JUNE 2007
Little Relief on Ward 53
At Walter Reed, Care for Soldiers Struggling With
War's Mental Trauma Is Undermined by Doctor Shortages and
Unfocused Methods
By A.Hull and D.Priest
On the military plane that crossed the ocean at night,
the wounded lay in stretchers stacked three high. The
drone of engines was broken by the occasional sound of
moaning. Sedated and sleeping, Pfc. Joshua Calloway was
at the top of one stack last September. Unlike the others
around him, Calloway was handcuffed to his stretcher.
When the 20-year-old infantry soldier woke up, he was
on the locked-down psychiatric ward at Walter
Reed Army Medical Center. A nurse handed him pajamas
and a robe, but they reminded him of the flowing clothes
worn by Iraqi men. He told the nurse, "I don't want
to look like a freakin' Haj." He wanted his uniform.
Request denied. Shoelaces and belts were prohibited.
Calloway felt naked without his M-4, his constant
companion during his tour south of Baghdad
with the 101st Airborne Division. The year-long
deployment claimed the lives of 50 soldiers in his
brigade. Two committed suicide. Calloway, blue-eyed and
lantern-jawed, lasted nine months -- until the afternoon
he watched his sergeant step on a pressure-plate bomb in
the road. The young soldier's knees buckled and he
vomited in the reeds before he was ordered to help
collect body parts. A few days later he was sent to the
combat-stress trailers, where he was given
antidepressants and rest, but after a week he was still
twitching and sleepless. The Army decided that his war
was over.
Every month, 20 to 40 soldiers are evacuated from Iraq
because of mental problems, according to the Army. Most
are sent to Walter
Reed along with other war-wounded. For amputees, the
nation's top Army hospital offers state-of-the-art
prosthetics and physical rehab programs, and soon, a new
$10 million amputee center with a rappelling wall and
virtual reality center.
Nothing so gleaming exists for soldiers with diagnoses
of post-traumatic stress disorder, who in the Army alone
outnumber all of the war's amputees by 43 to 1. The Army
has no PTSD center at Walter Reed, and its psychiatric
treatment is weak compared with the best PTSD programs
the government offers. Instead of receiving focused
attention, soldiers with combat-stress disorders are
mixed in with psych patients who have issues ranging from
schizophrenia to marital strife.
Even though Walter Reed maintains the largest
psychiatric department in the Army, it lacks enough
psychiatrists and clinicians to properly treat the
growing number of soldiers returning with combat stress.
Earlier this year, the head of psychiatry sent out an
"SOS" memo desperately seeking more clinical
help.
Individual therapy with a trained clinician, a key
element in recovery from PTSD, is infrequent, and
targeted group therapy is offered only twice a week.
Young Pfc. Calloway was put in robes that first night.
His dreams were infected by corpses. He tasted blood in
his mouth. He was paranoid and jumpy. He couldn't stop
the movie inside his head of Sgt. Matthew Vosbein
stepping on the bomb. His memory was shot. His insides
burned.
Calloway's mother came to Walter Reed from Ohio
and told the psychiatrist everything she knew about her
son. Sitting in the office for the interview, Calloway
jiggled his leg and put his head in his hands as he
described his tour in
"I can't remember who I was before I went into
the Army," he said later. "Put me in a war for
a year, my brain becomes a certain way. My brain is a
big, black ball of crap with this brick wall in front of
it."
After a week in the lockdown unit, Calloway was
stabilized. They gave him back his shoelaces and belt. On
the 10th day, he was released and turned over to
outpatient psychiatry for treatment. And Calloway, a
casualty without a scratch, began the longest season of
his young life.
Inside Walter Reed
The
Washington Post began following Calloway after he was
brought to Walter Reed last fall with an initial
diagnosis of acute stress disorder. He had all the signs
of PTSD, but it would be the hospital's job to treat him
and then decide whether he met the Army's strict
guidelines for a PTSD diagnosis -- which required a
certain level of chronic impairment -- and whether he
could ever return to duty.
Calloway's physical metamorphosis was rapid. The
burnished soldier turned soft and fat, gaining 20 pounds
the first month from tranquilizers and microwaved Chef
Boyardee. He lived at Mologne House, a hotel on the
grounds of Walter Reed that was overtaken by wounded
troops. His roommate was another soldier from
For the first time in almost a year, Calloway had a
plush bed and a hot shower, but he was too angry to
appreciate the simple comforts. On an early venture
outside Walter Reed, he went to downtown Silver
Spring and became enraged by young people laughing at
Starbucks.
"Don't they know there is a war going on?" he
said.
