Healing Combat Trauma

When Two Are Better Than One: A Relationship That Can Save You

Although at first glance, we should really save ourselves -- not be saved by others -- there's something wrong with looking externally for something that should come ultimately from within -- still, relationships can exert powerful forces for good in our lives.  It's painful reading about the Vietnam veterans, for example, who are "unable to touch intimacy," or who still clearly keep intimate relationships at a distance, because they're afraid of the weight of failure, among other things. 

There's a nice segment of a poem from T.S. Eliot that speaks to this.  Eliot was a famous Modernist poet, from the school that developed around World War I, and while he wasn't sensational about this in his own life -- his first wife, Vivien, to whom the words "My nerves are bad to-night.  Yes, bad.  Stay with me." are attributed in Eliot's famous poem, The Waste Land, is also a woman he institutionalized; still, he is able to write these comforting words, which perhaps he practiced himself, and perhaps did not.  (They could also be about his marriage to his second wife, which was apparently much happier, though shorter-lived.  He was married to her at the time he wrote these lines.)  In any case, they can still serve to inspire us with their truth:

"If a man has one person, just one in his life,
To whom he is willing to confess everything --
And that includes, mind you, not only things criminal,
Not only turpitude, meanness and cowardice,
But also situations which are simply ridiculous,
When he has played the fool (as who has not?) --
Then he loves that person, and his love will save him."

-- T.S. Eliot, The Elder Statesman (1958).

Editor's note: For our ongoing series on "healthy sexuality and the combat veteran," go here.

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?”

 

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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).

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[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 Wet Bond of Blood: Combat Participants "Closer to One Another Than Even Lovers"

While we've been blogging about "healthy sexuality and the combat veteran" lately, in our series on sexuality and intimacy - the good, the bad and the ugly -- it's always interesting to note by comparison just how amazingly close combatants end up feeling to one each other.  It makes you wonder if some of that fellow feeling and clearly love could be transferred successfuly to other, more classically intimate relationships after combat -- some of which seem dysfunctional at best -- and if so, how.

In the meantime, let's take another look at the closeness combatants develop in combat, as expressed by several articulate sources.

---

A few weeks ago we blogged about an excerpt the stunning war poem by Robert Graves to Siegrifed Sassoon, both WWI soliders, one gravely wounded, the other with PTSD -- about the relationships formed in combat:

Show me the two so closely bound
As we, by the wet bond of blood,
By friendship blossoming from mud,
By Death: we faced him, and we found Beauty in Death,
In dead men, breath.

Here's another item, this time from prose, but so artfully written, as to be poetic itself.  It seems to be highlighting just the same bond:

"We sit opposite one another ... two soldiers in shabby coats, cooking a [stolen animal] in the middle of the night.  We don't talk much, but I believe we have a more complete communication with one another than even lovers have.

We are two men, two minute sparks of life: outside is the night and the circle of death.  We sit on the edge of it crouching in danger, the grease [from the fire] drips from our hands, in our hearts we are close to one another, and the hour is like the room: flecked over with the lights and shadows of our feelings cast by a quiet fire.  What does he know of me or I of him?  Formerly we should not have had a single thought in common -- now we sit with [the grilled animal] between us and feel in unison, and are so intimate that we do not even speak."

--from All Quiet on the Western Front, quoted by Robert Jay Lifton, in "Home from the War: Vietnam Veterans - Neither Victims nor Executioners."

Editor's note: There were some neat personal quotes I was going to add in here from a conversation with a veteran via email about his relationships with his foxhole buddies, but unfortuantely I can't seem to find them at the moment.  When I do, I'll add them back in to this post.  They seemed to quite confirm the two passages above.

Learning to Bounce Back: Helpful Hints for Increasing Personal Resilience

"Resilience" or the concept of "increasing personal resilience" is something we're hearing about more and more in connection with PTSD.  For combat veterans and their families, the greater the amount of personal resilience, the more fully they'll be able to "bounce back" from trauma (hence the image of the boomerang, which quickly returns to its source.)

 

According to the dictionary, "resilience" is "The ability to recover quickly from illness, change, or misfortune; buoyancy;" and the intrinisic "property of a material that enables it to resume its original shape or position after being bent, stretched, or compressed; elasticity."

According to the National Center for PTSD, and its PowerPoint presentation on PTSD 101, presented by Fred Gusman, M.S.W. and colleagues, three keys to resilience are the "ABC's" of "awareness" (of one's limits, emotions and resources); "balance") among personal and professional activities [their presentation was to clinical caregivers, so that's explains the inclusion of that sentence]; and "connection" (to one's inner self; to others, and to something "larger" (typically spiritual).) A connection with others, in particular, "breaks the silence of unacknowledged pain; offsets isolation; and increases validation and hope."

 

The short, pithy presentation also offers these

 

Helpful Hints for Personal Resilience:

• Make connections/relationships;
• Avoid seeing crises as insurmountable problems;
• Accept that change is inevitable;
• Set goals and actively move toward them;
• Take decisive actions;
• Look at problems as triggers for personal growth;
• Don’t blow things out of proportion;
• Remember and use past coping, success, strengths. 

-- Source: APA Task Force on Resilience, 2002, quoted in National Center for PTSD’s "PTSD 101," linked here.

Understanding the Veteran: Amount of Combat Experienced

Here's an interesting quote that helps to define the Vietnam experience, although the principle involved is the same irrespective of the war.  More combat = more chances to develop PTSD, as we've already covered in an earlier post, linked here.  It's important to learn from the combat veterans in your life just how much they actually experienced, even if they and you don't want to share the actual details.

"During World War II, the Sixth Marine Regiment served four years in the Pacific but only engaged the enemy for about four weeks. In Vietnam, the combat soldier typically served a 12-month tour of duty but was exposed to hostile fire almost every day of his tour."

Source: Article called "Vietnam Veterans, U.S. Crime and Prison," by John J. O'Connor in the New York Times, July 15, 1982.  The quotation is from the narration of a movie called "Vietnam Requiem."

Trauma Appears to Shrink the Brain's Hippocampus, Research Shows

An extremely recent article in the journal, Hippocampus, makes the simple observation that, according to recent medical research, trauma appears to shrink the size of the brain's hippocampus, a center linked (not surprisingly) to emotions and memory, thought to be part of the limbic system. This is good news, because it's always helpful if psychological topics such as trauma and PTSD can be shown to correspond to organic changes in phyisology: it gives them more credibility to the nay-sayers, of whom there are far too many.  The article itself is linked here.

According to MedicineNet.com, "The hippocampus is an area buried deep in the forebrain that helps regulate emotion and memory. Functionally, the hippocampus is part of the olfactory cortex, that part of the cerebral cortex essential to the sense of smell. Certain antidepressants (such as fluoxetine, or Prozac) influence the birth of new neurons in the hippocampus. The hippocampus is so-called because its shape suggests that of a seahorse. From the Greek hippos (horse) = kampos (a sea monster)."

The full citation of the journal article, for further study, is this:

AU: Fu L. Woon, Dawson W. Hedges
TI: Hippocampal and amygdala volumes in children and adults with childhood maltreatment-related posttraumatic stress disorder: A meta-analysis
SO: Hippocampus
VL: 18
NO: 8
PG: 729-736
YR: 2008
CP: Copyright © 2008 Wiley-Liss, Inc.
ON: 1098-1063
PN: 1050-9631
AD: Department of Psychology, 1001 SWKT, Brigham Young University, Provo, UT 84602; Neuroscience Center, 1001 SWKT, Brigham Young University, Provo, UT 84602
DOI: 10.1002/hipo.20437
US: http://dx.doi.org/10.1002/hipo.20437

The Carrot or the Stick: A Specialized "Cocktail" for PTSD?

Carrot of Hope is a nonprofit organization on the Web of individuals with PTSD, who are trying to pool their experiential knowledge base in order to create a better future for those with PTSD.  It's hard to figure out much from their website about what they're about, but perhaps that's just because they're a work in progress. 

However, much of the group's enthusiasm seems to center around a "PTSD cocktail," using various chemicals, that they feel -- from their members' accumulated experience with it -- has some beneficial effect on PTSD.  Apparently they are both trying to raise money to study the effects of this cocktail on PTSD, and also provide resources so that those with PTSD can take the information to their doctors and/or health care providers, and initiate a dialogue about whether this treatment might be beneficial.  Worth checking out -- especially worth sharing with your health care provider, to see if it might have promise in your particular case.

They say that they are "currently taking donations to fund a research project studying the role of the MAO-A enzyme in post-traumatic stress."  According to them, "the Monoamineoxidase-A (MAO-A) removes catecholamines (fight or flight chemicals) from the body," and that "studying MAO-A levels in PTSD patients could be a major key in curing" and possibly even "preventing PTSD in the future.

The article on their website about understanding catecholamines is linked here, and th material about the "PTSD cocktail," which contains three ingredients -- Geodon [Zeldox, Ziprasidone] (20 mg); Propranolol [Inderal] (10-20 mg); and Vistaril (25 mg) -- is linked here.  The main website is linked here.

Eyewitness to Combat - Misplaced Guilt Trip - Even the Survivors Lost (Survivor's Guilt)

This is possibly the most intense and heart-wrenching of the reminiscences of Pat, the young Marine who served two tours in Vietnam, whose recollections we are excerpting in this "Eyewitness to Combat" series.

 

He is shot five times, in the arm, leg, back and head, seriously wounded, medivaced out of Vietnam, and recovering stateside in Balboa Naval Hospital, when he gets some news that will change his life forever. If you read the foregoing episodes in the series, you learn a little of what the combat he saw was like. 

 

But let's pick up in his own words with how that affected him:

 

"Almost everything that I had done and experienced generated a corrosive guilt that continued to diminish any hope of a joyful life that I could have had. But the one event which brought overwhelming guilt and probably attributed more to my “death wish” than anything else was the one event which I had not even taken part in.

My unit had been completely destroyed and I wasn’t there to die with them. I was a coward: I had run away and hid and because of this, I was responsible for the complete elimination of “Bravo” Company.

 

That is what my mind was telling me -- even though I was stationed in the Balboa Naval Hospital, being treated for severe wounds that I had received when my platoon had been ambushed and annihilated on Hill 861 S. in Khe Sanh, South Vietnam.

 

I was notified of this event when a Navy Corpsman came into the ward that I was confined to and said “Weren’t you in Bravo Company, 1/9? I found an article in Time magazine that has an article about them getting wiped out. I thought you would like to read it.”

 

He could not have affected me more if he had hit me in the stomach. I read it and I silently cried for the first time since I had returned.

 

I was completely overcome with shame, and survival guilt took up permanent residence in my heart: I swore that I would never let the memory of them get lost, and that I would always carry the torch for them.

 

I looked out the window and there on the street outside of the Hospital entrance a large “anti-war” demonstration was in progress and the hatred was directed at the wounded vets while my beloved Bravo Company was gone, they were all dead, wounded or missing. I was twenty years old and I absolutely hated America.

 

The article epitomizes what the misplaced guilt trip was all about: “115 Dead, 276 Wounded, 26 Missing, A Battle Without Victory: The Wipe-Out of Bravo Company.” There were no winners, only losers again; even the survivors lost."

And then, in an echo of why other teenagers self-harm, such as by cutting themselves, in an attempt to "balance" the pain externally with the pain they feel within, we hear Pat describe the aftermath for him:

 

"I spent the next 35 years trying to find out “why some people survived and others didn’t”. More specifically, I needed to understand why I had “dodged the bullet” when so many other Marines had “bought it”. I constantly sought a place where the pain going on around me and outside of me matched the pain inside my head and which was literally eating me alive.

 

As weird as this sounds, the more I hurt physically, the calmer I felt. Only physical pain could suppress the mental pain that was always present. It was as if I had to be constantly punished just to survive. "

Despite the thousands of words that Pat has written to describe his experiences, his description of this episode in his life made me wonder if it in fact was the pivotal episode of all.  As to why he didn't deck the world's most insensitive human being -- the Navy Corpsman who "dropped" that bit of "news" in his lap?  Pat says that if he hadn't been lying in the hospital bed, shot up and paralyzed on one side, he would have been happy to.  I can easily see why.

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

The Tao on Caring for Others

Care.

(In short) “to care for others is to look after and nourish them.”

 

It is natural to care for others.  If you are the one dispensing the care, then do it happily.  It is really good fortune to have someone to love and to have someone who loves you.

From animals to sages, there is care.  A mother tiger, for example, will take care of her cubs.  An older brother will look after the younger.  Even in the temples, one monk looks after another.  And the sages often looked after one another.  Let us not be so concerned with our own practice that we do not look after others.

All is Tao anyway.  Who is to say that the only way to be enlightened is to be sealed in a cave?  Tao is movement.  Tao is diverse.  Our purpose is not to look in the Tao of books.  Our purpose is to look for the Tao of our lives.  If you have people you are in relationships with, then look after them.  Not because you owe it to them.  Not because it is the right thing to do.  Not because you will get something in return.  But because it is part of who you are.

 

-- Source: Everyday Tao: Living with Balance and Harmony, by Deng Ming-Dao. 

The Six Conditions for Healing

Another highly cryptic post, intended to stimulate thought and reflection.  We'll discuss and elaborate more later, but for now, contemplate what these words can mean.

The Six Conditions for Healing:

1.  Combat Veterans have to feel safe physically, mentally and emotionally;

2.  Combat Veterans need to relax deeply on a physical level;

3.  Combat Veterans’ minds need to quiet;

4.  Combat Veterans need support and permission to recognize and validate their feelings;

5.  Combat Veterans need to feel the importance and the sacredness of the moment (of bringing forth what they're struggling with, and contemplating health and integration);

6.  Combat Veterans need to open to the surge of increased chi (life energy) and to surrender to the power (of that force) withi (them).

The Three Stages of Healing

Shortest blog post ever on here; see what you think about this:

The three stages of healing?  According to one source, they're nothing more  -- or less -- than these:

1.  Pain;

2.  Confusion; and

3.  Change.

(More on that later...)

The Cortisol Connection: Sex and Sleep, Stress and Survival

An amusing quote from two women health experts on Oprah, back in February of 2001: "Sleep is the sex of the next century," (meaning this one that we're in, now), by Laura Berman, Ph.D. and Jennifer Berman, M.D.

Good sleep being equated in importance to good sex?  Ahhh, that's not just humorous, that's interesting!  And both topics are recent focuses of this blog, so we've got to dig in and discuss.

Recently, we've talking about sleep AND sex (though not necessarily at the same time, for obvious reasons ;-).  However, both are important to maintaining good psychological health and happiness -- and the reality is, they both have something to do with a topic we've recently mentioned: cortisol. 

