The Other Veterans

PTSD and other maladies of war—and how we can deal with them.

On a sunny day last October, I was cruising down Washington, DC’s T Street on a red Capital BikeShare bicycle when I was hit by a severe anxiety attack. Somewhere between Columbia and 17th, I began to fantasize about how good it would feel if the car behind me plowed suddenly forward, ending my life gracefully, without intervention on my part. My mind descended into a familiar spiral of confusion and hopelessness. I started to hyperventilate, and tiny rainbow-colored flecks appeared across my field of vision. I pulled over, took refuge against the brick wall of a CVS, and disintegrated into dry-heaving tears.

Sixteen excruciating months had passed since my return from Afghanistan. I was battling these attacks with increasing frequency—sometimes at predictable moments, like just before job interviews or late at night, other times, completely out of the blue. On that particular morning, one of my former colleagues had posted a link to Facebook about a female U.S. Air Force veteran who had been diagnosed with “chronic readjustment disorder.” The story, which originally appeared in Glamour magazine, was not particularly well-told, emphasizing her love of karaoke over her well-justified fear of sexual assault on the Provincial Reconstruction Team where she had served. This colleague and his friends were using the comments section to mock her mercilessly and refer to her service as a joke. “The military mauled my karaoke mojo,” one sneered.

I could hardly blame these men for deriding the article as written. I also knew that, for them, making fun of other people’s struggles was a socially acceptable way of coping with their own. Still, seeing them take this woman’s very real suffering so lightly, dismissing both her service and her fears as a woman, did more than hurt. It invalidated my own experience.

If a military veteran on a PRT had no right to struggle with readjustment, then by comparison, my year at the U.S. embassy compound in Kabul was a joke. My closest brush with terrorism was a distribution of children’s books I attended in Logar Province, pulling schoolchildren, government officials, and journalists together in a single building. The next day, that building was attacked by a vehicle-borne IED, and two of my colleagues were injured. I was shaken, but I wasn’t there. I also wasn’t there during the September 10 attacks, a fact that only seemed to invalidate my experience further.

In my mind and that of my colleagues, neither that woman nor I had the right to struggle with our transition. There was no excuse save PTSD, and I didn’t have that. I couldn’t have it. I wasn’t a veteran.

On June 9, 2011, I arrived at the U.S. Embassy in Kabul, apprehensive and excited. I believed that my language and public diplomacy skills could make a meaningful difference there. I had spent over a year learning Dari, one of the local languages, much of that on my own time. I had put all my things into storage, unfazed by the prospect of living for a year in a shipping container, and replaced my wardrobe with culturally appropriate attire. I learned to shoot an M4 and weave a Humvee backwards through cones. I viewed the work of diplomacy as essential to Afghanistan’s future, and I embraced the physical risks that came with serving in an active war zone.

What I could not embrace was the way people on the embassy compound treated each other. Our conflicts were often petty, but they were also inescapable. Hundreds of us lived stacked on top of each other in converted shipping containers that afforded little privacy and even less protection against the mortar rounds the Taliban aimed at our compound. Young, single women like me were few and closely watched. My office was a bullpen of tiny desks where people worked with their backs to each other, headphones swallowing their ears. Those who had doors shut them. It was a tiny, crowded, dysfunctional world—one we could not leave.

I often fantasized about walking off compound, just like Sergeant Bowe Bergdahl did in Paktika. In my imagination, even the Taliban seemed kinder than my colleagues. Six weeks into my tour, I was medically evacuated for symptoms (diarrhea, mysterious open sores, hair loss) that turned out to be stress-related. After that, I tried everything I could to manage my stress levels, from writing to alcohol to yoga to Crossfit to triathlon training. I even completed a makeshift half-Ironman with my friends. I did what my military colleagues taught me to do: STFU—Sack The F*** Up, meaning pick up your burdens and keep moving.

So I did. I also made a conscious effort to take care of myself. I got into a shared apartment with greater privacy. I formed my own little band of brothers with a group of people from across the compound. When the familiar “duck and cover” alarm signifying a potential attack wailed over the embassy, we huddled together and made the most of it. I spent fewer hours in the office and more time sleeping or thinking about other things. My productivity and quality of work increased dramatically, earning awards and accolades from Embassy leadership. I made it through all twelve months of my tour.

