Camp Lejeune whistle-blower fired

A psychiatrist who tried to prevent Fort Hood-style violence among Marines about to "lose it" instead loses his job
Salon/DG Strong

Last April, two Marines at Camp Lejeune predicted to a psychiatrist that some Marine back from war was going to "lose it." Concerned, the psychiatrist asked what that meant. One of the Marines responded, "One of these guys is liable to come back with a loaded weapon and open fire."

They weren't talking about Marines suffering from a tangle of mental and religious angst, like news reports suggest haunted the alleged Fort Hood shooter, Maj. Nidal Malik Hasan. The risk they reported at Camp Lejeune was broader and systemic. Upon returning home, troops suffering mental health problems were getting dumped into an overwhelmed healthcare system that responded ineptly to their crises, the men reported, and they also faced harassment from Marine Corps superiors ignorant of the severity of their problems and disdainful of those who sought psychiatric help.

As Dr. Kernan Manion investigated the two Marines' claims about conditions at the North Carolina military base, the largest Marine base on the East Coast, he found they were true. Manion, a psychiatrist hired last January to treat Marines coming home from war with acute mental problems, warned his superiors of looming trouble at Camp Lejeune in a series of increasingly urgent memos.

But instead of being praised for preventing what might have been another Fort Hood massacre, Manion was fired by the contractor that hired him, NiteLines Kuhana LLC. A spokeswoman for the firm says it let Manion go at the Navy's behest. The Navy declined to comment on this story.

While military officials and the media examine whether the Army missed warning signs that might have indicated an unhinged Nidal Hasan was capable of killing 13 people at Fort Hood, Manion's Camp Lejeune story is a cautionary tale of what happens to those who blow the whistle on conditions for military personnel with mental problems.

Manion says the April incident with the two Marines was just one of a series of disturbing events and serious problems with mental healthcare he saw at Camp Lejeune, a base that may be best known for a water contamination scandal that led to high rates of cancer and birth defects among Marines and their families who lived there. He was particularly concerned to see that troubled Marines were stricken with the overwhelming impulse to commit suicide or murder, telltale signs of severe combat stress.

In a telephone interview from his Surf City, N.C., home, Manion talked of overburdened staff and inadequate resources at the Naval hospital at Camp Lejeune. The psychiatrist charged that medical officials failed to study and discuss violent events among returning Marines in an effort to prevent further, similar events, and did little planning to improve handling distraught Marines who were killing themselves and others in shocking numbers. In 2008, for example, 42 Marines committed suicide and 146 attempted to do so, according to the Marine Corps.

Coincidentally or not, within 12 hours of Hasan's shooting spree, Camp Lejeune officials discovered the body of one Marine and took into custody another Marine, Pvt. Jonathan Law, who is accused of killing his colleague. Law, who had served a seven-month tour in Iraq, was suffering from self-inflicted wounds when arrested.

Mirroring reports from military installations across the country, Manion also reported harassment of Marines seeking mental help. The psychiatrist began to worry about the possibility of a major outburst of violence on the base.

"A significant number of Navy medical officials and Marine commanders do not get it," a frustrated Manion said about the situation at Camp Lejeune. "They do not understand the implications of what happens if somebody loses it," explained Manion, who has 25 years of experience as a psychiatrist and who also specializes in traumatic brain injury -- exactly the kinds of skills needed so desperately at military hospitals, because mental problems and brain injuries are the signature wounds of the ongoing wars. "People either commit suicide, commit homicide, get drunk, beat up the wife, all these things. I've seen it," he added. "That is how serious this is and they just don't get it."

Manion believes he likely prevented a "Columbine-style attack" late last April after the two Marines who warned that someone might "lose it" directed him to a third Marine who seemed on the verge of violence. Manion also provided his superiors with documentation showing troubling incidents and neglect for the needs of returning Marines that could easily precipitate violence. Maybe not on the scale of the massacre at Fort Hood, but more like the rampage by a frustrated Sgt. John Russell, who gunned down five fellow soldiers at a military mental health facility in Baghdad last May.

Manion provided to Salon a stack of correspondence with superiors, a virtual crystal ball predicting dire consequences if mental healthcare at Camp Lejeune isn't immediately improved.