According to one expert, "Elevated cortisol levels resulting from chronic stress" [PTSD is a chronic stress] have been associated with the following conditions: increased appetite and food cravings; increased body fat; decreased muscle mass; decreased bone density; increased anxiety; increased depression; mood swings (anger and irritability); reduced libido (sex drive); impaired immune response; memory and learning impairment; increased symptoms of PMS (cramps, appetite); and increased menopausal side effects (hot flashes, night sweats)." Oh, my goodness!  Is there anything that ISN'T on that list?

Remember, too, that increased cortisol levels such as exist in veterans with PTSD are also implicated in risk for heart disease, as we blogged about here, recently.

---

Shawn Talbott, Ph.D., who has an interesting book called The Cortisol Connection: Why Stress Makes You Fat and Ruins Your Health -- And What You Can Do about It, has several pages devoted to the all-important topic of how cortisol from stress -- which veterans with PTSD have -- wrecks people's sex lives.  Since we've been discussing healthy sex and the combat veteran lately, it seems tailor-made to discuss what Talbott finds.  As he writes:

“You don’t need to read a book about the relationship between stress and disease to know that when we’re stressed out, we also have problems in the intimacy department.  For starters, menstrual cycles get all out of whack, erections are more difficult to achieve and maintain, and overall libido (sex drive) plummets.  Stress simply makes us lose interest in sex.  In males, this is due primarily to a dramatic fall in testosterone levels during stressful times.  In females, the stress-induced loss of sex drive is a bit more complicated, involving disruption in levels not only of testosterone, but also of estrogen, progesterone and prolactin.

 

(We're skipping over the part where he goes into biology class level details about how cortisol levels affect men's and women's sex drives, and going straight to his conclusion.  His book, which is worth getting, goes into details about what you can to do affect your own cortisol levels, apparently for better health.)

“So what to do?  Quit your job, move to the islands, and open a surf shop!  Your sex drive is guaranteed to increase.  (Ever wonder why you feel friskier when you’re on vacation? – Less stress!)  Not practical to move your family to Tahiti?  Okay, then at least do something about your cortisol levels…”

 

---

Another part of Talbott's book I found interesting was when he talks about the three main factors that make a huge difference in stress levels of individuals.  Take a look at these and think about combat trauma in the lives of veterans you know, and wonder about these factors continue to play into their lives, from remembered combat:

 

“We know from studies of both animals and humans that at least three factors can make a huge difference in how the body responds to a given stressor: whether there is any outlet for the stress, whether the stressor is predictable, and whether the human or animal thinks they have any control over the stressor.  These three factors – outlet, predictability and control – emerge as modulating factors again and again in research studies of stress.”

It's safe to say, healthy sex could be an outlet for stress, intrustive memories of PTSD are relatively un-predictable; and veterans' ability to "control" their stressors, many of which arrive unbidden, is fairly sketchy.

 

Another aspect of Talbott's work I found interesting was when he talked about how even potentially stressful sitautions can eventually lose their "charge" over time, if only they become "expected" or "predictable."  Unfortunately, there's pretty much nothing about combat that's "predictable" (except that it will be unpredictable!) so it stands to reason why combat veterans struggle with both stress and high cortisol levels, implicated in various illnesses including heart disease.  This scenario, below, shows a great "de-fanging" of a potentially large trigger: but because it becomes "predictable" over time, it loses its intensity.  Unfortunately, probably VERY little of what combat veterans experienced fell in this category: 

"The scenario [of predictability] has been studied in Army rangers training at jump school to become paratroopers.  At the start of the training, the soldiers underwent enormous increases in cortisol levels during each jump, but by the end of the course, their stress responses were virtually nonexistent.  By making the stressor more predictable, the stress response of each soldier was controlled to a much greater degree (though skydiving will probably never become a completely stress-free activity)."

 

At the very least, Talbott's book is worth picking up because it gives many practical ideas (including exercise, relaxation and diet) for reducing cortisol levels, which ultimately should result in better health.  Since cortisol is implicated negatively in sleep and sex, as well as many other important categories, it's worth knowing more about how to modulate your own levels, to optimize your experience.

Sarah Haley - Psychiatric Social Worker, PTSD Pioneer, Friend of Veterans

Gerald Nicosia's book Home to War: A History of the Vietnam Veterans' Movement, is fascinating reading, if only to keep in mind the wisdom of the George Santayana quote, "If we do not learn from the mistakes of history, we are doomed to repeat them."  Nicosia goes into much detail about how the PTSD diagnosis was first determined and included into the DSM, and along the way he paints the picture of many of the key participants, including Sarah Haley, in first treating Vietnam veterans for combat trauma and the resultant PTSD.

Whenever we look at history like this, it becomes apparent that whoever is impressive today in this work owes so much to pioneers like Haley (who Nicosia discusses) and Lawrence Kolb, M.D. (who Nicosia oddly does not).  "Standing on the shoulders of giants" is the semi-cliched expression about what present practitioners owe as a debt to the pioneers of the past, and it is certainly true about Haley's work: she was a true giant.

Here I'm going to excerpt, with Nicosia's permission, parts of the many passages about her work so you can see three important things: what her background was, which gave her a special compassion for the truth the veterans first presented with; the extent of her rapport with and trust established with the veterans themselves, which allowed her to help them; and some of her more intuitive leaps about what PTSD really meant from the lives of veterans with whom she consulted.  What a truly remarkable person; and what a shame she's no longer with us, so that we can continue to benefit from her truly outstanding work with veterans.  (Few of these quotes are continuous; most skip around from important part to important part, with the gap indicated by the ellipses)

Haley's background:

"It was a woman .. a psychiatric social worker named Sarah Haley, in the big VA outpatient clinic in Boston, whose research into veterans’ stress disorder literally blew the existing psychiatric definitions to pieces and began to put a whole new definition on the map.

"Sarah Haley [initially] seemed the least likely person in the world to make waves…

Her friends all warned her that the VA’s psychiatry program was “fifth-rate,” that she would find herself treating ‘chronic schizophrenia and passive-dependent men with bleeding ulcers,’ and that her career would surely go down the tubes.  But despite the fact that she entered upon her new VA job with the meagerest of expectations, she couldn’t help being ‘shocked at the low caliber of the general run-of-the-mill health person there.’  As she recalls, ‘These were not mental health people that you would want anybody in your family to get near.’"

 

Haley's first astounding discoveries:

"One day, a young man in a highly agitated state was brought into the clinic by his parents.  He had only been home from Vietnam for three days, and his parents had no idea what to do with him.  He was having total body tremors and exhibiting ‘startle response’ every few minutes.  If a car backfired or a door slammed, he would dive under the nearest table.  After much rambling, the young man told her he had been at a place called My Lai, that terrible things had happened there, but that it was difficult to piece it together.  He was confused and experiencing a lot of amnesia, but he did remember seeing the bodies of women and children and vomiting into the bushes.  He also remembered that he could not shoot anybody himself, that he had thrown his gun down.  The American soldiers who did the killing had sought to intimated him and the others who didn’t shoot: ‘If you ever tell anybody, we’ll come get you.  Or we may come get you anyway.’

 

…

"Indeed, any other intake worker might have dismissed [this recent Vietnam veteran] as delusional, but Haley had reason to believe him.

(Her father had been on special operations with the OSS in North Africa during World War II, a self-admitted ‘assassin for the government.’  He had told her about seeing a truckload of German prisoners who were led out and made to kneel in front of a ditch, where an American officer shot each one of them methodically in the back of the head.  Then the Americans dumped their bodies in the ditch and shoveled it over.  Thus Haley, as she puts it, had “no illusions about war.”)

 

How Haley worked with veterans and understood their particular trauma:

"Haley had nothing to go on but a big hunch, but she decided to follow it.  It seemed to hear that a lot of mental health professionals – especially those at the Boston VA clinic – had great difficulty in listening to the recital of trauma: as a defense, they either disbelieved it off the bat, turning it into the less threatening notion of “delusion,” or else withdrew from the patient as quickly as possible so as not to have to hear more about it. 

 

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

Haley perceived correctly that the reason the My Lai vet could not remember all the details of his trauma was that much of the most painful material had been repressed.  In the coming years, she would encounter the same phenomenon in hundreds of Vietnam veterans, some of whom could only recall five or six months of their 12- or 13-month tours of duty.

 

More insights into how Haley worked with veterans, and uniquely modified the approach for dealing with combat trauma:

"She further realized that the stuff was eating away at them would have to be brought slowly and steadily to the surface – that there were no quick fixes, like ‘5 mg. Stelazine daily.’  Equally ineffective, she would soon discover, was ‘the sort of non-authentic treatment’ where the professional would talk about family issues or other daily matters that were troubling the patient, but never bother asking about the existence of trauma in his past; for if the professional didn’t ask, the trauma victim would seldom bring it up on his own. Haley was aghast to learn, for example, that an analyst friend of hers had “successfully” treated a Vietnam veteran solely on the basis of working through the rivalry with his father and never even asked the veteran about his [combat experience.]

"Most of the Vietnam veterans Haley found were coming in to see a VA psychiatrist merely so that they could get their next month’s supply of Valium.  Haley would go to the psychiatrists and inquire whether they had ever asked these veterans about their Vietnam experience; the usual reply from the shrinks was that they had stopped asking because the veterans didn’t want to talk about it.  Haley was flabbergasted that none of the VA psychiatrists – with the exception of two notable women, Lillian Rodriguez and Constance Hartwell – evinced any interest in learning the cause of the tremendous anxiety for which they were blithely prescribing shelves of medication.

Unique problems to Vietnam veterans that Haley noted:

"During those first few years at the VA, Haley encountered a great many vets who talked about participation in atrocities.  she found most of them to be ‘terribly guilty, feeling unclean, and not worthy to be back in the world.’

…

 

"… Instead of hearing, “Doc, I have a bellyache,’ or “Doc, I’m seeing visions,” or “Doc, I’m terribly depressed,” what Haley would hear time after time was, “Doc, I think I’m a murderer… I slaughtered innocent civilians.”

 

And finally, Haley's substantial impact:

"Working with these men and the material they brought up was so painful that it took Haley almost two years to complete her article…which was immediately recognized as a landmark work.  By precise delineation of the symptoms of several veterans she had treated, Haley established that the Vietnam veteran who had witnessed or taken part in atrocities could not be handled merely as a traditional case of traumatic war neurosis, but presented a completely new challenge to psychotherapy."

Sarah Haley was indeed a remarkable woman, and a great Friend to Veterans.  So much of the unique and compassionate approach to understanding PTSD's impact on veterans comes directly from this woman's work, and for that we are deeply appreciative and honor her in memoriam.

The Pain of Injury - "Weakness Leaving the Body," or Outrageous Endurance Contest Few Can Win?

I've known enough Marines to know they all love that saying, "Pain is just weakness leaving the body," or something like that.

Personally, that just sounds like something a particularly sadistic high school gym teacher or coach might have thought up, to help his students puking in the bushes after a particularly hard race or fight, to "reframe" what had really happened, so he wouldn't lose them on the team when they suddenly wanted to run away and quit. 

I don't have any real expertise in the area, but my gut-level sense is, that's just a quote; not a truth.  And a sufficiently-inspiring "quote," that those who hear it can hold onto their status among other people who learn to handle pretty outrageous amounts of pain, all in the guise of being warriors.  (And the congregation said, "OoRah.")

Here's how Pat, our Marine from Vietnam who we've been excerpting material from in the "Eyewitness to Combat" series, and who was seriously wounded in combat, described his own experience with that.  See if you "read" it as "weakness leaving the body," or else, as I do, as tremendous courage that someone could endure that level of outrage/assault and not lose their mind.  If it still isn't shocking/impressive enough, maybe additionally picture that this is happening to someone still in his teens at the time, and functionally cut off from all possible love, support and comfort -- except his other warriors, and, erm, supposedly the hospital staff -- but they're seeming none too warm and fuzzy:

"When I was shot in the arm and leg they were both "through 'n through wounds": meaning they went completely through the limbs.  I also had a head wound and therefore could not (would not) have any anesthesia or pain medications to reduce the intense, awful pain. 

Each morning they would roll me into the cleaning room, put me onto a stainless steel table completely naked (no one had any clothes on except the bandages and a blanket in this field hospital -- a MASH unit in the Army).  The corpsman would then take a stiff brush and dip it into iodine and run it through each wound to the other side to scrub out all dead and infected flesh.  I would pass out from the pain. 

On the first time, I started to cry, tears rolling down my cheek, and looked over to my side.  There was another Marine about my age who almost had no flesh on one side of him.  They were doing the same procedure on him and he just stared up and let the tears flow.  He made no sound, no quiver, just laid there and stared at the ceiling.  After that, I got calm and did the same from there on out. 

I remember a general coming through the cleaning area on one of the occasions and the head of the medical doctors present, probably a colonel, was explaining how each of us "felt no pain" while this was going on, the general was pleased: BullFuckingShit.  But we were MARINES.  "Take pain and embrace it and make it your friend" kind of shit thing.  Oh well, it gave me a perspective of how much physical pain I could endure and I have actually had to endure it several times since leaving Nam.  It never bothered me after that because I knew I could "hack it".  I did and I have..."

Really, what is even possible to add to that?  Just about nothing, except certain and really involuntary respect for what it took to undergo that, and not just shatter into a million pieces, like the shards of a mirror.  "Courage": the dictionary defines it as, "The quality of mind enabling one to face danger or hardship resolutely."  I think that's what we have here, multiplied by every combat veteran who ever endured it, but maybe didn't have the ability of Pat to describe it for you, so you could if not relate, at least possibly understand and respect or admire it for what it is.

Venturing into the Mental and Spiritual Wreckage of War ... in an Attempt to Patch up the Survivors

I've been enjoying reading Gerald Nicosia's exhaustive chronicle, Home to War: A History of the Vietnam Veterans' Movement, which we blogged about earlier, here.  It's hard to read it without appreciating both the tendency of history to repeat itself (even this recently, from Vietnam to now); and also the quality of the few greats who really stood out for doing important work in bringing the PTSD diagnosis into the modern era.  One such great was Robert Jay Lifton, M.D., a psychiatrist, Yale professor, and author of Home from the War: Learning from Vietnam Veterans, about whom Nicosia makes this wonderful remark:

"It was to Lipton's credit that he took the step no one had yet ventured, wading hip deep into the mental and spiritual wreckage of the war to begin a systematic effort to patch up the survivors."

It's significant that at the time, no one had yet "ventured" that -- one wonders whether today much on that front has really changed.  There are a few, maybe, but the "mental and spiritual wreckage" continues both to abound, and to devastate the survivors.