But by the end, I had nothing left. I was burned out and frustrated with the State Department for refusing to deal with serious management issues that were well within its control. I was slated to go back to Washington, DC to a high-profile position managing press and public diplomacy for our Office of Iranian Affairs. I called the office’s deputy director and told him the truth: I couldn’t do it. There was no way that the short period of time allotted for home leave would be enough for me to recover. After what I had been through in Kabul, I wasn’t sure I even wanted to be a diplomat anymore.

After speaking with my receiving office, my Career Development Officer, the Human Resources Office, the counselor in the Medical Unit, and several mentors, I applied for and was granted twelve months of Leave Without Pay.

It was that, or resignation. I had no other options.

At the time, I thought that walking away was responsible self-care. Instead of going into a job I was not healthy enough to do well, I could just live off my savings and maybe do some other meaningful things, like get to know my elderly family members and write a book. I saw unpaid leave as a privilege. I wanted to take my difficult situation and turn it into something beautiful and productive and good.

It didn’t work out like that. Within the first four months, I was in a serious car accident. Then followed a series of experiences that reopened my wounds: the attack on the U.S. Consulate in Benghazi, the release of the movie Argo, and finally, most powerfully, the death in Afghanistan of 26-year-old Foreign Service Officer Anne Smedinghoff. All these events triggered powerful emotional responses. I worked my way through them alone, from the limbo of Leave Without Pay. I spent hours on the phone with friends and even tried to write an op-ed about Anne’s death, but no one was interested in the topic.

I was convinced that no one outside the Foreign Service could ever understand what I was feeling. My family tried to support me, but they didn’t know how. When people wanted to share their opinions about Afghanistan or the State Department or anything even remotely related to the war, it set me off. They had no idea about the truth, and furthermore, it seemed to me that they didn’t want to have any idea, and that they thought they could just understand the war without even having read about it. My heart knew they were well-meaning. My mind hated them.

I found myself wishing I had been killed, either in the accident or in Anne’s place. I exhibited behaviors I had only ever seen in people with severe developmental disorders: violently shaking my hands, banging my head against walls, crying uncontrollably when I could not find words to express myself.

I also gave in to angry outbursts. A fellow student in my fiction writing program wrote a story about a guy who was killed in Afghanistan. For literary convenience, his remains were transported not through Dover Air Force Base, but directly to Detroit. The story was so full of factual errors, and my classmates so willfully oblivious to the ground truth, that one day, I let loose on all of them in class. With so many journalists putting their lives at risk to tell stories, and so many families going to Dover to receive their loved ones in flag-draped coffins, how could writers take so much license with the truth? I told them they had no right to appropriate the suffering of real people for the purpose of their frivolous emotional journeys. No one listened to my tirade; it was a low moment. I started to think I was never going to get better.

In late September, at the urging of a friend, I contacted the Department of State and demanded to speak with a counselor. When I finally reached one, what she said surprised and relieved me. She told me that, for people returning from war zones, symptoms of anxiety and depression are five times as common as PTSD. In other words, my anxiety attacks weren’t the result of some sort of chemical imbalance, they could not have been prevented with yoga, and they were not all my fault. They were a natural human response to the conditions I endured.

A few days after that anxiety attack in Washington, DC, I finally got help. I spent the last of my savings on therapy with a professional who works at the Department of Veterans Affairs during the week and with private clients on weekends. It worked. My therapist helped me understand what I was going through and gave me tools for holding back anxiety before it turns into a full-blown attack. Within three months of treatment, I started to feel like myself again.

It has been a hard journey, as everyone close to me can attest. Resignation has also had financial consequences. But money matters very little compared to having my mental health back. As of today, I have not had an anxiety attack in months. I credit psychotherapy for my recovery. The only question in my mind is why it took so long for me to get help—and why no one in the Department of State, not even when I announced my intention to resign, suggested the option. Instead, I suffered alone for a year and a half, convinced that I was simply a broken person who could never be put back together again. All of that could have been avoided.