In an April 24 memo to his superiors, including Cmdr. Robert O'Byrne, head of mental health for the Camp Lejeune Naval Hospital, Manion describes a frustrated Marine punching a telephone pole with his bare fists outside a treatment clinic, then storming around, cursing, with a piece of lumber with a nail in it, though nothing was done to ensure he didn't hurt himself, again, or others. In another case, a severely homicidal and suicidal Marine pounded his fists into a table and stormed out of treatment. Yet the hospital, Manion complained to his superiors, made no efforts to discuss these cases or how to better handle similar events in the future.

"There was -- and continues to be -- no means of discussion of high-intensity/dangerous cases such as this," a desperate Manion wrote on April 24. He warned of "immediate concerns of physical safety" at the base's mental health facilities. Manion wanted to set up special protocols for handling intense situations, such as having specially trained MPs ready to intercede if things got bad, and a plan to hospitalize potentially violent patients quickly. "They dragged their feet on that," he told me.

Within days that April, Manion intervened with the two Marines who'd warned of colleagues potentially losing it. They directed him to a third Marine who they believed was going to go on a shooting rampage. Manion worked hard to get that Marine into treatment, possibly averting bloodshed. The two Marines involved also reported harassment for working limited duty while seeking mental healthcare for themselves. They heatedly claimed that two noncommissioned officers had recently told them, "I don't care why you are on [limited duty]. You are nothing but worthless pieces of shit," according to an April 29 e-mail Manion sent to O'Byrne and others, complaining about such attitudes.

Like many healthcare providers at military bases across the country, Manion technically worked for a military contractor, Spectrum Healthcare Resources, a subcontractor for  NiteLines Kuhana LLC.

On June 24, a supervisor for the contractor warned Manion to stop making trouble. "Kernan Manion, it is requested that you cease and desist all further correspondence with the government," the supervisor with NiteLines, Pamela Friend, wrote to Manion.

But Manion was still frustrated that Camp Lejeune did not seem to be taking these risks seriously. On Aug. 30, he appealed to a series of military inspectors general in a written complaint. He warned of an "immediate threat of loss of life and/or harm to service members' selves or others" if conditions did not improve. He complained of a "complete disregard for ... implications for patient safety and well-being." He decried that officials at Lejeune had ignored "repeated overt and emphatically stated concerns about the very safety and overall welfare of the affected patients." And he warned that "many patients' lives are imminently at risk."

Four days later, the contractor fired Manion "effective immediately," according to his termination e-mail. The note provides no reason for the firing. Manion was directed to clean out his office the next day, under the watchful eye of a chief petty officer, and have no further contact with his patients.

In a statement to Salon, NiteLines said the Navy wanted Manion fired, but did not explain why. "The treatment facility at Camp Lejeune notified (Nitelines) that Dr. Manion did not meet the Government's requirements in accordance with the contract, and they directed he be removed from the schedule," it reads.

Salon e-mailed the spokesman for the Naval Hospital Camp Lejeune, Raymond Applewhite, with details of this story and then described some of these facts with him in a follow-up telephone call, requesting an interview with O'Byrne. The Navy did not respond further.

Manion left Camp Lejeune after he got fired, but he did not stop worrying about the potential for violence there. In mid-September, Manion filed a 14-page complaint with the Department of Defense inspector general. On Sept. 29, he warned the Navy's Bureau of Medicine and Surgery inspector general in writing of "serious mismanagement of post-deployment mental health services that was both endangering patient, staff and community safety as well as severely compromising the quality of care" for returning Marines. Manion noted that the poor care at Camp Lejeune continued despite "the ever present threat of life-threatening violence by distraught service members towards themselves or others."

Finally, Manion wrote President Obama that same day. "Frankly, in my more than 25 years of clinical practice, I've never seen such immense emotional suffering and psychological brokenness -- literally a relentless stream of courageous, well-trained and formerly strong Marines deeply wounded psychologically by the immensity of their combat experience," he wrote to the president. Manion added, however, that at Camp Lejeune, that immense problem was being met with "inadequate treatment" and "callous indifference."

He still worries. "I don't like seeing these guys mistreated," Manion said. "This is akin to somebody dying on the battlefield and not being attended to," he added. "These guys are saying they are broken and need help, and the system is saying, 'next, next, next.'" 

