Healing Combat Trauma

The Personal Narratives of War

One of the points that Patience H.C. Mason makes in her groundbreaking book about working with veterans of the last big war (Vietnam), is how important it is to get a feel for what the war was actually like to go through, even if the veterans in your life don't seem to particularly want to talk about it right now.  Patience, whose husband is a Vietnam vet and author of the famous war memoir, "Chickenhawk," spent a hefty first third of her book describing the Vietnam war through veterans' eyes.  Today, there is a wealth of "personal narratives" or "eyewitness accounts" of what it's like to have gone through the current wars of our era, whether the Gulf War, Afghanistan, or Iraq.  Part of establishing a compassionate understanding of what veterans' trials and tribulations really have been, besides an attitude of intentional listening, is to familiarize yourself with just what they've actually been through.  An online search at Amazon or your local library system, online, specifically for "personal narratives -- Iraq war," for example, should yield as many as 30 books to read.  For some of the authors who've written these books, the writing process alone was cathartic -- a way to process the burden of what they've experienced.  Reading those same narratives might turn out to be cathartic as well.  It's the opposite of escapism -- grounding yourself in what someone else has gone through, so you can attempt to care about it and them more constructively.

The Value of Intentional Listening

Here's a great quote on the therapeutic power of compassionate presence:

"One of the most valuable things we can do to heal one another is to listen to each other's stories." -- Rebecca Falls.

Legal Woes of Combat Vets

Besides being the official First Day of Spring, today is also an inauspicious date - it's 30 days until the anticipated trial of decorated Iraq war veteran, Daniel B. Cotnoir, in Lawrence, Massachusetts.  Cotnoir, the Marine Corps' 2005 "Marine of the Year," was indicted last month by a Massachusetts grand jury on charges stemming from a shooting in which he participated in August, 2005, which seems (to the outside observer) to have been a clear case of PTSD.  Unfortunately, the Essex County district attorney does not seem to agree, and it looks like Cotnoir will stand trial for his actions next month in a Massachusetts courtroom.

In future posts we will list some of the better recaps available about Cotnoir's difficulties, as well as a look at his quite heroic "before" picture, when he served in Iraq with the Marine mortuary service - a grimmer, more horrific job one is unlikely to find, and one with Cotnoir discharged with great dignity and compassion.  Sadly, Cotnoir is not only Iraq war veteran who's been experiencing legal woes arguably linked to PTSD from his combat experience.  The "Marlboro Marine" - you may remember his photo -- grimy, sweat-streaked face, cigarette gripped in mouth -- is someone else who's wound up on the wrong side of the law after experiencing a fair amount of stressful readjustment to civilian life -- he was diverted by the military to swabbing up after Hurricane Katrina while in the throes of dealing with his own bout of PTSD.

In addition to the substantial physiological and psychological trauma that combat veterans can experience, more than a few will doubtless experience run-ins with the judicial system that they are under-equipped to handle.  Few if any resources seem to be available for supporting the legal woes of combat veterans that may be directly related to the combat trauma they've experienced.  And few lawyers seem particularly aware of or experienced with the special difficulties these clients have faced.  As time goes on, no doubt the situation may improve, but for right now, these veterans may almost be the "test cases" for how the judicial system will handle returning vets whose crimes may turn out to be linked to what they've experienced as a result of combat.

Alcohol Abuse, Stress and Divorce

A recent article in the Stars and Stripes indicates that returning veterans struggle with alcohol abuse and experience divorce in greater numbers following their return from deployment.  (The article is linked from the National Gulf War Resource Center, Inc., whose website is here.)

Alcohol abuse can be an attempt at self-medication as well as an easily available, socially acceptable "sleep aid," since combat veterans often experience significant trouble falling asleep or staying asleep.  When alcohol consumption passes from "recreational" use to "medicinal" use, it's probably time to seek professional help.  Anything that can be done to improve sleep quality or length, without causing other problems, is also a great idea.  Experts are increasingly beginning to link quality of sleep to ability to withstand and recover from significant life stressors, such as PTSD symptoms.

