Mentally Unfit, Forced To Fight

By LISA CHEDEKEL And MATTHEW KAUFFMAN
The Hartford Courant

May 14 2006

The U.S. military is sending troops with serious
psychological problems into Iraq and is keeping
soldiers in combat even after superiors have been
alerted to suicide warnings and other signs of mental
illness, a Courant investigation has found.

Despite a congressional order that the military assess
the mental health of all deploying troops, fewer than
1 in 300 service members see a mental health
professional before shipping out.

Once at war, some unstable troops are kept on the
front lines while on potent antidepressants and
anti-anxiety drugs, with little or no counseling or
medical monitoring.

And some troops who developed post-traumatic stress
disorder after serving in Iraq are being sent back to
the war zone, increasing the risk to their mental
health.

These practices, which have received little public
scrutiny and in some cases violate the military's own
policies, have helped to fuel an increase in the
suicide rate among troops serving in Iraq, which
reached an all-time high in 2005 when 22 soldiers
killed themselves - accounting for nearly one in five
of all Army non-combat deaths.

The Courant's investigation found that at least 11
service members who committed suicide in Iraq in 2004
and 2005 were kept on duty despite exhibiting signs of
significant psychological distress. In at least seven
of the cases, superiors were aware of the problems,
military investigative records and interviews with
families indicate.

Among the troops who plunged through the gaps in the
mental health system was Army Spec. Jeffrey Henthorn,
a young father and third-generation soldier, whose
death last year is still being mourned by his native
Choctaw, Okla.

What his hometown does not know is that Henthorn, 25,
had been sent back to Iraq for a second tour, even
though his superiors knew he was unstable and had
threatened suicide at least twice, according to Army
investigative reports and interviews. When he finally
succeeded in killing himself on Feb. 8, 2005, at Camp
Anaconda in Balad, Iraq, an Army report says, the work
of the M-16 rifle was so thorough that fragments of
his skull pierced the barracks ceiling.

In a case last July, a 20-year-old soldier who had
written a suicide note to his mother was relieved of
his gun and referred for a psychological evaluation,
but then was accused of faking his mental problems and
warned he could be disciplined, according to what he
told his family. Three weeks later, after his gun had
been handed back, Pfc. Jason Scheuerman, of Lynchburg,
Va., used it to end his life.

Also kept in the war zone was Army Pfc. David L.
Potter, 22, of Johnson City, Tenn., who was diagnosed
with anxiety and depression while serving in Iraq in
2004. Potter remained with his unit in Baghdad despite
a suicide attempt and a psychiatrist's recommendation
that he be separated from the Army, records show. Ten
days after the recommendation was signed, he slid a
gun out from under another soldier's bed, climbed to
the second floor of an abandoned building and shot
himself through the mouth, the Army has concluded.

The spike in suicides among the all-volunteer force is
a setback for military officials, who had pledged in
late 2003 to improve mental health services, after
expressing alarm that 11 soldiers and two Marines had
killed themselves in Iraq in the first seven months of
the war. When the number of suicides tumbled in 2004,
top Army officials had credited their renewed
prevention efforts.

But The Courant's review found that since 2003, the
military has increasingly sent, kept and recycled
troubled troops into combat - practices that undercut
its assurances of improvements. Besides causing
suicides, experts say, gaps in mental health care can
cause violence between soldiers, accidents and
critical mistakes in judgment during combat
operations.

Military experts and advocates point to recruiting
shortfalls and intense wartime pressure to maintain
troop levels as reasons more service members with
psychiatric problems are being deployed to the war
zone and kept there.

"What you have is a military stretched so thin,
they've resorted to keeping psychologically unfit
soldiers at the front," said Stephen Robinson, the
former longtime director of the National Gulf War
Resource Center. "It's a policy that can do an awful
lot of damage over time."

Army officials confirmed that 22 soldiers killed
themselves in Iraq, and three in Afghanistan, in 2005.
The Army suicide rate was about 20 per 100,000
soldiers serving in Iraq - nearly double the 2004
rate, and higher than the 2003 rate that had prompted
alarm. Three Marines also committed suicide in Iraq
last year.

The military does not discuss or even identify
individual suicide cases, which are grouped with other
non-combat deaths. The Courant identified suicide
victims through Army investigative reports and
interviews with families.

Although The Courant determined that a spate of six
suicides occurred within eight weeks last year, from
late May to July, there is no indication that the
military took steps to respond to the cluster.

