Transcript - September 28, 2007
BRANCACCIO: Welcome to NOW.
If you've watched any of Ken Burn's series "The War" on PBS, you seen how even people who came back from world war two physically ok were changed in deeper ways. In one episode, an American pilot writes his fiancée that quote: 'we are all casualties.' In some cases back then, the psychological effects of war were labeled "combat fatigue" or "shell shock," but as one veteran said in the series, the typical prescription to a troubled veteran was quote "act normal and you'll feel normal." These days, with all the men and women returning from Iraq, psychologists and psychiatrists know a lot more about diagnosing post traumatic stress disorder...and there are now some innovative ways to help treat it. Dan Logan produced our report.
BASS: It's a process of still trying to understand. It's always a process of discovering what happened and how it is you find yourself in this position now.
BRANCACCIO: Nobody gets through military combat without a piece of it in their brain. For some vets it may be a somber memory. Many others have never left the battlefield... and their struggle with war is an ongoing, present-day reality.
HORSTMAN: I'm in a chair and I try to reenlist. I'd rather be man in a 50 on a turret. But they won't let me. But I'd do today. 'Cause that's where I belong. And that's where I'm still at. I'm still out on patrol.
BAZINA: Ironically it's more of a peaceful environment overseas fighting than it is being here in America.
BRANCACCIO: These veterans suffer from combat-related post-traumatic stress disorder, or PTSD... and there are hundreds of thousands like them across the country.
In World War II, there was no such diagnosis for veterans. But the psychological effects of combat are apparent in ken burns' documentary, The War, as veterans recount their experiences with painful clarity.
Quentin Aanenson flew sorties over France after d-day. Sometimes on a mission, his trigger-hand would quit working... burdened by so much death. It's something that persisted when he finally got home.
AANENSON: When I'd have these nightmares, in years after the war, many years after the war, if it was one relating to that mission or missions like that, when I'd get up in the morning, go out to the kitchen, Jackie would be there and she would have the coffee made. And she could tell when I walked in that my right hand wasn't functioning right. She'd pour a cup of coffee, not say a word, and she'd hand it to my left hand. Never a word said. We just went on.
POMERANTZ: When I talk with these people, you know, a favorite question I've always had is, you know, have you ever talked with your family about what happened? Almost invariably, the answer is no.
BRANCACCIO: Dr. Andrew Pomerantz has worked with World War II vets for over 30 years. He says it's clear now that vets who came back with psychological trauma needed more than attaboys and fleeting celebration.
POMERANTZ: They came back to ticker tape parades, welcomed with open arms. And thank you for all you did. And let's get back to work now.
BRANCACCIO: Too often, strange behavior on the homefront was blamed not on the horrific experiences in places like Peleliu, Anzio, or Normandy but on individual weakness.
POMERANTZ: Psychiatrists at that time, you know, it was the dominant way of doing things, was lie down on the couch. Tell me about your mother.
BRANCACCIO: Now there's a new urgency to develop more effective treatments... because of the wave of veterans returning from Iraq and Afghanistan. There are no hard numbers yet on how many might be affected of the one-and-a-half million who've served... But in a New England Journal of Medicine study, one in six Iraq veterans suffered from "major depression, generalized anxiety, or PTSD."
And the journal says many more veterans will suffer symptoms in the years to come.
ZACCHEA: I could not stand being here anymore. I couldn't stand being in America with—you know, just living my life the way everybody else does.
BRANCACCIO: Michael Zacchea, a highly decorated marine, was diagnosed with PTSD after a harrowing tour in Iraq in 2004.
A Lieutenant Colonel, he trained an Iraqi army battalion and was part of the most intense urban combat for the U.S. military in a generation: the battle of Fallujah.
ZACCHEA: Fighting street to street, house to house—you know, going into houses finding, you know, people dead and, you know, mutilated. Bodies in the streets.
BRANCACCIO: During a firefight, an insurgent fired off a rocket-propelled grenade.
ZACCHEA: Somebody said, "Is anybody hit?" And when I moved off the wall, there was a big bloody imprint from my body. And I said, "I'm hit."
BRANCACCIO: A piece of shrapnel had gone through Zacchea's shoulder...but he kept on fighting. Six weeks later, the Marines and Iraqis had secured the city.
But it was a time when kidnappings and beheadings of coalition personnel were all over the news. And soon, Zacchea got word that the insurgents were personally targeting him for assassination.
ZACCHEA: Basically the message was, you know, Zacchea's going to die like the other infidels. It really preyed on my mind. Because I never, ever knew. You know, I could be taking a shower and I could be killed. I could be doing absolutely anything. And I was extremely aware of how vulnerable I was at any given time.
