Randy Murnighan is a regular guy.
He takes classes at Arizona State University, where he does well. He does some freelance design work from his Chandler home. In the evening, he likes to settle down with a glass of scotch.
Except sometimes, Murnighan, 33, can’t remember what he was going to say, or what he just heard. Faraway chatter in the classroom can wreck his focus, or worse, cause a migraine. He lives every day with a persistent headache and tinnitus.
Murnighan, from 2001 to 2010, served as a combat medic in an army airborne brigade across the Middle East.
“I had about seven significant blast exposures, with varying degrees of intensity,” he said. “Both in and out of a vehicle, they range everywhere from having an explosion nearby the vehicle to having a close explosion within 20 meters knock me on my ass.”
Sometimes, Murnighan would be in an altered state of consciousness for several minutes following a blast.
And most times, despite what he said were seemingly obvious concussions, called mild traumatic brain injuries in a clinical setting, Murnighan’s only option was to get his wits about him and soldier on.
“Officially, anytime you were in a blast incident, you were supposed to have an examination,” he said. “About 95 percent of the time, that didn’t happen.”
And once he got back to the base, things weren’t much better.
“There was one physician’s assistant and one surgeon for more than 1,000 people,” he said.
So, tests for brain injury were fairly minor. Usually, the doctor would examine pupils and make sure patients were acting like themselves — all standard procedure — but would frequently stop short of more intense testing, like spinal exams.
Sometimes, doctors would conduct a mental examination, but when he enlisted, Murnighan said the army did not make an initial examination to get a baseline, making any further tests much less useful.
Still, Murnighan is relatively lucky. He’s received brain scans that show moderate abnormalities, and he was in far fewer blasts than some of his colleagues, who he estimates could have been in hundreds of explosions. He has all of his limbs, and he’s able to function in civilian life.
But it isn’t easy.
“My primary complaint has been chronic headaches and migraines,” he said. “I have a headache 24 hours a day, seven days a week. It never goes away. I’ve had short-term memory issues. It’s a crapshoot, which was never the case before. Definitely some degree of PTSD (post-traumatic stress disorder) — like most good veterans, I like to insist I don’t have PTSD, but I know it’s a load of s—t when I say it.”
He said some of the biggest issues have not arisen from the injuries themselves — which he had while he was serving — but from not having the support to cope with them that he had in the military.
“A huge part of PTSD is moving from a fraternal organization and then to civilian life,” he said. “None, or very few, understands where you come from. You don’t have the same network to help treat it. The VA (Veterans Administration) doesn’t push a lot in the way of support groups.”
Murnighan does not laud the quality of care received at the VA.
When he was still in the military, he went under every drug the army doctors would prescribe him in order to get healthy enough to be deployed back into combat. When the cocktail of anti-psychotics, anti-seizure medications and more didn’t work, he went before a medical board to get a discharge.
Once back in the U.S., it took him nearly a year to be seen at the Phoenix Veterans Administration hospital.
“I would try to schedule appointments, I would try to get seen, but I would have appointments get rescheduled without being told,” he said. “I spent six months trying to get a doctor to return a phone call or email.”
Eventually, he was told about the Southeast Veterans Affairs clinic in Gilbert, but a lack of neurological resources didn’t do Murnighan much good, he said.
One doctor he saw looked at his history but still tried to prescribe him the same series of pills that had failed to work previously. He tried seeking help outside of the VA through the Veterans Choice program, but had trouble finding providers willing to work with it.
From there, it was a series of one unsuccessful treatment after another. He had Botox injections to reduce headaches, but the efficacy subsided quickly.
He had some relief from mindfulness classes at the Southeast VA, but they were only available at one time in the week.
Murnighan has since stopped taking prescriptions for painkillers or other pills, and now goes about daily life tiptoeing around the possibility of a migraine or stress-related episode as he completes his education.
His treatment routes have stayed relatively traditional — for example, he doesn’t use medical marijuana, though he said it’s an absolutely viable alternative for some veterans.
“They should embrace it more than some of the drugs I’ve been prescribed,” he said. “Everything that’s highly abused is a top choice for something to give to veterans.”
Treatment leaves him ‘zombie-like’
Ricardo Pereyda, 34 of Tucson, is in a similar boat.
