Why did some WWII soldiers turn down morphine?

WOUNDS He is back from Afghanistan - and traumatized. Like him, many soldiers are lone fighters against the ghosts of war. And against the Bundeswehr. Can the Defense Minister change that?

■ The disease: Post-traumatic stress disorder, or PTSD for short, often occurs in soldiers, police officers or firefighters as a belated reaction to a stressful event that is extraordinarily threatening. PTSD can also occur after accidents, violent crimes or serious illnesses. Symptoms include insomnia, anxiety, flashbacks, or strong startle reactions.

■ The numbers: According to a study funded by the Department of Defense, between two and three percent of soldiers develop PTSD after being deployed abroad. The US government estimates that up to 20 percent of all returnees from Afghanistan and Iraq suffer from PTSD. Since 2002 there have been around 120,000 Bundeswehr soldiers for the ISAF mission in Afghanistan. In 2013, German soldiers were deployed abroad in 22,000 cases, including multiple deployments.

■ The therapy: The treatment of PTSD is often based on deep or behavioral therapies combined with trauma therapeutic techniques. This includes, for example, the "Eye Movement Desensitization and Reprocessing". Processing processes in the brain are stimulated through eye movements. Studies show that if the wounded are given morphine immediately, the risk of PTSD is halved.

■ The story: Even if the term was first coined by psychology in the 1980s, the symptoms of PTSD have been known for longer. During the First World War, traumatized soldiers were referred to as "war tremors". During the Second World War, the word "war fatigue" was common in the United States.

FROM REGENSBURG GABRIELA M. KELLER

Since that day in Kabul, nothing has been the same as it was before. Not his life, especially not himself, and not the struggles that he has to fight, even if he is so tired of the fighting.

He has a lot of opponents now. All the things in everyday life that others take for granted. He says that he is constantly faced with everything that no longer works. “That you only do rubbish and laundry. Then come these thoughts that you don't want to give in to. "

It's just after eight, a gray winter morning. Oliver Hanke lives in a semi-detached house on the outskirts of Regensburg, it is only a short distance to the banks of the Danube. Hanke let his dog off the leash. Hoar frost crunches under his shoes. The mongrel sniffs in the frozen grass. Fat crows flutter in the mist over the river.

Oliver Hanke says that he sweats through two or three T-shirts every night. “I dream, and as a rule it's about fight and death.” The morning walk helps to leave the night behind. After ten minutes he turns around, his head hurts, his jaw, his back. "It's the fear that sits on the back of your neck," he says. All muscles contract. Even the intestines cramp so much that there are cracks in the mucous membrane.

Hundreds of them return traumatized every year

There are experiences that are so stressful that the soul cannot process them. The term psychology has come up with for the consequences is Post Traumatic Stress Disorder: PTSD. The Bundeswehr has registered increasing numbers since Germany took part in missions abroad. In 2006, 83 soldiers were treated with the symptoms in army hospitals. In 2012 there were 1,143. These are the officially known cases.

It is the political will of the federal government that German soldiers are stationed in crisis countries. “From the army to national defense in the Cold War, the Bundeswehr has become an army for international missions worldwide.” This is what the Bundeswehr website says. The new Defense Minister Ursula von der Leyen traveled to Afghanistan immediately after taking office to visit the troops there. Germany needs a modern, powerful Bundeswehr, she said. For security and peace in the world.

The missions are associated with serious risks for the soldiers. Hundreds of them return traumatized every year. Von der Leyen also said in Afghanistan: "The most important thing is the person."

A few days later, she announced on Günther Jauch's talk show that she wanted to take care of traumatized soldiers more in the future. But what does that mean in concrete terms?

"The minister started work after the holidays and is currently being briefed on the various topics," says the Ministry of Defense.

Oliver Hanke is a staff sergeant, a police officer, i.e. a military policeman. He has asked to keep his real name and that of his relatives secret. He fears that he will become aware of al-Qaeda cells collecting information on Afghanistan veterans. He says he's not scared for himself, but for his family. The feeling of constant mortal threat seared into him a long time ago.

