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Monday, May 14, 2012

Unseen: Trailblazing Military Women Forced To Fight For Recognition, Equal Treatment



The following article is reposted from The Huffington Post 5/14/2012.

After a rocket-propelled grenade sent the Black Hawk helicopter tumbling out of the sky over Iraq, the medics got to work fast on the co-pilot, Capt. Duckworth. Standard operating procedure: cut away the desert-camo uniform before burnt fabric melds with burnt flesh. Get at the wounds. Stop the bleeding. Save what's left.

When you show up at Walter Reed Medical Center in that kind of condition, you show up naked, with nothing except the hospital gown. So you're given a "comfort kit," a little backpack containing some toiletries and clothes. Duckworth awoke there around Thanksgiving 2004, a few weeks after the shootdown, to find a comfort kit waiting with slippers, a shaving kit and men's jockey shorts.

She had to laugh.

"It was great. I don't have feet, so I can't wear the slippers, and you know, I just had my legs blown off, it's not like I'm gonna shave my legs any time soon," she chuckles. "I don't have jockey, I'm not gonna wear men's jockey shorts."

Tammy Duckworth had just become the first female double amputee from Iraq, losing one leg above the knee and one below, but she had been a woman for a while already.

"They just had kits for men," Duckworth says. "It never occurred to them to make kits for women."

Duckworth is one of more than 282,000 American women who have deployed to Iraq and Afghanistan during a decade of war, according to Pentagon figures. That's more than six times the number of women deployed in the first Gulf War and more than 35 times the number sent to Vietnam.

(An interactive timeline of U.S. women at war can be found here.)

The 207,308 women currently serving on active duty comprise some 14.5 percent of the U.S. armed forces, according to the military. While more than 2 million women have served since the Revolutionary War, some 1.9 million of them are currently living -- an unprecedented generation of women at war. The number of female veterans has doubled since 1990 and is expected to skyrocket given further drawdowns in the Middle East.

They are helicopter pilots, linguists and flight nurses, mechanics, mental health administrators and homeland security-force directors, intelligence officers and combat correspondents, Ph.D.s and amputees, Purple Heart recipients and prisoners of war. Seventy-one have become generals. One, in the Army, has four stars.

Duckworth, who received the Purple Heart, is one of 868 servicewomen who have been wounded in Iraq and Afghanistan. One hundred forty-four have been killed.
tammy duckworth
Tammy Duckworth looks on as President Barack Obama departs from the White House in November 2009.

Yet while women are undeniably at war, the full extent of their roles and capabilities still isn't formally recognized by the military brass. Today's servicewomen perform many of the roles that official policy says they cannot. Often, their service and suffering remain ignored by or invisible to the Pentagon and the public.

"First thing we can do for women veterans is to raise the awareness that women are veterans," says Maj. Gen. Irene Trowell-Harris, director of the Center for Women Veterans at the Department of Veterans Affairs and the first African American woman to reach the rank of general in the National Guard.

Of the 1.2 million positions available throughout the military, 252,179, roughly 21 percent, are closed to women, according to a Department of Defense report to Congress ordered under the defense budget bill for fiscal year 2011. At the report's release in February, the DOD announced plans to open 14,325 more jobs -- an additional 1.2 percent of that total -- slated for implementation on Monday.

All graphics by Chris Spurlock. A detailed table can be found here.



"The Department of Defense is committed to removing all barriers that would prevent Service members from rising to the highest level of responsibility that their talents and capabilities warrant," the report says. But it continues, voicing the concern of those who oppose women in combat: "There are serious practical barriers, which if not approached in a deliberate manner, could adversely impact the health of our Service members and degrade mission accomplishment. Change of this magnitude requires sufficient time and resources."

Incremental reforms, however, don't address the fundamental problem: a segregated system that denies women the chance to compete for the most elite positions in the military -- typically the fast track to advancement through the ranks -- as well as the respect that their service and sacrifice has earned.

That hasn't stopped Duckworth, named President Barack Obama's assistant secretary of Veterans Affairs in 2009 and now a Democratic candidate for Congress in Illinois. Yet for every Duckworth, thousands of military women remain trapped between the Pentagon's policy and practice, between rhetoric and reality.

'LET'S NOT TELL HIM UNTIL THE WAR'S OVER'
American women have served in the military since there has been an America to serve. During the Civil War, women on both sides disguised themselves as men to enlist. More than 400,000 women served during the World Wars, but as the United States demobilized, the military pushed women back to the homefront.




During Vietnam, Congress began to recognize that more women were needed for the U.S. military machine, repealing legal provisions that had prevented them from comprising more than 2 percent of the nation's troops. With the end of the draft in 1973, the military turned greater attention toward recruiting women, but struggled to treat them as equals -- the Pentagon's 1988 "Risk Rule" officially excluded women even from support missions if they were deemed as likely as combat troops to take a bullet.

The first Gulf War soon proved this doctrine untenable, however, as a clear gap emerged between the risk rule and the facts on the ground.

Rhonda Cornum lived in that gap. The call to war was a big change for Cornum, a biochemistry and nutrition Ph.D. recruited by the Army in 1978 to study wound healing -- when Iraq invaded Kuwait in 1990, she was primarily conducting research on helicopter pilot performance and helmet-mounted displays. For Operation Desert Storm, the Army assigned her as a flight-surgeon to an attack-helicopter battalion, directly contravening the risk rule.
commander cornum

You know, women aren't supposed to be in combat, Cornum recalls a colleague telling her at their staging grounds in Saudi Arabia just before the U.S. air assault on Iraq.

