Where Soldiers Come From: In Context

The Upper Peninsula of Michigan is the northern of the two major land masses that make up the state of Michigan. A unique and rich tapestry of dense forests, rugged waterways and small towns, the U.P. (as the area is commonly called) contains almost one quarter of the land area of Michigan but just 3 percent of its total population. It is bordered by the Lower Peninsula, Wisconsin, Ontario and Lake Superior. Residents of the U.P. are frequently called "Yoopers" (from "U.P.-ers") and have a strong regional identity.

The boys and families in Where Soldiers Come From are from the town of Hancock on the northernmost tip of the U.P., while filmmaker Heather Courtney hails from Houghton, a town next to Hancock. Due to Hancock's proximity to the Great Lakes, the average amount of snowfall in the town is 200 inches a year, more than any part of the United States east of the Mississippi River.

With a population of just over 4,600, Hancock sits on the north shore of the Portage Canal, some 10 miles from Lake Superior, the largest body of fresh water in the world, and just 45 miles from the northernmost tip of Michigan. Hancock was founded by the Quincy Mining Company in 1859, during the area's copper mining boom. The site of brass foundries and mining machinery factories, the town was once best known for the Quincy Mine. By 2000, however, there were no longer any copper mines in operation and only two iron mines are still in production today. Though the unemployment rate in the area was 11.8 percent in April 2011 (slightly above Michigan's 11 percent), the U.P. has seen an increase in jobs in tourism, which has since become the region's primary industry.

Hancock and the surrounding area (called "copper country" because of the history of copper mining) have a strong Finnish heritage, demonstrated in part by local Finlandia University and the many homes with their own saunas.

Photo caption: Childhood friends.  Credit: Heather Courtney

Sources:
» City of Hancock
» Hill, Danielle. "Tourism for the Michigan Upper Peninsula." USA Today.
» Hunts' Guide to Michigan's Upper Peninsula
» Where Soldiers Come From

The U.S. National Guard

The National Guard is the oldest branch of the U.S. Armed Forces and remains the only branch of the military whose existence is actually required by the Constitution. Close to 12,000 citizens of Michigan are now members of the Michigan National Guard.

Legend has it that citizens of Michigan were some of the first to answer President Abraham Lincoln's call to defend the Union at the start of the Civil War. When Michigan's soldiers showed up in Washington, D.C., Lincoln is said to have exclaimed, "Thank God for Michigan."

Close to 12,000 citizens of Michigan are now members of the Michigan National Guard, which contains an Army National Guard and Air National Guard component. Michigan has the 15th highest number of National Guard members in the country, with Texas and California having the highest Guard membership with more than 20,000 each.

The National Guard is the oldest branch of the U.S. Armed Forces and remains the only branch of the military whose existence is actually required by the Constitution. The dual federal/state status of the Guard (every member of the National Guard belongs to two organizations — the National Guard of the United States and the National Guard of his or her particular state) has been an important part of its structure and operations since its beginning and is the most fundamental difference between the Army National Guard and the Army Reserve. These two bodies comprise the reserve components of the U.S. Army, as opposed to active duty soldiers. About 55 percent of U.S. military manpower is made up of active duty soldiers, with the remaining 45 percent comprising the reserve forces (Army National Guard and Army Reserve), often collectively called "weekend warriors." There are Army Reserve forces for each of the active military services — the Army, Navy, Marines, Air Force and Coast Guard.

Recruited and trained locally, National Guard troops primarily serve communities at home or nearby in times of natural disaster or civil unrest. In the largest domestic deployment in National Guard history, 50,000 troops were deployed to the Gulf States following Hurricane Katrina in 2005. At the same time, the president has the power to "federalize" National Guard units, making them available for international missions. In such circumstances, guard members, who usually train for one weekend a month and two full weeks a year, can be called to duty for two-year deployments. If Congress declares a national emergency and a "full mobilization" happens, guard members can be required to serve for the length of the emergency plus six additional months.

The National Guard has played a role in every major U.S. military operation abroad, including the Mexican War, World War I and World War II, the Korean and Vietnam Wars and the current wars in Iraq and Afghanistan. Even a decade ago, however, overseas deployment was not as common as it is now for National Guard members. Fewer than 100 Michigan National Guard troops were deployed in 2001. That number increased to more than 1,000 by 2003. In 2011, roughly 2,000 Michigan-based Guard members were deployed. In all, more than 200,000 Guard troops have been mobilized for active duty overseas since September 11, 2001; at times they have made up half of all combat brigades in Iraq.

