SCARRED SURVIVORS

By Pamela Martineau and Steve Wiegand -- Bee Staff Writers
Tuesday, March 8, 2005
www.sacbee.com

Third of four parts

No one shot at Pamela Schultz. No one lobbed mortar shells in her direction, or planted mines under her vehicle during the time she was in Jordan as a master sergeant in the Air Force Reserve's 163rd Air Refueling Wing.

The nearest she came to death, in fact, was when she helped load planes with the caskets of American and coalition forces killed in Iraq.

But something in Schultz was deeply damaged anyway.

"It affected me, it changed me," she says from an easy chair in her Pocket-area home, where the rustling of the two Chihuahuas in her lap contrasts with the din of late-night warning sirens still echoing in her mind.

"It's not just that you were there and you could die, it's the way you lived," she says. "My body ain't broke.

"It's my mind and heart."

There's nothing new about what's wrong with Pamela Schultz, 48, whose friends call her "P.K." During the American Civil War, it was "Da Costa's syndrome," named after a doctor who wrote about the symptoms. During World War I, it was "shell shock," and in World War II "battle fatigue."

Even its current name, "post-traumatic stress disorder" (PTSD), dates back 25 years, when psychiatrists began using the term to describe the malady among Vietnam War vets.

Whatever it's called, PTSD is an illness with symptoms that range from headaches and insomnia to severe paranoia and deep depression - a group of debilities that often trigger problems with drugs and alcohol. Although it can affect anyone who experiences trauma, PTSD is most prevalent among
military personnel who have been in combat situations.

And medical experts fear that as U.S. troops return from the war, it could prove to be far more prevalent among female vets than among their male counterparts.

Women like Schultz, whose mood swings are so sudden and severe she must take breaks from her office job to retreat to a restroom and "just breathe."

Or Linda Wesner, 45, a California National Guard soldier from Sacramento, who came under fire several times as a heavy equipment truck driver in Iraq. Shortly after returning home, Wesner was in uniform at a pancake house when she was hugged from behind by a patriotic elderly woman.

Instinctively, Wesner flipped the woman to the floor.

Or California National Guard Sgt. Yolanda Medina, 30, of Long Beach, who decided to postpone facing her PTSD symptoms - drinking more, eating and sleeping less, snapping angrily at life's slight irritations - by returning for a second tour in Iraq.

"Everybody has it when they come back," Medina says during a break in training at Fort Lewis, Wash., a few days before leaving for another year in the war zone.

The hardest thing about adjusting to life after Iraq?

"Being a person," she replies.

Women at greater risk

The Department of Veterans Affairs medical division estimates it currently treats about 87,000 vets with PTSD, at an annual cost of $250 million. Many health care officials expect that number to more than double in coming years as troops return from Iraq.

A study released last July by the Walter Reed Army Institute of Research found that about 17 percent of vets already home from those countries reported some mental health problems, twice the rate of those who returned from the Persian Gulf War in 1991.

And studies done after the Gulf War found that female troops were twice as likely as male troops to develop PTSD, reflecting the 2-to-1 ratio of female-to-male PTSD sufferers in the general U.S. population.

Other studies have shown that the closer troops are to danger or distasteful assignments such as handling bodies, the more likely they are to have PTSD symptoms. That augurs ill for women in the military today, since more of them are put in harm's way than ever before.

"This is the first war where we have women who are truly in combat roles," said Dr. Patricia Resick, a psychologist who directs the VA's Women's Health Sciences Division in Boston. " ... (That) could be very significant" in influencing the number of women vets with PTSD.

Clinicians who treat women suffering from military-related PTSD say that their self-image can be an obstacle to receiving treatment. After serving in the military, many women no longer view themselves as veterans, the clinicians report; therefore they don't connect their symptoms to their military trauma.

