Toxic Care

Toxic Care

I spoke with a mom yesterday who told me her son who served as a combat medic in Iraq is having his PTSD diagnosis revoked until he can produce three witnesses to corroborate his traumatic events. The soldier was in Iraq two years ago. He was transferred from his unit in Iraq to work as a medic in Walter Reed’s traumatic brain injury unit.
He became so agitated and disturbed with Walter Reed he requested a transfer back to a combat unit and was sent to a unit about to deploy to Afghanistan. He didn’t redeploy because of a physical injury sustained in Iraq that required surgical repair.
As he was rehabilitating, the soldier began to self medicate and was having combat nightmares. He was constantly depressed and having suicidal thinking at times. He resisted seeking mental health care because he felt it would adversely affect him if he did have to redeploy. He feared others in his unit wouldn’t trust him if he was considered a “nut case”.
Finally with continuing urging from his family and friends outside the military, the soldier did seek mental health care. He also turned against the war and joined anti-war veterans to oppose the war when he wasn’t on duty.
The soldier was diagnosed with PTSD, Adjustment Disorder and Depression. He also entered a drug rehab program to help with his self-medicating. The Army came to the conclusion the soldier couldn’t be successfully rehabilitated while in the service. He’s to receive a medical discharge in the near future.
The parting gift of the Army for the young man who served as a combat medic is to demand he find three fellow soldiers to verify he witnessed the traumatic events of war that has led him to be suicidal, depressed, insomniac, hyper-vigilant and paranoid and driven him to using too much alcohol.
The Army says the soldier can go to the VA to regain his diagnosis of PTSD once discharged. His mom rightfully worries it will be a long time before he can be seen at the VA to determine he has PTSD that has already once been diagnosed. She worries he’ll be without treatment and his symptoms and problems will worsen.
I also recently spoke with a soldier who was about to be redeployed even though he’d been diagnosed with PTSD, Adjustment Disorder and Major Depression. The young soldier had attempted to harm himself but a fellow soldier had intervened.
Another soldier, the combat medic mentioned above, had called me because he was worried this soldier would harm himself before he deployed or once back in Iraq. He asked that I call his friend to advise him about his mental health issues.
I called and began a lengthy evaluation of the soldier’s situation over the phone. I have several years experience working with psychiatric emergency teams or in a psychiatric emergency room.
The soldier was very polite, using the word, “Sir”, often in our discussion. He told me he was worried he couldn’t perform the duties he would be asked to do if he were in Iraq because he was having daily panic attacks. The attacks were increasing in numbers and duration.
The soldier also had an eighteen year old wife who had taken a restraining order out against him. There hadn’t been violence but the soldier had become involved in verbal altercations with his wife and she was frightened he might act out against her.
He also has a three month old daughter he hasn’t been able to see since the restraining order. He worries about the care of the daughter because he found out his wife is going out with friends every weekend while leaving the daughter with the wife’s mother. The wife was spending late hours in bars with high school friends.
He reported having suicidal thoughts almost daily. He says he’s had thoughts of killing his squad leader who has been petty and harassing toward him since his return from Iraq.
The soldier was seen by an Army psychologist recently and diagnosed with PTSD, Adjustment Disorder and Major Depression. The psychologist arranged an appointment with an Army psychiatrist for the soldier to be evaluated for medication treatment.
The appointment date with the doctor just happened to be one day after the soldier was to redeploy to Iraq. His command told him mental health treatment would be available for him once he got settled in his base at Iraq.
The Combat Stress Team wasn’t based at the camp the soldier was to be assigned to, however. The soldier would have to be taken by convoy to the base the stress team was located. Fellow soldiers would have to accompany him to go to the appointments for his treatment.
The soldier adamantly told me he’d never put fellow soldiers at risk for possible IED and roadside bomb attacks to transport him to have treatment. He was also clear he felt he’d be unable to be as reactive and alert as he would need to be in a combat situation because his panic attacks were unpredictable and made him “freeze up”.
The soldier asked me if I felt he should be treated before returning to Iraq. I reviewed his risk factors with him. He had panic attacks with increasing regularity and intensity. He had suicidal thinking. He was having domestic problems. He had homicidal thinking. He faced a return to combat and he was untreated for any of his emotional problems.
The soldier was sure he couldn’t get the help he wanted through the military healthcare system because he’d already tried and they dismissed his symptoms as normal. He didn’t feel they were “normal”.
My assessment from our discussion was the soldier had significant risks that would make him a danger to himself or others. I felt his risks would be especially debilitating should he be in a combat zone trying to perform the duties of a combat infantryman.
I told him that I wouldn’t want him to be covering my back in the condition he described. I felt I had a certain expertise from my own combat experiences as a Marine infantryman in Vietnam during the 1968 Tet Offensive and the following eleven months.
I suggested the soldier could use a civilian hospital emergency room to get a full psychiatric evaluation since he felt sure the Army hospital on base wouldn’t address his mental health issues. The soldier told me he’d consider taking such action.
I found out the soldier did go to a local hospital ED the following day with two active duty soldiers accompanying him. He was placed on a mental health hold and admitted to the hospital’s psychiatric unit. The hospital kept the soldier hospitalized over a week before discharging him back to the military.
In today’s healthcare system being admitted to a psychiatric unit requires an individual be an extreme risk to themselves or others or be gravely disabled. The fact this soldier was hospitalized verified what I feared when I spoke with him.
The soldier was medically discharged from the Army under honorable conditions about a week after he left the civilian hospital. Now he faces getting his treatment expedited at the VA.
