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Laws encourage alternatives to prison for veterans with PTSD
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RALEIGH, N.C. (AP) — Defenders of a former Army sergeant say he truly believed he was fighting the Taliban bomber who blew off his friend's limbs when he emptied 24 rounds from his 9 mm handgun at police and firefighters who were responding to a fire in his apartment.

Psychologists testified that Joshua Eisenhauer returned from Afghanistan with post-traumatic stress that made him a paranoid, hyper-vigilant insomniac, and so delusional that he drew his weapon whenever anyone came to his door in Fayetteville, North Carolina.

They say untreated PTSD could scramble his mind beyond repair if he spends the rest of his sentence, up to 18 years, in Raleigh Central Prison.

"The only place where he belongs is one where he can get treatment for his PTSD," said Eisenhauer's father, Mark. "That was what caused all of this. This never should have happened in the first place."

North Carolina is now considering enabling judges to consider PTSD as a specific mitigating factor when sentencing military veterans like Eisenhauer, despite criticism that such measures are unnecessary and could end up harming people with the disorder.

As many as one in five veterans who served in Iraq or Afghanistan develop post-traumatic stress disorder each year, according to the U.S. Department of Veterans Affairs.

"I would hope the public policy of our state would be that we care about our veterans enough to do this for them," said state Rep. Billy Richardson, whose district includes more than 57,000 military personnel at Ft. Bragg, one of the world's largest military complexes.

Richardson's bill was approved by the House Judiciary Committee this session.

Most states lack such a law. Among them is Texas, where the well-documented PTSD of Eddie Ray Routh did not save him from life in prison without parole in the killing of "American Sniper" Chris Kyle and another veteran.

California, Kansas and Oklahoma do allow a court to consider post-traumatic stress disorder as a mitigating factor when sentencing a veteran in a criminal case. North Dakota lawmakers ordered a study of the issue last year.

Critics say the law is misguided, because PTSD already is among the many mental conditions that can reduce culpability in North Carolina and many other states. They worry about adding to the stigma veterans face, and leaving out others with PTSD, such as victims of war, domestic abuse and gang violence.

Dr. Allen Frances, an Army veteran and expert on combat-related stress disorders who calls himself a "PTSD skeptic," told the trial judge that Eisenhauer "is an absolutely classic case of unmistakable and extremely severe PTSD."

But Frances, who chaired the committee that revised the American Psychiatric Association's recommendations on PTSD treatment, said a law associating veterans and PTSD with criminality would be a big mistake, partly because the condition is self-reporting and easy to fake.

"I can't imagine someone facing a long sentence who wouldn't have PTSD, under the circumstances," Frances said. "Whenever there's a reward for a diagnosis, rate of that diagnosis go up very suddenly and rapidly."

The North Carolina bill would enable but not require judges to cite PTSD when issuing lesser sentences or ordering specific treatments, as long as the veteran was diagnosed before the crime.

The U.S. Army Surgeon General in 2012 recommended specific treatments for veterans with PTSD, including cognitive behavioral therapy, an intensive program in which participants are encouraged to identify, challenge and restructure negative thought patterns.

At Eisenhauer's sentencing, prosecutors said he neglected to actively seek out treatment for his worsening PTSD and consciously chose to drink heavily before he opened fire on the first responders.

Judge Jim Ammons found Eisenhauer guilty of 15 counts of assault on law officers, none of whom were seriously injured. He said Eisenhauer belongs in prison because he could endanger innocents if he experiences another flashback.

Eisenhauer apparently still believed he was under fire in Afghanistan when he awoke in the hospital, nervously asking the nurse treating his four gunshot wounds to tell him, "who's got the roof?!"

Later, behind bars, hearing gunfire from a nearby shooting range caused him consistent flashbacks and distress. He was moved to Raleigh Central, where he remains heavily medicated.

The judge strongly recommended psychiatric treatment, but sent him to prison despite a warning from Raleigh Central's chief of inpatient services, Dr. Michael Larson, that staffing limits and security concerns in the state prison system would prevent any semblance of the trauma-focused psychotherapy recommended by the Surgeon General.

Fayetteville neuropsychologist G Martin Woodard also advised the judge, saying prison can lead PTSD sufferers to shut down emotionally while amplifying their the numbing, guilt, nightmares and flashbacks "to the point of potentially psychotic symptoms."

But some experts worry about the unintended consequences of legislating treatments in criminal cases for a certain class of defendants.

"It's ambiguous whether we are doing this because we're concerned about PTSD or whether we are doing this out of our natural, appropriate sympathy for our vets," said Betsy Grey, an Arizona State University law professor who specializes in neuroscience.

Grey, who published a paper on PTSD and mitigating factors in 2012, said the legislation communicates social leniency, falsely suggesting that afflicted veterans are more deserving than others with PTSD.

Other experts say the justice system shouldn't consider PTSD alone, since other factors, since substance abuse, financial instability and other factors put veterans at greater risk for criminal behavior.

A "PTSD diagnosis is relevant, but it's the tip of the iceberg," said Duke psychiatry and behavioral sciences professor Dr. Eric Elbogen, who coordinates the recovery of veterans at the Durham VA Medical Center.