One soldier’s struggle with torture, trauma and moral injury

Written by Eric on February 13, 2016 in: Uncategorized |

Lt. Col. Bill Edmonds was shattered four years ago when he made a personal moral inventory and came to the realization that he had done too little to prevent Iraqi interrogators from abusing or torturing jailed suspects, some of whom may have been innocent.

It only deepened his devastation that he had recommended an investigation into the torture of suspected Iraqi insurgents, apparently with American troops being complicit, but the investigation by our military officials cleared all the interrogators.

“I came to the brink of insanity and quite literally lost my mind,” Edmonds writes in his book, god is not here. “Desperate and within an inch of losing my life, I reached out for help, to both mental-health professionals and my military superiors – and they rolled their eyes.”

Talk about a triple whammy! Just about all the elements for moral injury are present here.

Edmonds’ journey into hell started in 2005 when, as a major and a U.S. Army Special Forces officer, he was assigned to be an adviser to an Iraqi intelligence office who conducted interrogations in the basement of a palace in Mosul that Saddam Hussein used to call the Guest House.

But it wasn’t just questioning. Interrogators regularly lied to the insurgents, telling them that their wives, brothers or children had been killed and that unless they confessed, they’d be stuck in prison during the funerals.

Edmonds had forbidden extreme interrogation techniques in the wake of the recent scandals at Abu Ghraib, but the Iraqi interrogators constantly argued for more extreme measures, arguing that without using force to get confessions, these killers would be back on the streets within days to ramp up lawlessness and violence against American soldiers.

It got harder to resist, until Edmonds reached a breaking point.

“I feel a fracture slide down the center of my chest,” he wrote. “Tonight, for the first time in my life, I passionately, fervently want to kill another human being. I want to reach across this small prison cell and let my shadow fly.”

Edmonds was able to walk away without losing it, although he wrote: “I became a man I no longer recognize. I’ve lost myself.”

Then came a new challenge: one of the Iraqi interrogators slapped a suspect in front of Edmonds. “Regardless of my excuses to ignore what I know is right, I am overwhelmed by the atrocity and the inhumanity of these killers and here, in these cells, I have the power to stop them,” he writes. “And I’m morally wrong when I do, and when I don’t.”

His response was to quit going to the prison, but that only increased his sense of guilt as he thought about what was probably happening to the suspects being held there.

Then Edmonds discovered that eight Iraqi prisoners were missing from another of the Iraqi prisons where other American advisers worked. When he finally tracked them down in another part of Iraq, the abuse was apparent.

“Those eight prisoners … were horribly tortured: burns, knife wounds, broken bones, electrical burns and welts from slashing cables,” he wrote.

He suspected the Iraqis tortured these prisoners at another prison overseen by Americans and sent them to a different location where they couldn’t be found. His conflict over what was right vs. what might save lives paralyzed him for a long time, but he finally forced himself to report his findings to the military authorities.

A full-scale investigation was ordered, and everyone was exonerated, he said.

“God help me,” he wrote. “Because I still so desperately want to torture, to kill, these evil people: I can already feel purgatory stalking me. But I have never done what I uncovered and then covered it up by vanishing them! And then this? I finally sensed a light in the distance and then I find out that no one gives a shit?”

So here you have a terribly conflicted man trying to force himself to do what he knows to be morally right, but being betrayed by his superior officers.

Dr. Jonathan Shay, the psychologist credited with coining the phrase moral injury, defines a situation like that as betrayal of trust. And he says that a betrayal of what is right by a person in legitimate authority can impair the capacity to trust and elevate despair, suicidality and interpersonal violence.

Five years later, Edmonds began a month-long meltdown. He tried desperately to fix his problem himself because he didn’t want to jeopardize his top-secret security clearance, but he couldn’t function.

