In a behind-the-lines job in Mosul, Iraq, former Staff Sgt. Jeff Peskoff hadn't conceived he'd be cleaning up burned-out troop vehicles splattered with blood and skin. But those memories have stuck with him.
Similarly, Mike Lemke, a former National Guard sergeant, will never forget watching dogs scavenge fingers from corpses as he helped secure Abu Ghraib prison for coalition forces.
Former Army Sgt. Jeana Torgerson can't escape the images of the prisoners of war she saw trying to hang themselves from their own sheets and clothing.
And in a prison cell in Washington state, Army Pvt. Adam Kaplan is haunted by hallucinations of the sergeant killed by shrapnel from Kaplan's own grenade launch.
Although now far from Iraq, these one-time Fort Carson soldiers still haven't retreated from the war. All are grappling with post-traumatic stress disorder, commonly known as PTSD. Those afflicted with the anxiety disorder compare it to losing a limb, yet the army does not acknowledge it with a Purple Heart.
For its sufferers, PTSD can be crippling.
"I wake up in the middle of the night with cold sweats," Torgerson says. "I can't have walls next to me because I wake up with bloody fists. I talk in my sleep, violently. I have flashbacks of memories, sound. Any moment I can go into crying episodes, and I don't know why."
Of the 505,366 troops who have left the military after serving in Iraq and Afghanistan in the past four years, 144,424 have sought health care through Veterans Affairs. Of that number, 46,571 received preliminary diagnoses of mental disorders, including 20,638 with PTSD, according to the VA.
The numbers don't capture the full scope of the nation's growing PTSD caseload, however. Many former troops seek psychological help from private practices or other sources. Neither does the number account for PTSD sufferers currently enlisted in the military.
(The Independent requested the numbers of diagnosed PTSD cases from the various military branches, but officials are either still working to meet the request or say the information is not readily available.)
Studies have connected PTSD to increased suicide, domestic violence, drug and alcohol abuse and a range of other problems.
A key to preventing such personal and social problems is early intervention, says an expert with the VA.
Two of the four soldiers featured in this article, however, say they had to fight to get the military to acknowledge their PTSD. Another says the Army watched him spiral into drug addiction, but failed to connect it to PTSD.
Although they were given several days' notice, Fort Carson officials declined comment on this story, saying they would need more time to respond.
Mike Lemke, 47, sits at the only table in his small Colorado Springs apartment, chugging morning coffee. There's an electric guitar in one corner. A shelf holds trinkets he brought home from Iraq.
He chain-smokes cigarettes so rigorously that a black circle has developed on the kitchen ceiling, directly above his chair.
He says he used to run five miles a day, but started smoking upon returning from Iraq.
Asked about his personal experience in the war, he opens the fourth edition of Diagnostic and Statistical Manual of Mental Disorders and turns to the section on PTSD. He has the psychological manual because he's studying for a master's degree in counseling.
"There was a time when I would open it like a born-again Christian reading the Bible," he says, before reading aloud.
"The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury or a threat to the physical integrity of self or others," he reads. "The person's response involved intense fear, helplessness or horror."
Dr. Laurent Lehmann, the VA's national consultant for mental health, says PTSD, which can manifest within days or take years to emerge, is unique from disorders like depression. It requires that the person experience a life-threatening or dangerous stressor firsthand.
"Virtually everyone comes back from the war zone with some kinds of negative consequences from the terrible things they experienced, and the majority will find their way to work their way through it," he says. "There are other folks who have more difficulty for a variety of reasons," including the degree of their personal risk and the frequency of their exposure to negative events.
"There's a set of intrusive types of symptoms, such as easy startle, extreme flashbacks to the threatening experiences, avoidance, numbing and hyper-arousal. So you have to have this cluster of symptoms. You don't find that in generalized anxiety disorder or panic disorder. ... Depressive disorders are different, because they also have a very different symptom cluster."
PTSD also is characterized by a complex and, at times, overwhelming biological reaction. Soldiers with the disorder may feel they are burning up inside, as their system goes on overload.
"A lot of times, if you expose people to a reminder of the stressor, the heart rate will go up faster, it will go up higher, it will stay elevated longer than for an individual who does not have PTSD," Lehmann says. "If you, for example, show a stressor [or] stimulus of a firefight in Vietnam or Iraq to an individual whose actual stressor was an automobile accident [in combat] ... for them, the firefight scene might not be as arousing as a real accident scene."
