By Kathy Dobie

The Nation

18 February 2008 Issue

Marine Lance Cpl. James Jenkins is buried in the same New Jersey cemetery that he used to run through on his way to high school, stopping at the Eat Good Bakery to get two glazed doughnuts and an orange juice before heading off to class. When his mother, Cynthia Fleming, visits his grave, she looks over the low cemetery wall at not only the bakery but the used-car lot where James used to sell Christmas trees during the winter and the nursing home where he worked every summer and says, "Lord, son, you're on your own turf." James, who died at 23, is buried in Greenwood Cemetery; the owners told Cynthia they're proud to have him there.

During his short career as a marine, Corporal Jenkins received many commendations recognizing his "intense desire to excel," "unbridled enthusiasm" and "unswerving devotion to duty." It was for heroic actions performed during a fifty-five-hour battle with the Mahdi militia in Najaf that Jenkins was awarded a Bronze Star for valor. The fighting, which began on the city streets in August 2004 and moved into the Wadi al Salam Cemetery, was ferociously personal. Marines and militiamen were often only yards apart, killing one another at close range. When the battle was over, eight Americans and hundreds of militiamen were dead.

After that tour, his second in Iraq, Jenkins could barely sleep. When he did, the nightmares were horrible. He was plagued by remorse and depression, unable to be intimate with his fiancée, run ragged by an adrenaline surge he couldn't turn off.

Back at San Diego's Camp Pendleton the following January, Jenkins took to gambling, or gambling took to him; he became addicted to blackjack and pai gow, a fast-moving card game where you can lose your shirt in a minute. The knife-edge excitement felt comfortingly familiar. Jenkins went into debt, borrowing thousands of dollars from payday loan companies. Busted for writing bad checks, he was locked up in the Camp Pendleton brig that spring pending court-martial. In the months that followed, he was released, locked up and released again. He spoke often of suicide. The Marines never diagnosed his post-traumatic stress disorder (PTSD). When his mother called his command seeking help, Jenkins's first sergeant, who had not served in Iraq, told Fleming he thought James was using his suicidal feelings to his advantage. "I have 130 marines to worry about other than your son," she recalls the sergeant saying. When his command decided to lock him up a third time, James Jenkins ran.

On September 28, 2005, eight months after returning from Iraq, Jenkins found himself cornered in the Oceanside apartment he shared with his fiancée. A deputy sheriff pounded on the front door, while a US Marshal covered the back. The young man with the "intense desire to excel" decided he could not go back to the brig or get an other-than-honorable discharge. He would not shame his family or have his hard-won achievements and his pride stripped away. And he was in pain. "He said, 'I can't even shut my eyes,'" his mother says, recalling one of his calls home that month. "He said, 'I killed 213 people, Mom.' He said, 'I can't live like this.' He said, 'Everything I worked for is down the drain,' and he was crying like a baby." While the officers waited for his fiancée to open the door, Jenkins shot himself in the right temple.

In the wake of Jenkins's suicide, the Marine Corps attempted to deny death benefits to his mother by claiming he'd died a deserter; but in a report based on that eligibility investigation, Thomas Ferguson, a special agent from the Naval Criminal Investigative Service, described the young man as a "salvageable marine" whose untreated PTSD had led to his suicide.

"LCpl Jenkins was a bona fide war hero," Ferguson wrote. "Unfortunately, it is clear that when he most needed help from the military, the military failed him."

James Jenkins is a casualty of the war in Iraq as much as his fellow marines who died in that cemetery in Najaf, abandoned by an organization that has little tolerance for broken marines and is itself under tremendous stress from sustaining multiple deployments. "They didn't do anything," his mother says. "They just kept locking him up."

According to civilian and military defense lawyers, mental health professionals and veterans' advocates, the trajectory of James Jenkins's postdeployment life, with untreated PTSD leading to misconduct and then punishment, is all too common in the Marine Corps. A marine endures one, two, even three tours in Iraq, serves honorably and well, but returns suffering from combat trauma and starts to drink or abuse drugs or becomes violent at home, and suddenly finds himself ostracized, punished and drummed out of the Corps with an other-than-honorable or bad-conduct discharge. A history of service is tarnished, and the marine is denied benefits - even the treatment necessary to recover from combat trauma - and left with only a bitter sense of betrayal. A Corps review in 2007 of 1,019 other-than-honorable discharges issued to combat veterans during the first four years of the Iraq War found that fully a third of the discharged marines had evidence of PTSD or another combat-related mental illness. Lt. Col. Colby Vokey, the Marine Corps's legal defense counsel for the western United States, estimates that of all the Iraq combat veterans his office defends, one-third have PTSD or another combat-stress mental health issue. Many of these clients have served at least two tours in Iraq.