Wearing a rock band T-shirt, Calloway looked like any
other 20-year-old on the sidewalk, but an unspeakable
compulsion tore through him. He said he wanted to hatchet
someone in the back of the neck.
"I want to see people that I hate die," he
said. "I want to blow their heads off. I wish I
didn't, but I do." He made similar statements to his
psychiatry team at Walter Reed.
Violence seeped into his life in a thousand ways. When
he cut himself shaving, the iron smell of blood on his
fingertips gave a slight euphoria. But it was the
distinct horror of his sergeant's death that was encoded
in his brain. The memory made him physically sick. He
would sweat and shake as if having a seizure, and
sometimes he felt as if he were back in the heat and sand
of
The recognized treatment for PTSD is cognitive
behavioral therapy, in which patients are encouraged to
face their feared memories or situations and to change
their negative perceptions. A key technique is known as
prolonged exposure therapy. It involves revisiting a
traumatic memory in order to process it. The idea is not
to erase the memory but to prevent it from being
disabling. Highly structured, one-on-one sessions over a
limited time period have proved most effective, according
to Edna B. Foa, a professor of psychology in psychiatry
at the University
of Pennsylvania, who has been contracted by the Department
of Veterans Affairs to train 250 therapists who treat
PTSD.
But Calloway and a dozen other soldiers from
These soldiers said they are over-medicated and
treated with none of the urgency given the physically
wounded. One desperate patient, a combat medic who broke
down after her third tour in
In an interview this month, Col. John C. Bradley, head
of psychiatry at Walter Reed, said soldiers with
combat-stress disorders receive the accepted
psychotherapeutic treatment there. He said they are
placed in a specially designed "trauma track"
and are given at least an hour of individual therapy a
week and a full range of classes to help them cope with
their symptoms. Exposure therapy is as effective in group
settings as in individual sessions, he maintained -- a
belief that runs counter to the latest clinical research.
Bradley acknowledged staff shortages and said
vacancies in his department go unfilled for as long as a
year because of the Army pay scale and the high cost of
living in the
One of the country's best PTSD programs is located at
Walter Reed, but because of a bureaucratic divide it is
not accessible to most patients. The
Instead, Deployment Health was forced to give up its
newly renovated quarters in March and was placed in
temporary space one-third the size to make room for a
soldier and family assistance center. The move came after
a series of articles in The Post detailed the neglect of
wounded outpatients at Walter Reed. Therapy sessions are
now being held in Building T-2, a rundown former computer
center, until new space becomes available.
Joshua Calloway reported to Ward 53 five mornings a
week in his uniform. He was a tough patient from the
start, angering easily and impatient with anyone who had
not experienced combat. He was irritated that he had to
attend groups with soldiers who had bombed out of boot
camp or never deployed. He participated in processing
exercises using work sheets to help him manage his fears.
("For example, original thought: 'I'm in a crowd,
they're looking at me, they're all going to jump me, the
enemy looked at me in
With the exception of the post-traumatic stress group
run by Joshua Friedlander, a clinical psychologist and
former Army captain who had served in
There was another, more delicate, problem. The
psychiatrist was Indian. Calloway had a gut reaction to
anyone he thought looked Iraqi, a paranoia shared by many
of Walter Reed's wounded.
"You are seeing a [expletive] Pakistani?"
asked Spec. Isaac Serna, a fellow war-wounded soldier in
the 101st Airborne. "I'd freak, dude."
Calloway confessed his bias to the doctor. "I
want to kill Arabs," he said.
"Does that include me?" the Hindu doctor
asked, according to Calloway. "You can say it."
Antidepressants are most commonly used to treat PTSD,
and Calloway was on a total of seven medications by
Christmas, including lithium, used to treat bipolar
disorder. He had now gained 30 pounds and was too
lethargic to exercise. Bored one night, he took out the
sweat-stained spiral notebook he had carried in
"Balla hashee!" he said. "In
chep!"
He spent the holidays reading "The PTSD
Workbook" and eating Starbursts in a room piled high
with goody boxes from his church back home.
"You are in our prayers, Josh," one card
read. "We are so proud of your service to your
country."
Unabating Anger
In
I spent most of my time watching the rooftops and
side roads, looking into my rearview mirror to make sure
no one was creeping up on my car from behind. . . . Every
time I saw someone sitting contently inside a coffee shop
or restaurant, I wanted to yell at them, wake them up.
A social worker with a clipboard came to his room the
next afternoon. "The surgeon general is concerned
about all the soldiers coming home with smoking
habits," he said.
Calloway said he never smoked before
"Have you ever considered a patch?" the man
asked.
