Soldier Inadequately Treated for PTSD Kills Iraqui Family

Ken Kesey would be so proud of the cuckoo's nest we seem to have flown into in the war on Iraq.  Inadequate treatment of the mentally ill, the PTSD victims, the soldiers stressed beyond any ability to reason.  The consequences are heart breaking.  More if you can stand it below the fold.

Soldier Diagnosed With Mental Problems
By RYAN LENZ
Associated Press Writer

An Army private charged with the slaughter of an Iraqi family was diagnosed as a homicidal threat by a military mental health team three months before the attack.  Pfc. Steven D. Green was found to have "homicidal ideations" after seeking help from an Army Combat Stress Team in Iraq on Dec. 21, 2005. Green said he was angry about the war, desperate to avenge the death of comrades and driven to kill Iraqi citizens. The treatment was several small doses of Seroquel - a drug to regulate his mood - and a directive to get some sleep, according to medical records obtained by the AP. The next day, he returned to duty in the particularly violent stretch of desert in the southern Baghdad suburbs known as the "Triangle of Death."

Holy crap.  Love the benign headline-it bloody well should say "Mentally ill soldier kills Iraqui family after inadequate treatment by Army."  Paul Rieckhoff diaried recently about the inane and pathetic VA cartoon PTSD treatment video Cartoon treatment that basically tells doctors that soldiers with PTSD just "need to get some sleep" as well as stay off drugs, alcohol and caffeine; it sounds like some idiot was listening.

Another other good question is why anyone thought a short course of Seroquel would do any good for a seriously disturbed person.  Seroquel is a treatment for schizophrenia, which is not a sort term condition.  

SEROQUEL is indicated for the treatment of depressive episodes in bipolar disorder; acute manic episodes in bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex; and schizophrenia. Patients should be periodically reassessed to determine the need for treatment beyond the acute response.

Source: Seroquel webpage; (emphasis added).

If Green was actually schizophrenic, he should never have been returned to active duty. Or did they just think he had a "minor" psychotic break when he said he was "driven to kill Iraqui citizens?" Was the Army trying to treat with low doses of Seroquel as a sedative, without addressing the underlying illness? Or was it in some way ok because he only was "driven to kill Iraquis?"  I am so sad for this man, whose life is shattered, and for the dead family that suffered and died because the callous cartoon treatments are all that were available.

Peace.

•  who was the commander who overruled

  medical advice in this case?

  by Carl Nyberg on Tue Jan 09, 2007 at 02:19:36 PM PDT

•  Yes, I looked up Seroquel recently.

  Not in relation to this story, though.  If you think the disorders it is meant to treat are scary, the side effects can render a patient incapable of anything that requires concentration or being on their feet.

  So they probably dosed him briefly to calm him down(low blood pressure and general sleepiness are side effects) and then when he seemed normal enough, they took him off the meds and sent him back out.  Are we that desperate for boots on the ground that we set a raving lunatic loose with a gun?

  by Fabian on Tue Jan 09, 2007 at 02:34:21 PM PDT

  •  Apparently we are that desparate

    Truly sad.

    by barbwires on Tue Jan 09, 2007 at 02:44:55 PM PDT

    •  Hi Barbwires and thanks for the diary

      Just thought I'd point out one rather prominent spelling error.

      Normally, I wouldn't bother, but since it's in the title it kind of sticks out a little bit, so I thought you might want to change it.

      "Iraqi" with no "u" after the "q" is the accepted spelling.

      Again, usually spelling is not big deal, but I simply didn't want it to detract from your informative diary!

      Thanks for writing it!

      by BentLiberal on Wed Jan 10, 2007 at 06:46:34 PM PDT

•  Wow

  Never in my life have I heard the treatment of PTSD as: take some seroquel and get more sleep.  In order to be diagnosed with PTSD one must present with symptoms of reexperiencing, numbing, and hyperarousal. One of the symptoms of reexperiencing a traumatic event is recurrent, distressing dreams of the event.  One of the symptoms of hyperarousal is sleep disturbances.  I've been working with clients who have PTSD since 1990 and the client without insomnia, nightmares, and vivid thematic dreams is rare.

  As for the seroquel, it is prescribed for more than bipolar and schizophrenia.  It does help some people with PTSD.  But I have never seen it as the drug first prescribed.  The clients that I've had who have been on it received their first dose during an inpatient hospitalization.

  by sobermom on Tue Jan 09, 2007 at 02:37:37 PM PDT

  •  The drug write up

    implies that it should be used in conjuction with close observation.  It apparently can mess a body up pretty badly and is hard on the liver in particular.  If I prescribed this for someone, I'd be keeping a close eye on the side effects.  OTOH, that is also an argument for keeping someone on it for short, supervised periods.

