FORT LEAVENWORTH, Kan. (April 29, 2010) -- Ryan Kranc was traveling with the 3rd Armored Cavalry Regiment near Ramadi, Iraq, on July 23, 2003, when his convoy was hit with an improvised explosive device.
Kranc, now an Army major, survived. His commander, his friend, Capt. Josh T. Byers, did not.
Six years and two full combat tours later, Kranc committed himself to recovering from the emotional wounds sustained on that day in 2003.
While serving in Saudi Arabia in 2009, he notified his command that he had a problem. Although he had sought counseling before, Kranc decided he needed more intervention. He entered treatment for post-traumatic stress disorder at Landstuhl Regional Medical Center in Germany for six weeks. Kranc said the traumatic events of the war have forever changed his life, but because of his treatment he can now move forward.
Kranc is stationed at Combined Arms Center - Training awaiting the start of the Command and General Staff College Intermediate Level Education class in August. He wants to share his story in the hope that other service members suffering from PTSD will realize that they are not alone and there is nothing wrong with asking for help.
"When I came forward and said I needed help six years after the fact, I had nothing but support from my chain of command, and I think that by and large, that's the predominant attitude in the Army now," he said.
Although Kranc chose to fight his battle with PTSD head on, he said that doesn't mean he'll stop grieving for his friend.
"I don't mean to say that people need to get over it," he said, "because I think there are certain things, particularly in traumatic instances, that you want to remember. You want to remember that you were sad because your friend died. You're honoring them and there's nothing wrong with being sad. But I think it's also important to remember that I don't think your friend would want you to be so incapacitated that you could not go on."
Kranc said he's had no stigma from being diagnosed and treated with PTSD and no ill effects on his career. He has a mantra for coping with PTSD:
1. It's OK to be human.
2. I can't control everything.
3. It's acceptable to grieve. It's OK to be sad. It's also OK to move on; it's OK to continue forth and do your best for the better of the team to honor their memory.
"You're not broken, you're not damaged," Kranc said. "You're not mentally unstable. You're human. You're having a natural reaction to an unnatural occurrence or extraordinary act."
Diagnosis and treatment
Dr. Patrick Armistead-Jehle, a clinical neuropsychologist at Munson Army Health Center, has not specifically treated Kranc, but has treated other Soldiers with PTSD. Health care providers at MAHC's Community Mental Health, currently located at Hoge Barracks, treat PTSD cases on an outpatient basis.
Armistead-Jehle said patients don't have to experience a combat deployment to have PTSD symptoms. They can come from any traumatic event, such as a car accident or sexual assault.
Armistead-Jehle said there are three categories for PTSD symptoms. The first is re-experiencing the traumatic event, such as having a nightmare or flashback. The second is avoidance or emotional detachment. The third set of symptoms are arousal, such as insomnia, being startled, hypervigilant or "snapping" at friends and family.
Some of these symptoms are normal after combat, Armistead-Jehle said, or even helpful during deployment. When servicemembers have conditioned themselves to be hypervigilant for a year, it takes time for them to re-integrate back into garrison life, he said. When these symptoms begin to interfere with daily life on a long-term basis or are severe, servicemembers should seek help.
"If someone's on the fence and unsure, I would say come and see us," Armistead-Jehle said.
Kranc said he experienced the typical symptoms of PTSD: mood swings, apathy, loss of interest in activities he used to be excited about. He couldn't sleep. He couldn't get specific images out of his mind. He was angry and restless.
Kranc said one of the worst feelings was survivor's guilt.
"There's a guilt associated with the converse, 'Thank God it wasn't me' - it becomes this cyclic process of: Why me' Thank God it wasn't me," he said. "There's so many different emotions that get wrapped up in this critical event."
Kranc made the decision he did not want medication to be part of his treatment for PTSD. His health care provider used Eye Movement Desensitization and Reprocessing, known as EMDR. It's a comprehensive approach to therapy that involves stimulation while talking about a traumatic event.
Armistead-Jehle said EMDR is one of many treatment options available for PTSD.
"PTSD and depression are highly treatable conditions that, with effective therapy or treatment, can be brought into remission or under control," he said.
Armistead-Jehle said research suggests that a combination of medication and exposure-based therapy is the most effective for PTSD. Patients do have some choices concerning how they would like to be treated, and Armistead-Jehle said the treatment itself has to be a coordinated effort with the patient and care provider. He said the treatment typically focuses on re-integrating the traumatic experience into a person's regular cognitive functions.
"You're never going to forget it, it's always going to be a negative memory, but it doesn't have to drive a person's life," Armistead-Jehle said.
CMH has a full-time staff member fully dedicated to walk-in patients who want help immediately. Patients can also contact the appointment line at 684-6250 to schedule an appointment.
PTSD and family life
Kranc said it wasn't easy to admit he was experiencing PTSD.
"I would say, the quickest way to find out if you're different is ask people around you," he said. "And spouses are good at this. Spouses very much understand your baseline, and when you come back from a year, there's going to be a perceptible difference."
