So what will the Army do with Sgt. John M. Russell, accused of killing five fellow soldiers last week at a military stress clinic in Baghdad?
Or, more to the point, what should it do?
Five deployments into combat zones created more stress than Russell could handle, his family’s chaplain told me in a phone conversation from Germany.
“If this individual could have had some objective way of measuring the stress he was un-der, the outcome would have been different,” Phil Davis said in a telephone interview from the big Army base in Bamberg, Germany. “And that’s why I say to his wife and everyone else that this was a very avoidable tragedy.”
Now Russell has been charged with five counts of murder.
According to the Army Times, Russell, of Sherman, Texas, was scheduled to return home in three months from his third tour of duty in Iraq.
He previously was deployed for six months in 1996 to Serbia and for seven months in 1998 to Bosnia.
“When the full story comes out, we’ll see that he was just a normal guy put into an abnor-mal situation,” Davis told me.
The Army has initiated an AR 15-6 investigation to determine whether there are adequate mental health care resources available in Iraq, the Army Times reported.
“From all accounts, he was not showing any signs of stress (before his last deployment),” Davis said. “His family is a happy family, and everything had been going well.
“The Army inquiry is under way because — from all accounts — there was no indication of the tragedy about to happen.”
Davis said stress can disorient a deployed service member’s mind, increasing the perceived magnitude of problems.
“It’s a pretty accurate guess that he felt threatened by someone and that his thought proc-ess made the unreal real,” Davis said. “As he played and replayed the requirements he had in a place where he was not being treated well, it became more and more intolerable.
“He had no way of putting a perspective on it, (or) the tools he needed to distance himself from those problems,” Davis said. “They became a personal affront to him.”
Davis is working with soldiers at Bamberg to provide those tools.
One of them is the mind-body bridging technique advocated by Stanley Block in his book, “Come to Your Senses.” Davis worked with Block at the University of Utah in Salt Lake City.
One aspect of that technique is using the senses — listening, smelling, seeing and touching your environment instead of wrestling with your thoughts.
A second aspect is accepting the things that a person can’t change and consciously lower-ing expectations of what to expect in certain situations.
Davis said he is seeking a grant that will allow military health professionals to create a mental health database at Bamberg. The database will show the prevalence of combat-induced disorders and the success of various therapies in treating them.
But the final question is ultimately the first: What should the Army do with Russell? Should he be locked away for murder by a military system that trains its members to kill? Or should he be treated for the emotional disorders that resulted from five tours of duty in combat zones?
You know the answer as well as I do: treatment.

While Montana continues to have one of the nation’s highest rates of alcoholism and drug abuse, the recovery rate after treatment is nearly twice as good as it was when I was writing the “Alcohol: Cradle to Grave” series of stories a decade ago.

And it was wonderful to see that several of the problems identified by those stories have been fixed. I suspect that’s one of the reasons for the improved success rate.

For one thing, counselors have found that the one-size-fits-all treatment method doesn’t work for alcoholics either.

“One big change is putting wrap-around services into the mix and allowing people the amount of treatment they need,” said Joan Cassidy, chief of the state Chemical Dependency Bureau. “One individual may need two weeks of treatment versus the next one who might need one year of treatment.”

The state now offers three tiers of treatment options: full hospitalization, two eight-bed facilities with full medical attention 24-7 in a home-based environment, or 11 supportive living centers based around the state.

In addition, the state is providing assistance in other living skills that alcoholics may be deficient in — things like education or financial planning or anger management.

These are the programs that Cassidy calls wrap-around services. They are designed to give alcoholics the social skills they need to survive in society.

Those two elements have nearly doubled the success rate of treatment, which used to see only about 40 percent of the patients still abstaining from drugs and alcohol six months after treatment. I noted at the time that the Hazelden Foundation in Center City, Minn., boasted a success rate of around 60 per cent at the time, largely on the basis on assigning local mentors. i.e. recovering alcoholics, to each patient leaving their facility.

Since 2003, the state of Montana has been checking its former patients every quarter, and it has found that six months after treatment:

ã 75 percent of its patients remained abstinent from alcohol and other drugs;

ã 63 percent were employed full time;

ã 86 percent remained clear of the criminal justice system;

ã 0.2 percent reported homelessness.

