Combat Loss and PTSD – Part 7: When the War Continues – PTSD

This is a paper about how infantrymen in the United States Marine Corps handle combat deaths. It was researched and written by Stephen Smith, Th.M., in partial fulfillment for a seminary course on Death and Dying. While Steve has never experienced the dark side of man, his twin brother – me – has. Together, we offer this paper in eight parts. Footnotes follow at the end of each section.

This post, Part 7, relates anecdotes and statistics to demonstrate that Post Traumatic Stress is a normal response to abnormal circumstances. The behaviors and thought patterns precipitated during combat to enhance personal survivability can be gradually unlearned or mitigated over time. As proof of point, it should be noted that my own PTSD triggers and responses related in the following article have since lessened considerably. There is hope and there is help.

Part 1: Post 9-11 CasualtiesPart 2: The Link Between Combat and PTSDPart 3: Learning to Kill – Part 4: Preparing for DeathPart 5: When the Metal Hits the Meat – Part 6: Memorials and Unit Healing – Part 7: When the War Continues – PTSD – Part 8: Conclusion and Bibliography

Sometimes the War Continues: PTSD

But not all Marines are able to fully integrate their feelings related to combat death while deployed. While it is true that caring for casualties, contextualizing their death, telling stories about combat losses, and planning and attending memorial services for dead Marines all provide ways for fellow Marines to integrate feelings of loss and grief, it is equally true that many infantry Marines still carry a burden of un-integrated loss in conjunction with fallen comrades.

As we have seen, this relates to Marine infantry training which emphasizes desensitization toward combat deaths, both inflicted and incurred, and an aggressive tempo of combat which prevents Marines from taking the time to effectively process grief. Not only so, but the body’s own physiological responses to combat—increased vigilance, adrenaline, and the flooding of the limbic system—are all normal responses to danger.[1] The result—especially when combined with other traumatic events experienced during combat—is a high incidence of post-traumatic stress disorder (PTSD) among infantry Marines.[2] U.S. Navy Commander Charles Benson, psychiatrist for the 1st Marine Division operational forces at Camp Pendleton, California, acknowledges that emotionally shutting down during combat is normal for Marines, and that PTSD is not usually diagnosed until at least six months after a Marine has returned from battle.[3]

While we have already discussed the high incidence of PTSD earlier in this paper, it may be helpful to include anecdotal evidence from a number of former and current combat infantry Marines who have wrestled with PTSD. While not all infantry Marines suffer from PTSD, many do. The following stories provide a snapshot for how some Marines are coping with combat loss over the long term. Natasha Young is one of them. David Wood at the Huffington Post writes of Young’s experience:

She went to war twice, the last time five years ago in western Iraq with a close-knit team of Marines who disabled IEDs…. It was nonstop work, dangerous, highly stressful and exhausting. Six of the Marines were killed in bomb blasts, each death a staggering gut-punch to the others. After they returned home the commander took his own life. Staff Sgt. Young broke down, too, spent physically, emotionally and mentally. Eventually, she was diagnosed with post traumatic stress disorder (PTSD) and, last October, was medically discharged from the Corps.[4]

Lt. Colonel Michael Grice served two tours in Iraq as a platoon commander and one tour in Afghanistan as a Special Operations augment. All three tours were highly kinetic and involved up-tempo combat operations. After his third tour, Lt. Col. Grice began experiencing some of the symptoms of PTSD: trouble sleeping, hyper-vigilance, short term memory loss, and reliving traumatic events. A toughened warrior, Grice had trouble admitting that he had PTSD: “I was always of the macho opinion that only losers had PTSD—weak-minded or weak-willed misfits who were too effete to stand up to the rigors of combat,” he writes. “People like that ended up on the side of the road holding up cardboard signs asking for handouts, didn’t they?” But he learned that most of them didn’t. “Instead, they were just like me—professional warriors who carry the responsibility of leading others into harm’s way with the specter of their life-altering experiences constantly looming overhead.”[5]

Chris Lyon, a Marine who served two tours in Iraq as a machine gunner for Kilo 3/2, still has recurring visions of a dead friend:

Every day I relive Sgt. Z’s death, his screams for his mother while I helplessly raged in my turret, trying to find someone, anyone to shoot at. At first I tried to run from it. I couldn’t stomach Arlington [National Cemetery] even though I gave [Z’s] eulogy in Iraq. I tried to exorcise his ghost by telling his parents what really happened, and like a wild animal in a trap lashed out at friends and family, anyone who hadn’t “been there.” I drank like a fool, chain-smoked, and still every day I would see Sgt. Z’s smiling face in the doorway of Voodoo CP in East Husaybah, telling me we had another run to White’s position. Every day I would see the same face disappear around a cinderblock wall and never come back…. My wife eventually made me quit smoking. She made me go to counseling. And now I don’t scream in my sleep or get drunk or snap at my kids or go ballistic on strangers. But I still see Z every day. Every day.[6]

He acknowledges that the memory of the men who died proves both a cause of PTSD and a

The destroyed Humvee of Philips and Johnson.

The destroyed Humvee of Philips and Johnson.

comfort to him: “I see them all, the Voodoo boys [who were killed]. Luke, Eric, Ryan, Phillip. I have to recall them now, because it is the only way to keep the walls [of sanity] standing. They are the stones of those walls, the men standing in the breach against the countless, faceless screaming hordes of nightmares.”[7]

Other Marines are thankful that at least they can feel something after combat, since they were trained to be desensitized to trauma.[8] PTSD for these Marines means that their emotional numbness is beginning to thaw and that there is hope for them to re-integrate their emotions, even their painful emotions in order to become emotionally whole. A Marine on an online PTSD forum for veterans says, “You spend so long holding it all in and then it’s like the dam has burst. I’d say for me it actually feels good to actually feel something.”[9] Another veteran echoes that sentiment: “I’ve cried more in a year and a half than I have in the last 22. It’s good to get this shit out.”[10]

Former Marine Captain Nathan Smith realized he had PTSD seven months after he returned from his second combat tour in Iraq. He had initially chalked up his symptoms—constant anxiety, trouble sleeping, and difficulty concentrating—to moving across the U.S. to another military billet. But standing one night near Puget Sound, he saw the sunset clouds which looked like smoke, and which triggered a memory:

I went to the beach tonight because I wanted to forget the pain and to feel. I needed to forget a past that clawed at my mind like a demon. I needed to feel alive….Gray clouds scudded across the sky like smoke from a thousand burning fires. Like smoke from 3 September 2006…“Where is that medevac? It’s been twenty minutes and I haven’t heard anything on the radio! Tell them to follow the smoke in!” Marc’s voice was tight with fury and fear. The smoke. Painfully, I unclenched my sweating hand from the radio handset and walked heavily to the Command Post door. Peering out towards the west, I could see a thick column of black smoke coiling into the dusty sky. Later, the recovery vehicle would follow the smoke in and find only pieces of the Humvee. The medevac would find only pieces of the two dead Marines. Wearily returning to the radio, I continued to coordinate the company maneuver elements as dusk deepened into night. But that was the day the headaches started… and the choking.[11]

Smith found himself feeling nervous in crowded places. They made him feel out of control or in danger. “Anywhere there is no rank structure can be difficult for me,” he says. “Civilians are like cats running around with no one in charge.” He once fled from a large home-improvement store after suffering a panic attack. Traveling on crowded planes causes him great anxiety, though prior to Iraq he never had a problem. He sleeps at night with his phone turned off—in Iraq unexpected radio calls usually meant that something terrible had happened.[12] When he walks through the woods here in the States, Smith sometimes likes to hold his arms in the position he used to carry his M-4 rifle in Iraq. “It is a comfort thing,” he says. “I wish I could bring an M-4 with me, or do facing movements [military drill] in the parking lot, just to get some instant feelings of safety and structure. But you can’t do that at the mall.”[13]

Smith knows that he is not alone: “You can spot veterans suffering from PTSD as they sit uneasily in the back of classrooms, shift uncomfortably on the edge of pews, and scan the room nervously at family gatherings. Alcohol often becomes the unofficial medication that allows veterans with PTSD to feel ‘normal’ or to relax.”[14]

