And it was a tremendous amount of pressure that he went under. Can you imagine [being] the first person since Vietnam to be charged with a crime that's punishable by death if you're found guilty?
On the other hand, the Army and Marines are taking steps to meet the needs of folks in theater. They have the combat stress control units, and they're at least asking some questions upon their return home about people's emotional health.
I believe that in some cases, that you can have 1,000 programs, you can have 10,000 programs, but if you're not connecting the soldier face to face with the program, or if you're not employing the program when the appropriate time presents itself, that it is meaningless. And I've said about the Pogany case that had they done what they say they want to do with soldiers, it would have never gotten to where it is today. ... What I wouldn't have done is stomped my foot in the middle of his back, called him a coward and sent him home, because that sends a message to the next guy that comes forward that says, "If I have a problem, I might not want to bring it up."
And people will hear this and say, "Well, that's hindsight." No, that's leadership. That's what leaders do. They assess the situation, and they do the right thing based on the guidelines that the Army has. And what they did was against the guidelines that the Army has.
And it sent a shockwave. I got e-mails from soldiers who were having psychological problems. By the way, technology is so great today that I can communicate with a soldier who's in Iraq by e-mail. And they were saying that they didn't know what to do. They did not know where to turn if this was going to be the response from the military. ...
They did everything but actually physically string [Pogany] up on a rope. And through his own intestinal fortitude and through his own desire to clear his name, he's hung in through what I believe to be a monumental effort to kind of find some resolution. ... He has turned this into a crusade to save his name. And I would do the same thing if I were branded a coward and I knew I wasn't. It's not something you lay down with at night and feel good about. So he's gone out; he's gathered and presented the evidence; he's gotten the clinical diagnosis. The Army, even though they have dropped all charges, the one thing he's not going to get is an apology or the repairing of his name. And I don't think they're ever going to admit that they did something wrong. It will be up to him to fix that. And he's doing that.
But, you know, Andrew's going to be fine. My question is, what about the next Andrew? What about the next guy out there that wants to come forward but doesn't do it because the Army really hasn't corrected this yet?
We interviewed the family of another soldier, Jeff Lucey, who committed suicide. The numbers of suicides are definitely higher than any war ever in our history. Can you talk about that? Is there any reason why?
Well, suicides happen in the civilian world, and they happen in the military. They're happening more during this war. ... [The military] reported, I think as of today, that there have been 29 suicides in Iraq. But there's always been a question about whether this problem is even bigger than what they're reporting, because there are people that are coming home from Iraq that have killed themselves one week, one month, six months after the war. And the [Defense] Department says, "Well, we don't count stateside suicides, because we see no connection to them serving in the war." I don't understand that methodology. It seems like the big elephant in the room that nobody wants to talk about.
If there's something we can do to prevent a suicide -- if we need to do more than just have a bunch of programs, if we actually need to physically make contact with each one of these people and have a clinical encounter with a trained physician who's treated PTSD [Post-Traumatic Stress Disorder] before or treated severe depression, that's what we need to do.
But I think the [Defense] Department is quite frankly not interested in any more bad news stories, and they want to talk about the good. There's good things happening in Iraq, but that's not what we're talking about. We're talking about people who have come home and killed themselves. It ought to make the hair on the back of your neck stand up. ...
…How much of this has to do with command and not anything to do with all of these big notions that we hear about in Washington?
In Sgt. Pogany's case about what happened in Iraq to him, leadership failed him. And part of it is because of a mentality that some leaders have. …
…Fear is like cancer in a war. If you're afraid to do your job, if you're afraid to go out and fight the war, it's like a cancer. And what they thought they had with Pogany was somebody who was perfectly capable, but that just didn't have the moral character to fight. And so when they attacked him, they came with everything they had. And they went from zero to cowardice, claiming that he was refusing to fight. And that's not what happened.