By his fourth month as an outpatient on Ward 53,
Calloway had learned breathing techniques to ease his
panic. He had been asked to recite statements of
self-love in group therapy. He had learned to cook in
occupational therapy. But his core anger was as high as
ever, made worse by the relationship with his
psychiatrist. They met once or twice a week, mostly to
discuss meds and argue. "Why don't you ever come in
here and smile?" the doctor asked, according to
Calloway. "Why don't you ever come in here and think
today will be a good day?"
Walter Reed officials refused to discuss individual
patients for this story, citing privacy concerns.
Calloway wanted to scream. Disillusioned, he stopped
faithfully attending the combat-stress group he first
found helpful. In the cold of winter he went down to
Capitol Tattoo on
Even with his nihilistic markings, Calloway still saw
himself as a soldier. On Sunday mornings he attended a VFW
brunch in Arlington,
feeling at home with the snowy-haired veterans who sipped
coffee under an American flag. As an
But the girl went back to
"I'm not getting any better," he told his
mother on the phone.
His step-grandfather in
One night in his room, Calloway put in a DVD and
watched the opening scene of "Saving Private
Ryan," the American G.I.s coming onto
"See why I picked infantry?" Calloway said,
his leg furiously twitching. "There's no other place
in the world where you can have a job like that. It's a
brotherhood that's deeper than your own family."
His romanticized ideals clashed with reality. His
anti-nightmare medication made him a zombie in the
morning, and he slept through his alarm. After missing
morning formation, he was ordered by his platoon sergeant
to pick up trash, but in the middle of his work duty he
had an anxiety attack; shaking and unable to focus his
eyes, he was taken to the ER, where he overheard his
sergeant tell the doctor that it seemed to be a big
coincidence that Calloway had an attack while doing work.
'I Can't Handle Another Day'
He often wondered why he snapped. Several factors make
PTSD more likely -- youth, a history of depression or
trauma, multiple deployments, and relentless exposure to
violence. Calloway hit most of the criteria. He had been
depressed in high school, and four months out of basic
training he was in one of the most dangerous sectors of
Alpha Company, 2nd Battalion, 502nd Infantry Regiment
got to
Calloway had never felt such excitement or sense of
belonging. His best friend was Spec. Denver Rearick, a
grizzled 23-year-old on his second tour. In his Kentucky
cowboy wisdom, Rearick warned Calloway: "Your entire
body is a puzzle before you go to war. You go to war and
every little piece of that puzzle gets twisted and
turned. And then you are supposed to come back home
again."
The pressure and dread and exhaustion began to smother
Calloway. He survived several bomb blasts. Some soldiers
were sucking on aerosol cans of Dust-Off to get high, and
one accidentally died. Sleep deprivation mixed with the
random violence scrambled Calloway. He wore it on his
face. One of the sergeants asked him, "Are you gonna
kill yourself, Calloway?"
Music was his escape. On rare nights on base,
Calloway, Rearick and Vosbein would strip off their armor
and climb up to the roof to play guitars and harmonica.
Vosbein loved Johnny
Cash. He was from Louisiana,
free and easy with his affections, and at 30 he treated
Calloway like a kid brother.
The day Vosbein died was sunny and hot. A convoy
patrol in three Humvees
pulled over to check a crater in the road. As Calloway
was opening his door, Vosbein was already moving toward
the crater. The force of the explosion rattled Calloway's
teeth and knocked two other soldiers to the ground.
Vosbein -- whistling, happy Vos -- was eviscerated. Parts
of him were everywhere.
Calloway buckled and puked. Then rage. He wanted to
shoot the first Iraqi he saw, but his legs weren't
working. He was useless to help clean up the scene. Later
that night as the chaplain gathered the platoon to talk,
Calloway stood off to the side with two sergeants,
crying. They confiscated his weapon. Rearick sat up with
him in his room until he fell asleep. His commanders
watched him closely. "We want to do what's best for
you," the company commander told him with
compassion. "You need to tell me what you
need."
"I can't handle another day of this place,"
Calloway answered. He was sent to the combat-stress
control trailers, where the decision was made to ship him
to Walter Reed.
In his room at Mologne House, Calloway kept photos
from
"He was able to handle it," Calloway said.
But Rearick was in bad shape. While Calloway was at
Walter Reed, Rearick was home in Waco,
Rearick had sought help after coming home from his
first tour in
"All the banners said 'Welcome Home Heroes,'
" Rearick said. "But the moment we start
falling apart it's like, 'Never mind.' For us, it was the
beginning of the dark ages. It was the dreams. It was
going to the store and buying bottles of Tylenol PM and
bottles of Jack."
