Post-traumatic growth: Past the blast, and stronger for it
By MARTIN KUZ | STARS AND STRIPES Published: May 28, 2015
The noise jolted Joshua Fosher back to the moment he thought might be his last.
The first lieutenant stood talking with a group of soldiers in a motor pool at White Sands Missile Range in New Mexico. Across the lot, the crew of an armored vehicle began to deploy the massive collapsible bridge attached to its base. As the bridge unfolded upward and then eased toward the ground, the lift gear slipped. Tons of metal met concrete with the thud of a bomb detonating.
Most of the soldiers reacted by taking a step or two back. Some dropped into a crouch. Fosher moved toward the sound in a furious trance, hands curled into fists.
“I felt this extreme strike of anger,” he said, recounting the scene from last spring. “It took me a couple seconds to remember where I was. I had to tell myself, ‘Breathe, breathe — let it go.’”
In his mind, he had returned to Afghanistan, to the dirt hill where a bomb blast revealed the invisible distance between life and death.
On the morning of June 10, 2013, Fosher led his Army platoon into a farming village in the eastern province of Ghazni, an area choked by the Taliban insurgency. Joining the patrol were his unit’s commander, Capt. Dusty Turner, and a platoon of Polish troops led by Sgt. Jan Kiepura.
A handful of soldiers walked into a crop field and started ascending a slope. Fosher reached the top as Turner entered the field 30 feet behind him. Kiepura was midway between them when his foot landed on a short plank of wood buried in the soil. His weight triggered a homemade bomb that blew apart the earth.
The explosion shoved Fosher onto his stomach. Straining to stand, he turned and stumbled toward Kiepura. A medic tried in vain to revive the Polish soldier while Fosher retrieved pieces of the dying man’s body.
Farther down the hill, the blast had slammed Turner on his back. He slapped his arms and legs, grateful to find none had been torn off. His head rang from a ruptured eardrum, and like Fosher, he suffered a mild traumatic brain injury.
The two American soldiers flew later that day to Bagram Air Field, one of the primary U.S. bases in Afghanistan, to recuperate at the base’s TBI clinic. For the next week, they slept long hours to ease their nausea, headaches and dizziness, and doctors worked with them to restore their motor skills and short-term memory.
A month after the explosion, a Stars and Stripes reporter met the pair at Forward Operating Base Ghazni, where they were stationed with the 40th Mobility Augmentation Company, 2nd Engineer Battalion. By then, Fosher and Turner had made a second trip to Bagram after their symptoms recurred, and on the advice of doctors, their commanders pulled them from the patrol rotation for the rest of the unit’s tour.
Both men had persuaded their superiors to allow them to stay in Afghanistan, and they talked with Stars and Stripes for a report about deployed troops coping with brain injuries and combat trauma. The death of Kiepura, a husband and father, had exposed them to war’s absence of order.
“For some reason, I’m alive and he’s not,” Turner said at the time. “For some reason, God allowed me to be here. I have no idea why.”
The questions shadowed the officers during the last three months of the 40th MAC’s deployment and after returning to White Sands. Jagged memories of confronting their own mortality pierced the cognitive haze that sometimes still clouded their thinking. Doubts about their recovery mixed with frustration as the healing process proved gradual and uneven.
Yet by last fall, as the lingering effects subsided, Fosher, 28, and Turner, 30, came to regard their experience in terms that might sound surprising, even irrational.
They believed struggling with mental trauma changed them for the better.
The hardship intensified their appreciation of life, deepened their bonds with loved ones. They had extracted meaning from the inexplicable, from a tragedy that neither would have chosen to endure but that evolved into a source of strength and motivation.
“You learn to savor the moment more because you don’t know what the next moment could bring,” Turner said in a recent interview. He is the married father of two young children, a mirror of Kiepura at the time of his death. “When you’re so close to losing the people who matter most to you, you want to notice the small moments that he won’t get a chance to.”
Growth through pain
The recovery of Fosher and Turner illuminates a concept that behavioral health researchers call post-traumatic growth. The idea counters the dominant perception of post-traumatic stress disorder as an irreparable condition that forever holds the mind hostage.
