The first time Kristin Peterson's husband hit her, she was asleep in their bed.
She awoke that night a split second after Joshua's fist smashed into her face and ran, terrified and crying, to the bathroom to wipe away the blood spurting from her nose.
When she stuck her head back into the bedroom, there he was punching at the air, muttering how she was coming after him and how he was going to kill her. Joshua's eyes were closed. He was still asleep.
The next morning Joshua saw the dried blood on his wife. "Oh God," she recalls him saying. "I did that."
Peterson doesn't remember the night or the nightmares. He also can't remember punching his wife again in his sleep a few weeks later, this time driving her front tooth through her lip, all the while murmuring how he'd never go back.
For six months last year, Peterson helped build an oil pipeline across Iraq as a specialist in the Army's 110th Quartermaster Company. On the same highway where Pvt. Jessica Lynch was ambushed, he saw Iraqi soldiers, dead and rotting, dangling out of their tanks. One time Peterson's truck broke down, and he was surrounded by a group of Iraqi children, some throwing rocks, others toting AK-47s. "I kept thinking, 'God, I can't handle this,'" the 24-year-old says with a hollow laugh.
There are thousands of Operation Iraqi Freedom soldiers across the country like Joshua Peterson. They are coming home with minds twisted by what they've seen and done in Iraq. A December 2003 Army study published in The New England Journal of Medicine found that approximately 16 percent of soldiers returning from Iraq were suffering from Post Traumatic Stress Disorder (PTSD), a psychologically debilitating condition causing intense nightmares, paranoia and anxiety. But that study is already out of date.
Now, after a particularly bloody summer and fall, many military and mental health experts predict the rate of PTSD will actually run nearly twice what the Army study found, approximately the same level suffered by Vietnam veterans. Others think it could spike even higher and note that rarely before has such a dramatic rate of PTSD manifested itself so early.
At the same time, there is mounting concern over the system designed to help: the Department of Veterans Affairs. Numerous reports show the VA does not have many of the essential services veterans desperately need.
"I don't know how many people are going to be seeking treatment, or whether the demand is going to be met by available resources," acknowledges Matthew Friedman, executive director of the VA's National Center for PTSD. "What I am confident of is that people who come for treatment will get good treatment."
Yet the VA chronically has underfunded mental health programs and currently projects a $1.65 billion shortfall in those programs by the end of 2007.
"If we don't give the VA what it needs immediately, the consequences will be lifelong and devastating," says Steve Robinson, executive director of the National Gulf War Resource Center.
WRESTLING WITH GHOSTS
"When you kill someone in combat, two things can happen," says Sgt. Walter Padilla, Charlie Company, 1st Battalion, 12th Infantry Division. "The crazy ones go crazier. Or nothing happens."
In October 2003, Padilla was commanding a Bradley Fighting Vehicle near Kirkuk, rounding up insurgents and fending off mortar attacks.
On a break one day, Padilla's company headed to a deserted area a few miles from base to practice their marksmanship. When gunfire rang out from a nearby village, Padilla wheeled his Bradley around to investigate. He saw two groups of armed men arguing over a pile of wood. The Bradley rumbled closer, and the men began shooting.
"Everything slowed down. I lost sense of time. I saw nothing, felt nothing," he says. "Then I opened up with the machine gun."
After Padilla gripped the trigger long enough, he moved in for a closer look.
"You're walking up on something you've done with your hands. You see the back of brains blown out. You know it's either him or you! But I'd never seen anybody dying."
When Padilla's unit was shipped back to Fort Carson in late February 2004, his life unraveled.
While he was gone, his wife filed for divorce. He began having terrible dreams about Iraq. He grew paranoid anytime he left home.
One morning, on his way to work at Fort Carson, Padilla glimpsed the lights of an Air Force jet. He swerved his car off the highway and grabbed his cell phone to call his commanding officer "I thought it was a tube flash from a mortar," he says.
