Healing Combat Trauma

Quotable Quotes -- Edwin Shneidman on Walking Someone Out of Hell

Edwin Shneidman, who we've written about frequently on this site, was a mentor to Mark Goulston, M.D., the author of "Post-Traumatic Stress Disorder for Dummies," linked here. Goulston credits Shneidman with teaching him how to really listen to others, particularly patients, in a story he relays, here:

"Mark, if you listen for hurt, fear and pain, it is always there. And when the other person feels you listening and feeling them, they will lower their guard, open their minds and hearts to you, allow you to enter and comfort them and if you’re fortunate, will let you walk them out of hell." -- Edwin Shneidman to Mark Goulston, M.D.

Once again, we see the benefit of listening with the heart and from the heart, echoing yet again the great quote of Paul Tillich, that "the first duty of love is to listen."

Advancing the Dialogue: Can Veterans and Civilians Really See Eye-to-Eye?

We've all heard the horror stories about what ignorant, impertinent questions strangers and even family members ask of veterans sometimes. "Didja kill anyone?" "How many people did you kill," etc.

It doesn't take much sophistication or awareness about the topic of veterans and PTSD before you realize, those questions aren't appropriate at all, ever; and in general, when it comes to questions about combat experience and what veterans suffered, very clearly let them lead in terms of the disclosure. Don't press. But if they want to talk, be able and willing to listen, if you're so inclined.

Apparently the word hasn't gotten out as far as it should have, though. The other night, I went to a screening of some films by a veteran about his experience, and certain questions by audience members afterwards just made me and many of the veterans in the audience squirm.

I share them because I think it shows how far we all have to go if we actually desire authentic dialogue between the two groups.

(An appropriate disclaimer would be, I'm a civilian too, but I've spent the last five years learning from veterans about what they experience in combat, and about how post-traumatic stress disorder affects them and their loved ones.)

The setting was a small community college auditorium, where members of the public gathered to watch a series of short films produced by an Iraq veteran about his experience reintegrating. The film showing was followed by a panel discussion with a handful of Iraq and Afghanistan veterans, both men and women, and a few who'd served earlier. The films were good, and portrayed the experience well, and afterwards, the panel took questions from the audience. Several of the (undoubtedly well-meaning) questioners make me wonder if it's possible for civilians to breach the gap with military on something so raw, personal and volatile as their war experience.

Certainly, when the Vietnam veterans returned, they were met with open hostility and outright neglect, both of which were a problem, and where those after-effects are felt even to this day. Many who were alive during those days, both veterans and civilians, regret those times. It's certainly true that veterans today are getting a different reception -- but is that reception necessarily better, particularly if it includes questions like these? 

One audience member, an older woman, said -- though she had a son who had gone to war and was on the panel -- that she herself was a pacificist. "So I'd like to know," she asked (I'm paraphrasing), "just why you would have joined the military?"

The filmmaker who was hosting the panel responded that the answers to that question would be as different as individuals, and that there was no one way to answer to it. To which a young audience member, referring to the woman's question, replied privately, "Just because you don't personally agree with someone else, isn't any reason to question their motivation for doing what they did."

"Spill your guts"

"Take this opportunity right now, you have it, we're listening," another older woman suggested to the panel of veterans, "and tell us, right now, what you would like us to know, about the worst of what you experienced in war."

The panel was, as a whole, taken aback, incredulous; it was the equivalent, of her saying, "here, right now, spill your guts -- on the most difficult memories you  have -- what's stopping you? We're listening." In an auditorium full of literal strangers, the question was absurd.

One young Marine, who was on a tour in Iraq where many of his brothers-in-arms died, and has since gone on to study social work, demurred that even when his mother asks him, there are questions about what he experienced that he just doesn't feel comfortable answering.

One teenage audience member, at 18 a few years younger than the youngest veteran on the panel, had a question he wanted to ask, which might have gone over much better than some of the more insensitive ones. What he wanted to know is when veterans self-identify as such, whether they feel that the "label" of veteran helps them to integrate better into the community, or whether they feel it sets them apart?

A question like this, which didn't get heard, would have been one of the more pivotal ones to address. Because while it's great that being a veteran has "come out of the woodwork" so to speak -- and the veteran experience is now one that seems to elicit some interest, versus during the Vietnam era -- that also cuts both ways. For veterans who want to be accepted again for who they are, not necessarily thought of primarily in terms of their war experience, however much it's changed them -- it's hard to say whether identifying publicly as a veteran helps this or hurts it.

And while 'm glad to see civilians embracing to some extent the veterans in their community -- and giving them the recognition and to some degree, attention that they didn't give their Vietnam veteran counterparts -- the reality is, it still needs to be done with compassion, understanding and empathy. And NOT the desire to put veterans on the spot and make them squirm under the spotlight of fairly ignorant questioning, no matter how "well-meaning" their interest.

Someday I hope we'll all find the right balance on this: respecting veterans for their service and their sacrifice, and letting the veterans lead the conversation about how much they really want to say about it. In the meantime, the appropriate posture for the rest of us -- both individually and as communities, is to wait, not press, and certainly not pressure -- veterans to talk about what they've gone through.

© 2010 by Lily Casura / Healing Combat Trauma. All rights reserved. Use with attribution. 

Quotable Quotes -- Using the Heart to See Clearly

Two quotes that essentially say the same thing: "The heart sees better than the eye." -- Jewish proverb. This echoes a line from Antoine de Saint-Exupéry in "The Little Prince," where he writes: "It is only with the heart that one can see rightly. What is essential is invisible to the eye."

These both fit right in with one of our core beliefs around here, as expressed by Paul Tillich: "The first duty of love is to listen." 

When it comes to "listening" to combat veterans with PTSD in our lives, let's hope we do it with love, compassion, and empathy -- even if they can't, or won't, express what's really on their minds. Communication is based on trust, and comes in time. Patience and keeping the right intention are both important. Social support is known to be a preventative for PTSD (how cool is that?!) and even after diagnosis, trust and communication go quite a way towards helping the veteran bridge the perceived gap between their life before, and their life after, PTSD.

Editor's note: For more articles, including ones written by veterans, about communication skills, click here.

Conflict as Combat: When Words Become Bullets

A great comment in a panel discussion by veterans on re-integration, where one veteran was discussing how being asked the wrong questions can put him on the defensive and elicit an undesired response, thanks in part to military training and the normal reaction to being backed into a corner. "When rifles are no longer involved, words can become your bullets," he said.

For anyone who's ever been on either the "giving" or the "receiving" side of a difficult, heated conversation where it felt like life or identity was at stake, it's easy to understand exactly what he meant. It's also, obviously, not a prescription for harmonious communication that resolves issues effectively. For that, very different communication styles and skills are necessary. We try to cover that here from time to time, when we find someone with a worthwhile and constructive point of view -- and experience in the trenches, either as a veteran or a spouse of a veteran with PTSD.

Editor's note: To access that series of articles on communication skills, including those written by veterans and/or their spouses, click here. We're continuing to add more material to this section, including an upcoming article about "fair fighting." 

Talking -- and Listening -- with Your Combat Vet

On the topic of communicating with your vet, the "big three" to me are all women: Patience Mason, Aphrodite Matsakis, and Kathie Costos. I remember something wonderful and gracious that longtime veteran psychiatrist and advocate Jonathan Shay, M.D., Ph.D. wrote about several of them, that if everyone involved with combat veterans had read their books and absorbed their wisdom, there'd be nothing for him to do.

We've also written recently about how hard it is sometimes for families to hear about what veterans have gone through; and yet, how important also it is to ask and genuinely care enough to listen.

Here's an item from Patience Mason's classic, "Recovering from the War," about how to talk with -- and listen to -- your vet:

"Ray Scurfield said, "The vet's difficulties in sharing about his war experiences are at least partly due to the (mistaken) belief that 'only another vet can really understand what I'm going through.'

However, if you have experienced profound rage, grief or loss, fear, numbing, horror, shock, violence, tragedy, betrayal, etc., then you do have an experience base from which some understanding is possible. The vet has probably had his war experience rejected and avoided by others. 

Don't let him do the same to you and your valid life experience. Point that out to him if it's happening. But don't compare. Saying something like 'Maybe I can understand some of it. I notice you get so angry, and when my __________ [fill in the blank], I just felt like killing everyone, the police, my roommates, everyone.' There's a big difference between this and "I got over being almost raped. Why can't you get over Vietnam?"

She also writes, and this is very significant, that Ray Scurfield also advised, "You must ask yourself, 'Do you really want to know some of the dark secrets that trouble this vet so -- can  you really handle them if they are shared with you?" This is a heavy question and one that must be considered."

True. Wanting to listen to someone's stories and "be there" for him or her is very significant and worthwhile. After all, "first duty of love is to listen." But be aware that you need to also be prepared for anything they may say, and count the cost in advance about how that's going to affect you to hear. You may want to line up a therapist or some support of your own. Once spoken, those words can't be taken back, and you may end up with some vicarious trauma of your own from the telling. Which isn't necessarily a reason not to engage; just a reason to be wise in advance and be sure that you also have support and awareness about what you're possibly getting into by asking to hear...

As someone who's heard a lot of stories from combat veterans, I would have to say, being real about what I can and can't absorb, and at what pace, has also proved helpful. It communicates respect but also wisdom about not overwhelming the listener. As one veteran said, "telling me how to tell you was great because you weren't rejecting me, you were expressing how you could hear." Thank you.

Editor's note: For a link to Patience Mason's book, Recovering from the War, click here. For more on communication skills, about which we write as often as we can, click here. 

Willingness to Learn from Our Vets Can Be Very Healing for Them, Too

We've written before here about Thich Nhat Hanh's wonderful comment, as quoted by Claude Anshin Thomas, about how veterans understand deeply the nature of suffering, and because of that can be "a powerful force for healing in the world."

In the same vein are these comments by Patience Mason, in her book "Recovering from the War." While she was writing specifically about the Vietnam combat experience, once can substitute the word "combat" throughout and receive the benefit of her wisdom on this. The emphasis is still on letting the veteran guide the extent of sharing about his (or her) combat experience; and encouraging supportive listening, which communicates respect and appreciation for the vet and what he or she experienced. Mason writes:

"Saying to your vet, "I never realized what you had been through" can mean a lot to any vet -- brother, son, father, husband or lover. In its way, that's a paraphrase of his entire experience and an invitation. Willingness to learn from our vets can be very healing for them, too. They are the experts on [their combat experience]. When they came home they found that this expertise was a handicap. Some buried it. Some lived with it every day. It is still there for all of them, and sharing it can give them a sense of appreciation and respect that was owed when they got back from [combat] but never paid. Discussing [their combat experience], if it is done at all, should be done at your vet's pace."

Editor's note: Patience Mason's book, "Recovering from the War," is linked here. Claude Anshin Thomas' book, "At Hell's Gate: A Soldier's Journey from War to Peace," is linked here. For more on the all-important communication skills between a veteran and his or her loved ones, click here.

