Back from Iraq with Plenty of Problems
The patient came to Brentwood Hospital in handcuffs, escorted by Nacogdoches police. Paul Miles, 22. Something about making bombs and threatening to kill kids. He tested negative for drugs at Nacogdoches Memorial, and his parents had asked if he could be brought here to Brentwood in Shreveport.
During intake, he told the staff, "I have not had thoughts of hurting kids in years."
When he was passed on to Dr. Greg Seal, the treating psychiatrist, Miles was rambling, illogical.
post-traumatic stress disorder
"I don't want the cops to die," he told Seal. "I needed new boots."
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Seal got some of the patient's basic background: Five years in the Texas Army National Guard. Spent 2005 in Iraq. No history of physical, sexual or emotional abuse. No psychiatric history reported. Currently a student at Stephen F. Austin State University in Nacogdoches. Miles and a roommate lived in an off-campus apartment where, about eight hours earlier on this morning of November 20, 2006, police found gunpowder and PVC pipes. Federal agents were combing the place now. Neighbors were evacuated.
Fire fascinated him, he told Seal. He wanted to be recognized as artistic. He said he hadn't been sleeping or eating much. He understood the accusations against him, yet he was giddy, even euphoric during the interview.
Seal's impression was that Miles had bipolar disorder, type one, without psychotic features. Prognosis: "Guarded." He admitted Miles to the Enhanced Adult Psychiatric Unit, where he'd be monitored for signs of overt psychosis. He prescribed an antipsychotic called Abilify.
Over the next week, Miles talked about the need to build an arsenal "because the war is coming to America." You had to be ready for the coming doom, he would say.
Seal amended his initial diagnosis to bipolar with psychotic features. Still, he believed Miles had improved and would continue to improve with regular outpatient treatment. Seal set a discharge date of December 5, when he'd be released to his parents.
But Seal was beat to it. On December 4, Caddo Parish sheriff's deputies entered the hospital lobby with a search warrant and told nurses they would go from room to room until they found Miles.
Seal quickly wrote a letter "to whom it may concern" and gave it to the deputies, along with 30-day supplies of Abilify and a mood stabilizer called Depakote ER.
"I am writing this letter in support of Mr. Miles not being jailed," the letter stated, "as I believe any criminal activity he may have committed was the result of a very severe mental illness."
Saving the deputies the trouble of a search and seizure, Miles came down to the lobby on his own. The deputies took him to Caddo Correctional Center, where jail officials refused to dispense his meds. He stayed there for four days until he was extradited to Nacogdoches County Jail. It was December 8, 2006.
It would take a year and a federal court order before he was allowed to see a psychiatrist for treatment again.
During that time, Miles pleaded guilty to unlawful possession of a firearm — pipe bombs — and was sentenced to 30 months in federal prison. Prosecutors believe they brought a dangerous criminal to justice. But his family says the Paul Miles who came back from Iraq was not the Paul Miles they raised. Something must have shifted in the overhead compartment, and he came back damaged. And now, they say, the government he fought for has simply and coldly locked him away.
In October 2005, ten months into his second hitch in Iraq, Sergeant Paul Miles came up with a trick to surviving patrol. He thought of it a few days after someone tried to blow up his truck.
On patrol in the Sunni Triangle west of Baghdad, trying not to choke on sand, Miles pretended he was heading from his parents' home in Hallsville to the SFA campus in Nacogdoches. But then, just as soon as he hit North Street, he'd realize he forgot his pencil, so he'd have to whip back to Hallsville and then head to campus again. These security patrols were just like that, he wrote on his blog, "only there are no trees and the roads are more dangerous."
That trick was for mental survival, something beyond armor and artillery. There had been a lot of death in his head lately. It came from every angle, not just combat. First week of the month, a sergeant accidentally shot and killed himself while on base. Didn't think his 9-millimeter was loaded. Miles didn't get the guy's name.
When he was the Humvee's gunner, up behind the 240 machine gun, Miles was food for snipers. A six-foot-five sitting duck. But then, the entire truck was a target. You never knew when that dead donkey on the side of the road was going to explode. Insurgents stuck improvised explosive devices anywhere they could. On October 19, one was buried behind a brick. They were going from Talil Air Base to Anaconda. The driver swerved to miss the brick, and boom, Miles heard an explosion and saw a flash to his left. Blew the 240 straight off the turret. Amazing thing: No one was hurt and the truck still ran.
