Staff Sgt. Mark MacPherson spent a year with the Washington National Guard patrolling the treacherous turf surrounding a military base near...

Staff Sgt. Mark MacPherson spent a year with the Washington National Guard patrolling the treacherous turf surrounding a military base near Balad, Iraq. He said his scout platoon acted as bait, deliberately drawing fire so they could counterattack insurgents.

MacPherson returned from Iraq in March but still is not back to his civilian job as an environmental consultant. Instead, the 37-year-old soldier struggles with a debilitating combination of post-traumatic stress disorder (PTSD) and concussion-caused brain injury.

MacPherson takes pills to sleep, fight anxiety and dull the ceaseless headaches. While he sometimes can’t recall mundane details of life, he is haunted by memories of soldiers who died, insurgents he killed and the Iraqi family that made the fatal mistake of driving up to a security checkpoint.

“The doctors hope I will get better,” said MacPherson, who was awarded two Bronze Stars for his service with the Washington Guard’s 81st Brigade. “I should get better than I am. But what does that mean? I used to be a person who consulted on multimillion-dollar projects. … I don’t know if I ever will get back to who I was.”

MacPherson is part of the surging wave of U.S. troops returning from Iraq with mental wounds.

These troops are the target of an extensive outreach effort launched by federal and state officials. They hope that early treatment sometimes starting in Iraq — can help avoid the long-term chronic PTSD that afflicts thousands of Vietnam veterans, whose disorder was initially not even recognized upon their return from combat.

How to get help

Places for veterans to visit or call:

VA Puget Sound Health Care System: 800-329-8387

Deployment clinic for returning veterans: 206-764-2636

Seattle Division
1660 S. Columbian Way
American Lake Division
9600 Veterans Drive, Tacoma

Seattle Vet Center
2030 9th Ave., Suite 210, Seattle

King County Veteran’s Program
123 Third Ave. S., Suite 300, Seattle

Washington State Department of Veterans Affairs hotline: 800-562-2308

Web sites to visit:

Washington Department of Veterans Affairs PTSD programs:

National Center for PTSD:

Officials at the Department of Veterans Affairs are scrambling to get a better grasp on the number who need help and the complexity of their wounds.

• The VA reports that of the 360,000 soldiers who have been discharged after fighting in Iraq and Afghanistan, more than 9,600 have received a provisional diagnosis of PTSD.

Some believe the problem could go much deeper. An Army survey published last summer in the New England Journal of Medicine found that 15 to 17 percent of those who have served in Iraq suffered symptoms of post-traumatic stress disorder. At that rate, more than 70,000 returnees could eventually end up with symptoms of PTSD.

VA hospitals will need to provide long-term care to thousands of soldiers who suffer traumatic brain injuries from roadside bombs, rocket-propelled grenades and mortar attacks. These injuries may result in memory loss, headaches and attention-deficit disorder, as well as depression, anxiety and other symptoms that resemble PTSD.

• Puget Sound VA clinics have seen more than 350 Iraq veterans with PTSD. Hundreds more have sought help at Bellingham, Seattle and Tacoma storefront vet centers, as well as a network of private therapists funded by federal and state dollars.

In an effort cited as a national model, the state, the military and the VA are working together to identify and treat returning soldiers with mental-health problems.

Recent surveys show National Guard troops, who sometimes made an abrupt leap from civilian life to Iraq, may be at particular risk for PTSD.

In March, Washington Army Guard officials gained a disturbing mental-health snapshot when they sponsored a “family day” barbecue for a unit that had been back from Iraq for 11 months. Out of 76 members of Bravo Company, 14th Engineer Battalion, just under half were referred for counseling.

“Some of them had their wives tugging at their arms, saying, ‘You need to see someone,’ ” said Tom Schumacher, a PTSD specialist with the state Department of Veterans Affairs. “We really had to scramble to get them all services.”

Early intervention in the field

During the Vietnam War, soldiers who hit an emotional wall were often removed from the front lines for a few days or weeks of rest before being sent back to combat.

