The U.S. Defense Department has launched a new effort to address the mental health needs of members of the military. But it says the effort to coordinate medical, academic, research and other military capabilities, and combine them with civilian assets, will not be fully operational for two years. A new book by a U.S. Navy psychologist who served with the Marines in Iraq indicates there is a need right now for a strong focus on the mental health of the troops. VOA Pentagon Correspondent Al Pessin interviewed Dr. Heidi Squier Kraft.
"One thing I've learned about all of this is that all of us had no idea what expect, I think, and this went across all medical specialties," said Heidi Squier Kraft. "I really had this incredible feeling of being totally blind going in, just no idea what was ahead of us."
Dr. Kraft was driving home from work at a navy hospital in Florida in January of 2004, planning to spend the evening with her 15-month-old twins and her husband, when her pager went off. It was her commanding officer calling, and she used her cell phone to call back. The commander told her to stop the car, and then told her she was being sent to Iraq. Dr. Kraft had to report for pre-deployment training in 11 days.
"The way we were trained really was, was...They tried, but they didn't know what to expect either," she said.
Dr. Kraft says old terminology like 'shell shock' and 'combat fatigue' gave way to new concepts like 'post-traumatic stress disorder.' But she says none of it really described what marines face in combat. And she says the concepts didn't provide the military psychologists and psychiatrists with clear ways to treat men and women, who had lost limbs, lost friends, and had to function with almost indescribable fear on a daily basis.
"I think what it came down to was trusting my instincts because it had been a long time since we'd had mental health people dealing with any of these situations," she said. "We had to, sort of, just trust ourselves, our instincts as providers and as people who cared about our patients, and just know that there was no manual."
Dr. Kraft worked at the al-Asad Air Base in western Iraq's al-Anbar Province, which in 2004 was one of the most violent parts of the country.
She remembers one young marine in particular who came into the hospital with a severe injury to his arm. It was his third combat wound in just two months in Iraq.
"He expressed to me that he felt very fearful of going back to the battlefield," said Dr. Kraft. "And yet, more than the fear, he felt so much shame of feeling the fear. And so I said to him, 'There's nothing normal about this situation and there is absolutely nothing that tells us what you should feel right. So, pretty much whatever you're feeling is fine.' The fear, the grief, the guilt, the shame, the tears, every one of those things made sense."
A psychologist seldom deals with such trauma outside a combat zone. But at least Dr. Kraft had years of training and experience to prepare her to treat her marine patients in Iraq. What she was not so prepared for was the trauma she experienced herself, with shells landing on the base nearly every day for the first several months she was there, and helicopters delivering the war's carnage to her doorstep.
"The part that I realized as soon as we got there was that it was different being in that situation ourselves - the providers and the doctors also fearing for their lives and also seeing traumatic situations and losing friends and patients and people that they care about," said Heidi Squier Kraft. "It adds this element of needing to, sort of, dig deeper to find what you need in order to take care of your patients."
As her seven-month deployment went on, Dr. Kraft eased her own trauma by exercising every morning, even through the hottest months of summer, and by watching recorded television shows with other members of the medical staff most evenings. But when she got home, this navy psychologist found that, just like many of the soldiers and marines who serve on the front lines, she had trouble fitting back in.
"It was very difficult to reconnect with my family, my children, my husband, friends," she said. "Everyone said I sounded really different, that I sounded far away, distant. I cried when things weren't sad. I couldn't cry when things were sad. I really had a long hard road."
Dr. Kraft had classic symptoms of post-traumatic stress disorder, and she provided her own therapy, somewhat unintentionally, by writing her book.
"It was very painful at first, and I really resisted for a long time,"said Dr. Kraft. "And then I finally started, and the second chapter was a little bit easier than the first, and the third was a little easier than the second. And about a year later, 250 pages later, I felt like I was solid again."
Dr. Kraft's book is called Rule Number Two, Lessons I Learned in a Combat Hospital. 'Rule Number Two' refers to a quote from the old U.S. television show M*A*S*H, which is set in a combat hospital. A senior doctor tells the others that in combat, "Rule number one is, young men die. And rule number two is, doctors can't change rule number one." For Heidi Kraft, the rules for combat psychologists are only slightly different.
"Our version was probably more that war damages people," she said. "Rule number two, of course, is still the same, we still can't change that. We were faced with people who were damaged by the trauma of combat, and it was our job to try to mitigate that damage in any way that we could to try to help them find the way back."
In the book she wonders whether psychologists in combat can do much more than patch up their patients' mental trauma, just like physicians patch up their physical trauma - whether, as she puts it, combat and mental health are mutually exclusive. Now, she thinks she has an answer.
"Yeah, I think they're probably mutually exclusive," she said. "Mental health in the overall sense of wellbeing and peace and harmony within one's self - probably not a true goal for the combat zone."
But now, back in the United States, she has a better chance. Dr. Kraft left the navy after she returned from Iraq, not wanting to risk another deployment away from her small children. Now she works for the Navy as a civilian, treating marines who have psychological problems from their combat deployments, something her time in Iraq makes her uniquely qualified to do.