The day that divided his life into a before and an after was more than ten years ago. It is June 7, 2003. A suicide bomber detonates a bomb next to a bus carrying 33 soldiers who are on their way to the airport in Kabul to fly home. Four are killed, 29 injured. It is the worst attack on the Bundeswehr abroad to date.

Oliver Hanke says he had foreseen days before that something was going to happen. At that time he was a bodyguard, his job is to protect leaders of the Bundeswehr. He's often out there to identify potential risks. He saw that the shops all around were closing and that there were hardly any people on the street. He warns his superiors. But they pretend he just wants to play himself.

Then the bomb explodes. It's about three miles away, behind the headquarters building on Jalalabad Road.

He has to wait, the recovery takes time. “This terrible tension. Knowing the attack is coming, then it will come. The anger, the sadness. That triggered a lot. ”After an hour, he drives to the scene of the attack.

He no longer has any sense of time. But he still sees the pictures in front of him today. It is hot. The air smells like dirt. A helicopter is circling in the sky. Covered body parts lie on the street. One of them is still sitting in the bus, he no longer has a head.

Hanke is not the only one who says that the deed has been announced. In the summer of 2013, several media reported that the armed forces had been warned. The Ministry of Defense, on the other hand, always insisted that there was no evidence.

Oliver Hanke is 45 years old, not very tall, with a rosy face and square glasses. You don't see the illness in him. But to get from one day to the next, he needs medication. 300 milligrams Valoron, 225 milligrams Lyrica, 120 milligrams Cymbalta. Painkillers, nerve brakes, antidepressants.

The physiotherapist says it took him two years before Hanke's pain was reduced to a bearable level: “Every session of therapy was a struggle. That wasn't nice for me either. You run into a wall. "

Oliver Hanke lay down on the bench in the narrow practice room. The treatment of the jaw is behind him. Now comes the rest of the body. “The whole meat suit,” says the therapist, a wiry, nimble Russian who chats cheerfully while he braces his elbows into his patient's shoulder muscles. “You don't assume that a person can have so much.” Once Hanke tried to relieve his tension himself. He twisted, yanked to himself. So tight that his stomach slipped a little through his diaphragm and no longer closes properly. “I just want to fight,” he says.

He was 20 years old when he joined the Bundeswehr, first as a temporary and then as a professional soldier. He wanted to go out into the world, and as a bodyguard, ways opened up for him. NATO headquarters in Brussels, Sarajevo, then Kabul. After the attack, he felt hardly supported. “Then the agenda went on. We were left alone. ”In the team, they never talked about it again.

His doubts about the ISAF mission grew over time. But he continued as if nothing had happened. In 2004 he flew to Afghanistan again, this time Kunduz. 2005 again. His trauma took hold without his knowing anything.

In March 2006 he flew back to Bavaria. That was the moment when it suddenly stopped working. “Inside, everything was black, absolute emptiness. There was nothing left and I got scared because I didn't feel anything. "

His wife says the Bundeswehr, that was his life, it was always like that. Stephanie Hanke came home from work in the early afternoon, a petite woman, an administrative clerk, 37 years old. She prepared the snack, ate it with her husband and cleared the table. “He's always on guard,” she says. "I'm always looking to make sure there is no stress, and that is incredibly exhausting." Her voice is trembling, she is crying.

Sometimes it ticks when someone stands in the way

He brought the anger with him from Kabul, which is now constantly looking for new goals. It happens that he yells at her. If she has to get up at night, he suddenly stands in front of her, ready to jump, in a panic.

Even on the street, he gets angry every now and then. Sometimes it is enough that someone stands in his way. His wife can hardly bear it with worry when he is alone. What can happen. “The hardest part is dealing with the fear that one day he'll go nuts out there. He can turn someone off with his left hand. "

Oliver Hanke has not forgotten the hand movements, even if he has not trained for a long time. Since the old daily routine has dissolved, it has had to give itself an orderly structure. He tends to hang around his appointments with psychologists and therapists. They drain him so much that he has to lie down.

An hour later he comes down the stairs. He sits down with his wife. There is light wooden furniture in the small living room, and postcards and photos are stuck to the wall. Gismo, the dog, sleeps on the carpet.

