Healing Combat Trauma

Deep Survival -- Turns Out, It Can Be Due to "What's In Your Heart"

I read the most interesting book lately, having nothing to do with combat trauma and PTSD, yet everything to do with human beings' abilities to fight tenaciously for their own survival, and outmaneuver both death and chance, occasionally.  The book's title says it all: "Deep Survival: Who Lives, Who Dies, and Why" -- and it's by a risk junkie author who is himself the son of a genuine WWII battle hero, who survived some spectacular near-death experiences (including a fall 27,000 feet out of an airplane he was piloting, only to land in a German field and have a farmer nearby then try to shoot him to death, until that guy's gun misfired.  Unbelievable...). 

The book is riveting -- it follows the stories of well-prepared experts who perish needlessly, while under-prepared or un-prepared neophytes sometimes make it out alive -- and the author takes a look at recent brain research as well as in-depth accident reports to draw his conclusions about why sometimes the most unlikely types beat the odds and survive. 

The author's conclusion at the end of the prologue, introducing the rest of the book, is that often it's an unseen factor that accounts for who inexplicably beats the odds.  His book isn't at all about combat trauma or PTSD, of course, but I'm going to offer up what he says anyway, because I think (in a different, yet related context) it might give some people hope, who are struggling mightily with circumstances seemingly far beyond their control.  The message remains that there is still hope for them, too.  In the words of the author:

"It's easy to imagine that ... survival would involve equipment, training and experience. It turns out that, at the moment of truth, those might be good things to have but they aren't decisive. Those of us who go into the wilderness or seek our thrills in contact with the forces of nature soon learn, in fact, that experience, training and modern equipment can betray you. The maddening thing for someone with a Western scientific turn of mind is that it's not what's in your pack that separates the quick from the dead.  It's not even what's in your mind.  Corny as it sounds, it's what's in your heart." -- Deep Survival: Who Lives, Who Dies, and Why, by Laurence Gonzales.

We've talked about hope recently; and the reality is, sometimes you just know you're going to get better, even when it feels like no one else believes in you, or the evidence seems to point completely to the contrary.  Sometimes you just know, and it's only a question of time before that comes true. Here's "hope"-ing that many, many veterans survive and thrive, despite combat trauma and PTSD, even when initially it seems like there might be little realistic "hope" for doing so, whether the struggle has gone on for months...or decades. 

This blog isn't about me, in the slightest, but I do have a story to tell that somewhat relates.  Years ago, when I had chronic fatigue syndrome -- which at the time, as now, no one really understood well or unfortunately recovers from -- I went through a "state of the art" multidisciplinary program for treating chronic fatigue, covered by insurance.  Hmmmn.  No one really got better through that program either -- some people, including me, actually got sicker from reactions to the medications, etc. -- but, there was one odd moment in the program that stuck with me afterwards.  As part of what we had to do, we had sessions in biofeedback and hypnosis, among other things.  The psychologist who led those sessions was someone who at one point had been the team psychologist for a very competitive sports team.  After one hypnosis session, he came up to me, out of the blue, put his hand on my shoulder, and just said, warmly -- to me, and not to anyone else -- "I just know you're going to beat this..." -- and I thought to myself, how on earth does he "know" that?  I'm totally sick as a dog here.  So I put that moment completely out of my mind.  A few years later, when I WAS fully recovered, a complete rarity, it's sad to say -- almost all the people who were sick when I became sick still are, if not quite a bit worse -- years later -- suddenly that memory came back.  And someone he must have been able to tap into what was inside me, which definitely was a fighter, after all. Hmmmn. Even I didn't know that at the time, but he was able to figure that out.  Cool moment, even after the fact.

It's great to see when spouses and family members fight and never give up, for injured veterans they love (with TBI, for example, or amputation injuries from IEDs).  There are some spectacular stories out there of love, support, courage and tenacity.  But not everyone has people who can pull for them; and sometimes, veterans with PTSD have actually worn the most likely candidates out.  Even so, it may be possible for them to get better, "against all odds" -- because, who knows, it may turn out to be like the stories of survival from the book.  It may come down to something ineffable that never gives up, even when circumstances appear to be completely against you. Something like...what's already in your heart. 

One, Two, Now Three Military Generals Discuss Their PTSD Candidly

Here's something you don't see every day -- military generals sharing openly about their struggles with PTSD. 

CNN has a very brief story on their website today about two generals doing just that -- and if nothing else, the generals' refreshing candor should raise the profile of healing combat trauma and PTSD just because of who they are.  Says Brig. Gen. Gary S. Patton, tellingly, "We need all our soldiers and leaders to approach mental health like we do physical health. No one would ever question or ever even hesitate in seeking a physician to take care of their broken limb or gunshot wound, or shrapnel or something of that order. You know, we need to take the same approach towards mental health." Absolutely. This should be very helpful towards combating the stigma that exists about admitting there's a problem, or countering the somewhat prevalent "blame the victim" notion that servicemembers who do struggle with PTSD were somehow already "broken" -- previously unfit,or otherwise "less than" other combat veterans because they suffered in this manner.  Hmmmn.

In November of 2008, we discussed another Army general, this time Major General David Blackledge, coming forward and talking about his own experience with PTSD.  At the time, it seemed like possibly a one-off, once in a lifetime experience.  (That blog post, entitled "Army General and PTSD -- the Courage to Admit All is Not Well," is linked here.) 

Now, with two more generals -- Brig. Gen. Gary Patton, and Gen. Carter Ham (pictured) -- coming forward and self-disclosing about their own experiences with PTSD, there's even more hope that PTSD can be seen as a genuine consequence of combat, and not an opportunity for continuing silence and shame.

For a link to the story on CNN, click here.

An Over-Reliance on Expecting Medication Alone to Fix What's Broken

I really should be packing for a conference, not figuring out more stuff to blog about, but I saw an item in today's Boston Globe that I just couldn't resist, because it speaks so closely to what we're talking about on this blog. A woman pediatrician wrote an OpEd piece, in part, about the insufficiency of the strictly pharmacological solution for healing a broken childhood. 

In our case, since we're talking about combat trauma, the target is different, but the concept is identical.  Read what she has to say, and then think of the ways this applies to healing combat trauma.  Far too many health care providers -- and even veterans and their families -- are putting their faith exclusively in a pharmaceutical solution.  It isn't a Tom Cruise point to say, that's not really going to do the whole job. 

As we've seen and heard from too many veterans, the trouble with pharmaceuticals alone are many and varied...from giving veterans a grab bag of ones to mix and match and medicate themselves (yikes)...to the dangers of over-medicating (numbing out, not feeling like themselves) and under-medicating (well, that hardly ever happens, but still...)  Anyway...here's the pediatrician's extended commentary.  Make the application to veterans suffering from combat trauma and you'll see what we mean:

On one recent day in my pediatric practice, I saw or spoke with parents of eight children who had experienced a range of significant trauma. One was in foster care after living on the streets with drug-abusing parents. Some had been adopted following severe abuse and neglect. One had recently lost a parent to death, one had been abandoned by a parent. They were failing in school, impulsive, distracted, angry, and depressed. They were receiving minimal to no mental health support.

What they all had in common was a diagnosis of attention deficit hyperactivity disorder. Each parent expected that I would either: refill the medication, change the medication, change the dose of medication, or have the medication given at a different time.

When I suggested that medication alone was not the solution, I ran into walls. One mother had tried to get an appointment with a child psychiatrist, but the only one in town who accepted her insurance wasn't taking any new patients. My attempts to refer families for therapy were thwarted by many things, including lack of time and clinicians who did not take their insurance. One parent was irate that I asked so many questions and didn't just refill the prescription. These parents were discouraged and angry, and by the end of the day, so was I.

Our society has bought into a belief that manipulating medications will fix these complex problems. Not only parents, but teachers, physicians, and certainly the health insurance and pharmaceutical industries join in promoting this expectation. With our overreliance on psychoactive medication, we have created another Ponzi scheme where, just as Bernard Madoff's investment fund was not really earning any money, we are fooling ourselves into thinking that we are helping these children in any significant way.

Interesting and poignant, on so many levels.  The expectation, impatience and frustration of the patients' families, that manipulating the patients' biochemistry was the only "solution" expected or desired; the practitioner's frustration that she couldn't refer effectively to other providers who might have helped; and the generalized problem with only seeing a headache as an Excedrin deficit, so to speak, rather than looking for the broader understanding of what's sometimes at work with a specific symptom.

Fortunately there are complementary and alternative medicine ("CAM") modalities, including mind-body medicine, that look for and deliver other solutions, often by taking a more "holistic" view of the problem itself.  Not as a symptom that exists in a vacuum, but one that is part of an overall gestalt of the person's total physiological, psychological, spiritual and emotional health.

There's a form of acupuncture that professes to treat "body, mind and spirit."  I once questioned a practitioner of this type about what percentage of ailments patients present with that she would ascribe to each.  Interestingly, her response was that MOST patients' symptoms, well over 90%, according to their practice's teachings, were actually spiritual in nature.   Hmmmn. Even if only 10% were, even if only 1% were, think how inadequate a purely pharmacological solution would be.

With something as complex as combat trauma, it's just another reminder -- this time from a superficially unrelated source -- to look beyond a single, too-simple, purely pharmaceutically-based solution, to something that captures the more complex, multifactorial experience of being human.

The Double-Edged Sword Called "HOPE"

"Got hope?" the Obama bumper sticker asked.  (Hey, we're non-partisan here, it's just an illustration to make a point.)

The reality is, hope turns out to be VITAL, not optional, in someone's struggle to "heal."  And "healing," of course, is not specifically an end-result, a "one and done" event -- but a progress along a continuum. 

Even the Bible talks about how, "without vision, the people perish."  Emily Dickinson, who it's easy to imagine as a profoundly depressed, but nevertheless highly imaginative New England poet, referred in one of her more famous poems to hope "as a thing with feathers."  Meaning, pretty airy, light-weight, and able to fly away.  Hard to trap and catch, hard to hang onto.  If you put the two concepts together, though, hope is both necessary AND hard to hard to hang onto.  No wonder it's so important.

Over the last few months, I've been watching as a hardened combat veteran, with severe PTSD, has stepped out of his comfort zone, and put his "hope" to the test: Hope that there was a life for him outside the realms of severe combat trauma.  It's been incredibly interesting and refreshing to see what's happened to him since.  And hope shows up at every turn.  Without going into it in much depth here -- there'll be another time and place for that -- I've been able to see his physiology as well as his psychology change, in just a few short months -- and I've seen the renewal of "hope" this has caused within him.  For one thing, hope to be considered more than just another "crazy, effed-up combat veteran" -- the mask he's apparently worn for society for years (decades, in his case).  Hope that he can have an actual life and happiness beyond what he had been reconciled to, by virtue of "throwing off" some of what's hindered him (the Biblical wording here is purely incidental.)

The deal about having a mask that you wear, as a combat vet, because it's what society expects of you -- and it's also what allows you to keep other people at bay -- is a very interesting concept in its own right.  It helps, but it also hinders. It frees, but it also constrains.  And suddenly, with better health, comes the realization that it may be time to consider laying that mask down, at least part-time.

Whoa.  Strangely...that turns out to be a tad problematic.

Because there is comfort to be found behind that mask, and safety, and worst of all -- familiarity.  We all struggle with, "better the devil you know...than the devil you don't know."  And even a self-imposed mask offers a modicum of comfort, though at great cost (what you miss out on, wearing it).

The combat veteran and I had a conversation the last few days that mirrors several others we've had over time, as he's received extremely positive -- surprisingly positive -- news from his medical providers.  The sum of it is, he seems to feel he had an easier time picturing he was going to fade out and die...than actually revive and live.  Strange, isn't it -- the rest of us just want to get well.  But to the combat vet with PTSD, sometimes there's a fair amount of comfort (from the familiarity) of knowing things are bad...and likely to stay the same or keep getting worse.

What I've seen with this very courageous individual, as I've watched him fight to take this new hill, called health, is how hard it's been to reconcile himself to having hope now for an actual future, unmarred substantially by the PTSD that's dogged him so much from the past.  Not that he'll ever be "over" it completely -- but getting quite a bit better, and healing both on the outside and on the inside?  On the one hand, priceless. On the other hand, definitely scary.  Stay tuned...this has been an incredibly interesting journey to watch, and it will continue to be.

Finding the Balance: Rock Hard Abs and Soft Belly Breathing

This is a long overdue post about the apparent contrast, to military types, about some of the necessary "mind-body medicine" concepts like "soft belly breathing" -- a useful, easy form of meditative calming. 

A few months ago I was privileged to take part in a week-long practitioner training for mind-body medicine, and military providers and the VA made up a large percentage of the participants.  Much of the work took place in small groups, and in our ten-person group, there were more than a few VA providers (from occupational therapists to psychologists and counselors), along with one combat veteran.  As the group learned and practiced various techniques for mind-body medicine -- which have proven benefits for reducing stress, lowering heart-rate, increasing endorphins, etc. -- the combat veteran described his initial discomfort with the practice.  "This is just a hard sell to us veterans," he said, sitting up straighter in his chair, "we've worked hard to strengthen our core, and get the rock-hard abs.  And now you're telling us to practice something called 'soft-belly breathing'?"  We do everything in our power to avoid the soft belly, seemed to be his point.  And yet...funny how mind-body stress management techniques are actually another, potent way to do just that: Strengthen our core.  By the end of the week-long session, the veteran had gone from feeling like he was there as an impartial observer, to see if "this stuff" would "work for his guys," to someone who was starting to get the implication of how it could help him, too, in his own life.

Somewhere in the Midwest right now, I just know there's one great combat veteran, finding his own balance between "rock hard abs" and "soft-belly breathing."  And beginning to show the way to so many others... 

Editor's note: Here's an example of James S. Gordon, M.D., founder of the Center for Mind-Body Medicine, leading you through "soft-belly breathing." It's incredible simple to do.  In three minutes of practice you've pretty much mastered it.  Enjoy :-)

From a Combat Veteran Himself: A Suggested Guide for PTSD Veteran Charged with a Crime

The other day, we published, with the author's permission, Scott Lee's thoughts as a combat veteran and student of social work, on dissociative PTSD, criminality and the combat veteran.  Today we publish, also with his permission, the guide he wrote for combat veterans and their familiies, when a combat veteran with PTSD has run afoul of the law.  Scott isn't a lawyer, so this isn't legal advice.  But it is wise, compassionate, fellow veteran and fellow PTSD sufferer type advice.  Keep it handy to refer to; it's really, really good.  You can also look through the archives here for things previously written about legal issues and combat trauma.  (See topics like "legal issues," "legal justice," and "crime and punishment.")  Fortunately, in the several years since we started this blog -- at which point there were literally none -- some resources have sprung up in the legal community for helping combat veterans with PTSD to get legal advice for their situations.  There's also a good video by the Norfolk County, Massachusetts' DA's office, which we've blogged about earlier, here, that gives a good overview of the challenges returning veterans face in their communities, including with law enforcement.

 

 

Suggested Guide to Help Your Veteran or Soldier Diagnosed with PTSD, and Charged with a Crime

To whom it may concern,

I would suggest that you start researching about PTSD right away. The mind-body connection and interactions, the psychology of PTSD, defensive mechanisms, how the mind responds to trauma, the symptoms of PTSD, how extended combat (such as multiple tours served) effects soldiers and veterans, legal ramifications of criminal behavior and PTSD, the processes of the psychic split from reality and past combat experiences, how anxiety plays an everyday part of our lives, how ordinary stress can lead to higher levels of stress and extreme responses and flashbacks, the nature of flashbacks, the nature of triggers and how they apply to PTSD, and the mental compartmentalization that happens to a PTSD survivor. This is by no means a comprehensive list, but should give you some kind of idea of where you might want to start.

 

Like it or not, this has consumed your life by no choice of your own, instead of letting that energy overwhelm you and feeling helpless, turn that energy into a useful endeavor and focus it toward finding out as much as possible about PTSD and the effects of combat. You have more passion about this subject than anyone, use this as an opportunity to help your loved one get a fair trial and to force the courts to consider his/her mental illness as a contributing factor in their actions.

 

Do not take no for an answer from his/her lawyer as to your wanting to get involved in your significant others case, jump into his/her pocket and become the "paralegal" and find them the information that needed for fair consideration of the case. Most lawyers will resist this from you, again do not take no for an answer. I am guessing that the lawyer will probably be a public defender; they are overloaded with cases and cannot really give the appropriate attention that their caseload needs. So, you need to assume that role of "defender" and information detective, this can greatly impact the outcome of the trial.

Consider trying to find a high profile lawyer who will take the case on pro bono; this type of case has become a hot topic in the news and media. A lawyer might take a case for this reason and could benefit the outcome. Go to the clerk’s office and get a copy of the court case file, this will help you by becoming familiar with the states perspective on the case and what exactly is being done. Educate yourself in Miranda rights (If they violated his rights here, this could have a considerable impact on the outcome), federal constitutional law concerning 1st, 4th (emphasis here), 5th, 6th and 8th amendments, along with state constitutional law. Educate yourself on how the court works, the proceedings, when and where evidence can be brought, the questioning of witnesses and how that process is different in every aspect of the trial.

Educate yourself on case law concerning PTSD and other mental illnesses where a consideration or precedent has been set, this can be used in your case and can greatly influence what happens. Look into your state laws first as they will have the most sway, because state law guides state cases first, then look to federal law to find precedents and findings where PTSD was considered in the sentencing phase. Concentrate on first on the main trial part where the evidence and witnesses will be displayed then on the sentencing. Both of these parts of the overall court proceedings will be the most important part, your soldier or veteran’s fate will be decided between these two proceedings.

 

Educate yourself on and things to do:  

• Do not talk with the police or anyone else until you have talked with your lawyer, what you say will be used against you

• learn your rights and assert them, you do not have any rights if you do not know your rights

• get a copy of court case file

• get a copy of VA file and military file

• jump in your lawyers pocket

• try to find a pro bono lawyer

• individual rights, Miranda and if they were violated

• legal proceedings, structure of court formalities and rules of law

• psychology of PTSD

• case law, state and federal, concentrating on the main trial and sentencing process

• constitutional law

• legal responsibilities of the judge, your lawyer and the prosecutor

• find a support group

• contact your senator, congressperson

• contact your local VFW, AMVETS, or veterans associations

 

I know that this seems like too much, just figure out what is coming next and then concentrate your efforts into that. Take one court proceeding at a time and concentrate on the legalities of that part of the process and use it as a guide to where you need to research and what you should do. The structure of the next proceedings will be your sign post for the direction you need to concentrate on. You can do this, if you accept that you have been put on this earth for this.

 

You were born to do this; this may be your purpose in life, to be the freedom fighter for all veterans and soldiers who will face similar tribulations. You have more vested in this than anyone else, you have more to lose, do not stand by and be a spectator. Get involved and later you will not have the guilt of "I wish I had done something". A most important issue to face would be finding a support group that you feel safe with and trust. You cannot do this alone, enlist the help of as many people that you can. Contact your congressperson, senator and your local VFW, AMVETS, DAV or American Legion. This is only a suggestion for what to do. I have compiled this list and information as a suggested guide for personal empowerment.

  

Thank you for listening and God bless,

 

Scott Lee

 

Editor's note: Scott Lee has an excellent blog, PTSD: A Soldier's Perspective, linked here, where he talks about his own experiences as a Gulf War combat veteran with PTSD, and his reflections as a student of social work, attempting to learn what he needs to learn, in order to help other combat veterans with their suffering.  Go, Scott!

One Veteran's View - Dissociative PTSD, Criminality and the Combat Veteran

You've heard of Bruce Lee -- warrior, philosopher, actor -- now hear about Scott Lee -- Gulf War combat veteran, social work student, blogger.  Scott writes an excellent blog, PTSD: A Soldier's Perspective, linked here, which has been a finalist for the MilBlog award (given to military bloggers). 

Of particular interest to us, though, is this paper he just completed for a class in social work law, about PTSD, criminality and veterans.  Scott's background as a veteran and a student gives him a unique perspective not shared by most, and what he writes could serve to open many people's eyes to the problems faced by returning combat veterans. 

Scott has kindly given us permission to reprint his paper in full on this blog, so we're going to do that in two parts, because of length.  First up, the section that follows; a subsequent post will include his guide for returning combat veterans and their loved ones, if the veteran has been charged with a crime.  Scott isn't giving legal advice here (nor are we); he's sensitizing us all to the problem at hand.

--- 

Scott Lee writes:

The following is a paper that I have completed for my Social Work Law class, parts of the paper I have been writing about in my blog. The paper ties together the evolution in my train of thought concerning the veteran or soldier consumed by the ravages of full blown PTSD.

 

The paper is long, but relevant to the plight of our returning combat soldiers and veterans. If you want to understand more about why a veteran or soldier runs afoul with law and society then you should read this.

  

VETERANS, DISSOCIATIVE PTSD AND CRIMINALITY

  

Scott A. Lee

Kent School of Social Work, University of Louisville

November 3, 2008

The Modern Combat Veteran:

Dissociative Posttraumatic Stress Disorder & Influences

on Criminality

Statistics

 

As of August 27, 2008, according to the Congressional Research Service (2008) 4,726 soldiers have lost their lives in combat and 32,977 troops were wounded in action, with 8,089 suffering from Traumatic Brain Injury (TBI). The USA Today (2008) reported that 68% of all soldiers have been deployed to a combat zone, 31% have been deployed more than once and 2,358 have had more than five tours of duty.

 

The United States Department of Justice (2004) reports that, “[t]he majority of veterans in State (54%) and Federal (64%) prison served during a wartime period….[that] Vietnam War-era veterans were the most common wartime veterans in both State (36%) and Federal (39%) prison.” The 57% majority of State prisoners were serving time for a violent crime compared to less than half of non-veterans who were serving less time for similar crimes. The report indicates the Iraq-Afghanistan era veterans comprise 4% of both prison populations (U. S. Department of Justice [USDJ], 2004).

 

Posttraumatic Stress Disorder (PTSD), Dissociation and Other Considerations

PTSD is a life-long endeavor; there is no cure for it. The triggering traumatic event changes the landscape of the mind, it no longer works in the same fashion that it did before. The mind has been rewired; the neuropathways have been altered into a continuous loop. The PTSD triggering incident converts the fight or flight response in the primitive portion of our brain. Imagine having that scared feeling you get without the fear while keeping the bodily reactions; the tenseness, the adrenalin rush, the mind racing, heightened senses, and the hyper response reflex to react without thinking.

 

The incident that solidifies the mental wound of PTSD results in a mind numbing, or psychic shift. In response to the trauma of combat, the person needs to make a mental detachment to do what needs to be done. The survival mode of operation forgoes the higher levels of functioning and depends on the primitive reactionary portion of the brain. When this unconscious detachment has been activated to frequently or for extended amounts of time it becomes part of conscious processing and interferes with everyday interactions (Lee, 2006; & Cerone, 2006). According to Howell (2005), dissociation refers to the separation of mental and experiential contents that would normally be connected.

 

The word dissociation is laden with multiple meanings and refers to many kinds of phenomena, processes, and conditions. Dissociation is both adaptive and maladaptive, both verb and noun, both cause and effect….Dissociation is often psychologically defensive, protecting against painful affects and memories, but can also be an organismic an automatic response to immediate danger….Dissociation can be understood as taxonic or, varying in degrees….It is both occurent and dispositional….It refers to such psychical events as spacing out, psychic numbing, and even experiencing oneself as floating above one’s body. Dissociation has been thought of in spatial metaphor, as acts of ‘keeping things apart’ as well as ‘vertical splitting’ (p. 18).

 

The mind can develop into split affective regions where multiple self-states dissociate incompatible values systems and set up residence along with establishing a unified substructure within matching internal guidance systems. The dissociated subsystems run parallel to other self-states and emerge when a particular skill set needs asserting pertaining to situational interactions. Here trauma based disorders may lead the symptomology to further entrenchment and compartmentalization that may lead to personality disorders. “A war veteran with PTSD might have more significant structural dissociation, involving the sequestration of more and larger portions of experience” (p. 22).

