Healing Combat Trauma

The Sacred Brotherhood -- and Sisterhood -- of Those Who Understand

We read a few days ago Larry Heinemann's excellent quote about veterans after combat "carrying the darkness with us," linked here. And yesterday, in "War Creates Brothers," we learned about an historic gathering, a sacred ceremony of sorts, where Vietnam veterans like Heinemann met with Russian Afghansti veterans, at least a decade younger, and shared their stories with one another, bonding in the wet blood of brotherhood (and sisterhood, because it now applies to women veterans as well) from war. (That piece is linked here.) Now we synthesize the two together, with a quote from the article Heinemann wrote in 1989 in a national magazine, describing both the gathering mentioned above (lightly), and a much more extensive retelling of what the same Vietnam veterans' trip to Russia to meet with the Afghansti initially was like, a few months before.

Heinemann describes at great length the similarities and the bonds among the men that were formed, and tells the story of how the Russian veterans became involved in their own war in Afghanistan, leaving generally bruised and beaten "after nine years and 15,000 dead." Much of the article focuses on the stories of the Afghansti veterans they met in Russia, the grief of the devastated families of those who'd served, and the generalized indifference of the Russian government -- all of which he can compare, to one degree or another, to situations in our own country, after Vietnam. (As an aside, the bureaucracy of the VA seems to stand in for that of the Russian government in his analogy.)

As clearly as he paints the picture of the Russian veterans' suffering, and how it's mirrored in our own, one of the strongest descriptions he suggests is why the veterans on both sides of the conversation, separated by decades and culture, are nevertheless able to bond so strongly, through telling stories about their experiences, horrific and otherwise. This is the same principle we've been alluding to recently in the series about ritual, and the unburdening that can come from individual warriors when they meet up with one another, and have the safe "container" in which to share their suffering, confusion and grief. Here's Heinemann's remarkable quote:

"These stories and many others, came forward because the Afghansti finally had someone in their midst -- as we surely did not two decades ago [returning from Vietnam] -- who knew what they were talking about. We were fellow soldiers who could listen to the madness and know they were not mad; someone who could validate their worst blood-bath nightmares; someone who had an inkling of the brutality they had endured and inflicted; someone whom they could trust with stories about the deadest, darkest places in their hearts." -- Larry Heinemann.

Circling back around to Heinemann's earlier quote, mentioned a few days ago, we read in this article that it comes at the end of a longer declaration. As food for thought, I now include the full paragraph, in case it now adds fuller context, in light of the above.

"The Afghansti have caused a great many people a great deal of grief and have themselves suffered -- for a lie, let us not forget -- the same was we in the United States have caused much suffering in Southeast Asia, and have also suffered much in return, also for a lie. It was no small betrayal, no small lesson for a man to learn at the age of 19. Any soldier returning home must rediscover his humanity and establish a livable peace with the discovered, liberated, permanently dark places in his own heart --the darkness that is always with us."

Picking up the Pieces of Shattered Lives: Treatment or Prison

The other day was a momentous day in the life of two different combat vets. One, an older warrior, Marine, from the Vietnam war, the other, an Army vet, from the war in Iraq. Each of them wounded in combat.  Each of them knowing  intimately the sufferings of PTSD. Each of them having failed, at various times, sometimes spectacularly, other times less so, at "keeping it together" or being the person they wanted to be, for themselves, their employers or their families, because of their PTSD.

Yet what brought the two together this day was the one taking the other to an inpatient PTSD program at the VA; the older bringing the younger to a program he’d gone through himself, years ago; and one vet to another, the Vietnam vet to the Iraq war vet, encouraging him to pay attention, and to begin the process of change.

 Nobody goes to an inpatient program because they're doing so astoundingly well with their life or with their PTSD symptoms. Sometimes it's a diversionary program offered in the place of jail, which is why the Iraq vet this week was going. Drinking heavily, he'd been arrested for domestic violence, and the older vet stood up for him in court, but requested that the judge send him to treatment, in lieu of further jail time. This time, the Iraq vet was "lucky." There was room for him in the program. Many other Iraq and Afghanistan war vets -- Gulf war vets -- Vietnam vets -- have not been so lucky. They end up with extensive prison sentences for being in the wrong place at the wrong time, and getting arrested when their finely-tuned combat-trained hair-trigger reactions are out of sync with civilian life.