Court officials are beginning to recognize a need to treat these soldiers and veterans suf-fering from post-traumatic stress disorder and traumatic brain injury before they get caught up in a cycle of crime.
A coalition of legal officials and advocates for veterans in Maricopa County, Ariz., is con-sidering setting up a special court that would provide vets with the help they need to cope. Buffalo, N.Y., and Orange County, Calif., have launched similar specialty courts.
The courts’ goal: Keeping the troubled vets out of the criminal justice cycle. That could mean identifying veterans early in the system, connecting them to services the government already provides and linking the vets to a support network.
“One of the things that offended me is seeing a veteran who is self-medicating with alcohol or marijuana or meth and going to court and standing side-by-side with some gangbanger or lifetime criminal and being treated the same as them,” said Billy Little, an attorney and re-tired Air Force colonel. “I thought they deserved better than that.”
Many cities today have diversion programs that are designed to keep people in need of help — often alcoholics or drug addicts — out of the courts, provided they receive the treat-ment that they need.
With the growing number of combat vets suffering from PTSD, TBI or depression — one in three, according to the Rand Corp. in what it called a “conservative estimate” — it makes a lot of sense to create special courts for folks with these disorders. And it’s only fair to help these vets get the treatment they deserve — rather than a prison term.

Matt Kuntz of Helena, one of the major figures in Faces of Combat, is one of 18 “everyday Americans” selected to join President-elect Barack Obama on a Whistle Stop Tour to the nation’s capital on the Saturday before Inauguration Day.

Kuntz was chosen for his efforts in helping the mentally ill after his stepbrother Chris Dana committed suicide after returning from combat and being kicked out of the Natiopnal Guard with a less-than-honorable discharge. His work has led to changes in the way the Montana National Guard screens returning soldiers for post-traumatic stress disorder — and that was the focus of Faces of Combat.

A former Army officer and attorney who is now head of the Montana office of the National Alliance on Mental Illness, Kuntz met with Obama in Billings last fall as the Illinois senator was heading to Denver to accept the presidential nomination at the Democratic National Convention. Kuntz gave him a copy of Faces of Combat, which the president-elect promised to read. A few days later, in a nationally televised speech fromn Columbia University, Obama talked abolut ways in which the Montana National Guard had improved mental health services for its returning combat vets and referred to it as a national model.

Kuntz will fly to Philadelphia with his wife a few days before the Jan. 20 inauguration. They will travel by train with Obama to Washington, D.C. and then attend the inaugural ball.

            Montana is a state that clearly shows the stress of combat.

            It’s a patriotic place, where many sons tend to follow their fathers through military service. Even though their dads may still be struggling with the aftermath of the war in Vietnam four decades ago, our kids still think they’re tough enough to skate through a war unscathed..

Montana has the second-highest ratio of veterans in its population, ranking only behind Alaska.

It also has the second-highest number of alcohol-related deaths per capita in the nation.

And Montana leads the nation in the number of suicides per capita. While America as a whole reports 10 or 11 suicides per 100,000 population, Montana doubles the national average with 22 suicides per 100,000 population in 2005, the most recent year for which there are statistics.

There are about 180 suicides in Montana each year, and each suicide leaves an estimated six, emotionally scarred survivors.

The state health department talks about Montana as a frontier state; with about 4 people per square mile, there’s a lot of social isolation. In rural Montana, there’s not much access to mental health care, and there’s a stigma against seeking out a counselor. Furthermore, the state’s alcoholism rate is estimated to be 50 per higher than the national average. And there are a lot of guns available.

But I submit that the correlation between military service, post-traumatic stress disorder, depression, alcoholism and suicide may be one of the strongest indicators of the toll that combat takes.

Just in time for Veterans’ Day, there’s a growing realization that America’s 24 million vets are experiencing domestic violence in greater numbers than the general population at large.

Two professors at Washington University in St. Louis are teaming up to address this problem. One’s a specialist in post-traumatic stress disorder, while the other works with domestic violence.

“Treatments for domestic violence are very different from those for PTSD,” Monica Mattieu, Ph.D., an expert in vets’ mental health at Washington University, told Medical News Today. “The Department of Veterans Affairs has mental health services and treatments for PTSD, yet these services need to be combined with the specialized domestic violence intervention programs offered by community agencies for those veterans engaged in battering behavior against intimate partners and families.”

VA research shows that male vets with PTSD are two to three times more likely than vets without PTSD to be engaged in domestic violence and/or the legal system.

Vets are at higher risk anyway, partly due to the violence combat vets became accustomed to on the battlefield. Some of it may be due to traumatic brain injuries they brought home. But much of it is due to the depression and anger many combat vets experience. The Rand Corp recently released a report that said one in three vets will return home needing medical help for PTSD, TBI, major depression or a combination al all three.

“Veterans need to have multiple providers coordinating the care that is available to them, with each provider working on one treatment goal,” said Mattieu. Coordinated community response efforts such as this bring together law enforcement, the courts, social service agencies, community activists and advocates for women to address the problem of domestic violence.”

Again, the whole focus should be on understanding the cause of a problem and working to fix it, rather than the hard-nosed — and ultimately unworkable — approach of locking people up and throwing away the key. Our corrections system is a classic failure, so we have to create new approaches that will be more effective. As they say in the treatment community, insanity is continuing the same tactics and hoping for different outcomes.