Sometimes those mental tricks worked. Other times, they imploded. A few months before, he was thinking about being with his friend Sarah, flying kites by Lake Nacogdoches. Then his alter ego butted in: Now that's not a fuckin' option now, is it?
The daydreams that seemed to stick were the ones where he was the "bad" soldier. In July, Miles blogged that being a good soldier didn't pay off, so "I have chosen to be bad. Hopefully I can intimidate my boss to move me into a new unit. I don't try to intimidate many people. Sometimes I scare people I'm not trying to scare. Maybe I should stop telling strangers how I could silently kill them four times before they hit the floor."
Yet nothing in Miles's military record indicates he was a bad soldier. He received an Army Commendation Medal, for "exceptionally meritorious service....His accomplishments reflect great credit upon himself, the 56th Brigade Combat Team, and the United States Army."
When the end of his tour was just a few days away, the bad soldier receded and Miles focused more on what home was going to be like. He'd need to get a gun permit. Just couldn't imagine not having a weapon on him. He figured a Desert Eagle .50, maybe. That was one reason he should live off-campus.
This time, at least, he'd be ready for people not caring about what actually went on here. When he had two weeks' leave in September, he found plenty of yellow ribbons but no one to talk to. The ribbons were more of a fashion statement than anything. Threw him for a loop. He had a sense then that he wasn't ready to move on with his life. Now he knew for sure and that somehow seemed better.
Before he left, he had to complete the post-deployment health assessment. A bunch of bland questions with the occasional zinger such as: "Have you ever had any experience that was so frightening, horrible or upsetting that, in the past month, you were constantly on guard, watchful, or easily startled?" Miles answered "yes" to that one, as well as the one about feeling numb or detached from people, activities or surroundings. Ditto for the one asking if he was concerned about serious conflicts with friends and family.
The tricky one was the question asking if he was concerned that he might hurt or lose control with someone. For that one, he put "unsure."
He was only at his parents' home a few days before he went back to school. He didn't feel like he could open up to his family. The few times he tried to talk, he just felt like they looked at him funny. Like when he told his mother about this little girl who tried to trade her infant brother for a Meal, Ready-to-Eat. That had really messed with him. But his mom just kind of blew him off. Not much he could do about that. Only another soldier could understand.
When school started, he moved into South Hall on campus and commenced drinking heavily.
In South Hall, rooms were set up like suites, with separate quarters sharing a common door. A few of the rooms were unoccupied, so those doors weren't locked.
"Last night, in a drunken stupor, I checked the security of my floor," Miles blogged on January 31, 2006. When he heard voices coming from the room adjacent to one of the empty rooms, "I opened the door with a loud creak. The guys next door got all pissed off and opened their door like, 'What the hell?!?' I told them they should leave their door locked. Next time, it may be Ali Baba comin' after them. Haha. There's only room for one paranoid nutjob in South Hall, and that's SGT. MILES!"
In October, he moved into an off-campus apartment with a National Guard buddy, Carl Timmons, whom Miles called Crazy Carl. They had been roommates before Iraq and got along well enough, even though Miles liked to mess with him. You could really dish it out to Timmons and he'd never do anything back.
Before Iraq, when Timmons came home one day and found his pet goldfish, Audi Murphy, dead in his bowl, Miles said Audi must have committed suicide. Stabbed himself with a fork and choked on orange juice pulp. Turned out Timmons had a lot of suicidal pets. Shithead the crawfish drank too much booze. Trogdor the tadpole shrimp drowned in a vial of rubbing alcohol.
While Timmons and Miles may have disagreed over the value of marine life, they were on the same page when it came to explosives. When they moved back in together, they fooled around with their own IEDs. Pipe bombs. They also grew marijuana and mushrooms — wanted to make a little money.
One September night, they grabbed a friend and went searching for something cool to blow up around campus, like a garden gnome. They wandered onto the Catholic Center grounds and found the next best thing: the Virgin Mary. All four plaster feet of her. They taped a cell-phone sized bomb to her head and boom, it shredded half her face. Loud as hell. Funny stuff.
