Friday, July 9, 2010

Tom Matlack - A Good Man: Discussing Army Behavioral Health

Tom's latest column at Huffington Post takes a look at the military's version of behavioral health, or what we generally consider mental health.

On the bright side: Government To Stop Requiring Veterans To 'Prove' PTSD
WASHINGTON — The government is making it easier for combat veterans diagnosed with post-traumatic stress disorder to receive disability benefits.

A Good Man: Discussing Army Behavioral Health

Tom Matlack, Former venture capitalist turned writer
Posted: July 8, 2010

"You need somebody to assure you that it's not abnormal. It's not abnormal to have difficulty sleeping. It's not abnormal to be jumpy at loud sounds. It's not abnormal to find yourself with mood swings at seemingly trivial matters. More than anything else, just to be able to say that out loud."

--General Carter Ham, Commander of U.S. Army Europe and one of the U.S. Army's eleven four-star generals.

I interviewed Bob Davis, a Veterans Outreach Coordinator for the Red Sox Foundation/Massachusetts General Hospital Home Base Program. Bob has been an Army reservist for more than 12 years, working as a member of the 883rd Medical Company Combat Stress Control Unit based in Boston. He served two tours of duty in Iraq, during which he was awarded the Bronze Star, two Army Commendation Medals, the Combat Action Badge, and the Combat Medical Badge for his service. Bob earned an associate degree from American Military University in 2008 and is currently pursuing a Bachelor of Fire Science Management. When not at the Home Base Program, Bob works as a firefighter for the city of Newton, Massachusetts.

Q: Tell me a little bit about how you got into the army.

A: I grew up here in Boston, West Roxbury, and I had been kicking around the idea of joining the service all through high school. I was a great student but decided I was better off working and making money. Then a couple years later, I was 18 years old and my girlfriend was pregnant, so I went back and finished school. I've always wanted to join the service; my dad was a Marine in Vietnam and several of his brothers served as Marines in Vietnam. A couple years later, my girlfriend and I broke up. So at the age of 23, I walked into a recruiter's office, decided I wanted to join the Army, and I got into the field of behavioral health. I was working as an EMT at the time, so I already had a medical background.

I really put myself into making rank and doing my job well and was promoted five times. I really enjoyed it, always thought I'd do twenty years. But now, two deployments later and all banged up -- my entire life has changed. I've got a wife, another kid, a job that I love that is more than full-time, and now a part-time job with Home Base.

Q: How did it come about that you were deployed for the first time?

A: In 2002, we were kicking around the idea here in the States of searching for WMDs in Iraq. I got a sense months in advance that we were going to deploy, because mental health assets in the Army are few and far between. I think there are 12 combat stress units in all five services.

We deployed into Iraq, set up a hospital, and then did outreach to people that were seeing and doing terrible things. These are people who want to talk to somebody but don't necessarily want to come out of their job because it's something they trained for most of their adult life. They really believe in what they are doing. Plus, they don't want to leave their buddies.

But combat stress is an all-encompassing behavioral health issue. What's difficult is that behavioral health is a matter of degrees. Everybody's own frame of reference is the worst because it's the only one they know. If the soldiers just wanted to interact with somebody, that's what we were there for.

Q: Your unit was actually embedded in with the troops?

A: My team was under the operational control of the Third Infantry Division, which is the group that went into Baghdad in 2003. So we saw the groups taking the most casualties, the frontlines, and those interacting with the civilian population.

Q: I have read about the mindset of the guys who are on the absolute frontline in Afghanistan, and there's this kind of adrenaline rush that causes those guys to want to go back.

A: It's a very real phenomenon. I work as a firefighter, and that's probably the second closest thing to being in combat -- knowing you rely on the person to your left and right to keep you alive, to watch your back. You're giving up a part of your own security to someone that you trust to have your back. And in the midst of all that, you yourself need to be a force to be reckoned with.

Q: What happened in your second deployment?

A: My second deployment was, for lack of a better term, a shit show. In 2005, instead of being a division mental health asset, three of us were dedicated to 900 people of a battalion. It's a role that we took on willingly, because we really got further into a deployment style than ever before -- a chance to grow very close to them. It was Second Brigade combat team of the 101st Airborne Division in Mahmudiyah, Iraq, south of Baghdad. The Triangle of Death.