But the idea was, they were trying to send a message, a message to other people around them that fear will not be tolerated. That wasn't what Pogany's problem was. Pogany's problem, although it manifested itself in what looks like fear, it was a reaction that he had no control over. ... The junior leader that was responsible for him should have recognized the real problem and not given him the boot in the ass, but given him a hug and said: "Hey, bud, this happens. We're going to get through it." ...
One of the staff sergeants we talked to said if someone came to him with that kind of problem, his response would be, "I can't have that guy in theater anymore, because none of the other soldiers are going to trust him anymore. So even if he gets back on his feet and he goes back out into combat ... he's a liability. And honestly, I can't take the risk."
... If the medical professional says that soldier can return to duty, then you bring them back to duty, and you monitor them, and you watch them. And if they turn out to be not ready or have further problems, then you have to evacuate them. ...
If you're constantly screwing up and you never do anything right and you hold your weapon backwards and, you know, you have got all of these problems, and then you say, "I've got a mental health care problem," or "I'm afraid," or whatever, that's one thing. But if you're a well-respected, trained [soldier, and] people know that you know what you're doing, if you have all of these things going for you and you come forward and say something, when they come back from these combat stress teams, they're welcomed back. Man, they're hugged. "We need you back. We need you on the left and right."
You'll still monitor them. You should become cognizant of the fact that they had a problem and that they took some time off and now they're back. You have to, as a leader, monitor them. But the notion that you would give up on somebody after they sought mental health care treatment is what the stigma is all about.
But it's real.
It's absolutely real. The stigma is very real. It is almost a self-fulfilling prophecy that if a leader or a junior leader says, "I've got a problem," that when they come back you're going to look at them differently.
But there's enough evidence to show that if people get help early and often, they can recover and continue to fight. Now, whether or not we can convince the military of that and change the stigma within the military is a whole other question. But absolutely there's a big issue with stigma, and we have to rely on the medical health care professional to make the call.
One of the military guys said to us: "What do these mental guys know? Some of these combat stress control unit folks are young, inexperienced. They've never been in combat. What do they have to say to a commander?"
Well, he's right. He's absolutely right. What do they know? Have they ever been in war before? It's really a judgment call. It's a combination of what the clinician says and what you feel in your gut. And I'll tell you, when it comes down to war, and it comes to knowing for a fact that you can count on the guy to your left and to your right, if you have any doubt whatsoever, there's a problem in your team. If you've got any doubt whatsoever, you've got a problem. And it makes things even more difficult to know that you have to pay particular attention to Pvt. Joe because he went to mental health care while you're conducting your mission in Iraq.
Let me just say, you can't give up on your soldiers. And even some of the most powerful people in the world have sought and are seeking mental health care services. And you'd be surprised if we published a list of who takes Prozac -- the people that are on it, and how high-functioning they can be.
But on the other hand, it's a leadership decision. And these leaders that you talked to that said, "I don't want that guy back on my team," I can understand why they would say that, because you have to be on your game if you're going to survive. And if you're not on your game and you're lagging behind, or you can't process the orders that you're being given, you are a risk to everyone around you. And that is why it is imperative that when these people go to these combat stress teams that they get not a crystal-ball evaluation, but an actual evaluation about what their condition is and a medical determination so that the leader can be confident. "He's good to go, man. He is good to go. He's going to be OK, but keep an eye on him." ...
I'm not quite sure that [combat stress teams] are really addressing the psychological issues for why [soldiers] come, because they know, too, that they can't just simply evacuate every person. Let me give you an example. In World War I, 80,000 British soldiers were evacuated for a newly termed definition called shell shock. And the British government recognized that this was a big problem, [that] 80,000 people had been evacuated. The first thing they said to themselves was: "We do not want soldiers using this definition to get out of the war. We do not believe this event has occurred. Shell shock? What's that?"