The factors leading to the abandonment of combat-broken marines are both cultural and operational. The Marine Corps is the youngest, most male, most junior and least married of all the services. Sixty-six percent of the troops are 25 or younger; 13 percent are teens; and 39 percent hold the rank of private, private first class or lance corporal. Fewer than 7 percent are female. The Corps's deeply macho culture, which values stoicism in the face of pain and disdains "weakness," makes it hard for marines to seek help. Judith Broder, a civilian psychiatrist who treats Iraq and Afghanistan vets, says, "They all know of stories where buddies have asked for help and have been ridiculed by the chain of command or given some kind of treatment that is not really adequate and told they have to go back."

This harsh culture is exacerbated by the relentless tempo of training and deployment, which pressures commanders to quickly replace broken marines with deployable ones. "You read the Marine Corps values and you'll find that anybody that gets hurt isn't courageous or doesn't have honor," Judith Litzenberger, a civilian defense lawyer and twenty-one-year Navy veteran, explains. "That's how the marines interpret it: 'I went to Iraq and I didn't whine and I didn't claim that I had a mental disorder, and damn well marines don't do that - we suck it up.' And it has to be that way because they have a mission that's bigger than the number of people they have. They can't spend all their time taking care of people who have mental disorders. They've got to wash them out quickly and move on."

The Corps also places more emphasis on discipline than any other branch of the military. According to USA Today, the Corps prosecutes close to the same number of troops for misconduct as the Army does, though it is one-third the size. "I don't think the legal system is being used improperly according to regulations," Lieutenant Colonel Vokey says. "The problem is I don't think the system accounts for these folks with PTSD. There's got to be another way to handle this without lumping them in with every other marine who commits misconduct. They were fine when they went to Iraq, we broke them, this is what combat did to them, and I think we should feel some responsibility for what happens to them."

Add to these factors the political and financial pressures surrounding the Iraq War, which have resulted in a mental health system so underfunded that last year a Pentagon Mental Health Task Force termed its staffing "woefully inadequate." The Navy, which provides psychological healthcare to the Marines, has filled only 72 percent of its psychologist billets and 62 percent of its psychiatrist billets.

"The funding has just been awful, the worst I've ever seen in my twenty years in the military," says Dr. Katherine Scheirman, a retired Air Force colonel who served as chief of medical operations in the Air Force's Europe headquarters from July 2004 to September 2006. Scheirman says the current political environment has made it "impossible" to give wounded soldiers proper care. "It's all about money," she says. "Every kid that gets kicked out with PTSD is gonna be a lifetime of disability payments for the government. Every kid who gives up and kills himself, nothing." Scheirman's unit was in charge of evacuating the wounded from Iraq and Afghanistan and transporting them to the Landstuhl Regional Medical Center in Germany and on to the United States. She says politics infused every aspect of care. When she tried to beef up the hospital staff at Landstuhl, she was told, "No, we can't put more doctors or nurses in there because it will look like we expect more casualties." She was not allowed to send the visibly wounded home on commercial planes. "The rule," she says, "was they couldn't fly commercial if they had injuries that showed because it would upset the American people." The military planes were so cold the Air Force ended up running clothing drives for hats, scarves and mittens - a situation that continues today. In one e-mail requesting donations, a lieutenant colonel wrote, "Mittens are preferred because they often fit better over wounded hands/fingers."

"What kind of Army doesn't provide mittens for its wounded soldiers?" Scheirman asks. "What's sad is this isn't the way it's ever been before. I came into the military under Reagan, and George Bush's dad - they treated people well. The Clintons treated people really, really well. It's only this Administration that acts like the lives of these soldiers are expendable."

