updated 3/31/2004 2:19:52 PM ET 2004-03-31T19:19:52

To quote Civil War General William Sherman, “War is hell.”  And while the men and women who have served in Iraq draw upon a deep well of courage and patriotism every day, there‘s now a growing concern, as statistics are showing, that U.S. soldiers in Iraq and Kuwait have committed suicide in record numbers. 

Last year there were 24 suicides, according to an Army study.  That equates with a suicide rate of just over 17 per 100,000 soldiers serving in Iraq and Kuwait, compared to a rate of almost 12.8 for the entire Army in 2003.  By comparison, the overall suicide rate in the U.S. during 2001 was 10.7 per 100,000.

But those numbers don‘t even tell the whole story.  For some soldiers the anguish continues after they return home.  That‘s when the psychological effect of post-traumatic stress syndrome can occur, reliving the horror of what they saw and experienced. 

Dr. Murray Raskind is director of mental health services at the V.A.  Puget Sound Medical Center in Washington State.  He treats combat veterans for post-traumatic stress and other stress-related disorders.

And with him is Derek Perkins, who served as a Marine corporal in Kuwait and Iraq.  He says he‘s been suffering from post-traumatic stress disorder relating to his experiences there. 

DAN ABRAMS, SUBSTITUTE HOST: Doctor Raskind, are you surprised to hear this about the troops in Iraq and Kuwait?

DR. MURRAY RASKIND, V.A. PUGET SOUND MEDICAL CENTER: It‘s unfortunate, but I‘m not surprised.  We saw very similar problems after the Vietnam War.  And there are many similarities between the soldiers‘ experience in Vietnam and what the soldiers are experiencing in Iraq and other theatres in the Middle East today. 

ABRAMS:  What is it that leads them to become so despondent that they take their own lives?

RASKIND:  Well, I think that‘s often a combination of factors, and I think it‘s probably also really the tip of the iceberg of the behavioral and psychological problems that many combat troops face. 

We know that post-traumatic stress disorder is associated with a substantially increased risk of suicide and that, coupled with depression, another reaction to combat trauma, and perhaps together with a loss or a “Dear John” letter from home can be enough to tip someone over the edge so that they see ending their life as the best alternative, tragic as that may be. 

ABRAMS:  Doctor Raskind, I would think that also there‘s probably a sense, with regard to the timing, that it would be easier if there were a definitive period, if they knew, for example, we‘re here for four months and then we‘re done with this particular project and then we move on. 

But with this war, I‘m sure that they have specific times when they‘re supposed to be sent home.  That moves at times; they may come back.  Is that a problem?

RASKIND:  Yes, I think it is.  I think it makes one, perhaps, more discouraged by any of the problems that they‘re facing. 

There‘s another factor that I should have mentioned.  And that is that often in combat when one‘s buddy is wounded or loses their life, sometimes even though it‘s not true, the soldier who survives feels guilt over that or responsibility.  They can think that if they‘d just done something else, their comrades would be with them today. 

And that coupled with the post-traumatic stress disorder symptoms can really present an overwhelming psychological problem. 

ABRAMS:  Derek, what have you been experiencing since returning home?

DEREK PERKINS, VETERAN SUFFERING FROM POST-TRAUMATIC STRESS DISORDER:  Well, a lot of sleepless nights, increased irritability.  It‘s just been really hard to adjust back to my normal life before I went to the war. 

ABRAMS:  What is it about being there that has been most difficult for you?

PERKINS:  Most difficult to deal with right now?

ABRAMS:  Yes. 

PERKINS:  Well, I—it‘s very hard to focus.  That‘s one big thing.  It‘s hard to stay focused on simple tasks. 

ABRAMS:  Was there something in particular that you saw there that has led to nightmares, et cetera, or was it just the entirety of having been there?

PERKINS:  There‘s a couple of isolated incidents that I can see in my mind a lot.  But just the whole war in general has been very stressful and caused grief on me. 

ABRAMS:  What were the incidents?  If you don‘t want to talk about it I mean, I don‘t want to sort of make it worse for you, if that‘s going to happen. 

PERKINS:  I would prefer not to. 