We all know that the Department of Veterans Affairs is chronically under-funded, especially compared to the Department of Defense. We spend billions on equipment to go to war without calculating the costs of its damage to people and families. Every person who goes into a conflict zone to advance U.S. foreign policy is a valuable asset to our nation whose energy could be used in other ways. And every person who comes back physically or mentally disabled, even temporarily, should be given the chance to become a productive member of society again.

PTSD as we now understand it is a tiny part of the overall problem. Not only are there many more military veterans suffering from other stress-related disorders, there are also tens of thousands of public servants who we do not think of as veterans. These include diplomats, contractors, and U.S. citizen employees of local organizations whose salaries are ultimately paid by our government. These are the “other veterans” of our nation’s wars.

What does our nation owe to these “other veterans”? At a minimum, we should be educated. The counselor I spoke with at the Department of State was well aware that people are coming back emotionally wounded and in need of care. Everyone who serves in an environment like Afghanistan should be aware that symptoms of depression and anxiety are common, even for those who were never in direct combat. This will empower civilian returnees to make smart decisions about their own self-care.

Everyone who serves in an environment like Afghanistan should be aware that symptoms of depression and anxiety are common, even for those who were never in direct combat.

Second, high-threat post outbriefings should be part of the package for anyone who serves in an environment like Afghanistan, even on contract. Counseling should be the default option, with opt-out available for those who don’t need it (and opt-in available for those who later realize they do). This would enable early treatment of symptoms and rapid response to declining mental health.

Third, everyone deserves a proper evaluation. The paper-based screening given to me on my last day in Kabul was very limited. It made me believe that unless I had been in a specific terrorist attack where my life was at risk and was having nightmares about it, nothing could be wrong with me. This seems like more of a way to shield the Foreign Service from liability than a good faith effort to support its corps. It should be replaced with in-person screening at appropriate intervals.

Fourth, the federal security clearance process must get rid of its prejudice against mental health treatment, which deters people from seeking the care they need. There is a double standard here: If you are physically wounded in action, you are a hero. But if you come back from a theater of war psychologically broken, wired to treat everyone as a threat, and angry at the world, you cannot seek help without risking your security clearance—and with it, your job.

Fifth and finally, we need to change our attitudes surrounding mental health. Our national conversation suggests that seeking counseling is a precursor to an Elliot Rodger-style psychotic break, rather than a tool for prevention. It is perfectly acceptable to spend months in the hospital recuperating from physical injuries, but not to spend hours with a psychotherapist as we heal from emotional pain. The attitude is one of “once broken, always broken.”

In order to achieve these changes, more of us need to speak up. Persuading those who have suffered from mental illness to share their stories is no easy task, especially not when they are struggling to stay employed. Yet in private conversations all over the nation, we learn of marriages ended, careers cut short, and reputations destroyed by the struggle to readjust to normal life. Some people, like me, make radical career shifts in an attempt to escape their feelings. Others become war junkies, stakeholders in an aggressive foreign policy that guarantees them job security so long as they stay in conflict zones. A far larger number suffer or rely on unhealthy coping mechanisms like alcohol rather than seek the help they need. None of those options are good for the nation or for the people who serve it.

There are thousands of civilians serving right now in Iraq, Afghanistan, Yemen, Saudi Arabia, Libya, Sudan, Mexico, and other high-threat posts. Thousands more are at their next station but still suffering from their experiences in conflict. Not all of us come back wounded—but those of us who do should have access to proper treatment and care.

Many of us, once recovered, would gladly serve again. I was nineteen when I made a ten-year commitment to the Foreign Service, twenty-four when I joined, twenty-eight when I left for Afghanistan, and thirty when I resigned. I dedicated my entire education and personal life to becoming the best diplomat I could be. I learned Dari, Polish, and Russian, and some Georgian, Mandarin, Pashto, Portuguese, and Spanish. I have a Master of Science in Foreign Service from Georgetown University and an unquenchable passion for public service. I swore an oath to uphold the Constitution at all costs. When my nation called, I answered.

But when I called out for help, no one answered me. It’s time to change that, for all of us—those who wear the uniform and those who wear headscarves, those who carry guns and those who carry hope, those whose wounds are visible and those whose wounds you cannot see. We are your veterans, too.

If you want to see more public servants get the information, permission, and treatment they deserve, please click “recommend” and/or share this article with your networks. Many thanks to all of you who’ve listened.