When the fourth Army Mental Health Advisory Team (MHAT IV) traveled to Iraq in 2006 to assess the mental health of soldiers and marines in theater, they noted the intensely "personal" nature of duty there - that is, the high percentage of soldiers and marines who knew someone seriously wounded or killed and could describe an event that had caused them "intense fear, helplessness or horror": seeing a friend liquefied in a tank, being attacked by IEDs, being caught in the open under sniper fire, "seeing, smelling, touching...dead people." Last June the Pentagon's Mental Health Task Force reported that 31 percent of the marines who served in Iraq or Afghanistan are suffering from traumatic stress, and Marine Corps suicide rates have been above average since the United States invaded Afghanistan. In 2004 the Corps reported thirty-two active-duty suicides, six of them from Camp Pendleton.

Marines have not only been heavily deployed during Operation Iraqi Freedom; they've been sent into some of Iraq's most volatile areas, and they suffer 25 percent of the casualties, though they make up only 16 percent of ground forces there. "It has long been recognized that mental health breakdown occurs after prolonged combat exposure, a considerable number of Soldiers and Marines are conducting combat operations everyday of the week, 10-12 hours per day...for months on end," the MHAT IV report explains. "At no time in our military history have Soldiers or Marines been required to serve on the front line in any war for a period of 6-7 months, let alone [a] year, without a significant break in order to recover from the physical, psychological, and emotional demands that ensue from combat."

Their deployments generally run seven months, though last year 4,000 marines had their tours extended. Once home, they are given up to thirty days of leave to reconnect with their families, though many cannot even adjust to sleeping in a bed. Then they are back in training for their next deployment. The average break between tours is only six months. According to a mental health counselor at the Marine Corps Air Ground Combat Center in Twentynine Palms, California, who requested anonymity, marines suffering from combat trauma often decide not to seek counseling because they simply don't have time. Moreover, they tell the counselor, since they'll just be sent back into combat, what's the point? "In some way it is miraculous if someone doesn't have PTSD with these repeated tours," says Judith Broder, the psychiatrist. She founded The Soldiers Project, which provides free psychological services to Iraq and Afghanistan vets and their families, including, currently, several active-duty marines. "There's this heartbreaking sense these guys express of, 'I don't know who I am or what I did over there, and I have to hold myself together because I'm going to have to do it again, so don't try to pull me back into something soft and sweet. This is not going to do me good.'"

"Maybe we have to recognize that after a deployment or two, you're not able to deploy anymore because the stresses on the mind are just too great," says Maj. Haytham Faraj, the lead defense counsel at Camp Pendleton. The case that made Faraj "the angriest I've ever been at the Marine Corps" involved a 19-year-old who was severely wounded by a rocket attack during his first tour in Iraq.

The marine's wounds left him unable to control his bowels, and he lost sexual function. After being treated at several military hospitals, he was sent home to his parents on convalescent leave. His military counsel, former Marine Capt. Melissa Epstein Mills, now in private practice, says that during those months, the teen was "falling into the depths of depression dealing with these truly traumatic injuries and the death of his best friend, who died shortly after he was hit. [Then] his wife served him with divorce papers while he was in the hospital. His parents described it as a downward spiral."

When they found themselves unable to help their son, his parents asked his command at Pendleton to come get him. The 19-year-old confessed to his company commander that he had been smoking pot while convalescing.

"He had been on some pretty heavy painkillers and was being transitioned off," Epstein Mills explains, "but it was [also] a coping mechanism." The young man's regimental commander recommended him for an other-than-honorable discharge for drug use, which, Epstein Mills says, would likely have meant denial of his veterans' benefits - including mental healthcare - for the rest of his life.

"What a lot of people miss is that, in general, it's totally up to the commander what happens to their troop," says Scheirman. "They can send him to the hospital and say, 'Hey, this guy isn't able to do his work. Would you look at him for PTSD?' Or they can just kick the guy out." A medical discharge, which is generally under honorable conditions, can take many months, sometimes longer, and all the while the commander is stuck with an undeployable marine. An administrative separation usually takes a few weeks, at most. "If you kick the guy out, you'll get somebody to replace him," she says. "So that's the incentive for the commanders."

Epstein Mills and the 19-year-old's Marine Corps lawyer won him a general discharge under honorable conditions. Unlike an honorable discharge, it will not qualify him for educational benefits from the GI Bill, but he'll probably get some medical benefits.