Surveys by the Department of Veterans Affairs have found that women vets tend to feel the definition of "veteran" applies only to males who had combat duty. They often will check "no" on a questionnaire when asked if they are a vet, but "yes" when asked if they have served in the military. One VA study found 57 percent of the women interviewed did not know they were eligible for VA programs.

Yet many researchers believe female troops actually have greater need for PTSD treatment programs for reasons rooted in both environment and physiology.

Physiology may play a role

Anyone who has been sexually assaulted before entering the military, then suffers more trauma, is at greater risk of developing PTSD. And women are more likely than men to have been sexually assaulted at some point in their
lives.

A woman's chances of developing PTSD are even greater if she is assaulted or physically threatened while she's in the service.

"The military can be seen as a way to get away from a bad environment," said Dr. Paula Schnurr, deputy executive director of the VA's National Center for PTSD in Vermont. "The idea of trying to go to a place that is safe and structured, and then finding in fact that it is not ... It really makes things worse."

P.K. Schultz, for example, vividly recalls standing in a chow line in Jordan and asking a drunken soldier of lesser rank to watch his language. When the soldier raised a fist to punch Schultz, an MP intervened. The next day, Schultz says, a colonel sharply questioned her version of events.

"You'd have thought I did something wrong," she said.

Indications that physiological factors also play a role in female troops being more susceptible to PTSD come from the VA's Clinical Neurosciences Division in West Haven, Conn. Researchers there have found female brains may be less efficient than male brains at producing the neurosteroids that help human beings cope with stress.

Other studies have shown women deplete serotonin, a substance that helps combat depression, more quickly than men and regenerate it more slowly. And menstrual cycles may also play a role in making women more vulnerable in stressful situations.

All of which is of only passing interest to female vets like Schultz, whose post-service nadir came when her sister found her sitting in the dark in her Pocket-area home, unkempt, with no food in her cupboards or refrigerator.

Schultz just wants to feel better.

"You feel no worth. No motivation. No hope," she says. "It takes everything I have to try to make my lunch to go to work."

A dive into despair

Like many young people from families of modest means, Schultz left her hometown of Petaluma at age 19 and joined the Army to get financial aid for college.

She stayed just eight months. But she felt like a quitter, and military life appealed to her. Eventually she signed up for the Air National Guard, later switching to the Air Force Reserve, which became her full-time career.

Schultz became the first woman in California certified to load weapons onto F-4 Phantom jets, and was honored by her unit as Noncommissioned Officer of the Year. She trained as a medic, and earned an associate of arts degree.

"I liked the continuity," Schultz said. "The uniformity. The structure."

But more than 15 years of service in the Reserve didn't prepare Schultz for the reality of life in the Jordanian tent city of 6,000 people that served as a supply base for units in Iraq.

Eight-hour workdays became 15-hour workdays, loading and unloading planes, punctuated with sessions serving as a den mother for some of her tent mates, most of them much younger than she.

"They'd never been away from home," she recalled. "Some were still living with mom and dad and then they were going off to war. I saw young girls just petrified. Other girls just lived to get drunk and get laid."

A born-again Christian, Schultz was appalled by what seemed to her the reincarnation of Sodom and Gomorrah:

Tents that reeked of alcohol, smoke and vomit. Couples standing cots on their sides to form an area for sex. Illegal affairs involving enlisted personnel, noncommissioned officers and officers.

Coupled with the assault on her sense of morality were the conversations with troops taking a break from the fighting in Iraq.

"They'd describe the smells, the sounds, the cries, the screams," she said, "and then they'd want to go back and just kill."

Schultz found herself in a continual state of fear and despair, carrying her chemical attack protective gear everywhere and dreading the next blast from the warning sirens and the loudspeaker warnings to seek shelter.

"I felt dark. I felt alone. I was scared."

In 2003, shortly after her unit returned to the States, Schultz retired from the Reserve. She sat through a mandatory, but brief, group lecture about adjusting to life at home. But unlike active duty military personnel who return to bases and are surrounded by colleagues and commanders who might notice PTSD symptoms, Schultz was on her own.

