War Wounds

By NICHOLAS D. KRISTOF

IT would be so much easier, Maj. Ben Richards says, if he had just lost a leg in Iraq.

Instead, he finds himself losing his mind, or at least a part of it. And if you want to understand how America is failing its soldiers and veterans, honoring them with lip service and ceremonies but breaking faith with them on all that matters most, listen to the story of Major Richards.

For starters, he’s brilliant. (Or at least he was.) He speaks Chinese and taught at West Point, and his medical evaluations suggest that until his recent problems he had an I.Q. of about 148. After he graduated from West Point, in 2000, he received glowing reviews.

“Ben Richards is one of the best military officers I have worked with in 13 years of service,” noted an evaluation, one of many military and medical documents he shared with me.

Yet Richards’s intellect almost exacerbates his suffering, for it better equips him to monitor his mental deterioration — and the failings of the Army that he has revered since he was a young boy.

Military suicides are the starkest gauge of our nation’s failure to care adequately for those who served in uniform. With America’s wars winding down, the United States is now losing more soldiers to suicide than to the enemy. Include veterans, and the tragedy is even more sweeping. For every soldier killed in war this year, about 25 veterans now take their own lives.

President Obama said recently that it was an “outrage” that some service members and veterans sought help but couldn’t get it: “We’ve got to do better. This has to be all hands on deck.” Admirable words, but so far they’ve neither made much impact nor offered consolation to those who call the suicide prevention hot line and end up on hold.

The military’s problems with mental health services go far beyond suicide or the occasional murders committed by soldiers and veterans. Far more common are people like Richards, who does not contemplate violence of any kind but is still profoundly disabled.

An astonishing 45 percent of those who served in Iraq or Afghanistan are now seeking compensation for injuries, in many cases psychological ones. It’s unclear how many are exaggerated or even fraudulent, but what is clear is this: the financial cost of these disabilities will be huge, yet it is dwarfed by the human cost.

Richards’s finest hour, and in retrospect his worst, came in Iraq in 2007. He was then a captain assigned to the city of Baquba, a hotly contested area where he was welcomed on his first day by a 12-hour firefight. In Baquba, Richards pioneered an initiative to cooperate with local Sunni Muslim militias — who had previously attacked Americans — to defeat the local branch of Al Qaeda.

This was ferociously controversial at first and Richards was bitterly criticized by other officers for collaborating with the enemy. But the strategy worked and was broadly adopted by the military in Iraq. The New York Times wrote that year about Richards’s leadership; the Army promoted him, and he seemed destined for greatness.

Then one day a car bomb destroyed his Stryker vehicle, giving Richards a severe concussion that left him nauseated and dazed for a week. Three weeks later, a roadside bomb knocked him out again, and he suffered a second concussion, with similar results.

Richards, now 36, struggled for months with headaches, fatigue, insomnia and fainting spells; once he passed out in the middle of a firefight. Still, he didn’t seek medical care. He figured he wasn’t really injured, and that has been a widespread problem: the military value system is such that warriors disdain medical care as long as they are physically capable of fighting.

“Coming from an Army ethos,” he says wryly, “you’re not even entitled to complain unless you’ve lost all four limbs.”

Yet there’s growing evidence that concussions — whether in sports or in the military — are every bit as damaging as far bloodier wounds. When someone suffers blows to the head, the result can be a traumatic brain injury, or T.B.I. This, eventually, was Richards’s diagnosis.

Richards’s wife, Farrah, was thrilled when he returned “safely” from Iraq in the fall of 2007, and she counted them both very, very lucky. But almost immediately, Farrah says, she noticed that the man who came home wore her husband’s skin but was different inside. “There were obvious changes in his personality,” she recalls. “He was extremely withdrawn; he would go into the bedroom for hours.”

A once boisterous dad who loved to roughhouse with his children — now there are four, ages 1 to 14 — Ben no longer seemed to know how to play with them. He often suffered incapacitating headaches, overwhelming fatigue and constant insomnia. Especially when dozing, he was on a hair trigger. If Farrah rose at night, she sometimes didn’t return to bed for fear that her husband might think she was an enemy and attack her. Instead, she’d spend the rest of the night on the couch.

For a woman who had been functioning as a single mom and was now eager to resume her former married life, all this was devastating. And it got worse. Farrah would tell her husband things, and then he would repeatedly forget — and reproach her for not telling him. He was distracted, withdrawn and unhelpful, and he repeatedly let her down.

“Our marriage was at real risk at this point,” Richards says. “We got to a point where we thought about separating.”

Yet it became increasingly apparent that the problem wasn’t that Richards was a jerk. It was that he had a war injury, an invisible one.

It’s often said that traumatic brain injury and post-traumatic stress disorder, which Richards’s doctors also diagnosed, are the signature wounds of the Iraq and Afghan wars. That’s partly because of the strains of repeated combat tours and partly because the enemy now relies more on bombs than bullets.