Woody Harrelson on war, death, LBJ and Obama

The one-time "Cheers" star turned eco-radical climbs into bed to talk about his new film, and the new James Dean
Oscilloscope Laboratories
Woody Harrelson in "The Messenger"

Woody Harrelson began our interview by climbing barefoot onto the interior windowsill of his hotel room overlooking New York's Union Square to point out an apartment across the square where he lived briefly, 15 or 20 years ago. (It's in the building that houses the Heartland Brewery, if you know the neighborhood. On the second or third floor, he couldn't remember.) Then he got into bed.

There wasn't an ounce of pretense about any of this, I swear. He was curious to get a look at that old apartment, and felt like telling me about it. He was tired, so he got into bed. When you meet Harrelson, you get a momentary glimpse of what a strange and exhausting job it must be to be famous. The job involves meeting an endless ocean of people you don't know and most likely will never see again. The obvious solution would be to retreat behind a well-rehearsed performance of your persona, to recycle a handful of gestures and mannerisms.

Harrelson, on the other hand, seems like a guy totally determined not to let the artificiality of these interactions impinge on his sense of who he is. Perversely, the fact that he is frank and thoughtful, and known to hold unorthodox political opinions he doesn't keep to himself, has only augmented his fame. You can't throw an empty Chardonnay bottle out your car window in west L.A. without hitting a Hollywood liberal, but Harrelson is something much rarer: a vegan, raw-foodist, antiwar, anti-capitalist, pro-marijuana, eco-funky, genuine radical who happens to be a beloved character actor with a good-ol'-boy demeanor.

Like the other journalists who showed up to talk to him about his role in "The Messenger," writer-director Oren Moverman's film about the United States Army's Combat Notification Unit (i.e., the dreaded door-knockers who show up with really bad news), I was asked by the publicists to restrict my questions to the film and Harrelson's acting career. It's a laughable request anyway, but in fact I would have needed to tie Harrelson up and gag him if I didn't want to hear his opinions about the wars in Iraq and Afghanistan, the dangers of capitalism and the looming possibility that Barack Obama could become a second LBJ.

For the first half of this decade, Harrelson was mostly absent from the movie screen; he did some theater and TV, a fair amount of environmental and pro-cannabis activism -- his illegal banner-drop from the Golden Gate Bridge goes back to 1996 -- and a lot of time with his family. (He lives most of the year on Maui with his wife and three daughters.) It seemed entirely plausible that the one-time "Cheers" star and Oscar nominee (for "The People vs. Larry Flynt") had burned up his 15 minutes, and then some.

It doesn't look that way now. Harrelson has appeared in more than two dozen films over the past three years, with more in the pipeline, and three of them are piling up on top of each other this fall. He co-stars in the action-comedy "Zombieland" and the apocalypse-thriller "2012," both of them likely to gross more in a single weekend than "The Messenger" will in its entire history. But Moverman's low-budget, high-intensity drama about the social and psychological costs of war is clearly "a labor of love" for all concerned, as Harrelson puts it.

In "The Messenger," Harrelson plays Capt. Tony Stone, a damaged, middle-aged hardass assigned to mentor the younger Sgt. Will Montgomery (Ben Foster), a decorated and wounded Iraq vet, as they take on the uniquely difficult task of informing civilians that their loved ones serving overseas won't be coming home. If that sounds wrenching, well, it is. But the acting is superlative -- Harrelson's right when he says that Foster's starring role has echoes of James Dean or the young De Niro -- and the half-improvised quality of the filmmaking feels dangerous and intimate but never showoffy.

When Stone and Montgomery are assigned to notify an NOK -- that's "next of kin," in Army parlance -- Foster and Harrelson literally went into the scene not knowing what would happen. They hadn't even met the actors playing the bereaved-civilian roles, and weren't sure whether they would break down in tears or respond with physical violence. (Moverman and co-writer Alessandro Camon partly based his screenplay on stories they heard from casualty-notification soldiers.) The story of what Stone and Montgomery have to do, and how it affects them, offers an intimate, human-scale portrait of the real costs of warfare.

Once Harrelson was safely tucked under the covers, wearing an Army T-shirt and a pair of blue jeans, I put my tape recorder on top of the duvet and we got talking. It was a nice big bed, and looked extra-comfy. Woody probably wouldn't have taken it the wrong way. I can't say I wasn't tempted.

This movie isn't connected to the Fort Hood shooting in any way, but still. It's kind of intense to be talking about this subject, about death and the military, right after that.

It's related in the sense that it's another sad story connected to this war. There's a lot of those, and that one's pretty devastating. I feel really terrible for those families.

