Healing Combat Trauma

Quotable Quotes -- The Dalai Lama on Life Purpose and Satisfaction

That Dalai Lama -- he's amazing! If "personal outlook" were a software package, I'd ask for the Dalai Lama upgrade: because I like how he thinks. So compassionate and kind and reasonable, but not afraid of science. A fascinating, compelling combination. 

Some of his great quotes lately:

"We can't be useful to ourselves unless we're useful to others. Whether we like it or not, we're all connected, and it is unthinkable to be happy all by oneself. Anyone concerned only with his own well-being will suffer eventually. Anyone concerned with the well-being of others takes care of himself without even thinking about it. Even if we decide to remain selfish, let us be intelligently selfish -- let us help others." -- The Dalai Lama.

And another:

"Once you shift your focus from yourself to others and extend your concern to others, this will have the immediate effect of opening up your life and helping you to reach out. The practice of cultivating altruism has a beneficial effect not only from a religious point of view but also from a mundane point of view; not only for long-term spiritual development but even in terms of immediate rewards."

And another:

"The world's major religious traditions all give the development of compassion a key role. Because it is both the source and the result of patience, tolerance, forgiveness and all good qualities, its importance is felt to extend from the beginning to the end of spiritual practice. Even without a religious perspective, love and compassion are clearly of fundamental importance to us all."

And another:

"Satisfaction is characterized by inner peace. It arises from generosity, honesty and what I call ethical conduct, a way of behaving that respects others' rights to be happy."

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Bringing this all back around to veterans with combat-based PTSD and their families, think how crucial what he's expressing are. Eighteen veterans a day kill themselves -- a shocking statistic -- and we seem to be at the beginning, not the middle or the end -- of that particular trend. Army and Marine suicides -- they see the bulk of the action, after all, in these wars -- are both up, despite the "best of intentions" on the part of the services to bring down the numbers. Pep talks on prevention and more prescriptions aren't solving the problem, nor are they likely to. Because, as one combat vet with PTSD said, "pep talks are hard to take seriously because that is for the normal life of a normal person, not for a veteran contemplating suicide because of combat trauma." True, that.

It's coming up on two years, shortly, of my first phone conversation with the combat vet, a Vietnam vet, Marine, with 40 years(!) of severe, chronic PTSD, which plagued his life, despite "all the best" of what the VA threw at him (his words, not mine), including an inpatient, residential PTSD program that was cutting-edge at the time. (Would it surprise you to know that most of his classmates in that program, according to him, are now dead, also from suicide?) After our first conversation, which seemed relatively pleasant and positive, he followed up with an email about wanting to drink and put a gun in his mouth to end it all, because he was sure God hated him; after all, he himself did. Sparkly stuff. Lots of unicorns and rainbows and fluffy clouds there...not one bit.

Of course, the end of his story is quite a bit more positive, mostly because it didn't end. He's made the transition from bleak, grim and grisly to mostly inspirational and awesome. And it took a while, a solid footing, a hand reaching across the abyss and pulling him up and out -- a hand which he importantly grabbed (it doesn't work if you don't ;-). It took some specific therapeutic treatments to help remove trauma from the body. We tried a few, intentionally, and they worked; there are others that might as well. And it took a huge motivation on his part to reach out -- however ugly his mess at the time -- to get some help and be real about where he was really at. For years, decades really, he'd been the one other vets' wives called to take the gun out of the mouths of their husbands. Now he finally had some hope to offer others. But it took commitment on his part, believing that the hope was out there, and going after it with all he had. Not always pretty, but effective :-)

(He's the veteran in the "Eyewitness to Combat" series on the site. Here are two items about his turnaround, linked here and here. The second is in his own words.)

Anyway, the upshot of the whole experience is wanting to build a program to bring other combat veterans with PTSD through, and help their families as well, who are often left holding the bag (of misery) but not really getting the help they need either. Combat veterans with PTSD have often lost their life purpose completely, and as we've been talking about lately, purpose is key.

The "eyewitness to combat" veteran, described above -- he and I share a purpose. It's helping others overcome. It's possible. And as the Dalai Lama says, that's being intelligently selfish -- taking care of those 18 vets a day who'll be killing themselves, BEFORE it happens. So it doesn't HAVE to happen. That's the best use that you and I could put our time and energy and compassion to. Please join in helping others so that they don't have to suffer so intensely, when there is a way out.

Editor's Note: A California-based psychology grad student is doing a Ph.D. thesis on Iraq vets with PTSD and life purpose. If you qualify based on the above criteria, he'd like to talk to you, and will pay you $50 for your efforts if you participate. Here's the link to his study. His brother is a combat vet. 

Additionally, you can "follow" the Dalai Lama on Twitter -- @DalaiLama -- and you can follow us on Twitter as well @HealingPTSD.

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.

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

Anatomy of a Suicide: OEF Veteran Orrin McClellan, RIP from PTSD

The Seattle Times has an article in yesterday's paper about a young Whidbey Island OEF veteran who unfortunately killed himself in May of this year. Orrin Gorman McClellan served with the 173rd Airborne Brigade Combat Team in Afghanistan in 2005-2006. He took a lot of photos of his experience in Afghanistan, and he also wrote, poignantly, about his experiences as a soldier in an online journal, where he wrote every day. (The article doesn't reveal the location of that journal.) In what's known in the journalism biz as a "package," the article also has two multimedia presentations included with it: a video of his parents leafing through a book they're putting together of poems Orrin wrote, linked here, and a video narrated by his parents of some of his photography from Afghanistan, linked here. "I've become numb," McClellan writes, "but not comfortably so."

It's wrenching watching his parents in the videos sit side-by-side on the couch, in a tableau no doubt repeated across America, as the parents of the approximately 18 veterans a day who kill themselves must do, trying to make sense of why Orrin had to go, and still actively grieving, trying to come to terms with their own loss. In Orrin's case, his mother is a social worker, who the article says specializes "in the treatment of traumatized individuals." Of course, not even a mother with this background can necessarily save her son, which only adds to the tragedy. It says his mother even "took a counseling job with the Whidbey Island NAS and helped her son navigate through the VA system." He was retired with a 100% disability due to PTSD. The article quotes the mom as saying that as a community, we all need to listen better to our vets. And practice "deep listening" to their stories of what they've gone through.

What makes the article good, from this reader's perspective, is that it positions Orrin McClellan's death against the backdrop of the statistics of veterans suicides across the country, and then projects how those statistics affect Washington state, where the Seattle Times is based, and where Orrin lived. Eighteen deaths of veterans a day, the number of suicides approximating deaths in combat this year -- these are shocking statistics, but like so many others, we become numb to them over time. Bringing it closer to home, those same statistics mean of the almost 36,000 OIF and OEF veterans from Washington state, a dozen would be lost to suicide. In 2010, Orrin McClellan was sadly one of that number.

(Army veteran Chris Loverro, who served with the Stryker brigade from Fort Lewis, Washington, did a poignant video of his own about PTSD and suicide in the life of a veteran. We've shown it in a recent article, linked here.)

McClellan's mother, Judith Gorman, says that her son never really came all the way back home, because of his PTSD. Retired Army General Eric Shinseki, now head of the VA, is also quoted in the article, as ruminating -- perhaps not about McClellan's death in particular but about veterans' suicides in general -- that he often asks himself, "Why do we know so much about suicides, but so little about how to prevent them?" That's a fabulous quote, but it's also quite a profound question.

Edwin Shneidman, the so-called "father of suicidology" -- who ironically got his start leafing through files at the VA, reading suicide notes of veterans -- is someone we've written about a fair amount on this site. He's also known as the originator of the concept of a "psychological autopsy," where someone, reasoning backwards from the fact of the a person's death, tries to reconstruct the extent and timing of the stressors in that person's life, to determine how and why it became too much for them (the "when" having already been determined.)

I'm not sure, but I would hazard a guess that, other than the families of veterans who commit suicide, who are directly involved, there isn't much of an effort made on a larger level to reconstruct what stressors became unbearable in the lives of those who kill themselves, during or after military service. Perhaps a broader study into this, a la Shneidman's methods, would produce important or helpful conclusions.

McClellan's story is in many ways all too typical...except for the social worker mother, and the wonderful legacy he left behind in the poems he wrote and photographs he took. He struggled, as many veterans with PTSD do, with drugs and alcohol, with trying to fit back into his life, with impulse control, with hypervigilance, with nightmares, with combining alcohol with prescription medications, with grief and perhaps blaming himself over the deaths of two close friends. And he struggled with long drives to the VA, which was located quite a distance from his home.

His parents sound like amazing people, who tried so hard. They even established a Veterans Resource Center, on the island where they lived, "to offer referrals, networking and other assistance," to help other veterans in addition to their son. In the wake of his son's death, they may also publish a book of his writings, to raise awareness about PTSD.

Digging around on the Web, especially within social media, it wasn't hard to find some of McClellan's thoughts. He had two journals where he kept his writings, one on MySpace and one on LiveJournal. I've chosen not to link to them, to protect his privacy in case that's an issue. But in one he quotes from T.S. Eliot's famous poem, "The Hollow Men," which closes with the memorable lines about "this is how the world ends, not with a bang but a whimper."

It also contains an entry from September of 2008, while McClellan was actively struggling with PTSD, but a full year and a half before he ended his life. In an entry called "What the hell happened to me?" he writes:

"I read some entries in my journal from two years ago" 

[2006, the end of his Afghanistan deployment and beyond]

I love who I was.

Why did I do this to myself?

Was it war?

Did I implode from all the shit I saw?

Or was it something else?"

Questions really with no answer. He goes on for a bit more, and then concludes with the poignant question:

Why did I let myself

Get so lost?

RIP Orrin McClellan, gone too soon, and comfort to your family and your friends.

Editor's note: The photo is of a point on Whidbey Island, a thoroughly beautiful place in Washington state.

Literary Fireworks! Combat Vets Celebrate the Fourth with 5...7...5...Haiku

War poetry has a long and storied history; combat veterans and haiku, not so much. But that may all be changing, thanks to Susanna Speier's innovative "Politiku" -- the application of the traditional Japanese short-form poem familiar to schoolchildren everywhere, with its three line structure of five, seven and five syllables apiece, which can also be a suitable vehicle for expressing profound and personal reflections on trauma.

Speier has already developed some fans for her Politiku concept -- it appears regularly as a column in the Huffington Post -- but thanks to an introduction by the very kind and genuine Craig Newmark, Speier and Healing Combat Trauma connected this week over Speier's interest in bringing the Politiku work to combat veterans.

Speier has a lovely and appealing presentation she's been working on, but as we discussed it further, one particularly timely theme -- it being July Fourth and all -- leapt into Speier's mind. "Fireworks" would make a perfect theme. To most Americans, celebrating with their families on the Fourth, fireworks represent one gigantic surge of pyrotechnic patriotism, awing small children and grownups alike as they soar into the air and explode with fabulous colors and ear-popping, ground-shaking reverberations. It's America's birthday, after all, but in place of the cake and candles we get...concerts, barbecues, parades and FIREWORKS!

For the combat veteran, however...and only approximately 11% of our population has served in the military...fireworks can remind them a little too much of the sights and sounds of combat. Many combat veterans, especially those with PTSD, find themselves dreading the Fourth and the fireworks in particular; and often find themselves unable to explain this (satisfactorily) to family and friends. Quite a few vets make plans beforehand to "head to their bunkers," and not come out until it's over. Others talk about how their own veteran dads, growing up, spent the holiday every year, in a haze of drugs or alcohol, waiting out the celebration. Some veterans feel bad about not being able to join in the celebration, but they can't; and some families of affected combat veterans wonder whether to leave their veteran home while they go enjoy the show...or miss the celebration themselves while not being able to bridge the gap with what their loved one is experiencing.  

So into this mix comes Speier, Politiku, and the idea of having combat veterans write a haiku, with 5/7/5 syllabication, to express their feelings around fireworks, and what it reminds them of, or what it causes them to miss. We put the post out on Facebook, on the Healing Combat Trauma fan page, as well as my personal page, and got some interesting results. Speier is collecting more over at her site and in the comment section of the Huffington Post article, and assures that the combat veteran/haiku author's anonymity will be protected, if desired.

Here's a sample haiku to get you started, written by, erm, Healing Combat Trauma: 

Blue night red rockets

White sparklers Percussion blasts

Vets feel more than Fourth

And here's a better one, written by Angela Peacock, U.S. Army veteran, who served in Baghdad during the early days of the Iraq war, and who has allowed her name to be used:

Fire lights up the sky

Like old memories burning

Too much for my nerves

If you'd like to be part of this project, go here and read the FAQs on what Politiku is and how to write them; or just dive in and send your Politiku/Haiku in as a "comment" in any of the threads listed above, and we'll make sure to get your poem(s) headed in the right direction. Also add whether you'd like your name on or off the submission, if it's used. (Be wise about whether you want to have your name and PTSD associated in the same subject on future web searches, if you're thinking about employment prospects...)

And, if you'd just like to think more about poetry in general, and war poetry or combat veterans and poetry in particular, there are two sources right here on this site. One is the collection of articles on poetry, linked here; and the other is the list of "war poetry" books, which can be found along the upper right hand side of this website. Enjoy!

Kind Words from a Mentor and Friend about "Healing Combat Trauma"

Unsolicited feedback can be encouraging, especially when it's positive. Had a very nice surprise of that kind this past this past week when I received a lovely and unexpected email from Arthur Egendorf, Ph.D., a dear mentor and friend, whose own work with war veterans recovering from trauma gave me practical hope that good, heartfelt work could be done in this area.

(Egendorf is a Vietnam veteran [Army intelligence] with a Ph.D. in psychology from Harvard, and a lifelong interest in therapeutic healing modalities, beginning with talk therapy and branching out from there. He was one of the originators, in the 1970s, of the "rap groups," that allowed returning Vietnam veterans to have someplace to go and peers to talk with, when they weren't willing to take part in the services offered by the V.A. In any history of the Vietnam era that focuses on PTSD and veterans, such as Gerard Nicosia's encyclopedic "Home to War: A History of the Vietnam Veterans' Movement," Egendorf is one of a handful of experts from the time whose name keeps coming up.) 