Before Lt. Col. Andrew Horne left Iraq in 2005, where he was the civil military operations officer for western Anbar province, he and every marine under him above the rank of staff sergeant attended a briefing on PTSD given by the division psychiatrist, a Navy officer. "They said it's been determined that it comes from a feeling of helplessness, and elite units like Marines don't get it," Horne says. "And the ones who do get it have usually been discipline problems before or have a pre-existing problem. So it was really designed to, one, make you not report it yourself and, two, be suspicious of anyone who was reporting it."

More than two years later, despite a growing acknowledgment within the Corps of the mental costs of war, PTSD remains underdiagnosed and undertreated. At Twentynine Palms, some of the civilian counselors on base avoid sending marines to division psychology because at least a dozen marines they referred there for treatment were given "personality disorder" diagnoses and kicked out of the service [for more on the personality disorder scandal, see Joshua Kors, April 9 and October 15, 2007]. Mary Jo Thornton, a licensed family therapist and former base counselor, remembers one Marine sergeant coming back from his appointment with the naval psychologist, saying, "Thanks, you ruined my career. Now they're ad-sepping [administratively separating] me out of the military. The little guy talked to me for a half-hour and told me I had a personality disorder." Many active-duty marines go off base to veterans' centers for counseling, because only there do they feel safe from punishment.

When Cpl. Michael Cataldi, who served with the Third Light Armored Reconnaissance Battalion based at Twentynine Palms, returned from his first deployment, he was angry and depressed. "Helicopters scared me because I picked up a helicopter crash," he says. "Thirty marines and one Navy corpsman all died, and we were the first four people there. I did a body count when I was 20 years old." The pilot was on fire, and Cataldi had to put him out with a shovel. "I smell burning flesh when people grill chicken. I can't be in crowds," he says. "This all happened before I went over the second time."

It took months between deployments for him to get an appointment with the regimental psychologist, and when he did he sensed the doctor was trying to talk him out of his symptoms. "He kind of told me, as I was telling him what I was feeling, that I wasn't really feeling that," he recalls. Cataldi was diagnosed with anxiety and depression, not PTSD, given anti-anxiety meds and antidepressants, and sent back to Iraq. There he was put in charge of the guard at Camp Apache.

After four months the medical officer left Iraq, and suddenly Cataldi had no more meds. "I had a breakdown," he says. "I even defecated all over myself, and I don't remember doing it." Cataldi was evacuated to the combat stress center at Camp Al-Assad, where he was diagnosed with PTSD and given three weeks of treatment. When he returned to base, he began to get disciplinary write-ups: one for an unauthorized absence, the other for allegedly threatening his executive officer. "They were trying to take my rank and call me a horrible marine," he says. Cataldi ended up facing a nonjudicial punishment proceeding and losing half a month's pay. "They thought I was trying to go home," he says.

When Cataldi returned to the States at the end of his second deployment, with only a few months left on his service contract, he stayed low to the ground, afraid his commanders would take his rank or kick him out. In his last evaluation before leaving the Corps, Cataldi had a fifteen-minute appointment with the naval psychiatrist on base, who told him he had "anxiety disorder."

Unlike the Army and the Air Force, almost every Marine and Navy base has a brig on board, and that makes it easy to use the brig as storage for a troubled marine. "We think pretrial detention is overly prescribed," Faraj says. "More often than not it's used as a tool, because the command doesn't want to deal with someone." Consequently, marines with mental health problems are not only locked up in a brig without adequate mental healthcare but are asked to make serious legal decisions while actively suffering from mental disorders. "I think doing a court-martial at that time is a setup," Judith Litzenberger, the civilian defense lawyer, says. "It's totally devoid of due process. You don't have a client there that you can talk to. We need some long-term psych hospitals that can treat these guys." The hospital at Pendleton lost its psych treatment certification a few years ago and never worked to get it back, so the camp no longer has an inpatient psychiatric facility. Marines who attempt suicide in the brig are sent to the Naval Medical Center in San Diego, but the naval hospital offers only acute care to marines, so once the suicidal marine is stabilized, he is sent back to jail. Though commanders do not purposely use pretrial detention to break a marine, that is often the effect on a marine suffering from PTSD - as it was in the case of Sgt. Patrick Uloth.

