Slowly, very slowly, Thomas Staskal is coming to grips with things he saw and did in Iraq. He is depressed, anxiety-prone and has an acute fear of crowds. Since returning home to the Green Bay area in November 2005, the 25-year-old Army reservist has lost three jobs and flunked out of college. Common things, like a flash of lightning, can induce the shakes.
'I used to have dreams where I was chased by the people I had to kill in Iraq,' he says, over doughnuts and milk at his east-side Madison apartment. 'I no longer wake up from the nightmares, but the panic attacks are getting worse. One of the problems is that I'm angry, but I don't know at what.'
Rarely is a soldier's return seamless, but for battle-weary vets like Staskal, post-traumatic stress disorder can crash their landing in the civilian world. PTSD is caused by a traumatic event, witnessed or experienced, often involving the threat of death or grave injury.
Symptoms include acute anxiety, isolation, intrusive thoughts, emotional numbness, depression, nightmares and, in extreme cases, flashbacks and thoughts of suicide. For some, pills and therapy can spell relief. For others, treatment does little, and the disorder becomes a psychic wound, one that can bleed for a lifetime. Staskal, whose treatment has reached a critical one-year window, worries that he'll never get better.
'What's the alternative?' he asks. 'You deal with it the best you can. Is it depressing? Yeah, it's depressing to think about dealing with this for the rest of my life.'
The National Center on PTSD reports that 40% of those who've fought in Afghanistan or Iraq have or will acquire this disorder. These rates have already eclipsed the 30% lifetime rate of Vietnam vets. The rise is attributed to longer, more frequent combat tours and to the nearly 96% survival rate of seriously injured combatants due to advances in battlefield medicine.
More than 6,000 state soldiers have returned from active duty in and around Iraq or Afghanistan, according to Col. Tim Donovan of the Wisconsin National Guard. This does not include soldiers from other branches of military service.
The military, rocked by emotional fallout from the war in Vietnam, is paying unprecedented attention to the problems mental injuries pose to war-zone morale and the domestic life of soldiers after they return. Dozens of studies have been ordered on the effects of combat stress and related disorders. Neuroscience has begun explaining the biochemical mechanisms behind PTSD. And innovative therapies are being tried at many Veterans Administration hospitals, Madison's among them.
Bob Kelter, chief of social work and chaplain services at Madison's VA hospital, has counseled an endless stream of returning troops, many of whom have maladjustment problems.
'Our realistic goal in working with someone here at the VA is to reassure them that they're not crazy, that these abnormal and unbelievable human experiences actually did happen,' says Kelter. 'As much as they can't imagine the world operating that way, that it is real, and their survival is real.'
Dealing with the aftershocks
Thomas Staskal was raised in Tisch Mills, a small, unincorporated town south of Green Bay. He joined the Army Reserve at age 17, and was trained as a water purification specialist. But on arriving in Iraq, Staskal learned that this job had been contracted out to a private company. He was given a larger gun and put on a protection and escort detail. Some convoy gunners panicked in battle and didn't fire their weapons. Others didn't stop firing them. But Staskal was coolheaded. Because of this, he was often assigned the more dangerous daytime missions.
The incident Staskal believes triggered his PTSD occurred in April 2005, when his convoy came under attack in a town near the Syrian border. As he returned fire, the Humvee driver abruptly swerved to avoid an object in the road. When the vehicle hopped the curb, Staskal was bounced up in the turret. Consequently, his weapon swiveled downward and cut down a 6-year-old Iraqi boy.
The killing ' 'collateral damage' in military parlance ' rattled Staskal to his core. Once a confident gunner, Staskal told his lieutenant he could never again pull the trigger. Back at base, he cried often, and was seen by some as unfit for war. He met with military psychologists three times a week. Ultimately, he was put on chow hall detail, withdrew from his comrades and served out his tour honorably.
'I'm a soldier,' he says, his voice choking up. 'Rationally my actions justified what I did, and I'd do the same thing again in the same situation. Emotionally, though, I can't justify the killing of a kid. Especially with my values, which say children should be protected to the utmost.'
Many soldiers simply absorb combat stress and slide into a normal life. Others are hit hard by the aftershocks of trauma. They come home with high expectations, only to find themselves unhappy and upset. They struggle to relate to others once close to them. Those with strong family and social networks tend to get better faster. But, too often, family and friends don't associate behavior with symptoms of PTSD. For vets with PTSD, life can quickly become agonizing and lonely.
'They often say they feel empty inside ' nothing really makes them happy, nothing really makes them sad,' says Tracy Smith, the Madison VA's clinical director for post-traumatic stress disorder. 'If someone comes across as flat and nonresponsive, that can be troublesome.'