Speaking of Catharsis: One Magnificent Quote

Catharsis:

The word comes from Greek katharsis, from kathairein, to purge, from katharos, pure. 

Among other definitions, "catharsis" means: "a purifying or figurative cleansing of the emotions, especially pity and fear..."; "a release of emotional tension, as after an overwhelming experience, that restores or refreshes the spirit;" and "a technique used to relieve tension and anxiety by bringing repressed feelings and fears to consciousness; also, "The therapeutic result of this process."

Catharsis is the unspoken theme, hope and dream for veterans on this blog, but periodically we make it more explicit, as we did here, in a blog entry about art therapy's surprisingly potential for purging combat trauma and PTSD in veterans.

At virtually the same moment I was posting this, friend and apparent psychic twin on all things veteran, Chris Lombardi, was posting this remarkable quote on her blog.  Lombardi is writing a book for the University of California Press on soldiers and dissent (watch for it), and here she is quoting Walter Kirn in the New York Times, reviewing The March, which Kirn called "E.L. Doctorow's heart-squeezing fictional account of Gen. William Tecumseh Sherman's fiery, rapacious last campaign through the cities and countryside of the Confederate South". 

The quote that Lombardi pulls from Kirn offers a stunning perspective on how great catharsis can really be, when veterans (and others) decide that "the only way out [of their suffering] is through":

The rampant destructiveness of Sherman’s march is, of course, the stuff of high school textbooks, but what isn’t so obvious is the way that destruction transfigures and transforms, pulverizing established human communities and forcing the victims to recombine in new ones. Inside the churning belly of Doctorow’s beast, individuals shed their old identities, ally themselves with former foes, develop unexpected romantic bonds and even seem to alter racially. Yes, war is hell, and “The March” affirms this truth, but it also says something that most war novels leave out: hell is not the end of the world. Indeed, it’s by learning to live in hell, and through it, that people renew the world. They have no choice.

From the blog post, "What We Write About When We Write About War,' by Chris Lombardi, at her blog, Incredible Panic Rules, linked here.

Racktime, Sacktime: The Importance of a Good Night's Sleep for Brain and Heart Health

Trying to pull together two seemingly unrelated concepts lately: the importance of a good night's sleep (heck, any decent sleep would be a good idea) and heart health, let's look at this longish quote from an interesting and worthwhile book, The Cortisol Connection: Why Stress Makes You Fact and Ruins Your Health -- and What You Can Do About It, by Shawn Talbott, Ph.D. 

 

Essentially the background here is that high cortisol levels are both common in veterans with PTSD, and implicated in the literature with increased risk of death from heart disease.  It's also thought that cortisol causes other problems, including weight gain, diminished libido, increased blood pressure, and other topics of interest to veterans and their families, some of whom struggle with all these issues.

 

By writing a whole book about cortisol levels and their effect on health, Talbott is able to isolate the importance of some things we might not ordinarily think about (as well as suggest improvements). Says Talbott on cortisol levels and sleep:

 

"If you’re like most people, you understand that stress management can be used effectively to help with stressful events.  After reading the previous chapters, you now know that effectively managing your stress response will help you maintain your cortisol levels within a more normal range.  What you may not know, however, is that as little as a night or two of good, sound, restful sleep may do more for controlling your cortisol levels and reducing your long-term risk for many chronic diseases than a whole lifetime of stress-management classes.  Here’s why:

 

When you were just a few months old, a mere babe, your brain had you programmed to sleep about 18 hours a day – not a very stressful existence.  Upon reaching adulthood – say, about 20 years of age – your nightly allotment of sleep had been slashed to less than seven hours (six hours and 54 minutes, according to the National Sleep Foundation.)  That’s around two hours less than the eight to nine hours recommended by sleep experts for optimal physical and mental health. 

 

Progressive changes in your body’s internal clock (the suprachiasmatic nucleus), combined with alterations in your patterns of hormone secretion, have you going to bed later, and waking up earlier with each successive decade, resulting in nearly 30 minutes less sleep per night with each passing decade. 

 

By the time we reach our thirties and forties, we’re getting 80% less time in the most restful “slow-wave” period of sleep (as compared to our teenage years), and by the time we hit our 50s and 60s, we get almost no uninterrupted deep sleep.  (We still get some deep sleep, but it tends to come in short fragments that do little in terms of recovery and repair for mind and body.)

 

What does this lack of sleep mean for your cortisol levels?  It means that the average 50-year-old has nighttime cortisol levels more than 12 times higher than the average 30-year-old – yikes!  Perhaps the worst piece of news is that not only will an inadequate quality or quantity of sleep result in elevated cortisol levels, but high cortisol will also limit both your ability to fall asleep – and the amount of time that your mind spends in the most restful stages of deep sleep.  This sets you up for a vicious cycle of poor sleep, elevated cortisol, and subtle changes in metabolism that lead you down the path toward chronic diseases.  So get some sleep!"

 

-- Source: The Cortisol Connection: Why Stress Makes You Fact and Ruins Your Health -- and What You Can Do About It, by Shawn Talbott, Ph.D.

You'd have to read Talbott's book -- and you should -- to learn more about the relationship between high stress, cortisol levels and disease (as well as his recommendations for what to do about it).  However, even several items we've got linked to this blog are possible suggestions, among others, for getting a better night's sleep.  Not to pun, but most experts' recommendations on this topic often sound like a "real snore," they're so basic (practice sleep 'hygiene,' set a regular bedtime, warm milk for tryptophan, don't exercise within several hours of bedtime, etc.)  What's of greater interest to me at least is what items can we use to de-stress or relax more completely so that we can sleep.  Some suggestions:

 

Sleep Soundly CDs, by Steven Halpern; The Delta Sleep SystemDVD, by Dr. Jeffrey Thompson; and, of course, the highly-recommended Pacific Light DVD, by Thomas Day Oates, Jr.  And of course the restful, soothing lavender sleep pillow, which you can make yourself; or if you're really lucky, a massage.

 

Happy Zzs...

Helping Military Families Cope and Heal from Stressors of Deployment and Combat

(From a press release)

Helping Military Families Help Themselves

For a civilian, it’s hard to fathom the stress a military family faces when a parent or spouse is sent to combat zones. Long and often multiple wartime deployments take a toll not only on the service member on the front lines but on family members back at home. According to recent figures released by the RAND Corporation, one in five veterans of the Iraq and Afghanistan wars may suffer from psychological health problems, which can add the strain on military family members.

Now, a program initiated at the University of California, Los Angeles (UCLA) and supported by the U.S. Navy’s Bureau of Medicine and Surgery is reaching out to military families to help prevent the personal and family problems such stress can bring. Project FOCUS (Families OverComing Under Stress) is now being rolled out to nine military bases across the nation and in Okinawa, Japan.

“There is increasing awareness that military families, especially the children, can be significantly affected when a parent is deployed, and there is even greater psychological wear and tear when there are multiple deployments,” says Patricia Lester, MD, an assistant professor of child and adolescent psychiatry at UCLA and the director of the FOCUS program. “The spouse left behind is suddenly thrust into the role of being a single parent; routines are interrupted; the children may not understand where their mom or dad has gone; and the service member on the front lines is constantly worried about how their family is doing back home.”

The FOCUS program provides parents and children with customized training that will address the impact of wartime deployment on families and helps them learn very specific communication and problem-solving skills to address these challenges. In addition, FOCUS trainers will provide outreach to groups within military communities to raise awareness about the kinds of pressures families face and to let them know help is available to cope with deployment.

“We build resiliency,” Lester says. “It’s a three-pronged approach to restore a psychological balance to the family, promote future resiliency, and increase knowledge and understanding among the military family culture.”

Families meet with counselors in multiple sessions. Some of the sessions are only with the parents, some are only with the children, and the rest are family sessions. Each session focuses on helping family members identify and share their concerns and fears about a spouse or parent being deployed to a war zone. In separate sessions with parents and children, FOCUS trainers teach them skills to help manage their emotions, solve problems within the family, set goals, and communicate with one another.

“If there are five family members, there’s a good chance that there are five different stories of what that most recent deployment experience was like,” Lester says. “Family members often don’t want to ‘burden’ each other with their personal problems, but in these exceptional circumstances of long-term separations, building a shared family narrative can be very helpful in reestablishing a close family identity and building its strength.”

— Source: University of California, Los Angeles, Health Sciences

Is Pain Really the Enemy? The Tradeoff between Suffering and Awareness

We're starting to look at a very important topic to veterans (and their families): managing acute and chronic pain with PTSD.

Earlier today, I ran across some interesting thoughts in a book about the ancient Eastern healing art, Qi Gong (there are multiple spellings, including Chi Kung and other variants.)  I include it here for several reasons: One, it helps us to look a pain in a new way -- in terms of the encoded lessons it may have to teach us.  Second, it sets up the balance between pain and awareness, and how awareness without the ability to address a particular condition might be more difficult than the pain itself.  Third, it reinforces what Claude Anshin Thomas, a decorated Vietnam vet and now Buddhist monk, said about how it's not really our suffering that's the enemy, anyhow.  Fourth, it suggests there is definitely a "payoff" to the body for not addressing physical pain until we are ready, which probably perpetuates the state of chronic pain. And finally, this passage lists a number of beneficial conditions to have in place before healing can be addressed. 

It's nice to see these spelled out, and it may help you to just see them in print.  There's an old faux-Asian saying about, "When the Student is Ready, the Teacher Appears" -- and if there's any truth to that, it just might be, that nobody's really ready to address their own healing, no matter how badly they might want it, until they have some key supportive conditions in place first -- to make the journey somehow softer and better.  We need all of that we can get.  Here's the passage, and I'm going to go ahead and highlight some of what stood out to me when I read it, including those supportive conditions. 

In my opinion, we hold onto toxicity mainly for protection.  It is an automatic response from ourselves comparable to muscular armoring.  Muscular armoring is an involuntary contraction caused by emotional charges.  These contractions allow one to mobilize the body's stress response, bringing up involuntary avoidance reactions before any emotion can be felt.  In the same way, there is a strong tendency to accumulate toxicity: we hold onto it because there is only so much that we can allow ourselves to feel, given our mental state, level of emotional maturity, and our support system.  Accumulating toxicity, along with muscular armoring, is a strategy of protecting oneself from getting emotionally hurt.

Feelings compel us to react and process, but if for some reason (lack of energy, maturity, safety, or a weak support system), we can't afford to let ourselves feel something, then the unprocessed issue has to be stored until we can afford it.  This is the reason why we "forget" about childhood traumas and other overwhelming stressful situations in our lives.  The body does not forget: it just makes the choice not to remember.  The information is still there,  held in different areas, in different ways in our bodies, protected by tension and the accumulation of toxicity.  A part of our self is in charge of making sure that an emotional charge is not accessible unless an opportunity presents itself to access it safely enough.

Elsewhere the same author writes, somewhat repetitively but with some new emphasis:

The Price of Awareness:

The power that keeps us unaware of tensions in our bodies and the underlying emotional charges is our mind.  It tries to protect us from getting in touch with places that don’t feel so good.  It will not let us feel anything that might make us remember a traumatic experience too hard to handle.  Our minds help us organize ourselves to avoid bumping into painful spots, facing them, or touching them when we don’t have sufficient energy, maturity, or an adequate support system.  We avoid any movement in these areas of our bodies, which includes not allowing movement of the breath.

 

Our bodies hold patterns of tension, or involuntary contraction, which generally reflect emotional charges coming from unprocessed states of feelings.  That’s how we are recognized as angry of scared, enthusiastic, joyful, worried, and sad; how we hold our bides reveals our feelings.  After many repetitions of the same kind of emotion, if they are not processed, the patterns of tension become familiar, and we are unable to remember how it feels to be free of these tensions.  We experience a numbing that paradoxically expresses very clearly to others what we generally don’t want to admit to ourselves. It becomes a posture, an attitude that typifies and characterizes our personality.

 

Awareness is information and, as we very well know in the Western world, information is the most expensive item you can find.  There is a good reason why we don’t let ourselves be aware of certain things: awareness has a price and we need to be able to afford it.

 

So part of it, even if it’s an unconscious part, is always thinking about how much awareness will cost.  We have a financial adviser and bookkeeper hiding within us.  The bookkeeper within holds us back when we are about to invest ourselves in something we can’t afford in terms of some vital force, support system, and emotional maturity.  But without some kind of inner protective mechanism no healing process would be possible, and the human mortality rate would be much higher.  The art of the practitioner is to recognize that this bookkeeper, keeper of the door to our feelings, protects us from being asked to pay more than we can afford.  It is an ally in the process of healing.  Recognizing its role, giving it credit, and making that guardian feel safe will let [people] become more in touch with parts of themselves they have had to hide.

 

Source: Healing from Within With Chi Nei Tsang: Applied Chi Kung in Internal Organs Treatment, by Gilles Marin.  Berkeley, CA: North Atlantic Books (1999). 

(To learn more about Chi Nei Tsang, or to find a practitioner in your area, go to the main website, linked here.)

(To be continued...)

Jagged Little Pill: Pain, Chronic Pain, Pain Control, Pain Management and PTSD

I feel like I'm a little late to the party on this one, because I'm not clear yet why chronic and/or excruciating chronic pain would be a hallmark of PTSD, but according to the veterans I know, it's one of the most difficult conditions they face.  So, obviously, one worth discussing and learning more about.

The VA's site has some information about chronic pain and PTSD linked here, but it seems like fairly generic information, and not much of it is related to combat trauma specifically.  So I guess we need to "tie a string" around this topic and come back to it, when we learn more.  My guess is there's something about "adrenaline gone wild" in combat that sears these graphic memories into the body as a form of pain, and then the pain gets "refreshed" whenever the adrenaline gets refreshed.  Obviously, this is pretty rudimentary (and possibly even, completely wrong...) but, stranger things have happened; and I've personally heard odder things from medical specialists who later just threw in the towel on things that weren't as obvious as they seemed at first.

Certainly there are landmark books in the Mind-Body Medicine spectrum of approaches, such as the "The MindBody Prescription: Healing the Body, Healing the Pain," by John Sarno, M.D., (recommended by Andrew Weil, M.D.); and "Wherever You Go, There You Are: Mindfulness Meditations in Everyday Life," and other books written by Jon Kabat-Zinn, Ph.D., that address mindfulness meditation as a coping strategy for chronic pain (whether physiological or psychological in origin.) (Patience Mason's husband, Vietnam veteran Robert Mason, the author of Chickenhawk, apparently thinks Zinn's work is great.)  And there are other forms of "energetic medicine" (e.g., acupuncture, in particular) are good at lessening the experience of pain so that it can be managed, sometimes also reducing the source. 