"Right, I know that," was her answer.

Do you think the colonel knows you're a girl? he asked.

"I said, 'Well, I've been living in the parking space next to him in the Dhahran Airport parking lot for the last four months,'" she says. "'If he doesn't know by now, let's not tell him until the war's over.'"

This kind of doublethink was a standard part of Cornum's experience in the Gulf. "So when people would come around or dignitaries would come," she says, "they'd send me off to the motor pools."

Yet by the end of the Gulf War, Cornum had participated in roughly one-quarter of her battalion's attack missions. "One time, it didn't go all that well," she deadpans.
rhonda cornum
Rhonda Cornum deplanes after being released from Iraqi captivity on March 6, 1991.
On the last day of the war in 1991, Cornum's Black Hawk was downed by Iraqi forces during a rescue mission. She broke both her arms and a finger, tore knee ligaments and, yes, took a bullet, but nonetheless managed to crawl out of the wrecked bird. She and the two other survivors of her eight-person crew spent a week as Iraqi prisoners of war before being released.

"Nobody made any comments about, 'Oh, she shouldn't have been there,'" says Brig. Gen. Cornum, who was awarded the Purple Heart. "My boss got promoted again."

A 1993 Government Accountability Office study concluded that the some 40,000 servicewomen who deployed to the Gulf performed well on all fronts. Congress quickly repealed legislation dating to the 1950s that barred women from flying in combat and serving on combat ships.

Yet while the Pentagon also lauded servicewomen's combat performance, the official expansions of opportunities for military women did not include ground combat. Instead, Clinton Defense Secretary Les Aspin replaced the risk rule in 1994 with the "Direct Ground Combat Definition and Assignment Rule," still the military's official policy. Aspin's rule gave women more options than the risk rule, but it also severely constrains them, excluding them from ground combat that could involve hostile fire and physical contact "well forward on the battlefield."

His rule also gave the services broad discretion to further restrict women from positions that entail physically demanding tasks, special operations, direct combat, stationing or cohabitating with combat troops and a lack of privacy.

With the Sept. 11, 2001, terrorist attacks and a global "war on terror," America's definition of combat radically changed. The Pentagon's policy, however, has not.

An April report by the Congressional Research Service argues that the Defense Department's embrace of counterinsurgency strategies should prompt officials to rethink more than 14,325 positions. "Recent changes in Army doctrine have in many ways called into question the ground exclusion policy, or at least, the services' adherence to it," the report's author writes.

"In 1994, we didn't know what was coming," says Rajiv Srinivasan, who led an Army platoon as a lieutenant in Afghanistan. Now, he says, "There is no front line, no protected circle where we can hide the women."

ATTACHMENT VS. ASSIGNMENT
The military is about to roll back the part of Aspin's rule that bars women from officially serving in direct ground combat units below the brigade level -- allowing them to be assigned at the narrower battalion level, in specialties in which they are already serving. It will also lift the portion barring women from serving in units or positions that co-locate with direct ground combat units that are closed to them. The Army accounts for the majority of the 14,325 affected positions.

Army Maj. Gen. Gary Patton, the Defense Department's principal director for personnel policy, says the changes are a response to servicewomen's performance during the past decade of war. Like many throughout the chain of command, he says the new policy isn't a change in at least one way: women are already mission-critical.
majgen gary patton
Maj. Gen. Gary Patton discusses the DOD Women in Service Review at a Pentagon press conference on Feb. 9.

"Women have shown immense courage and have contributed greatly to our mission -- we simply could not accomplish our objectives without them," Patton, who served as a top commander in Iraq and Afghanistan, says in an email.

This line of reasoning also acknowledges that the military has for years tacitly violated the spirit of its own policy, if not the letter. While the 1994 rule bars women from being officially assigned to combat units, they can still be assigned to support positions "attached to" combat units. Thousands of the "new" positions opening to women are just formal assignment, rather than attachment, to units they already serve with, according to Pentagon spokeswoman Eileen Lainez.

Both Patton and Lainez cite as an example the position of Army tank mechanic among those newly opening to women. But Spc. Latoya Lucas served in a comparable role nine years ago.

Under Aspin's rule, Lucas could not be assigned to an infantry battalion or brigade. She could, however, be attached as a mechanic to an infantry division, as she was to the 101st Airborne a month after the 2003 invasion of Iraq. She was part of an engineering unit tasked with resupply and infrastructure work in Mosul, an Iraqi provincial capital where fighting was heavy.

"DOD's policy regarding women in combat was due for a revision," she says, "particularly because so many [Iraq] and [Afghanistan] female veterans have found themselves in combat situations."

Lucas was one of them. During a supply run, she was blown out of her Humvee when it took a direct hit from a rocket-propelled grenade. She suffered burns, shrapnel wounds, broken bones, hearing loss, paralysis and traumatic brain injury, as well as intestinal damage that required a permanent ostomy -- surgery to reattach her intestine to the surface of the skin.

"I will have these ailments for the rest of my life," Lucas writes in an email. "When I look at my scars, I cannot help but feel resilient. You have to be."

