The attack happened one night at Camp Warhorse-now known as Camp Freedom-in Baquoba, Iraq, 40 miles north of Baghdad, in October 2003.
When the first mortar hit, "you could pretty much feel it in your body," says Spc. Abbie Pickett, 22, of the Wisconsin Army National Guard's 229th Engineer Company.
She and several other soldiers were in the morale, welfare and recreation (MWR) tent relaxing and enjoying the few amenities available in the field when they felt the loud, firework-like booms strike nearby.
Specialist Pickett says she grabbed someone's sleeve and headed outside. There weren't any bunkers nearby so she and a few others hit the ground between an eight-foot stack of Hesco Bastion sand bags and the building.
Moments later, a mortar landed about 25 to 30 feet away from them.
"We were actually within the kill zone," she says. "I remember not being able to breathe for a few minutes because there was so much sand and smoke. I remember just gasping for air."
With mortars still going off around her, Specialist Pickett ran back into the MWR tent to render aid. The lights were off and all she had was a flashlight, but even with that she could see blood all over the ground.
She noticed an injured soldier giving aid to another with shrapnel in the neck.
"He said, 'I think I've been hurt, but she's far worse,'" Specialist Pickett says. "But his lower arm was pulsating blood. I saw that he had taken shrapnel to an artery and it was squirting ... all over."
She did her best to stabilize him before medical technicians arrived to take him, the other soldier and two Iraqi nationals to the hospital.
Specialist Pickett's story, like the stories of thousands of others in combat, is unlikely to ever leave her. It still gives her nightmares and keeps her from concentrating on her college studies. Ever since that day, she's nervous, jumpy and takes anti-depressants to help balance out her days.
She suffers from a combat-stress-related illness called posttraumatic stress disorder (PTSD), and she is not alone. The New England journal of Medicine reported last year that nearly one in six people who serve in a combat zone return home with PTSD.
The disorder-characterized by symptoms of numbness, hyper-vigilance, startle responses, disassociation, flashbacks, intrusive memories and nightmares (box, page 28)-is usually triggered by a traumatic event, such as combat, rape or assault or other catastrophic accident. It can take months and even years for symptoms to surface, says Col. Elspeth Cameron Ritchie, psychiatry consultant to the U.S. Army Surgeon General.
Though most never fully recover from of all the symptoms, the goal, Colonel Ritchie says, is to get them the help and resources they need so they can manage the disorder and live a healthy, normal life.
Unfortunately, for many reasons, such as the negative stigma in the military attached to seeking professional mental help and the lack of a nationally organized mental health program in the Guard, many slip through the cracks.
Before Specialist Picket! was called up, she was taking 18 credits per semester; this past semester she took only four.
"I went from being a 3.6 [grade point average] student to a 3.1 and from wanting to be a physician's assistant to really not knowing what I'm going to be able to accomplish," she says.
She isn't sleeping much at night, she jumps when someone closes a door too loudly and she gets agitated more easily now. Unfortunately, she's unable to regulate the medications she needs, because she has yet to see a psychiatrist. She's been trying to make an appointment since January.
"It's hard to get into the [Veterans Administration] system; it's hard to get the information on where to go, and sometimes when you have the right information-like in my case, I had two numbers for mental health in my region and they both came up as disconnected-it's wrong," she says.
She adds that she has many friends who have given up on the VA because it takes too long to get an appointment or they're unhappy with their treatment. Sometimes those who are happy with the treatment have difficulty getting a follow-up, she says.
Florida National Guard Col. Lynnette Kennison, who works as a behavioral health staff officer for the Office of the Surgeon General Health Policy and Services, says glitches like this are a great concern and pre-deployment training and post-deployment care are areas in Guard health care that could use some improvement.
Her primary concern is whether Guardsmen have enough combat stress training to effectively go into theater, meet their mission requirements and psychologically deal with the impact of combat.
Until recently, many current Guardsmen had only been mobilized for state missions like civil disturbances and natural disasters.
But as a result of the accelerated Guard operations atter 9/11, most states realize the need for some sort of mental health preparation before mobilization and follow-up after the Guardsmen return, Colonel Kennison says.
Because each state manages the care of its soldiers and airmen individually, their approaches may differ significantly.
Despite the fact that there is no nationally organized mental health program, Colonel Kennison says it is likely that the states will teach, leam and borrow ideas from each other to make the process more effective and solid.
At the very least, upon demobilization from active duty, Guardsmen are required to fill out a couple of questionnaires and surveys that help the chain of command determine whether they need further help.
When Guardsmen return home, they do not have to report back to their unit for 90 days. But PTSD and other combat stress disorders often emerge within the first month after returning. Health care professionals are concerned about how Guardsmen are coping during those QO days away from the military support system.
The Florida Guard, for example, allows individuals to voluntarily return to their unit 30 days after demobilization in plain clothes, with their families, so that they can speak with a counselor, get information about mental health facilities and professionals in their area and to network again with their unit members.
In West Virginia, Guardsmen are required to attend at least one counseling session. New Hampshire Guardsmen returning home in February and March also received mandatory one-onone counseling.
For those who do not live near a military base, in military communities or near fellow Guardsmen, experiencing the isolation and symptoms on their own can be devastating. So attending these sessions is highly encouraged, Colonel Kennison says.