When he sought help at a base mental health clinic, a psychologist listened to as much of the story as he was able to tell, then told him there was nothing wrong with him and sent him home. That’s likely because his symptoms were those of someone suffering from a moral injury, and the medical definition of PTSD doesn’t include moral injuries. The traditional diagnosis of PTSD is only about what others are trying to do to you – moral injury is about what you have done to others, or failed to do for others. PTSD should encompass both aspects, but it currently doesn’t.

So Edmonds said the docs told him he didn’t have a problem, just go home and get a grip. And that, of course, was another betrayal.

When he reported for work, Edmonds told his bosses what he figured they’d find out anyway, that he had gone to a mental health clinic seeking help for PTSD. With that, he said, they concluded he was a security risk and made his life an even greater hell for a month until they told him that if he would transfer out of the unit voluntarily, the episode wouldn’t be reflected in his personnel file.

Huge betrayal and a gaping moral injury.

“I don’t know how to put Iraq in words,” Edmonds wrote. “I don’t have the words to describe that inner fight, how my many selves struggled to navigate a year-long moral battlefield. How every day I was forced to make a choice – do I torture another human being or not – and how every day, over and over again, no matter the decision, I made a soul-crushing wrong choice, and how the other stresses of war, the daily expectation of death, the failing war strategy, the isolation, the austere environment, and the girlfriend back home, how these other things only compromised my mental immunity, lowered my resistance. Over time, my mind slowed, and then I just … turned off. I shut down.”

Did you notice that phrase, “I don’t have the words”?

That’s exactly what Bessel van der Kolk was talking about a couple of months ago in Philadelphia. When a brain is traumatized, the prefrontal cortex – the center of rational, ethical decision-making – shuts down. In particular, the brain’s language center – the Broca’s area – shuts down. “Without a functioning Broca’s area, you cannot put your thoughts and feelings into words,” van der Kolk said.

If Edmonds couldn’t talk about it, he could at least try to write about it. And writing became his therapy.

Getting up well before dawn, he thought about each of the moral quandaries he had found himself in. Slowly, he analyzed each of the actions he had taken … or failed to take. And when he felt his analysis was honest and accurate, he wrote it down on a pad over the kitchen table while his wife and children slept.

“The main lesson I took away from my moral examination is that it’s not the person that’s bad – it’s the situation,” Edmonds told me over dinner one night recently in Washington, D.C.

His book ends with one challenging statement: “The never-ending search for redemption is how I survive my purgatory.” I asked if that meant he was seeking to make atonement for what he had done, or failed to do, and Edmonds said that was right.

“My decision to write was my therapy, just for me,” he said. “But my decision to publish that writing was my way of seeking redemption.”





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After three years, VA finally reads a vet’s medical records and changes disability rating

Written by Eric on February 8, 2016 in: Uncategorized |

After battling a Missoula veteran’s disability rating for a traumatic brain injury for more than three years, the VA has finally blinked.

“The VA’s Appeals Management Center conducted a records review inclusive of my prior neuropsychological test results conducted by the Department of Defense (Army) and determined those original test results were sufficient to overturn the VA’s initial rating decision,” Charles Gatlin said last week.

Meanwhile, a second mental health advisory council to Montana’s governor accused the VA of providing substandard care to vets suffering from TBI.

Gatlin, a former infantry captain, suffered head injuries when a vehicle bomb exploded near him in Iraq in 2006. His wife, Ariana Del Negro, said his concussion was caused by the blast, by the engine block hitting his head, and by hitting his head again when he fell.

After undergoing extensive neurological testing for two days each in 2006, 2007 and 2009, the Army concluded that his injuries were permanent and discharged him with a 70 percent disability rating.

When Gatlin moved to Missoula to attend graduate school at the University of Montana, he went to Fort Harrison for his VA disability rating. His Army medical records were received by the VA in January 2012, but apparently ignored. Instead, Gatlin was given a brief screening assessment called RBANS (Repeatable Battery for the Assessment of Neuropsychological Status).

