On April 24, 2010 James Dao and Dan Frosch published an article in the New York Times entitled “Feeling Warehoused in Army Trauma Care Units.” The story documents the nature of the WTU system at a base in Colorado well before I encountered it at a base in Georgia. It is worth reading and I can verify most of the details. As a psychiatrist I would take issue with the statement that the soldiers are “fed a diet of powerful prescription pills.” It is true that medication is used to treat the behavioral consequences of PTSD, traumatic brain injuries and depression, but the soldiers are treated by medical professionals under strict ethical guidelines. I can not say as much for the WTU cadre. Soldiers are commonly treated harshly by noncommissioned officers, with statements like” you are here because you are a crazy psychotic.” I have heard the words, “being in the WTU is worse than being in Iraq.” The story of my soldier, Eddie, is therefore not an isolated incident: “Because of their wounds, soldiers in Warrior transition Units are particularly vulnerable to depression and addiction…and many feel their treatment has made their suffering worse. ”
Eddie had two admissions to the inpatient psychiatry unit at the Army Medical Center in January and February for Major Depression with psychotic features (paranoid ideation) and PTSD. His acute symptoms of suicidal ideation were under control when he was discharged to outpatient care, but he faced an even greater battle with the WTU than he faced in Iraq and Afghanistan. When I first saw Eddie, in March 2011, he presented in uniform, ACUs or Army Combat Uniform,; this is the only real connection the WTU system has to their claim that the WTU maintains the Army unit; actually, the ACUs are most often a bitter reminder and recall of trauma and loss, sometimes shame and guilt, sufferred by soldiers while deployed. In the WTU they are not treated like honored and often decorated soldiers. Other than the grim reminder of the uniform, they are treated like wayward children. During our first encounter in the outpatient clinic Eddie did not make eye contact with me and all he could say repeatedly was that he did not feel anything. He just wanted to go home. But he did have one overwhelming emotion that has dominated him for the last 10 months. That emotion is anger at a system that shames him, isolates him and indeed warehouses him. He is not close to going home because his MEB, Medical Evaluation Board, is being processed. (If the WTU system is a debacle, it is child’s play incomparison to the contemtible disaster of the MEB– more on this later). In fact, Eddie is being held a hostage in the suspended animation of the WTU while waiting so long for his MEB that he no longer cares if gets any benefits like medical care in the VA. Decisions about his life are made by a committee made up of poorly trained and bored officers (who have never laid eyes on him) and equally angry noncommissioned officers who are pissed off that they are stuck in the WTB command. Their anger often boils over onto soldiers, like Eddie. The cadre consider Eddie to be uncooperative and therefore “high risk” when he asks for leave to go home. Eddie understands they are just trying to cover their butts, but day after day,week after week and month on end he is not able to control his anger. Of course an expression of emotion, frustration and anger is considered a sign that Eddie is not a good soldier. Eddie’s repeated complaint that he just did not feel anything is in sharp contrast to the emotional energy he generates just entering a room. He did try to sustain a relationship with a young woman he had known prior to his deployments but he was just not interested: ” I know I should feel something but it is just not there.”
In a brief diversion, it may be of interest to discuss the WTU soldiers encountered today. In the Army Substance Abuse Program the history of a 28 yer old soldier was presented for confirmation of diagnosis and recommendation for level of care. He belonged to a state National Guard and his unit had recently been activated with orders for deployment to Afghanistan. This soldier and his unit had never been deployed before. The initial posting was to Camp Shelby in Mississippi for pre-deployment training. While there the soldier was found unconscious and it was determined he had accidentally given himself an overdose of heroin. It seems he had been opioid dependent (an addict) since the age of 18. In Mississippi he was sent to a local substance abuse facility, civilian, and was detoxed from the opioid and treated for what the facility called anxiety and he completed the 4 week rehabilitation program. By the time he was discharged his National Guard unit was in Afghanistan and it was determined at Camp Shelby he needed treatment for anxiety, which was and remains a lingering residual of his substance (heroin) addiction. The Army could have returned him back to his home state and his National Guard facility where he could, if he wanted, receive ongoing treatment as a civilian. However, in its wisdom, the Army sent him to the Warrior Transition Unit. Since the soldier was unemployed before his unit was activated he wants to stay activated as long as possible so he gets a guaranteed salary and benefits. So, he is pleased to be in the WTU and he fully expects he will be here for a year. Besides, he did not want to go to Afghanistan in the first place. He admits he was pretty anxious about the deployment. He will see a psychiatrist about once a month, talk to his case manager once every week or two, go to therapy at the ASAP once a week. Three hots and a cot (actually his own room in the barracks) and a pay check. And he will quickly learn where he can score some narcotics and all the Spice (a synthetic cannibinoid that causes psychosis) he can handle. He is in the same unit as Eddie, in fact he may be in the room right next to him. It is expected this new soldier will be an ideal soldier for the WTU: he is no warrior and does not need to be there. In comparison is another soldier presented in ASAP today. He also came form a National Guard unit and was at Camp Shelby for pre-deployment training. However, in his pre-deployment physical examination he was found to have significant venous insufficiency in his lower extremities (varicose veins) and should not be deployed with his unit until he had surgery on his varicose veins. He has been deployed before and has a history of alcohol abuse in remission. He is very upset his unit is going to be deployed without him. He hopes to catch up with his buddies. It is unclear how and why he needs to be in the WTU, but I guess they have to put him somewhere. I expect this soldier may understand some of the Eddie’s experience and anguish. Juxtapose this with Eddie, who I saw for his weekly visit this evening. He presented exactly on time, in ACUs, and he still does not make eye contact. He also sees a very skilled and experienced psychotherapist on a weekly basis. Her efforts are aimed at his extreme social isolation and avoidance. She helped engineer a visit from his girlfriend last Fall. Eddie knew what he was supposed to feel and do, but he could not. Aside from his anger at the WTU for making him feel like a criminal for his illness, he is not a danger to himself or others. With his diagnosis of PTSD and Depression he is considered High Risk, despite my repeated statements that he is not high risk. Today he stated he did not leave his barracks room other than to report his presence to his squad leader and he did not eat breakfast or lunch. He told me he did not want to be around people, even other soldiers. However, since he came to the hospital to see me he will have dinner in the hospital dining room, which will be nearly empty this evening. Now, he states he does not care where he goes when he leaves the Army, whenever that happens, he just wants to be away from the WTU. He states “I don’t care about any benefits, I just want my life back.” And, for the first time he asked me if I thought there was any way he could be deployed again. “If I go back to Afghanistan I will be out of the WTU and I can be useful for something…I have to get my life back.”