BRANCACCIO: Zacchea's tour ended in February 2005... and he came home.
ZACCHEA: I didn't sleep for four or five days at a time. I just could not go to sleep. I couldn't relax. I couldn't let myself go.
MARCY ZACCHEA: I had no idea how changed he would be. Really nothing could have prepared me for what I encountered.
BRANCACCIO: Marcy and Michael Zacchea were engaged to be married before Michael's tour in Iraq. Marcy had worried that the war might drive them apart, so she encouraged Michael to tell her everything he saw.
In phone conversations to Iraq, she could tell he was starting to change.
MARCY ZACCHEA:A sense of urgency in his voice. A sense of, he's a very good speaker. He speaks extremely well. Like stuttering, he couldn't get the sentence out. Like, "Oh, you—you can't believe—you—" you know, that kind of very intense. And I thought, "Oh, geez you know, it's sounds, this is not good."
BRANCACCIO: That summer, months before Michael's return, Marcy decided to see a counselor to learn more.
MARCY ZACCHEA: I just knew that I needed to be able to try to understand what it—what was going on for him and be prepared for when he returned.
BRANCACCIO: Many vets in need go years without seeking psychological help, but Michael had Marcy who insisted right away that he get in for counseling himself.
MARCY ZACCHEA: I kind of gave him an ultimatum when he first got home. I said, "I'm not marrying you until you go to counseling with that." And I felt a little bit bad about that. But I also knew that we would never, our marriage would never last if he did not see counseling.
BRANCACCIO: He did... and they were married last year. But it's been a hard road. Sometimes, Michael's mind convinced him he was back in Iraq... including the time he was actually at the christening for a friend's son in the states.
MICHAEL ZACCHEA: I started taking all the waters?
MARCY ZACCHEA: Oh, yeah, yeah, yeah, yeah.
MICHAEL ZACCHEA: And then yeah I, you know, they had all these bottles of water in my, like armfuls of bottles of water. And then they had this like this bubble wrap on the floor and kids started jumping on it.
MARCY ZACCHEA: Oh, yeah, yeah, yeah.
MICHAEL ZACCHEA: And it sounded like, you know, like the popping noise, that high pitched noise, and I left 'cause it sounded like gun fire.
BRANCACCIO: Given everything Zacchea saw in Iraq, including the violent deaths of his comrades, the trivialities of everyday life back home sometimes seemed incomprehensible, even infuriating.
One day, he was buying roses for his wife from a florist.
MICHAEL ZACCHEA: She had an attitude, and she tossed the change at me. And I took her by surprise. I swiped with my left hand. I caught all the change in my hand, and in the same motion, I reached out and I grabbed her by the throat and I started squeezing.
And that scared her. And it scared me. And I left. I quickly ran away. But it was definitely not what she was expecting. And she didn't do anything wrong. It was my reaction.
BRANCACCIO: And from time to time, Zacchea still receives terrible news from his old unit.
MICHAEL ZACCHEA: I got an e-mail from the Iraqi battalion that one of my interpreters with whom I was close his name was Arkan had been assassinated. And I was very, very upset about that. And devastated, in fact. He had just written me a letter like two weeks before, three weeks before. So shortly thereafter, a couple days later, I had a meltdown. I had basically wrecked the house and scared Marcy, and broke a lot of things, and you know, it wound up being a bad situation. You know, I'm not proud of it.
MARCY ZACCHEA: I would see like a switch would be flipped and I would just say to my therapist. He look—he looks like a monster. Like he turns into a monster. It was the best way I could describe it.
BRANCACCIO: Michael has never gotten physical with her, Marcy says. And she knows these things do take time... time often measured in years.
We've been following the struggle of Jeremy Lewis now for over two years. Lewis spent a dozen years in the Navy and more than a decade in the National Guard. Before going to Iraq, Lewis was a long-haul truck driver. But after serving in a war zone, driving took on a whole new meaning.
Here's Jeremy when we met him in the spring of 2005, soon after he was diagnosed with PTSD.
LEWIS: If I saw a dead deer on the side of the road or something like that, I'd always try to move over thinking there was a bomb under the deer. And if traffic got heavy, it wasn't comfortable because one of the ways they ambush you is to block you into traffic.
BRANCACCIO: So he had to quit that profession and take a job as a photo clerk at a drug store... at a third of the pay.
Now, Lewis says, his doctor at the department of Veterans Affairs, or VA, has warned him not to work at all. His experiences under fire in Iraq had left him unable to cope with the comparatively minor stresses of dealing with customers.
LEWIS: I think I had all the diplomacy of a piano falling down the stairs.