I'll write more later in the month, as a certain anniversary date rolls around, about how much his award-winning book "Healing from the War: Trauma and Transformation after Vietnam," (sadly, now out of print) was put to constructive use with one veteran, whose life it helped to change. It's fair to say that my copy of his book is fairly well completely yellow from highlighting key passages, thoughts and inspirations, so it was especially gratifying to receive these unsolicited kind words from him.

Dear Lily,

In dedicating so much of yourself to the men and women who risk and give their lives for duty, honor, country you do all of us, this mostly sleep-walking America, a great service.  As tireless, fearless, noisy (when necessary) and deeply caring witness you give our soldiers and veterans what they deserve from this entire country but get from only very few.  As one who knows a bit of what it takes to love and care for bloodied and pained survivors who've fought for all of us and then have been mostly ignored, I salute and cheer you on to keep waking us up.  Keep shaking us, Lily.  Keeping making us see how much those who've served have given to us, and how much we owe our thanks, respect and unending care.  You go girl.  

Artie Egendorf 

Editor's note: For more of an introduction to Egendorf's work, here are a few posts that mention him, linked here, here, here (this one in particular, called "A Hand Across the Abyss: How Openness Helps Heal"), and here, among others.

More Praise for "Healing Combat Trauma"

Belleruth Naparstek, Ph.D. is a psychotherapist, author, and guided imagery pioneer who is also the author of Invisible Heroes : Survivors of Trauma and How They Heal, and Health Journeys: A Guided Meditation for Healing Trauma (PTSD), two items that have helped many veterans interested in healing to make definite forward progress.

This past year, Naparstek published an important and educational article in the Huffington Post in May called "Note to Colleagues: Please Stop Saying Post Traumatic Stress is Incurable," linked here, as well as one in February called "Returning Troops from Iraq and Afghanistan are Different From Our Vietnam Vets," linked here, both of which are "required reading" for those who want to understand what obstacles face veterans and clinicians alike in treating combat-based post-traumatic stress.

Just the other day I happened to read an article on Naparstek's own HealthJourneys site where she mentioned our very own Healing Combat Trauma as "an excellent site" and referred readers to it. Very gratifying praise indeed from a someone who's a true pioneer in thinking about and working with trauma survivors.

Praise for "Healing Combat Trauma"

Had a nice surprise at the week-long clinical training in PTSD at the National Center for PTSD. Picked up a copy of Ray Scurfield, Ph.D.'s comprehensive "War Trauma Resources," and in it read something very nice he said about this site: "Lily Casura’s very rich compendium -– she has over 100 categories of information! -- of books, article, commentaries, resources, other readings and information regarding military, veterans and their families. I am most impressed with Lily’s passion, dedication and abilities as an advocate for vets and their families." -- Ray Scurfield, Ph.D.

 Scurfield is and was one of my first heroes in this because of his longtime work with veterans healing from war trauma, so it's extra-nice to hear something like this from him. In addition to the resources he provides nationally, Scurfield is also the author of three key books about veterans and PTSD: A Vietnam Trilogy, Healing Journeys, and War Trauma.

Quotable Quotes -- José Narosky on All Soldiers Are Wounded

 "In war, there are no unwounded soldiers." -- José Narosky

At Last, Some Good News: A Personal "Before" and "After" in the Life of Someone with PTSD...

There's a lot of bad news going around: suicides up, PTSD wrecking lives and families, not much constructive help in sight. But here's a story that's GOOD news...about how much progress one combat vet with severe, chronic PTSD -- for 40 years(!) -- made in just a year of trying integrative medicine techniques and therapies, in addition to his medication. (He was able to lower his psych meds to an absolute minimum as part of the progress.)

At the end of year one, I asked him to write up his experience so he could contrast, for himself, a personal "before" and "after." Knowing him and the story, I know that he left out the highest highs and the lowest lows, but still, it paints a powerful picture of one life substantially freed from the ongoing torment of PTSD.

If you want a little backstory on who Pat is, he's the author of the "Eyewitness to Combat" selections on this site. Read those, linked here, for background about his tours in Vietnam and the after-effects of PTSD in his life. (That's him in the photo at left.)

Here's the letter:

    Healing Combat Trauma

     Re: Alternative Modality Treatments for PTSD

 Dear Ms. Lily G. Casura,

WHAT A DIFFERENCE A YEAR MAKES?  It has been one year ago that I first made contact with the web site “Healing Combat Trauma” in an effort to find out information on the treatment of Post Traumatic Stress Disorder.  As back-story, I was a Disabled Vietnam Combat Vet.  I was attached to “Flames”, 2^nd Battalion, 9^th Marines (Hell in a Helmet) my first tour of duty and with “Bravo” Co., 1^st Battalion, 9^th Marines (Walking Dead) my second tour of duty.  It was during this second tour of combat that I was wounded three different times in a battle with North Vietnamese Army troops on Hill 881 north of Khe Sanh.  I spent another seventeen months recovering in various Navy and VA hospitals and was partially paralyzed for five additional years during which time I married, attended college and received a Bachelors and Masters Degree in Forestry.

From the time I got back from Vietnam, I suffered from mild to severe to devastating symptoms of what is now known as Post Traumatic Stress Disorder but was not even recognized as a mental disorder much less treated until twenty five years after the fact.  The further I moved from the date of my deployment to Southeast Asia, the more intense the symptoms became and the more aggressive and destructive my behavior evolved into.  Not knowing that I was suffering from a “disorder” which affected all of my fellow combat veterans, I simply assumed I was going “Crazy”, just being a “Marine”, and was of course a “fucked up Vietnam Vet”.  I made no apologies for my behavior because my close friends, all former combat vets, were exactly like me and what we did was “normal” for us.  It was the rest of the “world” that was screwed up including our wives.

However as the years rolled by it became clear that a definite pattern of cyclic behavior, action, response, aggression and consequence began to manifest itself.  Regardless of determination, courage, education, competence, and ability; quality jobs lasted on the average of no more than an eighteen months and no less than one year.  They averaged about thirteen months, the same as the Marine Corps Tours of Duty in “The Nam”.  I was excellent and even exceptional at all of the tasks of my profession but could never become acclimate to following “orders” by anyone in “authority”.   I just wanted to be left alone to “do my job”. 

Not only did the patterns of behavior and consequence continue to recycle in my and my family’s life, they intensified with each cycle and became more and more destructive as time went on.  This resulted in extreme “guilt” and “withdrawal” and developed into a “hatred” for anyone who had not gone into “combat” in Vietnam.  They had not been where I had been and had absolutely not “earned the right” to judge me or criticize me for my actions.  Raising five children was a huge financial burden which weighed heavily upon me because I knew that I was not going to be able to work for anyone but took as many labor jobs and engages in as many “self employment” activities as I could. 

Twenty five years into this self destructive lifestyle and monumental stressor left me broke, unemployed and unemployable, family in constant turmoil, physically ill with heart disease and arthritis, and mentally devastated with depression and constant suicidal thoughts.  It was then that I was told that the VA had identified PTSD in 1976 but was reluctant to let veterans know because of the reality of paying disability to them.  So it was suppressed from us.  Even so the treatment they were then engaged in was a combination of “physiological and therapeutic drug” treatments.  I entered their treatment program in a desperate effort to save my family and my own life.  I was diagnosed with severe PTSD and rated 100%.  And it had already taken its toll on me.  I ended up with two quadruple heart bypasses, congestive heart disease, electro-cardial heart failure requiring radical clinical trial surgery and pacemaker, Rheumatoid Arthritis destroying my body and severe clinical depression.   The VA solution was to continue the “group sessions”, the “psychological counseling”, and increasing the amount of “psych” drugs I was to take.  I literally became a drooling “zombie” unable to carry on a coherent conversation, unable to remember what anyone was saying to me, looking at everything in a blur of fog and sleeping 20 hours per day.  The VA had essentially “locked” me up in a “mental institution” and thrown away the key.

My family went on with their lives and I became an invalid.  Then my almost-grown kids began to experience the exact same symptoms of PTSD that I was having.  I just quit taking the “meds” and actually “awakened” enough to realize that one of them was about to kill himself.  I began to desperately search the interned for anything that could save my boy and me.  If he killed himself, I would do the same but go out in a “blaze of glory”, taking those with me whom I blamed for the hell we were living. 

This is when I came upon a “web blog” called “HEALING COMBAT TRAUMA”.  As I began to read the blogs, I became not only interested but engrossed in and awe struck by the intuitive content of it.  Whoever wrote the blog KNEW what living with PTSD was like and began to cry.  This was not someone who had been educated about it, this is someone who had LIVED with it but was incredibly intelligent and understanding.  As I read, I began to understand what was going on with me, my wife and my children.  I began to “believe” that there really was another way to treat Post Traumatic Stress Disorder besides being quizzed about how bad your father treated you and then prescribed “killer” drugs.  The quality of the web site and the professionalism of it made me believe that this “Company” had a huge staff of Doctors, technical staff and alternative modality practitioners.   They most probably would not even be interested in me.  Hesitantly, I contacted the individual listed on the contact page.  Beyond belief, she answered me.

I waited a while to answer back because I was embarrassed to have even made contact.  It was a “Don’t hang your dirty laundry out in public” sort of thing.  My life was so complicated and I had spent forty years trying to put it down in writing to find the magic answer to it.  I asked if she would be interested in reviewing my much self-edited draft and this lady said YES.  Wow I was excited and flabbergasted.  Maybe there was help coming that I could share with my family, my son in particular to let him know there was real HOPE.  And I could take this “hope” to the remaining Nam buddies who were still alive.  Most had committed suicide, at least fourteen, in the last twenty years.

Lily Casura took a sincere interest in my “story” and in my plight.  Her interest was genuine and not usury.  I knew that if what she said were true, then she needed to take this program to the rest of the mentally wounded souls still living from Vietnam, and to the Desert Storm and Iraq and Afghanistan warriors.  But I had been “screwed” by so many “too good to be true” schemes from religion to insurance that I wanted to be shown.  My challenge to her was: “If you can heal me, you can heal anyone”!  She accepted and our journey into absolute “HEALING” began.  The road was rocky as she got to actually experience the “ups and downs”, the “rages”, the inconsistencies of working with an actual Marine Corps combat vet.  It was a wild ride for both of us to say the least as I “spoofed” most of the treatments as something that a real “Marine” would never do; especially some of the “Yoga” exercises.

However, as I was moved through them one by one, I began to “feel” much differently and I began to “change”.  I felt physically better and mentally at peace.  Something I had not experienced in forty years.  I became a true “BELIEVER” and want to share it with the world.

What a difference a year makes? One year ago I was suicidal, physically dieing from multiple illnesses and immobile.  My heart has stopped eight times and had to be resuscitated.   My family was suffering from depression and my son was on the verge of killing himself.  I had no Hope, no future, no purpose and no reason to live.

One year later, I am disease free; my Rheumatoid Arthritis has been declared in complete remission, my heart has actually healed itself, my arteries are completely free of plaque, the acute pain that I have always had is no longer there, my anger is gone, my mind is at complete peace, my son is fine, my family is happy, I am thrilled at every day I am here, I have hope in a wonderful future for me, my family and my fellow vets.  I was taking over 58 prescribed medications one year ago; I am taking nine now.  I was taking huge doses of prescribed pain medications and ongoing treatments for the same.  I no longer have any pain, do not take any of the medications and no longer need the treatments.

The Difference One Year Makes: I was dead and now I’m alive!  That’s the Difference!

Thank you, Lily, for saving my life and for giving me HOPE and a FUTURE. I am, for the first time in my life, looking forward to the rest of my life, and can't wait to see the difference one more year will make.  

 

Patrick ______________.

Sgt., USMC

Bravo Co., 1^st Battalion, 9^th Marines

Vietnam 1966 and 1967

An American Veteran -- Eddie Writes a Moving Letter about Four of His Other Shell-Shocked WWII Veterans

Eddie Livingston was a teenage paratrooper with the 82nd Airborne who participated in five European campaigns, was a Prisoner of War for a year in Germany, and returned home with a slew of medals, honors...and a lifetime wracked by PTSD and abject poverty. Read more about him in the  "An American Veteran" series we've been bringing to light, here. In this very interesting letter, Eddie takes on the persona of a friend, "Willie," to write to a battle buddy named "Ben," about his own fears and concerns; but also, so importantly, about the bravery of the other, equally "unknown" soldiers who have succumbed to PTSD. With writing that's plain-spoken, deeply emotional, and straight from the heart, the unschooled Eddie Livingston is a match for any of the war writers out there, whose names are far more famous than his. Read on:

"Dear Ben:

Tomorrow is the big day. The day they open the old bean. And what they don't find, will probably worry them more than anything they do find. Ben, I would be the biggest liar in the world if I said I wasn't scared. It started -- the fear did -- the minute I said, "Yes, you can operate." The doctors leave the decision up to you. And that's what makes it so hard, Ben. And scary. And so different from Venafro. Or the other places. It hit me all at once, Ben, that I would be ALONE for this one. Completely, utterly alone.

Ben, I wrote you a letter a while back, and in trying to be funny, I may have left you with some wrong impressions about a wonderful bunch of people. I am speaking of the psychiatrists and related personall -- from ward boy right on up to specialist. These people are rendering incalculable service, Ben.

Because in the case of our mentally and emotionally disturbed veterans, Ben, psychiatry is their best bet, the only bet for many. The tragedy, Ben, in too many cases, that I have aseen is that "My world and your world" is lost to them. Irretrievably lost. Modern medicine with its miracle drugs can relieve their physical suffering. The psychiatrist can snatch one back -- briefly -- from that netherworld. But all too often, Ben, there is simply nothing that can be done, for too many of them.

I do not understand the problem. Nor do I know what needs to be done, or what can be done, even. But, Ben, I do know that we cannot afford the disgrace of apathy. For no group of Americans ever served our country more valiantly, and at greater cost to themselves, than did these men.

Let me tell you about four of them. Their stories are probably typical of most.

Just across from my bunk is a young fellow. Except for his eyes, which remind you of dark windows in an empty house, he looks no different than you or I, Ben. But on that shell-torn purgatory called Anzio, something went wrong with this kid, and he will never be right again. The guns of that inferno blaze and thunder in his mind, today, just as real and vividly, as on those terrifying days when the beachhead was active. Ben, this kid will never know even the make-believe peace of the Cold War.