Another funny thing happened the following month. Miles picked up an orange-and-white kitten from a guy giving away a litter in a Wal-Mart parking lot. When Miles took it home, the sucker scratched him, so Miles tied a twine noose around its neck and swung it around in a circle, expecting centrifugal force to kill it. When that didn't work, he just whipped the kitten up and down. That did it. He stuck the body in the freezer. The next day, he and Crazy Carl hung it from a flagpole outside the ROTC building.
Things weren't so funny the night of November 19, 2006. Miles and Timmons really got into it. They were arguing enough that Crazy Carl split to his girlfriend's. But around 1 a.m., amassing his powers of intelligence, Timmons went to the SFA Police station and told an officer that Miles had punched him in the face, thus putting police on a path to his own drug- and explosive-filled apartment.
Since Timmons and Miles lived off-campus, the university police notified the Nacogdoches Police Department, who dispatched an officer to talk to Miles. That's when officer Charlotte Hines saw the stuff on the floor: PVC pipes, powder, tacks, broken glass. Hines thought maybe this was more than simple assault. When she tried to talk to Miles, he just babbled. Complete nonsense. She figured it'd be a good idea to get him into Nacogdoches Memorial and see what drugs he was on. She also called for backup. Didn't know if anything inside was rigged to explode. Throughout the morning, agents from the Bureau of Alcohol, Tobacco, Firearms and Explosives, as well as the Fort Hood bomb squad, were on-site.
At a command center the agents set up across the street from the apartment complex, Crazy Carl was feeding ATF agents frightening information. After confessing to being involved with the Virgin Mary incident, Timmons told agents that Miles was extremely dangerous. He said Miles kept an AK-47 and a shotgun at the apartment. He said Miles also had a Tommy gun by his window. Miles had drawn a map of the viewable area outside the window and then calculated the distance to certain points on the map, so he'd know how far away he'd be shooting.
Timmons kept going: Miles said he'd be doing high school kids a favor by blowing off their heads. Miles wanted to eat a puppy. Miles hated blacks and wanted to kill a black child who lived next door to them. He also hated Catholics, which was why he wanted to blow up the Virgin Mary statue. Timmons made sure to tell the agents that he had felt just awful about going along with that. He had felt pressured. He said he confessed to a priest and had scoured eBay, looking for a replacement statue, but he couldn't find one he could afford.
He told the agents that Miles wanted to bury IEDs and a bunch of firearms behind the Veterans of Foreign Wars building and that Miles was extracting the deadly poison ricin from castor beans and threatened to use it on him. He said Miles wanted to plant a bomb in the parking lot of an auto repair shop that overcharged a friend.
Timmons never explained why, after hearing Miles talk for months about killing kids, he never went to the police. And as for Timmons's explosives? Just firecrackers, really. Homemade Black Cats. One of the agents asked Timmons about a jar found in his bedroom that had "two electrical wires and a plastic tube sticking out of the lid, and that also had two wood rods attached to the electrical wires inside the jar." Timmons said it was used for the express purpose of inflating balloons.
Meanwhile, ATF agents were collecting evidence from the apartment. This included a pound of gunpowder, PVC pipe glue and fittings, a four-inch cannon fuse, a box of cut tacks, and several broken beer bottles — material they figured was for shrapnel. Agents also found "an electronic remote detonator affixed to a residential doorbell lying on top of the kitchen refrigerator." Timmons asked the agents if he would be able to get any of the stuff back. Especially his GMC drill. He really liked that drill.
"They believed they interrupted Paul just before he was going to do harm to people," Miles's attorney, Wes Volberding, says of the U.S. Attorney's Office. "They were very concerned about Carl Timmons's reports that Paul had made threats against children."
Volberding, a private attorney who's in the Army Reserve and a major in the Judge Advocate General Corps, says prosecutors felt they stopped what could have been another Virginia Tech. He points out that the only thing they had to go on was Timmons.
He believes that, even if Miles suffers from bipolar disorder without post-traumatic stress disorder, Miles's combat experience was certainly a factor. As far as he and Miles's family are concerned, there are two injustices here: Training a man to fight and kill for his country, then refusing to fix him when he's broken; and casting him into a criminal justice system that is not equipped to treat the mentally ill.
