Before Lt. Col. Andrew Horne left Iraq in 2005, where he was the civil military operations officer for western Anbar province, he and every marine under him above the rank of staff sergeant attended a briefing on PTSD given by the division psychiatrist, a Navy officer. "They said it's been determined that it comes from a feeling of helplessness, and elite units like Marines don't get it," Horne says. "And the ones who do get it have usually been discipline problems before or have a pre-existing problem. So it was really designed to, one, make you not report it yourself and, two, be suspicious of anyone who was reporting it."

More than two years later, despite a growing acknowledgment within the Corps of the mental costs of war, PTSD remains underdiagnosed and undertreated. At Twentynine Palms, some of the civilian counselors on base avoid sending marines to division psychology because at least a dozen marines they referred there for treatment were given "personality disorder" diagnoses and kicked out of the service [for more on the personality disorder scandal, see Joshua Kors, April 9 and October 15, 2007]. Mary Jo Thornton, a licensed family therapist and former base counselor, remembers one Marine sergeant coming back from his appointment with the naval psychologist, saying, "Thanks, you ruined my career. Now they're ad-sepping [administratively separating] me out of the military. The little guy talked to me for a half-hour and told me I had a personality disorder." Many active-duty marines go off base to veterans' centers for counseling, because only there do they feel safe from punishment.

When Cpl. Michael Cataldi, who served with the Third Light Armored Reconnaissance Battalion based at Twentynine Palms, returned from his first deployment, he was angry and depressed. "Helicopters scared me because I picked up a helicopter crash," he says. "Thirty marines and one Navy corpsman all died, and we were the first four people there. I did a body count when I was 20 years old." The pilot was on fire, and Cataldi had to put him out with a shovel. "I smell burning flesh when people grill chicken. I can't be in crowds," he says. "This all happened before I went over the second time."

It took months between deployments for him to get an appointment with the regimental psychologist, and when he did he sensed the doctor was trying to talk him out of his symptoms. "He kind of told me, as I was telling him what I was feeling, that I wasn't really feeling that," he recalls. Cataldi was diagnosed with anxiety and depression, not PTSD, given anti-anxiety meds and antidepressants, and sent back to Iraq. There he was put in charge of the guard at Camp Apache.

After four months the medical officer left Iraq, and suddenly Cataldi had no more meds. "I had a breakdown," he says. "I even defecated all over myself, and I don't remember doing it." Cataldi was evacuated to the combat stress center at Camp Al-Assad, where he was diagnosed with PTSD and given three weeks of treatment. When he returned to base, he began to get disciplinary write-ups: one for an unauthorized absence, the other for allegedly threatening his executive officer. "They were trying to take my rank and call me a horrible marine," he says. Cataldi ended up facing a nonjudicial punishment proceeding and losing half a month's pay. "They thought I was trying to go home," he says.

When Cataldi returned to the States at the end of his second deployment, with only a few months left on his service contract, he stayed low to the ground, afraid his commanders would take his rank or kick him out. In his last evaluation before leaving the Corps, Cataldi had a fifteen-minute appointment with the naval psychiatrist on base, who told him he had "anxiety disorder."

Unlike the Army and the Air Force, almost every Marine and Navy base has a brig on board, and that makes it easy to use the brig as storage for a troubled marine. "We think pretrial detention is overly prescribed," Faraj says. "More often than not it's used as a tool, because the command doesn't want to deal with someone." Consequently, marines with mental health problems are not only locked up in a brig without adequate mental healthcare but are asked to make serious legal decisions while actively suffering from mental disorders. "I think doing a court-martial at that time is a setup," Judith Litzenberger, the civilian defense lawyer, says. "It's totally devoid of due process. You don't have a client there that you can talk to. We need some long-term psych hospitals that can treat these guys." The hospital at Pendleton lost its psych treatment certification a few years ago and never worked to get it back, so the camp no longer has an inpatient psychiatric facility. Marines who attempt suicide in the brig are sent to the Naval Medical Center in San Diego, but the naval hospital offers only acute care to marines, so once the suicidal marine is stabilized, he is sent back to jail. Though commanders do not purposely use pretrial detention to break a marine, that is often the effect on a marine suffering from PTSD--as it was in the case of Sgt. Patrick Uloth.

Uloth's command thought "he walked on water," Faraj says. After two tours in Iraq, they even recommended him for an officer-training program. "I thought the Marine Corps did no wrong," Uloth recalls. "I could watch you do something and if the Marine Corps told me you didn't do it, I believed it. I loved the Marine Corps that damn much." But untreated PTSD, pretrial detention and official callousness destroyed his career in the Corps.

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