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SUNDAY, JULY 18, 2010
WHITNEY SHEFTE/THE WASHINGTON POST Staff Sgt. James Ownbey has enchiladas for dinner with his family at home in Hedgesville, W.Va. He returned from Iraq with PTSD. “Every day he deteriorated for over a year,” said his wife, Sandy.
‘PTSD and traumatic brain injury are not phantom conditions exhibited by weak soldiers’
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ter Chiarelli, Amos’s Army coun- terpart, has been especially out- spoken. “PTSD is not a figment of someone’s imagination,” Chiarelli lectured an auditorium of skepti- cal sergeants last fall. “It is a cruel physiological thing.” The challenge facing Amos and
Chiarelli has been convincing an undermanned force that PTSD and traumatic brain injury are real injuries that demand imme- diate care. The generals also have run up against an overburdened military medical system that is short on doctors and reluctant to take risks with new types of treat- ment.
“I have been asked . . . should
you have figured this out sooner?” said Amos, who was recently tapped to be Marine Corps com- mandant. “Yeah, we should have. But we didn’t. It has been evolu- tionary.”
Only a few weeks before the blast that injured him, Ownbey had reenlisted for another four years. His engineer company’s job was to find and destroy roadside bombs, a dangerous mission that had claimed the lives of eight Ma- rines over two tours. The toll weighed heavily on Maj. Jeff Hackett, Ownbey’s commander, who had begun to blame himself for the deaths. “I can’t stand to look at myself,” he confided in an e-mail to his wife. When Ownbey arrived at his
base’s aide station after the blast he immediately called Hackett, who rushed to see him and the other wounded Marines. Ownbey remembers the relieved look on his commander’s face. Later that night, Hackett told his wife about the apparently un- scathed survivors of the massive bomb. “They are so fricking lucky!!!” he wrote.
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n late September 2007, about three weeks after the blast, Ownbey returned to Camp Lejeune, N.C., after finishing his third combat
deployment. This homecoming was nothing like the first two. The Ownbeys had bought a small house near the base. On the first drive home with his wife and three children, Ownbey slammed on the brakes, stopping just short of a pothole that had been re- paired. “Why is that there?” he asked, pointing to the square of pave- ment, which resembled the holes insurgents use to plant roadside bombs. “What do you mean?” his wife, Sandy, recalled asking him.
COURTESY STAFF SGT. JAMES OWNBEY
When Ownbey reenlisted in August 2007, his friend Maj. Jeff Hackett donned a blast-resistant suit for the ceremony, which took place in 120-degree heat in Iraq’s Anbar province.
Ownbey jerked the wheel to the right and drove across a neigh- bor’s lawn to avoid the patched pavement.
Sandy took her husband on a mountain getaway a few weeks later. After dinner and a few glasses of wine, Ownbey began rambling incoherently about friends killed in Iraq. “He was walking and talking as if he wasn’t really there,” she said. Sandy called up one of her hus-
band’s close friends from his Iraq tour. Ownbey spent the next three hours talking and sobbing before he fell asleep with the phone cra- dled to his ear. The next day he sought counseling for PTSD. As time passed, Ownbey’s hands began to shake and he be- gan to put on weight. Five months after the blast, he finally landed an appointment with a neurolo- gist at the Camp Lejeune hospital. The military cannot fill its pre-9/ 11 quotas for neurologists, creat- ing agonizingly long waits. At the examination Ownbey
couldn’t remember and repeat three simple numbers. He was so twitchy that his doctor ordered him to stop driving. In late 2008, blood clots caused by the blast injury migrated to Ownbey’s lungs, leaving him so
short of breath that he couldn’t climb a flight of stairs. He coughed so hard that he snapped six ribs. The doctors at the Camp Lejeune hospital moved him to Bethesda in February 2009. “Every day he deteriorated for over a year,” Sandy said.
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on
washingtonpost.com Bloodless trauma in battle
D I
Staff Sgt. James Ownbey, his family and two
generals weigh in on brain injuries at www.washingtonpost/ mental-wounds.
Ownbey’s slow recovery from post-traumatic
stress disorder and life back home with his family in West Virginia after tours overseas.
n spring 2009, the top brass in the Marine Corps and the Army were seeing troubling signs that the force was starting to fray. The suicide
rate in the two services was on pace to set a record. The percent- age of the Army’s most severely wounded troops who were suf- fering from PTSD or traumatic brain injury had climbed to about 50 percent, from 38 percent a year earlier. Amos and Chiarelli ordered the
military’s top psychiatrists and neurologists to the Pentagon for a meeting. “We were looking for some treatments,” Amos said. “Something we could do right now.” To moderate the session, the
generals brought in David Hovda, a UCLA neuroscientist who had worked closely with the National Football League on concussions.