 

A defined preconditioned set of beliefs and values, the combat schema enables the warrior to navigate efficiently through the adversity of combat without a detailed consideration of consequences. I propose a unique set of beliefs, Combat Values Theory (CVT), based on the survival of self in relation to the context of war and the “combat-othering”, for we must wholly demonize our adversary and in the process dehumanize ourselves. The combat veterans primitive fight or flight defensive mechanism has been repressed through the training in the military, conditioning the troop to take up the fight portion leaving a proclivity for violence without a concern for personal safety. To engage in a mortal fight with the enemy this schema spells out the actions in a given situation without becoming preoccupied with survivability in the moment which could get a soldier killed.

 

The warrior with PTSD has grown accustomed to the value and belief systems of war and feels threatened when they become faced with having to let go of this security in an attempt to reintegrate back into society. Howell describes animal defensive and posttraumatic biological states,

 

The human animal may have a repertoire of discrete behavioral states that are adaptive to conditions of predation….[t]hese animal defense states may underlie different dissociative parts of the personality….[t]his begins a neurophysiological alarm reaction…[and]…a tendency to over read cues as threatening, which can increase the probability for violence (p. 29).

 

The ambiguity inherent in social dynamics can lead to mixed feelings or even a lack of feelings depending on the degree of interpersonal relatedness to the returning combat veteran (RCV). We rely on our parental figures to shape healthy personality and values structures through attachments with significant others, the attachments become avenues of exchange, a distillation of proper interactions and expectations according to society norms. When this exchange becomes distorted to the point of the child becoming a repository of negative energy, instead a healthy exchange solidifying proper boundaries, then the nature of our attachments may become warped and disorganized further compounding the RCV’s reintegration.

 

The combat attachments born of blood do not leave us because we depart the battlefield; they become an empty feeling inside of us. The soldier develops a highly narrow functioning self-organization in conjunction with his or her other squad members. This organization, "troop-organism," becomes an extension of the combat-self, no different than an arm or leg. We do not will our arms or legs to move, we react from the expectations of intentional imagery based upon the combat values structure. It happens, such as the members of the "squad-herd" where each part of the troop-organism and acts in a homogeneous way, each troop becoming part of the others self-states.

 

These attachments to the other require a splitting within the interpersonal self-states where many such dissociated selves birth into existence, as each of the value system constructs do not match and out of necessity, develops into a complete compartmentalized persona while maintaining the "whole" sub-self organizations. Each of the self-states run parallel to one another and have the capacity of switching back and forth when the proper situation requires appropriate specialized skill sets. The interpersonal self of the civilian self becomes supplanted and filed away by the combat self due to the incompatibility of the value structures for survivability that requires a conforming from a civilian society to the norms of the combat environment.

 

Attachments can be considered the path to rigidity or vehicles of spontaneity; to become spontaneous the person must develop a mechanism for the free exchange of intimacy through beneficial interpersonal skill sets. Without a healthy development of attachments then disorganized attachments (d-attachments) form. The d-attachments become the mechanism to gauge interactions in the environment and in doing so they become rigid, an if this then that experiential existence. The d-attachment arraignment only allows for what can be controlled under a series of contingencies plans, or procedural knowledge, usually modeled after our parental attachments, an identification with the aggressor or other such negative role model. Becoming an identity of an exclusionary “personal culture” where the individual becomes estranged from regular society and defending their boundaries as they were national borders between two hostile countries (Howell, 2005; & Lee, 2006).

 

The cycle of procedural enactments play out in significant others that we allow in our lives, the reason why we keep having the same dramatizations and arguments while never finding a resolution. We enact our past roles and project them into our relationships cast from our childhood in an attempt to resolve the attachments constructively. Since we have not been shown healthy attachment enactments we reside in the cycle of d-attachments and further compound our disorders through retraumatization and or neglect, predisposing the person to develop trauma based disorders and or personality disorders (Howell, 2005).

 

Without a reintegration of the self and of attachments and d-attachments, a combat veteran can and will run afoul of friends, family and society. The returning combat veteran faces hurdles that they have not been trained to handle, the training and experiences they have navigated and survived will lead them to think a civilian life will be easy compared to the battle life. What they fail to realize is that they have replaced their civilian self with an operational combat value system and attachments, where in American society the individual has the utmost consideration further combining and compounding issues of integration. Little concentration on developing healthy attachment systems the untenable situation can lead the RCV with severely dysfunctional interpersonal skills and a mechanism of perpetual isolation.

 

Indoctrination

Combat alters and modifies the value system, a preconditioned set of beliefs, entailing a value-orientated constitute of definitions of situation in terms of direction of solutions and action dilemmas, formulating a culture of killing, stripping the combat vet of the niceties that lubricate society’s interactions, which in combat would result in death. In combat the fluidity of boundaries becomes awash in the relational adaptation to an integral cohesion with their battle buddies, a devolution of survival mindset develops and provides a sense of safety; the germination of base natural selection process by successful integration of the combat value system. With a disproportionate 56% of Army veterans incarcerated, the Army culture seems to generate people more prone to violence (USDJ, 2004).

 

The war zone recons the birthing of the “trooper organism,” where the firing squad becomes integrated with one other with a culture of survival. The individual boundary of the soldier submerges within the organismal boundaries of the trooper organism while shedding the individual identity. The troop organism allows for the diffusion of immense responsibility over all involved making the transition to an evolution of survival more manageable wherein the herd mentality brings forth the primitive instinctual remnants and the decentralization of obligation. Military culture portrays the combat arms military occupational specialty (MOS) as having more cultural capital and esteem. The infantry MOS with combat decorations increases the rate of promotion, rank and respectability while non-combat soldiers tend to be overlooked (Lee, 2006; & Howell, 2005).

 

Situational Imprisonment

Military enculturalization subsumes CVT into an identification born of survival and dependant on the assimilation of the “firing squad mind set”, where one troops thoughts relates to an extension of his battle buddies. The fluidity of boundaries births the “troop organism” and forever impairs the RCV to return home without his “other selves.” Now the RCV has to try and interrelate without his relational attachments and attempts to reintegrate back into the civilian world where nothing makes sense anymore, where boundaries cross without attachments as a normative experience triggering perceived threat-states. This leads RCV to become his own “isolated island organism,” or an identity incomplete without the other part of the firing squad, that thinks, feels and acts as they do. The RCV becomes unable to interrelate with family and community in a meaningful way, impeded by the fluidity of boundaries.

 

As their safety has been compromised, a feeling of abject detachment has arisen from the conditioned reality of the combat organism that depended upon the battle buddy “having his back.” Therein leading to a sense of safety, the combat vet needed only to worry about their own personal “line of sight” in a battle field environment requiring a 360 degree threat radius. On his own in society this burden becomes an impossibly overwhelming sense of danger engulfing the RCV, leading to a susceptibility to triggers. A culture of 360 degree radius in the battlefield and shackled intimately with the culture of combat values, hereinto relying on the troop attachments and the evolution of survival, the RCV becomes stuck on the troop-organism functionality.

 

The troop-organism capacity becomes problematic to the integration of the “civilian-self” as it now has become supplanted by the “combat-self.” An attachment of the self to the self that is the identity of one whom sufficiently succeeds in suffering, completing the veteran and familial rift. The fluidity of boundaries in an intimate relationship with a loved one becomes a threat to the RCV due to the misidentification of signals between the two, one having adapted an independent perspective and the other a dysfunctional dependent state. The crossed-signals of the significant others has complicated the adaptation from independent relational skills verses over dependence and the perceived threatening self states with both parties expectations of returning to “the way it was.”

 

Compounding the issue, the RCV has now been conditioned to the “culture of killing” and the relational fluidity of boundaries between the two have become incompatible, further given rise to the RCV’s sense of threat as he where in combat. In combat a registering between non-compatible boundaries would be reconciled by a reflexive reactionary exercise of survival, triggering the culture of killing (Kirmayer, Rousseau, and Lashly, 2007). “Those supporting the use of culture as a defense argue that is it intrinsically unfair to judge someone exclusively by the rules and values of a society that he or she does not know” (p. 98). The above goes to the creation of a Veterans Court, where culture competency would require a special understanding of combat vets cultural “shaping.”

 

Criminal Behavior, Context and Responsibility

“[T]rauma exposure and symptoms of PTSD are prevalent among incarcerated veterans….[e]xposure to combat was the trauma most likely to lead to PTSD among males in a general population survey of 5, 877 individuals, [totaling] 19 percent” (Saxon, A. J., Davis, T. M., Sloan, K. L., McKnight, K. M., McFall, M. E. & Kivlahan, D. R., p. 962, 2001). Saxon et al. indicated a higher prevalence for PTSD in incarcerated veterans than the general population. Additionally veterans who screened positive for PTSD had significantly higher numbers of childhood trauma, indicating a possible correlation between peritraumas, military culture and past traumatization.

 

Taking culture into account means that the purposes of the criminal justice system—which include prevention and rehabilitation—can be achieved more effectively. Cultural awareness must be coupled with an equally astute political awareness that traces the consequences of clinical or forensic consultations out into the larger society (Kirmayer et al., 2001, p. 101).

 

Before the Insanity Defense Reform Act of 1984, questions of the “ultimate issue” when a defendant pled insanity in federal court was whether he lacked “the substantial capacity either to appreciate the wrongfulness of his conduct or to conform his conduct to the requirements of the law” (As cited in Buchanan, 2006, p. 14). After the bill was enacted, the question now goes to whether he “appreciated the nature and quality or the wrongfulness of his acts” (p. 14). “Case law and the Rules’ legislative history suggest also that in less clear cases an issue’s ‘ultimate’ status hinges on who has the authority to decide it….because it amounted to an ‘ultimate opinion’” (pp. 14-15). Psychiatric expertise falls under the Civil Procedure Rules (CPR), Part 35, whereby the duty of the assessor, in an expert capacity, is to help the court. A mental defense with the question of competency will rely on the weight of cognitive capacities.

 

With our modern soldiers averaging two to three tours of combat, we will begin to see an increasing epidemic of incarcerated veterans. In the next 10 to 15 years the American public will see a sharp rise in veterans suffering from Post-Traumatic-Stress-Disorder, to the point of epidemic proportions. You see, never before in war have our troops been subjected to such prolonged exposure to combat and life threatening situations. In World War II our troops were fighting a defined enemy while engaging real objectives with sufficient downtime in between engagements. Most of the troops to see combat were infantry soldiers fighting on a distinct front, not the ones "in the rear with the gear". With a real threat to our sovereignty and way of life soldiers of this era were less affected by the trauma of war.

 

The significant political interference of the Vietnam War generated little to no tangible objectives for our soldiers solidifying and branding their levels of anxiety and forever troubling their minds. Guerrilla warfare, an inherently cognitively damaging military action compounded the neuropathic damage experienced by our troops in Vietnam. Even with the troops having regular downtime in between engagements the cognitive fractures of these veterans were enhanced by more intense combat and the rejection of our returning soldiers.

 

The soldiers in the Iraqi war have been sent on multiple deployments with an average of two or three tours of duty with little time in between. While in Iraq, there are no friendly countries or areas to spend leave time to relieve stress while residing on constant alert and most, even non-combat soldiers, see combat or threats on a daily basis. Now combine this with the most intensive warfare possible, guerrilla warfare in an urban environment. We get troops that are overextended and overexposed to life threatening situations within unprecedented levels of combat. Our troops in Iraq have no respite from danger, further entrenching the effects of PTSD through the hyper levels of neurotransmitters (Lee, 2008).

 

Dissociated attachments reenact combat trauma somatically and between interstates within the RCV resulting in a “civil war” amongst oneself. A seemingly supra-intelligent guidance of the unconscious, this device of PTSD that engages in the survival defensive mechanisms that has sustained the combat veterans life on a persistent basis. Thus becoming the protector and a “conceptualization of hostile self-states in ‘personified narcissistic and sociopathic defenses’ that defend against dependency, vulnerability, and guilt…[and]…applies just as well to pathological narcissism” (Howell, 2005, p. 224). The ‘diminished capacity’ rule would apply when dissociative episodes result in a “psychotic” break, whereby a thought disorder could be ascribed.

 

Diminished capacity resulting in a thought disorder would be split between two categories; one being “disturbances in the content of thinking and perceiving (hallucinations and delusions), and… [the second would be]…disturbances in the form of thinking (formal thought disorder)” (Young, 2003, para. 7). Procedural memory becomes disengaged from experiential memories where reactionary encoding enables the maladaptive somatic response encoded reactions needed during survival in the moment situations. Multiple self-states dissociate and boundaries within boundaries abound.

 

I am just now starting to sift through the sea of case law and journal articles on the considerations of PTSD and criminality; unfortunately I think that there will be an ever increasing need for individuals well versed in the pitfalls of combat trauma and difficulties in reintegration. I feel as you do that something needs to be done to address this issue head on, such as a Veterans Court much like the one just established in Minnesota. Additionally, we have only begun to see the tide of returning veterans with psychological troubles facing criminal charges.

 

Never before in the history of American warfare have we seen such high numbers of soldiers who have been under unimaginable stress. In WWII 18% of our soldiers actually engaged in combat, with Vietnam it was 30-40%, today 68% have actually engaged in combat (Veterans for common Sense & Veterans United For Truth, Inc v. Veterans Administration, item 54, & National Center For PTSD Fact Sheet, Aftermath of Violence section, paragraph 2). Not only have more soldiers engaged in combat, they have been in combat longer with an average of 2 to 3 tours of duty. Many have been on 5 tours and some as much as 6. As high as 80-90% of soldiers (Hoge, C. W., Auchterlonie, J. L., & Charles S. M., 2008, results section, paragraph 5) have seen someone get killed, or been in a combat zone, we have reached "Combat Saturation."

 

Today 15% (300,000; Rand Corporation, 2008) of our soldiers and veterans have been diagnosed with PTSD and this seems like it may be a smaller number compared to other wars. 30% PTSD rates in Vietnam, 15% estimated in WWII and 15-20% of Gulf War I vets reported to have PTSD. It took Vietnam veterans up to 10-20 years before their symptoms reached the point of becoming debilitating. The implications for our modern veterans will have monumental deleterious effects in the next 10 years, it has been projected that PTSD rates in today's wars will reach 50-60%. We will be inundated with mentally ill veterans who have few options and nowhere to turn and they will run afoul with the law (Lee, 2006).

 

Today we have become faced with a growing trend of soldiers and veterans becoming enmeshed in the court systems. In direct conflict with the perception in the media I propose the theory that our veterans and soldiers face an insufficient mental health care which has a major impact to their lives, families and communities. The problem is not individualistic but systemic requiring major changes in how we view and treat PTSD. The care of our soldiers and veterans is not being met and we have just begun to see the aftereffects of the mind shattering results of combat trauma. Untreated PTSD can destroy the lives of many, not only the soldier and veteran. We send our soldiers to war for our freedom and then lock them up when they are broken and of no use anymore (Lee, 2008).

 

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References

Appelbaum, P. S., Jick, R. Z., Grisso, T., Givelber, D., Silver, E., & Steadman, H. J. (1993). Use of posttraumatic stress disorder to support an insanity defense [Electronic version]. American Journal of Psychiatry, 150(2), 229-234.

 

Brook, T. V. (2008, August 12). Report: 57% of troops sent on combat tours. USA Today. Retrieved October 12, 2008, from http://www.navytimes.com/news/2008/08/gns_deployments_081108/

Bourget, D., & Whitehurst, L. (2007). Amnesia and crime [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(4), 469-480.

Buchanan, A. B. (2006). Psychiatric evidence on the ultimate issue [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 34(1), 14-21.

Cercone, K. (2006). Brain based learning. In E. K. Sorensen (Ed.), Enhancing learning through technology (pp. 293-322). Hershey, PA: Information Science Publishing.

Congressional Research Services (2008). United States military casualty statistics: Operation Iraqi Freedom and Operation Enduring Freedom. CRS Report RS22452. Retrieved on October 29, 2008, from http://assets.opencrs.com/rpts/RS22452_20080909.pdf

Hoge, C. W., Auchterlonie, J. L., & Charles S. M. (2006). Mental health problems, Use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan [Electronic version]. Journal of the American Medical Association, 295, 1023-1032.

Howell, E. F. (2005). The dissociative mind. Hillsdale, NJ: The Analytic Press.

Kimayer, L. J., Rousseau, C. & Lasley M. (2007). The place of culture in forensic psychiatry [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 98-101.

Lee, S. A. (2006). Effects of combat on returning veterans. Unpublished manuscript, Jefferson Community and Technical College at Louisville Kentucky.

Lee, S. A. (2008). Combat veterans and institutions: A systems analysis. Unpublished manuscript, Kent School of Social Work at the University of Louisville.

National Center for PTSD. (n. d.). The unique circumstances and mental health impact of the wars in Afghanistan and Iraq. Retrieved December 23, 2008, from http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_iraqafghanistan_wars.html

Mezey, G. (2006). Post-traumatic stress disorder and the law [Electronic version]. Psychiatry, 5(7), 243-247.

Poortinga, E., & Guyer, M. (2007). Criminal responsibility and intent [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 124-125.

Powers, R. (2005). Deployment rates, United States military. About.com. Retrieved on December 26, 2008, from http://usmilitary.about.com/od/terrorism/a/deploymentrates.htm

Rand Corporation (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Retrieved December 23, 2008, from http://www.rand.org/pubs/monographs/2008/RAND_MG720.pdf

Robinson, C. L. (1999). Observations on cognition and insanity [Electronic version]. American Journal of Forensic Psychology, 17(4) 63-75.

Saxon, A. J., Davis, T. M., Sloan, K. L., McKnight, K. M., McFall, M. E. & Kivlahan, D. R. (2001). Trauma, symptoms of posttraumatic stress disorder, and associated problems among incarcerated veterans [Electronic version]. Psychiatric Services, 52(7), 959-964.

Young, D. W. (2003). Varieties of thought disorder in the criminal context. Washington State Bar Association. Retrieved October 29, 2008, from http://www.wsba.org.media/publications/barnews/2003/mar-03-young.htm

United States Department of Justice. (2004). Veterans in state and federal prison system, 2004. Retrieved November 20, 2008, from http://www.ojp.usdoj.gov/bjs/pub/pdf/vsfp04.pdf

Veterans for America (n. d.). Talking points: The consequences of churning & weekend warriors to frontline soldiers. Retrieved October 29, 2008, from http://www.veteransforamerica.org/wp-content/uploads/2008/04/talking_points.pdf

Veterans for Common Sense & Veterans United For Truth, Inc v. Veterans Administration, C-07-3758-SC, 2007 U.S. Dist.

 

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(To come...Scott's guide to dealing with PTSD and the law for veterans and their loved ones, linked here.) 

Army General and PTSD: The Courage to Admit All is Not Well

In honor of Veterans' Day -- hey, every day should be Veterans Day, but we're not so lucky -- there's an important story to let people know about, because it so stands out from the crowd, in more ways than one.

In the wake of a recent apparent suicide by a top military officer, Air Force Brigadier General Thomas Tinsley, from unknown causes, this general's admission about his personal struggle with PTSD is all that much amazing. 

"Officers just don't get PTSD," one combat-hardened Vietnam-era veteran told me recently, knowing full well that it's not so much that they don't get PTSD, but that there's no real way to admit that they struggle with it.

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An Associated Press report from the weekend talks about Army Maj. Gen. David Blackledge's courage to come forward, after returning from Iraq, and getting psychiatric help to deal with the trauma of war.  As the article says, by doing so, Blackledge is (fortunately) "defying the military's culture of silnece on the subject of mental health problems and treatment."

Says Blackledge, quoted in the article, "It's part of our profession ... nobody wants to admit that they've got a weakness in this area," Blackledge said of mental health problems among troops returning from America's two wars. "I have dealt with it. I'm dealing with it now," said Blackledge, who came home with post-traumatic stress. "We need to be able to talk about it."

The article focuses on the perceived "stigma" in the military culture about admitting there is a problem, seeking help and getting treated -- as well as indications that some positive change is afoot in this area.  Blackledge, who served in Civil Affairs in Iraq, and now works at the Pentagon, is clearly leading by example.  He was involved in several traumatic incidents in Iraq -- his convoy was ambushed, his driver was killed, and he was in a hotel that was bombed by suicide bombers -- and he's successfully sought help dealing with the incidents, help which he believes has strengthened him.

Given that we all pretty much know the statistics of how few people seek treatment vs. the ones who should, as well as how pervasive the culture of silence and fear of retribution is, it's GREAT to see Maj. Gen. Blackledge's openness -- and on this Veterans' Day, we can only hope it encourages many other servicemembers to go for help. The article is linked here. (Thanks to veteran John M. for the heads up!)

Editor's note: That's Maj. Gen. Blackledge 2nd from left in the photo, standing just to the right of Bob Dole, in this picture from a charity fundraiser for the Jericho Project.

The "Other" Wall: Veterans Walling Themselves Off, and Others Out

A while back we wrote that not only veterans have their own personal Vietnams.  One of the key elements in that story is the idea that significant emotions, such as profound grief, strike the individual suffering through them as almost "too powerful" to experience fully in the moment, out of a fear that they will be overwhelmed with such a powerful flood of emotion, and incapable of coping.  The defense mechanism then is to block experiencing so much painful emotion (i.e., grief).  Of course, the unfortunate truth is that grief doesn't go away...it just waits for another, inconvenient time to intrude -- because it must be dealt with to actually move on (by moving through).

Interestingly, Arthur Egendorf has something to say about this, too, and how it gets folded into a diagnosis of PTSD, perhaps unfairly:

"At such times, vets may decide to let go, to allow a sensitivity that was formerly taboo.  What happens for some, however, is that they then fall prey to a long-held belief that once they let themselves respond [to something] emotionally, the flood of feeling will be too much for them to handle.  Believing that if they really open up they’d be overwhelmed, men worry all the more over emotional outbursts and haunting memories.  The various correlates of this distress, from troubled sleep, to loss of interest in life, to guilt and other complaints, are now lumped together and called “stress disorder.” [now, PTSD.]  What the diagnosis doesn’t say is that if you’re convinced that extremely strong feelings are a sign that you’re sick or weak, then the only options you’ve got are to make yourself numb, or let it all out and think of yourself as crazy…"

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

Egendorf returns to this same theme of veterans freeing themselves up to cultivate a healthy sensitivity to what they've experienced when he writes:

“The tendency among many veterans and the public is to respond to talk of “stress disorder” with the seemingly logical but mistaken idea that what veterans need is to reduce their level of stress.  This idea has the unfortunate effect of encouraging veterans and well-meaning supporters to think that men in pain should shrink from life.  Or one might think that veterans need to change or reprogram their responses, when in fact their horror, rage, guilt and desperation may be quite genuine, [as well as] the signs of a re-emerging sensitivity.  Taking the direction implied by Jung and others, we can simply invite troubled veterans to revise their notions of what kinds of responses are admissible.  For once a man grants himself the freedom to be appropriately upset by what he has seen and done, his reactions subside quite naturally, and he experiences himself as “more himself.” 

Sounds promising...especially since often the veteran's tendency is, to wall one's self off from life and from others, rather than proceeding gingerly, tentatively but nevertheless purposefully -- in a supportive, loving, accepting and nonjudgmental environment -- to begin to process what's actually been experienced -- at ever step, checking to see whether it's too much, too little, or just enough to integrate. For rather than seeing him or herself as separate entities -- the pre-war and the post-war selves -- whatever gets integrated allows the veteran, as Egendorf writes, to experience him or herself as "more" of who they really are.  Wonderful...and the goal.

The Catharsis of Writing: Telling Your Story is Therapeutic

We recently talked about several veterans' stories of combat, and how their telling or re-telling of their stories allowed them to achieve some degree of catharsis about what they'd been through.  (The blog entry that discusses that is linked here.)  According to Arthur Egendorf, that's exactly the point.  He writes:

“Retelling one’s story is an ancient cure.  It allows people to take a more livable stance toward what they’ve experienced, one that may not have been possible at the time the events originally took place.  Retelling is likely to allow us to feel “more human” afterward, for recapturing the past in a sensitive way, often through the process of mourning, enables us to set aside our fearful self-protectiveness.  In this way we overcome the greatest burden we carry away from shocking experiences: the limits we’ve placed on our capacity to care.”

