"In my first deployment, we lost 19 guys, including five of my closest friends," Sam said. "My company commander was killed in an IED attack. In my second deployment, I lost one of my soldiers to a vehicle [attack], and then a week after we returned home, one of my soldiers committed suicide."
In his job as a correctional officer at a national prison, Sam has kept his PTSD under control. He knows that he has to, because he feels that the public -- and prison management -- sees PTSD as something that could make him "snap."
"PTSD isn't something that's going to affect my job," he said with conviction.
For Sam, the responsibility of protecting the public from convicted felons is honorable, the badge and uniform familiar. In his job at the prison, he's a soldier serving his country again, and he wraps his military training around him like a cocoon.
"When I'm in uniform, I'm still working for the government, protecting society," Sam said. "I love protecting America. It's something that I cherish. It gives me a sense of duty."
But six weeks and counting into the shutdown, Sam and fellow correctional officers, many of them veterans, are feeling the pressure. How will they pay their mortgages? How will they pay for gas to drive to work when credit cards are maxed out? Sam estimates that he's got another three weeks before everything implodes.
"Yesterday, I stood in line for a handout of food from our union," Sam said. "I work for everything I need. Taking a handout is something new to me; I feel really ashamed. To have to stoop to this level because I'm not getting paid is hurtful, really hurtful.
"We fought for that red, white and blue," Sam said. "We died for it. And everything we bled for is betraying us right now."
Fellow veteran John Kostelnik is also disillusioned. He represents a thousand union employees at the federal prison in Victorville, California; nearly 80% of those employees are veterans. He says he's getting dozens of calls a day from frantic union members who never expected to go without paychecks this long.
"We swore an oath when we took this job as law enforcement officers, and we see the honor in it," Kostelnik said. "But honor doesn't put food on the table for our kids."
Strict requirements
Considered essential federal employees, correctional officers are required to work during the shutdown. Per government regulations, all approved time off has been canceled. Moonlighting is discouraged. A memo released this week by the Office of Personnel Management makes it clear that anyone calling in sick without special permission -- even to go to a therapy appointment -- will be considered AWOL (absent without leave) and disciplined.
"They have said loud and clear that if we don't show up to work, we will face discipline, so we can't go to these appointments," Kostelnik said, adding that disciplinary actions limit promotion.
"This just breaks my heart," said Emory University psychiatry professor Barbara Rothbaum, who served on a congressionally mandated committee that investigated the treatment of PTSD by the Department of Defense.
"It's so hard for veterans to admit they have an issue to treat and to make it to their appointments at all," Rothbaum said. "To then to put up another barrier to treatment just seems criminal."
The only way to get permission, Kostelnik said, is through the Family and Medical Leave Act. But few of the employees with PTSD will apply, he added, fearful they will then be considered unfit for duty and demoted or removed.
"The horrendously sad thing is that they're not wrong," said Washington State University's Lois James, who has published studies on the prevalence of PTSD in prison employees. She found extremely high rates of PTSD among all prison employees, not just the 30% who are veterans of wartime tragedy.
"There's a huge stigma around mental illness," James said. "Sometimes, when correctional officers do speak up about having a hard time, they're not provided with the support they need and either taken off assignment or shuffled around."
The Bureau of Prisons did not respond to a request for comment.
In a statement, the Department of Veterans Affairs encouraged any veteran "to visit the closest VA health care facility, all of which provide same-day services in primary and mental health for Veterans who need them," or to call a 24/7 crisis intervention line at 1-800-273-8255.
A risk of suicide?
For federal workers such as these in the nation's prisons, the financial clock is ticking. Stress, anger and despair are mounting. If that stress is combined with mental disorders such as PTSD, experts say, it could be a perfect prescription for disaster.
"What we know is that folks who live with PTSD, who live with depression, who live with addiction, they will have an elevated risk for suicide," said Stanford University psychiatrist Dr. Shaili Jain, who specializes in PTSD. "That's a fact.
