The Sandbox

GWOT hot wash, straight from the wire

Welcome to The Sandbox, a forum for service members who have served or are currently serving in Iraq and Afghanistan, returned vets, spouses and caregivers. The Sandbox's focus is not on policy and partisanship (go to our Blowback page for that), but on the unclassified details of deployment -- the everyday, the extraordinary, the wonderful, the messed-up, the absurd. All correspondence is read, and as much as possible is posted, lightly edited. If you know someone who is deployed who might have something to say, please tell them about us. To submit a post click here.

HOW THE PURPLE HEART CAN HELP HEAL VETERANS WITH PTSD |

August 26, 2013

Name: MAJ Ben Tupper
Returned from: Afghanistan
Hometown: Syracuse, NY

Criteria for the Purple Heart medal seems straightforward: “any action against an enemy of the United States” in which a service member is “wounded or killed” merits the award. But in practice granting of the award is a contentious issue among combat veterans and a charged field for both the wounded and those who judge the wounds.

Purple Heart

Pablo Martinez Monsivais, Pool/AP

In Afghanistan, I knew soldiers who earned Purple Hearts for very minor wounds sustained in combat. Bruises and small lacerations that required no stitches were technically eligible, and soldiers who received them were rightly issued the medal. But technical criteria aside, most soldiers look down on awards given for minor injuries, arguing that doing so cheapens the Purple Heart’s significance for those who were killed or more gravely wounded.

Today, even while the Department of Defense wages a full-scale campaign to educate service members on the legitimacy of mental health injuries caused by war, many veterans are still discouraged from seeking treatment for post-traumatic stress disorder (PTSD) by a fear of being stigmatized. Current DoD policy, though a step in the right direction, has not been enough to change a culture, both in and outside the military, that still views PTSD as somehow less real than physical traumas.

Given these DoD attempts to promote understanding within the ranks that PTSD is a legitimate product of war, the question before us is this: should PTSD meet the criteria for the Purple Heart?

When I posed this question to a wide range of veterans from Vietnam to Afghanistan they universally answered “NO,” PTSD does not merit the Purple Heart. I myself shared their opinion, until I began to investigate the issue more closely and found that the reasons cited for denying Purple Hearts for PTSD were fundamentally flawed and inconsistent with other military award practices.

The first issue of contention with PTSD is whether it’s a real “wound”, but the answer to this is obvious and well documented by the fact that more combat veterans from Iraq and Afghanistan die from suicide related to wartime service and mental health issues, than from enemy bullets and bombs. That should offer grave and definitive proof that PTSD is very real and that its consequences can be as deadly as an IED.

Another false premise used to undermine awarding the Purple Heart for PTSD is that the mental disorder causes no physical damage nor changes to the structure of the body. But the regulation for the Purple Heart never makes any distinction between internal wounds or external wounds. The precedent for awarding the Purple Heart for an internal mental wound is in the case of traumatic brain injuries (TBIs), which cause no visible disfigurement but still qualify for the Purple Heart. Finally, it is important to note that although PTSD isn’t detectable from the surface, the disorder does have a physiological signature and can be detected in brain scans that show changes to the brain’s structures and wiring, much like with TBIs.

Then there is the argument that there is no clear chain of evidence linking an enemy action to the onset of PTSD. The disorder can take months or years to fully manifest and may be caused by more than one incident, including traumas other than wartime service. Again, this objection is moot given that the same argument can be made about TBIs, which can also be cumulative and triggered by multiple causes that may have occurred prior to war.  No distinction is made for a wound that is initially precipitated by falling off a bike as a child and later aggravated during an IED explosion that culminates in a TBI when issuing the Purple Heart to affected service members.

Finally, the most frequent and emotionally charged objection to awarding the Purple Heart for PTSD is the fear that people will fake symptoms to earn the award. Sadly, fakery can occur in any military award and that is why the current award system requires multiple witness statements to corroborate the award narrative. The same stringent review would be required for service members being submitted for PTSD related Purple Hearts: corroborating witness statements documenting combat exposure, as well as statements from professional mental health clinicians.

The case for reconsidering PTSD and the Purple Heart might be made best by turning from argument to the story of one of my combat veteran friends from Afghanistan.  My buddy, I’ll call him Ralph, was by my side in combat many times, and in the course of these violent and harrowing events he had a series of wounds inflicted on him. The first occurred when a pebble-sized fragment of shrapnel ricocheted off his machine gun shield and hit him in the fleshy part of his earlobe. There was minor bleeding but within days the wound had healed. In accordance with the regulations he was correctly and rightly awarded the Purple Heart because the wound was incurred during combat and clearly caused by enemy action. Some hardliners may scoff at this, but had the shrapnel hit two inches to the right it could have taken out his eye and lodged in his brain.

