Post-Traumatic Stress Disorder: The Ticking Bomb in the Foreign Service

Rachel Schneller joined the Foreign Service in 2001, serving in Skopje, Conakry and Basrah, where she was a Provincial Action Officer from 2005 to 2006. In the January 2008 issue of the Foreign Service Journal, she wrote a piece about her personal struggle with PTSD  (See Recovery: When  Surviving Isn’t Enough, FSJ, p. 35). That same year, she was awarded the William R. Rivkin Award for Dissent. The excerpt below is from her 2008 FSJ article:

Since returning from Iraq over a year ago and being diagnosed with the disorder, I’ve gotten a crash-course on the subject. So perhaps I can contribute to the dialog in a way others cannot, by describing what it is like to recover from PTSD.

My PTSD came about due to the conditions I endured while on assignment with the State Department, but State left me to fend for myself when it came to seeking treatment. In June 2006, after having worked in Basrah for several months, I took leave to return to Washington for a few weeks. A Foreign Service National employee in my office had been murdered, and I’d dreamed of hanging myself from my office light fixture.

During leave, I asked the Medical Services Bureau for help and they referred me to an in-house social worker. While telling him about the whole horrible situation, including the dream about killing myself, I broke down in sobs. The social worker was nice but offered me no actual treatment. He did not refer me to a psychiatrist for an evaluation; he did not offer me medication for my depression; and he did not address my thoughts of suicide. Disappointed, but fearful of being labeled a “quitter” or worse, I chose to return to Iraq.

When I think about how poorly State treated me when I sought help, I am outraged. After all, I was in no condition to make decisions about my own well being, any more than an alcoholic can make a well informed decision in a liquor store. Any competent, qualified mental health care provider would have known this. I had requested help but found only more danger. It was as if the ambulance coming for me in my elevator dream not only did not stop for me, but ran over me in the process. I — and everyone else  serving our country in a war zone — deserve much better.
[…]
In any war zone, some people going through the experience will likely come out of it with PTSD. But if the State Department is going to post its employees to war zones, it should be prepared to deal with the mental health aftermath and offer treatment to those who need it.

I completed my Iraq tour at the end of July 2006 and returned to Washington, where I began my next assignment, long-term training at the Foreign Service Institute. After all I’d been through, I was grateful  to be home alive and in one piece, reunited with family and friends. But soon I just stopped functioning normally. I was unable to sleep. I started getting lost on my way home from work, waking up in a sort of fugue state blocks away from my apartment in Georgetown. I don’t remember precisely how, but I burned myself several times so badly that I scarred — yet I didn’t feel it. I only noticed the burns the next day. Rage overwhelmed me. I nearly attacked another person in one of my FSI training classes, but walked out of the class in time and had a meltdown in the bathroom. (That poor woman had no idea how close she came to being strangled by me for making a completely innocent comment.) I couldn’t keep up the  pretense of being normal any longer.

Regions of the brain affected by PTSD and stress.
National Institutes of Health

Last week, I posted about a grievance case by a Senior Foreign Service Officer who claimed PTSD and whose suspension was affirmed by the Foreign Service Grievance Board. In its FSGB filing, the State Department contends the following:

“Grievant served approximately one year in [REDACTED], [REDACTED] and returned to the U.S. on August 11, [REDACTED].  He served nearly seven months at the [REDACTED] without incident, and then, on March 2, [REDACTED] was assigned as Office Director to the Bureau of [REDACTED] and his misconduct began. Grievant waited until almost six months after he was removed from [REDACTED] to seek any medical advice.”

The Foreign Service Grievance Board in affirming the suspension writes:

“The year and a half referred to by the social worker encompasses the first seven months after his return to the U.S. from [REDACTED] when grievant served at the [REDACTED] apparently without incident. Grievant has not stated what he did in {REDACTED]  or what experiences he had that could have caused PSTD. He has presented no testimonials from others at the [REDACTED] or prior to his service in [REDACTED] to support his claim that PTSD accounted for his “out of character” behavior afterwards. There was no evidence that the claimed PTSD impacted any other aspects of the grievant’s life beyond the threatening and demeaning and bullying behavior that formed the basis for the discipline in this case.”

