Bearing the pain of war

By: WILLIAM FINN BENNETT - Staff Writer | Saturday, October 21, 2006 10:39 PM PDT ∞

NORTH COUNTY ---- For Gulf War veteran Nick Morris, it's the smell of diesel. In the case of Vietnam War veteran Charles Hargett, it's the sound of a car backfiring or the scent of Asian food.

For victims of post-traumatic stress disorder, certain sights, smells and sounds trigger such symptoms as nightmares and flashbacks, insomnia, detachment and depression. Mental health professionals say that in some cases, the disorder leads to acts of violence, substance abuse, divorce, job loss, homelessness and even suicide.

Troops from the Vietnam era and later wars have struggled with the disorder, and now a new crop of Iraq and Afghanistan veterans are being diagnosed at an increasing rate, according to the Department of Veterans Affairs.

A recent VA study shows a tenfold increase in the number of Iraq and Afghanistan war veterans who had sought treatment for symptoms linked to combat stress in the previous 18 months, affecting fully one-third of veterans.

North County figures have also increased. The number of visits to the Vista Veterans Center by recent combat veterans seeking help for mental problems jumped from 459 in fiscal year 2005 to 727 in fiscal year 2006, officials with the center said last week.

The VA's National Center for Post-Traumatic Stress Disorder estimates that about 30 percent of Vietnam War veterans have experienced the condition upon returning to the United States, while about 8 percent of veterans from the first Gulf War are believed to have experienced symptoms.

The center defines the condition as "a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape."

Specialists working with patients who are suffering from the condition say that some victims show relatively mild symptoms at first, such as shortness of temper, detachment and depression ---- symptoms that can suddenly worsen, months or even years later, during a period of crisis.

San Marcos resident Morris, 41, is somewhat of a textbook case. He was discharged from the Army's Special Forces in 1993 after serving in the first Gulf War, where he "saw lots of bullets, lots of bodies, lots of death," he said last week. Given the secret nature of many Special Forces operations, he said he could not comment on all of the places in which he saw combat.

Morris said he lived a relatively normal life for the first three years after his discharge, with occasional angry outbursts, "but nothing that would arouse any flags or suspicion." Then in 1996, he broke his neck in an injury at his job.

During the prolonged and extremely painful convalescence that followed, he began to find himself suffering bouts of rage and depression, Morris said.

"The tiniest bit of stress would completely set me off," he said.

Eventually, he sought professional help with a licensed therapist. But when the therapist diagnosed him with post-traumatic stress disorder, he didn't want to believe it, Morris said.

"I swore up and down, 'No, it can't be,' " he said.

At first, he felt that admitting the condition would make him weak.

"It's a man thing, the ego, male testosterone," Morris said.

But he knows that's an illusion now, he said, and encourages anyone who is suffering from the symptoms to seek help.

"When you go through something, it's always better to go through it with someone else ---- even misery," he said.

If he could, he would tell them, "You're not crazy and you're not alone," Morris said.

Over time, the therapist taught him to isolate the pain and anger he carried and to beware of the triggers that unleashed the symptoms.

By recognizing those triggers and learning coping skills such as meditation, counting to 10 and thinking of positive experiences, it is possible to reduce the impact of the symptoms, he said.

"Over the seven or eight years I have seen him, I have learned to deal with the triggers and situation pretty well," Morris said.

Specialists who work with victims of the condition say treatment can include prescription drugs, such as antidepressants, group therapy sessions and individual therapy sessions that involve reliving the experience over and over again.

Through late 2004, Jennifer Morse, M.D., served as chairwoman of psychiatry at the Naval Medical Center of San Diego. In that role, she treated many victims of post-traumatic stress disorder, she said.

Initially, many patients resist the cognitive therapy sessions in which they are asked to relive their traumatic experiences, Morse said.

However, "repetition of the trauma is the most effective form of treatment," she said.

Not that it's easy on the patient ---- or the therapist, she added.

Morse began treating men and women with post-traumatic stress syndrome during the first Gulf War in the early 1990s. But the symptoms she has seen in recent Iraq war veterans, in many cases, are even stronger than the ones she saw during and after the first war, she said.

In part, she attributes that to multiple deployments and repeated exposure to danger, death and destruction, Morse said. Some Marines, soldiers and sailors are now on their fourth tour of duty in Iraq.

"I had problems listening to these young people," Morse said of the newer veterans. "I got tears in my eyes listening to the horror of what they had been through. They would be sweating while describing it, getting more and more upset, snapping their head around and actually talking to their fellow gunman."

She might have had San Marcos resident Jeffrey Eckert in mind. The 43-year-old electrician served with the Army National Guard in Iraq from May 2003 to May 2004. Eckert said Wednesday that he saw a lot of horrible things during that year. On a couple of occasions, he told his VA therapist the details of what he endured, "but I didn't like it."

To this day, it's tough to talk about his experiences, Eckert said.

"The horror of what actually happened, what I did, what I had to do for my guys, it just repeats in my mind all the time," he said.

Only those who have seen combat can understand what it's like, Eckert said. And that is why group therapy is so important. He said he has participated in a group for about two years and expects that he will continue to go for the rest of his life.

