Editor's note: This is a sidebar to a longer story on the psychological impact of the Iraq War, "Soldier's Heart."

Veterans groups and mental health experts are particularly concerned about National Guard and Reservists, who make up 40 percent of the fighting force in Iraq and will be thrust back into the civilian lives upon their return. PTSD treatment emphasizes the importance of remaining around people who’ve been in combat and can relate to a patient’s suffering.

Though it was just over three years ago, Santa Fe Reservist Makayla Watts can’t pinpoint why she enlisted in the Reserves. “I go back to that day and wonder what I was thinking,” the 22-year-old Santa Fe native says. “I have no idea what I was thinking. I wanted to go to college, and I’m not from a wealthy family. I thought it would be one weekend a month. Plus, on top of that, the college money would get me through school.”

Enlisting four months before 9.11, Watts never believed she would be deployed. “I know that sounds ignorant or oblivious, but my dad was in the Naval Reserves for over 20 years, and he never once got activated—through Desert Storm, through everything.”

But as Watts would find out rather abruptly, she would, in fact, be deployed. “It just so happened that right after I got out of training we went overseas.” When Watts’ unit left for Iraq in February 2003, she felt dangerously unprepared. “It’s all about the numbers,” she says. “It doesn’t matter how well-prepared you are, how well trained you are. It’s all about intimidation. The more troops we have over there, the more powerful we look.”

Once in the desert, coming back alive and in one piece was Watts’ primary concern. “I didn’t think I would make it out alive. I thought I would come back with one leg or an arm missing. I had no idea what I was in for. I was pretty much self-absorbed. I fell into a depression that was overwhelming. I was trying to look out for myself and make sure I made it out.”

Watts was particularly dismayed when she learned weapons of mass destruction in Iraq were never found. She thought, “I’m over here fighting a war basically for oil. I’m here fighting a war for money. It was really disappointing. It would be one thing if we were fighting for people’s freedom, but it’s their culture…How would it make us feel if someone came over here and told us we shouldn’t be living this way?”

Though Watts respects the Iraqi culture, interacting with Iraqis put her on edge, primarily because it was nearly impossible to distinguish the civilians from the combatants. “They wouldn’t be dressed like soldiers, they would be dressed in civilian Iraqi clothes. If they were dressed in uniform, you would obviously know they were an enemy.” Watts didn’t trust any Iraqi, including the children. “Over there, they don’t respect the younger children. They would have kids run in the street and hold us up because they knew we weren’t going to run over a small child. I was scared of the children because you didn’t know what they would do.”

While travelling to the water point, Watts also encountered Iraqis. She felt vulnerable and exposed during every journey she made for water. “We took the same route through every time, which was really high risk. If somebody was out to ambush our convoy, they would catch on. Every day we were taking the same position. It was amazing that nobody was smarter.”

Though Watts doubted that she’d make it home alive, in February of 2004, her unit was demobilized and she returned to the states. “I went through demobilization. They screen you for psychological problems, dental, hearing. Everything.” But perhaps the military isn’t thorough enough during the demobilization process, Watts says. “I put down I thought I needed to seek help on my paper work when I was getting released and nothing happened.”

The fact that she needed help became evident while at work as a bank teller. “It got to the point where my boss at work said that my attitude needed to change. I went off on a male customer who was being pushy and bossy. I told him he needed to stop bossing me around, that I was trying to figure out what he wanted.”

Watts has a particularly difficult time being around males as result of her time in Iraq, because she felt sexually harassed by some of her colleagues there. Now, stationed at Fort Carson in Colorado, says, “I only have two males that I work with, and I’m hardly ever around them. I don’t respond well to males telling me what to do.”

Problems also surfaced at her first drill. “I’ve never been an anxious type of person,” she says. “I’ve never had problems with anxiety and depression. When I had to do my first drill, I freaked out. I had my uniform pressed and ready to put on, and I started shaking. I was throwing up. I couldn’t breathe. That’s when I knew something was wrong. My body had never reacted to any kind of circumstance that way.”

Through a military help hot line called Army Source One, Watts was referred to a psychiatrist in private practice and diagnosed with post-traumatic disorder after four sessions. Even after diagnosis, she suffers, as people with PTSD do for the entirety of their lives.

“I can’t even be around people in large crowds,” she says. “I’m constantly looking over my shoulder. I think, ‘I’m going to die. Someone is going to be shooting at me.’ I’m in my car, and I’ll see something on the road and think it might be an explosive and try to dodge it. I could cause a wreck. I could harm innocent people.”