Months after receiving the Purple Heart for the wound to his ear, Ralph suffered a far more grievous injury that put him in the hospital for months, mostly in a coma, where he was expected to die from the head injuries he had suffered. After being released from the hospital he was deemed unemployable for life and granted 100% disability status by the Veterans Administration. Ralph now walks with a cane, is riddled with scars and dependent on a wide range of medications to survive and manage his pain. Yet for this second wound, by any measure more severe than the wound he suffered to his earlobe, there will never be any Purple Heart, because this second wound was PTSD.

Upon returning home from war, Ralph was haunted by the comrades he lost and the enemies he killed. In an attempt to escape his pain and grief Ralph turned to drinking and long periods of solitary confinement, barricaded in a small room in his father’s house. Some days when he felt especially hopeless he would get behind the wheel of his car and drive fast in an effort to flee and find relief. On one such day, craving the adrenaline rush of combat, and fueled by rage and alcohol, he drove his car right into a telephone pole and suffered the injuries that caused his coma and continue to limit his mobility and physical health today.

Ralph’s experience, taken together with the large and growing body of clinical literature on PTSD, ought to be enough to finally dispel any lingering notions that PTSD is any less legitimate or serious than other battlefield wounds. A serious consideration should be given to revising the award criteria to make those with mental and psychological injuries caused by direct combat exposure eligible for the Purple Heart.

Granting the Purple Heart is just the first step in fully legitimizing and addressing PTSD. We also need systemic reform of the VA and a better system for providing the long term clinical treatment that its casualties deserve. But awarding the medal in cases of PTSD will accomplish one essential goal: giving the respect and acknowledgement to those who are suffering from invisible wounds that we already bestow on those with scars we can see. By doing this, we would acknowledge that the anxiety, rage, depression and disrupted emotional and social lives that veterans with PTSD experience are a result of war, and not some personal defect. By honoring them like we honor those scarred by bullets and IEDs we may be able to alleviate some of the shame and fear that have led so many to suicide.

 

This piece originally appeared on The Daily Beast.

Benjamin Tupper is an infantry officer currently serving in the Army National Guard, a graduate student at Syracuse University, and the author of two books on his experiences in the Afghan war: Greetings From Afghanistan: Send More Ammo and Dudes of War.

A LETTER TO A STRANGER ABOUT PTSD |

August 22, 2013

Name: Mikey Piro
Returned from: Iraq
Hometown: Lindenhurst, NY
Milblog: ptsdsurvivordaily
Email: mpiro45@gmail.com

My PTSD Google Alert brings through many interesting articles. The volume of disturbing articles seems to be increasing over time. This morning a link from Gawker was at the top of my news feed. I am not a huge fan of Gawker, but I felt compelled to read this article. I read it and was overwhelmed with the tragic stories that are still persisting and were presented there.

I have been avoiding the shit out of many things and unfortunately the pressure has built up too high. The bottom of the article had a link. So on a whim I penned a letter.

Dear Hamilton,

Reading the accounts of other Veterans is upsetting to me, but a story that needs to be told.

I exited the Army in 2006 after two tours in Iraq. They were in relatively close order and the ten month break in-between trips was not nearly enough time to readjust. The second trip was worse than the first and exposed me to new and different horrors of war. That deployment compounded what was most likely a case of PTSD from the first tour.

When I returned home I slogged through the VA benefits process with the help and support of my wife and family. For a while I lived away from my wife and newborn son. For a while my father drove me to and from work as the medications I was on rendered me unable to function as I was coming up from them.

Each week for the better part of six years I saw a therapist at the VA and chipped away at learning to deal with a new normal of persistent anxiety and depression. In that six years I fired two therapists and cannot speak highly enough of all the rest.

I quit drinking and all drugs but I am still addicted to work to keep my mind away from the negative patterns of thought that are ingrained from years of training and fighting. I finally got off the antidepressants about a year ago. Despite all that, some days I still break down and cry in the bathroom at work. I consider myself lucky to even have a job.

I wish I could say that after these six years I am an integrated happy member of society, but I am afraid that will not be true for many years, if ever. I can keep the wild and extreme thoughts at bay, but they still linger in the dark corners of my mind. One day seven years ago I took out my gun and considered getting some rest from those thoughts.

That day I doubled down on my family and my therapy and today I am able to survive and more often than not, flourish. I did not do it alone. We Veterans cannot do it alone.  It takes lots of hard work and discipline to maintain this steady state. My perspective coming through the other side of this is now valued by my coworkers and family, but only as I am able to present it currently. If it was any rougher or more graphic, I don’t think they could handle nor tolerate it.