At a bar, he argued with a stranger over a pool table "Doesn't this guy know I've fucking killed people?" Padilla thought incredulously.
That night, Padilla lay awake, contemplating whether he should rush out into the night and search for the stranger. He shoved some sleeping pills in his mouth and fought to let it go. "If I'd have found him, I would have beat him over the head with a bar stool," he says.
While Padilla grasped at his ghosts, Washington bureaucrats were hearing about another nightmare. On March 25, 2004, Dr. James Scully, medical director of the American Psychiatric Association (APA), testified to the House Appropriations Subcommittee on VA, HUD and Independent Agencies.
Scully, a Navy veteran, reported a 42 percent explosion in VA patients with severe PTSD, with only a 22 percent increase in money spent on PTSD services. The discrepancy was particularly "startling," he said, because there were more vets using the VA for psychological help than ever nearly a half million.
It was the latest blow for an institution that has struggled for decades to fulfill its mission.
A mammoth federally funded agency, the VA's health care system began treating veterans in 1930, charging a sliding fee based on a variety of factors. But in the wake of the first Gulf War, the system swelled out of control. The soaring cost of civilian health insurance, combined with aging World War II, Korea and Vietnam vets, pushed droves of servicepeople toward the VA where everything was cheaper.
In 1995, the VA began realigning its health care system and opening hundreds of outpatient clinics. Yet by 2001, only half provided mental health services, according to the National Mental Health Association (NMHA).
Again, funding was a factor. By 2003, the previous decade had seen a 134 percent jump in vets seeking care, with only a 44 percent increase in the budget.
In April 2003, as U.S. troops pushed toward Baghdad, Dr. Joseph T. English, Chairman of Psychiatry St. Vincent's Catholic Medical Centers of New York, told the House Appropriations Subcommittee on VA, HUD and Independent Agencies that veterans were waiting an average of 47 days to get into PTSD inpatient programs and up to a year at some outpatient facilities.
VA secretary Anthony Principi (who resigned Dec. 8 as part of the Bush Administration's cabinet shuffle and will leave when his successor is confirmed by the Senate) had commanded a navy gun boat during Vietnam and understood PTSD. He also knew that with combat-dazed vets beginning to trickle home from Iraq, he needed to move. So he commissioned a task force to cobble together the VA's mental health services on short notice.
In a revealing June 3, 2004, memo to VA Undersecretary for Health Dr. Jonathan Perlin, Principi wrote that the task force had discovered four major deficiencies: Mental health services were scattered; substance abuse programs had been reduced; the VA's mental health leadership hadn't been diligent in overseeing the situation; and there was no coherent mental health strategy. Principi ordered VA brass to begin plugging the holes immediately. While the VA worked on a long-term mental health plan to implement the reforms, the agency's Special Committee on PTSD delivered an October report to Congress, warning that with more soldiers with PTSD arriving home, services needed beefing up. During the 1980s, the VA had recommended that there be teams of PTSD counselors at all VA medical centers. Two decades later, the report noted, barely half of the 163 facilities had them.
The VA plan estimated it would take $1.65 billion by 2008 to fix things.
Similarly, the PTSD Committee conceded that the VA couldn't be expected to treat psychologically troubled vets from Iraq and Afghanistan while still caring for those already in the system. "If the human cost of PTSD and its related disorders is staggering, so are the long-term medical costs to the VA associated with chronic PTSD," the report stated.
The House Veterans Affairs Committee urged Congress to pump an additional $2.5 billion into the Bush Administration's VA health care budget for 2005. But by November, with the budget poised for passage, it seemed unlikely, despite warnings from veterans groups and VA doctors on the PTSD Committee.
These same doctors knew they could treat the disorder better than anyone. They have been on the cutting edge of PTSD since its diagnosis was born from a war whose lessons now seemed distant.
