As a Marine stationed in Ramadi, Iraq, in 2007, Christian Warren spent his days and nights living among the Iraqis the Americans were trying to help. This meant delivering aid like a humanitarian but being ready at any moment to respond like a soldier should an attack occur.
That state of hypervigilance that served him in Iraq isnt so useful now when Warren is studying for classes at Fort Lewis College, where he plans to major in adventure education.
Memories, flashes, sensations all flood in unbidden. Sleeplessness, anxiety and resignation result.
Some days it becomes overwhelming, and I just break down for a day, Warren said.
He has done counseling and group therapy and briefly found himself approaching dependence on painkillers. These days, his medicine is the outdoors, where he hikes and climbs.
The term used to describe this reaction, post traumatic stress disorder or PTSD, has become part of the mainstream vernacular as vets like Warren stream home from the wars in Iraq and Afghanistan.
PTSD is really coping mechanisms gone awry, said William McKeon, a local therapist who has treated veterans.
Although the acceptance and knowledge surrounding PTSD has grown exponentially since the Vietnam War, much about its treatment remains elusive.
One confounding factor is the overlap in symptoms of PTSD and traumatic brain injury, which is also common among soldiers hit by improvised explosive devices, so ubiquitous in Iraq and Afghanistan.
In fact, the latest studies are finding that some of the symptoms attributed to PTSD might actually be the result of brain damage similar to that found in football players and other athletes who suffered successive concussions. The degenerative disease can result in dementia, memory loss, aggression and depression.
Sadly, it could also suggest that the worst is yet to come, for C.T.E. (chronic traumatic encephalopathy) typically develops in midlife, decades after exposure, New York Times columnist Nicholas Kristof wrote in an April 25 article about the research. If we are seeing C.T.E. now in war veterans, we may see much more in the coming years.
LeAnn Shaw, emergency services manager at Axis Health Systems Crossroads facility next to Mercy Regional Medical Center, takes crisis calls from recently returned veterans at all hours of the day.
They are usually in the throes of a flashback, and she attempts to bring them back from some distant battlefield.
Because the center provides crisis services to all comers at no charge, she and her staff are on the front lines in dealing with PTSD.
Once the veterans are stabilized, the center connects them with follow-up services. If their symptoms are too severe to be managed on an outpatient basis, the center arranges hospitalization. But beds are few and far between. Recently, the closest bed they were able to find for a veteran was in Sheridan, Wyo., and it took a week and both ambulance and plane rides to get him there.
And the scarcity is growing, Shaw said.
Still, she did give the military credit for acknowledging the psychological effects of war.
The military has made it where its OK to have PTSD for the first time, and thats huge, she said.
McKeon, the local therapist, has been involved with a nonprofit organization that incorporates alternative methods such as yoga, massage, acupuncture and Native American ceremonies into providing PTSD treatment for veterans and their families.
The therapies were provided at weeklong retreats that ran through the summer last year in Angel Fire, N.M. No retreats are scheduled this summer because of lack of funding, which comes mostly from private donors.
McKeon, who provided couples therapy to retreat participants, said that a holistic approach is needed to get to the core of disorder.
Medications, which the VA has faced criticism for distributing freely, are cold medicines they treat the symptoms but not the cold, he said.
Warren said he was routinely offered medication for anxiety and sleeplessness but declined them. While he feels the military is overreliant on medications, he says vets have a choice.
Its my responsibility to say no, he said.
Susan McGinness, director of the Fort Lewis College counseling center, has seen a slow but steady increase in vets coming to the center. According to administration figures, FLC had 72 vets enrolled in the spring, about 2 percent of the total student population.
McGinness said that while PTSD and brain injuries are real problems among vets, many are coping extremely well, especially given all they have experienced.
Theyre not basket cases, she said.
And with a little support, she said, most FLC vets will go on to be successful college graduates.