Following up on "Hidden Wounds"

There's a very good article on the Web, by Frontline reporter Christopher Buchanan, that investigates the story behind what drove Marine Corporal Jeff Lucey to his tragic death, a suicide that was profiled on "Hidden Wounds."  Chris Buchanan's article, which is well worth reading, his here.   Nate Fick, who's also profiled in the same documentary, has written the award-winning book about his time in Afghanistan and Iraq, One Bullet Away: the Making of a Marine Officer.  Information about Nate's other writings and his book tour are available on his website.

In addition, PBS's Frontline has a number of resources online about their documentary about combat trauma, called "A Soldier's Heart."  (This presentation is available on VHS and DVD).  The material on combat trauma and experts' opinions is linked here.

"Hidden Wounds" Documentary on Local TV

If you're in the New England area this weekend, be sure to watch "Hidden Wounds," an award-winning documentary on the effects of combat trauma, to be aired multiple times on New England Cable News (NECN.com).  See schedule here.

According to the promotional material about the show,

"Hidden Wounds'' is a powerful documentary about veterans returning from Iraq with post-traumatic stress disorder. The film profiles three local men and their struggles with overcoming the affliction, which affects 1 in 6 returning veterans.

The one hour film -- shown without commercial interrruption-- tells the story of Nate Fick, a graduate of Dartmouth College who believes privileged men like himself should be represented in the military. He was a platoon commander in “Recon,’’ the elite unit of the Marines. He fought in Afghanistan, then Iraq, returning from war in June of 2003. Fick descended into depression for close to a year. To cope, he began writing. His resulting book, “One Bullet Away’’ has been met with wide acclaim. He is currently pursuing graduate degrees at Harvard’s Kennedy school and business school.

“Hidden Wounds’’ also delves into the life of Sgt. Russell Anderson of Norton, MA who joined the Army in 1969, right out of high school. He served four years monitoring worldwide communications. He returned to civilian life, but kept re-signing with the reserves. Sgt. Anderson volunteered to go to Iraq in 2004 because he wanted to continue to serve his country. He returned in February 2005 hostile and depressed, but he was too proud to seek counseling. He finally agreed to treatment when he “bottomed out,’’ but he continues to cope with the affects of PTSD.

And, it spotlights Jeff Lucey of Belchertown, MA who joined the Marine Reserves as a high school senior in 1999. He spent a year as a truck driver in Iraq, returning home in 2003. He drank heavily and became increasingly despondent. His parents tried to get the Veterans Administration to commit him and treat him for post-traumatic stress disorder, (PTSD) but the VA refused to do so until Jeff Lucey stopped drinking. He committed suicide at age 23. His parents are now activists trying to ensure adequate government funding for PTSD treatment.

It was written and produced by NECN’s Executive Editor Iris Adler, edited by Beth Kidwell, and primarily shot by chief photographer John Stuart and videographer Ryan Scafuro. Graphic design was done by Angela Bertalotto.  (It sounds like it's narrated by Natalie Jacobsen, but perhaps this is in error.)

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NECN does a great job identifying in their blurb about the documentary where New England veterans can go for help with PTSD symptoms.  See the link to the site for details, because there are too many to list here.

It's not clear yet whether those outside the viewing area (New England) will be able to purchase this show on DVD.  If the answer turns out to be yes, we'll post details here shortly.

Paddling the Canoe Without Tipping It

The inimitable Chaplain John Morris, quoted in the equally inimitable Pine Journal of Cloquet, Minnesota, as it wraps up its four part series on returning veterans, called "The Long Road Home," had these highly quotable things to say, in an article published today:

“Going into combat is a little like canoeing across the lake of life,” said Morris.  “When you leave for war, it’s like standing up in the canoe and upsetting the balance of family life.   While you’re gone, your family takes over the paddling, but when you return,  you’re likely to jump out of that canoe and flip it, swamping it.  Many families have been faced with bailing out that canoe, and they suffer extreme duress over something they thought would be joyful.  A lot of families can become exhausted from paddling that canoe through life.”