NEW NAME, OLD PROBLEM
Sgt. Dave Durman did a tour in the Mekong Delta in 1969. He was 18 and had joined the Navy the minute he got his draft notice, even though some of his buddies had already gone and died there. "I think it was because I just really loved the water," Durman says.
Durman also loved working on the supply ship where he was stationed and the pulsing adrenaline whenever his unit supported the Marines on missions around the South Vietnamese coast. He loved it all so much that he stayed in the Navy for nine years and, in 1995, joined the Virginia National Guard's 1032nd Transportation Company, 10 miles from his home in Kingsport, Tenn.
In February 2003, Durman's unit was sent to Kuwait. He was 52 years old.
Two months later, the 1032nd crossed into Iraq, charged with shipping supplies from the southern city of Talil 300 miles north to Balad. Other convoys had been attacked on the same route, so Durman and the 19-year-old soldier who rode with him slung their flak jackets protectively over the outside of both truck doors because, Durman says, "You could stab a hole through those doors with a knife."
During one August haul, Durman came upon a group of Iraqi police who had just shot two children for stripping a car on the side of the road. He drove right by their bodies. "We're told not to interfere with domestic affairs," Durman says quietly.
"I didn't want to get personally close to the Iraqis, because I knew we might have to shoot them," he continues. "I'd look into their eyes and they all looked like gooks."
In September, Durman's unit shipped back to Virginia. It was then the nightmares started, about Iraq, but also things he'd buried his abusive childhood, Vietnam.
His girlfriend, Teresa A. McKay, noticed that Durman, once confident and kind, now broke into random sweats and angered easily. He drank too much whiskey and bought a .357-caliber pistol. Their sex life, McKay said, went "190 degrees different."
To McKay, a former nurse who'd worked with homeless Vietnam veterans, Durman's behavior looked disquietingly familiar.
Indeed, Vietnam provides the clinical and historical framework for PTSD and Iraq. Before Vietnam, treatment of a soldier for the psychological effects of battle was not really treatment at all, even though PTSD had long been acknowledged under a variety of names.
In 1871, former Union Army medic J.M. Da Costa wrote about a disorder caused by heavy fighting. He called it "Irritable Heart," a name changed shortly thereafter to "Soldier's Heart."
During World War I, according to VA psychiatrist Jonathan Shay, veterans returning home with Soldier's Heart were told by doctors they had "shell shock," or "combat neurosis."
After World War II, says Shay, when tens of thousands of soldiers were hospitalized with psychiatric problems, doctors diagnosed the majority with paranoid schizophrenia.
"The diagnostic spirit which prevailed was based on Plato's idea that if you had good parentage, good genes, a good education, then no bad things could shake you from the path of virtue," says Shay.
During Vietnam, that Platonic ideal began to shift. In 1970, 20 young vets from the group Vietnam Veterans Against the War (VVAW) called in psychiatrist Robert Jay Lifton to speak with them about the war. The vets didn't trust the VA or the military, but knew they needed to calm the devils they'd brought home.
Lifton, who had studied Hiroshima survivors and been an army psychiatrist, began meeting in New York with the group in what became known as "rap sessions."
He was shocked by the veterans' traumas.
"These men talked about a particular combat situation that had a level of extremity which was new, even to me," Lifton says.
Prompted by the rap sessions, VVAW opened up dozens of "storefront" counseling centers places where Vietnam veterans could speak with other vets about their experiences, a crucial part of treating PTSD.
Still, despite the growing number of vets clearly suffering, the VA wouldn't accept PTSD as a diagnostic entity.
"This was because many of them were talking about atrocities, and that process was associated with a political view of the war," says Lifton.
In 1979, the VA opened up its own network of storefront "vet centers." A year later, the American Psychiatric Association recognized PTSD as a legitimate medical diagnosis.
When the National Vietnam Veterans Readjustment Study concluded in 1988 that 30 percent of Vietnam vets suffered from PTSD, not many were surprised.
