On an afternoon in June 2008, police in Pinehurst, North Carolina, were dispatched to a white farmhouse. The town is set in an idyllic location, complete with woods, plantation houses and eight golf courses. Many of its inhabitants are retirees, so law enforcement officers generally don't have much to do. But, in the previous months, they had repeatedly been called to this particular address. Its owner, a 31-year-old man named Joe Dwyer, had been barricading himself in his house, where he kept several pistols and a semiautomatic rifle.
This time, the officers broke down the door. Once inside, they found Dwyer lying on the ground, covered in feces and urine, gasping for air. "Help me!" the young man begged the officers. "I can't breathe." Surrounding him were dozens of empty cans of Dust-Off, an aerosol spray meant to clean electronic equipment. But it can also be inhaled as a kind of sedative, which can cause heart and lung damage if repeated.
A taxi driver had alerted the police. She told them that, for months, she had been driving him to local shops every day to buy his cans of Dust-Off because he had wrecked his own car veering to avoid a roadside object he thought was an Iraqi bomb.
Joseph Dwyer was a giant of a man with reddish-brown hair. He died that same day while being rushed to the hospital. He was buried a few days later with military honors. While handing Dwyer's widow, Matina, the folded flag that had been draped over her husband's coffin as a mark of respect from the US Army, an officer fell to his knees in front of her.
Joe Dwyer, who had died so lonely and miserably, was an American hero. In March 2003, the front pages of newspapers across America featured a photo of Dwyer carrying a small Iraqi boy to safety shortly after a firefight. "It was the image of war that everyone wanted to see," says Warren Zinn, the photographer who took the picture. It was also the image that America wanted the rest of the world to see: a brave, compassionate US soldier doing something helpful and acting with the best of intentions in the Middle East. It just might be, however, that Joe Dwyer didn't outlive the war in Iraq precisely because he actually was the way America wanted to be seen.
The Soldiers' Epidemic
Matina Dwyer has short brown hair. A thin, silver cross hangs around her neck. "Joseph did not commit suicide," she says. "He died because of the combat wounds he sustained in his mind." Sitting in a restaurant in Pinehurst, Matina picks at her Caesar salad. It takes her a long time to finish each sentence. "I have peace knowing that he does not have to fight his horrible memories anymore, that he finally does not have to suffer so much," she says. "I can only bear that he is dead because this maybe was his way to help people."
Indeed, after meeting Joe Dwyer, a US Army psychiatrist began developing new methods for treating combat veterans who have been emotionally damaged by their combat experiences.
Joe Dwyer suffered from post-traumatic stress disorder (PTSD). More and more servicemen and women returning home to America -- but also to England and Germany -- are being diagnosed as suffering from PTSD. About one in every five US soldiers who returns home after a tour of duty in Iraq or Afghanistan later finds him- or herself battling traumatic neuroses. An estimated 300,000 US war veterans suffer from PTSD, though many don't seek medical help for fear that they will be classified as being mentally ill. According to the findings of a survey commissioned by the Rand Corporation, an American think tank, only half of those who can eventually overcome their reticence and seek medical help receive even the "barely adequate" treatment they require.
In 2009, more than twice as many US servicemen and women committed suicide than were killed in combat in Iraq (334 and 149, respectively). A year earlier, military doctors found that, each month, roughly 1,000 veterans were trying to take their own life. More than 100 veterans of the fighting in Iraq and Afghanistan have completely snapped after returning home and ended up killing others. A third of their victims were girlfriends, wives or other family members.
John Fortunato began seeing the first signs of this epidemic five years ago while working as a US Army psychiatrist at Fort Bliss, near El Paso, Texas. The young veterans returning from Iraq who came to see him spoke of being plagued day and night by feelings of guilt, panic and rage as well as dark thoughts.
Like any other Army psychiatrist, Fortunato prescribed medication to soldiers. If he had time, he would also speak with them. In most cases, though, Fortunato merely issued medical certificates that got his battle-scarred patients discharged from the army on the grounds that they had been deemed unfit for combat duty. In reality, though, by then, they were also unfit for life.