PTSD affects an estimated 20 percent of the 2.6 million troops who served in Iraq or Afghanistan, and common symptoms include acute anxiety, flashbacks, insomnia and social isolation. Many combat veterans with the disorder also exhibit a constant state of heightened alertness that carries over from the war zone.
Rising awareness of combat trauma over the last decade has led the media, with ample reason, to examine the link between PTSD and violent behavior, substance abuse, depression and suicide. But the coverage has obscured reports from the National Institute of Mental Health and other public health organizations that show most people overcome the condition.
The study of post-traumatic growth builds on the theme of resiliency, offering evidence that survivors of a life-threatening event can resurface with a renewed sense of purpose.
Richard Tedeschi and Lawrence Calhoun, psychologists at the University of North Carolina at Charlotte, pioneered research into severe mental trauma as a potential catalyst for personal change. In a 1995 survey, they interviewed 600 trauma victims and found that the majority believed their lives had improved in a handful of areas over variable periods of time.
The men and women related that they now derived more pleasure from daily life and enjoyed closer relationships with others, and possessed greater self-confidence and stronger spiritual beliefs. The two clinicians dubbed the phenomenon “post-traumatic growth.”
“It’s important to understand that people don’t choose growth over emotional pain,” said Tedeschi, repeating what he has told military and veterans groups across the country. “PTSD and post-traumatic growth share the same foundation and can coexist. The growth results from processing the emotional pain and coming to terms with it, even when they’re continuing to deal with symptoms.”
Tedeschi and Calhoun determined that trauma survivors who experience growth typically pass through a stage of “intense reflection” that may last several months or longer. Serving in Afghanistan provided little chance for Fosher and Turner to untangle their thoughts. They set aside introspection amid the havoc of war.
"PTSD and post-traumatic growth share the same foundation and can coexist."
Two months after Kiepura’s death in June 2013, a roadside bomb killed a pair of soldiers from the 40th MAC, Spc. Kenneth Alvarez, 23, and Pvt. Jonathon Hostetter, 20. Five days later, insurgents breached the unit’s base in Ghazni after detonating two vehicles laden with explosives outside its walls, the violent prelude to a six-hour firefight. The attack killed Staff Sgt. Michael Ollis, 24, of the 10th Mountain Division.
“I knew I didn’t entirely comprehend what was going on in my mind,” said Turner, a native of Center Point, Texas. “But I also knew our tour wasn’t over. It wasn’t time for a long walk on the beach to figure it out.”
The 40th MAC flew back to New Mexico that October. Both men had told their wives a sanitized account of the explosion that killed Kiepura soon after it happened, omitting details that might provoke even greater concern. They offered a more complete version after arriving home, yet while they could describe the blast and its physical aftermath, the full scope of their mental trauma remained beyond their understanding.
Nalani Fosher noticed her husband’s unseen wounds within days of his return. Conversations seeped from his memory after an hour or two. At the gym, she needed to explain how to use a piece of equipment long familiar to him. On hiking trails, he obsessively removed rocks, chunks of wood and other small objects as if he were in Afghanistan searching for evidence of buried bombs.
Fosher realized early last year that his mind required further care. He talked with Turner, who shared that his own problems persisted, and with the support of his commanders, Fosher began working with an occupational therapist at nearby Fort Bliss in Texas. He approached the weekly sessions with the belief that regaining his cognitive acuteness would help him subdue the inner tremors wrought by the explosion.
“If I tried to hide or ignore what happened, then it was going to rule my life,” said Fosher, who grew up in Exeter, N.H. “I lived through it, so I couldn’t be scared of it. I had to learn from it and move forward.”
Around the same time, Turner started visiting a psychologist at Fort Bliss twice a month. His wife, Jill, had glimpsed fissures in his placid personality. His anger spiked over minor matters and he grew anxious in public. During a family outing to a pumpkin patch, he walked away from the entry line, worried that the crowd would block his escape if an attack occurred.