Some of this group was unfortunately involved in an incident you may have heard about in the press: Four soldiers snuck away from their checkpoint one night, got drunk, went to a family's home near their checkpoint, raped and killed the 14-year-old daughter, killed the entire family -- a 6-year-old girl, two parents -- set the house on fire, tried to cover up the crime as a Sunni-on-Shi'ah or Shi'ah-on-Sunni violence. And for several months, nobody was the wiser. Looked like a local incident. Later on that summer, two soldiers from the battalion were kidnapped from a checkpoint. Of course, it became a huge operation to try to find these missing soldiers. And in the course of this search for the missing, somebody finally opened their mouth.

The reason this weighs so heavy is that in the period between the event happening and it coming to light several months later, every one of those soldiers that participated in the rape and murder of this family came to us for help, claiming combat-related concerns. Of the four, my psychiatrist identified one of them as a personality disorder who probably came into the service with that and was worthy of a discharge. Little did we know, we had just processed out the main perpetrator of the crime before it ever came to light. He was ultimately arrested by the FBI and tried in a civilian court last year.

You think you're dealing with people that are all on the same level. You think everyone is basically doing good, and then you find out that the population of the service reflects that of society. Not a day goes by that I don't think about some way, shape, or form of how that could have been prevented. That's the crux of behavioral health.

Q: What was the worst combat situation you found yourself in?

A: Everybody got shot at, everybody in Iraq has an IED story driving down a road. But mine was far less insidious. All over Iraq, there would be random rocket attacks. By time our stuff identifies the incoming trajectory, they're already gone. This happened to our base maybe eight or 10 times in the course of a year. Nobody was injured. Then one time, a rocket hit 10 feet next to my tent, destroying the tent next to me. Me and my buddy just happened to be in our tent, and when the rocket hit -- it's this weird whistle you only hear for a half a second, and it didn't make a sound until a half a second before it exploded. I'm thrown to the ground. The guy I'm working with goes to the ground. We get up, run outside and see a tent collapsed, on fire, debris everywhere.

The two of us find the two people inside. One's unconscious, the other has a cut on his head. Me and my partner just grabbed the two of them and walked them outside. By now, everybody on the base is running towards us, and the medics take over, start treating those two. We got our bells rung. Turns out when I fell to the ground, I got a compression fracture in my C5-C6 vertebrae and tore my rotator cuff. Ever since then, I have some small neuro-deficit on my left side.

Q: How did you get hooked up with the Home Base organization?

A: I like taking care of my soldiers, and I made it my mission when I came home to seek out benefits that I was entitled to and make sure younger soldiers or soldiers with fewer resources were getting them, too. That was my sole exposure to being an advocate for veterans. It was local. It was to do good for the people in my circle, those for whom I felt responsible. Other than that, I never wanted to do anything as a vet. It always pained me to some degree because I had all that behavioral health knowledge I didn't use in my civilian job.

Then, last November or December, an email was distributed throughout my Army Reserve unit saying hey, the Red Sox Foundation and Mass General Hospital have this job for a veterans outreach coordinator. And my wife said, "This job is written for you." I wasn't looking to make our life harder by taking on a second job, but I also don't ever want to regret missing up an opportunity to say that I saw a job that was tailor-made for me. There's the obvious name recognition that comes along with Red Sox and Mass General. I started in February, and I've loved it every minute.

Q: What is your sense of how prevalent the problem is?

A: Coming from a behavioral health background in the Army, I'll tell you there are far more people that need help than are reported as needing help.

Q: Because of self-reporting or because they don't have the ability to get help?

A: Both, but I think it's more a matter of self-reporting. There's still such a stigma attached to mental health. You're the best-trained, best-equipped fighting person the world has ever seen. Oh and by the way, when you can't sleep at night, call this number because now you're a mental health casualty, now you're PTSD and you'll be debilitated or lessened in some way for the rest of your life because we put it on paper once when you were 20. Some people mask symptoms. Alcohol and substance abuse are a problem. Some people join the service hiding stuff from the military, and then they deploy overseas, and when their 90-day supply of Ritalin runs out and they're not themselves, they have to go see behavioral health. And they admit that they lied, which is not the bigger concern. It's how do we get a stock of meds that we don't supply to help this person?

Q: What do you say to families and to servicemen who clearly have a problem but aren't acknowledging it?