The second thing they did was, they said that through their compensation and pensions program that they would not approve any disability for anyone who had been diagnosed with shell shock. And so the stigma goes way back. I mean, it goes back to Roman times, people that, you know, for whatever reasons could not perform their task.
But I think we're smarter than that today. I think we have the kind of capability that we can educate the clinicians in the field to recognize who is and who is not capable of fighting the war, because there's going to be people that aren't capable and that do not deal.
I mean, I talked to a guy the other day that said his buddy was cut in half. A friend of his was cut completely in half by an RPG [rocket-propelled grenade] and that he wakes up in the middle of the night saying, "I can't put him back together, I can't put him back together." That's how he wakes up. That's an image that is forever burned in his mind. It affects his relationship with his wife. It affects his ability to economically earn a living. It has devastated him. And it's not just a memory. It is a chemical change that has occurred in his body. ...
Some of the first signs of PTSD are disassociation where, you know, the guy that I sent to war isn't the guy that came home. "That's not my husband who walked in the door. He's not loving the kids the way he used to. He's not responding to me." [Or] hypervigilance. It would amaze you to watch these guys from Walter Reed who are on the psychological ward. They have to get out of the hospital every now and again, and they go and do things. And when they go to the movies, they're not just going to the movies; they're on a patrol. They're looking out to their left and to their right. And they're looking on top of buildings. And they're making sure they don't step on the trash pile. And if you walk up behind them and touch them on the back, you could be in trouble, because they are very hypervigilant. ...
This is what really bothers me about military medicine for returning war veterans. In a civilian setting, if somebody from September 11 was in therapy and they got up and they threw a chair, well, of course the therapist would say, "That's an inappropriate way to direct your anger, and let me give you some coping skills," and they'd talk about it. In the military, they would punish that soldier through the Uniform Code of Military Justice for the destruction of whatever he did, not taking into account the actual illness that the veteran has. That's like looking at an amputee and getting mad at him because he can't do a two-mile run. These guys have a real illness, and it's not being taken into account.
We were just at Walter Reed. Let's talk about the psychological care that they receive.
Walter Reed Army Medical Center, in terms of how they care for the psychologically injured soldier, they are definitely not leading edge in terms of their treatment. For example, there are group therapy sessions in which there are combat soldiers, females who are civilians that have had hysterectomies, grandmothers who have had surgery, all in the same therapy session talking about their PTSD. You've got soldiers who didn't deploy commingled with soldiers who saw combat.
What Walter Reed doesn't do that I think they could do better at is individualized, tailored care for the individual and their specific needs. What they have is a Burger King mentality: to get as many people together as you can, put some information out to them and get them out of the hospital as quickly as you can, because tonight, at 1730, there's going to be another busload of wounded soldiers coming in. ...
What we're calling for ... is a refocus on getting face-to-face contact with the veterans. Handing them a piece of paper and saying, "Here's a number you can call," is not the kind of care they need. ... I've said that if we would aggressively and proactively meet every single veteran that comes back and give them a face-to-face clinical encounter with someone who is educated about the special needs of returning combat veterans, we could save this nation billions of dollars over the next 50 years for any long-term disability payments that may come out of not treating PTSD. And [lawmakers] seem to get excited about that. So maybe if we kind of refocus them, they'll take it seriously. But it is going to cost this nation billions of dollars to take care of these [veterans] -- not only the psychologically injured, but the amputations, the broken backs, the fused spines, the kidney disorders. It's going to cost billions.
The VA system already seems completely overburdened.
... As this war moved on, the veterans' service organizations like myself and others began to question the government's commitment to returning soldiers when they purposefully underfunded the Department of Veterans Affairs by billions of dollars, not even addressing the needs of future veterans that are coming back from this war, but underfunding the needs of veterans from previous wars. ...
George Washington said this, and I'll paraphrase it: The willingness of future generations to serve in wars directly depends on what we do for those who just came from war. It's not rocket science. We have to take care of soldiers so that people will want to join the military and will want to raise their right hand and support this nation. And underfunding the VA in a time of war, I don't know how you can explain it.
