Donna St. George / Washington Post – 2006-08-24 22:51:59

http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/08/20/MNGK9KLV8L1.DTL

Iraq War First Hard Look at Women’s Level of
Combat Post-traumatic Stress Disorder

WASHINGTON, DC (August 20, 2006) — There are times when Trinette Johnson’s life seems to stall, when she finds herself staring at the ceiling fan in her bedroom, watching the blades spin, her mind hung on nothing — not her receptionist job, not her fiance, not her ailing father or her four children.

Not even the war.

The war, of course, is always there, she said, an unseen force in her life, sometimes producing moments of blank detachment, sometimes stirring up anger like nothing she has ever known.

More than two years after returning from duty in Iraq, she has found herself cursing at other drivers on the road. Panicked in crowds. Seized with fear at the sight of highway overpasses and tunnels that might suddenly explode.

Doctors gave the 32-year-old Johnson, who served in the District of Columbia National Guard, a diagnosis of post-traumatic stress disorder, which has plagued thousands of U.S. troops after combat in Iraq — bringing on flashbacks, numbness, rage and anxiety and leaving many at odds with their old lives, families and jobs.

How women are affected after combat is only starting to be probed. This is the first war in which so many women have been so exposed to hostile fire, working a wider-than-ever array of jobs, for long deployments.

“This is a really unique experience, and we just don’t know,” said Ronald Kessler, a Harvard University professor and author of a landmark study of post-traumatic stress disorder.

For women who are mothers, combat-related PTSD may have added significance. Often, after war, “it’s not the same mommy who left,” said Yale University Associate Professor Laurie Harkness, who runs a Veterans Affairs mental health clinic in Connecticut.

Although the same can be said for fathers, she said, “mothers in general are the emotional hub of a family.”

About 137,000 female troops have served in Iraq and Afghanistan, some exposed to the most profound stresses of combat: ambushes, mortars, bombs, fallen comrades. They have fired M-16s and grenade launchers, killed people and been shot at.

As these women have returned home, Army researchers studying the psychological fallout of Iraq have noted a surprising trend in early studies: Women appear to be showing symptoms of post-traumatic stress disorder and other mental health troubles at roughly the same rates as men.

If this result holds true, it would stand out because women studied in the overall population show markedly higher rates of post-traumatic stress disorder than men — about twice as much.

“It’s not definitive, but it’s encouraging,” said Patricia Resick, director of the Women’s Health Sciences Division of the National Center for PTSD, part of the Veterans Affairs Department. Resick said more research is needed.

While studies of the war’s effects continue, one fact is clear: A generation of U.S. military women is at risk of combat-related stress disorder as never before.

A recent study showed that overall, more than 1 in 3 U.S. troops sought mental health care in the year after returning from Iraq. An earlier study found that about 1 in 6 troops showed signs of PTSD, major depression or anxiety after Iraq.

“From our data, what it looks like is that women serving in combat have the same risk as men of getting PTSD or other mental health conditions,” said Charles Hoge of the Walter Reed Army Institute of Research.

For Johnson, it was a doctor at Walter Reed Army Medical Center who first uttered the letters PTSD, a defining moment that came after she spent nine months working the bomb-blasted roads near Baghdad as a truck driver for the 547th Transportation Company of the D.C. Guard. Her job was hauling — troops, supplies, equipment — and security. At one point, she transported dead Iraqis to their wailing relatives.

In the fall of 2003, Johnson was riding in a truck with her M-16 rifle pointed out the passenger-side window. Out of nowhere came a deafening blast. A bomb, hidden along a guardrail, had detonated as her convoy drove by.

Johnson received a Purple Heart for hearing loss in her left ear, but stayed in Iraq for several more months, working the same roads. “It seemed like once every other or three days somebody was getting hit,” she recalled.

But the enemy was elusive. She never fired her M-16.

In January 2004, she was shipped home three months early, sidelined with severe kidney stones. Later, at Walter Reed, the dreams started: violent dreams, with exploding mortars and hordes of barking dogs. She mentioned them to a doctor.

At the time, she was living on the hospital grounds, seeing specialists and worrying about whether anyone in her unit had been injured or killed.

For Johnson, treatment at Walter Reed made things better, with group sessions, art therapy and combat-stress counseling. “You’re in there with other people who are going through the same things,” she said, “and you kind of feel like, ‘OK, now I don’t feel crazy.’ ”

The most wrenching day, as she remembers it, was when she was sent home: Oct. 3, 2004. She was on her own — medically discharged from the military because of the stress disorder.

Once, she asked her doctor: How long am I going to be like this? “It could stop today, or it could go on for years,” she said she was told, which brings her to this: “That’s what scares me. I just get scared that I’ll be one of those homeless people that you see holding the signs because I’ve lost my mind.”

For now, her fate is nothing like that. She lives with her fiance — Mark Branch, her battle buddy who was driving the five-ton truck the day the bomb went off along the guardrail. They bought a house this year. Her children seem happier, planted.

Some days, though, she feels perilously close to the edge.

If she is home, she may retreat to her bedroom to collect herself. Or she may, for a moment, lose her connection to everything, as the ceiling fan turns, as her mind goes blank.

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