Another day, another lurid headline. A Marine Lance Corporal in Texas, recently returned from three back-to-back tours of duty in Iraq, and allegedly suffering from PTSD, breaks into his former girlfriend's home, stabs her to death and then waits, "covered with blood and looking dazed," in the parking lot for police to arrive and arrest him. On the surface, another brutal domestic violence story, with a very tragic ending. Behind the headlines, though, more questions than answers about troops' after-care, and whether ethnicity (the Marine in question is Hispanic) plays or ought to play a part in how PTSD is diagnosed and treated.
First, some facts. Marine Lance Corporal Eric R. Acevedo, 22, was arrested over the weekend for allegedly murdering his former live-in girlfriend, in Saginaw, Texas, a suburb of Fort Worth. The Fort Worth Star-Telegram has been covering the story, and it's typically gruesome, but it's also a tragedy for all concerned. The victim, who was a single mother; the alleged perpetrator, who will likely do substantial prison time; and both people's families -- the 10 year old girl who now grows up motherless, as well as Acevedo's family, who believed he was struggling with PTSD, but was sent back to Iraq.
There are several items that stand out immediately from this story. One is the obvious: three tours in Iraq by the 
time you're 22? Wow. That's a lot of compressed heavy living right there, at a very young age. (Acevedo joined the Marines just a few days after graduating from high school.) Another is obvious from the photos that run with the story. There's one of Acevedo in his dress blues, looking fit and tanned and what they call in language of the personal ads, "height-weight proportional." Then there's his booking photo, where he looks, oh, about 44, not 22, and seems heavy, puffy and bloated. It doesn't even look like the same person.
Then there are the comments from his family, which underscore that to them, Acevedo wasn't the same person anymore. (Granted, those have to be taken with a grain of salt, because, after all, they're coming his family. But still, listen to what they have to say.) The following quotes are from the Star-Telegram. His aunt: "I know he was a good soldier. I just don't know what happened. When he went in, he was so proud. When he came out, he had so many problems. I don't know what happened to him." His dad, who feels that his son has never been the same since his second tour of duty in Iraq: "I gave him to the government nice and healthy, and the government returned somebody who is capable of doing something like that...I'm out of words as far as to just how sorry I am."
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In the Marine Corps, Lance Corporal Acevedo did three tours of Iraq over four years' time, returning for the last time 13 months ago, and leaving active service to go into the Individual Ready Reserve. According to a Marine spokesman quoted in the article, Acevedo had been stationed at Twentynine Palms, California, "and was deployed for about seven months in 2004 and again in 2005-06, and for six months in 2006-07." The Marine spokesman says Acevedo was "a good Marine," and received various medals for his service, including the Marine Corps Good Conduct Medal, Navy and Marine Corps Achievement Medal, Iraq Campaign Medal, Global War on Terrorism Service Medal, Global War on Terrorism Expeditionary Medal, National Defense Medal and Combat Action Ribbon.
But according to at least his parents, something drastic happened to Acevedo between his second and his third tour of duty. Says his father, "I was very proud of him. He served well over there. He never complained. But when he did this last tour, he was feeling kind of like he didn't really want to go because of the nightmares and stuff he had had from the second time. My wife tried to stop it over medical issues. They still sent him off."
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Because it's always worthwhile to find out if there's any backstory worth knowing, I did a little digging. 
What had Acevedo experienced that might have caused the change in his behavior? Deep within the archives of the Marine Corps' own website, there's a wonderful, even iconic photo of a grieving Lance Cpl. Acevedo, grasping someone who's identified only as a young relative in an emotion-filled hug. The occasion is a memorial service to commemorate the 13 lives lost by Acevedo's battalion, 10 of them on a single day in Fallujah, making that one of the largest losses of American life in the Iraq War. Acevedo served on that tour with the 2nd Battalion, 7th Marine regiment, also known as "the War Dogs." On December 1, 2005, ten of his brother Marines died in an IED blast while out on patrol. While all lives lost are precious, and close-knit groups like the Marines feel every loss deeply -- one wonders, is it harder to endure large losses at once, than multiple losses, individually? Has this even been studied? (Seemingly not.) One thing is sure: studies show that the more traumatic incidents a person is exposed to, the greater the likelihood that they will develop PTSD.
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From what his father says, reported by the Fort Worth paper, Lance Cpl. Eric Acevedo wasn't coping so well anymore. Six months ago, a military doctor "diagnosed his son with post-traumatic stress disorder and placed him on medication that seemed to calm him down." But there's some dispute about whether those facts were strictly true. The paper also reports that, according to records kept by the Dept. of Veterans Affairs, Acevedo had "not enrolled enrolled in the VA North Texas Health Care System or applied for any VA benefits." So time will tell which of these stories are true. But one thing is certain: If Acevedo really did have diagnosed PTSD, at the end of his second tour (after the Fallujah incident), it wasn't a good idea to send him back so quickly for a third deployment, if at all.
And then there are other implications. The multiple tours and long deployments, with insufficient breaks in between tours, all recent news reports indicate, seem to be wearing troops out, not just the Marines. (See discussion in today's Military Times.) Even the Dept. of Veterans Affair's own data shows that when it comes to PTSD (this data is based on Vietnam veterans), "higher levels of war-zone exposure tend... to contribute to a higher degree of symptoms." (Longer tours and more of them certainly constitute higher levels of war-zone exposure.)
In addition, the same study showed that "race/ethnicity appeared to be an important risk factor, as African-American and Hispanic Vietnam veterans tended to report more mental health and life adjustment problems. For PTSD in particular, Hispanic male veterans had the highest prevalence rate..." Not to argue for preferential treatment for various ethnic groups, but, shouldn't the implications of this data at least be acknowledged? Maybe PTSD is affecting different people differently, even if we don't know all the reasons why yet. (There are other implications, too, about medications that purport to solve some problems while increasing risks of others; and the jagged line where domestic violence and PTSD can intersect, with often tragic consequences -- but we'll have to save both those discussions for another time.)
Editor's note: The Marine Corps story about the memorial service for Acevedo's battalion is linked here. The list of Marines who died on 12/1/05, according to Marine Corps sources, are as follows: Staff Sergeant Daniel J. Clay, 27, of Pensacola, Florida; Lance Corporal John M. Holmason, 20, of Suprise, Arizona; Lance Corporal David A. Huhn, 24, of Portland, Michigan; Lance Corporal Adam W. Kaiser, 19, of Naperville, Illinois; Lance Corporal Robert A. Martinez, 20, of Splendora, Texas; Corporal Anthony T. McElveen, 20, of Little Falls, Minnesota; Lance Corporal Scott T. Modeen, 24, of Hennepin, Minnesota; Lance Corporal Andrew G. Patten, 19, of Byron, Illinois; Sergeant Andy A. Stevens, 29, of Tomah, Wisconsin; and Lance Corporal Craig N. Watson, 21, of Union City, Michigan. All 10 Marines died December 1, 2005, from an improvised explosive device while conducting combat operations against enemy forces in Fallujah, Iraq. All 10 Marines were assigned to 2nd Battalion, 7th Marine Regiment, 1st Marine Division, I Marine Expeditionary Force, Twentynine Palms, California; During Operation Iraqi Freedom, their unit was attached to 2nd Marine Division, II Marine Expeditionary Force (Forward).