And then I just happened to notice, on the same page of today's New York Times as that story, two more of those names in bold-face type. Two more soldiers whose families are going to be getting visits from guys like the one you play in the movie. [Just to put names to them, they were Spc. Tony Carrasco Jr., of Berino, N.M., and Staff Sgt. Amy C. Tirador of Albany, N.Y.]

It really is a devastating thing. I've had an evolution of sorts in terms of my attitude toward the war. Not in the sense of the war itself, which I do continue to think is wrong -- and I think it's pretty obvious what the war is about, both of them. During the course of making this, I had the opportunity to spend time with a bunch of soldiers and hear a bunch of stories, and you know, just start to feel a great deal of empathy and compassion toward the men and women who are over there working their asses off every day, not getting paid much and just putting their lives on the line for love of country. I do think that a big part of supporting the troops would be the concept of not sending them into battle in a war for resources.

So you think both Iraq and Afghanistan are wars over resources?

Iraq's about the oil and Afghanistan's about a pipeline. It always has been. They started building a pipeline as soon as there was a moment to do so. They started building a pipeline to the Caspian Sea, that's always been their directive. The guys from Chevron went in and met with the Taliban and realized those guys just weren't in control enough. That's why they wanted to oust them. Otherwise it's an absurd concept: You're going to war because a guy from some other country, a Saudi, is living somewhere in the mountains? So we're going to bomb Kabul, bomb the cities? That's absurd. It's a foreign policy gone way wrong. But that's how it always is. American foreign policy has always been, not about spreading democracy, but about spreading capitalism.

It does feel sometimes like our government suffers from some kind of amnesia or OCD. It's like they keep making the same foreign policy mistakes and just hoping it won't turn out quite as badly the next time.

I'm hoping that other countries look at us and say, "OK, there's the government and then there's the people." Granted, you'd like the will of the government to be conjoined with the will of the people. But it's the same way I've made the evolutionary step of looking at the war as separate from the soldiers. When I look at Russia, I don't look at Putin as representing the Russian people. I'm sure they'd love to get him out of there. Regardless, the Bushes and their various oligarchies have gotten us into a situation that's just very unfortunate.

At least at this point, it appears that Obama is pushing onward with the war in Afghanistan. Is he just constrained by geopolitics? Is he simply not free to say, "Look, we're not going to do this anymore"?

I think there's a lot of persuasive and powerful people around Obama. For a president to make his own decisions, I think that's a rarity. Even someone who we think of as our guy -- this is a guy with integrity, a guy who cares, for the first time in a long time -- in the Oval Office, even with him we don't really know who's pulling the strings. I think of every president as being a marionette. Whether he's any different, I don't know. Certainly his military advisors all want him to prosecute this war to the end, just as they did in Vietnam with LBJ.

It's just too depressing, I think we're going to have to hit the streets. Obama has the chance of becoming JFK or LBJ. I think JFK was one of our last great presidents, although I thought Carter was pretty great too. LBJ could have been a great president if he hadn't gotten bogged down in war, but that was quite a war to get bogged down in. Notwithstanding the fact that the war was wrong and they were talking about the Red Scare and the domino effect, if you go and read the Pentagon Papers they were also talking about rubber, tin and oil. They killed 2 and a half million people. What was it all for? In Korea they killed 4 and a half million. Like, we're liberating these people?

Well, one of the things this movie engages, in a way, is the fact that the combined U.S. fatalities in Iraq and Afghanistan are still below 4,500. Not that that's not terrible for those families, but it's not a number that has affected every town and every neighborhood, the way other wars did.

Yeah, but it's got to be more than 10 times that in terms of people with injuries, people strongly affected by it. I'm not sure what's going to make people hit the street, and, you know, I'm one of those people who's not on the street. I recognize that I'm just a guy bitching about it, not a guy who's doing anything.

The thing I love about this movie is that it really takes into account the consequences of going to war. It's been gratifying to me to hear from people who say, "Before it was just a thing in the news, a statistic." You're not really seeing a blown-up body, or seeing the coffins at Dover. I think it's a good thing that it puts a human face on it.

On one level I really dreaded those scenes where you and Ben went to knock on people's doors, do the notifications. They were hard to sit through. But on the other hand, I kind of needed that emotional catharsis. And they're very intense. In the first scene we see, the woman completely goes nuts and attacks you.

