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Deeper Scars: When soldiers come home, some encounter the aftermath of war within themselves

The first time Staff Sgt. David Winkel returned from a year in Iraq, he was 30 pounds lighter and used to sleeping a handful of hours, a gun by his side. 

The 23-year-old says he re-enlisted in the U.S. Army because he loves the feeling of being a part of something that makes a difference. But coming home to Champaign after that first tour of duty threw him into a period of adjustment. He would wake up two or three times a night searching for his weapon. And he found it difficult to reconnect with some of his family and friends. 

Now preparing for his fourth tour in Iraq, he says he has learned to anticipate the jolt that comes with each transition from active duty to civilian life.

Others haven't been so lucky.

In December, about 196,000 active U.S. troops were serving in Iraq and Kuwait, and another 19,000 were posted in Afghanistan, according to the U.S. Department of Defense. Among those soldiers were nearly 1,400 Illinois National Guard members and reservists, according to the Illinois Department of Military Affairs. But some who returned home this year after the Iraqi elections weren't prepared for the challenges they faced on the home front. Some had to struggle harder than Winkel to make the transition to civilian life.

Veterans of previous wars struggled with this transition, too. But the psychological, physical and economic challenges facing the nation's newest veterans have been getting attention from politicians in Washington, D.C. and Springfield. 

Early this year, Winkel, the son of state Sen. Rick Winkel of Champaign, visited his father at the state Capitol, where the legislature was trying to address some veterans' needs in its spring session. Illinois lawmakers introduced nearly two dozen measures designed to help veterans financially, at least in small ways, by granting property tax exemptions, fishing license waivers and scholarships for their children.

In addition, Gov. Rod Blagojevich asked lawmakers to support a $10 million program to help Illinois veterans get health care. In the first phase of the proposed Veterans Care program, the state would assist 7,000 former soldiers, or 10 percent of Illinois veterans who are younger than 65 and lack health insurance, says Januari Smith, spokeswoman for the Illinois Department of Veterans' Affairs. She says the program could be expanded to offer universal health care to veterans. 

The governor also proposed boosting state spending on homes for aging and disabled veterans, and he's tapping 25 new services officers to help veterans apply for state and federal benefits.

Illinois Lt. Gov. Pat Quinn, meanwhile, has implemented a plan to fund services for post-traumatic stress disorder. His office expects the scratch-off lottery game, called Veterans Cash, to raise an estimated $3 million annually for the state veterans' agency. 

Eric Schuller, Quinn's senior policy adviser, says the money also will help homeless veterans, which account for one-third of the state's homeless population. He says the residual effects of post-traumatic stress disorder, including homelessness, are state problems that can be prevented.

Dr. Ronald Davidson of the Department of Psychiatry at the University of Illinois at Chicago supports the lieutenant governor's proposal, but says the trick in dealing with the disorder is to prepare for it ahead of time. "The best way to 'prevent' or deal with post-traumatic stress disorder is through education, to increase the education troops and their families get before they leave and certainly when they come back."

Furthermore, Davidson says, more veterans could be helped if more public funds were provided to private and nonprofit organizations. "You need to help get those resources and those funds out to community mental health clinics to make it easier for people to get help. 

Buy some more doctors' time; buy some more psychologists' time to work with military families," he says. "There are things where you can throw money at a problem, and I think this is one of them, if you target the money carefully."

Nevertheless, the primary responsibility for helping veterans falls to the federal government through its Department of Veterans Affairs. That agency operates some three-dozen medical centers and clinics for treatment of returning soldiers, including those suffering from post-traumatic stress disorder. 

In 2003, the agency covered more than $1.8 billion in health care, pension and education costs for Illinois veterans. Still, Illinois' disabled veterans received some of the lowest average disability payments in the nation — about $7,000 each. U.S. Sen. Barack Obama, a Chicago Democrat, has pushed to get an increase. At the same time, though, the White House has proposed trimming veterans' services over the next five years, meaning benefits could actually decline for middle-income veterans.

Yet, many returning soldiers face the challenge of just finding a job. And often, these financial strains dwarf other problems, such as psychological stress, according to Davidson of UIC. 

In fact, returning veterans are re-entering a less-than-booming economy, which is why some enlisted in the first place. According to the U.S. Department of Labor, veterans between ages 20 and 24 had an unemployment rate of more than 15 percent in July 2005. That's nearly double the rate for their cohorts who were not in the military.

Still, the psychological impact of war can be profound. And even physical injuries can carry deeper scars, as one New York photographer found in her research on veterans who were wounded in Iraq. "I don't see physical wounds. I see the psychological wounds," says Nina Berman, author of Purple Hearts: Back from Iraq, which is the basis of an exhibit that will be at the National Vietnam Veterans Art Museum in Chicago until May.

Berman says she wants to show a more realistic picture of the war than what is seen through the media. "You saw the weaponry of war, but you didn't see what those weapons did," she says.

Through her work, she also saw the impact of the war spread to families, who often had a hard time understanding why their son or daughter, who was happy before, had fallen into depression.

"There's a huge ripple effect of the aftermath of war," Berman says. "It's not just on the combatants. It's on the whole community."

The cause stems in part from the nature of this war. The National Center for Post-Traumatic Stress Disorder says in addition to being away from their families, some of the main stressors affecting men and women serving in Iraq are the lack of combat lines and the prevalence of ambiguous threats. They're constantly on guard and at risk of mistaking a friend or a foe.

Vietnam veteran Donald Smithenry knows the feeling. "You don't know who the enemy is because you're associated with all of them. In Vietnam, you would talk to them during the day and fight them at night."