You've written about the stress factors specific to this war. One is not knowing if it's a civilian or an enemy you're killing.
Well, this war is absolutely different than the first Gulf War, for example. The first Gulf War was very short, limited, long-range tank battles, not a lot of up-close and personal fighting. Not that some people didn't see death and destructions -- many did, but not on the kind of scale that soldiers in this war are seeing.
So this war's different, and the stress factors are different. Some of the examples are, for example, the environment -- you know, extreme hot, extreme cold. I've got a 110-pound rucksack on my back that's filled with ammo and all kinds of things I need, and, you know, it's 110 degrees, and the water supply didn't come today. So that's a stressor. Extreme cold.
The pace at which operations are occurring: Soldiers are putting in 18-hour days. They get up; they go do their missions. If they're fortunate enough to make it through the day without getting hurt, they get back home late that night. They sleep for four or five hours. They get up. They go do it again. This pace is really stressful.
The kind of war that is being fought right now is extremely stressful. Soldiers have what's called rules of engagement which prohibit them from randomly firing when something happens. They're supposed to identify the target. And it's very difficult in this type of environment to pick out the one person in the crowd of 300 that's got the RPG or the AK-47. And quite often, if you're worried about your life, you might not consider and just simply fire where you think it's coming from. I know that I've talked to many soldiers, [and] that it's very difficult for them to distinguish between enemy and friend. I've met soldiers that have said that, you know, "On one hand, the little Iraqi girl came up and asked for food, and we gave it to her. And five minutes later, the Iraqi grandmother came up and blew up."
So it's a difficult environment. Who do you trust? The enemy surrounds you 360 degrees. They're above you, below you, to the left, to the right, you know? When in our world, we might walk by a bag of trash on the street and not think twice, in their world, they're thinking about it, every little step.
Some of the other things that are stressors are not being properly equipped, knowing that you're entering into a combat zone without the proper body armor, for example, or armored Humvee, ... or not knowing what your mission is and not having a clear understanding, not knowing how long you're going to be in Iraq, not being able to have a target date. Everything we do in life has a goal. When you play football, the goal is to get more points. And when you're in Iraq and you're a soldier, your goal is to reach the point in which you can come home to your family, and not knowing that is a tremendous amount of stress. [This is known as] stop-loss, not allowing people who have successfully completed their tour of duty to actually leave and fulfill the contract that they signed.
Also, things happen while you're gone. I mean, the stress of worrying about your family at home. Many National Guard and Reserve soldiers aren't professional soldiers. They're not part-time soldiers either. They're soldiers that we call up in case of emergency. And we absolutely need them. But they're civilians first, and they have lives and jobs that may or may not be there when they get back. And so they're worried about that.
What about the National Guard and the distinct kinds of differences and the stresses that they experience?
Well, I think one of the biggest differences between the active duty and the National Guard, first off, is training. It doesn't stretch the imagination to look at the NFL, for example. There's a practice squad, and then there's a squad that actually plays in the game. And in many cases our National Guard soldiers are as trained as any active unit, but then in other cases they're not. And they try to get as much training in as they can during their drill cycles and their ATA [Annual Training Assistance] sessions.
But they're not professional soldiers. There are some highly professional soldiers in the National Guard unit, some on par with any unit in the world. But many of the units are not professional. They consist of people who may not necessarily have all the skills needed. And some people are going to hear this and say, "Oh, well, that's denigrating to the National Guard." The fact is that some National Guard soldiers from some units just don't have as much training as active-duty soldiers do. So there's the first thing: that you feel like you're entering into a world in which you're not prepared or you know you're not prepared.
The next thing is that there's a real perception that there's a difference between being active duty and National Guard; that is, active-duty people treat National Guard soldiers differently. ... That perception carries on to when they come back from war and they're trying to receive treatment. It seems that the active-duty forces [are] getting more treatment and more care and more priority. ...