Pushing beyond it
For Madison Reservist Patrick Wilcox, 26, the first year back was the toughest. The Memorial High graduate never saw combat, but daily confronted the horror it produced. For nearly 17 months, Wilcox worked in a hospital in Balad, about 50 miles north of Baghdad. Seeing soldiers ' and more often, Iraqi civilians ' torn open from bomb shrapnel or gunfire was as regular as the meals he ate. Many of these casualties died from infections.
'One day we had four people come in after their Humvee flipped into a river and they drowned,' he says. 'Another day, a little Iraqi boy came in who'd been shot. He lived, but I mean, it's hard to see that. You'd see a lot of that stuff every day.'
Within days of coming home in November 2004, initially to stay with his father in Madison, Wilcox began feeling depressed, guilty and was unable to focus. But there was little time to sulk. He had to find a job, an apartment, buy a car and get his papers together so he could begin college. But no matter how busy he kept himself, Wilcox couldn't shake the memories of war.
'I just felt bad, I really did,' says Wilcox, who hasn't been diagnosed with or treated for stress disorders. 'There are some days, even now, where I feel really bad about things and others when I really miss being there, which is weird. You get a lot of those mixed feelings.'
Shortly after returning to Madison, Wilcox enrolled at Edgewood College. But he had trouble concentrating on his studies, and felt resentment toward classmates who seemed indifferent to the war.
'Not that I expected them to understand, but it's the fact that people seemed like they didn't really care,' says Wilcox. 'Maybe that's not the case, but that's how I felt. You're just very angry and for no real reason.'
Wilcox, a button-wearing member of Veterans for Peace, survived the semester, and is still pursuing a degree in nursing from Edgewood. He has spoken about his time in Iraq to high school students. He wrote an essay about his experience for the new book Long Shadows: Veterans' Paths to Peace, which features memoirs by 19 local vets. Wilcox says sharing with others what war is like helps him push beyond it.
Staskal's first postwar semester, at the UW-Green Bay, was more disastrous. Depression kept him in bed, and anxiety kept him from the classroom. His grade-point average plummeted, and he dropped out. Now in Madison, Staskal is enrolled at Madison Area Technical College, hoping to improve his grades and transfer back into the UW System. He still battles with PTSD, trying to manage his symptoms, realizing they may not go away.
'A lot of people never get cured or better,' he says. 'They simply learn how to deal with it.'
The VA to the rescue?
When 800 members of the Wisconsin Army National Guard returned to Fort McCoy last month from Kuwait, Bob Kelter was on hand and spoke to many of them. The VA hospital's point of contact for soldiers being transferred out of the military's health-care system, he oversees many of its outreach programs. He receives up to three inquiries a day about mental health services, often from soldiers' spouses.
'What we're doing here is an unprecedented outreach effort to reach vets fairly early,' says Kelter. 'One of the major problems with these maladjustments is that there's the sense, 'I must've been wrong. I screwed up.' Unfortunately, as you become invested in saying, 'I did something wrong,' you invest in guilt and lowered self-esteem.'
When speaking with vets, Kelter tries steering the discussion toward uplifting subjects, like their competency as a soldier and the value of survival. But bad memories aren't easily left in the war zone. As Staskal and Wilcox point out, homecoming engages soldiers in a different kind of battle. And too often, the military isn't there to help.
'If you call the Army, they'll tell you to go to the VA,' says Wilcox. 'We're lucky in Madison that we have a good hospital, but a lot of people don't live near one, and maybe they can't get there because they just got home and don't a have a car. There's got to be a way to follow up with people, 'cause that's when things get real bad, once you realize there's problems that come along with being home.'
In other words, just because help is available doesn't mean it's always accessible. Staskal moved from Tisch Mills to Green Bay not only for college but to be near a VA hospital. Unhappy with the level of care he received, he transferred to the VA hospital in Appleton, where he was given one hour of therapy every four to six weeks. Even then, Staskal recalls, 'They didn't really want to talk about what I wanted to talk about. They just wanted to prescribe me more medicine.'
Some soldiers fear that seeking psychological treatment might have repercussions, both in terms of their military service and civilian life. In fact, the Army's first war-zone study, conducted in 2004, showed that roughly 32% of soldiers who felt therapy would help them were afraid to seek it.
'I think there was a generation of military men who would say psychological stuff is for cowards: Have a drink and forget about it,' says Kelter. But he thinks such attitudes are less prevalent today. 'I don't see it now. I sense a genuine concern.'
As understanding of post-traumatic stress disorder has increased, so has the scope of the problem. It's estimated that 72,000 vets currently receive a disability pension for PTSD. And the VA has seen a 30% increase in PTSD claims over the last few years.
This presents serious challenges to the military, which is supposed to discharge those diagnosed with mental disorders. Because doing so would weaken the ranks, it has taken to treating war-fatigued troops on the battlefield, then returning them to battle. And, with so many soldiers seeking discharges, the military has made it more difficult to win mental health disability claims.