Staff Sergeant Ammon Jay Cornwell, an elite Force Recon Marine and a veteran of Somalia, recalls the death of his friend which led to his own PTSD: “My best buddy Gunny Bohr was a vet of Grenada and served with me in Africa. He saved my life there when a grenade blew up in my face and he drug [sic] me to safety. He lost his life in the invasion of Iraq when his platoon was hit hard and he rushed to the front lines to give guys medical aid and then held off attacking forces single handed… he was a great Force Recon Marine and I will always miss him. Why war in general…I’ve lost so many good friends and for what!”[15]

Some few Marines, in a place of desperation with their PTSD, resort to suicide to end their

In Memory of James "Rooster" Dixon III

James Dixon III

painful memories.[16] James Dixon III was one of these. Dixon served three combat tours with the 3/2 Marines in Iraq. Nathan Smith writes of James on his blog, The Soldier’s Load:

James “Rooster” Dixon III was killed by a State Police SWAT team on the steps of his house early on a quiet Sunday morning in Baxley, Georgia. The Purple Heart recipient left the Marines after his third combat deployment to Iraq and went on to earn his MBA at Georgia Southern University in the spring of 2011. But friends and family noticed a sobering difference in the once gregarious and still tousle-headed veteran: although James had left the service, the effects of his service hadn’t left him. James sought treatment from the VA for his Post-Traumatic Stress Disorder (PTSD), but was unable to shake the constant anxiety and depression that are hallmarks of the disorder. On February 19, 2012 James decided to end his struggle by walking into the bullets of law enforcement: as much a casualty of the war as any service member who died in Iraq.[17]

Karl Marlantes, a Marine Lieutenant in Vietnam, returned from his combat experiences with PTSD and his society’s ingratitude. It took him many years of counseling to reach a point of emotional and psychological health. Part of his healing process involved writing a fiction novel about the Vietnam War, Matterhorn, which actually served as a thinly-veiled memoir. In his non-fiction book, What it is Like to Go to War, Marlantes says, “The Marine Corps taught me how to kill but it didn’t teach me how to deal with killing.”[18] He suggests a process for reintegrating combat Marines into society:

Before being discharged veterans should be gathered in small groups with career veterans who have had some training in group dynamics and be allowed to talk themselves down. Just talk, in a safe place, with other veterans. It gets the talk started, breaks the damaging code of silence that stops the integration process. This process could then go on in civilian life, because now it’s legitimized and the young veterans know how to do it. Some veterans will always be afraid to bring back their nightmare. They need to know early on that the nightmare can be faced. All veterans fear being misunderstood. If war detox is required while people are still in uniform, the shame and fear will be faced cleanly and won’t have to come out twenty years later.[19]

What the Marine Corps is Doing about PTSD

While it is beyond the true scope of this paper to talk about treatment of PTSD, it feels irresponsible to discuss how infantry Marines handle combat death without describing what the Marine Corps is doing about it. There are several ways that the military is trying to help veterans who have PTSD.

Prevention

An ounce of prevention is worth a pound of cure. The Marine Corps is currently trying to increase Marine resiliency to combat trauma through realistic simulated combat and specialized brain-training techniques such as guided imagery and meditation. Brian Mockenhaupt writes, “Though brain-training programs… are still gaining traction in the military, mental-fitness regimens may soon be as much a part of a soldier’s life as push-ups and running.”[20] In addition, the Marine Corps has begun to train Marines in how to prepare for and avoid combat and operational stress.[21] Yet the effectiveness of these programs is not yet known. Several military organizations are working on research in this area.[22]

Screening and Treatment

When Marines return home from combat, they are now evaluated within 30 days, and again within six months (a Post Deployment Help Reassessment) to identify any symptoms of PTSD. Marine units which have seen exceptionally heavy combat receive special attention.[23] For those Marines who have already suffered PTSD, the mental health arm of the Marine Corps, OSCAR [Operational Stress Control and Readiness], is trying to ensure that no Marine has to recover alone. Psychiatrists and nurse practitioners now deploy with combat troops and embed at the battalion level to experience many of the same hardships as infantry Marines. The goal is for Marines to trust the psychiatric staff since they share similar experiences. This hopefully will enable Marines to open up about how they feel in combat and medical professionals can then facilitate their healing.[24]

The initial route of healing involves psychotherapy and counseling. According to Dr. Benson at Camp Pendleton, usually 60% of Marines respond to this level of treatment and are able to integrate their feelings with the traumatic experiences they had in combat.[25] For the 40% who don’t respond to psychotherapy, medication is prescribed. For those who don’t respond to medication or therapy, about 20%, OSCAR will recommend them for medical retirement or a VA hospital, depending upon the severity of symptoms.[26]