Then the VA dropped Gatlin’s TBI rating from 70 percent to 10 percent, although it attributed some of his difficulties to PTSD and added a 30 percent disability rating for that.

Gatlin challenged that rating and testified before the VA Board of Appeals in Washington D.C. in October 2013.

Gatlin and Del Negro also took their case before the Montana Board of Psychologists in Helena, arguing that the RBANS test was inadequate to measure mental deficits, that the psychologist who administered the test misinterpreted the results, and that the psychologist, Robert Bateen, wasn’t qualified to interpret the results.

The VA objected strongly, but the state licensing board agreed a year later. It concluded that Bateen was not qualified to provide a neuropsychological assessment of Gatlin, that he had failed to provide an adequate standard of care, and that he could not argue he was merely following VA policy.

“Licensee has an independent professional obligation to ensure his work as a psychologist complies with the statutes and rules governing his license,” concluded the Montana Board of Psychologists, and it barred him from evaluating vets for traumatic brain injuries at Fort Harrison.

In response to a query from Sen. Jon Tester that fall, the VA said it fully supported the test and the psychologist. It also said it had no intention of re-evaluating other vets who had been evaluated by Bateen.

“The stipulation Dr. Bateen signed with the Montana Board has not impacted our ability to conduct residual TBI C&P (compensation and pension) examinations in the state of Montana,” wrote Dr. Carolyn M. Clancy, interim under secretary of health for the VA in Washington, D.C. “The VA Montana Health Care System has three additional licensed psychologists who perform TBI C&P examinations, so there will be no impact on the completion of these examinations.

“These psychologists are not licensed in the state of Montana and need not be because this is a federal jurisdiction,” she added.

Then in May of 2015, after mulling the case for a year and a half, the VA Board of Appeals directed that all of Gatlin’s medical records be added to the case, that he be re-evaluated by “an appropriate medical specialists,” and that the claim be re-adjudicated. If the decision was adverse to the veteran, the appeals board said it wanted to see the case again.

But nothing happened until the Appeals Management Center, the VA’s top medical board actually read the record and reached its decision last summer without new testing.

Then two weeks ago, the Governor’s Traumatic Brain Injury Advisory Council decided to endorse the standards of the Montana Board of Psychologists, specifically citing the letters from Clancy.

“The letters …state the intention to not use methods of evaluation which apply to the condition or injury causing the disability and to not observe the standards of care outlined by the Montana Board of Psychologists,” council Chair Angela Wathan wrote in a letter to PHHS Director Richard Opper.

“It appears to the council that the VA is deliberately adopting a lower standard of care for veterans than that which is accepted for civilians,” she added. “This accepted standard of care is not always achieved in civilian care either, but it is remarkable to see it explicitly rejected by the VA.”

Wathan noted that vets who live more than 40 miles from a VA facility can choose to receive care from civilian providers, adding that she hopes they aren’t forced to abide by “the inadequate standard of care adopted by the VA.”

“Thus, veterans might still be denied access to appropriate specialists, evaluations and interventions,”Wathan wrote. “This would tend to oppose the efforts of the council to improve access and standards of care for all Montanans.”

However, Special Assistant Attorney General Tyler Moss of the state Department of Labor and Industry said Thursday that all psychologists licensed by the state are required to abide by state standards.

A greater concern is apparently that vets who receive blast injuries generally are treated for their physical injuries and possibly for concurrent PTSD, but seldom for neurological damage. The scientific literature shows that repetitive brain injuries can change the metabolic and immune systems. For example, the metabolism of oxygen diminishes in an injured brain, causing a lack of energy, cell damage, inflammation, and potential cell death.

Vets need greater access to neurologists than they’re currently getting, some mental health experts argue.

A spokeswoman for the VA’s, public information office in Washington, D.C., said Friday that she was not aware of any restrictions of private-care service imposed by the VA and that the number of neurologists employed by the VA has increased by about 13 percent in the past five years, from 619 in fiscal 2011 to 700 at the end of 2015.


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