And on the topic of is pain really the enemy, or is it more likely actually part of us -- there's almost nothing better than the Claude Anshin Thomas quote, excerpted from his book, At Hell's Gate: A Soldier's Journey from War to Peace, that we blogged about back in March of 2006.  If you're not familiar with what he said, go here and read that entry.  His perspective is sensational, and as often-wounded Vietnam veteran, his experience counts on this matter.

So it will be interesting, over time, to see where this goes, and take a look at "different strategies that might work" for pain control and pain management.  All I know for sure, from the veterans I've talked to, is that it's a MUST to cover, because it's a crucial, nonstop, searing reality of their lives.  And that's nothing to take lightly.

Eyewitness to Combat: What Fluttered in the Trees

Another installment in our ongoing "eyewitness to combat" series.  Beware that this materail contains graphic images of war, not for the squeamish or the faint of heart (although the image to the left that appears to be a human being's body is actually a strangely human- shaped tree root):

During June of 1966, the entire Battalion was committed to Operation Liberty.  I was detached out to Foxtrot Company for this one.  We had been running County Fair Operations throughout the 2/9 TAOR and much of the northern part of it was declared as cleared of V.C. 

However, the southern portion south of the La Though River to the Key Lam River was still not cleared and was literally crawling with the V.C. This operation was supposed to be an on line sweep clear to the Key Lam River with each company having their own objective area of responsibility. 

 

We were to secure Route 4 to the river.  This area was where we had made contact with a large V.C. force in April and it really made me jumpy.  Mines and booby traps were everywhere and the area was covered with punji stakes and spider traps. 

 

As we moved across one rice paddy through a tree line to the next rice paddy, we had cleared a safe area. 

 

However, Nick Sparicino or some reason just cut through an unsecured brush area before we reached the cleared area.  He had just stepped into the tree line when he dropped and screamed in agony.  He had stepped into a punji pit.  The bamboo stakes had impaled his lower leg and calf and the punji stakes around the sides of the pit and pointing down had impaled his thigh pinning him there. 

 

He screamed; “Pat, Help Me! God Dammit! It Hurts. Hurry!”  I ran to him and Bradford and I grabbed him under the arms and tried to pull him up enough to get the pressure off of his leg.  Another guy started digging around the outside of the pit to get him out.  This took a really long time because he was so stuck and bleeding like crazy.  

We were all sweating like pigs and he kept slipping.  We would just about have him out and then he would slip and fall back full weight onto the punji stakes and he would scream out in pain.  The muscles in my arms were starting to cramp us but I couldn’t let him go until we got him out.

 

He continued to scream and started really shaking.  This made it harder to hold him up.  We finally got him free and were able to pull all of the stakes out of his leg.  One went up through his foot into his leg; another went up through the calf and ripped it completely open to the bone. He had three really deep punctures in his thigh where the lateral spikes had got him. 

 

Doc gave him morphine, the chopper came in and just like all of the others, he was gone, never to be mentioned again as if he also never had existed.  I had allowed myself to get close to him and we had been through a lot of shit together and he was gone.  I did not like making friends.  I was feeling very alone as we all did.  Hadn’t had been killed in the last of May, and now Nick was gone.

 

The next morning, around the 11th or 12th of June we moved across one large rice paddy, over a dike across a shallow channel and onto a grassy field bordered by very thick and dense tree lines.  The flanks and point squads had already moved across and then the center portion of the platoon came onto the field.  I was still carrying a flame thrower and could not clear the ditch in one jump, so I jumped into the bottom of it. 

 

When Nick had been wounded, I had to take the tank again and its weight caused me to bend at the knees and waist when I landed in the ditch.  There were several loud simultaneous explosions and dirt pelted me all over.  My ears were really ringing. 

 

When I came up, there were Marines knocked down all over the open field and the dry grass started to burn from the explosions.  We had walked into a mine field full of Bouncing Betties and booby trapped with artillery rounds.   This was some real serious stuff.  I was afraid to try to help because of more mines and afraid not to, too. 

 

I thought of De La Fante and dropped my tank and got to the nearest guy.  He was really messed up.  The other squads were now moving in to help.  I thought: “We are dead if they hit us now.” 

 

There were arms, hands, legs, feet, boots, helmets, busted rifles, and body parts and pieces of Marines and blood swaths scattered all over the field.  The fire was burning toward the wounded and dead and setting off other mines, taking out even more Marines.   I thought to myself, “This is some really, really, bad shit!” 

 

Guys were moaning and screaming out in pain all around me and their bodies were convulsing like crazy.  I didn’t know what to do other than to just try to stop the bleeding of the one that was next to me and put out the fire as it came close to someone.  Everyone around me was down.

 

The clothes on the wounded Marines were starting to catch on fire as they lay in its path. Other Marines started to pour out onto the field from the tree lines and rendered whatever aid they could as they began stomping out the flames around our guys and emptying their canteens on the burning Marines. 

 

When this was gone many of those rendering aid began to urinate on their buddies to put out the flames.  This became a very frantic effort as we also began to take sniper fire from the tree-line dropping other guys as they tried to help their wounded buddies. 

More jets came in and dropped 500 pound napalm bombs on the tree-lines and after a while the snipers became silent.  They had been either killed or had simply moved back down into their tunnels and disappeared. 

 

After the fire had swept through the field and the wounded were finally taken out by media, those of us that were left were ordered to get on-line and sweep across the area to police up body parts, equipment and ammo. 

 

As one of the choppers was taking off, I noticed something flutter in an un-scorched nearby bamboo tree-line. I looked closer and it was the face skin and scalp of one of our dead guys.  It had evidently been completely blown off of his skull and had landed in the bamboo thicket and was caught on one of it branches.  The blade wash from the chopper had caused it to flutter and move to where I could see it. 

 

It made me wonder what in the hell we were supposed to be accomplishing other than getting friggin blown away.  We took all of these horrific casualties and didn’t fire one friggin shot at anyone.  Hell, we didn’t even see anyone to shoot back at.  It took us all day just to clear the field of our wounded, dead and spent equipment and body parts.  I hated it then and just wanted to kill something really, really, really bad.

Eyewitness to Combat: Surviving the Casualties with "Out of Sight, Out of Mind"

(This material in this post is reminiscent of and confirms that in the recent one from the OEF/OIF era, that talks about how it's best to "shut down, block out, give up being yourself" -- if you intend to survive the psychological rigors of combat trauma.  Two different wars, separated by decades: same "coping" strategies of combat veterans.)

 

---

 

In our ongoing series of "eyewitness to combat," here are some more remiscences of Pat, the young Marine's, first tour in Vietnam:

 

Sometime around the middle of April, I was still attached to Hotel Company and we had been moving south toward Highway 4.  It was constantly hot as hell and we had been taking sporadic and effective sniper fire and had encountered a few mines and some booby trapped gates.  However, we had not made any real eyeball-to-eyeball contact with the V.C. even though we knew that they were all over the place. 

 

There was an abandoned ARVN Army outpost at Phuong Thu.  We set in our position just north of Highway 4 right across the road bed.  We dug two man fighting holes or fox holes, and where I was, we were defending an area about the size of a football field. 

 

It got dark, real dark with no moon at all, and was very hot and still.  Again no one had slept much during the sweep and the mines had us all keyed up.  Several squads had been sent out to establish ambush sites and listening posts had also been sent out.  We rotated these every night with different squads going out, ambush one night, parameter defense the next, and sweeps during the day.

 

I had just finished my watch and had passed the watch to Worsley.  Just as he was waking up we started receiving mortar and recoilless rifle fire and all kinds of stuff broke out south of the road where one of the ambush squads were.  Tracers were going everywhere.  Worsley jumped up and said; “What the Hell?” 

 

Then the V.C. attacked from across the road and began to really lay down a high level of automatic AK 57 rifle fire. 

 

Through the flashes we could see that there were really a lot of them.  The mortars kept coming but were primarily hitting toward the center of our position.  Everyone was shooting and hollering and we shot a lot of them as they crossed the road toward our position. 

 

Whenever they came upon the road they were completely exposed and made a somewhat easy target.  A bunch of them were killed in the rice paddy in front of us.  Our own mortars were putting up illumination rounds as well as our artillery. 

 

When our 155’s started coming in, the V.C. shelling of our position stopped but they kept coming in to drag off their dead and wounded.  People were getting hit all around us and the call for “Corpsman Up” was going on from everywhere. 

 

After a real intense period of time, they stopped their main attack but continued to probe us the entire rest of the night, again mainly to get their dead.  I was real frightened and excited at the same time and for a while wasn’t real sure of the outcome.  

 

When daylight finally came, we were all completely exhausted from the intensity of the battle and from the gigantic adrenalin rushes we were experiencing.  However when we finally were able to take an accounting of the fire fight, all that we found of our elusive enemy was a whole bunch of blood trails, body parts and some clothing and a few weapons and scattered ammo. 

 

There were only about ten or so V.C. bodies that could be absolutely counted but we had experienced a whole lot more Marine Corps casualties than that: killed and wounded. 

This really did a mind job on us and made the hatred for them very engrained.  We had fought most of the night and the only thing we had to show for it was a bunch of our guys hit.  I think that we had almost 50 plus casualties but it looked like a hell of a lot to me. 

 

Choppers came in the next day to take them out.  There were a bunch of medivac Hueys. 

This was really discouraging.  I thought that finally we had had a real shot at ‘Charlie’ and we still got our asses kicked.

 

After all of the casualties were gone and the battle field was sanitized; we just filled in the fighting holes and continued on south of Highway 4 toward the Key Lam River, again as if those people never existed and to never be mentioned again.  You learned to survive the casualties by “Out of Sight, Out of Mind”.  Once you were hit and removed, it was like you’d basically never existed.

Eyewitness to Combat: A Farce of Filth, Fear and Killing

In our ongoing "Eyewitness to Combat" series, here's another recollection from Pat, the Marine who went to Vietnam right out of high school, and landed in a completely different world.  Beware: this entry has graphic images of war that are not for the faint of heart.

---

"For the next couple of days we continued to sweep along rice paddy dikes, hedge rows, and toward some occupied villas that had been labeled V.C.  During this time we hit more mines and took sniper fire during the day and sporadic mortar fire at night, and lost more Marines but never saw the enemy or returned any fire. 

 

No one had fired a shot in their defense.  We couldn’t even hit back.  And all the while, the villagers just looked on as if we were just cattle.  We would hit a mine and they would look up from their field work, grin, and go about their business as if nothing had occurred.  There was just no one to shoot back at.  I felt like I was in a shooting gallery. 

 

A few more of the guys in the flank squads stepped into punji pits and had been impaled with punji stakes set out along the sides of the trails.  A sniper would open up and take out one of our guys; everyone would dive for cover and become impaled with the punji stakes. 

 

Then when we would try to recover our wounded the snipers would continue to take out our guys, piling them up like the flies that my granddad used to swat on his back porch. 

The incoming mortar fire, at night, became so accurate that we would set in just before nightfall; start digging in, and after dark, fill up the holes, move to a different location and re-dig in. 

 

I had been in-country less than 30 days and was real confused about what I was experiencing.  I kept waiting for this great enemy attack.  I thought that we should be doing something; like getting into the damn fight. 

 

This was a terrible feeling: to know that I could die at any time and not have ever been able to even fire a single shot in retaliation.

 

We were all exhausted, no one slept, we were extremely angry, we were miserable and everyone was real pissed off and we just wanted to get a crack at ‘Charlie’. 

Then we moved into the parameter of a small villa below the Cau Do in the Duong Son II hamlet area.  It seemed deserted except for some pigs, a couple of food dogs, and some Water Buffalo that were left in a pit beside a couple of hooches.  There did not appear to be anyone around.  

 

Then we took some sporadic small arms fire from one of the hutches, which dropped one of our guys.  Everyone instantly opened up and were firing and yelling like crazy men.

The lieutenant yelled, “flames up!” and Nick Sparicino and I moved immediately forward at a run.  The lieutenant pointed at one of the hooches and yelled: “Torch It!” 

 

I moved into the open area, struck the match (sparkler like igniter) and started torching it.  My heart was pounding so hard that it make my ears hurt. 

 

I fired into the doorway, through the front two window openings, and then up over the roof.  Suddenly the most frightening scream I had ever heard up to that time started coming from the inside of the hooch and someone ran out of the doorway still burning with napalm. 

 

I instinctively brought the flame down and followed the gook out into the courtyard and stayed on him until I ran out of fuel.  He was holding some form of weapon to his chest and I used that as my target.  The heat was so intense that it actually burned the hair off of my arms and face. 

 

Nick and I moved back.  The hooch went up faster than I had thought it would.  The screams lasted, it seemed to me, a long time.  The gook was knocked to the ground and was jerking, rolling, and thrashing his arms and legs kind of like De La Fante and in some way I felt a weird sort of satisfaction.  Nick shot him several times and then started firing into the hooch where other screams were still coming from. 

 

One of the other Marines had picked up a couple of the pigs and had also thrown them into the flames of the burning hooch.  They squealed like crazy.  The hooch collapsed and everything got real quiet.  The hooch was burning, the gooks were burning, the pigs were burning and there was an air of electrical energy everywhere. 

 

Nick kicked the weapon away from the gook and it was a small child, and the gook was a woman, probably the child’s mother.  Nick and I looked at each other and felt sick.  He just said: “Jesus Christ, Pat” and shook his head. 

 

This was the first time that he had fired his M-14, the first time I had fired the flamethrower in combat, and this just wasn’t the type of real combat that either of us had imagined. 

 

The other squads started shooting the other pigs, the dogs, and even the water buffalo in the pit.  They had also set fire to all of the other hooches in the villa and there were secondary explosions from the weapons and ammo stored in them. 

 

We pulled back a little further as these intensified.  I refilled my tank from Nick’s five gallon re-supply can of napalm.  Everything burned for quite a long time.  More gooks were pulled out of the hooches.  They were black, raw and burned to a crisp. 

 

Bones in the skulls, fingers and legs were showing.  The teeth on their faces showed and that really hit me hard.  I went over to pull one gook into the clearing and the skin on his arm came off in my hands leaving his arm raw red meat and bone. 

 

This also hit me like a blow in the stomach. When we had gotten all of them out of the hooch that Nick and I had torched there were five bodies; a man, two women, a small boy, and a baby. 

 

Their bodies were grotesque and the smell, like burning hair, was pungent and stung my nostrils.  I could never get that image out of my mind, ever.  Nick and I couldn’t even look at each other. 

