the mental wounds of iraq and afghanistan. THE RETURN.

The traumatized veterans of Iraq and Afghanistan.

By David FinkelSeptember 2, 2013

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The way it worked was that they joined the Army because they were starry-eyed or heartbroken or maybe just out of work, and then they were assigned to be in the infantry rather than to something with better odds, like finance or public affairs, and then by chance they were assigned to an infantry division that was about to rotate into the war, and then they were randomly assigned to a combat brigade that included two infantry battalions, one of which was going to a bad place and the other of which was going to a worse place, and then they were assigned to the battalion going to the worse place, and then they were assigned to the company in that battalion which went to the worst place of all. If you listen to the eulogies, so much of war is said to be accidental. Poor Harrelson. Wrong place. Poor Cajimat. Wrong time. But for members of Bravo Company, which in 2007 and 2008 spent fourteen months in combat, in a bomb-filled neighborhood in east Baghdad, the war eventually felt like the wrong everything. Twenty-five-year-old Nic DeNinno was in 3rd Platoon. He thought of himself as a patriot who had enlisted in the Army for the noblest of reasons: to contribute and to make some kind of difference. Then he punched his first Iraqi in the face, and pushed his first Iraqi down the stairs. Now he was back in the United States, crying and telling his wife, Sascha, “I feel like a monster.”

It was November, 2010, and he was in a twenty-three-bed psychiatric facility called Haven Behavioral War Heroes Hospital, in Pueblo, Colorado. It’s on the top floor of a six-story building; the exit doors are bolted and the windows are screwed shut, to keep patients from jumping out. Two and a half years earlier, Nic had come home from the war relatively healthy. Then he began having nightmares and flashbacks. He talked with increasing frequency of killing himself, and made at least one attempt. He was counselled and put on anti-anxiety and antidepressant medications, but when he was found one night in mid-flashback, driving in the wrong direction on a one-way street, the decision was made to send him to a residential treatment program for twenty-eight days. Twenty-eight days to get it fixed, as one of Nic’s sergeants said.

If war is accidental, so is what happens afterward. Two million Americans have fought in Iraq and Afghanistan. Most of those who have come back describe themselves as physically and mentally healthy. They move forward. Their war recedes. Some are even stronger for the experience. But studies suggest that between twenty and thirty per cent of returning veterans suffer, to varying degrees, from post-traumatic stress disorder, a mental-health condition triggered by some type of terror, or a traumatic brain injury, which occurs when the brain is jolted so violently that it collides with the inside of the skull, causing psychological damage. Every war has its after-war: depression, anxiety, nightmares, memory problems, personality changes, suicidal thoughts. If the studies prove correct, the wars in Iraq and Afghanistan have created roughly five hundred thousand mentally wounded American veterans.

For the worst off, there are programs like Haven Behavioral’s, which offers intensive therapeutic services. But the Army has yet to figure out which of its hundreds of programs across the country are most effective. Some are part of the U.S. Department of Veterans Affairs. Others, like Haven Behavioral, are private and for-profit. Some last seven weeks; others four weeks. Some mix soldiers who have served in Iraq and Afghanistan with Vietnam veterans; others are made up entirely of soldiers from Iraq and Afghanistan. Some have been around for decades; Haven Behavioral, which opened in 2009, is one of a wave of programs begun when the extent of psychological damage caused by the current wars was becoming apparent and the wait for a vacancy in a V.A.-run program was lengthening. Is one program better than another for a mentally wounded soldier? The answer, in Nic’s case: Haven Behavioral had an open spot.

“Contraband items,” the instructions Nic was sent before leaving Fort Riley, Kansas, read. “Weapons or any object which could be used as a weapon. Razors. Hangers. Neckties, scarves, belts, shoe laces, strings in sweatpants. Any ropes, strings, or chains. Neck chains longer than 24 inches. Panty hose or long stockings. Glass of any kind. Any electrical appliance using an electrical cord. Any sharp object. Plastic bags—any and all . . .”

He saw the theme here.