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Books Fall Open, We Fall In: Reading to Better Understand the Vietnam War and Its Veterans

The kindly and indulgent boyfriend, GuvBoy, left for the local library book sale with instructions to purchase anything that looked good about the Vietnam war and several other blog-related topics. As a former journalist and all-around smart person, he knows how to figure that out, so I knew I was in good hands.  As it turns out, he returned with some good ones, that seem to have been lost to history.  So I thought I would point them out here, in case they help anyone else who's interested in digging deeper into what went on and what the combatants experienced. 

(In case it's never been clear what orientation the categories of books in the various columns flanking this blog have, here's the breakdown:

The column to the right here on this blog lists various books of poetry about war, any war; followed by a section of all sorts of excellent first-person narratives about various wars, the better to give us an understanding of what veterans went through.  Those first-person narratives are organized by war, to make it more self-explanatory.  The column to the left here lists therapeutic resources for dealing with combat trauma up on top; and various miscellaneous things that get mentioned on the blog further down).

For Vietnam-era veterans who want their families (i.e., children and grandchildren) to better understand what the war was like, I'm still recommending "Home to War: A History of the Vietnam Veterans Movement," by Gerald Nicosia, because while he's talking about the veterans movement, in 700 pages, he's capturing all sorts of history of the era and feelings for and against.  The book is actually pretty neutrally, historically written, and it's a very good resource.  I've blogged about it earlier, here.  Except for its oversight of the extremely impressive (to me, anyway) Lawrence Kolb, M.D., I can't say enough good things about Nicosia's book.  There's a fascinating wealth of information about the legitimization of the PTSD diagnosis in the book as well.

Here are a few others:

Stanley Karnow's Vietnam: A History, is also good.  The cover calls it "The first complete account of Vietnam at war" -- maybe it should actually say, the first complete account of Americans at war in Vietnam -- so it has its place.  It was written as the companion to the long-ago PBS series of the same name.

Plus three new finds, though, thanks to the pleasantly-disposed boyfriend and his handful of small bills:

"Long Time Passing: Vietnam and the Haunted Generation," by Myra McPherson; "Healing from the War: Trauma and Transformation after Vietnam," by Arthur Egendorf; and "Vietnam: the Valor and the Sorrow" (from the home front to the front lines in words and pictures), by Thomas D. Boettcher.

Each of these books has a particular reason why it's good and worth perusing.  McPherson was a Washington Post and New York Times reporter who carried on 500 interviews with veterans and others to get her material; Egendorf, who Nicosia writes about in his history, was a Harvard graduate, Vietnam vet and psychologist who became one of the founders of the first rap groups to help veterans deal with the personal fallout from the war; and Boettcher was a graduate of the U.S. Air Force Academy who served in Vietnam in the press corps.  His book has more than 500 photographers, many never before published, which adds greatly to its interest (it's also very well-written and well-paced, not deadly.) 

---

Additionally, we've already blogged about Lori Sekala's great bibliography on PTSD and war in the blog post entitled, "A Good Librarian is a Wonderful Resource," linked here.  (Sekala is the collection management librarian at the U.S. Army War College library).  But here's something we haven't talked about yet -- possibly THE definitive bibliography on books about the Vietnam war, to better understand the experience.  It's linked here.  Enjoy :-)

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

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

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

 

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

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

One Author (and Former Marine's) Attempt to Make "Darkness Visible"

I read the classic Darkness Visible: A Memoir of Madness, by William Styron, the other night.  It's a quick but melancholy read and takes about an hour. (What I didn't realize at the time -- and it's completely tangential to his story, which is really about a four year bout the well-known author had with clinical depression, and the closeness he felt to suicide -- is that Styron was a former Marine.)  Styron died of pneumonia in 2006, at 81 years old.

In an obituary printed about Styron on Martha's Vineyard where he had a home, the following information about his military service is revealed:

Following high school [Styron] joined the reserve officer training program for the United States Marine Corps, and enrolled at Davidson College. He was unhappy there and through the Marines transferred to Duke University in June of 1943. In October of 1944 he was called to active duty and in late July 1945 was commissioned a second lieutenant. He was assigned to participate in the invasion of Japan; a month later the atomic bomb attacks forced the surrender of Japan and he was discharged. ... In 1955 he published The Long March, originally a novella about his experiences in the U.S. Marine Corps.

The same obituary also makes clear the trajectory that led to Styron's depression, and the resultant book that introduced this highly personal experience of the author's to the American public:

[Styron] drank heavily and smoked cigars until the summer of his 60th birthday in 1985, when he decided that alcohol no longer agreed with him and gave it up. But the abstinence triggered mood disorders which required medication, and the drugs in turn brought on a deep, enduring and suicidal depression that required him to be hospitalized for more than two months. The experience prompted him to write Darkness Visible: a Memoir of Madness, after he had recovered.

The book earned Mr. Styron a whole new set of followers. "I think it causes people to realize two things," he told the Gazette in an interview in 2001. "That this is a pain that afflicts a lot of people; it's universal and if I could describe it in this way and people could relate to it, it meant they weren't alone; and the second thing - almost as important or more important - is stressing the truth that people can get well, and that it's not by any means fatal."

Styron's book is interesting, to a degree, mostly because of his prominence as an author at the time he wrote it, and because it is so uniquely personal: One person telling the story of his own descent into "madness." I wasn't a complete fan: it's a little hard to keep reading how marvelous Styron's life was, yet how unhappy he was within it -- true though that might be.  And the entire book, while short, is one continuous slog through the same miserable territory, until his case finally improves towards the end (mostly thanks to hospitalization, it would seem.)

However, there are some interesting parts.  One is near the beginning, where he quotes the French writer Albert Camus, "There is but one truly serious philosophical problem, and that is suicide."  In Styron's hands, the problem becomes more physiological than philosophical.  He tries to put off suicide, while coping with his depression -- but first, cataloging his depression fairly exhaustively for the reader (or himself, it's never too clear.)  He covers some standard themes, such as how self-medication with alcohol kept his demons at bay for years, until he cold turkey gave up drinking, and watched his depression take on form and substance.  He explains how the common response of depression is to be more interested in injuring self than others (small comfort, that).  And he mentions the unique aspect we discuss here from time to time, about how psychological pain can manifest as, or at least be accompanied by, physical pain.  In Styron's words, about his own case:

"What I had begun to discover is that, mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain.  But it is not an immediately identifiable pain, like that of a broken limb.  It may be more accurate to say that despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room.  And because no breeze stirs this cauldron, because there is no escape from this smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion." 

(Hmmmn.)

Styron indulges in one of the book's only tiny moments of humor when he describes the loss of his libido, which he says happened pretty much as soon as the depression settled in.  Describing a conversation with a doctor he felt 'just didn't get it,' Styron writes:

"...I wondered if he seriously thought that this juiceless and ravaged semi-invalid with the shuffle and the ancient wheeze woke up each morning from his [sleeping pill-induced] sleep eager for carnal fun."

Styron helpfully delineates his personal symptoms and by so doing, provides an example for others about what depression can look and feel like.  He describes his sensations of pain, his loss of libido, his weakness, his weak and distant voice that made him sound much older than his years, etc.

He also describes his troubling experience with several doctors (he calls them "careless") who overprescribed medications to him, including sleeping pills, at levels that were dangerous and could have provoked suicidal thoughts. It's unclear whether Styron ever considering a malpractice lawsuit against these doctors, but what he describes doesn't sound good -- and it sounds like he just took it in stride and was thankful he wasn't harmed, but didn't pursue any further action.  Ironically, eventually it's medication that helps him get well, once he is hospitalized.  Before he commits himself, however, he reaches the end of his rope and contemplates suicide.  When he finally realizes how sick he is, he heads for the hospital, and, there removed from other distractions, is able to (in his opinion) concentrate on his cure.From other things I've read since, it sounds like Styron continued to battle depression off and on for the rest of his life, and probably had struggled with it for many years beforehand, also.  At no point in the book is there any indication about his military service having an effect, pro or con, on his depression.  In fact, it sounds like his depression was both genetic and environmental -- but had nothing to do with being a Marine.

By page 84, the last page of the short book, there is finally a ray of at least faint light.  Styron is getting better, and he sums up -- neatly mentioning Dante, the subject of a previous post here on this blog:

For those who have dwelt in depression's dark wood, and known its inexplicable agony, their return from the abyss is not unlike the ascent of the poet [Dante], trudging upward an upward out of hell's black depths and at last emerging into what he saw as "the shining world."  There, whoever has been restored to health has almost always been restored to the capacity for serenity and joy, and this may be indemnity enough for having endured the despair beyond despair."

And then he concludes with a quote from Dante, mirroring the optimism that is finally able to see in his own situation:

"E quindi uscimmo a riveder le stelle.

And so we came forth, and once again beheld the stars."

Editor's note: If you want to read more about Styron's later work, referencing this book as well, there's a good article from 2003 in the Guardian, linked here.

Nate Fick, Part II?: Tyler Boudreau - Unpacking the Inferno

It's hard not to be impressed with Nate Fick.  Smart guy with a conscience, warrior, longtime Marine officer, great writer.  Now it sounds like there might be a Nate Fick, Part II, in Tyler Boudreau.  Boudreau, a 14 year veteran of the Marine Corps, has just published a book about his experiences as a Marine officer in Iraq (2004), and it sounds absolutely great.  The book is called "Packing Inferno: The Unmaking of a Marine," and it was just published this month.  Check out these reviews, from people whose opinions matter.  It's not clear yt how much of his book deals with the consequences of combat trauma for those who served (or resultant PTSD), but even if it doesn't, the frequent remarks made about the 'self-awareness' of his writing mean that it will help the reader put himself or herself on the ground with the writer, seeing what he saw, feeling what he felt.  That's always a great (and necessary) precursor to understanding what the particular challenges are of combat for the veteran.

 Advance Praise for "Packing Inferno, The Unmaking of a Marine":

“I don't know another book on any subject, let alone on war, let alone on Iraq or the Corps, that combines such breath taking candor and self-awareness with such impressive insight and extremely good writing, as well. Riveting, engrossing, simply terrific, a page-turner” -- Daniel Ellsberg, Marine veteran, D.O.D. consultant during the Vietnam War.
 
"Tyler Boudreau is the real deal.  His personal story of what it's like to know the 'ground truth' of the war in Iraq chills the soul.  This is a must read for any of us who care about our country and our soldiers in harms way."  -- Max Cleland, former U.S. Senator, Vietnam veteran
 
“What do you get when you combine The Things They Carried and Dispatches with the unblinking, crystalline style of Friedrich Nietzsche?  You get Packing Inferno. Boudreau has a gift for vivid scene and narrative pace, and brings those together with something very rare: an unblinking sight of what’s right and what's not in this war, in his Marines, and in himself.  There is a clarity in his words that will not leave you alone. You will definitely feel your time has been well spent.” -- Jonathan Shay, MD, PhD, author of Achilles in Vietnam and Odysseus in America, MacArthur Fellow
 
"Tyler Boudreau lives now to help the rest of us see the monstrous face of war as clearly as he does. Alas, it is our own face, which we fail to recognize. This bravely truthful book is an urgently needed cure for America's chosen blindness about the war to which this nation condemns its young." -- James Carroll, author of House of War

“I read Packing Inferno in a single sitting, and when I finished, I sat back down and read it again…and again. Packing Inferno is a wonderfully written, deeply passionate account of one man’s journey to the ‘foyer to Hell’. Tyler Boudreau draws the reader into the subtleties of his ‘everyman’ tale of conflict until it is too late, and we are trapped in a journey up the Euphrates River valley, a Mesopotamian ‘Heart of Darkness’ which leads us straight into Dante’s Ninth Circle of Hell, a place reserved for traitors. Packing Inferno makes traitors of us all, those opposed to the war in Iraq, those who support, and those who remain indifferent. And yet, in telling his story, Tyler Boudreau has liberated himself from Dante’s Ninth Circle of Hell, because he betrays no one in doing so. And while the reader in some way becomes trapped along with Tyler by reading Packing Inferno, we are traitors to humanity if we don’t.” -- Scott Ritter, Former Major, United States Marine Corps, and Chief Weapons Inspector in Iraq, 1991-1998
 
"Eloquent, impassioned, written in the moments, written after, before, and around the moments, dripping with the blood of pain and seeking the blood of breathing, Boudreau has written from the zones of war under the guns and from the zones of war beyond the guns and from the zones of war in our hearts and minds - and in our memories and agendas - and he hasn't just written from those realms, about the culture, the training, the killing, the being killed, the coming home and not being home, he has displayed it all, dissected it all, unmercifully and mercifully relived and explored it all. Only a human ostrich can avoid these truths - don't be one. Read this." -- Michael Albert, Co-editor of ZNet and co-founder of Z Magazine and South End Press
 
“Tyler Boudreau has written a different war story which chronicles his journey of conscience.  His feat is to survive the inferno of relentless anger to reach an understanding of what war entails.  His is also an investigation into the morality of war, with all its quagmires and self-justifications.  Soldiers must come to terms with their war to truly survive it, and Boudreau offers great insight into the hurdles facing returning veterans as well as advice for those who would help them.” -- Elise Forbes Tripp, author of Surviving Iraq: Soldiers’ Stories
 
“This is a deeply stirring book, angry and funny and insightful, about war and those whom war envelopes. It will bring knowing nods of recognition from veterans; it may shock others.  To all of us, Tyler Boudreau offers a profound gift: the moral clarity we need to welcome the warriors back home.” -- David Bowne Wood, National Security Correspondent, The Baltimore Sun; author of A Sense of Values: American Marines in an Uncertain World
 
“Packing Inferno represents an extraordinary meditation on the lethal contradictions of war and a grunts-eye view of the debacle in Iraq.  Tyler Boudreau is that rare creature: a literate observer of the absurdities and tragedies of modern combat (American-style), and a no-holds-barred participant in the carnage of Iraqi urban warfare.  Forget the high-falutin' tomes on America's mission in Iraq; this book really explains why the U.S. strategy was doomed to failure.” -- Michael T. Klare, Five College Professor of Peace and World Security Studies and author of Rising Powers, Shrinking Planet, the New Geopolitics of Energy

You Never Knew What Somebody's Limit Was - WWII Vet Reflects on Combat Trauma

"Plus ca change; plus c'est le meme chose."  Translated from the French, that means, "The more things change, the more they stay the same."  All too true when it comes to combat trauma and PTSD, as well.

The other day I was reading an award-winning newspaper story by a colleague, where he profiled a World War II veteran, now in his mid-80s.  The Army infantryman veteran saw an awful lot of action with the 79th U.S. Infantry Unit liberating Cherbourg.  He says, "The casualties were fierce.  I ended up as the only officer left in the company.  One was killed, the rest were injured."  He continues, "I was just a little kid from college.  With my pink cheeks, I looked like I was about 12.  But I took over the company.  Then, I went to sleep, because I hadn't slept in three or four days, and I'd been injured." Tellingly, he adds: "There were 200 soldiers in the company," when he went to sleep, but, "when I woke up, I could only find six..."

Here's what the veteran said about combat trauma, as he became aware of it at the time, along with the lead-in to it by the journalist:

"The fear of coming home in a body bag could cause many men to tremble."

"One of the company executive officers went into a catatonic trance.  Boom!  The first day," said [the veteran].  "You never knew what would set somebody off or what their limit was.  You got guys who can handle it all and others who struggle and struggle and then just go over the edge and they're gone."

"Crying, weeping and lying on the ground and hugging your feet.  You had to be careful not to judge them.  Everybody reacts different[ly] to a situation."

Wisdom, indeed.

Vietnam Veteran: "Most Of Us Are Afraid to Love" - A Profound and Generalized Sense of Distrust

As part of our ongoing series on "healthy sexuality and the combat veteran," here are some fascinating excerpts from Yale-trained psychiatrist Robert Jay Lifton's work with Vietnam veterans in "rap groups" in the 60s and 70s. 

It's also interesting, in light of the extraordinary closeness and love that combatants feel for one another, how very little of that appears to be transferred successfully to relationships with intimate partners.  Combat seems to develop a closer bond than often even marriage; and the reasons for that are both various and fairly obscure -- not to mention, hardly ever even broached.  We have some ideas, and in the forthcoming months we will be discussing those.  But for now, we're setting the stage with more "raw material" from the veterans themselves about the difficulties they have touching love.

There are very few works that even mention sexuality and intimacy and the combat veteran -- literally, even mention the concept -- so it's interesting how many aspects of it he is able to cover here.  Quite thought-provoking.  "The word on the street" is that, among Vietnam veterans at least, this situation also hasn't changed in the decades since.  They're still pretty much stuck in the same patterns, for the same reasons, that Lifton talks about here:

(In Vietnam,) … even authentic intimacy and love had to be in some degree contaminated by the counterfeit universe, had to be a little distrusted.  Just as men felt that “Whenever you tried to be human you got screwed,” so one of them added, “If you got close you got burned.”

 

Vietnam had absolutized (or totalized) the whole question of intimacy for the American survivors.  Having experienced a particularly poisonous version of the “end of the world” image that characterizes extreme situations, they distrusted, feared, and could not believe in, the renewed human ties they so desperately craved as a psychological basis for reconstituting that world.  The death-dominated imagery they retained had to do with disintegration, stasis and separation.  The overall sense of disintegration (physical, psychic, moral) associated with the Vietnam environment is internally maintained in approaching the environment back home. 

 

The stasis or cessation of feeling derived from extreme psychic numbing in Vietnam leaves one with an image of a world that neither lives nor moves.  Vietnam’s extreme elements of separation – from familiar landscapes of any kind and especially from purposeful or visible images and symbols – results in an ability to find or catch hold of anything with which one can authentically connect.

 

Toward potentially intimate relationships the men at first brought a sense that any such promise of renewed life was counterfeit.  This intense suspicion of counterfeit nurturance – a form of “tainted dependency” in which love and help are equally strongly sought as a personal need, and resented as a sign of weakness – also had direct origins in the counterfeit universe of Vietnam.  There, as the men recalled all too readily, any form of help, nurturing or love was equated not only with weakness of the blind-helpless giant, but with the corruption of the executioner-victim.  To be sure, the men brought to Vietnam earlier imagery of a similar kind involving suspicion and doubt concerning love and nurturing they craved.  But that negative imagery, present from all childhoods, ordinarily combines with alternative images of trust involving one to respond to love and care with the mixed capacities characteristic of all adult life. 

 

In Vietnam, however, the negative inclination – the image of the counterfeit – is likely to be aggravated to the point of dominating one’s entire psychic life – which is why we can speak of the totalizing of conflicts around intimacy, love and nurturing.

 

The men revealed their sense of the importance of these issues in their energetic criticism of one another for maneuvers of any kind that seemed to be flights from intimacy – whether these took the form of shifting the discussion toward safely distant matters, telling shallow war stories, or suddenly shifting into revolutionary diatribes or leaden silences.  Adept as they were at exposing these maneuvers, none was free of profound individual conflict concerning intimacy.

 

Associating Vietnam as they did with their parents’ generation, ultimately with the whole of American society, their sense was something like, “After Vietnam, what could you trust of anything?”

 

---

 

A man with unusually profound difficulties with intimacy (exceeding but touching upon those of the others), he seemed to lapse into puzzling understatement when he went on to conclude: “People aren’t perfect,” and “People are fallible.”  But what he really meant, as his subsequent behavior revealed, was that unless people (and all relationships with them) were “perfect,” they were threatening, untrustworthy betrayers.

 

An engaging person with a certain talent for human relationships, his pattern of keeping people at a considerable emotional distance was interrupted by his falling in love with an attractive young married woman.  He enthusiastically described to the group their plans to save money in order to buy a Volkswagen bus and drive around the country together.  But at subsequent meetings he seemed much less certain and talked of going south alone for a couple of months in order to earn the money for the trip.  He also said that he wanted to “test the relationship” in various ways in order to find out “whether two people can really get along when they are with each other twenty-four hours a day.”

 

It was he who had the garbage-dump dream, and in it he was expressing (in addition to the themes already described) his fearful sense that all claim to love and intimacy was counterfeit, filthy, “garbage.”  Others in the rap group pointed out that he was being hopelessly absolute about the relationship, that nobody could stand anybody for twenty-four hours a day, that he was “manipulating” arrangements with the girl, “preparing a time bomb,” and “setting things up for a break.” 

 

He denied none of this, and was even willing to explore sources of his mistrust, but nonetheless insisted on doing things his way.  He went further and said, “If I can’t love her, then I don’t think I’ll be able to love anyone.”  And when one of the [other] men gently commented, “Most of us are afraid to love,” he answered with a poignant question, “How do you tell when you feel love?”

 

He was soon to prove the men right: before long the relationship dissolved.  But he went on insisting upon “complete independence – being able to get along without needing anybody.”  His all-or-nothing approach to relationships – the totalism we spoke of before – was discussed extensively. both in connection with the Vietnam experience and his own psychological development.  He did not, during the six months or so I knew him, overcome either this totalism or his profound and generalized sense of distrust.  But he did open himself a bit to his own feelings and to glimmerings of insight; and the rest of the group seemed to benefit greatly from what they learned about themselves through him.

 

Falling in love, or feeling oneself close to that state, could be especially excruciating – an exciting glimpse of a world beyond withdrawal and numbing, but also a terrifying prospect.  A typical feeling, when growing fond of a girl was “You’re getting close – watch out!”  The most extreme emotion of this kind expressed was:

 

“If I’m fucking, and a girl says I love you, then I want to kill her [because] if you get close…you get hurt.”

 

Love or intimacy, in other words, posed the threat of still another form of corruption and disillusionment, of still another ‘death.’[1]  It was much easier to avoid that risk and stay numb (remain in an evenly deadened state) – “I feel like hiding out in my own head,” was the way the same man expressed it.

 

But the men did of course fall in love.  When that happened, especially if soon after returning from Vietnam, they would find themselves breaking off relationships because “I couldn’t go through with it,” or “I didn’t want to be tied down to anything.” What they meant was that their psychological work as survivors was so demanding as to preclude, at least for a certain period of time, sustained intimacy or long-range personal commitment.

 

---

 

The general dilemma of these veterans had to do with the extraordinary intensity of both their need for and difficulty with sustained intimacy.  Breaking off relationships was as painful as it was necessary.  On many occasions, entire rap groups were devoted to such closely related themes as: the general problem of fidelity, notably sexual fidelity,[2] the hunger for love and nurturing, and the sense of being chained by sustained intimacy in a relationship; and the powerful influences of Vietnam corruptions – with their residual fear and guilt of great magnitude – extending backward and forward into old and anticipated corruptions that touch virtually all aspects of existence. 

 

This entire pattern of holding on and breaking off contained a continuing dialectic between persistent death imagery and imagery of life renewed.  But they came to realize that the equation was never simple: holding on could take the form either of revitalizing intimacy (life renewed) or of numbed distanced in proximity (a new death), and breaking off could be a pathetic need to reject the intimacy one craved (a self-inflicted death) or a liberating opening out to deep experience and greater self-knowledge (renewed life).  Over the course of time most of the men increased their capacity for intimacy, but that dialectic would simply not go away.

 

-- Source: Home from the War: Vietnam Veterans – Neither Victims nor Executioners, by Robert Jay Lifton, M.D. (Yale-trained psychiatrist).  New York: Simon and Schuster (1973).

---

[1] It is possible that he and many others continue to associated the nakedness of sex with Vietnam images of grotesque bodily disintegration – as did Guy Sajer, with memories from the German Army experience of World War II: “As soon as I saw naked flesh [in a beginning sexual encounter] I braced myself for a torrent of entrails, remembering countless wartime scenes, with smoking, stinking corpses pouring out their vitals.

 

[2] I use the term fidelity here to suggest more than loyalty, though loyalty itself was of great importance.   Also involved was authenticity – in sexual matters, for instance, the genuineness of an impulse to find a new partner at precisely the time that an existing relationship showed promise of deepening intimacy.  Fidelity thus involved being true to, having faith in, the animating principle of the new self being formed.  It included overcoming fears that one’s residual destructiveness and death taint would not harm or contaminate others.

