Hurry Up & Wait: Veterans die waiting for health care.

(Article by By Scott Bronstein and Drew Griffin, CNN Investigations, 23 APR 2014. Source. H/T Veteran’s PTSD Project on Facebook.)

(CNN) — At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.

The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.

For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care. But the new revelations about the Phoenix VA are perhaps the most disturbing and striking to come to light thus far.

Internal e-mails obtained by CNN show that top management at the VA hospital in Arizona knew about the practice and even defended it.

Dr. Sam Foote just retired after spending 24 years with the VA system in Phoenix. The veteran doctor told CNN in an exclusive interview that the Phoenix VA works off two lists for patient appointments:

There’s an “official” list that’s shared with officials in Washington and shows the VA has been providing timely appointments, which Foote calls a sham list. And then there’s the real list that’s hidden from outsiders, where wait times can last more than a year.

Deliberate scheme, shredded evidence

"The scheme was deliberately put in place to avoid the VA’s own internal rules," said Foote in Phoenix. "They developed the secret waiting list," said Foote, a respected local physician.

The VA requires its hospitals to provide care to patients in a timely manner, typically within 14 to 30 days, Foote said.

According to Foote, the elaborate scheme in Phoenix involved shredding evidence to hide the long list of veterans waiting for appointments and care. Officials at the VA, Foote says, instructed their staff to not actually make doctor’s appointments for veterans within the computer system.

Instead, Foote says, when a veteran comes in seeking an appointment, “they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there’s no record that you were ever here,” he said.

According to Foote, the information was gathered on the secret electronic list and then the information that would show when veterans first began waiting for an appointment was actually destroyed.

"That hard copy, if you will, that has the patient demographic information is then taken and placed onto a secret electronic waiting list, and then the data that is on that paper is shredded," Foote said.

"So the only record that you have ever been there requesting care was on that secret list," he said. "And they wouldn’t take you off that secret list until you had an appointment time that was less than 14 days so it would give the appearance that they were improving greatly the waiting times, when in fact they were not."

Foote estimates right now the number of veterans waiting on the “secret list” to see a primary care physician is somewhere between 1,400 and 1,600.

Doctor: It’s a ‘frustrated’ staff

"I feel very sorry for the people who work at the Phoenix VA," said Foote. "They’re all frustrated. They’re all upset. They all wish they could leave ‘cause they know what they’re doing is wrong.

"But they have families, they have mortgages and if they speak out or say anything to anybody about it, they will be fired and they know that."

Several other high-level VA staff confirmed Foote’s description to CNN and confirmed this is exactly how the secret list works in Phoenix.

Foote says the Phoenix wait times reported back to Washington were entirely fictitious. “So then when they did that, they would report to Washington, ‘Oh yeah. We’re makin’ our appointments within — within 10 days, within the 14-day frame,’ when in reality it had been six, nine, in some cases 21 months,” he said.

Thomas Breen was so proud of his time in the Navy that he wanted to be treated only at a VA facility, his family says.

In the case of 71-year-old Navy veteran Thomas Breen, the wait on the secret list ended much sooner.

"We had noticed that he started to have bleeding in his urine," said Teddy Barnes-Breen, his son. "So I was like, ‘Listen, we gotta get you to the doctor.’ "

Teddy says his Brooklyn-raised father was so proud of his military service that he would go nowhere but the VA for treatment. On September 28, 2013, with blood in his urine and a history of cancer, Teddy and his wife, Sally, rushed his father to the Phoenix VA emergency room, where he was examined and sent home to wait.

"They wrote on his chart that it was urgent," said Sally, her father-in-law’s main caretaker. The family has obtained the chart from the VA that clearly states the "urgency" as "one week" for Breen to see a primary care doctor or at least a urologist, for the concerns about the blood in the urine.

"And they sent him home," says Teddy, incredulously.

Sally and Teddy say Thomas Breen was given an appointment with a rheumatologist to look at his prosthetic leg but was given no appointment for the main reason he went in.

The Breens wait … and wait … and wait …

No one called from the VA with a primary care appointment. Sally says she and her father-in-law called “numerous times” in an effort to try to get an urgent appointment for him. She says the response they got was less than helpful.

"Well, you know, we have other patients that are critical as well," Sally says she was told. "It’s a seven-month waiting list. And you’re gonna have to have patience."

Sally says she kept calling, day after day, from late September to October. She kept up the calls through November. But then she no longer had reason to call.

Thomas Breen died on November 30. The death certificate shows that he died from Stage 4 bladder cancer. Months after the initial visit, Sally says she finally did get a call.

Sally says the VA official told her, “We finally have that appointment. We have a primary for him.’ I said, ‘Really, you’re a little too late, sweetheart.’ “

Sally says her father-in-law realized toward the end he was not getting the care he needed.

"At the end is when he suffered. He screamed. He cried. And that’s somethin’ I’d never seen him do before, was cry. Never. Never. He cried in the kitchen right here. ‘Don’t let me die.’ "

Teddy added his father said: “Why is this happening to me? Why won’t anybody help me?”

First hidden — and then removed

Foote says Breen is a perfect example of a veteran who needed an urgent appointment with a primary doctor and who was instead put on the secret waiting list — where he remained hidden.

Foote adds that when veterans waiting on the secret list die, they are simply removed.

"They could just remove you from that list, and there’s no record that you ever came to the VA and presented for care. … It’s pretty sad."

Foote said that the number of dead veterans who died waiting for care is at least 40.

"That’s correct. The number’s actually higher. … I would say that 40, there’s more than that that I know of, but 40’s probably a good number."

CNN has obtained e-mails from July 2013 showing that top management, including Phoenix VA Director Sharon Helman, was well-aware about the actual wait times, knew about the electronic off-the-books list and even defended its use to her staff.

In one internal Phoenix VA e-mail dated July 3, 2013, one staffer raised concerns about the secret electronic list and raised alarms that Phoenix VA officials were praising its use.

"I have to say, I think it’s unfair to call any of this a success when Veterans are waiting 6 weeks on an electronic waiting list before they’re called to schedule their first PCP (primary care physician) appointment," the e-mail states. "Sure, when their appointment is created, it can be 14 days out, but we’re making them wait 6-20 weeks to create that appointment."

The e-mail adds pointedly: “That is unethical and a disservice to our Veterans.”

Last year and earlier this year, Foote also sent letters to officials at the VA Office of the Inspector General with details about the secret electronic waiting list and about the large number of veterans who died waiting for care, many hidden on the secret list. Foote and several other sources inside the Phoenix VA confirmed to CNN that IG inspectors have interviewed them about the allegations.

VA: ‘It is disheartening to hear allegations’

CNN has made numerous requests to Helman and her staff for an interview about the secret list, the e-mails showing she was aware of it and the allegations of the 40 veterans who died waiting on the list, to no avail.

But CNN was sent a statement from VA officials in Texas, quoting Helman.

"It is disheartening to hear allegations about Veterans care being compromised," the statement from Helman reads, "and we are open to any collaborative discussion that assists in our goal to continually improve patient care."

Just before deadline Wednesday, the VA sent an additional comment to CNN.

It stated, in part: “We have conducted robust internal reviews since these allegations surfaced and welcome the results from the Office of Inspector General’s review. We take these allegations seriously.”

Read the full statement here

The VA statement to CNN added: “To ensure new Veterans waiting for appointments are managed appropriately, we maintain an Electronic Wait List (EWL) in accordance with the national VHA Scheduling Directive. The ability of new and established patients to get more timely care has showed significant improvement in the last two years which is attributable to increased budget, staffing, efficiency and infrastructure.”

Foote says Helman’s response in the first statement is stunning, explaining the entire secret list and the reason for its existence was planned and created by top management at the Phoenix VA, specifically to avoid detection of the long wait times by veterans there.

"This was a plan that involved the Pentad, which includes the director, the associate director, the assistant director, the chief of nursing, along with the medical chief of staff — in collaboration with the chief of H.A.S."

Washington is paying attention

The Phoenix VA’s “off the books” waiting list has now gotten the attention of the U.S. House Veterans Affairs Committee in Washington, whose chairman has been investigating delays in care at veterans hospitals across the country.

According to Rep. Jeff Miller, chairman of the House Committee on Veterans’ Affairs, what was happening in Phoenix is even worse than veterans dying while waiting for care.

Even as CNN was working to report this story, the Florida Republican demanded the VA preserve all records in anticipation of a congressional investigation.

In a hearing on April 9, Miller learned even the undersecretary of health for the VA wasn’t being told the truth about the secret list:

"It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care. Were you made aware of these unofficial lists in any part of your look back?" asked Miller.

"Mr. Chairman, I was not," replied Dr. Thomas Lynch, assistant deputy undersecretary, Veterans Health Administration.

Congress has now ordered all records in Phoenix, secret or not, be preserved.

That would include the record of a 71-year-old Navy veteran named Thomas Breen.

SOLDIER STORIES: Dogs are people too.
the-pink-mist:

There was a split second there where his like, “wait, what? bro what are you doing?” 
On more serious note, PTSD dogs for veterans are so fucking therapeutic. They’re like the one person you can spill your guts to and never worry about ever being judged or have that secret divulged. There are times when I definitely prefer the company of a dog over a human. 

SOLDIER STORIES: Dogs are people too.

the-pink-mist:

There was a split second there where his like, “wait, what? bro what are you doing?” 

On more serious note, PTSD dogs for veterans are so fucking therapeutic. They’re like the one person you can spill your guts to and never worry about ever being judged or have that secret divulged. There are times when I definitely prefer the company of a dog over a human. 

