MARINE CORPS BASE CAMP LEJEUNE, N.C. -- Marines from the II Marine Expeditionary Force are returning from combat tours in a physical sense. However, for some, clashes with insurgents may have been replaced with a mental battle against paranoia, anxiety and the stress of re-acclimating to the environment at home. The Navy and Marine Corps team has assistance available -- organizations such as the Community Counseling Center and the naval hospital can assist Marines and sailors in overcoming these issues and get them back in the game.
“Seeking help for combat stress and post-traumatic stress disorder doesn’t mean a medical board and being kicked out of the military; not at all,” said Cmdr. Thomas C. Armel, assistant director for mental health services at Naval Hospital Camp Lejeune. “There isn’t a commander out there who doesn’t want their people to be at 100 percent, ready to go – who doesn’t want their folks to get the help they need.”
Post-traumatic stress disorder is a psychological condition a person may experience when they have confronted a stressful, disturbing or unpleasant experience. It can manifest itself through sleeplessness, nervousness and a laundry list of behaviors best summarized by being “on-edge.” However, the PTSD experience is unique to every individual, whether they are firefighters, police officers, combatants or victims of a crime.
A little “shell shock” and symptoms of stress don’t automatically qualify a Marine as having one of the most talked-about side effects of the war in Iraq.
Combat stress is different from PTSD. According to Armel, a psychiatric nurse practitioner who has been working in mental health for more than 22 years, “Combat stress is normal -- approximately 90 percent of service members returning from combat deployments will experience some form of combat stress.
“It’s expected there will be an adjustment period after coming back from a combat zone,” said Janice Kight, a clinical social worker at the Marine Corps Base Community Counseling Center. “The expectation is that there will be noticeable improvement after a certain amount of time. With PTSD, the symptoms don’t go away so quickly.”
II MEF is working to support its warriors with a robust campaign which encourages communication, identifying issues, counseling and eliminating combat stress before it gets out of hand.
What PTSD is … and isn’t
“PTSD is an actual diagnosis that means you meet certain criteria, and it has been going on for a length of time,” said Kight. “There are other people who are experiencing symptoms that are combat stress related but are not actually post-traumatic stress disorder. Our goal here is to help them not end up with a diagnosis by treating the symptoms.”
According to Rebecca Haga, a victim advocate at the counseling center, PTSD manifests itself in several abstract forms.
“Families may notice changes in their sleep patterns and anger outbursts. A lot of people tell me that when they hear a loud noise, they want to run for cover,” said Haga.
“One of the things we try to stress is that a lot of these things will be going on in the family, and so, they come in for marital counseling, or their command will send them in for anger management,” said Kight, explaining how PTSD can can sneak up in disguise. “They’ll say, ‘My husband won’t talk to me, he’s not communicating, and he wants to spend more time with his friends,’ and really what it is, is the post-traumatic stress disorder coming out.”
The disorder is not the result of a pre-existing mental disturbance but rather a direct reaction to a specific event or events. In other words, a person who is otherwise mentally stable may experience disruptions in their life due to one traumatic event.
Living with PTSD
Retired Chief Warrant Officer Hartman Slate served in the Marine Corps for 17 years and currently lives in San Antonio. He has vivid memories of the earth shattering 1983 barracks bombings in Beirut, Lebanon, as well as deployments to all ends of the earth, including Nicaragua and Somalia. He was diagnosed with PTSD in September and is currently seeking treatment through a therapist and psychologist.
Slate can rattle off several combat-stress related effects he has felt for so many years, he said, “it feels like those symptoms are a normal part of life. I had difficulty sleeping, memory loss, inability to concentrate, guilt, and irritability.”
“Every October, I would kind of get into a funk and later come out of it,” he said. “But I also had to deal with other losses along the line, and after a while, they just build up and build up.”
