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BREAKING POINT

The Baltimore Sun

GARMSIR, AfghanistanIn -- In the dying sunlight, the day's heat radiates from a farm compound's baked adobe walls, which enclose Marines slumped wearily against their rucksacks.

Here in southern Afghanistan, where the men of the 24th Marine Expeditionary Unit are battling Taliban insurgents, life comes in a simple equation: There are men out there who will kill you, unless you kill them first.

Out here, you've got to figure out how to handle the stress of that exhilarating and awful equation.

Bust it or park it, use guesswork or patchwork or whatever works. Suck up the heat, the dust, the physical exhaustion, the fear, the loss. Help is a long way away.

For all the attention the U.S. military has recently given to mental health, it's clear that at the source of the tension borne by Americans in combat, they are pretty much on their own. That burden consumes strong men.

"I can't do this anymore," said a weary Gunnery Sgt. Rosendo DeLeon, 40. "After this deployment I am done."

In these hours before nightfall, when the hunt will begin anew, there is precious respite. Chins rest on flak vests, weapons across knees. Sodden, gritty uniforms bind and chafe - even where the Marines have stretched duct tape across their ribs for protection.

Momentarily safe from all but a chance mortar round, there is only the easing of aching muscles, cool water in parched throats, a blessed movement of air across bare scalps.

Or maybe it all comes back unbidden, in that terrible rushing dread. Tonight could be it - the sudden, searing injury, the torn limb, the awful bleeding out, the sickening smell of blood. You could die here. Worse, your closest buddy could.

Some close their eyes and project themselves back home. Some simply let the stress buzz alongside. Some pop a pill. Some joke about it, belittle it.

Basically, stuff it down out of sight, hope it won't come back in all its dark and evil power.

"Let's go, we're pushing out!" With DeLeon's cry, Marines heave themselves to their feet, throw on rucksacks, clamp on helmets and stride into the dusk.

Deal with it later. For now, focus on the mission.

"Stoicism is necessary for their survival," says Dr. William Nash, a psychiatrist who until this month directed the Marine Corps' combat stress programs. But shoving stress down out of the way lasts only so long.

"Everybody," said Nash, "has a breaking point."

Hey - remember Molly and the leg? In Ramadi last year, a suicide bomber in a car came at us, and our guys at the checkpoint got him stopped but he detonated the bomb anyway and blew himself all over the place. We had this Iraqi dog we called Molly?

Staff Sgt. Julian Lumm is telling the story between bursts of laughter. He is handsome in the classic Latin manner, tall and hefty with dark, liquid eyes. He is 30 years old and is on his fifth combat deployment in five years, and he's got Carlos Orjuela and DeLeon, the two company gunnery sergeants, remembering and sputtering and guffawing.

So here comes Molly trotting back to where we are and she's got a piece of this guy's leg in her mouth, and we're going, "MOLLY! BAD DOG! PUT THAT DOWN!"

Lumm collapses, helpless.

Orjuela: And Molly's going, like, What'd I do? She's lookin' so proud, ya know, like a cat bringing you a mouse, and she keeps comin' and we're going, "NO NO, GO AWAY, GIT THAT THING OUTTA HERE!!"

Oh, man. Lumm wipes a tear. That was hilarious, wasn't it?

When the 24th MEU went into Afghanistan in March, it took 2,500 Marines, a hundred armored Humvees, jet fighters, about 4,000 assorted weapons - and a psychiatrist.

Marine Maj. Ann Radford came to try to prevent Marines from being evacuated for combat stress. But when the Marines went into action, she stayed at her assigned place in camp.

"They are their own first line of defense," she said. In previous combat tours, "they have learned stress management and reaction to trauma by doing it."

Trouble often begins when they got home. At the Parris Island Marine base, where she works, Radford sees a lot of drinking and some spousal abuse. "That's when the work begins," she said. That work may require having a Marine relive emotional trauma, a delicate process that's best done away from combat.

But she is deployed to Afghanistan, she said, because the Department of Defense "likes to have a psychiatrist out here." Given the political pressures at home to care for deployed troops, "it's a box to check off."

Before a mission, DeLeon and other Marines are razzing one another about how they'll behave if they get wounded.

"You'll be lyin' out there going, 'Hey, I can't feel my legs!"' jokes Cpl. Elvin Hendrix, "and we'll go, 'Gunny, you ain't got no legs!"'

Acute stress among troops in Afghanistan is rising significantly, according to a new mental health study by the Army. The main reason: Combat here is intensifying. Three times as many soldiers reported being wounded in 2007 as in 2005, and those troops who killed an enemy combatant rose in that period from 13 percent to 21 percent, according to the Army surveys last October and November.

