A War Within

STAR-TELEGRAM
Pfc. Jacob Hounshell was classified as a deserter after he refused to return to Fort Hood. The Iraq war veteran has contemplated suicide and is losing his hair in spots.
A war within
A GI's story illustrates the challenges the military faces in delivering mental health services to troubled soldiersBy Chris VaughnStar-Telegram Staff Writer

BROWNWOOD - Pfc. Jacob Hounshell wrote his goodbye on notebook paper, wrapped it around a photo of himself in uniform, left it on his bed and climbed into his pickup.
He was supposed to be heading back to Fort Hood. But he had no plans to make it that far. He'd already figured out what he would do -- drive as fast as he could into an oncoming 18-wheeler. Less than three months after returning from a 14-month hitch in Iraq, Hounshell had come undone.
He could barely remember the excitement he carried to Iraq in early 2004. He was an excellent soldier, by most accounts, even though he was only 18 when he left. On one memorable night, his quick thinking helped his platoon defeat a group of insurgents in Baghdad.
Today, the same soldier, now 20, is wanted for desertion, a particularly loathsome act during wartime and one that could bring a prison sentence.
Hounshell's problems began after he returned to Texas in late February. He couldn't sleep, often wandering through Killeen's all-night Wal-Mart. He had panic attacks and sometimes exploded in anger at the slightest change in plans. He played chicken with other drivers on Central Texas highways.
When he asked the Army for help, he said, he was greeted mostly with indifference.
"I told them numerous times, 'I'm having problems here. I'm seeing ... [things] at night.' They didn't take it seriously," he said. "They did the minimum thing they had to do."
Finally, in May, at the end of an emergency leave, he vowed never to go back to Fort Hood.
It was May 15 when he wrote the suicide note. His mother found it before he could leave the driveway. She jumped in the pickup and wouldn't let him leave.
His family is desperate to get him help, but they have no idea where to turn.
"We're not trying to hurt our soldiers overseas, and we didn't want this fight with the Army," said his mother, Bobbie Hounshell. "But my son had problems when he came home, and all he was told was, 'Drive on.' "
An Army spokesman said Hounshell got help and should have taken the initiative if he needed more. His commander took his situation seriously enough to begin the process of discharging him early, Maj. Scott Bleichwehl said.
"The bottom line is, he got the counseling," said Bleichwehl, spokesman for the 1st Cavalry Division, to which Hounshell was assigned. "He had the attention of the command. He had access to all the services and counseling that all soldiers do.
"The vast majority of our soldiers make the right decisions, and they don't go AWOL."
Whatever happened to Pfc. Hounshell, his story illustrates a challenge facing the U.S. military amid the first massive, extended deployment of troops in a war zone since Vietnam.
Thousands of soldiers are returning home mentally and emotionally spent, some of them with symptoms of post-traumatic stress disorder.
The Pentagon is making unprecedented efforts to help them deal with the trauma, including sending counselors to the battlefield. But the military's culture keeps many troops from seeking help, fearful of being labeled weak or damaging their careers.
"Some commands are sensitive to the fact that not everybody is Superman," said Steve Robinson, executive director of the National Gulf War Resource Center in Silver Spring, Md., and a retired Army Ranger. "But those soldiers that do need help should not be belittled. They should not feel as if the military does not support them.
"Because none of us should forget that the soldier supported the nation."
Soldiers' symptoms
American troops in Iraq are dealing with an unpredictable and unseen enemy, close-up urban fighting, complicated rules of engagement and yearlong deployments. The conditions have taken a toll on many soldiers and Marines on a scale not seen since the late 1960s.
One in six soldiers and Marines reported symptoms of post-traumatic stress disorder, major depression or anxiety after deployment in Iraq, according to researchers at Walter Reed Army Institute of Research in Maryland. The findings were published in the New England Journal of Medicine last summer.
Things might be worse now, some experts said.
Walter Reed conducted its survey in 2003, well before the insurgency escalated and before the deadly Sadr City uprising and the bloody attack on Fallujah in 2004.
The Army is trying new approaches in the field of mental health, including sending professionals to Iraq for on-scene counseling and quizzing every soldier about potential problems when they come home -- part of a process known as reintegration training.
But several advocates for soldiers said getting help still requires a sympathetic chain of command, which is not always present in the Army's warrior culture.
A majority of soldiers who reported mental health problems in the Walter Reed study said they had no intention of seeking help because they would be viewed as weak, their commanders would blame them or their leaders would treat them differently.
Martha Rudd, an Army spokeswoman at the Pentagon, said the Army's leaders are working to lessen the fear of stigma.
"Command influence is the most powerful tool," she said. "When a commander tells his staff that something is important to him, they will pay attention to it. That's the way the Army works."
Deploying to Iraq
Hounshell enlisted in June 2003, eager to follow in the footsteps of his grandfather, who fought in World War II. He selected the infantry, knowing that he would go straight to Iraq.
The thought of war excited him. He was, after all, a kid from a sleepy farming community north of Brownwood. His town, May, had one blinking traffic light.