She received her Purple Heart at her bedside during her five months at Walter Reed. A year later, she was forced to retire, even as she continued what would total two and a half years of rehab to regain her mobility. Now a public speaker, she continues to serve in a different way: Late last year, she was appointed to the VA's advisory committee on women veterans.
latoya

At the committee's annual meeting in late March, Lucas sits toward the end of a long table surrounded by glass and a projector screen, her sleeveless white shirt an outlier in a roomful of somber suits. Dark lines of scar tissue snake across the rippled skin of her bare arm. She asks about the transfer of medical records for combat veterans -- a particular concern to women seeking treatment for injuries that, officially, they shouldn't need.

"Did you serve in theater?" asks Michael Cardarelli, the VA's principal deputy undersecretary for benefits and one of the only men in the room. From the head of the table, he can't see her scars.

Like Lucas, Staff Sgt. Marti Ribeiro officially should not have been in a position to take fire, but she did. A combat correspondent who spent eight years with the Air Force, Army, Navy and Marines, she deployed to Afghanistan's Bagram Air Base in 2006, accompanying medical convoys to remote areas without local doctors. The Army deployed such clinics in set locations rather than going door-to-door, so the locals needed significant advance warning of their arrival.

Unsurprisingly, that also made the convoys vulnerable to attack. The first night that they set up on the fringes of the northeast province of Laghman, bullets started flying. When the weapon on top of Ribeiro's Humvee jammed, the driver got out to give suppressive fire while Ribeiro provided cover. Returning fire under fire earned her a Combat Action Badge.

By the end of her last deployment, the 5-foot-9 blonde also had a nickname, "Combat Barbie," and was suffering from post-traumatic stress disorder, traced to trauma from combat and from a sexual assault by a fellow member of the military. Yet she faced raised eyebrows when she sought treatment: The first time she walked into a VA clinic, an older male veteran asked, "You lost, darlin'?"

(More on the issue of military sexual assault in the second installment of this series.)

marti ribeiro
Marti Ribeiro at an Afghan village in 2006.
Given the military's official policy, Ribeiro says, women veterans face dismissive treatment from the VA's staff, too. "They're getting denied filing for PTSD because they're not allowed in combat," she says. "The VA's looking at them going, 'You're not allowed in combat.'"

In their February report, Defense Department officials say they have learned much over the last decade "regarding the demands of operating for extended periods at the limits of human capability." But until they're satisfied that women won't hamper units operating at those limits, they say, broader changes to the 1994 rule remain off the table.

FORCE-READINESS AND THE FAST TRACK
Pentagon officials say they plan to develop gender-neutral physical standards and use the coming changes as a step toward more fundamental reconsideration of the 1994 rule. "As a former infantry battalion commander, I can tell you I wish I'd had the opportunity afforded by this change to policy," says Patton, the personnel policy director. "Commanders want the best talent available to maximize their unit's capabilities."

The 14,325 positions, Patton adds, mark the beginning of a process, not the end. Defense officials often hedge, however, when it comes to eliminating gender restrictions entirely, with the caveat, "where feasible while maintaining force readiness."

Translation: Barring outside pressure, enlisted infantry, special operations units and other elite, especially intense military positions are likely to remain denied to women for the foreseeable future, as is the advancement that comes with them.

That's not to say women cannot rise through the ranks, as Duckworth, Trowell-Harris, Cornum and others have demonstrated. But while women account for 14.5 percent of active-duty military personnel, they make up just over 7 percent of general officers.

The Defense Department calls these figures "strong," because far fewer women than men serve for more than 20 years, and it generally takes longer than that to reach a senior rank. (Generals, for example, typically put in 30 years.) Given that, the DOD's February report concluded, women are not disadvantaged under the current assignment policy.

Yet the Military Leadership Diversity Commission reports that while the percentages of occupations open to women "do not appear inordinately low, exclusion from these occupations has a considerable influence on advancement." In the Army, where only two-thirds of positions are currently available to women, four in five general officers came from the third of positions that are not.

"You're keeping women from rising from the ranks," Duckworth says. "You need to have some real combat under your belt. You want them to have a shot, just like you would want anyone to have a shot."
tammy army
Tammy Duckworth with her Black Hawk in Iraq, 2004.

For her part, Duckworth says she stayed with the military because she "fell in love" with the physical and psychological demands. And given clear physical standards, she argues, there is no reason to keep women out of infantry or special ops. "Let's not bar a few women who might be capable of doing it," she says, "same way we wouldn't bar a man from a desk job."

"Any general who doesn't think, any politician who doesn't think women can handle it" is sorely mistaken, says Srinivasan, the platoon commander. As for space-sharing and privacy, he says, "We're all adults."

The "legacy thinking" restricting military women is a kind of "iceberg," says Cornum, alluding to her work on the "comprehensive soldier fitness" program, which treats psychological well-being like physical well-being. "That's one of the skills we teach," she says, "to recognize that you have an iceberg, a deeply held belief that may be getting in the way of you seeing what's going on around you."

In any case, she says, future servicewomen have time on their side. "Eventually," she says, "everybody who believed the world is flat died off."

'THE INVISIBLE ONES'
For veterans like Latoya Lucas or Tammy Duckworth, the costs of their service are visibly striking, undeniable. But when women's wounds are tougher to spot, since they should not officially be facing the rigors of ground combat anyway, the military bureaucracy has often left them unseen or unaddressed. This blind spot forced Ribeiro to take her story public, and it nearly cost Jennifer Crane her life.

Crane, whose first morning of Army training was Sept. 11, 2001, arrived at Bagram, in Afghanistan, in 2003. Bagram was then just a seven-mile circle of wire around three concrete buildings and a mass of tents. Crane principally served as a paralegal for the Judge Advocate General Corps, but she still had to drive mine-pocked roads and patrol for Taliban fighters in dangerous territory.

jennifer crane
Jennifer Crane in Afghanistan in 2003.
"We were in a valley," she says. "They could literally just stand on the edges of the cliffs and drop bombs on us."