Right down the aisle from this kid is another young fellow. His eyes are sky-blue, but there is no sunshine in them. There never will be again. The life has burned out of them, leaving two employ blue holes. He was a farmer. He was a farmer until 1940, when he joined the Army. He still had the dreams and visions of a farmer, Ben, until one bleak morning in June '44. It happened at Normandy. On Omaha Beach. The Germans swept in on the unprotected right flank of his outfit, and wiped them out, killing them all, except for him. He doesn't remember green fields. The harvest. Not even his dog, Bozo. But you should see his eyes when he tells you, 'I kept telling them the right flank was open! I kept telling them! I kept telling them!'" When you look into those empty blue holes, Ben, you have a feeling that freedom's right flank is now securet. That, because of the price he paid, the right flank is now secure -- perhaps forever. Thanks to the price he paid -- we can't forget.

The third kid is a youngster you will never forget. He's always in a rush, Ben. If you to stop to chat with him, even for a minute, he is fidgety. Pretty soon he will say, 'Please come back later. I am expecting my wife and two sons.' He will tell you that they come every single day. And, although he expects them momentarily, he will take time to show you their picture.

The picture, Ben, is just a landscape on a postcard. A winding country road and a sunny sky, by some forgotten artist. There are no people in the picture. Oh, yes, he had a wife and two sons. HE HAD THEM RIGHT UP TO IWO JIMA.

The last fellow is one you would understand, Ben. He was in North Africa, at Kassarine Pass. He was with Patton in Sicliy. With Mark Clark at Salerno and Anzio. He was with the first wave in Normandy. He helped to liberate Saint Lo and Paris. He marched clear across France. He fought in the Battle of the Bulge. He knew war long enough and well enough to write a book about it. And Ben, that's what he's done, he tells everybody. WROTE A BOOK ABOUT WAR.

He smiles shyly when he shows you his book. He tells you he is very sorry that he can't offer you a copy. But he has only ONE COPY at present.

"Here!" he hands you the book. "Look at it! Read a page! Like it?" he smiles.

"S-U-R-E," he will promise, eyes aglow with pleasure. "An autographed copy -- just for you! And very soon, now, too!"

The book, Ben, that he clutches to him so desperately, the book he shows you with such eager pride, is just an ordinary copy of the Bible. One a Red Cross lady gave to him a long time ago. So it's really a little more tattered and worn than most Bibles.

Ben, perhaps he did, well, help to write HIS BOOK. It doesn't seem at all impossible when you look into his eyes. Eyes a world from your own. Eyes that are always looking back ONE WAR. Eyes that are a world, a war, from your own, and always will be. Eyes that make you feel strongly that maybe he did at least help to write HIS BOOK.

Perhaps he researched HIS BOOK at Kassarine, amid the despair of defeat. Then wrought a first draft from the fury that was Sicily. Edited this for feeling in the agony of Salerno. Rewrote for effect in the fear that was Anzio. Illustrated for clarity -- and hope -- in the early dawn that was Normandy. Dedicated it to show the futility of war in the Battle of the Bulge. And prays now that all of us will join him in a rededication to end the need for war, in the Halls of Peace at the United Nations, and in our hearts.

Pray for me, Ben. And with warmest regards and best wishes, I am, your friend and buddy, Willie."

A Corrective to Believing PTSD is Responsible for Everything

I found this line last night on a blog. It's jagged and funny because, really, people do blame too much on PTSD, when it's sometimes not PTSD's fault at all.  Here's one veteran's barbed but humorous take on it:

"As to PTSD, I know some veterans have been emotionally devastated by their service experience. In no way do I not respect their experiences. The majority are, I believe, like me. I was an asshole when I went into the Army. The Army didn’t cause that. When I got out I was the same, only with some stress added."--- Anonymous

An American Veteran -- "The Only Happiness I Have Ever Known"

It's undeniable what a hard life Eddie Livingston had: 30 years of living in squalor, without electricity or running water, despite being an American hero, a seven-time Purple Heart winner, and a former P.O.W. in a brutal German camp. We've been reading about his life lately in the "An American Veteran" series, linked here. And we're so grateful to Eddie's niece, Pam Baker, for sharing Eddie's writings with a larger audience. He lives on in what he wrote so plainly from his large and broken  heart. And yet there is real wisdom, too, and surprisingly -- though not surprisingly for veterans, who sometimes truly brim over with it -- there is true compassion for others, and sage thinking about how we can interact together in the world, for the benefit of all.

In lines that could have come straight from Max Ehrmann's 1952 masterpiece, "Desiderata," reminiscent of sayings like "You are a child of the universe, no less than the trees and the stars; you have a right to be here," we find simple, plain yet profound truths in what Eddie wrote. And deep love for his fellow human being, despite all he personally had been through:

"The strong help the weak, the rich help the poor, the well help the sick, the intelligent help the ignorant, the good help the bad, the fortunate help the unfortunate.

Our nation is rich and strong, therefore we have a great responsibility to help those less blessed than ourselves.

It is not necessary that those people thank us or even appreciate our help. Let our reward be the good satisfaction that comes from helping others.

We cannot limit ourselves to helping those who we deem deserving of our help. We would run into controversy trying to decide who deserves our help, but all of us can see and define need.

A young enemy girl gave her life to save mine in POW Stalag. She did not even know my name, she only knew I needed help.

The only happiness I have ever known is the satisfaction that comes from helping another human being." -- Eddie Livingston, 1966.

An American Veteran -- Who Eddie Livingston Was, a Decorated War Hero with PTSD

Finally, a newspaper documents Eddie Livingston's struggle on its editorial pages. They write, giving him his due but was it too little, too late?

"Eddie's life must spur change."

If people noticed Eddie Livingston, they saw a small, shabby man with a white beard wearing tattered clothes and a soiled bucket hat. They may have smelled him before they saw him, as Eddie's clothing was always in need of a good washing. They wouldn't know that Eddie and his wife lived in a decaying house without water or electricity.

They wouldn't know that by anyone's definition, Eddie Livingston was one of our nation's most esteemed war heroes. They only saw a man who appeared as a vagrant, who shunned other people, who trusted no one, and stuttered badly on the rare occasions when he would talk with others.

They wouldn't know that Eddie Livingston had been among our nation's bravest soldiers in World War II, that he was a teenaged paratrooper dropped into Normandy as part of an advance team for an initiative that would become known as D-Day, that he was captured by the Germans on that mission and held in a prison camp for almost a year, that he was awarded seven Purple Hearts, three Bronze Stars, a Distinguished Service Cross, and two Presidential Unit citations.

People he encountered may have never guessed that the harrowing experience of war, particularly life as a prisoner of war, was what took a psychological toll on Eddie. They could not have known.

But plenty of people in the network of services our nation provides for veterans knew. Eddie struggled for years to get his benefits, then lived with his wife in heartrending surroundings that suggest he felt unfit for the world.

A story featured in the May 31 Eagle chronicles Eddie Livingston's tormented post-war life, particularly how he never received the help he needed for his post-traumatic stress disorder.

The system failed this decorated war hero and, in doing so, fails every American. Our nation must do a better job of supporting the men and women who have contributed their time, their sanity, their health, and their lives to the service of their country." 

An American Veteran -- A Sad and Painful Homecoming: "Loneliness and Peace Was Breaking My Heart into Little Pieces."

There are a lot of disappointing homecomings that veterans talk about. I remember reading Claude Anshin Thomas' in "At Hell's Gate: A Soldier's Journey from War to Peace," about how uneventful and dissatisfying and not like he thought it would be, when he came back injured from Vietnam. Then I remember reading Pat, the protagonist here of "Eyewitness to Combat" share about his in the same way, in the piece called "Winners Go to Harvard, Losers Go to Vietnam," linked here. But Eddie's is the one that currently rips my heart out. Listen to the plainness and the plaintiveness of his language, and think about a man who went from being a teenage paratrooper from Alabama, jumping with the 82nd Airborne, to being a veteran with an astounding seven Purple Hearts, three Bronze Stars, a Distinguished Service Cross, and two Presidential Unit citations after his five European campaigns and year as a prisoner of war. Read his remarkable retelling of his own homecoming. Sad to say, it only got worse.

---

"My homecoming was understandably sad. All the real friends I ever had were the Jokers; all dead now at Anzio, and dozens of other bloody battlefields.

My first night in the states I was in Washington, D.C. It was a rainy night. The rain was a thick mist really, with just enough breeze to give it life and the myriad of lights did many beautiful things to the mist. If Washington had ever looked prettier it must have been very long ago.

The unaccustomed lights dazzled me with an awesome foreboding. I was sure the bombers would come. I thought peace was all a gigantic hoax! And that war like some evil spirit was lurking in the shadows, waiting for the right moment to pounce on me again. I walked the streets with a sad loneliness that was as absolute as creation's first dawn. Loneliness and peace was breaking my heart into little pieces. I had not the capability to cope with my loneliness, nor the ability to cope with or comprehend peace -- an incredible, awesome thing to me.

As I walked I instinctively surveyed my surroundings with the practical curiosity of the combat infantryman. Manholes became foxholes, unobstructed streets would afford good fields of fire, car parks became tank parks, etc.

As I walked, lonely and broken-hearted for my comrades forever lost to me, every awesome noise of war just echoed, reechoed in my mind and heart. I cried, wept. Every once in a while I would lift my head and catch a full face of rain to hid the fact that I was crying." -- Eddie Livingston, decorated war hero, World War II veteran, former P.O.W. The illustration is by his niece, Pam Baker, with whom he went to live, shortly before he died.

An American Veteran -- Begging Would Desecrate the Memory of My Fallen Brothers

"That VA psychiatrist was right: I can get in the street and beg, or I can take my gun and do as the VA told me and blow my disordered brains out. I will not get in the streets and beg and thus desecrate beyond redemption the service of every man who ever served our great nation. And I am thinking particularly of the brave men in the 82dn Airborne Division, whom I soldiered with, "I" Company, 3rd battalion, 504 parachute infantry regiment, most of whom are dead, as I wish I were." -- Letter of WWII veteran and former P.O.W. Eddie Livingston, who had survived five European campaigns, to Alabama Senator John Sparkman, April 22, 1962.

Editor's note: This display of Eddie's medals was photographed by his niece, Pam Baker, who found the medals under a pile of trash in Eddie's squalid living conditions. He and his wife Helen had lived for 30 years without electricity or running water, though he had served his country with valor and endured great personal hardship because of his service. The grand total of Eddie's war medals and honors is staggering: He was awarded seven Purple Hearts, three Bronze Stars, a Distinguished Service Cross, and two Presidential Unit citations.

An American Veteran -- The Long, Never-ending, Tiring Struggle of PTSD

"I do not think I will ever find any peace or happiness; probably I would be better off dead. It does not matter one way or the other. I just get so tired of things at times." -- Eddie Livingston, WWII veteran, former P.O.W., PTSD sufferer, in a letter to his wife, Helen, August 1, 1966. 

Editor's note: The graphic illustration is of the house where Eddie and his wife Helen lived in squalor, without lights or running water, for 30 years. The illustration is from Pam Baker, Eddie's niece, with whom Eddie went to live right before he died.

An American Veteran on Neglect -- "Compensation for the Scars, Nothing for the Wounds"

Jim Tabb, who writes the wonderful occasional blog post at OldTimer, has an exceptional article about the history of the American veteran as abused and discarded, after he'd served his usefulness. 

Here's just one excerpt about how difficult the conditions World War II veterans returned to at home:

"In 1946, the VA had beds for about 82,000 patients but the VA rolls swelled to 15 million in just a few months and the hospitals were virtually all swamped.  There were 26,000 non service related cases also on the waiting list. The VA was building new hospitals but had money for only 12,000 more beds.  They came too few, too late."

Eddie Livingston, pictured at left, was an American hero, but you've probably never heard his name. A World War II veteran and former P.O.W., he was with the 82nd Airborne 504, 3rd Battalion, I Company. He fought in five European campaigns. When he came home, he felt abandoned by his government, and lived with his wife, Helen, without lights or running water for 30 years. Periodically he wrote his thoughts down and shared those with others, in letters to elected officials. He also told his story to family members, such as his loving niece, Pam Baker, with whom he came to live right before he died. Pam has since shared parts of his painful story with others. The snippets that emerge are of an amazing "everyman" veteran, who speaks from his heart about the agony and very little ecstasy after combat. Eddie Livingston's story is very much consistent with what Jim Tabb writes about, in the tradition of the American veteran being abused and discarded after war.

The Greatest Generation didn't talk about PTSD, though many, like Eddie Livingston, endured it. In another excerpt from a letter he speaks pointedly, though obliquely, about his PTSD:

"I have just one question: How callous and uncaring can one's government get? I understand Germany -- West Germany -- has made a remarkable recovery thanks to billions in American aid. But I have not done so well and am getting worse. All I have ever received from my government has been insults and abuse and 10% ($19.00) service-connected compensation per month for the scars, multiple of wounds (7) suffered in action. $19.00 for the scars; nothing for the wounds."

An American Veteran on the "Addiction" of Combat -- "I Made the Mistake of Staying in Combat Too Long."

More from World War II veteran and former P.O.W. Eddie Livingston, who lived with his wife Helen for 30 years in squalor and neglect -- no lights, no running water. Conditions not befitting an American hero, an American veteran. But very much the case for one who fell through the cracks, for whom there no safety net. He writes poignantly about his experience of combat:

"After four years, seven wounds, a year as a P.O.W., World War II ended for me. I did the best I could, and no man should feel ashamed of his best. I have always known that war is our ultimate failure. But war is an addictive thing. I became addicted, and now I am addicted to agitation. I have no way of knowing how crazy I am. I doubt if the psychiatrist would (even) know. I made the fatal mistake of staying in combat too long. I had no choice; I had to stay. What we know does hurt us. It is what I know that has made me the way I am."

 Editor's note: the photo of Eddie Livingston, neglected American hero, and its caption were written by Eddie's niece Pam, with whom he lived right before he died.

