Mentally Unfit, Forced to Fight

Some soldiers now serving second tours in Iraq say they are wrestling with debilitating PTSD symptoms, despite being placed on medications.

Jason Sedotal, a 21-year-old military policeman from Pierre Part, La., returned home in March 2005 after seven months in Iraq, during which a Humvee he was driving rolled over a land mine, badly injuring his sergeant. After completing his tour, Sedotal was diagnosed with PTSD and placed on Prozac, he said.

Last October, after being transferred to a new unit, he was shipped back to Iraq for a one-year tour. During a short visit home last week, he described being wracked by nightmares and depression and convinced that "somebody's following me.'' When he conveyed his symptoms to a doctor at Fort Polk in Louisiana last Tuesday, he said, he was given a higher dose of medication and the sleeping pill Ambien and told that he was to go back to Iraq.

"I can't keep going through this mentally. All they do is fill me up on medicine and send me back,'' he said. "What's this going to do to me in the future? I'm going to be 60 years old, hiding under my kitchen table? I'm real scared.''

More than 378,000 active-duty, Reserve and National Guard troops have served more than one tour in Iraq or Afghanistan, representing nearly a third of the 1.3 million troops who have been deployed, according to Department of Defense statistics. That repeat exposure to combat could dramatically increase the percentage of soldiers and Marines who experience PTSD, major depression or other disorders, some experts say.

Recent studies have estimated that at least 18 percent of returning Iraq veterans are at risk of developing PTSD after just one combat tour.

"The [Department of Defense] is in the business of keeping people deployable,'' said Cathleen Wiblemo, deputy director for health care for the American Legion. "What the consequences of that are, we haven't begun to see.

"This is uncharted territory. You're looking at guys being extended or sent back multiple times into an extremely stressful situation, which is different than past wars. ... I think the number of troops that will be affected, it will be a huge number.''

Preserving The Force

Military officials insist they have made aggressive efforts to improve mental health services to troops in Iraq in the past two years. After the spate of suicides in 2003, the Army dispatched a mental health advisory team, which issued a report recommending additional combat-stress specialists to treat troops close to the front lines, and encouraging training and outreach to reduce the stigma associated with mental health problems.

A follow-up report, released January 2005, cited the drop in suicides in 2004 as evidence that the Army's efforts were successful. It also highlighted a decline in the number of soldiers who were evacuated out of Iraq for mental health problems -- from about 75 a month in 2003 to 36 a month in 2004. In 2005, an average of 46 soldiers were evacuated each month, Army data show.

Overall, barely more than one-tenth of 1 percent of the 1.3 million troops who have been deployed to Iraq and Afghanistan have been evacuated because of psychiatric problems.

Both advisory team reports recommended that soldiers with mental health problems be kept in the combat zone in order to improve return-to-duty rates and help soldiers avoid being labeled unfit.

"If you take people out of their unit and send them home, they have the shame and the stigma,'' said Ritchie, the Army's mental health expert.

But with the suicide rate climbing, the emphasis on treating psychologically damaged soldiers in the war zone is raising new questions.

"You think it's a stigma to be sent home from the Iraq war? That might be the line they're using'' to justify retaining troops, said Dr. Arthur S. Blank Jr., a psychiatrist who formerly served as national director of the Veterans Administration's counseling centers. "I wouldn't say that.''

Mental health specialists who have served in Iraq acknowledge that their main goal, under military guidelines, is to preserve the fighting force. Some have grappled with making tough calls about how much more stress a soldier can handle.

"You have to become comfortable with things we wouldn't normally be comfortable with,'' said Bob Johnson, a psychologist in Atlanta who counseled soldiers last year as chief of combat stress control for the Army's 2nd Brigade. "If there were an endless supply [of soldiers], the compassionate side of you just wants to get these people out of here. They're miserable. You can see it in their faces. But I had to kind of put that aside.''

Army statistics show that 59 soldiers killed themselves in Iraq through the end of last year -- 25 in 2003, 12 in 2004, and 22 in 2005. Twelve Marine deaths also have been ruled self-inflicted.

The only confirmed Connecticut suicide is that of Army Pfc. Jeffrey Braun, 19, of Stafford, who died in December 2003. His father, William Braun, told The Courant he still did not have a full explanation of what happened to Jeffrey, but said, "I've chosen not to pursue it or question it. It's over and done with.''