A Veteran Spouse Asks the Key Question: Will You Love Them Enough to Learn?

Longtime veterans advocate and ecumenical chaplain Kathie Costos is a hero of mine. On dealing with the spouses and the families, it's hard to find anyone wiser, having lived through the crucible of her own experience -- being married to a Vietnam vet for lo these many years (28, at last count), and raising a family with him, after he got back from the war.

In conversation, she admits she had to learn it all the hard way -- as many do. When she gives advice, she says it's like she's speaking to her 26-year-old self; giving out the advice she wishes she'd gotten at the time but had to learn on her own.

Here she is on a crucial question many folks should come to terms with: Do you care enough about them (veterans) to learn what they went through? She writes about some who do, and many who do not:

"My husband was married before we met. He was married soon after he came back from Vietnam. During their six years together, she didn't want to know about Vietnam, had no tolerance for his nightmares, flashbacks or short term memory loss. She didn't want to hear anything about Vietnam and they separated so many times he lost count. She just couldn't take it and this, this was when his PTSD was mild. 

His Dad, a WWII veteran with a Purple Heart and Bronze Star, didn't want to talk to him about war at all other than a few stories about some of his friends. His Mom didn't want to talk to him about anything other than what she wanted him to do for her.

Friends didn't want to listen and he never felt he could talk to any of them even if they were willing to listen. A few of them were also Vietnam veterans but they didn't talk about much either. There was no communication and no support. They had nothing to really connect. No emails with buddies back home in the states. No news reports from around the country. No books on PTSD with personal stories were written. There were only clinical books for me to read when we met and I wanted to find out why this veteran was so much different than everyone else in my family.

My Dad was a disabled Korean Vet and my uncles served in WWII. My husband was totally different.

Today there is the Internet, books, videos, media attention, sites like this one putting together news reports from around the country and more programs than I can remember, yet today there are still high numbers of divorce, suicides and attempted suicides with more and more veterans ending up homeless from Iraq and Afghanistan. Their families and friends are not perfect. Most of them have the same attitude my husband's inner circle did when they could have been trying to be supportive instead of telling him to "get over it" and stop.

Today wives like me are no longer left in the abyss trying to claw their way out alone because they have a lifeline to reach for, but too many never take hold of it. Their families, spouse and kids, suffer just as much as they do but they have the power to end the suffering and begin the healing. They have the power within their reach but they just won't take it.

Do they love their veteran enough to learn? Do they care enough to find out what they can do to help instead of judge and blame?

My husband's ex-wife didn't care enough to find out what she was facing and their marriage ended after six years. We've been married for 26 years and with all the heartache and struggles, I wouldn't have missed a day of it because in the process of learning what I could do for him, I discovered a more marvelous man under all the pain he carried.

All of us can discover the people they really are under all the pain when we care enough to learn and help them heal. In the process, we heal ourselves, forgive what caused us pain because we understand what is behind it and know how to respond to help them see the person they are under all of it."

Reprinted with permission. For Kathie Costos' blog, Wounded Times, click here.

"Fighting Fair" vs. "Picking Your Battles" with a Combat Vet with PTSD

Everyone needs a friend like Kathie Costos. Kathie is my go-to person when I have questions about how to communicate with -- read, resolve conflicts with -- the combat vets with PTSD in my life. (She's also known as "Nam Guardian Angel" -- she's married to a Vietnam vet, Jack, with PTSD, and she's written a book about the experience, as well as created innumerable blog posts, videos which are widely disseminated on PTSD, and probably had enough conversations with spouses and family members to save a small army herself.)

Best of all, she's an absolute fount of wisdom, whose advice is spot-on, and comes from the trenches: 28 years of loving, and 26 years of being married to, a combat vet with PTSD herself. Very wise and compassionate lady, whose friendship and advice I treasure (and who I've been lucky enough to be able to meet in person). I thought I'd share her side of a recent email dialog we were having. As she puts it, she's giving advice to her younger self -- the advice she wishes she'd had, decades ago, but had to figure it out the hard way.

Her conversation is flecked with spirituality, but of a kind that even someone non-religious, or irreligious, can handle. It's golden-rule spirituality, and common sense heartfulness, that is so very rare indeed. Here she goes -- the context was "giving up" because "I can't win." She wisely responded:

"Winning depends on which battle you choose to fight.  Twenty years or so ago, I gave up on a lot of battles. My husband had changed from "best friend" to opposition and I was tired of giving up my life in all of this.

It was during a time when it didn't matter if I lost or gained 20 pounds, cut my hair shot or just let it grow, moved furniture around or let the apartment get dirty.  Nothing was noticed by him.  It was also the time I noticed that he was showing symptoms of OCD, focused on something's like a pit bull not letting go and basically worrying about not having anything to worry about.  It was one needless fight after another until I surrendered on certain things that had more to do with my ego than anything else.

I stopped letting my self worth be determined by his mood.  Not to say that I did any of this perfectly but what I couldn't "win" on was not a battle I was willing to fight anymore.  I got happier.

The more you learn about what PTSD is and what it does, the more you will be able to adapt and find your own "life" in all of this.  I spend most of the time happy when we share parts of our individual lives together but not regretting when we do our own thing.  He's welcome to spend time in my world but I won't give it up anymore when doesn't want to go there.  He's welcome to come where I go but I don't change plans or let it hurt me that he isn't there.  There was so much that I gave up to stay with him but the things I need, I fight for and the rest really didn't matter enough to go to war with him over.

Mood swings, ambivalence and neglect should only be allowed to go so far and then it comes into unacceptable behavior and you have to let him know that.  If he wants you in his life, he has to open the door to let that happen.  There are still times when my husband gets the best of me because no one is perfect in this but spiritual healing took a lot of the anger/blame/shame away.  Much of coping skills with PTSD comes close to AA and allowing a "higher power" take over some things in order to live again.

As he healed it was important to let go of the past negative feelings, hurt, disappointment and regrets. Hanging onto them would have filled me up with so much junk that I wouldn't have had room for what was good being returned to our lives.  It took good old-fashioned faith and what Christ taught me so that I could forgive him as well as myself.  For others, they can turn to their own spiritual healing by turning it all over to their own "higher power" to let it go so they make room for the good stuff to come back into them."

-- Kathie Costos, Senior IFOC Chaplain, DAV Auxiliary Chapter 16, independent PTSD Consultant

Her blog, linked here.

Her website, linked here.

Her downloadable PDF book, "For the Love of Jack," about life with her husband, a Vietnam combat vet with PTSD, linked here.

© 2010 by Lily Casura / Healing Combat Trauma. All rights reserved. Use with attribution.

 

 

When Is PTSD NOT PTSD? When Stubborn Pride Takes Control

Editor's note: We're not giving you medical or psychological advice here; consult with your own health care practitioner for that. What we are doing is sharing a longtime PTSD sufferer's opinion with you about his own situation, on the off-chance that it may instruct or enlighten. We have the feeling, now that he's outed himself, others may quite enjoy learning the distinctions he shares from his own life. And when we say "others," we mean spouses, significant others and family members...

From the subject of "Eyewitness to Combat," a Vietnam vet, Marine, with 40 years of "experience" on the subject:

"Post-Traumatic Stress Disorder has many faces and it sometimes masquerades as a behavioral problem; conversely, there are times when behavioral abnormalities masquerade as PTSD.  In other words, sometimes PTSD is mistaken for just stubborn Pride; and sometimes stubborn Pride is excused as PTSD.  There is also a third face, the one in which we appear completely “Normal.” So the “trick” becomes knowing which one is in control – the PTSD one; the PRIDEFUL one; or the NORMAL one. 

One of the most frustrating and difficult problems in sorting this out with traumatized MST or PTSD combat vets is that by their very nature, MST and PTSD sufferers are very complicated individuals, to say the least. It’s almost as if we are different people at different times.  And in fact we are.  My wife used to say she “never knew which one” of me “was coming home.” In other words: “PTSD really screws us up: mentally, emotionally, socially, personally, professionally and physically”.  However on many of the occasions that get blamed on PTSD, it is in fact our own personality “quirks” that have intervened, kidnapped and magnified the suffering from PTSD. And in the healing process, this habitual behavior must be sorted out before any true healing can “stick.” It’s true that we can be healed from our PTSD “disorder” but also allow our pride, habitual bad habits and negative attitude to completely mask any real improvement.

