VA have been treated for substance abuse.

In Nebraska and western Iowa, 3.8 percent of Iraq and Afghanistan veterans who have received VA care (85 veterans) have been treated for substance abuse.

Is this a new condition?

Whatever its name, PTSD probably is as old as war itself.

During the Civil War, doctors often diagnosed "cardio-respiratory condition" when they noticed anxiety-stricken soldiers having difficulty breathing.

In World War I, doctors usually diagnosed "shell shock."

In World War II, mental problems were often lumped under the diagnosis of "battle fatigue."

In the mid-1980s, the Defense Department acknowledged PTSD as a diagnosis in soldiers.

In 1989, the VA established the National Center for PTSD to study and treat the condition.

Sources: National Institute of Mental Health, VA officials in Nebraska and Washington, D.C.

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Larry Scott  --