Watts’ mother decided to journey from Santa Fe to be with her as she readjusts. “She’s the only person I can turn to,” Watt says. “I’ve gotten really defensive around everybody else, but she’ll always be my mother.” Nonetheless, being with her mother has sometimes been challenging. “It was really weird at first. I knew she wouldn’t harm me or try to put me in a situation that I wasn’t comfortable in. It was the aspect of talking to people. I would space out. I would go for minutes without saying anything. She took me out to dinner, and she’d been talking for three minutes, and I didn’t hear a word she said. I was kind of floating in space.”

While Watts makes slight attempts to improve her interpersonal skills after Iraq, she has avoided anything involving the military. “I haven’t been to drills for over five months,” she says. “I got a letter about disciplinary action for so many unexcused absences. If I wind up getting kicked out, I could lose all my college benefits. There’s a drill next weekend. I’m going to try to go to that. If I can’t, I’m going to go the hospital and tell them I need help.”

Though the military referred her to a psychiatrist in private practice, Watts has been unable to find help for PTSD within the Armed Forces. Since she requested services on her demobilization paperwork, Watts says that every time she has reached out for help, the reaction from military officials has been silence. Two months ago, Watts says, “I told them I was suicidal and depressed and couldn’t get out of bed, and they asked me if I was going to make it to drill that weekend. What kind of question is that?”

When Santa Fe Reservist Jessica Rich returned from Iraq in January, she couldn’t sleep for three weeks, and, when she did, she had nightmares. “I had a lot of dreams people were attacking me, that I was getting bombed,” the Los Alamos native recalls. In her waking hours, things weren’t much better. “I was really jumpy. I wouldn’t be alone. I was very paranoid,” she says. “I would hear something and think someone was shooting at me, that we were getting attacked. I would turn around and think I was seeing something that later I wouldn’t see.”

Suffering weeks of skittishness, Rich sought counseling. “I went to find out what the hell was wrong with me,” she says. After a mental health evaluation, she was promptly diagnosed with post-traumatic stress disorder. Shortly before the diagnosis, however, Rich was found to have a chronic physical condition called fibromyalgia, which has been linked to PTSD. In fact, between 1998 and 2001, the Department of Veterans Affairs commissioned a study of 1,000 deployed Gulf War veterans and 1,000 non-deployed Gulf War veterans to see if deployed veterans had higher incidences of conditions such as PTSD, chronic fatigue syndrome and fibromyalgia. “It’s a condition that affects your muscles and your nerves,” Rich explains of the disorder. According to the VA study, “Attention/working memory deficits and fibromyalgia may also be related to deployment to the Gulf War.” Resulting in pain, tingling and dryness throughout the body, there are multiple, but, as of yet, no definite causes for fibromyalgia. However, stress and sleep disturbances, both of which Rich suffered as a result of combat, have been linked to the condition.

According to the Mayo Clinic, alteration of a brain chemical known as substance P, linked to stress, anxiety and depression, can trigger fibromyalgia. Moreover, once thought to be a symptom, researchers now posit that disturbed sleep patterns may actually cause fibromyalgia. Those with the condition often have unusually low levels of a hormone called somatomedin C. Considered vital for the body to rebuild itself, somatomedin C is only secreted during stage four sleep. However, because stress from Iraq resulted in sleeplessness for Rich, it is possible that she failed to secrete this crucial hormone. What’s more is that Rich may have been experiencing PTSD months before diagnosis, when in June 2003, she began exhibiting signs of fibromyalgia. Then, “I started having lot of back pain,” Rich says. “I started getting sicker more often, getting fatigued, having a lot of weird symptoms, muscle spasms.”

Similar to PTSD, fibromyalgia may make having healthy interpersonal relationships and working a job extremely trying. Now stationed at Fort Carson in Colorado, Rich has weekly counseling sessions to treat her PTSD but says she has been fighting for the military to recognize her related fibromyalgia and grant her release from duty. “It’s been horrible,” she says. “The medical services have been horrible. Every kind of medical care I’ve received I’ve had to fight for.” She says the military wants to diagnose her with back pain, a condition for which she’d only receive 30 percent disability. “Back pain is more convenient for them than fibromyalgia,” Rich says.

During the writing of this story, Rich suffered a flare-up of fibromyalgia, which resulted in her being hospitalized.

Nadra Kareem can be reached at nadra@sfreporter.com.