Within the first two weeks, she saw her first military funeral after a friend who deployed with her dropped dead of a heart attack. By the latter half of 2003, she found it difficult to eat or drink, and became consistently, critically malnourished and dehydrated. To her superiors' credit, she says, they tried to send her home, but she managed to convince them she'd pull through -- until her heart began racing and the base medics were unable to slow it back down. At that point, she was at constant risk of a heart attack herself.

Spc. Crane was forcibly evacuated from Afghanistan. Her official discharge was administrative separation: adjustment disorder. "I couldn't 'adjust' to wartime service," she says of the Army's assessment, with a hollow laugh. "A physical condition, not a disability."

Years later, the Defense Department began recognizing such cases as post-traumatic stress. "If I would've known then what I know now," Crane says, "I might have been able to get actual retirement from the military."

She was home in time for Christmas, but it wasn't home anymore. Nightmares kept her from sleeping much, and even while she was awake, she'd have sudden flashbacks, feel like she was back in Afghanistan. Loud noises or lights, from sirens to fireworks and thunderstorms, would leave her hyperventilating or unconscious.

Yet because Crane's PTSD went undiagnosed, she says, she struggled even to seek help. "I stigmatized myself because I was a woman," she says. "Other people, they'd been through it, lost limbs, been in firefights and everything else. I really discounted my own experiences. Quite a few years self-medicating, getting rid of the nightmares, the flashbacks. Getting rid of myself."

In 2004, Crane started using cocaine, which ended her nightmares by keeping her awake -- she barely slept for a month. Her boyfriend kicked her out, and her drug use left her unwelcome at her parents' house, too. She started self-mutilating. After attempting suicide, she was admitted into a VA program, where she was diagnosed with PTSD. By that time, however, she was far gone: After the five-week VA program ended, it was "right back down the hill," to crack.

She spent two years homeless. "I had decided I was gonna let the drugs kills me," she says. During that time, she started paying her dealers in sexual favors.

In a desperate moment, she says, she prayed for help, for someone to save her. "And 12 hours later," she laughs, "I was arrested."

After her arrest, for possession of crack cocaine, Crane was allowed to enter the drug court program in lieu of serving time. She moved back home. The program, her parents and the one friend who stuck by her saved her life, she says.

jennifer crane
Jason and Jennifer Crane.
That friend, Jason, is now her husband. Their daughter, Hailey, turns 4 on May 17, a few months before Crane is to begin nursing school. She was recently awarded a fellowship to work at the VA.

The military and the VA have come a long way in treating veterans since 2003, Crane says. She remains concerned, however, for the latest waves of returning troops, especially the women. People still tell her she doesn't "look like a vet."

"I had high commanding officers question me once, about how I had PTSD if I was JAG Corps," she says. "I think them allowing women to be in more 'combat fields' could dramatically impact the respect women get in the military."

Military women who do not have combat decorations, high rank or visible war wounds often do not receive enough respect from their peers, Crane says. But the greater problem, she says, remains the skepticism that meets such women when they seek treatment or other help.

"It's the invisible ones we're struggling with," she says. "These veterans could just fall through the crack. And we may never hear from them again."

'LET'S NOT WAIT TOO LONG'
Defense Secretary Leon Panetta has directed the services to update him on military gender integration in November. His department's upcoming changes carry the caveat, however, that the Pentagon respects Congress' intent to "remain the arbiter of the ground combat exclusion policy."

Servicewomen have found some advocates in Congress. Duckworth hopes to join them. But as in the Pentagon and the court of public opinion, there are those on Capitol Hill who turn a blind eye to or even dismiss women's service.

"What else has she done? Female, wounded veteran ... ehhh. Now let's move on," Rep. Joe Walsh (R-Ill.), the freshman incumbent Duckworth is looking to unseat, said of his opponent in March. "Wearing the uniform should immediately earn everyone's respect," he said in a statement after the minor furor his earlier comments caused. "It should not, however, earn everyone's vote."
Through a spokesman, House Armed Services Chairman Buck McKeon (R-Calif.) declined to comment.

On the campaign trail, the Pentagon's February announcement of new openings for women elicited opposition from then-presidential candidate Rick Santorum, once the third-ranking Republican senator and a favorite among social conservatives. "I do have concerns about women in front-line combat," Santorum said. "I think that could be a very compromising situation."

Retiring Sen. Olympia Snowe (R-Maine) counsels patience, predicting in an email that "barriers that prevent women from serving in certain roles will continue to fall in the years ahead." But Rep. Niki Tsongas (D-Mass.), who serves on McKeon's armed services committee, says women have waited long enough. "Let's not wait too long to do more," Tsongas says.

On her first trip to Afghanistan, Tsongas recounts, she had lunch with a female first lieutenant, whose brother had worked on Tsongas' campaign. Three weeks later, the woman was killed by an improvised explosive device -- a testament, Tsongas says, to the combat risks women already face.

"I think the steps they've made also acknowledge there's an inevitability to this," she says of the Pentagon, citing estimates that women will comprise as much as 25 percent of the military by 2025.

Beyond Capitol Hill, however, Cornum says her decades in the Army taught her that any policy change will come slowly, citing "don't ask, don't tell," the longstanding, now-repealed ban on openly gay service members. Positions like hers started becoming available to women, she says, because the military found it increasingly difficult to enlist enough men.