I do know that true healing from the destructiveness of PTSD is possible and real. I know this because I lived with all three faces of it for forty years and I have been healed.  Not “cured” but healed to a point that I now have a mostly “normal” a life rather than a mostly PTSD, prideful, bad habit and negative attitude life.  From this very long journey to healing I am able to speak from wisdom and experience on behavioral abnormalities disguised as PTSD.  I have been there; done that; and, for the most part, “have gotten away clean with it.” Now looking back, I am embarrassed and ashamed of myself for falling into the “pity party” that “works for me” trap.  I allowed myself to become “victimized,” believing that I was “entitled” to feel sorry for myself and that everyone else should feel sorry for me as well.  My PTSD actually made me feel “special” as everyone was made to “tiptoe” around me like a king walking among his subjects, so as not to “set me off”.  Trust me when I say that “this gets very old very quick” to those who love you, care for and about you; and it should be of no surprise when they begin to get a little bitter and non-empathetic toward our behavior.  It just gets tiring!  Upon entering the 90 day VA in-house PTSD treatment program years ago, I came face-to-face with a sign over the door of our billet, made by one of the previous vet therapists, that said: “How long would YOU put up with YOU?!  Well, not very damn long, I can tell you that – and that sign made the point for all of us.  So why should we expect others to do so?!  And if that’s true, why do we resist healing? Suffering from PTSD for most of my life made me very familiar with all of its symptoms and destructive consequences, along with what it does to our own physical body.  I am well aware of how devastating it is upon the family, friends and employers of those suffering from this disorder.  Today though, when I’m substantially healed, (see “before and after” story, linked here) I find that I can still act like a full blown PTSD’er.  The only difference is that now it’s my choice when to move into that arena, or not.  As my youngest grown son would say, “I’m going with NOT!”.  So in going there now it’s a premeditated decision to do so, not one dictated by PTSD. It’s premeditated because I first think about it, usually when my feelings get hurt, and then I stop taking my meds, as in “I’ll show them”, followed by then I stop doing what I know to do to keep me grounded and clear of stress such as EFT or Qi Gong.  Then I isolate myself in my all-too-familiar bunker, and “Away I go!” But this time it’s stubborn, God-damned pride that is pushing my behavior and keeping it in play, NOT PTSD. It might look like PTSD, sound like PTSD, feel like PTSD – and I am enjoying the effects. My world is now totally miserable, and I am glad – because I am back in control! The poet John Dryden put the sequence this way, “We first make our habits, and then our habits make us”.  Relinquishing control to our Prideful self is a habit we simply cannot afford if we suffer from PTSD.  It will destroy us and everyone around us. Again, if it is so miserable and so devastating, why stay in it? They “why” is PRIDE: Stubborn God-dammed, destructive PRIDE, a shitty attitude and very bad habits.  How does this fit into having PTSD?  It doesn’t fit into HAVING PTSD at all, but it DOES fit into KEEPING it!  And why would we want to KEEP Post-Traumatic Stress Disorder going, when we have the tools to get rid of it? Because it’s comfortable; it’s normal to us; it gives us control whenever we want; it gives us an excuse for bad behavior; it gives us an identity; it’s amusing to “shock” others; it draws attention to us; we don’t have to follow the rules and get a pass for doing so; it gets us “stuff”; it makes us somebody special and we can even be “paid” to have it.   And if you are getting “paid” to have it, it makes you a professional PTSD’er.  Sooooo why not act like one and let the spouse go to work; you get paid not to! You can sit on the couch and own the friggin’ remote and when you want to watch something cool you can clear the room and get a beer delivered to you in the process.  All the while someone can give you the beer, the TV and the couch.  I also know this to be true because I have spent up to a month terrorizing everyone in my life with my fucking PRIDE disguised as PTSD.  And I enjoyed the whole experience! But eventually even my pride got to a point that I couldn’t stand it anymore.  I allowed myself to be ashamed of this childish behavior and to apologize and ask for forgiveness so that I could come out of the corner.  NOW I really am ashamed of myself because I hurt those I loved and they didn’t deserve it at all.  But now I know what it is and will not go there again. (Publishing this handy little guide to PTSD vs. PRIDE of course will help!) I’ll use the tools I have been given in healing and use them gladly.  I do not want my loved ones to suffer the fool that I could become.  Scripture puts it this way in 1 Corinthians 13:11: “When I was a child, I talked like a child; I thought like a child; I reasoned like a child. When I became a man, I put childish ways behind me”.  In other words “it’s time we grow up!” Understand I am NOT talking about what “reaction” PTSD compels us to do that is destructive.  What I am talking about is what keeps us continuing the destructive behavior AFTER our PTSD moment has PASSED.  The fact that we suffer from a trauma-induced survival skill does not make us “crazy” or “insane” or incapable of being aware of our surrounding and how our actions affect others.  We still have the ability to know right from wrong and we know when we hurt others and we know when we hurt ourselves.  PTSD also doesn’t change our “moral code”.  If you were a nice person before; you are generally still a nice person and that becomes your “Normal” face.  If you were a courteous person before; you are generally still a courteous person and “Normal”.  If you were a grateful person before; you are generally still a “Normally” grateful person.  If we are truly remorseful for our actions which harm others, as we should be when we are “Normal”, then the abnormal behavior will stop until triggered again. And in our “Normal” state we are ashamed, embarrassed and truly sorry.  If we are not at least remorseful and/or our misbehavior is enjoyable, then we are either a narcissistic “asshole” or we are pretending to continually have PTSD behavior for control and that is our “Prideful” face.  If we are ashamed, embarrassed and sorry but continue in bad behavior, then we are stubborn “Prideful” fools using the ole, “That’s my story and I’m stickin to it” crap.  It will lead to your destruction and that of your family.  And PRIDE becomes the driving force, not PTSD, and the NORMAL face is destroyed.    That was PTSD.  But then I would get embarrassed and mad when “corrected” and take the Prideful mental position of: “Well I sure fucked that one up; so screw them all” and I would then “dig my heels in” and really make everyone miserable.  And I enjoyed it.  I was “showing them” for getting justifiably upset at me for my action.  That was PRIDE.  “They would learn to leave me alone whenever I would go into one of my “Marine Corps Moods”, as my kids would call it.  Yep, goddamn Marine Corps PRIDE!  (In truth, I have three kinds of pride: Texas pride! Irish pride! And Marine Corps pride! And that is a whole giant bucket of PRIDE…) Understand that I DID have severe PTSD and those triggering events happened a bunch but the moment I realized I had screwed up, PTSD ended and PRIDE took over to magnify the damage.  I was too proud to admit that I was wrong and then ask for forgiveness or even to say I was sorry.  For a Marine to apologize was a “sign of weakness”.  To take this action with those who love you only adds INSULT to INJURY.  However for a father, a husband, a son, a partner, to apologize is essential and your “Normal” self and is a great sign of love, appreciation, humility, strength, self-confidence and courage. When scripture states that “the meek shall inherit the earth,” it is not talking about the weak but the gracious, strong, self-confidently humble who attempt to right the wrongs they have done to others. Our families and loved ones know when that moment of awareness happens, and they appreciate it and respond to it, but conversely, with no remorse on our part they start to lose empathy for our plight, and rightfully so.  If our prideful attitude and bad behavior keeps up, they become aloof, distant, uncaring and bitter – and here’s the thing, we’ve helped to make them that way through our actions. PTSD is what causes the hyper-vigilance and other survival reactions triggered by events in our lives, but PRIDE is what causes us to stay in the now habitual act of PTSD.  True healing can only come when we understand that we will have the tendency to move into survival mode for the rest of our lives and that there are things we can do to effectuate a smooth, peaceful, happy life.  AND it is essential that we do those things consistently for the rest of our lives. (Examples would be taking our medication, and using the tools we can do at home for our own self-care, such as meditation, deep breathing, qi gong, EFT, music therapy, aromatherapy, etc. -- and knowing when it's PRIDE that's taken control!) We also must learn to be grateful to those around us who put up with our “moments” and have enough respect for them to swallow our pride and say we are sorry and mean it; then sincerely ask for forgiveness in love.  If you are unwilling to do this, then you are not ready to be healed because you are enjoying being miserable and making others miserable too much.  And I really feel sorry for you.  When we realize we have just had one of those “moments”; STOP, regain your composure, look around at what you have effectuated and apologize and mean it.  But if you do nothing else, just STOP and go to your corner.  When you have calmed down, then correct it before PRIDE takes control and kills everyone around you or before it forces you back into the “bunker”.  Your families know when you are faking PTSD and when it is real; so grow up and get your shit together."Pride goeth before destruction, and a haughty spirit before a fall.” Proverbs 16:18. Even with PTSD!"

© 2010 by Lily Casura / Healing Combat Trauma. All rights reserved. Use with attribution.

 

The Good Work of Talk: Healing the Wounded Heart Veterans Workshop

Practicing psychotherapist Allen L. Roland, Ph.D., tells the story of a group of veterans he's been working with in Northern California this past spring, along with Sal Ueda, M.S.W., counselor from the local Vets Center in Concord, CA. Roland writes (bolding is Roland's own emphasis):

"Five Vietnam veterans, all with PTSD, faced their fears and not only opened their hearts but found and began to heal themselves in the process.

The first meeting of the "Healing the Wounded Hearts Veterans Workshop" was on March 11, 2010 at 4 p.m.

They had never met me but they had been told about me, by their adjustment counselor Sal, and were prepared for an eight week commitment to face their fears and open their hearts in the process. They knew I was a Veteran and that made a big difference. 

I told them that this was an action based workshop and if they did their homework they would reach a place of not only another choice but would open their closed hearts in the process. They would also begin to see through different eyes ~ eyes unclouded by fear, resentment and unworthiness. I also explained through my Cycle Of Life chart how psychic pain will override Joy to the extent that most people have no idea that beneath their deepest pain and aloneness is love, joy and connectedness ~ the Unified Field. 

Of course, that first session I shared my own hearts journey to find a lost and alone little boy within myself who not only wanted to fly, and became a Navy Fighter pilot, but also to love as deeply as I loved my beloved grandfather before he was torn away from me at six years old. We didn't talk about the war ~ we all briefly shared our heart's journey and by the end of two hours ~ we became a band of brothers. Their homework was a life chart of the paths of their individual hearts. 

The second session, a week later, we all shared a childhood picture of ourselves and shared our life chart with the group describing our individual journeys to find love and acceptance as well as ourselves. We barely talked about the war ~ we all realized our commonality in that our lives had all been a quest to find meaning and that all of our love relationships had significant meaning. We were a band of brothers on an inner journey of the heart. 

The third session, a week later, they did the Vic/Acct exercise and had the chance to feel the lightness of being accountable versus the heaviness of being a victim. Their homework was to take the people they had resentment towards off the hook and realize that many of them they had deeply loved and were really gifts in their lives. 

Al felt it was the most meaningful aspect of the workshop ~ " I let my ex-wife off the hook ! I hadn't spoken to her in over four years. I was harboring extreme resentment. After the exercise, I was able to call her and let that resentment go. That alone has made a huge difference in how I feel today with her and my life." 

We barely talked about the war ~ we were a band of brothers on a common journey to find ourselves. 

The fourth session, a week later, they met the child within by means of a powerful guided visualization. Every one of them saw that long lost innocent child who told them what they needed to do to fully embrace him in their lives now. Their faces literally changed and became younger as they made that inner connection ~ it was like long dormant flowers suddenly blooming. I was moved almost to tears to see these Veterans suddenly claim their joy and innocence after years of self doubt and despair. For Tom it was the most meaningful aspect of the workshop ~ "Just seeing the look on the other Vets faces as they met the inner child." 

Their homework was to give that child a voice and hang out with him. 

The Fifth session, one week later, was all about gratefulness and thanking the people who have been there for them their whole life ~ with the help of a guided visualization. Many of them had not thanked anyone and certainly not themselves. Thomas shared his homework from the previous session and had 12 pages of notes on his experience. Here are some excerpts ~ " Once again, I was so surprised when it happened at the group meeting that I could hardly wait for it to happen again and again. Just the thought made me feel like a weight was lifting my shoulders and mind ... I meditated and saw him again. I asked him again ~ What do I need to do to fully embrace you in my life ? He immediately answered ~ Since birth, I have always been with you constantly. You just weren't looking for me. You just didn't see me or believe in me but I see a change in you now ~ more than any time since Vietnam." 

Thomas ended his notes by writing ~ " I can't believe that I have had this problem for some 40 years and I feel like a new born child. I'm still amazed that I had blocked out so much and yet this was the right key to change things for the better ~ and it was so simple to initiate ~ I feel good !!! " 

By now the Band of Brothers were inspiring each other on their common journey through fear ~ they were beyond the point of no return. Their homework was to thank at least 25 people who had touched them before the next session. We still barely talked about the war for there was no need to. They were already healing themselves by taking responsibility for love and coming from gratitude. 

The sixth session, one week later, was the Death Exercise where the group, through a visualization, were guided in a profound death exercise which helped them to experience the degree to which the people closest to them really knew them. The exercise actually simulates your death and the resultant shock of knowing that you did not truly share yourself with the people closest to you or that very few people really knew you.Obviously, it is a strong inner stimulus to open your heart with the people closest to you ~ and that was their homework to accomplish with the five people closest to them before the next session. 