During the Iraq war, such soldiers may stay engaged in combat as military medical staff increasingly try to treat their psychic wounds in the field.

It is unclear whether early intervention will help head off long-term mental illness. But some soldiers say it can help them continue to perform day-to-day duties.

MacPherson’s problems boiled over in June 2004, when two members of another platoon were killed in an ambush. An anguished MacPherson watched the attack unfold from a sniper’s position on a nearby hillside. He raced down the hill to arrange an evacuation. Back at the base, overwhelmed by feelings of guilt, he broke down and cried.

MacPherson realized he had to seek help.

“Part of my problem is that I held responsibility really tightly. So, when we started losing those guys, that really got to me. I felt — right or wrong — that I was responsible.”

Late into the night, MacPherson talked with a chaplain who helped him settle his emotions enough to go on a scouting patrol the next day. MacPherson underwent his first PTSD counseling session that week with an Army psychiatrist, and began to take medications.

Some pills helped him deal with the anxiety he felt on patrol. Others put him to sleep for eight hours, so he would often stay up for a couple of days until he had enough down time to grab that much uninterrupted rest.

This treatment regime continued for eight more brutal months in Iraq.

In one incident, a car crashed a road checkpoint. Fearing a suicide-bomb attack, MacPherson and his men unleashed volleys that killed the family inside the vehicle.

A roadside bomb killed one soldier and wounded three others in his unit. After that, he assumed command of the two squads that made up his 32-person platoon.

“The therapy was definitely helpful,” he said. “Otherwise, I would not have made it. But it was really just Band-Aids.”

On at least three occasions, MacPherson suffered concussions. The most serious came when he was knocked out by two roadside bombs that went off near his Humvee.

“It’s the one where everyone noticed the personality change,” MacPherson said. “I could always focus on a mission, but I would bungle administrative tasks, spelling would become harder and I would forget what I was doing.”

MacPherson declined an offer to leave Iraq early. He felt like he would have been abandoning his platoon.

In March, he returned to Fort Lewis and was assigned to a medical-hold unit, where doctors diagnosed him with severe PTSD.

A nurse practitioner noticed something that had eluded the Army doctors in Iraq: MacPherson’s eye had a peculiar droop, a possible sign of brain trauma. Follow-up tests confirmed damage to his brain’s front and left lobes. In addition, the scans uncovered a cyst in the back of his brain that might have been caused by an injury.

Many suffer brain trauma

Army medical staff are increasingly on the alert for brain trauma among the Iraq returnees.

A new generation of body armor has helped many soldiers and Marines survive roadside bombings, rocket-propelled grenade and mortar attacks. But survivors may suffer from a mix of PTSD and brain trauma.

According to an estimate cited in May’s New England Journal of Medicine, about 22 percent of the wounded soldiers evacuated so far through a U.S. military hospital in Germany are expected to eventually be diagnosed with traumatic brain injury.

Other soldiers, such as MacPherson, may display no outward signs of physical injury. But due to concussions, they may also suffer brain trauma.

“I think the knowledge about traumatic brain injury is really going to grow,” said Harold Kundler, co-chair of a VA committee on PTSD. “This will be the signature mental-health illness of this war.”

At Fort Lewis, MacPherson undergoes dual treatment. Some therapy may help him regain mental abilities, while some helps him deal with stress.

Sometimes, the therapies seem to be working against each other. Pills that help him relax also dull the mental edge he’s trying to regain.

On good days, MacPherson dreams of reclaiming his civilian job and easing the strains that the injury have put on his wife, Naomi, a veterinarian.

Other days, his headaches hit like a sledgehammer. He feels dizzy just trying to walk, and trembles as if he has Parkinson’s disease. So he stays in bed, and feels like he would rather have lost a leg.

“At least they would have already stuck on a prosthetic — and I would have learned to walk again,” he said.

Psychological “dog catcher”

Plenty of other deployed soldiers — even if troubled by symptoms of PTSD — still balk at seeking help.