The wars in both Iraq and Afghanistan are also the first large-scale conflicts since the Revolutionary War that have been fought by an entirely volunteer force. Of over 300 million people in the United States, approximately 2.4 million (less than 1 percent) serve in the military.

Photo caption: Cole greets crowd.  Credit: Heather Courtney

Sources:
» Martin, Tim. "Michigan National Guard Deployments Rise in 2011." Detroit Free Press, October 22, 2011.
» Melnyk, Les A. "National Guard: Why So Special?" Soldiers Magazine, August 2, 2006.
» Michigan Department of Natural Resources. "Civil War Military Recruiting."
» National Guard
» Umansky, Eric. "Army Reserve vs. National Guard: What's the Difference, Anyway?" Slate, January 7, 2005.

Forward Operating Base Salerno

A forward operating base (FOB) serves as both a staging area for tactical operations and a home for soldiers. FOB Salerno, in southeastern Afghanistan, served as the headquarters for Combined Task Forces Currahee, which is comprised mostly of U.S. troops, including Dom, Cole and Bodi during their deployment.

A forward operating base (FOB) serves as both a staging area for tactical operations and a home for soldiers. Conditions and facilities at FOBs vary (some bases have more "quality-of-life" facilities, such as coffee bars and movie theaters, than others), though most U.S. soldiers in Afghanistan live in air-conditioned dormitory-like quarters with Internet and phone lines and contracted dining facilities.

With 300 acres and a population of nearly 5,000, FOB Salerno functions like a makeshift small town and serves as the headquarters for Combined Task Forces Currahee, a force comprised mostly of U.S. troops. The base is in the province of Khost in southeastern Afghanistan, close to the border with Pakistan — an area where hundreds of Taliban and Al Qaeda fighters are believed to be hiding. Salerno is a main coalition hub for operations and is where Dom, Cole and Bodi were stationed during their deployment. The base was named for the beachhead in Salerno, Italy, where the 505th Parachute Infantry Regiment landed in 1943 during Operation Avalanche in World War II — the first large-scale invasion of Europe by Allied Forces. Approximately 60 years later, an Italian light infantry battle group established FOB Salerno.

While at Salerno, Dom, Cole and Bodi spent most of their days sweeping the countryside in tanks and on foot looking for improvised explosive devices (IEDs). According to the Joint IED Defeat Organization, 80 percent of Afghan IEDs are made using homemade explosive components, such as farm fertilizer and ammonium nitrate, along with wood, saw blades and other everyday materials.

The latest Pentagon figures show that the number of planted IEDs is rising. Insurgents in Afghanistan planted 4,472 bombs from May through July 2011, a 17 percent increase compared to the figure for the same three months in 2010. Even with enhanced armored vehicles widely used, IEDs remain the number one cause of death among NATO troops in Afghanistan and have led to a large increase in numbers of troops with traumatic brain injury.

Photo caption: Dom rests during a cache sweep in Afghan village.  Credit: Heather Courtney

Sources:
» BBC News. "Italian troops attacked in Afghanistan."
» O'Connor, Maura. "Rocket City, Afghanistan." Dispatches and Published Work, September 13, 2011.
» Pincus, Walter. "IEDs killing fewer troops in Afghanistan." The Washington Post, September 25, 2010.
» Powell, Brent C. "Base Operations Section Keeps Camp Salerno Functional." RC-East.com: Official Website of Combined Joint Task Force-1, September 26, 2010.
» U.S. Department of Defense. "Reporter's Notebook: Forward Operating Base Gardez 'Feels' Like Afghanistan."

Hidden War Wounds

According to the U.S. Department of Veterans Affairs' National Center for PTSD, many veterans experience some level of sleeplessness, anger, anxiety, irritability, unwanted memories, guilt, hopelessness or feelings of isolation. If the symptoms become severe or persistent, they are often diagnosed as either post-traumatic stress disorder (PTSD) or major depression. Some troops who have suffered concussions (from IEDs, for example) may be experiencing the effects of traumatic brain injury (TBI).