Behind the lines
Lemke never thought he'd be dealing with anything like PTSD. He just wanted to serve his country.
In 2001, as he watched the Twin Towers come tumbling down on live television, he immediately tried to enlist in the Army, where he spent a good portion of his younger years as an active, and then reserve, soldier. Because he was in his 40s, the Army refused him. So he turned to the National Guard.
By late March 2003, Lemke was sent from Fort Carson to Iraq. He commanded a Humvee crew alongside troops breaching the Iraqi border through Kuwait, running security sweeps and white-knuckle truck convoys.
"The first time you see the burnt hulk of what was once a Humvee, it's disconcerting," he says. "You know there are people who are not making it, and they're wearing your uniform. It doesn't take you long to get in touch with your mortality."
Images of Abu Ghraib prison are etched in Lemke's memory, he says. He'll never forget the sweet, sick smell of death. He was among the first soldiers to arrive at Saddam Hussein's notorious prison for dissidents months before the United States reopened it as a coalition military prison.
He saw blood splattered on a wall near hangman's gallows, where ropes dangled. Outside, dogs gnawed on half-unearthed corpses.
In May 2003, Lemke suffered a heart attack. But his service in Iraq wasn't over. Within a month, he was sent back into the fray, taking on full combat duties, grappling with orders and counter-orders. But he'd lost trust in his superiors. Looking back, he says this is where the PTSD started to take root.
"It gets very confusing very quickly," he says. "Finally, nothing really makes sense to you. You've lost your frame of reference. You have this vague knowledge there may be a wife and family there for you when you return, if you return."
He figured another heart attack would come, and became suicidal.
"I was notgoing to put a gun to my head," Lemke says. "I was not going to overdose on some kind of pill thatwas going to take me out. I was notgoing to jump off a cliff into the Euphrates. I was so apathetic. I assumed I had a mental state that I was not going to be going home. ... I basically got into a mindset: "If I'm going down, I'm going to take some people out with me.'"
He requested assignment for the most dangerous jobs. Now, he knows he wasn't as vigilant as he and his fellow troops needed him to be. He says he's lucky to be alive.
Three months after his heart attack, acute muscle problems in Lemke's feet forced doctors to send him home.
When he returned to Fort Carson, his wife left him, and he began drinking any hard liquor he could find.
Like Lemke, Jeff Peskoff didn't imagine the war would change his life so profoundly. His job overseeing the crew that kept Humvees and big trucks on the road was exactly the kind of work he was looking for when he joined the Army in 1995.
He enlisted almost on a lark, after following the Grateful Dead on tour. Band icon Jerry Garcia had died and Peskoff wanted a change.
It was peacetime, he reasoned, and as a mechanic, he wouldn't have to kill anyone. He soon fell in love with the Army's array of personalities, as well as its emphasis on discipline. He became highly decorated.
By 2003, he was in Mosul, Iraq, in charge of the Army's 52nd Engineering Battalion motor pool, and far from the front lines.
But the war came to him, in the form of twisted Humvees and other mangled vehicles.
Before they could be assessed for possible repair, the vehicles had to be cleaned wiped free of the human remains that sullied their interiors. It was a job Peskoff chose to do alone.
"I didn't want my soldiers being around it," he says from his home in Fountain. "It was something somebody had to do. I took charge."
When his tour of duty ended, Peskoff came home.
Back at Fort Carson, the 35-year-old soon caught himself yelling at his soldiers more than he had in the past. Some sergeants are known for their constant hollering, he notes, but he'd never been one of them.
He couldn't sleep. He was having nightmares, visions of death. He developed obsessive-compulsive disorder.
Eventually, he contemplated steering his car off an Interstate 25 overpass, near Fort Carson's Gate 20. The only thing that stopped him was thinking how it would affect his two kids and wife.
Today, both Lemke and Peskoff receive regular treatment for their PTSD. They each take a laundry list of prescription pills that help them sleep or cope with depression or anxiety. They also are in therapy.
Peskoff, who is now trying to get his life on track as a military pay clerk, says he had no problems getting commanders to recognize his PTSD. But Lemke says getting such help wasn't easy. He claims doctors at Fort Carson only seriously started listening to him after he obtained a psychologist outside the Army to advocate on his behalf.
