The Wounded Platoon
COMMENTS

Interview Robert Alvarez

“It's not OK to tell a kid needing treatment two or three times a week that we can only see you once a week, or you'll have to go somewhere else.”
Robert Alvarez

A former Marine, he's a psychotherapist for the National Organization on Disability's Wounded Warrior Program in Colorado Springs, Colo. This is the edited transcript of an interview conducted on Feb. 20, 2010.

[Tell us what] you do now.

I work for an organization called the National Organization on Disability. We have a Memorandum of Understanding with the U.S. Army. We serve the U.S. Army with the Wounded Warrior Program [AW2]. That's our primary focus: to serve the U.S. Army's wounded warriors. ...

All of our services and all of our efforts are designed to help these kids transition from the Army back into the civilian world and to deal with all the issues in terms of employment. In our program we address mental health and employment simultaneously, and it's a holistic program. We deal with families; we deal with the systems around the family. So we try to really provide holistic care for these guys until they completely reintegrate safely and are pretty independent and healthy. ...

How did you end up getting involved in this work?

A few years ago I took a job at Fort Carson working in the ACAP [Army Career Alumni Program] program, and ... the Army implemented the Warrior Transition Unit for the returning soldiers that were suffering from injuries from the war and needed consistent medical treatment. They were pulled out of their regular units and put into a special unit. ... This became a more specialized unit and had all kinds of medical care built in. [It is] now known as the Warrior Transition Unit and, in larger facilities, Warrior Transition Battalions.

I was a counselor assigned to them from ACAP, and I became very intimately knowledgeable with the types of cases that were coming through from these wounded soldiers. I was being exposed to kids that were coming back that were facing all kinds of criminal charges. And as a therapist, I was recognizing the lineage between their service to their country and their history, and then started investigating with their families what kind of soldiers these kids were before they deployed, what kind of people they were.

And I almost always found a pattern of kids that were fairly good people in society, very good kids. They wanted to serve their country. They went off to war, and when they came back, everybody around them noticed a distinct difference in their demeanor, in their character and in their behavior.

It really piqued my interest, and I became familiar with an individual named Andrew Pogany, [a former U.S. soldier and volunteer at Fort Carson]. ... Andrew had already been heavily involved in cases. I started sharing cases with Andrew and spinning them off, basically saying: "Andrew, you know there's only so much I can do here. You certainly, in your capacity, can help these kids." And we kind of teamed up on a lot of cases to help these kids get the proper care and a dignified end to their military career instead of what we saw a lot in 2006, and '07 and '08 even, kids being chaptered out for issues that were absolutely attributed to their injuries from the battlefield. It just seemed completely unjust to do that to somebody who volunteered, put on a uniform and sacrificed so much.

It really, really offended me as a former Marine and as an American citizen. It offended me to the core to see us put kids on the street in absolutely hopeless situations -- broken, ill and now financially destroyed because they lost their job at the Army and then they became the civilians' problem. They became our community here in Colorado Springs' problem.

At the same time I was doing that, we were going to our district attorney saying, "We need to do something." And that's where the concept of developing a veterans court was hatched here in Colorado Springs. A number of us were all at the same time knocking on the door saying, "Something's wrong" -- some great people like [Kenny Eastridge's lawyer] Sheilagh McAteer from the public defender's office; a good friend of mine, Charles Corry, [the president of the Equal Justice Foundation]; Andrew Pogany. A number of us were saying: "Hey, we have kids that are very sick, but they're not criminals. They're sick, they're injured, and they're acting out because of their experiences from this battlefield."

Looking at this community that's [around] Fort Carson, [which is] an enormous piece of the community -- the military community, the veterans' community, the civilian community -- what's the scope of the problem here?

Wow. The impact on our community, I think it's still immeasurable. We are tapping into nonprofit resources every day for financial assistance for kids. Our mental health system is overtaxed. The military's overtaxed with the mental health problem. They're relying on the civilian population to assist when they're overtaxed.

I know there's a problem with neurologists here. We have a number of kids that are coming back with brain injuries, and there's not near enough neurologists here in town, or psychiatrists. If one of my veterans needs to see a psychiatrist and he's unstable, but yet not suicidal or homicidal, he may have to wait five or six weeks to see a neurologist or a psychiatrist to get proper medications. That's not good.

When you get somebody who's destabilizing and you tell them they have to wait five or six weeks to see a doctor, that's not good. That's very dangerous. And then if there's not anybody really case-managing the individual, they're just free individuals in the community and they don't have any support system, they might act out.

That's why we have a very high crime problem here with veterans and with our active duties, because if we don't have the support systems for that individual, it's going to lead to unchecked behavior. And that's exactly what's happening here. It's unfortunate.

Talk about what happens on Tejon Street [in Colorado Springs] on the weekends and how that's related to what we're talking about.

We're dealing with a lot of young kids, kids that have experienced war. Unlike a lot of the previous veterans that have served in other wars, these kids have been back multiple times. I served right at the end of Vietnam, and I remember, just as it ended, and we had kids back in the units that served, and they did one tour, maybe two; but we're seeing kids doing three, four, five tours. Three tours is not an unusual number for a kid who's been in five years, six years in the service.

And these are young kids that come in at 17. They're now 22, 23, 24 years old. They're kept away for a long time from their family, and then they come home. And when they're over there, they're not allowed to experience alcohol, and it's almost a binge thing when they come home. When they first hit our city, the big thing is to go out and have a lot of parties, and it's led to a lot of incidents and violence downtown. ...

We're going to go into some of the different guys in our platoon, and we'll ask you to comment on facts of their cases and how that is an example of larger issues that we're dealing with. The first guy is David Nash. ... He was chaptered out after failing a drug test which he said he went to cocaine. He was too young to go to the bars, and he needed to self-medicate. Then when he realized he had a problem, he was asking for help for his addiction, but instead they demoted him, and they chaptered him out. They kicked him out. ...

Anytime I have a soldier who is referred to me that has any type of problem with the law or with the illegal use of drugs or abuse of a substance, the first thing I want to find out is, what was his experience in Iraq or Afghanistan? ... My first interest is getting to know their personal experience in the battlefield because I want to know the level of mayhem, of carnage that they may have been exposed to.

Quite often, in almost all the cases I've been involved in, these kids have had horrific experiences, and they're not diagnosed. And they're having symptoms such as, people that come back and are suddenly irritable all the time, absolutely snapping at their wives, snapping at their kids, snapping at NCOs [noncommissioned officers]. We see kids that have become discipline problems with authority, and then of course we see sometimes drinking, or we see them, in the case of this fellow, he couldn't get alcohol, [so] he went to another easy substance, which was cocaine. And we've seen them use that. Any substance will do; it doesn't really matter. It's whatever you can get your hands on.

So I think the failure here is that the expediency in dealing with the problem, "You've got a cocaine problem," not "Why do you have a cocaine problem?," and that's the real thing. We ought to be asking why. And we need to keep asking them why until we get to the root cause of why. Because I like it -- not because I'm addicted to it, not because it's available, but because I have a problem with dealing with life since I've come back from this war. I have problems with nightmares; I have problems with friends; I have problems with my job. And so when I go to cocaine, I don't have problems anymore.