 

I was 19 years old, Nick was 18, the Lt. was 21 and the Sergeant was the old man at age 25. The Sergeant just called in a body count with everyone having the same value, big or little, man or woman. 

 

If it had not been for the rage that had built up prior to the engagement I didn’t want to be there anymore.  This was not the kind of war that I had come to fight and I still had 12 months more of it to go.  In fact, this process was repeated more or less endlessly over the next three months in the friggin’ rice paddies.

 

I had lost something important, though, and no longer felt in control of my destiny.  I hated everyone who had sent me to Nam.  I was still numb, I was still angry, and now I was also emotionally dead. 

Catharsis: Art Therapy, Trauma and PTSD

At almost 500 posts, if I had to choose the them that represents the underlying intention of this blog, it would be the Greek word, catharsis -- a word which suggests a transformative state change, in which "the only way out is through." 

 

Combat trauma, which often so clearly plagues veterans' lives, and frequently develops into PTSD, is much easier to "diagnose" than it is to "cure."  My goal on this blog has always been to find what methods, no matter how diverse or unusual or at first, unlikely might have potential for "clearing' combat trauma from the combatant, to whatever degree is possible (and that may be different from person to person).  Understandably the images from and the experience of combat are lodged deep within the veteran's psyche, from where they often continue to torment him or her over the course of literally decades. 

 

While various approaches including psychotherapy, EMDR and especially pharmaceutical medications are typically tried in an effort to relieve, manage or otherwise control the symptoms, it seems that a greater goal would be to achieve any success in actually removing the pain and the grief associated with these memories.  This might allow the combat veteran to integrate these extremely difficult experiences into the whole of who they are today, realizing that they are as much a part of them as anything else they've experience over the course of their lives. 

 

Instead of focusing on the painful scars, the idea would be to clear as much of the associated pain and grief, leaving only the experience, without the accompanying triggers.  Can this be done?  Is anything managing to do that?  I think that's why this blog exists, is to take a look at each of those alternatives in turn, and see whether they appear to be useful and effective methods for clearing combat trauma.

 

To that end, we have considered pretty much everything that might possibly have merit, in the hopes that veterans will find among these offerings things that intrigue them or "speak to them" individually to try, ideally in concert with the efforts of a qualified healthcare provider, who is sensitive to veterans' concerns.  Periodically, we mention therapeutic approaches that do not seem to need an outside healthcare provider's involvement, things like like mindfulness meditation, yoga, mind-body medicine, art therapy, music therapy, writing and poetry, among others.

 

It's interesting to see that the New Dictionary of Cultural Literacy, Third Edition, defines "catharsis" as "An experience of emotional release and purification, often inspired by or through art."  In psychoanalysis, they continue, "catharsis is the release of tension and anxiety that results from bringing repressed feelings and memories into consciousness."

 

Notice how if we combine those two concepts, it suddenly has potential to attempt to clear some of the negative emotions associated with trauma through what amounts to art therapy.

 

Recently I interviewed a former Marine Vietnam veteran, Steve Piscitelli, who said that when he first was treated at the VA for PTSD in the course of the Vietnam war, his psychotherapists at the VA wanted to discuss standard psychological topics, such as his childhood, and how he felt about his parents, when he was aching in his desire to discuss what he believed was affecting him -- THE WAR. Eventually, Piscitelli turned to making art about his experiences -- to convey the images he remembered from war -- in an effort to turn the conversation with the therapist around, and focus more on what he believed the bigger issues were. 

 

Doing this -- literally, making art from war -- created a breakthrough in Piscitelli's therapy, he says.  Suddenly, what he'd been wanting to express was being understood.  From that day forward, he's made art on his own, often using it to purge the images he remembers, and destroying the art once it's "function" has been served.  At the same time, he's gone on to study art formally, and has become a sculptor, who vacillates between images of great aesthetic beauty (in his case, the form of ballerinas) and the most hideous images available to him, which come straight from his subconscious mind in the form of memories he carries with him from Vietnam.

 

I learned about Steve PIscitelli in a roundabout way, from the work of Kate Collie, who is mentioned in a truly superb article about art therapy and PTSD, written by Jenny Hontz, and published in the LA Times of March 20, 2006.  That article, entitled "The Healing Canvas: Art can soothe the mind and body, therapists say. Now science backs them up," is linked here.

 

Hontz writes:

A small 1997 study of in-patient Vietnam veterans with PTSD published in the Journal of Traumatic Stress compared the effectiveness of a single session of 15 different treatment methods administered to 25 veterans over 16 weeks. Art therapy was the only treatment method that reduced PTSD symptoms in the most severe patients. Researchers theorized that it not only provided a distraction, but it helped vets deal with traumatic memories at their own pace.

 

Additionally, Hontz writes:

 

Psychiatrists already have strong theories about how art therapy works, especially as it relates to trauma treatment. Allan Schore, associate clinical professor of psychiatry and biobehavioral sciences at UCLA's School of Medicine, says that traumatic and stressful memories are stored in the right hemisphere of the brain, which processes emotions, visual and nonconscious information.

 

The left brain controls logical thinking and verbal skills. But for therapy to be effective, "it has to get into the right brain," Schore said. Creating art is a fast way to access the right brain and the emotions stored there.

 

"Saying I'm scared and angry is one thing. Taking a crayon and scribbling on a piece of paper is a visceral way of not just saying it, but experiencing it," said Jan Oxenberg, a TV writer who tried art therapy after she was involved in a shooting during a civilian ride-along with the LAPD.

 

While making art activates the right brain, talking about it and constructing a coherent story about the traumatic experience activates the left hemisphere as well. Integrating the two leads to healing. "What is expanded is the interconnectivity of the brain," Schore said.

Kate Collie, MFA, Ph.D., who Hontz mentions in the LA Times article, worked with Piscitelli in a series she called "Soldier's Heart," linked here.  Collie did a series of paintings about the former Marine (2/5, 1969 and 1970, wounded three times, two Purple Hearts), and combined them with excerpts from her methodical interviews with him about his experiences: in Vietnam, back at home with PTSD from the war, and recovering from PTSD using art therapy. 

 

Collie's paintings of Piscetelli at various stages in his trajectory are striking, and the text that goes along with them, culled from in-depth conversations with the former Marine, is revealing as well.  (If you click on any of the images of the paintings themselves, you'll read recollections of Piscitelli's that go along with the artwork, such as those describing his PTSD or his recovery from it, using art therapy.)  Very much worth your time, as is Hontz's article, above.

Veterans Can Be a "Powerful Force for Healing in the World"

Again from Claude Anshin Thomas, a lovely quote about the true power of the combat veteran's experience.  For every veteran who suffers whether silently or with loud cries and tears; or who ends his or her life because they simply can't take the pain anymore (and I wish they wouldn't -- they have so much to give), here's a reflection on what their experience can really communicate:

 

"At the retreat Thich Nhat Hanh said to us, “You veterans are the light at the tip of the candle.  You burn hot and bright. You understand deeply the nature of suffering.”  He told us that the only way to heal, to transform suffering, is to stand face-to-face with suffering, to realize the intimate details of suffering and how our life in the present is affected by it.  He encouraged us to talk about our experiences and told us that we deserved to be listened to, deserved to be understood. He said we represented a powerful force for healing in the world.

 

He also told us that the nonveterans were more responsible for the war than the veterans.  That because of the interconnectedness of all things, there is no escape from responsibility.  That those who think they aren’t responsible are the most responsible.  The very lifestyle of the nonveterans supports the institutions of war.  The nonveterans, he said, needed to sit down with the veterans and listen, really listen to our experience.  They needed to embrace whatever feelings arose in them when engaging with us – not to hide from their experience in our presence, not to try to control it, but just to be present with us.”

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

The Vietnam Veteran as Exile: Missing in America, But Hidden in Plain Sight

My friend the veteran artist John Paul Hornbeck made this flag -- I just love it.  It carries forward the whole issue of POW/MIA into the present day, by asking in effect why the veteran is "still" Missing in America (that's the "MIA" part these days.)  He mocked up this flag, using the old and familiar symbol, to highlight the cause of homeless veterans in America -- a cause worth addressing.

I'm broadening the point, though, to something else:

Why ARE Vietnam veterans, in particular, still exiles in their own land?

And what should we, as a country, be doing about that?

Because failing to address that, failing to welcome back these warriors into their own land, perpetuating their exile both from what they've seen/done/experienced and how they were received when they returned -- has left a gigantic, gaping gash in the "fabric" of the American psyche; and decades worth of not addressing it has not resulted in any pain being healed.  Sure there are sporadic attempts made here and there, but they're relatively weak, lackluster, or involve too few people to really make a difference.

If you read Pat's "Welcome Home" story, or Claude Anshin Thomas', just to use the names of two representative Vietnam vets among thousands -- you find out that they are STRIKINGLY similar, almost verbatim copies of each other (and the rest who haven't written them, I suppose).  The hopes, the dreams, the flat-out fantasies (under the circumstances) of how they were to be received -- combined with the completely dashed, rejected and really shattered realities of how they were -- aie, the mind boggles.  It's surprising the whole generation of warriors didn't go postal, not just a few.  It also explains why so many of them are still living in pain to this day.  Turned into exiles by what they lived, that they had no possible means of integrating -- and shunned by the country they fought for.  If that woudn't give you issues, I'm not sure what would.

---

So let's think outside the box on this, FAR outside the box.  (If the box is the status quo, that is, because that's not particularly impressive.)  What prevents us from giving veterans, in every city across America, down EVERY Main Street -- a true, genuine, and long-overdue "WELCOME HOME"?!

Couldn't we use that psychic energy we'd gain back as a nation -- from repairing the rent in our actual psyche -- to surge forward, and embrace our combat veterans from here on out, with all the services and the help they so desperately need?  We've seen the problem: it's been well-documented.  But even to go forward successfully, in this case, I think we also need to go backwards -- make use of the "invisible bridge" -- and welcome the group of veterans who are STILL waiting, 40 years out, for America to acknowledge their return.

---

I learned a long time ago, that even in personal relationships, there's a big difference between the crappy/weak/self-serving apology -- "sorry IF I hurt your feelings" -- and an actual, gut-level, authentic and genuine apology, that takes responsibility, asks for forgiveness from the injured party, waits for the answer, or renegotiates the situation -- and then moves on, healed.  In the Bible, that's even called the difference between "worldly sorrow" (sorry I got caught) and "godly sorrow" (sorry that I did it, because I know it was wrong).  Without making a point about religion here, I'm merely trying to show that many traditions understand there's a difference between a heartfelt apology, a lame one, and none at all.  It's like the Oliver Wendell Holmes line from a few blog posts back, that "even a dog knows the difference between being kicked, and being tripped over."

---

Let's harness or leverage the momentum from the current groundswell of public "enthusiasm" for veterans' rights, exemplified by support for passage of the new GI bill, and the continuing emphasis on not settling for less in healthcare, particularly PTSD and TBI.  Let's expand that, though, to other issues of concern to veterans, before the "mood" passes -- as it surely will -- to be eclipsed by other different, pressing concerns.  Let's settle our largely unspoken national shame with how we treated Vietnam veterans, while a few of them are still alive to appreciate that our apology is genuine, and acceptance would heal us all to be able to move forward.  What we don't want to do is to create two different classes of veterans: the ones we care about, who get the right treatments for the right reasons; and the ones we don't, because we frankly made such a mess of it it's just easier to overlook it than apologize and move on.  It's time to make things right for ALL veterans.  Let's have those Welcome Home parades NOW...

Editor's note: John Paul Hornbeck is the artist (and veteran) who made "Shattered Soldier," the lifesize scultpture of a veteran with PTSD, that we blogged about earlier, here.  He is the child of an American Vietnam war veteran Army father, and a Vietnamese mother.

Uncomfortably Numb in Combat: "It's Best to Shut Down, Block Out, Give Up Being Yourself"

Continuing our periodically recurring current theme on eyewitness to combat, this telling snippet from Generation Kill about how troops attempt to cope with the mundane frightening rigors of combat:

When [Marine Captain Nathaniel] Fick passes the word that the men in Second Platoon are to remain in place, Espera turns to his men in the next Humvee over from our and says, "Stand by to die, gents."

The twenty-two Marines in the platoon sit in their vehicles, engines running, as per their orders, while blasts shake the ground beneath them. Everyone watches the sky. A mortar lands ten meters from Espera's open-top Humvee, blowing a four-foot-wide hole in the ground. It's so close, I see the column of black smoke jetting up from the blast area before I hear the boom. I look out and see Espera hunched over his weapon, his eyes darting beneath the brim of his helmet, watching for the next hit. His men appear frozen in the vehicle as the smoke rises beside them. Before leaving on this mission, many of the men in Colbert's platoon had said good-bye to one another by shaking hands or even hugging. The formal farewells seemed odd considering that everyone was going to be shoulder-to-shoulder in the cramped Humvees.

The good-byes almost seemed an acknowledgment of the transformations that had taken place in combat. Friends who lolled around together during free time talking about bands, stupid Marine Corps rules and girlfriends' fine asses aren't really the same people anymore once they enter the battlefield. In combat, the change seems physical at first. Adrenaline begins to flood your system the moment the first bullet is fired. But unlike adrenaline rushes in the civilian world -- a car accident or bungee jump, where the surge lasts only a few minutes -- in combat, the rush can go on for hours. In time, your body seems to burn out from it, or maybe the adrenaline just runs out.

Whatever the case, after a while you begin to almost lose the physical capacity for fear. Explosions go off. You cease to jump or flinch. In this moment now, everyone sits still, numbly watching the mortars thump down nearby. The only things moving are the pupils of their eyes. This is not to say the terror goes away. It simply moves out from the twitching muscles and nerves in your body and takes up residence in your mind. If you feed it with morbid thoughts of all the terrible ways you could be maimed or die, it ges worse. It also gets worse if you think about pleasant things. Good memories or plans for the future just remind you how much you don't want to die or get hurt.

It's best to shut down, to block everything out. But to reach that state, you almost have to give up being yourself. That is why, I believe, everyone said good-bye to each other yesterday before leaving on this mission. They would still be together, but they wouldn't really be seeing one another for a while, since each man would, in his own way, be sort of gone."

-- Evan Wright, Generation Kill: Devil Dogs, Iceman, Captain America and the New Face of American War.

Editor's note: the 1st Recon Marine platoon that Wright profiled in Generation Kill included Nate Fick and Rudy Reyes, each of whom have been mentioned multiple times on this blog.