"The military doesn't want to find PTSD," Lemke says. "They don't want to have to treat it."
He's not alone in his assertions.
Fighting the Army
Jeana Torgerson says she loves the Army so much she had planned to serve 20 years before retiring. But the 25-year-old was discharged after just four years.
She lives in her family's hometown, Sedro Woolley, Wash., north of Seattle. She says she can't visit Colorado Springs without breaking down in tears. It reminds her of Fort Carson, the soldiers in Iraq and events she still can't find words to describe.
She was first stationed at the U.S. military camp at Guantnamo Bay in Cuba in 2002.
There, where the United States holds prisoners of the ongoing war on terror, she says she the inmates threw urine and feces at her.
At least two attempted to kill themselves, she says.
"They hung themselves inside the cells," she recalls. "One of them used his sheet, and another one used his pants. The cells are made of this wire-mesh metal. They would tie a knot and jump off their beds."
After nine months at Guantnamo Bay, she volunteered to be deployed to Iraq for six months to be closer to her husband, who also was a soldier.
She says Baghdad was a bloody, smoky blur of rockets and explosions.
"It was constant attacks," she says.
She arrived home in April 2004, and took a screening test. In writing, she told commanders that she was experiencing the "worst possible pain," caused by "fear, hate and sadness." She said she was crying herself to sleep. She felt suicidal and requested to be hospitalized immediately, according to Army documents Torgerson provided.
It was 10 days before she saw a doctor.
"I really only received medication for my problems," Torgerson says.
By May 18, she had attempted suicide, using a razor blade on her wrist while severely intoxicated. She was admitted to Evans U.S. Army Hospital on Fort Carson for review.
Soon, the Army began actions to discharge her.
"When I tried to kill myself, they tried to boot me out of the Army as quick as possible," Torgerson says.
Following a diagnosis of a pre-existing personality disorder, superiors at Fort Carson had pursued actions that would have led to a less-than-honorable discharge, Torgerson says. This would have left her without long-term disability benefits.
"They tried to say I had a pattern of misconduct. I was suffering the whole time," Torgerson says. "The problems they were having with me were connected to PTSD, but they weren't willing to hear that."
In August, she tried to kill herself again. She would try one more time a few months later.
Eventually, Torgerson retained a lawyer to help her fight the Army and the discharge actions she faced.
Finally, her lawyer helped secure an examination from an Army medical board. Over several months, it determined she had PTSD. She is considered 70 percent mentally impaired.
"If you've got [at least] 30 percent, you've got military benefits," she says. "You get medication and help and you can still use the commissary. It's the stuff I know that I earned, and they were trying to take it away from me."
Torgerson aspires to study business in college one day. Yet she appears to have a long way to go.
"This other day, I was in the middle of the store and I completely forgot why I was there, and I started wondering why everyone was around me. And then I started thinking, "How am I going to get home? What am I going to do? Who is following me?' I don't know," she says, starting to cry. "I have a hard time trusting anyone and I used to be a very trusting person."
A month ago, a Pentagon survey found that within a year of their return, 35 percent of the troops that served in Iraq received psychological counseling. Half the troops returning from Iraq said they felt their lives had been threatened a precursor to PTSD and more than 2,400 reported having suicidal thoughts.
The Army's first Iraq war mental-health study, completed in 2004, concluded that one in eight soldiers returning from the war experienced PTSD symptoms.
Local and national advocates for PTSD sufferers say such research, and other emerging data, hint at a national veterans crisis comparable to the one seen during the Vietnam War era. Significantly, the majority of the VA's 215,000-plus PTSD cases are from that era, with many Vietnam veterans still seeking help.
Researchers discovered that soldiers struggled with anger problems after they were deployed in the war on terror, and were more likely want to get a divorce after spending time in combat. They also found a 13 to 21 percent rise in alcohol abuse among soldiers in the year after their return from Iraq or Afghanistan.
Other drugs are problematic as well. They've drastically altered the life of Adam Kaplan, who is locked in military prison at Fort Lewis in Washington state.
In April 2003, the Lafayette Times, a weekly paper that covers Broomfield, where Kaplan's family lives, trumpeted him as a hometown hero. He boasted to the paper that he'd soon customize his Mitsubishi Eclipse with $10,000 in bonus pay.