So all the kid is doing is trying to calm his inner self because he's not getting that anywhere else. It's sad. I think it's a failure on the system to not answer the question, "Why?," the ultimate question, all the way back. ...

We've invested in people. We've invested in their training, in their combat training, lots of money. So when a kid comes forward and he has a problem, the Army has a great program, the ACAP program, to treat some of these things. I think we should we should at least attempt to treat it first. And if treatment fails and there still isn't a hope, then we need to look at chaptering the person out or giving them a medical discharge if this is a result of post-traumatic stress.

In Nash's case, as far as we can tell, he was never referred to the ACAP program; he was never counseled; he was never given any sort of treatment. Heidi Terrio, [the director of deployment health at the Soldier Readiness Center at Evans U.S. Army Community Hospital in Fort Carson,] tells us that if they're chaptering somebody out for substance abuse, the Army will always give them counseling before they go. She said, basically, "We'll fix them before we get rid of them."

I'm not going to say that's absolutely 100 percent. That may be a good percentage of the time, but I've also seen chapters that have occurred in a matter of days. [The] ACAP program is three or four weeks long, and I've seen kids chaptered out within a week or two, and they're absolutely not receiving ACAP treatment. ...

... Could you explain how and why soldiers come home and feel the need to self-medicate once they're home?

I think when a lot of these kids come back home, there's a sudden, rapid decompression from the battlefield. It's very hard to describe. People say you can't understand it unless you've been there. And to be honest with you, I can't disagree with that. To live every day in an environment where you accept the fact that you could die, and some of them expect at any time to be killed, and you live in that environment for 12 months, and you watch friends die, and you see children die, and then you come home and suddenly you're immersed in the normal environment that you and I live in, that ordinary people live in, and they're dealing with things that are insignificant -- kids fighting over this or that, and they've just come from a place where people are dying -- they can't cope with that. They have a lot of issue with it.

A lot of them have problems with sleep. And one of the really dangerous things is when people become sleep-deprived, people can become psychotic from that depravation. People can act irrationally when they suffer from sleep depravation, and [for] a lot of our soldiers, that's one of their big complaints: sleep. They have very poor sleep patterns. So what they find out right away is, well, when [they] drink they believe they sleep. They really don't.

The problem with alcohol is that it causes a very restless sleep. It doesn't allow good, natural REM sleep. It actually interferes with that. But the soldier thinks he sleeps because he goes to bed at 10:00 and he wakes up at 5:00 and he thinks he's got a good night's sleep when in fact his brain is very active during the night with nightmares. But because he's suffering from alcohol effects, he doesn't get up; he just lives through the nightmare, and he has that burned into him.

So it's a very dangerous situation, and it creates a cycle of wanting to drink more to try to quell that same thing. And it does work. I mean, let's face it: Alcohol has a euphoric effect when you first drink it. For the first few drinks you're very euphoric. That's normal. But then it has the depressive effect, and it will put you to sleep, but the problem is it's addictive. ...

I see a lot of veterans that have suffered from being chaptered out or had problems on their way out of the Army, especially veterans in the 2004, 2005, 2006 time frame. There's a number of them that left the service with bad conduct or Other than Honorable [OTH] conduct, and it was clear that they were undiagnosed; they were untreated.

I think it's fair to say, at that time, everything that I know about the services [that] were available, they were woefully inadequate. They weren't as available.

And worse than that, it was the stigma. I think a lot of soldiers came back, and they were trying to suppress the PTSD. And one of the ways you suppress is by doing cocaine, doing alcohol, doing illegal drugs, trying to distract your mind from dealing with the symptoms of PTSD. And it was more common back then.

I think as we go forward here today in 2010, we're recognizing a lot more of these cases. In my opinion, there's still not enough proper treatment. We're using a lot of pharmacology to treat the symptoms of post-traumatic stress and depression and anxiety and brain injuries, and we're using a lot of cocktails on kids that for the moment are somewhat stabilizing them, but they're also very dangerous because they cause addictions.

But in the case of Nash, you know, if he's ticking off all these symptoms [on a questionnaire at Fort Carson] --

Back then -- we're talking 2005, right?

Right at the end of 2005. He put down on his form and ticked all these boxes. Early 2006 he got an Other than Honorable discharge.

2005, 2006, in my opinion, that was probably the peak of all of the worst of the worst that happened in terms of care, lack of care, at a point where the problems were the greatest. I think everybody recognized that there was a much bigger problem than anyone admitted to prior to that. I think that's probably fair to say. I think the Army might even say that's true. But they really recognize that we have this wave coming back from this war of kids with PTSD and with traumatic brain injuries [TBI].

So they started to really plug in things besides just that screening that occurred with that young man. But it also relied heavily on the unit to follow up. As a squad leader or as a first sergeant, when you see these kids coming back and they're checking all the boxes, as a good leader you're saying: "Hey, this kid needs treatment. What's going on with you?" Call them in: "Have you gone to ACAP? Have you gone to mental health? Have you been up there?"

Back then there wasn't any of that, because these battle-hardened first sergeants, they come back with these kids -- "Suck it up," you know, "Soldier on." There still wasn't acceptance as it is today with PTSD. A lot of people still thought it was bullshit. I can't tell you how many times I've heard from people with a lot of stripes on them, saying: "This is all bullshit. Kids are just using it to get away with stuff."

As a mental health professional, we can be fooled, but if you're pretty good at what you do, you don't get fooled that often. ... I will absolutely say that 95 percent of the kids I've worked with have been absolutely legitimate, right on about what's going on with them. In fact, they often are reluctant to ask for help. They're not looking to get away with anything. ...

Another issue connected to this PTSD business is where we've heard of an institutionalized pressure not to diagnose PTSD from soldiers who are misbehaving. ...

I'm aware of the story [of the secret recordings] on Salon.com. I'm aware that, when I worked at Fort Carson, I saw cases of kids that I would absolutely believe to have PTSD. My professional judgment was they were suffering from a pretty serious case of PTSD, and yet they were coming in with diagnoses of anxiety disorder or anxiety and/or adjustment [disorder]. Of course, the argument went back and forth: Well, certainly PTSD has anxiety as one of its symptoms, but at a point where something passes anxiety and you attribute it to a profound experience, a horrific, profound experience, and it's chronic, the recurrence of this -- either nightmares, or this anger or irritability, or this inability to sleep -- you start to realize that we've passed anxiety; we've now gone onto PTSD.

It's just like depression. People suffer depression, but then when it gets to a level where you're debilitated, to where you're suicidal, then it passes to a new phase called major depression. It's now got a new diagnosis. ...

A social worker that we talked to, a fellow named Justin Cole, said, "I would give a diagnosis of PTSD, and I would have a supervisor of mine come in and say: 'Well, do you really think that is post-traumatic stress disorder? Do you really think that soldier deserves post-traumatic stress disorder associated with the true diagnosis? It's not like we're doing him a favor.'" He said these soldiers have legitimate, bona fide psychiatric ailments. Mental health diagnosis, PTSD, allowed them benefits, and the soldiers and commanders didn't want to give them the benefits.