One of the biggest differences between being active duty or National Guard in terms of reintegration is that active-duty soldiers come home to their home, the base in which they left from, and National Guard soldiers that come back come back to that base. And then they go to their home, which is not a military installation, and they go back to the civilian world, where the support systems -- like the military hospital, the military counselors, the Army emergency relief -- they're not there. Those support systems are not out there in rural America where these guys are. ... And when an active-duty soldier returns to his military installation and a National Guard soldier returns to that same installation that they've mobilized from, the active-duty soldier can go home to his family. The National Guard soldier, if they're on medical hold awaiting some medical evaluation process, they're kept away from their family until this convoluted workmen's comp decision is arrived at.
They get two years of benefits, I believe, and then they're cut loose?
Every National Guard soldier and every active-duty soldier, if they get out of the military, will be entitled to two years of benefits as a result of serving in this war. The question is, what happens at two years and one day when they need something? Because the law allows for two years. Some illnesses don't manifest themselves in two years. Or what if you're at two years and you haven't resolved your problem, but yet you require further care? Are you eligible underneath the law to get further care?
There's a move in Congress right now to extend Tricare with health insurance benefits to National Guard and Reserve soldiers. They may make them buy into it; they may give it to them -- it's not really clear. But if we're going to use the National Guard and Reserve soldiers like active-duty soldiers and put the burdens of the military mission on their back, then we need to provide some kind of health care for them to keep them fit and ready to fight and to be ready to go when they get called.
People in support groups have talked to us about being "medical boarded [out]" versus being "chaptered out. " These are words that mean nothing to civilians. Why are they willing to wait around in the military, even though they hate it, praying and hoping for a medical board?
When wounded soldiers come back from war, if their injury is so debilitating that they can no longer stay in the military, one of two things will happen. They will be offered a severance, an amount of money to have no further claim with the military, or they'll be offered a medical evaluation board, which is basically the most convoluted workmen's comp, paperwork-driven, bureaucratic way to treat wounded veterans when they come back that you could ever imagine.
So in the case of a medical evaluation board, the soldier comes back. The military rates the soldier not on the whole body, not on the 15 things that's wrong with you. They rate you on the one thing and the one thing only that prevents you from staying in the military. For example, if you've lost your leg, that's one thing. But you've [also] got a skin rash that you developed from a biting insect, and you've got some other illness. They're more concerned about the one thing that keeps you from being in the military. And so you go through a process in which you get a diagnosis. Then people review that diagnosis, and they adjudicate a decision on what percentage of disability you should get.
Chaptering people out of the military is ignoring whatever their medical condition is and putting them out of the military on either discipline, personality disorder, disobeying order. There are all kinds of different chapters in the Uniform Code of Military Justice. And if you receive a chapter, if it's anything less than honorable, then you have lost the access to the VA health care system, and you'll have to find some other way to get your medical care. ...
A lot of the soldiers also say that they really won't trust anyone they're talking to in mental health because they know their command can get their hands on it. What are the confidentiality issues?
That's one of the reasons why I'm starting to question whether or not the military can actually make the soldier conform to the standards of the Uniform Code of Military Justice, deal with their mental illness, and maintain confidentiality and prevent stigma all at the same time. I don't think that if a military doctor meets a patient from this war and that patient says, "I want to kill people," or "I want to kill myself," that that should somehow be kept secret, like you're in a confessional. I think people need to know about that. In fact, the doctor has a duty to act. When somebody intimates a suicidal or homicidal ideation, they have a duty to act and talk to that person and really determine, "Do you mean that?," and if they do, to get them locked down or helped, whatever it is they need.
