Monday, October 24, 2005 From war hero to war haunted


October 23, 2005

Army Spc. Joseph Dwyer angled a mirror out the back window of his apartment in El Paso, Texas, trying to make out the Iraqis in the evening gloom. He couldn't see them, but he felt that they were out there somewhere, ready to attack.

Holding his 9-mm handgun tight, the 29-year-old medic from Mount Sinai phoned in an air strike using military code. He directed the fighter jets to his own street address.

Then he heard a noise from the roof -- maybe an Iraqi trying to get in? -- and that's when Dwyer began firing.

Nobody was hurt in the three-hour standoff Oct. 6 in which Dwyer, deep in a post-traumatic stress-induced delusion, barricaded himself into his apartment, fighting off an imaginary Iraqi attack.

Back then, an image of hope

So much has changed for Joseph Dwyer. Only two and a half years earlier, in March 2003, a startling battlefield photograph of him cradling an injured Iraqi child showed America a hopeful image of the new war.

Dwyer, who is still in the service, is being treated by psychiatrists on the Army base in Fort Bliss, Texas. He was released on bail and faces a misdemeanor charge of discharging a firearm in a municipality.

During his 92 days in Iraq, Dwyer was attached temporarily to the 3rd Squadron of the 7th Cavalry Regiment of the 3rd Infantry Division. The unit scouted for the division which saw heavy combat in the first days of the war as U.S. forces swiftly moved north from Kuwait to Baghdad. One Army officer called the unit "the tip of the tip of the spear."

"It took 21 days to get to Baghdad," Dwyer said last week, speaking by telephone from the William Beaumont Army Medical Center in Fort Bliss, Texas. "We had four days that we didn't get shot at."

Dwyer came back to the United States in June 2003, and visited his family on Long Island on July 4. He seemed happy to be back and easy to laugh, but he was also gaunt and fidgety, said his sister, Christine Dwyer-Ogno, 38, of Mount Sinai. His wife, Matina, declined to comment.

"We didn't think of his mental health," said Dwyer-Ogno. "We were just so glad to have him back in our arms."

He was back, but he wasn't the same, and he continues to struggle. Dwyer can no longer go to movies or other crowded public places. At restaurants, he'll only sit facing the door, with his back to the wall. A month ago in Texas, he crashed his car when he swerved to avoid what he thought was a roadside ambush by Iraqis.

Concerned about Dwyer's increasingly strange behavior and his use of inhalants to get high, three friends staged an intervention days before the El Paso standoff. They tried unsuccessfully to persuade him to give up his weapons and to get the help he needed.

He knew on some level that they were right, Dwyer said, but he still couldn't do it.

"I'm a soldier," he said. "I suck it up. That's our job."

Dwyer is one of many Iraq and Afghanistan veterans who suffer from post-traumatic stress disorder, or PTSD. Known in previous wars as "shell shock" or "combat fatigue," PTSD was identified as a psychiatric disorder in 1980 after its symptoms were seen in returning Vietnam veterans. Those with PTSD often relive the stressful event in nightmares or flashbacks; avoid activities, places, or people that are reminders of the trauma; and have a sense of perpetual vigilance, as if on sentry duty. PTSD is often compounded by substance abuse.

Psychological fallout

Almost one in six soldiers returning from Iraq have symptoms of PTSD, major depression or anxiety, a study published in July of last year in the New England Journal of Medicine found. If the study, led by Department of Defense researcher Col. Charles W. Hoge, is an accurate predictor, more than 25,000 of the 154,000 who have served in Iraq will have mental health problems.

Always a quiet kid, Dwyer enjoyed a happy childhood on Long Island, family members said. Son of a New York City Transit Police lieutenant, Dwyer loved to fish, and he played golf for Mount Sinai High.

He signed up for the Army two days after the Sept. 11, 2001, attacks. At the time, he was living in North Carolina, working as a transporter at a hospital and considering going into a nursing program. But his plans changed when his older brother, Patrick, lost two close colleagues in the attacks.

"They knocked my towers down," Dwyer said. "So I was ready to go."

In March 2003, a week into the Iraq war, it's easy to see why the photograph of Dwyer cradling an Iraqi boy struck a chord and why it ran in newspapers nationwide. Dwyer's face is worried but resolute, his mouth slightly open as if gasping for air. His eyes, behind square glasses, focus on a distant point -- perhaps the field hospital where he later treated the boy's broken leg. The boy, about 4 years old, wears nothing but a stained jacket, a kaffiyeh scarf tied around his leg and a grimace of terror.

