Murder-Suicide Antidepressants 24/02/2008 Iraq/Illinois Soldier on Antidepressant for PTSD Kills Wife & Self Summary:

Paragraph 21 reads:  "In one instance, the Air Force repeatedly deployed to Iraq, Afghanistan and elsewhere Sgt. Jon Trevino, a medic with a history of psychological problems, including post-traumatic stress disorder. Multiple deployments eroded Trevino's marriage and worsened his mental health problems until, in 2006, he killed his wife, Carol, and then himself."

Fourteenth paragraph from the end reads:  "The Air Force acted quickly. He was abruptly restricted from “special operational duty.” An Air Force doctor diagnosed “acute PTSD,” calling it a reaction to the war and marital problems. Trevino began taking a cocktail of antidepressants and underwent therapy. According to doctors' notes, he did not express thoughts of homicide or suicide. By the time Hurricane Katrina hit the Gulf Coast in August 2005, he was considered well enough to be deployed domestically."

Paragraph 43 reads:  "Some researchers draw a fairly firm connection between post-traumatic stress disorder and domestic violence. A 2006 study in The Journal of Marital and Family Therapy looked at veterans who sought marital counseling at a Veterans Affairs medical center in the Midwest between 1997 and 2003. Those given a diagnosis of PTSD were “significantly more likely to perpetrate violence toward their partners,” the study found, with more than 80 percent committing at least one act of violence in the previous year, and almost half at least one severe act."

The diagnoses of PTSD almost invariably results in a prescription for an antidepressant. 

http://www.theday.com/re.aspx?re=01b66f81-440e-4d1c-9128-14af7d4b5a8a

'The War Could Only Make Things Worse'
Strain put on military families by deployment, combat can be overwhelming -- and fatal
[]    
By Lizette Alvarez , Deborah Sontag , New York Times News Service    Published on 2/24/2008

A few months after Sgt. William Edwards and his wife, Sgt. Erin Edwards, returned to a Texas Army base from separate missions in Iraq, he assaulted her mercilessly. He struck her, choked her, dragged her over a fence and slammed her into the sidewalk.

As far as Erin Edwards was concerned, that would be the last time he beat her. Unlike many military wives, she knew how to work the system to protect herself. She was an insider, even more so than her husband, since she served as an aide to a brigadier general at Fort Hood.

With the general's help, she quickly arranged for a future transfer to a base in New York. She pressed charges against her husband and secured an order of protection. She sent her two children to stay with her mother. And she received assurance from her husband's commanders that he would be barred from leaving the base unless accompanied by an officer.

Yet on the morning of July 22, 2004, William Edwards easily slipped off base, skipping his anger management class, and drove to his wife's house in the Texas town of Killeen. He waited for her to step outside, and then, after a struggle, shot her point-blank in the head before turning the gun on himself.

During an investigation, Army officers told the local police that they did not realize Erin Edwards was afraid of her husband. And they acknowledged that, despite his restrictions, William Edwards had not been escorted off base “on every occasion,” according to a police report.

That admission troubled the detective handling the case. “I believe that had he been confined to base and had that confinement been monitored,” said Detective Sharon L. Brank of the local police, “she would not be dead at his hands.”

The killing of Erin Edwards directly echoed an earlier murder of a military wife that drew far more attention. Almost 10 years ago, at Fort Campbell in Kentucky, a different Army sergeant defied a similar restriction to base, driving out the front gate on his way to a murder almost foretold.

That 1998 homicide, one of several featured in a “60 Minutes” expose on domestic violence in the military, galvanized a public outcry, congressional demands for action and the Pentagon's pledge to do everything possible to prevent such violence from claiming more lives.

Yet just as the Defense Department undertook substantial changes, guided by a congressionally chartered task force on domestic violence that decried a system more adept at protecting offenders than victims, the wars in Afghanistan and then Iraq began.

Pentagon officials say wartime has not derailed their efforts to make substantive improvements in the way the military tackles domestic violence. They say they have, for example, offered more parenting and couples classes, provided additional victims advocates, and afforded victims greater confidentiality in reporting abuses.

