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Afghanistan takes mental toll on military

3rd Herd

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Afghanistan takes mental toll on military
Updated Mon. Jul. 23 2007 8:25 AM ET

Canadian Press

About once a week, David would quietly leave his office, drive a half-hour away and change out of his uniform before sitting down with a doctor for a regular appointment.
For months, the young soldier ventured far from his military base in Edmonton to seek help for a problem that had robbed him of his sense of humour and left him haunted by memories of comrades' bodies being loaded into helicopters in the deserts of Afghanistan.

It was a hassle, but it was the only way he felt he could get the treatment he needed without facing repercussions from a military he and others say is failing soldiers traumatized by the rigours of war.

"They've made it impossible," David, who insisted on using a pseudonym, said in an interview from his Edmonton home.

"I had to drop my treatment because I couldn't get the time off from work and I was embarrassed to tell the people I work with. Once you start going to see someone to help you out, they treat you like you can't do your job no more.

"You come home and you almost feel like the army's turning its back on you."

The blunt criticism comes as the Canadian Forces begins to deploy a fresh batch of troops to the country's restive southern flank, and welcome home still more who have endured everything from the tedium of life on a military compound to the stress of heavy combat.

It's likely some of them will suffer from what the medical community benignly refers to as "operational stress injuries" - a range of afflictions that includes alcoholism, depression and post-traumatic stress disorder, or PTSD.

Numbers obtained by The Canadian Press show that of 1,300 Forces members who served in Afghanistan since 2005 and underwent a post-deployment screening, 28 per cent had symptoms suggestive of one or more mental health problems.

Of those, 16 per cent showed signs of high-risk drinking and just over six per cent were possibly suffering from PTSD. Five per cent showed symptoms of major depression.

The numbers aren't alarming, says Dr. Mark Zamorski of the deployment health section of the Canadian Forces, but they do show how negative combat experiences are contributing to mental health problems.

For example, only eight per cent of troops who completed post-deployment questionnaires after rotations in Kabul - a less hostile mission than the current operation in Kandahar - showed signs of mental health issues.

"The magnitude of the health impact is about what we'd expect given the nature of the deployment," Zamorski said in an interview from Ottawa where he conducts research on ways to mitigate adverse health consequences on members of the Forces

"Mental health problems are a major source of casualties these days."

PTSD is a complicated disorder characterized by what Zamorski described as "the intrusive re-experiencing of a traumatic event." That can happen through nightmares, flashbacks and vivid memories, all of which can cause problems sleeping, expressing emotion, anger and avoidance of situations that remind someone suffering from PTSD of the traumatic event.

For David, the signs began surfacing about six months after he was back from what was his first deployment. His wife and family kept telling him he was different, that he didn't laugh like he once had and that he was hanging out only with the guys from his tour.

"You don't see the problems right away," he said. "My wife kept mentioning it. So I went civvy street (to get help) because I didn't want to go on base. We have tons of psychiatrists on base, but you won't see anybody going to them because you can't - it's during the workday and everyone sees you, so who wants that?"

But while David is reluctant to openly deal with a mental health disorder, former corporal Brian Stevens says his plea for help went unheeded by military superiors.

Stevens, a 10-year veteran of the Canadian Forces, served in Afghanistan from August 2005 to March 2006. It was a rude awakening for the soldier from a small town in Nova Scotia, who on his first overseas deployment spent much of his time away from the main Kandahar base and taking fire while driving the area's treacherous roads. Witnessing the extreme poverty and dismal humanitarian situation didn't make it easier.

When he returned home, he displayed the telltale signs of a stress injury. He was irritable, couldn't sleep, flew into rages and became indifferent to most things, especially the authority of the military. Soon he was drinking heavily and racing down rural highways with a beer between his legs.

That summer, he hit rock bottom, indulging in a panoply of drugs that included intravenous cocaine, Dilaudid, OxyContin and morphine - drugs he insists he had never tried before.

"I never thought I'd stick a needle in my arm, but when I came home I did," he said from Edmonton, where he was recently living after being released from the military.

"I went right off the rails. They didn't know how to deal with me, you know: 'How do we deal with a junkie?' There was nothing in the rule book, so they didn't do nothing."

His mother Bonnie said she noticed marked changes in her son, who was once outgoing and talkative. He spent most of his time sleeping, became moody and withdrew into himself.

"He wouldn't get up out of bed in the morning to go to work and they'd send the military police and that wasn't like him at all," she said from her home in Salmon River, N.S.

"The military didn't seem to understand. He would go AWOL and he wouldn't know why and all they'd do was throw him in jail instead of giving him the help he obviously needed."

An already bad situation grew worse when he and four other soldiers at CFB Gagetown, N.B., were charged with trafficking in cocaine, ecstasy and marijuana. Stevens denies selling drugs, but is facing a court martial on Sept. 11 and could be sent to prison if convicted on the four counts against him - a place not unfamiliar to him.

Stevens, 32, landed in a military prison in Edmonton for 30 days last Christmas for repeatedly going absent without leave. He had already spent time in a prison facility at his base at Gagetown for a similar offence. It was in Edmonton where he says a physician diagnosed him with PTSD.

He claims he begged his bosses to lock him up in Edmonton, hoping it might help him kick a habit that he says had eaten up about $100,000 and killed his career.

"I said, 'Do something, send me to jail - I'm going to be dead in a month if you don't do something,"' he said. "Prison was my only way to get help. I said if that's the only thing you've got, I'll take it.

"It's pretty sad that a soldier has to ask to go to jail."

Zamorski, who couldn't comment on Stevens's case, insisted people seeking help will usually get it, but that soldiers also have to be held accountable for their behaviour.

"No system is perfect," he said. "Some people are very difficult to help for a lot of reasons."