"He encouraged returning soldiers to seek whatever help they need so they can make a successful adjustment back into the life of the community.  And if the community is committed to helping them, he said, that period of readjustment faces a much greater chance of success."

The article also concluded that it was wiser for "anyone seeking advice and direction ... to contact any of these resources rather than to try to “tough it out” on their own. (The resources are very Minnesota-specific, but the concept is good overall).  Kudos to the Pine Journal on a truly excellent, yet homespun series of practical, well-written articles, that should be a guide for other papers nationally to do the same.

PTSD Symptoms Arising Sooner

A recent, likely overlooked article from US Medicine: The Voice of Federal Medicine, in September of 2005 is a good, in-depth look at one Iraq veteran's suicide and his family's interaction with veteran mental health services before, during and after.  The veteran was an Army captain, married to another Army captain, with a young baby and a brand new house.  The story is definitely one of not enough services available to be delivered in a timely manner, a horrible cost paid in human life, and some improvement after the fact, because of the brave, grieving wife's willingness to go forward and push for change.

The story makes the point that part of the reason the system is having a hard time responding to the current wave of returning veterans with PTSD is that their symptoms are coming up sooner and more severely than had been anticipated.  Hear what Dr. Matthew Friedman, executive director of VA's National Center for PTSD in White River Junction, Vt, has to say:

"Another challenge to VA clinicians is the acuteness of symptoms among veterans with adjustment reactions or PTSD, Dr. Friedman said. During the post-Vietnam era, most veterans with PTSD were considerably older and had much more chronic PTSD before they sought or received VA treatment.

"With the improvement in VA/DoD diagnosing, an increasing number of OIF/OEF returnees are requesting care at a much earlier stage in their post-traumatic clinical course.

"What's new now is that there are families [seeking help] who have returnees that came in [from deployment] one or two days ago," Dr. Friedman said.

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Importantly, there are also serious legal or insurance-related repercussions to PTSD diagnosis, or a lack thereof, which will be discussed in future posts.  The military is essentially refusing to consider a veteran's PTSD-related death from suicide to be "combat related" unless he or she has been officially diagnosed with PTSD, but making a timely appointment to be seen with symptoms arising so shortly after returning from combat has kept many veterans unable to avail themselves of the services they so desperately need.

Veteran Suicide: The High Emotional Cost of War

It is so heartbreaking to learn the stories of returning vets from Iraq who don't feel able to cope with the pain they feel, and end their lives.  The wrenching loss, pain and emptiness their families feel is enormous, and often they wish to "get the message out" that PTSD is affecting vets in far more powerful ways, and sooner, than anyone has realized.  Their veterans paid the ultimate price, but their families don't want others to have to.  As more veterans return from this war, we will unfortunately see more of the same thing -- calls for help which go unanswered, tragic choices made by hurting people, and the pain their families feel, mobilizing into action to spare others the same fate.  It's said that the one thing Vietnam veterans wish to convey to America today is to not have to let another generation of veterans suffer on homecoming they way that they did.  Please be sensitive to the needs of all veterans and their families, and see what you can do, what we can do as a society, to ease their enormous pain.

A few memorial websites of grieving families who've lost their Iraq veterans to suicide are here and here.  "All gave some, some gave all."

Soldier Describes the Emotional Burden of War

A decorated Army Iraq veteran, with a master's degree, shares the pain he feels:

“I am a man who carries the emotional scars of tragedies that have befallen me.  From my initial activation for the World Trade Center disaster, to my deployment to Iraq in 2003.  Seeing so much destruction and death, and having lost friends in both catastrophes changes a person.

I don’t go out and have wishes of committing violent acts, nor do I see apparitions.  I just have developed very little tolerance for ignorance and unsophisticated thinkers – who believe that all soldiers are trained just for killing, and that there is no compassion for human life.  If you know someone who’s been over to Iraq, please remember one thing: he or she is not the same, and it’s a burden in their lives that they were there, and what the saw.  Show your love and support, and never turn your backs on them.”