Talking with some young Iraq and Afghanistan combat vets a few months ago, guys who were residents in another cutting-edge residential treatment program for PTSD, they told similar stories, of having been given the chance to do the inpatient program after being arrested for something they did, fully inappropriate for the civilian world, when they first returned from combat. One guy told a story of going with his wife and kids to Walmart, and having her touch him from behind, which startled him, and as he told the story, when he "came to," he had his hands around his wife's neck, choking her. An inpatient PTSD program seemed like a better choice than jail. And for what it's worth, it did sound like he was sorry, and it also sounded like his wife was still with him -- but, everyone involved acknowledged that he needed treatment, including him.

It's reasonable to ask, how do we know whether inpatient programs do much good for the combat veterans with PTSD who go through them? We'll have to wait and hear from the graduates, but also, watch their lives, so to speak, for years afterwards, and see how things really turn out.

The older combat vet, the Marine, who took the younger vet to the program the other day, recalls that from the graduating class of his own program, most today are dead: many took their own lives, despite what they'd learned in the program. At most, he credits the time in his own life with learning to recognize what many of the danger signals of PTSD are, the "red flags" that a situation is escalating. At this remove, he considers what he learned to be "behavior management" -- learning coping skills for managing a disorder that nobody really expected to be healed or cured, at least through conventional means. Hmmmn.

In other parts of the country, veterans are doing jail time for similar offenses, even some seemingly more light-weight. Whether a veteran goes to a treatment program or to jail seems at this point to be mostly the luck of the draw. There’s also some concern, among veterans advocates and others, that the way police arrest combat vets with PTSD can further escalate the vets’ reactions. Many first responders are military veterans themselves, sometimes with their own cases of PTSD – from combat or the job. Training is needed so that arresting a combat veteran in the throes of a PTSD-fueled reaction can go as smoothly as possible, with as little collateral damage as possible. Additionally, when combat veterans with PTSD are arrested and imprisoned, they lose their VA benefits – and are often left completely untreated. This only compounds the problem/tragedy further.

Jamie Keyes daily endures the struggle of knowing that her son, Nathan, jailed for a PTSD-fueled reaction, might have benefited from treatment, but instead is doing time. A highlight of her Christmas vacation was driving to another state, where he is jailed, to spend a few short hours with him. She worries what incarceration will do to her son, and even to her elderly father, who raised Nathan as a boy, and is heartbroken to know that he’s in jail.

The story of what happened to Nathan Keyes is here – but if you want to see a mother’s perspective even more strongly, watch the video she made about Nathan, here, before his trial.

Jamie Keyes writes, 

“This is a tribute to my son, Nathan Keyes, who is a veteran with PTSD. Nathan spent 8 years in the Army and two long tours in Iraq, before returning home bearing the mental wounds of war. Nathan is now incarcerated for an act resulting from his PTSD, and will spend three years in prison. The state of Florida wanted to give him more than 15 years for his offense, instead of giving him treatment. Instead he took a plea deal that will leave him with a felony record for the rest of his life and 3 years in prison without treatment. Nathan sought help from the VA but never got adequate treatment, and was subsequently failed by our criminal justice system. This is how we treat the returning veterans in this country. This type of incident is happening in epidemic proportions all over this country, and it is a dishonor to those who so selflessly served their country.”

Treating combat veterans with PTSD who commit crimes in inpatient PTSD programs “sounds” a lot better, on the surface, than jail time – definitely. Questions still remain about how effective the inpatient treatment programs are, but it’s obvious that they’re preferable to jail – which takes away the opportunity for treatment, and further harms the veteran, on several levels. However – it’s also necessary that first responders learn how to arrest combat veterans with PTSD who may be in the middle of a PTSD episode when they’re arrested. No one knows right now how many police departments across the U.S. even recognize this is an issue to be addressed. Ideally, before too long, all first responders will be trained to recognize the signs and symptoms of PTSD and how to deal with combat veterans when they have to arrest them. Averting forseeable tragedies is always a worthy goal.