Retention remains a problem for the armed forces, with multiple deployments sidelining ever-greater numbers of veterans. "We live in a country where the same 500,000 to a million people have been going to war over the past 10 years," says Srinivasan, the Army platoon leader. "Anyone who is willing to volunteer, more power to them. Who is our nation to judge?"

Ultimately, necessity may force the end of the 1994 rule, though the military's stated plan is to radically reduce ground combat operations in the coming years. "We cannot exclude an entire force of very capable people who can do those jobs," says Duckworth, who became a Black Hawk pilot because aviation was the closest she could get to ground combat.

After her shootdown, Duckworth refused medical retirement. Now a lieutenant colonel, she still drills with the National Guard.

"We're warriors," she says. "We're not victims."

Sunday, May 13, 2012

Thanks for the Votes!

Many thanks to all my readers and dear friends and family for supporting my blog by voting in the 2012 Milbloggies Award contest.  Last year we won, but this year we were a finalist.  Winners were announced on Friday, May 11.  Congrats to all the winners listed below! The winners are as follows:

Best U.S. Military Parent Blog:  Semper Fi Parents
Best U.S. Military Supporter Blog:   Character Does Matter
Best U.S. Marine Corps Blog:   1One Marine's View
Best U.S. Navy Blog:   USNI Blog
Best U.S. Coast Guard Blog:   http://ryanerickson.com/
Best U.S. Air Force Blog:  Aim High Erin
Best U.S. Military Veteran Blog:  You Served
Best U.S. Reporter Blog:   The Unknown Soldiers
Best U.S. Military Spouse Blog:  **Wife [Widow] of a Wounded Marine**
Best U.S. Army Blog:  The Rhino Den

Tuesday, May 8, 2012

Military psychiatrists seek new name, and less stigma, for PTSD

This article is re-posted from The Washington Post.
By Greg Jaffe
The Washington Post
Published: May 6, 2012

It has been called shell shock, battle fatigue, soldier’s heart and, most recently, post-traumatic stress disorder, or PTSD.

Now, military officers and psychiatrists are embroiled in a heated debate over whether to change the name of a condition as old as combat.
The potential new moniker: post-traumatic stress injury.
Military officers and some psychiatrists say dropping the word “disorder” in favor of “injury” will reduce the stigma that stops troops from seeking treatment. “No 19-year-old kid wants to be told he’s got a disorder,” said Gen. Peter Chiarelli, who until his retirement in February led the Army’s effort to reduce its record suicide rate.

On Monday, a working group of a dozen psychiatrists will hold a public hearing in Philadelphia to debate the name change. The issue is coming to a head because the American Psychiatric Association is updating its bible of mental illnesses, the Diagnostic and Statistical Manual of Mental Disorders, for the first time since 2000.

The relatively straightforward request, which originated with the U.S. Army, has raised new questions over the causes of PTSD, the best way to treat the condition and the barriers that prevent troops from getting help. The change also could have major financial implications for health insurers and federal disability claims.

Chiarelli took on the problems of PTSD and suicide after two tours in Iraq and pressed harder than any other officer to change the way service members view mental-health problems. His efforts, however, have not resulted in a reduction in suicides.

Dropping ‘disorder’

PTSD refers to the intense and potentially crippling symptoms that some people experience after a traumatic event such as combat, a car accident or rape. To Chiarelli and the psychiatrists pressing for a change, the word “injury” suggests that people can heal with treatment. A disorder, meanwhile, implies that something is permanently wrong.

Chiarelli was the first to drop the word “disorder,” referring to the condition as PTS. The new name was adopted by officials at the highest levels of the Pentagon, including Defense Secretary Leon E. Panetta. But PTS never caught on with the medical community because of concerns that insurers and government bureaucrats would not be willing to pay for a condition that wasn’t explicitly labeled a disease, disorder or injury.

Some psychiatrists suggested post-traumatic stress injury as an alternative, and Chiarelli heartily endorsed the idea.

The question for the working group of doctors debating the change is whether the nightmares, mood swings and flashbacks normally associated with PTSD are best described as an injury.
Those in favor of the new name maintain that PTSD is the only mental illness that must be caused by an outside force.

“There is a certain kind of shattering experience that changes the way our memory system works,” said Frank Ochberg, a professor of psychiatry at Michigan State University.

The intensity of the trauma, whether it is a rape, car crash or horrifying combat, is so overwhelming that it alters the physiology of the brain. In this sense, PTSD is more like a bullet wound or a broken leg than a typical mental disorder or disease. “One could have a clean bill of health prior to the trauma, and then afterward, there was a profound difference,” Ochberg wrote in a letter backing Chiarelli’s request for a change.

Psychiatrists who oppose the change argue that PTSD has more in common with bipolar or depressive disorder than a bullet wound.

“The concept of injury usually implies a discrete time period. At some point, the bleeding will stop. Sometimes the wound heals quickly, sometimes not,” said Matthew J. Friedman, executive director of the Department of Veterans Affairs National Center for PTSD. A disorder can stretch on for decades.

Although everyone is equally susceptible to a gunshot wound, not everyone exposed to trauma suffers from PTSD. Genetics, military training and even the cohesion in a soldier’s platoon all play a role in determining whether a combat experience results in PTSD or simply a bad memory, experts said.

“The word ‘disorder’ reflects the fact that some people are more vulnerable than others,” said John Oldham, president of the American Psychiatric Association.