SOLDIER STORIES: Life preserving message.
Marine veteran Lance Cpl. Jeremiah Arbogast in the pool at the 2012 Warrior Games in Colorado Springs, Colorado. 
(Courtesy photo, 24 APR 2012. Article by Molly O’Toole, 24 SEP 2013, Huffington Post.)
When Jeremiah Arbogast entered the home of his former boss, a Marine staff sergeant, he was wearing a body wire hooked up by the Naval Criminal Investigative Service, which was listening from a nearby car.
"I need to know what happened," Arbogast told the staff sergeant in 2001. "I need to get help. I can’t get help if I don’t know what happened."
The man began to coolly list everything he had done to Arbogast, recounting his rape.
"I don’t know what possessed him to just be like, ‘I did this, this and this, and that’s that,’" Arbogast said. "No remorse, no nothing." Arbogast got his rapist’s full confession on tape, but the process severely traumatized him — again.
The staff sergeant was convicted by court martial in 2002, given merely a “bad conduct” discharge from the Marines. But Arbogast’s ordeal went on for seven more years of severe depression, nightmares and insomnia. He had trouble concentrating; his mind would wander back to the rape. He swung abruptly from rage to numbness. He got divorced. Then got remarried. He drank. Nothing worked.

In 2009, Arbogast aimed a gun “right dead in the chest, where my heart would be, where my pain was.” He missed and became partially paralyzed.

His wife told him, “You’ve got a gift now. You’ve been given a new life in death and you’ve got to do something with it.”
Men accounted for only about 12 percent of reported military sexual assault cases in fiscal year 2012. But more men than women are sexually assaulted each year in the military, given that men make up some 85 percent of service members, notes Michael Matthews, a close friend of Arbogast. Matthews’ own experience as a veteran and victim of rape served as the catalyst for "Justice Denied," a documentary about male military sexual assault survivors.
Back in 1998, when Arbogast joined the Marines just after high school, no one was talking about these issues. He started as a motor transport operator, and later served as a lance corporal in a weapons training battalion. He was preparing to deploy to Okinawa, Japan — until he was assaulted.
"I served honorably," Arbogast said. "The rape trumped it."
Arbogast was unconscious during his attack — doctors believe he may have been drugged — and he didn’t report it for months. “I’m trying to explain this to base counselors, and it was just eating me alive,” he said. “I could not believe what I was going through … It spiraled my world out of control.”
After he confronted his rapist and went through the court martial, he didn’t want to go near a base, but every six months the military brought him back to check on his health. It took him five years until he could formally retire from the Marines on medical grounds.
Then he had to face his demons in civilian life. His daughter was just under a year old, but he couldn’t connect with anyone. He tried to move forward, marrying his daughter’s mother in 2004.
"As much as I love my daughter, I didn’t have the relationship with her that I should have," he said. "I ruined a lot of relationships."
Arbogast and his wife divorced. He withdrew from the world, unable to trust others or himself. He went from being uninterested in sex to engaging with a “chronic,” endless string of faceless female partners. “The myth is that men can’t be raped, so when this trauma takes place, it plays with their mind so bad,” he said of men who become victims of sexual assault. 
When he met his current wife, Tiffany, he was sure his experiences would chase her away. But it all came tumbling out. “She looked at me and told me it didn’t matter, she would love me regardless. As much as I wanted to believe her, I couldn’t,” he said.
His downward spiral continued. On Oct. 1, 2009, about four months after they were married, Tiffany took his handgun, planning to keep it in her car while she was at work.
"I thought I was poison to everybody I was around, or anything I had ever touched," Arbogast said. "I was dragging people down again, it was starting all over … I decided that’s when I was gonna end it, stop being a problem to everybody else."
That afternoon, he got his 9mm handgun out of Tiffany’s car before she left for work. “I told her I wasn’t gonna do anything,” he said. Hours later, he was sitting on the ground beside the car, “trying to make reason of why my life was the way it was.”
He raised the gun to his chest, but because he had been drinking, slumped at the last second. The bullet tore through his high abdomen and blasted out through his spine, damaging his spinal cord. He lost 60 percent of his blood, and woke up a week later in the hospital from a medically induced coma.
His depression only deepened over the coming months, until his wife told him that he had a gift. Arbogast now had the understanding to spread awareness and speak for three groups that often suffer in silence: military sexual assault survivors, suicide survivors and people with disabilities.
"Something clicked," said Arbogast, now 32. "I didn’t want anybody else to go through it."
"People don’t understand why it’s a gift," he added, reflecting on his whole experience. "But many people die and never realize what they really had, what their purpose in life was. My life was spared to give me a purpose."
Not that his recovery has ever been easy. He says, simply, “You can’t undo a gunshot wound.”
Though grateful for his military health care and benefits, he has relied less and less on medical facilities. “When you’re in a wheelchair, you get so tired of being poked and prodded,” he said. “One day I just said, ‘enough. I need to live my life.’”
He has become involved in Paralympic and adaptive sports and is a decorated athlete in cycling and swimming. He had never skied in his life before he became a paraplegic; now he loves it, terrorizing the slopes in a monoski, a bucket chair with a ski attached. Recently, he’s been learning how to get around with braces.
Arbogast has just begun to talk about his experience to his daughter, Brianna, who’s now 11. “I’ll tell her, ‘Daddy tried to kill himself because he didn’t want to be here,’ and she’ll say, ‘I want you here.’”
Brianna helps him move around their house, which is not accessible for wheelchairs. “I’ll tell you what, it’s extreme hell,” he said. “I can’t even get into the bathroom safely, my wife has to get me a roll stool and roll me. Just think of all the places in a house when you’re in a wheelchair you can’t get to.”
He said it’s difficult for military and sexual assault survivors, especially men, to speak out about the issue. “We don’t talk about sexual assault because it’s ‘complex,’” he said. “Complex? You try and come live for just an hour in my complex life.”
But he feels strongly that the discrimination and misunderstanding he faces are worth it if he can help to save someone’s life.
"I’ve been through life and death," he said. "There is gonna come a time in your life when you have to say enough is enough. You’re letting that perpetrator who assaulted you rent your life for free. You’re becoming a slave to what they’ve done to you."
Others may see his experience as a reason to want to give up. But he says it’s the reason to keep living. “It’s all the tragedy and the triumph between where I was and where I am today.”
Several organizations have been trying to help the Arbogast family raise money to adapt their home, but so far, the funds have fallen short. Click here for more about the project and to donate.
This article is part of a special Huffington Post series, “Invisible Casualties,” which spotlights suicide-prevention efforts within the military. To see all the articles, blog posts, audio and video, click here.
For a review of warning signs someone may be at risk of suicide, click here. For a list of resources to get free and confidential help, click here. If you or someone you know needs help, call the national crisis line for the military and veterans at 1-800-273-8255, or send a text to 838255. High-res

SOLDIER STORIES: Life preserving message.

Marine veteran Lance Cpl. Jeremiah Arbogast in the pool at the 2012 Warrior Games in Colorado Springs, Colorado.

(Courtesy photo, 24 APR 2012. Article by Molly O’Toole, 24 SEP 2013, Huffington Post.)

When Jeremiah Arbogast entered the home of his former boss, a Marine staff sergeant, he was wearing a body wire hooked up by the Naval Criminal Investigative Service, which was listening from a nearby car.

"I need to know what happened," Arbogast told the staff sergeant in 2001. "I need to get help. I can’t get help if I don’t know what happened."

The man began to coolly list everything he had done to Arbogast, recounting his rape.

"I don’t know what possessed him to just be like, ‘I did this, this and this, and that’s that,’" Arbogast said. "No remorse, no nothing." Arbogast got his rapist’s full confession on tape, but the process severely traumatized him — again.

The staff sergeant was convicted by court martial in 2002, given merely a “bad conduct” discharge from the Marines. But Arbogast’s ordeal went on for seven more years of severe depression, nightmares and insomnia. He had trouble concentrating; his mind would wander back to the rape. He swung abruptly from rage to numbness. He got divorced. Then got remarried. He drank. Nothing worked.

In 2009, Arbogast aimed a gun “right dead in the chest, where my heart would be, where my pain was.” He missed and became partially paralyzed.

His wife told him, “You’ve got a gift now. You’ve been given a new life in death and you’ve got to do something with it.”

Men accounted for only about 12 percent of reported military sexual assault cases in fiscal year 2012. But more men than women are sexually assaulted each year in the military, given that men make up some 85 percent of service members, notes Michael Matthews, a close friend of Arbogast. Matthews’ own experience as a veteran and victim of rape served as the catalyst for "Justice Denied," a documentary about male military sexual assault survivors.

Back in 1998, when Arbogast joined the Marines just after high school, no one was talking about these issues. He started as a motor transport operator, and later served as a lance corporal in a weapons training battalion. He was preparing to deploy to Okinawa, Japan — until he was assaulted.

"I served honorably," Arbogast said. "The rape trumped it."

Arbogast was unconscious during his attack — doctors believe he may have been drugged — and he didn’t report it for months. “I’m trying to explain this to base counselors, and it was just eating me alive,” he said. “I could not believe what I was going through … It spiraled my world out of control.”

After he confronted his rapist and went through the court martial, he didn’t want to go near a base, but every six months the military brought him back to check on his health. It took him five years until he could formally retire from the Marines on medical grounds.

Then he had to face his demons in civilian life. His daughter was just under a year old, but he couldn’t connect with anyone. He tried to move forward, marrying his daughter’s mother in 2004.

