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Less agony, no Ecstasy 

Fort Carson aims to better handle PTSD but it'll pass on the newest trendy treatment

Editor's note: Click here for updated information on Rick Duncan, who was interviewed for the story below.

The most exciting news in recent months about treating post-traumatic stress disorder involves MDMA. Otherwise known as Ecstasy.

Michael Mithoefer, a South Carolina psychiatrist, has researched the effects of giving the drug to help patients confront their traumatic pasts. He's nonchalant when asked if it actually worked.

"It did," he says, explaining the drug seemed to enable a large majority of subjects to "change their relationship to their trauma."

Excitement about Mithoefer's work sent ripples across the media landscape, with the results described in The Economist magazine and trumpeted on CNN by none other than Dr. Sanjay Gupta, President Barack Obama's nominee to become surgeon general.

But at Fort Carson, where PTSD has become part of the military vernacular, a question about MDMA's potential is met with decidedly less ... enthusiasm.

"If someone is so emotionally numb that they can't affectively connect, that would be an interesting place to ask that question," Col. George Brandt says quietly as a couple onlookers chuckle in an Evans Army Community Hospital meeting room. Then he adds for clarity: "We're not doing that here."

A wider net

That's not to say they're doing nothing. Fort Carson and the Army took fire in 2006 and 2007 after combat veterans started talking about being ignored, ridiculed or even kicked out of the Army for reporting the nightmares, sleeplessness or anxiety that can accompany PTSD. Screens to find soldiers who've experienced these symptoms have increased, and Army has announced efforts to make soldiers more comfortable admitting to having them.

Brandt, a psychiatrist and the hospital's chief of behavioral health, talks in general about one brigade with about 4,000 soldiers that was given a total of around 9,000 screens. About 650 soldiers screened positive for possible behavioral health problems and were sent on to be evaluated by social workers.

In the end, Brandt says, about 160 were sent for further evaluations to see if they had PTSD, depression or another disorder.

"I'm screening more people positive than actually get referred for care, but that's the way I want it to be," Brandt explains. "That's the way a screening procedure should work the goal is to go fishing, to identify cases, pull people in, and refer them accordingly."

The numbers bear that out, at least partially. According to Fort Carson statistics, 547 PTSD cases were identified in 2005 and 535 in 2006. With all the attention devoted to PTSD, diagnoses climbed to 750 in 2007.

They dropped again in 2008 to 450. Brandt couldn't be reached for follow-up after Fort Carson released the PTSD numbers, but the drop could be related to a lull in soldiers returning from combat or a reduction in the severity of fighting.

Embedded distrust

When Brandt came to Fort Carson in August, there were fewer than 50 psychologists, psychiatrists and social workers handling mental health care at Evans.

"Now we're well over 60, on our way to 70," he says.

"We have many open hiring agreements out there, looking for psychiatrists and psychologists," notes Lt. Col. Nicholas Piantanida, deputy commander for clinical services at Evans. "My guidance is that we will continue to hire these individuals."

After reports of untreated PTSD cases circulated, congressional pressure built to change procedures and attitudes so soldiers can get help. In August 2006, then-Sen. Ken Salazar called for a hearing on the subject, and legislation was eventually passed giving some protection to veterans discharged for mental health reasons or injuries.

Salazar, now Barack Obama's secretary of the Interior, could not be reached to comment on how the Army is now handling PTSD cases. Newly sworn-in Sen. Mark Udall, in an e-mail, offered only: "It is important for the Army to identify and treat soldiers with Post Traumatic Stress Disorder (PTSD) cases as soon as possible."

Rick Duncan, with the Colorado Veterans Alliance, says programs now are in place. But there's still what Duncan calls a "structural" problem, with soldiers facing skeptical colleagues once a mental-health problem rears up.

Duncan describes the experiences of a soldier he knows who is now in Fort Carson's Warrior Transition Unit, a special unit for wounded troops. The soldier, he says, was involved in an incident during which Iraqi civilians were killed in 2006, and he started having sleeplessness, nightmares and other symptoms of PTSD when he returned to combat in 2008. Even if he makes a full recovery from PTSD, Duncan says, this combat veteran will have to worry, "Are soldiers going to trust me?"

lane@csindy.com

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