I've been on both sides of that conversation, where I've had soldiers say: "I didn't want to be diagnosed with PTSD. I don't want people to think I'm whacked out." And especially in 2007 and so on, and '06, if you got diagnosed with PTSD, truly diagnosed, it often led to you being kicked out of the service -- not kicked out, but medically retired and possibly chaptered out if you acted out badly. So people tried to hide from that diagnosis. They avoided mental health for that reason, or wanted to go off post or a number of places.

But as the battle to destigmatize PTSD got under way somewhere around 2007, we saw a lot more people coming forward saying, "Yeah, I had PTSD." But it isn't soldiers waving the flag. They're coming in, and they're describing what they're suffering. And it's not like there aren't things around you to see that. For example, often the guy has got DUI, suppressed case of DUI. And once again, if you deconstruct and you talk to the family, yeah, he came home. He didn't drink before, but he started drinking as soon as he hit our home, and he's now up to drinking 24 cans of beer a night, and he never did that before. And he's up all hours of the night. And he can't sleep, and he's struggling. Nobody picked up on this.

And [even] the soldier sometimes, because it ratchets up gradually, doesn't always recognize it -- you know, a little trouble sleeping, I'll drink a couple of beers. Doesn't associate it with PTSD right away. So a couple of beers helps. Next night, same problem. Well, I'll drink a couple, and I'll drink an extra one. And it slowly escalates until it's become a problem.

And it's just like anything: If you gain weight, people living with you don't see it, but if you go to an old friend who hasn't seen you in three months, "What happened to you?" You know, it's dramatic. But people around [you] don't really notice it because it gradually happens. ...

So just to be clear on this question of people being pressured not to give PTSD diagnoses, when you were at Fort Carson, did you ever have a situation where you wanted to give somebody a PTSD diagnosis and were told no?

No, I was not in a position to diagnose at Fort Carson. That wasn't my role there. But I was in a position to recognize kids that were being told they didn't have a problem, being told they weren't suffering from PTSD and recognizing they clearly were.

And why were they being told that?

That answer I can't tell you. I suspect some things, but I think we had some bad players over there.

What do you suspect?

I suspect that there might have been a problem with the numbers, but I don't know. ... I know of some cases where we repeatedly referred people back for proper evaluation. Couldn't get it. Had to take them off post to private doctors [to] get the right diagnosis, the correct diagnosis, and then go back and argue with the Army.

I remember a case of a particular soldier who Andrew Pogany and I worked on. The Army actually said he had nothing wrong with him, and I said: "No, this kid's bipolar. He's bipolar because he experienced this battle, but he never had it before. He's suffering from this, and it's part of a blast injury and a number of things." We finally got the kid to V.A. [U.S. Department of Veterans Affairs] while he was still on active duty. We asked the V.A. to evaluate him -- comes back bipolar. And the Army doc and [senior behavioral stress officer at Fort Carson] Col. [George] Brandt and everybody swore up and down: "Nope, nothing wrong with this kid. He's just a malingerer. He just a malingerer." And I'm saying: "Malingerer my tail. This kid has got bipolar disorder. It's obvious as hell. What's going on here? This is too fishy."

But they were going to chapter him out ... because he was late for formation. He was having issues with behavioral problems and sleep. He was on a ton of medication. And even though they said he was malingering, they were treating him with antipsychotic medications, which was interesting, because the question I asked, "When do you treat normal people with antipsychotic medication?," and [they said], "Well, when people have a problem with sleep [we] give them antipsychotics."

Wow, that's interesting news, something new for me to know, because civilian doctors don't do that that I know of. So the evidence pointed to something totally different, but their lips were saying different, which I thought was interesting. And it was funny. ... It was almost comical, except we were talking about some kid's life, sadly. ...

This group of guys, it's not anywhere close to a generation, but the cohort in the early part of the war that came back, they're now well out of the Army, in civilian life, most of them. Talk about that group of guys before PTSD became something --

Every day in this job I run into people who are either referred to me or need help, and they're of that time frame 2004, '05, '06, that didn't get a med board [Medical Evaluation Board, or MEB] process; that simply left the Army with issues, and the issues weren't recognized, or they weren't treated, or they may have been recognized but went untreated, or they were chaptered out for conduct issues.

There is a whole bunch of these kids out there, and I can't even guess the amount, but I would say they're in the thousands. I think that a fair thing to do would be probably to go back through those. Our government should probably go back through those cases and take a second look at them and see if in fact we have not mistakenly chaptered people out for PTSD. It's not that hard, because a lot of these kids have ended up at the V.A., and they've been diagnosed. ...

That then gets into this whole question of the eligibility with the V.A., and these guys like David Nash who was [in] 2006 Other than Honorably discharged. ... What's the deal with being eligible [for benefits] when you have an Other than Honorable discharge?

When you have an Other than Honorable, there's some limitations to what you can get. I know absolutely you're not going to get any of your educational benefits, even if you've served five or six years, eight years, 10 years. You get an Other than Honorable, you've lost your Montgomery GI Bill, [which provides education benefits to veterans and active-duty military]. You're not eligible for the new GI bill.

In terms of medical care, I know the vet centers will treat them and do treat them. I have heard stories of vets that have been turned away. I know that somewhere around 2007 the Army came out with a policy that said that anyone who served in OEF [Operation Enduring Freedom] campaigns would be eligible for five years of medical care. Sadly, people like this individual need to go back through the Army's board of medical records to correct them, and that takes a year or two. So the care falls back on the civilian community again. Again, when we wrongfully discharge kids or don't treat them, they become a burden in the community. So now he's probably going to a private or to public mental health, I would imagine. Is that where this individual is?

No, he's not. He's trying to get into V.A., and they said, "Well, there is a process." So talk about that process.

One of the things that people that get an Other than Honorable can do is they can apply to upgrade. There's a process [whereby] you can upgrade your discharge. In my years of working with the military, I've never seen anybody who's successfully done it. I've been told you need to go through and get the support of a local congressman or senator to process this. I have not seen it done. I think you have a better chance of going back through the BCMR [Board for Correction of Military Records] ... for medical records to review those records and overturn your discharge than you do getting an upgraded discharge. It's terrible. ...

I've run into numbers of kids with Other than Honorable discharges, what they call OTH, that clearly were kids that left the service with post-traumatic stress or a head injury or both. And because they acted out in ways that were behavioral problems for the military, they were kicked out and not eligible for a lot of the benefits that they should have today. ...

And somebody like David Nash who, wandering around the country for four years, finally realizing that he's got these issues, or realizing enough to go to the V.A., the first day he went he went to the vet center and I talked with him and he was like, "Wow, it was great; I talked to this Vietnam vet, and he really understood me," and the next day they were signing up for the eligibility to get him to the medical center, and it was like he just got punched in the stomach.

Yeah, my heart goes out to those guys, because for somebody who's served and deployed and gone into harm's way and suffered whatever injury it is, and then to come back and have issues and then be kicked out, I've seen that too often.

I know, first of all, the devastation of losing your job, especially in today's economy, losing any job, much less a career job. A lot of the kids that I see planned on spending 20 years or more in the service. ... They were real gung-ho soldiers, and they went to war, and they did their job and came back broken, and then they had these problems. And to be kicked out and be stripped of your benefits, it's tragic. It is unconscionable, at best, to do that to these kids. And we need to look. The nation needs to look at fixing that.