When he left for the airport, Sascha watched him go, her heart sinking. They had been married for fourteen months. They had met a week or so after Nic got home, when she heard that some soldiers were back and went online to see who they were. Her father and her grandfather had been soldiers. Most of her uncles had served in the Army. She had a soft spot for the military. She liked that Nic was big and muscled and spoke thoughtfully and had a tattoo on his back that read “Unity and Peace.” He got it when he was a teen-ager, he told her, before he thought of becoming a soldier, and she liked that about him, too. “You do know that something’s wrong with him,” a friend said.

He didn’t like crowds. He had nightmares. He had received a diagnosis of P.T.S.D. and depression from the Army. She was concerned. But there was something about Nic that made her want to stick with him, and so she did, through his flashbacks, and drinking binges, and a suicide attempt by overdosing on drugs, and then she married him. Now she was six months pregnant, and hoping that Haven Behavioral would make him realize that he could tell her about the war, and that she could take it.

“Report to the East Entrance by the flag pole and statue of Mary,” Nic’s instructions continued. “Go to the elevator, 6th floor, left out of elevator and pick up phone dial ‘0.’ ” He dialled “0.” A door swung open and locked behind him, and before long someone was explaining how the program worked. For the first three days, he would be constantly monitored and could have no contact with anyone outside the program. After that, his privileges would be determined by his behavior, up to Level III, which included computer use, cell-phone use, trips under escort to the Loaf ’N Jug convenience store on the far side of the parking lot, unsupervised shaving, wearing shoes with laces, and having visitors. The day would begin with exercise at 6:30 a.m. There would be group sessions with the other twenty-two men in the program, on dealing with anger, setting goals, and, most important, talking about what had happened, over and over. Lights-out would be at 11 p.m. Nic was also expected to keep a journal. Out of profound need, or just the desire to wear shoes with laces again, he started doing that right away.

He wrote:

“My childhood was quite a normal one growing up, no physical abuse, loving parents. My dad traveled a lot but made up for it in family trips we took yearly around the world and all over the country. My mom never let me play with toy guns or any kind of weapons or watch TV during the day, instead she forced me and my brother to play outside rain or shine in the woods behind our house.”ADVERTISEMENT

Of his decision to join the Army, he wrote that it was “one of those apifany-like moments.”

He wrote about an early mission in Iraq:

“I don’t remember the exact briefing before we left but we were to show extreme force and to let these people know we owned this city now. The adrenaline began to flow, the thought of having that kind of control was intoxicating in a sick way.”

He wrote about the first soldier he saw killed in action, who had burned to death:

“What was left of his skeleton was hanging out of the driver-side door, his helmet a different color possibly fused to his skull and his IBA and plates which made up his torso, or what was left of it. That image still haunts me, it changed me. . . . I don’t know how many others saw that as we turned our trucks around but all I wanted was death and violence from then on. . . . To me this is where I lost my old self.”

He wrote about being home:

“I try so hard to be polite to everyone but I don’t know how much longer I can do it. I am trying to let this anger out bit by bit but it’s like holding up a dam with my mind, letting bit by bit out to keep it from going over the edge or breaking all together. Is there no medium, have I gone past that point where there is a safe way to get all this out without losing control? I am beginning to feel not. I feel it’s gonna happen soon. It’s just a matter of who says the wrong thing at the right time.”

He wrote about a nightmare:

“The anti-nightmare meds are not working. I was on a patrol last night and we entered a school, same as one from our deployment, but as we were clearing the school I went into an all-girl class and in real life they just screamed but in my dream they screamed and I opened fire, killing the whole class. What that is about I do not know. I am angry I have these dreams, I am angry they don’t stop. I miss my pleasant dreams of my past.”

He started to write about another nightmare, but he didn’t finish. Two weeks had passed, and he had made it past Level I, past Level II, and arrived at Level III. He could wear shoes with laces. He could shave unsupervised, and go to the Loaf ’N Jug.

What he had written so far:

“What the fuck is going on in my mind? Last night I was sitting in bed and looked across the room to a chair in my room and there was a young girl covered in blood. What happened after that I don’t remember. I was told a full-scale panic attack. This is not the first time I have seen dead bodies. For a while I used to find dead Iraqis floating in my bathtub. Why they were in the bathtub I will never know.

i feel so fucking violent right now.”

