Lance Cpl. James Nuzzolillo knew he needed to seek help after he had a breakdown, crying and hyperventilating in an office at Camp Lejeune.
Nuzzolillo hesitated to seek help. He didn't want to be labeled as "that guy," he said. He added that no one wants to be "that guy" who falls out of a hike, or "that guy" who can't complete a run.
Essentially, no one wants to show any sign of vulnerability.
Mental health is often associated with a stigma and within the United States' Marine Corps, that stigma is heightened by a need to eliminate weakness.
Marines need help, too
Marines protect their homes, their country, their families. They protect strangers who won't ever thank them for the sacrifices they make on a daily basis.
The sacrifices begin in boot camp when recruits are first subjected to the demanding actions asked of them. They are screamed at and pushed to their limits through obstacle courses and rifle training. Recruits endure 13 weeks of boot camp before performing the ultimate test -- The Crucible. In 54 hours' time recruits survive on limited food and sleep to overcome obstacle after obstacle at the end of their boot camp journey.
And that's all before they officially become a Marine.
In return, society often views Marines as tough -- so tough they shouldn't need help.
While most agree Marines are some of the most resilient men and women in America, the daily strains of their jobs can take a toll on their mental well-being. Being away from their loved ones for months to years at a time, seeing combat and feeling the pressure of the image of strength they're sometimes expected to portray affects them.
Nuzzolillo, 25, said he was having heavy suicidal thoughts. When the thoughts started, his first instinct was to suppress them, to eliminate that weakness.
"I didn't think I needed any help," he said.
He explained how he was feeling to his gunnery sergeant and Nuzzolillo was told that since he hadn't seen combat, he shouldn't have these feelings.
"It made me feel like I didn't deserve to feel how I felt," Nuzzolillo said.
Nuzzolillo, an infantryman, is a self-proclaimed lucky Marine. His gunnery sergeant eventually became a huge supporter in getting Nuzzolillo the help he needed and he experienced little to no negative consequences for seeking help, but he knows many Marines who have.
After speaking with a doctor at the Naval Hospital, Lance Cpl. Kyle St. Pierre, 25, also an infantryman, said he was diagnosed with adjustment disorder, mild anxiety and mild to severe depression. St. Pierre currently serves at Camp Lejeune with 3rd Battalion, 6th Marines.
St. Pierre said he suffered from severe mood swings and he felt more homicidal than suicidal due to the stress of his job. He was working on anger management and because his job caused the bulk of the stress, his doctor suggested limited duty.
When a Marine is being treated for a medical condition that would inhibit their ability to perform military duties, a medical board determines the severity of the Marine's condition, according to the Naval Hospital's public affairs specialist, Danielle Bolton.
The findings are reviewed by physicians who will either recommend that the Marine is fit to continue service or recommend temporary or permanent separated from the Marine Corps, Bolton said.
St. Pierre's chain of command decided to do their own assessment "even though they had all the paperwork," he said. "If they don't believe it's true" the Marine Corps will try to stop treatment.
"They analyzed everything I said," St. Pierre added.
St. Pierre's chain of command believed he was battling depression and anxiety for insignificant reasons, the Marine said. His doctor wanted to take St. Pierre away from the major stressors of his job, but he says his chain of command didn't understand that.
The Marine Corps responds
Although St. Pierre said he thinks there's a stigma attached to mental health in the Marine Corps, Cmdr. David Hutcheson-Tipton the director of mental health at Naval Hospital Camp Lejeune disagrees.
"I'm not aware of any evidence that it's higher in the Marine Corps," Hutcheson-Tipton said. "Mental health problems are common, not just with Marines."
However, Camp Lejeune has multiple options for any service member in need of help. There'rs so many options, in fact, Bolton said finding the right path to take can seem overwhelming.
At the two mental health clinics at Camp Lejeune, service members can be referred by their unit's medical professionals or can walk in and request to be seen, said Hutcheson-Tipton.
"There's no reason (the medical professionals) would deny a referral," Bolton said, adding that to her knowledge, no medical professional has denied a referral before.
The Daily News reached out to Camp Lejeune officials to ask about the obstacles St. Pierre said he faced.
"While a command may offer counsel on a Marine's performance, they do not determine a Marine's medical status," said Deputy Director Maj. Kendra Motz with public affairs.