See, nothing happened in seven months, so how could he possibly have PTSD?

I don’t know how knowledgeable is the FSGB about PTSD, including an occurrence described as Delayed Onset PTSD, which can happen anywhere after six months to four years of the traumatic event. Or much longer than four years in some cases.  In fact, according to the LA Times, just a few weeks ago, Tech Sgt. Stanley Friedman, 92 was finally compensated for PTSD by Veterans Affairs (it was called shell shock or battle fatigue when he served nearly 70 years ago) for his service during World War II.  Our Foreign Service folks have not only served in war zones but have been subjected to  terrorist attacks, natural disasters and other traumatic events overseas.  I fully expect that the FSGB will be called on many more times in the foreseeable future to adjudicate cases relating to PTSD in the Foreign Service.

There is no question that the State Department needs to do a better job at screening for PTSD in the Service rather than its “cursory 3 hour High Stress Debrief session” plus handouts or one-day High Stress Assignment Outbrief Program, MQ-950 (which appears to be available only to employees and not/not to family members).  And by the way, spouses/partners who may be working in high-stress posts will not necessarily be working when they are back in the U.S., so they would presumably fall under the Non State Employee category.  The tuition rate for that category for taking MQ-950 is $260.

Rachel commented about the grievance/PTSD blog post, which I am highlighting below.

My heart goes out to everyone involved in this case. The employee having served in a PRT in what must have been extraordinarily difficult circumstances. The bewildered employees who felt threatened by the disturbing behavior of their boss. The State Department system, which has so little capacity for dealing with situations like this, which will only become more prevalent as more and more of us serve in combat zones. And come back.

A couple of things- a diagnosis of PTSD is your best defense, and can only be made by a qualified professional. A social worker cannot diagnose. If you have served in a combat zone and come back acting weird, please do everyone a favor and go see a psychiatrist or psychologist who can actually give you a diagnosis. You will not know you have a PTSD when you come back. You will just feel different and angry all the time. Trust me, get diagnosed. It is the only way to get good treatment.

Second, PTSD is a ticking time bomb. It is completely to be expected that someone with PTSD will come back from their service in a combat zone and be able to hold it together for a while. Luckily for me, I lost it only a few weeks after coming back and so was able to get treatment quickly. But in many cases, someone will not “lose it” for months or years afterward. You get triggered by something and BAM! You are right back in the war zone. That trigger may happen soon or it may not happen for a long time.

Third, you are an adult and so even if you have PTSD, you still are responsible for not attacking people or otherwise breaking the law, and you can and will be held responsible. PTSD is not a license to break the law. It does not make yelling at people OK. The soldier who “lost it” and killed all those innocent Afghani civilians a few months back? He probably had major PTSD, but he also killed a bunch of innocent people. Getting suspended from State is a good thing, because if you have PTSD you need to get treated, and this is your wake-up call.

And State, this sort of situation is going to keep happening. We need to do a better job of handling this sort of PTSD situation. It is only a matter of time before someone comes back and instead of yelling at their employees, actually does someone, or themselves, physical harm.

While I do believe that the State Department has the responsibility for conducting more effective PTSD screening for returnees, I also agree with Rachel’s point that mental health is an individual responsibility.  As she puts it plainly, “if you wait for State to get its act together on PTSD, you will be crazy for a long time.”

Wednesday, June 27 is PTSD Awareness Day. DiploPundit will be blogging about this topic the whole week.

Domani Spero

4 responses

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  3. Great read, interesting as always. Reblogged this via Tumblr…appreciate your honest non-angry (so non-We-Meant-Well) approach to things on the blog.

    As we come to grips with CIV/MIL integration in conflict zones, we need to be equally prepared to come to grips with the fallout of same (i.e. long-term effects on our personnel).

    • Thanks for the note, Dan. But no one has been poking bureaucratic needles at me, that’s probably why. The thing that really give me nightmares is bath salts + returnees suffering the fallout from our wars.