In 2006, when Fortunato found himself writing a certificate for a patient named Joe Dwyer, he starting wondering whether he was doing the right thing. "Dwyer was a great guy with a good sense of humor," Fortunato recalls. Dwyer's slow downward spiral prompted the psychiatrist to set up a center that aimed to turn emotionally wrecked combat veterans back into relatively normal human beings. The center's opening ceremony was held in 2007. Officers gave speeches, and a general cut the ceremonial ribbon.
Rocketed to Hero Status
A 24-year-old Joe Dwyer enlisted in the Army two days after 9/11. He was stationed at Fort Bliss, where he shared a windowless room with three other medics. The four soldiers -- Dwyer, Dionne Knapp, Angela Minor and Jose Salazar, their sergeant -- got on well, and fellow soldiers dubbed them "The Four Musketeers." "We talked about what was important to us, the deep stuff," says Knapp. "Joe was like the kid brother I never had."
When Dionne heard she was being sent to Iraq, she confessed to Joe that she could never leave her two children behind, claiming that she'd rather desert than go to war. The next day, Joe went to see his commanding officer. "Why don't you send me?" he asked. His request was ultimately granted.
In February 2003, Matina accompanied her husband to the bus. To allay her fears, Joe had told her he would be stationed at a hospital in Kuwait. In reality, though, he had been assigned to the 3rd Infantry Division's 7th Cavalry Regiment, a legendary unit described by an officer as "the tip of the tip of the spear" for the march on the Iraqi capital. "It took 21 days to get to Baghdad," Dwyer later told Newsday. "We had four days that we didn't get shot at."
Warren Zinn, a photographer with the Military Times, was embedded with Dwyer's unit. On the fifth day of fighting, a destroyed bridge brought the six-kilometer-long (four-mile-long) convoy of US military vehicles to a halt. Iraqi rockets rained down on the convoy from both sides. All of a sudden, an Iraqi man carrying an injured boy ran toward the convoy. Dwyer was the first to break cover and run out to meet him. He took the child in his arms and turned around. At that very moment, Zinn snapped a photograph. Another medic later removed a piece of shrapnel from the boy's knee. The boy was four years old. His name was Ali.
The photo was beamed around the globe. Dwyer's wife, Matina, saw the photo at work on the cover of USA Today. Dwyer's mother, Maureen, also saw the photo back home in North Carolina. Maureen had a premonition that her son would never return.
But, in June, just three months after leaving for Iraq, Joe Dwyer did return home. He had lost weight and become serious; he answered questions with monosyllabic words. He made a deal with Matina: He wouldn't tell her what had happened if she wouldn't ask him about the terrible things he had witnessed. Little did they know that this was completely the wrong thing to do.
Back at Fort Bliss, Joe obsessively followed his unit's movements in Iraq online. He also bought two pistols and an assault rifle and practiced with them at the firing range. He panicked whenever he saw a box lying on the side of the road, thinking that it might be a bomb. When he went to restaurants, he would always choose a seat that allowed him to keep his back to the wall so that nobody could sneak up on him from behind.
After "The Four Musketeers" went their separate ways, things started going downhill for Joe. He called Angela Minor almost every day. She knew he spent his days sitting in his Ford Taurus in a Best Buy parking lot, drinking 12 cans of beer, one after another. He also began inhaling Dust-Off in an attempt to drive the demons from his mind -- if only for a short while. While high, he once told Angela something about his flashbacks. "He saw people dying," Angela says. "He saw children dying."
Joe also told her about another episode in Iraqi, when a boy stopped after seeing a weapon lying in the dirt. "Don't pick it up, kid! Don't pick it up!" a soldier next to Joe whispered under his breath. But the boy did pick the gun up, and the soldiers shot him dead. "I don't know who pulled the trigger," Minor recalls. "Joe didn't want us to know. He was looking for forgiveness."
But, as his widow, Matina, says: "He felt there was no forgiveness for him."
Desperation and Oblivion
The Dwyers had a modest apartment on the second floor of the Vista Village Apartments. Before long, Joe would only open the front door if he had a pistol in his hand. Almost every other night, when Martina came home from work, he would think his own wife was an Iraqi insurgent. His war had clearly not ended.
