With so much attention understandably focused on the economy and the incoming administration, the struggles being faced by G.I.’s coming home from combat overseas are receding even further from the public’s consciousness.

If you’re in your late teens or early 20s and your energies have been directed for a year or more toward dodging roadside bombs and ambushes, caring for horribly wounded comrades and, in general, killing before being killed, it can be difficult to readjust to a world of shopping malls, speed limits and polite conversation.

It’s good to be home. Or is it?

That day you dreamed about the past few months – it’s finally here. Sure, it’s great to be back, but after a while something sinks in. “It’s not as sweet as you think it is,” one vet recalls of his return.

After riding high those first few days or weeks, the honeymoon period can end abruptly. It doesn’t take long before everything that used to be familiar feels unfamiliar. You might feel like a stranger in your own town. You may feel you’ve changed, but nothing else has.

On top of that, after living on alert for so long, life at home can feel like living “with the volume turned down,” in one Iraq vet’s words. Disappointment and disorientation can mount early.

It helps to find an outlet, something you’re passionate about. “Everybody needs something to focus their energy on other than what’s going on,” one vet says. “You need something to get your mind off everything else.”

Bryan, now 24, was an Army sniper in Iraq from February 2004 to February 2005. At an age when many youngsters go to college or line up that first significant job, he and his squad-mates were prowling Tikrit with high-powered weapons, looking for bad guys.

He was shot in the leg and hand during a firefight, and he saw and did things that he was less than anxious to talk about when he came home.

“I wanted to go to college,” he told me. “I had all these plans, but I couldn’t seem to make them happen. I couldn’t focus. I would get, like, depressive thoughts.”

He said that he would party a lot. “Party” was a euphemism for drinking.

The drinking made him more depressed, and then he would get angry that he was “partying but not having a good time.”

Bryan said he would “flip out,” and friends began to shun him. “I just didn’t care what I did or who I affected with my actions. I would break stuff. I’d break, like appliances. It was bad.”

Writing on Veterans Day, Paul Rieckhoff founder of IAVA, explained the intentions behind this Public Service Announcement (PSA) [via Talking Points Memo].  The title of the piece was aptly named Veterans Day 2.0.

A study released today by the VA's National Center for Posttraumatic Stress Disorder found that 15 percent of the Iraq/Afghanistan vets seeking treatment at VA facilities report experiencing some kind of sexual trauma while serving in the military.  Additionally, these veterans are 1.5 times more likely require mental health care.  These numbers are derived from the nearly 40 percent of recent war veterans who've sought general medical care since being discharged from the military.  Screening all vets coming through VA medical facilities for sexual trauma is a standard practice.

Here are more statistics referenced in the report [via Reuters and USA Today]:|

• 76 percent of women who've had previous sexual trauma reported mental health problems, 51 percent of which include some form of PTSD.
• 47 percent of women without a history of sexual trauma reported mental health problems, 22 percent of which include some form of PTSD.
• Women with military-related sexual trauma experiences have a 59 percent higher risk of mental health problems.
• Men with military-related sexual trauma experiences have a 40 percent higher risk of mental health problems.
• One in seven female vets reported an instance of military sexual trauma.
• Just under one percent of male vets reported an instance of military sexual trauma.

The study covered 125,000 veterans seeking treatment from the VA between October 2001 and October 2007.  Active duty soldiers were not included because the VA is not involved with their care.  Additionally, the specific types of sexual trauma were not included, only the number of occurrences.

Reuters spoke to the new report's co-author Rachel Kimerling:

Kimerling said in a telephone interview the term "military sexual trauma" covers a range of events from coerced sex to outright rape or threatening and unwelcome sexual advances...

..."If you think about military service where you are living and working so closely with the same people, that even if it is not sexual assault ... it is possible that severe sexual harassment is just as traumatic," she said...

...Kimerling said that may mean many veterans are unaware they can be helped and she said she hoped more would come forward to seek treatment.

"There are dedicated health care services for military sexual trauma at every VA facility across the nation," she said.

Sexual trauma can lead to depression, anxiety, substance abuse and post-traumatic stress disorder, Kimerling said.

"We know there are effective, evidence-based treatments for them that are used in VA," she added.

Many women are afraid to report the assaults, says Anita Sanchez of the Miles Foundation, a non-profit that provides services to victims of military-related trauma. Fewer than a third of women who come to Miles for help after sexual assaults say they've told the military, she says.