Treatment for the malady often includes remembering the traumatic event under controlled conditions until it loses its power.

Origins of PTSD
PTSD made its first appearance in the diagnostic manual’s third edition, which was published in 1980. The doctors who lobbied for its inclusion viewed it as a measure that would finally legitimize the pain and suffering of Vietnam War veterans.

Before the creation of the PTSD diagnosis, Vietnam War-era hawks saw troops suffering from such symptoms as weaker than their World War II-era colleagues. “The view was that they should just suffer in silence,” said Charles Figley, director of Tulane University’s Traumatology Institute. The antiwar doves often portrayed Vietnam War veterans as crazy, deranged and dangerous.

“PTSD was a validation that what the Vietnam veterans were reporting was true, and it connected them to other veterans in other wars and other people who had experienced trauma,” Figley said.

Political fallout

The name-change debate is also being influenced by bureaucratic politics. In 2008, the military considered awarding the Purple Heart to troops suffering from PTSD, but ultimately decided that brain science had not advanced far enough to prove that people were suffering from the condition.

A change to “injury” would make it easier to revise the award criteria, advocates of the name change say.

“To be injured in the service to your country is entirely honorable in the military culture,” said Jonathan Shay, a psychiatrist who specializes in treating the psychic wounds of war and has worked closely with the U.S. military. “To fall ill is not dishonorable, but it is unlucky.”

A shift to “injury” could make it harder for service members to collect permanent-disability payments for their condition from the government, some experts warned. “When you have an injury, you follow a treatment regimen and expect to get better,” Figley said. “This change is about medicine, but it is also about compensation. We are talking about hundreds of millions of dollars.”

Finally, the name change has unearthed other sensitive arguments about the best way to prevent PTSD in the military.

“The whole history of psychiatry is to change the names of conditions. If the problem doesn’t go away, we change the name,” said Bessel van der Kolk, a professor of psychiatry at Boston University. “It makes us feel momentarily better. But it doesn’t change anything.”

If the Army really wanted to protect soldiers, it would limit the number of tours that troops are permitted to do in Afghanistan, van der Kolk said. Medical studies have suggested that a soldier’s resilience is depleted with each battlefield tour. “As long as you have repeated deployments, you will have devastating effects on people,” he said.

Tuesday, May 1, 2012

I Was a Mortuary Worker in Iraq: A Marine on What Remains After War

The following essay by Jessica Goodell and John Hearn first appeared on May 1 in Religion & Politics, a new online weekly journal based at the John C. Danforth Center on Religion & Politics at Washington University in St. Louis. 

Editor’s Note: Jessica Goodell served in the Marine Corps’ first dedicated mortuary affairs unit. The platoon, deployed to Iraq in 2004, was tasked with recovering and processing the remains of the fallen, many of whom were killed by Improvised Explosive Devices. Their grim work occasionally required scooping up human remains and depositing them into body bags. Once home, she struggled with finding meaning and structure in her life. A turning point occurred when taking a community college course titled “American Institutions.” Jess and the instructor for that course, John Hearn, co-authored her story in Shade It Black: Death and After in Iraq. In the following essay, Hearn’s words are italicized.

“We need to understand how much of our lives is lived in and through institutions,
and how better institutions are essential if we are to lead better lives. In surveying
our present institutions we need to discern what is healthy in them and
what needs to be altered, particularly where we have begun to destroy the nonrenewable natural and nearly nonrenewable human resources
upon which all our institutions depend.”
– Robert N. Bellah, et. al., The Good Society 

We would inventory everything. Everyone had a copy of The Rules of Engagement in their left breast pocket. Some would have knives or earplugs, food, a spoon. Pens. Rolled up pieces of paper, a scribbled reminder to ask their mother to send Skin So Soft to keep the sand fleas away, a scrunched-up wrapper, trash that wasn’t thrown away, that didn’t become litter, that would now become part of a family’s lasting memories of a son, husband, brother, father, hero. There were pictures. A man and his wife and daughter. A farmhouse and barn in Iowa. Many were the pictures teenagers would carry back home. A high school student with his football teammates. A young man in a sleeveless t-shirt leaning against a 1983 Camaro. A letter in which a Marine tells his widow that he is now dead, but that he loves her still, and he wants her to give their daughter a kiss from him. Some items were uncommon, like the sonogram of a fetus. Some were not uncommon enough, like a suicide note.

We felt privileged to do what we could for the families of the dead, yet the work took its toll. A couple of our unit’s members left the platoon voluntarily, while another was asked to leave. It was difficult to eat and sleep, and we all began to feel and hear what we believed were the souls of the dead.

When our four years were up, some of us reenlisted, some of us did not. The former seemed to fare better than the latter. Of those who came back to civilian life, one spent two and half of his first three years home in jail; another, to this day, has been unable to hold a job; one shot at neighborhood kids from his apartment window, telling police afterwards that he feared they were about to attack his family; another could not leave her small apartment for months; still another, in a hospital after a failed suicide attempt, texted me this message: “I have $2,000 in the bank. Let’s meet in NYC and go out with a bang.”