“If you tell them you are having [mental] problems, you are going to be branded as some sort of malingerer,” said Army Spc. Hugh Gemmel, a 50-year-old Vietnam veteran who served in Iraq with the Oregon National Guard and, after returning home, was diagnosed with severe PTSD. “You are someone who is copping out and, if worse comes to worse, a coward.”

Military PTSD researchers, in their Iraq survey published in the New England Journal of Medicine, found that only 23 to 40 percent of Army and Marine troops who met the criteria for mental disorders actually sought medical assistance. That survey found that the fear of being stigmatized was greatest among those with the most-severe symptoms.

Washington state’s effort to reach these soldiers includes radio ads and a telephone hotline at the state Department of Veterans Affairs. The National Guard is holding more than 30 “family days” this year for returned units, to offer the services of a mental-health counselor along with barbecue fixings and kids’ games.

The outreach also involves Dr. Mike Colson, a self-described “dog catcher for trauma,” who tries to find returning soldiers with signs of PTSD.

Hired earlier this by the Seattle Vet Center, one of five storefront clinics in the state funded by the VA, Colson stars in a DVD titled “Getting Home — All the Way Home.”

Colson is a retired Navy chaplain and psychiatrist who served in Iraq and was diagnosed with PTSD. He gives mental-health talks to returning troops even as he undergoes his own treatment.

“When you talk about your nightmares, I share with you mine,” he said.

Colson tells bawdy tales of life on the front lines to loosen up his audience, then jumps to his message: Sleeplessness, depression, flashbacks and other post-traumatic-stress symptoms are not signs of weakness but the body’s response to the extreme events of war.

In addition to his Seattle Vet Center office, he has a room set aside at Fort Lewis, where on a recent afternoon he saw more than a dozen soldiers, including several in crisis.

Wherever he goes, Colson always is on the lookout for soldiers with that “tunnel vision — or a thousand-yard stare.”

Those most at risk for PTSD are frontline combat soldiers, according to the military survey published in the New England journal.

But plenty of other soldiers have similar symptoms.

Some served as truck drivers and got caught up in roadside-bomb explosions. Some offered medical care to the wounded and dying, and left with their own trauma. Others held support jobs that kept them largely behind desks inside fortified bases, but still endured repeated mortar attacks that randomly wounded or killed those around them.

An unprecedented number of women have also been thrust into combat situations in Iraq, and studies predict that they are more likely to end up with PTSD.

Possibility of deception

As the outreach program gains momentum, returning soldiers are briefed about PTSD again and again. Some worry this may push people to exaggerate — or feign — symptoms in hopes of gaining disability payments.

“It can be a guaranteed way of making money — and we have been briefed so many times, so people know exactly how to play this,” said Spc. Audra Fyhrie, a Washington National Guard soldier who was injured in a roadside-bomb explosion.

Fyhrie says a VA official urged her to file for PTSD disability benefits even though she did not feel like she had serious symptoms.

Therapists say they are on alert for those more concerned about money than treatment.

“Most of the people you see, there’s no question but that they’re hurting,” said Schumacher, the state PTSD specialist who has helped find treatment for Washington soldiers returned from Iraq.

“No one was not affected”

After his return, MacPherson was quartered at the Fort Lewis medical-hold unit, where many of the physically wounded soldiers also receive counseling for PTSD. As if to underscore their trauma, they often jump — or dive to the floor — when live rounds crackle from a nearby firing range.

MacPherson this month escaped that irritant when he was allowed to take convalescent leave at his Seattle home.

There, he spends a lot of time on the phone with members of his 16-person squad who shared the hardships of the long year in Iraq. He says many are struggling with symptoms of PTSD. Some freak out in crowds; others drink heavily or down sleeping pills to get through the night.

“The work we did — trying to get hit so we could find the enemy — it was insane,” MacPherson said. “And the guys that did the work, no one was not affected. It’s just whether you choose to admit it or not.”

Hal Bernton: 206-464-2581 or

Seattle Times reporter Nick Perry and researcher David Turim contributed to this story.