"A typical scenario is it's either a supervisor or someone at her level, in the same military unit. If you come forward, you're tattle-telling on a comrade. Women have told me about the sneers, the sarcastic comments. They can find themselves ostracized," says Sanchez, and when other women see this, the lesson isn't lost on them.

Movie critics have pointed to the fact Americans already see the war everyday on the news (at least, for many years they did), and fictionalized portrayals simply don't have the escapism movies can provide.  Then there's the over-saturation of political messages some of the movies contained.  Washington Times movie critic Christian Toto told NPR last year: "A lot of the critics of the more recent films have said that the films are full of speeches, and it's very obvious what the political angle is.  And I think an artist, maybe if he or she had some time to reflect on the material, may give a more nuanced balanced performance."

Creative Loafing's J.r. Jones took a brief look at the history of war movies made soon after the wars they portrayed ended.  He began with 1946's The Best Years of Our Lives, a truly amazing film following three veterans home from WWII as they deal with alcoholism, family tensions, and their injuries.  The film was awarded eight Oscars.  The post-Vietnam era saw the movies The Dear Hunter and Coming Home receive critical acclaim and solid public interest.  Then came Iraq (and notice there really hasn't been any major film looking at the Korean War, other than maybe the Manchurian Candidate -- but, that's a different story).  Jones gave a solid history of Iraq movies up to this point:

Dramas about returning Iraq war veterans haven't received nearly so warm a welcome. The first, Irwin Winkler's Home of the Brave, opened in New York and LA shortly before Christmas 2006 and was released a little more widely the following summer, mostly near military bases, but it quickly vanished. Clearly modeled on The Best Years of Our Lives, it followed three soldiers as they tried to adjust to life in a country that didn't want to think about them or the war they'd been fighting. I wouldn't call it a knockout, but it had some powerful scenes, particularly those involving Jessica Biel as a soldier who'd lost a hand and was now forced to make do with a big, clumsy prosthesis obviously designed for a man. Kimberly Peirce's Stop-Loss, an MTV-produced drama about three young grunts returning from the war to their stars-and-stripes Texas town, got a more respectful rollout from Paramount Pictures this past March, but it flopped, grossing less than half its $25 million production cost.

"The Lucky Ones," co-writer/director Neil Burger's credible if unremarkable follow-up to his extraordinary "The Illusionist," refers to soldiers returning from Iraq in one piece...What follows is a series of occasionally funny encounters, as well as some soapy complications not so unpleasant as they are predictable. There are the requisite moving moments, too, making "The Lucky Ones" no more or less noteworthy than the slew of war movies preceding it in the last year or two.

The film...has Iraq on its mind, though it never mentions the word. It wants to make some kind of commentary on how the country hasn't come to grips with the war or its veterans without taking the issue head-on. Perhaps the director and his co-writer, Dirk Wittenborn ("Fierce People''), thought a lighter, entertaining approach would work after so many box-office failures about the war that were either dark thrillers or dramas. But the contrived and convoluted plot of "The Lucky Ones'' eventually undermines any serious intentions.

The Post-9/11 Veterans Educational Assistance Act is designed to offer the brave men and women who have served honorably since September 11, 2001 a level of educational benefits on par with those provided to veterans of the World War II era.

Many people enlist to earn money for college, and almost everyone signs up for the education benefits -- which, in the case of the main GI Bill, requires a service member to pay about $1,200 into the plan-- but not everyone takes advantage of it. And that buy-in is not returned even if the benefits are unused.

About 70 percent use at least some part of it, said Keith Wilson, director of the education service, but the VA does not track how many earn degrees.

An independent study found that just over half use some part of the benefits, said Ray Kelley of AMVETS, a veterans support group, and only 8 percent use all. "Congress is realizing we're not giving them the benefits we say we're giving them," Kelley said. "They only have 36 months from the time they start using it to the time they finish." That means going to school full time, year-round.

The suit claims that many disabled combat veterans are in dire need of counseling and other services they are not currently receiving from the U.S. government. Erspamer [the plaintiff's counsel] estimates that 120 veterans who served in Iraq or Afghanistan commit suicide each week. The veterans' groups are not seeking monetary damages but want reform of a health care system in which they allege a huge backlog of cases prevents veterans from receiving timely care.

A majority of the VA's counselors, doctors, social workers and psychologists "don't have the tools and the information that they need to intervene effectively with suicidal vets," said Maris, a former president of the American Association of Suicidology who has been a consultant to the Army on suicide prevention.