ABRAMS:  Well, then, let‘s not talk about it. Doctor, during the press briefing today the military said they‘re intensifying suicide prevention efforts in Iraq, requiring all soldiers to take a suicide prevention class within three months of arriving in Iraq or Kuwait.  Will that help?

RASKIND:  Well, hopefully that will help some.  And I‘ve been impressed with the military mental health professionals—psychiatrists, psychologists—efforts and dedication to working on this problem.  Unfortunately, we‘re not really sure what the answer is.  And I think we have to be creative and combine efforts between the Department of Defense and the Department of Veterans Affairs.  Because we‘re really working at the same problem, perhaps separated by a month or two, to come up with new and better psychological approaches and medical approaches. 

I know when Derek came to see me, we proceeded to help him with a combination of psychotherapy and medication.  And even though all of the problems have not resolved, I think that we have made substantial progress. 

ABRAMS:  Derek, how about your friends and colleagues?  Are you alone in this?  Have you found that many of the people that you were there with are having similar problems?

PERKINS:  I just recently spoke to a fellow comrade that came back with me, and we were both hesitant to bring up the subject.  But when we brought it up we found out half of my platoon that was there is suffering from the same post-traumatic stress as I am, and it‘s quite a relief to me and to all of us to find out that we‘re just not alone in this. 

ABRAMS:  Did you have any psychological problems before you went?  Did you have a major concern about going there in the first place?

PERKINS:  No, not at all. 

ABRAMS:  So this was purely a result of having seen what you saw.  And I guess the question is apart—without getting specific, was it the experience of having been there in particular, or was it having been away for so long?

PERKINS:  I think mostly being there.  But there could be, you know, part of it being away for so long. 

ABRAMS:  Doctor, what can they do now?  I mean, there have got to be a lot of soldiers who deserve all of the help and assistance that the U.S.  government can provide.  All right?  I mean, if anyone deserves U.S. tax dollars, it‘s people who‘ve been fighting in a war overseas.  I don‘t care what war it is. 

RASKIND:  Yes.  Dan, we totally agree.  And I can just tell you what Derek and I have been working on.  And he can correct me if I make any errors. 

We first prescribed a medication called Prezazin (ph), which is extremely helpful in getting these nightmares under control and pretty much getting rid of them and allowing a normal night‘s sleep. 

That helps in many areas and it also helped with Derek‘s problems during the day, when he was actually having flashbacks of combat trauma experiences, which were very frightening and upsetting to him and obviously distracting him on the job. 

And all of these things, together with the irritability, were causing problems at home with his wife and family. 

So, the medication, together with psychotherapy and finding out, veteran to veteran, that you‘re not alone, that this is a quite normal—it‘s not a universal but a quite normal response to going through what these men and women have been through.  So they don‘t feel that they‘re bizarre in any way. 

ABRAMS:  Derek, it reached a point for you where it was so bad that you had actually contemplated suicide.  Correct?

PERKINS:  Yes. 

ABRAMS:  Wow.  And it was—what sort of held you back?  Thinking about your wife?  Was it going to Dr. Raskind?  What was it that made it so that we‘re all happy to see you‘re here with us?

PERKINS:  I just—I didn‘t want to die.  I wanted to continue living, continue with my life and have a good life with my wife and child.  And suicide just seemed like not the way to go. 

ABRAMS:  Derek, why are you going public with this?  I‘ve got to believe that, you know, there‘s some level of private shame that some would associate with it. 

I think it‘s very brave of you to go public with it.  What made you decide to do that?

PERKINS:  I don‘t know the reason that made me decide to go public with it.  Of course, it is hard for me to do it.  But I just feel it‘s something that I should do, and it will be good for me and good for other people to see what certain types of medication and treatment can do for them, if they‘re suffering from the same problems that I am. 

ABRAMS:  Derek, good luck to you.  It‘s good so see that you‘re in good hands there with the good doctor.  It seems that there‘s some real progress being made. 

And you know what I say to anyone.  I get to sit in the chair here while soldiers get to go to Iraq.  I say thank you to anyone who has to serve our country when I get the pleasure and luxury of getting to stay here at home.  So thank you. 

And thank you, doctor. 

PERKINS:  Thank you.

RASKIND:  Thank you.

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