How do you fix that?

I think the Obama administration needs to put out a directive to the military and to the V.A. to go back through these cases of veterans that are discharged who have wartime experience and were for some reason discharged on conduct issues. It doesn't take a rocket scientist to see the linkage. Go back through the medical history and go back through that solider or Marine or Air Force kid's battlefield experiences, and if he was there, we need to bring him back and evaluate whether or not this individual has psychiatric issues that were related to his combat experience. And if so, then you need to reverse it and fix it. I think it's the only honorable thing to do. People serve honorably, and our country ought to act honorably, and that's a mutual contract. It's not always kept.

But the Army will tell us David Nash may have served honorably, but when he got back he had a terrible attitude. He pissed out once. He pissed out a second time. He wasn't going to turn into a good soldier, and the only thing we could do with him was an Other than Honorable discharge.

Well, that's a sad, sad statement if somebody said that, because what David Nash should have gotten was medical treatment first. And they couldn't have fixed David. What they should have done is offered him the medical retirement he so deserved, not the front door or the front gate that he got. And if that's the circumstances in this case, I'd be deeply disappointed, especially if they occurred today.

This is 2006. I think that that's very possible in 2006 that that happened way too often. If it happened today, I'd be very disappointed. Does it happen today? Yes, but less frequently.

Here's what I experience: There's no real oversight. Kids are chaptered out. It's completely an Army decision. There is no independent agency overlooking. It's like all of the wolves have gathered to get rid of the chicken, and we've all decided we're going to eat the chicken; it's a done deal. There's no surveying agency stepping in and going: "Wait a minute. There's some wrongdoing here. There's some facts here you're not looking at." There is some. And we've advocated for that. ...

The military traditionally has been a very, very closed organization. They don't like outsiders. They don't like people that poke their nose around inside the organization. They don't like reporters. Nobody's told you that, contrary to popular belief. They don't like people to come in and question them. But you know what? Every other part of our government [has] oversight. We need to have more oversight.

Let's talk about drugs in the combat zone and the mental health report from the Pentagon that showed 12 percent of the troops in Iraq, 17 percent in Afghanistan are taking antidepressants or sleeping pills to help them cope. That's two years ago, so it's possibly quite higher. Two guys in our platoon talked about how easy it was to get those when they were out at FOB [Forward Operating Base] Falcon in 2007, [to] just go and say, "I need drugs."

Yes. My experience as told to me by many, many, many soldiers over the last few years was that while in deployment, while in Iraq or Afghanistan, that it was common practice for the Army docs -- what they call the docs; the medics in the field -- to carry Baggies of medication that were unregulated.

[There was] unsupervised distribution of medications like Ambien, for example. Kids would come back very, very dependent on Ambien and then suddenly not have accessibility to Ambien because they never got a prescription for it, and it never really was logged in their records that they were receiving Ambien. So now they've got a pretty good dependence on Ambien, even though it's not a very addictive drug, but you get used to something working for you. And so when a lot of our kids have come home, they couldn't get the Ambien, they switched over to alcohol, so that's created a problem.

But it is not news to me to hear that. It is a very commonly known problem that kids had access to meds in Iraq that were given in Baggies, and there was not a lot of questions asked about it. And it wasn't prescribed by psychiatrists -- most often by the Army medic that was assigned to the platoon.

What's the reason for that? Why do they need to give them these medications?

I think it's to keep them battle-ready. The bottom line is, you're in a combat zone, and you need to get some sleep, and if you can't sleep you become ineffective and possibly could cause people to lose their lives. So it's very easy to say: "Here, take this. You can sleep."

I don't have a problem with the use of medication; it's the abuse of it that I have a problem with. It's also recognizing that if we make people dependent on medication, then we have an obligation to make them independent of medications, and that's where we don't do a good job. Usually it comes at the end of something very bad happening: somebody getting in trouble, somebody getting caught buying illegal drugs because they can't get what they're used to, or somebody trading drugs to get what they need. Big problem.

Are there pharmacological dangers of overprescribing a lot of drugs in a combat zone?

Well, I would be worried. I'd be worried if somebody was on pain medication or things that alter their state of mind, absolutely. You can't imagine how focused you have to be in a battlefield or in a circumstance like they're in every day in Iraq.

Personally, if I was there, I wouldn't want to be under the influence of drugs. I know in Vietnam there were a lot of guys that were on opium drugs and heroin. It was a big problem in Vietnam, because I think guys accepted the fact that death was imminent, so they wanted to go out and they didn't want to feel it. They didn't want to deal with it emotionally, so [the drugs] were accessible.

In this case, they're handed to them by the medics. It's not as accessible [as] opium and these other illegal drugs because they don't mix with the population over there. It's not like in Vietnam. It's different. I have a lot of Vietnam vet friends who had drug problems, but they got it in Vietnam on the streets.

Kenny Eastridge got his Valium from the Iraqi National Police they were working with.

Oh, well, that's unusual.

And marijuana.

I've not heard of a lot of illegal drugs being a problem in Iraq. The drugs that I am aware of that were a problem were the ones that were handed to them from medics -- the Ambien, the painkillers, the OxyContin. Wow, some really bad stuff. The psychiatric medications, those usually got prescribed by a doc, but the painkillers and the sleep sedatives, those were available pretty much through the medics. ...

This is a quote from the medic in our platoon who said everybody was on Ambien -- everybody: "It was hard to find somebody that wasn't taking Ambien. It helps you sleep, but it also fucks you up. So it's like a legal drug. You get a body high, and you have trouble remembering things. It lowers your inhibitions, all that stuff. They shouldn't give soldiers Ambien in Iraq." What's your response to that?

I'm not going to disagree with that. It is. It has a number of warnings about the drug if you read about. People hallucinate on the drug, and I can't imagine if you're surrounded by weapons and people [and] are hallucinating. It would scare the crap out of me to be in an environment with people that are on those medications.

But [I] also appreciate the need for sleep. So what do we do? You have to control it. You just can't, unregulated, give it out, because then it becomes a recreational thing. ... Somewhere we cross the line between wanting to do good and inadvertently doing bad. ...

That leads me directly to my next quote from another guy in our unit, Jose Barco, who said they gave eight or nine different medications: "Every symptom for PTSD, they had a medication for it. If you couldn't sleep, they gave you something. If you had nightmares, they gave you something. If you drink too much, they have something for that. They were just pulling medications out of nowhere, like a business."

I'm concerned with the pattern that I see of kids that are on six, seven, eight, I've seen as many as 12 medications in some of my soldiers that I work with, and it's very disturbing.

First of all, you question the toxicity to the organs itself. We have young men who are 24 years old. They're being told in 10 to 15 years they'll start suffering organ failure, liver disease caused by these medications. That's a serious concern.

The other thing is that, in my personal opinion, do we need medications? We do, but that is not the answer. That is not the final answer to what we do with these kids. We need to find solutions for what they're suffering from -- real solutions. Medications are useful at stabilizing, but at some point you need real treatment. We need to come up with more readily available treatment programs.