"As much as I love my daughter, I didn’t have the relationship with her that I should have," he said. "I ruined a lot of relationships."

Arbogast and his wife divorced. He withdrew from the world, unable to trust others or himself. He went from being uninterested in sex to engaging with a “chronic,” endless string of faceless female partners. “The myth is that men can’t be raped, so when this trauma takes place, it plays with their mind so bad,” he said of men who become victims of sexual assault. 

When he met his current wife, Tiffany, he was sure his experiences would chase her away. But it all came tumbling out. “She looked at me and told me it didn’t matter, she would love me regardless. As much as I wanted to believe her, I couldn’t,” he said.

His downward spiral continued. On Oct. 1, 2009, about four months after they were married, Tiffany took his handgun, planning to keep it in her car while she was at work.

"I thought I was poison to everybody I was around, or anything I had ever touched," Arbogast said. "I was dragging people down again, it was starting all over … I decided that’s when I was gonna end it, stop being a problem to everybody else."

That afternoon, he got his 9mm handgun out of Tiffany’s car before she left for work. “I told her I wasn’t gonna do anything,” he said. Hours later, he was sitting on the ground beside the car, “trying to make reason of why my life was the way it was.”

He raised the gun to his chest, but because he had been drinking, slumped at the last second. The bullet tore through his high abdomen and blasted out through his spine, damaging his spinal cord. He lost 60 percent of his blood, and woke up a week later in the hospital from a medically induced coma.

His depression only deepened over the coming months, until his wife told him that he had a gift. Arbogast now had the understanding to spread awareness and speak for three groups that often suffer in silence: military sexual assault survivors, suicide survivors and people with disabilities.

"Something clicked," said Arbogast, now 32. "I didn’t want anybody else to go through it."

"People don’t understand why it’s a gift," he added, reflecting on his whole experience. "But many people die and never realize what they really had, what their purpose in life was. My life was spared to give me a purpose."

Not that his recovery has ever been easy. He says, simply, “You can’t undo a gunshot wound.”

Though grateful for his military health care and benefits, he has relied less and less on medical facilities. “When you’re in a wheelchair, you get so tired of being poked and prodded,” he said. “One day I just said, ‘enough. I need to live my life.’”

He has become involved in Paralympic and adaptive sports and is a decorated athlete in cycling and swimming. He had never skied in his life before he became a paraplegic; now he loves it, terrorizing the slopes in a monoski, a bucket chair with a ski attached. Recently, he’s been learning how to get around with braces.

Arbogast has just begun to talk about his experience to his daughter, Brianna, who’s now 11. “I’ll tell her, ‘Daddy tried to kill himself because he didn’t want to be here,’ and she’ll say, ‘I want you here.’”

Brianna helps him move around their house, which is not accessible for wheelchairs. “I’ll tell you what, it’s extreme hell,” he said. “I can’t even get into the bathroom safely, my wife has to get me a roll stool and roll me. Just think of all the places in a house when you’re in a wheelchair you can’t get to.”

He said it’s difficult for military and sexual assault survivors, especially men, to speak out about the issue. “We don’t talk about sexual assault because it’s ‘complex,’” he said. “Complex? You try and come live for just an hour in my complex life.”

But he feels strongly that the discrimination and misunderstanding he faces are worth it if he can help to save someone’s life.

"I’ve been through life and death," he said. "There is gonna come a time in your life when you have to say enough is enough. You’re letting that perpetrator who assaulted you rent your life for free. You’re becoming a slave to what they’ve done to you."

Others may see his experience as a reason to want to give up. But he says it’s the reason to keep living. “It’s all the tragedy and the triumph between where I was and where I am today.”

Several organizations have been trying to help the Arbogast family raise money to adapt their home, but so far, the funds have fallen short. Click here for more about the project and to donate.

This article is part of a special Huffington Post series, “Invisible Casualties,” which spotlights suicide-prevention efforts within the military. To see all the articles, blog posts, audio and video, click here.

For a review of warning signs someone may be at risk of suicide, click here. For a list of resources to get free and confidential help, click here. If you or someone you know needs help, call the national crisis line for the military and veterans at 1-800-273-8255, or send a text to 838255.

SOLDIER STORIES: A fractured shard, a glimpse of human cost.
farmerveteran:

reportagebygettyimages:

in his book War is Personal, photographer Eugene Richards, the recipient of two Getty Images Grants for Editorial Photography, follows the stories of veterans and families who have been deeply affected by war. This Saturday, those stories will receive a dramatic interpretation, as actors perform a staged reading as Richards’s subjects. More info here about the performance at Brooklyn Museum.
Image: Carlos Arredondo grieves for his son, who was killed in Iraq, at his home on March 19, 2006, in Roslindale, Mass. (Photo by Eugene Richards)

I have mentioned it before, but if you have not seen this book, you need to get on it. No punches pulled, deeply personal look at the effects of war.

[Click through to the book’s website for an excerpt video highlighting the book’s content; slideshow images accompanied by narration of content from the veterans and their families. The lack of inflection in the narration creates a detached, dissociated, emotionless conveyance of situational parameters that impacts the viewer on an entirely different level. That experience of shock-trauma disengagement which cannot be described any other way.] High-res

SOLDIER STORIES: A fractured shard, a glimpse of human cost.

farmerveteran:

reportagebygettyimages:

in his book War is Personal, photographer Eugene Richards, the recipient of two Getty Images Grants for Editorial Photography, follows the stories of veterans and families who have been deeply affected by war. This Saturday, those stories will receive a dramatic interpretation, as actors perform a staged reading as Richards’s subjects. More info here about the performance at Brooklyn Museum.

Image: Carlos Arredondo grieves for his son, who was killed in Iraq, at his home on March 19, 2006, in Roslindale, Mass. (Photo by Eugene Richards)

I have mentioned it before, but if you have not seen this book, you need to get on it. No punches pulled, deeply personal look at the effects of war.

[Click through to the book’s website for an excerpt video highlighting the book’s content; slideshow images accompanied by narration of content from the veterans and their families. The lack of inflection in the narration creates a detached, dissociated, emotionless conveyance of situational parameters that impacts the viewer on an entirely different level. That experience of shock-trauma disengagement which cannot be described any other way.]

Curator’s Choice: OCT 2011.
His place shall never be with those cold and timid souls.

It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly; who errs and comes short again and again; because there is not effort without error and shortcomings; but who does actually strive to do the deed; who knows the great enthusiasm, the great devotion, who spends himself in a worthy cause, who at the best knows in the end the triumph of high achievement and who at the worst, if he fails, at least he fails while daring greatly. So that his place shall never be with those cold and timid souls who know neither victory nor defeat.
—from the speech “Citizenship in a Republic” by Theodore Roosevelt, at the Sorbonne in Paris, France on 23 April 1910.
High-res

Curator’s Choice: OCT 2011.

His place shall never be with those cold and timid souls.

It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly; who errs and comes short again and again; because there is not effort without error and shortcomings; but who does actually strive to do the deed; who knows the great enthusiasm, the great devotion, who spends himself in a worthy cause, who at the best knows in the end the triumph of high achievement and who at the worst, if he fails, at least he fails while daring greatly. So that his place shall never be with those cold and timid souls who know neither victory nor defeat.

—from the speech “Citizenship in a Republic” by Theodore Roosevelt, at the Sorbonne in Paris, France on 23 April 1910.

(via soldierporn)

Moral Injury - The Huffington Post's 3-Part Project

overhawk:

Leave no man be behind

Neither in the heaviest of firefights Nor the wasteland of their own mind, Fighting demons that lurk in dark corners And follow, relentless. 
Biting at heels and unguarded flanks, fraying the edges sanity to ribbons With needle sharp teeth And vicious whispers. 
A feast for doubt and despair That weakens even the strongest.For one cannot stand vigilant forever When war is left behind But the battlefield remains In the heart and mind, Forever indelible. 
-R

overhawk:

Leave no man be behind

Neither in the heaviest of firefights 
Nor the wasteland of their own mind, 
Fighting demons that lurk in dark corners 
And follow, relentless. 

Biting at heels and unguarded flanks, 
fraying the edges sanity to ribbons 
With needle sharp teeth 
And vicious whispers. 

A feast for doubt and despair 
That weakens even the strongest.
For one cannot stand vigilant forever 
When war is left behind 
But the battlefield remains 
In the heart and mind, 
Forever indelible. 

-R

(via itsramez)

Another KIA on home soil.

andrewwadenunn:

Jimmy Murrillo was a quiet guy. He always seemed positive, and simply glad to be alive every day while we were serving together in Germany. Even in Iraq, although we were in different platoons, on different COP’s, whenever I saw him, he had that quiet smile whether he was neck deep in a Bradley’s engine, or just chilling he made the best of everything.
Jimmy and I weren’t best friends. He was in my company, and was my patient. I remember him. He was a good guy.
Last night, it appears that Jimmy made the decision to end his life. I don’t know how, I don’t know why, but I know that he hurt a lot of people by leaving them. His friends, his family, guys like me who he served with. He could have reached out. He could have asked for help.
If you’re sad, if you feel hopeless, call a friend. If you don’t have a friend, call an acquaintance, the va hotline, a complete stranger. Just know that you’re not alone. Know that you are needed in this world.
Another man from my alma mater has left without paying his tab.

Veteran Crisis Hotline 1-800-273-8255 PRESS 1, Text to 838255, and Confidential Veteran Chat.

