Behavioral Health Deployment Stress

I did my first Mental Status Evaluation for Spc. Danczak who was facing a UCMJ Article 112a following a positive urine analysis for “spice” (synthetic marijuana). The smoking and test for spice happened in garrison prior to deployment. The results had just come in. The soldier’s immediate supervisor wanted him to stay in theater and the soldier also wanted to stay. He was cooperative during the interview and knew the consequences of his action. The decision about whether he stayed was beyond my control, but I did check the box that he was fit for duty.

Just before dinner, a soldier walked in and asked about smoking cessation. I pointed to Li, as she was trained in this, indicating that he needed to speak with her. She conducted the interview, got some history, and offered some suggestions.

On the morning of August 18, I donned my body armor and walked over to the Seabees HQ to help Preventive Medicine submit a work order for two non-working 110 electrical outlets. Then I walked over to the motor pool. I spoke with Dido, whom I hadn’t seen in a while, and we caught up on some news. While I was there, one worker asked what happened to Movie Night. I told him Li and I had been away on a mission, but I promised next Wednesday we’d show Rise of the Planet of the Apes.

I saw a new client, 1st Lt. Autry, referred by one of her soldiers, Jane, whom I had treated for being overly emotional and stressed at work. Autry had similar problems. Her anger was “through the roof.” This was a common theme, and I needed to create a handout about how to use tapping to relieve tension. This was the third soldier Jane had referred to Combat Stress.

In the afternoon, Li and I had a scare when our phones suddenly weren’t working. The last time this happened was the day a master sergeant was killed and we went to COP Little Blue. When there’s a death, the army blocks all communication until the deceased soldier’s family is notified. Li and I were afraid that soon the 1-10 Cavalry executive officer or chaplain would walk into our office and tell us to go to a COB. We walked around outside to see if anyone knew anything. The Mayor Cell said the phone system was down. I hoped this was true. Two hours later, the phones were working again, and no one had told us to go outside the wire. Whew!

Li and I spent the next morning surfing the Internet to find organizations that donate clothing, toiletries, and books to deployed soldiers. There are many military-friendly organizations, but there didn’t seem to be an easy method to request donations. We even wrote to the USO. If we had some things soldiers needed, they might be more likely to come into Combat Stress Control, giving us a chance to talk with them.

In the afternoon, Maj. Michaels came in asking for help to compose an email to his wife. His wife had many problems: her father’s health, a special needs child, and her own poor health. She essentially wanted her husband to leave Afghanistan and return home. We discussed possible support systems for her, but no option was viable. Eventually, Michaels remembered his wife had been independent and self-determined when he first met her. This was reflected in his email to her, but she threw it aside and told him that he cared more about his job than her. She no longer wanted to talk to him and ended her email with “have fun over there doing what u do and who you do.”

After Michaels left, Cpl. Mayer was escorted in. Mayer had a characteristic well-built military physique, but he couldn’t hide his contemptuous tone. Ten days earlier, Mayer was on patrol when an insurgent shot him, injuring his right side. Fortunately, the body armor plate stopped the bullet.

“I can’t sleep. I keep thinking of being shot over and over again. I was knocked down but was able to crawl behind the truck for cover.”

“What happened next?” I asked.

“I fired back, but no else did…just me.”

“Why not?”

“I don’t know…I looked around…they all looked scared.”

Mayer had had continuous flashbacks, insomnia, and anger about the lack of support from his team. There were approximately 15 soldiers dismounted from their trucks when he was shot, but he was the only one that returned fire. I taught him how to tap for his anger and for his insomnia. Mayer should return to the clinic the next day.

Li and I returned to the office after our lobster-tail dinner. I almost asked for three tails since I had missed the previous Friday. Li needed to write her clinical notes for Cpl. Mayer but couldn’t log in to the AHLTA-T program. This had been a problem for the last week and we finally phoned the administrator for help. Luckily, the administrator was in his office at 2030 hours. After half an hour, Li was able to get in and complete her notes.