He had taken a dangerous job in Fort Carson's 3rd Armored Calvary Regiment as a "target" he'd be first to emerge from an armored Bradley Fighting Vehicle to provide cover for fellow troops.
His reasons for enlisting were idealistic.
"In this day and age, joining the military is the most noble thing you can do for your country," he told the paper just prior to his deployment.
Things went drastically wrong within weeks. Speaking via collect call from prison, Kaplan describes the May 19 raid of a suspected arms cache in a theater building at Ar Ramadi.
The soldiers encountered a problem busting open the metal-plated doors of the building. As they stood back, Kaplan fired his grenade launcher at the doors.
Shrapnel struck Kaplan's protective vest, causing him to spin around. As he did, he saw Staff Sgt. William T. Latham, 29, of Kingman, Ariz., grab his eye and collapse.
The shrapnel from the explosion also struck Latham's head, severely wounding him.
Kaplan rushed to Latham, who was covered in blood.
"I ran up to him," Kaplan says. "He started to make this horrible gurgling noise."
Troops found nothing in the theater. Latham was airlifted out.
"Somebody came up to me and said, "Hey, man you know it's not your fault,'" Kaplan says. "It hadn't occurred to me before: I had killed Sgt. Latham."
For several weeks, word made its way through the ranks to Kaplan that Latham might pull through even that California Gov. Arnold Schwarzenegger had been present as Latham was awarded a Purple Heart. The staff sergeant was a leader and inspiration to Kaplan.
"He was the person everyone looked to," Kaplan says of Latham.
For about a month, Kaplan kept up his tour of duty, hoping for the best for his friend.
But then he learned Latham died at Walter Reed Army Medical Center in Washington, D.C. Soon, Kaplan went to Fallujah, then came back to Ar Ramadi. He killed a couple of Iraqis, he says, something he can't bring himself to discuss.
He was promoted to corporal and drove a parts vehicle basically a behind-the-front-lines job.
Months passed. Kaplan doesn't recall how many.
"Then I'm walking one day and looking straight at someone looking straight at me," he says. "It was Sgt. Latham. I started seeing him. At the chow hall, he was there. Wherever there was a crowd of uniforms, I saw him."
When Kaplan returned to Fort Carson in spring 2004, he noticed he was "edgy and startled easily."
The visions of Latham would only increase in frequency.
"A great soldier"
Steve Robinson, executive director of the nonprofit National Gulf Resource Center, fears untreated PTSD is creating a rise in suicide rates, domestic violence, drunk-driving accidents and other social problems that remain largely unrecognized, due in part to a lack of local and national tracking of soldiers and Marines returning from Iraq and Afghanistan.
"We are using and abusing the troops in a bad way," he says. "Then we're letting them and the public down when we don't help."
Kaplan, who pleaded guilty to charges of use of illegal substances and possession of drug paraphernalia, could be released from military prison in a matter of weeks, following a 15-month sentence.
At this point, the 23-year-old cannot receive any benefits for his military service, because he is facing a dishonorable discharge.
"I tried to get help, but was basically ignored," he says.
He first was offered help for PTSD in Iraq by a combat-stress team several weeks after Latham's death.
"It wasn't something I liked to talk about at the time," he says.
So he shrugged it off. By the time he returned home the visions of Latham were hitting hard almost everywhere on base.
"I was having attacks, and I couldn't deal with it," he says.
He turned to marijuana. Then he hooked up with several members in his unit who smoked methamphetamine.
According to a May 2005 letter from Fort Carson adjutant general Mary L. Foster, sent in response to an inquiry from Colorado Congressman Mark Udall, Kaplan first tested positive for drugs in July 2004. Udall had inquired about the case at the behest of Kaplan's mother.
Foster also wrote to Udall that during his tour of duty, Kaplan had been "a great soldier." Still, he was demoted to private and his pay was reduced.
Even after the first positive test, Kaplan smoked, snorted and then shot up methamphetamine. The 6-foot-6, 240-pound soldier shrunk to 175 pounds. But the drugs made the visions of Latham stop.
"It would make life normal again," he says. "I wouldn't keep seeing the person I killed."
By the end of the year, he had tested positive three more times.
Along the way, in December 2004, he had a moment of clarity and checked himself into a substance-abuse program with Penrose-St. Francis Health Services in Colorado Springs. For seven days, he went through a psychiatric and substance-abuse evaluation.
