Smoke blackened the morning sky after a car bomb exploded outside an elementary school in northern Iraq. Todd Kuikka and his team of bomb technicians drove into downtown Kirkuk to secure the area and aid the wounded. His truck pulled up near the ruined building. He stepped out and entered a recurring nightmare.
Images and emotions from that summer day in 2004 still cut into his sleep a decade later. He sees again the shattered bodies of Iraqi children and feels once more a furious despair. He awakens between worlds, believing he has gone back to war.
The anxiety dissolves by degrees as Mr. Kuikka, a former Air Force staff sergeant, remembers his surroundings. He lives among fellow veterans in Sauk Centre, a small town in the land of lakes and Sinclair Lewis in central Minnesota, far from the battlefield but close to those who hear its undying echoes. He knows that here at Eagle’s Healing Nest, a nonprofit transitional home for retired service members, he can talk to others who have returned to America yet remain lost inside the country’s 21st-century wars.
“There’s mutual understanding because of our parallel experiences,” says Kuikka, who has been diagnosed with post-traumatic stress disorder (PTSD), the fallout of three tours in Iraq and two more in Afghanistan between 2003 and 2010. “We share things that we won’t share with anybody else – not family, not therapists. It comes down to one simple term: trust.”
The program’s emphasis on veterans looking after their own mirrors a larger trend in the treatment of war’s unseen wounds. Peer support, to invoke the clinical term, has taken hold in recent years as nonprofit groups and the Department of Veterans Affairs (VA) confront the military’s deepening mental health crisis.
Studies show that 20 to 30 percent of the 2.8 million US troops sent to Iraq and Afghanistan suffer from PTSD, severe depression, or a related condition. In January, the VA revealed that from 2009 to 2011 the number of suicides among veterans under age 30 spiked by 44 percent, rising from 88 to 152. (Overall, 22 veterans commit suicide every day, with the annual toll exceeding 8,000.)
The surging need for mental health services has breached the federal agency’s capacity at its nearly 1,000 hospitals and clinics nationwide. In 2012, nearly 1.3 million veterans received care, almost 400,000 more than in 2006. The VA Office of Inspector General reported two years ago that the average wait for treatment ran to 50 days. In an effort to reduce delays, the department has since hired 3,500 behavioral health providers, including psychologists, psychiatrists, and social workers.
During the same span, to comply with an executive order from President Obama, the VA added and trained more than 900 peer specialists, defined as retired service members recovering from a mental health disorder. Their work as counselors defies the prevailing assumption that mental trauma cannot be tamed, an assumption reinforced when news erupts of a soldier or veteran committing a violent act on American soil.
The latest episode occurred April 2 at Fort Hood, Texas. Ivan Lopez, an Army specialist who deployed to Iraq in 2011, shot and killed three people and wounded 16 before turning the gun on himself. Military officials disclosed he had been diagnosed with anxiety and depression and evaluated for PTSD.
Media coverage of such events tends to obscure that in most cases PTSD is “highly treatable,” says Dimitri Perivoliotis, chief psychologist at the Aspire Center, a VA residential program for veterans of the Iraq and Afghanistan wars in San Diego. In a therapy setting, he says, the presence of peer specialists signals “that it’s possible to put the pieces of your life back together and make sense of your trauma.”
Similarly, as nonprofit recovery programs sprout across the country as a supplement or alternative to VA care, solder-to-soldier support has emerged as a guiding ethos. The approach eases the alienation of a new generation of veterans afflicted with PTSD, whose plight has so far failed to arouse a national response.
“We’ll rally public support real quick when another country has a tsunami or earthquake,” says Fred Gusman, executive director of The Pathway Home, a residential program for soldiers suffering from PTSD in Yountville, Calif. “But what we don’t seem to get is that, quietly, we have a human tsunami going on in this country. That same despair that disaster victims feel – that they’re alone and forgotten – is what veterans experience.”
Persistent problems within the VA network intensify their sense of neglect. Last month, Eric Shinseki, the agency’s secretary, resigned after evidence emerged of widespread misconduct at VA hospitals. Workers at more than 40 facilities are suspected of covering up long delays faced by thousands of patients, dozens of whom may have died waiting for care.
