Ron Capps | Back From The Brink: War, Suicide, And PTSD

Ron Capps retired from the Foreign Service and the Army reserve in 2008. During a twenty-five-year career, he served  in Kosovo, Rwanda, Afghanistan, Iraq, and Sudan, just about all the hell holes on earth.  He is founder and director at Veterans Writing Project.  He blogs for the Battleland blog at TIME Magazine and in his personal blog, The Next Lost Generation.

In a 2010 issue of Health Affairs, Mr. Capps wrote, Back From The Brink: War, Suicide, And PTSD. The piece is one of the most poignant agonies of post-traumatic stress disorder I have read.  He imagined the dead coming to talk to him every night asking, “Why didn’t you do more to save us?”  He had memories of “the dead, the mutilated, the burned.”  He wrote a story where the protagonist shoots himself in the head with a pistol.  He borrowed a gun, and put a gun to his head.  A timely phone call from his wife saved him.

“When the phone rang I jumped—startled—and nearly shot myself. This was almost comic, because I was already planning to kill myself and was holding the pistol in my hand. So I would have pulled the trigger while the pistol was pointed at my foot rather than my head. The ringing phone broke the spell.”

He was afraid to ask for help, writing, “I thought I would be ridiculed, considered weak and cowardly.”  This from a man who had two Bronze Star medals and tours in Airborne and Special Ops units.

He also writes about Question 21, the one that keeps many soldiers from asking for help. This was changed under Secretary Gates but apparently some things remain the same.

The magazine won’t allow republication on the web (we asked), so go read it in full at the HA website.
Domani Spero

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Quickie | Running Amok: Mental Health in the U.S. Foreign Service

Via Diplo Denizen by James Bruno (author and ex-diplomat comments on foreign affairs & writing). Mr. Bruno is the author of political thrillers Permanent Interest and Chasm and an Afghanistan thriller, Tribe; all available via Amazon Kindle:

In the second year of my Foreign Service career, I was assigned to Vientiane, Laos.  My deployment was accelerated by my predecessor’s seeking and being granted a one-year curtailment of his tour of duty because he was going bonkers.  Moreover, an admin officer had to be removed in a straitjacket after holing himself up in his house and smearing the walls with his own feces, another victim of mental and emotional stress.  I, on the other hand, thrived at this isolated outpost, our only one in Indochina five years following the fall of Saigon.  The setting was a cross between “Heart of Darkness” and “Casablanca.”  My seizure at gunpoint and brief incarceration by the authorities, which prompted a diplomatic row, was just one of the pressures at this surreal place.  Years later, in civil war-torn Cambodia, the State Dept. regularly sent a psychiatrist to post to measure our stress levels amid coup attempts, assassinations, 12-14-hour work days seven days a week and an unhinged ambassador.  At another embassy, one of our largest, the Secretary of State discreetly sent out two senior officials to gently pry our prominent career ambassador out of his job in the wake of his increasingly bizarre behavior, including public denunciations of an American ally.
[…]
In recent years, the number of Foreign Service personnel medevacced for mental health reasons has doubled.  One study revealed 15 percent of FS members suffered from PTSD.  A similar study done by the Defense Dept. found that 17 percent of soldiers returned from Iraq and Afghanistan suffered from the same condition.  As the U.S. has gotten involved in more overseas conflicts, the pressures on our diplomats have compounded.

A particularly sad case was documented in the September 2010 issue of the Foreign Service Journal.  A former military officer and tsunami survivor, this FSO was assigned to one of the most dangerous war zones six years into his State Dept. career.  He worked 12-14-hour days amid gun and mortar fire.  After being injured in a roadside bomb attack, a State Dept. psychiatrist prescribed an antidepressant for his PTSD.  But the medication caused lack of sleep, loss of appetite and high blood pressure.  When he complained about the side effects, he was prescribed a different antidepressant.  But the side effects continued and he was evacuated from post and placed in psychiatric hospitalization in Washington.  State Dept’s MED office failed to provide him with a doctor proficient in treating PTSD, so he found one on his own.  He was told he could not return to post.  Further treatment did not resolve his problem and he was medevacced again from another post.  He lives in Washington, separated from his wife, and essentially grounded for medical reasons.  His career prospects don’t look good.  This officer is convinced that, had he received better treatment, his current situation could have been avoided.

Continue reading, Running Amok: Mental Health in the U.S. Foreign Service.

Domani Spero

Former FSO William Anthony Gooch: No Mercy for Broken Men?

On May 12, 2012, William Anthony Gooch, 52, was sentenced to 12 years in prison – the maximum he faced under a plea agreement in the Nov. 7, 2010 episode, in which Gooch rammed a Jeep into his estranged wife’s home before setting it ablaze.

What was not widely reported is that he’s a former Foreign Service officer.