While the 2005 jump in self-inflicted deaths was as
pronounced as the 2003 spike that had stirred action,
Army officials said last week that there were no
immediate plans to change the approach or resources
targeted to mental health. They said they had
confidence in the initiatives put in place two years
ago - additional combat stress teams to treat deployed
troops and increased suicide prevention programs.

Col. Elspeth Ritchie, the top psychiatry expert for
the Army surgeon general, said that while the Army is
reviewing the 2005 suicides as a way to gauge its
mental health efforts, "suicide rates go up and down,
and we expect some variation."

Ritchie said the mental health of troops remains a
priority as the war enters its fourth year. But she
also acknowledged that some practices, such as sending
service members diagnosed with PTSD back into combat,
have been driven in part by a troop shortage.

"The challenge for us ... is that the Army has a
mission to fight. And as you know, recruiting has been
a challenge," she said. "And so we have to weigh the
needs of the Army, the needs of the mission, with the
soldiers' personal needs."

But The Courant's investigation shows that troubled
soldiers are getting lost in the balance:

Under the military's pre-deployment screening process,
troops with serious mental disorders are not being
identified - and others whose mental illness is known
are being deployed anyway.

A law passed in 1997 requires the military to conduct
an "assessment of mental health" on all deploying
troops. But the "assessment" now being used is a
single mental health question on a pre-deployment form
filled out by service members.

Even using that limited tool, troops who self-report
psychological problems are rarely referred for
evaluations by mental health professionals, Department
of Defense records obtained by The Courant indicate.
From March 2003 to October 2005, only 6.5 percent of
deploying service members who indicated a mental
health problem were referred for evaluations; overall,
fewer than 1 in 300 deploying troops, or 0.3 percent,
were referred.

That rate of referral is dramatically lower than the
more than 9 percent of deploying troops that the Army
itself acknowledges in studies have serious
psychiatric disorders.

In addition, despite its pledges in 2004 to improve
mental health care, the military was more likely to
deploy troops who indicated psychological problems in
2005 than it was during the first year of the war, the
data show.

The Courant found that at least seven, or about
one-third, of the 22 soldiers who killed themselves in
Iraq in 2005 had been deployed less than three months,
raising questions about the adequacy of pre-deployment
screening. Some of them had exhibited earlier signs of
distress.

Also, at least three soldiers who killed themselves
since the war began were deployed despite serious
mental conditions, including bipolar disorder and
schizophrenia.

The military relies increasingly on antidepressants,
some with potentially dangerous side effects, to keep
troops with known psychological problems in the war
zone.

Military investigative reports and interviews with
family members indicate that some service members who
committed suicide in 2004 and 2005 were kept on duty
despite clear signs of mental distress, sometimes
after being prescribed antidepressants, including a
class of drugs known as SSRIs.

In one case, a 26-year-old Marine who was having
trouble sleeping was put on a strong dose of Zoloft,
an SSRI that carries a warning urging doctors to
closely monitor new patients for suicidal urges. Last
April, within two months of starting the drug, the
Marine killed himself in Iraq.

Some service members who experienced depression or
stress before or during deployments to Iraq described
being placed on Zoloft, Wellbutrin and other
antidepressants, with little or no mental health
counseling or monitoring. Some of the drugs carry
warnings of an increased risk of suicide, within the
first weeks of their use.

Those anecdotal findings conflict with regulations
adopted last year by the Army cautioning that
antidepressants for cases of moderate or severe
depression "are not usually suitable for extended
deployments."

Also, the military's top health official, Assistant
Defense Secretary William Winkenwerder Jr., indicated
in testimony to Congress last summer that service
members were being allowed to deploy on psychotropic
medications only when their conditions had "fully
resolved."

The use of psychiatric drugs has alarmed some medical
experts and ethicists, who say the medications cannot
be properly monitored in a war zone. The Army's own
reports indicate that the availability and use of such
medications in Iraq and Kuwait have increased since
mid-2004, when a team of psychiatrists approved making
Prozac, Zoloft, Trazodone, Ambien and other drugs more
widely available throughout the combat zone.

"I can't imagine something more irresponsible than
putting a soldier suffering from stress on SSRIs, when
you know these drugs can cause people to become
suicidal and homicidal," said Vera Sharav, president
of the Alliance for Human Research Protection, a
patient advocacy group. "You're creating chemically
activated time bombs."

The military is sending troops back into combat for
second and third tours despite diagnoses of PTSD or
other combat-related psychological problems - a
practice that some mental health experts fear will
fuel incidents of suicide and violence among troops
abroad and at home.

