A war within

Something was wrong with Michael. His aunt, Cindy Bumbico of Warren, knew this. She knew the boy who began his military career by playing with G.I. Joe action figures in the backyard ended it by trying to stay awake on 26-hour guard duty. She knew that when he came home he complained of seeing lights flash in his head at night and that he slept barricaded in his room with his back to the wall beneath a window. She knew that he was short-tempered and would leave his family for hours at the suggestion that something wasn't right with him.

When he came home from Iraq, Michael John Ecker, 25, was not the same person, but he never opened up to his aunt.

Except for one conversation.

"I remember him coming over and laying on the couch one day in March and telling me that that was the day he had to kill the very first people that he did ... He said, 'I will never get over this. I will never forget this day as long as I live,'" she said.

Bumbico said Michael's parents tried getting help through Veterans Affairs.

On Aug. 28, 2009, Michael shot himself.

According to a Champion police report, he fired a round inside his parent's Champion home as his family called police for help.

He saluted his family before turning the gun on himself.

His obituary said he was a victim of "post-traumatic stress disorder and traumatic brain injury."

Taking a toll

An average of seven veterans take their lives each year in Trumbull County, according to a study of county coroner records. Through that study the Tribune Chronicle has identified at least two veterans of the recent war in Iraq. Relatives like Bumbico are left to wonder how much combat-related stress played a role in the suicides.

Veterans account for 20 percent of all suicides in the United States, according to Veterans Affairs Secretary Eric Shinseki. However, Trumbull County coroner records dating back to 2000 show Trumbull County often outpaces that statistic. In 2007, veterans accounted for 37 percent of the suicides in the county.

These suicides take place across the age spectrum, though the majority seem to be middle-age to elderly victims. According to 2000 Census data, veterans are 16 percent of Trumbull County's population. However, they make up more than 16 percent of its total suicides in all but two years.

Coroner Humphrey Germaniuk keeps case files on suicides and tries to find one reason, called a stressor, that caused someone to take his or her own life. For example, many elderly veterans are believed to have committed suicide for health reasons.

Germaniuk and a mental health professional with the VA said people do not usually commit suicide for a single reason. Though the mental health professional said instances of post-traumatic stress disorder (or PTSD) are on the rise in the military, it's difficult to determine what role it plays in veteran suicides, which are also on the rise nationally. A soldier with a stress disorder might also have relationship problems, money problems or trouble at work. These are more likely to be listed as the ''reason'' someone took his or her life. In fact, staff at the coroner's office said in an entire decade, Ecker's family was the only one to suggest post-traumatic stress disorder as the cause.

Edgardo Padin, chief of Psychological Services at the Lewis Stokes Cleveland VA Medical Center, has been studying stress-related disorders among veterans for two decades and said more work should be done to mentally prepare veterans for combat and families should be aware of the risk.

He estimated that about 5 percent of veterans in the northeast Ohio VA two years ago were returning with stress disorders. He believes that number has gone up to about 8 percent - a rise he credits to multiple deployments.

"We've sent over 2.75 million soldiers to Iraq and Afghanistan; and not only that, we've sent them a second or third time. It takes its toll," he said.

Other factors?

According to information from the Veterans Affairs Web site, a large body of research indicates a connection between PTSD and suicide, but it states there is a debate about the reason for the increase - whether it is the stress alone or things that accompany it such as depression and substance abuse.

As the war continues, the VA reported that suicide among veterans who could have served in Iraq and Afghanistan has increased by 26 percent from the years 2005-07, according to a USA Today report.

But some believe hanging all of those suicides on post-traumatic stress disorder may be oversimplifying the problem.

"It's important for people to understand it's not just about PTSD," Padin said. "It's what they bring home from the war.''

That could include questions about their future, feelings of disillusionment with their previous life, hopelessness and depression.

''Major depression has incredible implications for suicide. Most suicide attempts are in the midst of major depressive disorder,'' Padin said.

Padin said soldiers suffering from a stress disorder can notice it in different ways and in different degrees of severity. He mentioned one case of a soldier who was fine except when he had to drive under a bridge. That one thing would cause the soldier to have a panic attack.

There are common signs that someone has a stress disorder. Padin listed "hyper vigilance," such as what Ecker's aunt noticed. He said someone suffering from PTSD would always seem to be on the alert. With that, there could be accompanying problems such as depression or drug and alcohol abuse. Injuries sustained in combat, such as a head injury, can complicate problems. For example, the lights Ecker complained of seeing could be attributed to a head injury.