In the July/August 1998 issue of State Magazine, he was listed as an “FS Specialist Intake.”  In the February 2003 issue of the same magazine, he was listed under “Foreign Service Retirements”

There is no public catalog of what happened to him after he left the Foreign Service. But apparently in 2005, while visiting Roswell, Ga., Mr. Gooch broke into his brother’s gun safe and ended up in a standoff with police where he begged to be shot.

In 2008, he reportedly shot himself in the chest, narrowly missing his heart. The suicide attempt led to a period of sobriety, and a seeming improvement, according to unnamed relatives cited in local reports.

In August 2009, Mr. Gooch was arrested after a six-hour standoff. This time, he also had a gun and was threatening suicide.

In 2010, El Paso County sheriff’s deputies told local news that Mr. Gooch crashed his car into the Black Forest home of his estranged wife, set the house on fire and then barricaded himself inside.  He was reported to be in critical condition in the burn unit at the Anschutz Medical Campus in Denver, according to hospital officials cited in local reports.

On May 12, 2012, he was sentenced to 12 years in prison – the maximum he faced under a plea agreement in the Nov. 7, 2010 episode.

Colorado Springs’ The Gazette had a write up on the hearing that details the unraveled life of former foreign service officer.  Excerpt below:

According to the family’s account, Gooch served in the Navy and the U.S. Agency for International Development before his 1998 transfer to the State Department, where he worked in the security office.

Within months of accepting the new post, Gooch and his family were assigned to Kinshasa in the Democratic Republic of Congo, where tensions were mounting between warring factions, according to his son, Andy Gooch, a private first-class in the Army National Guard and senior at Virginia Commonwealth University.

The six families in their compound were eventually moved out of Kinshasa as violence ramped up, Andy Gooch told the court, describing how they were driven past the dead and wounded on their way to the airport.

His father remained behind to help evacuate other Americans and nongovernmental aid workers, he said.
Gooch told his family that he was detained and beaten by Congolese police during the ensuing choas. He said a fellow Foreign Service officer secured his release.

Later that year the family was sent to Nairobi, Kenya, where according to Andy Gooch’s account, his father helped identify victims in the wake of a 1998 bombing that killed hundreds at a U.S. Embassy.

In Nairobi, the family survived an attempted car jacking when William Gooch shouted for his wife and children to get down while he drove around a road blockade past men armed with AK-47s, Andy Gooch said.

“When I was 10 or 12 years old, I saw things most people don’t see in their whole life,” Andy Gooch said. “If I got that little piece, I can’t imagine what my father saw.”

Said Sotela: “His mental health was deteriorating through the years that he was exposed to that situation.”

Gooch’s career with the State Department ended with a medical discharge in the early 2000s after he suffered a breakdown during an assignment in Kingston, Jamaica, family members said.

According to The Gazette, Mr. Gooch addressed the court in a soft voice, apologized and said he never meant to hurt anyone except himself – by swallowing pills, shooting himself and trying to get “someone else” to shoot him.  “Jumping off a bridge is about my last resort,” he told Judge Greg Werner, before ending his comments with a pledge to take treatment seriously.

I had this story the same week that George Gaines died in Barbados.  I just could not get myself to write about two tragic episodes that same week. The prosecutor in this case, suggested in court that Mr. Gooch exaggerated his experiences in a bid for leniency.  Nothing in the press reports suggested that Mr. Gooch was diagnosed or treated for PTSD. But it says he was medically discharged after he suffered a breakdown in Jamaica.

Domani Spero

Rachel Schneller | PTSD: The Best Thing that Ever Happened to Me

Disclaimer: The views expressed in this article are those of the author, and do not necessarily reflect those of the U.S. Department of State or the U.S. Government.  Read more about Rachel here ~ DS

PTSD: The Best Thing that Ever Happened to Me

by Rachel Schneller

PTSD felt like the worst thing that had ever happened to me. I came back from Iraq in 2006 feeling damaged, like the FedEx package in the movie Cast Away that arrived at its final destination beaten up beyond almost all recognition. I didn’t know I had PTSD, I just knew that something was wrong. Everything and everyone felt like a threat. Everything made me angry and want to fight. I oscillated between sheer rage and numbness, because feeling angry all the time left me exhausted. But I couldn’t sleep much, which also made me angry.

Photo from Private Collection (used with permission)

If I had not sought out treatment for PTSD, I believe I would have wound up dead, in prison, or homeless and unemployed, carrying a sign on a street corner somewhere raging against the world. Best case scenario, I would have managed to continue to somehow drag my bitter mess of a self to work each day, where I would have made the lives of everyone around me absolutely miserable.

