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Embedded in Iraq

Embedded reporter and NIMH discuss mental health issues for some Iraq War veterans

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Announcer: For nearly a year and a half a reporter with the Washington Post witnessed up close some of the fighting in Iraq embedded with a battalion of Army Rangers from Ft. Riley, Kansas. Battalion 216 was exposed to some of the most vicious fighting of the war with several soldiers killed or wounded by countless numbers of roadside bombs in East Baghdad. That experience led Pulitzer Prize winning reporter David Finkel to write the book The Good Soldiers. Finkel sat down with National Institute of Mental Health Director Dr. Thomas Insel to talk about mental health issues facing Battalion 216.

Dr. Thomas Insel: You know, in reading the book, in reading what the soldiers go through, what sounds like a particularly difficult deployment you begin to wonder why everyone doesn't have PTSD or doesn't come away in some sense severely wounded psychologically and yet they don't.

David Finkel: Typical soldier in that battalion- 19 years old, first deployment, hadn't been out of the country before and in many cases hadn't been out of their home state before… before ending up in Ft. Riley. And suddenly they lift off and through a plane, to a helicopter and they're dropped into this… this place that, you know, that just made no sense. And so, they come home at the end of it and I've seen every reaction there is. There are guys who seem to be doing fine. There are guys who you would think are doing fine and give every appearance of being able to do fine. And they email me privately to say, you know, that's not the case- they're just barely holding on by the skin of their teeth. And then, at the far end are the guys who just… just simply can't hold it together because of what they've been though. There is one soldier in particular who I'm spending time with for a second volume of the story- a guy who couldn't have been more heroic. He was in a Humvee that blew up and he was thrown out of it with a broken leg. He made his way back to the Humvee as it caught on fire and all the thousands of rounds stored inside began cooking off- began firing- and in the midst of that he pulled two injured guys out- he saved them. He couldn't get to the driver- a 19 year old kid- who burned to death. And he held it together as long as he could. He was a good soldier then and he stayed a good soldier and then the day came where it finally just broke through him. And because, as he described later, every week since then… often twice a week - three times a week- he would have the same dream. The dream was that the guy who was on fire was looking at him on fire, saying, why didn't you save me? So his dreams weren't about the two he did save, a perfectly reasonable dream. But instead, for some reason, about the guy he didn't. So many versions of that.

Dr. Thomas Insel: Is there a way to get past that? Have you seen people who have dealt with it and either because they received professional help or support from a buddy who went through this with them they've been able to get help..

David Finkel: Yes. Well, this guy- this guy in particular- I mean, he had a breakdown and then he was wise enough to insist that he be checked into a psychiatric facility where he had stabilizing care for a little over a week. Then he came out and he was put into an all-day program that didn't do anything for him. And he finally ended up in a VA hospital in a seven week program… an intensive seven week program for people with severe PTS…PTSD. He's come out of that and he's doing well. I know other people who have been in that program and they come out a mess. I have seen guys helped tremendously by the professional structure in place. And I've seen guys trying to get help and there is no structure to help them because it's so haphazard depending on where you are in the country. It's a pretty slippery, slipshod thing at this point. And I've seen many guys get better and I've seen many guys desperate to get better who aren't getting anywhere at all.

Dr. Thomas Insel: So, what's the message for us? What would you want most of all for people who are in the mental health community who are thinking about how to have the biggest impact on people who have done so much for us- really put their lives on the line and now are coming back and need something from us. What is it? What's the best way to deliver that?

David Finkel: Maybe this goes against scientific principals but when I write it's important for me to have some image in mind of what I'm writing and in some ways who I'm writing to. And maybe a helpful thing would be if you're a professional working on this problem and you've read the papers and you know the research and you've studied it at this end… it might be helpful somehow to follow it as far back as you can to have an image in mind of the person who comes before you for help today- have a fully formed image of who he was at the moment whatever happened… happened that led him into your office. Understand it… see him… don't assume you know the answer. I went into this thing thinking I knew a thing or two about war- I've covered wars for the Washington Post and I didn't know anything at all. And after having spent so much time there… getting past my assumptions and then seeing what the soldiers themselves went through- it's a whole different game. Once you get it in mind, whether you're a journalist, whether you're a therapist, whether you're a soldier, it's not going to leave your mind anytime soon.