The Final Score of War: Brotherhood 1; Humanity 0

Periodically we come across great quotes (and poetry) that serve to illuminate the human condition in combat.  One is the Augustine of Hippo quote we learned about from Nate Fick, which we blogged about here, in 2006:

"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. From One Bullet Away: The Making of a Marine Officer, by Nathaniel Fick.

Another one is the great Tim O'Brien one, which Jonathan Shay, M.D., Ph.D. wrote about here:

"As Vietnam combat veteran Tim O'Brien wrote in his novel, The Things They Carried: '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; if you don't care for the truth, watch how you vote. Send guys to war, they come home talking dirty'." -- Achilles in Vietnam, by Jonathan Shay, M.D., Ph.D.

Do you see where this is going yet?  If a war story isn't brutal, isn't ugly, it isn't true.  People do unspeakable things to each other in combat; and the way they survive is focusing on how to get through (the band of brothers, for whom they fight -- the wet bond of blood -- fighting for the one who stands at your shoulder); and numbing themselves out so that they can keep going on, putting one foot in front of the other, but feeling ... nothing... that they can manage to feel at the time, because there simply isn't psychic space, isn't room.  If they feel at all, that will come later.  But not during.  God help the ones who feel, during.  They're likely to not even be able to go on.

To put this another way, they focus on what they can control (almost nothing, literally) -- like being there for the guy or gal next to them; not what they can't control (everything else, including why they're there, whether the mission now or ever did make sense, whether they'll survive, whether they'll ever see home again.)  By putting one foot in front of the other, by continuing to stand shoulder to shoulder, somehow, they make it through, often, just barely, and are left -- usually alone, I might add, and it's shameful that this is the case, these people we ask to fight -- to deal with the repercussions themselves, when they simply aren't capable of integrating such a great (as in mighty), all-encompassing, horrific, and horrifically graphic experience on their own.  Imagine trying to put these pieces together, yourself.  You simply could not; or you'd be the ridiculously rare and most likley superhuman individual if you could.  That's just not a realistic (or fair) expectation at all; so let's dispense with it, and get on with the business at hand: understanding what they actually went through, and developing some compassion -- fellow feeling -- for it.

As you read Pat's reminiscences -- the series of accounts of this young Marine, 17, in Vietnam, which I'm titling "eyewitness to combat" -- think about these things. 

Remember what Ernie Pyle, the greatest and significantly most humane American war correspondent called it?  "The Powerful Fraternalism of the Ghastly Brotherhood of War."  And he made the point, too, that these guys did it -- sometimes the only thing they could adequately focus on was that:

"He did it for the kid next to him; he couldn't let him down.  They needed one another so bad." 

So don't get up on your high horse and be horrified by what Pat's saying, if he has to say something that strikes you as terrible.  War IS terrible; it IS never moral; and it DOESN'T make for perky stories told in three points with a snappy introduction and a great takeaway message to mull on with your popcorn.  It's dirty, messy, evil business that often breaks those who participated in it, who rarely even come to terms with what went on while they were.  And we just stand by and WATCH that, and wonder, or criticize them, for not being able to cope "better" with what they went through.  What would be "better" be, exactly?  Would WE know it if we saw it; would THEY?

--

Remember too, you weren't there.  Our "Representative Veteran," Pat, was -- and he's still trying to process why he had to experience that, and what it means to him that he did.  The remiscences, of which we'll only be sharing some, took 40 years to get down in transmissable form.  That's a lot of painful "elephant" being fed through a very small aperture, so that it can be understood by the rest of us -- and hopefully taken to heart, so that we treat this generation of returning warriors better, and don't make them beg for the services, and the appreciation, that they deserve.  Remarkably, scratch a Vietnam vet -- lonely, neglected, cast off by society, EXILED in his own land -- and you find someone who would give half a paired something to see the current generation better than they were.  Not bitterness, a desire for betterness.  Well, most of them at least.  And the bitterness is easily understood, where and when it exists, as to why.

--

And by the way -- we never did give these guys an offical, actual "Welcome Home."  Chew on that instead, if you want to point fingers about who should have done what in war.  WE should have done THAT.  And in some small way, by making one combat veteran's experiences known in this manner, on this blog -- heh -- that's exactly what we're doing now. 

Welcome Home, Pat, Rob, Claude, Grif, Jeremy's dad, Ray, Shad, John Paul's dad, Steve, the other Steve, Congressman Thompson, Max Cleland, Kathie's husband, Bet's husband, Cecil, the cute flirty guy with the eye patch, who sat next to me at a photography exhibit (still learning!) and who'd just survived a stroke -- everybody else who didn't get that at the time, and we can guess with great certainty hasn't been able to since, either.  Oh, and that would certainly include the abandoned and forgotten guys on the streets (homeless), and the various guys lolling off to sleep in wheelchairs at the veteran's homes, with their little American flags staked into their chairs, who I am pretty sure aren't having visitors, and are dying by the score every month, lost to us for good. 

I had a conversation lately with Pat: how many of those guys are you still in touch with?  Because it sounded like very few.  This is what he had to say:

"The problem with being attached to [that group of] Marines is that very few of each deployment survived long enough to ever get together.  1/9 tried reunions for a while but too few [were alive] to meet so they suspended it.  2/9 still is trying but no one from my days are there.  The thirteen guys I went into the Marines with were either killed in action; died of their wounds; committed suicide later; [or] were so severely wounded that they are still in VA mental hospitals and don't recognize anyone [so there'd be no point].  Only two of us are still alive 'n kicking and we got together for eleven years on what we called our "kill day".  He drifted up into Canada, I drifted to Texas; we have not spoken for over 20 years so I don't even know if he is still around." Yikes.  See bolded statement for emphasis... 

Really and truly, America -- don't you dare criticize these people.  You haven't walked a mile in their shoes -- and until you do what YOU need to do, and uphold YOUR side of the bargain -- you really haven't earned the right.  If anything, read and learn -- and recognize how very human the motivations, compromises, and eclipsing of characters is.  And just be glad that you didn't have to be there; and do what you can to provide a measure of comfort, acceptance and acknowledgement to those who were.  Don't NEGLECT America's warriors; FAIL to welcome them home; STAND BY and watch them be crippled from what they experienced, for which they have often have no HEALTHY RECOURSE WHATSOEVER; and then have the NERVE to point out their moral turpitude, as if you knew.  You don't; they do.  Point, theirs.  And that's the only point worth hearing on this one; sorry.

"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. From One Bullet Away: The Making of a Marine Officer, by Nathaniel Fick.

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.

The Tao on Trusting in the Power of Touch

I remember reading in Kurt Vonnegut's book, Slaughterhouse-Five, as a kid about this mythical person the narrator knew, who made a point of sanding down his fingertips so he would ever so much more skilled as a lover, and be able to pick up the subtle electricity of his partner.  I highly doubt someone ever did that, but still, as a metaphor it's got its place.  Maybe set to the tune of the Pointer Sisters singing, "I Want a Lover with a Slow Hand..." (and sanded fingertips, besides :-). 

Anyway, it probably won't surprise you to learn that the ever-balanced Tao has something to say about the power of touch, too.  Interesting how it combines it with hope.  Thinking about how babies who are never picked up experience "failure to thrive."  As babies in adult bodies, perhaps we are all more alike than different there, after all.

Touch.

“To touch, to feel, to rub, to caress.  Our lives cannot be sensed whole.  We have to feel our way forward.  And what we feel, we have to trust.”

 

One of the hardest things to do is to trust our own feelings.  Beginning with well-meaning parents and teachers, we hear so many instructions that thwart and ridicule our perceptions that we eventually internalize this mistrust of our own feelings.  Far too many of us have voices of doubt continuously playing in our minds.  Soon, it is hard to feel anything genuine, because these voices are always telling us that we are wrong.

 

Disappointments and setbacks reinforce these voices.  Maybe we start out trying to be extraordinary. “I’ll be great,” we vow, but then we stumble a little, and then voices become louder.

But we have to stick to our perceptions and to our feelings.  That is where experience, philosophy and self-refinement come in: we know that we have accomplished things, we know that we can coordinate what we perceive with established principles, and we trust that our beings are finely tuned enough to accurately feel what is around us. 

 

What we do in life is up to us and will not be known all at once.  Therefore, we have to feel our way along, little by little, building the vision to know what we are individually meant to do.  We can’t let doubt interfere with our touch.  We have to trust our touch.

Editor's note: If you need some vintage Pointer Sisters to go with this, here's the link to their video of this on YouTube.

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.

Unhealthy Sexuality: A Hot and Horny Babe Who Nevertheless Just Couldn't "Get" It

In our continuing, semi-regular series on "Healthy Sexuality and the Combat Veteran," we need to take a look at three or so "unhealthy" variations on a theme.  The second, here, is about what starts out great but deteriorates quickly over an inabilty or even perhaps an unwillingness to absorb the realities of combat for the veteran. "Love is blind," but that's not always a good thing, as we shall see.  Sometimes it kills a relationship dead.

 

Home: Day One

 

I started down from the steps of the plane, looking around to try to spot her. Not hard at all: around five-feet, nine-inches, very voluptuous, but at eighteen, just out of high school, and almost through Cosmetology College.

She was screaming “Tom, Tom, over here, Darling!” —and running towards me. God, she was, and probably still is, beautiful. (Side note: I still love her.)

She jumped into my arms, and we went home to start a “normal” life. But in my case, how do you do that—as I had re-enlisted in the Army to get the money to marry her. We had a connection on a couple of dates before I left for Vietnam, and during correspondence (assuming we were both telling the truth) we had fallen in love, and become engaged.

 

So, things rolled along, and we got married, and went and used my “blood money” as I thought of it—as a down payment on a two-bed trailer home. Many soldiers and their wives were what some called “Trailer Trash” but it was a start. Due to the permissive society we lived in, we had gone on a drive one time to Pagago Park, it was almost sunset, we had been talking, and all of a sudden, she said:

“Love me, Tom,” and, well, what could I say or do, but what I felt?

 

The day they delivered our trailer—a beautiful twelve-by-sixty foot, two bedroom, freshly bought with a VA loan—we showed up to move in on the last week or so of my post-Vietnam leave. We had not been sleeping together. Her father, a 1st Cavalry Division veteran of the Pacific war in WWII would not hear of it and I respected that. We basically had that one slip in Papago Park; but, in all honesty, we had some “plans” after that, though we were staying in the same house, in separate bedrooms.

Yeah, I know the setup to this story is a little long, but it relates to understanding the rest of it. A hot and horny young warrior back from the war, and a hot and horny babe anxious to be married and start what was supposed to be the “perfect life.”

On night one, I felt I owed it to her to explain to her a crucial point based on the story of the tunnels of Cu-Chi. We did not know it at the time, but I still needed to relate to her the story of how the people who oriented us as we came into Vietnam had mentioned that there had been soldiers found with their throats cut. They told us we needed a “password” to get back into the “Hootches” we lived in after dark, or we could end up dead. Then, after I moved up to Dau-Tieng, and began going out on combat operations with a direct support artillery outfit, it became real one night, as I was on perimeter guard, and we were hearing reports about possible enemy infiltration through the perimeter from our “listening post” outposts.

Bottom line: I had to try to explain to her that I slept in hyper-paranoid mode, and under no circumstances was she to touch me anywhere, except in drill instructor mode: tap the bottom of my foot, or whack it. She could not get it. She did not want to get it. It was just too horrible for her to contemplate, and eventually, it ended in our divorce. I cannot count how many hundreds of times she forgot what I reminded her of every single day: while I am asleep do not touch me anywhere, but on the bottom of my foot, drill-instructor-style.

And the poor beautiful baby only wanted to wake me up passionately and lovingly to a brand new, shiny day, with some love, and maybe even some sex, and instead I had the guilt of waking up with her throat in my hands, and her eyes bulging in horror, because in my unconscious mind, I was fighting for my life against a Sapper. Her mother and father thought I abused her, because she insisted on turning over and like the beautiful loving person she was—trying to throw her arms around me and “Welcome me to another morning of love between us.”

I tried and tried, but she just could not get it. She did not want to contemplate or understand such horrible things. To get it. Double emphasis, I know, but important enough to be double. And the worst part was—she tried to tell them there was no abuse, but “Daddy’s Little Girl” could not possibly be to blame for that. And of course, that is partly true, though, it was not really her, but the mindset of Middle American womanhood.

The guilt—the good part is that eventually, my guilt forced behavior changes and it ended, but the damage had been done.

After years of bitterness about why “they” did not understand, I finally realized that there was no possible way we could possibly expect them to.

Not only were they unable to—they did not want to.

But then, the next revelation was: hell, they are just like me! I do not want to understand it, or know it, either! My kingdom for a memory eraser! What kingdom? Okay, my ratty little trailer, and my lousy seven-dollars-per-hour job. Anything! Only take the weight off! Let me live again!

-- a Vietnam veteran and PTSD survivor (name withheld for privacy)

 

Reprinted with permission from Close to Home: A Soldier's Guide to Returning from War, by Britta Reque-Dragicevic.  The e-book is available here for the very affordable price of $10.  Buy it :-) 

Unhealthy Sexuality: Unable to Touch Intimacy - "You Don't Want to Degrade Your Wife to That Level"

In our continuing, semi-regular series on "Healthy Sexuality and the Combat Veteran," we need to take a look at three or so "unhealthy" variations on a theme.  The first, here, is "inability to touch intimacy" -- there's plenty o' sex (promiscuity), just not with the wife.  The material is quoted from a Vietnam veteran participating in a program with Jonathan Shay, M.D., Ph.D.:

 

Nantucket in the summertime was a fucking playground.  You meet broads, we’re stationed there, we don’t know what the fuck we’re stationed there for.  A different broad every night, twosomes, threesomes, it was a liberal fucking place.  It was just fucking crazy, but it was a relief for a short period of time.  It worked better than booze.  In my mind it had intimacy.  With booze, I didn’t have intimacy.  You’re fucking someone you don’t even know; but you know that you’re fucking.  I wouldn’t even call it lust.  It’s what I’m supposed to do and I feel good doing it, but then you get up and leave.  After you’re done you couldn’t wait to get the fuck outta there.  Also on Nantucket.  Once you’re done everything popped back up [i.e., intrusive memories and emotions related to Vietnam.]  But for that five minutes you forget everything.  Then you get up and leave.

You know you’re walking down the street [today] and you see a guy with his wife, holding hands, and you wonder “why can’t I do that? Why can’t I hold hands like that?”  I want to, but I don’t know how.  It seems like there’s a process to it, but we don’t know the process.  You know, people hugging and shit like that?  We do it in different ways.  We take care of our wives, we give them what they want.  We make sure they’re not afraid of anyone – we’re there if anything fucking happens.  We have intimacy in that way.