I am now dedicated to see my two boys grow up and reach a ripe old age with my wife.

I write a blog about PTSD and my treatment. (My friends were harassing me about not having a post lately)...

Thanks again for raising awareness.

Sincerely Yours,

Michael “Mikey” Piro

It was liberating to write this little summary and confess how I feel. I am still deeply emotional about my experiences in war, but I have so much to celebrate and be thankful for. I am flourishing. These past 16 months have been the best since I came home and each month continues to be better. I could not have done it without you that are reading this right now and this convention of baring my soul into the internet. I am doing fine, thanks to you.

So here comes the ask: find a Veteran, give them a hug.  Accept them for who they are and give them an opportunity to flourish.

SIX WORD WAR |

August 19, 2013

Name: Charlie Sherpa
Previously embedded: with former unit in Afghanistan
Hometown: Boone, Iowa
Milblog: Red Bull Rising
Email: SherpaatRedBullRising.com


 

Through Kickstarter, two U.S. Army veterans are currently crowd-funding a hardcover collection of Iraq and Afghanistan war memoirs, each delivered in punchy six-word shot groups.

I wish I'd thought of that!

West Point classmates Mike Neman and Shaun Wainwright are seeking $4,900 through a fund-raising campaign that ends Aug. 30, 2013. Neman is also an author of humorous parenting books, and has previously conducted two other Kickstarter projects.

At the time of this writing, the pair have raised more than $4,000 toward their objective. Donors of $20 or more can receive a copy of the book. An accompanying video further describes the project:

"Six-Word War" is the first-ever crowd-sourced war memoir. It will give you unique perspective on our nation's wars in Iraq and Afghanistan. Instead of a traditional war memoir that may give you just one person's perspective, this book will give you hundreds, hopefully thousands, of short stories from soldiers, sailors, airmen, and Marines.
Previously submitted entries range from pissy and punny, to provoking and poignant. Here are a couple of examples:
Simple people – complex problems – harsh terrain
— OEF IV 12-month deployment with 2-27 Infantry out of 25th Infantry Division.

PowerPoint Storyboard. Or it didn't happen
— Bobby Ragsdale
Running over soccer balls creates terrorists
— Nate Nahm

News stories must contain no downers
— Posted all over our 4ID office in Tikrit, per General Odierno
Where is your reflective belt, you?
— Will F.

Hearts and minds are only targets
— Anonymous
Veterans and military family members can submit their own six-word memoirs through a project website: www.sixwordwar.com.

For more information on the fund-raising campaign, click here.

There is also a Facebook page here.

WHAT AMERICA NEEDS TO KNOW |

August 09, 2013

Name: Matt Gallagher
Returned from: Iraq
Milblog: Kerplunk

What does America need to know about its new veterans? That we aren’t one voice, one experience, one memory, one preconceived notion fulfilled that can be stapled to our country’s heels like Peter Pan’s shadow? That we’re both varied and small? That 2.5 million of us have served in Iraq and Afghanistan since 2001, a number that’s roughly the population of tiny, frozen Latvia, a number that only begins to hint at the separation between the postmodern empire and its legions?

Does history, the teacher of life according to Cicero, yield answers? How did a nation two generations removed from pushing back the onslaught of fascism get here? How did a society one generation removed from the great scar of Vietnam arrive here?

What happened to the America we woke up to on September 12, unified, defiant and proud?

Is it because in an all-volunteer force, it’s someone else’s sons and daughters who fight?

Shouldn’t supporting the troops also mean hiring them? Does the skittish corporal who managed $500,000 worth of equipment in a forgotten outpost of hell get hired, or just the officer with the plastic smile and business degree?

What’s the biggest divide between those who have served and those who haven’t? Other than getting shot at in strange lands? Recognizing that we’re as responsible for the divide as much as civilians are? That we know insulating ourselves in vet squads and platoons bridges nothing, but do it nonetheless?

That our own veterans’ movement has already splintered because of money and egos and a VA far too interested in public relations’ doublespeak and shooting messengers?

What of war’s end?

What of the future? Will our voices and experiences and memories mean anything when these questions arise yet again?

 

This essay originally appeared in Stars and Stripes as part of a column called "What do we need to know about veterans?"

Matt Gallaher's numerous contributions to The Sandbox during his deployment include RULES OF ENGAGEMENT, iWAR, A SOUNDTRACK TO WAR, and CRANK DAT IN IRAQ.

He is the author of Kaboom: Embracing the Suck in a Savage Little War, and co-editor of Fire and Forget: Short Stories From the Long War.



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