“If I tried to hide or ignore what happened, then it was going to rule my life."
“He wasn’t the same when he came back from Afghanistan,” she said. “I could see pretty quickly that he wasn’t just going to bounce back and be happy or involved in stuff. He needed space and time.”
As he groped for meaning in Kiepura’s death, talking with the psychologist yielded less insight than his casual discussions with an Army chaplain at White Sands. The chaplain confided that his faith had wavered during multiple combat tours. For Turner, the revelation served as a kind of permission to reexamine his religious beliefs, and to consider his uncertainty a normal aspect of spiritual maturation.
“What he said made me feel like I could still be confident in my faith even though I was taking a step back from the way I had always viewed it,” said Turner, who was raised Protestant. “I was trying to figure out how I should view God when somebody who was no different than me ended up dead. What I eventually accepted was that it’s OK to not always find comforting answers. That’s part of faith.”
‘A natural, personal progression’
The American Psychiatric Association recognized post-traumatic stress disorder as a clinical diagnosis in 1980, five years after the Vietnam War ended. Public awareness of the condition spread slowly until the last decade, when coverage of troops returning from Iraq and Afghanistan explored how some struggle to leave war behind.
Tedeschi and Calhoun published their study of post-traumatic growth in 1995, and their thesis has received occasional criticism from behavioral health providers. Author David Morris, a former Marine who covered the war in Iraq as a journalist, described one reason for that skepticism in his book “The Evil Hours: A Biography of Post-Traumatic Stress Disorder,” published earlier this year.
In talking with leading PTSD clinicians, Morris writes, “Part of the undisguised disgust I encountered was no doubt due to the fact that the idea of telling someone that trauma might be good for them seems morally outrageous.”
His own misgivings about post-traumatic growth dissolved as he delved into the science and literature of PTSD. He pursued the book project, in part, to decipher the psychological fallout of his reporting trips to Iraq, where he narrowly survived a bomb blast in 2007. He contends that focusing on the cause of trauma has blinkered many clinicians to the potential for people to learn from their anguish.
“The pendulum has swung too far toward the assumption of PTSD,” Morris said in a phone interview. “By encouraging people not to dwell on the things that are upsetting, we miss a lot of opportunities to look at what might be gained from the experience. I saw that growth wasn’t simply a trend thing. It’s a natural, personal progression.”
Fosher’s memories of the bomb blast receded as summer gave way to fall last year. His therapy took the form of training one of his two dogs for skills competitions and exploring the wilds of New Mexico with Nalani. In February, she gave birth to their first child, and raising his son reminds him to savor the present instead of marooning himself in the past.
“You can’t have that split second control your life,” he said. “Was that split second awful? Absolutely. But you’re still here for some reason, so you try to use that experience rather than allowing it to destroy you.”
Last summer, Turner drove from White Sands to Columbus, Ohio, to enroll in a master’s program at Ohio State University. He visited a few family members and friends while wending his way north, and as the miles rolled past, he felt as though he were floating up from the ocean floor.
“You don’t specifically think, ‘OK, brain, it’s time to sort yourself out,’” he said. “But just having nothing to worry about helps recharge your mind.”
Jill joined him in the fall with their young son, and the couple welcomed a daughter into the family in February. He will earn his masters next spring before beginning a three-year teaching assignment at West Point Academy. Remaining in the Army without juggling the daily rigors of running a company of soldiers has enabled him to set down his internal burden. He has come home at last.
“I’ve always felt that people who suppress or avoid thinking about what happened to them are the ones who end up angry,” he said. “I’ve seen a lot of old soldiers who are just not right. I never want to forget what happened in Afghanistan. But I don’t want to live the rest of my life like I’m still there.”
1st Lt. Joshua Fosher poses with his wife, Nalani, and their infant son, Kai, born in February. Fosher suffered a traumatic brain injury in a bomb blast that killed a Polish soldier in Afghanistan 2 years ago. He was open about needing help after he came home. 'If I tried to hide or ignore what happened, then it was going to rule my life.'
PHOTO COURTESY JOSHUA FOSHER