By then, Lifton (who never worked for the VA) and individual VA psychiatrists like Friedman had become leading experts on PTSD and pushed the condition into psychiatric and public consciousness.
Through therapy, and sometimes medication, the VA was helping veterans heal, though the process could take years.
But by the time U.S. soldiers touched Iraqi soil, because of the enormous growth in the number of vets seeking mental health services and the VA's failure to adequately respond, the advancements in PTSD treatment were being compromised.
A new conflict, which bore an uneasy resemblance to Vietnam for the doctors who knew that war's demons, would test those advancements even further.
As Crystal Luker tells it, May 5, 2004, was the day her husband's platoon ran into trouble.
As usual, on that afternoon, Spc. Ron Luker was patrolling a section of Baghdad with his 1st Cavalry Division platoon.
"There was a lieutenant in the first Humvee, Ron was in the second, and his platoon sergeant was in the third with a group of privates," Crystal says.
A 19-year-old specialist from Tulsa named James Marshall, whom Ron had been looking after, also rode in the third Humvee. As the convoy snaked through a teeming Baghdad street market, there was an explosion.
"The lieutenant was yelling over the radio for all of them to haul ass back to the base because they were coming under fire," Crystal says.
When Luker looked behind him, he was horrified. The third Humvee was gone. He flipped his vehicle around and hurtled back down the street.
"When Ron tried pulling James' body out, his hands just went right inside of him. He pulled James' flak jacket back and his chest was gone."
Before that day, Luker called and wrote home religiously, unburdening himself to the woman he'd fallen in love with at a Mariposa, Calif., restaurant four years earlier. But when he came home to Fort Hood, Texas, for a week in August, things changed dramatically.
That first night, at a welcome-home barbecue, Luker cornered his wife in the kitchen.
"He asked why I'd been avoiding him and said that I didn't want to be around him," Crystal says. When Luker started cursing, some army friends pulled him away. "You didn't come all the way home to fight with your wife," they told him.
As the week went on, there was more arguing. Crystal says her husband accused her of cheating while he was gone. He rifled through her purse and the bedroom drawers, and repeatedly listened to old phone messages, searching for proof.
"I told him, 'You're scaring me! You're not acting right, Ron!'" Crystal says.
Luker also seemed bothered around his three daughters. In an emotional revelation, he told his wife why.
"He said he'd turned into a monster in Iraq. How he couldn't bounce his kids on his knee when he'd shoved guns in women's faces and busted into houses and pushed kids on the floor. He kept saying, 'I'm just trying to remember who I was before.'"
Ron Luker's problems fit into those of the growing numbers of PTSD soldiers. They also signal another trend soldiers experiencing PTSD early.
VA psychologist Scott Murray says many vets won't feel symptoms of PTSD until 15 months from now.
"This early on, PTSD is much higher than anything we've seen in previous conflicts," Murray says. "We anticipate the numbers are only going to keep getting higher."
Psychologist Kaye Baron currently treats some 70 active soldiers and their families in a private practice in Colorado Springs, near Fort Carson. From clinical discussions she's had with soldiers, Baron thinks the PTSD rate could spike as high as 75 percent.
Such a rate, Lifton says, is inexorably tied to the war itself.
"This is a counterinsurgency being fought against an enemy which is hard to identify, and that leads to extraordinary stress," he says.
According to Shay, the issue with the most potential for psychological torment is whether soldiers feel they've been led into battle for a noble cause.
Shay, who compared the Vietnam veteran's battle experience to that of Achilles in his book Achilles in Vietnam: Combat Trauma and the Undoing of Character, wrote that the Greek hero felt betrayed by his arrogant general, Agamemnon, whose disrespect of a priest of Apollo brought down a plague on the Greeks.
"If a soldier has experienced a betrayal of what's right by those in charge, their capacity for social trust can be impaired for the rest of their lives," Shay says.