He says that he can no longer do what he once liked to do. Do not do sports anyway. Not even cooking. He lacks the strength. He can no longer enter the sauna in the basement of the house. Memories come up in the heat. “Triggers,” say the psychologists. Key stimuli. Hanke can no longer distinguish between the images in his head and the situation in front of him. "It's like I'm still standing on Jalalabad Road in Kabul."

There are many triggers. The sun. Noise. Smoke. Gasoline smell. He lowers the blinds as soon as it gets warm outside. If his wife puts out the candles, he leaves the room beforehand.

Nobody knows exactly how many soldiers actually suffer from post-traumatic stress disorder. The number of the Bundeswehr, 1,143 cases in 2012, is likely to be only a fraction. Those who receive therapy in civil institutions are not included. In November, the Technical University of Dresden, together with the Psychotrauma Center of the Bundeswehr Hospital in Berlin, published a "dark figure study". According to this, PTSD does not occur as often among soldiers as feared. Between two and three percent of the operational soldiers are affected, that would be an average of 200 to 300 per year for the ISAF mission. However, the study also found that almost one in four experiences something traumatic while on a mission. And that mental disorders are recognized and treated in less than one in five cases.

Johannes Clair, second chairman of the Association of German Veterans, says that the official figures are only partially meaningful. “It's only about the cases that have been dealt with. And if I take the dark figure study as a reference, then something does not fit together. "

In addition, trauma can also trigger other psychological problems: addictions, depression, anxiety disorders. They don't appear in the statistics.

Clair says a soldier swears an oath on his country and deserves special care. “But that's still far too little in the mind. Politicians could position themselves significantly more and lower the hurdles for those affected. "

Oliver Hanke noticed in the course of 2007 that his pain was getting worse and worse. At first he thought it was his back. The orthopedist sent him to the neurologist. He said right away: PTSD. Oliver Hanke thought: "I don't have anyone to deal with."

The doctor only diagnoses schizoid disorder

His son says that he can no longer take it. That he has to move to another city. “My father was my hero. I've wanted to be as cool as him all my life. ”David, 19 years old, comes from Hanke's first marriage. After his parents separated, they had little contact for a few years. Then he fell out with his mother and moved in with his father. That didn't go well for long. So he took an apartment. He was 16. “I tried to take the pressure off not being a problem child.” He's now had episodes of depression. He says he used to be afraid of his father. They often clash. Roar at each other. David says he's now reacting much more aggressively than before. “It makes me so mad that it is what it is. It pisses me off like hell. "

In autumn 2007, Hanke was admitted to the Ulm Army Hospital. He did not yet know that there was still another struggle ahead of him, the struggle for recognition, for his economic existence. He says the psychiatrist told him: “There is no such thing as PTSD.” The doctor later wrote in his report that “no evidence” could be found for a PTSD diagnosis. Instead, "pronounced narcissism and an additional schizoid disorder" is the reason for his condition.

Hanke flew safely to Afghanistan. He returned sick. The diagnosis hits him like a blow. Basically, it says that his suffering has nothing to do with the effort, but is his fault.

The lawyer Arnd Steinmeyer says that he represented many soldiers with PTSD who had to struggle with the armed forces for every detail. “And there are rapidly more.” He is one of the few experts in military service damage proceedings. He says the laws were improved in 2011. The only thing is that there is a lack of implementation. "It is a huge problem to break the structures."

Every traumatized soldier has to have his diagnosis checked by an expert. The lawyer is amazed at the reports that come out of it. “Sometimes people argue so bluntly that you don't even know what to answer.” He often reads that soldiers' problems lie with trauma in their childhood, not with their war experiences. “The question is whether these are not very favorable reports for the Bundeswehr. Because that means the claims are rejected. "

Peter Zimmermann heads the Bundeswehr Psychotrauma Center in Berlin. The psychiatrist says that the subject is no longer as taboo in the Bundeswehr as it used to be. There are prevention seminars before and after each use. “But the dark figure study taught us that that may not be enough.” Everything takes time. “The Bundeswehr is a large corporation. It would be too much to expect if you think that changes can happen as quickly as in a medium-sized company. "

But the longer Germany's soldiers participate in international conflicts, the more return with PTSD. The Afghanistan mission ends on February 28, 2014. For many, the war does not end there.