Possible warning signs of suicide include things such as someone giving away possessions, or having several family members over for a meal where they had not done so before. Sometimes they could bring up personal memories to their family.

"If a soldier won't talk to them, seems isolated or won't go out in public or if they're bunkering down, that is definitely a problem," Padin said.

At war with a stigma

Army Staff Sgt. Justin Jewell of Southington, who fought in the Battle of Fallujah in 2004 has not been diagnosed with post-traumatic stress disorder, but he knows there's something wrong.

"Stress problems. My whole unit. Everyone has it ... I'm still having problems that I'm dealing with every day," he said.

For Jewell, the stress manifests itself when he's at home.

"I'm jumpy and loud noises bother me. I flinch and sometimes I duck. None of us can sleep very well. We toss and turn," he said.

Even though he hasn't sought help, Jewell said he thought it would be easy for a soldier to get help through the military if he felt he was experiencing a stress disorder. However, he said many don't because of the stigma that comes with it.

"The majority of the guys do not want to talk to mental health experts. They don't want to get looked down on because people would think they're sissies or that sort of thing," he said.

Padin said the military needs to work to overcome that stigma, and to mentally prepare soldiers like Jewell. The latter could be as easy as additional training, the former Padin compared to trying to move a mountain.

Padin cited a new predeployment program such as "Battlemind," which claims it gives soldiers skills to cope with combat stress. The program, which has the tagline "Armor for your mind," attempts to teach soldiers ways to remain positive during obstacles and challenges and to rely on their fellow soldiers as well as themselves.

But problems that would prevent a soldier from seeking help occur in the culture of the military itself, Padin said. He said that soldiers stigmatize people who seek help for stress - the "sissies" idea Jewell described.

Padin said he sees soldiers who are afraid that their friends will know that they've broken down. Others threaten to leave therapy if they think their records will get out and affect their careers. This is a very serious and difficult problem to overcome, Padin said.

"The Department of Defense and company commanders are working really hard to do away with this. This is a massive culture change ..." he said.

Reaching out

Padin said soldiers who have sought help are now being asked to talk to their fellow soldiers about seeking help if they need it.

Jewell said the members of his unit rely on each other for their mental health. His unit stays in contact even when they're on leave.

"When we are by ourselves or around other people we know we get tense and uncomfortable. You're always wondering what your buddies are up to so you keep calling," he said.

When asked how friends and families could help, Jewell said they could be there to listen.

"Communication is good," he said.

Padin commented that reports of stress-related disorders in the United States military go back as far as the Revolutionary War, but it's almost as though everyone forgets about their effects after the war is over. Stress disorders can stick with a soldier long after the war has ended.

This could lead to something that Vietnam War veteran Jay Hays only recently realized about himself. He heard stories about veterans who had high job turnover, had drinking problems or had relationship problems, but his problem was subtle.

"I wasn't a candidate, but I did (have a problem). I was diagnosed officially about six months ago," Hays said.

Hays was a combat aviation crew chief and a platoon sergeant with the 281st Assault Helicopter Co. Hays had steady work. He had no relationship problems. He never touched alcohol.

"I absolutely didn't like crowds, in a restaurant or anywhere. I get my back into a corner or against the wall. Everything has to be in front of me so I can be in control," he said.

Hays believes community support helps. He said some people were hostile to veterans when he returned home and he felt vulnerable.

"You crawl into a shell," he said.

Ways out

The good news, according to Padin, is that as more people become aware of the link between combat stress and veteran suicides, there are more opportunities to keep veterans from slipping through the cracks.

"At this VA we are extremely well-equipped (to help) ... We have a lot of resources to do community outreach," Padin said, pointing out the Stokes center has patient advocates to help veterans navigate the VA system.

Padin said friends and family members shouldn't pressure soldiers into talking, which in itself can be stressful, but he said communication helps if they let the soldier be in control of how much he or she discusses.

"Ask general things, like 'How does it feel for you to be back,' that kind of thing. Get the conversation started without pushing it," he said.

Padin said support groups can help those suffering from a stress disorder, but it's important for family and friends to be there for soldiers as well.

"Their greatest need after a traumatic experience is to be actively engaged and to have relationships where they feel safe and comfortable, where they can talk to people and feel supported," he said.

brodgers@tribtoday.com