Most of them enjoyed the element of the unknown that they were continually coming face to face with in these sessions, especially Al ~ " I enjoyed the element of surprise. It was hard to know week to week just what the activity would be and how it would effect me. Every week was different and unique but it all came together " 

The seventh session, one week later, reinforced that we are continually being called from within to the path of the heart, but few listen and fewer still respond. It is in this session that they understand that they have been called to the inner journey of the soul ( through Love) versus the outer journey of the ego ( through Fear ). This session ended with a visualization exercise in which they realize that the most precious gift they have always wanted is themselves ~ free from fear. 

For Barry, this was the most meaningful aspect of the workshop " For me, getting in touch with my inner child and having it pointed out to me that the key was just being myself and to trust myself without any fear or fears of the consequences." 

The Homework as well as ongoing homework was to share the gift of themselves with others but in the spirit of celebration ~ not deprivation. 

It was in that same spirit of celebration that we had our Eighth and final session where everyone acknowledged each others common journey through fear to the joy, love and light beneath. As George said, "Now, I truly know I have another choice and I can be loved for just being myself and I don't have to enable people to win their love.... I see the growth in my fellow members but also how we learned to love each other ~ a true Band of Brothers." 

It was also an incredible experience for both myself and Sal, a Veterans Readjustment counseling therapist (from the local Vets Center) who both formed the group and then fully participated in the sessions. 

Sal's most meaningful aspect of the workshop was "To witness and see the burden of fear, guilt and pain of each group participate lifted. To see the youthfulness return to their eyes, faces and demeanors. It is a blessed experience to see the joy return to these war veterans after years of despair. It is simply humbling and a beautiful sight." 

I was also humbled by this experience and validation of my empowering work as well as the receptivity of these veterans who obviously longed to be seen from the heart and not through eyes of fear. 

They had been trained many years ago to kill and I, in essence, jump started their hearts by re-training them to love and they began to heal themselves in the process by realizing that they indeed had another choice. 

And we never concentrated on the war for the real war had been waged within themselves ~ and they were now victorious."

-- Written by Allen L. Roland, Ph.D.  Used with permission.

Editor's note: The accompanying photo is of five other Vietnam veterans from a different gathering, not the ones described in the article.

Quotable Quotes -- Sarah Haley, M.S.W., on Combat's Effect on the Veteran

"Combat veterans may play down or embellish their 'war stories,' but initially their reports should be taken at face value. The only report that should not be accepted at face value, although one may choose not to challenge it initially, is the patient's report that combat in Vietnam had no effect on him." -- Sarah Haley, M.S.W., "When the Patient Reports Atrocities: Specific Treatment Considerations of the Vietnam Veteran," published in Archives of General Psychiatry, Vol. 30, Feb. 1974.

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."

Sometimes You Have to Choose to Love -- A Love Story after PTSD

Into the dearth of "good news" about combat veterans with PTSD and their partners comes the remarkable love story of Josh and Helen, who met and fell in love AFTER his service, his suicide attempts, and his PTSD diagnosis. While PTSD can seem like the "third partner" in a relationship -- the ever-present elephant in the room -- in Josh and Helen's story, it's what brought them together, and love, wisdom and maturity is what keeps their union intact.

I had the pleasure of getting to spend a few days recently with Josh and Helen, and was impressed by both of them, and the sheer fun of their relationship, which can be too rare among partners where one has PTSD. I was struck by Helen's clear-eyed, open-hearted approach -- the education she sought about PTSD, as she was falling in love with Josh -- and the way in which she's really becoming a wise "spokesperson" for how love is possible after PTSD. For all the broken relationships out there, and all the partners barely enduring and tolerating one another, I felt like Josh and Helen's story needed to be told, so I asked Helen to tell it. Just as a point of reference, Josh served in the U.S. Army from 2002 to 2008. He was honorably discharged in 2008, and served in Iraq from 2005 to 2006.

Here is Helen's story:

"I met my husband Josh on December 27th, 2008. That's about two years after he returned from Iraq and about two months after he tried to commit suicide for the second time. He was at my house attending an after-Christmas-before-New-Years party that my then roommate Chris was throwing, and he was there against the medical advice and wishes of the team of specialists overseeing his psychiatric care at a well-known men's inpatient program for PTSD.

He was home for the weekend to visit his family and in order to do so he was required to fill out a schedule of where he'd be, what he'd be doing, and with whom. If they'd known he'd be at that party, they more than likely wouldn't have let him go home. And if they knew he'd meet me, they'd probably have chained him to the wall. Of course I don't know that for certain because it's not the way things happened. He did come to the party, I was there even though I had other tentative plans that night, and we did meet each other.

Josh told me later that he wasn't looking for anything other than to feel normal for a few hours. He hadn't really expected to feel comfortable at all and certainly had no intention of telling me that he had PTSD. Again, not the way things happened. He started by telling me that he was a soldier which really intrigued me. In my head I can't help but equate military service with nobility, honor, and authority, probably because the only other people I knew that had been in the military were my grandfather -- who had served in the Navy in World War II -- and a family friend who took unfair advantage of my googly eyes at the tender age of 15, later dubbed "evil Army guy" though I never really associated the service with the man.

I had heard of PTSD and sort of knew what the letters in the acronym stood for. It was a pretty basic concept; formerly known as "shell shock" which Great Uncle Paul, Grandpa's brother had. I remember thinking when it became apparent that Josh and I were going to have a relationship that I should probably be concerned, but I wasn't. I don't know why. I had also heard that men with PTSD could be violent and do harm to the people they most loved. But then again, so can most of the people I know. I knew I'd have to educate myself on what exactly PTSD is, a fact that was compounded when I came up against some opposition from a friend of mine who thought Josh would kill me and then take his own life. She thought this because a friend of her grandmother's had been murdered by her husband, a veteran of either Korea or WWII. I started with the basics (the basics being the extraordinarily reliable source of Wikipedia....you can't tell, but that was written in a sarcastic voice) which actually gave me a pretty decent base.

From there I moved on to other sources including the VA, National Institutes of Mental Health, and last but not least, Josh's therapist. Josh took me to see him because, he said, "I want you to know what you're getting into". Among other things, what I learned was that, aside from the fact that Josh's PTSD was focused inwardly and therefore he wouldn't hurt me, he was being monitored by so many mental health professionals as well as regulating himself that he was the least likely person in the world to do so.

We got lucky. One of the most interesting things I learned was that PTSD is, for lack of a better word, normal. When a person is placed in an extremely traumatic and/or stressful environment, their mind enacts hyper-vigilance, paranoia, insomnia, etc. to enable survival. In a war zone, PTSD is useful. It's when the soldier comes home in time of peace that there are problems. Actually, many people with PTSD have it because of domestic violence. Some people get it from car accidents. The list goes on.What Josh told me really helped him was that I didn't push. When he told me about Iraq, I didn't launch questions at him that he probably wouldn't want to answer. I waited. I focused on him as best I could, I listened carefully.

Eventually he opened up to me, but the fact that I fostered an environment where he felt safe to talk about it, without judgment, without questions, without a sense of urgency helped him immensely. Communication is not our weak point because both of us took a chance at being safe with one another. At first it was scary, but it was completely worth it. One of the most important lessons I've ever learned thus far is that sometimes you have to choose to love. I took on the attitude (I was newly in love so it wasn't too hard for me...plus he's awesome) that he was (and is!) the most incredible, sexy, wonderful, manly man on Earth. I tell him frequently that he is an excellent provider, that he takes good care of his family, that he satisfies my basest urges (*giggle*), that I choose him and marry him every day and will have only him for the rest of my life, and most importantly that I love him so much and love him for who he is. I mean every syllable of it, it's completely true, and I stand by my bold statements and declarations. My heart melts every time because I see him sheepishly look down or puff his chest out, or I notice that he's walking just a little bit taller. He loves it, and his life is made easier and he is made happier knowing that I adore him and that I'm there for him (and he responds in kind).

This is not to say that it's always a cake walk. It isn't. Marriage is hard enough work without mental illness in the mix. His anxiety will act up, he'll get scared, he'll feel depressed and useless and insecure and jeez, we haven't even gone in to MY issues. But he knows that I'm always there for him. We made the conscious decision to put in the effort to speak, to care, to look out for one another, and to work through our arguments and disagreements. Sometimes that is damned hard. But in the end, loving him is easy because of it.

I know that our relationship is different than many other spouse-vet relationships for a variety of reasons. First, I met Josh after he came home from Iraq, after his suicide attempts, after he started treatment for PTSD. I never had to wait for him, never had to live away from him during deployment, never had to worry that the phone would ring or I'd get a knock on the door. I didn't have children to be both mother and father to while he was away, never had to experience my husband being a different man now than he was when he left me. I don't pretend to know what that must have been like.

But if there's anything that I can offer, anything that WE can offer, it's that there is hope. Josh was convinced once that the only good thing he could do was destroy himself; get rid of the burden. Find peace in death, in drinking, in drugs, ANYTHING. He had a plan in place to move to Seattle with just some basic gear with which to live on the streets, and he chose Seattle because their Department of Public Health has a clean needle exchange program. Almost two years later, he's married with a loving wife, a service dog who needs him, two cats who love to annoy him, a sound support system, and more and more he is learning that he's not alone. I am, and by choice always will be, his biggest fan, his cheering section, his advocate, his confidante, and his partner. As his wife, my job, my goal, my honor, my privilege and my pleasure is make sure he never feels otherwise."

Editor's note: The photo of Josh and Helen is used with their permission.

The PTSD Veteran Parent or Spouse: Occasionally Disconnected at the Source

Gayook Wong, who writes about PTSD occasionally in her own blog, focused on Qi Gong -- which we've written about, here -- talks about the disconnect she regularly experiences with her own children, because of her own longtime PTSD. The scenario she describes should be very familiar to spouses, significant others and family members of those with PTSD.

She writes:

"I have suffered from PTSD since I was a child, even though I never knew what it was. I couldn’t understand why I had so many nightmares, why awful moments of terror would suddenly come upon me accompanied by dry sweats and rancid fear in the pit of my stomach. 

Many of my clients have expressed similar outrage at what they are going through. Some have even told me they felt were being punished, but didn’t know why.  When a survivor is enveloped in PTSD symptoms, he/she cannot even begin to consider anyone else. 

 When these symptoms come upon me, I am not my chronological age. I’ve stepped back into the past, where I feel terrorized all over again. I am no longer here. Unfortunately, my children feel most the brunt of my trauma. I am not the mother they know and trust.  I become a stranger to them. They have told me that they feel abandoned, that I don’t carry through what I’ve told them I would do. They have accused me of lying to them, that they can’t trust me, so they feel they have to take over the role as adults and figure things out in a crisis. 

 My children have told me many times over the years that when I have bouts of anger or periods of regressing back to a terrorized child, they feel absolutely helpless. They don’t know what to do to help me. Over time, this helplessness has turned into resentment. They don’t understand why I can’t just get over it -– it’s been so long. 

