Suicide Mission (Guest blog)

 SPECIALIST TY CARTER LAY IN BED, DREAMING OF DEATH – SOME WONDERED IF EXORCISM COULD CURE PTSD.

It was October 2009, just days after a brazen Taliban attack on a remote American military base in eastern Afghanistan killed eight of the 53 members of his unit and wounded 27 others. The trim 29-year-old had hauled ammunition to pinned-down U.S. troops and killed close to a half-dozen Taliban fighters. His acts of bravery helped keep the tiny base from being completely overrun and later earned him the Medal of Honor, the U.S. military’s highest commendation. Carter didn’t feel like a hero, however. Alone at night, tossing and turning in his bed, he couldn’t escape the sounds of that fateful firefight and the sight of Spc. Stephan Mace — immobilized after his legs had been blown away — begging for help, tears streaming down his dirt-covered face. Carter had raced across the battlefield and treated the 21-year-old’s wounds, but, ultimately, Mace died during surgery just hours later. Carter felt that he had failed his comrade; if only he’d moved faster, he thought, Mace would have lived. And though Carter’s platoon sergeant encouraged him to feel proud about having helped save other troops, “I couldn’t really hear him,” he said during a recent speech in Maryland. “I was more focused on getting to my bunk, burying my head into a pillow, and not existing. I wanted to find a deep hole and just disappear.”

The final months of Carter’s yearlong deployment passed by in a blur of fear and despondency. He went out on every combat patrol he could, hoping that the adrenaline would wash away the crushing feeling that he was a failure. The descent only continued when he returned home to Colorado’s Fort Carson in the summer of 2010. Car rides evoked memories of the roadside bombs that wounded his friends in Afghanistan. Even mundane trips to a shopping mall led to crippling panic attacks; the lights seemed too bright, the music too loud, the other shoppers too pushy and intrusive. Alcohol, he soon found, dulled the pain. His weekend sprees — often including top-shelf liquor, crowded bars, and drunken cab rides — typically cost him around $500. And his relationships with women were nothing but a series of short-lived affairs in which “I was a prick,” he admits today. But the breaking point came at his next post, Washington’s Joint Base Lewis-McChord, where he began showing up late for military formations and reeking of alcohol. Carter’s commanders had had enough. A frustrated noncommissioned officer said he would bust Carter down in rank, effectively ending his military career, unless he got his act together.

It was just the prod he needed.

Gradually Carter came to accept that he had post-traumatic stress disorder, or PTSD. The signature wound of the wars in Iraq and Afghanistan, post-traumatic stress has been linked to, among other fallout, a suicide epidemic that has taken the lives of more than 2,500 U.S. troops since the conflicts began. But this isn’t unique to American soldiers: PTSD also affects those in the Israeli, British, and Canadian militaries, among many others, though at rates far lower than in the United States. That’s because few other militaries in the world have been continuously at war for so long or have sent their sons and daughters off to fight on distant battlefields as often. British troops have fought alongside American ones in Iraq and Afghanistan, though for shorter amounts of time and often in less dangerous parts of the two countries. A recent study by researchers at King’s College London found that just 2 to 5 percent of British war veterans experienced symptoms of PTSD, a fraction of the 21 to 29 percent among U.S. troops.

Today, Carter’s fight isn’t against a heavily armed Taliban militant, but against the social stigma attached to post-traumatic stress. The 34-year-old staff sergeant devotes his days to traveling around the United States delivering speech after speech — to strangers he doesn’t know, but whose night terrors he well understands — in an effort to convince troops and others not only that the psychological reaction is real, but also that seeking help is a sign of strength, not weakness. It’s a lonely fight, however. No other living Medal of Honor recipient publicly talks about personal experiences with PTSD.

“Post-traumatic stress is natural. You’ve been through combat. You’ve seen and done things you never thought you were capable of doing. You’ve lost friends. You’ve lost your illusion that the world is a safe place,” he told Foreign Policy in June. “There’s nothing wrong with you if you come back from combat with post-traumatic stress. There’s something wrong with you if you don’t.”