Uloth's command thought "he walked on water," Faraj says. After two tours in Iraq, they even recommended him for an officer-training program. "I thought the Marine Corps did no wrong," Uloth recalls. "I could watch you do something and if the Marine Corps told me you didn't do it, I believed it. I loved the Marine Corps that damn much." But untreated PTSD, pretrial detention and official callousness destroyed his career in the Corps.

It began during his second deployment to Iraq, when Uloth and members of his unit manning a vehicle checkpoint fired on a car speeding toward them. "When they went to see what they'd gotten, in the car were a father and three young kids," Faraj says. "That troubled him so much that he began to have nightmares, and that's when the PTSD set in." Two weeks before his tour ended, an explosive-filled truck detonated at another checkpoint, where Uloth saw two of his marines die. Under heavy fire, he retrieved the decapitated head and body of his best friend. Then he held the hand of a dying 19-year-old marine and told him he was going to be OK.

Once Uloth's unit returned to Pendleton, he began to suffer from PTSD, depression and "conversion disorder," characterized by flashback-related seizures. Each time he tried to see the unit psychiatrist, he was given an appointment weeks away - a typical wait, according to Faraj. Uloth decided to go home to New Orleans, where he checked himself into the psychiatric ward at a nearby Air Force hospital. After forty-five days, the Marines sent chasers to pick him up. Back at Pendleton, he was charged with unauthorized absence (UA) and thrown into the brig.

There, Uloth was put in isolation, stripped to his underwear for up to twenty-four hours a day and was so heavily medicated he felt like a "zombie." Once a month he was taken in handcuffs and leg shackles to see a psychiatrist. Faraj wanted to go to trial, sure that they could beat the charges. But after two months in the brig, Uloth told him, "I can't take it anymore. You got to get me out." Faraj's plea agreement included a reduction in rank to corporal and a general discharge under honorable conditions.

While Uloth waited for his discharge to come through, he was transferred to a new unit. When a marine faces misconduct proceedings, he is often transferred from his parent company to a headquarters unit. The people he served with in Iraq were busy training for redeployment or were back overseas, and the rear command knew him only as a marine charged with substance abuse or UA, another one of "the broke, lame and lazy." In the new unit, Uloth, an experienced sergeant, was subject to daily ridicule and assigned to pick up trash.

Uloth told Faraj he couldn't take it. Faraj told him to hang in there, but a few days later, Faraj got a call from the unit's first sergeant, asking if he knew where Uloth was. Six months after that, Uloth was picked up again in New Orleans, this time on a DUI, and thrown back into the Pendleton brig.

The previous terms of his discharge were voided, but Uloth told Faraj, "Any way you can get me out, I just want out." Uloth was separated with an other-than-honorable discharge, with all direct medical benefits denied him, his history of faithful service erased.

Now Uloth cannot afford medication to control his seizures, so he just "wings it" and has ended up in various emergency rooms. He uses alcohol to put himself to sleep. Recently, several of the marines who served with him in Iraq tracked him down. "We all served in combat together and all of them have the same problems," Uloth says. "They've all been diagnosed with PTSD, their lives are upside down, a lot of them have tried committing suicide, a lot of them are alcoholics, they can't keep a marriage or a relationship, everybody's lives are shitholes."

The Marine Corps has always taken pride in caring for its own, but its efforts to take care of mentally wounded marines have overwhelmingly failed, plagued by denial, machismo, an unrealistic war tempo and a severe shortage of resources. In the spring of 2007 the Corps set up the Wounded Warrior Regiment, where marines suffering from physical and mental injuries could be tracked and supported. "I spoke with the guy at Quantico who was going to be running this warrior regiment," says Steve Robinson, a Gulf War veteran and veterans' advocate. "And one of the first things he said that made me sit up in my chair was, 'Look, we don't want to diagnose marines with PTSD. We need them to get back into the fight. Call it something else, whatever you want to call it, and then we try to retrain them.'"

Robinson told him, "Well, that's great, but the DSM-IV [Diagnostic and Statistical Manual of Mental Disorders] clearly states that if they have these signs and symptoms, they should be diagnosed."