There are times, I’m sure, that they feel I’m using this to control them – which only adds to the resentment.It is only after some recovery that I am able to hear them, to see how my trauma has affected them. And, how the effects of the trauma gets yet passed onto the next generation. My children learned that, when I “space out”, as they label it, they have to be the adults. In many ways, this has happened since their childhood. As for me, I just want them to understand that the symptoms appear sometimes out of nowhere, and I feel like I’m defenseless, that no one and nothing can help me. But, of course, they don’t. And, logically, I can’t expect them to. 

I want them to understand that it’s not something that I want to have happen, that I feel like I’m going to die in there.  I really make an effort to return to the present moment. Some times are easier than others. It depends on what gets triggered. Even as I am learning more about PTSD and how these symptoms have defined my and the lives of so many others, the labeling of my periodic states  brings up another scare for my children, my daughter especially. She reacts angrily when I label myself. She is afraid that the label gives me more reasons not to heal, that I am using the symptoms to control.   

However, for me, understanding  what has been happening to me all these years and why,  has helped me to name the symptoms faster. Once I name them, I am able to come out of it much quicker.  And, the quicker I can come out, the less adverse affect it will have on my family and friends."

She also recommends counseling:

"Close family members, especially if they are caregivers, need to also have a support system,. Find others who are undergoing similar circumstances. It helps to know that you’re not alone. I strongly urge counseling to families, either together and/or individually. When tragedy befalls one family member, there is no way that others will not also be affected. My family and I have all gone through counseling through the years, together and individually. Now, they know what’s happening to me, we have a code that helps me to come back into the present moment. This helps me to recognize what’s happening to me. And, even better, my children don’t feel as powerless because they are part of the solution."

Gayook Wong makes so many good points in this post. Most of all, she is doing a good job of describing the disconnect that PTSD can connect, the unreachability of the sufferer when he or she is in the throes of their symptoms. Afterwards, of course, things can improve, but sometimes too the damage has been done. The "not being able to consider anyone else" truly takes its toll on friends and loved ones. Others may come to regard the sufferer warily, and the sufferer himself or herself wonders if they can be trusted again, when there are no guarantees.

While few programs offer resources for family members of veterans suffering from PTSD, some do. Check out the Vet Centers in your geographical area, and also The Soldiers Project, which offers free, confidential counseling to family members as well as veterans.

Going to the Bunker: A Combat Veteran with PTSD on the Purpose of Protective Isolation

Every combat veteran with PTSD knows what is meant by their "bunker," or what "going to their bunker" means. It's a walled-off, isolated situation that allows them to get some space to themselves, away from other people (including family and friends), when they feel particularly triggered, and they need to stay in there for, well, as long as they're going to. They come out when they're ready, and not a moment before. Obviously this situation can be very frustrating to others in the vet's life, but for the vet it affords him or her some very necessary, protective isolation.

The rest of us who aren't combat vets with PTSD I suppose could think of it as the vet putting himself or herself in a time-out from the world, by taking themselves out of the mix, and away from people and stimulation, both bad and good. And the time-out will be over when it's over, because they decide when it's up.

The recent Fourth of July with its fireworks that remind many vets of combat was a classic bunker situation. Many, many vets were making plans before the Fourth for how to protect and insulate themselves from being triggered by the fireworks (noise, smoke, crowds). One Gulf War vet with PTSD who had already isolated himself, wrote of putting a pillow over his head and just wanting it to be over, so that he didn't have to experience it. The next day, fireworks all exploded, he was better. But during, he had to be in the bunker. Another combat vet with PTSD, from the Iraq war this time, talked about staying in her bunker for days, making brief provision runs, every fourth day or so, to the grocery store and then...back to her bunker. When she needed to be in her bunker...

The bunker concept/construct is so typical to combat vets with PTSD that I thought I'd ask one who I know fairly well how he'd describe it. He has decades of PTSD "experience" under his belt, and I've also seen him retreat to his bunker at various times. A month one time, a week another time, the last time, a day. Sometimes even a few hours. But however long the episode lasts, during that time: totally unreachable. And realistically, you better not even try...because it just makes the situation worse. 

The more chances I've had to experience this with him, the more certain I can be that, short time or long, he'll emerge from his bunker, when he's good and ready, and with a new and improved outlook on why he went in the bunker in the first place. (For those who don't know, the bunker can be anywhere...a shed, a garage, a spot in the woods, a room in a house, even a chair. But it's sacred, inviolate, untouchable space...and the vet goes there in retreat, partly to spare those around him, but also strongly to get control over what he's feeling. (He or she, obviously.) So I figured he'd be able to offer his personal/expert advice on this.

Here's how the conversation went.

Me: "What typically sends vets to their bunkers?"

Him: "Any situation -– losing a job, losing their cool, a fight with their kid -- that makes them lose control sends them back to their bunker, so they can regain control. It may not be much, but while they're there, at least they have control over that little room they're in."

Me: "What's the longest time you've ever spent in your bunker?"

Him: "A year."

Me:  "!!!"

And then he clarified. (Remember, this is just his opinion, but it's worth sharing, because of the number of vets he knows and has observed, as well as what he knows about himself.) "Each time a vet goes into their bunker, they go in for a longer period of time. Until one time they go in and they don’t come out." (He does know an awful lot of other vets who have sadly killed themselves. That happens in bunkers, too. No wonder families and friends are justifiably concerned.)

The progression he just mentioned...vets spending longer and longer times each time in their bunkers...is actually the opposite of what he's been doing, since I've known him (which coincides with his getting better). Each time he goes to his bunker, it's both less frequent, and for shorter and shorter times each time, to the point that the last "bunker" episode I observed him in was actually only about half an hour.

In the middle of a frustrating conversation, not quite an argument, but one where emotions were high and we weren't communicating smoothly, he "withdrew" to his bunker of self-enclosed, protective space -- without moving from the couch he'd been sitting on. I saw him cross his arms, very agitated, close his eyes, and start doing something that looked like huffing and puffing. Even on an animal instinct level I knew, give this person his space. All the body language was daggers. I stepped away, and a short while later, he bounced back, and resumed where things left off, able to manage the conflict without any undue strain. Turns out what he'd been doing during the huffing and puffing phase was actually deep breathing, to calm himself down and regain control. Very smart. On the outside, he looked furious. On the inside, he was doing what he could to get back under control. As a result, he was able to "emerge" from his bunker in record time -- which speaks to the tremendous benefits of learning coping skills and stress-reduction techniques, as he has.

When I first knew this vet, he talked about what he'd learned at an inpatient PTSD program at the VA years ago. It was the cutting-edge program at the time, and he speaks of it with great appreciation, even though many of the guys he went through the program with sadly did not make it. ("Did not make it" is euphemistic code for "sadly, later killed themselves.") One of the biggest things he learned in the program, according to him, was about "red flags" and "triggers," and how to get away before you make things worse. Heading for the bunker, just like in the description of the vet with the pillow over his head,  is one way to keep things from getting worse. For the vet, that is -- for the family or loved ones, it's very difficult to experience, and hard to ignore, though one of the secrets seems to be, going on with your own life, while maintaining a compassionate (but not nagging) concern for how they're doing.

One of the distinctions he likes to make, though, between what he learned from the behavioral modification skills, above, in the VA program, and what he's learned since then, following more of a healing path, is that now he has some ability to not just "avoid" triggers but also "deal with" situations as they come up. The red flags still show that the problem is coming, but instead of being ONLY triggered, there are now new ways to deal with it that don't only involve avoiding or isolating.

The situation above, of being in conflict but being able to "be" with it, and breathe through it, meant that the conflict didn't have to explode into a multi-day saga or a physical exit to an actual bunker, which could last for weeks or months -- or even a year(!) Ahhh, progress is a beautiful thing...

Editor's note: For Part II, "Busting Out of the Bunker at Last," go here.

---

© 2010 by Lily Casura / Healing Combat Trauma. All rights reserved. Use with attribution.

A Veteran's Journey from Suffering and Despair to a "Happy and Productive Life..."

Had this conversation just now with a Vietnam combat veteran, who struggled for decades with severe and chronic PTSD. (Read about him in the "Eyewitness to Combat" section. It's gripping...)

It's been almost two years now since we first started talking, and I was looking back on how very much he'd changed. The most noticeable thing to me is how consistent he is now, along with the much lower intensity of the darkness and despair. Back then, when he was suicidal, it was a constant feature. I never knew from one conversation to the next whether that would be our last talk, so close to the edge he was. But that was a phase...and the phase changed, and the "mood" of that phase "lifted," and now I can look back and think how very long ago that seems, even though it was "just" two years ago.

In trying to find words to convey how much I'd seen him changed, I found the analogy of a staircase, maybe one with gigantic stone steps. It seemed that though he was still climbing -- we all are, of course -- he'd cleared those gigantic steps found at the absolute bottom and walked up a few more as well. Now when he slides back down, as we all do, also to some degree -- he no longer hits rock bottom --- so it might still be low, but it's much farther up from where he was, and that progress he made, he gets to keep.

He agreed, and said that it wasn't so much that the demon of despair wasn't there anymore, as that it was something he could now overcome. "Healing," he said, "is when you're able to use what you've been taught" from all those hard experiences. And one of the most key, is not to give up, but to do what you know to do. Whether it's to stay on the lowest dosage of the medications that keep you functional; or the healing techniques you know can help -- whether by going to a practitioner, or even the ones you can practice yourself. And ideally both: appropriate medication AND healing work. Together: an excellent, therapeutic combination. Singly? Not so much. It's like there's something missing...and there is. Synergy, for one thing.

St. Patrick's Day is this vet's "Alive Day," or as he used to call it, his "Kill Day." The day that everyone else was shot or killed, and he was shot and almost died, and barely didn't. Not a major celebration in his life; one with a whole lot of guilt for surviving, and one guy in particular who died who was a short-timer, and went into the fight with him because of their friendship.

St. Patrick's Day last year, this vet was doing great. On his medication AND doing healing work. Pleasant, engaged, out in public (even in crowded places), managing, letting his whole personality out, the bad as well as the substantial good. Major progress.

This year, St. Patrick's Day, not so much. Kinda "backslid," as the old churches would say. Had abruptly stopped his medication, because he wanted to "feel again," or "feel more." And what he felt wasn't so pleasant for him or anyone he was around. His personality was coming out then too: but it was the dark side, with only glimmers of the light.

That was a learning experience, for everyone. Get back on the meds, but don't stop the healing work either. They're BOTH important. They both produce the synergy necessary. With both, he says, he's able to stabilize; see the triggers and the red flags for what they are, but not react in the same way. Without the medication? As he describes it, "I'm looking for the switch..." to turn off the triggers "but there is no switch." Together, it works. And together with support from others: WE all work better too :-)

(Interestingly, though, he was still able to do one major thing THIS St. Patrick's Day. He told the story, in a powerful, moving and very public way, of the last seven days of his friend's life, leading up to his tragic death on that infamous "Kill Day." He said he'd never before had the strength to tell that story, and this time he did. Fellow combat vets eyed him nervously, preparing for the big crash...that never came. How well did he make it through? With an enormous sigh of relief. He went to bed and slept deeply, finally able to lay that burden down that had dogged him for 43 years. He was able to let the haunting memory go, without giving up the love of his friend. And that's what you'd call...healing. Bonus points were when the dead friend came to him in a dream that night, and they saluted one another. As though it were safe to let that memory go...but let the love remain.)