Indeed, Durman says he first began feeling uncomfortable in Iraq when it became clear there were no WMDs. He says his unit was furious when Gen. Tommy Franks retired midwar, while the rest of the National Guard and reservists were subject to the Army's "stop-loss" policy, which extends soldiers' deployments.
Padilla and Luker were outraged when they saw Iraqi children playing in human sewage gurgling through the streets while the Army did nothing. "I thought we were here to help these people," Padilla says.
That sense of betrayal translates into what Shay calls "complex PTSD": nightmares, paranoia, violence, self-hate and a crippling distrust. Shay, who also analogized the Vietnam veteran's homecoming to Odysseus' tortured return to Ithaca in a second book, Odysseus in America: Combat Trauma and the Trials of Homecoming, says that after Vietnam, "vets were coming home and burning through their social capital. Everything in their life was being destroyed or used up."
Peterson's dream-induced violence, Padilla's bar fights, Durman's drinking, Luker's accusations about his wife are powerful examples of a similar dynamic.
According to the VA, veterans with PTSD are more apt to be jobless, impoverished, homeless, addicted, imprisoned, without a stable family and three times more likely to die early.
Many of the soldiers Baron treats tell her they want to get far away from home. "They just want to go off in the mountains," she says.
Since reporting on this story began in October, Peterson and Durman have started therapy at the VA. They're likely getting some of the most advanced care in the world. They're also lucky. Peterson's mother-in-law knows a VA psychiatrist, and Durman was already enrolled, thanks to his time in the Navy.
Meanwhile, Padilla is trying to leave the military and says he'll get help once out. Luker is still in Iraq and Crystal Luker says she'll drag her husband to the VA if she has to.
These soldiers won't be alone. So far, more than 10,000 veterans from Iraq and Afghanistan have sought psychological help from the VA, and there's every indication the numbers will jump significantly.
Despite the challenges these numbers predict, Harold Kudler, co-chair of the VA's PTSD Committee, says, "We've never been so prepared," and points to unprecedented cooperation with the Department of Defense, intensified PTSD outreach and the 206 vet centers.
Some say that preparation isn't enough. "You can only provide the services for which you have the resources," says VA psychologist Murray. "There has to be significant improvement in an allocation of funds to make that occur."
On Nov. 20, Congress added $1 billion to the Bush Administration's $27.1 billion VA health care budget for 2005. The amount fell $1.5 billion short of what was recommended by the House Veterans Affairs Committee. And while Congress earmarked an additional $15 million for PTSD, few think that money will make much difference.
"The heads of the VA health care networks are all trying to figure out how the hell they're going to manage," says Rick Weidman, director of government relations for Vietnam Veterans of America.
As for the VA's mental health plan, which estimated an extra $1.65 billion was needed to fix things fully, VA spokesperson Laurie Tranter says, "We cannot comment on this now. The plan is still being finalized."
Still, all the money and services in the world will not necessarily solve the pain of PTSD.
In 1968, a young soldier named Lewis Puller came back from Vietnam without his legs and part of his hands, which were blown off by a Viet Cong land mine. Puller, the son of the most decorated Marine in American history, soon became a veterans' rights advocate and later a Pentagon lawyer. He married a politician, had two children and, in 1991, wrote a Pulitzer Prize-winning memoir called Fortunate Son. Popular on Capitol Hill and among veterans, Puller had seemingly risen from the physical wounds and the depression and alcoholism which haunted him for years to live a remarkable life.
On May 11, 1994, 26 years after returning home, Puller shot himself. In the end, the Soldier's Heart hurt too much.
Amidst an outpouring of grief, one Vietnam vet wrote an e-mail to Shay, which he published in Odysseus in America.
"I get real tired of hidin' and runnin' from the demons," the vet wrote. "Am I the only one? Has it crossed anyone else's mind? You think maybe Lew was right? Is it the only real escape? I got questions. I'm out of answers."
Thirty years from now, one wonders how many veterans from this war will echo those words.