Smithenry, who is 59, lives in Springfield and serves as the state adjutant and quartermaster for the Illinois Veterans of Foreign Wars. He recalls coming home from Vietnam on his 21st birthday to little welcome.

"You just came home from the war into civilian life, and you're supposed to adjust in one day," he says. When he couldn't find an outlet for his emotions, he coped in the only way he knew how. "I tried to drown [my emotions] with alcohol." He tried to survive that way for a decade, only seeking help after the shock of a divorce. 

Winkel says post-traumatic stress disorder is still a reality for many of his fellow soldiers. So is depression, alcoholism and an inability to relate to loved ones.

"We have a lot of soldiers that started their divorce papers in Iraq," he says. "It's a big issue."

The U.S. military tries to help. In addition to coordinating a Seamless Transition program, the Department of Defense requires soldiers to spend some time in "reintegration training," learning how to cope if their children don't recognize them or if they can't relate to their spouses.

While government and private organizations try to reach out to veterans, some returning soldiers can't or don't want to be reached. Why soldiers don't seek help is something that concerns Davidson. 

He directs the UIC mental health policy program and says there's a major disincentive for soldiers to ask for help.

The federal government documented one reason in a 2002 Department of Defense health survey of soldiers. An entire chapter is dedicated to mental health issues. Slightly more than 5 percent of nearly 13,000 survey participants reported seriously considering suicide the previous year. Davidson says those numbers have likely increased since the rise of the insurgency in Iraq. The most critical finding, however, is that up to 20 percent of military personnel in each service indicated they had felt the need for counseling in the year before the survey, but more than half of them reported they believed asking for mental health services would negatively impact their military careers.

The Department of Defense report acknowledged the problem. "It is quite possible that the fear of negative career consequences is preventing some service members from seeking mental health counseling. In recent years, the military has taken steps to reduce the stigma associated with receiving mental health care." A few sentences later, the report added, "Despite these efforts, it appears that more assurance may be needed to combat the widely held concerns that seeking help will damage a career."

Davidson says high-stress situations penetrate even the healthiest individuals. When they don't ask for help, there's a systemic problem. "It's still a macho military culture. There's a hidden army of troops out there who may be, and probably are, experiencing enormous emotional problems, and they admit that they're afraid to even ask for help because it could hurt their military careers," he says. "The problem's not with the troops. The problem is with the Pentagon, the military. The culture is not changing."

In fact, the National Center for Post-Traumatic Stress Disorder says a 2004 study indicates about 80 percent of the Iraq and Afghanistan soldiers who had a serious mental health disorder acknowledged they had a problem, but only about one-fourth of them reported receiving formal mental health care.

Even if the stigma dissolved, Davidson says, a second barrier to seeking mental health services is location. "If you're within 50 miles of Chicago, you're in luck because the [federal] Veterans Affairs has some wonderful services. You get south of I-80, and you can shake a stick at the number of doctors you can find."

That's where Jill DeBord comes in. She is a licensed clinical social worker who coordinates care for veterans who have served in Iraq or Afghanistan. 

She works at the federal veteran department's Illiana Health Care System in Danville, one of 22 outpatient clinics in the state. As part of a national initiative, she screens as many soldiers as possible for post-traumatic stress disorder, depression, alcohol abuse or infectious diseases specific to Iraq or Afghanistan.

Of the 705 veterans who have enrolled in the Illiana Health Care System since September 11, 2001, about half are showing signs of post-traumatic stress disorder. That doesn't mean they've been diagnosed with the condition, she says, but it does indicate a potential need for treatment.

Many of these veterans are getting treatment, but many more don't know they're eligible. For up to two years after discharge, a veteran can get free health care through Veterans Affairs if their condition is in any way connected to combat. "If they enroll within the two years, they'll be grandfathered into the system, and they can continue to receive care even if they are over the income cap," DeBord says. Noncombat veterans must make co-payments or pay minimal fees for health care services if they are single and make more than $25,000 or married and make more than $30,000.

To spread the word, she has sent out 3,500 "welcome home" packages from the Department of Defense that detail services. She says her biggest concern, however, is that there won't be enough clinicians to specialize in treatment of post-traumatic stress disorder.

"It may seem like it's hitting us really hard now, but this is just a tip of the iceberg. We're going to be dealing with this for a long time to come."

Photographer Berman says the public also needs to adjust its lens to focus on larger social problems that affect everybody, including the economy and access to health care.

"A lot of issues that can be seen through veterans can become more clear," she says, "because you feel as though they should have a higher standing somehow." 


Legislation may help vets

Veterans were on the minds of state lawmakers this spring, but only a few measures intended to help returning soldiers advanced through the legislative process.

State Senate Minority Leader Frank Watson, a Greenville Republican, got a bill out of his chamber that would establish a revenue stream to support the troops. The purchase of a special Iraqi Freedom license plate that says, "Support our Troops," would raise $25 for the Illinois Veterans Assistance Fund. Another $25 would be raised through each renewal of the special plates. In turn, the state would provide financial aid to children of veterans who were injured or killed in the line of duty.

Another measure would have punished people for fraudulently claiming they were a veteran to get one of the special license plates. The measure was stuck in the legislative process. 

A measure that would punish people who wear a Purple Heart medal if it was awarded to someone else, even a relative, won approval in the House.

Other measures were intended to give financial assistance to soldiers who are buying a home, paying property taxes or preparing to send their children to college. One would waive a fishing and camping license fee.

Bethany Carson

llinois Issues, April 2006

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