You know, I just wasn't a very tactful person. So I figured before my friend had to fire me, I was just gonna quit. You know, and I did. And I told Dr. Burnett, who was dead set against me working again.
BRANCACCIO: So he didn't want you to work 'cause of the added stress?
LEWIS: He didn't want me to work because of the added stress and the fact that I'm what they call no fight or flight reflex. If I get into a situation that's hostile, I'm just gonna attack. I'm not gonna back away.
BRANCACCIO: Lewis gets some disability pay for his condition from the VA... but not enough to make up for losing a job. He's been struggling mightily to get his level of benefit increased but the VA is swamped with claims and as Jeremy tells it, the bureaucracy is yet another nightmare.
LEWIS: I'm probably gonna have to sell the house and, you know, go back to living on like $51 a week.
BRANCACCIO: How can you even do it?
LEWIS: Well, look at my refrigerator.
LEWIS: There's nothing but condiments in there. And I think there's a cup of yogurt and some Pepsi.
BRANCACCIO: There has been one nice development in Jeremy's life... Kim Rorick, who he has been seeing since February.
RORICK: What do I see in him? I see a lot. First of all, I think he's very genuine. He's very honest. He's very committed. But he's got a lot of demons. A lot of demons.
BRANCACCIO: You do see those demons sometimes?
RORICK: I see the demons a lot of times.
BRANCACCIO: Earlier in the Iraq war, Lewis had routinely patrolled the Sunni Triangle. He engaged in firefights with attackers, earning the army's commendation medal with valor.
But it was the sudden mortar attacks at the home base in Iraq that got to him the most.
One summer night in 2003, Lewis and his platoon were watching a movie.
LEWIS: I remember when that first mortar hit about 100 people screamed all at once. I can clearly remember thinking to myself this cannot be happening. There is no way they are shooting mortars into this camp. The thing is if that movie had ended 15 seconds sooner, half of my platoon would have been walking right where the first mortar hit. So we would have lost about 20 guys.
BRANCACCIO: After that night, the attacks came more frequently. Jeremy started sleeping face-down on his stomach, so that his internal organs might be more protected from shrapnel. He still sleeps that way today.
He found the randomness of those attacks excruciating... until at one point something snapped, and Lewis found himself no longer caring.
LEWIS: No matter what I do to change it, it's gonna happen to me. So, you know, why worry?
BRANCACCIO: It's almost like a fatalism. The idea is that if you're gonna die or survive, it isn't up to you anymore?
LEWIS: Yeah, kind of. And then it just—it never goes away. You start feeling that way about everything.
BRANCACCIO: Before he went to Iraq, Jeremy described himself as a motivated, type-a person. But now, things are different.
RORICK: There are days he could sleep 18 hours a day and just not give a flyin' toot, you know. Just could care less, don't wanna get up and shower, don't wanna get up and eat, nothing.
LEWIS: It's weird 'cause sometimes I'll be obsessed with, like, taking a chainsaw and cuttin' a branch. And other times, like, the backyard could be on fire, and I'll be like, "Yeah, who cares." You know?
RORICK: He talks a lot in his sleep.
RORICK: And I try, I keep tellin' him I'm gonna record it, you know, because he'll say, like, "No, no, no, no, no, no, no, no, no." And he'll go, "All right, all right, all right, all right. I can't, I can't, I can't, I can't, I can't." And just like this repetitive stuff, like, all night long. And I know there's a lot of deep, deep, deep things that, you know, I may never know.
BRANCACCIO: It's even more difficult for Lewis to explain his feelings to his 12-year-old son, Max. One night this summer, after a spat with Kim, Lewis walked out and vanished.
LEWIS: Kim and Max were really upset, you know. And you know, I came back and told him, "You know, sometimes, you know, you guys are going to push me, push a button, and I'm just gonna get up and leave. You know, so don't take it personal 'cause it's what I need to do to get out of there." So, that really kind of opened Max's eyes. And Kim sat down with Max the next morning and explained it to him at a level he could understand.
BRANCACCIO: Painful memories of war can never be eradicated... but the strategies to treat PTSD are evolving. There are medications for anxiety, depression, and nightmares... and some new approaches to therapy, based on how combat affects memory and the brain.
DR. ANDREW POMERANTZ: The belief is that people lay down these memories and—and record events in the middle of chaos, in the middle of their brains and bodies being filled with adrenaline. In other words, in a situation that's least likely to leave people with decent memories and accurate memories.
BRANCACCIO: One therapy that seems to be working is calmly walking the patient back through their experience... again and again.
DR. ANDREW POMERANTZ: The real breakthroughs have really been in the cognitive therapies that teach people and guide them through the events. And help them take a look at what happened, but from a safe place.
