WASHINGTON, July 19, 2016 — As each brushstroke touches the page, blending the shades and drawing out the lines, the Marine’s shoulders relax. This is something he can lose himself in, pouring his thoughts and emotions into his art.

For Marine Corps Staff Sgt. Tony Mannino, art and music therapy at the National Intrepid Center of Excellence in Bethesda, Maryland, is a way for him to recover from his traumatic brain injury and post-traumatic stress.

“I choose to work with water colors primarily, because it makes it very hard to get the fine details perfect,” he said. “So for someone who has struggled with perfectionism and has always wanted to be in control and remain in control in any situation, it really helps to release, to relinquish the reins and let the colors do what they’re going to do on their own. That’s very therapeutic.”

First Injury

Mannino joined the Marine Corps in May 2003, along with his sister, Angela, so that he could get an education. “We decided to join the Marine Corps because it was the most difficult, because we were young and in shape, just looking for a challenge,” he said.

His sister went into the Marine Corps Reserve and deployed to Ramadi, Iraq, as a field radio operator in 2004. Mannino initially went into the Reserve and switched to active duty. He started in the administration career field, but was sent to the division machine gunner’s course and deployed in that role.

“It was my favorite time in the Marine Corps,” he said smiling. “I loved the heavy guns. I was on the 50-cal. I was pretty much in the turret my whole deployment.”

He deployed for eight months total to Iraq in 2007 and 2008. For four months, he was in Diyala province in the city of Ashraf on the border of Iran, and then he went to Ramadi. “Originally, I was trained to do detainee operations and route recon, but that was completely different once we got to the city,” he said. “Our camp was the actual hospital for the region, so we had to triage a lot of patients, both good and bad, so it was interesting.”

He said the first half of the deployment was in a small, rural flat town, mainly working in the hospital, and the hardest part was working on the wounded, especially the children. The second half was in a larger city, where they had to drive in traffic and in markets, where the sniper threat was real.

“Sniper fire was going on constantly; we were going to the government center on a weekly basis,” he said.

Throughout his time there, his vehicle wasn’t hit directly, he said, but he was exposed to improvised explosive device blasts. “There was one when we were going across the bridge over to the government center that was pretty big that really rattled me, and I [ended] up getting a bloody nose from it,” Mannino said. “But I wasn’t knocked unconscious -- just really dazed, just trying to find anybody on the rooftops and just trying to scan and take control of the situation. It really screws you up.

“Luckily, I wasn’t hit directly by one, but at least we found the bombs,” he continued. “Thank God we didn’t drive over them, so we got pretty lucky with that. I did dislocate my shoulder, but that’s a minor injury compared to what others have going on. It’s all cumulative, so as you sustain different head traumas, I guess it just adds on to the effects of TBI and any kind of concussive disorder.”

Second Injury

While stationed in Hawaii in January 2013, Mannino was running along a city street when he was hit by a truck. “A pickup truck went right through the stop sign, and there was crossing guard in the crosswalk, and it just drove into the right side of me,” he said. “Initially, I was on the hood and got thrown to the ground. I woke up with the crossing guard and the driver helping me up.”

He said he went to the emergency room, but didn’t have any X-rays taken. There were no apparent broken bones, he said, but the impact did break one of the discs in his spine, which leaked into his nerve canal.

“It really didn’t affect me until about five weeks after the accident,” Mannino said. “I wound up getting sciatica and had a concussion. It snuck up on me after the accident.”

Road to Recovery

The 32-year old said he was hypervigilant and had a rough time adjusting when he returned from his deployment. When he returned home to West Islip, New York, he said, he realized his drinking had been getting out of hand, so he quit drinking on his own in December 2013.

“I didn’t realize how much drinking was helping with some of the symptoms,” he said, noting that without the alcohol, he was having trouble fighting his symptoms. But he didn’t realize he had post-traumatic stress disorder or a TBI, he added.

“I just knew I was having a hard time mentally,” Mannino said. “I talked to the command and told them I need to get some help. That’s when I started to get some treatment.”

His first treatment was an inpatient PTSD residential program for 120 days. Then he was accepted into NICoE’s four-week intensive TBI program. NICoE, a directorate of Walter Reed National Military Medical Center, helps service members and their families manage their TBI and psychological health conditions through diagnostic evaluation, comprehensive treatment planning, outpatient clinical care and TBI and psychological research.

