What follows is an excerpt from David Wood's, "Beyond the Battlefield," an intimate portrait of the soldiers and Marines who volunteered for wars in Iraq and Afghanistan, and what happened to them after bomb blasts and bullets changed them forever. First published as a 10-part series, this e-book is an expanded version, including a Forward and several new chapters, as well as some of the most poignant photography and revelatory graphics from the original series.
For more on "Beyond the Battlefield," the Huffington Post's third e-book, check out Arianna's blog post here.
To buy the book, click here.
Chapter 8: 'I'm Not Who I Am in My Mind' -- The Invisible Toll of PTSD
The day began quietly enough, at least for western Iraq. It was a broiling hot day in November, 2006, and the Sunni city of Ramadi was a bloody killing field, for Americans and Iraqis. A small patrol of Iraqi army soldiers and their U.S. Marine advisors approached a school to hand out free backpacks to the kids. The schoolyard was eerily empty. Trouble was at hand.
K.C. Schuring, a Marine major, paced warily at the rear of the column as they headed back to Combat Outpost Steel. A hefty man, he weighed in at well over 200 pounds even without his body armor, helmet, radio, M-4 carbine, grenades and extra magazines of ammo. He heard the first shot snap past his ear. The second shot struck him just above the forehead. It felt like he'd been struck with a baseball bat. The bullet penetrated his helmet and his skull and blew out a small piece of bone from the back of his head.
He went down hard and landed face-down on top of his rifle, bleeding heavily but conscious. Out of the corner of his eye he could see the rest of his patrol sprinting away across the dusty courtyard and disappearing around a corner. He was alone.
Then rounds started impacting the ground beside him. He was shot in his right leg, the bullet passing cleanly through the flesh. The next round struck his other thigh, shattering his femur. The pain was excruciating.The insurgents, firing from behind walls and windows, meant to finish him off, and they were close to succeeding. In a daze, K.C. thought of movies he'd seen where somebody got shot in the head. None of them ever lived.
Many people would be terrified in a situation like this. K.C. was not terrified. He was angry. And he was able to translate that anger into courage and determination as he fought through the hours of that awful morning.
He rolled to one side, pulled out his weapon and sighted it on the corner from where the last shots had come. If I don't fight these guys off or die trying, he thought, then they'll take me, and my wife is gonna see me beheaded on al Jazeera. Blinking away sweat and blood and pain, he waited for the shooters to emerge from around the corner.
He would draw heavily on that courage in the years ahead, as his physical wounds healed and he struggled with stronger demons, the ravages of Traumatic Brain Injury (TBI) and severe Post Traumatic Stress Disorder (PTSD).
Every night for years, the ambush would play over in nightmares as he wrestled with what he could have done differently, with the agony of being left alone, with the guilt over having left his Iraq and American battle comrades after he was medevaced out. Months later, he began noticing that he was slurring his speech and hesitating in conversation, struggling to find the right word. He forgot things. He experienced violent outbursts at home. He would chase down motorists who cut him off in traffic, corner them in a parking lot or in their office and yell at them for being jerks and for not volunteering to fight in the war. He was losing control. He felt like he was going down for a second time.
"It was very scary,"' he told me. He suspected he had PTSD but shoved that thought away, "basically out of fear of never being a Marine again."
TBI, the bruising of the brain, is caused by the concussion of explosions or other head wounds. PTSD also is a medical disorder, which stems from mental trauma or sudden and prolonged emotional shock. Either or both conditions can cripple reasoning and upset emotional balance and cause memory loss, debilitating nightmares, sudden violence, migraine headaches, slurred speech.
Invisible wounds like these, in mild or severe form, affect at least half of of the 2.3 million Americans who have served Iraq or Afghanistan (and, of course, the generations who fought in Vietnam and previous wars: according to the VA, as much as 30 percent of Vietnam veterans have PTSD, which went largely unrecognized in the 1960s and 1970s.)
PTSD also affects over five million civilian Americans who develop PTSD at some point in their lives. About 10 percent of women and 5 percent of men acquire PTSD after experiencing traumas from disasters, sexual assault or abuse, accidents, or prolonged exposure to a situation where they feel their live is in danger.