When Hutcheson-Tipton was asked about whether he's seen a chain of command cause issues regarding mental health, he did not respond. Instead, the director reiterated the resources available at the Naval Hospital.
"There is no wrong door," he said, in regards to seeking medical help.
No individual matters
There are certain conditions for receiving help, said Nuzzolillo. For him, the conditions happened to be just right.
"It was kind of like all the stars ... aligned," Nuzzolillo said of his experience.
During the time Nuzzolillo was receiving help, his chain of command changed three times and, not knowing the full situation, didn't interfere with his treatment. His unit had just come home from a deployment and when he had his breakdown, it was in an office on base. All of this made it easier for Nuzzolillo to receive treatment, he said.
For Marines about to deploy, Nuzzolillo said the command makes it difficult. St. Pierre's situation has been one of the difficult cases. Although he wasn't suicidal, that's what his commands focused on most.
"They just wanted to make sure I wasn't going to off myself," St. Pierre said, adding that everything just boils down to what the Marine Corps wants.
But for many Marines, suffering from a mental illness is an inconvenience for the Marine Corps, Nuzzolillo said. If there's anything that could affect the Marine Corps numbers, like suicide or a high number of people receiving help, the commands try to squash it.
"On the bigger scale, no individual matters," Nuzzolillo said. "When someone asks me about the military, I tell them it was the best and worst years of my life."
St. Pierre is contracted with the Marine Corps until April 2017, but he won't finish his contract.
The Marine will be kicked out within a month or two because the Marine Corps determined he's not able to perform his job due to his mental struggles, he said. St. Pierre believes it's because he sought help.
While medical professionals are evaluating a Marine, they sometimes recommend light duty and removal of weapons, like in St. Pierre's case. Hutcheson-Tipton said that many of those Marines return to regular duty after they get the help they need.
"Safety is central in everything we do," he added.
During the process of seeking help, St. Pierre said he's had to fight with the Marine Corps to keep his benefits.
Whether a Marine receives benefits or not is determined by taking into account years of active duty, preexisting conditions, stability of the condition, ability to perform at their job and what disability rating was given during the process, Bolton said.
The rating is affected by numerous things, Bolton continued. A rating is given between 0 and 100 in increments of 10. A member would be separated without pay if the medical condition is preexisting and was not permanently worsened due to their service.
Medically separated with pay is provided when a disability rating is 30 percent or higher and varies depending on rank and years of service, Bolton said.
After therapy and medication didn't help as much as he'd hoped, the military started the process to have him medically discharged, Nuzzolillo said. He was medically separated from the Marine Corps and given an 80 percent rating.
"3/6 is a good place to be from an administration standpoint, but everything else is just horrible," St. Pierre said.
Marines: It's okay to ask for help
What St. Pierre has taken away from his experience is that anyone, no matter their rank, is affected with mental health. At the Naval Hospital, St. Pierre said he saw Marines from the lowest to highest rank receiving help.
"The thing about mental illness is you never know who or what or why," Nuzzolillo added. "Mental illness is a serious issue, especially in the military."
Bolton said there are several ways for military men and women on Camp Lejeune to receive help, including chaplains and primary care doctors at the command level.
"There is no wrong door to access care as there are several avenues to reach treatment, either from a primary care manager or mental health or counseling," Bolton said.
Service members in need of help are encouraged by Bolton to contact their primary care team to schedule an appointment.
In an effort to change the stigma, Bolton said the Marine Corps has changed questions for its top secret security clearance regarding mental health in 2007.
She added that some of the questions caused a negative stigma and they "changed the questions so Marines wouldn't be scared of seeking help and losing their clearance."
In addition to changing security clearance questions, Hutcheson-Tipton said that the Marine Corps is implementing programs to lessen the stigma and encourage people to seek help. Some of the programs include educating through OSCAR, Operational Stress Control and Readiness. OSCAR is designed to educate commands to assess stress responses and train Marines to identify their peers' struggle early to help them manage it.
Bolton said this program is not intended to replace mental health, but to foster an environment where mental health treatment isn't needed.
Before asking for help, St. Pierre said he was worried he "wasn't going to be taken seriously," and in some ways, he wasn't.
"The two times I tried to inform my chain of command that I was probably going to need some help, they didn't care," St. Pierre said.
But he hopes Marines understand that asking for help doesn't mean you're helpless.
"I don't want people to feel like you have to hold it in because it makes you look weak," he said.