An American Veteran -- on Decent Treatment for Veterans vs. War Memorials

 We've been sharing lately on this site the wonderful writing of Eddie Livingston, World War II veteran, former P.O.W., whose life after war was one long, unrewarded struggle, taking place far away from the concerned glances or compassionate inquiry of his fellow citizens, or even the government he served in war. His niece, Pam Baker, with whom he lived right before he died, has been bringing some of his writings to light, as they touch the heart of others who understand how representative Eddie was of many veterans who slip beneath the cracks, and fall away from any social safety net. Here is a crisp letter to the editor Eddie wrote a paper in Danville, Calif., where he lived before he died, on how veterans would like to be treated...and commemorated. It's almost Biblical in its straightforwardness and emphasis on binding up the wounds of the brokenhearted and neglected.

The Combat Veteran's Lament: "My Mind is Not a Faucet That I Can Turn On and Off at Will..."

"People tell me to forget the war, telling me it is over. Their advice is sound and well-intentioned but impossible to follow. Simply because my mind is not a faucet that I can turn on and off and at will. I am working on it." -- Eddie H. Livingston, World War II combat veteran, former POW.

Belleruth Naparstek to Mental Health Colleagues: "Please Stop Saying PTSD is Incurable."

Note to mental health colleagues: "You can recover from posttraumatic stress. Certainly, you can significantly reduce - not just manage - its symptoms. But - and here's the thing - not with traditional treatment. The problem is, a lot of my colleagues don't know this yet. So they go about it in traditional ways and pronounce the condition incurable, based on the results they get." -- Belleruth Naparstek, from her article "Note to Colleagues: Please Stop Saying Post-Traumatic Stress is Incurable," just published in The Huffington Post on May 1, 2010, and linked here. The whole article is excellent; please give it a read and a think as well...

Editor's note: We've written about Naparstek before on this site, here. Her guided imagery tapes, CDs and DVDs, including "Health Journeys: A Guided Meditation for Healing Trauma (PTSD)," and her book, "Invisible Heroes : Survivors of Trauma and How They Heal," are loved by many.

Understanding Post-Traumatic Stress as a Mental "Illness" without Judgment: A Sufferer Clears Things Up

Periodically we come across something great that a PTSD sufferer has written about what it's like to live that experience, not just read about it. The following post is uniquely compelling and articulate, and it's written by Joan Esnayra, Ph.D., founder of the Psychiatric Service Dog Society. Read more about Joan's organization here. But for her wonderful letter, reprinted with permission, keep on reading below:

Dear Veterans,  

Here is what I wrote in response to one of [name redacted's] posts the other day about whether or not PTSD is a mental illness.   It comes from the heart and it is offered with respect, (if not a little tough love, too).

Dear [Name Redacted],

I know that a lot of veterans are not happy hearing PTSD referred to as a mental illness.  Perhaps this is because of some latent fears about what mental illness really is.   Mental illness is quite simply abnormal brain function in the domains of speech, cognition, behavior, and/or sensory capacities.   Not all abnormal brain function is a mental illness, but all mental illnesses are characterized by abnormal brain function.  Does this make sense?

PTSD is described extensively in the DSM-IV. This is the 'Diagnostic and Statistical Manual of Mental Disorders.'   It is the bible of Psychiatry. You don't go to a podiatrist or an audiologist for PTSD treatment.  You go to a mental health professional. This is because it is a mental illness. There is no value judgment, here. It's just a fact.

I've been diagnosed for so many years that sometimes I forget how scary it was for me when I received my first mental health diagnosis at the age of 25 (Major Depression & PTSD). Having grown up with a mother who attempted suicide with some regularity throughout my childhood years, the last thing I wanted to receive was a mental health diagnosis. Voila! There it was staring me in the face. And, despite the fact that I should have been hospitalized (indeed hospitalization was offered to me), I declined the invitation, swearing to myself that I would not become my mother!  he idea of psychiatric hospitalization was absolutely frightening to me at the time.  

Since then, I have "been there, and done that". I've seen what psychiatry and neuroscience have to offer people like me (and people like you). Did you know that Bipolar Disorder is believed by some researchers to be a dysregulation of the circadian rhythm circuitry of the brain? Where is the mental illness in that?   How can a genetic malfunction of the brain's day/night &  sleep/wake cycle cause people to suicide to the tune of 25%? To say that something is a mental illness, is not personal.  There is no value judgment in the statement. It is just the category of pathology that each of these mental disorders falls under.   It is logical and nothing else.

One of the things that veterans with PTSD have to reckon with is that they do have a mental illness. For some of you, this is a no-brainer, no big deal, like "Duh, that's pretty obvious, Joan." For others, especially the newly diagnosed, this prospect is exceedingly frightening. Allow me to proffer that the fear is not in the classification, rather, it is in our own assumptions about mental illness. When I give public presentations on PSD, sometimes people assume that I am a non-mentally ill psychologist, because I come across professionally, and because I know my subject matter, and I'm articulate. I couldn't possibly be a knife-wielding psycho, right?  I mean, isn't that what mentally ill people are really like?

Of course not!  Mentally ill people are as diverse as any other group of people. You have the high functioning, the low functioning, the assertive self-starter entrepreneurial types, and the passive, quiet, stay at home types.  The whole gamut of humanity is represented on the spectrum of mental illness. There is no "type" among those who live with mental illnesses. As a result, there is no judgment, either. 

The mental health consumer community has been pioneering PSD for 13 years.   We have an intervention that the veterans community wants and needs.  Thus, we need to be building bridges to communication so that we can benefit one another over the long term. Disparaging the characteristics of persons living with mental illness is not going to get us there. So, I'm asking you to re-think your assumptions about mental illnesses and the people who live with them.  

Someone in this group recently disparaged others' talk of suicidal ideation and self-injury. This is incredibly disrespectful to our community members.  Unless you have walked a mile in someone else's moccasins, it is inappropriate to disparage a legitimate feature of their disability. To do so is tantamount to making fun of someone who wears a colostomy bag.  "Hey Poopy Boy, You Stink!" That would be terribly rude. Don't you think?

One of the assumptions that people who are not comfortable with the concept of mental illness make is that people with mental illnesses are victims. This strikes our community as a completely bizarre attribution. What is a victim? Ostensibly, it is someone who, through no fault of their own, is harmed, used, or taken advantage by some force that is more powerful than they are. Using this definition, one might conclude that persons living with mental illnesses are indeed victims to the same extent that anyone is a victim,...of their own genetics!

But, there is another way of using the term 'victim' that disparages the sufferer. In this instance, there is implicit judgment that the person is weak, cowardly, ineffectual, and quite frankly, worthless in the eyes of society.This is the version of 'victim' that I was responding to when I read the term in your previous post. It offended me. I am not weak or cowardly or ineffectual, or worthless, and I AM mentally ill. I have no shame about saying to the world, "I live with mental illness". If I did have a problem with this, then, it would be more so a problem of self-acceptance. The fact is, I am mentally ill. Underestimate my abilities and I will prove you wrong.   Call me mentally ill, and I will agree with you.   Do you see the challenge, here, to familiar assumptions?

The veterans community needs the PSD community, and the PSD community needs the veterans community. We are like newly reunited cousins.  My side of the tracks has never gained societal acceptance because we could never hide the fact that we live with mental illnesses.  (We've been symptomatic our entire lives). Your side of the tracks has experienced societal acceptance in your role as non-mentally ill soldiers. Importantly, your side of the tracks (your peer group) has accepted you on the condition that you are not mentally ill.   

Well, guess what? Living with PTSD means that you ARE mentally ill.  So, do you go into the proverbial closet (a lot of people do), or, do you establish a separatist agenda ("we are not like those people"), or are you going to challenge society's fundamental assumptions about mental illnesses?  It is my sincere hope that you will choose the more enlightened path and look for ways to challenge societal assumptions about persons living with mental illnesses with an eye towards growing a more equitable society for all of us.

Joan

The Spouse's Point of View: "I Just Want It Over With, and Buried..."

Watched a great documentary last night, one hour long, originally broadcast on "The History Channel." The documentary was "Vietnam: Homecoming," and I rented it on Netflix, in their instantly-playable section. They describe it in the following manner:

"This moving documentary follows Pervis Crowe, Stanley Parker, John Hedrick and Mike Cook -- who suffer from post-traumatic stress disorder -- as they prepare to attend Operation Homecoming, a gathering in Branson, Mo., to help Vietnam veterans mend. Through poignant interviews, these anguished men share their personal stories of the pain and torment that scarred their psyches and forever changed their lives."

Good stuff. Because I've been privileged to have two years of in-depth, daily conversations with one suffering Vietnam vet, as well as having read his life story, mostly focusing around combat in Vietnam and its aftermath in his life as PTSD, which he sent me two years ago this week, I was astounded by the compelling similarities in what I heard on the screen with what I knew in real life.

Every veteran shared something meaningful. In the conversation illustrated above, a Vietnam vet and his wife exhibited typical conflict over, "you were only there for such a short time...how is it that you can't get over it yet?" frustration. As the wife said, pointedly,

"As your spouse, I don't want you to have to relive it. I want it buried. I just want it over with, and buried."

Unfortunately, that's not likely to be the case. She had "stuck by her man," -- whereas most of the wives in the documentary had not -- and yet, there were tremendous issues. In a suicide note this veteran had left, ironically with his combat brothers, he had mentioned how not only was he expecting to die, but also his wife and their daughter -- a fact that troubled his family members, not unexpectedly, quite a bit when they learned what he had said.

Another veteran, a black soldier, talked about how he managed to keep PTSD at bay until his daughter went off to college. Then his inborn conditioning that "if you get close to someone, they die" kicked in, and he became unrealistically fearful for her safety. At 50 years old, he checked in with what the VA had to offer, the first time he'd realized what an impact PTSD had made on his life, despite the decades of being afraid to get close to people or show his emotion.

Another Vietnam veteran, Marine, sat on his single bed in what looked like a hotel room, and grabbed his shaving kit of medications. This vet's "backstory" was that he was an entrepreneur, a businessman who created a company from scratch that went on to be worth millions. As he described it, he went from rags to riches, and then suddenly at age 50, he couldn't handle it anymore. The empire he built came crashing down, because his PTSD kicked in, and he couldn't run from it, couldn't keep it at bay anymore. And now he was single, marriage destroyed, dependent on pharmaceutical medications to keep his anxiety and sleepness at bay. As he sat on the bed, he took out large pill bottle after large pill bottle, filled with prescription medications, and described his dependence on each one, to help him sleep and help him cope.

I remember the second time I met with the Vietnam vet, Marine, who sought me out for help. He gave me his single-spaced, typewritten list of medications that he was on, 58 in a day, and I almost fainted. Some of them were just for the side-effects of other medications he was on! I was horrified, and sobered. No wonder he had an upset stomach all the time...

A year later, he was down to eight medications from the original 58. Gone was the pain patch, the Oxycodone, the night sweats, the nightmares, the muffled screams, the crappy sleep. Progress is possible. But it started, ironically, with listening to what the veteran went through. "No one wants to hear my story," he said. "They think I should be over it by now. I was only there for two years," he said, "they can't understand why it's the dominant experience in m life, and they're bored with it. Why can't I just move on?"

I heard echoes of that last night in the documentary, with the wife's question: "Why can't this just be buried?" I don't know if I have the stature to comment on this, but this is what I'd say. Honestly, he's not the same person you thought he was. War changed him; combat changed him. And if you can't accept that...you can't accept HIM. He's different now. And whether and how he chooses to show that, it's affected him to the core of his being. He can get better, and he can "improve," and be happier and healthier, by all external metrics...but seriously, if you don't value the core of what he experienced, and why it changed him...you are missing something very, very important. It's key to who he is. And if you wanted someone who wasn't affected by combat, well, that's not who you have right in front of you. It permanently expanded, and blew out, the boundaries of who you knew, and changed him into who he IS. And that is the veteran you can embrace, or not. The choice is yours. The experience was his (or hers). And he (or she) can share it with you, to the extent that you're open to accepting it. Be open. Work on it, if you're not. The payoff is immense. Because you will KNOW who the other person really IS.

Demons on the Battlefield, or, Integrating the Warrior Within

Back in the fall of 2005, I had a conversation with a Marine officer in Ramadi, when Ramadi was an extremely violent place. The officer was on his third or fourth tour, and confided that he thought he'd come back to Iraq "to lay my demons down on the battlefield." Not sure what he meant by that, I suggested that more likely the opposite was true. People picked up demons on the battlefield (e.g., post-traumatic stress) but were rarely able to lay them down. If they could, more people would probably want to go to war.

In any case, as our conversation progressed over the ensuing months, I strongly preached the "gospel" of integration: something I'd learned from my own excursion into Taoist acupuncture and Chinese medicine in general. The concept of embracing opposites within us, and not rejecting one side of ourselves while embracing the other; recognizing that the good and the bad are both equally "us." It's an abstract concept, and until there's a reason to face it head-on, perhaps we never really do. Post-traumatic stress is of course one great reason to face it. We're both the angels we were before combat and the demons we found ourselves being during combat.

Many a Marine and soldier has expressed their observation about being two people. The Marines even have a saying about it, how they know how to be "the best friend and the worst enemy." The yin and the yang, the dark and the light, both dwell within. Part of the exasperating hardship of PTSD is coming to terms with how this can even be true, and yet, not destroy you. Churches and sometimes even well-meaning friends and family members insist that you can only be one or the other: the good or the bad, and if you're conflicted, well, you must just need to "pray about it harder," or, "try not to think about it so much." In fact, while balancing two selves may seem quite precarious -- the ideal self and who you've actually become -- the reality is, synthesizing the two into the "non-dual" self may ultimately be a healthier expression and resolution of the conflict within.

With this as a background, it was with interest that I read the following passage in a short but powerful book by a Jungian psychoanalyst who wrote, addressing the intrinsic conflict in warriors,

"Medieval heroes had to slay their dragons; modern heroes have to take their dragons back home and integrate them with their personality." -- Robert A. Johnson, "Owning Your Own Shadow: Understanding the Dark Side of the Psyche." 