Seeking leniency in Miles's sentencing, Voldberding collected sworn statements from 38 friends and relatives attesting to Miles's character before the war. These included Boy Scout leaders, elementary schoolteachers and clergy. One glowing statement came from Robert Allen Jr., the administrator of a pre-vocational center for mentally retarded adults in Shreveport. He wrote that Miles volunteered to play Santa Claus at the center on at least two occasions.
"He gave out gifts, went from table to table talking to clients, made snapshots with each person and generally helped the MR clients to have a positive and memorable experience," Allen wrote. "Very few 18-19-year-olds would have reached out to others this way."
Which is all well and good, but John Ratcliffe, U.S. Attorney for the Eastern District of Texas, is quick to point out that "prior military service is not a license to commit crimes." (Lisa Flournoy, the prosecutor who handled the case, declined to comment for this story).
Ratcliffe says he was well aware of the campaign to paint Miles as a man in need of treatment, not incarceration. He says he received countless e-mails, letters and phone calls urging him to drop the charges. He also received calls from the media and he told at least one newspaper that he was not in the position to give Miles "a pass" — a rather odd statement, since, as the head prosecutor, he's the one who decides whether or not to charge someone.
He also mentioned that Miles certainly had the right to present a PTSD-based defense before a jury — a right he waived when he never got that diagnosis.
"Mr. Miles, like every criminal defendant, had every right and opportunity to tell and convince a jury that he did not commit a crime or that he had some medical condition that excused his crime," Ratcliffe says. "Mr. Miles chose not to present evidence at trial to justify or excuse his conduct. Mr. Miles chose to plead guilty to the crime that he committed, and he was sentenced according to the law."
Moreover, he added that "my understanding is medical experts examined Mr. Miles and reviewed his records and history and those experts determined that...he did not have post-traumatic stress disorder, that he is in fact bipolar, but that is a condition that is not and cannot be caused by military service."
(Ratcliffe is correct: Bipolar disorder is genetic. However, military service can potentially exacerbate preexisting conditions. Sleep deprivation, for example, can trigger manic episodes.)
One stumbling block in this area is the U.S. Department of Defense-mandated Post-Deployment Health Assessment given upon demobilization. To start with, the assessment only screens for PTSD, depression and substance abuse. It only asks about any troubling thoughts a person has had in the last month. To really drive that one home, "in the last month" is in all caps. Any nightmares or feelings of detachment from others that occurred, say, 32 days earlier instead of 31 do not count.
According to joint Department of Defense/Department of Veterans Affairs guidelines, service members who respond positively to at least three out of four specific questions may be at risk for PTSD. However, DOD health care providers make the final call as to who in the at-risk population is flagged for further evaluation. (A 2004 study in The New England Journal of Medicine estimates that 15 percent of service members deployed to Iraq and Afghanistan may develop PTSD. The U.S. Government Accountability Office has used that percentage in its analysis of VA services).
A 2006 report from the GAO stated that, because there is no protocol for these health-care providers to follow, it is difficult to measure whether those who need treatment will get it. In reviewing the health assessments of close to 180,000 service members, the GAO found that 5 percent were at risk for PTSD, yet only 22 percent of those were referred for further evaluation. The percentage of those referred also varied among military branches. "DOD cannot provide reasonable assurance that [Iraq and Afghanistan veterans] who need referrals receive them," the 2006 report states.
Other GAO reports claim that the VA has responded sluggishly to recommendations its own Special Committee on PTSD has issued since 1985.
"Officials at six of seven medical centers told us that they may not be able to meet an increase in demand for PTSD services and...the VA Inspector General found that VA's PTSD capacity data are error-prone and inadequately supported," a 2004 GAO report states.
And while the DOD/VA assessment only screens for PTSD, the Iraq Clinician Guide states that deployed psychiatrists should be aware of signs of other mental illnesses.
"Clinicians should keep in mind that most combatants are young and that it is during the late teens and early twenties...when vulnerable individuals with family histories of psychopathology...are at greatest risk for psychological decomposition...caused by the stress of war. As a result, a very small number of veterans of the Iraq War may present with stress-induced severe mental illness."
According to the Guide, "currently deployed psychiatrists report good success in treating ASD [Acute Stress Disorder], PTSD, and depressive disorders...Only those military patients with psychotic symptoms, bipolar disorders and suicide risk are evacuated to a higher echelon of care."