It was an eight-hour drive from Fort Riley to Pueblo, not easy for a pregnant woman in a compact car. But Sascha wanted to see if this program she knew nothing about was helping. In Kansas, Nic had been taking forty-three pills a day—for pain, for anxiety, for depression, for nightmares. Were there fewer pills now? Was he still having flashbacks? Thrashing around in his sleep? Sleepwalking into closets, looking for his rifle? Could he start telling her what had happened during the war? And could she tell him about what was happening to her? The other night, she dreamed that she had given birth, and for some reason she took the baby and put it in a pressure cooker. Could she tell Nic that soldiers aren’t the only people who have nightmares? Was he ready to hear that?

She checked into a hotel in Pueblo, and waited for visiting hours to begin. Meanwhile, a nurse gave Nic his anti-depressants and mood stabilizers. Pill, water, swallow. Pill, water, swallow. When he had finished, another soldier took his place—twenty-three P.T.S.D. cases in all, including one who was blinded in an explosion and had a guide dog. Many soldiers with psychological injuries envy those with physical injuries, because those soldiers can see that something is really wrong with them. But what to make of this poor sightless soldier who didn’t get even that benefit? The other soldiers were especially gentle with him.

“Smoke break,” a soldier hollered. “Smoke break.”

“Level III smoke break,” a nurse called out, checking the time. The smokers with Level III privileges were led out by an escort, who unlocked the door; after they returned, all the soldiers went into a conference room for cognitive-processing therapy, an hour-long session whose purpose is to get them to read from their journals and talk with one another until they are no longer avoiding the subject of what has happened to them. Of all the protocols being used to treat P.T.S.D., this one is considered to be among the more effective.

“All right. Everybody pay attention, and don’t talk when others are talking,” a staff member leading the session said. He thought for a moment. “Also, don’t fart,” he pleaded, and, with that out of the way, the first soldier began reading.

He had spent his war in a vehicle that crept ahead of convoys, looking for roadside bombs. “This is just something that’s been on my mind for quite a while,” he said. “It’s entitled ‘Bombs Bombs Everywhere.’ ” He sat at the head of a long table with his journal, reading slowly, and if this were happening anywhere else guys would have laughed at him, or thrown beer bottles, or done whatever it would take to get him to shut the fuck up. But, in this room, when he said, “I still see the bombs, I see bombs all the time,” a few of the other men ducked their heads, because of what they were seeing, too. “Make it stop,” he read. “Make the bombs go away. I don’t want to see them anymore. How do I become normal? How can I stop seeing bombs?”

He looked up from his journal. Heads hung. Feet tapped. Legs twitched. Another guy pressed his hands between his knees and then stood up, too nervous to sit. Nic was standing, too, at the far end of the room, and he asked the guy who had been reading, “What kind of vehicle did you drive?”

“I was the Husky guy.”

“The Husky’s the big one?” Nic asked.

“It’s the vehicle that goes in front of the convoy.”

“You were in Iraq, right?” another Husky driver, an Afghanistan soldier, asked.

“Yes.”

“Were you hit?”

“Yeah.”

“It’s hard being the first one,” the other driver said. “I mean, you have the whole convoy coming behind you, and if someone behind you gets hit you feel bad, because you’re supposed to be the one to find it.”

“Yeah.”

We dont need to reinvent the wheeljust the earnings report.
“We don’t need to reinvent the wheel—just the earnings report.”

The session leader spoke to the group about a process he called habituation. “Think about when you guys go see a scary movie,” he said. “The first time you see a scary movie, at least for me, it sucks. I get home, and I have nightmares, and I’m frustrated, and I don’t sleep well, and just whatever, because I’m a wuss at scary movies. If I go see the same scary movie the next day, and I go see it a third day, the third day it’s still a little bit scary, but it’s not getting to me as bad. The fourth and fifth day is when I’m starting to sit there and I’m actually starting to get a little bit bored. The tenth time I see that scary movie, I’m, like, O.K., cue Freddy Krueger, here’s the cheerleader who gets her neck cut off, here’s the blood, and now the chainsaw, and I’m getting bored. It’s the same principle with explosions for you guys. If you guys can go to a place and have the experience repeatedly, and stay with it until it starts to dissipate, that’s when the explosion starts to be less and less impactful. It’s called habituation. To habituate. Make sense?”

https://www.newyorker.com/magazine/2013/09/09/the-return

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