He was in active duty in Iraq from 2003 to 2006, and from his time there, some of the poster symptoms of PTSD began to present themselves.
He said while he was serving, his opinions were valued, his training was justified and he had a support system. But when he came back to Fort Huachuca, just west of Sierra Vista, the structure went away.
“There was a fraction of the personnel (that I was used to),” he said. “No camaraderie. Nothing you would need to be prepared for any kind of combat scenario. I found myself with a bunch of people who had been dodging deployment, and a bunch of civilians who had no idea what was really going on in Iraq.”
Every day, he had to face a series of internal questions.
“What triggers my anger?” he said. “What jaded me? Why are you such a bitter f—k? Why can’t you sleep? Why are you depressed?”
An army doctor had first mentioned PTSD to him when he was trying to get redeployed, but he bristled at the thought, not wanting his career to be hindered. But he began to realize it was affecting him.
“The way people smell gets to you, the way people laugh gets to you,” he said. “Long lines, traffic…”
Like Murnighan, he was put on a variety of pills to treat his anxiety, depression and irritability. However, he said they made him “zombie-like.” He drank heavily, smoked close to two packs a day, and embodied the “crazy vet,” as he put it.
His wife left him, and he moved back to Tucson to be with his family. It was here things began to change, though not because of the VA — Pereyda said they responded to his symptoms with more pills.
His family intervened, and he conceded that pills weren’t working. He used his G.I. Bill to enroll at the University of Arizona. At the veterans organization there, he found community again. He held a number of leadership positions in that organization. And, he began smoking cannabis.
Soon, he realized that other veterans in the organization were doing the same, and it was helping them conquer their demons much more than prescription pills did, he said.
“It enables me to be present, to live in the here and now, and not get bogged down in the past,” he said. “I’m back to a regular sleeping schedule. But our society has created a need for the pill.”
Now, he is at the forefront of the legalization crusade on the eve of the vote on Proposition 205, which would legalize recreational marijuana for individuals above 21 years old in Arizona.
Pereyda, whose ailments make him eligible for medical marijuana, said cannabis isn’t for everyone, and some do need prescription pills, but that he sees it as a non-toxic alternative that has worked better than any other treatment he’s received.
And he said that those against the proposition, namely the pharmaceutical companies that have bankrolled ads against it, are contributing to the pill problem.
“My story is a threat to their bottom line,” he said. “It’s a rhetoric based on fear mongering and bigotry.”
Preferring therapy over pills
Pereyda and Murnighan are not unique, and many veterans are driven to seek alternative treatment after a lack of sufficient care, or access to care, at the VA, said Karen Gallagher, an ASU doctoral student and Gulf War veteran conducting research in treatment of cognitive issues in veterans returning to civilian life.
“For the most part, the input I get is that the actual care at the VA is good; it’s accessing the care that’s the problem,” she said. “Because they’re backlogged, because they’re trying to get everyone seen, they only thing they can do is write prescriptions.”
Representatives of the VA could not be reached for comment in the timeframe of this story.
Gallagher said the veterans she works with don’t want pills — they want therapy. She said the scope of care the VA needs to provide has expanded significantly in the last two decades, but the VA, despite funding cutting edge research, has not been able to keep up in the providing of its care.
She said the problem begins with diagnosis.
She pointed to a culture of suppression in the military that prevents many cognitive issues from being identified or treated, and when the veterans get to the VA, the administration is too judicious in diagnosing cases in an attempt to weed out those exaggerating PTSD or MTBI (minor traumatic brain injury) as a way to get disability benefits.
Gallagher said the Department of Defense “admits that MTBIs are grossly under-diagnosed.”
And then, when veterans get to civilian life, they are unequipped to deal with the lack of structure or the abundance of unfamiliar stimuli, especially in a classroom environment.
She still recommends that veterans returning from combat visit the VA to get a medical baseline, but her research comes in if the care is insufficient.
She is working on developing cognitive exercises and tests to assess and improve the mental readiness and abilities of veterans through individualized therapy. And she said for many, it’s working much better than traditional treatment.
“They respond really quickly to my research,” she said, “because there is a gap in the care at the VA.”F