Occupational Therapy and PTSD -- It Had Its Origins in WWI, with Shell Shock

April is "Occupational Therapy" month, and come to find out -- Occupational Therapy has an interesting past! It was founded in World War I as a way to deal with shell shock -- what PTSD was called at the time -- because it was thought that "doing" was therapeutic for injured veterans, not just "talking." I've been fascinated with this ever since I learned it from an OT with a specialty in mental health, who has practiced in and around the military for decades.

(If you know any veterans who have been injured, you've probably heard about occupational therapy for traumatic brain injuries (TBIs), amputations from IED blasts, etc. But PTSD? Wow. Who knew that it was founded as a discipline to address that!

On the hunt for more information about this topic, I uncovered the following. Carolyn M. Baum, Ph.D., the immediate past president of the American Occupational Therapy Association ("AOTA") presented testimony on post-traumatic stress disorder to the House Veterans’ Affairs Subcommittee on Health on April 1, 2008. Her testimony, "Post-traumatic Stress Disorder (PTSD) Treatment and Research: Moving Toward Recovery, "explained the unique contributions of occupational therapy in the treatment of PTSD and other mental health issues."

"Occupational therapy brings a third dimension to the system of care for PTSD. Medication and counseling, supported by occupational therapy and performance, is the approach that we recommend the VA adopt, she said."

Dr. Baum also promoted the role of occupational therapy broadly with the Veteran's Administration (VA).

(Inquiring minds want to know what happened with that...)

Here are her remarks in full:

Statements of Carolyn M. Baum, Ph.D., OTR/L, FAOTA, Immediate Past President, American Occupational Therapy Association, and Professor, Occupational Therapy and Neurology, Elias Mitchell Director of the Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO; David Matchar, M.D., Member, Committee on Treatment of Post-Traumatic Stress Disorder, Board on Population Health and Public Health Practice, Institute o Medicine, the National Academies, and Director and Professor of Medicine, Center for Clinical Health Policy Research, Duke University Medical Center, Durham, NC; and Mark D. Wiederhold, M.D., Ph.D., FACP, President, Virtual Reality Medical Center, San Diego, CA; Accompanied by Gerald M. Haase, M.D., Founder and Chief Medical Officer, Premier Micronutrient Corporation, Nashville, TN.

Statement of Carolyn M. Baun, Ph.D., OTR/L, FAOTA:

Dr. Baum. Thank you, Mr. Chairman, Members of the Subcommittee, for giving me the opportunity on behalf of the American Occupational Therapy Association to discuss issues regarding post traumatic stress disorders.

You introduced me, so I will bypass that. I also am the Professor of both Occupational Therapy and Neurology at Washington University School of Medicine.

Occupational Therapy (OT) has had a rich history providing services to veterans dating back to World War I. Occupational therapists help wounded warriors return to their military responsibilities or transition into civilian life. We do this by helping them set goals, develop strategies to accomplish their goals, and gain the skills that allow them to achieve the maximum level of participation and independence.Occupational therapy perhaps is best known for its work in rehabilitation services after stroke, loss of vision, physical injury, including amputations, and traumatic brain injury, but occupational therapists also treat individuals with stress-related disorders that result in mental and cognitive impairments as well.

OT plays a unique role in helping veterans recover from PTSD as they serve as key members of the team, that along with physicians and psychologists who use medication and counseling, the occupational therapist employs performance strategies that support the veterans in achieving success in their performance in daily activities.

Actually, it is in these daily activities that it is possible to observe the problems veterans are having with multi-tasking, with sequencing of tasks, with their safety, with their judgment, and actually identifying the cognitive fatigue which has a very important need for consideration.

These are all problems that require strategies for individuals to overcome.

The effective treatment of PTSD and the return of veterans back into their work, their family, and community lives really requires an integrated system of care that includes assessment, goal setting, treatment, and learning to self-manage life with PTSD.

Rehabilitation does not stop when veterans are discharged from hospitals or medical care. It must be provided along a continuum addressing community reintegration, social reconnections, and work accommodations. All these are areas in which occupational therapists play an important role.

Veterans with PTSD often have difficulty in their daily lives and avoid activities because they result in anxiety or fear or even anger. Consider, for example, a soldier who is driving on routine patrol when a road-side bomb explodes. Upon returning home, the veteran might experience flashbacks of that event triggered simply by driving.

The therapist might use simulated or virtual reality driving experiences or even actual driving experience in a controlled environment to help the veteran extinguish or reframe the negative stress reactions.

Therapists also work with veterans to help them manage issues related to PTSD such as depression, mild head injury, or concussion, and substance abuse by helping them develop strategies to reengage in daily life that are meaningful for them and their families. Having the families involved is particularly important because we know the importance of social support to individuals recovering from PTSD.

The unique contribution of occupational therapy is highly valued by the Army for their combat stress control. The Army model deserves additional attention from the Veterans Administration and the Subcommittee because it fully recognizes occupational therapy's contribution as a member of the team by adding the performance component to the medication and counseling provided by other team members. We recommend the VA consider and adopt the Army model.

The Veterans Administration has made significant strides in preparing to meet the needs of veterans, but work remains to be done. There are only 750 occupational therapists in the entire VA system. While both the Veterans Administration and the Department of Defense guidelines for PTSD exist and include occupational therapy, it is the experience of our members that the inclusion of occupational therapist varies from site to site. This variation does not ensure full access to effective treatment.

The American Occupational Therapy Association encourages the Committee to look at this issue. From the consultation with AOTA's members within the VA, we have heard that they are struggling to maintain the quality of care for which they are known because of increased demand for rehabilitation services and gaps in staffing.

The most important issue is to ensure that veterans receive the services they need to recover and reenter community life, able to care for themselves and others, able to work and make contributions to their families and communities. If the VA has staffing problems, they should look for, and contract with, community programs to provide the services that the veterans need.

Just as you discussed earlier with Colonel Hoge, there is also a need to study the effectiveness of complex interventions, medications, counseling, and I would ask for consideration to add the third leg to the stool, the importance of daily life performance.

Research should seek to understand the relationship of quality of life to PTSD symptom severity, disability, treatment outcomes and cost. The problem begs for an interdisciplinary translational clinical study.

Mr. Chairman, I have made additional recommendations in my written testimony, but I want to highlight a couple of issues for your Subcommittee's consideration.

To increase the numbers of occupational therapists within the Veterans Administration, we would urge that the Subcommittee consider expanding the Student Loan Repayment Program to ensure that the VA remains an attractive employment option because there is a real supply and demand issue for OTs right now and that would draw people to the VA services.

Salaries in the VA appear to be lower than other healthcare settings. The Bureau of Labor Statistics estimated in 2006 that the average salary in California for occupational therapists was $73,000. Right now the Palo Alto Polytrauma Rehab Center is offering $50,000 for two new positions that have been vacant since last July.

New positions continue to be added across the country, but salary will continue to be an issue, and AOTA urges the Subcommittee and the VA to attend to salary, recruitment, and retention issues.

Mr. Chairman, in conclusion, I want to reiterate that occupational therapy has expertise in the treatment of functional impairments resulting from a broad range of conditions faced by veterans, including PTSD. Occupational therapy should be explicitly included on treatment teams to address the every-day life issues of veterans and their families through the phases of recovery and community reintegration.

Thank you very much for the opportunity to provide testimony to the Subcommittee. AOTA looks forward to working with Congress and the VA to meet the needs of our veterans. And I would be happy to answer any questions. Thank you.

[The prepared statement of Dr. Baum appears on p. 45.]

Mr. Michaud. Thank you very much, Dr. Baum.

Editor's note: The source for the testimony is linked, here.

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."

Quotable Quotes -- Nate Fick on Combat Veterans, PTSD and Reintegration

"It took me a year to adjust after coming home from Iraq. Afghanistan was different -- it wasn't very violent and we came back on a ship. I had a month, including some vacation time in Perth and Sydney, before getting back to the States. But I left Iraq on a Sunday night, and was in San Diego on Tuesday. It was surreal. I had all the stereotypical little signs of post-traumatic stress disorder -- jumping at loud noises, nervous in crowds, short-tempered, insomnia. And you know what? I came back to a loving family and supportive friends. I had a good education and solid prospects for the future. This experience almost unhinged me. What about all the men and women who don't have the support I had? What happens to them? This is a question the military -- and our society more generally -- should be addressing. We'll have something like half a million combat veterans trying to reintegrate into American society over the next few years. They can be a source of wisdom or of destruction. It depends on how well we care for them." -- Nathaniel C. Fick, former Marine captain, author of "One Bullet Away: The Making of a Marine Officer."

Quotable Quotes -- Former U.S. Senator Bill Bradley on PTSD

Former U.S. senator Bill Bradley (D-NJ), NBA Hall of Famer, and Rhodes Scholar, had this to say in a commentary published in Vanity Fair today about PTSD. The occasion was the premiere of the Tom Hanks/Steven Spielberg/HBO miniseries, "The Pacific," about U.S. Marines in the Pacific during World War II, also getting screened privately at the White House today.

Bradley thinks there are several things that the president and the first lady should be thinking about while they watch the miniseries. One of those topics is PTSD. Says Bradley:

"Both The Pacific and Band of Brothers focus on the horrors of the war and the emotional trauma that a soldier or Marine can endure. P.T.S.D. should be treated with as much seriousness as a gunshot wound. If the president is going to send tens of thousands more troops [into combat], he also needs to consider the emotional payload. With suicide rates up among veterans -- accounting for 20 percent* of all suicides among Americans -- the government must dedicate more money to support programs for our returning troops."

Editor's note: If 8,000 veterans kill themselves every year, conservatively, and the national suicide rate is close to 34,000, according to the NIMH, the percentage of suicides who are veterans is closer to *25%. They also represent almost 50% of the homeless population. So yes, please, let's do that...and sooner rather than later...

(The full commentary is linked here.)

Picking up the Pieces of Shattered Lives: Treatment or Prison

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

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

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

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

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

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

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

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

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

Jamie Keyes writes, 

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

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

Holiday Gift: Rudy Reyes' Hero Living

If you're stumped for a holiday gift this year, think about the new inspirational book by Rudy Reyes, called "Hero Living: Seven Strides to Awaken Your Infinite Power," linked here.

Rudy Reyes is an inspirational "everyman" -- former Marine 1st recon, star of Generation Kill, who grew up admittedly hard and has honed, ever since, a set of internal values modeled on attributes of classical warriors. While Reyes, a former world martial arts champion, has honed his body to a superlative degree, it's his inside that's even more interesting -- how he's dealt with, and is still in the process of dealing with -- assaults on his soul, from childhood through combat.

Reyes has much in common with his childhood hero, Bruce Lee, from the unparalleled attention to fitness, to the equal attraction to the philosophical underpinnings of what success really is.

There's something for everyone in this book, and best of all, it reflects someone who's inspirational, yes, in his attitudes towards obstacles -- systematically conquering them all, in a focused way, one after another -- but is also, even by his own admission, very much "still a work in progress." Go, Rudy!

Editor's Note: For a recent article in "Military Times" about Rudy Reyes, entitled "The Hero Life: For Rudy Reyes, Inspiring Others is a Full-Time Job," click here.

Honoring Women Veterans Who Served and Suffered

October 12th through 16th is "Military Rape Awareness Week." In observation of that, the story of Colleen Mussolino, as retold by veterans advocate Susan Avila-Smith:

In Memory of Colleen Mussolino, Women Veteran Trailblazer

"I wanted to be an aviation engineer," Mussolino said.  "The recruiter said I could get into the program, but I found out that was closed to women." Instead she became a cook.  Soon the young WAC would find out just how differently women were regarded in the military.  On December 29, 1965, Colleen was raped by four men and left for dead.  She spent one night in the hospital and was sent right back to her barracks.  Colleen was treated like a prisoner of war, interrogated and was blackballed on the post trying to force her to sign a paper that she would not prosecute. Threatened with a dishonorable discharge, Mussolino signed the paper and was honorably discharged in March 1967.

For the next 20 years, Mussolino raised two sons, and lived her life.  But as time went by, the traumatic assault that was supposed to be covered up and forgotten began to take its toll.  "I was getting more and more short-tempered," Mussolino said. "My temper was just bad."  One day, while fishing with a World War II veteran, he told her she was entitled to veterans benefits.  She applied and began to receive benefits. She also joined a women's support group at the Brooklyn, N.Y. VA Medical Center.  "I was looking for other women who went through what I went through," Mussolino said. "Your civilian counterparts have no clue."

Women Veterans of America
With talk of the war breaking out in the Persian Gulf, she realized more women would be involved in combat than ever before.  In response, she co-founded Women Veterans of America to offer support and attention to the issues facing women in the military.  "The transition from military to civilian life is difficult," Mussolino said. "Once the uniform goes on, it never comes off." Their mission: Information and support for women veterans; liaision to government agencies; obtaining veterans' benefits and health care; advocacy in local and national isues affecting women veteran and women serving in the military. Pressure on Congress and the Department of Defense to cahnge the Uniform Code of Military Justice to include a fair avenue for victims of assault and rape to be able to report their cases and get their day in court. Punish those who perpetrate such crimes and offer protection from intimidation and threats for women who report the assaults. "The repercussions from the way the victims are treated only adds to the problem and can cause severe PTSD symptoms," the statement reads. "The UCMJ does not protect the victim, but instead rewards some perpetrators with promotion, and does not punish except with a slap on the wrist and a finger shaken in the face it continues.  It is difficult for many to fathom the emotional and physical turmoil that the men and women of the armed forces are put through.  To add sexual assault to the burden is unconscionable."

In November 1996, reports of sexual harrassment and sexual assault against women at the Army Proving Ground in Aberdeen, M.D., prompted "20/20" to put together an investigative piece on the military's handling of sexual assault.  A member of Women Veterans of America wrote to 20/20 about her own experience. "She was afraid to be interviewed because she had been given death threats," Mussolino said.  Instead, Mussolino agreed to share her own story of sexual assault and cover-up in the military with Peter Jennings. "I figured if anything came out of it, women would know they are not alone, and there is help," Mussolino said.  "Not only women are raped, but men are raped. The story seemed to validate them, too." During the show's airing, the Department of Veterans Affairs made a toll-free number available for women to call in for counseling.  "Over 3,000 women called that night from all diferent wars and branches of service," Mussolino said.  "The Department of Veterans Affairs realized more had to be done for women veterans." "A lot of Vietnam veteran women in this country don't come forward," said Mussolino.  They don't talk about it.  Those are the ones I want to reach. There is help. There is therapy by talking to a brother or a sister."