Slate patiently watched over the years and identified deeply with current events. The Sept. 11, 2001, tragedy, the Iraqi car bombs on the nightly news, and occurrences in his own life stacked up against his resolve.
“It was kind of like the straw that broke the camel’s back,” he said.
As the symptoms weighed on Slate's mind, they also took a toll on his life.
“All those symptoms make you a difficult person to get along with,” he said objectively. “It can cause you to have bad relationships, and you almost begin to anticipate loss. One of the biggest, overwhelming thoughts I had was the realization that I was always expecting to lose everything good I had.”
Slate recalled a prominent example of his depression when he had purchased his first house.
“I was really proud of my new house, and I wanted to paint it,” he said. “I went to the local hardware store and spent some time figuring out which paint I wanted to use, and I bought all the brushes and rollers and things like that, but I never painted my house. I figured, ‘Why bother if I’m just going to lose it?’”
Slate had no reason to believe he wouldn’t keep his house, but he said he harbored the overwhelming thought that something that nice couldn’t last … it was too good to be true.
“I don’t really know what it was that caused me to seek treatment,” he remembered, stating he had gone to a counselor and immediately announcing “I’ve got issues.”
“I was always kind of taught that if you went to mental counseling, you were nuts and had no business being in the military,” said Slate. “I was told you’re not supposed to feel this way, and then, I really had no choice.
“However, you shouldn’t really care what other people think about you,” he said
“Getting help doesn’t mean you’re weak,” he emphasized. “That attitude needs to be taken from the command to the small-unit level and be recognized at the sergeant and corporal level,” he said.
Slate is able to talk about his experiences with PTSD, which is a benchmark sign of improvement. However, he acknowledges his recovery period isn’t over yet.
“It was really helpful to me to talk to a counselor outside of the military. They were really able to put some things in perspective for me. I learned a lot about myself,” he said. “I think there were things I could have done better in life if I sought out help sooner.”
The most important message Slate sends to young Marines with emerging combat-stress related issues is, “Go see someone. If you feel like you have any of these issues, at least they’ll be able to validate what you’re going through. Not getting help hurts all aspects of your life. After you talk to someone and know what you’re dealing with, you can learn how to deal with it.”
Slate best explains his PTSD survival method as “Improvise, adapt, overcome, and get help.”
Reaching out as a community
“There are various ways someone can receive help (at the naval hospital). The most important to emphasize – Anyone who has been in a combat environment and wants to see someone about combat stress can self refer,” said Armel. “However, we get most patients after they have gone through their (primary care manager) and they have been referred to us.”
“A lot of Marines are apprehensive about coming in to get help, or they don’t want to tell us everything, because they’re afraid they’ll get discharged from the active duty military,” said Kight. “The thing is, that’s not what we’re here for. Our mission (at the counseling center) is force readiness and mission accomplishment, so it benefits us more if we can address the issues and send them back to their units ready to do their jobs.”
According to Armel, the clinic at the naval hospital offers services ranging from single-counseling sessions to long-term counseling, referral to other sources like the chaplain or family service center and sometimes even medication and more intense services for some individuals. He also stresses documentation.
“This is what most are afraid of. However, that documentation will help later in life. Veterans Affairs, for example, needs to have the documentation in your record book to correctly process your paperwork,” said Armel.
“It’s ok to get help,” said Kight. “Not everybody has the same symptoms, and there are so many, that what you may not think is a symptom really is.” Kight added that any symptom that interferes with daily life could be a possible trigger of larger issues.
Kight also noted that commands have been highly supportive in referring Marines who may have to get something off their chests.
“Chain of command from here to Washington is 100 percent behind this,” said Armel. “The bottom line is we need people to get the help they need, at the level of help that they need.”
Dealing with combat stress is the responsibility of the Marine Corps community, the individual Marine, and their command. However, with the proper knowledge and treatment, Marines can leave the war behind them. For more information or services contact the clinic at 450-4700 or the CCC at 451-2864.