Thwarted by the department’s bureaucracy, many veterans choose to languish in isolation.
Those who come to Eagle’s Healing Nest in Sauk Centre, some 100 miles northwest of Minneapolis, find relief in a milieu that nurtures collective empathy. Melony Butler cofounded the organization in 2012 after noticing the lingering effects of multiple combat tours on several soldiers in her husband’s Army National Guard unit. They are the casualties of an invisible after-war. One of them is her stepson, who has been shadowed by suicidal urges.
“Soldiers have to trust each other on the battlefield because their lives are on the line,” says Ms. Butler. “That’s what we’re trying to re-create – that feeling of ‘I’ve got your back.’ Because their lives are on the line as much as ever.”
• • •
Kuikka showed up last summer exhibiting typical symptoms of PTSD, two years after his honorable discharge capped an Air Force career that began in 1998. In Iraq and Afghanistan, as the leader of a bomb disposal team, he defused and destroyed hundreds of explosive devices, and survived countless firefights and mortar attacks. Back in his native Minnesota with his wife and infant daughter, he struggled to decelerate from the extreme alertness required in combat. As his mood spun in a closed loop of anger, anxiety, and depression, he tried to slow the cycle with vodka. War had made his mind a stranger.
“I really lost who the hell I was,” says
Kuikka, wearing a blue hoodie with the words “Bomb Squad” imprinted on the back. His rectangular glasses and seaweed goatee lend him the mien of a beatnik professor. “I still think that serving in the military was an honorable thing to do. But the military trains fighters. It doesn’t untrain them.”
The Nest, as the veterans refer to it, provides a chance to release the internal burdens they carried home, or what Butler calls “their ugly.” The campus consists of two renovated buildings on the wooded grounds of a defunct state reform school that closed in 1999. The empty buildings used to be dormitories. Each veteran is given a small bedroom and asked to help with cooking, cleaning, and similar daily tasks, evoking a casual variation of barracks living.
Butler, quick to hug and unafraid to cuss, runs the Nest with fiery benevolence. Her program accepts veterans of any era, and the waiting list for the Nest’s 42 rooms nearly equals that number. For now, only men are admitted. In coming years, she intends to purchase the two rented buildings and the 17 vacant structures on the 80-acre property, expanding the Nest’s capacity to 200 rooms, with dedicated space for women.
She patches together private grants and donations to cover operating costs. Most of the men pay nothing. Many are referred by VA hospitals, and some travel from as far away as Texas and Montana. All can stay for as long as they need to thaw. “The one thing that really matters,” Butler says, “is for them to learn to feel again.”
It is a fitful, elusive process. The Nest offers classes in art therapy and meditation, meetings on substance abuse and financial planning, visits from a chiropractor and a physical therapist. A “vets for vets” support group gathers twice a week. But perhaps the greatest comfort arises from the camaraderie borne of combat, from realizing no one leaves war unchanged, from the absence of reproach and blame and revulsion.
“If you say something reminds you of the smell of burning bodies, people don’t think there’s something wrong with you,” says Sam Sater, who deployed twice to Iraq with the Army National Guard. One memory in particular trails him. Bullets struck a bystander during a firefight between insurgents and Mr. Sater’s platoon. Medics were unable to reach the man, and as he bled to death, his groans softened to silence.
Sater unspooled after coming home to Minneapolis in 2011. In his sleep, he relived fraught moments from his tours, punching walls and flipping furniture. More than once he wrapped his arms around his girlfriend’s neck in a chokehold. He discovered his behavior only when she told him in the morning.
By early last year, when she brought him to a VA hospital, he was marinating his days in alcohol and mulling suicide. As Sater tells the story, a doctor prescribed sleeping medication and informed him that he would have to wait at least a month to see a therapist. “When you hear that,” he says, “you understand why some guys end up killing themselves.”