The Other Purple Heart: For Wives, Husbands and Partners of Those with PTSD

The Bible, in the section known as Proverbs (from the Wisdom Literature tradition), has a stunning description of a woman known as the "Proverbs 31 Woman," or the "wife of noble character."  Here's just one sampling of what she's said to be like: "A wife of noble character who can find? She is worth far more than rubies. Her husband has full confidence in her and lacks nothing of value. She brings him good, not harm, all the days of her life."

From the spiritual to the secular, we have another example of the same in the praise that well-known philanderer Ben Franklin (and yes, that's a man who collects paramours, not stamps -- in his case, on two sides of the Atlantic) heaped on his wife, Deborah, for being the highly-cliched but apparently in their case, true, "wind beneath his wings."  While Franklin became famous for, among other things, his witticisms about wealth in "Poor Richard's Almanac," he often credited his wife and her good habits with being the reason they saved any money at all. (I'll find the reference later, but it's true.)

Well, if you scratch the surface of PTSD and veterans, you quickly find how many of the perhaps less famous (guys get famous) , nonetheless vitally key players, heroes and and true angels, are women.  There's Sarah Haley, who we read about the other day; Kathie Costos; Patience Mason; Aphrodite Matsakis; the list goes on and on.  (We fully expect that Kellee Twiggs was that kind of woman, too; as is Bet Ison; as is the highly-impressive Jennifer Briest, though that's TBI not PTSD.) And now, there's Pat Kemm Mann who we can add to the list.  (Not the same "Pat," whose wonderful insights and recollections into his time at war we've been reading about in the "Eyewitness to Combat" series.)  This lady is one impressive person, in her tremendous caring for her husband who she met and married when he had PTSD, as well as her remarkable smarts and strength of character in being the support he and their subsequent family needed.  Just an amazing woman. 

Not saying she's likely to be the only one out there -- actually, she reminds me very much of Kathie Costos, through whose blog I learned about her story, and secured permission to reprint it here -- but she IS very much worthy of our admiration, and she is also articulate and organized enough to tell her story in a compelling way: a story she's willing to share in the hopes that it helps younger wives and women learn what it takes to "love someone with PTSD" and be a real support to them in the life they build together.  As we read about yesterday in the Tao of Caring for Others, sometimes caring for someone else can be just an expression of who you are.  In Pat's case, that's the story.  Here it is, in her own words, about "loving someone with PTSD":

"At the age of 32, I met a man who wasn’t intimidated by my independence or education. A man who made me laugh, introduced spontaneity into my life and who cherished me. He was a 30 year old Nam vet...and twice divorced. But we shared the same family values and dreams for the future. When he proposed, I told him that I was not going to be his third wife; I would be his LAST wife. I only intended to get married once.

He told me that he had a dark side. I had no idea what he meant. I was to find out within months of our marriage. He was driven at work. Always put in more than was required. Naively, I just assumed he had a strong work ethic. I didn’t realize he was trying to escape demons. He had warned me about nightmares; told me how to wake him so he wouldn’t inadvertently hurt me. As a GI Brat growing up in a family with a strong, military tradition, I didn’t think it that unusual since I had several uncles with the same problem.

3 months after we married, however, his behavior began to change noticeably. He began “self-medicating” with alcohol. And he began seeing things that weren’t there. Hearing people calling him for help. Sometimes hearing a child cry would make him jumpy. The smell of urine would bring flashbacks. He had to sit with his back to the walls in restaurants. Anxiety attacks in crowded places. Sudden noises, like party balloons popping or a car back-firing would make him jump or even “hit the deck”. He would be embarassed and apologetic, telling me it sounded like small arms fire.

I was to learn that he had entered a 6 month period of “anniversary dates”. Not pleasant anniversaries. Anniversaries of the Tet Offensive, of being left for dead under a pile of bodies, of being a VC POW (until he managed to escape), of ambushes, being overrun, of being shot down, wounded and crawling and hiding for 7 days until he reached a friendly LZ. All of them crashing down on him like an avalanche of horror.

One day he came home from work and instead of coming into the kitchen where I was washing baby bottles, he went downstairs to the basement. That was unusual but I didn’t think too much about it. Then suddenly I felt an overwhelming sense of panic. I dropped the baby bottle and ran down the stairs. He was standing under them, in the dark, with a pistol in his hand. He was exhausted and terrified of going to sleep because at least when he was awake, he could see what was happening around him as well as the “film” his mind was playing. But he couldn’t make himself blow his brains out because he didn’t want me to have to live with that image forever burned in my brain.

The term PTSD wasn’t known then, or at least not known by many. But I knew my husband was suffering from “Combat Fatigue”. He didn’t want to believe that. Hell, he was a Hillbilly. A rough, tough coal miner. A combat hardened Marine. A third generation Marine... But one who’d been on Valium (through a civilian doctor) since he finished his second tour of duty.

He ended up starting therapy before our first anniversary. The man I had fallen in love with was slowly disappearing, being overshadowed by an often cold, uncommunicative loner. Sometimes I felt like a Life Guard, hanging on to a drowning man, refusing to let him go under.

But I had an advantage that many of the younger wives of combat vets didn’t have. Growing up on military bases. A brother and friends who’d gone to Vietnam while I was in college. I was 33 years old. And I had enough psych courses under my belt that I was able to "deal" with the nightmares, hallucinations, rages, and suicidal ideations as well as monitor and administer the massive quantities of anti-psychotic medications the VA was doling out... (and to eventually question the efficacy of most). Even so, the pain of seeing him look at me, with total confusion in his eyes - knowing he doesn’t know who I am but thinks he should... the pain and sorrow was indescribable.

His cup of stress was full to the brim from memories alone. Anything at all, no matter how minor, was like that one extra drop that causes the cup to overflow. Every car “accident” - always single car accidents, one near fatal - happened immediately following his 6 months of anniversary dates, when he had reached the limits of his endurance.

At one point, we lived on the Texas coast. Driving to the Houston VA was a challenge. It’s a nice, straight highway but for long stretches, it has rice paddies on both sides. He drove hunched over the steering wheel , knuckles white. Eyes darting constantly left and right. Muttering about damn rice paddies. I knew what he was doing and finally told him “I’ll drive. You watch for Gooks.” After that, I always drove that stretch.

I found myself “interpreting” other people’s actions and comments to my husband so he wouldn’t deck someone who had merely glanced our way but whom he thought was challenging him. He was quick to anger and quick to fight. But he was mostly able to keep his promise not to get in fights after I told him I knew he could take care of himself but no matter how the other guy looked, it hurt me to see him with scraped and swollen knuckles.

It wasn’t easy. And it wasn’t fun. But the man I loved was still in there and I was determined to beat back the demons that were dragging him down. We lost some friends who just saw him as crazy or irrational or scary. I remember once asking “Who are we not friends with this week?” His head kind of jerked, he looked at me for a moment and then he laughed. It stopped another rampage over an imagined insult or slight.

He had no patience at all. If we decided to go somewhere, the girls and I had to be ready to go the second he was. I’d remind him that no one’s life was in jeopardy if we were slower than he wanted. The thing that did the trick, though, was the time I finally took the car keys from him, handed over our two small daughters and told him that this time, HE could get them ready to go. I’D sit in the car and honk the horn.

He started group therapy and we found friends who understood because they were going through the same thing with minor variations. Almost all had done the “geographical tour”, moving from job to job or state to state as they tried to escape what was inside them. Some had used alcohol, prescription drugs or even street drugs to escape the psychological pain. And, like so many of the guys, his previous marriages didn't last simply because he couldn't let himself care that much and did everything he could to protect his fragile emotions from being fully engaged. A lesson he learned too well from losses in combat.

For some reason, he trusted me enough to open up about a few things that happened in Nam - things that clawed and burned in his mind. Which was both a good and a bad thing for him. He knew he had a safety net but letting those painful memories out (those he hadn't completely blocked, anyway) ripped the scabs off some horrendous memories.

Our two daughters were old enough to know that their Daddy was different from most of their friends’ daddies. But our daughters maintain that the thing that helped them understand their dad the most was that I always explained his behavior to them in terms that were age appropriate. One thing I'm especially proud of was when a VA Therapist asked me how I'd managed to raise such normal kids. While they didn't always LIKE him or what he was doing, they always loved him and knew that he loved them in return, even when he would "go bush", miss out on important events in their lives, or self medicate to excess.

And yes... he went to counseling and group therapies. We went through marital counseling and family counseling as well after one particularly rough patch. All of which were extremely helpful only because he was able to get outside his comfort zone, accept the validity of our feelings and make the effort to change certain behaviors.

When his PTSD, appointments and hospitalizations began to interfere with his ability to support his family, we began the torturous process of applying for disability. And we had to do it all over again for Social Security. Writing to every doctor he’d ever seen, every hospital he’d ever been in and trying to locate witnesses who had made it home, up to ten years after the fact.

I had to help him with the VA claim statement. I remember sitting, after the girls were in bed, writing down what he said as he spilled his guts and his pain all over the dining room table. Crying inside because of the horrors he went through and yet not daring to show any emotion on my face because it would have made him stop talking - for fear of upsetting me, disgusting me, or making me think less of him. And then having to sort through the jumble and make complete, intelligible sentences out of it.

I am eternally grateful to the PVA (Paralyzed Veterans of America) service rep who took the 13” thick stack of documents covering 10 years and went to bat for my husband.

In spite of one VA doctor who attempted to keep me out, I sat in on every appointment with my husband after I realized that the doctor didn’t know half of what was going on. This was something I felt very strongly about. I had to play an active role in his treatment. No one knew him better than I did.

The doctor would ask “How have you been since I last saw you?” And my husband would reply “Fine.” Then I’d jump in and tell the doctor what I’d observed. He WASN’T “fine”. And the fact that he couldn’t recognize his actions as irrational proved my point! Reactions that can keep you alive in combat are not always appropriate Stateside. Asking some of these guys how they are is like trying to get a blind person to describe the color yellow.

And I remember the anger I would feel each time a new doctor was assigned to my husband. The dreaded First Three Questions: Have you ever seen anyone killed? Have you ever been in fear of your life? Have you ever killed anyone? Check his records! 3 Purple Hearts. Siver Star. Bronze Star. Presidential Unit Citation. Combat Air Crew Wings with 3 or 4 devices. You don’t get those sitting behind a desk!

We've had our share of difficulties and I've often been asked why or how I stuck it out with him. My answer was always very simple: He's a good, kind, and decent man with serious problems. I wouldn't leave him if he had Cancer; I won't leave him because he's got emotional or mental problems. With close friends, I laugh and say "Because I'm strong, stupid or stubborn. Haven't figured out which yet!"

After almost 30 years, we're still married. Our family is stronger and closer than ever. The grandchildren all love their Pa-Pa and he adores them. Both daughters have chosen careers in medical fields where they can help others and are totally comfortable dealing with what some of their co - workers call "crazy Nam vets". And they're quite vocal in the defense of these guys. I'm proud of them. But then, almost all of our best friends are men (and their families) that we met while they were in the “Nuts and Flakes” wards at various VA Hospitals.

And I'm proud of my Marine, a crew chief and door gunner on med-evac choppers who served two tours (during which he endured being shot down 13 times, left for dead 3 times and 58 days as a POW of the VC). Once, he apologized to me for "being so weak". I told him he was the strongest man I'd ever met and that I would never want to be with a man who saw and went through what he did... without it bothering him.

My husband is worth the effort it’s taken and the rewards are immeasurable. He’s not “well” by any means, and he may never be because serious help came too late. But we have a good marriage filled with humor, love, respect and trust that goes both ways. Even with the problems, that’s still more than many have.

I have hope for our new Walking Wounded. No one questions the reality of PTSD anymore. More help is out there. I just hope that those who need it are informed that it is available... without the stigma my generation had to fight and without the delays that make it less successful.

Pat Kemm Mann
Fruitland Mesa
Crawford, CO 81415

Eyewitness to Combat: I Didn't Want to Get to Know Anyone After That

I was lucky enough to be "given" one Marine's recollections of Vietnam and his struggle with PTSD since, whose storyline he spent 40 years crafting, apparently in an effort to explain the experience to his family, and himself.  I have his permission to excerpt it here on the blog and it's great stuff.  Not pretty; in fact, often very graphic; hmmmn, just like war.  Here goes the first installment:

 

---

 

When I arrived in Vietnam in January of 1966, I did not get there with any official orders.  They had somehow been lost on the way over from the States.  I was totally confused and quite anxious because no one knew who I was or that I was even in Vietnam.  I didn’t even receive any pay until four months later when I finally wrote to my dad and he went to Senator John Tower. 

 

However, on the 22 of February I was assigned to the “Flames” section of 2nd Battalion, 9th Marine Regiment which was operation in the Da Nang Special Sector TAOR from the Cau Do River to the North, Ky Lam River to the South, Highway 1 to the East, and the Da Nang N/S railroad to the West. 

 

After a one week crash course on using the flame thrower, I was sent out with Hotel Company as a Gunner with Nick Sparicino as my A-Gunner and ammo humper.  We were all given what were called the Rules of Engagement which meant that we couldn’t return fire unless we could actually see a clear target which was impossible, we could never see them. 

 

This area had hundreds of small villages and hamlets and we were told that about a quarter of a million people, made up of all Viet Cong or V. C. sympathizers-families of the V.C.  We were told that there were NO friendlies in our area of operation and that they all knew how to and did set mines and booby traps.

 

A special amount of time was spent letting us know the seriousness of this threat.  Our section leader, a sixteen year Marine by the name of Corporal Cook put a five gallon gas fuel can of napalm in a rice paddy, put a grenade on it and pulled the pin.  When it went off it produced a huge fire ball explosion. 

 

He then said: “Print that in your brain because that’s what you will look like if you hit one of the mines while carrying your flamethrower or the five gallon can of extra napalm.  That really scared the crap out of me.  Choppers were bringing people in from the field all of the time who had hit mines and were literally blown apart, some killed outright. 

 

Cook took us to a group of Marines covered with ponchos that was laid out by the command post for tagging.  He threw the ponchos off one of them.  There was a Marine, probably 18 or 19 with real blond hair, and deep blue eyes with one arm and one leg missing and the side of his head torn up. 

 

Cook told us to take a good look and that this wasn’t a friggin' game and that if we f---ed up we would be laying there where he was.  That was the first time that I had ever seen someone dead up close.  The area was mostly rice paddies, tree lines, hedgerows, streams, and grass or thatch roofed hutches.

 

Punji stakes, punji pits, and booby traps were everywhere and every hamlet seemed to be sitting over huge tunnel complexes and every tree line had bunkers and spider holes (V.C. fighting holes covered with vegetation) in them. 

 

Most of the Battalion’s casualties were from these devices, mortars, or snipers.  Mostly we just walked around and played moving target and sitting duck.  We would lose people every day and never fire a shot. 

 

We never saw the V.C. They would come up through a tunnel in a tree line and take out one of our guys, then disappear while the “friendly” villagers would stand in their fields and watch us hit ‘Bouncing Betty’ mines that they themselves would set.

 

We did this day after day, all of the time until I really hated these people. 

 

I was so scared every time that I went out with the flame that sometimes I thought that I wouldn’t be able to go on.  But you couldn’t show fear and you never talked about being scared, you just kept functioning and pushing forward into the unknown.  We couldn’t fight back and we didn’t know where the mines were until we hit them. 

 

I kept wondering, “What in the Hell are we doing? This is crazy!” Sometimes the feeling of helplessness was almost totally overwhelming. 

 

It was like a very dark cloud engulfing you but again no one spoke of it but when we looked at each other in the eyes you could see it in everyone.  So we just kept moving and taking casualties and getting madder and hating the Vietnamese; all of them.  We weren’t controlling the war; the V.C. was and we were their targets and whenever they wanted us.

 

The weather was so damn hot in the rice paddies that we lost people constantly to heat stroke.  I carried the 105 pound flame thrower plus an additional 35 to 40 pounds of personal gear; C-rations, ammo, water, a 45 pistol, and sometimes an M-14 rifle.  I only weighed 135 pounds and the weight and especially the heat, seemed unreal.

 

I would hump the flame during the day and run listening posts and ambushes at night with the M-14 rifle.  We never completed any “Clearing Operations” because the V.C. was still there after we would sweep through and they would re mine and re booby trap the areas that we had already moved past.

 

This got so bad that Col. Donahue ordered us to “Scrub the V.C. cancer out of the hamlets”.  We were told to destroy everything and anyone that we took fire from.  If we took sniper fire from a hamlet, then it was declared a free fire zone and anything that moved could be killed with malice. 

 

Choppers would fly over these hamlets dropping leaflets telling the inhabitants that they had to surrender all V.C. “infiltrators” or they would be killed.

A few days later we would go in and “take the hamlet apart” and torch it.  This was a real bad place to be because No one liked us and the V.C. was everywhere.

 

The entire five months that I operated in this area was so constantly scary that it made me completely numb which was the only way to survive.  If someone else hit a mine, they lost a leg or an arm.  If I hit one, my flamethrower tank would explode and I would go up like a fireball. 

 

No one ever got near me.  They stayed a good distance away and I felt isolated and numb that all I could do was to keep putting one foot in front of the other. 

 

When we took sniper fire, everyone else could lay flat but my tank stuck up like a huge pillow.  I always knew that I would die at any moment and couldn’t do a damn thing about it except wonder what it felt like to burn to death.  I even tried to get transferred back to a rifleman. 

 

But I was refused by the First Sergeant and told that the Marine Corps had put me where they had wanted me and that is where I would stay.  I was trained as a rifleman, not a flamethrower gunner, it bothered me and I hated every minute of it.

 

From the last of January, 1966 to about the middle of March we had been moving into position to conduct what was called a company sized “County Fair” operation in which the V.C. and V.C. sympathizers of hamlets would either be killed or captured, questioned and then killed.

 

These County Fair cordon search and destroy operations were directed at the hamlets directly north of the La Th o and Thanh Quit line where we had been hitting a lot of the mines.  It was miserably hot and the heat coming off of the rice paddies made us look like ghosts as it shimmered up and around us.

 

We looked like we were moving through a mirage. We stayed to the trails and the rice paddy dikes because there were punji stakes everywhere else.  We had come out of a tree line and were moving along one particular rice paddy dike. The flame was digging into my shoulder and my hands were getting numb. 

 

The column kept moving but I had to stop and readjust the straps, they were hurting me so much.  I stopped and squatted down; Nick Sparicino moved up to help me with the tank.  De La Fante moved off into the rice paddy in an arch around us.  He was still keeping his distance from us. 

 

Then all of a sudden there was a loud bang, and explosion.  The field had been mined.  We looked up and De La Fante’s body was flying through the air and hit the ground surrounded by dust and grey smoke. 

 

He had hit a mine and it had pulverized his legs and one arm.  He was flopping on the ground in shock convulsions like a fish out of water.  I was totally stunned. 

 

It was so hot and the load was so heavy that I was carrying that I wasn’t paying attention and was just concentrating on one-more-step.  The Sergeant yelled: “Everyone down!”

 

Nick and I started to move toward De La Fante and the Sergeant yelled again: “God dammit, I said get your asses down, NOW!”  De La Fante was screaming: “My legs, oh God, my legs!” Then he went into shock. 

 

I stayed in my position but kept thinking: “What in the hell is he (the sergeant) waiting for? De La Fante is hit and needs help now.” 

 

My gut felt like it was being ripped from my body.  I felt absolutely helpless and was getting really pissed off but I had been ordered down and that is what I did. 

 

I was so frustrated that I started to cry as I looked over at De La Fante on the ground and no one moving to help him.  I prayed: “God, please stop his pain, let him die.”  I think it was more for me than for him.  I couldn’t just squat there and watch him like that. 

 

The Sergeant finally called “Corpsman up, Doc, get the f—k over here”, and he and Doc moved very cautiously toward De La Fante. 

 

Upon reaching him, the Sergeant held him down, he was still bucking and jerking and Doc gave him morphine.  The Lt. called in a medivac chopper and I thought that it took forever.

 

I can remember how hot I was squatting next to the rice stubble and how dry my mouth was.  I couldn’t even spit.  The smell of powder, blood, feces, and burned flesh hit me hard: It was so dry that there weren’t any other odors.  I almost gagged.

 

The chopper came in; De La Fante was put on a poncho, placed on the chopper, and he was gone just like that.  The platoon Sergeant yelled “Move out and stay the hell off of the rice paddy!” and we resumed the patrol as if nothing had ever happened and as if De La Fante had never existed.

 

I never saw him again and no one ever mentioned his name after that.  He had simply disappeared from our existence.  While no one ever said anything, war is just like that, I felt unbelievably guilty for stopping to adjust my shoulder straps.

 

I kept thinking that had I kept going, then he would have not hit the mine.  Then I felt guilty about not going to get him after he was hit.  Even though we were ordered to stay down, I was also afraid to go get him because I didn’t want to hit a mine too. 

 

Now I felt like a coward and there wasn’t anything that I could do to change anything.  We moved out but I was totally numb but the anger started to really well up in me.  I wanted to kill someone.  I wanted to get at Charlie for De La Fante, for having to hump so damn much stuff in the friggin’ heat, and for not showing himself so that we could get a definable target to kill. 

 

I had been warned and told about this stuff and had seen the results of a mine but this was the first experience of watching it happen.  I blamed “Charlie” for every miserable thing that had ever happened to me in my entire life. 

 

After that incident, I never complained or shunned carrying the flamethrower.  In fact I was glad that it was my weapon because I wanted to get even, and I had developed a mature hatred for the enemy now.  I also didn’t want to get to know anyone after that.

Unhealthy Sexuality: A Bond That Is Strong, But Lack of Desire - We Just Gave Up

Here's an item from a woman I admire to the hilt, who has been the wife of a Vietnam veteran since she was 24.  Her husband, more or less 10 years older, fought in Vietnam, and has suffered from PTSD ever since. She ended up writing a book about how she came to learn about PTSD and how it affects the family, and since then has done exceptionally kind, warm-hearted and great work on behalf of veterans and their families with PTSD.  In her case, she found that being married to someone with PTSD presented unique relationship challenges, which didn't always work out to her satisfaction.  On balance, she still accepted and took comfort in the relationship, but the sexual aspect was hard to work through, and painful to talk about.  With her permission, we have excerpted the relevant passages from her book (these passages offer a look at a slice of life from decades ago, but they are very accurate nonetheless, as hard as this stuff is to share):

Some general information about the situation:

It is amazing what changes happen to a person. Facing Jack’s problems and sticking it out made me realize something about myself that had to be changed. It was time to make the same commitment to my current job and stick it out. All the other jobs I had, I ran away. I would quit the job and move on to another one. I was always good at what I did and tried to give 100% but I never felt that my effort was appreciated. I was always taken for granted and devalued. I was feeling the same way about my current job. I didn’t want to run away this time and end up learning a job all over again. I didn’t want to start from scratch. I was just going to make my attitude different and stick it out.

It took five years of going to the VA for help before Jack eventually dropped out of

treatment. The denials were like a knife in his back. He couldn’t take it any more. It was causing us financial hardship and he lost time at work going to the appointments along with the times he couldn’t function at all. There were so many times that he couldn’t bring himself to get up off the couch. There were times when I saw it coming. He would become edgy, agitated and quick to anger, then silent, motionless holding his head in his hands. I was losing the battle. The fight had gone out of me and I was looking for a reason to stay with a man who could no longer be a husband or a father. I was in all respects a single parent. I had stress at home and a stressful job.

It tore at me knowing that no matter what I did, I would not be happy. If I left him, I would have felt guilty for turning my back on part of my family. If I stayed I knew that I wouldn’t be happy knowing what I would never have again. I didn’t know if I could do it. I didn’t know if I could keep looking in the mirror as the years left their mark on me, knowing that I would never feel desire or passion again.

 

It was like living on a roller coaster. I would start to relax when Jack would level off and he would be easy to live with, then just when I was getting over the bad days, they would come again. It was as if he couldn’t stand being emotionally close to me. There were times of the year that seemed worse for him. November was bad, the month he went to Vietnam and the month he came home. It was also the same month that Camp Evans had the 122mm rocket and mortar attack. February was a bad month for him. So was April. The other months were bad but those three months seemed the worse for him. I suppose I could have become an angry, bitter woman. I could have taken out the unfairness of my life on others. I could have but I didn’t. I credit God and Jesus, as well as an understanding of the Bible for providing me with the strength and courage to stay true to who I was.