Despite her disabilities which have put her in a wheelchair, she would be at every significant event for MST and Vietnam vets, and was the primary point of contact for the media since the early 1970s.  Since Colleen's terminal illness, Women Veterans of America "decided that WVA is taking too much time on the issue of MST, and has dropped it from their services."

PTSD from Military Sexual Trauma (MST) is caused by sexual harrassment, rape and intimidation, or any improper sexual behavior.  Perpetrators often go unpunished, and have no "record" in an effort to play down the prevalence of assault and harrassment.

Editor's note: There's a "fan page" for Colleen Mussolino on Facebook, linked here.

"Not Victims, but Veterans": Max Cleland Writes an Open Letter to Other Combat Veterans

Max Cleland, decorated Vietnam war hero, triple amputee, head of the Department of Veterans Affairs under President Carter, and PTSD sufferer, who came to that knowledge in later life, decades after his military service, has written a new book, called Heart of a Patriot: How I Found the Courage to Survive Vietnam, Walter Reed and Karl Rove.

There was an interview with Cleland on NPR's Morning Edition yesterday, October 6, 2009, linked here.

But most interesting for our purposes -- since this blog is about combat veterans and PTSD -- is the "open letter" to other veterans that Cleland writes, and which is excerpted as part of the NPR piece.

"As combat veterans," he writes, "we have been through some of the most traumatic life experiences possible. War is as close to hell on earth as anything ever could be. That does make us different from our loved ones back home. War marks us all, some more deeply than others."

There's some wonderful, heart-felt expression in this letter:

"The soldier's lot is to be exposed to traumatic, life-threatening events — happenings that take us to places no bodies, minds, or souls should ever visit. It is a journey to the dark places of life — terror, fear, pain, death, wounding, loss, grief, despair, and hopelessness. We have been traumatized physically, mentally, emotionally, and spiritually. Some of us cope with exposure to hell better than others. Some are able to think of their combat experiences as but unpleasant vignettes in a long and wonderful life. It is not to those veterans I am speaking. I love them, but I am not afraid for them.

I am speaking to the rest of my brothers and sisters, those who find themselves trapped in the misery of memories as I was for so long. For them, I am afraid.To those veterans I say, you are not alone.

Many of us have been overwhelmed by war. Many of us have been unable to cope on our own with what has happened to us or with what we have done. Many of us have been left hopeless, lost, and confused about ourselves and our lives in ways we never thought possible.

That does not make us victims. It makes us veterans."

The rest of the open letter is equally wonderful, and well worth reading. In it, Cleland talks about his own personal highs and lows, what he understands about PTSD and his own case, and what has helped him get through. It's clear the concern and caring he feels for other combat vets. The letter is linked here.

After Combat: Too Much Time on My Hands, Missing the Action

Among the many first-person narratives to come out of the wars in Iraq and Afghanistan, a few start to address their growing awareness that they came back from the war with symptoms of PTSD. The recent warriors, now writers are just beginning to come to terms with the their experience, and both figuring it out and giving it effective voice is a difficult task that may get somewhat easier to accomplish in the years ahead. It's remarkable and positive to see the shortened cycle time in play as these warriors realize they may have PTSD, and it's also educational to hear how they describe what their concerns are, and what their adjustment has been like.

In former Marine sergeant Clint Van Winkle's recently published autobiographical work, "Soft Spots," he talks in one section about the experience so common to warriors -- that back in the "safety" (and boredom) of civilian life, they both have more time on their hands to think and revisit the past; and also an increasing sense that they miss tremendously the amped-up experience of war and their buddies -- the living and the dead.

Van Winkle, a Marine sergeant who first went to war on Valentines Day, 2003 was, according to the book jacket, "among the first wave of troops that crossed into Iraq, and his first combat experience was the battle of Nasiriyah, followed by patrols throughout the country, house-to-house searches, and operations in the dangerous Baghdad slums."

Here's how Van Winkle describes this collection of feelings and impressions, in an extended passage we've cut and spliced together somewhat for easier reading. The phrases in bold for emphasis are ones you hear again and again from combat veterans, in one form or another. With love and appreciation for the recent combat vets who are still processing these issues, and may be for years to come, here's what Van Winkle had to say about his own struggles to re-adjust:

“In war, no one asks you if you killed anyone.  You don’t have to say anything after a firefight.  You just come back and sit around with your fellow Marines. All you have to do is nod and they know. The questions are answered because you were there together.  They know and you know.  Nobody asked why one of us shot into that window or why the unit in front of us ripped into that bus or why I shop the group of men hiding behind that wall.  Everything was understood.

Maybe it wasn’t the war itself but the people who were in the war with me that I missed. Perhaps all I really wanted was to know it was all right and worth it and that my actions were justified.  I wanted to be back in the company of others who understood what it’s like to pull the trigger.  Wanted to get away from the questions and the made-up answers – to get back to a place where I felt normal again.

...

Names of the war dead for the week scrolled across the bottom of the big-screen television. … No matter how many times I saw the different list of dead troops, I never got used to it or the feeling that maybe I should have been included.  I wasn’t familiar with any of the names, but that hardly meant anything to me.  I didn’t have to know the dead personally to know what kind of stuff they had participated in.  I mourned each as if he had been a personal friend, and the grief took a toll on me.

...

I had too much time on my hands.Even though I was taking classes…I was bored – like being stuck in Kuwait without anything to do.  It was easy to understand why Gunny always had us doing something…. He must have known that boredom brings problems, allows too much time to think….

In some messed-up way, being home produced withdrawal symptoms. I’d experienced the most exciting events of my life. Nothing could ever compare to the feelings war induced.  Nothing. I’d never get the same adrenaline rush or create the kinds of bonds we Marines had with each other.  Civilian life was dull compared to what I’d done.

...

But I wasn’t being unappreciative. If anything, the war had made me appreciate life more, helped me see what was important. It was just hard to express that appreciation when all I could think about was Iraq.  There was no escaping it.  Iraq was everywhere.

...

True, it was over.  But in some respects the war had become more real than it had been while I was in Iraq.  There wasn’t much time for reflection while we were in country. I never stopped to think about what it all meant, or really even cared.  It wasn’t until I got home and started to talk to the dead, revisiting the war, that anything started to sink in. Was it worth it? I don’t know. That’s up to the dead to decide.

When I’m an old man and all the dreams and sights have left my head, when the memories are stolen from me, then historians will tell us whether it was worth it or not – if the war really helped anybody.  Until then, I’ll live with the dead.  We’ll carpool together.  Do lunch and late-night snacks.  Slumber parties and drinking binges.  It really won’t matter what anyone says, or if the whole stinking operation finally gets labeled a “good war.” It was too late for me. The dead and I were together.

From the book jacket:

Clint van Winkle, Soft Spots: A Marine's Memoir of Combat and Post-Traumatic Stress Disorder. Winkle was a sergeant in the U.S. Marine Corps. While in Iraq he served as an Amphibious Assault Vehicle section leader attached to Lima Company 3rd Bn 1st Marines. After completing his enlistment, he earned a B.A. in English, and then a Master's in Creative and Media Writing.

Editor's note: The illustration for this post is a wonderful drawing by Marine combat artist Michael D. Fay, of Lance Corporal Nicholas G. Ciccone, who suffered from PTSD and later sadly took his own life.

For One Veteran, Writing His Story is "An Act of Spiritual Renewal"

If you're a combat veteran and in the Buffalo, NY area, you might enjoy checking out the writers group at the VA Western New York Healthcare System.  Led by a Vietnam vet, "participants can share their stories and offer each other suggestions to improve the readability of their experiences. The group meets on the first and third Monday of every month from 1:30 to 3:30 p. m. at 3495 Bailey Avenue, Room 422b, Buffalo, NY 14215." All veterans "interested in writing their story" are encouraged to attend.

---
We've talked about writing as catharsis before on this blog, many times, but the above item comes from an opinion piece called "Recording War Stories Allows Spiritual Renewal," published July 5 in the Buffalo News, and linked here.  In it, the unnamed veteran (maybe the print version of the story contains his name; the online version does not) says plainly, "We veterans should break our silence and write about the unspeakable events. I’ve written my stories and they’re more than just about me."

In the short opinion piece, he talks about the deaths of three of his friends in Vietnam, and how "documenting unspeakable memories" like these, "labeling those events and feelings with words and closing the cover" on those stories "is cathartic. The result is a spiritual renewal, a freedom that allows me to choose when to open and close the past while trying to live in the present."

Writing sounds like it's cathartic for this veteran, but it's also a concrete way for him to give honor to the lives of those he loved, and misses.

Escaping from the Bamboo Chest

Every once in a while I come across a book about war and healing combat trauma that's new to me, and such was the case recently with one by Frederick Graham, called "The Bamboo Chest: An Adventure in Healing the Trauma of War," linked here. Unfortunately, the subtitle is a bit of a misnomer, unless you interpret it in a particularly specific way, in which case it works.  But while it's far afield from actual "healing combat trauma," the reality is, it's an amazing true-life adventure story by someone who understands he's very lucky to be able to tell it. 

For those of us who grew up reading books like Papillon, by Henri Charriere, who uses the opportunity of his captivity in and subsequent escapes from the notorious French prison, Devil's Island, to teach himself some things about himself, or any of the wonderful high-adventure historical novels by James Clavell -- Shogun, Tai-Pan, King Rat, Noble House, etc. -- Graham's book fits right in.  It's a remarkable story about a guy whose dad was a Marine, who grew up in and around Vietnam and Southeast Asia, and then finds himself imprisoned in a South Vietnamese jail in the 1980s, with an absolutely frustrating roommate who he'd been arrested with and grows to really detest, for all the right reasons.  Graham uses the opportunity of his imprisonment to reflect and make adjustments to his character, finds and nurtures his inner strength, and experiences several important insights from his childhood around the war in Vietnam that helps his adult self integrate itself more completely. 

Unfortunately, though Graham is plenty psychologically adept with his own experience, because he wasn't actually involved in the Vietnam war directly as a soldier, the "war" in the subtitle is at a slightly larger remove than it was for the actual participants.  However, as a story about man against the elements -- particularly man against society, and in some ways, man against himself -- it's really quite an exciting tale, and one worth reading.

The Real Meaning of Memorial Day: Remembering the Sacrifice

For the real meaning of Memorial Day, remembering the sacrifices that have been made, there's a powerful essay written by a trauma surgeon in Iraq about the tragic death of one Marine he treated that might be worth your while to read.  Beware: it's completely gruesome, and spares no detail, though is done respectfully.  And it has an even doubly tragic ending (you'll have to read it to see what it is.) If you have been to war, you might not need to read this -- you're already plenty in touch with what carnage and sacrifice are all about.  If you haven't been, though, it might be a little more eye-opening about what those who serve go through and ultimately sacrifice.

The most impressive part of the story to me, besides the great care the trauma surgeon takes with every battlefield injury, is his love and respect for those he's working for -- and on, a love and respect shared by everyone involved in the course of his workday.  The sheer magnitude of what they go through, and its power to numb the human heart and psyche, is astronomical.  The fact that they fight through for it not to numb them is even more remarkable.  It's a complex human reaction, best expressed by the doctor himself, but it's also summed up centuries ago in the following quote, which we've used before on this blog:

"Anyone who looks with anguish on evils so great must acknowledge the tragedy of it all; and if anyone experiences them without anguish, his condition is even more tragic, since he remains serene by losing his humanity." -- Augustine of Hippo, quoted in One Bullet Away: The Making of a Marine Officer, by Nathaniel Fick.

If you want to read a gory but powerful reflection on the true cost of sacrifice, read "A War Surgeon's Perspective on Memorial Day," by John P. Pryor, M.D., quoted in full on the blog, The Kitchen Table. The reflection is linked here.  It's well worth reading, though completely sobering and sad.

Editor's note: For more material along the same lines, there's an OEF/OIF memoir by another doctor who served, "On Call in Hell: A Doctor's Iraq War Story," by Cdr. Richard Jadick, which is linked here.

Hanging Tight to the Narrative, to Pull You Out of Hell...

More Tyler Boudreau, from "Packing Inferno: The Unmaking of a Marine," on why he writes:

"They say war is hell, but I say it’s the foyer to hell.  I say that a lot.  I say coming home is hell, and hell ain’t got no coordinates.  You can’t find it on the charts, because there are no charts.  Hell is no place at all, so when you’re there – you’re nowhere -- you’re lost.  The narrative, that’s your chart, your own story.  There are guy who come home from war and live fifty years without a narrative, fifty years lost. They don’t know their own story, never have, and never will.  But they’re moving amidst the text every day, and every long night without even realizing it.  They’re out there beyond the wire, trudging through the sentences, tangled in the verbs, suffocating on the adjectives, wrecked by the names.

They live inside the narrative like a cell, and their only escape is to understand its dimensions.  Once you get it, maybe you can start tearing down the walls.  Every soldier’s mind is different.  There is no single code to break.  It’s ever-changing.  I don’t have a recipe, but there’s one thing I do know, and that is the power of the narrative.  Put the story together.  Understand the story.  Ask questions of the story; make it answer you.  Make it.  You don’t take no for an answer.  You keep building that narrative until the answer comes around.  That’s the low road out of hell."

Okay, the low road out of hell: Maybe. It's not the first time someone's thought that telling their story -- just getting the words down on paper -- would have curative powers.  Read another Marine captain, Nate Fick's, essay for Powells, the great used book store in Portland, Oregon, about why he wrote "One Bullet Away: The Making of a Marine Officer."  See other veterans from other eras -- for example Claude Anshin Thomas, who wrote At Hell's Gate: a Soldier's Journey from War to Peace -- as they grapple with the narrative, to pull themselves to safety -- or sanity.  See and feel the way they fight for it, with every breath, with every word on the page. The same goes for the veterans who are the authors and the poets in Maxine Hong Kingston's anthology, Veterans of War, Veterans of Peace. Many,  many people feel...that this way lies redemption.