Although Department of Defense standards for
enlistment in the armed forces disqualify recruits who
suffer from PTSD, the military is redeploying service
members to Iraq who fit that criteria. The practice,
which military experts concede is driven partly by
pressure to maintain troop levels, runs counter to
accepted medical doctrine and research, which cautions
that re-exposure to trauma increases the risk of
psychological problems.

At least seven troops who are believed to have
committed suicide in 2005 and early 2006, and one who
has been charged with killing a fellow soldier, were
serving second or third tours in Iraq. Some of them
had exhibited signs of combat stress after their first
deployments, according to family members and friends.

Some soldiers now serving second tours in Iraq say
they are wrestling with debilitating PTSD symptoms,
despite being placed on medications.

Jason Sedotal, a 21-year-old military policeman from
Pierre Part, La., returned home in March 2005 after
seven months in Iraq, during which a Humvee he was
driving rolled over a land mine, badly injuring his
sergeant. After completing his tour, Sedotal was
diagnosed with PTSD and placed on Prozac, he said.

Last October, after being transferred to a new unit,
he was shipped back to Iraq for a one-year tour.
During a short visit home last week, he described
being wracked by nightmares and depression and
convinced that "somebody's following me." When he
conveyed his symptoms to a doctor at Fort Polk in
Louisiana last Tuesday, he said, he was given a higher
dose of medication and the sleeping pill Ambien and
told that he was to go back to Iraq.

"I can't keep going through this mentally. All they do
is fill me up on medicine and send me back," he said.
"What's this going to do to me in the future? I'm
going to be 60 years old, hiding under my kitchen
table? I'm real scared."

More than 378,000 active-duty, Reserve and National
Guard troops have served more than one tour in Iraq or
Afghanistan, representing nearly a third of the 1.3
million troops who have been deployed, according to
Department of Defense statistics. That repeat exposure
to combat could dramatically increase the percentage
of soldiers and Marines who experience PTSD, major
depression or other disorders, some experts say.

Recent studies have estimated that at least 18 percent
of returning Iraq veterans are at risk of developing
PTSD after just one combat tour.

"The [Department of Defense] is in the business of
keeping people deployable," said Cathleen Wiblemo,
deputy director for health care for the American
Legion. "What the consequences of that are, we haven't
begun to see.

"This is uncharted territory. You're looking at guys
being extended or sent back multiple times into an
extremely stressful situation, which is different than
past wars. ... I think the number of troops that will
be affected, it will be a huge number."

Preserving The Force

Military officials insist they have made aggressive
efforts to improve mental health services to troops in
Iraq in the past two years. After the spate of
suicides in 2003, the Army dispatched a mental health
advisory team, which issued a report recommending
additional combat-stress specialists to treat troops
close to the front lines, and encouraging training and
outreach to reduce the stigma associated with mental
health problems.

A follow-up report, released January 2005, cited the
drop in suicides in 2004 as evidence that the Army's
efforts were successful. It also highlighted a decline
in the number of soldiers who were evacuated out of
Iraq for mental health problems - from about 75 a
month in 2003 to 36 a month in 2004. In 2005, an
average of 46 soldiers were evacuated each month, Army
data show.

Overall, barely more than one-tenth of 1 percent of
the 1.3 million troops who have been deployed to Iraq
and Afghanistan have been evacuated because of
psychiatric problems.

Both advisory team reports recommended that soldiers
with mental health problems be kept in the combat zone
in order to improve return-to-duty rates and help
soldiers avoid being labeled unfit.

"If you take people out of their unit and send them
home, they have the shame and the stigma," said
Ritchie, the Army's mental health expert.

But with the suicide rate climbing, the emphasis on
treating psychologically damaged soldiers in the war
zone is raising new questions.

"You think it's a stigma to be sent home from the Iraq
war? That might be the line they're using" to justify
retaining troops, said Dr. Arthur S. Blank Jr., a
psychiatrist who formerly served as national director
of the Veterans Administration's counseling centers.
"I wouldn't say that."

Mental health specialists who have served in Iraq
acknowledge that their main goal, under military
guidelines, is to preserve the fighting force. Some
have grappled with making tough calls about how much
more stress a soldier can handle.

"You have to become comfortable with things we
wouldn't normally be comfortable with," said Bob
Johnson, a psychologist in Atlanta who counseled
soldiers last year as chief of combat stress control
for the Army's 2nd Brigade. "If there were an endless
supply [of soldiers], the compassionate side of you
just wants to get these people out of here. They're
miserable. You can see it in their faces. But I had to
kind of put that aside."