[My inbox is always open, they just don’t get public responses. Please reach out to someone, you’re not alone. -R]

A Short History of PTSD: From Thermopylae to Hue, soldiers have always had a disturbing reaction to war.
(Article by Steve Bentley, from the Voice of the Vietnam Veterans of America, feature in the MAR/APR 2005 issue. Original print date, JAN 1991. Source.) 
Post-traumatic Stress Disorder (PTSD) is defined by the American Psychiatric Association as an anxiety (emotional) disorder which stems from a particular incident evoking significant stress. PTSD can be found among survivors of the Holocaust, of car accidents, of sexual assaults, and of other traumatic experiences such as combat. The fact is, PTSD is a new name for an old story—war has always had a severe psychological impact on people in immediate and lasting ways. PTSD has a history that is as significant as the malady itself. It’s been with us now for thousands of years, as incidents in history prove beyond a doubt.
Three thousand years ago, an Egyptian combat veteran named Hori wrote about the feelings he experienced before going into battle: “You determine to go forward… . Shuddering seizes you, the hair on your head stands on end, your soul lies in your hand.”History tells us that among the Egyptians, Romans, and Greeks, men broke and ran in combat circumstances—in other words, the soldiers of antiquity were no less afraid of dying.
For instance, the Greek historian Herodotus, in writing of the battle of Marathon in 490 B.C., cites an Athenian warrior who went permanently blind when the soldier standing next to him was killed, although the blinded soldier “was wounded in no part of his body.” So, too, blindness, deafness, and paralysis, among other conditions, are common forms of “conversion reactions” experienced and well-documented among soldiers today.
Herodotus also writes of the Spartan commander Leonidas, who, at the battle of Thermopylae Pass in 480 B.C., dismissed his men from joining the combat because he clearly recognized they were psychologically spent from previous battles. “They had no heart for the fight and were unwilling to take their share of the danger.” (Herodotus tells of another Spartan named Aristodemus who was so shaken by battle he was nicknamed “the Trembler”—he later hanged him- self in shame.)
One thousand years later, things had changed very little at the front. The Anglo Saxon Chronicle recounts a battle in 1003 A.D. between the English and the Danes in which the English commander Alfred reportedly became so violently ill that he began to vomit and was not able to lead his men.
We also know PTSD doesn’t confine itself strictly to the war experience. Samuel Pepys was an Englishman who lived in London during the 1600s. His surviving diary provides an excellent record of the development of PTSD. In writing of the Great Fire of London in 1666, Pepys recounts people’s terror and frustration at being unable to protect their property or stop the fire. Pepys writes: “A most horrid, malicious, blood fire… . So great was our fear… . It was enough to put us out of our wits.”
Although his own home was untouched, Pepys was unable to sleep for days after the fire. He scrawls: “Both sleeping and waking, and such fear of fire in my heart, that I took little rest.” Two weeks later, Pepys writes: “[M]uch terrified in the nights nowadays, with dreams of fire and falling down of houses.”’ The diary reports general feelings of anger and discontent over the next four months. Pepys then records that news of a chimney fire some distance away “put me into much fear and trouble.”It appears Swiss military physicians in 1678 were among the first to identify and name that constellation of behaviors that make up acute combat reaction or PTSD. “Nostalgia” was the term they used to define a condition characterized by melancholy, incessant thinking of home, disturbed sleep or insomnia, weakness, loss of appetite, anxiety, cardiac palpitations, stupor, and fever.
German doctors diagnosed the problem among their troops at about the same time as the Swiss. They referred to the condition as heimweh (homesickness). Obviously, it was strongly believed the symptoms came about from the soldiers longing to return home.
In time, French doctors termed the same symptoms maladie du pays, and the Spanish, confronted with the same reactions among their soldiers, called it estar roto (literally, “to be broken”).
During the siege of Gibraltar in 1727, a soldier who was part of the defense of the city kept a diary. In it, there is mention of incidents in which soldiers killed or wounded themselves. He also describes a state of extreme physical fatigue which had caused soldiers to lose their ability to understand or process even the simplest instructions. In this state, the soldiers would refuse to eat, drink, work, or fight in defense of the city, even though they would be repeatedly whipped for not doing so.
The French surgeon Larrey described the disorder—what we now call PTSD—as having three dif ferent stages. The first is heightened excitement and imagination; the second is a period of fever and prominent gastrointestinal symptoms; the final stage is one of frustration and depression.
During the American Civil War, military physicians diagnosed many cases of functional disability as the result of fear of battle and the stresses of military life. This included a wide range of illnesses now known to be caused by emotional turbulence, including paralysis, tremors, self-inflicted wounds, nostalgia, and severe palpitations—also called “soldier’s heart” and “exhausted heart.” It was reportedly surprising to some Civil War physicians that soldiers on normal leave often collapsed with emotional illness at home, even when they had shown no symptoms of mental debilitation before they had left the fighting.
Many consider the Civil War the first step on the road to modern warfare. Civil War soldiers made the first frontal assaults into repeating rifles and pistols, as well as the Gatling gun and delayed-time artillery rounds that allowed air bursts. Civil War technology also included telescopic sights and rifles with spiral barrels that greatly increased their accuracy and destructiveness in battle.
The immediate result was that psychological symptoms became so common, field commanders as well as medical doctors pleaded with the War Department to provide some type of screening to eliminate recruits susceptible to psychiatric breakdown. Military physicians, at a loss to treat the problems, simply mustered the extreme cases out during the first three years of the war. “They were put on trains with no supervision, the name of their home town or state pinned to their tunics, others were left to wander about the countryside until they died from exposure or starvation,” reports Richard A. Gabriel, a consultant to the Senate and House Armed Services Committees and one of the foremost chroniclers of PTSD.
Gabriel’s research tells us that in 1863 the number of insane soldiers simply wandering around was so great, there was a public outcry. Because of this, and at the urging of surgeons, the first military hospital for the insane was established in 1863. The most common diagnosis was nostalgia. The government made no effort to deal with the psychiatrically wounded after the war and the hospital was closed. There was, however, a system of soldiers’ homes set up around the country. Togus, Maine, was designated as the eastern branch of this system, and in 1875, its director noted that, strangely enough, the need for the hospital’s services seemed to increase rather than decrease.
For civilians in the 1800s, the growth of the industrial era created large companies with machinery operated by workers who often had injury-producing accidents. Train wrecks became common.
Author Charles Dickens was involved in a railway accident at Staplehurst in Kent, England, on June 9, 1865. He suffered symptoms which today would be diagnosed as PTSD. Dickens described the horrifying scene in a letter: “[T]wo or three hours work … amongst the dead and dying surrounded by terrific sights…” Sometime after, he wrote he was “unsteady” and said, “I am not quite right within, but believe it to be an effect of the railway shaking.”
Railway accident victims began suing the railroads. Lawyers for the railway companies fought back with the term “compensation neurosis,” which charged that litigants were trying to get something for nothing.
This discounting of effects of the trauma by charging the victim with having ulterior motives was also common in the military. “It is by lack of discipline, confidence, and respect that many a young soldier has become discouraged and made to feel the bitter pangs of homesickness, which is usually the precursor of more serious ailments,” commented the assistant surgeon general in 1864, reflecting the sentiment that most who suffered signs and symptoms of war trauma were, in fact, malingering.
Unfortunately, the attitude that combat veterans with psychological problems are really malingerers trying to gain economically is still with us today. That attitude, combined with veterans’ pride and distrust, accounts for the fact that, while a Research Triangle Institute study concludes 830,000 Vietnam veterans have full-blown or partial PTSD, only 55,119 have filed claims, and the adjudication boards have only believed 28,411 (July 1990) of those claimants.
Emotional stress builds very fast on a battlefield, and if there is no permissible emotional outlet, the soldier will “convert” his symptoms into physiological conditions. Gabriel, who was an active intelligence officer for 22 years, offers Maj. Marcus Reno and his soldiers as a classic example of the breakdown of men in battle. Major Reno’s troops served as a blocking force for Gen. George Armstrong Custer at the Battle of Little Big Horn. The battle had hardly begun when Reno himself became a psychiatric casualty. The major’s Indian scout, Yellow Knife, was struck square in the face by a bullet, which sent his blood, flesh, and brains spattering all over Reno, who immediately went into shock. He began foaming at the mouth, and his eyes rolled wildly in his head. He uttered sounds which made no sense.
Some of Reno’s men were so paralyzed with fear, they couldn’t defend themselves. They were so terrified, in fact, the Indians thought them cowards and refused to kill them. Maj. Myles Moylan was found later by the cavalry rescue force, “blubbering like a whipped urchin, tears coursing down his cheeks.”Some of the soldiers reported they hallucinated during the fight, seeing columns of soldiers approaching and hearing voices when there were none. Others entered into states of shock approaching stupor from the emotional exhaustion generated by fear. About the only thing that didn’t happen to Reno’s men during the battle was desertion, but this was because there was simply no place to go.
The first army in history to determine that mental collapse was a direct consequence of the stress of war and to regard it as a legitimate medical condition was the Russian Army of 1905 in their war with the Japanese. Gabriel states that Russian attempts to diagnose and treat battle shock represent the birth of military psychiatry. The Russians’ major contribution was their recognition of the principle of proximity, or forward treatment. Although it’s believed by most armies today that the Russians were right in treating psychiatric casualties close to the front, with the goal of returning them to the fight, the recorded rate of those who returned to battle suggests the method was not very successful. In actuality, less than 20 percent were able to return to the front.
The brutalities of WWI produced large numbers of the psychologically wounded. Unfortunately, what little had been learned up to then was forgotten. The only American experience with psychiatric casualties that anyone remembered was when American soldiers under the command of Gen. John J. Pershing in Mexico exhibited an abnormally high rate of mental illness. Consequently, the medical establishment set out once again to recreate the wheel. This time, they began by attributing the high psychiatric casualties to the new weapons of war; specifically, the large-caliber artillery.
It was believed the impact of the shells produced a concussion that disrupted the physiology of the brain; thus the term “shell shock” came into fashion.
Although WWI generated stress theories based on models of the mind, such as Freud’s “war neurosis,” these theories never gained wide acceptance. Quite simply, Freud postulated “war neurosis” was brought about by the inner conflict between a soldier’s “war ego” and his “peace ego.”Another diagnosis at the time which gained little currency was neurasthenia: “The mental troubles are many and marked; on the emotional side, there are sadness, weariness, and pessimism; repugnance to effort, abnormal irritability; defective control of temper, tendency to weep on slight provocation; timidity. On the intellectual side, lessened power of attention, defective memory and will power….”
By the end of World War I, the United States had hundreds of psychiatrists overseas who were beginning to realize that psychiatric casualties were not suffering from “shell shock.” These psychiatrists came to comprehend it was emotions and not physiological brain damage that was most often causing soldiers to collapse under a wide range of symptoms. Unfortunately, they continued to believe this collapse came about primarily in men who were weak in character.
During WWI, almost two million men were sent overseas to fight in Europe. Deaths were put at 116,516, while 204,000 were wounded. During the same period, 159,000 soldiers were out of action for psychiatric problems, with nearly half of these (70,000) permanently discharged.
Harking back to military medicine during the Civil War, psychiatrists concluded that the answer to psychological casualties was to more thoroughly screen those entering the military. Based on this, the main effort to reduce WWII psychological casualties was to focus on sifting through draftees in order to weed out those predisposed to break down in combat. The military used the best available psychiatric testing and rejected no fewer than five million men for military service.