As I was still in the office, I called Rob. Nine-thirty in the evening in Kandahar is nine in the morning in San Francisco. (Afghanistan is 11.5 hours ahead of California.) As always, it was comforting and grounding to hear Rob’s voice. It made me feel less far away from him. After we finished the call, Rob wrote me an email: “Thanks for calling. As always, I love to hear your voice. Funny, I keep a voicemail of you on our home phone and sometimes I play it just to hear you. Your grunt, Rob.”

On Saturday, at 1130 hours, I was enjoying the now-functioning air conditioning in our office when there was a loud boom and the building shook. I stared at Li with wide eyes and she stared back. I didn’t register what it was, but I knew it was serious. I ran outside and looked toward the Mayor Cell’s office. People were scattering and yelling. I ran back to tell Li and we quickly heaved on our body armor and helmets—these are kept in the office, since that’s where we spend most of our time. I snatched an eight-pack of water and was ready to run to the bunker when Li told me I had forgotten my rifle. Well, that was embarrassing! I gripped my rifle, but now I saw people calmly walking away from the bunker. They were saying, “Con det.” What was con det? A passing soldier told us it meant, “Controlled detonation.”

Oh, thanks for the advance warning. Adrenaline rush for nothing!

Cpl. Mayer returned for a follow-up visit. “I still can’t sleep. I keep playing this movie over and over in my head…being shot…knocked down…hurting...”

Li gave him an audiotape to help him relax for the night. Li also administered the PTSD checklist (PCL-M) and his score indicated that he was experiencing many reactions of posttraumatic stress: flashbacks, insomnia, irritability, and rage.

“Let’s schedule your next appointment,” I said.

“Ah, no. The guys already think I’m crazy. I can’t keep coming here.”

I explained to him the importance of fully processing the trauma so he didn’t get stuck, which could result in long-term problems. He made a commitment to come back.

War trauma (now called posttraumatic stress disorder) was first chronicled in the eighth century, with Homer’s recounting of Odysseus’s rage, violence, and inability to adjust to civilian life after returning from war. During the American Civil War, soldiers were diagnosed with “soldier’s heart,” and WWI soldiers were diagnosed with “shell shock.” WWII called it “combat exhaustion” or “battle fatigue.” By 1952, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II) included a diagnosis for “gross stress reaction.” It wasn’t until 1980 that the DSM-III used the term “post-traumatic stress disorder.” (In the DSM-V, the term is no longer hyphenated: posttraumatic stress disorder.) Soldiers with PTSD commonly report symptoms of hypervigilance, anger, insomnia, numbness, flashbacks, and sensitivity to loud noise.

On Sunday, Mayer came in and paraded a copy of the official storyboard of his shooting incident. “Look, here’s some bullshit creative writing…that way we followed the proper protocol. For example, ‘Question: Why did all the soldiers dismount from the vehicles before higher-ranking personnel gave the order? Answer: To meet up with the Afghan National Police.’ But they weren’t there!”

The corporal also presented pictures of the round that he caught on his body armor and the ensuing damage. Fortunately, most of the damage was on his vest and ammo magazine. Mayer suffered a neck injury, back injury, and bruises in his rib area.

“Oh, by the way, I heard the camp might be attacked soon,” Mayer said.

This was distressing news.

“Yeah,” he continued, “the latest rumor was that the US government stopped paying the warlord the monthly rent of $93,000.”

Was it true, $93,000 a month? It was a great sum of money. I received the information with skepticism, however. Although, since CNS was attacked on August 13, why continue paying warlords for protection if CNS wasn’t protected?

Security had increased around the camp. Locals, civilian contractors, and soldiers wearing PT uniform had to show their identification cards in certain areas: dining facilities, gym, and certain buildings. At dinner, I asked the brigade surgeon about the increased security. He understood the entire RC-S (Regional Command South) had gone to this measure. I felt slightly relieved that CNS wasn’t the only base targeted. And perhaps this was happening because August was usually the deadliest month of the war.