    But nowhere in the literature does it imply that a brief run of the drug cures anything!  This gives me a horrible feeling that the military is falling back on the old, terrible tradition of "patching up" shell shocked soldiers enough to send them into the fray again.

    by Fabian on Tue Jan 09, 2007 at 02:46:36 PM PDT

    •  Monthly med checks

      and weekly therapy are a bare minimum even for someone who has been on seroquel for over a year.  I'm not sure how frequently blood work is done.  Those clients that I've had who were on it had a very hard time functioning in any environment.  They were clients I saw up to 3 times a week, who had group therapy and regular appointments with a psychiatrist.  They worked hard to get to a point where they were functioning at school or work.  And they weren't required to carry a gun.

      by sobermom on Tue Jan 09, 2007 at 02:57:36 PM PDT

    •  Most anti-anxiety and antidepressant drugs

      REQUIRE close monitoring, especially in the first 6-12 weeks.  Some can actually CAUSE hallucinations, depression and homicidal/suicidal impulses.  I was put on one that made me a basket case--fortunately, I checked up on it, called the doctor, told him agt was happening, and stopped taking it with his approval.  

      by irishwitch on Tue Jan 09, 2007 at 02:58:14 PM PDT

      •  seroquel is one of those

        the side effect list is long and the drugs it adversly interacts with is even longer.  (almost any liver affecting drug - seroquel must be murder on the liver)

        by Fabian on Tue Jan 09, 2007 at 03:02:41 PM PDT

        •  Probably either a cytochrome

          P450 liver inducer or inhibitor-either one can mess up the metabolism of other drugs and make them either less effective or a lot more toxic.  A good example of an enzyme inducer is grapefruit juice, which can make a lot of drugs metabolized by the liver more toxic.

          by barbwires on Tue Jan 09, 2007 at 03:07:29 PM PDT

          •  Oneof my friends has a hsuband who took

            Elavil,a nd he spent a lovely day on the California beaches, without ever leaving their Rocky Mountain home, because he'd drunk a lot of grapefruit juice....

            by irishwitch on Tue Jan 09, 2007 at 03:44:30 PM PDT

•  This is a disgrace to whom ever gave him the

  pills and then sent him back out with a gun.  Whoever it was should be charged WITH THE MURDERS OF THESE PEOPLE. I am really getting the feel that Iraqi lives are not important to the military or the repubs and bush. The only important item is to win and control the oil in Iraq.  We need to bring this up often and loudly every chance we get.

  by Owllwoman on Tue Jan 09, 2007 at 02:41:37 PM PDT

•  It is the direct result of streching out

  the army. The decider is the one who should get the blame. Impeach the miserable fuck!

  by Asinus Asinum Fricat on Tue Jan 09, 2007 at 02:46:23 PM PDT

•  Sending soldiers with PTSD back

  into combat on meds is a common practice.    I';d hate to be the doctor.  They're likely torn between following orders to get people back on the job ASAP and good medical practice.  It's pretty clear this guy should NEVER have been sent back  to hsi unit; he should have been sent to Germany or the States to psych ward where he could be treated properly, because he's a danger to everyone around him.

  Ex-Navy wife here. We were stationed in Japan for 7 years, and I had a nasty run-in with a Navy shrink I was sent to in order to determine whether we should reduce the meds I am on for a chronic sleep problems (night terrors).   The man was a horror. Treated me like dirt. Couldn't understand why a  40 year old  woman with two graduate degrees, childless by choice, a feminist, a liberal Dem, a Wiccan, didn't just make friends with the 20-25 year old Mommies (most fundamentalist Christian, conservative) who lived in base housing.

  All the other medical care I got there was superb. But the shrink was ghastly. He wrote some rather nasty things in my record--which, fortunately, I was able to remove later. They had nothing to do with the reason I was there, and represented nothing but his dislike for a woman who told him the truth--that some of us DON'T fit in.

  I don't want tot hink about thwta this doctor would be like treating a man with PTSD.

  by irishwitch on Tue Jan 09, 2007 at 02:56:13 PM PDT

•  God help us

  This is a reflection on everyone of us. What have we become ? 18 year old kids, scared shitless ,automatic weapons, no plan , no clear enemy, "Good Morning Viet Nam "

  by oldnavigator on Tue Jan 09, 2007 at 02:58:40 PM PDT

•  Most people suffering from PTSD NEVER kill anyone

  Under what scientific criteria is it proposed that a man who was trained as a killer is mentally ill because he kills?  If anything, it seems like an adjustment and judgement problem.   What kind of society are we living in, where soldiers are labelled as mentally ill for wanting to do what they are trained for?  

