On Oct. 3, 2009, 54 soldiers from Troop B, 3rd Squadron, 61st Cavalry Regiment, defended Combat Outpost Keating, near the town of Kamdesh in eastern Afghanistan’s Nuristan province, from an estimated 400 enemy fighters who breached and nearly overran the position.
Eight U.S. soldiers died during or after that day’s actions, and more than 25 were hurt. After a ceremony next week, two survivors of the battle will have the right to wear the star strung on a pale blue ribbon that the United States reserves for its most revered heroes: the Medal of Honor.
In an Aug. 26 White House ceremony, Army Staff Sgt. Ty Michael Carter became the second soldier from the battle to receive the nation’s highest award for valor, with President Barack Obama, as commander in chief of the armed forces, presenting the medal. Six months ago, former Army Staff Sgt. Clinton L. Romesha received his Medal of Honor for his actions during the same battle.
Carter was a cavalry scout in the rank of specialist assigned to the outpost, which was scheduled to be closed. Carter was one of two soldiers who held back attackers on the southern flank of the outpost for some six hours. Speaking to reporters late last month at Joint Base Lewis-McCord, Wash., where he is now assigned, Carter described what the soldiers went through.
“The incoming firepower was so intense,” he said. “If you look at the sheer numbers [and realize] there were five of us there at the fighting position — three men lost their lives there. There were also two [other] men who lost their lives trying to support that position.”
Carter has said that what troubles him the most is the death of his friend, Army Spc. Stephan L. Mace, who was 21 and from Virginia. Mace was wounded early in the fighting, and his fellow soldiers, Carter and Army Sgt. Bradley Larson, spent hours battling heavy incoming fire before they could get him to medical help. Mace later died of his wounds.
“When I saw Mace and I was told that I couldn’t get to him, it broke my heart,” Carter said. “A good man was lying there, wounded, begging for my help, and so dehydrated that he couldn’t even have tears. … He was in pain. But Larson being, the [noncommissioned officer] that he is — he’s a great leader — he knew that if I went out there, I’d be dead, too. And for that I owe him my life.”
Carter told reporters that after he and Larson fought their way to the aid station with Mace, he rejoined the rest of the unit, pushing back the attackers and dousing the fires the enemy had set.
“We spent the rest of the day continuing to gather our wounded, our killed in action, and retake the COP. … It felt very draining through the day,” he said. “Then there was a sorrow that went through the troop, because we found out that [Mace] was killed. That’s one of the main things that kind of affected me.”
Carter said his own physical injuries were scrapes and bruises, “a little bit of shrapnel,” concussion and hearing loss. He credits treatment for a different kind of wound with helping him go on living after the hell he saw in Nuristan.
“I have been in counseling ever since that incident,” he said. “And because of that counseling, I am able to be a good husband and a good father –- at least that’s what [his wife, Shannon Derby] tells me — and I probably will continue to go to counseling, just so I can improve and be able to speak to individuals like yourselves.”
Navy Capt. Richard Stolz directs the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, overseeing three centers: the Defense and Veterans Brain Injury Center, the Deployment Health Clinical Center and the National Center for Telehealth and Technology.
In an email interview, Stolz told American Forces Press Service that most service members who have deployed won’t ever develop symptoms of post-traumatic stress disorder, but an estimated 10 to 20 percent of the 2.6 million who have deployed since 2001 have or may have developed the condition.
All combat experiences have the potential to induce PTSD symptoms, Stolz said. Service members intent on staying alive in combat, he explained, push traumatic memories away and stay focused on the present danger.
“When service members return home, they often continue to follow the same strategy that helped them to survive in combat,” Stolz added. “When they experience distressing thoughts, feelings or images they do their best to bury them. However, in most cases, efforts to control any PTSD symptoms actually make them worse.”
Self-medicating and unhealthy coping mechanisms can lead to substance abuse, depression and anxiety, he noted.
“In many cases,” Stolz added, “the longer the symptoms are avoided, the worse they become and can lead to long-term disabilities.”
PTSD is highly treatable and a number of evidence-based treatment approaches are readily available, Stolz said. He noted that along with therapy, it often is helpful for service members to share their combat experiences with other veterans who have had similar experiences.
Stolz cautioned that the best post-traumatic treatment for some may not work for others.
“Sometimes it takes a while to find the most appropriate treatment for the individual,” he said. “Once in therapy, it’s important for a patient to establish a strong therapeutic relationship with their therapist and understand what has to occur to experience long-term healing. It might get worse before it gets better. Ultimately, they will greatly benefit from facing, expressing and accepting the truth of what they have experienced.”
Stolz noted the department also is looking to develop preventive approaches to PTSD, including pre-deployment training that includes information about what to expect during a deployment.
“It is also best to educate service members on the things that they can do to become more resilient,” he added. “Adopting an accepting attitude towards ourselves and our world makes a significant difference in how resilient we are.”
He pointed to DCoE’s “RESPECT-Mil” program, short for Re-engineering Systems of Primary Care Treatment in the Military.
“The program currently operates in 90 military clinics and screens more than 80,000 primary care visits each month for PTSD and depression,” he said. “Service members diagnosed with psychological health concerns are assessed and treated in primary care with periodic follow-up, and clinics are closely monitored through embedded program evaluation measures. This concept also helps to lessen the stigma that prevents service members from seeking help for mental health concerns.”
Mental health care has advanced across the department over the past 12 years, he said.
“However, the demand to expand our knowledge and methods to effectively prepare, screen, diagnose and treat service members with PTSD will remain long after all of our nation’s heroes have returned home,” Stolz noted.
Derby met and married Carter after the battle that earned him the Medal of Honor. She told reporters during July’s news conference that when she realized what her husband and the rest of the troop had been through, “it was overwhelming.”
“I could never wrap my mind around it — the severity of what they went through and what they had to do — because I’ve never been a part of anything so dramatic,” she said. “So it was hard to understand and cope.”
Now that her husband is talking about the experience more openly, she said, it’s heart-wrenching.
“It makes me cry,” she said. “And when he had to go back to Afghanistan [for a second deployment], it just makes me relive everything that he had told me, [knowing] that it could happen again.”
Derby said that fear was hard for her, but she focused on supporting her husband.
“I have to be strong. I have to help him be strong. So that’s what I try to do,” she said.
Carter said he had hoped to move on in the Army to a warrior transition battalion “if they’ll take me,” though the Medal of Honor may change that. He said the work that warrior transition unit staffs do is similar to what he wants to do in the future: “Get rid of the stigma of post-traumatic stress.”
A lot of troops have the condition, he said, and are too ashamed to talk about it or get help.
“Eventually, whether it’s now or in the future, it becomes an issue,” he said. “A warrior transition unit, I thought, was an excellent place for me, just because of my experience, and … the men and women that are there, they would listen to somebody who’s seen it, done it, been there.”