Staskal and his girlfriend moved to Madison in August, just before the start of the new school year. When he tried enrolling at the local VA hospital, he learned that transferring his file from Appleton would take 30 days. After that, he'd be put on the waiting list. Meanwhile, time was running out on the two years of VA benefits that reservists are given.
'If you are on active duty, there's a lot more help,' says Staskal. 'The reservists get shafted. I don't function 100% and the Army should help me, but they're not. You can't just use us then leave us out to dry, which seems to be what's happening.'
The symptoms of post-traumatic stress disorder have been described since the wars of antiquity, but weren't accepted as a disorder until 1980, when the illness debuted in the Diagnostic and Statistical Manual of Mental Disorders. Overall, it's estimated that 30 million Americans will experience PTSD-like symptoms sometime in life. And the disorder, because it's not well understood, is difficult to treat. But not impossible.
'If you look at rates of success for treatments of PTSD relative to other disorders, they're actually quite good,' says Smith of Madison's VA hospital. 'My personal mission is to reach these vets early and get them into treatment, because we can make a big difference in terms of its trajectory.'
Over the last five years, neuro-imaging has shown that key parts of the brain function irregularly in victims of post-traumatic stress. But the findings are ambiguous.
'We don't understand if the brain abnormalities are risk factors or are consequences of trauma,' says Eileen Ahearn, a psychiatrist at Madison's VA hospital. 'Because we don't do pre-stress studies, we can't say what a person's brain looked like before.'
Parts of the brain that regulate fear and reasoning fall out of sync, producing a confusion of raw feelings. The inability of the brain to discern safe stimuli from those representing actual danger leads to a variety of hyper-arousal symptoms like anxiety and undue vigilance. Crowds, car wrecks, thunder and the evening news are among the events that can trigger panic attacks.
Drugs designed to treat psychoses, depression and anxiety can remedy or offset these chemical imbalances. Some blood-pressure drugs have been found to quiet the nightmares. How the medications work is just as mysterious as the disorder itself. Finding the most effective ones requires time, patience and a little luck.
Therapy can address how the trauma is remembered. Madison's VA hospital has embraced an innovative cognitive processing therapy that helps soldiers reconstruct their traumatic experiences in a more positive light.
'Therapies work because it's changing the reaction, how you think and how you feel about it,' explains Smith. 'A big part of it is your rules and beliefs, how they've changed since the event and how would you like them to be.'
This approach was developed 15 years ago to help rape victims, but has been increasingly used with combat vets. It involves talk therapy ' vets meet individually with psychologists once a week for 13 weeks ' as well as homework assignments, which often require vets to write about their traumatic experiences.
'We ask people to read it every day. And then when they come into session, we ask that they read it to us,' says Smith. 'The writing part makes it easier to titrate how upsetting it is to you, because you can stop, you can put it down, you can put it away.'
Through the redemptive powers of the written word, vets learn to deconstruct and rebuild their memories. The goal is that, over time, vets will ascribe different, more positive meanings to them.
'People can get better,' says Ahearn. 'We have seen it with the cognitive processing therapy. They may have some minimal symptoms, but they're getting better.'
Learn all about it
Not long ago, on a drizzly Saturday afternoon, 12 people arrived at the Labor Temple on Park Street for a screening of The Ground Truth, a heartbreaking documentary that follows five Iraqi war vets from boot camp through to their hard return to civilian life. By the end of the film, most of the audience was crying.
Jane Jensen, whose son has served in Iraq, organized the event. As founder of Military Families for Peace, Jensen is trying to bring awareness to the PTSD issue. 'It's just awful what these troops go through when they get back,' says Jensen, whose group has grown to more than 200 members.
Countless Web sites have sprung up bringing awareness to the effects combat-stress disorders have on soldiers and their families. The online journal ePluribus Media lists 128 news articles from 2002 to present, highlighting crimes and suicides committed by former combat vets. About 90 combat soldiers have killed themselves since October 2001, and at least 30 have been charged with homicide.
A definitive work called Flashback: Posttraumatic Stress Disorder, Suicide and the Lessons of War, was recently published. The author, Penny Coleman, watched her husband wither away from the disorder for years after returning from Vietnam, until the day he killed himself.
Government studies continue as well. A major study currently under way requires post-deployment mental wellness screenings of all returning vets. And Madison's VA hospital is part of a cooperative study looking at how a specific drug eases the symptoms.
'There's been huge movement to really attend to the mental health needs of soldiers,' says Smith. 'There's a lot of suffering with these illnesses. If people could just pull themselves up by the bootstraps, they would.'
Not a day goes by that Staskal and Wilcox don't think about the awful things they saw in Iraq. War has changed them, and there is no changing back.
'I forget stuff or I just kind of don't do what I should be doing. I just kind of blank out,' says Wilcox, who has received an honorable discharge. 'That's how I react to it, and I don't like that. I don't want it to affect me that way, but I don't ever want to forget the things that happened. It's strange that that was my life for a good amount of time.'