As a result, the incidence of depression, anxiety and acute stress was "significantly higher" than in a previous Army survey in 2005. One of five soldiers now says that acute stress causes them to work less carefully.

Most soldiers get stress management training. Two years ago, about half said the training was not helpful. In the new survey, two-thirds said the training is inadequate.

Training encourages junior leaders to watch for stress and take steps as simple as telling a soldier or Marine to take a few hours off to catch up on sleep, sending him or her to the chaplain - or assigning extra chores to chase away boredom.

In the hours before they launch a 4 a.m. attack, Marines sprawl restlessly on iron bunk beds. Idle chatter has died away.

In the dark, whispers:

Hey, man ... You OK? You scared?

(In a shaky voice) Nah.

Good, because you shouldn't be.

The scary thing about combat stress, a lot of Marines say, is that continued exposure doesn't get you used to it.

It makes it worse.

"I hate the blood and gore part of this," says one of the Marines' most combat experienced members. "I always throw up."

This is Gunner Robert Tagliabue, a warrant officer who is the senior weapons expert for the 1st Battalion, 6th Marines, the 1,200-man infantry unit of the 24th MEU. He's been in and out of combat since the U.S. invasion of Panama in 1989. With the battalion, he returned from a combat tour in Iraq less than a year ago.

"I remember the first guy I killed, at near point-blank range. This was in Desert Storm [1991], and the guy came up suddenly, and I just reacted. I thought later, Jeez, what have I done?"

Tagliabue says he has mild post traumatic stress disorder: "I talk in my sleep, and [my reactions to] thunderstorms are a family joke."

Late one night outside Fallujah last year, Sgt. Thomas Pizzillo, a lean, dark-haired 22-year-old from New Jersey, was assigned with his nine-man squad to check out an apparently abandoned house, to make sure no insurgents were hiding inside.

Peering through his night vision eyepiece, Pizzillo crept down a hallway, swiveling into one room: empty. Another room: empty. Pulse hammering, he turned back into the hallway and "HOLY -----!" bumped into ... something - a solid, moving, breathing mass of ... a cow.

It's funny now. In the retelling, Pizzillo has Marines shrieking with laughter. But the mirth is short-lived.

"Actually, it was a bad night for the platoon. Our corpsman was killed. We had a Marine shot six times."

Combat veterans say the devotion among warriors is their best defense against stress, their physical and emotional refuge.

Yet in war, that devotion itself is most at risk.

For months on end, they endure knowing that a loved one could be snatched away at virtually any moment. The stress eats away like acid at their sense of well-being.

"The scariest thing about being out here is [the possibility of] losing another one of my boys. ... You get so close to these guys," Pfc. Brandon Vallee, a 19-year-old from Worcester, Mass., told a Marine interviewer. "Not too many people understand except for the guys serving with you, guys left and right of you."

With time, loss is harder to endure.

"It's like losing your child," said Sgt. Maj. Charlie Stanford, responsible for all enlisted Marines in the battalion. He lost Marines last year in Ramadi, and recently lost another in Garmsir. A balding, muscular man of 42, he's been a Marine for more than two decades and is a martial arts enthusiast. He is not given to introspection. But each combat death rips open a raw wound.

"It drives you to your knees," he said.

Unless you quit and go home, stress like that accumulates.

About 10 percent of Marines who've been in one or two firefights report PTSD symptoms. Among those who've been through five or more firefights, almost 20 percent report such symptoms, according to Marine Corps data.

The others may be hiding it.

"Denial is necessary to survive," said Nash, the psychiatrist.

He added, "Stoicism is not just a cultural thing; when you are facing adversity, you can't afford to talk about it or even be aware of how it's affecting you.

"You will never get Marines, no matter how much you educate them, to raise their hands and come forward to say, 'I can't sleep, I have horrible nightmares. ... "'

Quitting may not be an option. Not when it means returning to a place where no one understands what you've been through.

"I have PTSD, I get the shakes and can't sleep," a senior enlisted Marine confided, asking not to be identified.

"I volunteered to come back out here. It's the only place I feel comfortable.

"At home, I'm a mess."

In Ramadi in 2006 and 2007, Capt. Todd Mahar and his men endured a daily hailstorm of firefights.

On a mission to rescue a Marine patrol, his own vehicles were damaged by roadside bombs. He led a counterattack and personally recovered the bodies of three fallen Marines, according to his Bronze Star citation.

Mahar, since promoted to major, is a tall, barrel-chested man, revered by younger Marines. As battalion operations officer, he plans and oversees combat missions, a high-stress duty he handles with hard-eyed stoicism.

But at what cost?

"There is a lot of stuff I don't want people to know about," he said privately one day.

"Losing a Marine, the sight and smell of it, makes me sick. People don't need to know that. I don't want my kids to know."

david.wood@baltsun.com

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