Army statistics show that 59 soldiers killed
themselves in Iraq through the end of last year - 25
in 2003, 12 in 2004, and 22 in 2005. Twelve Marine
deaths also have been ruled self-inflicted.

The only confirmed Connecticut suicide is that of Army
Pfc. Jeffrey Braun, 19, of Stafford, who died in
December 2003. His father, William Braun, told The
Courant he still did not have a full explanation of
what happened to Jeffrey, but said, "I've chosen not
to pursue it or question it. It's over and done with."

Military data show that deaths in Iraq due to all
non-combat causes, such as accidents, rose by 32
percent from 2004 to 2005. Of the more than 500
non-combat deaths among all service branches since the
start of the war, gunshot wounds were the
second-leading cause of death, behind vehicle crashes
but ahead of heart attacks and other medical ailments.

While many families of service members who died of
non-combat causes say they are not familiar with
military deployment policies, some question whether
the military knowingly put their loved ones at risk.

Among them are relatives of Army Spec. Michael S.
Deem, a 35-year-old father of two, who was deployed to
Iraq in January 2005 despite a history of depression
that family members say was known to the military.
Shortly before Deem deployed, a military psychiatrist
gave him a long-term supply of Prozac to help him
handle the stress, his wife said.

Just 3½ weeks after he arrived in Iraq, Deem died in
his sleep of what the Army later determined was an
enlarged heart "complicated by elevated levels of
fluoxetine" - the generic name for Prozac.

Family members of some troops whose deaths have been
labeled suicides complain that the military has given
them limited information about the circumstances of
the deaths. Some have had to wait more than a year for
autopsies and investigative reports, which they say
still leave questions unanswered.

Barbara Butler, mother of Army National Guard 1st Lt.
Debra A. Banaszak, 35, of Bloomington, Ill., said she
has trouble understanding why her daughter would have
taken her own life in Kuwait last October, as the
military has determined. She said that while Banaszak,
the single mother of a teenage son, was proud to serve
her country and had not complained, the stresses of
the deployment may have exacerbated her depression.

"She was used to being in charge and being a leader,
but never in these circumstances," said Butler. "If
the Army is right that she did this, it was nothing
she would have done ordinarily. It was that war that
brought it about."

Recognizing Trouble

Some autopsy and investigative reports obtained by The
Courant make clear that service members who committed
suicide were experiencing serious psychological
problems during deployment.

In the months before Army Pfc. Samuel Lee, of Anaheim,
Calif., killed himself in March 2005, an investigative
report says, the 19-year-old had talked to fellow
soldiers about a dream in which he tried to kill his
sergeant before taking his own life, and of
kidnapping, raping and killing Iraqi children. Three
times, a soldier recounted in a sworn statement, Lee
had pointed his gun at himself and depressed the
trigger, stopping just before a round fired.

But two of Lee's superiors gave statements saying they
did not realize Lee was having trouble until the day
he balanced the butt of his rifle on a cot, put his
mouth over the muzzle and fired.

But a number of other reports on 2004 and 2005
suicides indicate that military superiors were aware
that soldiers were self-destructing.

Among them was Army Staff Sgt. Cory W. Brooks, 32, of
Philip, S.D., who shot himself in the head on April
24, 2004. In sworn statements, a major and first
lieutenant acknowledged they had conducted
"counseling" with Brooks, and a first sergeant
"detailed his knowledge of SSG Brooks' suicidal
ideations."

Brooks' father, Darral, said he believes his son's
death stemmed from a combination of personal and
combat-related stress, and he does not blame the
military for retaining him in Iraq.

"Cory was a dedicated soldier. He wanted to be there,"
he said. "If his captain told him to walk off a cliff,
he'd do it."

But in other cases in which superiors retained a
soldier who was experiencing mental health problems,
families are not so forgiving.

Ann Scheuerman, mother of the soldier who shot himself
after his suicide note was discounted by Army
officials, said her family has had a frustrating time
getting the military to acknowledge mistakes in the
way her son was treated.

"We wanted to make sure that whatever protocol they
have in place is used, and if it doesn't work, fix
it," Scheuerman said. "And to date, we're just not
getting anything at all.

"Nothing can bring back my son," she said. "But if
something can be done to prevent any more deaths, then
if I offend a couple of people, I'll go ahead and
apologize up front. Go ahead and come after me, but
something needs to be done."