Tuesday’s presidential election promises a bright new day for America after eight long years of the Bush Administration, although the New York Times had an ominous editorial this week about the civil liberties infringements and environmental damage it fears in the next 100 days before Barack Obama actually takes office.

Many political commentators thought that much of the popular vote for Obama was, in fact, a vote against President Bush. I suspect that’s true — Bush has done enormous damage to this country. I was intrigued to see an analysis by The Times of London ranking U.S. presidents. Bush came in 38th or 39th in a dead heat with Richard Milhouse Nixon, just behind Herbert Hoover whose administration was sandbagged by the great depression. Last on the list was James Buchanan, under whose lack of leadership the nation plunged into the Civil War. Leading the list was the man who inherited that mess, Abraham Lincoln.

So following a failure, Obama also has a good chance to succeed. I hope he can find a dignified way to quickly back out of the Iraqi-Afghan conflict, which has nearly bankrupted this nation, and bring our troops safely home. In addition to saving lives, that will cut a lot of our excess spending — a billion dollars a day, do I remember reading? But Obama’s hands will still be tied because Bush has run the national debt up to $10 trillion — one dollar of four that the government spends on discretionary budget items now goes to pay interest on all the money we’ve borrowed. By taking over Fannie Mae and Freddie Mac, the government may have taken on another $6 trillion in bad debt. And the Treasury Department is just beginning to take on another massive amount of debt to pay for the bailout of the nation’s financial institutions. (How can they call the Bushes and Ronald Reagan conservatives? They didn’t conserve a damn thing.)

The Iraq and Afghanistan Veterans of America (IAVA) has written to Obama to congratulate him on his victory, but also to ask him to convene an urgent presidential summit of leading veterans, to advance-fund VA health care, to implement GI Bill transferability, and to issue a national call for mental health professionals to help care for vets coming back from combat with post-traumatic stress disorder and traumatic brain injuries.

Right on! Our new president should consider health care for veterans as part of the national debt. We owe that to them for what we’ve asked them to go through, and we can no more default on that debt than we can on any other.

I don’t often agree with the lawyers, but there’s one in Colorado who’s right on the money.

Earlier this week, Kenneth Eastridge, 24, a soldier who had previously been deployed to Iraq, was sentenced to 10 years in prison for being an accessory to the shooting death of another Iraqi veteran, Kenneth Shields.

Prosecutors said another Iraqi vet, Louis Bressler, killed Shields after the two of them fought in a park in Colorado Springs and Eastridge later helped get rid of evidence.

“I don’t have the right to ask for forgiveness, but I just hope that everybody knows someday that I really am sorry,” Eastridge said, visibly shaking as he read his statement in court on Monday

Eastridge’s attorney, Sheilagh McAteer, said during the sentencing hearing that he was the least culpable of the defendants. She said Eastridge didn’t actually participate in the attack but watched from the backseat of a car and helped get rid of evidence because he felt he had to help a friend.

McAteer said that during two tours in Iraq, Eastridge manned a machine gun on top of a Humvee and saw “more battles and bloodshed as a 19-year-old than most will ever see in a lifetime.”

She said he suffered a serious head injury when a roadside bomb struck his Humvee during his first tour, tossing him 30 to 60 feet. She said a pre-sentence report found Eastridge suffered from post-traumatic stress disorder, and she blamed the military for discharging him without medical help.

She’s right. We’re repeating the same short-sighted behavior that Americans adopted post-Vietnam, and we’re doomed to pay the same huge price in lost lives and perpetual personal pain unless we find ways to help vets deal with the emotional trauma that they return from combat with.

However, both El Paso County District Judge Theresa Cisneros and Shields’ family rejected McAteer’s argument. “He needs to take responsibility,” Debra Shields said. “He’s a grown man. He can ask for help.”

That’s kind of like asking an accident victim with a broken leg to walk to the hospital for help. Post-traumatic stress disorder is an emotional injury that most vets try to deny, especially active-duty soldiers who fear they’ll lose their jobs if they can’t handle the stress they’re subjected to.

According to a report by The Associated Press, one of the other defendants, Bruce Bastien Jr., was sentenced in September to 60 years in prison. He pleaded guilty to being an accessory to murder in Shields’ death and conspiring to commit murder in the August 2007 death of another soldier, Robert James.

Eastridge, Bastien and Bressler are three of at least five soldiers deployed to Iraq with the 4th Brigade Combat Team who have been accused in slayings in the past 15 months. A sixth faces attempted murder charges.

Army commanders said they have formed a task force to identify any commonalities in the slayings allegedly committed by the soldiers.