His version of events traces a narrative familiar to hundreds of thousands of veterans stymied by chronic delays within the VA system, and though he has since received counseling, he echoed common complaints about its providers. He criticized them as too quick to prescribe drugs and suggested that their lack of military experience – most VA therapists have never served in the armed forces – inhibits candid conversation.
“You can see they can’t relate, which just makes you unwilling to delve deeper,” says Sater, who works with incarcerated veterans as an inmate liaison for the Minnesota Department of Corrections. “With the Nest, there’s a different level of compassion. You’re around people who completely understand what you’re going through because they’ve gone through it.”
Kuikka has thrived in the Nest’s less clinical environs. He has returned to college to pursue a degree in criminal justice, and a local judge has recruited him to act as a mentor to veterans caught up in the court system.
“I don’t care how many PhDs you have on your wall,” he says, referring to VA counselors. “If you haven’t been in combat, you’re not going to understand. That’s the biggest difference between the Nest and the VA. Here, you don’t feel judged.”
• • •
The VA has sought to blunt the skepticism of veterans toward its counselors with the hiring of more than 900 peer specialists in response to Mr. Obama’s executive order in 2012. Many advocates consider the effort at once overdue and inadequate. “That should have been done a long time ago without the president having to get involved,” says Jason Hansman, a senior program manager with the Iraq and Afghanistan Veterans of America, a national advocacy group based in New York. “The need has been obvious, and it’s obvious it will grow. My concern is the VA will continue to be slow to respond.”
Peer specialists fill the role of first listener in attempting to smooth the entry of veterans into therapy. Moe Armstrong runs Vet to Vet, a nonprofit program in West Haven, Conn., that trains veterans to work as peer counselors nationwide. “With a lot of these younger men and women, their anxiety levels are so high,” says Mr. Armstrong, who copes with PTSD himself almost a half century after deploying to Vietnam with the Marines in 1965. “If they don’t talk to another veteran first, they’ll just blow the therapist out of the water. If they can talk with a peer, they start to come down a little bit.”
Still, the influence of specialists remains limited, bound by their scarcity and the prevailing reluctance of veterans to confide in VA clinicians. The wariness explains, in part, the growth of nonprofit recovery programs rooted in peer support.
Two years ago, the state of New York launched a pilot project in four counties that allocated funding for nonprofit groups to hire and train veterans as peer counselors. John Schultz, the project coordinator for Suffolk County, home to 90,000 retired service members, describes the program as a remedy for therapy aversion.
“There’s nothing worse than trying to tell a psychologist what you’re feeling and knowing the person has no idea what you’re talking about,” says Mr. Schultz, a former marine who deployed to Iraq in 2009. “That’s what happens to a lot of men and women at the VA, and that keeps them from trying to get help in the future. So we give them a place where they feel they can reveal themselves without being judged.”
Veterans with acute PTSD tend to succumb to a paralyzing shame. Taught by the military to practice and revere self-reliance, they perceive their mental trauma as a personal failing, counseling as an abject surrender. “It’s the ‘I don’t need help’ reflex,” says Bryan Escobedo, a peer counselor with the Lone Star Veterans Association in Houston. “These are trained warriors. They feel like they should be able to take care of their own problems.”
Mr. Escobedo returned to his native Texas in 2008 after three tours in Iraq with the Marines. Besieged by PTSD, he withdrew from family and friends until his older brother, another former marine, coaxed him to open up. Escobedo applies that lesson in his work with Lone Star, a statewide organization that assists veterans of the Iraq and Afghanistan wars to reacclimate to civilian life. “When you talk with guys who have been there, you’re brought out of your toxic isolation,” he says. “There’s an unspoken bond that lets you feel like you can say anything.”
Dan Klutenkamper, a former Army sergeant diagnosed with PTSD, has found reassurance at Eagle’s Healing Nest since arriving last October, six weeks after Kuikka. “If it wasn’t for this place and having guys to talk to, I probably would have killed myself,” he says. “Now I know that, for the things I’ve been through, I’m normal.”