You’re drunk, you’re slobbering over some broad – I touched it [intimacy].  I didn’t touch it with the person I want to [i.e., his wife], but I touched it.  Back then I didn’t know what it was for.  It felt good, and not too many things felt good lately and this is one of them.  You know I can drink till I drop.  Booze and fucking has a lot to do with our scenarios, booze would lead to sex.  Half of us don’t drink anymore.  The pact between booze and sex fucking ended.

And when I went home – you know, I think I still have a problem, I still have a problem today, approaching my wife for sex.  I don’t know if she wants me to approach her.  I don’t know the steps.  Every once in a while it’s okay, but most of the time it ain’t.  I won’t say it’s the punishment, but I’d say for us it’s the way it’s supposed to be.  We don’t put a lot of stock in it.

You’ve got a wife and a family, and you can’t abandon them, so, you just fuck.  There’s nights you don’t come home.  The wife, she figures you’re out on a drunk again.  And most of us did weird things, really, but we always left the money at home.  Like, “That’s for you, because this part of me isn’t good.”  [I would] fuck nasty, but you couldn’t do that kind of thing to your wife.  That’s a whole different thing.  That’s the woman who nurtures you, and puts you back together, and puts up with your bullshit.

If you look at a lot of us, we had solid women, the women were strong, they were solid.  That’s what we lost.  We were in the fucking jungle while they were going to their prom, the holding hands.  You know, the high school sweetheart, we gave that up.  Willingly, we gave that up.  We didn’t know it.  But we gave it up willingly and said, “I’m going to do this [fight a war],” so we can’t capture [what was lost], don’t know how to.  Before Nam, I remember going out with girls in high school, not fuck or anything, but making out all night, kissing and – I remember doing that.  [Before Vietnam] not really fucking.  It was that time in the early 1960s, you went home and took a cold shower half the time.  But the intimacy was there, the hugging and the kissing and you could put your arm around the girl you went out with.  These weren’t sluts…”

…

You don’t want to degrade your wife to that level.  [Like a slave?]  Yes.  There’s times when she approaches me, and you know what?  You’re very careful making love.  You’re very careful in your mind.  In your mind you don’t want to get dog-fucking dirty.  This is my wife, the mother of my kids.  She’s the one who holds the family together.  I supply [the family’s livelihood].  That’s a whole different thing.  I don’t have a word for it.

It has a type of relief that’s good for a while, sure as hell better than any booze.  Some of us ain’t drinking anymore so it’s harder.

The way we are, amongst ourselves, look at it is it’s just another price we pay.

For Combat Vets, Sex Can Be "More Than Sex" - PTSD Medicine

In our semi-regular continuing series here on healthy sexuality and the combat veteran, here's an important quotation from Aphrodite Matsakis, Ph.D., quoted by Jonathan Shay, M.D., Ph.D.:

“For some vets, sex is more than sex.  It is a form of tranquillizer or sedative for their anxieties and other tensions.  Not only does sex provide a sense of physical peace, but of emotional peace as well.  “Sex takes away my anger,” explains Tom.  “After satisfying sex, for a few moments at least, all seems well, both within and without.”  … Furthermore, for some vets, orgasm functions as a form of “shock treatment” for their depression.  “If I don’t have at least three orgasms a day, I get so blue I can’t stand it.  The minute I start feeling down, I reach for my wife…” [said another veteran.]  When his wife refuses him sexually, it is not just sexual frustration he feels, but the full weight of some of his symptoms 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.

 

Healing and the Mind: Mind-Body Medicine and Mindfulness Meditation

"May the stars carry your sadness away. May the flowers fill your heart with beauty. And may hope forever wipe away your tears." -- Chief Dan George.

Continuing our series on mind-body medicine, here's a little information about Jon Kabat-Zinn, Ph.D. whose multiple works on mindfulness meditation are mentioned frequently in the field.  (See Patience Mason, etc.)

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Back in the early 1990s, journalist Bill Moyers (pictured, left) had a great series on PBS, followed by a book of the same name, called "Healing and the Mind."  It was a fascinating look at the way non-medical aspects of healing could come into play and help restore people to health and vitality. The series was really the first of its kind to talk about these far-ranging subjects to a mainstream American audience, and many people achieved a measure of fame and prominence by being highlighted by Moyers and this series.

Jon Kabat-Zinn, Ph.D., trained as a molecular biologist at MIT, was one such person.  According to Wikipedia, which happens in this case to be right, "Kabat-Zinn is the founder and former Executive Director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. He is also the founder (1979) and former director of its renowned Stress Reduction Clinic and Professor of Medicine emeritus at the University of Massachusetts Medical School."  Mindfulness Meditation is Kabat-Zinn's specialty, and he's had great results teaching it.

Other luminaries in the field of mind-body medicine, of which Kabat-Zinn's work is a part, include James S. Gordon, M.D., Dr. Bernie Siegel, Rachel Naomi Remen, and John Sarno, M.D, among others.

I wish I could remember, at this remove, what the point of Kabat-Zinn's work at the University of Massachusetts Medical Center's Stress Reduction Clinic was - but I think it had something to do with heart disease in men, and whether leading patients through mindfulness meditation exercises would have some beneficial effect on the men's stress levels and heart health. My memory is that it did, and "Healing and the Mind" featured some compelling stories of how much the men's lives had changed who practiced mindfulness meditation with Kabat-Zinn. 

There's a whole semi-wiggy at first but highly interesting concept that's been put forth by several leading lights in the medical arena that "hearts" are where men store "stress," in the form sometimes of sadness and depression -- possibly over all they've experienced in their lives, but have not had the benefit of sharing openly (it's not a guy thing ;-).  If I remember from that program, lo these many years ago, I think it mentioned something about how men who had undergone open heart surgery often suffered severely from post-operation depression, and lives were being lost AFTER operations had been successfully, because the predominantly male patients had not learned better ways of coping with stress, sadness and depression, and would succumb, in a weakened state.  My memory is that when Kabat-Zinn invited some of these very sick patients to class, over a short amount of time they learned to process their needed grief and pain and regret, but still move on with their lives, thanks to the techniques of mindfulness meditation, as taught by Jon Kabat-Zinn, Ph.D.

It's interesting to note how many others have turned to this same "technique" to deal with some of the horrors they've experienced, like PTSD.

Editor's note: Jon Kabat-Zinn, Ph.D.'s most famous books are: Wherever You Go, There You Are: Mindfulness Meditations in Everyday Life, andFull Catastrophe LIving: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness.

Couples Massage: Sensual Seduction or Stress Reduction? You Decide

We mentioned aromatherapy or making "potions" or blends of essential oils the other day -- not that horrid fakey stuff that's sold in the supermarket, or the dead stinkpots of "potpourri," looking like what's left over after someone dredges a pond, boiling away on somebody's stove (yuck...) -- the REAL STUFF, which is tremendously lovely to experience. 

Essential oil blends can be amazing to smell, and reputedly have some therapeutic properties, especially for stress reduction -- but imagine how great they could be if you could combine them with a lovely, tender massage?  Giver or recipient: it's hard to say who has the better time.  And if you switch off, both get to enjoy.

When it comes to aromatherapy, Valerie Cooksley, who we talked about here, is the recognized expert.  She has a few great recipes "for lovers" in her book, but here's one that's specifically for massage. 

Says Valerie, "Here is a very sensual massage oil designed for the whole body (2% dilution). I suggest warming the oil in a hot water bath prior to application to increase absorption.  There is enough here for two bodies, so decide who will go first.  Review the helpful tips for aromatherapy massage [in her book]...If this oil appears too strongly scented, simply add more vegetable oil (the sweet almond or the safflower) to dilute it:

4 Tbsp. sweet almond or safflower oil

1/2 tsp. Evening primrose oil (optional)

1/2 tsp. carrot seed oil (optional)

12 drops Sandalwood essential oil

6  drops Ylang Ylang essential oil

4 drops Clary Sage essential oil

2 drops Rose oil (for dark hair and skin) or

2 drops Neroli oil (for light hair and skin).

Directions, according to Valerie: Mix the essential oils with warm safflower or sweet almond oil in a shallow dish.  Apply to the body in small amounts using a comfortable pressure and working toward the heart.  Avoid the face  and genital area.

Her book also includes several bath recipes with "aphrodisiac qualities," and a very special inhalation recipe. (For the uninitiated, essential oil blends, depending on their specific properties, can be appropriate for sniffing, dabbing on the skin, adding to a bath, adding to a carrier (lotion or oil), etc., but usually each blend -- because of its constituent parts -- is suitable for one, not a variety of those uses.  Hence why it pays to learn more about this topic, and picking up a book like one of many Valerie has written is just the way to go.)

Editor's note: If you don't know how to give a really great massage, pick up a book, watch a DVD, or take an adult education class in your area.  The essentials oils are typically available (Aura Cacia is a good and reputable brand) from various decent health food stores (Whole Foods, Wild Oats, etc.) plus online at Amazon.com and at Frontier Organics, among others.  Image is by German photographer Thomas Wanhoff.

Everyone Has Their Own Vietnam - Or, The Experience of Seeing the Elephant at 17

I was writing the original version of this entry last night, when the whole neighborhood lost power until the morning, and whatever I had written ended up "gone with the wind."  In a way, it might be nice to just leave it at that because it means less exposure, but whatever...I'll make another attempt at saying the same thing. Here goes:

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It was interesting how Claude Anshin Thomas talked about how "Everyone has their own Vietnam," "Their own experience of violence, calamity or trauma."

This summer I noticed that Janis Ian is on tour.  A young contemporary of Billy Joel, back in the day, one of her big hits was "At Seventeen," which she will no doubt be trotting out on this tour.  The song is basically a lament, in the person of a high school student, about how only the popular girls get the guys, and how miserable it is to be outside the popular group.  Ahhh, teenage angst.  We all remember it so well, because everyone alive has felt some. 

But contrary to Janis Ian's wistful reflections on the hot cheerleaders getting the hot football players and vice versa, and how "painful" that was for her to be left out of the loop, the reality is, many of us "at 17" were dealing with things much more significant than that.  Seventeen is the age that many of the guys were who went to Vietnam for the first time, and saw their worlds turn upside down with what they saw, did and experienced -- things it's safe to say they were completely unprepared for.  17 is also the age that many of the young men and women were when they made the fateful decision to sign up for the armed forces, and ended up in Iraq or Afghanistan or, a few years back, in the Persian Gulf.  Their childhood came to an end very suddenly, and perhaps they couldn't relate any more, well, to the friends they left behind, who didn't have nearly the same things on their plates; who in fact had much simpler lives.

I have one memory of being around 17 that stays with me to this day.  My mom was dying of cancer the whole time I was in high school, but it advanced and escalated in intensity, as cancer has a way of doing, as I got closer to graduating.  The cancer had started as breast cancer, metastasized into her spine, and caused all the usual horrific problems that come about when it's diagnosed too late in the cycles to be saved.  My mom tried to still be a good mom and try not to have us focus too much on "the elephant in the room," that was she was actively dying, every day, and that the end would come shortly.  She still tried to be a mom, and go to the store and cook dinner, when she could, but she was so darn sick, and just so frail and helpless by then, that it was a tremendous effort, and really painful to watch.  But I also understood that it was part of what she needed to do: almost keeping the illusion alive that she was still coping with her mom role, because somehow to stop doing that would have meant we could all realize the huge disaster we were in: we're about to lose our mom, and there WILL be no replacement, not now, not anytime in the future. 

Well, anyway, the memory that I have is not that significant except for what I thought about at the time.  In this guise of "she's trying to seem like things are semi-okay," we went out to the grocery story together one night when it was already dark.  She went in, probably very slowly and feebly, by herself to pick up a few things, and I used that opportunity to stay outside in the car, and just think.  I remember looking up at the moon, from inside the empty car, staring out at a very dark night, and realizing that although the night seemed perfectly ordinary: black night, white moon, mom in store doing a little shopping, it was anything but ordinary: in fact, I could tell by how sick she was that there really weren't going to be many more times she could even go to the store, and this in fact might be the last.  I sort of paused mentally to take that in, and realize how the sky and the moon and the ordinary sameness of the even ing would "keep" going on like that, but very soon, my mom would not, who I really dearly loved, as much as she sometimes vexed me.  And the next thought that crossed my mind was my personal Vietnam:

I started to sob, thinking about how I was going to have to live the whole rest of my life without my mom, and then I quickly pulled up short, realizing: oh, man, if I start getting in touch with how I REALLY feel about this -- completely devastated, bereft, alone -- you fill in the blanks, they're all appropriate -- I will basically start crying, and NEVER be able to stop.  And then what will I do?

So I caught myself at the beginning of whatever the harshest, deepest, raw-est cry  could have -- the cry that Oprah and others refer to as "an ugly cry" (and then some) -- and just shoved the whole experience -- or the potential for getting in touch with that much emotion -- about as far down and out of the way as I could -- and I bet by the time my mom came back to the car, I was "all better." Maybe I even thought I was doing it for her sake; I certainly thought I was doing it for mine.

But as you can imagine, the pain from that experience didn't get any less because I refused to really cry from that gut-wrenching a level, and when my mom did die, a few months later, and literally for years afterwards, I was still in a suspended state of grief, where something terrible and yet completely vital to deal with, ran just below the surface, like a terrible, powerful undertow, running through the quicksand of my actual life.

It's fair to say that this experience gave me some "life-based empathy" for people who deal with things far beyond their ability to endure at such a young age: in many ways, I bet our emotional lives just STOP when we encounter heavy-duty psychological losses like those.  But at the same time, I have nothing but respect for people who can, even at a later point, begin to crack the gigantic ice floe of their emotions into manageable pieces again, and look at each one in turn, and see if it's really the demon or the disaster they've made it out to be.  So many things that haunt us for years are not just the acts themselves, but the interpretations we've placed on them.  Not just "what" happened, but "how" we interpret what that actually meant: what was the message to us, encoded in the circumstance.

Speaking of Oprah, there's a revelation she had years later after seesawing so heavily in public on the otherwise very private issue of her weight.  What she eventually realized, having noticeably gone to extremes over the years, was that the core issue to her was that she had a hard time handling disappointment, and rather than "sitting with" those feelings when they happened, as they inevitably do, she instead "turned to" other things (in her case, food) that would take the edge off, distract her, and provide some level of comfort.  Because we're all human beings, we too can understand what Oprah was going through; and we understand as well her eventual realization that she was short-circuiting her own healing by doing so.  The desire to avoid pain, while a completely understandable desire, also sometimes gets in the way of actually becoming free from it.  What you hear when you read what Claude Anshin Thomas and others say is, although they initially turned to drug, sex and alcohol (workaholism also counts) as a way to "manage" and blunt the acutely, horrifically painful memories of war; ultimately it became necessary to confront what the actual memories were, in order to finally break free.