The current wars in Afghanistan and Iraq are the longest U.S. military operations since the Vietnam War. Operation Enduring Freedom/Operation Iraqi Freedom troops returning from combat have experienced a wide range of psychological responses and mental health problems. According to the U.S. Department of Veterans Affairs' National Center for PTSD, many veterans experience some level of sleeplessness, anger, anxiety, irritability, unwanted memories, guilt, hopelessness or feelings of isolation. The group Iraq and Afghanistan Veterans of America reports that the severity of these symptoms varies widely among individuals, and that a veteran's symptoms may fluctuate over time, cropping up several months or even years after he or she has settled back home. If the symptoms become severe or persistent, they are often diagnosed as either post-traumatic stress disorder (PTSD) or major depression. In addition to these psychological injuries, some troops who have suffered concussions (from IEDs, for example) may be experiencing the effects of traumatic brain injury (TBI), including mood/behavior changes and cognitive impairments. It is not unusual for veterans to be coping with both psychological injuries and TBI, and the effects of these two kinds of injuries can overlap.

Post-Traumatic Stress Disorder (PTSD) and Psychological Injuries

PTSD wasn't recognized by the American Psychiatric Association until 1980, when troops traumatized by hand-to-hand combat, insurgencies and ambushes in the Vietnam War had been back on American shores for years. For some vets, the warning signs appear quickly after deployment. For others, months or years pass before they surface.

According to a 2008 population-based study by the RAND Corporation, Center for Military Health Policy Research, nearly 20 percent of military service members who have returned from Iraq and Afghanistan — 300,000 in all — report symptoms of post-traumatic stress disorder or major depression, yet only slightly more than half have sought treatment. The disorder may include the following:

1. Reliving the event (also called re-experiencing symptoms):
Bad memories of the traumatic event can come back at any time, resulting in nightmares and flashbacks. Triggers such as a car backfiring, which sounds like gunfire, may cause a veteran to relive events of war.

2. Avoiding situations that remind you of the event:
Veterans may try to avoid situations or people that trigger memories of the traumatic event and may even avoid talking or thinking about the event.

3. Feeling numb:
Veterans may find it hard to express their feelings and may not have positive or loving feelings toward other people.

4. Feeling keyed up (also called hyperarousal):
Veterans may be jittery, or always alert and on the lookout for danger, which can cause them to become angry or irritable suddenly or to have a hard time concentrating.

It's thought that by understanding traumatic stress symptoms and reactions better, veterans may be better able to cope with them. Treatment programs include different types of cognitive behavioral therapy (CBT) and a similar kind of therapy called EMDR, or eye movement desensitization and reprocessing. According to the Department of Veterans Affairs, certain medications used to treat depression can also be effective for treating PTSD. According to a 2011 study published by the Journal of the American Medical Association, however, drugs prescribed to treat severe post-traumatic stress symptoms for veterans are no more effective than placebos and come with serious side effects. About one fifth of veterans who seek treatment for post-traumatic stress receive a prescription for an anti-psychotic medication.

In recent years, the U.S. Department of Defense has encouraged the use of "post-traumatic stress (PTS)" or combat-related stress as the preferred terminology for general discussion and understanding of the combat stress response. This is part of an effort to reduce stigma among the general public toward combat veterans, and to differentiate between normal responses to combat situations and the persistent symptoms that may eventually lead to a formal diagnosis.

Traumatic Brain Injury (TBI)

Traumatic brain injury (TBI) is a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. It is not currently known how neurological trauma resulting in TBI exactly interferes with the emergence of PTSD, but like PTSD, traumatic brain injury is difficult to recognize, diagnose and treat. While the creation of mine-resistant ambush-protected armored vehicles has saved many lives, TBIs suffered through these blasts have become known as the new silent signature war wounds of the war in Afghanistan. Because these explosions were at one time deadly, it is unclear what the full effects are of surviving the kind of trauma associated with uncovering IEDs.

While severe TBI can leave a person almost incapacitated, even mild TBI (mTBI) — also known as concussion — can lead to symptoms, including headaches, balance problems, hearing problems, lack of self-control, mood changes, ringing in the ears, problems sleeping and memory loss. Recovery can take years.

Situations in Afghanistan and Iraq, where troops are likely to face multiple deployments and repeated ambushes by roadside bombs or improvised explosive devices (IEDs), are especially conducive to mild TBI. Out of 2 million troops who have served in Iraq and Afghanistan, more than 800,000 have had multiple deployments, many five or more. According to BrainLine.org (a multimedia project funded by the Defense and Veterans Brain Injury Center), approximately 80 percent of TBI diagnoses in the military are associated with closed head injuries incurred as a result of blasting or other activities not directly combat-related. A 2009 study published by the American Journal of Public Health documents that troops who face multiple deployments are at a 300 percent increased risk of several mental health outcomes.