SOLDIERS HAVE BUCKLED UNDER THE STRAIN OF WITNESSING AND COMMITTING HORRIFIC ACTS OF VIOLENCE FOR AS LONG AS HUMANS HAVE TAKEN UP WEAPONS AGAINST ONE ANOTHER. In The Iliad, Achilles experiences such overpowering sadness and rage after his closest friend dies outside the walls of Troy that he contemplates suicide. Achilles later publicly mutilates his friend’s killer in revenge. In The Odyssey, Homer plaintively asks, “Must you carry the bloody horror of combat in your heart forever?” For centuries, soldiers have returned from combat beset by lifelong bouts of depression, anxiety, and sleeplessness. They have felt disfigured and debased by war, even if they suffered no physical injuries. “I don’t believe I am the same being I was two weeks ago,” a Civil War soldier named Walter Lee wrote to his mother in 1862. “I don’t think as I used to and things don’t seem as they did.”

The names given to those types of psychological and emotional responses have changed over time, but their high human toll has remained grimly constant. Soldiers shattered by the carnage of World War I were told they had shell shock. By 1919, 38 percent of the veterans in U.S. military hospitals were “mental and nervous cases”; by the mid-1930s, that number had spiked to more than 56 percent. During World War II, military doctors said soldiers suffered from “combat fatigue” — an inability to fight due to anxiety, depression, and listlessness. The mental and emotional strains were so intense throughout that war that roughly 438,000 U.S. troops were discharged from the military for so-called psychiatric reasons, a little-known statistic that gives a sense of the anger, depression, and guilt that had built up in those fighting on the battlefields of Europe and the Pacific.

The Vietnam War took an even higher emotional toll. Troops fought guerrillas who wore no uniforms, hid among civilians, and emerged from the shadows to kill and maim American soldiers before disappearing again. U.S. forces responded with acts of sheer savagery, from the wholesale slaughter of civilians to the mutilation of enemy corpses. Some soldiers smuggled drugs and alcohol onto their bases, and returned home with severe substance-abuse problems; others killed their own officers and enlisted personnel in what became known as “fragging.” Veterans returned to the States feeling like they’d left essential parts of their humanity on the battlefields of Vietnam. One veteran of three combat tours told clinical psychiatrist Jonathan Shay that, physically speaking, he returned looking almost exactly the same as when he had left; his psychological state, however, was another matter. Old friends didn’t recognize the angry, moody, and occasionally violent man who had come home. “I’d be sitting there calm as could be, and this monster would come out of me with a fury that most people didn’t want to be around,” he told Shay. “It wasn’t just over there. I brought it back here with me.”

In 1980, the American Psychiatric Association finally gave a name to what many veterans would spend the rest of their lives fighting: post-traumatic stress disorder. The association’s official diagnostic manual said that those most at risk had “experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone,” such as a serious threat to the patient’s own life or the sight of other people who had been killed or grievously wounded. Common symptoms, the association said, included vivid nightmares, flashes of anger, insomnia, and substance abuse. A few years after the war, the Department of Veterans Affairs estimated that roughly 750,000 Vietnam veterans were at risk of developing some form of PTSD.  Later studies argued that the rates were slightly lower, but there is no question that traumatic stress was the single darkest legacy of that war. In 2011, nearly four decades after the last U.S. troops were airlifted out of Saigon, 299,076 Vietnam veterans were still receiving benefits for PTSD, far more than for any physical wound.

Most mental health professionals, both inside and outside the military, fear that post-traumatic stress will exact a heavier toll on the veterans of Iraq and Afghanistan. As in Vietnam, U.S. forces battled enemies they couldn’t see, and they guarded against buried bombs that they often had little chance of spotting or defusing. But unlike in Vietnam, many troops did two, three, or even four tours through the war zones (Carter deployed to Afghanistan twice). More than 2.6 million U.S. troops have circled through Iraq and Afghanistan since October 2001; the Department of Veterans Affairs estimates that up to 20 percent of those troops, or some 520,000 U.S. service members, have some form of post-traumatic stress. Not only that, but some of the senior officials who sent U.S. troops to war, such as Robert Gates, wrestle with their own psychological responses as well.

