CASE STUDY
Mr. K, a 38-year-old National Guard soldier, was assessed in an outpatient psychiatric clinic several months after he returned home from a 12-month deployment to the Sunni Triangle in Iraq, where he had his first exposure to combat in his 10 years of National Guard duty. Before deployment, he worked successfully as an automobile salesman, was a happily married father with children ages 10 and 12 years, and was socially outgoing with a large circle of friends and active in civic and church activities. While in Iraq, he had extensive combat exposure. His platoon was heavily shelled and was ambushed on many occasions, often resulting in death or injury to his buddies. He was a passenger on patrols and convoys in which roadside bombs destroyed vehicles and wounded or killed people with whom he had become close. He was aware that he had killed a number of enemy combatants, and he feared that he may also have been responsible for the deaths of civilian bystanders. He blamed himself for being unable to prevent the death of his best friend, who was shot by a sniper. When asked about the worst moment during his deployment, he readily stated that it occurred when he was unable to intercede, but only to watch helplessly, while a small group of Iraqi women and children were killed in the crossfire during a particularly bloody assault. Since returning home, he has been anxious, irritable, and on edge most of the time. He has become preoccupied with concerns about the personal safety of his family, keeping a loaded 9-mm pistol with him at all times and under his pillow at night. Sleep has been difficult, and when sleep occurs, it has often been interrupted by vivid nightmares during which he thrashes about, kicks his wife, or jumps out of bed to turn on the lights. His children complained that he has become so overprotective that he will not let them out of his sight. His wife reported that he has been emotionally distant since his return. She also believed that driving the car had become dangerous when he is a passenger because he has sometimes reached over suddenly to grab the steering wheel because he thinks he has seen a roadside bomb. His friends have wearied of inviting him to social gatherings because he has consistently turned down all invitations to get together. His employer, who has patiently supported him, has reported that his work has suffered dramatically, that he seems preoccupied with his own thoughts and irritable with customers, that he often makes mistakes, and that he has not functioned effectively at the automobile dealership where he was previously a top salesman. Mr. K acknowledged that he has changed since his deployment. He reported that he sometimes experiences strong surges of fear, panic, guilt, and despair and that at other times he has felt emotionally dead, unable to return the love and warmth of family and friends. Life has become a terrible burden. Although he has not been actively suicidal, he reported that he sometimes thinks everyone would be better off if he had not survived his tour in Iraq.
taken from “Posttraumatic Stress Disorder Among Military Returnees From Afghanistan and Iraq” by Matthew J. Friedman, M.D., Ph.D., American Jouranl of Psychiatry, April, 2006