One of my big concerns is we don't have enough inpatient PTSD treatment beds available to our soldiers and our veterans. And I know it. I have a soldier right now who just had a case of road rage, and he ran his car into some poor civilian and then fled the scene, and he's in trouble, and he's waiting for a bed, for a PTSD bed with the V.A. here, and there's no date in sight. And he's been out at the hospital. They hospitalized him for about a week to stabilize him. They did a really good job there, but now he's on this wait, and every day that he waits I am terrified the phone's going to ring and [hear that] he didn't make it to that bed.

So he's in constant contact with me. His job is to call me at least once every day, if not twice, to let me know what's going on, to let me know where he's at mentally, if he's feeling good or he's feeling bad. And I don't criticize him; I just want to know. So I keep a gauge or a pulse on these kids to find out, but I don't know when he's going to get a bed up there.

Andrew [Pogany] and I had a case on active duty where the kid's been waiting four months to get into an inpatient PTSD treatment, and he's been identified at Fort Carson by the medical staff as being a potential sentinel case. If you don't what "sentinel case" means, it means the person is at the risk of death or dying fairly soon ... because he's so psychologically damaged and he's on so many medications that he could inadvertently, accidentally or intentionally overmedicate and kill himself. Yet this fellow has been waiting four months to get to inpatient treatment. In the meantime, he's home free to kill himself, by accident or by intention. ...

And this is happening right now?

Yes, it's happening right now. And I'm not working with this particular soldier; I know of the case through Andrew Pogany. But it's like, wow, if we have a kid we've identified as an absolute risk for sentinel event, that is when you take action. As a therapist, if somebody tells me they're going to hurt themselves, man, I have to step in right then and there. I don't have a choice. I've done that from this desk many times. I've called V.A. and put kids right in the hospital. I had a spouse of a soldier, and I put her right in the hospital. I sent police right to the door at 5:00 in the morning when I got the call. I picked up. I [said], "Hang on a second. I need to call somebody," and I contacted the police. I'm not going to have somebody die because I didn't take action. I may take action sooner than some people, but I'd rather err on the side of being right than being wrong, because if I'm wrong, people die. And I just don't see a lot of that urgency in a lot of other individuals. ...

[Let's] move on to Mr. Eastridge and this crescendo. From what we've been told -- and we've talked with him and lots of his buddies and his mother and his therapist and other people -- that basically he was a good soldier in the first tour. Came back, had some issues. Picked up this domestic violence charge but was deployed again, started self-medicating once he got back to Iraq the second time. Started having disciplinary problems, insubordination to officers, and then came back after being court-martialed for a month, summary court-martial. Was involved in an assault on a woman and then the accessory to the murder of Kevin Shields. What happened in that crescendo?

It's like a recipe for disaster, and the fact is that all the ingredients that led up to the disaster were evident. The domestic violence: A huge red flag should have [gone] off immediately. If I was in a position to be his commander or his supervisor and I get a soldier like Eastridge who served honorably and did well, he comes home and is suddenly having problems -- the first thing is a DUI or a domestic violence or anything -- that should raise my level of awareness. Something is going on. Something uncharacteristic is happening. ...

Specifically with Eastridge, what should the Army have done?

I think they should have definitely evaluated him, diagnosed properly what he was suffering from and then put him in the proper treatment. Had they done that originally and early on, he might not be in prison today. And that is a common theme in a lot of the cases of kids that are in prison today, is that they were not identified, diagnosed or treated, and their behavior escalated. And rather than receive treatment, they receive punishment.

It's the same argument with the civilian courts, that a number of these veterans leave the service under honorable conditions; they finish their obligation, and they come into our community, and they act out. [There is] a case of a young man named Nic Gray -- ... got out of the service a few years ago. Wonderful sergeant. Did a tour in Iraq. Watched people die. Came back. Thought he could handle it. Thought he was doing OK. … They told me he was fit as could be. ...

He left the service, and he went out into our community to live his life, and within a few short months starts from PTSD. At first doesn't know what the heck is going on but recognizes that he's got a problem, goes to V.A. He starts receiving treatment. He's out of the service. Never got treated for it in the service. And he's doing OK. He's struggling with it. Has a lot of issues. One day he's on the phone talking to an Army buddy, chitchatting about his experience in Iraq, and he's sipping one glass of wine. And he nearly drank that. The next thing he's found three blocks over in his pajamas kicking in some poor civilian's door, trying to clear the house, trying to clear the insurgents. Total spontaneous flashback. Never treated for PTSD in the Army.

Part of that [is] stigma, because even though he knew he was different and felt some issues in Iraq and had some problems, he never reached out for help till it became a real problem. But in Eastridge's case, there was ample evidence that this kid had something going on, and I think they have an obligation to figure it out. I think the responsibility is to try to fix every one of them if they can, and if they can't, then, with dignity, retire them and give them to V.A. to get the proper help, and make sure they get there.

In August 2007, Eastridge had these charges against him for threatening an officer, and before they started the summary court-martial they had a mental health professional in Iraq evaluate him. Said he had chronic PTSD. They gave him the summary court-martial. They sent him back to Fort Carson.

Unconscionable. Unconscionable. They diagnosed the kid with PTSD, and he acts out, and you know he has PTSD. It's unconscionable to punish him for the injury that you caused.

It almost goes to the argument of self-defense. If I act out because you've injured me, isn't that self-defense? Doesn't that meet some sort of definition that aligns itself with self-defense? Being injured by the people I'm serving and then I act out -- it's just unconscionable. I can't even pretend to answer the question why that would occur. To me it would have to be sheer ignorance. And we're not that ignorant.

But they would say it's not ignorance. This guy is not a good soldier anymore. He's not the soldier that he was the first time around, and he's a bad apple. That's what the first sergeant told us: He was a cancer; we needed to remove the cancer.

No matter what, even if the Army or his first sergeant thought he was a cancer, this is a kid who honorably served, and up until that point they got every bit of use out of him, and then when he started to act out, what they owed that kid was help, not a kick in the ass by court-martialing him. All they did was add insult to his injury, and that is inexplainable [sic]. That is ignorance. It's ignorance to say he's cancer and not ask why. It's ignorance to say he's cancer and know he served honorably in his first tour and then started to come apart. It is ignorance because there is no other explanation for that, and I'm not going to offer one. It's simple as it is. ...

It goes back to accountability. Kenny Eastridge is going to serve [10 years in prison]. ... The other guys are going away for the rest of their lives. ... They have responsibility in that, ... the folks that denied him treatment. ...

With the domestic violence charge pending against him, should he have been deployed to Iraq?

Under the laws of Lautenberg, no. When a person is charged with domestic violence, the Lautenberg [Amendment, or the Domestic Violence Offender Gun Ban], which is a federal act underneath the Brady Bill, kicks in, and even while the charges are pending, an individual is restricted from carrying a firearm, here or anywhere.

So, by law, if you're charged with domestic violence, you cannot be a police officer and carry a weapon. You'd sit at a desk. You can be a soldier, but you can't carry a firearm. And one of the absolute basic tenets of being a soldier is being able to carry a weapon. You would not unarm a person and send him to Iraq.

So with that pending against him, how could the Army have sent him?

They should not have sent him. My opinion is an individual [who] is charged with domestic violence cannot deploy.