Sure enough, at 2230 hours, there was a loud explosion. I recognized the now familiar sound and went outside to get some information. A soldier from the aid station said there was an IDF (indirect fire) near CNS. Later this information changed to an IED (improvised explosive device) one kilometer away. Li called me on my cell phone and I joined her in our office, where we stayed until we got the all-clear. I couldn’t believe that CNS didn’t have a working siren. We were in a war zone and the camp couldn’t tell people to run to the bunkers or to signal the all-clear. Super distressing! As if it were the 19th century, we depended on word of mouth, and we hoped the information was accurate. I could hardly wait for the end of August—a holy month yet the most deadly. It just didn’t make sense to me…but war doesn’t make sense.

When I went to breakfast the next morning, I was asked to present my identification card before I got to the entrance. This was new. I was in my uniform, yet 100% ID was required. There was also a guard stationed at the dining facility’s exit.

I got my government computer back from being reimaged after it stopped working and all the programs were functional again. So I started my Commander Safety Course, which would take eight hours. Some of the information was boring, but it was necessary to read if I wanted to pass the test this time. When I was barely a quarter of the way through the course, Mayer came in complaining.

“I’m not doing well…can’t sleep. The blast bothered me a lot. And my neck is still killing me.”

He wasn’t interested in tapping for his anxiety, pain, or sleep. Instead he wanted medication for sleep, so I encouraged him to see the doctor in the aid station.

Then Sgt. Gallego came in. He was directed to us because of stress, home-front issues, poor sleep, and flashbacks of his friend dying. Scarred from the inside out, his work performance had deteriorated, with poor concentration and repeated tardiness. We discussed his wife’s support system, which was adequate, and how she could ask for additional help to relieve his worries. Then we discussed ways he could improve his sleep by eliminating noise and light, as he was sharing a tent with 15 other soldiers, all with different work schedules. Lastly, I taught him how to tap to diminish the triggers that set off the flashback of his friend’s death.

“Even though I miss my friend, even though I’m reminded of him from time to time, I deeply and completely accept myself. I choose to celebrate his life,” we tapped.

I asked him to return to check on his progress.

In the late afternoon, there was a drill in the camp. I couldn’t really hear what was going on because we had clients and the speaker system didn’t work. I moved outside and saw a soldier riding around in a utility vehicle with a handheld loudspeaker saying something that I couldn’t understand. At first I was worried. But once I heard him say, “…this is a drill,” I was thankful.

At ten at night, I was in bed reading another thriller book when there was a loud knock on my door. When I opened it, I was alarmed to see a massive German shepherd tethered to a burly civilian contractor, accompanied by a soldier.

Staring up at the soldier, I said, “Yes?”

“We’re conducting a room-to-room search, Ma’am,” he said.

“For what…”

“Um…alcohol.”

Since I didn’t drink, I wasn’t concerned and opened the door for the dog to sniff around, and they quickly left. But really…alcohol?

The next morning, Li went around and learned from some soldiers at the PX and the aid station that the dog was actually searching for a bomb. There was speculation that there might be a bomb in CNS, and it might be in the dining facilities, gym, or sewer system. Everyone was on edge, sharing a mixture of facts and rumors. Later in the afternoon, Li and I understood that a bomb had been discovered in the local bazaar. During our walks around the camp, we noticed more razor-sharp wire around central buildings and markedly heightened security.

Going out for lunch, we gazed up and saw a huge banner introducing Instatelecom, a new Internet service at CNS. The cost was $50 a month for unlimited service. Apparently, another Internet company called Sniperhill would arrive here the following week. The current service was expensive with poor and frustrating connectivity. I hoped that one or both of these companies would be better.

I finished the Commander Safety course. I barely passed, as I only read three of the 10 chapters. But at least I was done with it!