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Monday, Nov 9, 2009
Politicians and celebrities -- like Dale Earnhardt Jr., ZZ Top and President Bush -- routinely visit the wounded at Walter Reed; but dignitaries don't come to Ward 54. When I first visited the lockdown unit in February 2004, it held around 35 patients, who slept as many as six patients to a room. Most patients stay in lockdown for just a few days, then are moved to rooms in hotel-like facilities to get treatment at the Walter Reed outpatient clinic, known as Ward 53. Within the lockdown unit, doors were kept open so that the patients who padded around the linoleum floors in Army-issued slippers, pajamas and robes could be observed at all times. Patients in various states of consciousness, from alert to near catatonic, sat around a television in a communal room. Some wore bandages from what other soldiers said were self-inflicted wounds. Patients were not allowed near the twin electric doors to Ward 54; these open by a buzzer from the nurses' station, staffed 24 hours a day.
Soldiers who have stayed in the lockdown unit say they were heavily medicated the entire time. Some remember hearing screaming, or patients being subdued on stretchers after shock therapy. "Inpatient can be a traumatic experience for anyone," said Lt. Jullian P. Goodrum, 34, who was in Ward 54 last February after serving in Iraq. Records show Goodrum was held in the ward 13 days longer than needed while the Army decided whether to charge him as absent without leave when, after getting back from Iraq, he was earlier hospitalized by a civilian psychiatrist. He is fighting those charges.
The soldiers told me about their textbook symptoms of PTSD: sudden, ferocious bouts of rage, utter detachment, anxiety attacks accompanied by shortness of breath, and increased perspiration and rapid eye movement. They complained of relentless insomnia, racing thoughts, self-loathing, blackouts, hallucinations and the constant reliving of war through flashbacks by day and nightmares at night. Some described vivid fantasies of violence toward the Army brass in charge of patients there -- slicing their throats, throwing them out windows or shooting them. One psychiatric outpatient, who watched as his best friend was blown up by a roadside bomb in Iraq, said: "It does not matter how hardcore you are. Once you go to that war and you start to see dead bodies -- you see an arm over here, you see guts over there. There is no way you are ever going to erase that."
When it is done right, PTSD treatment is a delicate task. Trust is crucial, and medications are carefully administered and monitored. Most critical is getting patients to control the powerful and destructive emotions that can follow a traumatic event like fighting a war. What bewildered the soldiers at Walter Reed, though, was that the Army seemed determined to downplay their war trauma and search for other causes for their mental health problems. In group therapy, sessions often focused more on family relationships and childhood experiences than war, the soldiers said. One outpatient soldier was so angered about this avoidance of the topic of war, he threw a chair during group therapy. Doctors promptly sent him to lockdown.
"When you get [to Walter Reed], they analyze you, break you down, and try to find anything wrong with you before you got in" the Army, said Spc. Josh Sanders, in a telephone conversation from his home in Lovington, Ill. "They started asking me questions about my mom and my dad getting divorced. That was the last thing on my mind when I'm thinking about people getting fragged and burned bodies being pulled out of vehicles," said Sanders. "They asked me if I missed my wife. Well, shit yeah, I missed my wife. That is not the fucking problem here. Did you ever put your foot through a 5-year-old's skull?"
Sanders, 25, served in Iraq with the 1st Brigade, 1st Armored Division, from May until December 2003. I met him in the summer of 2004 while he was getting treatment at Walter Reed in the outpatient clinic. Sanders had been evacuated from Baghdad because of the toll the war had taken on his mind. His complaints about Walter Reed were sadly typical. "Nobody hears about this. Nobody hears about what really happens when you are there getting the 'premier' medical treatment," Sanders said.
Dr. Herbert Hendin, medical director of the American Foundation for Suicide Prevention spent many years studying and treating veterans with PTSD after the Vietnam War. In discussing their treatment, Hendin said, "What veterans need is not simply to be able to talk about their combat experiences but to be able to talk about them with someone who understands the context." Hendin said a combat veteran "needs to feel an empathic connection with the treating professional." But to the soldiers, the atmosphere in the Walter Reed psychiatric units wasn't conducive to feeling understood, or getting better.
In Ward 54, recent combat veterans are mixed with other soldiers and even civilians suffering a wide range of mental problems. For them, coming back from Iraq and being treated alongside soldiers with schizophrenia, for example, or maybe even soldiers' dependents with schizophrenia, makes them feel "crazy," as opposed to having a natural reaction to combat stress. "If you are a hard-charging person, or somebody who tries to do things right, you are already taking a huge hit to your ego by being put in there," Beeson, the Army colonel, told me. One of the two Walter Reed officials who spoke on condition of anonymity agreed that recent combat vets shouldn't be lumped in with other psychiatric patients. Those soldiers "need to have a specialized unit," the official said. "They are labeled goofy and crazy, and they are not crazy."
Beeson served in Iraq with the Army's Civil Affairs Command, part of the Army's special-operations units. He is a 47-year-old reservist with 26 years of service under his belt, a wiry man grizzled by war. Beeson says his PTSD manifested during his second tour in Iraq. He was flown to Walter Reed. When I first met him in August 2004, heavy medication made him speak in slow, halting sentences like a drunk with a stutter. "A lot of the therapy was counterproductive to me," Beeson said in a telephone interview from his home in Arkansas, after getting out of Walter Reed. "It was a very paranoia-inducing place. If I was not paranoid when I got there, I was paranoid when I left ... To me, they need to figure out if they are going to treat people for war or be a regular hospital."