Camp Pendleton also has a group for families of Marines who suffer from PTSD, called FOCUS (Families Overcoming Under Stress), under the Bureau of Navy Medicine Program. The lead family resiliency trainer, Tom Babayan, says that it is important to work with families of affected sailors and Marines, “because PTSD has a lot of effects not only on individuals but within the family, also. During wartime, routines and roles are disrupted. Deployments and reintegration may cause stress for children and spouses.”[27]

To promote research within the military, the Department of Defense recently announced that Camp Lejeune, North Carolina, will receive its own National Intrepid Center of Excellence (NICO) to research traumatic brain injury and PTSD. The main NICO center was built in 2010 at Walter Reed National Military Medical Center in Bethesda, Maryland. “This is about more than brick and mortar,” said Gen. Joseph F. Dunford Jr., assistant commandant of the Marine Corps. “What we are really doing here today is building a commitment to our wounded warriors and their families. We’re rebuilding the lives of those who made a significant sacrifice for our nation.”[28]

[1] Dr. Charles Hoge notes that: “PTSD is essentially a manifestation of the natural mechanisms for survival and functioning under extremely threatening situations. Everything we label a ‘symptom’ of PTSD is an adaptive and beneficial response when there is a threat to your personal welfare or that of others, and the persistence of these reactions is the body’s effort to ensure that you’re immediately ready if the danger occurs again.” Charles W. Hoge M.D.. Once a Warrior–Always a Warrior: Navigating the Transition from Combat to Home–Including Combat Stress, PTSD, and mTBI (Kindle Locations 639-641). Kindle Edition.

[2] Refer to section one of this paper for the relevant statistics.

[3] Erickson, Judy. “Marine Corps Wages War on PTSD” Camp Pendleton Patch, July 14, 2011. http://camppendleton.patch.com/articles/marine-corps-wages-war-on-ptsd Accessed 11/15/12.

[4] David Wood. “Iraq, Afghanistan War Veterans Struggle With Combat Trauma,” 7/04/2012. From http://www.huffingtonpost.com/2012/07/04/iraq-afghanistan-war-veterans-combat-trauma_n_1645701.html Accessed 11/15/12.

[5] Grice, Lt. Col. Michael D. “Leading With PTSD: Suffering From What They Have Experienced” From http://www.mca-marines.org/gazette/article/leading-ptsd-suffering-what-they-have-experienced, Accessed 11/15/12.

[6] https://thesoldiersload.com/2012/03/27/whats-it-like/, Accessed 11/29/12.

[7] https://thesoldiersload.com/2012/05/03/walls/, Accessed 11/29/12.

[8] “Shutting down emotions is a necessary skill in combat, and it can sometimes be very difficult to turn them back on after coming home. Warriors often describe not being able to feel love, not caring about others, and feeling numb or detached. This is also essential for survival in combat.” Charles W. Hoge M.D.. Once a Warrior–Always a Warrior: Navigating the Transition from Combat to Home–Including Combat Stress, PTSD, and mTBI (Kindle Location pp.606-607). Kindle Edition.

[9] JarHed, Aug 31, 2012 #10, From http://www.mycombatptsd.com/threads/sadness.1801/

[10] Wagon, Aug 31, 2012 #9, From http://www.mycombatptsd.com/threads/sadness.1801/

[11] https://thesoldiersload.com/2011/09/01/the-sound-and-the-fury/, Accessed 11/29/12.

[12] From a personal conversation with the author, 5/20/2010.

[13] From an interview with the author, 11/16/12.

[14] https://thesoldiersload.com/2012/03/06/a-legion-of-shadows/, Accessed 11/29/12.

[15] From http://www.mycombatptsd.com/threads/navy-seals.815/ accessed 11/15/12

[16] The rate of suicides among active-duty military members reached almost one per day in 2012, according to Robert Burns at the Huffington Post. And the rate among non-active duty members or veterans may be even higher.“Military Suicide Rate Surges To Nearly One Per Day This Year” http://www.huffingtonpost.com/2012/06/07/military-suicide-surges-_n_1578821.html Accessed 11/29/12.

