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WASHINGTON — Matt LaBranche got the tattoos at a seedy place down the street from the Army hospital here where he was a patient in the psychiatric ward.
The pain of the needle felt good to the 40-year-old former Army sergeant, whose memories of his nine months as a machine-gunner in Iraq (news - web sites) had left him, he said, "feeling dead inside." LaBranche's back is now covered in images, the largest the dark outline of a sword. Drawn from his neck to the small of his back, it is emblazoned with the words LaBranche says encapsulate the war's effect on him: "I've come to bring you hell."
In soldiers like LaBranche — their bodies whole but their psyches deeply wounded — a crisis is unfolding, mental health experts say. One out of six soldiers returning from Iraq is suffering the effects of post-traumatic stress — and as more come home, that number is widely expected to grow.
The Pentagon (news - web sites), which did not anticipate the extent of the problem, is scrambling to find resources to address it.
A study by the Walter Reed Army Institute of Research found that 15.6% of Marines and 17.1% of soldiers surveyed after they returned from Iraq suffered major depression, generalized anxiety or post-traumatic stress disorder — a debilitating, sometimes lifelong change in the brain's chemistry that can include flashbacks, sleep disorders, panic attacks, violent outbursts, acute anxiety and emotional numbness.
Army and Veterans Administration mental health experts say there is reason to believe the war's ultimate psychological fallout will worsen. The Army survey of 6,200 soldiers and Marines included only troops willing to report their problems. The study did not look at reservists, who tend to suffer a higher rate of psychological injury than career Marines and soldiers. And the soldiers in the study served in the early months of the war, when tours were shorter and before the Iraqi insurgency took shape.
"The bad news is that the study underestimated the prevalence of what we are going to see down the road," said Dr. Matthew J. Friedman, a professor of psychiatry and pharmacology at Dartmouth Medical School who is executive director of the VA's National Center for Post Traumatic Stress Disorder.
Since the study was completed, Friedman said: "The complexion of the war has changed into a grueling counterinsurgency. And that may be very important in terms of the potential toxicity of this combat experience."
Mental health professionals say they fear the system is not moving fast enough to treat the trauma. They say slowness to recognize what was happening to Vietnam veterans contributed to the psychological devastation from that war.
More than 30% of Vietnam veterans eventually suffered from the condition that more than a decade later was given the name post-traumatic stress disorder. But since their distress was not clinically understood until long after the war ended, most went for years without meaningful treatment.
"When we missed the boat with the Vietnam vets, we didn't get another chance," said Jerry Clark, director of the veterans clinic in Alexandria, Va. "When they left the service, they went away not for a month or two but for 10 years. And they came back addicted, incarcerated and all these things. We can't miss the boat again. It is imperative."
Experts on post-traumatic stress disorder say it should come as no surprise that some of the soldiers in Iraq are fighting mental illness.
Combat stress disorders — named and renamed but strikingly alike — have ruined lives following every war in history. Homer's Achilles may have suffered from some form of it. Combat stress was documented in the late 19th century after the Franco-Prussian War. After the Civil War, doctors called the condition "nostalgia," or "soldiers heart." In World War I, soldiers were said to suffer shell shock; in World War II and Korea, combat fatigue or battle fatigue.
But it wasn't until 1985 that the American Psychiatric Assn. finally gave a name to the condition that had sent tens of thousands of Vietnam veterans into lives of homelessness, crime or despair.
A war like the one in Iraq — in which a child is as likely to die as a soldier and unseen enemies detonate bombs — presents ideal conditions for its rise.
Yet the Army initially sent far too few psychiatrists, psychologists and social workers to combat areas, an Army study released in the summer of 2003 found. Until this year, Congress had allocated no new funds to deal with the mental health effects of the war in Iraq. And when it did earmark money, the sum was minimal: $5 million in each of the next three years.
"We're gearing ourselves up now and preparing ourselves to meet whatever the need is, but clearly this is something that could not be planned for," said Dr. Alfonso Batres, a psychologist who heads the VA's national office of readjustment counseling services.