When members of President Bush's Commission on Care for America's Returning Wounded Warriors visited Pendleton last spring, they spoke with a group of marines housed in the wounded warrior barracks who said they felt they were being punished for being wounded. The marines pointed to the sterile living environment, rigid rules banning rest in their rooms during the day and menial tasks assigned to those well enough to work. In his report to the President's commission, Lt. Col. Leslie Chip Pierce said visitors from the commission "were taken to a location in the barracks known to these wounded warriors as the petting zoo." At the camp's Behavioral Health Clinic, the staff expressed "frustration" too, saying, according to the report, that "line commanders are not always committed to PTSD identification and treatment once they have returned to home base."

After the Marine Corps conducted its review of less-than-honorable discharges, Navy Capt. William Nash, who coordinates the Marines' combat stress program, recommended, according to USA Today, that "any marine or sailor who commits particularly uncharacteristic misconduct following deployment...be aggressively screened for stress disorders and treated." Almost a year later, the Navy and Marine Corps have yet to implement these screenings. They simply don't have the manpower.

More than two years have passed since James Jenkins's death, which Lieutenant Colonel Vokey describes as a "terrible tragedy" that should never have occurred. It was three months after returning from Iraq, in April 2005, that Jenkins first complained of depression and was referred to Division Psychology. There he was diagnosed with "adjustment disorder," which meant he would not receive treatment for PTSD. He was then given Ambien to help him sleep and an antianxiety drug, Ativan - and declared fit for duty.

The Ambien didn't help, and he took himself off Ativan. On May 5 he asked for help with his depression again. He was told to continue taking Ambien.

At the end of that month, Jenkins was confined to the brig to await his court-martial. While there, he filled out a Chronological Record of Medical Care, checking the "yes" box after the question "Have you had any thoughts of injuring yourself or others?" Beside that box, Jenkins wrote, "Combat, Kill the enemy." Still he received no mental healthcare. The medical officer merely noted, "PT [patient] has hx [history] of Adjustment D/O [disorder] with depression and anxiety."

Cynthia Fleming kept calling the first sergeant, trying to get her son help. "I told him my son was going to kill himself. They told me the brig was a form of suicide watch. I said, 'That's a jail.'"

Inside the brig, the situation took a bizarre turn. Another jailed marine, a gunny sergeant, tried to hire Jenkins to kill five people and kidnap another sergeant's daughter. Jenkins informed his lawyer and was released in order to work as an informer. But when he began to gamble again and cash worthless checks, he was rearrested. Because his life would have been at risk inside Pendleton, Jenkins was locked up in the Miramar brig instead. A judge quickly released him, but his command decided to send him back to the brig at Pendleton. "Of course, he's petrified of the guy who he's reporting on and being back in the brig with him," Vokey says. "That's when he took off."

Jenkins stole a gun from an Oceanside pistol range, a gun with one bullet, he told his mother on the phone. She called his unit; the defense lawyers called, too. "We had talked to the unit, trying to get them to go find this kid because he was going to kill himself, and didn't get a lot of compassion," Vokey says. "They were just fed up with him."

Fleming told her son she could fly out to California the next day. "Tomorrow will be too late," he said. "Tell everybody I'm sorry. Tell my sisters, tell my brother, tell my nieces, I'm so sorry. All I wanted to do is make you proud."

When Fleming arrived at Scripps Memorial Hospital, James was brain-dead. Two noncommissioned officers were in the room with her, one of them James's first sergeant. Fleming told the nurses, "See that sergeant right there? He said my son was using this to his advantage. But look at my baby now."

His command gave up on him, but Jenkins never gave up on the marines - not when it counted. The citation accompanying his Bronze Star reads, in part, "With the squad pinned down under intense enemy fire in the Najaf cemetery, he moved along the lines to reestablish communication with Company B. When he reached their position, four enemy militiamen located to his direct front attacked. Without regard for his own well being, Lance Corporal Jenkins climbed on top of a tomb and fired directly down at the enemy.... After eliminating the four militiamen, he returned to the squad's position and directed an attack that destroyed four additional enemy combatants. He continued to risk his own safety as he covered the withdrawal of his fellow Marines to friendly lines."

These days, Cynthia Fleming rarely goes into the storage room where she keeps James's belongings; the scent of him lingering on his clothes is too painful. "But one day I went out there and I picked up his boots that were in a box, and when I picked up his boots, the Iraqi sand fell out, and I lost it," she says. "His boots was so worn you could tell that boy did some fighting and running over there in Iraq."

-------