[17] https://thesoldiersload.com/2012/03/06/a-legion-of-shadows/, Accessed 11/29/12.

[18] Marlantes, p.3.

[19] Marlantes, p.206.

[20] Brian Mockenhaupt, “A State of Military Mind” From http://www.psmag.com/health/a-state-military-mind-42839/, Accessed 11/15/12.

[21] “OSCAR [Operational Stress Control and Readiness] makes sure Marines are taught about PTSD and screened for signs of being at-risk before, during and after deployment. Marines can be at risk from extra or ongoing anxiety, mental illness, depression, ongoing PTSD from previous deployment, or from childhood experiences. So, officers look for signs of risk, and they recognize, understand and treat their Marines. If an at-risk Marine is identified, he or she won’t be allowed to deploy. Extensive preventive measures include building a small, highly cohesive unit that trusts each other and its leaders. Marines are trained on mental health issues through a Combat Operational Stress Continuum. They learn to recognize and self-monitor using a color-coded system. Green represents one’s state of mind when sitting around relaxing. But the stress continuum progresses through yellow, orange and red, indicating intensity of problems.” Judy Erickson, “Marine Corps Wages War on PTSD” From http://camppendleton.patch.com/articles/marine-corps-wages-war-on-ptsd, Accessed 11/15/12.

[22] “One of the many organizations that research PTSD and brain injuries, and look for interventions is the Naval Center for Combat Operational Stress Control, the research and education arm in San Diego. The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury in Washington, D.C., looks at the bigger picture for prevention and treatment.” Judy Erickson, “Marine Corps Wages War on PTSD” From http://camppendleton.patch.com/articles/marine-corps-wages-war-on-ptsd, Accessed 11/15/12.

[23] Judy Erickson, “Marine Corps Wages War on PTSD” From http://camppendleton.patch.com/articles/marine-corps-wages-war-on-ptsd, Accessed 11/15/12.

[24] According to U.S. Navy Commander Charles Benson, psychiatrist for the 1st Marine Division operational forces at Camp Pendleton. Judy Erickson, “Marine Corps Wages War on PTSD” From http://camppendleton.patch.com/articles/marine-corps-wages-war-on-ptsd, Accessed 11/15/12.

[25] Though a recent scathing report by the Department of Defense disputes the effectiveness of military treatment of PTSD. Cf. Patricia Kime, “Report: DoD does not know if PTSD programs work” Marine Corps Times 7/13/2012. http://www.marinecorpstimes.com/news/2012/07/military-report-dod-va-ptsd-programs-effectiveness-071312/ Posted : Friday Jul 13, 2012 13:08:21 EDT, Accessed 11/15/12.

[26] Judy Erickson, “Marine Corps Wages War on PTSD” From http://camppendleton.patch.com/articles/marine-corps-wages-war-on-ptsd, Accessed 11/15/12.

[27] Judy Erickson, “Marine Corps Wages War on PTSD” From http://camppendleton.patch.com/articles/marine-corps-wages-war-on-ptsd, Accessed 11/15/12.

[28] Cpl. Damany S. Coleman, “Camp Lejeune to receive premier facility for TBI, PTSD treatment, research facility,” From Camp Lejeune Globe, Posted June 21, 2012. http://www.camplejeuneglobe.com/news/inside_lejeune/article_e2ed138a-bae9-11e1-a475-001a4bcf887a.html

About Nate

A 2003 graduate of the Virginia Military Institute and former Marine infantry officer, Nate is the Chief Operating Officer of Hire Heroes USA, a nonprofit organization that helps veterans get jobs. He holds a Master's in Public Administration from the University of Georgia. Nate lives with his wife and dog in Alpharetta, Georgia.
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One Response to Combat Loss and PTSD – Part 7: When the War Continues – PTSD

  1. Jerry says:

    God Bless you for what you do, especially the many hours in planes-especially now when they are all small. While mild in comparison, during this time of the year I always relive 35 years ago when our co-joined twins were born-one died in 4 days and the other went on to have 15 surgeries in 10 years. While 35 years have passed, there is a part of my mind that creates the numbness behind the eyes you feel when you are left with no way to help, other than wait and love.
    The loss and violent ways many of you and your fellow service men were left with scars, is part of what you gave us-thank you for your service and scars. Take care Nat

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