Combat Trauma in the UK

There's a sad story in the Scottish news website, ScotlandonSunday.com, about a severely-injured UK veteran of the Iraq war's experience back home in Scotland.  The article is entitled, "Veterans Abandoned After UK's 'Vietnam'."  Apparently, services aren't nearly up to par, and the biggest reason the article offers is that UK public sentiment is as much against the war in Iraq as it was in the U.S. against Vietnam.  Several people are quoted in the article as saying that Operation Iraqi Freedom has become the UK's Vietnam.  With little public sympathy behind the war -- as many as 2/3 are opposed to it -- there's little public embracing of the warriors who come back from the war, and they find it's too uncomfortable to talk about it with others who just don't understand. 

Additionally, services for veterans have been severely curtailed, so veterans are returning to poor care and little psychosocial support, for a war they weren't really that interested in fighting in the first place.  Read the article for a greater sense of what's going on in the UK, but let's hope that their veterans can get the care they need at this time, not later on after they've suffered even more.  One of the only great lessons for us in the U.S. after Vietnam is that we at least are coming around to understanding treating veterans better and more quickly.  It would be a shame to watch the UK suffer through what we've already lived in this regard.  Let's hope they don't have to and can fix the situation before it needlessly becomes any worse.

PTSD - What Is It?

There's a good, somewhat generic but helpful article in Yahoo's "Kids Health" section today about Post-Traumatic Stress Disorder - what it is, what causes it, and what its signs and symptoms are.  The focus is more general than PTSD specifically as a result of combat trauma, but it's still informative and serves as a good introduction to the topic.

PTSD An Insipid Disease - and Denial

In an article in today's Bangor Daily News, from Bangor, Maine, Michael Uhl, Ph.D., a writer and charter member of Veterans for Peace, as well as the Disabled Veterans of America, speaks about his own experience coming to terms with PTSD, as a Vietnam veteran.

Says Uhl, "In my own experience, PTSD is an insipid disease, one which I went to great lengths to deny in my own life for decades. Denial, in fact, was my biggest enemy, in the sense that I failed to grasp for years that PTSD, perhaps all mental illness, has a life of its own, and is not subject to conscious regulation like the normal ups and downs most people experience.

"When I realized that PTSD often controlled me, and not the other way around, I was able to finally confront my condition, and learn how to better cope with and manage my symptoms."

Because the article is in part about proposed cutbacks to the VA's budget and what that will mean to veteran's care, Uhl continues, "Without the safety net provided by the VA, that would not have been possible."

Transition Time from Warrior to Citizen

Here's a link to the second part in the series, "The Long Road Home," from the Cloquet, Minnesota Pine Journal about integrating veterans successfully back into their communities.  What a truly excellent series.  More on this later.  Looks like Minnesota is setting the pace in compassionate treatment of returning vets.  Another article in the paper details the "Sponsor a Soldier" campaign for returning vets.  According to the paper, "This year, area residents have a chance to thank the soldiers personally with a $100 “Sponsor a Soldier” donation, which will offset the cost of dinner for a soldier and a guest, and hotel room for the night.  “They really need this, it’ll be a great night for them,” said Sergeant Jesse Sigurdsen of the Cloquet Army National Guard."

Just amazing.

Straight Talk for the Long Road Home

The Pine Journal, from Cloquet, Minnesota, continues its excellent series on healing from combat trauma with another installment in today's paper, called "The Long Road Home: Community Can Provide Key Support."  As the article points out, Minnesota is doing some progressive work in re-integrating combat veterans by making their adjustment a priority.  At a recent meeting, community service providers and others got some extremely straight talk from a return chaplain and National Guard veteran, John Morris.

A few quotes from Morris:

To law enforcement:  “Don’t lie to me when I get in trouble,” he stated. “Don’t tell me it will be all right. And don’t talk down to me. Instead, we need to work through things together. You might be able to identify me as a combat vet because chances are, I am going to talk tersely. If that is the case, call me by my last name [as they do in the military] and that will help diffuse the situation.  “I need clear and defined guidance from you."