Mr. Klutenkamper endured two tours in Iraq followed by a third in Afghanistan, where the intensity of the fighting convinced him he would fly back to America in a metal box. He witnessed a rocket-propelled grenade decapitate a member of his unit and a roadside bomb tear off a soldier’s legs at the knees. Moving from Fort Carson, Colo., to suburban Minneapolis, Klutenkamper holed up in his parents’ basement, numbing himself with pot and alcohol for almost two years.
He has forged a friendship with Kuikka, and when difficult thoughts surface, they pull each other aside. Klutenkamper might recall the young soldier in his unit who was shot dead in Afghanistan days after learning he would be a father. Kuikka sometimes brings up the school explosion in Iraq, the young bodies flung into the street. The exchanges allow them to exhale.
“All of us have storms in our heads,” Klutenkamper says, “but here you don’t feel alone anymore. It’s a brotherhood. It’s like being in a platoon again.”
He mentions the sense of solidarity to veterans who tour the Nest when deciding whether to apply for admission. One afternoon he greets a young man who has brought along his mother. Both appear drawn, weighed down. Klutenkamper shakes their hands and speaks with the sincerity of a man resurrected. “It’s a good place,” he says. “It’s like home. Saved my life.”
• • •
Fred Gusman sat in the parking lot of an outlet mall in the heart of northern California wine country. He wanted to decompress. It was a summer afternoon in 2007, and minutes earlier he had left the Veterans Home of California in Yountville. For the past few months, a group of mental health and veterans advocates had lobbied him to create a residential therapy program on the campus solely for troops returning from Iraq and Afghanistan.
The group could supply a three-year, $5.6 million grant through the California Community Foundation in Los Angeles to establish the nonprofit venture, which would be the first of its kind. The state of California could donate a vacant building on the lush grounds of the Veterans Home. Mr. Gusman, then a senior director with the VA National Center for PTSD outside San Francisco, could offer more than 30 years of experience in treating psychological trauma.
The project presented an ideal blend of resources and expertise. The only hitch was Gusman. He had already taken a position with the VA division office in Hawaii and planned to move by summer’s end.
The group nonetheless persisted in courting him, and finally, as a goodwill gesture but more to quash the group’s pursuit of him, he visited the Veterans Home. It is nestled in the low brown hills of Napa Valley beside the Domaine Chandon winery, and as he chatted with the advocates, he toured the hushed campus. He admired the Spanish-style buildings and sky-piercing redwoods and explored the empty space that could house the program. Hours later, hearing the words as if someone else were speaking them, he agreed to lead the project.
Now, gazing out his car’s windshield at the Napa Premium Outlets, Gusman pondered the link between two generations of troops. They fought different wars yet afterward faced the same enemy within. “We gotta do it right this time,” he told himself. “We gotta make sure these guys get the help that wasn’t there last time.”
In the late 1970s, in the wake of Vietnam and before post-traumatic stress disorder was recognized as a clinical diagnosis, he observed the inner ravages of war. Not long after finishing a six-year stint in the military, he joined the staff of a VA clinic south of San Francisco as a social worker. Gusman and a colleague, aware of a growing population of veterans living on the area’s margins, started circulating among low-rent apartments, discount motels, and homeless camps. They met dozens of men who relied on alcohol and drugs to subdue their rage, paranoia, despair, and other symptoms related to combat stress, one of several terms that preceded the designation of PTSD by the American Psychiatric Association in 1980.
The two providers cultivated a rapport with the veterans over weeks and months, persuading small groups of them to drop by the clinic to discuss their troubles together. Those initial support meetings inspired Gusman to develop the first VA residential therapy program for Vietnam War veterans. The peer support model, along with his reputation, slowly spread across the agency’s network, and since leaving the VA to open The Pathway Home in 2008 he has sought to rescue America’s newest veterans from the after-war.
“The conflicts have changed, but soldiers trying to deal with trauma – that hasn’t,” he says. “The need for basic empathy is still there, but when you have less than 1 percent of the country that serves in the military, it’s hard for these guys to find people to talk to.”
The four-month program accepts three classes of 12 to 15 men every year. Their arrival from across the country shows the extent of the latent toll of two distant wars on America. Some 70 percent have attempted suicide, almost 60 percent have been homeless, and about half have lost their marriages.