Rearick retired from the Army earlier this year. In
the bucolic green of
"At least Calloway doesn't try to sugarcoat
it," he said. "He's like, 'I'm [expletive] up
and I'm pissed off.' "
Rearick knows his outlaw paradise of guitars, guns and
Willie
Nelson is just a cover.
"Everyone thinks you are a badass," he said.
"But you are scared of the dark."
Going Home, Far From Cured
Calloway put a Johnny Cash song on his cellphone to
describe his sixth month on Ward 53.
I'm stuck at Folsom Prison
And time keeps dragging on
One night he mixed Monster energy drink and Crown
Royal and got so drunk he was taken to the ER at Walter
Reed, which landed him in the Army's alcohol counseling
program. He had to submit to a breathalyzer test at 7
each morning. "I am losing my mind more and more
while I'm here," he said.
His psychiatrist had referred him to the
The relationship with his psychiatrist was barely
tolerable. The frustration seemed mutual. "He
complained about his problems but did not seem eager to
listen to any suggestions I provided him," the
doctor noted in Calloway's records. He added that
Calloway showed up to Ward 53 not in uniform but in
cutoff shorts with his tattoos showing.
Even on high doses of sedating drugs, Calloway's rage
crackled, and one night he started breaking things
outside Mologne House. He was again taken to the ER,
where he screamed that he wanted to kill his
psychiatrist.
Finally, Calloway got what he wanted -- a new doctor.
Lt. Col. Robert Forsten had served in
Something clicked for Calloway. But it was so late in
the game. His physical evaluation board process was
nearly complete, and he would be going home soon. His
worries turned to what diagnosis the Army would give him
and how he would be rated for disability pay. His case
worker had told him that she could not locate anyone at
"During a routine route clearance in August 2006,
PFC Calloway's team leader (SGT Vosbein) was clearing a
suspected IED crater while PFC Calloway was inside his
M1114. SGT Vosbein stepped on a crush wire that detonated
2X155 mm artillery shells. The detonation killed SGT
Vosbein and knocked the remaining soldiers to the ground.
PFC Calloway came to the site and saw his team leader
blown apart into several pieces."
Forsten would soon get another assignment and leave
Walter Reed.
The evaluation board diagnosed depression and chronic
PTSD in Calloway, and ruled that his conditions had a
"definite impact" on his work and social
capabilities. He was given a temporary disability rating
of 30 percent, which meant he would get $815 a month. He
would be reevaluated in 2008. He would report to the VA
hospital in Cincinnati
for treatment when he got home.
After eight months at Walter Reed, Calloway showed
"some improvement of his symptoms," according
to his medical records. But his step-grandfather, Greg
Albright, who came from
Even on his last night, Calloway avoided the open
grassy spaces in front of Mologne House. He chain-smoked
under the awning. He wondered what home would be like.
At dawn the next morning, he set out for
Staff researcher Julie Tate contributed to this
article.
"See why I picked infantry?" Calloway said,
his leg furiously twitching. "There's no other place
in the world where you can have a job like that. It's a
brotherhood that's deeper than your own family."
His romanticized ideals clashed with reality. His
anti-nightmare medication made him a zombie in the
morning, and he slept through his alarm. After missing
morning formation, he was ordered by his platoon sergeant
to pick up trash, but in the middle of his work duty he
had an anxiety attack; shaking and unable to focus his
eyes, he was taken to the ER, where he overheard his
sergeant tell the doctor that it seemed to be a big
coincidence that Calloway had an attack while doing work.
'I Can't Handle Another Day'
He often wondered why he snapped. Several factors make
PTSD more likely -- youth, a history of depression or
trauma, multiple deployments, and relentless exposure to
violence. Calloway hit most of the criteria. He had been
depressed in high school, and four months out of basic
training he was in one of the most dangerous sectors of
Alpha Company, 2nd Battalion, 502nd Infantry Regiment
got to
Calloway had never felt such excitement or sense of
belonging. His best friend was Spec. Denver Rearick, a
grizzled 23-year-old on his second tour. In his Kentucky
cowboy wisdom, Rearick warned Calloway: "Your entire
body is a puzzle before you go to war. You go to war and
every little piece of that puzzle gets twisted and
turned. And then you are supposed to come back home
again."
The pressure and dread and exhaustion began to smother
Calloway. He survived several bomb blasts. Some soldiers
were sucking on aerosol cans of Dust-Off to get high, and
one accidentally died. Sleep deprivation mixed with the
random violence scrambled Calloway. He wore it on his
face. One of the sergeants asked him, "Are you gonna
kill yourself, Calloway?"