But Dwyer hated the fame the picture earned him.

"To be honest . . . I was embarrassed by it," he said. "I saw so many heroic things like that. It kind of made me stand out as the glory boy, but really it was one team, one fight."

An indelible image

To Dwyer, the moment captured in that famous photo is not the most significant among the blur of impressions that stay with him from that day in a farming village by the Euphrates River.

Ali, the boy in the picture, was struck by shrapnel when an enemy weapons cache blew up in a firefight, Dwyer said. Ali's mother, older brother and grandfather also were hurt.

Dwyer remembers daylight coming after a night of shooting and his awful realization that there were homes and families in the firing line. He remembers the awkward modesty of Ali's pregnant mother as he checked her for bombs before she was moved to the field hospital. He remembers the quick work of another medic who pulled a piece of shrapnel "the size of a silver dollar" out of Ali's bloody knee.

What Dwyer mentions only in passing is this: During the firefight the night before, a rocket struck the Humvee he was driving. No one was killed, but something fundamental shifted in Dwyer. He started to accept the inevitability of his own death in Iraq.

"That made it easier for me to do my job," he recalls. "It made it harder to think about mom and wife, and them having to bury me, but it made it easier to do my job."

First signs of trouble

When Dwyer returned to Texas after a brief trip to Long Island, he shrugged off the attention that the picture brought him with his characteristic modesty, said Dwyer's close friend and fellow Fort Bliss soldier Angela Barraza.

In retrospect, she said, it's clear he was already having trouble coping. He seemed isolated, away from those he served overseas with because he had been temporarily attached to a unit from Fort Stewart, Ga., and returned before them when other medics became available.

"He told me every time he talked to me that he was doing good," said Dwyer's mother, Maureen Dwyer, who now lives in North Carolina. "But he didn't sound good."

He told his family very little of what he'd been through, said his father, Patrick Dwyer.

"None of us really know how to react," his father said. "None of us really know what combat is like."

Dwyer had lost 30 pounds in Iraq, and in Texas he gained back 50 with a speed that drew teasing from co-workers. He hated leaving his "brothers" behind in Iraq, he said. He obsessively scanned television and Internet images of the war, looking for faces he knew.

Unable to sleep without nightmares and trying not to worry his wife, Matina, Dwyer talked to Barraza about the disturbing images, she said.

"He would refer to the flashbacks and the things in his heads as 'demons,' " said Barraza, 23, of Sound Beach. "That scared me a little."

Struggle to make things right Even as he struggled, Dwyer tried to right himself. With Barraza and his wife, Dwyer -- born a Roman Catholic -- started to attend a Baptist church in Texas. Dwyer says he found God in Iraq. He also gave up his social drinking. In December 2004, he was baptized.

Of those returning Iraq and Afghanistan veterans in last year's study who screened positive for PTSD, depression or anxiety, the majority had received no treatment, the researchers found, with 23 percent to 40 percent reporting that they had. Even more disturbing to the study authors, those who screened positive were twice as likely to report concern about being stigmatized for seeking mental health services -- meaning those who most needed help were least likely to seek it.

"This finding may indicate that within the military culture, 'succumbing' to PTSD is seen as a failure, a weakness, and as evidence of an innate deficiency of the right stuff," an editorial accompanying the study said.

Initially, Dwyer was getting no psychiatric treatment, something he blames himself for because, he explained, he faked the post-deployment assessment sheet he filled out on his way home through Kuwait.

"Did you see any dead bodies?" was one of the test questions, he recalled.

"Did you fire your weapons?"

"Did you see any tanks burning?"

"I just answered no, no, no, down the line," Dwyer said. "I wanted to go home, take a shower, hug my wife."

Leary of psychiatry

Even as a medic who had referred others for mental health treatment, Dwyer said, he was suspicious of psychiatrists and didn't want to look bad in front of his fellow soldiers.

In a routine medical checkup in March 2004, Dwyer said a doctor concerned about his demeanor referred him for counseling. He was put on anti-depressants, but he didn't keep up with the counseling. Over the past two years, he has had brief stints with different counselors, but until now nothing has stuck. This summer, he said, he was put in the barracks at Fort Bliss for 72 hours after he trashed his apartment trying to find an Iraqi he thought had gotten in. He then spent 11 days at Beaumont Hospital, for his PTSD and because his inhalant use was discovered.