Gates served as defense secretary, first for George W. Bush and then for Barack Obama, during the Iraq and Afghanistan troop surges. Even though Obama asked Gates to stay on through the end of his second term, the defense chief declined and left in 2011. The horrors of war, the impact of combat on U.S. troops, he told me, left him fundamentally changed. He is haunted by memories of the thousands of young soldiers, airmen, sailors, and Marines he visited in military hospitals around the world as they recovered from lost limbs or hideous burns. Gates personally wrote condolence letters to nearly 3,000 families.

“I think that there’s a form of post-traumatic stress for those who are not directly involved in the battle but who see the consequences of the battle, who are watching the wounded being brought in, who are watching the procession of dead soldiers on the tarmac getting, being taken, onto the planes and things like that,” he told me in April 2013, two years after leaving the Defense Department. “I began to wonder, frankly, toward the end of my time, whether I had some measure of it myself.”

CARTER IS AN UNLIKELY HERO. As a shy, freckled teenager from California, he joined the Marine Corps in October 1998, right after graduating from high school, but was honorably discharged in 2002 after getting into a fight with his roommate. He spent the next five years working odd jobs, such as cleaning the bottoms of yachts, assembling furniture for Home Depot, and delivering packages for UPS. By 2008, Carter had soured on civilian life and decided that he was better suited for the military, which, strained by the long wars in Iraq and Afghanistan, was desperately looking to recruit new troops. He enlisted in the Army and spent a year training at Fort Knox in Kentucky with his new unit — Blue Platoon, Bravo Troop, 3rd Squadron, 61st Cavalry Regiment, 4th Brigade Combat Team, 4th Infantry Division — but he didn’t quite fit in. A loner growing up, Carter struck many of the other soldiers as standoffish and a bit prim. “We had a platoon full of guys that were on a lighter side of life [who] liked to joke around,” retired Sgt. 1st Class Jonathan Hill later told CNN. “Carter really never got involved.… He thought it was immature,” he said, adding that Carter “really didn’t make friends with a lot of guys.”

In the summer of 2009, Carter’s unit shipped off to Afghanistan. It was the height of the surge there, and the Pentagon was flooding the country with tens of thousands of troops. He landed at a base known as Combat Outpost Keating, which would soon become shorthand for the bravery, folly, and tragedy of the Afghanistan war — and also would become the nightmare that would haunt Carter for years to come.

On the evening of Oct. 2, unbeknownst to the U.S. troops, hundreds of Taliban fighters silently took up positions a short distance away from Keating’s sandbagged walls. They struck just before sunrise, lashing the base with mortars, rocket-propelled grenades, and machine-gun fire until they had breached the makeshift walls surrounding the outpost and had forced their way into the base itself. “Enemy in the wire at keating,” a young soldier messaged to a nearby base. “ENEMY [sic] IN THE WIRE ENEMY IN THE WIRE!!!”

Carter had just awoken and was in his Army-issued workout gear when he heard the gunfire. He grabbed his body armor, M4 assault rifle, and as many rounds of ammunition as he could carry, and he sprinted toward an armored Humvee parked at the southern end of the compound. Bullets crashed near his boots, snapping small plumes of sand and dirt into the air around him. To Carter, “it looked like it was rain hitting desert soil.”

Once at the Humvee, he found two soldiers, Spc. Stephan Mace and Sgt. Justin Gallegos, trapped inside. He gave his ammunition to them and then charged back through heavy gunfire to grab more. By the time he returned, the vehicle — taking fire from all directions — was rocking on its tires, and two more soldiers had squeezed inside; within minutes, a series of rocket-propelled grenades smashed into it. The heavy machine gun mounted to the Humvee’s turret was destroyed, sending shrapnel cascading down and wounding three of the five men.