Combat Veterans, PTSD and Acupuncture

We've written about acupuncture before on this blog, in posts linked here. And an article in the current issue of "Acupuncture Today" magazine (May, 2009) discusses -- tangentially -- the use of acupuncture for PTSD.  It especially emphasizes the costs savings, particularly when used as a form of pain control (a typical use of traditional acupuncture, known as TCM). Here's a story, though, that shows the human side of acupuncture's worth for a combat veteran.

Recently I met a Marine who was part of a wounded warriors unit.  I won't say who he was or where he was located, to protect his privacy, but he had completed several hazardous deployments in Iraq and had come back to the Marine base to continue his service. I happened to learn that he sampled a few modalities from the "complementary and alternative medicine" spectrum we've discussed on this blog before, and one of the therapies he'd tried was acupuncture.  I happened to catch him in an unguarded moment, when he had his mind on other things (what amount to pain control, at the time) and I asked him to describe his experience, because I wasn't sure who he'd seen or what type of acupuncture it had been.  He described that he'd been interested in checking it out, but that the commanding officer  had considered it to be some form of "voodoo," so was pretty much against it.  But there was one acupuncturist from the town near the base who was willing to come on base and offer it, and do that for free.  So that removed some of the initial barriers to trying it, and the commander okayed it.  With those circumstances in mind, I asked him what his experience was like.  This is what he said:

"After she stuck me (needled me), I went back out to my truck, and I just sat there, for about an hour and a half, just GLOWING (his words.)."  His eyes moistened briefly as he said, "I realized it was the first time I had felt happy in two and a half years," he volunteered, continuing, "I had forgotten what it was it like to feel real joy."

I couldn't leave well enough alone -- I had to track down the acupuncturist he'd seen.  I figured out who she was, called her up, she answered the phone, we identified him as the patient in question, and then had a brief conversation about what he'd shared.  She told me she had goosebumps from hearing the story, which she hadn't known before, and added, "this is why we do what we do."

With all the lip service -- and, one hopes, quite a bit more than that -- these days being paid to treating combat veterans in more comprehensive ways that meet their needs better, I hope ancient methods will merit due consideration.  When I remember this short conversation with the very much moved Marine, it's hard not to appreciate its merits. Neatly, there are several types of acupuncture -- one which specializes in addiction treatment, one which focuses on treating body, mind and spirit, and a general, all-pupose form (along with many others).  With many offerings to choose from, and increasingly more research to support its efficacy, acupuncture truly deserves a place at the table in treating the hidden wounds of combat veterans.  I have only to remember the glow in this Marine's retelling of his experience to remember why.

Vietnam Veteran Turns to Acupuncture, Qi Gong and Yoga for Relief from PTSD

We've been discussing various forms of Complementary and Alternative Medicine, or "CAM" for short, which seem to have potential therapeutic usefulnessness for treating PTSD.  Here's a mention in a recent article in the Salt Lake Tribune of March 14, 2008, of other Eastern methods, including the energetic medicine, "Qi Gong," which appear to have brought some relief to one Vietnam war-era nurse.  From an article by Matthew D. LaPlante:

Mary Jane Shipley is a 62-year-old former trauma nurse who was stationed at a mobile Army hospital in Vung Tau, Vietnam. 

Shipley's "eyes well with tears," LaPlante writes, at the recollection of the young men she watched die there, burnt and broken and missing pieces of their bodies as they faded away." 

He continues, "Shipley says she knew almost immediately after returning home there was something wrong with her. In part, it was the helicopters. She could hear them, even smell them, ferrying patients to the Salt Lake City hospital where she worked - sometimes minutes before any of her associates could."

Her other symptoms are hallmarks of PTSD: "She had trouble relating to other people. She was restless. She was constantly afraid. Perhaps to the eyes of today's doctors and nurses, Shipley's illness would have been obvious. But back then, no one reached out."