But the PTSD suffered by many active-duty troops and combat veterans is sharply different from that experienced by most civilians, experts say. Many of the "symptoms'' of PTSD, which haunt veterans and their families at home, are normal adaptations to staying alive in combat: being hyper-alert, staying awake for long periods of time, being intolerant of mistakes, being quick to violence, and the ability to ignore, or deny, pain and emotion. In the war zone, these are not symptoms of illness; they are critical skills, necessary and normal on the battlefield.
The problem emerges as the combat veteran comes home and must readjust to a civilian environment, said Dr. Charles W. Hoge, who served on active duty for 20 years as an Army psychiatrist treating military service members and their families. As many returning warriors and their families have discovered, the military-civilian transition is not so easy.
"There is a naive expectation in society that veterans should be able to transition home smoothly and lead a 'normal' life after serving in a war zone," Hoge wrote in the fall of 2011 in the Vietnam Veterans of American magazine. "Combat-related responses don't just shut off upon returning home. The body doesn't have an 'on-off' switch, for good reasons, since these responses have to do with survival," he wrote.
The result: men and women returning from combat can feel jumpy and out of place. Many say they don't belong at home any more; some families complain that the person they sent off to war came back changed. Senior Army officers have said it takes 24 to 36 months to a returning soldier to return to civilian rhythms of life, and many soldiers and Marines were deploying back to combat with barely a year at home.
In the meantime, the symptoms of mental health injury can wreck marriages and tear apart families, whose members sometimes suffer secondary PTSD from acute stress or physical or mental abuse. Between 2004 and 2009, at the height of the fighting in Iraq, spouse and child abuse in Army families skyrocketed 177 percent, according to a 2010 Army study. The mental storms of PTSD can make it impossible to hold jobs, a major cause of veteran homelessness, according to the VA. PTSD can easily lead to hopelessness and sometimes, suicide.
For many veterans, the final straw is not being able to get help. Many say they feel that no one understands what they went through and no wants to take the time to listen.
"It was the utmost feeling of being alone,'' Dan Williams told me. He was injured in an IED blast in Iraq in 2003 and was having the nightmares and spasms of rage and depression that characterize PTSD, and he was trying to dull the pain with alcohol and drugs. But he said the Army wouldn't help, brushing him off with explanations that he was having "readjustment issues.''
One night, a year after he was injured, he locked himself in the bathroom and put a .45-caliber pistol in his mouth. His wife Carol begged him to open the door and when he refused she called the police. When they kicked in the door he pulled the trigger and click! -- the weapon misfired. He was handcuffed and put in the squad car, and when one of the cops tried to clear the weapon it went off, luckily hitting no one.
The burdens of mental health injuries are so severe that more than 6,000 veterans a year do take their own lives, according to the VA -- including 1,800 veterans a year who are receiving VA mental health care. Among active-duty troops, some 2,000 have taken their own lives since 2001, including 295 in 2010.
But tens of thousands of combat veterans are not receiving military or VA mental health care, either because they are unaware that they have a treatable condition or because they don't believe they can be helped.
War-zone stress can cause PTSD even among those who don't experience ground combat.
Justin Gourley served aboard the aircraft carrier George Washington in 2002 and 2003; as a Rapid Response Team leader he was responsible for helping protect the ship against terrorist attack. It was a high stress job, and when his enlistment was up in 2004 he declined to check a standard Navy form acknowledging mental health problems. "No way I was going to say I was having problems, I knew all the craziness would go away once I got home," he said later.
But at home his problems got worse. The smallest things would send him into a rage. His marriage started to fall apart; he lost his job. He couldn't sleep, then couldn't stay awake. He and his wife Shawn argued bitterly and violently over money, over sex, over everything. When someone suggested he might have PTSD he protested: "How could I? I never saw combat!'"