Family members of Jeffrey Henthorn, the Choctaw,
Okla., native, are concerned that the Army ignored
blatant warnings that Henthorn was suicidal.

An investigative report into Henthorn's death contains
statements indicating that Henthorn's "chain of
command" was aware that he had tried to harm himself
in November 2004 - by slashing his arm "intentionally,
in a [horizontal] manner" - in the weeks leading up to
his second deployment to Iraq, while he was stationed
at Fort Riley in Kansas.

Then, soon after his deployment in December, a
distressed Henthorn took his gun into a latrine in
Kuwait and charged it, in what fellow soldiers feared
was a suicide gesture. Although his superiors at the
scene grabbed the weapon away, his platoon sergeant
returned the gun the same day, after talking to
Henthorn for about a half-hour, according to a sworn
statement. The platoon's first lieutenant was
notified, but there is no indication that Henthorn was
referred for a mental health evaluation or counseling.

Eighteen days later, after crossing into Iraq with his
unit, Henthorn finished what he had started.

"If you lock yourself in a latrine for 10 minutes with
your gun and threaten to hurt yourself, you don't just
get your gun back. You get relieved of duty and sent
home," said Henthorn's father, Warren, who is still
struggling to understand what happened to his only
son.

"It's the same as Vietnam - all they care about is the
numbers in the field," he said. "That's all that
matters, having the numbers."

Ritchie insisted the military is working hard to
prevent suicides, which she said is a challenge, given
that soldiers have access to weapons.

"When you go back, in retrospect, there may be warning
signs," she acknowledged.

Addressing The Courant's findings, she added, "What
you don't see from that are the other cases that
perhaps had the same warning signs and were kept in
[the combat] theater and went on to do OK in their
job."

While they would not comment on particular cases,
Ritchie and other military officials said they believe
most commanders are alert to mental health problems
and open to referring troubled soldiers for treatment.
It is commanders, not medical professionals, who have
final say over whether a troubled soldier is retained
in the war zone.

"I think the majority of our commanders are very
receptive," Ritchie said.

But some service members say commanders' sensitivity
to mental health issues varies.

"As a practical matter, the quality ... of the
military's mental health care professional is uneven,"
said Maj. Andrew Efaw, a judge advocate general
officer in the Army Reserve who handled trial defense
for soldiers in northern Iraq last year. "Likewise,
the understanding of mental health issues by
commanders may also be spotty."

He said commanders weighing whether a service member
should be retained have to be mindful of how their
troops will perceive the decision.

"Your average commander doesn't want to deal with a
whacked-out soldier. But on the other hand, he doesn't
want to send a message to his troops that if you act
up, he's willing to send you home," Efaw said.

Some troops and their families say the military has
not made good on its pledge to make mental health care
easily accessible in the field.

Summer Lipford of Statesville, N.C., said she urged
her son, Pfc. Steven Sirko, to talk to a counselor in
April of last year, after he complained in a phone
call from Iraq that he was having nightmares, losing
weight and not sleeping.

"I asked Steven, `If you're having dreams that are so
[messed] up, why don't you go talk to somebody?'"
Lipford recalled. "He said, `Yeah, Mom, like that's
gonna happen.' He said it was an act of God to get to
see somebody."

Four days later, Sirko, a 20-year-old medic, injected
himself with vecuronium, an anesthetic that causes
muscular paralysis, and died of an accidental
overdose, according to what the military has told
Lipford.

Some returning troops acknowledge that their own fear
of being stigmatized kept them from seeking
psychological help during deployments. Despite the
military's efforts to improve mental health care,
soldiers' perceptions of a stigma associated with
seeking such care remained unchanged between 2004 and
2005, with more than half of the soldiers surveyed by
Army teams expressing concerns that they would be
viewed as weak.

Matthew Denton, a Camp Pendleton Marine and helicopter
mechanic, said he spent most of his six-month
deployment in 2005 quietly contemplating his own death
aboard a ship in the Persian Gulf.

"My head was in a scary place. I remember thinking, `I
can't believe I'm working on a $14 million aircraft. I
just don't care about this,'" he said. "When I'd come
out of my daze, I was worried about messing up and
endangering the life of my guys."

Denton, 30, said his depression was easy to keep
secret - pre- and post-deployment health screenings
were self-reported, and commanders hustling Marines
through six-month rotations never probed his mental
state.

Now back home, Denton, who is being treated for
depression, isn't sure whether he managed to stay
below the radar - or whether there was any radar to
stay below.
Copyright 2007, Hartford Courant



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