Trapped in a disabled vehicle and largely out of ammunition, Gallegos, Mace, and Sgt. Vernon Martin made a run for the nearby tactical operations center, one of the most fortified structures on the base. They didn’t make it. Gallegos had almost reached the building when he saw Mace drop to the ground; as he made his way back toward the fallen soldier, Gallegos was killed by a volley of Taliban bullets. Martin was hit in the leg and managed to crawl under a nearby building, where he died. Back in the Humvee, Carter, horrified, watched Mace crawl through the dirt, blood smearing behind his blown-off legs, while bullets and rocket-propelled grenades punctuated his friend’s movements. Mace was just a few yards away, crying for help. Although Carter knew it was too dangerous to leave the Humvee, he raced onto the battlefield anyway, pulling Mace to safety and performing emergency first aid on him. He kept the soldier alive until Mace could be airlifted to a larger base and rushed into surgery. The firefight raged for more than 12 hours before U.S. combat aircraft helped the battered survivors of Blue Platoon repel the attackers.

“There are some images that last with you,” Carter said during a speech this past summer, using a version of the language about Mace that he inserts into virtually all his public remarks. “When a man who is suffering and bleeding out in front of you is asking for help and you say no, what kind of person are you? How do you come back from that?”

In the days after the firefight, Carter and the other survivors of the Keating battle were transported to a larger base to escape the active battlefield. One night, Hill, Carter’s platoon sergeant, noticed him standing alone in the dark, shoulders slouched and head down, holding his M4 rifle across his waist. In a later interview with an official Army magazine, Hill said he could see that Carter “was hurt bad on the inside.” When he asked Carter what was wrong, the soldier “looked me in the eyes and he had tears streaming down his face. And he says, ‘I just couldn’t save him.’ I hugged him and he hugged me and we both cried right there,” Hill said in the interview.

Hill introduced Carter to the world of therapy — and took him to the first session of the counseling that Carter credits with saving his life. Carter became indebted to Hill and the other soldiers who had encouraged him in this, especially when he got word that Spc. Edward Faulkner, who had fought at his side during the firefight at Keating, died of a drug overdose in the fall of 2010, just months after he’d returned to the United States. The medical examiner said that post-traumatic stress was a “contributing” factor in his death. Faulkner had the same symptoms as Carter, but he hadn’t managed to get help in time. “I could be just like Edward Faulkner,” Carter says. “I had the nightmares. I had the flashbacks. I had the anxiety. I had the chemical dependence, in this case alcohol. But what I had that he didn’t have was the support. And that was the difference.”

BY THE SUMMER OF 2013, CARTER FINALLY BEGAN TO FEEL THAT HE WAS GETTING HIS POST-TRAUMATIC STRESS UNDER CONTROL. He’d re-enlisted, done a second yearlong deployment through Afghanistan, married a woman whom he had met online, and had a baby girl with her, making the third child for the family — he had a daughter from his first marriage, and she had a son from hers. He had fewer and fewer flashbacks, and he had managed to sharply reduce his drinking. Carter knew that his superiors had nominated him for a Medal of Honor, but he didn’t think he would get it, and he certainly didn’t think he deserved it.

Others felt very differently. In early July, an officer at the Pentagon called Carter to ask whether he’d be able to take an important call from a high-ranking military officer in a few days’ time. Carter said no — he and his family were about to leave for a road trip through an area with poor cell-phone reception — but he recognized the urgency in the officer’s voice and promised to find a place where he’d be able to take the call. A short time later, Carter pulled his camper to the side of an Oregon highway to take a call from the president of the United States. Obama thanked Carter for his service, said he had approved Carter for the honor, and told the stunned soldier that he looked forward to meeting Carter and his family in Washington, D.C.

On Aug. 26, 2013, Carter stood at attention in the East Room of the White House as the president draped the star-shaped medal around his neck. Mace’s mother, Vanessa Adelson, attended the White House ceremony along with relatives of Keating’s other fallen soldiers. Carter, Obama said, was a hero, both for what he did during the fighting at Keating and for his willingness to speak out about his own struggles with PTSD. “Let me say it as clearly as I can to any of our troops or veterans who are watching and struggling,” Obama said. “Look at this man. Look at this soldier. Look at this warrior. He’s as tough as they come. And if he can find the courage and the strength to not only seek help, but also to speak out about it, to take care of himself and to stay strong, then so can you.”