But interviews with members of the task force, as well as an examination of cases of fatal domestic violence and child abuse, indicate that wartime pressures on military families and on the military itself have complicated the Pentagon's efforts.

“I don't think there is any question about that,” said Peter C. McDonald, a retired district court judge in Kentucky and a member of the Pentagon's now disbanded domestic violence task force. “The war could only make things much worse than even before, and here we had a system that was not too good to begin with.”

Connie Sponsler-Garcia, another task force member who now works on domestic violence projects with the Pentagon, agreed. “Whereas something was a high priority before, now it's: 'Oh, dear, we have a war. W'ell get back to you in a few months,' ” she said.

The fatalities examined by The Times show a military system that tries and sometimes fails to balance the demands of fighting a war with those of eradicating domestic violence.

According to interviews with law enforcement officials and court documents, the military has sent to war service members who had been charged with and even convicted of domestic violence crimes. Deploying such convicted service members to a war zone violates military regulations and, in some cases, federal law.

Take the case of Sgt. Jared Terrasas. The first time he was deployed to Iraq, his prosecution for domestic violence was put on hold. Then, after pleading guilty, he was pulled out of a 16-week batterers intervention program run by the Marine Corps and sent to Iraq.

Several months after Terrasas returned home, his 7-month-old son died of a brain injury, and the Marine was charged with his murder.

Deployment to war, with its long separations, can put serious stress on military families. And studies have shown that recurrent deployments heighten the likelihood of combat trauma, which, in turn, increases the risk of domestic violence.

“The more trauma out there, the more likely domestic violence is,” said Dr. Jacquelyn C. Campbell, a professor at the Johns Hopkins School of Nursing who served on the Pentagon task force.

The Times examined several cases in which mental health problems caused or exacerbated by war pushed already troubled families to a deadly breaking point.

In one instance, the Air Force repeatedly deployed to Iraq, Afghanistan and elsewhere Sgt. Jon Trevino, a medic with a history of psychological problems, including post-traumatic stress disorder. Multiple deployments eroded Trevino's marriage and worsened his mental health problems until, in 2006, he killed his wife, Carol, and then himself.

The military declared his suicide “service related.” Within a six-week period in 2002, three Special Forces sergeants returned from Afghanistan and murdered their wives at Fort Bragg in North Carolina. Two immediately turned their guns on themselves; the third hanged himself in a jail cell. A fourth soldier at the same Army base also killed his wife during those six weeks.

At the beginning of this wartime period, the cluster of murder-suicides set off alarms about the possible link between combat tours and domestic violence, a link supported by a study published that year in the journal Military Medicine. The killings also reinvigorated the concerns about military domestic violence that had led to the formation of the Defense Task Force on Domestic Violence two years earlier.

National attention to the subject was short-lived. But an examination by The New York Times found more than 150 cases of fatal domestic violence or child abuse in the United States involving service members and new veterans during the wartime period that began in October 2001 with the invasion of Afghanistan.

In more than a third of the cases, The Times determined that the offenders had deployed to Afghanistan or Iraq or to the regions in support of those missions. In another third, it determined that the offenders never deployed to war. And the deployment history of the final third could not be ascertained.

The military tracks only homicides that it prosecutes; the majority of killings involving service members are handled by civilian authorities. To track these cases, The Times used records from the Army, Air Force and Navy ­ the Marines did not provide any information ­ and local news reports.

It is difficult to know how complete The Times' findings are. What is clear, though, is that these homicides occurred at a time when the military was trying to improve its handling of domestic violence. The Pentagon's domestic violence task force, appointed in April 2000 and comprising 24 military and civilian experts, met regularly for three years to examine a system where, they found, soldiers rarely faced punishment or prosecution for battering their wives and where they often found shelter from civilian orders of protection.

When the moment arrived to explain their findings and recommendations to Congress, however, the timing could not have been poorer. Deborah D. Tucker and Lt. Gen. Garry L. Parks of the Marines, the leaders of the task force, presented their final report to the House Armed Services Committee on the very day the Iraq war began, March 20, 2003. Tucker called it “one of the more surreal experiences of my life.”