Music was his escape. On rare nights on base,
Calloway, Rearick and Vosbein would strip off their armor
and climb up to the roof to play guitars and harmonica.
Vosbein loved Johnny
Cash. He was from Louisiana,
free and easy with his affections, and at 30 he treated
Calloway like a kid brother.
The day Vosbein died was sunny and hot. A convoy
patrol in three Humvees
pulled over to check a crater in the road. As Calloway
was opening his door, Vosbein was already moving toward
the crater. The force of the explosion rattled Calloway's
teeth and knocked two other soldiers to the ground.
Vosbein -- whistling, happy Vos -- was eviscerated. Parts
of him were everywhere.
Calloway buckled and puked. Then rage. He wanted to
shoot the first Iraqi he saw, but his legs weren't
working. He was useless to help clean up the scene. Later
that night as the chaplain gathered the platoon to talk,
Calloway stood off to the side with two sergeants,
crying. They confiscated his weapon. Rearick sat up with
him in his room until he fell asleep. His commanders
watched him closely. "We want to do what's best for
you," the company commander told him with
compassion. "You need to tell me what you
need."
"I can't handle another day of this place,"
Calloway answered. He was sent to the combat-stress
control trailers, where the decision was made to ship him
to Walter Reed.
In his room at Mologne House, Calloway kept photos
from
"He was able to handle it," Calloway said.
But Rearick was in bad shape. While Calloway was at
Walter Reed, Rearick was home in Waco,
Rearick had sought help after coming home from his
first tour in
"All the banners said 'Welcome Home Heroes,'
" Rearick said. "But the moment we start
falling apart it's like, 'Never mind.' For us, it was the
beginning of the dark ages. It was the dreams. It was
going to the store and buying bottles of Tylenol PM and
bottles of Jack."
Rearick retired from the Army earlier this year. In
the bucolic green of
"At least Calloway doesn't try to sugarcoat
it," he said. "He's like, 'I'm [expletive] up
and I'm pissed off.' "
Rearick knows his outlaw paradise of guitars, guns and
Willie
Nelson is just a cover.
"Everyone thinks you are a badass," he said.
"But you are scared of the dark."
Going Home, Far From Cured
Calloway put a Johnny Cash song on his cellphone to
describe his sixth month on Ward 53.
I'm stuck at Folsom Prison
And time keeps dragging on
One night he mixed Monster energy drink and Crown
Royal and got so drunk he was taken to the ER at Walter
Reed, which landed him in the Army's alcohol counseling
program. He had to submit to a breathalyzer test at 7
each morning. "I am losing my mind more and more
while I'm here," he said.
His psychiatrist had referred him to the
The relationship with his psychiatrist was barely
tolerable. The frustration seemed mutual. "He
complained about his problems but did not seem eager to
listen to any suggestions I provided him," the
doctor noted in Calloway's records. He added that
Calloway showed up to Ward 53 not in uniform but in
cutoff shorts with his tattoos showing.
Even on high doses of sedating drugs, Calloway's rage
crackled, and one night he started breaking things
outside Mologne House. He was again taken to the ER,
where he screamed that he wanted to kill his
psychiatrist.
Finally, Calloway got what he wanted -- a new doctor.
Lt. Col. Robert Forsten had served in
Something clicked for Calloway. But it was so late in
the game. His physical evaluation board process was
nearly complete, and he would be going home soon. His
worries turned to what diagnosis the Army would give him
and how he would be rated for disability pay. His case
worker had told him that she could not locate anyone at
"During a routine route clearance in August 2006,
PFC Calloway's team leader (SGT Vosbein) was clearing a
suspected IED crater while PFC Calloway was inside his
M1114. SGT Vosbein stepped on a crush wire that detonated
2X155 mm artillery shells. The detonation killed SGT
Vosbein and knocked the remaining soldiers to the ground.
PFC Calloway came to the site and saw his team leader
blown apart into several pieces."
Forsten would soon get another assignment and leave
Walter Reed.
The evaluation board diagnosed depression and chronic
PTSD in Calloway, and ruled that his conditions had a
"definite impact" on his work and social
capabilities. He was given a temporary disability rating
of 30 percent, which meant he would get $815 a month. He
would be reevaluated in 2008. He would report to the VA
hospital in Cincinnati
for treatment when he got home.
After eight months at Walter Reed, Calloway showed
"some improvement of his symptoms," according
to his medical records. But his step-grandfather, Greg
Albright, who came from
Even on his last night, Calloway avoided the open
grassy spaces in front of Mologne House. He chain-smoked
under the awning. He wondered what home would be like.
At dawn the next morning, he set out for
Staff researcher Julie Tate contributed to this
article.