Last year, 1,100 troops who had fought in Iraq or Afghanistan (news - web sites) came to VA clinics seeking help for symptoms of depression or post-traumatic stress; this year, the number grew tenfold. In all, 23% of Iraq veterans treated at VA facilities have been diagnosed with post-traumatic stress disorder.
"And this is first-year data," Batres said. "Our experience is that over time that will increase."
In the red brick buildings of Walter Reed Army Medical Center, the "psych patients," as they are known, mingle, sometimes uncomfortably, with those who have lost limbs and organs.
One soldier being treated at Walter Reed, who spoke on condition of anonymity, walks the hospital campus in the bloodied combat boots of a friend he watched bleed to death.
Another Iraq veteran in treatment at Walter Reed, Army 1st Lt. Jullian Philip Goodrum, drives most mornings to nearby Silver Spring, Md., seeking the solitude of movies and the solace of friends.
He leaves early to avoid traffic — the crush of cars makes him jumpy. On more than one occasion, he has imagined snipers with their sights on him in the streets. Diesel fumes cause flashbacks. He keeps a vial of medication in his pocket and pops a pill when he gets nervous.
"You question — outside of dealing with your psych injury, which will affect you from one degree or another throughout your life — you also question yourself," Goodrum said. "I trained. I was an excellent soldier, a strong character. How could my mind dysfunction?"
When it began to become clear that what the Pentagon initially believed would be a rapid, clear-cut war had transmuted into a drawn-out counterinsurgency, the Army began pushing to reach and treat distressed soldiers sooner.
The number of mental health professionals deployed near frontline positions in Iraq has been increased. Suicide prevention programs are given to soldiers in the field. According to the Pentagon, 31 U.S. troops have killed themselves in Iraq.
At more than 200 storefront clinics known as Vet Centers — created in 1979 to reach out to Vietnam veterans — the VA has increased the number of group therapy sessions and staff. Three months ago, the VA hired 50 Iraq war veterans to help serve as advocates at the clinics.
Officials acknowledge that is only a start. The Government Accountability Office found in a study released in September that the VA lacked the information it needed to determine whether it could meet an increased demand for services.
"Predicting which veterans will seek VA care and at which facilities is inherently uncertain," the report concluded, "particularly given that the symptoms of PTSD may not appear for years."
The Army and the VA are also trying to catalog and research the mental health effects of this war better than they have in the past. In addition to the Walter Reed study, several more are tracking soldiers from before their deployment to Iraq through their combat experiences and into the future.
If Iraq veterans can be helped sooner, they may fare better than those who fought in Vietnam, mental health experts say. And they note that the nation, although divided on the Iraq war, is more united in caring for the needs of returning soldiers than it was in the Vietnam era. And in the last decade, new techniques have proved effective in treating stress disorders, among them cognitive-behavioral therapy and drugs like Zoloft and Paxil.
Whether people like Matt LaBranche seek and receive treatment will determine how deep an effect the stress of the war in Iraq ultimately has on U.S. society.
Before the war, LaBranche was living in Saco, Maine, with his wife and children and had no history of mental illness.
He deployed to Iraq with a National Guard transportation company based in Bangor. He came home a different person.
Just three days after he was discharged from Walter Reed, he was arrested for threatening his former wife. When he goes to court Dec. 9, he could be looking at jail time.
He lies on a couch at his brother's house most days now, struggling with the image of the Iraqi woman who died in his arms after he shot her, and the children he says caught some of his bullets. His speech is pocked with obscenities.
On a recent outing with friends, he became so enraged when he saw a Muslim family that he had to take medication to calm down.
He is seeing a therapist, but only once every two weeks.
"I'm taking enough drugs to sedate an elephant, and I still wake up dreaming about it," LaBranche said. "I wish I had just freaking died over there."
Point/Counterpoint
12-02-2004, 20:04
The Unseen Wounds.... 