In World War II, the ratio of rear-area support troops to combat troops was twelve to one. In the four years of war, no more than 800,000 soldiers saw direct combat, and of these, 37.5 percent became such serious psychiatric cases, they were permanently discharged. In the U.S. Army alone (not counting Army air crews), 504,000 men were lost to the fight for psychiatric reasons. Another 1,393,000 suffered symptoms serious enough to debilitate them for some period.
It became clear it was not just the “weak” in character who were breaking down. This is reflected in the subtle change in terminology that took place near the end of World War II when “combat neurosis” began to give way to the term “combat exhaustion.” Author Paul Fussell says that term as well as the term “battle fatigue” suggest “a little rest would be enough to restore to useful duty a soldier who would be more honestly designated as insane.” While the name change showed movement away from psychopathology, it didn’t keep the military model of “predisposition plus stress equals collapse” from working its way back into military medicine.
Fussell was a 20-year-old Army lieutenant and the leader of a rifle platoon in France. He was severely wounded in 1945 and came home to earn a Ph.D. from Harvard. In the preface to his highly acclaimed book, Wartime, he writes, “For the past 50 years the allied war has been sanitized and romanticized almost beyond recognition by the sentimental, the loony patriotic, the ignorant, and the bloodthirsty—I have tried to balance the scales.”Fussell quickly cuts to the heart of the war experience, reminding us that those who fight are at once young, athletic, credulous, and innocent of their own mortality. He points out that the populace is naive to their pain and suffering. Fussell quotes Bruce Catton: “A singular fact about modern war is that it takes charge. Once begun it has to be carried to its conclusion and carrying it there sets in motion events that may be beyond men’s control. Doing what has to be done to win, men perform acts that alter the very soil in which society’s roots are nourished.”
Astonishingly, Catton was writing about the Civil War, which Fussell in turn characterizes as “long, brutal, total, and stupid”—something that can be said about any war when we fully realize that before society’s roots can be altered, soldiers’ very souls are seared by the acts they witness and perform.
The denial and naivete of the populace as to what war really is becomes a dynamic underlying the trauma of soldiers: “[S]evere trauma was often the result of the initial optimistic imagination encountering actuality.” Many Vietnam veterans can attest it’s a long way from the jungles of Vietnam to Disneyland (America). That is just about as far as Erich Maria Remarque knew it to be from the Western Front to home in WWI: “Now if we go back we will be weary, broken, burnt out, rootless, and without hope. We will not be able to find our way anymore. And men will not understand us… . We will be superfluous even to ourselves; we will grow older, a few will adapt themselves, some others will merely submit, and most will be bewildered.”Fussell points out all wars are boyish and are fought by boys who are useful material for the sharp edge of war, but only for a short time: “[A]fter a few months they’ll be dried up and as soldiers virtually useless—scared, cynical, debilitated, unwilling… .”While the average age in the military during WWII was 26, it was the 18-year-olds who were up front. “Among the horribly wounded the most common cry was ‘mother!’” Replacements got hit before anyone knew their names, “forlorn figures coming up to the meat grinder and going right back out of it like homeless waifs, unknown and faceless to us,” said poet James Dickey.
Fussell notes the detachment may be heartless but it makes it possible for sensitive people to survive the war relatively undamaged. While it’s true that we detach ourselves from war in order to survive, it’s also clear that the act of detachment is itself a kind of willed destruction. It’s the price paid; it’s why we never learn. The psychic numbing necessary to survive combat is not something you step into and out of easily. You can’t do it halfway.
The attitude is betrayed by phrases such as, “It’s just dead meat,” “Kill ’em all and let God sort ’em out,” or “Bomb Hanoi, Bomb Saigon, Bomb Disneyland, Bomb everything.” This attitude is about as tangible a thing as you can find. It is all consuming and pervades the soul. You carry it with you when you leave the battlefield. You carry it home, where you live with it. You share it with your family and your friends and your kids, and ultimately with your society. And it is poisonous, exceedingly poisonous—and it alters “the very soil in which society’s roots are nourished.”At the close of WWI, Edmund Wilson looked out over London and said, “No one pretends to give a damn anymore—unless they are one’s close friends or relatives—whether people are killed or not… . The long-continued concentration on killing people whom we rarely confront, the suppression of the natural bonds between ourselves and these unseen human creatures, is paid by repercussions. The spitefulness and fear and stifled guilt, in our immediate personal relations… . Our whole world is poisoned now.” It takes time and effort to overcome such detachment—some people never do. To look at any of it is to look at all of it. It can be overwhelming. It may be the reason Kurt Vonnegut took 23 years to tell us about his experience during the fire bombing of Dresden, just as it took Fussell 50 years to say, “Now there has been much talk about ‘The Good War,’ the justified war, the necessary war, and the like, that the young and innocent could get the impression that it really was not such a bad thing after all. It’s thus necessary to observe it was a war and nothing else, and thus stupid and sadistic, a war, as Cyril Connally said, ‘of which we are ashamed, a war…which lowers the standard of thinking and feeling…which is as obsolete as drawing and quartering; further, a war opposed to every reasonable conception of what life is for, every ambition of the mind or delight of the senses.’”Of course, the same can be said for the Korean War. In Korea, 1,587,040 served—33,629 were killed in combat and 103,284 were wounded. Of the 198,380 who were actually in combat, 24.2 percent were psychiatric casualties. In other words, the chances of being a psychiatric casualty in Korea was 143 percent better than the chances of being killed.
In Vietnam, 2.8 million served. Given the nature of guerrilla warfare, it is hard to estimate the number exposed to hostile fire. However, the Research Triangle Institute’s Vietnam readjustment study concludes 480,000 have full-blown PTSD and another 350,000 have partial PTSD.
The British psychiatrist R.D. Lang has written that an insane response to an insane situation is sane behavior. Working with schizophrenics, he concluded many were the way they were because of massive double-bind situations they were put in—telling them one thing while their reality and treatment were the opposite. For instance, the religious child grows up being told, “Thou shalt not kill,” until he is drafted and the message becomes, “Kill, kill, kill!”Gabriel writes in No More Heroes, a study of madness and psychiatry in war, that contrary to what is in the movies, television, and the military, it is not only the weak and cowardly who break down in battle. In reality, everyone is subject to breaking down in combat, “perhaps most telling, not only are there no personalities or demographic factors which are associated with psychiatric collapse; neither are there any factors associated with heroism. It’s impossible to predict which soldiers will collapse and which will behave bravely.” A soldier who is brave one day may well be a psychological basket case the next. Gabriel states flatly, “There is no statistical difference in the rates of psychiatric breakdown among inexperienced troops and battle-hardened veterans.” When all is said and done, all normal men are at risk in war.
Gabriel believes there is enough evidence from studies done after WWII to suggest it is only those who are already mentally ill, about two percent of the population, who don’t break down in battle. In other words, only the sane can go insane; the already insane remain that way. “Perhaps it is simply that while collective insanity can destroy normally sane men, it cannot reverse individual insanity,” writes Gabriel.
This idea, that all normal men have a breaking point and all combat veterans will fall off a continuum at recovering, from mild to severely pathological, has been called the endurance model. It looks at war madness as a form of adaptation. The task for therapists and psychiatrists is to unravel the sense behind the symptomatology, acute or chronic, that is observed in veterans today: “Fatigue and listlessness, depression, startle reactions, recurrent nightmares, phobias and fears involving situations associated with trauma, mixtures of impulse behavior, unsteadiness in human relationships and projects of all kinds (including work or study), that may take the form of distrust, suspiciousness, and outbursts of violence.”Robert J. Lifton is a psychiatrist based at Yale University, and he is renowned for his work with trauma patients, including Vietnam veterans. His response to the illness model (soldiers in their conflictive “neurotic” state become afraid to die and afraid to kill) is he doesn’t see not wanting to die or kill as being very “neurotic” and that, in fact, perhaps mankind can use a little more of this attitude. Lifton points out this model worked in WWII because the Nazis were so obviously evil: “Those soldiers that broke down, who were afraid to die and afraid to kill on behalf of this crusade, could be quite comfortably viewed as neurotic.” The dynamics were different in Vietnam, where conditions of the war were such that moral revulsion combined with psychological conflict lead to both acute and delayed reactions. Lifton writes, “[M]onths or even years after their return to this country, many Vietnam vets combined features of the Traumatic Stress Syndrome with preoccupation with questions of meaning—concerning life, and ultimately, all other areas of living.”Lifton argues that in the search to understand the soldiers’ traumatic stress reaction, doctors should focus on the death and destruction that actually took place and its related questions of meaning, rather than invoke the idea of “neurosis.”“At the heart of the traumatic syndrome—and of the overall human struggle with pain—is the diminished capacity to feel, or psychic numbing. There is a close relationship between psychic numbing … and death-linked images of denial (‘If I feel nothing, then death is not taking place’), or ‘I see you dying but I am not related to you as your death.’”In order to survive, soldiers undergo a radical reduction in their sense of the actuality of things. One example is Canadian bomber-pilot J.D. Harvey on his return from rebuilding Berlin in 1960: “I could not visualize the horrible death my bombs … had caused here. I had no feeling of guilt. I had no feeling of accomplishment.”Lifton tells us this happens in order for the soldier to avoid losing his sense completely and permanently. “He undergoes a reversible form of symbolic death in order to avoid a permanent physical or psychic death.”Having closed off and numbed themselves in order to survive, soldiers are then faced with the task of working their way back toward humanity. The struggle is to “re-experience himself as a vital human being.” However, it is not all that easy, for “one’s human web has been all too readily shattered, and in rearranging one’s self-image and feelings, one is on guard against false promises of protection, vitality, or even modest assistance. One fends off not only new threats of annihilation but gestures of love or help.”
This goes to the heart of current concerns about PTSD—that, paradoxically, its tremendous incidence in Vietnam was ultimately a sign of the sanity of those who fought in the war. Otherwise, why be disturbed by the killing, by the stuff of war? But ever after, in peacetime, the reconstruction of “the human web” becomes more and more implausible: if societies are sane—if, in fact, they are civilized—why are there wars?
The arguments are circular. The question of PTSD is always thrust back upon us. The reason there are wars is because most societies are not civilized, but might be someday. There are “cures” offered in the best of societies for PTSD, programs that are established to reintegrate sane men and women into the established order. But always the absolute cure to the eradication of symptoms of PTSD is to eradicate their causes. We are disturbed by war, and justly so.
As we know it today, Post-traumatic Stress Disorder is marked by a re-experiencing of the trauma in thought, feeling, or dream content, which is in turn evidenced by emotional and psychological numbing. Today, PTSD is characterized by depression, loss of interest in work or activities, psychic and emotional numbing, anger, anxiety, cynicism and distrust, memory loss and alienation, and other symptoms. And why not?
Who would not be alienated from the scenes of death witnessed by soldiers? The point is that throughout history, men and women have acted to suppress the horrors that they’ve seen. It’s time we recognize that for what it is—as not only the outward manifestation of PTSD, but the clearest evidence we have that wars are destructive in other ways than in body counts. It takes many years for even the most sane among us to arrive at what we have seen and wanted to forget.
Psychiatrist Victor Frankel survived internment in four Nazi concentration camps during WWII. It would be quite a few years before he wrote his book, Man’s Search for Meaning. In the book, he states clearly that “an abnormal response to an abnormal situation is normal behavior.” In other words, if some things don’t make you crazy, then you aren’t very sane to begin with.
Unfortunately, it’s an idea whose time has not yet come. High-res