These factors suggest an answer to a continuing mystery: Why is suicide among soldiers and veterans more common now? Data collection has been poor, but several studies suggest that suicides among Vietnam veterans were not elevated. And traditionally, suicide rates among military personnel were lower than among civilians. Yet that has changed in the last decade, perhaps because of the increased time that today’s troops have spent in combat and how common explosions — and resulting concussions — have become in war zones.

OF the 100 soldiers under Richards, about 90 were hit by at least one bomb blast, and one Stryker crew was hit five times, Richards says. Yet few received significant medical treatment or were pulled out of harm’s way to protect them from a repeat concussion.

Richards himself didn’t receive any thorough examination or prompt diagnosis, even though he sought help from a series of doctors and counselors. He and Farrah just knew that something was wrong with his mind — and the intellectual toll became clearer when the Army sent him to Georgetown University to earn a graduate degree. The once brilliant scholar found that his brain just didn’t function properly.

“The paper is disappointing,” Professor Nancy Bernkopf Tucker commented on one of his term papers, on China. “Parts are not coherent and overall it is not effective. It is not well written and it is sloppy. Of greatest significance is the lack of analysis.”

Tucker told me that she recalled Richards well. “I remember him partly because I liked him so much,” she said. “He never told me about his background, and all I saw was someone not living up to his potential.”

Richards agreed with her comments on his work. His pure reasoning capacity is unimpaired, but his memory and ability to concentrate are faulty. In effect, he is a brilliant man tracking his cognitive deterioration.

After stumbling along to complete his Georgetown degree, Richards moved to West Point two years ago to take up a teaching position. He was elated to be teaching there — but he found himself losing his train of thought in class. He couldn’t read more than a few pages at a time. Richards saw that students were looking at him questioningly, trying to figure out what was wrong.

“It hurts, it’s humiliating,” he said. “I was always thinking maybe this is just something psychological — I’m an Army guy, I can get over this.” It was at this time, three years after the concussions in Iraq, that military physicians finally gave Richards a diagnosis of traumatic brain injury. Meanwhile, the headaches, the insomnia, the fatigue and the concentration problems grew worse, and he was embarrassed that medication for the headaches led him to put on 45 pounds.

Realizing that he wasn’t cutting it as an instructor, Richards asked in March to be relieved of his teaching duties. After a battery of physical and psychiatric tests, including a scan that found eight lesions in his brain tissue, the Army confirmed that he was disabled. He is retiring this month.

“Leaving the Army is the hardest thing I ever did,” he told me, and he seemed near tears.

Sometimes Richards is optimistic and imagines that he can find a new career — “if I get smart again,” as he puts it. But then reality sets in, often in the form of an agonizing headache. As we sat together in their living room, Farrah gently dismissed the idea of Ben’s working and said that she can’t even trust him to look after the toddler. Ben bit his lip and nodded slowly. “I’m basically unemployable,” he said.

Ben and Farrah found that they could no longer afford to live near West Point, so they have just moved to Iowa to be near Farrah’s parents. The couple’s marital strains seem mended, and Farrah says that now that she understands that her husband is suffering from a war wound, she is committed to seeing him through.

“Farrah is an amazing lady to stick through this,” Ben told me. “I am not sure who is having a harder time with T.B.I., me or my wife. In many ways, I am different from the man she married.”

Countless spouses, parents and children of returning troops are struggling with similar challenges. Spouses often complain that the military treats them particularly poorly, and rarely communicates adequately. “They’ll be like, ‘your husband was briefed on that.’ ” Farrah said. “And I say, ‘well, my husband can’t remember that briefing.’ ”

COMPOUNDING the stress, the military and the Department of Veterans Affairs are vastly overburdened by the mental health demands of returning soldiers. And that’s not just the view of the troops but also of Secretary of Defense Leon Panetta.

“This system is going to be overwhelmed,” he said at a Congressional hearing last month. “Let’s not kid anybody. We’re looking at a system — it’s already overwhelmed.”

Panetta said that the “epidemic” of military suicide was “one of the most frustrating problems” he has faced as defense secretary. Obama talked about the challenge of military suicides as early as the 2008 campaign, and his administration deserves modest credit for (inadequate) steps to improve mental health care. Dr. Jonathan Woodson, assistant secretary of defense for health affairs, told me that the military had made progress in screening and treating traumatic brain injury and mental health, so that a soldier would be more likely to get help today than five years ago, when Richards suffered his blast injuries.

“We’re light-years more advanced now in terms of how we approach these problems and what we teach troops about getting help,” he said. In particular, blast injuries are tracked and treated more rigorously, he said, but he acknowledged that more work needed to be done.

Grim experiences like the one Richards endured might create an opening for Mitt Romney, but he isn’t taking it. As a governor and candidate, he has had a weak record on veterans, and he hasn’t shown leadership on the issue. He managed to speak to the Veterans of Foreign Wars last month without addressing veterans’ issues in a substantive way.