---

About their honeymoon, and subsequent relationship:

We went to Niagara Falls but it was not romantic. We had a king-size bed and I am sure that he didn’t sleep in it for more than a few hours. I’d wake up in the morning and Jack was sitting in the chair watching TV. I think that we made love once, maybe twice on our honeymoon. During the day it was romantic and we were happy. We kissed a lot, held hands and held each other. At night it was as if he couldn’t stand me near him. Sex was never really that important to us. I already had a marriage where sex was too important. That didn’t bother me as much as the fact that he didn’t want to hold me or be near me. I thought there was something wrong with me. It hurt. I understood quickly that to wake up Jack was like waking a grizzly bear. He was ready to attack but stopped himself.

We continued to visit his friends and enjoy life. I got over the hurt of his lack of desire and realized that he was older than I was. I thought that maybe his sex drive wore down with age. We still hugged and kissed a lot. We both worked hard, so when we did get to “fool around” it was enough. It was at least once a week and that was enough for me.

 

Once in a while we would end up down the beach and make love in the car even though we were married and finally had a place to be alone. He said it brought back memories. It felt good to just be in his arms.

 

There were still times when I wondered how this happened and I will probably wonder for the rest of my life. I wondered what it would have been like if the first time I left him, it ended. I listened to the experts on TV when they talked about marriage. They could only give advice on a limited basis to the “normal” side of society.

 

The experts never had much to say about a family like mine. I laughed knowing that a marriage could survive without sex, without the partnership. Children could thrive in a dysfunctional home if there is love there. An illness did not have to mean the end of everything. It was hard. Don’t get me wrong. There are families with alcoholics who in the process of their illness hurt the only ones who should matter to them. I believed that they feel so terrible about themselves that they strike out at the ones they are letting down unable to face the truth. The families are left to pick up the pieces of shattered lives and emotions. A father is supposed to love us and protect us. A mother is supposed to support us emotionally and nurture our souls. Husbands and wives are supposed to complete each other, keep us grounded when we get too full of ourselves and build us up when we feel pulled down. Home is supposed to be a place of refuge from the craziness of humanity and obligations. A place where we feel we are able to be ourselves and be loved despite ourselves.

I did have a place to be myself and I tried to give Jack a safe haven, a place where he didn’t have to worry about the outside world and his past. At times it seemed impossible but still there was a bond between us that existed before the illness was into full swing, before all the tragedies happened. We are not married in many senses of the word but the one that matters most of all to us, a bond that is strong.

The woman who wrote this is tremendously compassionate and knowledgeable about PTSD and veterans.  She is warm, caring, and selfless about sharing what she knows with others, and openness like this is only part of her "secret sauce" for helping veterans and their families cope with the many unforeseen difficulties of PTSD.

Attemping to Cover Up the Pain Like a Blanket

More reflections from Claude Anshin Thomas:

 

"So you see that the war is not over; it never ends.  My involvement in this war has scarred me in many wars.  It scarred my body, it scarred my heart, it scarred my soul.  The reality of this war lives with me today.  It doesn’t go away.  There is no sense trying to hide it, because war does not go away.

 

 

 

 

Vietnam was the first war after which society could not sweep its soldiers’ pain and anguish under the carpet of heroism and adulation.  The defeat and shame of that war have allowed us to see more truthfully the defeat and shame of all war and all violence, but Vietnam veterans have paid a heavy price for this truthfulness.

 

 

 

The embrace of family and friends and the celebration of ticker tape parades can seem to justify much hardship and cruelty.  But as I have been able to interact more and more with people of my father’s generation, I have discovered just how many veterans from the Second World War spent their entire lives isolated from their families, suffering in silence.  They have spent endless hours in the garage or the basement alone, many of them – like my father and other veterans I grew up with – attempting to drink away the guilt, the shame, the confusion, the fear, the anger, all the feelings of lack of feelings that are the reality of war.  These men are trapped in a code of silence, and many of them are dying there.

 

 

 

The military teaches you to dehumanize, but much in our society also teaches us to dehumanize.  And once you dehumanize, once that becomes a habit, it doesn’t change easily.  When we dehumanize others, we lose our humanity.   This doesn’t just happen in the military: it happens through television, in the movies, in the magazines; it happens on the street; it happens in stores and in the workplace.  Those who haven’t served in the military are confronted with very similar kinds of issues.  Think of those shootings in schoolyards, people beating someone [else] to death because the person is gay, road rage.  Even just shouting at someone in a checkout line because we can’t tolerate the uncomfortable feelings that can arise when we have to wait. 

  

 In many life experiences, we are dehumanizing others and being dehumanized The war in Vietnam, the war in the Persian Gulf, the war in Kosovo, the war on the streets of [South Central] Los Angeles, Hartford, Denver, Cleveland, or any town, the wars that take place in our homes – what are the seeds of those wars?  Vietnam is only an expression of something that beings inside each and every one of us, male or female.  We all possess the seeds of violence, the seeds of war.

 

 

When I entered a rehabilitation center for drug addiction in 1983, I was able to stop using drugs, stop drinking.  After I stopped using drugs and alcohol, the obvious intoxicants, I began to be able to learn what the other intoxicants were that were preventing me from looking at myself.  And I began to stop using those things also.  I stopped using caffeine, I stopped using nicotine, I stopped eating processed sugar, I stopped eating meat, I stopped going from one relationship to another.  I kept coming more and more back to myself, in my commitment to heal, even though I did not understand (in any intellectual way) what it was that I was doing.

 

 

In 1990 it became impossible for me to hide from the reality of my Vietnam experience any longer.  Vietnam was not just in my head; it was all through me.  I had talked intellectually about Vietnam, but I had never fully opened myself to the totality of the experience.  Now the pain reached a point where it was so great that I only wanted to hide from it, to run from it yet again.  My first thought, of course, was to get drunk.  When I drink, it covers the pain like a blanket.  But under the blanket, inside me, is full of barbed wire; every time I move it cuts at me, tears my skin.  When I drink, I have the illusion that I have put a buffer between my skin and the barbed wire, but this is not the truth; when I am anesthetized, I am just not so aware of the ripping and tearing…"

 

--  from At Hell's Gate: A Soldier's Journey from War to Peace, by Claude Anshin Thomas.

Accessing Your Built-In Healing Mechanisms after Combat

It's safe to say that Patience Mason is a one-woman, cottage industry of helpful materials about dealing with PTSD.  Married for umpteen years to a Vietnam veteran with PTSD (Robert Mason, author of Chickenhawk), Patience has learned many life lessons of tremendous value to veterans. Along with Kathie Costos, Aphrodite Matsakis, Ph.D., and a few others, Patience Mason is one of the women who've given the most to helping vets and their families to recover from "combat trauma."  Read her helpful suggestions, below, and notice the emphasis on mind-body medicine, and in particular, mindfulness meditation.

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"Since PTSD can also be triggered by subsequent events throughout the rest of your life, it is wise to learn how to heal. Many older veterans have lost their friends and families because of the struggle to hide symptoms and seem fine. The current war has also re-triggered PTSD symptoms in many older veterans because they remember. They know what you’re facing. If this has happened to you, don’t think treatment didn’t work. It worked before and it will work again. Go back for more.

Each symptom of PTSD develops from a bodily-based, God-or-evolution-given built-in survival mechanism, designed to keep you alive. We all have these survival mechanisms, and if we had been through what you have been through, we would also be affected. You learned these survival mechanisms under the hammer of war.

When you are ready to get better, you have to learn what they are, when and how they are useful, and new skills for when they are not. Each met a need, usually for survival, and finding other ways to meet your natural needs for safety and security is the job of recovery.

We also have built-in healing mechanisms. Attention (eye contact, being listened to, receiving empathy and respect), telling your story, safe touch, acceptance (bad things happen; they are painful), crying, making a contribution (working for the common good [altruism] and to support your family), justice, and spirituality are some of our built-in healing mechanisms. Our culture finds some of them awkward.

While avoidance strengthens and perpetuates PTSD symptoms, it is much less painful than the work of healing, especially if you have lost buddies, your sense of yourself as good or competent, and/or have shame or guilt or despair associated with the trauma as most people seem to. Somehow feeling like it is your fault, and if only you had done something, it wouldn’t have happened, makes you feel less powerless. The essential ingredient of trauma, however, is that it is overwhelming and you are powerless. No one can stop bombs or bullets with if-onlys. Many people spend their lives after trauma waiting and wishing for a better past, instead of working through the pain and anxiety for a better future.

Exposure is the basic task for healing PTSD. It teaches the parts of your brain that don’t speak English and can’t tell time that it is over. Exposure to what you are avoiding in small safe doses with a trained trauma therapist makes a huge difference. Often this is telling parts of your story again and again so that details come back and you can comprehend the whole experience. If you want to avoid these details because you think whatever happened was your fault, talking can help with that, too.

Most vets feel that if they ever let themselves feel, it would destroy them, but numbing bad feelings means the good ones are gone, too. Healing means you learn how to sit with a feeling and let it peak and fade, so you can process your memories. You went through hell. The feelings will hurt, but they will also pass eventually. Your therapist can teach you how to identify your feelings, that you are not your feelings, and that other people can have different feelings without either of you being wrong.

You can even learn to go in and out of numbing, since it can be handy, as can many of these survival skills. If you have developed an addiction to help you maintain numbness, you probably need to get clean, sober or abstinent from the substance or behavior.

The best way to deal with non-verbal memories is to move them from the non-verbal parts of the brain up to the frontal lobes and turn them into narrative memories, in other words: remember. Writing and rewriting something that happened to you is one way of doing it. Talk therapy is another. You get to tell your story. This is painful but you made it through the event, and you can make it through the memory.

For hyper-arousal, I always suggest basic un-training. Every soldier I’ve ever met thinks the military taught him to take care of himself. “Oh, really?” I often say, “So you used to say to your drill instructor, ‘Sorry Sergeant, I can’t do that. I need a nap.’” This usually gets a big laugh, but that is the kind of self-care you need to learn. After you have been to war, there are some things you simply can’t do. Sometimes it’s parties (don’t bunch up), cookouts (burning flesh), family fights. Sometimes it’s “Don’t ever come up behind me and grab me.” Whatever it is, learning to speak up is important. You have to learn self-soothing methods, so you’re not always yelling and angry.

You have to expose yourself to triggers in small safe doses, too, so they lose the power to trigger you. Learning that what triggers you is not necessarily dangerous here is also important, so your family doesn’t have to avoid your triggers.

Learning to meditate helps with these tasks and keeps you present in the present. The book Wherever You Go, There You Are, by Jon Kabat-Zinn helped Bob a lot. He also reads Thich Nhat Hanh. [Editor's note: Claude Anshin Thomas likes his work very much.] You may also find ways to heal your body’s constant state of tension through somatic therapies or yoga.

You may have to heal your beliefs. During extremely traumatic events, such as having a buddy die in your arms, or get killed when you weren’t there, people often decide “I will never love anyone again” or “I should never have left” or “It’s my fault.”

Other beliefs that can interfere with healing and with everyday life include ideas like “Don’t talk about it,” “Only weaklings and whiners ask for help,” “You can’t trust anyone who wasn’t there,” and its converse, “You can (and must) trust anyone who was there.”

PTSD can make you feel totally out of control. By choosing to take new actions which have worked for others, you can regain that sense that you are in charge of your life."

-- Home from War, by Patience Mason.

 

Between the Sheets: Healthy Sexuality for Combat Veterans

This is going to be the beginning of an extended cycle of posts on "healthy sexuality for combat veterans," a subject that desperately needs to be addressed.  There's too much to cover in just one sitting, though, so stay tuned for a few here because we're first going to have to cover the problem, in depth, before we can turn to some of the solutions.  It's really pretty surprising that no one is talking about this stuff professionally -- other than the veterans themselves, if they can ever work up the courage to.  So here goes. I have my "focus group" of veterans: they're telling me what they want to hear discussed out in the open.

You'd be surprised, as I was, if you reviewed the literature on veterans and PTSD, and found literally almost nothing written on this subject. Well, unless you count references to "sex addiction."  Addiction, really?  That's apparently a tell-tale marker for chronic PTSD.  Ahhh...but thankfully "sex addiction" isn't all that firm a professional diagnosis.  What seems like addiction to one, seems like the actual engine of life, to another.  And fortunately we're able here to consider both perspectives as we talk about it.

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Here's one of the best items we've found in the literature, and it's from Aphrodite Matsakis, Ph.D.'s book, Vietnam Wives.  It talks about sex for the veteran with PTSD as "the total stroke."  Here goes:

"On one level, this intense need for sex [on the part of the combat veteran] can be related to the veteran's loneliness. Socially isolated people are often lonely. Although they may desire to be separate, their isolation often results in their becoming "stroke deprived" -- they do not receive the smiles, the hugs, the compliments, or any of the visual, verbal, or physical recognitions (strokes), large or small, which naturally come about when with supportive others. In this state of deprivation, the vet may turn to sex to meet his social and relationship needs. Sex becomes a substitute for in-depth emotional communication, or even casual socialization.

One vet called sex the 'total stroke.' For a long time, he believed that sex would satisfy all his hungers -- his hunger for sex, as well as his hunger for human companionship and intimacy. Like many persons, he confused sex with love and emotional closeness. When sexual activity without communication left him unsatisfied, he increased his sexual activity. Even after more sex, however, he still felt restless and empty inside. Eventually he found that some communication with his sexual partner and more time spent socializing with others, not more "pure sex," helped satisfy him.

On another level, the vet's need for sex can be intense because, biologically, sexuality is "the antithesis of anxiety." As has been repeatedly proven in studies of both men and women, anxiety interferes with sexual performance, especially with orgasm. Conversely, it is difficult, if not impossible to be anxious while highly sexually aroused. Hence, for some vets, sex is more than sex. It is a form of tranquilizer or sedative for their anxieties and other tensions. Not only does sex provide a sense of physical peace, but an emotional peace as well...in this sense, sex can be used like a mood-altering drug."

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Says Jonathan Shay, M.D., Ph.D., in his book, Achilles in Vietnam:

"The overwhelming majority of combat veterans whom I have known are painfully aware of the absence of intimacy, tenderness, light playfulness, or easy mutuality in their sex lives. For many, sex is as sure a trigger of intrusive recollection and emotion from Vietnam as the sound of explosions or the smell of a corpse. Sex and anger are so intertwined that they often cannot conceive of tender, uncoerced sex that is free of rage. When successful treatment reduces their rage, they sometimes report that they have to completely relearn (or learn for the first time) the pleasures of sex with intimacy and playfulness."

(To be continued...)

Shaking Off the Blues: Two New Books Help Veterans and Others Get "Unstuck"

A well-regarded psychiatrist who thinks there are other-than-pharmaceutical antidotes to biochemical depression?  Rank heresy!  Oops, actually we meant -- how very refreshing indeed. 

A soulful journalist who's lived and worked in war-torn countries, and knows what it's like to be a survivor -- who then turns her attention to helping veterans and their families come home from war and rebuild the pieces of their often-shattered psyches? Again, a wonderful suggestion.

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NPR the other day published a great interview with none other than James S. Gordon, M.D., author of the new book called "Unstuck: Your Guide to the Seven-Stage Journey Out of Depression." Depression is an important topic, because many people who are risk for suicide have depression as an underlying state.  According to one psychiatry textbook for medical students, "A majority (60% to 80%) of people who commit suicide carry a diagnosis of depression."   

If you remember, we've talked about Dr. Gordon on this blog before.  He has an impressive, very talented background academically (Harvard College, Harvard Medical School), and is the founder of the Center for Mind-Body Medicine in Washington, D.C., as well as a frequent lecturer at the Smithsonian, and the former chairman of the White House Commission on Complementary and Alternative Medicine, also known as "CAM."  (We've blogged about CAM, also known somewhat misinformedly as natural medicine, and its opportunities for treating PTSD here on the blog, at length here; and also about the varieties of mind-body medicinethat might show some promise for treating combat trauma and PTSD, here.)

To listen to the NPR interview, or to read the accompany material on getting unstuck -- in Dr. Gordon's words -- click here.  To read Dr. Gordon's bio -- click here.  To read our previous posts about his work on "Healing the Wounds of War," click here; on "Healing the Troops," click here; and on his and the Center for Mind-Body Medicine's annual conference, planned for October 25-29th in Minneapolis, Minnesota this year, click here.  The topic of this year's conference is the highly-appropriate "Integrating Mind-Body Medicine into Clinical Practice, Medical Education & Trauma Healing."  As Dr. Gordon's website says, "We're teaching thousands to heal the world's millions." Indeed -- and what a noble task that is; and how very, very vital.

If I had ONE RECOMMENDATIONfor the Pentagon, the DOD, the VA, the various branches of the military (Army, Air Force, Navy, Marines, National Guard) that frequently comb this site, looking for answers to the questions they have -- it's that they would get to know Dr. Gordon's work, and send representatives to this conference in late October, 2008.  Check into mind-body medicine, with a credible expert, and somehow who's already worked with, and proven his work with, the war-torn and traumatized (troops and civilians) here and abroad.  Broaden the outlook on how to treat PTSD and combat trauma, by returning people to themselves, and helping them to learn to manage their own stress in creative and supportive ways.

Dr. Gordon says his book, Unstuck, goes into many of the same principles that his trauma work does. I can't wait to start reading my copy, which his office promises to send.

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In the meantime, I hope Dr. Gordon gets to cross paths professionally with Minnesotan Britta Reque-Dragicevic. I have read her book-- devoured it in one sitting is the more accurate description -- and think it has lots of potential to comfort, support and nurture returning veterans and their families in putting the pieces of the puzzle back together.  (One thing I love about both Dr. Gordon and Britta Reque-Dragicevic -- they both "get" it.  They've had a personal experience with what they're talking about; it's not just academic.  And they're both driven to help others heal from their suffering -- the not exactly unspoken single purpose of this blog: there's synchronicity.)

Reque-Dragicevic has written a completely soulful manual on getting unstuck herself, and with her profound understanding of the needs of trauma survivors, as a longtime journalist in post-war Saravejo and Bosnia, I sense a little (**magical?!**) professional matchmaking going on that would only serve to increase the amount of healing and overcoming in the world, especially among trauma survivors and veterans with PTSD.  If you want to read more about Reque-Dragicevic's marvelous book, Close to Home: A Soldier's Guide to Returning from War, click here.  Her book is endorsed and recommended by Dr. Edward Tick, among others.  At a mere $10 as a download on the Web, you really can't go wrong.  (We'll be quoting from Reque-Dragicevic's book on this blog in the future, with her permission, because it's wonderful stuff and she really "gets" it. Veterans and their families need to experience this.)

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If you have $10 to spare, or as a gift for someone else, buy Britta Reque-Dragecivic's book.  It's a download, and you can have it in your hands within minutes, from anywhere in the world, and start the healing process today.  If you have about $18 and shipping, buy Dr. Gordon's book, and start the healing process when it arrives in the mail -- or at your local bookstore.  If you have about $40, buy them both :-)

Transforming the Scars of War from Within

Considering that we're often used to looking for solutions primarily from outside ourselves, instead of doing the often harder work of looking within, here are two interesting meditatations on what "scars" really are, and how they affect our lives.  Scars such as the ones we receive from war -- the external, obvious ones; and even the internal, less visible ones, which often mark us as profoundly.  How do we come to grips with being scarred, and yet move forward in our lives effectively? 

The first passage is by a Vietnam veteran, Claude Anshin Thomas, who has studied with Thich Nhat Hanh, and the other is by Den Ming Dao, a classical Taoist scholar, poet and artist.

First, Claude Anshin Thomas:

Our suffering is not our enemy

“Society teaches us that suffering is an enemy. We are constantly encouraged to reject what is unpleasant, disappointing or difficult. “What’s all this suffering? Let’s be happy! Have fun!” But our suffering is not our enemy. It is only through a relationship with my pain, my sadness, that I reach the other side, that I truly can know and touch the opposite, which is my pleasure, my joy and my happiness.

“I often relate to my emotional suffering as though it were a physical pain. When I feel physical pain, society pushes me to take mediation to relieve it, not to touch it, not to explore it or seek to understand it. I am conditioned to make every effort to avoid discomfort. I went through a long period of my life living from this conditioning. I took a lot of drugs, so many that I couldn’t feel my physical pain or my emotional or spiritual pain – at the same time, it was also impossible for me to touch genuine joy, or healing, or anything at all. It was just impossible.

“My body is covered with scars from my wars. Every time I look at my body, touch one of these scars, I touch against the reality of war, and when I touch the reality of war, I touch all the suffering that is intrinsic to war. In the past, when I felt pain from a scar, I tried to repress it, to hide it from myself. But the physical wounds are not the most significant wounds of war. The wounds of the soul, the spiritual wounds, the emotional wounds – they are far deeper, though less obvious. And they are much more unpleasant to look at.

“Can I imagine a time in the future when these scars and these experiences will dissolve, drop away, so that I will finally be free? This is not actually a condition of freedom. I’m free right now. Because I can acknowledge that the scars are there. Because I no longer wish for them to be any different from what they are. Don’t get me wrong. I spent a long time wishing that the scars of my life would just go away. But the more I wished for this, the crazier I felt. Because the reality is that my scars are part of me, like my own hand. I needed to learn to acknowledge them and to live with them in peace and harmony.”

-- At Hell’s Gate: A Soldier’s Journey from War to Peace, by Claude Anshin Thomas. Boston: Shambala Press (2004).

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And now, this by Den-Ming Dao, author of the superb book of daily contemplations, 365 Tao, which always start with a short poem:

Markings in dry clay disappear
Only when the clay is soft again.
Scars upon the self disappear
Only when one becomes soft within.

Throughout our life, but especially during our youth, many scars are inflicted upon us. Some of them are the results of violence, abuse, rape, or warfare. Others arise from bad education. A few come from humiliation and failure. Others are caused by our own misadventures. Unless we recover from these injuries, the scars mar us forever.

Classical scriptures urge us to withdraw from our own lusts and sins. But scars that have happened through no fault of our own may also bar us from spiritual success. Unfortunately, it is often easier to give up a bad habit than to recover from the incisions of others' violence. The only way is through self-cultivation. Doctors and priests can only do so much. The true course of healing is up to us alone. To do this, we must acquire many methods, travel widely, struggle to overcome our personal phobias, and perhaps most importantly of all, try to acquire as few new problems as possible. Unless we do, each one of them will bar us from true communion with Tao [the life force].

-- 365 Tao, Den-Ming Dao.

Swift Silent and Deadly - That's First Recon Marines - But It's Also Combat Trauma and PTSD

"Make that -- 'Swift, Silent, Deadly' -- and ridiculously hottt!"

That's a modified Paris Hilton-ism, we know, but... of course we're talking about Rudy Reyes, former 1st Recon Marine, playing himself on the HBO series, "Generation Kill," from the book of the same name, by Evan Wright. (If you've read Nate Fick's wonderful book, "One Bullet Away: The Making of a Marine Officer," you've also read about Rudy Reyes in that.)

We've written about Rudy Reyes before on this site; and we're secretly chuckling about how absurdly many people worldwide are searching for -- literally -- ANY scrap of news about The Hotness That Is Rudy-- or preferably any pictures.  His own website seems to be "under construction" -- let's hope it gets online soon to satisfy the teeming hordes of fans, internationally.

In the meantime, though -- it's important to remember that Rudy has seen and done, many many things in his time - in battles in Afghanistan and Iraq.  First Recon Marines are known as "Swift, Silent and Deadly" ... and if you think Marines in general are ROCK STARS (we certainly do -- our friend the Beautiful Redhead, married to a Marine officer, gave us a T-shirt that said just that) -- well, Recon Marines are all that and then some.  It's the most physically, emotionally, mentally demanding job in the Marine Corps.