She sold her house in Southern California and moved to Sacramento to live closer to her family, and start over.

But Schultz couldn't shake her memories of Jordan. She couldn't focus enough to ride her beloved Harley-Davidson "hog." She went days without showering and rarely went outside. She couldn't work, and began drawing on state disability benefits, which made her feel "like a whore on Main Street."

It was a long fall from her days as a can-do sergeant.

"Everybody knew I was G.I. Jane," she said. "They knew my awards, my history."

Schultz hit bottom the day last summer that her sister found her despondent, sitting alone in the dark, and took her to a local VA outpatient center. Workers there referred her to the VA medical facility at Mather Field, and followed her there to make sure she went.

After weeks of outpatient counseling, Schultz developed some tools to deal with her PTSD, and got a job at an in-home health care service - for half her salary as a full-time reservist. After a few months at her new job, Schultz fell behind on the rent on her Pocket home and was forced to move to a much smaller duplex near Country Club Plaza.

By her own account, Schultz was barely holding it together. Small annoyances by co-workers seemed almost intolerable. Her performance review said she lacked communication skills.

"To say that I can't communicate, that's been like my strongest gift all my life," she said as she read over the review. "It's like a slap in the face.

"I'm feeling vulnerable," she said. "I'm feeling exposed. I'm feeling frightened."

Mobilizing to treat PTSD

By many estimates, the VA mental health care system already is grossly underfunded. The American Psychiatric Association, for example, estimated last October that while the number of VA patients with severe PTSD increased 42 percent from 1996 to 2001, VA spending on PTSD increased only 22 percent. The APA said it would take an additional $500 million a year for the next four years just to close the gap between available resources and mental health program needs.

While it copes with a crush of demands for service, the VA also is trying to figure out how best to deal with a relatively new kind of patient: female combat vets.

At the VA's PTSD center in White River Junction, Vt., researchers are completing a $5 million study of 384 female vets with PTSD. The study, the first VA cooperative research effort to focus on women, is testing two different kinds of psychotherapy treatments to determine which is more effective.

"We don't have expert therapists on this," said Dr. Schnurr, the study's co-director, "so we have been training therapists as we go. If this is found to be effective, it will give us more confidence that the treatment will work in large health care systems."

While the new study is based on one-on-one therapy, a program at the VA's Women's Trauma Recovery Program in Menlo Park relies on group sessions.

The program, which started in 1992, has recently broadened its treatment to include women who have been sexually assaulted in the Iraq combat zone. It focuses on practical classes that range from managing personal finances to improving interpersonal and communications skills.

"One of the first and most important things that happens is they come to realize they are understood," said Dr. Darrah Westrup, a clinical psychologist and director of the Women's Mental Health Center, where the 60-day, 10-bed program is located.

But programs like this are likely to be inundated over the next few years.

Despite a recommendation in 1990 that each of the VA's 206 medical centers have a PTSD clinical team of psychologists and psychiatrists, fewer than half currently do. Last summer, the VA did hire 56 Iraq War veterans to serve as mental health counselors back home to other Iraq vets.

One of the new counselors works at the VA's outpatient counseling center on Howe Avenue, where requests for help are up 30 percent since the war in Iraq began.

Mike Miracle, a counselor who's worked at the center since 1980, said he's never treated as many patients a month as he does now. Because of the crush, patients can't be seen as often as they might need to be.

"Fifteen years ago I would see a vet every week," said Miracle. "That doesn't exist anymore. The only people I see once a week now are crisis cases."

Recovery can be elusive

P.K. Schultz had moved out of crisis mode and was seeing her VA counselor monthly. Recently, though, she went back to once-a-week visits.

Her life is unraveling again.

She sold her truck back to the dealer because she couldn't afford the payments. And she's moving again - for the fourth time in less than two years.

The only thing that seems to endure is the depression and anxiety.

"I'm just taking it one day at a time," she said.