"Whatever we can do to make sure they're getting the support they need, the care they need, is huge in preventing that really tragic outcome."
Just over a week ago, a federal prison employee attempted suicide, said Clinton Buchanan, who oversees the South Central Regional Office of the American Federation of Government Employees Council of Prison Locals.
The person, who was an Army veteran, "had stress over not being able to pay child support and not being able to pay the bills," Buchanan said.
"We're going to make sure that he gets help and he stays under observation," Buchanan added. "He's had a lot of support from family and co-workers, and I'm hoping that he's able to hold on and not try again."
In an interview with local media not long after that, 20-year union representative Edward Canales expressed concern that stress from the ongoing shutdown could lead to more such incidents.
"If this shutdown does not stop, we are going to have fatalities. We're going to have suicides," said Canales, who is a retired correctional officer and 100% disabled veteran.
Just a few days later, US Department of Veterans Affairs Secretary Robert Wilkie sent a letter to the president of the American Federation of Government Employees, David Cox, accusing the union of politicizing the shutdown and of promoting "insulting and misleading stereotypes" of today's veteran as a "victim."
"AFGE Local President Canales' attempt to use Veterans as pawns in a political debate while exploiting the serious issue of Veteran suicide is nothing short of disgraceful," Wilkie wrote. "I ask you to apologize publicly for your AFGE colleague's reckless comments and to outline the steps you plan to take to ensure AFGE leaders demonstrate proper respect for our nation's heroes."
Response from the union was swift. In a letter dated the next day, Cox called Wilkie's comments "absurd" and "contemptible."
"I have some advice for you," Cox wrote. "Try learning a little something about the causes of veteran suicide attempts. You will learn that prior mental health conditions (such as PTSD) and stressful life events including financial pressures and unemployment are well-known risk factors for suicide."
Wilkie's office responded in a statement, "It's disappointing but not surprising that AFGE would double-down on its exploitation of the tragic issue of Veteran suicide and PTSD in order to make political arguments," the statement said.
"Once again, the 'Veteran as victim' myth is just that, and for AFGE to wield it as a weapon in policy disagreements is as disgraceful as it is demeaning to our nation's heroes. We expected more."
Though insulted, Canales finds the charge of political maneuvering ironic. "I voted for President Trump," he said. "I'm also a Republican."
Reducing the risk
One of the major risk factors for PTSD in her study, Jain said, was feeling a distinct lack of support from management and the administration.
"I had a lot of people saying that suiting up to go into the prison was like suiting up to go to hell," Jain said. "They felt prison administration and management were more concerned about the inmates than the well-being of the employees."
But on the flip side, Jain said, workers who felt supported by management were less likely to be stressed, "and it was actually protective against developing PTSD."
Rothbaum points to the many evidence-based therapies available for PTSD today and encourages veterans and other prison employees struggling with the condition to find appropriate treatment. Emory Healthcare, for example, has free two-week inpatient sessions funded by the Warrior Care Network that she says have been "transformative."
"So, even if they have tried one and it didn't work, don't give up hope," Rothbaum said. "It's hard work."
Back at work, Sam is worried about his colleagues. He found one woman sobbing uncontrollably. Her landlord was not cooperating, and she was frightened she would soon be homeless. Another buddy, a fellow veteran with PTSD, is going through a divorce. He was recently kicked out of his home, separated from his family and unable to make child support, and Sam is afraid he's a walking tinderbox.
"I'm like, we have to check on this guy," Sam said. "What he's going through is pretty intense, and I don't want to see anything bad happen. When you put all this together, it's like a disaster waiting to happen."
But no matter how dark his feelings or how intense his PTSD symptoms, Sam knows that he will never hurt anyone or take his own life. His reason is powerful.
"My best friend in Afghanistan died to save me," Sam explained. "And so I inherited his life. I can't commit suicide like some of the other guys can, because this life isn't really mine to take."
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