Adding to the complication of sealed court records, the U.S. Attorney's Office and county officials denied the Press personal access to Miles, who has been waiting in a series of East Texas jails until his transfer to federal prison in Missouri.
When the Press attempted to interview Miles in Lufkin's Angelina County Jail, sheriff's deputies said that, because he was a federal inmate, interviews would have to be cleared through the U.S. Marshal's Office in Beaumont. That office, in turn, said no interviews could be conducted without written permission from the prosecutor and the judge who handled the case. The next day, the planets realigned, and the U.S. Marshal's Office said it was up to the Angelina County sheriff after all. Unfortunately, Sheriff Kent Henson doesn't like anyone interviewing his inmates.
It might have to do with complaints about Miles's medical treatment. According to a letter Volberding sent various officials, "although the jail protocols require monthly blood testing of inmates like Miles on certain types of medication, the jail did not do so from December 2006 to August 2007."
And according to Volberding, the jail didn't provide results of the August 2007 test until two months later, at which time Miles saw that the levels of one medication were "outside the recommended range." Another test was done in October. Miles is still waiting for the results.
In June, Dr. Seal (who originally diagnosed Miles) wrote the federal magistrate in Miles's case, stating, "It is not appropriate for only these professionals to be treating Mr. Miles, as he needs immediate physician evaluation for his mental instability."
Prior to Angelina County Jail, Miles was held in Nacogdoches, which had the 30-day supplies of the meds prescribed by Seal. But the drugs are expensive, and when they were gone, nurses told Miles they couldn't afford to buy another round. Miles's parents called Dr. Seal, who reluctantly prescribed lithium and Haldol — drugs from an earlier generation of antipsychotics.
According to Volberding, Miles suffered from side effects on the meds — tremors, weakness, depression. Miles's parents told Seal, who called the jail and asked to speak to the doctor. But Nacogdoches County Jail contracts with an osteopathic doctor who works in Nacogdoches Memorial Hospital's emergency room, making him a tough guy to pin down. Seal never heard from him.
Jailers in Liberty County, according to Volberding, substituted one drug and added a third. From jail to jail, Miles never knew what pills he'd be popping. Volberding sought help from the U.S. Marshal's office, saying Miles's parents would gladly pay for the right meds, but without a request from the Marshal's office, jailers would keep him on whatever meds were handy. Didn't make a difference.
"The level of indifference by all levels of government," Volberding wrote, "is astonishing."
Calling collect from Liberty County Jail, Miles says he didn't sleep well the night before.
He says another inmate was asking him questions about Iraq, like could Miles have killed a teenage boy if he had to? It kept him up all night, walking circles in his cell.
He speaks slowly, in a monotone. The same flat delivery whether he's talking about Jesus or jail.
"I plan on becoming a missionary and working in Eastern Europe and actually using this for the good of mankind," he says. At least this whole mess brought him close to Jesus. Looking back on it, setting off pipe bombs was just a cheap thrill. A crude attempt to get the adrenaline rush he had in Iraq. Federal authorities shouldn't have even gotten involved, he says, but once Crazy Carl started telling stories about Miles wanting to kill kids, the feds had to come down hard.
"That made the media and the [news] got big, and I'm the big bad guy in Nacogdoches now, so now the feds have to come after me to express their power," he says.
He says he's a lot more mellow now, but he also believes another attack on American soil is inevitable. If he weren't a felon, he could stockpile weapons, but not even that would make him feel safe.
"There's a million ways to attack anything and anywhere," he says. "And there's a whole bunch of people that have nothing to do but think about it, and they think they'll be rewarded for it if they do."
The strange thing is, Miles isn't convinced he has bipolar disorder. Never had outrageous thoughts before Iraq, and there's no family history. He thinks it's PTSD. Maybe the Army should have picked up something from his post-deployment health assessment. But after he filled it out, he never heard back. And he had a life to get back to. Had to go to school. Didn't have the time to go to a hospital and fill out more paperwork to find out if he had a problem.
When he handed in his health assessment, he says, it was just a formality. The Army going through the motions.
"Just 'thank you for turning in your form,'" he says. "'Go away, now.'"
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