Gourley was an early mental health casualty of the Iraq and Afghanistan wars, and he and his wife fought for years with the VA to get understanding, therapy and disability payments -- which the VA at first denied. Getting the proper medication was an ordeal as well. "The problem is in order to control the symptoms you have to decide whether to over-medicate, which makes him a zombie, or have an out-of-control husband,'' Shawn said. She and Justin have written a book about their struggle in the hope that their experiences will help other families with PTSD.
Such wartime mental health issues can be treated -- managed, if not cured -- and the military's efforts to provide treatment have improved dramatically over the past few years, said Hoge, the retired Army psychiatrist.
Among the treatments most effective are simply talking about traumatic events with a sympathetic and understanding person, most usefully with a trained combat veteran. Visiting places that can cause stress, such as crowded shopping malls, can help desensitize veterans. Relaxation exercise, said Hoge, can help "dial down'' the levels of adrenalin and improve sleep. Medications that seem to help include seratonin reuptake inhibitors such as sertraline and paroxetine.
Hoge told a hearing of the Senate Veterans Committee that treatment for PTSD can be 70 to 80 percent effective "as long as individuals are able to access the care and continue with treatment long enough for it to be effective.''
And that's the problem: too many active-duty military personnel and veterans simply don't get the mental health care they need, say frustrated military and VA officials. Despite a concerted effort by the VA to locate and draw in Iraq and Afghanistan veterans, Hoge estimates that only half of those who need mental health treatment seek those services out. Of those who do begin treatment, he said, "many receive less than optimal care or leave before achieving recovery."
One reason is that the VA's mental health services are simply overwhelmed by the high demand. In 2010, over two million veterans sought mental health services from the VA, including almost half a million with a formal diagnosis of PTSD. In a Nov. 2011 survey of its own mental health care providers -- psychiatrists, psychologists and therapists -- the VA found that nearly 40 percent said they could not schedule an appointment in their own clinic within the 14-day window mandated by VA headquarters. More than two-thirds said they had inadequate staff to meet current demand.
At the VA medical center in Wilmington, Del., for example, there is no full PTSD treatment team, according to Michelle Washington, a VA psychologist and coordinator of PTSD services at the center. Neither is there a primary care provider dedicated to treating the flood of PTSD and TBI patients from Iraq and Afghanistan; the person who previously held that job had 1,038 patients to handle in two days a week allotted to those patients. She said a case worker at one VA outpatient clinic had more than 200 patients, including many at risk of suicide.
K.C. Schuring was lucky. He got all his medical and mental health care on active duty -- not in the vast VA system but within Defense Department facilities, at the Walter Reed National Military Medical Center. There, attention is lavished on fewer than 200 in-patients
Over the course of four years, K.C.'s head wound healed, He had 27 surgeries, mostly on his legs. Eventually, he was convinced to get intensive treatment for his TBI and PTSD.
But first, he was in a jam in Ramadi.
Blinking through the blood and pain of his head and legs, K.C. kept peering at the corner where an insurgent gunman had last appeared. Finally he was rewarded. A face appeared: close-cropped black beard and hair, a gray dishdasha, or robe, and black sandals. "I remember every detail about him. He looked like that guy who's the president of Iran,'' he said later. "I'll probably remember him for the rest of my life."
The shooter stepped out with his weapon up, perhaps thinking K.C. was dead. K.C. sighted in on him and squeezed the trigger, aiming at his chest. The shot hit his head and the insurgent dropped lifeless.
Within a heartbeat another man stepped out and began firing, and bullets thudded into the wall behind K.C. K.C. squeezed off three or four shots into the insurgent's left side and that man dropped, too.
Then, silence.
"I'm sitting there thinking, 'OK, Marine, what now? I'm still alive out here.'" No Americans or Iraqi soldiers in sight. He put his head down and breathed heavily a few times. Then he raised his torso up on his elbows, and began crawling toward safety, his M-4 riding on his arms, his legs lifeless. In 10 minutes his elbows were bloody and he had hauled himself maybe 10 meters. Suddenly his radio crackled into life with his call sign: Raider Five. Help was seconds away.