To security guards, in local casinos:  “When you approach me from behind,” he said, “announce yourself, and then tell me what you are going to do.”

To social service providers: “Don’t feel you have to ‘fix’ us. You don’t have to handle our problems alone. You already have training in dealing with trauma, so try to treat us with respect no matter what we may be going through and validate what we perceive ‘normal’ people should be like.”

To local religious leaders: “If you tracked with my family while I was gone, I will give the church a great deal of respect. If not, you will not see me again. Also, before announcing my return in church, ask me first if I’m feeling confident enough to deal with it. Otherwise, let me keep a low profile. Create a safe place for me and offer me hope of forgiveness, and please don’t talk about the politics of war.”

To employers: “Remember we are severely handicapped by what we’ve missed while we were gone,” he said, “and help us pole vault that 18 months.”

And to bartenders, he said, “Be sympathetic when you hear my story, but don’t buy me another drink. Instead, start slowing me down. What I really need is a ride home.”

WOW.  This is a man, and a newspaper, we'd enjoy hearing a lot more from.

"The Road Home" - Upcoming Conference

The Therapeutic Communities of America in conjunction with the US Department of Health and Human Services, Substance Abuse and Mental Health Administration (SAMHSA) is holding a conference called, "The Road Home: The National Behavioral Health Conference for Returning Veterans and Their Families" at the Washington Hilton, Washington, D.C., March 16-18.  Further information is found here.

The purpose of the conference, according to organizers, is to give Federal, State, and local public and private service providers "evidence-based information and information and approaches that can help veterans and their families build resiliency to prevent and to treat mental health disorders (including PTSD or Post-Traumatic Stress Disorders), substance abuse disorders, suicide, and/or co-occuring disorders."

Hidden Scars and Shaking Off the Black Dog

An article from the island of Wales describes one British combat veteran's healing from long-ago military trauma that's come about as he's worked on a documentary for the BBC called "Hidden Scars".  In the article, Falklands veteran Simon Weston talks about the effort it's taken him to "shake off the black dog," what he calls his own personal battle with PTSD.  As Weston says, sometimes PTSD "can show itself in the lack of a good sleeping pattern or drinking huge volumes and becoming irrational. You can become totally unreasonable, but it's just a normal reaction to something very abnormal."

Says Weston, "The authorities are very good at looking after the physical well-being of former service people, but far less sensitive to their psychological needs."

Mental Health Screening Just "Optional"?

An article in the Boise Weekly challenges the idea that the one hour mental health screening of National Guard veterans returning from combat has gone from being "mandatory" to being "optional."  Seems like there's something potentially political behind why that is.  It's not the purpose of this blog to get into the politics of veterans' care -- many other blogs can and will be able to do that -- but just to mention that it's an issue.

Personality Traits and PTSD

Without implying in any way that "personality traits = destiny" on this topic, because that would be patently unfair and unreasonable, a recent Yugoslav study quoted in Psychology Today indicates that personality traits may affect experience of PTSD.  In general, the subjects studied who had experienced the greatest exposure to combat trauma were also the ones who suffered the most PTSD, but they also found that subjects who had certain personality traits reported PTSD more frequently than others in the study.

According to the article, "Inge Bramsen, a psychologist at Vrije Universiteit in Amsterdam, tested 572 men who participated in the United Nations Peacekeeping Force in the former Yugoslavia for PTSD. Men who reported seeing the highest number of stressful events—shootings or dead people, for example—showed the most severe symptoms. But those who rated highest on personality traits such as negativism and paranoia before deployment also tended to show more signs of PTSD later. A hostile person may see more personal menace in events than others do, says Bramsen. An anxious person may also cope with stressful situations less effectively.

Bramsen believes that a better understanding of what causes PTSD might help to protect soldiers and others sent into harm's way. But, "I think we will never be able to prevent PTSD," she says. "It is a normal reaction to an abnormal situation."