On those nights, Martina had no choice but to spend hours waiting in her car in front of the house until he had either sniffed himself unconscious or his paranoia had subsided. Lying side-by-side in bed at night, Joe would inhale from his aerosol can about every 30 seconds. When he chose to sleep on the living-room floor, Matina would listen from the other room to the psssh-psssh sound of the spray can.
She begged him to stop. But the psssh psssh continued.
She would kneel down beside him on the brown carpet, Bible in hand, reading aloud: "Though I walk through the valley of the shadow of death...." And she would pray: "God, please make him stop."
Matina now says she can't stand the sound of a spray can.
Likewise, Dwyer's friends became so concerned that they decided to act. Angela Minor overdrew her bank account and flew down from New York. The three other "Musketeers" wanted to convince Joe to at least surrender his weapons.
The Shooting Incident
Joe had tears of joy in his eyes when he saw his three friends. But he refused to give up his guns -- ever. He was convinced that he was still in Iraq -- and that he needed his weapons to defend himself. The three friends' planned intervention had failed. The next day, Dionne telephoned a number of hospitals and counseling centers. But no one could help.
Not long thereafter -- at some time around 9 PM on October 6, 2005 -- police officers were dispatched to the Vista Village Apartments. Joe Dwyer had slid a mirror out of the apartment's bedroom window to help him spot Iraqis creeping across the roof in the twilight. He picked up the phone and used military code for calling in an air strike, ordering fighter jets to speed to his own address.
Suddenly he heard a noise. Were Iraqis trying to break in, he thought?
Without warning, Private First Class Joseph Dwyer opened fire -- through the windows, the walls and the ceiling. He fired off more than 200 rounds. Under normal circumstances, Texan police officers don't take kindly to people firing guns around apartment complexes. But then -- luckily for Dwyer -- his commanding officer intervened, showing the head of the SWAT team Dwyer's famous photo. He told them that Dwyer was no nut case, but an American hero, whose own father and brothers were also police officers.
The police officers telephoned Joe's brother Brian, a fellow law-enforcement officer living on Long Island. Sitting on his living-room couch in his pajamas, Brian tried to calm his little brother down. Three hours after the standoff started, Joe laid down his weapons and gave himself up.
The next day, Dionne Knapp sent the commander of Fort Bliss an e-mail, saying that Army officials were "proud to display him as a hero" but had now "turned their back on him." In the wake of the shooting, Joe was admitted to a hospital for treatment. He was given medication and counseling. Another veteran, who also suffered from PTSD, came to talk with him every day. But it didn't help.
Dwyer was given an honorary discharge from the Army. A little over a year later, on July 10, 2007, the Restoration and Resilience Center opened its doors at Fort Bliss.
Army psychiatrist John Fortunato has a small office in the outpatient clinic. He has a buzz cut and wears khaki pants. His office furniture is strictly no-frills; he's not interested in keeping up appearances. Fortunato is a Benedictine monk, but he also fought in Vietnam. When he returned from Southeast Asia, he found himself face down in the dirt every time a car backfired. Now, whenever a soldier insists he's absolutely fine, Fortunato replies: "Do you think if you just wait this out, it will go away? Go down under Gaywick Boulevard and see those guys living in cardboard boxes who are about my age. Those are my buddies from Vietnam. I guess it didn't go away."
Combat trauma usually triggers three typical behaviors. First, soldiers avoid situations that scare them. Joe Dwyer, for example, didn't go out to see movies anymore.
Second, they are continuously plagued by memories of combat. They see their fallen comrades, and they see themselves killing others -- as if it were a film projected in their head on a continuous loop.
Last but not least, they are constantly on edge. In a combat zone, the only way to stay alive is to keep all your senses on full alert at all times. But, off the battlefield, such hyper-alertness is damaging. "They never relax," Fortunato says, "and they come back, and their central nervous system is really kind of fried."
The first thing doctors do is to prescribe sedatives. Soldiers are then given counseling to encourage them to speak about the images plaguing their minds in the hopes of reducing their impact. It also helps for them to discuss their experiences with others who have had similar ones. Oftentimes, though, even that is not enough.