But for the command to get involved in -- other than [in] suicidal and homicidal ideation -- the confidentiality between the patient and the doctor is 100 percent inappropriate. And we do know that it happens. There's soldiers that have had their command try to influence the doctor's decision on whether or not somebody has PTSD or not, basically saying that they're faking it. That's what they did to Pogany. They said he was faking it. ...
What about the emotional impact of killing? How does that affect soldiers?
... We desensitize soldiers to the idea of killing by starting them off with drills and paper targets that don't look like anything, and then ultimately transition to moving targets, pop-up targets and things that are shaped like humans, so that your response is automatic. You don't think. The last thing you want in war while somebody's bearing down with their rifle onto a target is [for them] to think to themselves, I wonder what the consequences are going to be to my long-term psychological health about this act that I'm about to commit. So reflexively, because of drill, they pull the trigger, because that's what they're trained to do.
Unfortunately, there is a reaction that occurs after the fact that they don't spend a lot of time teaching people about. It's the big elephant that's in the room that nobody wants to talk about. Hell, it could be leaning on you, and they still don't want to talk about it. And that is, what are the consequences? There are people that believe that there is no way to train someone to kill and be totally unaffected; that even on a subconscious level, something happens when you commit that act, when you actually pull the trigger. And there are others that believe that by drill and training that they'll get the end result, but they're not really concerned about what happens afterwards. ...
In the post-deployment questionnaires, there's not even one question that has to do with killing. It's all about what you see and not what you've done. Can you comment on that?
The post-deployment assessment form that the soldiers fill out when they come back lists a bunch of questions about a bunch of different things. They ask you if you have concerns about depleted uranium. Did you see combat? Or did you see dead bodies? They don't collect information on what you did personally. And we think -- the organization thinks and I think; even the VA thinks -- that that's a bad idea. Each soldier's experience is important in understanding the health consequences that will come out of that experience. ...
I think they have acknowledged [killing]. ... We all know there's going to be killing. People in the military aren't stupid. They know that there's going to be killing. But the idea is it's not going to happen to you. ...
There's a whole other side to it that isn't discussed, and that's the part that we're talking about right now, is what happens when you kill, or what happens when you see your buddy killed. How does that affect you? And how do you continue to function? I think that it's something that the Department of Defense would rather not talk about, the ugliness.
Look, war, it's ugly, and it hurts people. And people's legs are going to get lopped up. And people are going to get horribly burned. And some of these soldiers are going to be responsible for inflicting that pain on others that they're fighting. And you would think that you would want them to be able to process this information to have all the tools necessary to do so. But I think in this war, a lot of guys went over -- and girls -- unprepared. I mean, they were told they were going to be met with open arms and flowers, and instead they were met with RPGs and IEDs [improvised explosive devices].
You would think that the Department [of Defense] would be interested, ... but it's really like the bastard child nobody talks about. It's not emphasized in training. They don't really talk about feelings. Are soldiers supposed to have feelings? "If I wanted you have to have feelings, I'd have issued them to you."
It's kind of like the way the military acts. But there are feelings that occur in war and in training that, if left unaddressed, make you less strong, and if you would address them could maybe be the key thing to help you get through the problem, whatever it is. But it's the elephant in the room. Nobody wants to talk about it.
This idea of having therapists in theater, having combat stress control teams, do you think that's effective?
What [the soldiers] get from the combat stress teams is a warm meal, a place to sleep, some drugs to fall asleep and a little bit of talk therapy. I mean, they really could be talking to a garbage can or something. It's not really designed to fix the problem; it's designed to give them a break. And there's not enough therapy that can be conducted in 72 hours to address what a lot of the soldiers need. ... I think the combat stress teams are like a Band-Aid over a gaping wound that may need really a different kind of attention. But it's better than kicking them in the back and telling them that they're cowards and sending them home.
We have to hope that those people are making the correct clinical diagnosis. It appears that in many cases, they are not. ... They're reluctant to send [soldiers] back. And that's unfortunate. Time will tell if it's going to be devastating or not. ...