That was cool because of the way Oren shot it. We really didn't know what was going to happen. I didn't know she was going to hit me. You don't know what level the people are going to, the way they'll manage their grief. I think it made those scenes much more realistic. We never rehearsed, and never even met the people ahead of time. We shot those in one shot. All of that was really good.

They weren't all done in one shot, were they?

No, there's only two notification scenes that are actually one shot as you see them in the movie. One is Steve Buscemi's and then there's another one. But they were all shot as a one-camera, single-shot thing, with one camera following the action. Later on, if Oren did three takes or whatever, he'd join the different takes together, find whatever worked better. But they were designed to be one-shot takes, and it felt very real. It kept us right on our toes, and on edge.

That guy that you're playing felt very real to me. He's this hardass military lifer, an Army guy, and he's really messed up in ways he doesn't even recognize. I mean, this guy badly needs a hug.

[Laughter.] That's the best description yet. He badly needs a hug. That's true.

I thought there was terrific chemistry between you and Ben Foster, who plays your younger tag-team partner. Obviously you guys are pros so it can be hard to tell, but it felt like there was something real happening there.

Oh, it was incredible. I feel like he's my brother, I really love him. And as an actor, he's one of the best I've ever worked with, if not the best. Total immersion in the mind-set of the character, and constantly reminding himself of the significance of what we're doing. Just before a scene, maybe I'm not completely grounded, and he hands me these pictures of soldiers smiling or hanging with their kids, and they're marked with the dates they died, 2003, 2004, whatever. You can't help but be full of the emotion, with what this movie's connected to. It's one of the few times that I've felt emotional pretense really skirting on emotional reality. I don't think I said that right. It's just, you know, we're pretending, but the reality of it is big.

I've seen him in other movies, but people are really going to notice him this time, if they haven't already.

I think he's one of the most amazing actors. It's like I'm working with James Dean before people know that he's James Dean. I feel like I just did "East of Eden" with James Dean. His talent is so expansive, he's got a huge career ahead of him.

You took several years off, and for a while there it didn't seem clear whether you wanted to make Hollywood movies anymore. I guess you're at peace with them now! I'm not ranking on you for making movies. You're an actor. But does it help you somehow to do a smaller project like this one alongside a big movie like "2012," which can pay a lot of bills?

You know, I don't feel like a movie has to have a message, necessarily. If a movie's fun and funny and just great entertainment, that's enough. But it's nice to do a movie like "The Messenger" where you feel like people watch it and it's initiating conversations that are important. What more could you hope for?

I did take a long time off. I wasn't planning on taking that long, it just kind of happened. Five years. I did keep my hand in, in terms of doing some plays. I wasn't entirely out of the loop. But it was a good thing. I needed to spend some time with my kids. I needed to get away from it. I wasn't liking the whole, I guess you would say, business-y side of it. I came into acting initially because I loved theater, I wanted to be on Broadway. You know, I would have been on Broadway, but I ended up doing this show.

I've heard about that! Apparently you were on TV for a few years.

Yeah. Otherwise I just would have been here in New York. I love theater, that is where my passion is. There was a lot about "The Messenger" that felt very theatrical. Just really being in a scene with a fucking serious actor, like a young De Niro type of actor. It was just a great experience all the way around. I feel super lucky to be a part of this movie.

"The Messenger" opens Nov. 13 at the Angelika Film Center and Lincoln Plaza Cinemas in New York, with wider release to follow.

The Army denies that combat stress causes homicide

An Army report seems to confirm a Salon investigation linking battle stress to murder. But the Army begs to differ
Read excerpts from the Army's report on homicides at Fort Carson here or download the full study here. Read Salon's Coming Home series about preventable deaths at Fort Carson here.
Photo by Michael de Yoanna
Maj. Gen. Mark Graham (right), Fort Carson's commander, speaks to members of the press on Wednesday. Behind him are the Army's chief of personnel, Lt. Gen. Michael Rochelle (left), and, Army Surgeon General Eric Schoomaker.

FORT CARSON, Colo. -- The harsh combat in Iraq, including potential war crimes that were witnessed by soldiers, contributed to a series of brutal murders by soldiers based at this Army post near Colorado Springs after they returned home, according to a hard-hitting Army study released Wednesday. Many of the findings in the study, which was announced by senior Army brass at a press conference on the post, mirror those in Salon's Coming Home series, which identified a pattern of preventable homicides and suicides at Fort Carson among soldiers who served in Iraq with combat stress and failed to receive proper medical treatment.