In Shipley's case, according to LaPlante, "It took her 30 years to realize she wasn't alone. Now in treatment for post-traumatic stress disorder, the Western-trained nurse has found Eastern therapies to be most helpful. She practices yoga and qigong. And at least twice a week, she undergoes acupuncture. "It took me so long to figure out what works for me," Shipley laments, "and I still have so much trouble."

The Danger of Incomplete Mourning: "Unable to Achieve the Catharsis of Grief"

Deep within the William Styron memoir, "Darkness Visible," which we blogged about recently, here, is this observation of his about what might have precipitated his own depression.  Because it touches on things we've covered over and over again on this blog, it seemed very worth mentioning -- as well as quite profound:

The morbid condition proceeded, I have come to believe, from my beginning years – from my father, who battled the gorgon for much of his lifetime, and had been hospitalized in my boyhood after a depression spiraling downward that in retrospect I saw greatly resembled mine.  The genetic roots of depression seem now to be beyond controversy.  But I’m persuaded that an even more significant factor was the death of my mother when I was thirteen; this disorder and early sorrow – the death or disappearance of a parent, especially a mother, before or during puberty – appears repeatedly in the literature on depression as a trauma sometimes likely to create nearly irreparable emotional havoc. 

 

The danger is especially apparent if the young person is affected by what has been termed “incomplete mourning” – has, in effect, been unable to achieve the catharsis of grief, and so carries within himself in later years an insufferable burden of which rage and guilt, and not only damned-up sorrow, are a part, and become the potential seeds of self-destruction.

From Darkness Visible: A Memoir of Madness, by William Styron.

The Doppelganger of PTSD: the Unwelcome Stranger Who Follows You Home from War

Over time, more and more grassroots efforts spring up as veterans try to help one another deal with the effects of combat trauma and PTSD.  Some of these are simply conversations, where those who went share what the experience was like, and how they've suffered since -- and ideally, also what they've been able to do about it that helps.  The Peoria Journal Star in today's paper has an article about just such a conversation, held by local central Illinois veterans in conjunction with a traveling exhibit of the Vietnam Wall.  The article is short but poignant in the reminiscences shared by predominantly Vietnam veterans about how combat trauma and resultant PTSD has changed their lives, and not for the better.  Click here for the link to that story. 

There's nothing particularly "extraordinary" or "dramatic" about these men's PTSD or their comments about it -- but that's the thing.  They've very representative of what actual people go through who weren't expecting the experience to scar them for years after combat.  Just one example: a combat photographer with a Ph.D. talks about his own experience. "Divorce, alcohol, drugs, jail, attempted suicide ... I've done them all," he said.  If combat trauma is the stone thrown into the pond, just think of the ripple effects of every item he just mentioned.  Sadly, combat trauma affects not only the participants, but also many of the people in their lives.  Recently I received an unsolicited memoir from a former Marine and Vietnam veteran about his experiences with war and PTSD, and on practically every page the same thing ran true: the enormous remorse and regret he felt from the pain he'd inadvertently inflicted on his family members, because of what he was going through at the time, and couldn't cope with.  Combat trauma, left untreated (and we don't mean, with drugs and alcohol ;-), can become the uninvited guest in far too many veterans' homes and every family gathering.