Just how many troops are affected is hard to know. Sections of the government have released numbers ranging from 50,000 (Department of Defense) to 115,000 (the Pentagon), while the Brain Injury Association of America estimates the number at 360,000 and RAND corporation has suggested it could be as high as 400,000.

Contributing to the uncertainty are the facts that TBI is difficult to diagnose, and that some soldiers may be reluctant to be diagnosed. The Pentagon found that 60 percent of the soldiers who suffered from TBI symptoms refused help because they worried unit leaders would treat them differently, or that the condition would prevent them from getting jobs as police officers and firefighters after they got out of the service.

The military uses two in-the-field methods to discern damage: the Military Acute Concussion Evaluation, or MACE (a brief clinical exam taken immediately after an incident), and the Automated Neuropsychological Assessment Metrics, or ANAM. Many soldiers have learned how to "trick" the first by memorizing the words they're supposed to recite back to the medics, in order to avoid the stigma of being injured or being separated from their platoons; reliability of results from the ANAM is no better than a "coin flip," according to recent Congressional testimony by Lieutenant General Eric Schoomaker, the U.S. Army's top medical official. ANAM is a computer-based tool designed to detect speed and accuracy of attention, memory, and thinking ability.

Even sophisticated CAT and MRI scans rarely show damage, though a new study at Washington University in St. Louis that used a new scanning technique did show that about one third of American troops who have suffered brain injuries from bomb blasts show immediate evidence of stretched and damaged nerve fibers at both the front and the back of the brain. Brain scans show that for days and even weeks after a traumatic brain injury, the brain's metabolism slows down, leaving some cells starved for energy.

David Hovda, who directs the Brain Injury Research Center at the University of California, Los Angeles says, "During the time when this metabolism is altered, the brain not only is dysfunctional, but it's also extremely vulnerable, so that if it's exposed to another mild injury, which normally you'd be able to tolerate really well, now there can be long-term devastating consequences." Bodi suffered repeated concussions, about 10 in all, before he was kept from going on missions.

According to NPR, brain injury experts are trying to apply lessons from the football field to the battlefield. Brain injury experts say mandatory rest and evaluation are even more important in combat because of new discoveries about the way energy from an explosion appears to reach the brain and cause damage. When somebody is involved in a blast, he or she experiences impact plus blast, which makes a blast injury different from other impact injuries, such as car accident injuries and sports injuries.

Efforts have increased to stop military personnel from suffering multiple concussions. The Pentagon recently released a new policy for the treatment of TBI, which includes a mandatory 24-hour rest period after a blast and a complete neurological assessment for anyone who's had three or more concussions. The United States Congress has mandated that military and veterans' hospitals screen all service members returning from combat assignments. Yet even when TBI is properly diagnosed, it is difficult to treat properly. Often a soldier does not realize he or she has suffered a concussion — symptoms may first surface months or years later. Those who go untreated may find their symptoms worsening over time, with some patients at risk for depression, substance abuse, severe anxiety, obsessive-compulsive disorders, Alzheimer's and suicide. In 2010, almost as many soldiers committed suicide as died in battle.

Experts polled by NPR unanimously agreed that in cases of lasting or severe damage, cognitive rehabilitation therapy (CRT), which retrains patients for tasks such as counting, cooking and memory, is an effective and helpful treatment. CRT takes time, however, and can cost $15,000 to $50,000 per patient. Many patients are treated only with weekly therapy or with medication. According to the U.S. Department of Defense, the majority of those with moderate to severe brain injuries never completely recover prior functioning.

Due to a recent change to the military's recognition of TBI, troops who have suffered a traumatic brain injury are now eligible for the Purple Heart, traditionally awarded to those wounded or killed by enemy action.

Photo caption: Bodi  Credit: Heather Courtney

Sources:
» American Psychological Association
» Berglass, Nancy. "America's Duty: The Imperative of a New Approach to Warrior and Veteran Care." Center for a New American Security, November 2010.
» BrainLine.org
» Brown, David. "Study of Troops with Traumatic Brain Injury Hints at Specific Sites of Damage." The Washington Post, June 1, 2011.
» Defense and Veterans Brain Injury Center
» DeGrandpre, Andrew, and Richard Sandza. "Mild Brain Injury Could Soon Rate Purple Heart." Marine Times, March 15, 2011.
» Freeman, David W. "Traumatic Brain Injury Seen in 'Healthy' Soldiers, Thanks to High-Tech Scans." CBS News, June 2, 2011.
» FRONTLINE. "FAQs "