In your opinion or in a court of law?

In a court of law. Now, has it happened? I knew of some cases, yes. I know of some felony cases that are -- when you are charged with a felony, you can't have a firearm. Convicted felon in possession of a firearm is another crime. And yet I do know of cases as we speak of people that are on active duty getting ready to deploy, and they're convicted felons.

And [I'm] not going to disclose because I'm happy that the person is able to maintain their job and serve their country. I'm not saying whether it's right or wrong. But the fact is, when we go back to the fact that somebody is charged with domestic violence, what it says to me is, should we deploy them, morally? Forget the legal question; let's ask the moral question. You've got a problem with somebody acting out violently, inappropriately, and now we're going to deploy them into a violent environment. I'm very concerned.

[Eastridge] wanted to go back.

Absolutely. I hear it all the time. Kids with PTSD want to go back. Soldiers do what soldiers do. They want to be with their troops. People that have been injured catastrophically, amputees, they all want to go serve again. Every kid that comes in my office to visit me, almost 100 percent will sit here and say, "I wish I could go back."

But is that the proper thing to do? ... Would you put yourself back into an addictive environment? These kids want to serve with their comrades, their friends, but you know as professionals -- the Army has medical professionals, and their judgment should say no. All we're going to do is further damage the chance that you'll recover.

Some people can go in there and serve three or four tours, and yes, they're probably going to get PTSD, but not near as bad as somebody who might have experienced one tour. But when somebody has been catastrophically damaged from a tour, they should not return ... to that environment. Even if we're able to stabilize them, get them healthy, until we come up with a treatment program that absolutely removes the effects, cleans the slate, kind of tabula rasa for that individual, we don't have that. We don't have a medicine. We don't have a therapy that creates that tabula rasa for somebody that has PTSD. So we're running a huge risk by putting them back out there, even if they want to. ...

And the Army needs the bodies.

And they need the bodies. I understand the constraints on the Army. They have a job to do. And if you come and volunteer yourself, even though you're broken -- I remember sitting with Andrew [and] with a commander, and he was questioning the soldier. He was begging to go back, and this was a very, very wise commander who says, "Son, I'm very worried about you going back." ... He had a domestic violence case. It got taken care of; it got dismissed. But it was enough for this commander to know he was a very good soldier who acted inappropriately and uncharacteristically, and he knew he had a problem.

And he says, "We're going to see." He didn't promise anything. He said, "We're going to see how you progress in mental health" before he redeployed that soldier. But it's one of the first few times I actually saw a commander who acted in a way that I thought was 100 percent the way it should be. ...

That's a pretty big indictment of the Army if that's one of the few times you've seen that.

Unfortunately, I usually don't see the good cases. We see the bad cases. ... So I'm not so sure it's an indictment on the Army or just a case of -- it's like judges would say, "All I see are bad people; the world must be full of bad people." Not true. We just work in that arena.

Let's move on to TBI [traumatic brain injury]. ...

It's really daunting to understand TBI. What a subject. I've learned to [expect] one expert who contradicts another. So it just depends who wore a pretty suit that day: I'm going to go with you and not the other one. Science is still way behind, I think, on TBI.

There are a number of guys in the platoon -- a lot of them ended up with Other than Honorable discharges who probably had mild TBI along the way, certainly not treated ever. Eastridge got blown up at one point. His ears were ringing, he had clear fluid running out of his ears, and they just went back in the war.

This is [an] absolutely fascinating part of medicine today, these brain injury cases. I've sat in on experts in seminars. ... You have to be very careful when you say mild, moderate, severe [TBI]. What does that mean? I say, don't concern yourself with any of that stuff, but concern yourself with the behavior that presents. If you have an event where somebody has suffered a blast injury and they are acting uncharacteristically and uncannily and they're acting out behaviorally or ... they're having symptoms that are consistent with a brain injury, you treat it.

The problem is, what do you do for them? Typically what I see a lot of is medication. There is cognitive therapy. If you test somebody and you determine they have cognitive deficiencies, you can retrain parts of the brain to basically to pick up the slack where other parts don't. It's kind of a rewiring of the brain. But the oxygen therapy is hopefully going to rejuvenate those damaged parts. And that's the theory behind that, is to rejuvenate those parts that are damaged.

I think we're still years away from really, really being able to address TBI issue properly. Lots of research on it. I'll say that this war has really brought brain injuries to the forefront in this nation, because I don't know how many cases there are of brain injuries, but it's a very common injury in this country, and there's been a real lack of research because of dollars. And because of this war, we're now seeing a lot of dollars being poured into brain injury research.

So it sounds, to us at least, that a lot of these guys in the platoon, their TBI issues really fell through the cracks. Do you think that still would be the case today, or has that situation changed?

I still see cases where TBI cases fall through the cracks. ... There is that consensus out there that mild TBI will treat themselves; they'll heal themselves, and it shouldn't be a major issue. But in fact, I see symptoms that mild TBI cause major impediments to people's lives, and left untreated it often turns into the Eastridge cases and these other kids. I have no doubt it played a role in that.

The lawyer in Barco's case, in the sentencing argument, talked to the judge about TBI and that he'd had it as a factor in contributing to his violent behavior.

It's very tough. These are called the hidden wounds. Brain injuries are very difficult, for intelligent people included, to really appreciate. It takes a little wisdom to understand that we might not necessarily see that physical injury. I mean, if you walk into a courtroom and you're missing your leg or both your arms, judges are overly sympathetic. They get that. But when you walk into court and you've got two eyes, 10 fingers, 10 toes, you're dressed nice, the judge can't necessarily appreciate that you're suffering from a brain injury, much less that that brain injury caused you to do something violent.

Very often, especially if it's a frontal lobe injury, you have impulsivity. We have people that act out violently. And that's our whole argument for this veterans court. If we can make that linkage between the brain injury and the act, and we can make that intelligently and articulate that, then how do you hold that person accountable? Is he a willful criminal, or is he a broken person with a damaged brain who's acting the way his brain has now been left to act and to tell the body to act?

How would you go about making that linkage with someone like Jose Barco, who clearly had concussion, brain injury, TBI, and gets angry and shoots up a party and wounds a pregnant woman?

I would imagine in this fellow's case he was drinking at the time, too -- another disinhibitor for the brain. So now if you have a brain injury and you're adding a chemical disinhibitor to yourself, you're now really escalating your chances of acting out violently or stupidly. How do you answer that?

Some folks would say, well, he willfully drank the alcohol. Possibly. But in many of the cases with these kids, we know they're self-medicating. ... How do you answer that question? Is that it takes a little bit of education? It really does. And that's what I often do. I go to court, and I explain to judges, does it remove the criminal act? Does it make it go away? No. I can't heal the person that got injured, ... but what I can do is intelligently explain through brain scans, through neurophysiological testing, through clinical counseling assessments and psychometric tests, I can come into court and I can, with some level of science, say, "This individual is damaged." Better yet if I have some of this before you deploy and I can show that you suffered a loss in that battlefield.