It often takes years for symptoms of post-traumatic stress disorder to emerge. It may be that there is still a lot to come for the Bundeswehr. Zimmermann is currently negotiating with the Bundeswehr leadership to set up additional day clinics. “If we have that, then we can do it,” he says. If not, then the Bundeswehr hospitals could reach their limits. There are currently 101 beds nationwide for soldiers with psychiatric illnesses.

Oliver Hanke says that he had to look for every piece of information himself. He has spread a folder on the table in front of him, pulls out reports, doctor's letters and notices. In spring 2008 he hired a lawyer. He appealed against the diagnosis from Ulm and ensured that he could be examined again in Hamburg. His superiors in the Bundeswehr supported him, otherwise everything might have turned out very differently. As it is, however, he received his diagnosis in May 2009: PTSD, due to the assignment.

Today, he says, he is fighting his country

But that did not end the dispute with the Bundeswehr. Sometimes it was about the appraiser who was to be assigned to him. Times the amount of his military service damage. Hanke is 70 percent severely disabled. The Bundeswehr only wants to recognize 60 percent. The rest is said to be due to his divorce around ten years ago. His lawsuit is still pending: "Oliver Hanke against the Federal Republic of Germany".He says he used to fight for his country. Today he is fighting against his country. “The Taliban used to be the enemy, the aggressor out there. And suddenly the enemy is in the system. "

The Ministry of Defense writes that the care for members of the armed forces who are mentally disabled is taken very seriously. A spokesman sends the answers, three A4 pages, on which it is listed what help is available, for example the Berlin Psychotrauma Center, which opened in 2009, with its research and clinic department. In 2011 the federal government appointed a PTSD officer as the central point of contact for those affected. There is also the psychosocial network of psychologists and doctors at the locations. But there is currently only one psychologist stationed in Afghanistan. And more than 3,000 soldiers.

In contrast to physical damage, psychiatric diagnoses are often not clear, writes the spokesman. "In order to meet the legal requirements, contradicting diagnoses have to be resolved seriously."

The only problem is: filling out applications, meeting deadlines, appointments, all of this takes strength that the sick often lack. “What they force on us,” says Oliver Hanke. In the meantime he has received the one-off payment of 150,000 euros that he was entitled to as compensation. He has to divide the money well. He is still a soldier and receives his salary, 2,400 euros net. Soon he will be dismissed as incapacitated. He assumes that after deductions he can still expect a pension of 1,500 euros. At the time of his trauma he was still a contract soldier, otherwise his demands would be considerably higher. "I'm falling through the bars."

His wife says it looks like they are leading a normal life. But that the facade holds is entirely up to it. He says that if it weren't for Steffi, then I wouldn't be anymore.

"I can't even manage to read the post."

"How can you say that so calmly."

"I won't let that touch me anymore."

Every morning she puts pieces of paper on the table on which she writes his appointments. Otherwise he forgets everything.

Oliver Hanke says that he is sometimes afraid that Steffi's love will be used up.

He tried to kill himself twice. Last time he took pills. That was two years ago, after a tantrum outside his in-laws' house. "I don't want to do it to Steffi anymore. And I don't want to do it to myself anymore. "He slept for three days. But he survived. But sometimes he doesn't know exactly why.

His illness has long been chronic. “It's no longer about healing. It's just about how many painkillers and psychotropic drugs I need. ”He tried to learn to play the guitar. But his concentration is not enough. He keeps the guitars that he bought on eBay in his hobby room. There they are now, on targets with human outlines.

Oliver Hanke says that he learned a lot from his dog. Make things happen. Take the day as it comes. "How bad does that sound? I use my dachshund-terrier mix as a guide. "

But that, he says, is the hardest thing for him. To let things take their course. And finally stop fighting.

Gabriela M. Keller, 38, is a reporter for the taz