Possible Trauma Treatment Drug

An interesting article in last Friday's Chicago Tribune (registration required) talked about the possibility of there being a pharmaceutical drug, already used for treating high blood pressure, that might have some off-label use in treating combat trauma (and other traumas as well), particularly if given within hours of exposure to the traumatic episode.  Studies are still being done on the drug, but it looks cautiously promising from the strict pharmaceutical angle.  (There are other options for treating trauma as well, that may not rely on drugs).  Some of the highlights from the article:

"Brain scientists think they have found a way to help by using a drug called propranolol to alter traumatic thoughts. It appears that the drug, a beta blocker used to treat high blood pressure, interferes with stress hormones in the brain to defuse the impact of horrific memories.  While use of the drug for this purpose has not been approved, some psychiatrists already have begun to prescribe it to patients with PTSD. (Other beta blockers do not seem to affect the brain the same way.)  "Researchers emphasize that the drug can lower the intensity of a bad memory--but not erase it."

Also,

"Dr. Roger Pitman, a professor of psychiatry at Harvard Medical School, wondered if giving propranolol as soon as possible after a traumatic event could prevent indelible, terrifying memories from taking hold.  He tested the idea on 41 people who had experienced car accidents, assaults and other events that brought them to a Massachusetts emergency room. They received the drug within six hours of their mishaps.  The results were dramatic. Three months later, 22 of the victims listened to audiotapes on which they had described their traumas. None of those who took propranolol showed strong responses to the tapes, but eight of the placebo patients were obviously shaken by reliving their experiences. Their heart rates increased, their palms sweated, their muscles twitched--all signs of PTSD.  Now Pitman's group is pursuing a study in which patients with chronic PTSD are treated repeatedly with propanolol.  "If we get positive results, there are many potential applications for people with PTSD from a variety of sources, including Hurricane Katrina and the Iraq War," Pitman said.

Coping with Trauma: Personal Self-Care

Another great, simple and profound article (short, too) from the Israeli site, this one on coping with trauma and practicing self care.  The link is here.

A capsulization of the advice?

1. Ask yourself if you need professional help;
2. Speak to family and friends;
3. Become experts in trauma;.
4. Maintain a healthy lifestyle;
5. Practice relaxation exercises;
6. Avoid self-judgment; and
7. Try to avoid making important decisions --at least in the days immediately following your return.

Read the whole article, though; it's great and very refreshingly, simply said.

Coping with Terror: Your Personal Survival Kit

Here is a link to a good (Israeli) site on the Web with specific advice for coping with terror, in a lovely resource article entitled, quite practically, "Coping with Terror: Your Personal Survival Kit."  The advice is low-key and reasonable, and apolitical; so potentially quite helpful.  We'll include a few highlights from the article below -- but be sure to check out the link to read the article in full.  There's also a companion article about talking to children about coping with terror.

They write:

"Ongoing international terror presents all of us with many challenges. Stress, anxiety, short temper and tiredness are common conditions in such a stressful situation. We may feel as though our reservoir of strength is being drained, and this may affect us at our studies, at work and at home. The purpose of this page is to provide you with tools for dealing with this very stressful situation successfully. Obviously these tools cannot change the political reality, but they can change your personal reality and help you get through the threat of terror, or other major stressors, safely. These tools are aimed at helping you become calmer, healthier and stronger."

The tools they highlight (and again, read the whole article, which develops each in more depth than is possible here) are:

• Stick to daily routine;
• Make sure you have a healthy diet, physical exercise and enough sleep;
• Practice relaxation daily;
• Talk about your emotions with the people who are important to you;
• Help others;
• Devote time to a hobby;
• Become an expert;

Combat Trauma on NPR

The Diane Rehm show on NPR today devoted a full hour to discussing combat trauma and returning vets.  Click here for the link.  The show was entitled, "Mental Health and Military Service in Iraq," and featured the following guests:

Charles Sheehan-Miles, executive director of Veterans for Common Sense and a veteran of the first Gulf War

Col. Dr. Charles Hoge, director of the division of psychiatry and neuroscience at the Walter Reed Army Institute of Research

Chaplain John Morris, chaplain for the Minnesota National Guard

Craig Smith, served as a Specialist in Operation Iraqi Freedom from April to November 2003

British Combat Stress Relief

An article published in a British newspaper today, entitled, "I'm Still Haunted by Pub Bombing," details the struggle of a British Army medic who witnessed, and then pitched in to help out with the victims from, a pub bombing by the IRA many years ago.  He tells the story that he lived for years without being aware of the effects of PTSD, which today he knows he suffers from.  The article is a human interest story which makes the point about how weak the PTSD available care is for veterans in England, such as this man; but it also points out the charitable work by an organization known as Combat Stress, whose website is linked here.