After the Marines, I moved from California to St. Louis to Seattle to Tucson to New York and back to Tucson, while trying unsuccessfully to leave an unhealthy relationship with a fellow former Marine. I looked for jobs as a security guard, a machine parts clerk, a waitress, a nail technician and a dog groomer. I was unable to find a place where I felt I belonged, a situation in which I was needed and where I needed to be, or a sense of control over my shrinking world. I discovered that many of my taken-for-granted assumptions about life and death, war and peace, justice and forgiveness, right and wrong, did not seem to apply to the world as clearly as they once had. The tight bonds that defined life in Iraq were loose and frayed back in the States; in fact, well-established patterns of interaction were difficult to discern, as the emphasis on self-sacrifice was replaced with one on self-fulfillment.

Over the course of the next several weeks, I noticed how we were always buying things, and then buying more. New cars and then new stereo systems for them, and then new wheels, and then newer, more powerful stereo systems. Clothes. Jewelry. Cell phones that would soon be replaced with fancier ones. Flat screen televisions that would be replaced with larger ones.

Everyone was busy. Too busy to meet, to have dinner, to carry on an actual conversation. Everything moved fast. Strangers became best friends—“brothers”—or they became lovers—“soul mates”—in an instant. Relationships and marriages ended overnight. Jobs were lost, families were broken, plans were changed and futures were canceled in the blink of an eye.

People seemed self-centered and relationships felt superficial. Favors were asked but seldom returned; everyone wished to talk and no one wanted to listen; plans were kept on hold until the last minute in the hope that something better came up; friends wouldn’t show up or couldn’t be bothered.

For a while I knew what it was like to have friends who would give their life to protect mine. Back home, I couldn’t be sure that one would show up to an agreed-upon lunch date or actually meet me at the library as we had planned. And instead of solidarity, the ubiquitous “support our troops” decals and token “thank you for your service” declarations contributed to a greater sense of isolation and misunderstanding.

Everyday life had the feel of a shopping mall, on Black Friday, and I was there alone, among total strangers, wandering around or, at most, transacting business. The Mall of America. It would be two years before I made a connection between this reality and President Bush’s post-9/11 exhortation that we respond to terrorism by going shopping.

All of this—the rampant consumption, the materialism, the self-centeredness—the Corps had purged from us; then we were dropped back into the middle of it all. The experiences of war, of combat and death, left us jittery in public places, jumpy at the sound of fire crackers, sleepless at night, but it was this fundamental shift in what we saw as important, in who we were, in how we lived, in the bonds that connected us, or didn’t, that created deeper problems in adjusting back to our old lives.

To say that this set of profound changes created a sense of confusion is to minimize our sense of the term “confusion.” We did get disoriented with regard to time and, certainly, identity, but it wasn’t just all in our minds. The disorder was also in our lives, in our interactions, our relationships, as well as in their absence. As we were soon to learn, the confusion was in the very ground beneath our feet that would give way like loose sand whenever we tried to propel ourselves forward, trying to get back to a source of social gravity, where life had meaning and our interactions had structure.

Not only was I floating aimlessly in the lazy institutional currents of life back home, but my beliefs about America’s role in the world were also being tested. I had thought we were in Iraq to fulfill our moral obligation to promote freedom and democracy, but I had seen little evidence of that over there. I had thought God was on our side, but I couldn’t feel his support in the MA bunker at Camp TQ. Like every Marine I knew, I went to Iraq to help the Iraqi people, but eight months later I left knowing I had not.

I WAS LOST WHEN, IN 2006, at the last possible moment, I enrolled as a student at a local community college. The coursework kept me busy, which was good. One course in particular helped to shift my perspective in a way that allowed me to see that there may be a way back to an involved, meaningful life, one that required understanding our society less through its national myths and more through the nature of its social institutions.

I teach at a small, rural community college tucked into the southwestern corner of New York State. We are located in a town of 30,000, a virtual island within a 50-mile radius of farmland and villages. In 2009 the county’s median household income was approximately $38,000. For several years now, a growing proportion of my students have been veterans of our Middle Eastern wars. In a course I taught last summer, five of the twenty students were vets. I’m getting better at identifying them. It’s not their age that gives them away. Some make it easy for me by carrying their books and other belongings in a military-issued MOLLE pack; their hair, if they are male, may be shorter than the norm, or it is, if they were Marines, still high and tight; several address me as “sir”; they often emblazon a forearm with a colorful emblem of the unit they served in, or a bicep with a single word, like “RAGE”; some disappear after a week or two and, like ghosts, reappear without explanation; or they attend every class, often sitting in the back of the classroom, but when I catch their eyes, I can see that they are not there at all.


In the fall of 2006, unable then to detect the student-veteran, I was nevertheless aware of a young woman in one of my classes who did stand out. She was slightly older and much thinner than her classmates. She never missed a class or arrived late. While many of her fellow students had a tendency to slouch down into their plastic chairs or lean forward to rest their arms on the table before them, she sat with a perfectly straight spine. She didn’t whisper to classmates, play with her phone or appear disinterested. And she did not say a single word throughout the semester.

The course, titled “American Institutions,” examined the nature of social institutions, focusing on our own. We discussed our political system, including the arguments that it is controlled by an unelected elite who make what C. Wright Mills called “history-making” decisions, such as the decision to participate in or to start a war …

I had fought in a war but hadn’t really given much thought to who it was that made the decision that there would be one, or why they had so decided. I knew that President Bush had said the war had been willed by God, but the state of the human remains we scooped up with our hands told me otherwise. I knew too that we had invaded Iraq because Saddam had weapons of mass destruction and was willing to use them against us, but those weapons were never found. Or we were going there to effect regime change, but … Or to liberate the Iraqi people, but … Or to establish a democratic oasis in the Muslim Middle East, but …

We talked about our globalizing economic system, with its steep stratification hierarchy and its shrinking middle class …


I grew up in a somewhat insulated middle class enclave, on a lake, outside of Jamestown, New York. Issues of inequality and social justice emerged during my military service (where a disproportionate number of my fellow Marines were from the ranks of the growing lower classes, and when we deployed to economically underdeveloped Iraq) and at the community college (attended by very few of my high school classmates), but it took a while before I saw the reality of inequality and the value of social justice clearly enough to connect them to my own experiences. I had never asked myself how it is that so few are able to consume so much of the world’s scarce resources.