“I knew that while we were at war all other considerations would push back,” she said, “and I hoped that Operation Iraqi Freedom would be a quick matter on the order of Desert Storm.”

The task force was disbanded, and its request to reconvene after two years to evaluate progress was rejected. But the Defense Department embraced most of its 200 recommendations and made many changes, from the increase in advocates to domestic violence training for commanding officers.

According to the military, the number of general spouse and child abuse incidents reported to on-base family advocacy programs began declining in 1998, before the special effort to address the issue began, and continued to decline significantly through 2006. But whether those numbers reflect a genuine decline is a matter of debate, given that large numbers of service members have spent considerable time away on deployments and that the strengthening of sanctions for domestic violence has made some women more reluctant to report abuse.

The accuracy of the military's domestic violence data has also been questioned, by advocates, the Government Accountability Office and military officials themselves.

Last fall, in a statement released during domestic violence awareness month, Mike Hoskins, a Pentagon official, said, “We shouldn't necessarily take comfort in reduced rates of violence.” He said they probably reflected “good news” but urged caution in interpreting the numbers.

Campbell, the former task force member, said the task force recommended periodic anonymous surveys to ascertain the full extent of domestic violence. She also said she believed the “true incidence” of domestic violence had probably increased as a result of service members returning from Iraq with combat trauma, which can exacerbate family violence.

Some researchers draw a fairly firm connection between post-traumatic stress disorder and domestic violence. A 2006 study in The Journal of Marital and Family Therapy looked at veterans who sought marital counseling at a Veterans Affairs medical center in the Midwest between 1997 and 2003. Those given a diagnosis of PTSD were “significantly more likely to perpetrate violence toward their partners,” the study found, with more than 80 percent committing at least one act of violence in the previous year, and almost half at least one severe act.

Pamela Iles, a Superior Court judge who was permitted by the Marines to set up a privately financed domestic violence education program at Camp Pendleton in California, views much of the domestic abuse on the base as “collateral” from the war. She sees the domestic violence committed by Marines, many of them young, as a reaction to jumping back and forth between the dangers of war and the trouble at home.

“One minute you are in Baghdad waiting for a bomb to go off and the next minute you are in Burger King,” Iles said. “There is a lot of disorientation.” It was a little before dawn on Feb. 20, 2006, in a bedroom in Edwardsville, Ill. Carol Trevino and her 9-year-old son, sleeping deeply after watching “Wayne's World,” were startled awake by a series of booms. “What was that?” Carol Trevino asked her son.

In seconds, Sgt. Jon Trevino, her estranged husband, barged through the door, according to a police report. Carol Trevino had just enough time to reach for her pepper spray before he shot her five times, the last time in the head. Then he shot himself.

Their son, wide-eyed, sat in bed watching his life explode, bullet by bullet.

Few details escaped the boy's notice. His father used a silver gun and it “didn't have a wheel on it, like the cowboys used,” he told the Edwardsville police. The boy could even name the precise time of his mother's death: 4:32 a.m., as the glowing clock read.

Outside in Trevino's car was the immediate motive for the murder-suicide: divorce papers, evidence of a marriage destabilized by multiple deployments to war zones and by Trevino's own increasing instability.

T. Robert Cook, his brother-in-law, said he believed Trevino's domestic violence was triggered by his combat trauma. “I'm 100 percent sure it was the war,” said Cook, who is raising the Trevinos' son along with his wife, Sheryl Gusewell, who is Carol's sister. “I don't have any doubt their marital problems placed a burden on him, but I am quite sure that, but for the war, he would have taken a different approach. When you see people being shot every day, death is not a big thing.”

Trevino, who had endured childhood sexual abuse and a difficult first marriage, suffered psychiatric problems long before he was dispatched to war zones to perform the highly stressful job of evacuating the wounded.

And the Air Force knew it.

Air Force mental health records show that Trevino, who was 36, had been treated twice for mental health problems before the war: once in 1995 for serious depression as his first marriage crumbled, and then, in 1999 for post-traumatic stress disorder stemming from the childhood abuse and marital problems with his new wife, Carol. He was counseled and treated with medication both times.

