U.S. military: Heavily armed and medicated

Two months after the new drug policy was issued, President Bush ordered more than 20,000 additional troops to Iraq in an attempt to quell the violence. This surge in American military presence in Iraq increased the pressure on Pentagon officials to quickly redeploy soldiers and Marines just back from war.

Surveys of behavioral-health professionals offer hints about what has happened as soldiers are medicated and then sent back to fight. In last year's surveys, carried out by teams sent to Iraq and Afghanistan by the Army Surgeon General, a staff member reported that there had been "quite a few [evacuations for] psychotic breakdowns."

"Many of these soldiers are sent to Afghanistan," the staff member said, "despite a doctor saying they shouldn't go or leaders knowing they shouldn't deploy."

To meet its needs, the army has also begun accepting more people with existing medical or psychiatric conditions. A recent study by U. S. Army medical staff found that 10 percent of new recruits reported a history of psychiatric treatment.

In an article in the journal Military Medicine, Jeffrey Hill, M. D., and his colleagues wrote about soldiers who had made suicidal or homicidal threats at a base in Tikrit, Iraq. Of 425 soldiers evaluated for psychiatric treatment, they reported, about 30 percent had considered killing themselves in the previous week, and 16 percent had thought about killing a superior or someone else who was not the enemy.

Each of these soldiers poses a dilemma for physicians, they wrote, because of his or her duty "to conserve the fighting strength" — the motto of the U. S. Army Medical Department. Doctors must try to avoid sending these soldiers home, but they must also recognize the dangers of keeping them in Iraq, where weapons are everywhere.

‘He was a good kid’
When Travis Virgadamo arrived from his army unit in Iraq for a visit with his family in July 2007, he hesitated to tell his grandmother, Katie O'Brien, what he had seen. "'I've seen little children killed,'" she remembers him saying. "'You can't imagine what it's like, Grandma. You just can't.'"

Virgadamo, shy and quiet as a boy, had grown up wanting to be a soldier. "It was his dream," O'Brien says. "He was a good kid. He would do anything for you."

Soon after entering the army, however, Virgadamo began to have problems. In boot camp he became angry and suicidal, prompting an army doctor to write him a prescription for Prozac, his grandmother says. Not long after that, he was sent to Iraq. One day as men in his unit were cleaning weapons, the commander sent Virgadamo for some gun oil, O'Brien says. When he didn't return, they went to look for him. They found him with a gun in his mouth.

Virgadamo was sent home to Pahrump, Nevada, to be with his family for 10 days. Then he would be returned to Iraq. O'Brien learned that he was sent to a class meant to help him, and that he had been given a new medication instead of Prozac. The day he supposedly completed his class, O'Brien says, his commander gave him his gun back.

That night he used it to kill himself.

"They all knew he was in a very serious situation," O'Brien says. "He was a danger to the other soldiers as well as to himself."

She is furious that the army gave him Prozac. She points out that the labeling of Prozac, Zoloft, and similar antidepressants state that the drugs have been shown to increase suicidal behavior in people age 24 and younger — a group that includes large numbers of American soldiers.

Virgadamo was 19 when he died.

"It was so unnecessary," she says. "We can't bring him back."

The U. S. Army's suicide rate is now at an all-time high. Colonel Ritchie says officials are studying the reasons for the increase, including the possible role of medications. Soldiers taking antidepressants have killed themselves, she says, but so far there is no evidence that the risk is higher for those taking the drugs.

Instead, the army has found, soldiers who committed suicide often had personal problems, such as troubled marriages or financial difficulties. Repeated deployments can strain family relationships. "The army has been at war for a long time," Colonel Ritchie says, "and everyone is kind of tired."

‘No condition to leave’
At age 26, with a new wife and child, Michael R. De Vlieger never seemed to have enough money. He had resorted to selling his blood plasma for extra cash when he noticed the recruiting station next door to the donation center. That was in November 2004. Fifteen months later he was on the ground in northern Iraq, a gunner with the 101st Airborne.

Not long after he landed in Iraq, roadside bombs blew apart two Humvees from his platoon, killing nine soldiers, including men he knew well.

The next month, as he manned a Humvee on patrol passing through a crowded market, grenade-throwing insurgents jumped from behind the fruit stands. One antitank grenade landed under the vehicle. The blast didn't pierce its metal, but the force drove De Vlieger's knee through the door.

He was later evacuated by helicopter and returned to Fort Campbell, in Kentucky, to recuperate. But his personality had changed. He began to drink heavily, and flew into rages. One day, he attacked his wife's dog.

"I had lost so many friends and went through a near-death experience," he says. "I wasn't who I was when I left."

He was updating his will and preparing to return to Iraq when he broke down. His wife, Christine, found him awake in the middle of the night, rocking while babbling incoherently. Frightened, Christine called his squad leader, who took him to the base emergency room. Doctors then sent him to a nearby private psychiatric hospital, where he stayed for 16 days, receiving medications to calm his panic and treat his blood pressure and depression. The doctors released him with four prescriptions.

A noncommissioned officer in charge of De Vlieger's unit's stateside operations told him that day that he had to leave immediately for Iraq. Less than 18 hours after being released from the hospital, De Vlieger was on a plane heading for the Middle East. "I was in no condition to leave," he says. "I'm an infantryman. If I'm screwed up in my head, it could cost my life or the lives of the men with me."

Pentagon policy requires that service members with psychiatric conditions be stable for at least 3 months before they can be deployed. Colonel Ritchie says she can't comment specifically on any soldier's medical history, but agrees that sending someone to Iraq just hours after leaving a psychiatric hospital would violate the policy.

DeVlieger says the medications altered his thinking — a side effect he didn't want to deal with at war. He threw the pills away.

"I had a weapon, entire magazines filled with rounds. It's not like it would have been difficult for me to commit suicide," he says. "I don't believe it was safe."

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