Or does it?

A little over a year ago, I was "gifted" with a narrative worthy of a Charles Dickens, if Charles Dickens had been to war.  Forty years the combat veteran had spent, trying to crack his own case (of severe, combat-induced PTSD), trying to get it all down on paper.  To make sense of it for himself, to make sense of it for his family.  And 40 years is not an insignificant amount of time.  He followed the narrative, all right; he clung to it like a rope.  But you know what?  All it did is lead him to the precipice of healing.  It wasn't even the precipice itself. What it did do was, in a way, detail the exhausting of his options, and get him in touch with the many things he'd tried -- including, in his case, religion -- so that he could he could continue the search, this time going even deeper.

Ironically, and we had several conversations about this -- he never finished the narrative, even after 40 years.  He didn't finish it, and he couldn't finish it -- we eventually agreed because it was his LIFE, and there was no real need to sum that up as though it was already over, because it wasn't.  It, and he, were still very much "a work in progress." And there weren't any simple answers, that would put everything into perspective.  Not for the combat veteran, not for his family either.  It was a pretty good narrative of what he endured, and the sense he was able to make of it.  But it was not in any way curative, though getting it down on paper was powerful, and compelling, and both moved his readers -- and himself.  It moved his readers (including his family) towards empathy, or a better, deeper understanding of what he'd gone through.  And it moved himself to continue going after the true prize, which was healing -- not just setting down what he had experienced.  IF writing were truly curative, we'd see more mentally unbalanced, yet otherwise fabulous authors experience "the cure."  (And one has only to think of the great Virginia Woolf, her pockets loaded with rocks, headed into the water to drown herself, to reflect on the apparent wisdom encoded in that statement.) What writing is, or can be, is deeply cathartic.  What it isn't, is the actual "cure."

When the Darkness Has Fallen...Just Me, in the Wake of Battle

I've been reading Tyler Boudreau's "Packing Inferno: the Unmaking of a Marine."  Probably a wise choice, in light of the news recently about combat stress and how servicemembers do and don't tolerate it.  I was drawn to reading Boudreau's book because I'd read several of his essays recently, and pretty much felt like they didn't go far enough -- and I was trying to understand the backstory.  His backstory, that is.  And how better to do that, than to actually read his book.  Boudreau comes across well, as he earnestly attempts to untangle the ordeal of his experience, both serving and (more to our point), coming home.  Within the first ten pages of the book, he's already described his PTSD, and it's a nice, succinct, almost poetic expression, which will help others who don't quite understand it yet.  Here it is, in Boudreau's own words:

"I’m hemmed into the night.  My brain has come to prefer the darkness.  I can’t say with any certainty if this is a product of never sleeping – that is, if it’s just a bad habit I’ve got to break – or if there’s something else going on, like the systematic avoidance of those bloody dreams.  I told the doc I wasn’t sleeping when I got home, and he glanced (up) casually from his desk and said, “That’s normal.  It’ll pass.”

Normal, he said.  When I told him I was just about jumping out of my skin every time I heard a loud noise, he said that was normal, too.  Normal, as in commonplace, as opposed to, say, pathological, like it would have been abnormal not to jump out of my skin.  It’s what they expected from me.  They figured I was in good working order, I guess.

Then they blew off my rage with the same line. “Everybody’s got that,” they said.  I wonder if they’d call me normal now, with all that I’ve got to say.  Three years later, my heart was still pounding, I was still raging, and I still wasn’t sleeping.  I was up, thinking about the war.  I finally told myself it’s like a bad back or a trick knee; you just learn to live with it and you walk. on.  So as I’m walking on, night after night when the darkness has fallen, and the rest of the world is silent, I go looking for my narrative."

(The narrative is something we've talked about earlier, here, and in Boudreau's case, we'll also talk about again -- but later, in another post.)  Suffice it to say, he finishes the foregoing description with a very potent, and poignant, explanation of who he is right now:

"The Marine Corps made a schizophrenic out of me, figuratively speaking.  I used to have only one voice, one point of view.  All right, so I’ve got a new perspective now. It happens.  But it’s not like I changed my mind.  My mind changed.  It split, two, three, and four ways over.  Now there are voices coming at me from all sides.  There’s no coherence to them, and no clear distinction either.  There’s the angry voice, and there’s the broken-hearted one.  There is the tender me and the savage.  And of course, there is the Marine.  There will always be the Marine, standing tall inside me, speaking smartly about values and patriotism.  There there’s all the rest of me, the part of me that was left over when I left the Corps.  He has no name, no identity, or credentials, or skills.  He has no title or rank.  He has no cause.  He is just me in the wake of battle."

With these words, both simple and profound, Boudreau expresses many, many combat veterans' experiences, that they will often spend decades trying to come to terms with, often failing, sometimes succeeding, and sometimes also killing themselves, in a forlorn attempt to, ultimately, attempt to bring resolution to that exact conflict.  Not the external one, in which they were involved as a warrior; but the internal one, with the battle that continues to rage, that they often feel they cannot escape.  Good for Boudreau for putting words to his experience, so that others -- veterans and the public at large -- can relate.

Editor's note: Boudreau's book, "Packing Inferno: the Unmaking of a Marine," is linked here.

Combat Veterans, PTSD and Acupuncture

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

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

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

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

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

"I Have PTSD," But "I Am Not PTSD"

This conversation goes back a while ago with a combat veteran of the Vietnam era, who has been trying various therapeutic methods for addressing his decades-long case of severe PTSD, and finding, by degrees, some actual and substantial relief.

Over the past few months, as his situation has greatly improved, aspects of his PSTD have fallen away, symptom-by-symptom.  But lest this lead you to believe that such progress, or success, is all "positive" -- the reality is, it doesn't always feel that way to the veteran, who has become habituated to seeing the world through the context of their having PTSD.  PTSD, of course, affects virtually every important aspect of their lives: from how social they are, to relations with their family, to how they can hold a job, how much pain they are in on a daily basis, how much stress they can manage, and how many medications (with their attendant side-effects) they take.  Psychological symptoms, physical symptoms, even "social" symptoms: they're all there.

And after a lifetime of identifying yourself as a "crazy, f*cked-up Vietnam vet," f'r instance, if that "identity" should start to fall away -- as you progress towards actual health and wholeness...mmmmnn, what do you replace it with?  Because there needs to be something.  Having relied on one identity for years (even decades) to manage life, and keep others at bay, suddenly that "crutch" or that "coping system" is no longer there.  And with all the other problematic pieces stripped away, piece by piece, what's actually left is a raw, brand new...baby. At least in terms of trying to cope with who you are in the world.  Amazing stuff.  And as great as it might be to get some symptom relief, and some ultra-positive life changes, at the same time...fear comes into play.  Who will I be without this shell I've learned to rest upon for so long?

Even the Bible talks about, in a slightly different context, how if you're going to sweep a place clean and remove all the demons, you have to immediately replace the empty space with something good, lest more demons come by (boy, the Bible is awful cheery; I'd forgotten...) and, finding the place vacant, immediately seek to fill it up with something "ten times worse" than what had been removed.  Mmmm. Lovely.  But the principle is a worthy one: If you're been relying on one thing, for a long, long time -- and you suddenly remove it -- you'd better find a way to be comfortable with the new self, because it's what's you have from here on out.

Having been privy to these struggles with one veteran as he walks his path, it's been surprising to me to see how "upsetting" the concept of healing can be -- initially upsetting, that is.  There's an old Tony Robbins line that human nature will do much more to avoid pain than they will to seek pleasure, and I think that comes in to play here, too. Change is painful; growth is painful; heck, even healing -- in that context only -- can be painful.  It's all new; it requires new skills; a new outlook; even new hope.  But ultimately, it's (obviously) the best way.  Most ironic of all is when the combat veteran, for example, has been the one to pursue the healing so radically -- and then when it starts to happen, in shock, he draws back, startled, as if realizing, ahhh, this is going to be my new life: how strange. I wonder if I recognize me in this at all.

Of course, over time, the progress coming in waves, as more methods are tried and proven useful, the experience gets better, and the veteran gets to be more at peace in his own skin.  Symptoms with which he has lived for decades start to abate, and be replaced by ... peace... and better experiences with himself, his family and loved ones. Overall, though the process is bumpy, the progress is sure.  There's no turning back: the combat veteran continues to WANT his healing, and his healing is happening.

And suddenly, the revelation, at least in his mind: "I have PTSD," he declares, decades into the fight, "but I am NOT PTSD."  Previously, of course, the unspoken assumption was that there was no distinction.  PTSD so consumed his life than in fact he WAS PTSD.  Now, he can say that he has it -- increasingly, even better, that he HAD it -- but that it is not him.  Wow.

Students' Documentary on Veterans: "It's a Privilege to Hear Their Stories"

The Boston Globe has a GREAT front page story today called "Battling a Different Kind of War," by Peter Schworm. The subhead gives you a clue to the content: "military college students document the struggles veterans face when they return." The students in question are from Norwich University, in Northfield, Vermont, and the documentary, done entirely by students, talks to Iraq and Afghanistan veterans about their readjustment issues on returning home.  As such, it's both a truthful and a cautionary tale, for those on both sides of the camera.  Great job!

Let's hope the documentary soon will be available for viewing publicly, to further enhance all of our understanding of what combat veterans go through when they willingly go to war, and return -- hoping, but maybe not always able, to pick up their lives "right where they left off." Because the students involved are at a military college -- and some of them have already served their country -- they're probably a little more sensitive to some of the issues involved, and presenting a less-biased approach than those who are necessarily "for" or "against" military service.  From the sounds of the Globe article, everyone involved seemed pretty aware and respectful of the price that veterans pay to serve their country. (The quote in the title above was said by one of the filmmakers in the story...)

Editor's note: The Boston Globe article is linked here.

The Poetry of War: This Time, from Afghanistan

The BBC has an article today called "Afghan Poets Tackle Scars of War," linked here.

The article writes, regarding the effect the war has had on the national literature:

"This theme of violence is playing out in other genres in ...[Afghanistan], such as short stories. But it is more visible in poetry.

"It is not the poets' choice to write about war and violence, they are compelled to do so - to express their reaction and hatred to bloodshed," says Darwesh Durrani, a popular [Afghan] poet and professor of literature in Quetta."

Additionally, 

"Poets are inspired by what is happening in the outside world. Their imagination absorbs it," says veteran [Afghan] poet in Peshawar, Rahmat Shah Sael.

"That is why [Afghan] poets are writing about violence in one way or another."

One of the poems in the article is evocative of the violence and grief Afghans are experiencing.  The lines are from Zarlasht Hafeez, "a female Pashto poet who has published a collection called 'Waiting for Peace'." Her lines read:

"The sorrow and grief, these black evenings,

Eyes full of tears and times full of sadness,

These burnt hearts, the killing of youths,

These unfulfilled expectations and unmet hopes of brides,

With a hatred for war, I call time and again,

I wait for peace for the grief-stricken [Afghans]."

It's unclear whether Afghan poets are publishing books of their poetry or reading individual poems aloud, according to local tradition.  However, the feelings about war, grief and loss that they're expressing through poetry are an essential communal reaction, and will take their place alongside similar expressions from others who have experienced the pain of war.  The right hand "sidebar" of this website includes a number of books of poetry, from this war and previous ones -- whether individual books of poetry, or anthologies of war poetry. For an index of material we've written on this blog about combat and poetry, click here.

Editor's note: The photograph, of an elderly man surrounded by villagers and Aghan National Army soldiers during search operation in rural Afghanistan, 2007, is by noted humanitarian photographer Zoriah.  Used with permission.  For more of Zoriah's work, click here. 

"The Hard Part Comes Later" - about PTSD, Grief and Letting Go

The Associated Press had a story on its wire tonight, called "Stream of horrific crimes takes toll on town cops," about the child murder in Tracy, CA. For our purposes, we're going to excerpt just a few lines from the story.  Because while we've talked before about the similarities in how police officers and combat veterans develop PTSD, here too is another similarity: how focus on the mission is paramount, and afterwards -- the grief sets in.

From the story:

"Police were especially stressed by the disappearance and murder last month
of 8-year-old Sandra Cantu. The department's sworn officers and staff pulled
2,966 hours of overtime on that case alone.

And tougher than the intense work is the lull that follows, when the mask of
professional composure comes down and doubts, sadness and anger come
through, said Tracy police chaplain Dan Higgins.

"When they're able to focus on their jobs and do their part, they have an
outlet," Higgins said. "The hard part comes later."

In other words, personal grief and coping with the horrors of the work (be it combat or in this case, police work) can be set aside effectively, sometimes, mostly, to get the job done.  The grief gets sublimated to or displaced by the job.  And that's effective -- as a coping mechanism -- only so long as it lasts.  Afterwards, when it's removed, the full feeling of the grief and the loss starts to creep back in, to the vacuum that's been created.

Again, from the story:

Detective Nate Cogburn worked 200 hours in two weeks in the search for Sandra and then for
her killer, the article said, adding:

"This meant little sleep, no breaks, a canceled second wedding
anniversary weekend in Napa with his cancer-stricken wife and less time with
his 10-year-old stepson.

[Even though police now have a suspect,] Cogburn remains haunted by the case.

"I feel nothing in terms of a sense of relief or solace. I feel nothing but
devastation. Nothing," he said. "It is a good thing that we've identified a
suspect ‹ a good thing for the investigation, for the D.A.'s office, for
being able to close this case, hopefully for the family. But emotionally
it's a vacuum."

Earlier I've written on this blog about a WWII combat veteran who only "noticed" his PTSD in his 80s, when he was finally retired. In other words, when work was no longer front and center in his life, and in the vacuum that removing his prior, sustaining focus on work created, the nightmares and the cold sweats from combat flooded back in.  Decades after his actual service.  This story was told to me by the local veterans service officer, who helped the man to realize that what he might be struggling with was PTSD, and to get some help.