As corpsmen cut away his clothes and started to prep him for the medevac chopper, K.C. called his wife, Lynn, back home in Michigan. "Hey honey, I wanted you to know I'm okay, but I didn't take your advice to be careful.'' (Heck, he told me, "how could I be careful? I was out there kicking in doors and killing people!'') To his wife, he said: "I wasn't careful and I got shot a couple of times today, but I'm coming home and I love you.'' He was flown to U.S. military hospitals in Balad, Iraq and Landstuhl, Germany, and on back to the States. He flatlined twice and caught a severe acinebacter infection and doctors threatened to amputate his leg if his fever didn't subside. But it did and they saved his leg.
It was his mental condition, though, that caused him the most trouble. As his symptoms deepened, he began to think of his grandfather. Pat Doyle, K.C.'s maternal grandfather, was a World War II artilleryman. He landed at Normandy four days after D-Day and fought his way across Europe, and after he came home he never talked to anybody about his experiences.
But Doyle began drinking heavily and became an alcoholic. His wife divorced him and his life pretty much fell apart. After he hit bottom he somehow pulled things together, joined Alcoholics Anonymous and stayed sober for 33 years. But it wasn't until young K.C. joined the Marines in 1991 that Pat Doyle began to talk about war, relating some of the horrific things he had seen and done amidst the brutal fighting of 1944-1945.
Thinking back after he was wounded in Ramadi, and starting to feel the effects of PTSD, K.C. suddenly thought, "I know exactly what happened to him. He had PTSD and never realized it. That was a huge realization for me.''
Still, it took the forceful intervention of his wife Lynn and a neuropsychiatrist, Dr. David Williamson at Walter Reed, to get K.C. into TBI and PTSD therapy, in March, 2009. He had his meds adjusted to take the edge off his nightmares, and that helped.
Among the therapies that have worked, he told me, are video combat games, and talk therapy. Talking with a sympathetic and experienced listener has helped him to see the ambush in Ramadi as a movie he's watching rather than a participant. He's also found it helpful to write out his account of what happened -- and compose a different ending. After these sessions, he'd sometimes have the Ramadi dream again -- but it didn't seem as powerful anymore.
Because loud noises sometimes triggered his PTSD reactions, Williamson encouraged him to go to the rifle range with Marines and hang out there, desensitizing him to the sound of rifle fire -- and that helped.
For the same reason, he began playing combat video games, Call of Duty and Battlefield. "When I first started I could only play a minute or two and then I had to stop," K.C.said, because his anxiety would spiral up out of control. But soon he found it really worked. "I can throw a grenade at insurgents and really feel good about it, and I can die in the game and not feel bad about it. I'm not as jittery and jumpy," he said.
K.C. is still a patient at Walter Reed, and hopes to return to his Marine reserve unit in Michigan in time for training exercises and a short deployment to Morocco in 2012 to help train their forces. In his speech are faint reminders of his physical and mental wounds: he speaks slowly and deliberately and sometimes pauses to think about his word choice. "I'll want to say 'green beans,'" and I'll say 'green' and … ah, you plant 'em? and … Jack and the Beanstalk? -- beans!" he said with a laugh.
His physical wounds have left him unable to be the marathon runner and triathlete he once was. "I'm a lot better, but it is frustrating. I am not who I am in my mind," he said, and that adds to the anger that without careful management can escalate.
And like others who suffer from PTSD, he understands that it is forever.
"I'll always have PTSD," he said over coffee at the Navy Lodge on the Walter Reed campus. "But I think given the tools they've given me, I'll be able to manage it better going forward."
K.C.'s main concern now is reaching out to combat veterans who won't seek treatment for their own PTSD, including two close friends.
"The way I try to tell to one friend who's a Marine sergeant is, if you're in a firefight and you're pinned down, what do you do? You call for fire support. So right now you're in a fight for your life and you gotta call in for support. There is support out there for you. You just gotta call in for it."
But as K.C. knows, sometimes you get caught in a firefight, and you have to fight your own way out of it.
The Pentagon maintains a 24-hour psychological health outreach center for active-duty personnel or veterans who need assistance. The VA mans a 24-hour crisis hotline at 800-273-8255, press 1.
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