“Our experience is that people don’t get better unless we treat the whole person,” said Dr. Louis French, NICoE’s deputy director, who’s been researching military TBIs for 16 years.

NICoE has interdisciplinary teams of health care professionals working together. A neurologist conducts sleep studies and MRI scans, family care physicians perform physicals, a psychiatrist may conduct couples counseling, and a physical therapist may address physical issues.

The medical professionals address each potential issue and communicate with each other to make sure that patients leave at the end of their stay with a solid plan for their primary care physicians at their home bases.

“I’ve had more changes to my medication and different types of therapy here than the whole two years I’ve been in treatment,” Mannino said. “This is the most thorough clinic I’ve been involved with. They got me off a lot of meds and switched me over to vitamins, which helped me with my migraines.

“It’s nice seeing everything under one building,” he continued. Everybody talks and updates each other on the staff, which makes it a lot easier to get help and for them to notice any changes. They care a great deal, and they really want you to get better. It’s a really great facility, and one of the best things I’ve done so far.”

Art, Music Therapy

The art therapy, music therapy and the couples therapy all have been helpful, Mannino said. “I was very hesitant at first,” he added, “which made it hard for them to help me. Once I actually accepted, I tried the art. I had never painted or drawn anything in my life, but that’s when the therapy started. I said, ‘I’m here. I’m getting help. What they’re saying is making sense. Some of the symptoms make sense for what I’m going through,’ and that’s when I really opened up.”

This led him to talk with others who were going through similar issues and who had experienced similar trauma, he said, helping him to learn he wasn’t alone.

He started with just writing words on paper, he said, and then it developed into images. As he worked with the art therapists, he brought those images to life through the watercolors and into a mask that each service member going through the program makes.

“My art therapist and I talk about issues I haven’t even brought up to my psychiatrist, so it’s really helpful. … Some of it becomes subconscious at a point, where you’re working with the paints in the art as other emotions and other thoughts come up. It’s really interesting and therapeutic,” he said.

NICoE art therapist and healing arts program coordinator Melissa Walker said one of her favorite parts of the job is to see service members like Mannino change from being skeptical in their first week to starting to trust others by the fourth week of group sessions.

“By that fourth week, they just jump in and use all the materials and really enjoy themselves and socialize and laugh with each other,” she said. “It’s incredible for us, and it’s in that fourth week, too, in the artwork that we see improvement -- that they’re symbolically showing this bright future, perhaps the contrast between how they felt before and how they’re feeling moving forward. And I’d love to see that next canvas, and I hope they continue to explore that.”

For music therapy, Mannino decided to learn how to play a guitar for the first time.

“It’s really helpful for memory, trying to remember each chord, each note,” he said. “It was super difficult at first just trying to remember which strings I’ve got to hold, but it brings a different level of focus. It takes your mind off of the therapy and all of the treatment. It’s more fun. It becomes a therapy in its own right.”

At the end of the program, each student takes home a CD with a piece of their music and a photo of their mask as the CD cover.

Future

Mannino is engaged to be married in October. He said he couldn’t have endured the worst of his PTSD and TBI symptoms without his fiancee, Diane.

“She’s stuck with me through all of this,” he said. “It’s been just as difficult for her, if not more difficult, because she sees the good days and the bad days, and she’s always around me. We’re working through it together. Having that kind of support just makes it that much easier to ask for help when it’s needed.”

He said his command has also been supportive.

“To have the support of command on top of it is even more helpful [in] trying to erase the stigma of getting help,” he said. “It’s been a journey. It’s been very difficult. I’ve made a lot of progress, but it’s a long road, and I just need to keep moving forward.”

Mannino earned a bachelor’s degree in business while serving in the Marine Corps and is now pursuing a master’s degree in physics. He is participating in an internship at NASA and hopes to work in physics or science research.

He also has an established Veterans Affairs support group in New York for his long-term care, and he recommends that anyone who has TBI or PTSD symptoms should not be afraid to seek out care.

“There is help out there; you don’t have to be alone,” he said. “You don’t have to be depressed every day. You don’t have to be loaded up on medication. There are different programs that work for different people. There are options out there. Help is out there.”

Part 2 of a five-part series.