  In short, I'm not defending this particular soldier, but using this case to illustrate how horrific our current attitudes on "mental illness" are and how the big business of psychiatry and legal psychology has affected America, for the worse.  Here is a case where an individual committed a horrific crime, and he should be judged for that action alone.  But after the legal teams and the psych teams get done with him, he will not only be a killer, but a quivering mass of labels from the psych community, which will only serve to hurt the rest of the victims of psychiatry in this country.  The media already points a finger at mentally ill and emotionally ill people as if they are less-than-human, and with the rate that the psych community is manufacturing new labels and victims, it won't be long before everyone is in danger.  

  by Braided Summer on Tue Jan 09, 2007 at 03:00:19 PM PDT

  •  To my mind

    the problem is that he was sent back out, after very limited and possibly medically questionable treatment, with a gun and a lot of rage.  

    I certainly don't think all people with PTSD are homicidal, and I know psych labels can be an undue burden.  But in this case I was just floored and really angry.

    by barbwires on Tue Jan 09, 2007 at 03:04:33 PM PDT

  •  I disagree.

    This guy was fixated on killing any Iraqis, including civilians in some attempt at revenge.  If he wasn't effectively treated and re-evaluated thoroughly before being sent out again, then it is absolutely no surprise that he did what he said he was going to do.

    If someone says they want to kill themselves, you get them treatment so they don't commit suicide.  If someone confesses to a homicidal obessession, you get them treatment so they don't commit murder.

    Homicide =! Suicide.  There is no standard form of PTSD.  There is no set forumula for a mental breakdown.

    All happy families resemble one another, but each unhappy family is unhappy in its own way.  

    by Fabian on Tue Jan 09, 2007 at 03:13:21 PM PDT

•  I wonder how much psych training

  the doctor had, and whether he recommended  treatment for the soldier and was overruled by hius company commander.

  If thsi goes onmuch longer we WILL need a draft because our sodliers are breaking in ways that don't make it safe  (for them, their comrades or Iraqi citizens) to be sent back.

  by irishwitch on Tue Jan 09, 2007 at 03:00:50 PM PDT

  •  I wonder how much pressure

    the docs are under to declare the kids OK and get them back out into the shitstorm.  Remember what Patton got in trouble for?  

    by marykk on Tue Jan 09, 2007 at 03:16:45 PM PDT

    •  Standard practice in every war.

      Battle fatigue or shellshock or PTSD, soldiers are told they're faking it to avoid their duty.

      by irishwitch on Tue Jan 09, 2007 at 03:43:12 PM PDT

•  If I recall

  this kid had been interviewed by a reporter for the NYT or WaPo who had found his comments to be quite disturbing some time before this incident.  Short of light up arrows a la Warner Brothers, every conceivable indicator was out there beforehand.

  by marykk on Tue Jan 09, 2007 at 03:10:47 PM PDT

•  millions of Iraqis have untreated PTSD

  and yes, vast majority do not kill anyone.  Small minority creates quite a mayhem.

  One thing that we often forget is that folks in places like Iraq, Afghanistan, Somalia and assorted less celebrated war zones are traumatized, and behave accordingly.

  by Piotr on Tue Jan 09, 2007 at 04:47:35 PM PDT

•  Here's a link to the story upon which this

  diary is based:  Soldier Diagnosed With Mental Problems

  And here is a link to the diary that provides insight into how the VA wants its doctors to treat soldiers with PTSD: A Peek Inside the Mind of the VA/DoD

  Also worth noting, from the same AP article:

  • Three months passed without Army doctors and clinicians from the Combat Stress Team having any contact with Green. He was summoned for a second examination on March 20, 2006 - eight days after the killing of the family. Green was diagnosed as having an anti-social personality disorder and declared unfit for service. The process of discharging him began a week later and he was sent home.

  .                                           ....

  • Lt. Col. Elizabeth Bowler, a psychiatrist and Army reservist from California who took over the Combat Stress Team with Green's unit in January, recommended his discharge after the second examination in March. Yet she wrote a final evaluation that said Green exhibited no traits that would indicate dangerously erratic or homicidal moods, according to documents viewed by The AP. [emphasis mine]

  barb, isn't anti-social personality disorder a personality type that would in all likelihood have been part of Green's character before enlistment? To my knowledge it's not trauma-induced. Acting out, and poor impulse control are definitional of anti-social personlaity disorder. Green should never have been permitted to enlist in the military. The new standards are now giving people with drug use and criminal convictions a 'second chance'.

  by Halcyon on Tue Jan 09, 2007 at 04:55:34 PM PDT