They move into Pathway’s white-walled, brightly lit building and devote most of the early weeks to an array of classes – art, photography, writing, yoga – designed to calm the mind. Around the midway point, Gusman and another licensed clinician begin a daily trauma therapy group, the core of the program’s curriculum. During the remaining weeks, prodded by Gusman and bolstered by peers, each veteran exhumes his anguish.
“You feel an immediate connection with one another,” says Ryan Ellis, who graduated from Pathway in February and lives with his wife and young daughter near Yountville. “It’s the realization, ‘I’m not the only person who’s messed up.’ ” The former Marine sergeant returned from Iraq in 2007 without three friends. Clenched by survivor’s guilt, he turned his anger against his wife, and following his second arrest for domestic violence last spring, he was staring at a five-year prison sentence.
The judge instead sent him to Pathway after learning that Mr. Ellis had been diagnosed with PTSD. The program guided him toward self-absolution for coming home alive from Iraq, and toward atonement for inflicting the war on his wife. He has seen his change in her eyes. “She doesn’t look at me like she’s scared anymore,” he says.
For his part, Ellis looks at the future with renewed purpose. He holds an informal cooking class at Pathway once or twice a week for the men staying there and speaks to community groups about the program. In March, at a meeting of the Kiwanis Club in the area, he recited a speech he had delivered a few weeks earlier when his group of veterans graduated from Pathway. His wife sat in the audience during the ceremony, the couple’s daughter on her lap. Reading the closing lines, he felt unburdened.
Pulled out of the well and saved is the best way that I can describe it
A rekindling of the coals that went out so long ago, strong and ready, my fire is lit
• • •
The Pathway Home gained wide exposure last year in David Finkel’s book “Thank You for Your Service,” a visceral account of the mental torment of a handful of soldiers back from Iraq. But behind the strong reputation lies a perpetual struggle for funding, with Gusman forced to halve admissions since the program’s start-up grant expired in 2011.
Even though his efforts to obtain public subsidies could succeed this year and enable him to restore full enrollment, he is pragmatic about the broader quandary of behavioral health services for veterans of America’s most recent wars. “The problem is too big for nonprofits,” he says. “The VA has to absorb most of the responsibility.”
In February, six years after Gusman founded Pathway, the VA opened the Aspire Center in San Diego, the agency’s first residential treatment program exclusively for men and women who served in Iraq and Afghanistan. The clinic bears semblance to Pathway in its approach to care. Veterans live at the center for two to four months while attending wellness classes and therapy sessions, and counselors push them to reengage with the civilian world. Gusman regards social rehabilitation as crucial to breaking their sense of estrangement.
“Nobody gave Vietnam veterans the guidance to take what they learned in recovery into their homes and communities,” he says. “So a lot of them went back to being isolated.”
Pathway and the Nest work with area businesses to support veterans and draw them out of their seclusion. Salons offer haircuts free of charge, movie theaters provide discount tickets, outdoor companies organize cycling and fishing trips. Civic groups host fundraising events that attract local residents, whose presence adds ballast to the “thank you for your service” mantra that, to veterans, sometimes sounds hollow.
“You see that people really care,” says Nate Njakoy, who arrived at the Nest last spring. Five years earlier, as a member of the Army National Guard, he had been stationed on a base in Iraq known as “Mortaritaville” for the frequent artillery attacks it absorbed. His year at the Nest has allowed him to purge the dread that lingered after his tour. “I’ve been able to dig deep inside my head – where I had been, what I had gone through,” he says. “It’s given me time to accept that I’m a different person than I was before, but I’m still a good person.”
The Nest sits a mile from the boyhood home of Sinclair Lewis, recipient of the Nobel Prize in Literature in 1930. His birth in 1885 represents Sauk Centre’s lone salvo against anonymity. In March, Mr. Njakoy prepared to depart the program and move into an apartment in town, where he has taken a job with an interior-design firm. He does not mind that he lives in a place on the edge of obscurity. He cares only that he has escaped his own abyss.
“I feel good,” he says. “I’m not afraid of who I am now.”