Pre- and post-deployment screenings are being done. So we're getting some of those now. Didn't in '04, '05, '06, '07. I want to say in '08, I think the Army started pre- and post-deployment testing, cognitive testing, which is, wow, that's tremendous. And it gives us an absolute concrete history. If you come back and you have cognitive deficits, if you have behavioral issues, we can now attribute it to this war. ...

If we don't have a pre- and post-, then we have to rely on friends and family members [for] what we in our business call collateral information to determine, is this person acting characteristically or uncharacteristically? And the cases we've worked and stood behind, they're uncharacteristic.

In Barco's case, when the judge sentenced -- and the judge was a pretty smart guy, and he was listening to the stuff -- he said: "You are a dishonor to the uniform that you're wearing. You bring shame upon it because you have to be held responsible for your actions, and your actions that night were reprehensible." Fifty-two years.

Sounds very good politically. Sounds good to the public. Being tough on crime is always the winning thing. It takes courage, and it takes courage for a judicial system to say like the judge in the Thomas Delgado case said, "Son, you're a hero." He didn't call him a dishonor to his uniform because he harmed his wife. What he told [him] is: "You're a hero, and you have to remain a hero. And [the way] you have to do that is to get help. And you need to stay in the programs, complete them. You need to do what you need to do to get healthy."

I commend a judge like that, who has the wisdom to know that this is not a criminal. This is a hero who acted criminally. There is a difference. ... What makes him a criminal is if he continues to do it, refuses all help, absolutely fails at every attempt to help him. Then when all that's happened, then maybe we say now you've become a criminal.

But by locking him in a prison, that judge made that kid a criminal. He will forever be a criminal. For the rest of his life, if he's ever lucky enough to come back out into society, he will be a criminal, because now he has not received the help he needed, and now he's been exposed to an environment where criminality is an everyday event, just like war was for him when he was over in Iraq. So there won't be any deprogramming when he comes out. There will just be his instinct to survive left, so we've now created a wholly dangerous individual. So the public might feel safe, but someday he might come out. How safe are you going to feel when he comes out? ...

It's easy to play the blame game. ... But when you find kids who join Army or the Marines or any of the branches and they serve honorably and come home, and they just completely disintegrate mentally and physically and act out, you don't have to be a psychotherapist; you don't have to be a medical doctor. You could just be Mom and say: "Something is wrong here. Something caused this to happen." ... We know what caused it: the trip to Iraq or Afghanistan. It's not a difficult thing to understand. It's just a question of whether we morally want to accept it or not. And my opinion, that's where we're failing. We're not morally doing the right thing all the time.

Why not? Why don't we morally want to accept it?

There's not enough people fighting for this cause. Let's face it: It's not popular to go into a courtroom where somebody has been injured and say, "Wait a minute. Don't put this kid in prison. Don't put this veteran in prison," because you know somebody has been injured and somebody wants that pound of flesh. ....

Let's face it: If it was your daughter that suffered a brain injury at the hands of some veteran who beat her, you'd want that pound of flesh. You really don't care why that veteran got there. That's not your concern. You want him to pay. But it's somewhat of a shortsighted, selfish emotion, because ultimately he'll come out. Most of these guys come out of prison, ... and we know when they come out that they're not going to be better, and we're pretty sure they're going to be worse. ...

Talk just a little bit about suicide. Big issue, increasing numbers. How are you dealing with it? How is the Army dealing with it? ...

Is the Army doing something about it? Yes. Recently Fort Carson implemented -- I attended a seminar for command to educate them on suicide and what leads up to suicide. Tremendous presentation. The question is, has that come to fruition in terms of programs or pieces? There are some suicide prevention programs that have been implemented recently with soldiers and with command, and is it effective? Not yet. I think the numbers are still climbing. So obviously the program has not been effective.

Some people might argue the numbers could be higher. We've prevented this number; instead this number has occurred. Here's my real concern: ... Preventing suicides is a multi-pronged effort. Needs to be. We need to educate family members. We need to educate commanders, NCOs [about] what it looks like. What are the identifiable factors that lead to suicide?

There is a lot of them that are available to the military to see. ... A lot of the cases that I've seen suicides, there were signs. They were evident. And it was sad because they were ignored, just like in the Eastridge case, where it led to a homicide. ...

I sat in a meeting where a commander says, "Well, the Army just found out that the main cause of suicide is divorce." I sat there, and I just had a grin on my face. I thought, wow, it can't be that simple. That's really crazy to say that. Yes, a number of soldiers are getting divorced that have committed suicide. But it goes back to what I keep saying. You've got to keep asking the why. Why is that soldier getting divorced in the first place? Why do you think the family is disintegrating? Is he just a bad husband? The fact is that, in a lot of these cases, they had PTSD, and they weren't getting proper treatment, or the treatment wasn't working, or they were substance abusing, or they were acting violently because of their PTSD. And then their wives left them, and it was the proverbial last straw. And that's what's really driving the suicide rate. ...

I have a recent case where a soldier that I know ... was just [sitting] in my office two days ago, going through a divorce. They diagnosed him with adjustment disorder, and they're chaptering him out, kicking him to the curb. And the kid just got hospitalized for suicidal ideations. You want to know what drives suicide up? Right there. And to me, [an] absolute indicator of suicide is hopelessness. In the case of this young specialist, his wife has left him, and now the Army has left him.

Why are there so many more hopeless soldiers now than there have been in the past?

I think we've got a lot of soldiers walking around with PTSD, and one of the components of that is depression in a lot of kids, anxiety, depression which leads to a hopeless state to begin with. And even if it's manageable at some level, if you continue to pile on the hopelessness by now punishing and taking away the individual's job and then maybe now the family is disintegrating, more hopelessness [is] added to the hopelessness. So we keep piling that hopelessness up to where an individual has no strength left to hope that tomorrow is going to bring a better day. ...

I can't just magically wave a wand. But if I could do something, that would be to prevent that loss of his job. To a lot of soldiers, the Army is like family. It's like family to them, so imagine your wife leaves you, and then your other family leaves you. And it is absolutely a big factor, I think, in a lot of the suicides is that we find kids who have been ridiculed. We find kids that have been punished instead of treated. Their mental health has been mismanaged, in my opinion, and they felt no other way out other than to take their life.

Some of the suicides were people who become hopeless because of drug addiction. They've been hooked on some powerful narcotics, and they abused. And they were suffering depression, and whether it was accidental or intentional, it sometimes is hard to know. ... But it goes back to, why are they on that kind of medication? Why do they have that kind of availability to that kind of medication, and why aren't we recognizing that they're in this trouble?

The EPICON [epidemiological consultation] report [PDF] that came out in the summer of 2009 supposedly was there to look into what had happened in the past and raise some awareness and come up with some suggestions and ways that things can be different.

That's an extremely difficult question. If they've gotten better, they're not near better enough yet, that's for sure. I think that there's still humiliation. I think it comes back to accountability. When people humiliate these soldiers, there's no repercussions. ...

One of the cases that I'm working on right now [is] where the soldier is in mental health and getting help in the unit, and his NCO called him out in front of the squad and humiliated him, told them he was a mental health patient. That's awful. That's awful. We identified this person to the command, and I've yet to hear that anything has been done about it.