"Sometimes they just don't want to go that path, they want to take care of themselves, and sometimes end up using alcohol and different things," she says. "Not all of our soldiers are near VA, and Tricare contracts with local providers [so] finding local providers that can treat PTSD is not always easy."
The 30-day session is also important because health care professionals have realized that often soldiers don't really absorb the information they receive at demobilization briefings.
"They're so focused on going home and have so much euphoria about that, they're not ready to hear anything that might delay that transition," Colonel Kennison says.
Specialist Pickett agrees that it would be more beneficial for everyone if all troops could take the surveys and questionnaires and talk to a counselor a few months after returning home.
"Soldiers at that point have usually either experienced something they know could be classified as PTSD or know that something isn't right," she says. "For them to ask these questions as you're demobing is ridiculous. You're going to say whatever it takes to get to your family you haven't seen in 15 months."
These lessons have led to a more proactive approach to the problem, Colonel Ritchie says.
Health care professionals in theater now use a system called, Proximity, Immediacy, Expectancy and Simplicity (PIES). Simple treatments, like "three hots and a cot."-three good meals, a good night's sleep, a chance to talk about what's happened and a warm shower-have become quite effective, she says.
The National Center for PTSD Web site says there is no definitive treatment and no cure for PTSD, but some treatments such as behavior, group and exposure therapies and certain medications like Prozac and Zoloft have proved useful.
Despite frustrations with the VA system, Specialist Pickett has received the therapy and support she needs. The most effective treatment for her was simply talking to other veterans with similar combat experience.
When she returned, she was a different person and said it's hard to relate to the triviality of normal society.
"I can't talk about the average things that girls my age talk about like clothing, because it seems materialistic," she says. "How can you get in on conversations ... about the latest W show, when you've been without TV for 15 months?"
Another new program that might prove helpful is called Coping with Development 101. The one-day workshop, created by the Florida National Guard Area 6 Family Assistance Centers, opens this summer to the parents, spouses and children of deployed 'Guardsmen. It's designed to help them understand what's going on in their loved ones' daily lives.
The program provides information on how they can be supportive during deployment and upon their return and briefs them on some of the changes that may occur post-deployment.
Colonel Kennison says it will also help families answer the question: "When do we raise the flag and get you help?" and it provides them with materials and information about where to get help.
Even with programs like this in place and mental health advocates working to get returning Guardsmen and other troops the help they need, many are still going unseen.
The New England journal of Medicine study also found that although approximately 80 percent of Iraq and Afghanistan veterans who had a serious mental health disorder, such as PTSD, acknowledged they had a problem, only about half with disorders stated they were interested in receiving help.
The study found that a major reason why soldiers reluctantly sought professional help is because they thought their unit leaders would treat them differently, or it might harm their careers.
"When you talk about mental health treatment, it is so foreign to their belief system. They'll go to a doctor and get medicine, but not a shrink," Colonel Kennison says. "There's a fear if someone discovers psychiatric or psychological intervention it will somehow taint their image in the military or compromise their security clearance or make others think they won't be able to do their job as well."
Eric Dean, author of Shook Over Hell: Post-Traumatic Stress: Vietnam, and the Civil War, told NATIONAL GUARD that because camaraderie and support is built so strongly in the military, troops may also feel as if they're letting their comrades down if they admit to a mental problem, especially, since it could be interpreted as "cowardice or weakness in personality."
First Lt. Debra Howard, PTSD program coordinator for the West Virginia Army National Guard, says they are steadily trying to quell those fears. They work to assure soldiers that the chain of command wants them to seek help and that everything they put forth in counseling or therapy is 100 percent private and will not affect their career in any way, unless they are suicidal or homicidal.
PTSD is not new and has been known by many names over the years, says Maj. Bruce Farrell, a full-time chaplain for the Pennsylvania National Guard.
"We went through combat fatigue in World War II, shell shock in WWI. During the Civil War it was called the Soldier's Heart," he says. "Seeing violence done to other humans ought to affect you, if it doesn't, wow!"
During the Vietnam War, the average soldier was age 19 and was flown into duty as an individual instead of with a team of other soldiers. Once in country, soldiers had to fight an unidentifiable enemy, which led to the deaths of hundreds of innocent civilians and lots of guilt.
"There's a certain amount of alienation being in a foreign nation," Mr. Dean says. "They're not really sure who's going to be shooting at them because a lot of insurgents do not wear uniforms."
Because of the fighting conditions, Vietnam soldiers were jumpy and nervous, ready to fire at and kill anyone they thought might be a threat. Mr. Dean is concerned the same thing could happen for soldiers serving in Iraq.
He notes that during 19th-century wars, soldiers dealt more with high explosives and artillery fire than man-to-man combat. As a result, there was a high incidence of shell shock then because soldiers would be put in a helpless position as enemy fire bombarded them for hours while they lay in the trenches.
"People would crack up," Mr. Dean says. "The worst thing ever is lying in a foxhole, not sure if you're going to be killed or not and there's nothing you can do about it."
It's the fear of the unexpected that's driving soldiers to problems associated with depression, anxiety and PTSD today, Mr. Dean says.
Either way though, whether because of massive amounts of artillery fire or having to drive a truck that could blow at any moment, one fact remains:
"The nature of warfare is that your life is in jeopardy and you could be killed, and that's just a terrifying thing," he says.
© 2005 National Guard Association of the United States Provided by ProQuest LLC. All Rights Reserved.
Source: National Guard