In any case, my take is that whatever political leaders say in Washington, and whatever directives emerge from the Pentagon, not nearly enough is changing on the ground. Mental health still isn’t the priority it should be. Just about every soldier or veteran I’ve talked to finds that in practice the mental health system is clogged with demands, and soldiers and veterans are falling through the cracks. Returning soldiers aren’t adequately screened, diagnosis and treatment of traumatic brain injury are still haphazard, and there hasn’t been nearly enough effort to change the warrior culture so that getting help is smart rather than sissy.

The National Alliance on Mental Illness recently offered an idea to help change this culture: the armed forces should award Purple Hearts for invisible, psychological wounds. That might help ease the stigma and would underscore that medical problems are real even if they are inside the head. The alliance also recommended that commanders be held accountable for preventable suicides.

While the challenges are acute for those on active duty, they often become even greater when troops take off their uniforms and become veterans seeking services from the hugely overburdened Veterans Affairs Department. Ben and Farrah have found it immensely difficult to get reliable information from the V.A. about what benefits they can count on. Richards says that in 11 phone calls, he has heard different stories every time.

“The V.A. is an abomination,” he said. “You see that hole in the wall?” He pointed at what looked like a rat hole. “That’s when I threw the phone after someone at V.A. hung up on me.”

None of this is a surprise. The V.A. says that veterans wait an average of eight months to get an initial decision on the claims they file. When service members seek to retire for medical reasons, the agency takes an average of 396 days to process their requests. Eric Shinseki, the secretary of veterans affairs, notes that the V.A. processes more claims each year than it did before, but that the number of new claims surges by an even greater amount. The upshot is that the V.A. steps up its game but still gets further behind.

Shinseki notes some areas of progress — the number of homeless veterans seems to have fallen significantly — and he points to new systems and hiring intended to make the system function better. The number of V.A. mental health staff members has risen from 13,000 in 2005 to more than 20,000 today, he said.

AT a time when nearly half of veterans returning from battle file disability claims, it’s fair to wonder whether word hasn’t spread that service members can claim some vague mental health ailment, like post-traumatic stress disorder, and get a paycheck from the government. The V.A. approves roughly half of claims, but the difficulty of diagnosis of mental health ailments means that they may not always be the legitimate ones. We may be getting the worst of all worlds: fraudulent claims approved, while legitimate ones are unrecognized or unconscionably delayed.

“The V.A. certainly doesn’t care,” says Jim Strickland, who runs the V.A. Watchdog Web site. “The very institution that should be at the forefront of caring for vets is dead last.” The Web site declares: “This country is capable of drafting you, putting you in boot camp, teaching you to kill someone, and then putting you in a war zone within six months. So why can’t they process a claim that fast?”

The same military that lavishes attention on its drones and aircraft carriers seems to take its people for granted. Stryker vehicles are refurbished, but not the men who operate them. The military health insurance won’t cover some of the treatments that doctors recommended for Richards.

All this is unforgivable, but it’s also shortsighted. The military’s most valuable assets aren’t its Strykers or tanks, but the highly trained troops inside them. When a soldier is harmed by repeat concussions, hundreds of thousands of dollars invested in training are squandered. And shoddy treatment of returning soldiers will undermine recruitment and retention in the future.

I asked Ben and Farrah why they agreed to tell their story and share medical and personal files, some of which detail Ben’s deterioration to a degree that is almost humiliating. “I regard this as my residual duty,” he replied. He thinks that he let his soldiers down by letting them return to action after suffering concussions, and he wants to atone by helping to call attention to a system that fails so many soldiers and veterans.

Farrah is scathing about what she sees as the failure of the Army and V.A. to support the troops. She adds, “Our leaders, political and military, have not been honest with people about the cost of the war.”

As for Ben, he’s not nearly as harsh. It’s clear that he still adores the Army, and he is less bitter than wistful.

“I’m extremely proud of what I did in Iraq,” he told me. “I recognize that this was a risk that I voluntarily accepted.” Many others have suffered far worse injuries, he notes, or are suffering alone without the soul mate he has in Farrah.

Both Farrah and Ben wish that his injury were more obvious. If he were in a wheelchair, neighbors would think of him as a hero, instead of as perhaps a malingering crackpot.

“I’d trade a leg for this in a heartbeat,” Ben said. “If all I was missing was a leg, I’d be a stud. And if I’d lost a leg, I’d be able to stay in the Army. That’s all I want to do.” He summed up his future: “it comes to failure.”

But that’s flat wrong. In speaking out with brutal candor about his injury and decline, Maj. Ben Richards exemplifies courage and leadership. He’s not damaged goods, but a hero. Maybe, if our leaders are listening, one of his last remaining dreams is still achievable: that his story will help win better treatment for so many others like him.

NYT