If, while you're waiting around for Rudy Reye's website to become active, or learn more about his "Hero Living" DVD series planned -- you might want to take a few moments and educate yourself more fully about some of the downsides of being "the best of the best" -- it's the PTSD that can come from the obscene amounts of combat and arduous undertakings you're exposed to.  The good news is that not everyone gets PTSD.  The bad news is, the chances of it increase with exposure to combat trauma -- and, for those whom it affects, it's a battle harder than any fight they've ever had.

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Rob Honzell, who, like Rudy Reyes, was also a Marine sergeant in First Recon -- but in Vietnam -- has written a good book about his experiences.  He calls it "First Person: Combat PTSD," and it's pretty eye-opening.  I had it on my bookshelf for quite a while before I opened it and really gave it a read -- but when I did, I couldn't put it down.  Rob in the meantime has become a friend, and frankly I was feeling guilty about not having taken his book more seriously; so I did.  It's quite a book.  

If you know Rob at all, you know that the reason he's willing to plumb the depths that he has in this book, and draw water from the deep end of the pool, is because of his deep, abiding and heartfelt concern that veterans today not have to go through what he's gone through as a combat veteran with PTSD.  Rob spent "one year, seven months, and twenty-one days" as a Recon Marine in Vietnam -- and has fought courageously ever since, to keep a toehold in the land of the living, and the land of the sane.  For anyone who thinks that Vietnam vets with PTSD just check out of life and don't contribute to society, Rob isn't in that mold.  He had his fun -- years as a traveling musician in Canada (he was a drummer in a bar band) -- but also his serious side -- decades spent in law enforcement as a police officer, police chief, K-9 officer, and criminal justice teacher.  He's completed his master's degree, and is struggling to complete a Ph.D. in psychology -- so that he can help other veterans, with PTSD. 

First, though, he has to get his own case in check, and that's been an arduous battle since Vietnam, where the nightmares and hallucinations started, while he was still in combat.  Killing dozens of people, up close and personal has left its mark -- in his book he gets wistful over snipers having it easier, because at least they kill their targets at a distance, and don't have to get soaked with their victims' blood, or watch them take their last breath, from inches away. By the end of the book, when you realize how many people Rob killed in combat, and then also realize the kind, caring person he is (evidenced by his work in law enforcement, for instance -- his book shares some good stories about that) -- you can see why his experiences in Vietnam got to him. 

On the one hand, he was at the top of his game.  His prowess in Okinawan karate gave the Marines an opportunity to further hone his skill as a killing machine; and his overall smarts helped him to be a very strategic, effective one at that.  But one thing comes through loud and clear in his book: that the innocent, 17 year old boy who joined the Marines straight out of high school, and later raised his hand to volunteer for Recon, when the call went out -- that boy not only died in Vietnam, that boy had literally no idea what he was getting himself into. 

Was 40 years of nightmares and the torture of a PTSD-wracked life, with all that that entails, a "fair trade" for not even two heavy-duty years in Vietnam?  That's a tough one.  How about the health problems, coping struggles, failed marriages, hard relationships with children, and simple fight for sanity and survival?  Rob carries the memory of the people he killed, and the way he killed them, every day.  I think that's part of how you can tell he's a "good person" -- because it still bothers him -- in fact it started bothering him at the time.  But of course he had to suppress that, a) to survive and b) to continue to do a good job.  Ever since, though, those memories have been a constant companion, despite the amount of good he's done in his life, and continues to do.

He writes poignantly in the book about that 17 year old boy, who's long gone by now, except in spirit, as he talks about what he imagines the "end of the road" will be like:

"I don't know when or where my journey will end.  You don't terminate dozens of people's lives and not have to stand in front of God and ask his forgiveness.  I have used, and I have been used, in my life; and I'm sure I'll have to answer to God for that also. I know it sounds weird, but I hope to go into heaven as that 17 year old boy that was always smiling, laughing, loving, and full of life..."

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I have to say, because I've come to really care about Rob, I sure hope his "exit" isn't anytime soon.  But it's impossible to learn his story and not realize how high a price veterans can pay, in service to their country.  And the more intense the service -- like Recon Marines -- the more intense the price they're likely to have paid.  They deserve our respect, and honor, and with that, our compassion. 

In the civilian world, there's a concept called "Informed Consent." If someone informs you of the risks, say of surgery or medication, you can always evaluate them and decide pro or con.  Then, if something comes back to bite you later, at least you know that you were warned ahead of time, and made your own decision.  In the military world, obviously, not so much.

I seriously doubt that if any commanding officer had explained to that 17 year old guy at the time, "hey, you look to be in great physical shape, how'd you like to do a super-demanding job for us that's called being a Recon Marine" -- and then explained what the human cost of suffering would entail, for the next 40 years of his life -- that he'd have had any takers. I wonder sometimes whether even the officers knew what the costs would be for the recruits.  In any case, it's been one hell of a journey for Rob, during which he's contributed quite a bit of good to society, and also never been able to fully and completely manage the horrors of what being a Recon Marine exposed him to. 

I have to say, I'm proud of him for what he did -- both as a Marine, and as a veteran -- to do his job, no matter how terrible, excellently at the time, and then afterwards, have this considerable desire that other veterans not have to walk the same incredibly difficult path he's walked.  It's an honor to be his friend, and I hope that somewhere in the bazillions of hits from people wanting to find out about one former Recon Marine -- Rudy Reyes -- that they take the time to also learn about the life and struggles of another former Recon Marine -- Rob Honzell.  They're both worthy of our attention; but I wonder -- will they both receive it?  If you haven't picked up Rob's book, it's a short but effective education in what it takes to serve our country, and the cost that can exact from the veteran, in very human terms. 

I learned just the other day that Rob's counselor at the VA is hoping to recommend his book to all her patients who are combat veterans.  That's a nice, and belated, testament to the caring heart behind this warrior: someone who's willing to pull the skeletons out of his closet, in the hopes that more recent veterans, and their families and caregivers, will understand more quickly the tremendous costs of combat trauma in terms of human suffering among the participants.

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Rudy Reyes is also a gem: someone who's had a hard life and made much of it, given it his all, and is pretty much poised right now to be a star.  I know he knows firsthand the challenges of extreme combat, as a Recon Marine.  I hope that he will use some of his burgeoning celebrity power and charisma for good -- lending his influence for issues that concern wounded Marines and other servicemembers, like combat PTSD.  Like Rob Honzell before him, and his prowess with Okinawan karate, Rudy's facility with martial arts has been a big part of his success, and where he finds some much-needed personal balance. 

Wherever life takes these men, I hope that others will continue to be blessed for knowing them, and for the substantial contributions they have made, both in service to their country and beyond. In Rob Honzell's case, with the publication of his book devoted to making clear the lifetime cost in suffering from just one former Marine's longtime battle with PTSD, I'm pretty sure we already are.  Thank you, Rob.

There's a Revolution Going On: Users Rate Their Drug and Non-Drug Treatments for PTSD

We're just about to wrap up our series here -- a cycle of blog posts about the various treatments available for PTSD from the pharmaceutical, Complementary and Alternative Medicine ("CAM"), and mind-body medicine worlds. We've talked about bodywork therapies that show promise. Heck, we've even talked about street drugs like marijuana and ecstasy that appear to have some beneficial effects as well! (Sheesh -- we're not recommending them, per se -- we're just trying to do a comprehensive look at everything reasonable that's out there, that might help sufferers.)

We started this cycle of blog posts back in the beginning of June, with one about how the military was expanding its concept of treatment options to include some "revolutionary" non-drug approaches, linked here.  (We'll add to the cycle of posts over time as the need indicates, but the bulk of it is already done on this topic. This post also builds on a previous post, which talked about how a layperson can learn more about the effects and side-effects of medications prescribed, as well as where to learn about possible warnings when used in combination with other medications.  That post is linked here.) 

One of the most interesting developments is something I get to share with you now -- that a year or so ago when I first learned about it, was not robust enough to be of much value to PTSD sufferers.  Perhaps by now it really is.  The "it" I'm talking about here is something called "Revolution Health," the brainchild of AOL co-founder and marketing genius Steve Case, a project he began in 2005, after he left AOL.

Revolution Health is a number of things, but particularly for our purposes here's it's an online "community" of other patients who give their impressions, pro and con, of the treatments they're using for various illnesses and conditions -- including PTSD -- and not just of all the popular pharmaceutical medications, but also the non-drug therapies as well.  Finally, in one place, patients can check out what other people's experiences of the same drugs or therapies they've been prescribed, along with more straightforward information about the treatments themselves, the possible side-effects.  Clearly, for something like this to work, there need to be a LOT of people checking in and providing their impressions. 

When I first checked out the site, those numbers just weren't there.  It's not so exciting, interesting, or frankly even helpful to learn what three people think of a medication or a non-drug treatment like acupuncture or craniosacral therapy -- it gets a LOT more interesting as more people participate.  Such seems to be the case these days (no pun intended) -- but act quickly -- the site has been experiencing layoffs, and with Web businesses, even those founded by geniuses like Steve Case, you never really can count on how long they'll be around.  So be sure to check out what interests you while you still can.

This is what the site said a year ago about itself, which is still good advice:

This service is in its infancy, but our philosophy is that if millions of people participate, it will emerge as a useful tool for people as they consider their treatment options. Please note that treatments include a mix of some that are designed to directly treat a condition, some that treat side effects, some that provide symptomatic relief.

While individual real-life experiences can be a valuable health resource, they must be viewed in the context of evidence-based data and are not a substitute for medical advice. You should always consult a qualified health care professional before beginning, changing or stopping a treatment.

Now let's get down to business:

Want to learn how other participants rank, rate and review the various treatments for PTSD, both drug and non-drug? (Currently there are dozens suggested!), say, Duloxetine? Click here, for a list of the various, searchable treatments. (Better yet, click herefor them ranked by users in order of effectiveness!)  Want to take a look specifically at the pharmaceutical drugs for PTSD? Click here.  How about the various non-drug treatments for PTSD?  They're there, too, by name.  (You can sort either set of results by "most helpful," "most recent," and "highest effectiveness" on any individual treatment (of the 363) or on the category as a whole.)

Note: Be aware that not everyone who's weighing in with their opinion on what treatment they're loving or hating for PTSD has combat trauma-induced PTSD.  They may have PTSD from some completely other cause.  However, as far as relatabilty goes, this is the best we're gonna get for now -- a "Revolution Health" for veterans only does not appear to be in the works.  Ahhh, but we can dream, can't we?!

To reinforce the warning, though -- given the fact that nothing's permanent on the Web, especially "revolutionary business models," get in -- get your information -- and get out -- in case the website goes away, and/or the company goes out of business.  We sincerely hope that Revolution Health sticks around, because it's performing a useful AND innovative, visionary function --  but even more than that, we want YOU to get the information you're looking for, while you still can.  Oh, and if you sign up to be a member -- I believe that it's free -- you can also contribute your ratings to the user-generated rankings.

There's a Revolution going on...in health care.  Get yours now, while it lasts.

Editor's note: The usual "yada."  Be sure to consult with a qualified health care practitioner before changing or implementing a course of treatment, to make sure that the choices you make are appropriate and best for you.  We are presenting this material as information only, and it's not to be construed as medical advice.  If we could, we would; but we can't, so we won't.  There, we've said it.

Doing My Time in Hell - War Just "Dirt, Death, Misery and Guilt," Not Glory - Say Veterans

This photograph of an American soldier displaying his ink about combat is by the noted photographer Zoriah, and is used with permission of the photographer.  (Zoriah's blog is linked here.) 

The tattoo reads: "Walk peacefully on heaven's streets,You've done your time in Hell."

Ahhh, if it only were that "easy." 

I've been keeping one eye on Zoriah's situation lately -- he's the embedded humanitarian war photographer whose iconic images of the true horrors of war apparently got him kicked out of Iraq -- and the other on some writing of Vietnam veterans, all of them Marines (but not for any particular reason), about what it was really like to "be there."  The outcome of my faux research?  Sounds like up close and personal, war can be plenty of "guts," but not necessarily all that much "glory."

"The flashbacks and the hallucinations manifested themselves while I was still in [combat], says one Vietnam veteran, adding, "They have stayed with me for the last forty years." (Rob Honzell, 1st Recon Marines. Rob Honzell's memoir is "First Person: Combat PTSD.)

Another Vietnam veteran questions why Americans reflexively call servicemembers who die in combat "heroes."  He writes,

"Heroes?!! I served two tours in Vietnam including the Tet Offensive of 1968. I killed someone -- a NVA solider -- I was elated -- but years later, I can still see my round hitting this guy. I never see any heroism in war -- just death, dirt, misery and guilt. I have never met a soldier or Marine who felt heroic. We do our jobs to protect our buddies and we want to get home and live our lives as ordinary men not as heroes. When you smell death you no longer have a glorified sense of war. There is honor and duty, but to kill or be killed does not make you a hero. I feel for these young people and their families -- but war and combat are not heroic actions -- they are doing a job and getting home."

(Or hoping to.)

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I've been reading voraciously the accounts of the Marines who survived the ferociously fought battle for Hill 881, part of the battle for Khe Sanh in 1967 -- a particularly vicious conflict.  (You'll find out why, in a few posts, but not right now.) 

One Marine captain writes about his guys, from there:

"As far as the individual Marine goes, I think I learned to respect the individual Marine -- the 18-,19-, 20-year-old, more in this one particular battle than any other time that I've been in the Marine Corps. He was given a job; he went up in the fact of danger, in the face of just being blown away, more or less, and he went up and did his job. To see the faces of the Marines dragging back their dead buddies, their wounded buddies, you could see how close the Marines really were with each other. It was true brotherhood, and I was really proud at the conduct of the Marines." (Capt. David G. Rogers, C Battery, 1/12 Marines.)

Says another Marine, reflecting on his part in the vicious battle for Hill 881 -- "I should have cried" (at the time), but I didn't.  I didn't have time.  I would cry later, and when I did - the tears would never completely stop..."

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It doesn't sound like war has changed all that much.  Remember Ambrose Bierce, Civil War era journalist and soldier, who we talked about a few weeks ago?  He wrote at the end of his highly-charged battle memory / short story, a line -- speaking about himself, after what he'd observed and taken part in -- "the life I should have thrown away, at Shiloh." (Bierce went on to stir things up for a few more years, though...)

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A current veteran and fellow fan of Zoriah, now studying social work in an attempt to ease the burden of his fellow PTSD sufferers, has this to say about combat trauma, on his blog, "PTSD - a Soldier's Perspective," linked here:

"We tell a soldier or veteran of war "welcome home" because the battle never leaves us, as we return from conflict everyday of our lives. This is my story and struggle with PTSD, it affects every aspect of my life. I want people to know what a combat veteran goes through after the media and people forget."

And later:

Taking another's life in the name of freedom, patriotism and because of your job description profoundly changes the person. How do we reconcile the killing of another human being and still maintain our principles and values? Someone who has not done so can say all they want about what they think or believe. When a soldier goes home to his or her family, friends and community, how do we relate to people who expect the person that is no longer us? How do we tell them that each time we took a life that, we too died in spirit a little more? They congratulate us on a job well done and we tell ourselves that we did our job, what we were trained to do. They tell us how proud they are, and we cannot make them understand how we feel guilty for that pride. How do we tell them that we cannot get those faces or images out of our mind?

Dirt, death, misery and guilt -- that's a heavy, heavy burden for any one person to share.  Let's hope we shoulder it with them, and NEVER forget.

We Made History Together: The Oral and Written Histories of Combat Veterans

Combat veterans - where did your memories go?  Not as in, "have you lost your memories?" but more to the effect of, "how are you saving them or transmitting them, for posterity?"

This marvelous photograph was taken by photographer Jeremy Hogan, and is used with permission. Hogan wrote the "Poem for My Father" which we blogged about earlier, and in his free time, he's helping to document the history of his father's squadron in Vietnam.  He says about this photo, taken over Memorial Day weekend, that the subject is, "Ron Klus, who served with my dad at Quan Loi, and received a Distinguished Flying Cross with an Oak Leaf Cluster. Unfortunately, Klus died due to issues related to his PTSD and now the VA is now denying his widow death benefits."

Recently, I've been privileged to receive several veteran's memoirs, bound up in book form -- one is a work in progress, the other already published.  I know that Jeremy is working with at least one of the guys from his dad's old squadron (13th Signal Battalion, part of the 1st Cavalry Division Airmobile), a combat photographer who did multiple tours of Vietnam, on cataloging his old photos, and creating some sort of archive for posterity.  That photographer says he's been interviewed as well, and is the subject of an upcoming article in a military magazine, but admits that dredging up the memories has been extraordinarily painful, because all those memories just come rushing back, from where they've been suppressed all these years.  That situation is challenging enough -- but what of others, who will die before they set anything down on paper, or on tape, about what they went through?  Those memories, painful and otherwise, which capture who the person was, will forever be lost to time. Unless...they're preserved some kind of way.

We've written on this blog before about the exceptional StoryCorps project -- click here for that link -- but what else is there out there, that archives veterans' recorded stories of their adventures and misadventures in combat?  (By recorded, we mean "set down" -- which could be on paper, digitally, or taped.)  One thing I've run across -- and please let us know if you know of other things like this, that are national in scope, not just regional or local -- is the "Veterans History Project," a project of the "American Folklife Center" at the Library of Congress, linked here. 

To participate in the project takes a few easy steps (their words, not mine), and seems pretty straightforward.  You register for the project, print the project field kit, prepare f the interview, conduct the interview, and send the resulting work product to the collection at the Library of Congress (of course keeping at least one copy for yourself).  Students and teachers can make this an educational project for school credit, -- that information is linked here -- but veterans themselves should think about getting involved. There's even a very cool place on the site where you can search for histories by other people who've participated -- for all you know, you might find a wartime buddy via that search engine, which is linked here.

I recently shared a quick conversation and a hug with longtime Friend of Veterans Maxine Hong Kingston, and asked her my one burning question, which was how long it took veterans before they were willing to talk about their experiences.  She said, "20 years."  I'm hopeful it doesn't always take that long -- or won't take that long, for the current crop of veterans -- but when you read some individual's war experiences you can see exactly why that would be. 

Current veterans like Tony Neff, author of the short autobiographical piece on his injury and convalescence, called "All I Want Is What I Deserve," which was published on this blog a few months ago, definitely took the plunge and jumped right in -- good for him. (His story is linked, here.)  I just have the feeling the current group of vets, thanks to the Internet and technology, etc., and their general comfort level with same, is going to break through all previous barriers more quickly with getting their stories told and out there, for the general public and to memorialize what they went through. In fact, it will seem unusual for them not to! 

But for everyone else, from previous wars, it's gonna take a little more coaxing and cajoling. So what of it -- is it time to start getting involved, and sharing with the world what only you know and experienced?  It might even help your loved ones understand you a little bit better -- and in the process, perhaps help you to understand and forgive yourself a little more, too.  Can you hear me cheering you on from the sidelines?  That's good -- because that would be the point :-)

PTSD: (That's Some) Pretty Terrible Sh*t (to Have to) Deal (With), Don't You Think?

Editor's Note: We commemorate the otherwise momentous, historic signing of the GI bill into law today with this little snippet of what life was like for someone who served recently.  For everyone who doesn't "get" what sacrifice is, and that those who've served have earned their accolades and rewards, here's a grunt's-eye view of the experience of combat trauma, and how that relates to PTSD and various other topics in the news.  It's doubtful that any one of us would like to have changed places with him, at such a young age.  Herewith, his story, emphasis mine:

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I'm no Vietnam vet, but a vet of Operation Iraqi Freedom. I turned 18 while in boot camp because I graduated high school at 17. I was discharged early for having "personality disorder" after I went to Iraq.

I was in the Marines, and my MOS was a ground communications electronics technician. A couple months after graduating my training for the job and going to my first unit, I was "volunteered" to join and train with another unit that was leaving soon. The new task I was given was "Mortuary Affairs".

This group was put together with a couple dozen other Marines from other sections. Our job was to go to locations where troops had been killed and not able to be retrieved by the group they were out with due to the fact they were under too much danger or whatever the case. I had no clue the effects this would have on me. It was a horrible experience.

It was not like going and picking up a corpse and that's it. For one, you were in a hot zone, where people were just killed, not just by gunfire.

Here are some brief descriptions of the missions I was a part of...
 

The first one wasn't too bad; the body was actually brought to us at the camp we were at.

 

It was a young male Marine. He was supposedly in a Hummer going somewhere and might not have been wearing his helmet. He had a silver dollar sized hole in the side of his head.

When we get the bodies back the camp we have to take off all materials on the body, and go through and bag each individual body part. It was more of a surreal experience really, I did not know how I was supposed to feel.

Once our troops invaded Fallujah was when things started to get worse. On another of the missions, a truck carrying fuel was crossing a bridge and was shot with an RPG. The truck went off the bridge and fell, the fire burning most of everything.

 

When we went out it was usually just a dozen of us with maybe 2 Hummers of security if we were lucky. For anyone who doesn't know, most the Hummers used were old and poorly maintained/equipped... almost no armor. So we get there and head down to the bottom where the truck fell and we had to pull out burnt bodies from inside of the cabin.

 

It sounds bad, but burnt bodies are almost like burnt food... so perhaps it wasn't as bad as the rest. It did not help our appetite when we had to eat in the same building we processed the bodies in. Our shop was just a medium-sized bunker, no walls or anything so yes we basically ate next to the bodies. It is obvious why some of us didn't eat the meat.

 

The worst mission I went on was when an army tank was traveling down a road and was blown up from a roadside explosive. The bomb was so powerful: you could not identify ANY part of the tank except for the tracks. It had been tossed a couple hundred feet in different directions.

 

It took us I think, about 15 hours to do this mission. There was gunfire when we first arrived but nothing more. I think we picked up a couple thousand pieces of flesh that day. Going through each one individually. They would range from small penny-sized pieces to legs, torsos, heads, feet, testicles, arms, etc.

 

There were a few more missions but we get the idea by now I'm sure. I guess it started to become noticeable that I wasn't doing well. I was taking whole boxes of NyQuil tablets and drinking bottles of medicine to get anything I could out of it at night. I smoked probably a pack of cigarettes a day, which is a lot for me because I have never really smoked more than a couple cigs a day if at all.

 

My officer had me go speak to the chaplain and from there a navy doctor who was a great person to have over there. He pulled strings and had me med-evac'd out of there a few weeks later.

 

In the meantime I had been moved out of my job until I was able to leave. I was harassed for leaving: superiors thought I was just faking to get out.

 

I had become highly depressed and my roommates noticed me screaming sometimes in my sleep.

 

From Iraq I spent a few days at an army hospital in Germany, talking to various doctors and such... going through the process.

 

I was being given pills for depression and for insomnia. Then I made it back to the US and once at my base I was seen by a psychologist. They actually gave me the option to get of the military, so I did.

 

I had been told the process takes several months to year until you finally leave. In the meantime I started drinking daily, and stopped taking the pills they gave me because they seemed to numb my mind and I could not stand it because I have always had such a wonderful and creative mind. It made me feel like a zombie, I could not even create artwork which was my biggest hobby.

 

A month down the road I started having nightmares, very detailed and morbid. A few times I would wake up with tears. I began having suicidal thoughts and crying at least a few times a day. Thank God my best friend was stationed not so far, he saved my life I think.

 

It was hard for me to wake up because of the medicine I had been taking, that’s another reason I stopped it, I was always drained. The first week I was back I never even reported back to my old unit, I didn't know what I was doing.

 

A week later they send somebody to come get me. There, I was harassed and treated like a piece of s%#t some more by my master sergeant. They had me sit in inventory room all day while I struggled to stay awake. I luckily had a very kind staff sergeant in charge of me at the time. He would let me sleep and go home early.

 

I admit I was very lucky in getting out, because it only took me about 2 months until I was officially a civilian again. I was going back home. I stayed with my older sister and her boyfriend at first, because I was not too fond of going back to my parents. My depression got worse and I started to drift further from sanity and comfort; people noticed I was a different person.

 

At this point I started smoking marijuana occasionally. Which was really the only time I felt anything, happy, able to think, speak, talk to people, feel normal.

 

Eventually I moved back with my parents and that's when things got worse for me. I had some additional problems I know was facing, I needed a job, and had people on my back constantly. I had no access to marijuana during this time.