COURTESY U.S. MARINE CORPS
Gen. James F. Amos, second from right, posed with the mine-resistant truck and its crew, from left, medic Sam Gulley, Gunnery Sgt. Christopher Wellman and Staff Sgt. James Ownbey.
Hovda gave a 15-minute pres-
entation on traumatic brain in- jury. Then the military doctors began to argue with him and among themselves, according to participants. PTSD and mild traumatic brain injury both cause a similar array of symptoms, such as migraines, sleeplessness, anxi- ety and memory loss. The mili- tary doctors worried that Hovda was too quick to blame repeated concussions for medical symp- toms that could also be attributed to PTSD or depression. “It’s not wrong to think these symptoms could be related to concussion,” said Army Col. Charles Hoge, one of the military doctors at the session. “What is wrong is to think that they are only related to concussion.” Hovda shot back that Hoge was underestimating the damage caused by repeated battlefield concussions. “I do not agree with Colonel Hoge’s position at all,” he wrote in an e-mail after the meet- ing.
Doctors say it is essential to un- derstand what is producing the symptoms they are trying to treat. PTSD is caused by the way the brain remembers a harrowing event. Traumatic brain injury re- sults from the jostling of the brain. The disagreement was deeply
frustrating for both Amos and Chiarelli. “It was three hours of hell,”
Chiarelli said. “No one could agree on anything.” Amos and Chiarelli stormed out of the meeting angry. They worried the internal debate was slowing the effort to help suf- fering soldiers and Marines. At 3:51 a.m. Chiarelli fired off an e- mail to Amos and Hovda. “I am frustrated with the way we are treating, or not treating, [trau-
matic brain injury] and PTSD,” he wrote. “There seems to be a lack of direction and so many differ- ent ideas of what right looks like.” The generals asked Hovda to
invite a dozen top civilian experts on PTSD and traumatic brain in- jury to Washington for two days of meetings. They wanted the ses- sions to focus on treatments that military doctors and researchers had overlooked. To prevent the sessions from bogging down into another academic debate, Amos and Chiarelli did not invite most of the military physicians from the first session.
Amos had his encounter with
Ownbey at Bethesda in late Au- gust 2009, four days before the meeting with civilian doctors and scientists. The general had been pinning Purple Hearts on wound- ed troops when he got word that one of the patients wanted to see him. The Marine was so weak he could barely walk. Electrodes and wires were pinned to his bare, puffy chest. The 2007 blast had damaged Ownbey’s pituitary gland at the base of his brain, and his weight had ballooned to 240 pounds. He was 165 pounds be- fore the injury. Amos extended a hand to in- troduce himself. “Sir, we’ve met before in Iraq,”
Ownbey said. Sandy watched as the general slowly recognized her husband. Amos’s face turned ashen. He hugged Sandy, and she began to cry. “We are going to figure out why this is happening to him,” he said.
Amos opened the meeting with the civilian doctors on Sept. 1, 2009, by passing out the now two- year-old picture of himself and Ownbey posing in front of the crumpled vehicle. Then he hand-
ed out the snapshot of the Marine in his hospital bed. “What can you do to help us with this now?” he asked the doc- tors.
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y early October, Chiarel- li had become obsessed with the science of PTSD and traumatic brain injury. He turned
an awards luncheon in Washing- ton for the Army’s 24 noncommis- sioned officers of the year into a half-hour seminar on the mental wounds of war. The Army general flashed a pic- ture of three brain scans depict- ing a normal brain, a patient in a deep coma and a UCLA football player who had suffered a mild concussion. The normal brain glowed red and yellow, indicating that it was actively burning glu- cose. Both the concussion and the coma scans were blue, a sign that the brains had shut down to heal. The football player’s brain would only return to normal if it were given a couple of weeks to heal before it was struck again, Chiarelli said, according to a tran- script of the event. Chiarelli then explained how
physiological changes caused by PTSD flooded the body with chemicals and triggered a rush of fear. “Contrary to what some be- lieve, PTSD and traumatic brain injury are not phantom condi- tions exhibited by weak soldiers trying to get out of a deployment,” he said. As the months passed, Chiarelli began to refer to post-traumatic stress disorder as PTS. “I drop the D because I believe it is more of an injury than a disorder,” he said. “A lot of doctors agree with me, but there are some who don’t.” He sent instructions urging commanders to hold full memori- al services for suicide victims just as they would for other Army fa- talities. Some field commanders argued passionately against the policy, insisting that it was wrong to salute troops who had shown a lack of resolve. Chiarelli over- ruled them. The best way to erase the stig- ma of mental illness, he insisted, would be to award the Purple Heart to troops suffering from post-traumatic stress. A 2008 study ordered by Defense Secre- tary Robert M. Gates had con- cluded that it was too difficult to prove that a soldier was suffering from PTSD. By 2010, Chiarelli countered that the science had sufficiently advanced and was worth reconsidering.
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