He was particularly critical of the VA's top health care administrator, William Feeley, who said in a pretrial deposition April 9 that the agency has no systematic national plan for suicide prevention. Feeley also said he was unaware of any methods of tracking veterans at risk of suicide and that suicide rates "are not a metric we are measuring."

Among our recommendations is that effective treatments documented in the scientific literature — evidence-based care — are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or major depression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.

They gave various reasons for not getting help, including that they worried about the side effects of medication; believe family and friends could help them with the problem, or that they feared seeking care might damage their careers.

Rates of PTSD and major depression were highest among Army soldiers and Marines, and among service members who were no longer on active duty (people in the reserves and those who had been discharged or retired from the military). Women, Hispanics and enlisted personnel all were more likely to report symptoms of PTSD and major depressions.

Last November the Pentagon opened the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury in an effort to bring together education, treatment, and research.  From the Department of Defense:

The center also will set standards and assess, survey and validate DoD programs, and decide, in part, how resources are directed... Center officials are reviewing hundreds of research project proposals that hope to claim a piece of the $300 million set aside by Congress last year for brain injury research. The office also will work with the military services to see which of the many programs funded with another $600 million from Congress are working and how to direct those funds to programs most beneficial to servicemembers and families.

After a brief hiatus last week, I've come back to this blog just as the news coverage of the Iraq war's fifth anniversary has winded down. Now we're back to the daily routine of chronicling what soldier's face on and off the battle front. In some ways these war anniversaries are an excellent opportunity to pause and remember where we've been, and where we're going. In other ways it is difficult to now find ourselves with a popular interest that's once again subsided. Nevertheless, it's crucial to keep moving on.

It is almost fitting then that today we focus on recent news that the remains of a soldier who went missing in 2004 have finally been found. U.S. Army Staff Sergeant Matt Maupin went missing on April 9, 2004 during an ambush outside of Baghdad. A few months later a video surfaced depicting the shooting to death of a man dressed in Army fatigues--a man said to be Maupin. But because of the video quality, investigators were unable to positively identify that the victim was indeed Maupin.

The Associated Press reported on the reaction of Maupin's parents:

...from that first impact, among many on the roof, the mood was scarcely one of cool detachment, or at least not as cautioned as it might have been by the longer-term implications of what we were seeing. Part of it, no doubt, was the air show — the sheer, astonishing, overwhelming demonstration of power, more like an act of God than man, unleashing in those watching from the roof something approaching awe.

The Army's 10th Mountain Division located in Fort Drum, NY, has been the most deployed unit since the 9/11 attacks. A new report highlights an inadequate system in place at the Army base for treating soldiers with mental health issues. The report, published by the advocacy group Veterans for America, said soldiers can wait more than a month before seeing a proper health care worker.

Fort Drum is located near the Canadian border. Its remoteness and harsh winter weather doesn't exactly provide the most uplifting setting for soldiers recently back from combat tours in Iraq. Veterans for America notes this as the report begins, offering a glimpse into the setting where PTSD can begin to surface among veterans:

Generally speaking, winter conditions at Fort Drum are dreary, with snow piled high and spring still months away. More than a dozen Soldiers reported low morale, frequent DUI arrests, and rising AWOL, spousal abuse, and rates of attempted suicide.  Soldiers also reported that given the financial realities of the Army, some of their fellow Soldiers had to resort to taking second jobs such as delivering pizzas to supplement their family income.

The report illustrates an atmosphere where lack of trained mental health professionals, combined with a military culture of keeping things to one's self, can leave many veterans going untreated. As the systems stands now, soldiers can easily provide false information on questionnaires designed to seek out those who need counseling. The most common way a soldier can received treatment is through self-referral. Furthermore:

In meeting with Fort Drum Soldiers, VFA found a number of disconcerting examples of inadequate mental health care at Fort Drum. Some Soldiers reported that the leader of the mental health treatment clinic at Fort Drum asked Soldiers not to discuss their mental health problems with people outside the base. Attempts to keep matters “in house” foster an atmosphere of secrecy and shame that is not conducive to proper treatment for combat-related mental health injuries. 

The New York Times profiled Eli Wright, 26, an Army medic based at Fort Drum. He described common episodes of flashbacks and shot nerves as routine occurrences. 