When Kranc returned from his first deployment to Iraq, his wife, Molly, began to notice changes in her husband. He was angry, he had trouble sleeping and she noticed he was drinking more alcohol than usual. At first, she thought the alcohol itself might be the problem.
"He had a really short fuse, and you almost felt like people had to walk on eggshells around him," she said.
Molly said her husband's behavioral issues would come and go in waves. It wasn't all bad, she said, and when the problems started, she and her husband both took action and got counseling.
"I did benefit from the family life chaplain," she said. "I had to focus on things that were going well, no matter how small they might have been at the time."
About a year after his first deployment, Kranc deployed again. Molly said that looking back, the redeployment was a big part of her husband's issues because he didn't have much time to spend with his family and readjust to normal life.
Molly said the hardest thing for her dealing with PTSD was when her husband pushed her away.
"I think spouses are probably pretty well aware of PTSD," she said. "I just want to encourage them to try to not take it personally ... if (service members) could just snap their fingers and get better, they would."
She had to learn to be patient; she couldn't force him to get better and she had to keep trying to convince him to get help.
"We would like to think that we wouldn't abandon our loved ones if they were sick with a physical ailment, and it breaks my heart to see families give up on their Soldiers," she said.
Fort Leavenworth has many services available to help families with such problems, including Family Life Chaplain (Maj.) Matthew Gibson, who works at the Main Post Chapel.
When Gibson went through training for counseling, he had to go through treatment to resolve his own PTSD issues. Also deployed to Iraq, Gibson remembers the names of dozens of Soldiers who died, how they died and how other Soldiers reacted to their deaths.
"Those chaplains that had been deployed, we all cried like babies in that room," he said.
Not only do servicemembers have extreme traumatic events to cope with emotionally, Gibson said problems could be compounded because servicemembers don't have the time to deal with the issues while deployed. He said PTSD issues can manifest themselves later through family or marital problems.
One of the ongoing programs at the Main Post Chapel is a class "Faith-Based Solutions to the Combat Experience." There's a separate class for couples, for spouses and for servicemembers using spirituality-based books "The Combat Trauma Healing Manual" and "When War Comes Home," both published by Military Ministry Press. Couples who have experienced combat deployments facilitate the couples group.
Gibson also said services aren't limited to recent combat veterans. He's also counseled civilians on post or veterans with PTSD issues that developed as early as the Vietnam era.
Confidentiality and honor
Armistead-Jehle and Gibson said while the majority of their services are private, there are a few instances in which they are required to breach confidentiality. If the person is likely to hurt himself or herself, if the person is likely to hurt someone else, or if there is a report of child abuse, providers are required to report. However, Armistead-Jehle and Gibson said that those instances are discussed up front, so patients will know beforehand.
Kranc said while he experienced no stigma from seeking help, he understands why servicemembers might be nervous about discussing something they can't control.
"I think the predominant mindset is, 'I'm not broken, I can fix myself, there's nothing wrong with me, why is everyone fussing about this''" he said.
Kranc said because servicemembers are well trained and competent in their fields, it's easy to build up a mentality that he or she can do anything.
"People are so used to being in the driver's seat, particularly leaders in combat," he said. "They call the shots, they have all the resources available to them in a combat context, and they can do things at relative ease within their own safe-house setting."
Kranc said it takes an incredible amount of courage and honor for a servicemember to say they have an issue and to deal with that issue.
"And, it's one of those things you can't do alone," he said. "You can't self-medicate. You can't compartmentalize it, because over time, that pressure builds up, sometimes to a catastrophic affect."
He's seen a change in attitudes about seeking help for PTSD since the beginning of the war.
"Chains of command should be supportive and avenues of care and treatment are available," he said. "Our suicide rate is horrific and high - it would be negligent of us as leaders to interpret a cry for help as an attempt to get out of another deployment or an attempt at malingering or to treat a Soldier asking for help as anything less than legitimate."
Kranc said he had to commit himself 100 percent to getting better. He believes his initial attempts to get counseling didn't work because he wasn't into it, or he wasn't convinced he had a problem.
"You have to admit something is wrong and submerge yourself in the concept of healing, and, above all, become open minded to treatment," Kranc said.
Since her husband sought treatment in Germany, Molly said she's noticed a change. Kranc said family is his highest priority, and he's using his time at Fort Leavenworth to be a good husband and parent to their two children.
One of the best things, Molly said, is watching her husband get involved in giving back to the community. Kranc is getting ready to race in the Command and General Staff College Triathlon May 1 and the Kansas City Triathlon May 23, and he's raised more than $5,000 so far in private donations for the Wounded Warrior Project.
Kranc said in addition to the treatment at Landstuhl, while he was in Germany he benefited from the Fisher House, the USO and the Wounded Warrior Project. His goal now is to give back to the groups that helped him.
"Now being able to give back and help others has been enormously cathartic," Molly said of her husband.
"I feel like we don't have to walk around on eggshells," she said. "We don't have to try and avoid social situations. We're just moving forward with life in a normal way, we enjoy each other's company, there's more laughter and fun in our house."