The military says it has gone to great lengths to make sure soldiers are as prepared as they can be before they deploy to deal with stress injuries as they develop. Officials have also added several screening steps when soldiers return to help identify signs of stress disorders.

Troops are briefed in theatre before they return to Canada on what it will be like adjusting to life at home and back in the garrison.

All soldiers who have been away for more than 60 days have to complete a detailed questionnaire that can indicate if they might have an operational stress injury. And they are supposed to undergo an interview with a health professional. If they are found to be in need of help, Zamorski says they can take advantage of several resources on and off base.

There is a new anonymous toll-free number staffed by health practitioners, specialized operational stress injury clinics, and trauma and stress support centres on bases across the country. And Ottawa has pledged to boost the number of mental health workers to more than 400 by 2009.

Some soldiers are also now trained in identifying potential stress problems so they can offer peer support while overseas.

"I'm proud that we really are doing the very best we can to take care of people who serve the country," he said. "Not that we don't have some work to do in terms of combating stigma in particular, but we have mechanisms to try to identify people early and we've got multiple mechanisms for care."

But only a fraction of redeployed troops have completed the questionnaire or undergone the interview, raising the likelihood that some are falling through the cracks.

Out of about 4,800 people who had returned from Afghanistan and were required to have the screening, 2,900 were still due for it and only 1,257 had completed the questionnaire.

The reason for the low numbers?

"The units are too busy doing other things, like getting ready for the next operation," said Zamorski.

David recognized that while officials are trying to help, they're not making time for soldiers to seek treatment or even be evaluated.

"We're just so busy training that it's almost impossible to hold on to the guys and make sure they're OK," he said. "There's not enough connection after you get back because we're just too busy."

Despite the growing pains in the Forces' expanded mental-health program, some soldiers praise the military for finally improving a system that has been widely criticized for its neglect of soldiers' welfare.

When Cpl. Will Salikin returned to Canada from Afghanistan after his deployment last July he was in a drug-induced coma with massive head injuries, a host of other health problems and only sketchy memories of the moments before a bomb hurled him through the air.

He had been travelling west in a convoy from the Kandahar Airfield on Jan. 15, 2007, when a suicide bomber rammed his light-armoured jeep, detonating rockets and "throwing it up in the air and across the street." The blast killed Canadian diplomat Glyn Berry and seriously injured his section mates, leaving one of them a double amputee.

Salikin, now back at his base in Edmonton, awoke at the University of Alberta Hospital with a shattered radius and ulna, burns, compromised movement in his right side, no recollections of the incident, slight neurological issues and a bacteria common to Afghanistan.

The 24 year old spent more than a month in hospital recovering from his physical wounds, but soon began to wonder if he was in need of help for more elusive issues that had begun to reshape his personality.

At home, little things like the way his fiancee placed the coffee table next to the sofa would enrage him. He no longer wanted to hang out with his many friends. He began harbouring grudges over trivial annoyances. And every morning he would awake exhausted at 4:30 a.m.

"Before my accident, I was a pretty laid-back person. Now I will fly off the handle for absolutely no reason whatsoever," he said in an interview.

"I would say that I'm significantly different now. I used to be a person who could make friends with everyone easily. Now, I'd rather hang around by myself. I'm not interested in friends."

Salikin, who was with the 3rd Battalion Princess Patricia's Canadian Light Infantry, finally sought help last September when he went to a psychiatrist on the base. The military hadn't indicated the service was available, leaving him on his own to find treatment.

"That's where the army dropped the ball. Nothing really was offered to me. I had to seek it out myself, but then they were fully helpful," he said. "Hopefully no one else has the same experience of having to walk through everything by themselves."

He ended up seeing a psychiatrist about twice a week to work on issues his doctor says could be linked to PTSD or another stress injury. Salikin, who has shifted to headquarters for a desk job, said the quality of military care rivals civilian services.

The challenge for the Forces, as it is for the civilian world, is to eliminate the stigma surrounding mental-health illnesses in the military's tough-guy culture and the long held belief that psychological ailments equal weakness.

A directive contained in a recent Defence Department briefing note states that due to the effect of operational stress injuries, "all unit commanding officers will assume a pro-active role in promoting a culture of support, understanding and caring towards injured personnel."

Zamorski said the higher profile of mental health issues and treatment options are helping reduce the stigma, but some soldiers don't believe it will ever be done away with entirely.

"We've come a long way, but we're still a bunch of guys in the army," said David, who's reconsidering his future in the Forces. "It's half our fault too. I was just too proud to go. We do have avenues, we just got to start taking them."

But for those like Stevens, now drug-free and who was recently working as an attendant at an ice arena, pride had little to do with his inability to get the help he needed.

"There should be safeguards in place to prevent the escalation of it, like what happened to me. I should have been stopped long before I was," he said.

"I was a great soldier the first nine years. I was a proud soldier. I was in the infantry and did what I had to do and in the end I lost out. And I'm still losing out."

Some facts on post traumatic stress disorder:

Symptoms: Irritability, anger, guilt, grief or sadness, emotional numbing, helplessness, loss of pleasure derived from familiar activities, difficulty feeling happy, difficulty experiencing loving feelings, fatigue, insomnia, vulnerability to illness.
Definition: PTSD is described as a complicated disorder characterized by the intrusive re-experiencing of a traumatic event, such as rape, warfare or the threat of physical harm. That can be in the form of nightmares, flashbacks and vivid memories, all of which can lead to problems sleeping, expressing emotion and avoidance of situations that remind sufferers of the traumatic event.
Number of cases: Of 1,300 Canadian soldiers who have returned from Afghanistan since 2005 and underwent screening, 28 per cent had symptoms suggestive of one or more mental health problems. Just over six per cent of those were possibly suffering from PTSD. Five per cent showed symptoms of major depression.