A Short History of PTSD: From Thermopylae to Hue, soldiers have always had a disturbing reaction to war.

(Article by Steve Bentley, from the Voice of the Vietnam Veterans of America, feature in the MAR/APR 2005 issue. Original print date, JAN 1991. Source.

Post-traumatic Stress Disorder (PTSD) is defined by the American Psychiatric Association as an anxiety (emotional) disorder which stems from a particular incident evoking significant stress. PTSD can be found among survivors of the Holocaust, of car accidents, of sexual assaults, and of other traumatic experiences such as combat. The fact is, PTSD is a new name for an old story—war has always had a severe psychological impact on people in immediate and lasting ways. PTSD has a history that is as significant as the malady itself. It’s been with us now for thousands of years, as incidents in history prove beyond a doubt.

Three thousand years ago, an Egyptian combat veteran named Hori wrote about the feelings he experienced before going into battle: “You determine to go forward… . Shuddering seizes you, the hair on your head stands on end, your soul lies in your hand.”

History tells us that among the Egyptians, Romans, and Greeks, men broke and ran in combat circumstances—in other words, the soldiers of antiquity were no less afraid of dying.

For instance, the Greek historian Herodotus, in writing of the battle of Marathon in 490 B.C., cites an Athenian warrior who went permanently blind when the soldier standing next to him was killed, although the blinded soldier “was wounded in no part of his body.” So, too, blindness, deafness, and paralysis, among other conditions, are common forms of “conversion reactions” experienced and well-documented among soldiers today.

Herodotus also writes of the Spartan commander Leonidas, who, at the battle of Thermopylae Pass in 480 B.C., dismissed his men from joining the combat because he clearly recognized they were psychologically spent from previous battles. “They had no heart for the fight and were unwilling to take their share of the danger.” (Herodotus tells of another Spartan named Aristodemus who was so shaken by battle he was nicknamed “the Trembler”—he later hanged him- self in shame.)

One thousand years later, things had changed very little at the front. The Anglo Saxon Chronicle recounts a battle in 1003 A.D. between the English and the Danes in which the English commander Alfred reportedly became so violently ill that he began to vomit and was not able to lead his men.

We also know PTSD doesn’t confine itself strictly to the war experience. Samuel Pepys was an Englishman who lived in London during the 1600s. His surviving diary provides an excellent record of the development of PTSD. In writing of the Great Fire of London in 1666, Pepys recounts people’s terror and frustration at being unable to protect their property or stop the fire. Pepys writes: “A most horrid, malicious, blood fire… . So great was our fear… . It was enough to put us out of our wits.”

Although his own home was untouched, Pepys was unable to sleep for days after the fire. He scrawls: “Both sleeping and waking, and such fear of fire in my heart, that I took little rest.” Two weeks later, Pepys writes: “[M]uch terrified in the nights nowadays, with dreams of fire and falling down of houses.”’ The diary reports general feelings of anger and discontent over the next four months. Pepys then records that news of a chimney fire some distance away “put me into much fear and trouble.”

It appears Swiss military physicians in 1678 were among the first to identify and name that constellation of behaviors that make up acute combat reaction or PTSD. “Nostalgia” was the term they used to define a condition characterized by melancholy, incessant thinking of home, disturbed sleep or insomnia, weakness, loss of appetite, anxiety, cardiac palpitations, stupor, and fever.

German doctors diagnosed the problem among their troops at about the same time as the Swiss. They referred to the condition as heimweh (homesickness). Obviously, it was strongly believed the symptoms came about from the soldiers longing to return home.

In time, French doctors termed the same symptoms maladie du pays, and the Spanish, confronted with the same reactions among their soldiers, called it estar roto (literally, “to be broken”).

During the siege of Gibraltar in 1727, a soldier who was part of the defense of the city kept a diary. In it, there is mention of incidents in which soldiers killed or wounded themselves. He also describes a state of extreme physical fatigue which had caused soldiers to lose their ability to understand or process even the simplest instructions. In this state, the soldiers would refuse to eat, drink, work, or fight in defense of the city, even though they would be repeatedly whipped for not doing so.

The French surgeon Larrey described the disorder—what we now call PTSD—as having three dif ferent stages. The first is heightened excitement and imagination; the second is a period of fever and prominent gastrointestinal symptoms; the final stage is one of frustration and depression.

During the American Civil War, military physicians diagnosed many cases of functional disability as the result of fear of battle and the stresses of military life. This included a wide range of illnesses now known to be caused by emotional turbulence, including paralysis, tremors, self-inflicted wounds, nostalgia, and severe palpitations—also called “soldier’s heart” and “exhausted heart.” It was reportedly surprising to some Civil War physicians that soldiers on normal leave often collapsed with emotional illness at home, even when they had shown no symptoms of mental debilitation before they had left the fighting.


Many consider the Civil War the first step on the road to modern warfare. Civil War soldiers made the first frontal assaults into repeating rifles and pistols, as well as the Gatling gun and delayed-time artillery rounds that allowed air bursts. Civil War technology also included telescopic sights and rifles with spiral barrels that greatly increased their accuracy and destructiveness in battle.

The immediate result was that psychological symptoms became so common, field commanders as well as medical doctors pleaded with the War Department to provide some type of screening to eliminate recruits susceptible to psychiatric breakdown. Military physicians, at a loss to treat the problems, simply mustered the extreme cases out during the first three years of the war. “They were put on trains with no supervision, the name of their home town or state pinned to their tunics, others were left to wander about the countryside until they died from exposure or starvation,” reports Richard A. Gabriel, a consultant to the Senate and House Armed Services Committees and one of the foremost chroniclers of PTSD.

