Editor's Note: With some 3,500 soldiers from the 4th Brigade Combat Team (Airborne), 25th Infantry Division due to return this month and in March, our military freelance writer Nina Peacock explores the many ways in which Fort Richardson Army Base prepares for their homecoming. This is the first in a series of four articles on their pending return.

Capt. Chadwick Shade operates a virtual reality simulator used to treat patients with PTSD inside Elmendorf Air Force Base's hospital. The video game-like scene on the computer - a village in Afghanistan - is the same scene a patient would see while wearing the simulator's virtual reality goggles. Photo by Nina Peacock

In a closet-sized room inside the hospital on Elmendorf Air Force Base, a computer screen displayed a video game-like graphic of a dusty street in a small town somewhere in Afghanistan. An Islamic call to prayer echoed in the distance. American soldiers in Humvees cruised down the road.

Then, a violent explosion erupted within a building in the foreground. It shook the scene and scattered debris. The once-peaceful street flooded with bloody victims and chaos. A soldier in a Humvee slumped forward, fatally wounded by the blast.

This dramatic scene reenacted in a tiny room in Alaska is one of the tools used by doctors at the 3rd Medical Group to aid patients who suffer from post-traumatic stress disorder (PTSD): a virtual reality simulator.

It's one of many resources available to approximately 3,500 soldiers from the 4th Brigade Combat Team (Airborne), 25th Infantry Division who will be returning to Fort Richardson Army Post from Afghanistan in February and March. Before their return, Fort Richardson's behavioral health teams geared up to screen soldiers and, when necessary, treat them.

Maj. Noel Cuff, chief of behavioral heath at Fort Richardson, used studies of combat soldiers to predict how many his staff will need to be prepared to treat during this re-deployment. "Re-deployment" is the Army's term for a groups' return.

A 2004 study of soldier and marines published in the New England Journal of Medicine estimated that 11 percent to 17 percent of soldiers returning from combat may be at risk for disorders three to four months after their re-deployment. Those results are similar to the U.S. Army Medical Department's Mental Health Advisory Team's report in 2007, in which 17.9 percent of soldiers in Operation Enduring Freedom reported a problem with their mental heath. These disorders can manifest as PTSD, traumatic brain injuries (TBI), depression, substance abuse or generalized anxiety.

The soldiers of the 4th Brigade will be screened several times before and after their re-deployment.

First they will fill out a health assessment in-theater. Two days after they return to Alaska, a medical provider will review that assessment with the soldier. At 30 and 180 days after returning home, soldiers will fill out a post-deployment health assessment, which asks questions about their physical and mental health. If at any stage there are warning signs, they will be offered treatment.

It's all part of the Army's plan to stem problems early and keep disturbed soldiers from going unnoticed.

"There's plenty of resources out there," Cuff said. "We'll identify these problems and get these people plugged into treatment. ... We just hope soldiers take advantage of them."

VIRTUAL TREATMENT

Cuff pointed to a brochure in his office that lists the resources. The mandatory screenings will help the Army assess the mental health of the returning brigade, but soldiers who experience problematic symptoms don't have to be treated at Fort Richardson. They can connect with Military One Source, an all-around resource for military members and their families, or seek help form the Anchorage Veterans Association, which treats active-duty soldiers, for example.

Soldiers also will participate in a new online screening process 14 to 21 days after re-deployment, in which they can speak privately to providers at Tripler Army Medical Center in Hawaii or Madigan Army Medical Center in Washington.

In some cases, Cuff may refer a soldier to use the virtual reality simulator, although the simulator is limited in its ability to treat PTSD.

During treatment, soldiers wear video-screen goggles that immerse them in game-like scenes seen on the doctor's computer screen. They can stand or sit on a box with subwoofers that make the soldier feel such movement as a Humvee rolling or the ground rocked by an explosion. A scent machine can create smells of diesel fuel, a weapon fired, middle eastern spices, or body odor.

Capt. Chadwick Shade, demonstrating the machine, said they considered getting a heat lamp to simulate Afghanistan's temperatures.

Soldiers also wear headphones to hear the sounds the simulator feeds them. The doctor can talk directly into the headphones to speak with the soldier and bring him or her mentally back into their room in Alaska, out of Afghanistan.

But if a soldier's combat experience does not match what the simulator can provide, it can't aid them in exposure therapy, where a soldier repetitively retells or virtually relives his traumatic experience in order to gain comfort with it. Instead, Cuff often uses cognitive behavior therapy in his treatments of soldiers with PTSD.

FIGHTING STIGMAS

Some soldiers may not seek treatment at all because of stigmas associated with behavioral health disorders. The 2004 New England Journal of Medicine report stated, "Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care."

Cuff explained soldiers may be worried that seeking treatment may be seen as a sign of weakness, or could negatively affect their career.

"It's OK to get mental health treatment," Cuff said. "We emphasize the normal reaction to an abnormal event. Your buddy dies, you see somebody blow up – well, yeah, you're going to have some nightmares.... but that's OK, you can get better."

He said medical board discharges from mental illnesses are rare.

Dan Powers, a soldier from 1993 to 2006, was medically discharged because of his PTSD diagnosis. He had mixed feelings at the time. Now he is a student at the University of Utah and a self-proclaimed advocate for fighting stereotypes about combat veterans with PTSD. He has co-written an article about PTSD in elderly veterans for his university's sociology journal and he's working on a special issue about veterans coming back to school.

"You see people killed that shouldn't get killed," he said. "The reality is you hope to think that the world operates in a way that if you're good in life, then typically good things will happen to you. But sometimes bad things just happen to people for no explainable reason. And so it's really difficult to try to reconcile that within yourself."

Being in a war zone was in some ways easier for Powers, because there it's easy to "focus on the next mission," he said. When he had time to think about his experience, that's when he started having trouble functioning in normal daily life.

For the soldiers soon to return from Afghanistan, he offered some advice.

"The truth is that you have to acclimate back.... You have to allow for a little bit of time to let some things to just settle down because the body's used to it, the mind's used to it," he said. "Sounds that simple, but in practice its much harder."

This article published in The Alaska Star on Thursday, February 4, 2010.