Hounshell flew out of Fort Hood on Jan. 9, 2004, with a cast on his right foot. He had broken his ankle in a fight during Christmas break and needed crutches to climb the stairs to the plane.
He trained for almost a month in Kuwait until his unit -- D Troop, 9th Cavalry Regiment -- prepared to move into Iraq at the beginning of February. It took them three days to drive to Baghdad, escorting a group of non-combat Army units.
Hounshell drove a Humvee the entire trip, braking with his left foot because of the cast on his right.
In Baghdad, Hounshell monitored the radios and did desk jobs in the headquarters platoon until his cast came off in late March.
His commanders told him he'd be going to 1st Platoon and driving for a highly experienced combat veteran and sniper, Sgt. Daniel Osborne.
"Me and him got along great," he said. "We were both from Texas. He was older, probably in his late 20s, and he knew a lot. He'd been on, like, seven combat deployments. He was an ex-Marine. I didn't have to watch what I said with him. I trusted him."
Their newfound friendship was forged April 8.
Five trucks and 18 soldiers were patrolling an area north of Abu Ghraib in Baghdad, "an area in constant combat between Coalition and anti-Iraqi Forces," according to the Army's report of the incident.
At 9:15 p.m., the lead truck spotted 20 insurgents armed with rocket-propelled grenades and rifles preparing a roadside bomb. The platoon attacked. Osborne did not have a night-vision scope on his rifle and couldn't see.
Hounshell gathered all of the flares from the platoon and shot them into the air with his grenade launcher, a tactic that no one had taught him.
Osborne, suddenly able to see, killed six insurgents, and the platoon captured numerous weapons as well as bomb-making material.
"Hounshell was directly responsible for the platoon's victory," read the citation for an Army Commendation, signed by his company commander.
His picture appeared in Stars and Stripes after he and another soldier stopped a car carrying makeshift bombs, and his father proudly recounted his son's wartime exploits in the Brownwood Bulletin newspaper.
Louis Vivian was a sergeant in D Troop during the Iraqi deployment and remembers Hounshell favorably.
"I thought he was a good soldier," Vivian said. "He followed orders."
On his 19th birthday, Hounshell received a four-day pass to relax in the "Green Zone" of Baghdad, where he ate a whipped cream pie and called his mother during a mortar attack.
"I never had any problems over there," he said.
Still, it was a war zone, and 2004 was a tough year for the 1st Cav and its units.
Hounshell rolled down "IED alley" virtually every day, waiting to see which coalition vehicle would be the target of a roadside bomb, or "improvised explosive device," as the Army calls them. He picked up the rotting bodies of Iraqis killed for collaborating with the Americans.
He stood guard at roadblocks, wondering whether the next car might carry a suicide bomber or if he might get in trouble for shooting an innocent civilian who made a threatening gesture.
He killed people, too. He keeps a photograph of his first in the back of his scrapbook.
Seeking help
Once back home, in late February, he couldn't sleep or eat at first. Then, during his scheduled leave in March, he began jumping at loud noises. He screamed at his family for inexplicable reasons and had panic attacks in crowds.
"His 30-day leave here was a nightmare," his mother said.
In early April, he was hospitalized in Brownwood for a bacterial infection in his intestines, his family said.
About a week later, his mother met with D Troop's first sergeant, William C. Davis. Her son was under tremendous stress, she told Davis, struggling to adjust after Iraq and weighed down by a series of medical crises in his family.
The meeting, as she described it, did not go well. Davis, she said, was curt and seemed disinterested. Frustrated, she cursed at him and went with her son to a psychiatrist on post, she said.
Hounshell said he answered a series of questions on a computer and was told that he had three disorders, including paranoid schizophrenia. The doctor, he said, told him she would forward her recommendations to his company commander, Capt. William O. Hickok.
"I never saw any paperwork, though," he said. "She told me she couldn't let me see it."
Shortly after, he went to see an Army chaplain, at the suggestion of his commander.
"He told me the same crap -- you're OK. It'll pass. There's nothing wrong. If you need someone to talk to, call this hot line," Hounshell said. "It was the same crap they give you at reintegration training."
At the same time, family pressures were bearing down on Hounshell.
His older brother's first child was stillborn, and he didn't get permission to attend the funeral. His father had gallbladder surgery. His mother had to quit her job at a dry cleaners to handle the family's medical problems.
His commanders, he said, were unsympathetic.
"The Army says they support families," Hounshell said. "It's true, if you're married. They'll bend over backward to support a soldier who's married. But if your family is your parents, your family don't matter."
The Army declined to make Davis or Hickok available for an interview. Hickok responded generally to questions through Bleichwehl, the division's public affairs officer.
Bleichwehl said he would not engage in a "he said, she said" regarding Hounshell's account. But he said Hounshell's commanders communicated often with him and tried to help, including granting the emergency leave in early May.
"He's had access to all the same post-deployment training and services that all soldiers do," Bleichwehl said. "If he wasn't getting it, there are recourses other than going AWOL.
"You could call the IG [inspector general]. You could call the 800 numbers. You could go to the walk-in clinic. It's ludicrous to say that they prevented him from doing any of it."
