Back from the Wars

An incipient case of “delayed onset PTSD”?

Posted Nov 21, 2018

In 2012, Jeremy was deployed to Afghanistan with his Marine Corps Reserves unit. His Military Occupational Specialty (MOS) was Combat Engineer: “I swept for mines, IEDs [improvised explosive devices], blew open doors to force entry into houses the Taliban were holed up in.” Jeremy’s unit completed a seven-month tour of duty there, doing their utmost to protect local civilians from the Taliban. They lost two of their own to IEDs, with a dozen more wounded. “I was lucky,” he says. “I came back – and with all my body parts.” He earned the Combat Action Ribbon and a Bronze Star for Valor. In 2014, after 8 years of service, he was honorably discharged at the rank of E-5 (Sergeant).

Since then, he has been doing fairly well. He has a good job, supervising production at a plant that makes “expedition quality” outdoor equipment (“We sell a lot of tents to the Department of Defense”). He applies his Marine Corp ethos to his work: “As a leader, it is my responsibility to be the first to arrive and the last to leave. I never ask anyone to do a job that I wouldn’t do myself. If we have to work on weekends or holidays, you can be sure that I am going to be there right next to you.” He admits that his job can be stressful: “In the final accounting, I am the person responsible for every product that goes out those doors. If someone gets hurt on the job, that’s on me. If we don’t meet our production schedule, I don’t go around looking for someone else to blame.”

He has earned several pay raises over the past few years. The owners of the plant value him very highly. They even backed Jeremy up when an employee complained about his unpredictable and intense anger outbursts. They equate his intensity with a drive to get the job done right, and his occasional anger with a predilection not to suffer fools lightly. And since Jeremy took over, the safety record in the plant has been outstanding. He seems to have a sixth sense in anticipated potential safety hazards, and he comes down hard on workers who aren’t using their protective gear.

His wife appreciates how hard he works, although she can’t help but worry about him. She knows that he doesn’t sleep well at night. They moved to separate bedrooms about a year ago; it was too frightening to wake up so frequently to his yelling in his sleep. More than once, she was awoken by Jeremy pushing her out of bed and onto the floor, yelling, “Down! Get down!” She often hears him walking around the house late at night; he can’t get back to sleep after waking up from one his nightmares about combat. She sometimes watches him as he patrols around outside the house at night, armed with a pistol.

Yeongsik Im/Shutterstock
Source: Yeongsik Im/Shutterstock

Jeremy was drinking a lot more than he used to after he got back from Afghanistan. At first, it was as if he was celebrating still being alive, but later when he drank, his moods turned dark. One night after dinner, he was sitting in the living room drinking beer after beer. When his daughter, then 6 years old, jumped into his lap for a goodnight hug, he cursed and sent her fleeing upstairs, crying. The next day when he got home, he reached into the refrigerator for a beer and found none. He looked where he kept his liquor and that was gone too. He stormed out of the house and drove around for a couple of hours. Neither he nor his wife ever talked about the incident, but he hasn’t drank since.

I asked Jeremy if any of the men from his unit had died by suicide since returning.

He said, “Yeah, a couple.”

Guys you knew pretty well?

“Sort of.”

How often does it cross your mind, dying by suicide?

“Look. I’m not going to lie. There’s nobody who doesn’t think about it sometimes. But there’s a long way from thinking to doing. I’ve never taken any action on it. No.”

Ever hold a loaded weapon with suicide on your mind?

“Yeah. Sure I have. But that doesn’t mean I was going to do it.”

Damn close, though, isn’t it?

“Yeah. Pretty damn close.”

What stopped you the last time?

“It’s weird. I saw my wife finding me. Like literally saw it. Like a vision. No one should have to see that.”

You should know.

“Yeah. I saw plenty of that.”

Lightfield Studios/Shutterstock
Source: Lightfield Studios/Shutterstock

I met Jeremy because he had filed a disability claim with the Department of Veterans Affairs for “insomnia.” When I asked if he had ever considered whether he might have Post-traumatic Stress Disorder, he said, “That’s not a very popular idea in the Marine Corps. It’s discouraged.”

Does that mean you don’t think you have it?

“PTSD’s for guys who never went out past the wire. The FOBBITs who wet their pants because a mortar round landed 200 meters away from them.”

So the idea of getting some kind of treatment – maybe talking to somebody like me about those nightmares…

“That’s not going to happen. I don’t have time for that.”  

“Jeremy” is a pseudonym, and the details of his case history are formed from a composite of hundreds of soldiers, sailors, airmen, and Marines I have evaluated over the past nearly two decades. If you recognize your own story in his tale, it is not because I met with you or read your medical records, it’s because there are so many other people like you going through the same struggle.

Currently, I see two main categories of combat veterans: 1) younger veterans like Jeremy who are “pushing through” their symptoms, primarily through overwork; and, 2) older veterans who managed their PTSD symptoms in the same way for decades, and who only sought mental health treatment after retirement, when their symptoms became unmanageable.

I will present the case of Hal, a retired Vietnam veteran who is new to treatment, in my next post.