One of the more interesting comments in the article was this, by Robert Marsh, the director of fundraising at Combat Stress (UK): “A new report from the States has shown that 35 per cent of people coming back from Iraq are needing some form of psychological care, so it is a big problem. In the military there is a culture of self-help rather than talking about issues in the open, but I think this is changing. The military has a duty of care, both physically and mentally, for its veterans. However, there is not enough awareness about the mental problems that are caused.”

Salient points to consider are these:  Combat trauma is a worldwide problem.  The UK has experienced its own with the IRA bombings over the years, as well as participation in foreign wars, such as Iraq, presently.  People can experience PTSD symptoms many years after the fact.  Treatment is not always what it could be.  And there's the need for the military, both in the UK and here in the US, to adapt from "self-help" to greater openness about these issues.  It's also great to conceive of the military understanding it does have a duty of care that extends past deployment for its servicemembers and their families.

Vets Encounter Emotional Rollercoaster Upon Returning from War

ABC News has a great story today about the National Guard in Cloquet, Minnesota, and the efforts there to make sure that returning veterans are as acclimated and supported as can be, in their transition back to civilian life.  Seems that the effort is spearheaded by leaders intent on seeing that these veterans are as "set up for success" as they can be, and don't experience anything like the reception that met veterans returning from Vietnam.  The article is called "Soldiers Describe 'Emotional Roller Coaster' Upon Return From War," and tellingly subtitled, "Psychological Toll on Battle-Hardened Vets Complicates Switch to Civilian Life."  It's well worth reading, so try the link here while it lasts.

Some of the better comments in the article would be these:

Maj. Gen. Larry Shellito is the father of the program, which works hard to address the emotional toll of returning from a war zone but also covers how to obtain federal benefits.

"We owe them," he said of the Guardsmen. "This country owes them to make sure that we can give them that box of tools to help them reintegrate and be successful." Leaving soldiers to their own devices for the first three months of their return, he believes, courts disaster.

"The ones that we just turn loose on society to fend for themselves," said Shellito, "those are the ones that I'm worried about because I don't know what support mechanisms they have."

Also,

"I don't know that the public understands," [a vet] said in an interview during a break in his presentation. "How can they? And I don't know that they want to know." ... Referring to the public, Morris said, "They don't understand that for most of us, the war is just starting [when we return]."

Similarly,

"If we do a good job reintegrating our combat vets and helping their families," Morris said in an interview, "we're going to have a tremendous citizen here.

"But if we don't. If we repeat what we did in Vietnam and shun or, at worst, shame these veterans, we're going to drive people underground. They're going to manifest terrible problems."

Bruce Ahlgren, the mayor of Cloquet, attended the community briefing a few days ago and said it was an eye-opener.

"We just kind of think they come back and they're in a comfort zone again and everything's hunky-dory." That's clearly not the case, Ahlgren acknowledged. And the words of Chaplain Morris still rang in his ears.

"Please be respectful and welcome us and show hospitality," he told the Cloquet city leaders, "until we get our feet on the ground."

