STUTTGART, Germany >> It might have been the 2,000-pound bomb that dropped near him in Afghanistan, killing several comrades. Or maybe it was the helicopter crash he managed to survive. It could have been the battlefield explosions that detonated all around him over eight combat tours.
Whatever the cause, the symptoms were clear. Brig. Gen. Donald C. Bolduc suffered frequent headaches. He was moody. He could not sleep. He was out of sorts; even his balance was off. He realized it every time he walked down the street holding hands with his wife, Sharon, leaning into her just a little too close.
Despite all the signs of post-traumatic stress disorder, it took 12 years from his first battlefield trauma for him to seek care. After all, he thought, he was a Green Beret in the Army’s Special Forces. He needed to be tough.
Bolduc learned that not only did he suffer from PTSD, but he also had a bullet-size spot on his brain, an injury probably dating to his helicopter crash in Afghanistan in 2005.
Now, after three years of treatment, Bolduc is doing better. And, in his role as commander of U.S. Special Operations Forces in Africa, he has become an evangelist for letting soldiers know that it is all right to get help for brain injuries and mental health problems.
“I’ve really seen a difference in myself,” Bolduc, 54, said. “There are still the nonbelievers. We’ve got to get to them.”
That means changing attitudes that equate mental illness with weakness. Donald Trump, the Republican presidential candidate, said in a speech this week that some veterans returning from war “can’t handle” the stress, a remark that drew scorn from veterans’ groups that work to reduce the stigma. (Trump’s campaign has said his remarks were taken out of context.)
On a recent afternoon, Bolduc, his starched uniform weighed down by a giant patch of colorful ribbons and medals across his chest, stood ramrod straight at the Stuttgart headquarters from which he commands Special Operations fighters battling the Islamic State, Boko Haram, al-Shabab and other terrorist groups in Africa, and he declared, “I’m in counseling.”
Bolduc wants soldiers under his command — who are stationed in some of the continent’s most difficult parts — to know that seeking help will not hurt their careers. In his opinion, PTSD is the same as a broken arm.
“The powerful thing is that I can use myself as an example,” Bolduc said. “And thank goodness not everybody can do that. But I’m able to do it, so that has some sort of different type of credibility to it.”
Other high-ranking officers have come forward to talk about their struggles with post-combat stress and brain injuries. And in recent years, Special Operations commanders have become more open about urging their soldiers to get treatment.
Gen. Joseph L. Votel, then the head of the U.S. Special Operations Command, spoke to CNN last spring about ending the stigma tied to seeking treatment. “It is absolutely normal and expected that you will ask for help,” he said.
The stigma can be particularly acute in specialized military units, like the Green Berets and the Navy SEALs, that are trained for the toughest assignments and consider intervention a sign of weakness.
Yet the Defense Department estimates that almost a quarter of all injuries suffered in the conflicts in Afghanistan and Iraq were brain injuries. As many as 20 percent of veterans of those two conflicts suffer from PTSD.
Traumatic brain injuries and PTSD share symptoms like headaches, depression and, sometimes, suicidal behavior. The consequences of not getting help are severe: In the past four years, more than 2,000 active and reserve military personnel have killed themselves, according to the department.
Across the military base in Stuttgart, suicide prevention and PTSD brochures are positioned on desktops and hallway tables. The base has a Preservation of the Force and Family center, a program created specifically for Special Operations forces, where anyone can seek help for behavioral issues, including alcohol or drug abuse, and counseling for family and financial problems.
When commanders rented a movie theater last year for a screening of the latest “Star Wars” movie, Bolduc made sure that the free tickets had to be picked up at the center, to get soldiers comfortable with stepping inside the door.
On base, officers talk openly about mood swings, making their wives cry and other indicators that led them to seek help.
Bolduc, who took command in April 2015, encourages these kinds of honest conversations. In speeches to his leadership team and in visits to his troops in Africa, and every time a new soldier comes into his fold, he tells his personal story and urges anyone experiencing the same kinds of symptoms to get help.
A native of Laconia, New Hampshire, Bolduc said he wanted to join the Special Forces ever since as a young boy he watched the movie “The Green Berets” with his grandfather.
“For all Bolduc males, service to country is a requirement,” said Bolduc, whose two brothers also joined the Special Forces. “My grandfather didn’t care what service, but he did feel that it was an obligation.”
He earned his ROTC commission in 1989, graduating from Salem State College in Massachusetts, and later earned a master’s degree in security technologies from the U.S. Army War College.
Last month, Bolduc awarded a Purple Heart to an airman 11 years after he had received a brain injury during a mortar attack in Iraq. The airman, Tech. Sgt. David Nafe, had suffered memory loss and migraines for years.
Bolduc made a fuss, summoning his staff to a ceremony for the award. The military publication Stars and Stripes published an article about Nafe on its front page. In front of the audience gathered for the ceremony, the general told the soldier he could relate to him.
“When people look at you, you look completely normal,” Bolduc said. “And then they see how you act and they say, ‘God bless, what’s wrong with that guy?’ “
The Defense Department and the Veterans Health Administration have worked to improve mental health services. Yet many service members do not regularly seek care, according to a 2014 report from the RAND Corp., a think thank that conducts government studies.
That procrastination is exacerbated by the hypermacho culture of Special Operations, Bolduc said, where high-stress tours leave members especially vulnerable. Members wait an average of 13 years and three months to seek treatment for injuries that are not catastrophic, according to Sarah McNary, a nurse in charge of traumatic brain injury cases at Landstuhl Regional Medical Center in Germany, who first convinced Bolduc to submit to a brain examination.
When a bomb dropped on his position in Afghanistan in 2001 — a friendly fire accident — Bolduc’s hip was badly damaged. He declined medical treatment and pushed ahead with the mission, an offensive on Kandahar, and later needed hip-replacement surgery.
An average-size man at 5-foot-7 and 145 pounds, Bolduc is so fit and focused that even if he were wearing overalls he would probably be identifiable as a Green Beret. Yet he has a soft side, offering a handshake or a hug to everyone he meets on a stroll around the base.
“He’s Captain America,” said Lt. Col. Nathan Broshear, a spokesman for Special Operations Command Africa.
Now, the general goes to counseling sessions with his wife, who for years urged him to seek treatment.
“The doctors love it because I’m still guarded,” he said. “First of all, you feel funny even talking about it. You’re not likely to give them your real symptoms. But your wife is going to say, ‘That’s a load of crap.’”
About a month ago, while visiting a team under his command, Bolduc asked how many of the men had been close to blasts, bombs and mortar shells. Everyone raised a hand.
“Then I said, ‘How many of you have sought treatment?’ ” he said. “No one’s hand went up.”
Bolduc told them his own story, and afterward, all of the men decided to get exams. Doctors found a tumor in one soldier’s brain.
He was flown to Walter Reed National Military Medical Center, near Washington, where he is being evaluated.