Treatment of PTSD and other combat-related mental health issues has come a long way since the Vietnam War, said Col. Elspeth Cameron Ritchie of the Office of the Surgeon General. Soldiers receive psychological preparedness training before they go to war, education and outreach while serving in a war zone, and a post-deployment health assessment on their way home. The disorder is considered treatable, usually with psychotherapy and anti-depressant drugs (often Zoloft and Prozac).

A little over 160,000 Vietnam veterans were receiving disability payments for PTSD treatment last year, according to the U.S. Department of Veteran's Affairs, along with about 13,500 veterans from the first Gulf war and 10,000 Korean War veterans. PTSD is considered harder to treat when it has been allowed to advance over the years, or become "chronic."

"What's different is that we're seeing soldiers now at three to four months from deployment," said Charlene Thomesen, chief of mental health services at the Northport VA Medical Center. "Our hope is that by this early intervention, we'll avoid the incidence of chronic PTSD."

Erratic behavior

In the month leading up to the stand-off in which he thought Iraqis were attacking his apartment, Dwyer's behavior was erratic. One day, he was driving on a highway in Texas. A van was pulled over on the side of the road, and three men got out, one carrying what was probably a tire iron.

"Out here in El Paso, these roads kind of look like Iraq," Dwyer said. "Sometimes, when the sun hits, you get that feeling."

Dwyer's combat instinct kicked in before he could have a conscious thought.

"I was going to get ambushed," Dwyer said. "They were actually Iraqis in my mind."

Dwyer sped through a red light, swerved down a side street and into a 7-Eleven parking lot, where he hit a curb and crashed into a sign. Nobody was hurt.

Dwyer didn't tell his superiors at Fort Bliss, which he now regrets. But his friends were worried. Over the next few weeks, his wife Matina was getting scared, and Dwyer sometimes locked her out of the apartment, Barraza said. When his pastor stopped by unexpectedly, Dwyer opened the door carrying a gun in his back pocket, Dwyer himself recalled. Barraza decided to fly down to El Paso from New York and, with two other friends, confronted Dwyer.

"The first thing we said was 'We want your weapons,'" she said. He refused to give them up.

Still, Dwyer admitted he had a problem. Later in the day, he was calm enough to enjoy an outing with friends to the park. Over the next few days he talked about how much he loved his wife, how he hated what he was doing to her. He promised to get help.

The morning of Oct. 6, some 12 hours before the standoff started, Dwyer called Barraza from outside his the Fort Bliss clinic where he works. He seemed disjointed and absent-minded. He drove home, and his friends say he spent part of that day sniffing an aerosol computer-cleaning product. He says he used the time to clean his guns, and, while inhalants were in the house, "I wasn't using like I had used it before."

A colleague alerted two of Dwyer's superior officers, who came to the house and tried to persuade him to go to the hospital.

One of the officers tried to put his foot in the door when Dwyer wouldn't let him in, Dwyer said.

"That's when I pushed him out and barricaded myself into the house," he said. "That's when my mind changed, I think . . . I was in danger for my life in my mind, even though I wasn't."

Barraza puts it another way. "He was not Joseph at that point," she said. "He was a soldier in Iraq."

Getting the word out

Dwyer says he's glad to be in the hospital now, where he is receiving daily therapy sessions, and this time he says he is sticking with the program.

"I know I've got to work with them," he said. "I know I've got to tell them 100-percent the truth."

He wants to get the word out to his fellow soldiers about PTSD. He'd like them to shed their fears about the stigma, and to get help: "There's a lot of soldiers suffering in silence."

Although his tour of duty is scheduled to end in November, Dwyer said, he will probably extend it to get the treatment he needs. After that, he plans to move to North Carolina to be near his parents and in-laws, and to become a paramedic.

Dwyer is still nervous about the challenges ahead. "I know I don't need to be carrying a weapon," he said. "And I'm scared of going home without having one, even though I know probably nobody's going to attack me."

He thinks sometimes of the children he encountered in war. He has heard that Ali, the little boy from that village by the Euphrates, is walking again. He recalls the giggles of other children he met in Iraq when he let them taste Tabasco sauce from Army-issued meals on the tips of their fingers.

And he thinks of his own child, due next spring. Last week in Texas, he saw the tiny heart beat on an ultrasound device. He hopes he or she does not have to experience a war.

"What would be awesome," he said, "is if they never have to go through that."

Copyright 2005 Newsday Inc.



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