---

"Life for me ain't been no crystal stair," the great American poet Langston Hughes wrote in his poem, "Mother to Son."

It's had tacks in it,

And splinters,

And boards torn up,

And places with no carpet on the floor --

Bare.

But all the time

I'se been a-climbin' on,

And reachin' landin's,

And turnin' corners,

And sometimes goin' in the dark

Where there ain't been no light.

So, boy, don't you turn back.

Don't you set down on the steps.

'Cause you finds it's kinder hard.

-- "Mother to Son," by Langston Hughes.

The same could be said by so many veterans who suffer. But yet there is still hope, and it's in the climbing, not the "setting" down :-)

Returning to the conversation with the Vietnam vet, I told him how much I appreciate the consistency since he's been back on the low dose of medication he takes. Failing to find a better word, I said how much I appreciated getting to see his "charming" personality again, instead of the roller-coaster of pain, frustration, anger and despair. "ALL of these guys have charming personalities," he reminded me; "That's why their wives married them...And that's what we've got to help them return to."

"Let's Give 'Em Something (Not) to Talk About..."

We mentioned in a post yesterday about reading in the introduction to Belleruth Naparstek's book, "Invisible Heroes: Survivors of Trauma and How They Heal," how talking about trauma may actually re-trigger the traumatic memories of PTSD survivors. (That post is linked here.) Further on in the book, she goes into a little more detail:

"Trauma produces changes in the brain that impede a person's ability to think and talk about the event but that actually accentuate their capacity for imaging and emotional-sensory experiencing around it. Imagery [then] uses what's most accessible in the traumatized brain to help with the healing."

And further:

"...Too few survivors know this and, sadly, too few professionals as well.  So people are not only baffled and alarmed by their symptoms; they are more often than not seeking -- and getting -- the wrong kind of help from people accustomed to using discussion, thinking, and language -- help that often misfires."

(Help of a particularly left-brain-oriented rather than right-brain-oriented kind.)  She continues:

"It's not that talk therapy is bad.  The emotional support of a sympathetic listener is as critically important as it ever was.  It's just that it's not enough by itself.  If a person has been deeply impacted by trauma, it's more than likely that he first needs to find an oblique route through the imaginal realm, using metaphor and symbolic language, to help him manage his symptoms, find a sense of safety, recontact his wholest self, and make language a viable avenue again. Once the imagery has established a beachhead of safety within the survivor, then the tools of language and cognition can be enlisted to help with healing.  But without the imagery first, the thinking and talking can run aground and catalyze even more severe symptoms, such as flashbacks and nightmares."

Now Naparstek is well-known for her work with imagery (CDs and DVDs she's produced, examples of which are here and here, etc.), and in the course of the rest of the book, I'm sure she'll bolster her case quite effectively. But what she's saying, even to the untrained ear, is this: there's often another, more indirect (aka, oblique) "way in" with trauma -- where touching on the trauma directly would be just too...traumatizing.

That reminds me of two different experiences.

One with a combat veteran, at the point of suicide, who wanted to discuss his experiences. He had me promise that if we started to discuss what he'd been through, that I wouldn't let him down. I promised, but what happened in the months that followed is that we never actually discussed those experiences in depth, in so many words.  We talked in and around them, and kept circling back to them.  But we never just camped out and stayed there, in a painful way for either one of us.  There was movement: surging forward, but also retreating. And no constant painful pressure to "uncover" all that he'd been through. What impressed me was that even so, he began to do signficantly better. Was it someone really listening to him? Or was it his being able to talk about the parts that mattered to him?  I don't really know.  All I know is that it wasn't constant painful pressure on the sore spots. It moved around, and kept on moving. And yet it helped.

Another is an experience, more recent, with a type of bodywork. An Asian bodywork that we've talked about on the blog here in the past.  I got to experience it for the first time, in the "hands" of a veteran healer, whose training was extensive. It felt a little bit like wrestling.  We were in constant contact. He pushed, pulled; I pushed against; yielded; we kept going.  I noticed that he would push just to the point where it was getting really uncomfortable physically for me; then he would pull back; circle around; do something else; in essence, divert or distract me; then come back to the same spot, where suddenly he was able to go deeper, encounter less resistance, create more change.  Obviously it's hard to articulate about a kinesthetic experience precisely with language, but I was struck by the analogy to conversation about difficult topics with a loved one.  How the give-and-take with pressure on a sore spot could only be there for so long; before the same cycle of retreat; divert; distract; come back and find the spot would yield to greater depth; etc.

Bodywork and therapeutic conversations: maybe both prefer the circuitous, rather than the head-on way in. Trust is crucial, but also the sense that the glaring spotlight of pressure isn't there to crumple underneath. Sideways makes better headway, sometimes.   

Triggered by Talking about Trauma

It seems a bit paradoxical that the very act of attempting to talk about trauma might actually trigger trauma, and turn out to be "too much" for the traumatized person to handle, but this can be the case, according to Belleruth Naparstek, in her well-regarded book, "Invisible Heroes: Survivors of Trauma and How They Heal." She writes:

"This is because with PTSD, language can be a trap. If a deeply traumatized person is prompted only to speak and think about the events that created his distress, without enlisting help from the imaginative, emotional, sensory and somatic capabilities of his right brain, his symptoms can actually get worse instead of better.  Encouragement to "talk about it" -- a therapist's and, for that matter, a good friend's stock-in-trade -- can catalyze a tailspin of flashbacks, nightmares and overwhelming anxiety."

Clearly, we're just scratching the surface here of a much larger topic.  But while the case can be made that listening to another deeply is often quite therapeutic, having to talk about (relive) something traumatizing might have adverse effects.

"Anything is Subject for a Poem" -- Even Combat and Its Aftermath

It's hard for me to believe I haven't already posted this, but that's what the blog search says -- and I must believe it. Here's an interesting item from the always-fabulously-insightful Deng Ming-Dao, on how "anything is subject for a poem," and why a regular discipline of "writing down the bones" can be advantageous to any of us, even -- or especially -- combat veterans.  He writes:

Anything is subject for a poem:
A catalog of boxing equipment, a collage of other poems,
Serpentine trail of incense, raised deer fur, old shoes pointed pigeon-toed,
Glass and steel cityscape, almond eyes of a saint, weeping tiny flowers,
Sunlight on whitewashed walls, blue shadows of stooped women,
A spring mousetrap, a trickle of blood in the gutter,
The homing swoop of a gull, chill white-capped bay, scent of eucalyptus.
Green lawn of broken blades, clods of fat earth.
Anything is subject for a poem.

Even in sleep, write a poem.
When waking, write a poem.
While loving, write a poem.
Even voting, write a poem.
When angry, write a poem.
While dreaming, write a poem.

The sages say quite seriously that those who wish to know Tao better should cultivate the poet in themselves.

-- 365 Tao: Daily Meditations, by Deng Ming-Dao.

Pulling the Pin: Combat Vets, PTSD and Troubled Personal Relationships

Combat veterans with PTSD often have tremendous difficulty with their closest personal relationships: marriages and families.  Divorces, multiple marriages, and short-term relationships that end unhappily are very common: All situations that compound the pain and suffering that already exists with PTSD.

While there are a few books out there that provide some helpful advice about the difficulty of combat vets with PTSD sustaining good relationships, some insight is also in order.  While many obstacles could be mentioned, we'll stick to just a few important ones.

1.    Needing to have a constant enemy. Combat veterans will tell you that their training requires a constant enemy for alertness, vigilance, what amounts to staying alive. Once combat ends -- or between episodes of combat -- that "role" needs to be filled by somebody.  The most obvious candidate to fill that role?  The combat veteran's usually unwitting, and unwilling, partner. If the spouse or partner isn't available, the next best candidate is a child. The combat veteran is often unaware that he or she is using this tactic at all, and the one victimized by it can often tell "something is wrong," but isn't always clear on exactly what that is.

2.    Pestering and teasing doesn't feel like love, but it does feel like irritation. Let's say the coast is clear.  It's a sunny day, everything seems (temporarily) all right in the combat veteran's world. But he or she teases and pesters a spouse, partner or family member (e.g., a child) incessantly, until that person gets fed up and walks away.  "But I was just teasing!" says the combat veteran.  Yes, but the frictional nature of the allegedly good-natured teasing has a predictable effect: it drives close others away, much like bad behavior also does. Now the combat veteran can be left alone: But is that what he or she really wanted?  Perhaps.  Perhaps not.  The main thing, combat vets say informally, that inspires this strategy, even on an unconscious level, is that too much peace and calm is off-putting, and creating (or re-creating) a little "chaos" in interpersonal relationships puts the combat vet with PTSD back where he or she is more likely to be comfortable.

Now factor either (or both) of these two behavioral patterns (among several others that could have been discussed) with the combat veteran's periodic desire for intimacy -- and imagine the realistic toll that such behavior, even if unintentional, takes on the spouse or partner's desire for intimacy.  More likely, either one or both of these behaviors is more likely to shut down or numb the spouse or partner, who then is more tempted to resist attempts at intimacy.  Is turning down intimacy the problem?  Is it the only problem, or even the central problem?  Probably not, if either of these fairly typical behaviors are an issue.

Helping Vets with PTSD: Rolling up Your Sleeves vs. Keeping an Arm's Length Distance

We've talked before on this blog about Paul Tillich's fabulous quote, that "the first duty of love is to listen." 

Here's a story that neatly conveys the polar opposite of that; or at least how someone, a VA provider, got actually PUNISHED for doing that (thanks to Ilona Meagher for noticing the story). But first, an aside.

I was at a dinner a while back that concluded a week's worth of focused training for health care providers, mostly psychologists, psychiatrists and social workers -- many of whom dealt with combat veterans.  Seated across the table from me was a VA provider, a Ph.D. psychologist who, to his credit, was of the Vietnam era but hadn't served, and who had gone into working with the VA so that he could "help" his generation of veterans, who he saw as being tremendously underserved.  True and good, so far.

As we sat at dinner, he told the private practice psychiatrist to one side of him, and the veterans service officer (and Iraq War combat vet/single mom) to the other side of him, about something "new" called "EMDR," that neither one had ever heard of, and that he had just learned about, and  was fairly enthusiastic about himself.  EMDR, for "Eye Movement Desensitization and Reprocessing," for one thing, is NOT new.  It's been in existence for years -- since the 80s, when it was developed by Francine Shapiro, Ph.D..  Something like 16 clinical trials have shown its efficacy. Heck, we've got several blog posts about it, from two years ago. So it's not really great news that the provider was "just learning about it" recently.  EMDR was one of the first quasi-"alternative" treatments offered in the psychological community for PTSD.  It's been widely studied and fairly widely recommended for PTSD ever since.  It's also something I've personally tried, so my ears perked up when I heard it.  "This stuff is so great," the VA psychologist enthused, warming to his true point: "You can treat people, and you don't even have to hear their stuff!"

