To war and back and back again: Multiple tours linked to higher risk of PTSD

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Revolving door of multiple tours linked to PTSD

It wasn’t his first tour in Iraq, but his second and third when Joe Callan began wondering how long his luck would last — how many more months he could swerve around bombs buried in the dirt and duck mortars raining from the skies.

It was only natural, considering the horrors he’d seen: One buddy killed when a mortar engulfed his tent in flames. A fresh-faced Marine sniper dead (also a mortar) on his first day in Iraq. A 9-year-old Iraqi boy, blood trickling from his head, after he was mistakenly shot by U.S. troops.

Three tours in four years and Callan wanted out. Out of Iraq, out of the Marines.

“I became numb,” he says. “I just wanted to be home. And that became more intense each time.”

When Callan did return to New Mexico, he couldn’t sleep. He drank heavily. He had a short fuse. “I knew,” he now says, “I was different. But I didn’t think it was going to be that bad.”

Maj. Jeff Hall’s world imploded after his second tour in Iraq.

Overwhelmed with guilt and rage, the 18-year Army veteran became so depressed that one day he lay on the ground and pointed a pistol at his head. The only reason he didn’t kill himself, he says, is he didn’t want his two daughters to discover him. “I couldn’t do that to my kids,” he says. “I had seen people with their heads blown off.”

But the war had pushed Hall to the brink. “I had no peace at all,” he says.

No peace — on the battlefields of Iraq and Afghanistan, or in the minds of men and women who fought there. Callan and Hall are among hundreds of thousands of U.S. troops who’ve served multiple tours; they’re also among the tens of thousands diagnosed with post-traumatic stress disorder.

That is not a coincidence.

With two long wars — Afghanistan is in its ninth year and Iraq just entered its eighth — the U.S. military finds itself straining to maintain a steady flow of troops. More than 2 million men and women have been deployed to serve in both conflicts, and more than 40 percent of them have served at least two tours, according to military records.

Nearly 300,000 troops have served three, four or more times. (The vast majority of deployments last more than six months.)

For these men and women, life becomes a revolving door of war, home, then back to combat — sometimes within months — as they face the same dangers, the same stresses and the same agonizing separation from family.

Multiple tours, according to several studies, have been linked to stress, anxiety and PTSD, which is often marked by nightmares, flashbacks, angry outbursts and insomnia.

“It’s common sense,” says Dr. Judith Broder, founder of The Soldiers Project, which provides free, confidential counseling to returning troops and their families. “The more deployments there are, the greater the danger not just of combat stress but depression. … Many people also feel alienated and isolated from their family.”

After two Iraq stints 10 months apart, Maj. Jeff Hall wanted to be left alone.

He didn’t think he had helped the Iraqis or accomplished anything.

Looking back, Hall remembers the day he realized something was terribly wrong. It was after his first tour, when his family was having dinner at a restaurant and his daughter, Tami, then about 12, refused to touch her steak because sour cream had gotten on it.

Hall began crying.

His family was stunned. So was he.

What Hall didn’t reveal was his daughter’s fussiness had revived memories of a very poor family in Iraq that would regularly pick up gas for cooking at a propane station he had guarded. Their two girls — close to his daughters’ ages — were so emaciated their skin hung like loose cloth.

“I could just see the faces of the little girls,” Hall says. “It triggered a feeling of sadness and anger.”

But suicidal thoughts didn’t surface until after Hall’s second deployment, which was more aimless than the first. “It was like we were driving around until we got blown up,” he says.

In the first few months, Hall’s brigade lost more guys than the entire year in his first tour. One day a Humvee under his command ran over a massive bomb, killing two soldiers, seriously wounding another.

“I felt shame, absolute shame,” Hall says. “I was suffering from guilt. We were having no results. I described it to the psychologist two years later … It was like a complete loss of identity … and how you think life is or should be.”

His wife, Sheri, who had been encouraging her husband to get help, finally called his commander. That led to a civilian psychologist and a diagnosis of PTSD.

“I thought my career was over,” Hall says. “I thought, ‘What am I going to do?’ At the same time, I had this feeling of ‘Aha, there IS something wrong. I’m not making this up.’”

There’s no way to know for sure how a soldier will react to multiple tours.

Some go to war four times and never have a problem. Others never leave the United States and develop PTSD.

Justin Taylor started having anxiety attacks on his third tour in Iraq.

“I couldn’t breathe,” the former Army sergeant says. “We had mortars coming in. I was shaking and (a friend) said, ‘Dude, are you OK?’ When I had to go on patrol, I started feeling it. I had to suppress it.”

Back home, he began drinking heavily. When he got his marching orders for a fourth tour in 2007, he signed himself into a mental hospital. He later received an honorable discharge — without returning to Iraq.

Soldiers face repeated stresses that pile up, says Dr. Paul Ragan, an associate professor of psychiatry at Vanderbilt University and a Navy psychiatrist for the Marines during Desert Storm.

“The bottom line is trauma is cumulative,” he says. “It embeds itself in your brain and you can’t shake it loose.”

Military in-field surveys support the notion.

A 2009 report of Army troops in Afghanistan found the rate of psychological problems rose significantly with the number of deployments: 31 percent for three tours, more than double the rate of those with just one.