BRANCACCIO: Despite these new approaches, there is no universal protocol for treating these veterans. Pomerantz says PTSD is the sort of condition where treatment must be tailored to each individual.
Yet many veterans are finding it difficult to get the care they need. The VA is the government agency that provides that care... but the surge of new veterans is taxing an already overburdened system.
Jeremy Lewis sees a VA psychiatrist only once every three weeks.
What's more, Lewis says, his psychiatrist was sent away for three months... to counsel soldiers in Iraq.
LEWIS: I just couldn't believe they could take a, head of a department, the VA, who was maybe seeing 80 patients, and put him in Iraq.
BRANCACCIO: So that means it must've been a stretch where you didn't get to see anybody?
LEWIS: I just got to see my counselor, Dr. Ferraro. And he's a psychologist, and as great as he is, he can't change my prescriptions or prescribe or anything like that.
REICKHOFF: It shouldn't be hard for someone who served their country honorably to get medical care
BRANCACCIO: Paul Rieckhoff is the head of Iraq and Afghanistan Veterans of America, representing the largest group of veterans of current conflicts.
RIECKHOFF: There's unfortunately a running joke that if you don't have PTSD by the time you get to the VA, you'll have it by the time you leave
BRANCACCIO: The VA's own inspector general found in an audit that one in four veterans were forced to wait more than 30 days for a doctor's appointment.
Rieckhoff says the number of veterans with mental health problems has been seriously underestimated.
RIECKHOFF: The President doesn't wanna talk about the fact that one in three veterans coming home have a mental health issue when he's trying to push for a war that's unpopular. The bottom line is that VA funding has not been a priority for this administration.
BRANCACCIO: That said, there has been more funding lately... and there are a lot of doctors and counselors at the VA dedicated to helping veterans. Like Jim Dooley at the Colchester, Vermont facility - a veteran of Vietnam himself. The past few years have been very busy for him as the Iraq war unlocked old anxieties in veterans of other wars.
DOOLEY: I have seen an enormous spike in anxiety and PTSD symptomology based upon the current war. People that I hadn't heard from for quite a while started popping up saying, "I can't sleep. I'm angry." One man summarized it. He said, "You know, I'm watching the news to make sure they do it right," because they're anxious for the young people.
BRANCACCIO: We spoke to his group of Vietnam, Iraq, and Afghanistan vets that meets every week.
MYERS: I have to come here every week, or I'll just, because it's the only place I feel like I can speak and not feel like a zoo animal.
MURPHY: I'm always going to have nightmares, you know, but I've changed 'em from night-terrors to nightmares. Okay? Jim has taught me, and this group has taught me, the little things that are the most important.
BRANCACCIO: Michael Zacchea sees a private counselor and has been attending group therapy every other week on New York's Long Island. He's the only Iraq veteran in a group of Vietnam Vets... but they've taken him under their wing.
MICHAEL ZACCHEA: It gets better with medication and with, you know, individual therapy, group therapy. Even things like this, being able to tell the story.
BRANCACCIO: There are other ways to cope. Classics major at Notre Dame, Zacchea discovered a book called "Odysseus in America," which uses Homer's "The Odyssey" to illuminate the experience of veterans coming home.
In the original epic poem, Odysseus - a veteran of the Trojan War - takes ten years to come home to his wife Penelope.
MICHAEL ZACCHEA: When he comes home, he is not recognized. Nobody recognizes him except for his nurse recognizes him by his scar.
BRANCACCIO: Everyone back home assumed Odysseus was dead... and the suitors were trying to steal his wife away. The story leads to a bloody confrontation.
MICHAEL ZACCHEA: He resolved his issues by killing all the suitors. I don't think that that would be an acceptable solution but I think that really the message is that I have to make my peace with people who, you know, did not go to Iraq or insulated from the reality of Iraq.
BRANCACCIO: The Odyssey is also the one where the hero has to get past the nearly irresistible call of the sirens... something Zacchea sees this way.
MICHAEL ZACCHEA: The Siren's song is the seduction to, you know, live in the past. And to, you know, relive the war and, you know, find out. And you may never find out the single truth of it. The basic equation is you gonna spend as much time coming back from the war as you spent in the war, at least. And that's what the real lesson is.
BRANCACCIO: Counseling and support from friends and family have helped Michael Zacchea come back from the war.
MARCY ZACCHEA: Just recently, a few months ago, my parents had said to me Michael seems to be a little bit more like he used to be. He kids around more like he used to.
MICHAEL ZACCHEA: I don't think, though, there's any such thing as getting over it. I think that there is such a thing as learning to live with it.
BRANCACCIO: And that's it for NOW. From New York, I'm David Brancaccio.
We'll see you next week.