Doctors would recommend he receive intensive in-patient care. But Fort Carson brought him back to base, telling him he had to obtain care through the Army. There, he started smoking meth again.
Soon, a medical board began the process that would allow him to leave the Army with a disability rating.
"I was going to get out," Kaplan says.
But he couldn't resist the drugs. Finally, just days before he says he was to be discharged, he was busted in a sting. A snitch had turned him in.
His mother, Liz Kaplan, says her son should have been placed on medical hold much earlier to determine whether PTSD was playing a role in his drug abuse. She says her son was "self-medicating" for PTSD.
But Army officials at Fort Carson zeroed in on the illegality of Kaplan's drug use.
As Foster wrote, "Doctors did recommend an order against illegal drugs to assist his motivation, and they diagnosed a methamphetamine addiction."
Now Kaplan is appealing to convince the Army that he was wronged and deserved treatment for PTSD.
"I still love my country," he says. "I still support my president and the Army. I'm proud of my service, and I want to be able to tell people."
The number of PTSD cases will probably increase in the coming year. President Bush has stated that troops will remain in Iraq through the duration of his presidency, which ends in January 2009.
Lehmann, of the VA, has praise for the Defense Department and the teams it has deployed to Iraq. Early intervention in suspected PTSD can make a big difference to the future of a soldier or Marine once he or she returns home, he says, citing studies.
"There's more openness to looking at these kinds of problems," he says. "I just think they're doing much, much more than they've ever done before."
Still, Lehmann says the military appears conflicted.
"Their job is to preserve the workforce, the fighting force," he says. "So they want to get people back into service as best they can, but that's stupid. What I mean by that is, they're looking at combat efficiency and combat effectiveness, and if there are individuals who are not going to be able to perform, they're not going to want to send them back because they're not going to help.
"I think the other problem [relates to] individuals who are having these difficulties. They sit on it, or they try to avoid it or they don't try to tell somebody about it, because they want to go back. They want to do the mission. They want to help their buddies. They want to cover the other guy's back, because the other guy has covered their back. They sometimes have a lot of reluctance to sharing what they're experiencing."
An official with the Defense Department at the Pentagon, who refused to be named, concedes that soldiers and Marines with PTSD may be returned to combat, but maintains the practice is not common. In an e-mail, the source writes that military teams attempt to identify PTSD in troops. Help may include a "few days away from duties involving likely combat exposures."
"Often, adequate rest and restoration will alleviate symptoms and restore function," the official said. "When it does not, medical intervention [in or near the war zone] and redeployment for those unable to function after initial treatment may be indicated."
Although Fort Carson officials wouldn't comment for this story, Foster's letter on Kaplan provides a glimpse at how the Army assesses PTSD and other combat-related psychological trauma.
"Upon returning back from Iraq, all soldiers went through a reintegration process and all high risk soldiers (suicidal, threat to themselves, family or loved ones, and PTSD) were immediately taken to medical facilities the minute the aircraft returned to Fort Carson, Colorado, for further evaluation before any leave was granted. Additionally, all soldiers are told if their problems were to reoccur that they could seek further medical attention."
When soldiers return, they are essentially expected to self-report mental issues. It is unclear whether all who need help actually get it, says Georg-Andreas Pogany, who runs the local Operation JUST ONE, a community mental health initiative that offers free care to soldiers returning from Iraq, their families and veterans.
Pogany, who suffered a breakdown as a Special Forces soldier during the war and also had to fight to get psychological care, says some soldiers won't admit they are having problems because they fear being stigmatized or letting down fellow troops. Others might stay mute because the evaluation process delays family reunions.
Pogany says mental exams should be mandatory upon return for all troops.
"It's not rocket science," he says.
The unnamed Defense Department official says comprehensive health assessments generally occur between three to six months after troops return from combat. The official cites a range of mental health resources, from chaplains to counseling professionals who promise to keep troops' conversations confidential so long as there are no threats to "others or themselves or to their military mission."
Mike Lemke says only after PTSD treatment did he stop feeling enraged by tailgaters. He still won't go to malls, and avoids patriotic parades honoring veterans' sacrifices. The crowds make the world close in.
"I've got to breathe before I can get out there," he says. "When you have to think about your breathing, you know you're in trouble."