Gabriel’s research tells us that in 1863 the number of insane soldiers simply wandering around was so great, there was a public outcry. Because of this, and at the urging of surgeons, the first military hospital for the insane was established in 1863. The most common diagnosis was nostalgia. The government made no effort to deal with the psychiatrically wounded after the war and the hospital was closed. There was, however, a system of soldiers’ homes set up around the country. Togus, Maine, was designated as the eastern branch of this system, and in 1875, its director noted that, strangely enough, the need for the hospital’s services seemed to increase rather than decrease.

For civilians in the 1800s, the growth of the industrial era created large companies with machinery operated by workers who often had injury-producing accidents. Train wrecks became common.

Author Charles Dickens was involved in a railway accident at Staplehurst in Kent, England, on June 9, 1865. He suffered symptoms which today would be diagnosed as PTSD. Dickens described the horrifying scene in a letter: “[T]wo or three hours work … amongst the dead and dying surrounded by terrific sights…” Sometime after, he wrote he was “unsteady” and said, “I am not quite right within, but believe it to be an effect of the railway shaking.”

Railway accident victims began suing the railroads. Lawyers for the railway companies fought back with the term “compensation neurosis,” which charged that litigants were trying to get something for nothing.

This discounting of effects of the trauma by charging the victim with having ulterior motives was also common in the military. “It is by lack of discipline, confidence, and respect that many a young soldier has become discouraged and made to feel the bitter pangs of homesickness, which is usually the precursor of more serious ailments,” commented the assistant surgeon general in 1864, reflecting the sentiment that most who suffered signs and symptoms of war trauma were, in fact, malingering.

Unfortunately, the attitude that combat veterans with psychological problems are really malingerers trying to gain economically is still with us today. That attitude, combined with veterans’ pride and distrust, accounts for the fact that, while a Research Triangle Institute study concludes 830,000 Vietnam veterans have full-blown or partial PTSD, only 55,119 have filed claims, and the adjudication boards have only believed 28,411 (July 1990) of those claimants.

Emotional stress builds very fast on a battlefield, and if there is no permissible emotional outlet, the soldier will “convert” his symptoms into physiological conditions. Gabriel, who was an active intelligence officer for 22 years, offers Maj. Marcus Reno and his soldiers as a classic example of the breakdown of men in battle. Major Reno’s troops served as a blocking force for Gen. George Armstrong Custer at the Battle of Little Big Horn. The battle had hardly begun when Reno himself became a psychiatric casualty. The major’s Indian scout, Yellow Knife, was struck square in the face by a bullet, which sent his blood, flesh, and brains spattering all over Reno, who immediately went into shock. He began foaming at the mouth, and his eyes rolled wildly in his head. He uttered sounds which made no sense.

Some of Reno’s men were so paralyzed with fear, they couldn’t defend themselves. They were so terrified, in fact, the Indians thought them cowards and refused to kill them. Maj. Myles Moylan was found later by the cavalry rescue force, “blubbering like a whipped urchin, tears coursing down his cheeks.”

Some of the soldiers reported they hallucinated during the fight, seeing columns of soldiers approaching and hearing voices when there were none. Others entered into states of shock approaching stupor from the emotional exhaustion generated by fear. About the only thing that didn’t happen to Reno’s men during the battle was desertion, but this was because there was simply no place to go.


The first army in history to determine that mental collapse was a direct consequence of the stress of war and to regard it as a legitimate medical condition was the Russian Army of 1905 in their war with the Japanese. Gabriel states that Russian attempts to diagnose and treat battle shock represent the birth of military psychiatry. The Russians’ major contribution was their recognition of the principle of proximity, or forward treatment. Although it’s believed by most armies today that the Russians were right in treating psychiatric casualties close to the front, with the goal of returning them to the fight, the recorded rate of those who returned to battle suggests the method was not very successful. In actuality, less than 20 percent were able to return to the front.

The brutalities of WWI produced large numbers of the psychologically wounded. Unfortunately, what little had been learned up to then was forgotten. The only American experience with psychiatric casualties that anyone remembered was when American soldiers under the command of Gen. John J. Pershing in Mexico exhibited an abnormally high rate of mental illness. Consequently, the medical establishment set out once again to recreate the wheel. This time, they began by attributing the high psychiatric casualties to the new weapons of war; specifically, the large-caliber artillery.

It was believed the impact of the shells produced a concussion that disrupted the physiology of the brain; thus the term “shell shock” came into fashion.

Although WWI generated stress theories based on models of the mind, such as Freud’s “war neurosis,” these theories never gained wide acceptance. Quite simply, Freud postulated “war neurosis” was brought about by the inner conflict between a soldier’s “war ego” and his “peace ego.”

Another diagnosis at the time which gained little currency was neurasthenia: “The mental troubles are many and marked; on the emotional side, there are sadness, weariness, and pessimism; repugnance to effort, abnormal irritability; defective control of temper, tendency to weep on slight provocation; timidity. On the intellectual side, lessened power of attention, defective memory and will power….”


By the end of World War I, the United States had hundreds of psychiatrists overseas who were beginning to realize that psychiatric casualties were not suffering from “shell shock.” These psychiatrists came to comprehend it was emotions and not physiological brain damage that was most often causing soldiers to collapse under a wide range of symptoms. Unfortunately, they continued to believe this collapse came about primarily in men who were weak in character.

During WWI, almost two million men were sent overseas to fight in Europe. Deaths were put at 116,516, while 204,000 were wounded. During the same period, 159,000 soldiers were out of action for psychiatric problems, with nearly half of these (70,000) permanently discharged.

Harking back to military medicine during the Civil War, psychiatrists concluded that the answer to psychological casualties was to more thoroughly screen those entering the military. Based on this, the main effort to reduce WWII psychological casualties was to focus on sifting through draftees in order to weed out those predisposed to break down in combat. The military used the best available psychiatric testing and rejected no fewer than five million men for military service.

In World War II, the ratio of rear-area support troops to combat troops was twelve to one. In the four years of war, no more than 800,000 soldiers saw direct combat, and of these, 37.5 percent became such serious psychiatric cases, they were permanently discharged. In the U.S. Army alone (not counting Army air crews), 504,000 men were lost to the fight for psychiatric reasons. Another 1,393,000 suffered symptoms serious enough to debilitate them for some period.

It became clear it was not just the “weak” in character who were breaking down. This is reflected in the subtle change in terminology that took place near the end of World War II when “combat neurosis” began to give way to the term “combat exhaustion.” Author Paul Fussell says that term as well as the term “battle fatigue” suggest “a little rest would be enough to restore to useful duty a soldier who would be more honestly designated as insane.” While the name change showed movement away from psychopathology, it didn’t keep the military model of “predisposition plus stress equals collapse” from working its way back into military medicine.

Fussell was a 20-year-old Army lieutenant and the leader of a rifle platoon in France. He was severely wounded in 1945 and came home to earn a Ph.D. from Harvard. In the preface to his highly acclaimed book, Wartime, he writes, “For the past 50 years the allied war has been sanitized and romanticized almost beyond recognition by the sentimental, the loony patriotic, the ignorant, and the bloodthirsty—I have tried to balance the scales.”

Fussell quickly cuts to the heart of the war experience, reminding us that those who fight are at once young, athletic, credulous, and innocent of their own mortality. He points out that the populace is naive to their pain and suffering. Fussell quotes Bruce Catton: “A singular fact about modern war is that it takes charge. Once begun it has to be carried to its conclusion and carrying it there sets in motion events that may be beyond men’s control. Doing what has to be done to win, men perform acts that alter the very soil in which society’s roots are nourished.”

Astonishingly, Catton was writing about the Civil War, which Fussell in turn characterizes as “long, brutal, total, and stupid”—something that can be said about any war when we fully realize that before society’s roots can be altered, soldiers’ very souls are seared by the acts they witness and perform.


The denial and naivete of the populace as to what war really is becomes a dynamic underlying the trauma of soldiers: “[S]evere trauma was often the result of the initial optimistic imagination encountering actuality.” Many Vietnam veterans can attest it’s a long way from the jungles of Vietnam to Disneyland (America). That is just about as far as Erich Maria Remarque knew it to be from the Western Front to home in WWI: “Now if we go back we will be weary, broken, burnt out, rootless, and without hope. We will not be able to find our way anymore. And men will not understand us… . We will be superfluous even to ourselves; we will grow older, a few will adapt themselves, some others will merely submit, and most will be bewildered.”

Fussell points out all wars are boyish and are fought by boys who are useful material for the sharp edge of war, but only for a short time: “[A]fter a few months they’ll be dried up and as soldiers virtually useless—scared, cynical, debilitated, unwilling… .”

While the average age in the military during WWII was 26, it was the 18-year-olds who were up front. “Among the horribly wounded the most common cry was ‘mother!’” Replacements got hit before anyone knew their names, “forlorn figures coming up to the meat grinder and going right back out of it like homeless waifs, unknown and faceless to us,” said poet James Dickey.

Fussell notes the detachment may be heartless but it makes it possible for sensitive people to survive the war relatively undamaged. While it’s true that we detach ourselves from war in order to survive, it’s also clear that the act of detachment is itself a kind of willed destruction. It’s the price paid; it’s why we never learn. The psychic numbing necessary to survive combat is not something you step into and out of easily. You can’t do it halfway.

