William Rider had never seen the young stranger standing in his office doorway. But as a Vietnam veteran who'd spent decades helping himself and other vets struggling with psychological injuries, he knew that face.
"I saw a look in his face like terror. He didn't know what he was going to say or if he was going to be judged," says Mr. Rider, who cofounded American Combat Veterans of War (ACVOW), a volunteer group that counsels and advocates for combat vets diagnosed with psychological injuries. "He sat down and started telling us about his combat trauma and he was there for over four hours.... He's been coming back ever since."
Using veterans who have recovered from psychological injuries to help others through the healing process is a novel, even a controversial approach. But there's growing evidence of its effectiveness, and it's now gaining greater acceptance in the US and abroad.
The approach is both simple and profound: Providing a safe, nonjudgmental place where someone who's "been there" can simply listen.
"There is this enormous chasm of understanding between people who have been to war and civilians," says Jonathan Shay, an author and psychiatrist who treated psychological injuries during a 20-year career with the US Department of Veterans Affairs (VA).
Rider's group is one of many formal and informal government and civilian efforts helping a new and growing generation of veterans recover from psychological injuries that disrupt their lives and, at a growing rate, end them.
ACVOW's 20 volunteers lend an empathetic ear for hours on end; pull veterans on the brink out of bars, jails, or fights at home; and give briefings to groups returning from war. As fellow warriors, ACVOW members believe they can earn the trust of troubled young veterans who are wary of civilian care providers and convince them to get help.
One concern is that without such help, today's combat veterans might experience the difficulties that continue to trouble many Vietnam vets.
Army suicides hit record in 2007
Last year saw the highest rate of suicide among soldiers on record, according to Army data. That year also saw rates of post-traumatic stress disorder (PTSD) diagnosed by the Army jump 50 percent. There have been 172 suicides among all branches of active-duty military while they were assigned to operations in Iraq or Afghanistan as of May 3, according to the Department of Defense.
The Department of Veterans Affairs counted 144 suicides among veterans of the Iraq and Afghanistan wars being helped within the VA system. But that count is only through 2005, and there is no nationwide tracking of suicides among all veterans.
More than 35,000 troops who served in those wars have been diagnosed with PTSD, says the Office of the Surgeon General (see chart). But a RAND Corp. report estimates that some 300,000 of them are experiencing PTSD or major depression, both considered factors in suicide. RAND reports that another 320,000 may have sustained a traumatic brain injury (TBI), usually caused by an explosion and associated with memory loss and personality changes.
Repeated and extended deployments to Iraq and Afghanistan are driving psychological injuries upward, say military and civilian doctors, despite a spectrum of new government programs aimed at preventing and treating them.
With the advent of the wars in Iraq and Afghanistan, the Army started programs to teach soldiers how to identify signs of PTSD, prepare mentally for combat, and remove the stigma of seeking help.
The VA recently announced the creation of a panel to advise the agency on improving its suicide-prevention effort. Last year it created positions at each VA medical center to oversee suicide prevention and started a suicide hot line.
There is also research involving new treatments. At the Naval Medical Center in San Diego, Cmdr. Scott Johnston, director for clinical research, just completed a three-year study using virtual-reality technology to help veterans overcome fear, anxiety, and flashbacks. After five to 10 weeks of treatment, 80 percent of the participants no longer had PTSD symptoms.
But for some vets struggling to overcome psychological injuries, an important element of treatment involves their peers. The Canadian government and the United Kingdom's Royal Marines have both adopted programs based on veterans helping other veterans with psychological injuries. In the US, informal veterans groups are providing similar services.
"It's not that credentialed professionals have no role," says Dr. Shay, who won a MacArthur Foundation grant for his treatment of Vietnam veterans diagnosed with combat trauma. "It's that they don't belong on center stage."
ACVOW's volunteers, who work from a tiny room in the La Jolla VA hospital as well as a facility on the Camp Pendleton Marine Corps base in San Diego, use their own money and some modest donations along with their credibility as combat veterans to help the new generation address psychological injuries and navigate the VA system. They see firsthand the cost of shortfalls in the mental-health care system.
"What we're seeing is marines committing suicide by motorcycle, or car," or by forcing police to shoot them, says Rider. "They are fed up with the fact they can't get some peace and quiet in their head."
ACVOW formed in 2001. Following the terrorist attacks of 9/11, many veterans of past wars reported troubling flashbacks.
"They were coming out of the woodwork," says Michael Sloan, a cofounder of the group. These days the La Jolla office is usually bustling with young men dropping by, cautiously looking for help.
How one marine got help
Josh, the Marine reservist who appeared at ACVOW's door at the La Jolla VA hospital and asked that his last name not be used, says he found what he was looking for – people who "get it."
The regular group meetings held by ACVOW got him through the week, he says. The group's office was also a place he could vent his anger. Fellow vets were there for him when he hit bottom in April.
As Josh tells it, he and his wife were arguing again, a new development in their relationship since he returned from Iraq in October 2006, and something snapped. His wife called the police, and he found himself in jail on several charges including domestic violence.
When Rider heard Josh was arrested, he contacted an officer in charge of the jail and explained Josh's injuries. "I guess I made an impression because after that they were all very nice to him and understanding. I do that because I know Josh would not tell them," says Rider. "Josh didn't do this because he's a bad person. He did this because he has combat stress and TBI."
Josh and his wife have separated, but hope for reconciliation is still in the air. Anger, distrust and sadness still course through him, he says, but lately he's been a little more at peace.
"He is 100 times more calm than a month ago," says Tim Jordan, a Gulf War veteran and ACVOW volunteer who started the group meetings that Josh regularly attends.
Last month, Josh and a Marine Corps buddy took the first steps to start a company they hope will be able to employ veterans and use its profits for charitable veterans causes. For now, Josh is living at the VA hospital, but he hopes to become one of ACVOW's volunteers. "It's like I need to find a new mission," he says. Being part of helping other veterans, "That's kept me more sane than anything."
It's a feeling Rider and the other ACVOW volunteers understand well. Rider is a decorated veteran of the infamous 1st Battalion, 9th Marines that suffered many casualties in Vietnam.
Both grateful and tormented for surviving war, he views the work today as a kind of penance and a duty. "It's like a balm that you put on the soul," he says.