Mr. Wright said he waited weeks at Fort Drum to see a mental health professional, who diagnosed post-traumatic stress disorder. He was prescribed medication and pointed toward group therapy, where, he said, “half the time the group is staring at the floor.” At times, he was taking two pills at once. “I couldn’t stay awake,” he said.

A few weeks ago NPR broadcast a lengthy report in which it detailed a number of the same issues outlined in today's report.  One soldier said he felt like he'd been tossed aside like a pair of worn-out boots. Last week Army Surgeon General Eric Schoomaker was interviewed by NPR about what was detailed in its initial story:

NPR: What do you say to these people who've had less help with their paperwork because of what you've described as a misunderstanding?
SCHOOMAKER: So far — you're giving me new information, I wasn't aware that anyone has not gotten the best advice. If anyone out there feels that they didn't get the best advice, they need to come forward and let us know about that.

Meanwhile, last Friday 19-year-old Pfc. Jack Sweet, a Fort Drum soldier, was killed by a roadside bomb in Iraq.
 

The fifth anniversary of the start of our war in Iraq is a little more than a month away. There will be retrospectives looking back to those early days of shock and awe, in addition to news analysis and the nation's self-reflection. Even a month out from the anniversary, conversations about the upcoming day seem to revolve around the same theme: "can you believe it's already been five years?"  It is a sobering thought.  And even if you believe in the war, or are staunchly at odds with its premise, five years is a unit of time to view not so much in length, but in the various phases that occurred.

The summer of 2003, as I saw it, was a honeymoon period. The optimism for Iraq's future still ran high (at least in some circles), and at the same time I could see questionable expressions on the faces of Iraq's citizens as we patrolled past them. No one knew how it would all play out. Personally the fragile tensions that held together a shaky peace ended on November 12, when a suicide bomber destroyed the building in An Nasiriyah that at one time was my platoon's headquarters.

Homecoming was also different. There were no VA scandals, or talk of PTSD, or advocacy groups comprised of Iraq veterans. We simply came home and quickly immersed ourselves back into civilian life. To watch how that has changed is to examine the evolution of the war in Iraq and on the home front. To ask a veteran about his or her experiences in Iraq yields not an overall glimpse into the war, but an occasion to see just one phase of it. This is what needs to be remembered as the anniversary coverage begins. I remember seeing soldiers entering Iraq July 2003 and feeling bad for them. They'd missed the defining war of our generation. They would spend a few months in post-invasion mopping up, and go home on the tail end of the operation. Of course, the irony in this cannot be overstated.

We have enough perspective over five years to eschew generic "looks back" for a more nuanced analysis of how our country has fared over this time. It must be broken into phases: the invasion, the time surrounding 2004's battle for Fallujah, the grinding years of 2005 and 2006, the Abu Ghraib and Haditha investigations, and the controversial surge plan that's brought us to this point. At home the fascination with the invasion's pyrotechnics has given way to simply reading of the daily casualty figures ticking away over the news wires. There's also the trends in media coverage to consider, the heightened focus of home front veterans issues, and how artistic mediums have sought to portray the war and inform us.

Looking back on the fifth anniversary means not so much seeing what happened, but understanding how we got to where we are today, and how driven we are to look at Iraq not simply as a war, but as a series of distinct eras.

The phone rings in the St. Paul office of Maj. John Morris, a chaplain with the Minnesota National Guard and point man in the Guard's effort to “reintegrate” soldiers returning from Iraq.

The caller is a woman from Crookston, wife of a soldier who came home last summer after an extended tour.

“We've been walking on egg shells, and we can't take it anymore,” she tells Morris, her frustration billowing like black smoke from a sabotaged Iraqi oil well.

“The kids come to me for everything, like they've been doing the past two years,” she said, as Morris recalled the conversation. “He doesn't want to spend time with our friends; he thinks their interests are trivial and they don't know anything about what his life has been like.

“He says, ‘I just want to be with my war buddies.' ”

How can we help? Morris asked her.

“Send him back to Iraq.”

"We took a unit that was extremely hostile - especially after their time in Iraq was extended - and they didn't want any help at all.  Soldiers can be very direct, and at first they told us, ‘Hey, this is a bunch of crap. I don't need it.'"

In contrast:

Family members often were more receptive to a helping hand than the returning soldiers were, he said. “They had seen things when the troops were home on leave - things like anger, feelings of isolation. They thought, ‘Boy, this is going to be harder than we thought it would be, pulling this family back together.' ”

Also, family members “had been more exposed to media and had heard stories from other families about soldiers coming back with problems,” Morris said. “They had a better idea of what might be needed.”