Almost as soon as he returned from Iraq, the symptoms of post-traumatic stress syndrome hit him ---- the anger, the sleep deprivation, the nightmares, he said.

The day he realized he could no longer feel love was the day he knew something was deeply wrong, Eckert said.

"It was all gone and no matter what I did, I couldn't get it back," he said.

Then, he began noticing his wife was full of bruises because of his hitting and kicking out during the night as he slept, he said. So, he sought professional help.

"I couldn't let that go on anymore," Eckert said.

Morse said that adding to the trauma of multiple deployments is the sense of dread that many experience in knowing they must return to the mayhem of Iraq, "having to convince themselves that everyone else has done it, and they have to do it, too."

After repeated exposure to trauma, some troops simply become numb to the violence, she said.

"It's almost like they have lost the capacity to feel sadness ---- they replace it with anger," said Morse.

Not everyone who experiences or witnesses severe trauma on the battlefield develops the condition, while some have more severe symptoms than others, she added.

"Some combat veterans become very paranoid, to the point of guarding their home with weapons, pacing the house at night," Morse said, noting that many veterans are hypersensitive to sound.

Another specialist in the treatment of the disorder agreed that multiple deployments are taking a toll on troops.

"I predict this war will probably produce a good number (of victims,)" said Jeffrey Matloff, who heads up post-traumatic stress disorder treatment for the VA in San Diego County.

He said that one of the most important ways of reducing the onset of severe symptoms is by providing veterans with family support and social support from peers, friends and churches.

"Social isolation can lead to severe PTSD, because it means you are stuck in your head more," Matloff said.

That is one of the reasons why group therapy is often recommended as a treatment for the disorder, "getting people to realize they are not the only ones in the world who have had the problem," Matloff said.

"Combat is a life changing experience for everyone," he said. "It's a difficult to go from combat to ... being a civilian."

Morris said he couldn't agree more. One of the hardest adjustments he had was giving up his weapon, he said.

"I used to put my finger on the trigger and right away feel better," Morris said. "Now, I don't have that ---- it's like losing a leg or an arm."

While some veterans experience delays in the onset of symptoms, others have had them for decades. Because they didn't seek treatment, the condition was never diagnosed. Health professionals say that if victims of the disorder go untreated, symptoms can become increasingly severe.

That is exactly what happened to former Marine Sgt. Hargett, the Vietnam War veteran said last week.

The Purple Heart recipient served in Vietnam in 1967 and 1968 and had five confirmed kills of Vietnamese, one of them a child of about 5 who was accompanying a woman who shot at him with a rocket, Hargett said.

He wasn't diagnosed with the disorder until 2001, after suffering from its symptoms for three decades ---- symptoms that grew more intense over time, he said. He had severe drinking problems, violent outbursts, a failed marriage and a series of arrests for driving under the influence and one for assault with a deadly weapon, Hargett said.

In 1994, he and his former wife had an argument over a family vacation and things quickly spiraled out of control, he said.

"I put a gun to her head and was getting ready to shoot her," Hargett said.

Most patients improve with therapy, but the duration and success of treatment varies from person to person, said Jim Chandler, medical director for behavioral health with TriWest Healthcare Alliance, a private company under contract with the Department of Defense to provide health care for military families.

"Some people get better without treatment, some people improve quickly with treatment and some people (the condition) affects for much longer, even with treatment," he said.

Each person is also different when it comes to which type of therapy suits him or her best, Chandler said. Some patients work better with individual therapy that often involves reliving their traumatic experiences, he said. In other cases, that's a bad idea, he added.

"It's not comfortable for some people, leading them to stop therapy," he said.

"Not all treatments are effective for every individual and it requires trying different therapies," Chandler said, adding that group therapy is more beneficial for many people.

Antidepressants, anti-anxiety and sleep medications are often helpful in helping to control symptoms, he said.

Patients are also taught techniques for minimizing the symptoms, things such as anger management and learning to think before acting, Chandler said.

"Anger tends to be impulsive, and impulse control requires training for some people, helping individuals to see the early warning signs and identify what leads up to the reaction," he said.

Psychiatrist Morse said too many men are sitting at home suffering and thinking they are going crazy and they must seek help.

"It doesn't mean they are a coward, (or) they are weak," she said.

Family members and co-workers should not hesitate to talk to veterans they believe are showing symptoms of the disorder, Morse said.

"These people just need someone to say, 'Have you talked with somebody since you have been back, gotten counseling?' " she said. "It can happen to anyone, it does happen to anyone, no matter how prepared they think they are."

Morris, Hargett and Eckert are going about their daily lives as best they can. Hargett dedicates much of his time to his volunteer work as commander of North County's chapter 493 of the Military Order of the Purple Heart. Eckert is working as an electrician who helps install cell phone towers. He said he puts in lots of overtime and finds it therapeutic. He and his wife recently bought a home. Morris stays busy working with his wife in their catering business and business is great, he said.

As the men continue their treatment for post-traumatic stress disorder, all of them say that therapy has provided some relief.

"It won't go away, but the treatment helps you cope with it," Hargett said.

Staff writer Joe Beck contributed to this report. Contact staff writer William Finn Bennett at (760) 740-5426, or wbennett@nctimes.com.

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