Ohmigoodness.  If that isn't just the gold standard of what we want to be doing.  I'm holding out hope we'll find an arm's' length cure for healing combat trauma (kidding, absurd).

In this article, a VA provider who seems like a serious, intense, and concerned practitioner -- as well as a favorite among the veterans who were her patients -- gets fired and reprimanded for "talking an Iraqi vet down off the ledge," so to speak.  It's a pretty shocking story.  The provider has yet to be re-instated, and the OIF/OEF veteran who narrowly survived killing himself, thanks to her intervention, also has been left scarred by the situation, and more antisocial/less trusting than before.  Ugh.  Is this the kind of care we really want to be delivering?

The VA, particularly now (as in, these days) is supposed to be "very concerned" about its reputation, and really adamant about "no more bad PR."  If that's the case, maybe it's time to examine some of the decisions that get made, and why they get made -- from what happened in this story, to the psychologist above who was so thrilled to learn about a treatment mode that he could practice without having to get too involved.

Somehow, this seems to be the EXACT OPPOSITE of the care and concern and COMPASSION that someone like Sarah Haley exhibited, herself a VA psychiatrist, through whose landmark work the shame of My Lai was able to come forth and be addressed, etc. A true hero in the pantheon of those who addressed PTSD at its roots -- and, coincidentally, ALSO someone very well loved by her patients.  Hmmmn.  There might be a not-so-subliminal message in that. 

Here's what Gerald Nicosia, author of Home to War: A History of the Vietnam Veterans' Movement, says in part about Haley (to whom he devotes more than a dozen pages of narrative):

"The other horn of this troubling dilemma was that the traumatized person, especially if he was a Vietnam veteran, would almost never come in and spill his guts to a perfect stranger.  Trauma patients need to establish trust with a therapist, and the Vietnam veterans coming into the VA clinic were never being given the chance to do this.  It was by the merest lucky chance that the My Lai veteran had seen something in Sarah Haley that made him believe he could confide in her, thereby opening the door not only to his own dark secrets, but also to possible help for a whole generation of trauma victims."

 

And, separately:

 

"What Haley did not realize was that John [the aforementioned patient, who spilled the beans on My Lai] had come to her initially because he had been told she was trustworthy by his friend Mike, whom she had treated previously.  A year later, John showed up in her office again under the pretext of bringing Mike back for further counseling.  At this time, John confessed to her that "he had needed to believe that just one person cared, that one person could be trusted to know what he had done, and not reject him.""

 

Hmmmn.  Food for thought, all the way around: but most especially for the VA, and their apparently quite shabby treatment of psychologist Sidney Ornduff, and by extension, the other veterans whose lives she could have been helping.

 

Writing Workshop Planned on "Trauma, Art & Writing" for June, 2009

Plan ahead for this writing workshop, June 15-26, 2009:

Sponsored by the William Joiner Center for the Study of War and Social Consequences and the Creative Writing Program of the University of Massachusetts Boston.

This workshop - open to writers of fiction and nonfiction, poetry, playwriting and translation - involves one or two weeks of working sessions and individual consultations with distinguished writers. The faculty includes Vietnam veterans and others whose lives have been altered by the experience of war, but applicants with diverse interests and backgrounds are encouraged to apply.

Visiting writers will join the teaching staff in a series of readings, seminars, and panel discussions. Special events held at UMass Boston and at other Boston locations will be open to both workshop students and the general public. This year's faculty reading series schedule will be posted.

Editor's note: Additional information about the writing workshop, including faculty bios, course schedule, accommodations, and application (as well as other materials) are linked here.

For the Good of All Concerned: Sexual Feelings v. Sexual Expression

Healthy sexuality is probably one of the hardest life themes to come to a successful resolution about, whether for combat veterans or really, anyone else as well.  Part of the problem is, of course, from childhood on we've received -- been bombarded, really -- with conflicting messages about whether sex is deeply good or troublingly bad.  After all, there's healthy sexuality and refreshingly bonding intimacy as the result of a connected relationship between two people, and then there are almost as many destructive opportunities as there are people and relationships themselves, from manipulation and selfishness to heavier topics like abuse and rape.  Here to shed some light on the subject is Gay Hendricks, Ph.D., the author of several best-selling self-help books.  In the passage below, he delineates the difference between the messages we get about sexuality and the actual reality:

"Ideally, we should teach children that sexual feelings are fine.  They are a natural part of life, a deep source of energy and potential joy.  We should teach them to be smart, though, about the expression of those feelings.  We would teach them the advantages and disadvantages of the various aspects of sexual expression: masturbation, intercourse, flirting, and so forth.  We should assist them in learning to open up to the feelings while finding means of expression that have positive consequences for all concerned.

Too often the elders confuse feelings with expression.  We are taught that the feelings themselves are somehow wrong.  This belief causes a logjam inside us.  We have a deep sense that sexual feelings are good, overlaid by a belief that they are bad.  This distortion causes us then to express our feelings in distorted ways.

To complicate matters, we also have a stack of decisions about sexuality based on old unpleasant events.  I remember getting caught by my mother in the act of looking at some pictures of naked women.  Several of my friends and I were studying these pictures, bought in the locker room from an eighth-grade entrepreneur, when my mother showed up unexpectedly.  I remember the hot feeling of shame that swept over me when I saw my mother’s reaction of anger and disgust.  I saw in that moment that my sexuality was something she did not want to acknowledge, that somehow it made her uncomfortable.  In fact, I never recall her or anybody in my family saying a word about sexuality in any way during my growing up.  In a way I feel grateful, because at least I did not get a lot of distorted information that I later had to unlearn, but I feel wistful about not learning things about my sexuality that would have helped me feel more comfortable with myself.

Some of us have had much more unpleasant experiences with regard to sex than the mild event I just described.  We have witnessed ugly scenes, been forced to have sex against our will, been seduced into doing things that we would not have done had we had our wits about us. WE cannot change events, but we can always look for any decisions about ourselves or life that we made at the time.  By looking at old decisions made in the heat of unpleasant experiences, we can break the grip the past has on us.

Beyond the traumas and the negative messages about sex is the fact that we often do not get any constructive information about it.  We are not usually blessed with a guardian angel who can come along when we need it and say, “Sexual feelings are good.  Let yourself feel them deeply.  Surrender to them.  Express them in ways that will bring happiness to all concerned.”  Adult life is a process of becoming a guardian angel to ourselves.  We have to learn how to nurture ourselves and how to gather the kind of people around us who can nurture us in the ways that we like.

We can begin by loving ourselves for all the reasons we do not love our sexuality, then going on through to open up in love and acceptance for those deeply positive sexual feelings inside.  By learning how to love sexuality, we can learn more about how to love life itself, for sexuality is but one expression of a deeper life energy which resides in us all.”

-- Source: Learning to Love Yourself: A Guide to Becoming Centered, by Gay Hendricks, Ph.D.

A Hand across the Abyss - How Openness Helps Heal - A Therapist Talks with His Patient, both Vets

I've recently started reading a very interesting book from the Vietnam era, by Arthur Egendorf, a Ph.D. psychologist who was first a veteran - and later tried to piece together what he had experienced in a way that could also help others. Egendorf's in-depth work at the time with veterans, and his motivation behind it, really seem exceptional. 

Gerald Nicosia writes about him, too, in the excellent "Home to War: A History of the Vietnam Veterans Movement," because Egendorf was instrumental in establishing the veterans' "rap groups" which were an early feature of attempts made to cope with the combat trauma and PTSD Vietnam vets experienced. 

This passage, from Egendorf's book, is remarkable to me for several reasons: Egendorf's own intuitions about healing; his humility, openness and vulnerability with his patient (and friend); their nuanced dance together; and of course, best of all, the effects it actually had on the Marine he helped.  Egendorf's book is out of print, but here and there copies are available used, including on Amazon.  Here's what he wrote:

“If you look, it’s not hard to find veterans who are engaged in healing.  I met one of them eight years ago while visiting a VA hospital.  His name was Jim, an ex-Marine from the Bronx recovering from his latest breakdown, back for another of the hospital visits that began a year after he returned from Vietnam.  I introduced myself as a fellow vet, now a psychologist, who wanted to interview him for a study that would help Vietnam vets.

 
“You want to help me?” he asked.  “For six years I’ve been in and out of this hospital, and I’ve heard enough of shrink talk.  I want to know how you made it.  That’s how to help me.  Tell me how did you get it together?”

 
I responded by making him an offer.  If he would let me interview him, he could ask me anything he wanted.  He accepted and spent ten hours telling me his story.  Before the war he was the kind of youngster teachers like.  He behaved well in class and worked part-time after school.  During his teens he had seen a psychiatrist for “nerves,” but generally had held his own.  In 1969, when he was eighteen, Jim was drafted and goaded into “volunteering” for the Marines, then sent to combat duty in Vietnam.  He saw action in I Corps, in the north of South Vietnam.

 
Ever since he came back, his mother and his wife had been trying to tell him that something was wrong,  For the first year all he did was stay in the apartment, smoke dope, and listen to music.  Then one day while looking out the window he saw a junkie trying to steal the radio from his car.  Jim grabbed a baseball bat, ran after him, and started pounding the guy so fiercely it took three people to tear him away.  After that he knew he was out of control and went for help.

 
Seven years after coming back, Jim described his burdens this way: “Before I went, I worked for six years.  I was the best assistant manager Martin’s Bargain Store ever had.  I can’t work now.  They messed up my head.  How the hell are you supposed to concentrate after all I’ve been through?  Reality sucks.  It’s not what you know, it’s who you know.  That’s why a nineteen-year-old acidhead or college guy gets out of it.  Who do I know?  My shrink from before the war said I was fine.  Now the VA says I was always cuckoo and my problem’s got nothing to do with the war.  My wife is scared of me.  My family thinks I’m nuts.  We were supposed to be over there fighting for freedom, killing people who never did us any harm.  What are you supposed to do after that?

 
I listened, particularly to what was left unsaid.  He had just started to find some direction in life when the war crashed in.  Then it was “pussy,” as his drill instructors called him, and thirteen months of being constantly threatened with death, and seeing a dozen guys he knew pulverized into heaps of bloody flesh.  Others made fun of him, mocking a grunt from New York who resented the practice of calling Vietnamese “slopes” or “dinks” or “gooks.” When the time came to go home and he looked forward to leaving the mess behind, he found that things didn’t work as he expected.  After coming back he wasn’t anybody’s hero, the afterimages of shattering brutality stayed fixed in his mind, and the business-as-usual reality at home had no room for what he carried inside.

For Jim and many like him, it was not them but the world that was crazy.  What was keeping all of it from blowing up, just like the people and placed he had seen “wasted”?  Presidents give the orders and people die.  It’s like a primitive ritual with human sacrifices to bloodthirsty gods.  Jim was sure about only one thing: The people pulling the strings didn’t care what happened to him.