We discussed the failure of our educational institution to provide the young with the knowledge and skills required to locate oneself in society and one’s society in history, or to engender reflection on what it means to live the good life in the Good Society …


A Marine recruiter suddenly appeared in my high school classroom and within days I had enlisted …

We discussed religion: the Durkheimian belief in its functionality—its contribution to group solidarity and meaning, and the Marxist argument that it is an opiate that undermines collective political action, as well as the loosening grip of the major churches, the depersonalization of the mega-churches and the related diminishment of a shared conception of the Good Society.


IN THE MORTUARY AFFAIRS bunker, we could feel and hear the souls of the dead. They emerged at night and hovered above us, pressed down upon us, pushed us away from their favorite resting spots, watched us through the eyes of severed heads. That there was an afterlife was as clear to us as Iraq’s bright yellow sun, but what it entailed and who its inhabitants were and how one gained admission were more of a mystery than ever. There was a chapel on the base which I visited every now and then, but I would leave still unable to explain what was going on around me, and no more comforted than when I entered. One day a fellow platoon member handed an Iraqi man two black plastic bags. One contained the remains of the man’s wife; the other the remains of his four-year old daughter. My chapel visits did not help me to make sense of this or the many other atrocities surrounding me. 

Two years later, sleeping on my father’s couch, unable to function, I sought advice from the youth pastor at our church. At his suggestion, I attended services regularly and donated time to the congregation’s children and elderly, but it too wasn’t enough to provide me with the grounding I sought or the conviction in the goodness of what we were doing, either in Iraq or here at home.
A hundred years after Emile Durkheim pronounced that the old gods had died and new ones had not yet arisen, I still could not find one.

We discussed war as an extension of politics and read Osama Bin Laden’s “Letter to America” …

I had thought Al Qaeda hated us only because we were free, a concept they found repugnant, as the president and his spokespersons told us, but here Bin Laden was making the case that we attacked Muslims in Somalia and in occupied Palestine, that we shored up oppressive dictators in one Muslim country after another, that we did not adequately compensate them for—or we stole!—their oil, that we starved their children through the implementation of unjust sanctions, and on and on …

We discussed the interdependence of our social institutions …


I was beginning to feel the reality of our social institutions and to see how our economy and polity and our educational, religious and family systems worked together to make us, individually and collectively, who we are. If I detected a crack in one institution, a gap between its ideals and actual functioning, I could trace that fissure into and through the other institutions.

Marx said that the critique of society begins with a critique of religion. For me, it began with a critique of war. Initially an unarticulated discomfort with roots in my experiences fighting a war, it became a more informed analysis based upon readings that allowed me to connect my war to the structure of our society and world.

I concluded that too many of the myths surrounding war, more than a few of which are religious in nature, are malignant, and too few of those embracing life are robust enough to provide substantive meaning.

We discussed the nature of social institutions …


That course, titled “American Institutions,” invited students to think about the nature of our political system and economy and educational system and family system as well as our military, and to understand how we form them and how they form us, and how, if we choose, we can change them, and reinvigorate them with the ideals and virtues they long-ago held.

I graduated at the end of that semester with a clearer understanding of how a goal larger than the self—a possible antidote to life in modern society—must contain a concept of the common good that is embedded in our shared institutions. I came to see that individuals can fulfill themselves only within a community that actively maintains the norms of honor and discipline and sacrifice and democratic participation, and that, in a globalizing world, the goals of peace and justice and equality of opportunity must extend to all of humanity.

Jessica had been a silent student that semester, uttering not one word in class. It was through her written work that I understood that she was listening and reading and thinking. The semester ended and I did not see her for a year or so, until she one day appeared at my office door. During our chat she mentioned that she was behind schedule academically because she had served four years in the Marines. As our conversation wound down, I invited her to drop by again when she was next on campus. “Next time,” she asked, “can we talk about forgiveness?”


When I transferred to a four-year school I founded a group for veterans. Together we tried to make sense of what we had done and were doing. Beneath our shared experiences was an unspoken understanding that we hoped to nudge ourselves and the college community toward a conversation about social justice. After graduation I moved to Boston and joined its Veterans for Peace chapter. In what is, for many, the birthplace of American democracy, we worked to remind our city and nation of its historic ideals, while we sought repentance through helping dislocated Iraqi families settle into the area. Today I see the Occupy Wall Street movement as an attempt, however unorganized, to nationalize the efforts to revitalize our institutions, to realign their goals with America’s true ideals, to infuse the process of collective meaning-making with democracy, and to do so in a more global context.

This is how I am integrating my past with my present, myself with my country, my life with my ideals, my present with the future, my experiences with hope.

Jessica is a PhD candidate in the counseling program at the University of Buffalo. John Hearn teaches at Jamestown Community College in Jamestown, New York.
This essay contains passages from the authors’ book, Shade It Black: Death and After in Iraq (Casemate Publishers, 2011).