According to the report, "Survey data from this investigation suggest a possible association between increasing levels of combat exposure and risk for negative behavioral outcomes." The study also says that "combat intensity/exposure . . . may have increased the risk for violent behaviors" and that its "findings are consistent with recent research on combat exposure and subsequent behavior outcomes among Soldiers."

Salon's Coming Home series showed that soldiers who returned from combat duty with symptoms of stress were often ridiculed or otherwise discouraged from seeking help, were overmedicated or misdiagnosed, or chose to self-medicate with drugs and alcohol. Many had been deployed even though they were already displaying signs of combat stress. Additionally, some of the soldiers involved in violence against themselves or others had preexisting conditions that should have disqualified them from service, but were allowed into a military hard-pressed for new recruits via waivers.

The 126-page report issued by the Army Wednesday -- an epidemiological study, or EPICON in military lingo -- focused largely on 14 of the Army post's soldiers allegedly involved in murders since 2005. Ordered by Fort Carson commander Maj. Gen. Mark Graham in the wake of the slayings, it is studded with statistical evidence that buttresses Salon's investigation. The numbers point to a link between violent behavior and substance abuse, repeated deployments, exposure to combat and enlistment waivers. In addition, many of the 14 soldiers allegedly involved in murders witnessed incidents described in the report as War Crimes. Five either heard of or witnessed the "murdering/killing" of non-combatants; three, "detainee abuse;" and, two, "fabricating evidence to justify attacks or criminal acts."

Yet the Army officials presenting the report denied that it established any cause-and-effect relationships. Eric Schoomaker, the Army's surgeon general, waved his hands across his chest under clear blue skies during the outdoor press conference, dismissing the notion that the report proved a tie between soldier-involved killings and the horrors those soldiers experienced in the war.

"While this is probably the most intensive and in-depth investigation on the clustering of violent-on-violent crimes in the Army that we've ever seen or are aware of," said Schoomaker, "it is still in many respects preliminary."

Without causation, there is no way to establish how the murders could've been prevented. "We would all like to look back at the cluster of misconduct and criminal activities," said Schoomaker, "that resulted in devastating human tragedies here in Colorado and be able to say, 'This is the reason they happened and we know exactly what could have been done to prevent them,' but that's rarely the way things work when dealing with human behavior."

Without causation, there is also limited accountability. While commanders were blamed for standing in the way of soldiers receiving mental health and substance-abuse care, Lt. Gen. Michael Rochelle, the Army's director of personnel, said the report "was not a tool that was intended to be used to either fix accountability or to be used for any sort of disciplinary action that may follow."

Schoomaker, Rochelle and Maj. Gen. Graham, who was also on the podium Wednesday, were able to deny cause-and-effect because of caveats in the study. The authors of the report, a 24-member team assembled the Army's Center for Health Promotion and Preventive Medicine, issued recommendations to stop the belittling of soldiers who seek mental health care and to identify units with high exposure to combat. They stopped short, however, of positing causation, saying that ""the cross-sectional nature of the study does not allow for making causal inferences."

Thus Schoomaker could say, truthfully, "It's pointing the finger to levels of causation, but we don't know direct causation yet. ... I'm very reluctant to put cause and effect there. In fact, the authors [of the report] are very careful to say these are correlations ... not necessarily one causing the other."

Yet Schoomaker also seemed to place some blame on the soldiers themselves for failing to seek help. He suggested that units where the soldiers were more willing to get help were less likely to be plagued with violence. The study, he noted, analyzed two brigades at Fort Carson, the 4th and the 3rd. "What did seem to differ between the two was the willingness and ability of those soldiers within the unit where crimes were committed to seek and get effective care for emerging behavioral health problems -- alcohol and drug problems -- and prompt attention to misconduct."

But Schoomaker also claimed that the experiences of the 4th and 3rd Brigades in combat were "similar." That's not what's indicated in the report -- the 4th Brigade, where the murder suspects were clustered, had eight times more combat deaths than the 3rd. Moreover, the report indicated that the Army itself played a role in denying care to the soldiers -- half, some with suicide issues, were sent back to Iraq "early," according to the report.

U.S. Senator Mark Udall, a Colorado Democrat, who met on Tuesday with Schoomaker, issued a statement following the release of the report, noting it raises "serious questions about whether the military is doing enough to help service members transition from battle back into civilian life."

