The Foreign Service Journal, January 2008

in a way others cannot, by describ- ing what it is like to recover from PTSD. Yes, recovery is possible, espe- cially with good treatment. When I think about where I was a year ago, I have no doubt about being much better. I sleep regularly through the night, and I recently read a book that was not directly related to Iraq — a first for me since returning. A year ago, there were only a few places where I felt secure: my apartment, my office and my car. Now, there are more safe than unsafe loca- tions in my life. I still have nightmares, like the one above, but not as often as I used to, and probably not any more than most people. The excellent treatment I have received for PTSD is in large part responsible for my recovery. The treat- ment is not passive, however, and it is not easy. I can honestly say it was easier to survive my tour in Iraq than to recover from it. Making it through a tour in a dan- gerous environment depends on luck and making split- second decisions that are immediately proven right or wrong. But recovering from the emotional and spiritu- al aftermath of witnessing and experiencing violence, death and suffering takes conscious, constant self- awareness and learning to discern between hundreds of moral shades of grey. It has taken enormous amounts of energy and effort to endure and withstand PTSD treatment. To hazard a comparison to something I know nothing about, I would compare the process to learning how to walk again after a major car accident while kicking a cocaine habit. It was something I did because the only alterna- tive I had was to go through life in a zombie-like state of misery and despair, and I didn’t like that alternative. Let Down by State My PTSD came about due to the conditions I endured while on assignment with the State Department, but State left me to fend for myself when it came to seeking treatment. In June 2006, after having worked in Basrah for sev- eral months, I took leave to return to Washington for a few weeks. A Foreign Service National employee in my office had been murdered, and I’d dreamed of hanging myself from my office light fixture. During leave, I asked the Medical Services Bureau for help and they referred me to an in-house social worker. While telling him about the whole horrible situation, including the dream about killing myself, I broke down in sobs. The social worker was nice but offered me no actual treatment. He did not refer me to a psychia- trist for an evaluation; he did not offer me medication for my depression; and he did not address my thoughts of suicide. Disappointed, but fear- ful of being labeled a “quitter” or worse, I chose to return to Iraq. When I think about how poorly State treated me when I sought help, I am outraged. After all, I was in no condition to make decisions about my own well- being, any more than an alcoholic can make a well- informed decision in a liquor store. Any competent, qualified mental health care provider would have known this. I had requested help but found only more danger. It was as if the ambulance coming for me in my elevator dream not only did not stop for me, but ran over me in the process. I — and everyone else serving our country in a war zone — deserve much better. The State Department could not have prevented me from developing PTSD as a result of my tour in Iraq, any more than it could have saved my FSN from being murdered or halted the nightly rocket attacks on our compound. In any war zone, some people going through the experience will likely come out of it with PTSD. But if the State Department is going to post its employees to war zones, it should be prepared to deal with the mental health aftermath and offer treatment to those who need it. I completed my Iraq tour at the end of July 2006 and returned to Washington, where I began my next assignment, long-term training at the Foreign Service Institute. After all I’d been through, I was grateful to be home alive and in one piece, reunited with family and friends. But soon I just stopped functioning nor- mally. I was unable to sleep. I started getting lost on my way home from work, waking up in a sort of fugue F O C U S 36 F O R E I G N S E R V I C E J O U R N A L / J A N U A R Y 2 0 0 8 If the State Department is going to post employees to war zones, it should be prepared to deal with the mental health aftermath.