But this has been pretty common practice. It's sad if it occurs. Is that the Army's policy? Absolutely not. But sadly, if you make a policy and you really don't have any way to enforce it or to hold people accountable to that, or you refuse to make people accountable, then you really become ineffective. I think that the Army really needs to hold people accountable who do those kinds of things that deny mental health care, that humiliate soldiers. ...

In my opinion, that's where the study absolutely failed and that it should have identified those people that consistently acted badly. We have individual providers that we know are consistently a common denominator in bad cases -- commonly misdiagnose, underdiagnose, wrongfully diagnose service members, and yet nothing happens. Nothing. ...

And people make mistakes. I get it. I'm not perfect. This is not a science; it's an art. When you get into mental health, it's an art. We have to deal with the facts that are given to us, and we have to make some type of educated guess, sometimes, as to what's going on. But you need to do that not in a vacuum. We need to do that in absolute exploration of what's going on, going back to asking the "Why?" It takes a lot of time. In fairness, maybe they don't have the time over there to call up family members to find out what kind of person Johnny was before Johnny joined -- you know, "Did he do this? Did he do that?" ...

I hear the problem [is] a lot of these clinicians have tremendous caseloads, not just there, V.A., [but] everywhere. They're overloaded. It's not fair. I carry 80 kids on my caseload. That's a lot when you're dealing with seriously injured people. And I want to serve all of them, and I don't want to turn any away. But I also recognize that I'm not able to give the right kind of care. And it's not by choice. It's just the reality of where we're at. We need more money. We need more help. ...

Some of these decisions are based on the finances and the economics of it. Here's an interesting thing: So many of these kids today that are coming out of this war, the cost will be staggering in the future to our government. … I've got kids that are easily going to be million-dollar cases, that require well over a million dollars in care. And when you start to look at tens of thousands of kids, maybe hundreds of thousands ... that could be impacted by this war, and if they cost a million apiece, do the math. We have a major, major storm coming. And health care, it's already what, 17 percent of our economy, our budget for the government? I can't imagine what it's going to cost at the end of these wars. ...

There have to be major factors in the decisions that go on in Washington. And I'm not privy to those, but I am smart enough to understand that this is a basic economic question.

What's the question?

The question is, what do we treat? What do we do, buy bullets, or do we create treatment programs, long-term care treatment programs for these kids? It's just like [V.A.,] when it takes months to get into an inpatient treatment program, it tells them that they need more of them. But yet we're not building new hospitals; we're not building new treatment programs to fill the need. So there's some constraint on the finances, and I think it's probably the cost of [maintaining wars]. ...

My impression is that [Evans U.S. Army Community Hospital in Fort Carson] was under huge stresses, 2007-2008 -- just didn't have the staff to deal with the scale of the crisis. It's essentially in chaos. Do you think that situation's improved?

2006-'07, absolutely. Col. [Brandt], he said it openly himself that they were woefully short of providers, very, very short and having a hard time filling them, for whatever reason. I think that they're still woefully short, and how I know that is that we're still relying on care in the community. When the Army can't meet a need, then they go to the community, and until they have capacity to serve all the kids that they have over there, all the soldiers, they have to rely on the community. The community's pretty involved in treatment because there's not enough providers still.

Even the civilian community is probably reaching capacity. We're just getting ready to see 2-12 [Infantry] come back again, a large wave of soldiers returning from their third tour, I believe. 2-12 is now coming back from its third tour, and we're at capacity now, and we're all wondering what's going to happen. It's a scary thought, what's going to happen in this community. Are we going to have more murders? Are we going to have more suicides, or are we going to have more crime? And I think the answer to that is probably yes, and we're going to have kids waiting for treatment that need it now.

It's not OK to tell somebody who needs treatment, "You've got to wait two months to see a psychiatrist." It's not OK to tell a kid who needs treatment two or three times a week -- if that's what it takes to keep him from committing suicide -- that we can only see you once a week, or you'll have to go somewhere else; we'll have to wait for your doctor to approve treatment somewhere. That's crazy. ...

[Can you talk about combat medics and what you've seen when they come back?]

I lost a Marine buddy of ours who was a combat medic from Vietnam who drank himself to death a couple of years ago. He was one of our Marine Corps elite buddies, and he was a Navy doc. This was years ago when I knew Doc and that combat medics are unique and that they suffer multiple psychological assaults. They suffer the loss of comrades and friends that they become attached to in the units, because they're assigned to platoons, and they get to know these guys. They've got to work with them, and then they suffer an injury like a gunshot wound, and that's bad enough for everybody in their unit to experience that one of their fellow soldiers got shot and maybe even died.

But then you're the combat medic who has to work on that individual, and you're desperately trying to save them, and you lose them. So now you have the same psychological damage of losing a buddy and then being responsible, thinking, wrongfully probably, that you failed to save his life. And not only do they treat their fellow soldiers but civilian casualties, children. They're the ones that are tasked with taking care of them, and the toll has been horrific, and most of my worst cases that I've run across over the years within combat medics, the suffering that these guys go through, these gals, is phenomenal. And I've had female combat medics, so they've all suffered equally.

It is very common to see these guys widely and seriously affected by PTSD. They scare me. If you choose that MOS [military occupational specialty], I think you choose your fate. There's no doubt in my mind, and it's impossible not to experience that. Doctors have one of the highest suicide rates in this country, and most people don't know that, medical doctors. The correlation with our combat mates is probably right along with it, and there's an absolute reason for that. So those are guys you have to watch really closely and [really] pay attention to -- and not that they get special treatment, but that is to recognize that their experience is going to be probably a little more severe than just everybody else.

You said a few minutes ago that 2-12 were about to come back, and your people are worried about what's going to happen. … We're about to have another 3,500 soldiers come home. …

It's a brigade combat team [BCT] coming back, one in particular that's on its third tour. One of the concerns in our community today among people that work with these kids [is that] ... a brigade combat unit of several thousand soldiers will be returning from Iraq here, sometime in March, I believe, and this is their third combat tour.

This is also a combat team that has been the single highest source of homicides in our community, identified specifically from a unit known as 2-12. So I think there's a lot of folks that are sitting on edge waiting for them to return, and we're hoping for the best, and we're preparing to give as much service as we can to prevent a repeat of some of the things that have occurred in their previous returns from the war zone, so we'll see how this works. ...

I think we'll have a little bit of everything again. Hopefully won't be as bad as the past, but still, if it's half as bad, we're going to suffer some experiences that, in my opinion, are a direct result of the war.

And what did it do to the community?

That's a question that all of us asked. Right now, Colorado Springs is a wonderfully supporting community, but a community can only take so much before they turn. In the case of Nic Gray, the victim ... called [him] "one of the crazies from Fort Carson" -- [that] was the quote in court; that when they first heard somebody kicking on their door, they thought "one of the crazies from Fort Carson" was loose. So that kind of mentality, that we're creating "crazies" over there, is what the fear is, that there will be a backlash against these kids for what's happening.

Fortunately, there's a lot of good education to the public. They're becoming more aware of PTSD -- what it's like, what it causes -- so we haven't reached that point where there's been a backlash yet, but there are a number of people that say, "Hey, is there a problem?" The Army's causing it, and they're angry. And it's an arguable question. Are they? Are they not?

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posted may 18, 2010

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