The German word "Doppelgänger" or "double-goer" comes to us from literature, but seems to have some application with what veterans go through as well.  The Doppelgänger is a person's double, often but not exclusively seen as an evil twin, and often in ominous contexts (premonition of someone's death, etc.).  But in the straight meaning of a connected but separate other self, a veritable "double" self, it conveys what some veterans seem to go through.  The memory of war they've experienced is so profound and powerful, it's permanently "attached" to them.  When they return to society, and have to "re-integrate," the combat self actually never leaves them, and this seems to produce a lot of the pain that they feel.  They frequently acknowledge being "permanently changed" by war -- but yet when the war is over, or when they come back, they're expected to integrate back into society, and into the lives they formerly led.  Many veterans talk about how almost no attention is paid to this experience by the military: you come back, and have to figure this part out for yourself, but it can be deeply troubling.  You can't shake the person you became in war -- in fact, it's always with you, as a "second self."  But at some point you have to come to terms with the fact that both those selves are you, and there is no separation.  In a lot of the pain you hear, see and feel from Vietnam veterans as they share about their experiences, you get a very profound impression that they are in fact feeling shame (and yet connectedness) with the person they became because of war, as well as a desire to protect their loved ones, however incapably, from that very person.  Tremendously, what you also see is a deep desire for other, more recent veterans to profit from their experience.  The "older brothers" (and sisters, but it's mostly men) want their "younger brothers and sisters" not to have to experience the tremendous pain, ostracizing, and neglect they felt -- as well as the inability to come to terms with what it meant.  The Vietnam veterans seem to have a deep, and laudable, desire to become the "readjustment counselors" for today's OIF/OEF veterans.  However, their own healing has to take place first -- and from the expressions of deep pain that get conveyed, you can tell how difficult that healing really is, and sadly, how infrequently it's been able to take place.  (True healing, after all, means going through the pain, processing it, and integrating it into the whole self.  Many people accomplish a "form" of superficial healing, which turns out to abandon them later, by masking over the pain with other "drugs," from drugs and alcohol, to social isolation, to even workaholism, to keep the pain at bay.)

Although we need to write more about this topic separately, even "workaholism" can be a drug to suppress painful memories and experiences.  This "drug" is better suited to some than others -- probably the 'Type A' types "enjoy" it most -- but it's effective as far as it goes, which of course is never quite far enough.  I heard an amazing story from a veterans service officer the other day about the most elapsed time he'd ever seen between someone suffering from combat trauma and realizing he had PTSD.  That's referred to as "delayed onset" but check out how delayed it really was, because of workaholism, most likely.  A World War II veteran, 84 years old.  Had fought in Normandy, Ardennes, the Battle of the Bulge.  He felt he'd led a "blessed life," and had in fact just retired (at 84!).  But in his retirement, with all sorts of unstructured time on his hands, started experiencing nightmares, and would wake up, having soaked the bed.  The nightmares were about what he'd experienced, over 60 years ago(!!!), but which he'd finally had "time" to start bringing up from the vault of memory.  And he was suddenly in terrific psychic pain from this.  Although I applaud the amazing things this man must have done during the intervening 60 years to consider he'd led a "blessed life," I can only wish that he'd also been able to find some healing during that time as well.  Experiencing delayed onset PTSD in your mid-80s, from battle you saw in your 20s, must be a terrible thing indeed.  It's also another reminder about how combat trauma continues to affect veterans from all wars.  And how extending compassion, wisdom and healing to veterans from every war is part of what we ought to be doing, as a society, and often do quite minimally, if at all.

The Perils of Suicide

A chaplain stationed in Iraq writes informally that six of the soldiers in his general area have taken their own lives recently, which is obviously six far too many.  No real conclusions as to why, but some soul-searching (no pun intended) as to how suicide has become "instant gratification" with a weapon when situations are beyond what we can handle.  No matter the reason or the circumstances, what a shame for those people and their families.

The Ineffable Sadness of Seeing

Tonight we heard a very sad story from a friend, whose young son killed himself after returning from Iraq.  The chaplain from her son's unit, who had served with the Army reserve in Iraq, a middle-aged pastoral leader in civilian life, had been routed to Louisiana to help with Hurricane Katrina "efforts" after returning from Iraq.  As with some others (e.g., the USMC's "Marlboro Man"), this seems to have been just the "1-2 punch" of too much devastation in too short a time to deal with, having seen so much chaos and tragedy in his time in Iraq.  The chaplain's marriage did not survive, and the man is currently living in a homeless shelter.  If the combination of "too" much war and devastation is what eventually broke this man's spirit, and we hope only temporarily, we feel nothing but compassion and great, great sadness for this loss.  Perhaps we are asking people to "handle," without resources, much more than they are able.  May it not be the case tomorrow, as well.

In the words of the Eagles' song by Don Henley, "There's a hole in the world tonight...don't let there be a hole in the world, tomorrow."