"This is a matter of life and death, for our service members – and civilians," Udall stated. "We must do everything in our power to ensure that the military is providing all necessary treatment and support to protect our service members, their families, and our communities."

That could be a long road. The report indicated that "overall staffing" for behavioral health at Fort Carson's Evans Army Community Hospital between 2006 and 2008 was just 65 percent of authorized positions.

 

"They felt naked without a weapon"

Read excerpts from the Army report that shows a link between combat stress and murder
Download the Army's full report on homicides at Fort Carson here. Read about the Army's spin on the report here. Read Salon's Coming Home series about preventable deaths at Fort Carson here.

FORT CARSON, Colo. -- Earlier this year, Salon published a multipart series called "Coming Home" exploring homicides and suicides among soldiers based at the Army's Fort Carson who had returned from war. The Salon articles found that most of the soldiers were suffering the telltale symptoms of combat stress or post-traumatic stress disorder on their return from deployments to Iraq and Afghanistan.

Instead of receiving proper care, however, these soldiers were ridiculed, discouraged from seeking care, misdiagnosed and given handfuls of medication and not much else for their symptoms. Others self-medicated with alcohol or drugs. Salon also found that some soldiers had troubled pasts and probably should never have been in the Army in the first place.

A new Army investigation of homicides at Fort Carson, released at a press conference at the Colorado Army post today, confirms these findings. According to the 126-page report, researchers found "higher levels of combat intensity" among soldiers who later ended up in trouble (p. 8). They also found "a strong theme of soldiers using alcohol or drugs to self medicate" after returning from war (p. 13). The troops reported problems getting proper healthcare, ridicule for trying, and complained about "an over-reliance on pharmacotherapy" when they did access healthcare (p. 16). A significant number of the soldiers being studied also witnessed incidents described by the report as "War Crimes."

Excerpts from the report follow, beginning with the introduction to the executive summary, which describes how the study was commissioned after "8 [alleged] homicides in the previous 12 months."

 

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Army suicides soar past 2008's pace

The day after the shooting at a combat stress clinic in Iraq, new data released to Salon shows soldiers committing suicide at a record-setting pace. Is combat stress the reason?

The Army is on a pace this year to shatter the record suicide rate set among soldiers in 2008, according to data released by the Army to Salon. And the numbers, obtained a day after a patient at a combat stress clinic in Iraq killed five, suggest that combat stress may be contributing to the spike in suicides.

During the first four months of 2009, 91 soldiers committed suicide, including suspected suicides still under investigation. During all of last year, 140 Army soldiers committed suicide, resulting in the highest rate on record. If Army suicides continue at the rate recorded from Jan. 1 to April 30, more than 270 soldiers will be dead by their own hands at the end of this year. The large majority of suicides are among enlisted soldiers, privates, specialists and sergeants.

The only bright spot in the new suicide data is some evidence that Army efforts to improve suicide prevention -- among other things, implementing "chain teaching" among troops on suicide risk, hiring more mental health workers and releasing suicide prevention videos -- seem to be taking hold. While 31 soldiers committed suicide in January, that number dropped to 28 in February, then 22 in March and then to 10 in April. (The month-by-month chart of suicides that the Army released to Salon is reproduced in its original form on Pages 2 and 3 of this story.)

Previous reporting by Salon has established the connection between combat stress and suicide. According to the new data, among the active-duty troops who have committed suicide so far in 2009, 48 committed suicide after or during a deployment, while only 16 killed themselves without having gone to war. Two of the active-duty soldiers who killed themselves did so after deploying to war four times. Among National Guard and Army Reserve troops, 11 died during or after deployments while 16 killed themselves having never deployed. The figures for the National Guard and Army Reserve include an unexplained bubble of seven suicides among never-deployed troops that occurred in February.

The Army data does not show whether those Guard troops killed themselves after receiving an alert that they would be deployed. Paul Sullivan, executive director of the advocacy group Veterans for Common Sense, says his organization is investigating what appears to be a pattern of suicides following notices to deploy or redeploy.

Salon obtained the data from the Army one day after a soldier at Camp Liberty in Iraq allegedly stormed into a combat stress clinic and gunned down five comrades. Sgt. John Russell, a patient at the clinic, stands accused of killing an Army officer and a Navy officer working on staff at the clinic, as well as three other enlisted soldiers. Russell, 44, was on his third deployment to Iraq and had also served in Bosnia and Kosovo. He is a communications specialist from Sherman, Texas, serving with the 54th Engineering Battalion, based out of Bamberg, Germany.