The attitude is betrayed by phrases such as, “It’s just dead meat,” “Kill ’em all and let God sort ’em out,” or “Bomb Hanoi, Bomb Saigon, Bomb Disneyland, Bomb everything.” This attitude is about as tangible a thing as you can find. It is all consuming and pervades the soul. You carry it with you when you leave the battlefield. You carry it home, where you live with it. You share it with your family and your friends and your kids, and ultimately with your society. And it is poisonous, exceedingly poisonous—and it alters “the very soil in which society’s roots are nourished.”

At the close of WWI, Edmund Wilson looked out over London and said, “No one pretends to give a damn anymore—unless they are one’s close friends or relatives—whether people are killed or not… . The long-continued concentration on killing people whom we rarely confront, the suppression of the natural bonds between ourselves and these unseen human creatures, is paid by repercussions. The spitefulness and fear and stifled guilt, in our immediate personal relations… . Our whole world is poisoned now.” 

It takes time and effort to overcome such detachment—some people never do. To look at any of it is to look at all of it. It can be overwhelming. It may be the reason Kurt Vonnegut took 23 years to tell us about his experience during the fire bombing of Dresden, just as it took Fussell 50 years to say, “Now there has been much talk about ‘The Good War,’ the justified war, the necessary war, and the like, that the young and innocent could get the impression that it really was not such a bad thing after all. It’s thus necessary to observe it was a war and nothing else, and thus stupid and sadistic, a war, as Cyril Connally said, ‘of which we are ashamed, a war…which lowers the standard of thinking and feeling…which is as obsolete as drawing and quartering; further, a war opposed to every reasonable conception of what life is for, every ambition of the mind or delight of the senses.’”

Of course, the same can be said for the Korean War. In Korea, 1,587,040 served—33,629 were killed in combat and 103,284 were wounded. Of the 198,380 who were actually in combat, 24.2 percent were psychiatric casualties. In other words, the chances of being a psychiatric casualty in Korea was 143 percent better than the chances of being killed.

In Vietnam, 2.8 million served. Given the nature of guerrilla warfare, it is hard to estimate the number exposed to hostile fire. However, the Research Triangle Institute’s Vietnam readjustment study concludes 480,000 have full-blown PTSD and another 350,000 have partial PTSD.


The British psychiatrist R.D. Lang has written that an insane response to an insane situation is sane behavior. Working with schizophrenics, he concluded many were the way they were because of massive double-bind situations they were put in—telling them one thing while their reality and treatment were the opposite. For instance, the religious child grows up being told, “Thou shalt not kill,” until he is drafted and the message becomes, “Kill, kill, kill!”

Gabriel writes in No More Heroes, a study of madness and psychiatry in war, that contrary to what is in the movies, television, and the military, it is not only the weak and cowardly who break down in battle. In reality, everyone is subject to breaking down in combat, “perhaps most telling, not only are there no personalities or demographic factors which are associated with psychiatric collapse; neither are there any factors associated with heroism. It’s impossible to predict which soldiers will collapse and which will behave bravely.” A soldier who is brave one day may well be a psychological basket case the next. Gabriel states flatly, “There is no statistical difference in the rates of psychiatric breakdown among inexperienced troops and battle-hardened veterans.” When all is said and done, all normal men are at risk in war.

Gabriel believes there is enough evidence from studies done after WWII to suggest it is only those who are already mentally ill, about two percent of the population, who don’t break down in battle. In other words, only the sane can go insane; the already insane remain that way. “Perhaps it is simply that while collective insanity can destroy normally sane men, it cannot reverse individual insanity,” writes Gabriel.

This idea, that all normal men have a breaking point and all combat veterans will fall off a continuum at recovering, from mild to severely pathological, has been called the endurance model. It looks at war madness as a form of adaptation. The task for therapists and psychiatrists is to unravel the sense behind the symptomatology, acute or chronic, that is observed in veterans today: “Fatigue and listlessness, depression, startle reactions, recurrent nightmares, phobias and fears involving situations associated with trauma, mixtures of impulse behavior, unsteadiness in human relationships and projects of all kinds (including work or study), that may take the form of distrust, suspiciousness, and outbursts of violence.”

Robert J. Lifton is a psychiatrist based at Yale University, and he is renowned for his work with trauma patients, including Vietnam veterans. His response to the illness model (soldiers in their conflictive “neurotic” state become afraid to die and afraid to kill) is he doesn’t see not wanting to die or kill as being very “neurotic” and that, in fact, perhaps mankind can use a little more of this attitude. Lifton points out this model worked in WWII because the Nazis were so obviously evil: “Those soldiers that broke down, who were afraid to die and afraid to kill on behalf of this crusade, could be quite comfortably viewed as neurotic.” 

The dynamics were different in Vietnam, where conditions of the war were such that moral revulsion combined with psychological conflict lead to both acute and delayed reactions. Lifton writes, “[M]onths or even years after their return to this country, many Vietnam vets combined features of the Traumatic Stress Syndrome with preoccupation with questions of meaning—concerning life, and ultimately, all other areas of living.”

Lifton argues that in the search to understand the soldiers’ traumatic stress reaction, doctors should focus on the death and destruction that actually took place and its related questions of meaning, rather than invoke the idea of “neurosis.”

“At the heart of the traumatic syndrome—and of the overall human struggle with pain—is the diminished capacity to feel, or psychic numbing. There is a close relationship between psychic numbing … and death-linked images of denial (‘If I feel nothing, then death is not taking place’), or ‘I see you dying but I am not related to you as your death.’”

In order to survive, soldiers undergo a radical reduction in their sense of the actuality of things. One example is Canadian bomber-pilot J.D. Harvey on his return from rebuilding Berlin in 1960: “I could not visualize the horrible death my bombs … had caused here. I had no feeling of guilt. I had no feeling of accomplishment.”

Lifton tells us this happens in order for the soldier to avoid losing his sense completely and permanently. “He undergoes a reversible form of symbolic death in order to avoid a permanent physical or psychic death.”

Having closed off and numbed themselves in order to survive, soldiers are then faced with the task of working their way back toward humanity. The struggle is to “re-experience himself as a vital human being.” However, it is not all that easy, for “one’s human web has been all too readily shattered, and in rearranging one’s self-image and feelings, one is on guard against false promises of protection, vitality, or even modest assistance. One fends off not only new threats of annihilation but gestures of love or help.”


This goes to the heart of current concerns about PTSD—that, paradoxically, its tremendous incidence in Vietnam was ultimately a sign of the sanity of those who fought in the war. Otherwise, why be disturbed by the killing, by the stuff of war? But ever after, in peacetime, the reconstruction of “the human web” becomes more and more implausible: if societies are sane—if, in fact, they are civilized—why are there wars?

The arguments are circular. The question of PTSD is always thrust back upon us. The reason there are wars is because most societies are not civilized, but might be someday. There are “cures” offered in the best of societies for PTSD, programs that are established to reintegrate sane men and women into the established order. But always the absolute cure to the eradication of symptoms of PTSD is to eradicate their causes. We are disturbed by war, and justly so.

As we know it today, Post-traumatic Stress Disorder is marked by a re-experiencing of the trauma in thought, feeling, or dream content, which is in turn evidenced by emotional and psychological numbing. Today, PTSD is characterized by depression, loss of interest in work or activities, psychic and emotional numbing, anger, anxiety, cynicism and distrust, memory loss and alienation, and other symptoms. And why not?

Who would not be alienated from the scenes of death witnessed by soldiers? The point is that throughout history, men and women have acted to suppress the horrors that they’ve seen. It’s time we recognize that for what it is—as not only the outward manifestation of PTSD, but the clearest evidence we have that wars are destructive in other ways than in body counts. It takes many years for even the most sane among us to arrive at what we have seen and wanted to forget.

Psychiatrist Victor Frankel survived internment in four Nazi concentration camps during WWII. It would be quite a few years before he wrote his book, Man’s Search for Meaning. In the book, he states clearly that “an abnormal response to an abnormal situation is normal behavior.” In other words, if some things don’t make you crazy, then you aren’t very sane to begin with.

Unfortunately, it’s an idea whose time has not yet come.

Never forgotten, honored always.

The OEW team with wounded veteran honorees Tito Pineiro and Scott Casmiro are officially out of the starting blocks and on the Ultimate Challenge Mud Run course, 12 APR 2014.

2 Year Army Veteran SFC Tito Pineiro is a 12B Combat Engineer with the 82nd ABN who is Airborne, Ranger, and Sapper qualified. In his selfless career, SFC Pineiro has deployed three times in support of Operation Enduring Freedom, two in support of Operation Iraqi Freedom, and twice in support of tours in Southern Africa. In SFC Pineiro’s career, he has been awarded the Purple Heart five times, and from his combat wounds, suffers from Post Traumatic Stress and Traumatic Brain Injury. Tito resides in Fayetteville NC with his wife Nina, his daughter Ashlyn, and his son Tristan. Tito still continues to serve today with the 82nd ABN.

Sgt Casimiro enlisted as a 0331 Machine Gunner in the United States Marine Corps in 2007. Stationed in Camp Pendleton, CA, Norfolk, VA and Camp Lejeune, NC. While conducting combat operations during his third deployment in Afghanistan with 1st Battalion 6th Marines Bravo CO, Sgt. Casimiro was wounded by an IED and awarded the Purple Heart November 10, 2011. Sgt. Casimiro is now retired and married to Rebekah Casimiro, and they are expecting their first child, Harper E. Casimiro in May 2014. Sgt. Casimiro is also employed with the VA in Columbia, South Carolina as a Certified Peer Support Specialist (Counselor) in the Mental Health Department.