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Stress, A Lingering Hazard

Dallas Morning News | December 09, 2005

DALLAS - Not all the wounds received in Iraq are visible. Not all the combat deaths occur on the battlefield. For Capt. Michael Pelkey, the war followed him home.

After a year in the Persian Gulf region, Pelkey returned to Fort Sill, Okla., in July 2003. He quickly immersed himself in a new Job and began getting reacquainted with his wife and infant son.

Then came the terrifying nightmares of the death and destruction he had seen in Iraq - and the inexplicable anxiety he felt in the safety of home. He grew forgetful. He began sleeping with a loaded 9mm handgun.

On Nov. 5, 2004 , a week after an off-post therapist determined that he had post-traumatic stress syndrome, Pelkey shot himself in the chest and died.

'Michael wasn't in Iraq, but in his mind, he was there day in and day out,' said his widow, Stefanie Pelkey of Spring, Texas. 'He'd never discuss the details of his experiences in Iraq, but they changed him forever. What killed my husband was a wound of war.'

Since combat operations began in Iraq in March 2003, 45 Soldiers have killed themselves in Iraq, and an additional two dozen committed suicide after returning home, the Army has confirmed.

And while no one knows precisely what pushes someone over the edge, the unresolved stresses of combat on the Soldier's heart and mind are a factor.

The Army surgeon general estimates that 30 percent of returned Iraq veterans showed signs of some mental stress three to four months after coming home. The 2004 Army Mental Health Advisory Team survey, while showing improved unit morale in Iraq over the previous year, also showed that nearly one in five U.S. combat Soldiers had acute post-traumatic stress syndrome.

'This is the froth of the wave. The big numbers are coming,' said Steve Robinson of the National Gulf War Resource Center, an advocacy organization for veterans of conflicts in the Persian Gulf region. 'It took years for the severity of PTSD among Vietnam veterans to show up. If we don't give the Soldiers the help they need, such as face-to-face counseling, we're cheating them of a debt owed.'

Another Army study, published in The New England Journal of Medicine, found that 17 percent of U.S. combat troops, including Army and Marines, experienced major depression and combat stress, the highest rate since Vietnam .

Just one-fourth to less than half of those with Post-Traumatic Stress Disorder sought help, according to the Army study. And some 65 percent of those questioned said they worry that if they asked for help, it would make them look weak or affect their military careers.

The military is keenly aware of the mental health need and the potential for numbers to increase. More mental health workers are serving in line units in Iraq. Commanders of units destined for Iraq and Afghanistan are urged to give Soldiers and their families information on the effects of post-traumatic stress disorder before and after deployment.

All returning Soldiers go through mandatory screenings, though they vary from commander to commander. And the Army is sending more mental health teams to Iraq to work more closely with Soldiers in the field.

'We recognize that it is in our best interest to decentralize mental health care. For the wounded sent stateside, it's presented as just another part of the care. We can provide some confidentiality,' said Col. Lorenzo Luckie, chief of behavioral medicine at Brooke Army Medical Center in the San Antonio area and a consultant with the Great Plains Army Regional Medical Command.

For those still overseas, the Army is improving access to mental health workers and making mental health care 'more visible to commanders as a source of help,' he said. 'We hope that leadership will present mental health care as something safe and without negative effects on career.'

National Guard and reserve Soldiers, who make up half the troops in Iraq and Afghanistan, show higher rates of post-traumatic stress. But once deactivated and sent home, they must fall back on the Department of Veterans Affairs for treatment. According to VA data, 9,600 of the 360,000 Soldiers discharged after fighting in Iraq and Afghanistan have received a provisional diagnosis of post-traumatic stress disorder.

'We're a lot better able to assess needs now than we were for Vietnam,' said Dr. Larry Lehman, chief psychiatric consultant with the Department of Veterans Affairs in Washington. 'We hope to identify the psychological and social problems resulting from combat stress before they harden into mental disorders.'

Critics of the VA, however, aren't convinced. On Veterans Day, retired Marine Gen. Joseph Hoar, a former commander in the Middle East , called on the federal government to strengthen its health care system for veterans.

'President Bush has consistently refused to provide enough,' Hoar said. 'Earlier this year, his administration admitted they were $1 billion short in funding for critical health care services. Thousands of veterans returning from Iraq and Afghanistan will require mental health care, yet the Bush administration has not taken action to deal with this emerging problem.'

In April, the Department of Veterans Affairs acknowledged it had underestimated medical care costs, requiring Congress to approve an additional $1.5 billion in emergency funds for this budget year.

Congressional leaders said the additional money would correct underestimations by the VA of the number of veterans seeking care, as well as increased costs of treatment and long-term care. But Congress also found that the VA had not taken into account the additional costs of caring for veterans injured in Iraq and Afghanistan.

Veterans in several states have found that Veterans Affairs had to stop scheduling appointments because of a lack of staff or a shortage of funds, said Robinson of the National Gulf War Resource Center.

'For the Guard and reserve, it's particularly bad,' he said.