 

My insomnia got to its peak to where I could not sleep AT ALL at night. I also began having more suicidal thoughts, nightmares got worse and I had them ANY time I could sleep which was usually from 7:00 AM to 12:00 PM, began having auditory and visual hallucinations everyday, and constant anxiety.

 

I knew I had PTSD and that the military used "personality disorder" so that they would not take the rap for it.

 

I finally couldn't take the insomnia anymore and was prescribed Ambien, which actually works extremely well and helped get my body back on schedule, only thing is I had to take it for 3 months and then no more because they said it was addictive.

 

So it became difficult without it. I did a long process of seeing doctors and filling out paperwork for the VA and was finally officially a disabled vet due to chronic Post Traumatic Stress Disorder, normally referred to as PTSD.

 

I started to be able to get a hold of marijuana again and when I had it things were more stable. My temper was not out of hand and I could sleep comfortably having less nightmares. At this point I had gone a year or more straight of having nightmares every night.

 

It has been three years now and I am much better. Time has healed me a little and I smoke marijuana as often as I can. I don't have hallucinations anymore, or rarely any nightmares. I do however still have bad anxiety, temper, and depression problems when I'm not high.

 

Another thing I forgot to mention is that PTSD has basically ruined my memory. Since I first showed symptoms until now, my memory does not work nearly as well as it should.

 

I still have major problems concentrating and working sometimes too. It makes interviews and other social activities near impossible for me, as I cannot speak or express myself as I used to. I get very nervous and my mind blanks out sometimes. I cannot say if marijuana will help all my problems, but I can say marijuana helps me feel alive.

 

Being high is the only time I feel good and happy, deep down. I can be around loved ones or any social crowd without tweaking out from anxiety, I can think and operate much more smoothly, I don't have a short temper, and it makes me want to live.

 

The past couple months have been rough on me and I have been going to the VA hospital here to try and get help. The first 4 times I went, they did the same exact thing which was to ask a series of questions, ask me if I want pills and send me home. I kept telling them I did not want pills because I have seen what they have done to people I know and what they have done to me.

 

All I wanted was someone to talk to.

 

After the fourth time of going in there feeling like I wanted to die, they finally got someone for me to talk to. We have just met once so far, but I think it will be good for me.

 

In the meantime I have not been able to smoke recently because I am trying to find another job, which is not going too well and I only have a couple weeks before my current job ends.

 

I have had a few interviews but blow them miserably because it’s getting harder and harder for me to go through the whole thing without my nerves choking me to death. It’s only been a week or two since I smoked last and my temper and depression are already busting through the door. I worry too easily and stress out to the extreme.

 

Take what you will from this story, but I know for a fact marijuana has saved my life numerous times.

 

-- One young former Marine's story, in his own words. Used with permission.

Editor's note: "Mortuary Affairs" was also the detail highly-decorated Marine ("Marine of the Year") Daniel Cotnoir worked in Iraq, before a combination of circumstances, including PTSD, triggered an event in his hometown of Lawrence, Massachusetts -- which got him arrested, and barely escaped conviction.  We have blogged about Daniel Cotnoir's case many times on this blog, going back several years, when it was current.  It's safe to opine, that even within the trauma of war, some things are harder to endure than others.  Our guess would be, mortuary affairs really qualifies for extreme hardship and exposure to things that make PTSD an occupational hazard.

PTSD Drugs: Better Living through Chemistry, or Purely Popping Pills for PTSD's Psychological Ills?

There was a story in the news recently about four young combat veterans in West Virginia, all seemingly in decent physical condition beforehand, who nevertheless all died in their sleep recently.  Besides combat PTSD, one thing the vets all had in common was the cocktail of drugs they were taking: Paxil, Klonopin and Seroquel.  (The Charleston, West Virginia Gazette-Mail reported this story on May 24, 2008 - it's linked here.)  An investigation is pending, but the story obviously raises the question: what are vets with PTSD being prescribed, and is it really working, or what's best?  (Continue reading, and you'll learn more about those specific medications as well.)

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Where to go for information about PTSD medications?  Here are a few, carefully-chosen selections, and their pros and cons - as appropriate:

Jonathan Shay, M.D., Ph.D., well-known VA psychiatrist and outstanding veterans advocate, has written before about medications used to treat combat PTSD, and his impressions of them.  He wrote the material for a lay audience, in the version that's kicking around on the Web, in several different locations, and although it has been quoted by many as gospel, it's more than 12 years old by now (first published in 1995), and that's much too much time that's elapsed to consider that information really current. (The Dr. Shay list, "About Medications for Combat PTSD,"  is linked here.)  So that information is interesting for background -- and particularly for Dr. Shay's explanation of how things work and/or what makes a good PTSD medication, and what doesn't -- it out of date and should not be considered current. 

There's another list on the Web -- a table, really -- that's much more current (2006), and it lists the drug names, brand names, and how the drugs are thought to work with PTSD.  That list is linked here.  It may be a little difficult to read if you're coming to the topic cold, but perhaps not.

Some other suggestions:

If you have access to a public library or academic library, you can check out the PDR -- the Physician's Desk Reference -- and read up on a drug's profile, side effects, warnings, etc.  But since you're already on the Web, we can assume, reading this -- try going to PDRHealth.com, linked here-- and read up on the prescription drugs prescribed for PTSD.  Of the three drugs mentioned earlier, Paxil is linked here; Klonopin is linked here; and Seroquel is linked here.  You can also do a straight search for any OTHER drug used in PTSD treatment, or one with possible interactions with a drug used for PTSD, at the same site, by searching within prescription drugs by name (e.g., Zoloft, Chantix, etc.), at the general search interface, linked here.

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But the information in the PDR, whether on the Web or in the desk reference, is going to dry and technical, though worth reading -- pretty much exactly like the fine print that's packaged with the medications themselves. What you're probably going to want to know more about is what in software is called "the user experience" -- how other patients like you have experienced the medications.  For that you will need to turn to some other sources.

For what amount to "user reviews," try PsychCentral, or Revolution Health, both of which have increasingly robust user communities who will comment on their own experiences of the medications.  (Of course, not all their users taking medications for PTSD have PTSD from combat trauma, so be aware that their cases may be substantially different.)  Combined with the technical information about the drug's effects, side-effects and warnings (see links, above), it might be helpful in creating a broader picture of what the user experience is like:

Dr. John Grohol's PsychCentral website:  Paxil (Paroxetene) is linked here; Klonopin (Clonazapam) is linked here; and Seroquel (Quetiapine fumarate) is linked here. A general search through the medication library is linked here.

AOL Founder Steve Case's Revolution Health:  Users in the "User Community" provide "Community Ratings" on various medications.  The items on Paxil, Klonopin, and Seroquel are linked here (click on any of those hyperlinks to take you to the community ratings), or, use a more generic search here, and look for the tab beneath that says "Community Ratings." (We will be blogging more about Revolution Health shortly.)

Don't forget books as well.  Mark Goulston, M.D.'s Post-Traumatic Stress Disorder for Dummies (2007), linked here, is very recent, and contains a whole chapter entitled, "The Role of Medication in Treating PTSD".

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You'll also want to learn as much as you can -- though this is primarily your healthcare provider's reponsibility, yet it's in your best interests to care about this as well -- about possible interactions, if you're taking a number of medications; as well as thinking through carefully whether the risks involved are ones you want to agree to, such as the potential that a medication -- bizarrely enough, prescribed for PTSD or depression -- may actually increase risk of suicide. (An example of news coverage about this is linked, here.)  Strange, and perhaps unavoidable, but true.

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Use caution whenever evaluating information about medications, especially as a non-professional, but at the same time, don't "just" believe what a healthcare provider tells you: be sure to check it out for yourself or your family member, at reputable sites like the ones mentioned above.  Your health is in your hands, so while you want and should actively solicit the expert advice of healthcare providers familiar with PTSD -- and don't settle for less :-), at the same time, YOU are the one who's going to be bearing the brunt of anything that goes wrong, so be sure to do your own due diligence and figure out what the possible side-effects, interactions, and unpleasant experiences might be for you, before you commit to a course of treatment.  You and your healthcare provider can be partners -- that's the new model -- not just "master" and "servant," or "priest" and "parishioner."  Take an active, informed role in your own healthcare, particularly where medications are concerned. 

Living in the Prison of PTSD - a Poem by a Vietnam Vet and Suicide

I received a photo of this poem, by a Vietnam veteran who committed suicide shortly after he wrote it, in the manuscript of another Vietnam veteran's memoirs from his time as a Marine in Vietnam, and after homecoming.  This poem is apparently up on the wall of the "Post Traumatic Stress Unit" at the Veterans Affairs Medical Center in Waco, Texas.

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(It's easy to understand honoring the vet who wrote this poem as one of his last pleas, but seriously -- if I were being treated for PTSD and were struggling with some of the same issues, I'm not sure it would be that perky to go by this particular wall art regularly and remind myself, oh yeah, right after that guy wrote that -- well, he ended things.  Even though it's perfectly understandable why he felt things had gotten to that point; and equally well how the other vets and the staff there would want to honor his passing with this tribute.  People who believe in the ancient Chinese art of placement, feng shui, would say, never hang anything on the wall that brings your energy down, not up, when you look at it.  But I'm sure they did it out of love and respect for the guy concerned...)

As for the poem -- well, it's not gonna win any awards as a poem, but in terms of conveying one man's brokenness and pathos, it does that really well. Very sorry the story had to have such a sad ending, and not just for this veteran, but for many others like him, from Vietnam and other wars.  Here's what the poet, known only to us by his initials, "A.W.D.," wrote in 1989:

Solitude

I have lived in this prison I built for most

        of my life

And I have blocked out all reason, all guilt

        and all strife.

No one may enter this prison of mine

For I have failed at life,

        now I resign.

Now as I sit here too cloudy to think

My mind and body, they no longer link

My life I see before me, like old movies that

        aren’t real

But that’s what I see and

        that’s what I feel.

May God have mercy, may He not be cruel

May He understand the prayer of a fool

Inside of me, I hear the screams of distress

Let me out of this prison

        Please let me rest.

-- A.W.D., 1989

Making an Attempt to "Strip the Fuse" - Initiating Dialogue between Local Police and Veterans

NPR has another great story today, on a few OIF/OEF (Iraq and Afghanistan) combat veterans telling their stories in a public setting, in an attempt to defuse potential conflict with the communities where they live, especially with the police.  The story is called, "Dialogue Bridges Divide between Vets and Police," reported by Libby Lewis, and you can read the story or listen to it, here. It highlights the work being done by Jay White of the Hartford, Connecticut Vet Center, a facility funded by the Department of Veterans Affairs. According to Lewis, "before becoming a counselor, White served two tours in Iraq. The dialogues he moderates are meant to connect veterans with people who have no experience with war, namely people who deal with trouble — like police and emergency rescue personnel. These are the people whom soldiers returning home often find themselves dealing with."  It's great to see necessary, proactive stuff like this.

A surprising statistic, quoted in the story, by Brian Killany, a police crisis negotiator:

"The chances of [veterans] becoming a target group for us to have to deal with as a [police] negotiator is probably better than 50-50.”

Y-I-K-E-S.  Forewarned is forearmed -- no pun intended.  So much better to prepare for this in the way this program is doing, than be surprised by it -- when it's clearly a strong possibililty.

The NPR story also highlights the work of a Connecticut-based group, "Brothers in Arms," which the program says is "run by Iraq veterans with a mission of helping other returning soldiers. They also organize public speaking events to create awareness among civilians about the struggles of war veterans."  Their information is linked here.

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In addition, although not mentioned in the story, there's a great, 10 minute long video available on YouTube, which we blogged about here, by William R. Keating and the Norfolk County (Massachusetts) District Attorney's Office.  It's called "PTSD and Veterans: Beyond the Yellow Ribbon," and part of what it addresses is the re-integration of a combat veteran into his or her community, including the possibility of conflict with the police, and how both sides can manage that.  Well worth watching and bookmarking. The blog post we did about it a year or so ago is linked here, and it includes the video.

(Other counties in Massachusetts and in other states should consider contact William Keating's office and seeing if they can use the video with their constituents.  Information useful for contacting the Norfolk County (Massachusetts) District Attorney's office is linked, here.)

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Recently, we blogged about the similarities that cops and troops share in their exposure to cumulative increments of trauma, which often result -- for either of them -- in PTSD.  Ultimately, cops and troops may find out that they may find out they have more in common than they thought -- in terms of what they've been exposed to in their lines of work -- not just wearing uniforms, working out and carrying guns to work. 

Editor's note: The Hartford, Connecticut Vet Center information is linked here.  The directory lists Jay White but provides no additional contact information for him; undoubtedly, he can be reached the Center.

Rob Honzell's First Person Account, as a Vietnam Vet, of Combat PTSD

An update on an earlier blog post, from February of this year.  Rob Honzell, Sr., M.S.'s book, First Person: Combat PTSD, is now available at Amazon.com.  It's Honzell's account, in his own words, of what his Vietnam experience was like, and how they've affected the ensuing years since.  Not sure how much of it relates specifically to PTSD, despite the title -- I've just started leafing through it -- but to the extent that it's written by a Vietnam veteran who's been coming to terms with what he experienced ever since, it's worth knowing it's out there, and maybe seeing if your local library will buy a copy, to keep the Vietnam experience alive so we can keep learning from it.

It's also fair to say, not many people are able to write about their own experiences with PTSD - it's just too devastating.  We mentioned the other day a book that's just come out by an Army Ranger, Nate Self, about his Two Wars: with insurgents and with his own PTSD -- from the current OIF/OEF conflict.  With hundreds of books about the wars in our collective lifetimes, the just aren't many that address this topic directly, by people who've experienced PTSD.  Let's hope these are the start of many more contributions to the first person narrative literature on the subject.

CranioSacral Therapy, PTSD and Veterans Resources

(This is a drawing by a young child who had PTSD but clearly was not a veteran, given to his CranioSacral practitioner, illustrating what he felt to be her "healing hands.") 

Some resources about CranioSacral therapy and PTSD (this list is not meant to be exhaustive):

An article written by Dr. John Upledger, founder of CranioSacral Therapy, published in the November, 2001 issue of Massage Today magazine, on "The Role of CranioSacral Therapy in Addressing Post-Traumatic Stress," linked here;

An article from the January, 2001 issue of Massage Today magazine, written by the magazine's editorial staff, called "The Power of Touch: Promising Studies on Treatment of Post-Traumatic Stress Disorder," linked here;

An article from the Internationa Alliance of Healthcare Educators (IAHE) newsletter, date unknown but possibly current/2008, written by the Upledger Institute, called "Upledger Research Effective for Vietnam Vets," linked here;

An article from the Upledger Institute's newsletter, apparently from 2007, entitled "CranioSacral Therapy Breaks 20 Year Cycle of PTSD," linked here.  That's the article that talks about Vietnam veteran and former Navy corpsman Steve Shumelda, LMT's experience with PTSD and craniosacral therapy, which predated his career path change.  That article is linked here.

One Great Book: "Home to War - A History of the Vietnam Veterans Movement," by Gerald Nicosia

"The Past Does Not Equal the Future" -- queue Tony Robbins -- well, unless we refuse to learn the copious lessons of the past, in which case it very well might -- or it might make the past look positively enlightened, by comparison.  Another take on the same thing, by the perennial, inveterate quotemeister himself, Ben Franklin: "Experience keeps a dear [expensive] school, but fools will learn in no other."  I'm reading the greatest book right now, recommended by another journalist who's interested in veterans issues -- "Home to War: A History of the Vietnam Veterans Movement," by Gerald Nicosia, linked here.  It's 2 lbs., 10 oz., 689 pages, and roughly 136 cubic inches of nowhere-else-to-be-found material on the actual history of what created the Vietnam veterans' movement, which informs the veterans' rights movement of today, including the efforts to destigmatize PTSD, figure out what it was, re-include it in the DSM manual for psychiatrists (where it had been removed), etc.  Just fascinating.  All the players are there -- dozens of politically important types, including John Kerry, Ron Kovic (if you've seen "Born on the Fourth of July," you know who he is) as well as therapeutically important ones -- Shad Meshad, Ray Scurfield, Arthur Blank, M.D., Sarah Haley, etc. 

As a late-model Child of the Sixties, I had completely forgotten how much sheer effort -- blood, sweat and tears -- it took to get certain things passed that we now take for granted: better care at the VA, better provisions in the GI Bill, etc.  I had totally forgotten about the armed protests, the hunger strikes and sit-ins at the VA, etc.  It made me wonder whether leaders of the current veteran rights movements actually KNOW this history, and know how far their predecessors had to go, to secure the rights veterans rely on today -- which still need to keep pace with the times, and haven't.  The book is just plain fascinating, and b/c it's relatively neutrally written (as opposed to written with partisanship), with a steadfast focus on the facts and the key participants -- and because it's based on 600 or so interviews with the actual players, it's both extremely well done (a PBS series in book form, but with more depth!) and should keep my interest for quite a while.  So fascinating to know, or begin to hazily recall, the all-important "backstory" of where we are today.  And the insights on the genesis of understanding PTSD are well worth revisiting, all on their own.  Great book - wish I'd known about it before. As more and more veterans send me (unsolicited, I might add) their life stories, or their experiences with PTSD, I have to say -- this book really puts an awful lot together, behind the scenes, as to why they suffered in silence for so long.  Wonderful effort, and a pleasure to read.

Too bad tomorrow is already "Father's Day," but if you're lacking a gift for a veteran dad, Vietnam era or later, and can find this in stock at a local bookstore, it's a superlative collection of everything that went before, and helps us to understand the issues of the present, through the highly informing prism of the past.

British Poetic Verse about PTSD

A smart lad and upstanding too
decided what he'd like to do
of years he had, he'd spend a few
protecting the likes of me and you

His friends all thought him barmy
when he signed up for the army
got a uniform and he was trained
he played in all the army games

Then off to war this boy was sent
proud member of his regiment
but soon was shamed by things he did
his job forced him to kill small kids

The things he saw in battle zones
made this boy wish he'd stayed at home
the things his comrades often said
the times he almost wound up dead

He didn't easily take fright
but being shot at every night
landmines, missiles, homemade bombs
attacked, it seemed by everyone

Call it shell shock
call it battle fatigue
post traumatic stress disorder
it's really all the same to me

There had been no preparation
for this mental situation
he had chosen his vocation
now he can find no consolation

Now all that keeps him calm
in a world he's sure will cause him harm
a firearm by his side
his sanity has been denied

Every night the nightmares come
his friends all fear what he's become
he tries to live on civvy street
suspecting everyone he meets

We trained him up, we taught him well
now every day he goes through hell
every night his mind in shreds
where's the cure to fix his head?

-- Anonymous

Editor's Note: If you happen to know who actually wrote this, please let me know so I can attribute it correctly.  But no guesses, please.

Army Ranger Writes Book about Fighting Two Wars - with Insurgents, and with PTSD

There's a new book out called Two Wars: One Hero's Fight on Two Fronts - Abroad and Within, by Army Ranger Nate Self (great name, on both counts).  It's already #3 on Amazon in books about PTSD - the rest are more typically clinically oriented texts about coping with combat trauma and PTSD, such as you'll see in the left hand column on this blog.  This one is written by a highly-decorated Army ranger (Purple Heart, Silver Star) and West Point grad about the two battles he's fought: one in Afghanistan and Iraq, with insurgents; the other on the home front, with PTSD.  I just learned about it today so haven't had a chance to look at it yet, but be forewarned - it appears to have a spiritual/religious angle to it, in terms of his recovery, and it's published by Tyndale House, which is typically known as a religious book and Bible publisher.  "Not that there's anything specifically wrong with that" - unless of course you'd rather know that in advance, which I certainly would.  Still, major kudos to Nate Self for a) recovering enough to tell his tale; and b) telling it in real time, when it can still help a lot of people, especially those who view life most through the prism of religion-based spirituality.  My guess is it must be pretty good to have already vaulted to #3 in its category on Amazon, although I'm sure the video helps, because that's a very wise marketing move indeed.  To the best of my knowledge, this is the first and only book written by an OIF/OEF veteran about his or her battle with PTSD, and subsequent -- what I'm assuming is -- recovery.  It will be great to take a look at this; and I'm hoping it helps a lot of people.

"Two Wars" by Army Ranger, Nate Self (book Trailer)

The Blunt Truth: Combat Veterans, PTSD and Medical Marijuana

There's a great article on the Web from the Salem (Oregon) News-Record of June 11, 2007, called "Marine Combat Vet Discusses Iraq, PTSD and Medical Marijuana," linked here.  The former Marine in question is Nicholas Burgin, and the subhead to the article is, "The courage of an Iraq War veteran continues in his honesty about PTSD."

In the tradition of Tony Neff's story, "All I Want is What I Deserve," about getting his veterans benefts for a service-connected disability, linked here, Nicholas Burgin's story is another great, first person narrative account of his experience, and what actually happened to him.  (We're in the process of seeing if we can get Burgin's permission to reprint his story in full, here, because it would help so many readers.)

In the meantime, read his story, while it's still up on the Web, or save yourself a copy of it, for future reference.  It's powerful.  And don't neglect reading the comments section, either, that follows the article.  A whole lot of people checked in and said they knew what he was talking about, and they agreed, from Vietnam vets through other OIF/OEF combat vets.

Burgin is a young Marine who, like a highly decorated Marine with PTSD we've blogged about here, Daniel Cotnoir, worked in mortuary affairs for the Marines in Iraq - a more gruesome job hardly exists -- and saw enough stuff to last a thousand lifetimes.  Later on, of course, Burgin had trouble with the memories, and despite trying everything recommended to him, found one and one thing only that helped him ease the pain.  He details his struggles, and his victories, in the excellent, first person narrative, and closes with the line, "Take what you will from this story, but I know for a fact marijuana has saved my life numerous times."  Good for him.

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In the 60s, draft dodgers and anti-war types in the U.S. made their way to Canada to ride out the Vietnam war.  Many stayed for years.  Today, with an all-volunteer military, "escaping" to Canada isn't nearly so popular; but if anyone compares the drug laws in the U.S. and Canada re: marijuana use, and finds themselves overly hassled by the perspective in the U.S. that it's still a criminal offense, they might start to find Canada more attractive again.  Depending on whether the party in power is liberal or conservative, their drug policy waxes and wanes, but more than 51% of Canadians are in favor of decriminalizing marijuna use, says the BBC, and using is often treated differently there than selling (possession v. intent to distribute).

Survivors Quilt: Combat Veterans Patch Meaning Together in Quilts about PTSD, War and Loss

You've heard of survivors' guilt - here we've got survivors' QUILTS.  (Bad pun, I know -- but true.)

We've been talking a bit lately about art therapy, and how combat veterans with PTSD use it successfully to tap into, and work through, some of the pain they feel inside. The photos here, by Mike Kane, at the Seattle Post-Intelligencer, are from a story published on March 19 about how the inpatient PTSD program at the VA hospital in Seattle has a "wall" of quilt squares, made by combat veterans, and encouraged by a nurse, Betsy Shapiro (she's at right, above), now retired, who gave deeply hurting veterans 6x6" cotton squares, on which to draw something or paint something that related to their experience: something they could leave behind, to let others know about them and what they had gone through. 

Initially, there was moaning and groaning, and reluctance to comply.  But shortly thereafter, everyone produced something, and the results were really pretty impressive.  The veterans also gave input into how they wanted the resultant squares displayed -- not set in pretty frames, like squares in a regular patchwork quilt might be, but together, side-by-side, touching.  The article, by Mike Barber, is called "Veterans tell stories in patchwork of memories," and it's linked here.

In an earlier article, from the Honolulu Advertiser from October 2, 2007, linked here, Glenn Reys, an Air Force vet in Honolulu worked through his recovery from drugs and alcohol by immersing himself in making a Hawaiian quilt, symbolic of his homeland, but also incorporating patriotric U.S. symbols.  He found himself devoted to the practice, and able to quilt for hours at a time.  "This kept me busy," Reys said. "When I do sewing like this, I can sew for like six or eight hours, and it's no problem. That's what I do in my continuing recovery."