Don’t get me wrong, there were parts about being completely lost in my traumatized self I enjoyed. The rage and anger resulting from my experience in Iraq made me feel more alive than I had ever felt before. I was completely focused and driven and could work insane hours at high intensity like a superhero. Everyone around me seemed slow and crippled by worry, whereas I felt no pain and absolutely no fear (I also felt no joy).

After six years of rigorous treatment for PTSD, I feel now like I am both healed enough to engage with the rest of the world in a healthy way, and still aware that I went through a life-altering experience that left a permanent mark on me. I am bilingual and bicultural in PTSD. And honestly, I would not have it any other way. My service in Iraq was important and one of the most meaningful periods of my entire life. My experience with PTSD has made me more sensitive and compassionate toward other people. My treatment for PTSD helped me grow into a better person than I ever could have become without Iraq and without PTSD.

My bottom-line message on PTSD is to get treatment.  To get treatment, you need a diagnosis.  To get both the diagnosis and the treatment, you need to see a professional.  You should do all these things because they will make you a better person.  Be brave and undeterred in your mission.  Since speaking out on PTSD several years ago, I have been approached by numerous people who are suffering symptoms of PTSD and ask for advice on what to do.  I tell them all the same thing: get treatment.  Some worry that seeking treatment might impact their careers or families.  What I always say is that untreated PTSD is much more likely to ruin your career or family than seeking treatment.  Some worry about stigma attached to a diagnosis, or that they will be limited in overseas assignments.  My response is: don’t worry about things outside of your control, such as what other people think and where you might be in a year or two.  Shift your attention to the here-and-now and do what needs to be done today.

I would love to design a compassionate, comprehensive program for people with PTSD.  I daydream about doing this, where several years ago my thoughts reverted back to helicopters, rocket attacks, and endless expanses of concrete barriers.  My ability to focus has been honed through years of yoga and meditation, practices I found particularly helpful in my treatment of PTSD.  I still feel no fear, and still have limitless energy to fight for the things that are important to me.  But now I also feel joy.  And finding joy and beauty in life after surviving a horrific event is to experience joy and beauty in a deeper, more meaningful way than ever would have been possible before.  Although I could not see it at the time, PTSD was the best thing that ever happened to me.

Pick the Long or Short Form, But Take the Post-Traumatic Stress Disorder (PTSD) Screening

Here’s how VA explains PTSD:  Posttraumatic stress disorder (PTSD) can occur after you have been through a traumatic event. A traumatic event is something terrible and scary that you see, hear about, or that happens to you, like:

  • Combat exposure
  • Child sexual or physical abuse
  • Terrorist attack
  • Sexual or physical assault
  • Serious accidents, like a car wreck
  • Natural disasters, like a fire, tornado, hurricane, flood, or earthquake

During a traumatic event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening around you. Most people have some stress-related reactions after a traumatic event; but, not everyone gets PTSD. If your reactions don’t go away over time and they disrupt your life, you may have PTSD.  Read more here.

The Department of Veterans Affairs also put together a PTSD screening online which has 17 questions on problems and complaints that veterans sometimes have in response to stressful military experiences. All references are to stressful military experience.  Click here to read each question carefully, then select the answer that indicates how much you have been bothered by that problem in the past month.

I don’t think I’m going bonkers but I took the screening anyway.  The portal says that no information is collected, stored or sent over the Internet. To ensure complete privacy, exit your web browser after completing the screening.

See the text-only version.

Results between 0 and 20 indicate few or no symptoms of PTSD. Results between 21 and 29 indicate minimal symptoms of PTSD. Results between 30 and 85 indicate many of the symptoms of PTSD.   The PTSD Screening is, however, careful to explain that it is not designed to provide a comprehensive assessment or diagnosis of PTSD:

“Only a qualified physician or mental health provider can provide a complete assessment and diagnosis of PTSD. Only a qualified physician or mental health professional can differentiate symptoms of PTSD from other medical conditions. Only a qualified physician or mental health provider can prescribe appropriate treatment for PTSD or other medical conditions.”

The State Department has its own  Four Question PTSD Screener and says, “If you have answered “yes” to three (3) items or more it is considered “positive” and your screening results are consistent with symptoms of PTSD.  Also that if the screening results suggested the need for further assessment/evaluation, to check out the following resources:

  • Visit a primary or mental health care provider.
  • If you are not sure about benefits or don’t have a primary care manager:
    Contact the Employee Consultation Service at MEDECS@state.gov or Call 202-663-1815.
  • Contact the Deployment Stress Management Program at MEDDSMP@state.gov or Call 202-663-1903.
  • Contact MHN Support Services are available through web, phone, and in-person.
    Internet: https://members.mhn.com/ company code: ‘unaccompanied tour’.
    Phone: Call toll free, 24/7 at 1-800-213-5811

As you can see, we tried that company code and it’s a dud.

Domani Spero


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