 
“How’d you get it together? That’s what I want to know,” he kept asking.  Our backgrounds were different, but the war gave us a common bond.  Jim was a ghetto kid who didn’t finish high school before entering the service, whereas I had gone to private school, Harvard, and then Europe for a year of postgraduate study before my draft board notified me.  Unlike him, I never saw a psychotherapist while growing up and was never seriously upset until after I came back, and then never so bad that I couldn’t go to school and hold a job, too.  All the same, he knew.  “Something got to you too, huh?”

 
He tested me to see if I’d open up with him. “People like you go into psychology to straighten themselves out, right?”  Yes, I told him, he was right about that.  After years of taking pills and hearing therapists interpret his past and try to modify his behavior, Jim wanted to “relate.”  It was the same hunger that led a dozen of us to form the veteran rap groups that began meeting in New York City in 1970.  In these groups we asked each other and the therapists who volunteered to assist us in gaining the same openness Jim now wanted.

 
After a few meetings Jim asked to be a regular client.  At the beginning he couldn’t take much – he would miss appointments and “forget” to return my phone calls. Eventually, though, we met more regularly, and he began to thrive on the questions I raised.

What had gotten to him?  What was so troubling?  What made him so vulnerable?  What was he going to do about it now?  How was he going to handle his life?  I didn’t intend for him to answer my questions the way elementary pupils answer their teacher’s drill.  Rather, the idea was for him to use the questions to orient himself, to direct his energies where the questioning pointed.  It was time for Jim to stop telling the same story over and over and to begin living out a new one.

 
The more we worked together, the more he saw opportunities to make himself useful – a gesture that would help his wife, an odd job to pick up some cash, a game he could play with his kids.  He studied enough to distinguish his sensitive reactions from his deluded flights of fancy.  And when he was ready, he acknowledged that his suffering would never make sense o its own.  It would only be valuable if he took it as a lesson, something he could use to remind himself that how he handles his life is up to him.

 
After a few months of groundwork, Jim was out of the VA for good.  Then he got off tranquilizers and stayed away from pot.  In the next year, he and his wife stopped fighting and started talking, and soon after that he was holding a job for the first time since he left the Marines.  Two years after we began meeting he bought his own house and was holding down two jobs.  Instead of complaining about his two kids, which is all he had done when we first met, he’d brag about them.

 
The time came when he raised a more ambitious question.  Given his suffering, and what he’d learned, what purpose would he devote himself to?  “People, I want to do something for people,” he’d say.  One of his dreams was to save enough money to start a summer camp for ghetto kids.  In the meantime, he began seeing the people in his daily lives as the ones to serve.

 
Jim still has bad days and times when his kids get to him, but he no longer doubts that his life is workable, which gives him a certainty that makes him proud.  He’s especially happy about the way men who live on his street now listen to him.  “They figure I must know something after I’ve been through.  They ask me how they can straighten themselves out.”  He volunteers at the local Outreach office for veterans, run by the Veterans Administration. “If a high school dropout ex-cuckoo like me can do it, anybody can.”

As powerful as that is, here's something I like just as much: Egendorf's own description of his participation in the dance between patient and practitioner:

“How did you do it?” was the question Jim kept asking.  I knew he wouldn’t be satisfied with some formula or set of rules.  He wanted me to open up, to make it safer for him to open up to himself and to me.  And so I told him about myself, but not to give him know-how.  I simply related bits of my story as they became relevant.  For example, I told him how sensitive I was when I came back.  At first, little things would get to me. I’d be overwhelmed by seeing a dead dog lying on a highway, or the picture of a mourning woman in a magazine, or newspaper listings of the soldiers just killed. Strangers halfway around the world, especially dead ones, seemed closer to me than anyone had ever been except my family and one or two lovers.

 
I also told him about how I threw myself into issues connected with the war.  Before Vietnam I had read newspapers casually.  In the months and first years after coming back I would tear into the pages to see what new horrors I needed to absorb and to find out which people in high places I would cheer that day and which ones I would scream at during the hours I spent raging in my head.  I was more deeply moved by tenderness than at any time in my life, and I was also more easily angered. I’d write scathing letters to editors, congressmen, and the President.  I’d blurt out slogans to old friends and family, who didn’t know how to talk with me anymore.

 
I didn’t tell Jim only about matters that weighed me down.  I made sure to tell him some things that were hard to admit to myself at first, things I needed guts to say, but once said would leave me feeling lighter. I told him it wasn’t just the pain that had surprised me; I had also begun to catch glimmers of some secret joy.  I was happy I had made it through the war when others didn’t, which was hard to acknowledge.  But something else delighted me even more.  Strangely, I was glad to feel so much hurt, as if having allowed something to tear me open meant one day I would give birth to something I might treasure.

 
Jim would compare himself to me and decide that I was so much better off that I had to know something that made life easy. So I also let him know about my awkwardness – the many times I flip-flopped back and forth, from wallowing in my distress to trying to hide from it.  But I also told him I learned more from my mistakes and weaknesses than from anything else.  In fact, my about-faces, in which neither wallowing in the pain nor turning my back on it satisfied me, eventually led me to the realization that I was searching for the third way.  I couldn’t say what it was at first, but I figured somebody had to know or there wouldn’t be such people as counselors and therapists.  They must know, I thought, and so, hungering to find out what they knew and daring to think I’d know too once I joined their ranks, I took a job as a crisis counselor.

 
Jim grasped the irony of my story.  Contrary to what he had initially thought, I wasn’t useful to him because of any information I had.  What I had to offer lay in my willingness to admit that I don’t have anything in particular to tell people until I hear them talk.  I’m willing to be with them without answers, so that I can assist them with their own search.  I told Jim that I’m as surprised as anyone when this works.  The moment when someone trusts me enough to tell  me his troubles a change takes place in me.  I suddenly have more wisdom for them than I usually have for myself. I listen, make comments, and without having to think or plan in advance, ask questions they find helpful.

 
In the end, what Jim accomplished by being with me wasn’t new information to pass along, something he could go out and tell someone else.  He developed an approach to life that transformed his experience of the war from a burden to an opportunity for healing.  The shift happened as a result of our being together, and by our pursuing a joint quest that fostered trust, respect, appreciation and the openness that is healing in itself.

Most crucial is the openness.  I’ve noticed this not only with Jim but also with hundreds of others I’ve worked with since, and with dozens of therapists I’ve trained.  In this book I intend to convey what I mean by openness, in such a way that healing from war dawns as a possibility for you.”

 
-- Source: Healing from the War: Trauma & Transformation after Vietnam, by Arthur Egendorf.  Boston: Shambhala Press (1986)

(Shambhala Press is what published Claude Anshin Thomas’ excellent book, At Hell’s Gate: A Soldier’s Journey from War to Peace, which we have mentioned frequently on this blog.)

 

What Lies Beyond "Welcome Home" - Opening Communication with Hurting Veterans

(This photo shows a life-sized sculpture of the Kuan Yin, the goddess of compassion. I love how she appears to be engaged in intently listening to someone she's in deep conversation with in this pose. We should all be a little more like Kuan Yin ;-).

Well, "WELCOME HOME" gets all the "publicity" as the #1 thing veterans -- especially the unfortunately way too marginalized Vietnam veterans wish someone had said to them. They fought in a brutal war, and came home to added heartache: no one to welcome them, oftentimes outright hatred on the part of non-participants in, and protesters against the war, and a general sense that they ought to put the war behind them as fast as they could (ha! try doing that!) because frankly, no one wanted to know about it, except in the most manipulative and excoriating of ways -- the "how many people did you kill?" variety of questions.

(Read a previous entry, linked here, about one Vietnam veteran's expectations of Home-Sweet-Homecoming and how they were miserably dashed.)

The hardship of Vietnam veterans, as a group, being made to become EXILES in their own country, because they fought a war in Indochina, is really outrageous, and profound, and numbing to those who experienced that reaction. We had more mixed feelings about Vietnam as a society than the wars which bookended it on either side, but really, it's always a mixed experience to be a veteran -- and they wonder, does anyone really understand? Or care, for that matter. Most, sadly, do not. Hence why veterans experience even further marginalization from the mainstream of society -- especially ones without families. They clearly suffer the most, though most also suffer intensely.

"WELCOME HOME" it's said, is what they wanted to hear. You can still tell Vietnam veterans that -- a little too late, of course, because it's been 40 years now -- I'm not sure how they managed to hold up all this time.� But they still appreciate hearing it, so go ahead and say it, if you mean it, because it still means something to them, that's for sure.

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If you look in the literature of something like suicide-- an event that far too many veterans who struggle with feeling exiled from the mainstream of love and family and country contemplate, at far too great a rate -- you find that there are also other kind, loving questions that can make a difference in someone like a veteran's mental health. And they are VERY SIMPLE QUESTIONS. The challenge for those of us who have combat veterans in our lives, particularly those with PTSD, is not whether the questions we should ask are complex enough (they're not)-- it's whether we care enough to ask them, and to stick around to hear the answers.� I guarantee it will start an interesting conversation.

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Here's an amazing quote, but with the usual academic preamble I just can't tear myself away from. Skip down to the questions, if you must; then back up to the explanation, if you want to know the context.

"Even though I know that each suicidal death is a multi-faceted event -- that biological, biochemical, cultural, sociological, interpersonal, intrapsychic, logical, philosophical, conscious and unconscious elements are always present -- I retain the belief that, in the proper distillation of the event, its essential nature is psychological. That is, each suicidal drama occurs in the mindof a unique individual. An arboreal image may be useful: See the tree; that tree. There is a chemistry of the soil in which the tree lives. The tree exists in a sociocultural climate. An individual's biochemical states, for example, are its roots, figuratively speaking. An individual's method of committing suicide, the details of the event, the contents of the suicide note, and so on, are the metaphoric branching limbs, the flawed fruit, and the camouflaging leaves. But the psychological component, the conscious choice of suicide as the seemingly best solution to a perceived problem, is the main trunk.

The implications of this psychological view are quite extensive. For one thing, it means that our best route to understanding suicide is not through the study of the structure of the brain, nor the study of social statistics, nor the study of mental diseases, but directly through the study of human emotions described in plain English, in the words of the suicidal person.

The most important question to a potentially suicidal person is not an inquiry about family history or laboratory tests of blood or spinal fluid, but "Where do you hurt?" and "How can I help you?"

-- The Suicidal Mind, by Edwin S. Shneidman. London: Oxford University Press (1996).

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Not all combat veterans have PTSD; not all are suicidal (obviously). But even as an exercise, to expand our consciousness AND our compassion -- would it not be a good, even a refreshing, opportunity, beyond saying, "Welcome Home!" (no matter how many years after the fact...) in your communication with a combat veteran to ALSO ask, "Where do you hurt?" or "How can I help you?"

My expectation: both sides of that conversation are going to come away refreshed and renewed, and with a deeper understanding of suffering human nature that could expand us all. This week: try it.