A Unique Therapy Regimen
Fortunato has identified nine areas in a soldier's psyche that his program works to address. First he tries to alleviate some of the nervousness and constant tension. The head drives the body crazy, as Fortunato puts it, so his program aims to relax at least the body. For example, battle-scarred veterans are given acupuncture treatments, massages and biofeedback.
There is also Reiki, a Japanese form of therapy that Fortunato calls "the craziest thing we do here." He describes it as a bit like a laying-on of hands. When his superiors first heard about it, they thought that he was the one who had gone crazy.
Likewise, veterans play water polo twice a week. "This helps them socialize again," Fortunato explains, "because the pills can't do that." Granted, his patients are given psychopharmaceuticals, but only half as many as other doctors tend to prescribe.
On Thursdays, the soldiers are obliged to go out in public. For a person who has had first-hand experience of house-to-house fighting in Fallujah, the local mall is the most frightening place in America. "Soldiers call Wal-Mart 'The Evil Empire,'" Fortunato says: It has lots of people, you can't see what's happening everywhere, and there's no way to assume control. Precisely for these reasons, Fortunato regularly marches his troops over to Wal-Mart, and whenever they feel the panic rising, they use breathing techniques he's taught them to help rein in their fears.
About 60 percent of the veterans who undergo this therapy regime are eventually healthy enough to return to duty. Half of that is usually considered a success. Fortunato estimates that every soldier discharged on account of PTSD costs the army $350,000 (€263,000), whereas his program costs only $28,000 per patient. Still, he is quick to point one thing out: "I really don't care about the numbers," he says. "I care about the soldiers. But I had to sell this."
Since starting his program, Fortunato has been visited by almost every high-ranking member of the American military. Defense Secretary Robert Gates has stopped by, for example, as has Admiral Michael Mullen, the Chairman of the Joint Chiefs of Staff. Other visitors have included senators and members of Congress as well as top European military officials.
The longer the war in Iraq drags on, and the more violent the fighting in Afghanistan becomes, the more pressing the need to address PTSD. And it appears that no one has had more success treating it than John Fortunato.
Descent into Death
Matina Dwyer says her husband often wished he had lost a leg in the war instead of his mind. "Dr. Fortunato explained things to us we did not know about," she says. Such as how important talking is.
After he was discharged from the army, Joe Dwyer was given a full disability pension, which amounted to about $2700 (€2,025) a month. He and Matina moved back in with his parents in North Carolina, into their lovely, big brick house with its own boat landing right on the lakefront. But, even there, Joe couldn't free himself from his memories of Iraq. He took to fishing for 16 hours a day. He drove his Harley around aimlessly. He was pleased about the birth of his daughter, Meagan, but the baby started crying whenever he got near.
Things took a turn for the worse when Dwyer bought the house in Pinehurst. Although rosebushes were blooming in front of the house and the air was filled with the smell of pine trees, Joe pulled down the blinds and spent his days playing war games on his computer. He bought himself an AR-15 assault rifle. When Matina tried to take it away from him, he threatened her: "Someone's going to die."
In August 2007, he returned to the veterans' hospital for another six months. But, within five days of returning home, he was back to inhaling Dust-Off.
Matina took their daughter and moved out. Three months later, Joe Dwyer was dead.
Shortly after Dwyer's death, Fortunato traveled from Texas to North Carolina. There, he met with Matina and Dwyer's parents and gave them their son's dog tags. He also told the family about his new treatment center and how he'd put a large photo of Joe on a pillar at its entrance. "It was nice to hear that," Matina says. But it was also painful. "Why couldn't Joseph have had all that?" she asks.
Dionne Knapp, one of Joe's fellow Musketeers, often thinks that she might have been destroyed by her experiences if Joe hadn't gone to war in her place.
Photographer Warren Zinn went back to Iraq and tracked down Ali, the young boy he had photographed in Dwyer's arms. Though Ali can only walk with difficulty, he has survived.
And Maureen Dwyer, Joe's mother, thinks about the photo of Joe on the front pages of all those newspapers. She remembers her premonition that he would never return. "Joseph never did come home," she says.