The good news in his story would be he didn’t go to Iraq and possibly endanger his own life or the lives of his fellow soldiers. Had the soldier gone along with the military in seeking help for his PTSD condition he’d be in Iraq with his symptoms worsening every day he was in country. And, he’d be without treatment.
Another mom called a friend of mine seeking help for her son stationed in Iraq. My friend works with local military families who are opposed to the war. Her son is the combat medic I first wrote about.
The mom with her son in Iraq was frantic because her son had gotten in trouble with his command. He was facing a Summary Court Martial for threatening the life of his 1st Sergeant, failing to carry out several normal duties expected of him and missing several formations.
The soldier had seen some of his fellow troops killed during his tour in Iraq and had been shot himself but his Kevlar vest had prevented him being wounded. He was also suicidal as well as homicidal.
His command placed the soldier on suicide watch in a closet which was situated next door to the quarters of his 1st Sergeant. The closet was full of potential weapons or implements the soldier could harm himself or someone else with if he wasn’t closely watched.
This soldier enlisted in Colorado despite his mom’s objection. His mom was terribly worried about him enlisting because he’d been diagnosed with Attention Deficit Disorder when he was eight years old.
He’d been treated with medications with only partial effectiveness up until the time of his enlistment. His psychiatrist, who testified by phone at his Summary Court Martial, stated he would be unable to function in the Army if he stopped taking his medication and in all likelihood even if medicated he’d be unable to withstand military life.
The soldier’s recruiter in Colorado was informed of his ADD by the mother. The recruiter told the mom he’d “note” it on the recruit’s record. During an Inspector General’s investigation the soldier asked for, there was no record of the recruiter “noting” the ADD diagnosis.
The soldier says the recruiter had advised him not to mention the diagnosis because plenty of soldiers had the ADD diagnosis. The recruiter denied doing this during the IG inspection. The IG found no basis for the recruiter falsely enlisting the soldier. They did find basis for the soldier being prosecuted for fraudulent enlistment under federal law. If convicted of that charge the soldier could be sentenced up to ten years in federal prison.
The soldier’s mom went to her congressman’s office for help. She was patronized by the military liaison. He told her the soldier should just go along with “the program” to avoid problems. He said the soldier reminded him of himself when he was a young rebellious soldier.
The mom then went to her Senator’s office. They told her it would take up to three weeks to do a welfare check. They also told her the soldier faced “big trouble” for his fraudulent enlistment and should just accept the Summary Court Martial and move on with his military service.
Finally the mom became frantic and called my friend who works with military families. She had some previous contact with the Senator’s military liaison. My friend was able to cajole the liaison to make an inquiry faster than the three weeks the mom had been told it would take.
The mom was also advised to seek legal assistance. She hired a local attorney who had military law experience. The attorney contacted a friend in the Green Zone to request he make inquiries about the soldier’s case.
The attorney in the Green Zone told the local attorney the commanding officer of the soldier planned on making an “example” of the soldier because he’d made a threat against the 1st Sergeant.
He also said the Combat Stress Team refused to become involved while the soldier was under indictment for a Summary Court Martial. Only the soldier’s civilian psychiatrist would testify about his mental health problems.
The soldier was convicted and sentenced to 15 days in the stockade in Kuwait and another 15 days in a Baghdad stockade. After his Baghdad incarceration the soldier is to return to his unit under the same command of the 1st Sergeant and commanding officer.
Currently there has been conflicting reports the Army plans on mustering the soldier out with a medical discharge based on his preexisting condition of ADD or that he will have to make up the time spent in the stockade and finish his tour in Iraq.
If the soldier is discharged for the preexisting condition he’ll be ineligible for VA benefits and all other veteran benefits. He’ll be without benefits despite being shot and spending time in combat.
The last time the mom heard from her son he told her he’d still not been given medications despite the psychiatrist’s testimony. In fact, the soldier hasn’t had medications since he joined the military.
There is some research that shows the regimentation of the military is beneficial to individuals diagnosed with ADD. The military does give waivers for individuals with ADD but their regulations state the person must have a stage of ADD that is controllable.
This soldier’s psychiatrist stated the soldier has never been fully controlled even with a higher dose of medications. He functioned poorly in school and in his attempts to go to college. And still the military seems to hold on to the need to not only punish the soldier but to further exacerbate his condition by returning him to a combat condition.
And a mother continues to frantically try saving her son from the possible horrible consequences of a toxic military healthcare system that seems to lack all standards of care normally expected in the treatment of mental health problems.
And we have to wonder just how many more mothers and fathers face such horrors for their children. How many parents have gone along with the suggested chain of command “ways” and lost a child because of it?
The latest news about the care of returning soldiers with both physical and mental health problems remains much the same as before the Walter Reed story came to light.
Now it’s coming to light that many of the troops who have lost limbs or are disabled because of mental health problems also face bankruptcy, loss of homes and poverty because of a system wide failure to provide the needed care and to compensate at a level above impoverishment when a disability is given a veteran.
The American support of troops obviously stops once the troops have done the bidding of their military masters. We fail to remember what was asked of the young men and women who sought to serve their country once they return.
We’ve become a disposable society to such an extent we aren’t troubled with the disposal of our young troops. Just as we marginalize the communities of color and poverty, we’ve come to do the same with the veteran.

Wm. Terry Leichner, RN
Psychiatric RN
USMC combat infantry veteran
RVN 1967-69