Hounshell was also told that he was "being processed for separation," a non-punitive method of granting soldiers an early release from their enlistment, Bleichwehl said.
It sometimes happens, officials said, when a soldier is no longer fit for duty. They are told to seek care from the Department of Veterans Affairs, said Jaime Cavazos, a spokesman for the Army Medical Command in San Antonio.
"It's not a case of the military wanting to get rid of the individual," he said. "If the Army has done what it can, at some point the decision is made to refer them to the VA. ... We're interested in caring for soldiers. We wouldn't have all these programs in place if we didn't."
But Robinson, of the National Gulf War Resource Center, said that, too often, busy top sergeants and commanders in front-line combat units expect soldiers "to buck up and move on." Junior enlisted troops are in no position to say otherwise, he said.
"What the Army has to recognize -- and I was part of the Army -- [is] that we have this mentality that 'if I can't use you, you're not worth anything to me,' " Robinson said. "But you want these guys to recover. You want to help them recover. There is treatment and care to get these guys back on their feet."
Going AWOL
Hounshell went AWOL a few weeks before he probably would have been discharged.
After he contemplated suicide, his parents sought help at a hospital in San Angelo but said they were told that the hospital couldn't admit an AWOL service member unless given approval by the soldier's commander.
A hospital spokeswoman said last week that she was unaware of such a policy.
It's unclear what will happen now.
"I want my son back," Bobbie Hounshell said. "I'm a strong woman, but this is very hard. He deserves a normal life."
Hounshell mostly spends his days tinkering with electronics and doing odd jobs for petty cash. He began using methamphetamine, he said, because it's the only thing that helps him control his anxiety.
His family is in financial difficulty. Jacob Hounshell had been the primary wage earner, his parents said, and his father, Larry, is disabled and doesn't work.
His military health benefits and pay ceased when he went AWOL, so he has yet to see a mental health professional or drug treatment counselor. He probably ruined his chances of receiving care from the VA, which does not treat veterans who have been dishonorably discharged.
He knows there will eventually be other consequences.
"What happens to me, I don't care," he said. "But I want parents to know that the Army is not helping their kids the way they're supposed to. You're a piece of equipment to the Army. If you're broke, they throw you away."
IN THE KNOW
Casualties of war
Conditions in Iraq -- including close-in urban warfare, harassment from a sometimes-invisible enemy and longer tours of duty -- have created tremendous stress for U.S. troops on the battlefield, according to the Department of Veterans Affairs and a study by Walter Reed Army Medical Center.
"Taken together, these unique features of the war in Iraq create the conditions whereby stress hormones are released excessively, with unknown, but likely significant, consequences regarding health maintenance, restoration and coping capacity," said Brett T. Litz, author of a VA report.
Here are some facts about the toll on today's military:
• Almost 20 percent of soldiers and 17 percent of Marines qualified as having "moderate or severe" mental health problems when surveyed in late 2003 after returning from Iraq.
• Of those, 65 percent said they would not seek help because they would be seen as weak, and 51 percent said their leaders would blame them for the problem. "Rather than focusing on their medical needs, they must weigh the risk of self-reporting mental health concerns and the possible career stigma attached to it. The military is aware of service members' fears of career stigma, but to date has not broken down this crucial barrier to care," wrote Steve Robinson of the National Gulf War Resource Center in a report titled Hidden Toll of the War in Iraq.
• One of the most common illnesses is post-traumatic stress disorder, which results from exposure to an extreme stress involving threat of death or serious injury. The trauma, although most often associated with combat, can also happen after rapes or other violent crimes.
• Symptoms of PTSD include sleeplessness, extreme anxiety or hyperalertness, frightening dreams, depression, social withdrawal and outbursts of anger.
• Studies suggest that most people who experience even horrifying combat adjust, adapt and do well in life. But others, particularly if the PTSD is untreated, are more likely to be unemployed, have lower incomes, show poor problem-solving capabilities, express violent tendencies and use more government and medical services in their lives, a VA study said.
• Through April 2005, the Army had evacuated 1,118 soldiers from Iraq for psychiatric reasons, mostly depression, PTSD and suicidal thoughts. That represented 6 percent of the total medical evacuations. The Army prefers to treat and counsel soldiers in Iraq, as close to their units as possible.
• The Department of Veterans Affairs has treated and/or counseled 6,400 men and women for PTSD who served in Iraq or Afghanistan and are no longer in the military.
• The Army's suicide rate fell from 12.8 per 100,000 in 2003 to 11 in 2004. So far this year, the rate is 6.7. The Marine Corps' rate rose from 13.8 in 2003 to 16.6 in 2004. So far this year, the rate is 14.7.
• Forty soldiers and nine Marines have committed suicide in Iraq since March 2003. At least 20 soldiers and 23 Marines have committed suicide after returning from Iraq.
• Most of those troops commit suicide at their home installations, and the majority use firearms. The largest number of suicides were in two age categories -- 21 to 25 and 36 to 40.
• Desertions -- defined as being absent without leave for longer than 30 days -- have decreased significantly in recent years. In 2001, 4,597 soldiers deserted. In 2003, 3,680 deserted. In 2004, the number had dropped to 2,436.