In his own remarks, Carter urged the American people to learn to treat those suffering from the “invisible wounds of war” with more understanding, empathy, and support. “Know that a soldier or veteran suffering from post-traumatic stress is one of the most passionate, dedicated men or women you’ll ever meet,” he said. “Know that they are not damaged. They are simply burdened with living when others did not.”

ON AN UNSEASONABLY COOL MARYLAND MORNING IN EARLY JUNE 2014, CARTER WALKS ONTO THE STAGE IN AN AUDITORIUM, LOOKS OUT OVER A CROWD OF HUNDREDS OF UNIFORMED AND ARMED POLICE OFFICERS, AND TELLS HIS STORY FOR THE 30TH TIME THIS YEAR. Although an introvert, Carter is a natural public speaker who talks without notes, maintains eye contact with the crowd, sprinkles jokes into his remarks, and paces the stage with the confidence and swagger of a motivational speaker.

“When trauma hits you, it changes your perception of reality,” Carter says. “If you let this eat at you, you can compartmentalize all you want, [but] it will come up. Things don’t ever go back to how they were.”

During the hourlong talk, Carter doesn’t sugarcoat the impact of post-traumatic stress. He tells the police officers that it has left him with chronic acid reflux, pounding headaches, and high blood pressure. He cautions that counseling isn’t like going to a doctor, where a physician can diagnose an illness and provide a quick cure. Instead, good therapists, he tells the crowd, provide the tools that allow those who are traumatized to find ways to heal on their own. “When you go to counseling you have a festering wound,” he says. “They help you open it up, and let it drain out, and close it back up. You go to counseling again, open the wound, let it drain out. Every time you do that, it hurts a little less.”

When it comes time to take questions, Carter isn’t shy about using profanity or admitting to things the Army would probably wish he’d keep private, such as sometimes wearing his Medal of Honor while drunk. When a police officer asks about the perks of being awarded the honor, Carter doesn’t hesitate: attending the Miss America pageant and hugging the winner.

But the vibe in the room changes when another officer asks how long police should wait before entering a building where a troubled veteran might be holed up after a severe psychiatric episode. Carter has a simple answer: Hold off as long as possible to see whether the veteran can be persuaded to leave willingly. Many soldiers, himself very much included, have training in marksmanship and know how to build homemade explosives and booby traps. Taking a more aggressive approach, he warns the audience, could exact a horrific toll on the officers involved.

“At my house, because I have land, it’s 100 yards from my front door to my front gate, which has cameras up with 360-degree visibility,” he says in a chilly, flat monotone. “In combat we got constant reports of enemies wearing our uniforms. So if I’m having an episode, and you’re breaching, and I think you’re harming myself or my family, I will defend myself to the death. Also remember that I have been outnumbered, surrounded, and low on ammo — and I still fought. So with the knowledge that I have and the experience that you have, I don’t care how many [officers] you have.… Maybe one of you will survive.”

The officers, who had been laughing moments earlier when Carter talked about Miss America, sit silently. Several leave the room.

After the speech, Luther Reynolds, the assistant chief of police for Montgomery County, Maryland, looks on as Carter poses for photos with some of the officers. The chief says that police officers, like soldiers, are often forced to either confront or carry out acts of violence. The stigma that surrounds mental health in the military exists in the police force as well; in both communities, reaching out for help is not seen as empowering. Reynolds says he hopes that Carter can inspire at least a few of the officers. “He carries a unique level of credibility because of who he is and what he’s gone through,” Reynolds says. “We have to change our culture so people are more open about what they’re going through. He can hopefully help us do that.”

IT HAS TAKEN FIVE YEARS, BUT CARTER SAYS THAT HE FINALLY HAS MADE IT THROUGH FOUR CONSECUTIVE MONTHS WITHOUT A NIGHTMARE AND FEELS LIKE THE WORST OF THE TRAUMATIC-STRESS SYMPTOMS HAVE FINALLY BEGUN TO DISSIPATE. “The flashbacks aren’t flashbacks anymore,” he says. “They’re more like faded memories.”

