Easing soldiers' returns

For soldiers who are injured or who witness traumatic events in combat, mental health professionals say it can be vital to their recovery that they talk with someone about the experience.

But for some troops who went through hell in Iraq or Afghanistan, the reluctance to talk is strong.

"In some cases, you feel you're protecting your family -- you don't want them to hear about it," said Lt. Col. Randy Nedegaard, behavioral health flight commander at Grand Forks Air Force Base, who commanded about half the mental health officers in Afghanistan during a nine-month deployment last year.

"And things happen in war that you're not proud of," he said.

"In one of the smaller units I worked with, there was a young soldier who was driving a large military vehicle at the front of a convoy. A 6-year-old Afghan girl ran into the road. He drove over her, and he killed her.

"It was traumatic for everybody. They all got out, and they all saw the body of this little girl. And this guy, the driver -- even if he did nothing wrong, there's a feeling of shame."

An officer ordered the driver to talk with a counselor. Nedegaard saw him, but only briefly.

"He really didn't want to talk about it, and I could understand," he said. "It was a pretty terrible thing, and he wanted to avoid the pain. It's natural to want to avoid pain."

Nedegaard, 45, who is about to retire from the Air Force and join UND's Social Work Department as an assistant professor, will participate in a panel discussion Saturday on mental health challenges in treating military personnel returning from conflict.

The panel discussion, part of the ninth annual Northern Lights Psychology Conference, will be from 10:30 a.m. to noon in the Memorial Union lecture bowl and is free and open to the public.

'Enormous issue'

Casey Lawler, a clinical psychologist and leader of the post-traumatic stress recovery team at the Fargo VA Medical Center, and Dr. Susan Thompson, a Grand Forks clinical neuropsychologist, will join Nedegaard on the panel.

Thompson is at Neuropsychology Associates in Grand Forks and specializes in the evaluation and treatment of people 16 and older who experience cognitive, emotional and behavioral changes due to traumatic brain injury and other conditions.

"It's an enormous issue," she said. "Concussion and TBI have been called the signature medical issues of the wars in the Middle East because of IEDs (improvised explosive devices), the weapon of choice for the insurgents, and rocket-propelled grenades, which can cause blast injuries that we're just learning about.

"An explosion can cause different kinds of injuries because of the heat and noise, the shock waves and electromagnetic pulse," she said. "And troops can be exposed to several blasts even in the same day. We take athletes out of a game after one concussion, but troops often go right back into action."

Doctors and researchers are looking to develop better recognition of such injuries and better treatment programs, she said. "The troops have better protective gear now, and we've made great advances in getting them medical attention, but a soldier might be treated for other injuries and a concussion is not recognized."

Soldiers, Marines and other service personnel returning from war zones may show signs of TBI and other injuries, such as headaches, dizziness, depression, anxiety and anger control issues.

"They can have catastrophic reactions to these events, affecting their motivation and drive," Thompson said.

If a combat veteran's diagnosis includes post-traumatic stress and a concussive injury, "they can exacerbate each other," she said. "It's up to us to help these people resume their lives."

One guy, 24 IEDs

During his deployment in Afghanistan, Nedegaard and members of his combat stress detachment suited up in body armor and rode in convoys to forward operating bases to meet with troops.

"We did a lot of walkabouts, teams of two, where we'd chat with people and see how they're doing and try to reduce the stigma about talking," he said.

"We tried to get them to talk with each other" about the things they'd done or seen. "It's a very intense, aggressive scenario they're in. It's war. You're talking about a bunch of 'alpha males,' and it's harder to reach out to some of those infantry combat units."

Nedegaard said the military "has tried really hard to respond" to the traumatic brain injuries, post-traumatic stress and other mental health challenges brought on by two wars and exacerbated by multiple tours of duty.

"But the military is having trouble getting enough mental health professionals," he said. "It's really hard, challenging work."

The incidence of post-traumatic stress in soldiers, Marines and others who served in Iraq and Afghanistan, at first below levels seen in Vietnam veterans, is catching up, he said, probably because of the repeat deployments.

And the traumatic brain injuries caused by IEDs continue to occur despite improved armor, in part because the Taliban is "getting better and better at making big ones," Nedegaard said. He talked with one soldier who rode in a special "mine-resistant, ambush-protected" vehicle, which takes the lead in convoys, who said he had been hit -- tossed around by smaller IEDs and rockets -- 24 times.

"I think the Veterans Administration is doing a fairly good job" of helping returning troops identify and deal with possible mental health issues, he said. "The concern I have is for the people out there who feel the stigma about getting help, or who live distant from where they could get help. As a country, we need to be more aware and encourage people to get support.

"It doesn't have to be from a mental health professional. It might be just talking with your buddies at the VFW. But keeping it all bottled up inside you is typically only going to make things worse."

Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com .