 
According to local news reports so far these two contrasting groups are now beginning meet halfway with the help of the National Guard program. Now lawmakers are seeking to make Beyond the Yellow ribbon a model for other states to follow.

Yesterday we learned from the Washington Post of the record-breaking number of Army suicides during 2007. This is the latest edition of veteran suicide news that's made national headlines--further evidence that this is one aspect of the homecoming experience that isn't getting any better despite all the attention.The latest figures as reported by the Post:

• In 2007, suicides among active-duty soldiers reached their highest point since the Army began keeping records in 1980.
• 121 soldiers committed suicide in 2007, a 20 percent increase over 2006.
• Attempted suicides or self-inflicted injuries rose sixfold since the Iraq war began: there were 350 cases in 2002 compared to 2,100 in 2007.
• Historically, suicide rates within the military decreases during wartime; the current trend is the opposite of that.
• In 2001 the suicide rate was 9.8 per 100,000 active-duty soldiers--in 2006 the rate jumped to 17.5 per 100,000.
• In 2007 twice as many soldiers committed suicide in the U.S. as they did in Iraq or Afghanistan.

The Post provides this sober passage about a young Army reservist currently hospitalized after her suicide attempt:

On Monday night, as President Bush delivered his State of the Union address and asked Congress to "improve the system of care for our wounded warriors and help them build lives of hope and promise and dignity," Whiteside was dozing off from the effects of her drug overdose.

Taking a look at the issue of veterans suicides it's somewhat alarming to read this USA Today article from 2003. The language, the sense of urgency, the utter surprise in statistical findings can make one wonder if five years from now we'll still be reading the same type of articles--waiting for things to get better. The lead paragraph from the article could easily be substituted for a story about the current findings:

Alarmed by the number of suicides among soldiers in Iraq, the Army has asked a team of doctors to determine whether the stress of combat and long deployments is contributing to the deaths.

One very simple idea that would have helped relieve the mental burden of our troops (short of finding a way out of Iraq), and help them get the care that they need, is to give them substantial time off between deployments. Spend two years in Iraq, spend two years at home. And, on the homefront, aggressively test, treat, and monitor troops for mental injuries...

...Even without dwell time, and a much deserved rest for our forces, we have got to be more diligent about mandatory and exhaustive screening of returning troops, and providing adequate care and monitoring.

Our Readers Who Comment for the most part commend The Post and reporter Dana Priest for continuing to report on what happens to mentally and physically wounded soldiers returning from Iraq. They express sympathy for the individual around whom this story is built, call for a change in political leadership, improved patient car...Some contend that such reporting aids the enemy and question the patriotism of the journalist and her news organization. And, as sometimes happens, commenters take the opportunity to issue boilerplate condemnations of the Iraq War, some of which are anti-Semitic.

OCTOBER 30 -- A study by the American Journal of Public Health reports findings that younger veterans are more prone to suicide. This is the opposite of suicide trends among the general public.

NOVEMBER 13 -- CBS News concludes a five-month investigation into the "hidden epidemic" of military suicides.

DECEMBER 12 -- The House Veterans Affairs Committee holds a hearing on how to stop veterans suicides.

Combat Stress is alarmed at the huge increase in veterans from the Falklands, Sierra Leone, Northern Ireland, Iraq and Afghanistan, who come knocking on their door for help. A few are still turning up suffering long-term effects from the second world war and Korea. The oldest applicant for help recently was aged 100.

The problems of veterans today are compounded by the widespread recognition through much of the army that the Iraq campaign is unpopular, nasty, unpredictable and brutal—and, in the views of a significant minority of soldiers and officers in private conversation, a pretty unnecessary conflict at that. In the first and second world wars, the plight of service personnel was shared by almost everyone in the land. More than 1 million soldiers served in Northern Ireland over 30 or so years, so that became part of the national experience.

But combat in Iraq and Afghanistan is not a national experience, and the services are worried that they appear in the minds of many now to be detached from most of British national life. Though more American soldiers have been involved—more than 3,000 killed and nearly 50,000 injured, physically or mentally—Iraq is not a shared experience nationally for Americans in the way that Vietnam was.

A well-trained fighting machine reduced to nothing more than an empty shell.  Combat stress is their calvary, the infantry to fight off their demons.  They were protecting you, now they need your help.