In Iraq, the survey found nearly 15 percent of Army troops who served two tours suffered from depression, anxiety or traumatic stress, more than double that of single tour. When it came to PTSD alone, the rate was almost 2.5 times higher for two deployments compared with one.

“We just don’t know whether it’s combat exposure, repeated separation from the family or (not enough) time off,” says Lt. Col. Paul Bliese, director of the division of psychiatry and neuroscience at the Walter Reed Army Institute of Research. “All of those are reasonable explanations.”

It’s not just combat that’s emotionally draining. It’s also the separation from families.

“When you come home, it’s not like everything is peachy keen,” Ragan says. “You’re trying to re-establish yourself with your family, then you’re gone again. How many times can you do that?”

And yet, some troops want to return, says Broder, of The Soldiers Project. “The big motivation is to be with their band of brothers,” she says.

Sam Rhodes, now a retired Army command sergeant major, was home about 40 days when he eagerly returned to Iraq a second time. “I felt that’s where I needed to be,” he says.

It was on his third tour when he collapsed — physically and mentally. He was diagnosed with PTSD.

The loss of seven soldiers in his brigade in a single month proved especially traumatic. “You think you’ve learned a lot in the previous deployments and you think ‘I’m going to do a better job of getting my guys home,’” he says.

When Rhodes returned to Fort Benning, Ga., in 2005, he and his wife of 26 years divorced.

In hindsight, Rhodes, who has since remarried, believes he should have taken a break of a year or more between tours.

Many experts believe soldiers aren’t home long enough — the military phrase is called dwell time — between tours. The Army study found it averaged 17 months, short of the two to three years considered optimal.

Ryan McNabb, a former Navy corpsman attached to the Marines, had four months between stints in Iraq — by choice. He volunteered for a regiment he felt would face less enemy fire than he saw on his first deployment.

On his second tour, McNabb worried constantly about family.

“Your mind is like, ‘Hey, things are fine.’ But no, they can’t be fine,” McNabb says. “You’re thinking, ‘I’m in Iraq, people are dying right and left.’”

Returning to North Carolina in 2006, he found comfort in booze. McNabb transferred to Italy, where he met his wife, Mandy. He later stopped drinking, but couldn’t control his anger.

Once when his wife couldn’t quiet their crying 8-month old son, he pulled the rearview mirror off their speeding car and smashed the global positioning system, shattering the windshield.

Others noticed McNabb’s troubles, but he was slow to acknowledge them.

“When you’re talking about PTSD, you don’t want to admit it to anyone or it’s, ‘Oh, yeah, I got a little.’”

Finally, his brother, Brock, an Army veteran of two Iraq tours, referred him to a center run by the Department of Veterans Affairs, where a counselor, a Vietnam veteran, helped.

McNabb, now 29, works as an outreach coordinator for a Vet Center in suburban Chicago. While Iraq is fresh in his memory, he’s not eager to share war stories.

“It’s like a drink. It makes you feel good right now,” he says, “but in the long run, what’s it going to do?”

The much-publicized suicides linked to PTSD are very real. But so are stories of those who find ways to survive.

Jeff Hall took the pistol from his head and put it down. He eventually found help in an intensive three-week treatment program at Walter Reed he attended with his wife.

“It gave me hope that there was a chance I could heal,” he says.

Hall is now creating the resilience campus at Fort Riley, Kan. The program will help soldiers and their families rebound from multiple tours and deal with the stresses of war and everyday life.

Still, he does not consider himself cured of PTSD.

“I don’t believe that you get over it,” he says. “I think you learn not to let it control you. You learn to control it.”

Sam Rhodes, the retired command sergeant major, has written a book about his own experiences, “Changing the Military Culture of Silence.” He travels the country, talking to military and civilian audiences to demystify PTSD.

“I tell people, ‘Look, I’m going to have PTSD the rest of my life,’” he says. “Only a normal person can go to war and see the things we have and feel what we have when we come back. If you’re rock hard and have no feeling of loss or anything, that’s what’s abnormal.”

Joe Callan, now 31, has always been rock hard. Growing up in rough neighborhoods and on a Navajo reservation exposed him to some harsh realities of life that were magnified thousands of times over in Iraq. He saw friends die, endured IED blasts and in one three-month period, faced almost daily mortar attacks.

His survival strategy was hang tough, be tough.

“I always ran at the problem. If we were getting shot at, I’d run at the bullets. If you shoot back more than they’re shooting at you, you’ll win,” he says.

Callan says he was told after his second tour that he probably had a stress disorder. He shrugged it off.

He ended his 11-year stint in the Marines two years ago, and it was then his life unraveled in a familiar pattern: Depression. Insomnia. Anger.

Callan credits his wife, Katy, their three kids and other family with helping him recover. Callan has been in and out of counseling; he has little time for that kind of stuff.

“I have to suck it up,” he says, “because people are depending on me.”

He has found renewed purpose in a job: He’s now an organizer for Iraq Veterans Against the War. Soon, he hopes, this war will be over.

“I just want to have a small farm,” he says, “hang out with my family, grow vegetables and be left alone. I just don’t want to be a part of it anymore.”

On the Net:

The Real Warriors Campaign: www.realwarriors.net

Sharon Cohen is a national writer for The Associated Press, based in Chicago. She can be reached at features(at)ap.org.