To me, that smells like a face-saving maneuver. It’s obvious that these soldiers need help, and a competent commander would be demanding that they get it immediately.

Hats off to Adm. Michael Mullen, the Pentagon’s top uniformed officer, for taking a leadership role in combating post-traumatic stress disorder among returning combat troops.

Mullen, chairman of the Joint Chiefs of Staff, is calling for all returning combat troops, including the commanders, to undergo screening for post-traumatic stress with a mental health professional, a move aimed at stemming an epidemic of psychological issues among veterans.

“The PTS issue is something we just all have to focus on,” Mullen said. “I think it’s a bigger problem than we know.”

Mullen said troops are reluctant to acknowledge psychological problems for fear of showing weakness. They now fill out questionnaires after combat tours that help determine if they have suffered psychological damage. They’re examined by medical professionals for physical injuries, but not by mental health experts.

“I’m at a point where I believe we have to give a (mental health) screening to everybody to help remove the stigma of raising your hand,” Mullen said. “`Leaders must lead on this issue, or it will affect us dramatically down the road.”

Mullen’s proposal is a great start because it focuses on active-duty personnel who can be ordered around. And if implemented properly, it will reduce the stigma both for active-duty troops and others.

But it’s only a proposal at this stage. Mullen doesn’t know when it would start, what it would cost, or where’s he’s going to be able to find the psychiatrists, psychologists and social workers to carry it out.

So this is a perfect time for me to make some suggestions that will help the admiral achieve his goal.

1) Expand the plan so it includes National Guard and Reserve personnel returning from combat. Their rates for PTSD are abnormally high because they tend to be older soldiers with families who never really thought signing up as a weekend warrior would land them in a combat zone.

2) Many troops develop PTSD six months to a year after their return. Soldiers should be checked for combat stress every six month for the first two years after returning from combat. Then at each annual physical exam, there should be a mental health component.

3) Crisis response teams, including a personnel officer and a chaplain, are invaluable in tracking down the soldiers who begin to exhibit problems, either on the job or during drill weekends. For National Guard troops in California and Montana, it has been very useful to have mental health counselors on base during drill weekends to chat with soldiers about any developing problems.

4) This doesn’t begin to address PTSD among the millions of vets who’ve left active duty, and the VA is currently swamped by the number of earlier-era vets — particularly the ‘Nam vets traumatized by the current conflict. The Pentagon should be working hand-in-hand with the VA to utilize effective techniques in common. But it will ultimately be up to Congress to provide the funding to begin to meet a massive backload.

These are some of the steps that the Montana National Guard has taken to become a national model in assessing PTSD among its returning combat troops and its veterans. For more information on the Montana model, check out my book: Faces of Combat, PTSD & TBI. I just got my first shipment of books from the printer this afternoon, so it should be in bookstores within days.       

Over dinner last night, my good friend and former colleague Tom Kotynski pointed out an article in the “New Yorker” that he said was journalism at its best. He’s right.

“The Last Tour, a decorated Marine’s war within,” by William Finnegan is the heart-wrenching tale of Travis Twiggs, who was deployed into combat five times, diagnosed with PTSD and wrote about what he hoped was his recovery in the “Marine Corps Gazette” last January.

That turned out to be an illusion.

Twiggs later came to believe that the acronym was merely a euphemism for a weak Marine. and he toughed it out for as long as he could — just four months. Last May, he shot his brother and himself to death after what appears to have been a failed double suicide attempt in their Toyota Corolla.

What jumped out at me, though, was the letter that one of Twiggs’ friends, Maj. Valerie A. Jackson, also a Marine, wrote to the “Marine Corps Gazette”: “There are many programs in place now to help those suffering from PTSD. By the time Twiggs got involved in those, though, it was far too late. His problems should have been identified after each deployment, and when the commands realized he needed serious help (after the second deployment), he should have been prevented from deploying again. Period. I realize that a symptom of the disease is an overarching need to be in the fight. But there comes a time when someone with some influence needs to say, ‘No Staff Sergeant, enough is enough. You’ve done your part.’ … The Twiggs family should not be mourning the loss of their husband, father and son. We let them down, and we let SSgt. Twiggs down.”

Amen to that, Maj. Jackson.

Twiggs’ story is a heartbreaking one, almost like a very expensive Purdy shotgun that blows up in your face. And that’s an apt analogy. Expensive weapons can be destroyed when their owners neglect to take proper care of them.

The same is true of our soldiers. They require faithful care and periodic inspection to make sure they’re capable of carrying out their tasks, to make sure that there are no cracks and potential malfunctions.

Our armed forces haven’t been doing that, and they should. A Purdy shotgun and a soldier are alike in many ways, but there’s one critical difference — when the shotgun jams, it doesn’t leave behind a widow, fatherless children and grieving parents.