As a result of these problems, the Air Force insisted that he secure a medical waiver for a promotion that he sought to become an aeromedical evacuation technician. And military doctors certified that he could handle the job, despite research that shows that pre-existing post-traumatic stress disorder is exacerbated in a war zone.

Col. Steven Pflanz, a senior psychiatrist in the Air Force, who was not involved in the Trevino case, said the Air Force considered the stress disorder to be treatable and therefore was willing to deploy an airman with a history of it. But the decision is not taken lightly, he said.

“It's not an exact science,” he said. “You try to make your best prediction. We spend a lot of time with our customers.”

In Trevino's case, the prediction was wrong. He had trouble shaking off the carnage that he experienced so viscerally while evacuating injured service members. After one deployment to Afghanistan and two to Iraq, his mental health and his marriage deteriorated. When he returned from his second tour in Iraq, Trevino acknowledged in a health assessment that he had “serious problems” dealing with the people he loved and that he was feeling “down, helpless, panicky or anxious.”

The Air Force acted quickly. He was abruptly restricted from “special operational duty.” An Air Force doctor diagnosed “acute PTSD,” calling it a reaction to the war and marital problems. Trevino began taking a cocktail of antidepressants and underwent therapy. According to doctors' notes, he did not express thoughts of homicide or suicide. By the time Hurricane Katrina hit the Gulf Coast in August 2005, he was considered well enough to be deployed domestically.

But his wife's family, which had taken him under its wing, found the once affable, quick-witted sergeant to be profoundly altered. His temper flashed unpredictably, white-hot. He acted threatened and paranoid, his behavior so erratic that he frightened his son. One late night, he took his son on a rambling drive to nowhere, ranting to the boy about his mother.

At least one time, he struck his wife. A friend gave Carol Trevino the pepper spray that she reached for the night of her murder. But she never considered his abuse serious enough to report him to the authorities.

Four days before the murder-suicide, Trevino bought a gun.

“This is just one of those things that unfortunately happens,” he wrote to his son in a suicide note. “I love you, and I know I let you down.” The Pentagon task force had one overarching recommendation: that the military work hard to effect a “culture shift” to zero tolerance for domestic violence by holding offenders accountable and by punishing criminal behavior.

There was, members believed, a core credo that needed to be attacked frontally: “this notion that the good soldier either can't be a wife beater or, if they are, that it's a temporary aberration that shouldn't interfere with them doing military service,” as Campbell put it.

The way the military handled several cases involving the deaths of babies and toddlers indicates that this kind of thinking has been difficult to demolish at a time of war.

In October 2003, four months after Jose Aguilar, 24, a Marine Corps sergeant, returned from the initial invasion of Iraq, his infant son, Damien, wound up in the intensive care unit of a local hospital with bleeding in his brain and eyes.

Aguilar, a mechanic based at Camp Lejeune in North Carolina, acknowledged to the local police that he had been rough with the 2-month-old baby, shaking Damien to stop him from squirming during a diaper change. He said that he had been abused himself as a child and that he did not mean to hurt the baby.

After the Marine was charged with felony child abuse, he and his wife completed a parenting program.

The following summer, while the felony charge was pending, Aguilar was deployed once more to Iraq, this time for nine months. His court case was put on hold, which did not surprise local prosecutors.

Michael Maultsby, the assistant district attorney in Onslow County, N.C., who prosecuted Aguilar, said such frustrating delays in justice sometimes occur in his county, home to Camp Lejeune.

“It depends on the needs of the unit,” Maultsby said. “We can't overrule them.”

In April 2006, a year after Aguilar returned from Iraq but before his felony case was resolved, Damien, who by then was 2, died of a brain injury. His father claimed that the boy had been injured by a fall in the bathtub. The medical examiner disputed that explanation. The Marine was arrested, pleaded guilty to second-degree murder and felony child abuse, and was sentenced last fall to 28 to 35 years in prison.[]

Regional