Suffering in Community

Reading the excellent book, The Gift of Valor, by Michael M. Phillips, it's hard not to be struck by what really is a side point in the book: the writer's depictions of the emotional hardship the medical personnel go through at the various trauma stations the wounded from the Iraq war go through on their way back to the United States.  No matter where the medical personnel are located, in aid stations in Iraq, at Landstuhl in Germany, even back in the U.S., or who they are, it seems they're generally unprepared for the sheer level of trauma they're encountering, and what it's going to feel like emotionally to see and treat one after another badly injured veteran.  Many of these doctors and nurses who deliver exceptional care under the circumstances, worked in fairly unrelated roles before -- dentistry, psychology, pediatric and ob/gyn specialties -- that while providing them with a medical background really didn't give them exposure to the types of injuries and hardships they're experiencing day after day in the current war.  In some of Phillips' descriptions, you see the doctors and nurses clamming up or turning away or crying profusely, because it's hard to control their emotions, under the circumstances.  Very understandably, naturally.

An excellent article in a recent issue of the Wall Street Journal (coincidentally, the newspaper where Phillips is a staff reporter), by Sue Diaz, a freelance writer who's also the mother of a soldier in Iraq, makes a similar point.  The hardships of war -- including its searing trauma --  are borne by and endured and affect, not just by those who go, but also by those who are in their immediate circle of community.  As Diaz writes:

"My son has learned much about life the hard way lately. But it seems to me there’s something he doesn’t as yet completely comprehend or perhaps has come to understand far too well. It is this: When he and his men are out on a mission, they are not alone. Whether we agree with this war or not, those of us who love them are out there, too, moms and dads, kids and cousins, sisters and brothers, neighbors and friends.

"Every time an insurgent bomb blows apart a Humvee or a squad on foot patrol, the shock waves from the blast reverberate in small towns like Wheeler, Texas, and big cities like San Diego. A young private takes a bullet; back at home his father’s heart bleeds. A soldier loses a leg; his wife struggles in the days that follow to simply keep putting one foot in front of the other. A sergeant’s eardrum is perforated; his mother hears the explosion in her dreams, time and time again. Truth is, the casualties of war go far beyond the numbers from the Pentagon. Love gives us no choice."

Our Suffering Is Not the Enemy Quote

And this longer passage, from a recent book:

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).

Unconquerable Soul Quote

"Out of the night that covers me

Black as the pit from pole to pole

I thank whatever gods may be

For my unconquerable soul."

-- "Invictus" by William Ernest Henley.

Quoted by Michael Fay, USMC combat artist, on his blog, Fire & Ice.

War Is Never Moral Quote

“A true war story is never moral.  It does not instruct, nor encourage virtue, nor suggest models of proper human behavior, nor restrain men from doing the things men have always done.  If a story seems moral, do not believe it.  If at the end of a war story you feel uplifted, or if you feel that some small bit of rectitude has been salvaged from the larger waste, then you have been made the victim of a very old and terrible lie.  There is no rectitude whatsoever.  There is no virtue.  As a first rule of thumb, therefore, you can tell a true war story by its absolute and uncompromising allegiance to obscenity and evil ... You can tell a true war story if it embarrasses you.  If you don't care for obscenity, you don't care for the truth…” – Tim O’Brien, The Things They Carried.  (Quoted by Jonathan Shay, M.D., Ph.D., in Achilles in Vietnam).

Jonathan Shay Quote

"If military practice tells soldiers that their emotions of love and grief -- which are inseparable from their humanity -- do not matter, then the civilian society that has sent them to fight on their behalf should not be shocked by their "inhumanity" when they try to return to civilian life." (In, "The Importance of Thwarted Grief," p. 67, in Achilles in Vietnam, by Jonathan Shay, M.D., Ph.D.)

Augustine of Hippo Quote

"Anyone who looks with anguish on evils so great must acknowledge the tragedy of it all; and if anyone experiences them without anguish, his condition is even more tragic, since he remains serene by losing his humanity." -- Augustine of Hippo. One Bullet Away: The Making of a Marine Officer, by Nathaniel Fick. Boston: Houghton Mifflin (2005).

 

(Congratulations to Nate Fick, whose excellent book, One Bullet Away, was just awarded top prize by Barnes & Noble for their "Discover Great New Writers" of 2005 Award.)

Great Quotes on Combat Trauma

Periodically we come across a great quote on combat trauma and healing, and it seems only fitting to post it here.  Consequently, we'll be posting a few here in subsequent posts.