In one of the best articles I've read about a Vietnam vet, Cecil Ison, struggling with PTSD, the author, Kathy Dobie, talks about visiting his home in Kentucky and watching his wife, Bet, a quilter, work on a quilt with Vietnam themes. Cecil and his two brothers all served in combat in Vietnam, and each responded in a different way.  Cecil's wife, Bet, attempted to capture her view of what they suffered in the quilt, turning an abstract -- feelings about the war, and the isolation it produced -- into something very concrete -- the quilt. She says that the quilt is too painful for Cecil to address directly, but through it, she is able to give vent to some of her feelings, about what she has watched her husband and his brothers go through.  Kathy Dobie writes:

[Cecil's wife, Bet, and I are spending time one afternoon.] We’re talking upstairs in the sewing room while she works on her Vietnam quilt. The room is stuffed with fabric: tweeds, cottons, velvets, hundreds of men’s ties. Bet sews at a small table by the window. She listens to oral histories of Vietnam veterans as she works. On the left side of the quilt is an army-green map of Vietnam, showing the three cities where James, Cecil, and Arnold served. The rest of the quilt is blue, and three male figures float there, separated from one another and bearing labels: anger, despair, and guilt. The quilt reads: "my husband and his brothers came home from vietnam…three islands in an ocean of silence."  James is the Angry one, Cecil the figure of Despair, and Arnold is Guilt.

(This is the quilt in question, pictured to the right.  From top to bottom, you can see "Anger," "Despair," and "Guilt," and "Vietnam" is written lengthwise, on the left.)  Quilt copyright Bet Ison.

Below is another quilt with Vietnam imagery by Bet Ison.  Both quilts are copyright Bet Ison, and property of the author.  Photos are shared with Bet Ison's permission.

(The article by Kathy Dobie article in GQ, is called "The Long Shadow of War," and we blogged about it earlier, here.  Dobie is also the author of the excellent article in the Nation, recently, called "Denial in the Corps" -- about Marines and the stigma of mental health issues, including PTSD, which we've also blogged about, here.)

Quilting is a uniquely American tradition.  Not that other countries haven't had their own versions of it, but it's uniquely tied up in the "fabric," as it were, of American history.  There are so many examples, from crazy quilts made of just scraps of silk, satin and wool garments, patched together on wagon trains as Americans headed West, to quilts made from flour sacks by pioneer women, to Civil War era "album quilts," to today's photo transfer quilts.  Quilts are often about "making do" with just the materials available, and there's something therapeutic about the needlework involved.  In 1837, American writer Nathaniel Hawthorne wrote in The Scarlet Letter, "Women derive a pleasure, incomprehensible to the other sex, from the delicate toil of the needle."  Well, by the 1970s, even he-men like football great Rosey Grier had picked up the needle, though not necessarily to quilt (he favored needlepoint instead).  Quilting is an unusual 3D art form that combines texture (the fabric, and the stitchwork) with color and design, and has a long and storied American history, besides.  It's interesting that combat veterans and their loved ones would find an outlet for some of their feelings in quilting.  Whether it's a square, a bed quilt, or a wall hanging, quilting allows for freedom of expression, and a form of "art therapy" that may just help those who are hurting to focus and transform their experience into something physical that they can share with others. 

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Editor's Note: If you want to continue this conversation about quilting and paying homage to a combat experience, your own or someone else's, email tributequilts AT gmail DOT com. 

Travis Twiggs' Widow, Kellee, Puts a Human Face on the Suffering of PTSD

I come away just so impressed with Kellee Twiggs, the grieving, sympathetic widow of the late USMC Staff Sergeant Travis Twiggs, who passed away recently, one might say, from PTSD complications, after a long and difficult battle with that powerful adversary.  Kellee was as much in the dark about the events immediately leading up to Twiggs' suicide as anyone else watching this painful scenario unfold; but she was and is very clear on the ravages PTSD took on her wonderful husband, who she dearly loved.  There's been a great raw video interview footage on the Web for the last few days of Arizona tv reporter, Suzanne Kennedy, interviewing Kellee Twiggs about PTSD and her husband, Travis.  Because it's unclear how long that video will stay on the Web, and also because so much of the Twiggs' story is worth knowing, I took the time to create a transcript of the interview, a downloadable copy of which is available here, Download transcript_of_kellee_twiggs_interview.pdf.

In the interview, Kellee Twiggs, who I very much hope has a future as a patient advocate, given what she's gone through, and how personally she knows the ravages of PTSD in a combat veteran's life, comes across very well -- as a kind, sympathetic, reasonable person, who ultimately feels that the Marine Corps did not do enough to save her husband's life (and that the current courses of treatment for PTSD -- at least the ones Travis was exposed to, with their emphasis on locked wards and overmedication with a slew of pharmaceuticals -- aren't the most effective treatments possible.  From her vantage point, they were tried with her husband, and they just didn't work.  Is her point of view that of a treatment professional?  No.  But it's very much as someone who loved her husband, and cared what he was going through -- and ultimately saw the system fail.  One of the most interesting parts of the video to me was how she isolated the need to address the guilt that her husband felt, and was apparently unable to overcome, from letting others down.  It's a very interesting video interview.  Watch the entire clip, here; or read the transcript, linked above.  And keep the Twiggs family in your thoughts and prayers this Memorial Day and after.  It's hard enough to be a military family with a deployed servicemember.  It's even harder to be a military family grieving a terrible, combat-related loss, as the Twiggs are presently.

Twiggs' Wife: "The PTSD Drove Him Crazy"

Wow...well, for a truly excellent experience, see this raw footage by Arizona TV reporter Suzanne Kennedy, interviewing SSgt. Travis Twiggs' wife, Kellee.  It's great stuff.  Kellee Twiggs speaks her mind, the reporter asks fairly good questions and leaves Kellee plenty of room to talk, and it's long -- which means you get quite an opportunity to hear from Kellee about what Travis Twiggs was going through recently, and how she felt about it.  Really excellent work.  It also clears up a lot of the mystery about what the last few months of Travis Twiggs' life was like, and reinforces the impression we probably already have, about how the Marines are still quite a bit better at fighting wars than they are at tending to the needs of their warriors, and how Twiggs' guilt over losing several men from his platoon weighed on him heavily, and didn't resolve.  Kellee comes across in a great way, and it's very sad at the end of the tape, when she breaks down talking about how much she misses him.  In the rest of the tape she's very composed, under the circumstances, and makes an impassioned advocate for better psychological care for the troops.  Here's the link to the excellent raw interview footage; if it becomes available as a video to embed, I'll add it here as well.  Great work.  Click here for the link.  (See also this later blog entry, linked here, which includes a transcript of the interview.)

Editor's Note: Elsewhere today we've learned that Kellee and her husband, Travis, go way back: they were childhood neighbors in Louisiana, and had been married for nine years, with two children.  That's another way of saying, she really knows the guy, and what's "normal" or "abnormal" in his behavior.

The Ballad of Travis Twiggs

I'm personally still reeling from the apparent murder-suicide of USMC SSgt. Travis N. Twiggs and his brother, Will Twiggs, as the cops closed in on them in Arizona yesterday.  (See umpteen shallow news reports for the same basic information, but no explanatory context or any insights as to why.)  Our previous blog entries about Travis Twiggs are here, here, here and here.

While I make my feeble attempt to sort through what is known and what is not, and blog about it later, I'm struck by one comment Twiggs made in the essay he published about his own signficant struggles with PTSD.  The comment is specifically about PTSD:

"I pray that no Marine or sailor, or any service member for that matter, ever has to go through what I went through." -- Travis N. Twiggs, RIP, 5/14/2008.

The Katz Email: Can We Just Call "Bullshh!it"?!

By far the most distressing revelation from the lawsuit by veterans against the VA, currently making its way through Federal court in San Francisco has to be the toxic email, disgracefully titled, "Shh!" and written by Ira Katz, M.D., the VA's top psychiatrist, about the not-exactly-light 'n humorous topic of veterans suicides.  The email essentially attempts to cover up the severity of the number of veteran suicides that are taking place by those who are undergoing treatment at the VA.  The contents of that email by now are fairly well known -- and the general reaction is to Katz's words, not surprisingly, is revulsion.  Senators Patty Murray (D-WA) and Tom Harkin (D-IA) are two legislators calling for Katz' removal.  There's been just enough stink about his ill-chosen words that Katz has been moved to make a very superficial apology for them, a la Roger Clemens.  An article in today's Seattle PI, linked here, quotes CBS News as saying Dr. Katz now calls his word choice "unfortunate."

Erm, well, can we just call "bullshit" on this?  Because, really, it's more than the choice of words people are reacting to -- they're sensing the specious and supercilious attitude behind them.  In the immortal lines from Oliver Wendell Holmes, "Even a dog knows the difference between being kicked, and being tripped over." 

The "Shh!" email brings to mind another bureaucratic bumbler of late, Michael Brown, head of FEMA during the Katrina crisis, who ostensibly fiddled while Rome burned, writing superficial emails to his colleagues preening about his choice in ties and lamely wondering if it was time for him to go home yet. "'Can I quit now?' FEMA chief wrote as Katrina raged," according to an article archived here on CNN.com.

Brown certainly seemed to be over his head (no Katrina puns intended) at FEMA; perhaps Katz, because of his psychiatry training is actually not.  However, they both have a world of learning to do in how to project empathic leadership.  There's nothing confidence-affirming about either one of their responses. Wounded warriors deserve a lot better from the top psychiatrist at the VA responsible for their care.  Those aren't just poorly-chosen words, there's an attitude of callous disregard for the patients behind them as well, that no thin veneer of apology really corrects.  Combat veterans struggling with alarmingly high and well-documented rates of PTSD and suicide need compassionate leaders with a vested interest in their care, not someone making light of the size and the severity of the problem.  In anyone but a psychiatrist, whose field after all is mental health, we might find this easier to understand or excuse.  But in a psychiatrist whose professional responsibility is the mental health of veterans?  Absolutely not.  That's a vote of no confidence, in someone who's sworn to uphold the Hippocratic oath to "first, do no harm."  The bumbling and apparent cluelessness of FEMA's Michael Brown in the face of a huge need for crisis management and control spurred calls for him to resign; perhaps outrage over Katz' email will do the same.  There's really no way to spin that into a positive.  The damage has already been done.

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Here's the content of the email Katz titled "Shh!" for those who haven't seen it.  According to the article in the Seattle PI, "Our suicide-prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities," Katz wrote in a Feb. 13 e-mail to Ev Chasen, the department's communication director. "Is this something we should [carefully] address ourselves in some sort of release before someone stumbles on it?"

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

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

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

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

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

Four Reasons Veterans Don't Get Their Benefits

I had a wonderful conversation on Thursday with the local Veterans Service Officer ("VSO"), who's the sole point of contact for 11,000 veterans in the local area, and 34,000 family members, total.  We had a great and wide-ranging discussion, about many things that concern veterans, but one point he made really stood out.  He said something pretty remarkable about why veterans don't take more advantage of the benefits they're entitled to.  (This veterans service officer says the population he serves is composed of WWII veterans, and those from the Vietnam War, the Korean War, peacetime, and the Gulf War -- which includes OIF/OEF veterans -- in that order, rather than predominantly OIF/OEF veterans.  But still, it's illustrative...)  He says the top four reasons veterans don't take advantage of the benefits -- health, educational and otherwise -- that they're entitled to are that:

1. They don't know that the benefits exist;
2. They don't think they'd qualify;
3. They don't know how to apply for the benefits, or assume that applying would be a real "pain in the butt";
4. They rationalize that there are others "worse off than me."  He says he hears that about once a week.  Very noble, truly, but not great when it comes to getting the benefits that service has entitled them to.  As the officer said, enthusiastically, "The veterans have EARNED those benefits!  The sacrifices they've made...!"

More about this conversation later...

Citizen Journalist Dad Uploads the Damning Ft. Bragg Barracks Video: "Ask Them to Fix This!"

A stunning video, shot by a returning combat veteran's dad, and uploaded to YouTube by him, shows the deplorable conditions awaiting his son in the barracks at Fort Bragg, North Carolina, after 15 long months in Afghanistan.  The screen capture to the left is a soldier plunging a clogged bathroom drain, on a bathroom floored filled with inches of standing water and raw sewage.  Ft. Bragg's living conditions, at least as shown in this video by a suitably outraged father, bring to mind those at Walter Reed, profiled by the reporting team at the Washington Post last year.  The Fayetteville Observer has weighed in with an article on the conditions at Fort Bragg, prompted by the release of this video, and they're asking for answers, too.  Do yourself a favor and watch what one citizen journalist did to document the conditions facing some returning military.  We are not remotely giving them the care that they deserve.  And it's shameful that public pressure has to be brought to bear, by videos like this, before conditions are improved for returning servicemembers. When you think of all the challenges they've been through, which are more than enough to process and decompress from, the last thing they need it to be "greeted" with hospitality like this.  If this is how we treat our returning soldiers, what hope can they have that we as a country really care about their welfare -- mental, emotional, physical and spiritual.  These pictures speak louder than words.  Watch the video, below.  The article in the Fayetteville Observer is linked here; with follow-up linked here, and three full days later (cough, cough) on CNN, linked here.  (It's great to scoop CNN on a blog ;-).  (Military.com has not covered it yet, but ideally they will, and soon.)  Over time, of course, we can expect to see follow-up, and damage control, and spin -- and eventually, one hopes, actual change.

Editor's Note: the video was uploaded by Edward Frawley, the father of a sergeant who served with the Army in Afghanistan, as part of Charlie CO 2/508 82n Airborne.  His son returned to the U.S. on April 13, 2008, and is living in the dilapidated barracks on base.

One Marine Reflects on His Battle with PTSD

Back in January, The Marine Corps Gazette published the account of one Marine's own struggle with PTSD.  The Marine was 1st Staff Sergeant Travis N. Twiggs, and the article was called "PTSD: the War Within - A Marine Writes about His PTSD Experience."  Twiggs had four deployments with OIF/OEF: one to Afghanistan, and three to Iraq.  He writes fairly bluntly about what his experience with PTSD was like; how it crept up on him; what the process of admitting that he had it was like; and what he did to recover from it.  He also writes a postscript about what his like has been since then.  I've tried to contact Twiggs several times and the Marine Corps Gazette, to see about getting permission to reprint Twiggs' story on this blog; but haven't heard anything back.  That makes me concerned that perhaps the end of the story isn't as positive as it seemed it was going to be; but I hope that I'm wrong about that.  Twiggs' writing his story about his own fight with PTSD is a very powerful thing.  While many veterans obviously suffer from PTSD, not many have come forward to really talk about what it's like to have had it, and to have made progress in overcoming it.  That's why Twiggs' story is so valuable.  It also has the added benefit of being a story by a combat veteran to other veterans -- with all the shared camaraderie and empathy that implies. I hope things continue to go well for Twiggs -- his example and his openness can really be helpful to other veterans who are suffering from combat trauma.

Some items that stand out from his story:

• A triggering point: arriving back in the U.S. after his third deployment, and being greeted by the families of the two Marines who were killed in action on his tour at the homecoming for his battalion.  It seems to have pushed to the forefront of his mind the question, "Why them, why not me?" which is classic for people to ask.  "From then on my life began to spiral downward," he says.
• At another point he describes being back from the front: "When I arrived back in the States, it was as though I had never left. All of my symptoms were back, and now I was in the process of destroying my family. This was all taking place because I did not understand what was happening to me. My situation worsened, if you can believe that. I started neglecting my work, and my answer for everything was alcohol."
• In other point, he describes with great poignancy the real battle within himself: "The true horror of war is coming home without all of your Marines, because at some point you have to look at yourself in the mirror and wonder, “Did I give them my all?” “Did I train them to the best of my ability?” I could not answer yes to either question. I still can’t and wonder if I ever will." (That last point also makes me concerned about how fully he's been able to put this in the past; it's probably still far too difficult to - and there's definitely no shame in that.)

Another constructive part of the article is the recommendations he offers as a layman, about what he believes helped his PTSD, and what might help others.  Here are the majority of things he says he learned from the experience, that he can recommend to others:

• Medication alone will not calm PTSD symptoms. Therapy is a must, and it has to be done with others who have experienced the same war or conflict. In other words, veterans of Operation IRAQI FREEDOM should not be undergoing therapy with Vietnam or Operation DESERT STORM veterans. The symptoms are the same, but the time periods are different.
• Alcohol and pills don’t mix. The Marine/sailor should never be told that moderate alcohol consumption is acceptable.
• It is okay to mourn those you’ve lost, but remember, they don’t want you to be sad. They want you to celebrate their lives.
• PTSD is not a weakness. It is a normal reaction to a very violent situation.
• I firmly believe that a lot of my [subsequent] problems were caused by overmedication. The medication affected my judgment and my ability to cope with the true issues that haunted me. I also have since suffered from a seizure, which is believed to have occurred from the same cause. So, ensure that the Marines/sailors know that it is okay to question the amount of medications they are taking and why.
• Place more emphasis on the post-deployment health questionnaire all Marines/sailors have to fill out before leaving theater. I remember Marines being told that if they marked “yes” to anything, it would cause problems with their taking leave. They don’t know that PTSD is not even noticeable until they come home. Marines/ sailors should fill out these questionnaires honestly when they get back in garrison, and they need to know that it is okay if they are experiencing difficulties readjusting.
• Leaders should sit down with their Marines/sailors prior to releasing them for leave and cite different examples of PTSD so that they know what to expect and how to recognize the symptoms. When they return from leave, leaders should get them enrolled in as many schools as they can. Regardless of whether they can get them into the schools or not, leaders should set up a well-planned schedule for them.

Wherever you are, Travis Twiggs, best wishes for your continued health and healing.  Thanks for being strong enough to write this; thanks for sharing it with your fellow combat veterans. 

Editor's Note: A copy of the original article is linked here; a PDF copy of it on the Web is also linked here.

"Shattered Soldier" - the Artist's Description

John Paul Hornbeck says his "Shattered Soldier" sculpture took about 500-600 hours to build, and probably cost at least that much in supplies.  "I went for realism," he says, "I wanted people to feel the psychological/emotional impact of being a soldier with PTSD."

The sculpture, shown here partially dismantled for shipment, head removed, was fabricated from an assortment of (inert) grenades, 50 caliber bullets, shrapnel, magazine clips, mini bombs, tank shells, mortars, and bomb fragments, for realism.  Hornbeck says he's spent hundreds of hours as a child with his father, a Vietnam veteran, at the VA for treatment, listening to the stories of his father's generation of veterans, telling stories about the Vietnam war.  Hornbeck himself served in the Army.  He says, "Many soldiers have stories about a piece of shrapnel they carry in their limbs.  That is why I used shrapnel to be part of the limbs in designing my soldier."

The sculpture is life-sized and at least as heavy as a real soldier.  Hornbeck says that it includes "at least 200-300 .50 caliber bullet tips that were tumbled, cleaned, drilled and strung up on aircraft wire, with splices of barbed wire, to form the ribs.  The torso is made out of a six-gallon gas tank.  Brass tank shells form the legs.  The tank shells couldn't be welded directly; instead, they were drilled, fitted with angle brackets, and welded to the mortar "feet" and ammo box "hip" at the base of the sculpture.  The M-16 magazines were cut in half, length-wise, and drilled so that wire could be woven through them to stitch them in place as the shoulder and collarbones."  "As you can see, the arms are grenades," he says, "Two dozen grenades that have been quartered and welded back together (so that they're fragmented, but also to reassure the public that there's no longer any powder inside.).  The fractured head is made from a brass drum cymbal, which is shattered into at least 80 puzzle-sized pieces to resemble both shrapnel and skull fractures (typical combat injuries), each drilled with several holes so that they could be woven together with wire to form a type of chain mail.  There are also more grenade pieces, mini bomblets, and the tailfin of a rocket."  A side view of the sculpture, he says, "shows you where it gets its name: the fractured skull represents brain injuries."  The legs bear many of the previous names for PTSD, "particularly in wars before it was diagnosed as a mental illness.  Vietnam was really the first war that gave it a name and a treatment."

Hornbeck hopes that the sculpture succeeds in capturing what many soldiers experience when they return from war: PTSD, survivors' guilt, flashbacks.  He says he was compelled to build it on receiving news of three comrades who'd returned from war and taken their own lives.  Hornbeck wanted the sculpture to deal with "issues directly affecting our vets: like lowering their suicide rates and trying to re-integrate them into society when they return."  Says Hornbheck, "these aren't new issues, they aren't propaganda -- these are issues that have been deal with in every way, though somehow people forget them after those wars are past, only to rediscover them again with the next war.  This makes for a very poor learning curve for both society and the VA to have to deal with these same issues over and over again," separated by intervals with little continuity.

The "shattered" nature of the soldier portrayed, Hornbeck says, attempts to address the many injuries of war, seen and unseen: "PTSD, soldiers' suicides, TBI (traumatic brain injury), eye injuries, among others."  "Veterans returning with these injuries," he says, "tend to get overlooked, or until elections are over, empty promises are made to veterans to take care of their healthcare.  I made this to raise awareness of current veterans issues: I believe that mental health among our troops is largely getting neglected, as we hear of soldiers being redeployed into combat despite being diagnosed with PTSD, and being at risk to themselves and others." "So much for the screening process," he says.  "There comes a time when you look at the military institution itself and the culture of masculinity it creates and reinforces, that doesn't enable guys to really approach treatment willingly, without criticism from their peers."

Hornbeck says, "This sculpture was created as a memorial for the living; and for those who died over there or returned as ghosts of the war, forever haunted with guilt and remorse from being witness to unspeakable things, and sometimes committing some themselves."  He says his father struggled with PTSD, as he himself does.  He says, "My father suffered PTSD from his time in Vietnam.  Growing up, I witnessed his episodes and even went to the VA with him on several occasions, trying to get him help.  I've known three soldiers who didn't receive the treatment they should have, after returning, and committed suicide."  Hornbeck is aware that not everyone wells over with warm, fuzzy feelings upon seeing his sculpture, but many also say how it has touched them like no other sculpture they've seen.  "This sculpture deals with intense veterans issues that sometimes make people cringe with discomfort, but it's the only way I've seen to highlight such difficult topics that are otherwise hard to discuss."  "I created this sculpture out of elements of war," he says, "to show how the soldier becomes the war, even when they return."  "It isn't something easily forgotten," he says.

Editor's note: See previous posts here and here on this artwork to learn more; go visit the show in Providence, RI at the Pawtucket Armory, linked here; or go to John Paul Hornbeck's website to make a donation to the starving college student's art fund, for building and shipping this piece on exhibit.  Ideally someday this sculpture can find a prominent "resting place" in an important American collection, for its singular ability to capture some of the trauma of war for the soldiers who serve in it.

Shattered Soldier - Veteran Makes PTSD Art

Shattered Soldier is the creation of Vietnamese-American artist and Iowa college student, John Paul Hornbeck, himself a veteran and a PTSD sufferer.  It's making its way cross-country right now to an exhibit in Providence, Rhode Island in the beginning of March, at the Pawtucket Armory. The show called, "Experiencing the War in Iraq," will run from March 5 to 30th, and it is described as "an artist-curated multi-media exhibition that brings together diverse expressions of the war in Iraq."  Click here to learn more about the exhibit.

Says Hornbeck, "I made this sculpture to address the issues coming back from the Iraq War: increased rates of PTSD, mental illness, soldiers'/veterans' suicides, TBI (Traumatic Brain Injury,) blindness, among other things. This sculpture was created as a memorial for the living, for those who died over there or who returned as ghosts of the war -- forever haunted with guilt and remorse for witness to unspeakable things, and committing some themselves. My father had suffered PTSD from his time in the Vietnam War. Growing up, I witnessed his episodes and even went to the VA with him on several accounts trying to get him help. I've known three soldiers who didn't receive the treatment they should've and committed suicide. This sculpture deals with these intense veterans' issues that sometimes make people cringe with discomfort, but it is the only way I see fit to express such difficult topics that are otherwise hard to discuss.  I created this sculpture out of elements of war, to show how the soldier becomes the war -- and how, even when he returns, war is something not easily forgotten.

To see more images of "Shattered Soldier," or If you are able to donate to Mr. Hornbeck to help defray his considerable expenses in building and shipping this sculpture for exhibition, please follow this link to his website.  Thank you.