We all know about how combat veterans can seek to numb their pain, whether successfully or unsuccessfully, and perhaps only for a time, with drugs and/or alcohol. We need to also realize how workaholism, Type A behavior, and focus on the job -- even though warranted -- can also be a way to "keep the demons at bay."  Unfortunately, when the focus changes, as it often will, in time, the vacuum that's been created when the main focus gets removed, can also exert a powerfully destructive pull on the individual.  Drugs, alcohol and work -- we can use them all as ways to keep PTSD at bay, however temporarily.  But ultimately, none will be completely successful, or produce thorough, functional results.  Always better to deal with the issues involved, however painful, and however incrementally we might need to do so.

With PTSD, Naming It Turns Out to Not Even Be Half the Battle...

From a friend and Gulf War vet's blog. I'm glad he finally wrote about this (his own PTSD diagnosis):

"I thought with finally learning what I had, or what was wrong with me (PTSD), it would be more helpful than it actually was.In the back of my mind I believed I was literally crazy until I learned about my malady. I had the thought that by knowing what was "wrong" with me, that in someway I would get better. I assumed this knowledge would somehow cause a shift in my thinking. I had expectations of my enlightenment to be more profound than it was; but nothing changed except that I now knew more than I did before. My mind at this time could not fathom that I had become a member of the walking wounded.

When I had the realization of my condition, that a name could be assigned, I felt an immense relief. But then it hit me that nothing had changed at all! I expected this awareness would have a greater impact than it did.What I did find in this new perception, a deep profoundness and discernment which had escaped me before,I finally found myself to be no longer alone."

His warranted conclusion?

"It hit me just recently that information can lead to knowledge but without necessarily leading to wisdom."

Editor's note: Scott Lee's background, in his own words:

"I am a Army veteran of the first Gulf War, I was a driver of a Bradley Fighting Vehicle. My unit fought the Iraqi Republican Guard in three campaigns and my vehicle was point for the brigade. I drove for 172 hours straight, engaged in 100 hours of sustained combat and witnessed literally thousands of enemy combatants die in that short span of time. Since being honorably discharged from the service of my country I have struggled with PTSD, depression, substance use disorder, homelessness, social and health issues. It took me 7 tries and 15 years to go through the VA bureaucracy to get the help that I needed. Nothing has been given to me that I have not fought for with my life, either in the Gulf War or with the VA. I gave freely of my time and service, the same was not done for me."

For a link to Scott Lee's excellent blog, PTSD: A Soldier's Perspective, click here.

Who -- and What -- a Survivor Is

Quotable quotes:

"I define a survivor as one who has touched, witnessed, encountered or been immersed in death in a literal or symbolic way and has himself remained alive." -- Robert Jay Lifton.

LIfton, an American psychiatrist and pioneer in PTSD studies from the 1970s, is also the author of "Home from the War: Learning from Vietnam Veterans."

(Hat tip to Chris Lombardi, for pointing this one out.)

A Look in "The Mirror" -- Great Britain Seeing War Trauma Now in 3 Years, Not 13 As Before

Because Americans are notorious for paying little attention to things that happen elsewhere, even among other English language-speaking countries, here's some news from Great Britain's tabloid-esque "The Sunday Mirror" today about their soldiers' battles with PTSD on the homefront -- soldiers who served in Iraq and Afghanistan.  For the link to the article, called "War's Silent Victims," by Rupert Hamer, click here. (The tabloid nature of the newspaper explains the fairly breathless writing style, but let's hope the facts and the reporting are accurate nonetheless.)

Points worth mentioning from the article include:

"Alarmingly, the charity [Combat Stress, see below] say[s] the figures are just the "tip of the iceberg" and add that the rate at which soldiers are developing the condition has accelerated. Usually it takes 13 years for cases of post-traumatic stress disorder to develop in veterans.

But psychiatrists at Combat Stress's pioneering centre say the men and women now being treated have come forward after just THREE years.

Also:

Dr Walter Busuttil, a consultant psychiatrist at Combat Stress, said: "What we are seeing now is just the tip of the iceberg.

"Because there has been no proper study of post-traumatic stress disorder among troops in this country we have no idea of the true scale of the problem.

"The same thing happened in the US after Vietnam. The Government tried to dismiss the disorder as a myth - then the whole thing exploded. Now when I speak to my colleagues in America they tell me: 'You are going through your Vietnam'."

And finally:

Dr Busuttil, 49, a psychiatrist in the RAF for 16 years, says the Government has covered up the severity of the conflicts from the public.

"The worst thing for a serviceman or woman is to come back from a war and for people not to have any idea what they have been through.

Editor's note: For a link to Great Britain's charity, Combat Stress, click here.  To find them on Facebook, click here. We've written about them before on this blog, but according to their website, "Combat Stress is the leading charity specialising in the care of British Veterans who have been profoundly traumatised by harrowing experiences during their Service career and who are suffering from poor mental health as a result."

A Combat Veteran Asks Himself, Who Am I, on the Inside?

The combat veteran, one with decades of severe PTSD, asks himself that question, and the answer that comes back isn't pretty.  "What's your biggest problem right now?" he was asked, and then handed some implements with which to draw his answer.  Describe what you've drawn, he was asked.  "My biggest problem?" he said, "It's that I'm 'an exploding ball of hate'...on the inside." (Comment and drawing, used with permission.)

Now, on the one hand, this doesn't tend to give you a lot of hope.  Forty years out, still thinking about life this way.  Ugh.  That's intense.  And so, so very tragic.

On the other hand, the story has a "happier" ending -- or at least, progress report.  The same person who said that is doing much better now (and has the drawings to prove it.)

But I was reminded of this story again today when I read of the terrible story of Marcus Luttrell, the former Navy SEAL, awarded a Navy Cross for his heroism, whose entire team was wiped out in a horrendous firefight in Afghanistan, and who suffered greatly because of that experience.  (Luttrell is also the author of "Lone Survivor," about that experience.) This past week, his lovely yellow Labrador retriever therapy dog -- who he named DASY, after a combination of the initials of his SEAL team buddies who were killed and himself,  who, parenthetically, says he also died on that mountain, with his team that day -- was shot in cold blood outside his house, apparently in a pointless thrill-killing by some heartless local punks.

From articles about the incident in the Houston Chronicle and on MSNBC, which described the 40 mile high-speed chase an injured (he was recently hospitalized) Luttrell went on to capture the perpetrators, assisted by the police:

"I did everything right; I didn’t do anything wrong," (Luttrell) said. "Make sure everyone knows they cold-bloodily murdered."

In other words, he was heavily provoked. (It's remarkable the self-control he exercised, just helping to capture, but not kill, the jerks who shot and killed his beloved therapy dog.)

The saddest part for me, after reading and hearing about this story, were these poignant lines from Luttrell, after the incident, no doubt disillusioned, despondent, as well as totally triggered.  Reportage said that Luttrell "said he had left his Huntsville home and [like Vietnam veterans before him, who took themselves out into the woods rather than deal with society that was hard for them to navigate anymore] was in "the middle of nowhere," adding that Dasy's killing -- of course! -- was a "huge setback" in his life. (A huge and completely unfair setback, too...cruel beyond cruel, and so completely pointless.)

Here are the heartbreaking lines of Luttrell's, as he's trying to come to terms with what just happened, not that he had any fault in the matter:

"I was trying to talk myself out of being who I am," he told the Chronicle. "Talking to myself about not doing the one thing I am good at."

Those are the words that should stick with people on this, who care about the topic of healing combat trauma, that is.  War -- and even training for war -- breaks people down and builds them back up in the mode of the warrior, in which they have a new, and very authentic skill set -- but one which they won't find much use for in civilian life, or are basically constrained by society from using.  Nobody wants to talk about it much, but the ability to kill, and the confidence and esteem that gets created by being "good at what you do," even if it's very much relegated to the combat experience, is a very hard thing to shake afterwards.

I can come back later and supplement this with references, but read the literature, watch the interviews with people who have combat-based PTSD.  There's a very uncomfortable relationship with killing: it's a high that's hard to deny, but also hard to live with, about yourself (no pun intended).  And that dilemma is at the basis of the combat veteran's, above, remark about what his biggest problem is: being "an exploding ball of hate," on the inside. 

It's very hard to get a grip on that, particularly when killing has become a significant skill set, and very hard to unwind from.  In many cases, veterans covertly mention, mostly to one another, it's become an addiction of its own.  Perhaps just the feeling of being amped up and in command of the situation, not necessarily the killing part, but whatever: it's a way they say they felt truly alive for the moment, and hard to replace in civilian life, which operates according to completely different rules, and is often ridiculously boring and unfair, by comparison.

No judgment intended: far from it.  It's the reality of the situation.  And it's part of why, as much as the military concentrates on breaking someone down to become the perfect warrior, there needs to be an equal and opposite side of the coin -- how to help someone reintegrate, so they can keep their skills, but become a whole person again who, most importantly, can look at himself or herself with appreciation and respect, for every aspect of their personalities.

Editor's note: For a video of Marcus Luttrell being interviewed by Matt Lauer, several years ago, about his book and the incident fighting the Taliban that inspired it, click here.

(Also, the second drawing, above, is done by the same combat vet mentioned in the first illustration, but it's not the one that shows improvement. It's another from the same day, where he answers the question about drawing himself "as I am now" -- in other words, with two very distinct sides to himself, darkness and light.

Reality Check: Every Warrior Affects 50 Other People Around Him or Her

I was privileged to get to go to the Roxie Theater in San Francisco yesterday and see the world premiere and kickoff of the national tour for "Broken Promise," part of the "In Their Boots" documentary film series that focuses on veterans issues.

The Northern California location was appropriate, because the "Broken Promise" segment focuses on the Pathway Home, at the California Veterans Home in Yountville, and follows the lives of three Iraq War veterans who are residents there, part of an innovative treatment program for PTSD, run by longtime veterans advocate, Fred Gusman, M.S.W.

The documentary is interesting -- I'm still mulling over what I think about it -- and it was neat both having gone to the Pathway Home before to visit with some of the residents, and then seeing some of them there at the screening (including one whose story was featured in the film).  However, the best part of the movie for me was this particular quote of Gusman's, which drives home the importance of both seeing -- and treating -- vets with PTSD in community.

Said Gusman, 

"For every one person that's affected (by PTSD), there's generally 50 others attached to them, when you start looking at family members, employers, educational systems -- all the different folks who are affected by just one warrior."

While Gusman (in the film) goes on to make the argument for including vets' families in the treatment of the vets, the point here is a separate one.  That a single vet who's suffering -- or for that matter, overcoming -- is not a single vet.  He or she is the center of a number of concentric circles of effect that ripple outwards, affecting many others.  All the more reason to not neglect, or ignore, or put aside the struggles of veterans with PTSD.  Each one has 50 people he or she is affecting -- by his or her failures, and, over time, by his or her successes as well.  They're not just individual struggles: they're the center of a social web in which many others play a part, either directly or indirectly (by compassion and concern, for example, or neglect and indifference).

Editor's note: For more on the "In Their Boots" documentary film series, click here.  For more on Fred Gusman, M.S.W., click here.  For more on his work as Executive Director of the Pathway Home, click here.  For more on the Pathway Home residential treatment center for combat veterans with PTSD, click here.

The Ongoing Struggle for Combat Veterans

"I know I have to deal with it (PTSD): Because I'm either going to destroy it...or it's going to destroy me." -- Vietnam combat veteran.

Combat Veterans Behind Their Personal Walls -- "It Would Be Weird for Me to Say I Was Happy..."

There are probably better ways to title this post but the point is to connect with veterans WHO do feel this things, and who have SAID these very things, to themselves or to others. 

The word "compassion," as we've talked about before on here, is from the Latin, meaning "to suffer with" (another).  Here's a full definition: "Deep awareness of the suffering of another coupled with the wish to relieve it."

You can't, or shouldn't, get to know much about combat veterans without developing some of this. And you might need to, because -- while they hold this for each other -- they often distinctly DON'T have it for themselves.  "Why did I deserve to live when others died?" "I don't deserve to be happy." "I should go back..." All these phrases, and thoughts, are common among combat veterans with PTSD.

As we've talked about before here, the goal is going to be...find some way to achieve catharsis with these feelings.  Don't invalidate them ... they're real, they're true, and they DESERVE to be there.  They're a very "natural" reaction to a very abnormal situation (combat).  But what also needs to happen, while acknowledging these feelings, is somehow to bleed the toxins out, to be at peace, or reconciled, or achieve some "normalcy" with these powerful emotions, but without letting them control your life, or dictate your decisions.  That's a pretty tall order, it would seem, depending on how badly things are going, on a given day: but let's hold that hope out there, it's still real.

As one hardened combat vet told me the other day, there really is a severe dichotomy -- the academic world would call it -- or a "split" -- the rest of the world would call it -- in the mind and behavior of a vet with PTSD.  On the one hand, he (or she), deeply wants to believe they can overcome, and see a brighter day -- somehow be reconnected to the self they dimly remember, but have functionally lost (and who they mourn, as beyond being able to be accessed anymore, except in memory).  At the same time, breaking away from who they've become with PTSD can be exceptionally hard. Not necessarily by anyone's ever wishing it to be so, the shell, or the mask, of PTSD has started to feel like a part of who they are.  It's both "not me" and "me."  Or maybe, a very undesirable outcome, who has nevertheless become me, without wanting this to happen.  And it can be very, very hard to contemplate breaking away from this person you've become...because the shell has somehow gotten comfortable.  Or manages to keep people away -- or the demons at bay -- or whatever it is.  There is some payoff here, as grotesque as the experience can be. And considering breaking free of this, and leaving this mask or this shell behind, as no longer serving you?  Tough, very tough.  Because it's become familiar...and in familiarity, there is a certain amount of safety.

Odd that there would be such a struggle here, but it's true.  "I want to get well..." or "I want to get better" -- and "I desperately want to believe that I can" -- versus, "I wonder what the world is like beyond this wall I've erected..." "I wonder if I can handle it..." "I wonder if I'm safer not even trying."

Heavy questions.  Very hard, very difficult, very real.  But even when you're struggling with this, you're still acknowledging that there is some tiny shred of belief here that things can get better.  On some level, find a way to give yourself credit for that.  And keep the hope, however miniscule, unlikely, or fakey it seems, alive.  Because it just might be the eternal flame (old reference to JFK's grave...look it up) that never goes out...and ends up lighting the way to something that DOES help you.  Let's hope.