A: Two things have recently begun to take hold in the military that are, I think, a huge boon to people seeking help. First is the idea this is a normal reaction to an abnormal situation. The other is the combination of peers coming out and seeking help along with senior leaders admitting they need help. Retired General Fred Franks has been a huge advocate of getting the word out. He suffered an injury -- I believe in Vietnam, had his left leg amputated below the knee, fought to stay in, and served as an armored commander in the First Gulf War. He made no secret of the fact that his fight was not just physical, but all of the stress-related stuff that comes along with it.

Q: The trauma that triggers the post-traumatic stress, is it usually something that's happened to the soldier or something the soldier actually witnesses?

A: There are people exposed to combat everyday that don't have problems. There are some exposed to combat once that have problems the rest of their life. There are those that never face an enemy and feel the helplessness of just having rockets lobbed at them, and then there are those struggling with the idea of pulling the trigger on another human being. So what is it? I don't know.

Q: Do you feel like you personally had any occurrence of it?

A: I've been diagnosed by the VA with PTSD. I spoke to someone for a period of time, and for me, a valuable resource was the support of my wife and family. As I mentioned, my father was a Vietnam vet. It's important people know that "talking to someone" is not just lying on a couch Freudian-style with someone examining your relationship with your mother. It's talking to people that went through similar situations. It's talking to people that you trust about what you're going through. After several months of realizing you're not the only one, you start to sleep a little bit better at night.

Q: Was it the event where your tent was torn up that triggered you?

A: That was one of the things. I have, to this day, a startle response. You know how a fire truck has that air siren? The first half a second of that winding up, it draws air into the horn, and for a split second, it sounds like a rocket. I'm a firefighter. How do I avoid that horn? Obviously when I'm on the truck and I'm running the horn, I know what it is. But I've jumped out of bed in my house when a half a mile away in the middle of the night when a fire truck driving someplace unrelated winds up.

As I told you, I worked as an EMT. The first time I went back to work and had to treat a little kid, a toddler, I almost lost it because in Iraq, I was at a checkpoint one time when a family come in. Their house or their vehicle or something had been hit by some type of explosive that might've been an IED, it might've been one of our outgoing mortars that missed its target. I still don't know. But an 18-month-old or two-year-old toddler died right there in my arms, with my medic next to me -- nothing we could do. He came in with his mother and father and grandfather, who are shredded with injuries, and are all going to make it. And this little boy with a pinhole-size hole in his belly was dead before he ever knew what happened.

And dealing with kids, that's a hard proposition anyway, but every injured kid is going to remind me of that for the rest of my life, and every fire I ever go to with kids inside, I'm going to think of that. But is it unmanageable? No. I go home and I hug my kids a little bit harder maybe than the next guy does.

Q: I interview all kinds of guys and I have a couple of standard questions I ask them.

A: Sure.

Q: Who taught you about manhood?

A: My father.

Q: Was he a tough guy?

A: My father is not a tough guy at all. My dad stands about five-foot four, is a very quiet guy, not very animated, but firm in a way like you think of an oak tree. Unbending, always knew he was there if I needed him.

Q: How are you different from him?

A: I'm very animated. I'm very loud, and I had more than my fair share of fights (laughs) that I couldn't talk my way out of.

Q: When was the last time you cried?

A: (Laughs.) I'm going to tell you the truth. The Lost finale.

Q: Oh yeah?

A: I brought the DVDs of the first two seasons to Iraq with me. I turned other people on to the show. So what actually happened at the end isn't important. The idea that a part of my life had just ended, a cultural phenomenon just ended, brought a tear to my eye -- more of the happy kind of tear. But I'm not afraid to cry. I'm not afraid of being emotional. I'd rather tell you the truth about what I'm feeling, and if it means shedding a tear, I'd rather do that than be stoic and be hurting inside.

Q: Last question. What's your favorite guy ritual thing to do?

A: Probably working with my hands, and it's a thing I developed over time. I'm not a builder; I'm not a carpenter. But it's the idea of accomplishing something I never did before. When I hear the doctor or the psychiatrist, that I work alongside sometimes, I look at them and wonder -- this Harvard-educated, wealthy, middle-aged guy, has he built something recently that he's proud of? I always used to wonder, would I be that guy left out in the cold who can't fend for himself? Now, there's nothing that's not doable.

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