Still, he acknowledges that changing the stigma that surrounds mental health in the military will take time. “There is progress, but it’s very slow, and it’s not going to happen now,” he says. “People are going to fight it.”

He’s right. Carter began his career at Fort Carson, a base that had some of the biggest problems with stigma and suicide in the entire Army. In one particularly striking incident, soldiers from the 3rd Brigade Combat Team of the 4th Infantry Division designed a fake “Hurt Feelings Report” and left copies near a sign-out sheet for those seeing one of Fort Carson’s doctors. The document began, “Reasons for filing this report: Please circle Yes or No.” The choices included: “I am thin skinned”; “I am a pussy”; “I have woman like hormones”; “I am a Queer”; “I am a little bitch”; “I am a cry baby”; “I want my mommy”; “All of the above.” There was a blank space for soldiers to fill in the “Name of ‘Real man’ who hurt your sensitive feelings.”

The military is devoting enormous amounts of money toward eradicating that type of stigma. A Congressional Research Service report estimates that the Pentagon spent more than $4 billion on mental health treatment between 2007 and 2012, pouring money into hiring more counselors, designing and conducting mandatory psychological health training for all troops, and creating new teams of therapists that are assigned to specific military units in order to build a rapport and comfort level with the soldiers. Senior leaders from Obama on down routinely emphasize that post-traumatic stress, depression, and other psychological effects can be as deadly as physical ones. But for these efforts to work, first the military’s culture and value system must fundamentally change.

The Army is the definition of a hierarchy, and younger soldiers won’t truly believe that they can seek help without destroying their careers until top generals and senior sergeants — those specifically selected for their resiliency and inner strength — begin to publicly share stories of their own struggles with combat stress, PTSD, and depression. Dozens of generals and high-ranking sergeants served in Iraq and Afghanistan. Many were at bases that came under regular insurgent attack, many lost friends, but all had to wrestle with the emotional impact of attending battlefield memorial services, writing condolence letters to grieving families, and visiting field hospitals where young troops who had lost limbs or suffered horrific burns writhed in pain. So far, only a small number of them have been willing to talk about what they saw — three generals, as far as I was able to identify in the course of researching my book.

Carter returned home without any serious physical injuries, but he has still endured a wrenching readjustment process. He once credited Shannon, his second wife, with helping to bring him back from the brink, but their marriage crumbled within three years. Their ongoing divorce proceedings have grown increasingly nasty, in part because they’re fighting over custody arrangements for their daughter. Carter is currently living alone in a small hotel room.

His professional life is also becoming increasingly unsettled. Even though he has long spoken about serving 20 years in the military, which would allow him to retire with full health and pension benefits, he recently asked the Army for permission to retire this fall so he can accept work with Operation Wounded Minds, a nonprofit organization that his father created to help veterans with post-traumatic stress. But Carter also wants to weigh offers from the private sector: He has been approached by ghostwriters who want to turn his story into a book, and he has spoken with Hollywood producers about possible movie projects. Either path could be hugely lucrative: As a staff sergeant, Carter earns roughly $35,500; movie or book projects could easily bring him hundreds of thousands of dollars.

In uniform or out, Carter won’t be leaving the public stage anytime soon.

AFTER HIS TALK IN MARYLAND, CARTER POSES FOR DOZENS OF PICTURES, OFTEN STOPPING TO SPEAK QUIETLY WITH ONE OF THE POLICE OFFICERS. Once the auditorium empties, he drops down into a padded chair, slumps back in the seat, and chugs a bottle of water. Carter says that recounting his story to groups across the country leaves him physically and mentally exhausted, but he sees it as a way of repaying a debt to the soldiers who died in the attack that led the Pentagon to label him an American hero. “I can’t save a life with a machine gun anymore,” he says. “Maybe I can save a life this way.” With that, he politely excuses himself.

Set to meet several top police commanders for beers, he wants to swap his dress uniform and medal for a T-shirt and jeans. It is clear that he is looking forward to spending a few hours without the Medal of Honor, and all that has come with it, hanging around his neck. “When I come to events like this I have to put on a face,” he had said earlier. “I really do value the times where I can take it off for a few hours and go back to being myself.”