Army officials confirmed for Salon Tuesday that despite some early rumors, Russell was not wounded by anyone else during the shooting spree, nor did he wound himself. Those officials would not discuss details of the events and would not comment on reports that Russell had argued with clinic staff just prior to the shooting.

The new suicide data obtained by Salon alarmed some veterans' advocates. "There is still a suicide epidemic," worried Sullivan of Veterans for Common Sense. "The Department of Defense failed our soldiers by not conducting pre- and post-deployment medical exams -- not paper screenings -- as required by law."

"This data," he said, "should set off an alarm to initiate medical exams, stop deploying unfit soldiers, launch an anti-stigma campaign and train our soldiers on how to spot mental health conditions."

Noting the shooting at Camp Liberty, and the rash of murders among troops coming back from Iraq and Afghanistan, Sullivan added that, "We may be verging on a suicide-homicide epidemic."

 

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"I believe that I did have PTSD"

Matthew Marino was sent back to Afghanistan for a second tour of duty after the Army diagnosed him with "anxiety disorder" instead of post-traumatic stress disorder.
Read about "Sgt. X" and his secret tape of an Army psychologist (and listen to the recording) here; read about the Army's investigation of that tape -- and the Senate's failure to act -- here. Learn why the Army might have incentives not to diagnose PTSD here.

Matthew Marino served five years in the Army and was deployed to fight in Afghanistan twice. He began to suffer from symptoms typical of post-traumatic stress disorder following his first tour. After returning to Fort Drum, N.Y. in late 2004, he couldn't lose the hyper-alertness he'd developed in Afghanistan. He had thoughts of suicide, was nervous, had nightmares, couldn't sleep, and stayed away from family and friends.

Despite his symptoms, however, the Army diagnosed the first lieutenant with anxiety disorder instead of PTSD. He was also diagnosed with depression and given antidepressants. The Army then "stop-lossed" Marino, to prevent him from leaving the Army although his time was up. He was shipped back to Afghanistan for a second tour in 2006. A diagnosis of PTSD might have kept him from being redeployed and sent back into combat; a diagnosis of anxiety disorder did not.

In two stories published this week, Salon has described how a soldier secretly taped an Army psychologist named Douglas McNinch saying that the Army was exerting pressure on him not to diagnose soldiers with post-traumatic stress disorder. According to McNinch, the Army preferred that he diagnose soldiers with anxiety disorder instead -- the same diagnosis Marino received. Marino's experience is a case study in what happens when Army medical care is influenced by the need to keep soldiers on the battlefield and the need to hold down the cost of long-term disability payments.

Marino returned to the States from his second tour in Afghanistan at the beginning of 2007 with symptoms nearly identical to those he'd experienced after his first tour. But the Army processed him out by Feb. 10, 2007 without a real medical examination. Marino recalls filling out a written questionnaire and then being discharged. "They didn't spend any time checking me when I went out the door."

When Marino left the Army, all he had were his anti-depression pills and a vague diagnosis from the Army. The diagnosis said, essentially, that Marino was anxious and depressed, but that neither his anxiety nor his depression were necessarily caused by the war. His condition worsened. "My wife was pushing me to go to therapy over and over again," he said.

And he did. This time, however, Marino went to a facility in Boston run by the Department of Veterans Affairs, the government agency responsible for pay and benefits for service members after they leave the military. There, doctors diagnosed him with PTSD from the war. This means he can receive therapy tailored to help ameliorate the symptoms of combat stress. He also now receives financial benefits from the VA for his mental wounds.

There is no way of knowing for certain whether the Army misdiagnosed Marino with anxiety disorder instead of PTSD after his initial deployment in Afghanistan. His symptoms, however, suggest that that's exactly what happened. "If you want my opinion," says Marino, "I believe that I did have PTSD after the first tour." Marino thinks the Army misdiagnosed him with anxiety disorder, but "I can't say whether it was by intent or negligence that it was misdiagnosed."

If Marino had not gone to the VA clinic in Boston and asked for help, who knows how long he would have gone on with the wrong diagnosis and without proper benefits. "There are probably plenty of people walking around with the same thing," he said. "PTSD has caused me a lot of hardship. If I can help anyone else with my story I'm happy to do it."

 

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