While this blog takes a lot of twists and turns from time to time, as it and its author come into maturity ;-), the reality is, there are some key main themes that get returned to again and again.  The "point" of the whole thing is "catharsis" -- which really means, "breaking through."  Or more to our purposes, "breaking through" without "breaking into a million pieces."  That's what I wanted for myself; that's what I want for you.  And I want you, and us, to consider absolutely anything practical that holds out any hope for changing what's affected us so drastically.  It's almost certain that there is "no silver bullet," no single solution that appears in "one size fits all" to take all the pain away.  Whatever it is, will surely involve work -- breakthroughs, while responsive to a good bit of luck, also take profound and sometimes even prolonged effort."  But it's also true that as less Western types are fond of saying, "When the student is ready, the teacher will appear."  If you're even reading this blog, you're wanting more than the ordinary "solutions" to a life-changing problem, PTSD.  You're at least curious to learn about what it would take to really heal, from the inside out.

What I've seen over the last few months, and ideally you have as well, is that contrary to their being "one method" that might help relieve the pain of combat trauma, and work through the agony of it, there are actually "quite a few" approaches that might offer some hope and help.  Systematically, you can look into each of those methods in turn, and evaluate whether it has benefit to you.  You can be inspired by those like Claude Anshin Thomas who were willing to strip life back to the essentials, and see what it would take to get free: not an easy task, but a crucial one.  You can appreciate the healthy "nerve" that it takes others, like Pat, to process what they're going through in writing, in an attempt to "explain themselves" to their families (maybe) but certainly in the process, to themselves.  And you can avail yourself of all the latest thinking, even from unconventional corners (our specialty ;-) about what various non-mainstream forms of treatment might hold out in the way of help. 

There's nothing wrong with the mainstream treatments, provided they work.  But if they tend to numb out the patient, and not help him or her move forward far enough in integrating the experience of combat trauma into their lives -- in fact, just putting off that inevitability -- then they too should be challenged for falling short of a solution that may actually still just be a dream.  Human beings are so different from one another, and PTSD is no level playing field.  Not everyone exposed to combat trauma develops it; not everyone who does, develops it in the same way, or can heal from it, even slightly, in the same way.  That's why it's worth considering "all" the alternatives, and not so eventually finding the "toolkit" that you can use to help overcome yours.  Can it ever be fully overcome?  In some ways that's a less important question than, are there things you can do today to help you achieve some victory and a semblance of peace, comfort or relief in yours.  With 475 blog posts behind us, and who knows how many to come, that would be the entire point of this blog. 

"To your health..." and to some semblance of integration with the life you left behind, because it is also part of who you are today.  Not an anti-self, a different self, which also needs to be integrated back into who you really are.  You saw the elephant; most did not.  But the elephant doesn't need to be the single defining moment of your life. It's an inextricable part of who you are, but the whole of you is so much greater than that.  Work to help it find its rightful place in your life: not by rejecting it -- it was still your experience -- but by finding a way to integrate it into the full, complete, total, adult you. With all possible best wishes for doing so, the expression of which at this moment is this continually updated blog.

Waking up to the Boundlessness of Suffering from War - One Veteran Learns How to Overcome

Continuing our theme of "mind-body medicine," which we revisit from time to time, one of the more interesting books to come out by a Vietnam veteran talking about his experiences in war and afterwards is "At Hell’s Gate: A Soldier’s Journey from War to Peace," by Claude Anshin Thomas. 

 

Thomas grew up like many guys who went to Vietnam: poor in a hardscrabble American town, son of a WW II veteran, with whom he had a rocky relationship; athlete in school who had perhaps a glorified view -- from his relationship with his dad and from athletics -- about what combat would really be like, or what it would do for him.  He was clearly under the impression that it would "make him a man," and when reality hit, and he saw the things war really was made of, and that he saw himself do, well, it was a little too late to turn back. That was Vietnam in 1966. The scars from that experience would be touchstones for the rest of his life, and honestly -- he's shown more healing than many. 

 

First and foremost probably because he's been willing to admit the level of pain and suffering that Vietnam left on his "soul."  Here's some of his reflections from his book that Michael Herr, author of Dispatches, says was "written with relentless courage and utter compassion."  According to Herr, "this account of violence and transformation is one of the most amazing and wonderful stories I've ever read."

 

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Thomas, who went to Vietnam at 18, received numerous awards and decorations, including 27 Air Medals, a Distinguished Flying Cross, and the Purple Heart.  We first wrote about him back in February of 2006, and several times since, because his book -- and the way he's transformed his experience -- appear to be virtually one of a kind.  As he himself says, Vietnam is not unique in that "everyone has their Vietnam...everyone has their own experience of violence, or calamity or trauma."  What stands out about Thomas, though, is his willingness to acknowledge all the raw trauma, and somehow, to transform at least parts of it.  Now, for Thomas in his own words about some of the scarring, as well as some of the transformation from within:

 

"My body is covered with scars from my wars.  Every time I look at my body, touch one of these scars, I touch again 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."

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"Recently I spoke with a man who said, “If you didn’t feel things so deeply, if you were numb or if you were able to deny your feelings, you probably wouldn’t have any trouble with the war.”  But in fact, the vast majority of the people who have closed themselves off from the reality of their experiences in war are suffering tremendously.  Hiding or avoiding does not eliminate suffering, it just drives it more deeply underground.  Then our suffering controls us more profoundly, in one form or another.  We cannot hide from our pain.  Trying to do so is like attempting to pour a liter of red paint into a half-liter container: It will spill and spread, covering every aspect of our lives.

 

That’s what was happening to me when I hit bottom, a place where the pain was so intense I didn’t know how to hold it.  I thought my only option was to die.  As we wake up to suffering, we may feel at some points as if we might explode.  Because waking up to the boundlessness of suffering is intense, the pain is raw, the feelings immense – spaceless, formless, empty.

The practices of mindfulness and meditation have provided me with invaluable resources and tools in those moments, in those hell places.  They also help me to go to those places with others, to support them in caring for and healing themselves.  I am able to sit with the dying, the wounded, encouraging them to tell their stories and listening deeply. I  also go to the front lines and talk to soldiers about not fighting.  I talk candidly with them about the effects and consequences of war.  I am also able to go to the back wards of hospitals and mental institutions to visit the hidden casualties of war and listen to their stories.  I sit with the disenfranchised, the social and cultural lepers, and listen. In all these places, with all these people, I practice breathing in and breathing out.  I practice being fully present.  And I offer them the tools of Zen Buddhist practice (direct experience), spiritual practice.  I hope to help them discover the practices and tools that have helped saved my life: sitting meditation, walking meditation, mindful speech, and deep listening.  I also hope to provide the experience of sangha (community) – to demonstrate how community can support us on the path to healing and the path to awakening.

 

I invite people to bring an end to their isolation.  Because together we can do more than we can do alone.  These tools, this practice of meditation, are important, even critical, because suffering is a reality of our lives, the lives of all of us.  The “Apocalypse Now” is not just in Vietnam; it is not just for Vietnam veterans.  It exists for all of us because we have eaten the fruits of war, the fruits of violence, the fruits of hatred.  If we don’t wake up to this, it will destroy us.  From the inside out, it will destroy us.  I know this from my own experience.  And I know this because I observe this happening all the time.

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

Study Shows Mind-Body Medicine Works on PTSD

(Just what we've been talking about, and who we've just been talking about as well.  Heh.  Love that.  So confirming...)

Read down and see how therapeutic this would be for people in rural communities, with little or no access to the VA, who are in therapy or not, for DIY types and those who prefer to access healthcare through a practitioner of one kind or another.  Just wonderful... and we knew it all along :-)

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The Washington, DC based Center for Mind-Body Medicine (CMBM) announced today the publication of a landmark study on the use of its comprehensive, non-drug model to treat posttraumatic stress disorder (PTSD) in war traumatized children. The study, “Treatment of Posttraumatic Stress Disorder in Post-War Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial,” which was published today online in the Journal of Clinical Psychiatry is the first randomized controlled trial (RCT) ever of any intervention with war traumatized children. It is also the first RCT of a successful, comprehensive mind-body approach with any traumatized population.

The study demonstrates that the Center’s groundbreaking model can be used to produce highly significant and lasting changes in levels of stress, flashbacks, nightmares, and symptoms of withdrawal and numbing in highly traumatized children – those who lived in an area of Kosovo where in 1999 90% of the homes were burned and bombed and 20% of the children lost one or both parents.

 The CMBM approach includes self-expression and mind-body techniques and was offered to these children over 12 sessions in an educational, supportive small group setting. Eighty-two high school students in Kosovo participated in the study. The program was conducted by teachers and included meditation, guided imagery, breathing techniques, and biofeedback as well as self-expression through words, drawings, and movement. All the students met the criteria for posttraumatic stress disorder (PTSD) which was measured using the Harvard Trauma Questionnaire. Following the program, the number of students having symptoms indicating PTSD was significantly reduced from 100% to 18%. The reduction in symptoms was maintained at a 3 month follow-up. The improvement in PTSD symptoms was significantly greater compared to a similar group of students who did not participate in the mind-body skills program. This is the same model that CMBM’s founder and director, James S. Gordon, M.D., describes in detail in his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression.

“This RCT,” Dr. Gordon, the lead author, says, “is important because it provides scientific evidence for the efficacy of a model that has been taught to almost 3,000 health and mental health professionals and educators worldwide. We’ve used this small group model to give tens of thousands of children and adults practical tools that help them to feel better quickly, and we’ve taught them to use their intuition and imagination to solve problems that had seemed overwhelming. We help traumatized people around the world to draw on strengths they may have forgotten they have, and we offer them a ‘safe place’ in which they can share their pain with others who have suffered as they have.”

“This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “It’s highly acceptable to populations which do not want to be given medication, those with no access to a doctor or therapist, and those who are in psychotherapy.”

This model, which Dr. Gordon presents in a step-by-step self-help format in Unstuck, is currently being used by CMBM with war traumatized populations in Israel and Gaza as well as in post-Katrina southern Louisiana. It is widely used with anxious and depressed people and those with chronic illness in the US, and has already been incorporated as a stress reduction program for students in a dozen US medical schools.

The CMBM model is also of increasing interest to the US Department of Defense and the Veterans Administration. “The military,” Dr. Gordon says, “understands the breadth and depth of the psychological crisis (as many as 300,000 returning veterans are expected to have posttraumatic stress disorder or major depressive disorder, and another 320,000 will have been made vulnerable to these conditions by traumatic brain injury). The military’s leadership is committed to finding evidence-based approaches, like the one taught by The Center for Mind-Body Medicine, that can make a difference for the individual veteran and his/her family, an approach that can be taught to the large numbers of professionals and peer counselors who serve them.” More than 100 health and mental health professionals who work with the military are expected at the next CMBM training in mind-body medicine on October 25-29 in Minneapolis, and many more are expressing interest in learning and using the CMBM model.

For more information about the upcoming training, click here,  or to order Unstuck: Your Guide to the Seven-Stage Journey Out of Depression", please email The Center for Mind-Body Medicine (CMBM) at mindbody@cmbm.org or visit www.cmbm.org.

Healthy Sex, Love and the Combat Veteran: Powerful Forces for Good

As we continue on in this series, begun the other day, we're going to need to talk about all of it: the bad, the good and the ugly.  There are so many problems combat veterans and their partners face, and to do this topic justice -- we have to talk about them all.

The poet Robert Frost once wrote, "Something we were withholding made us weak Until we found that it was ourselves."

The flurry of postings recently that illustrate the "Tao take on [fill in the blank]" are not there to make you into a Taoist -- ironically even the Taoists don't care if you sign up (how nice is that?!) -- they're there because the Tao is the literal quintessence of "balance," something we often lack to a great degree, and sometimes hearing this ancient Wisdom can somehow bring us back and ground us, where we should have been all along.  The Tao doesn't specifically have that much to say about "love, sex, 'n everything in between," but what it does have, I've posted recently -- in order to create a sense of balance, and a reflection as if in a mirror about what the "healthier"approach might be.  Sometimes, frankly, we each lack that.  We can do things for the wrong reasons, and betray ourselves in the process.  We can GET married for the wrong reasons; we can STAY married for the wrong reasons; we can LEAVE a marriage for the wrong reasons; we can be CELIBATE for the wrong reasons, within a marriage -- we can just fundamentally fail to understand ourselves, our motivations, and the ones we're with. 

Life is tricky, precious and fragile -- and we need to handle it with care.  For that very reason, before we delve into what's wrong with some combat veteran's marriages and sex lives, I thought it was important to take a moment, and re-establish what balance and healthy love and sexuality would be.  Now we'll have a frame of reference for the rest...

Ironically, if you read the short Tao passage on what being a "hero" actually means, you find someting really remarkable: it means showing up with everything in you, to participate in the life you have before you, like the Frost comment -- not withholding yourself, and who you really are.  That's refreshing, bracing, and often terribly hard to do: in other words, just plain perfect.  However else "America" defines "hero" -- if you can manage this, "you done good" :-)

The Tao on Making Love

Nocturnal downpour
Wakes the lovers,
Floods the valley.

Making love is natural. Why be ashamed of it?

That seems simple, but it is actually a great challenge in these complex times. Too many other layers of meaning have been imposed upon sex. Religions straitjacket it, ascetics deny it, romantics glorify it, intellectuals theorize about it, obsessives pervert it. These actions have nothing to do with lovemaking. They come from fanaticism and compulsive behavior. Can we actually master the challenge of having lovemaking be open and healthy?

Sex should not be used as leverage, manipulation, selfishness, or abuse. It should not be a ground for our personal compulsions and delusions.

Sexuality is an honest reflection of our innermost personalities, and we should ensure that its expression is healthy. Making love is something mysterious, sacred, and often the most profound interaction between people. Whether what is created is a relationship or pregnancy, the legacy of both partners will be inherent in their creation. What we put into love determines what we get out of it.

Source: 365 Tao, by Den-Ming Dao.

The Tao on Marriage

Marriage.

 

“Wall of flames, bridge of tears.

Snowflake on newly forged links.”

 

For a marriage to last, a couple must go through great travails and hardships.  It is like a process of forging steel links together.  The iron must be heated to a high degree and then plunged into cold water.  A marriage alternates between the heat of passion and love and the chilling times of tragedy, conflict and adversity.  An enduring marriage is like tempered steel.

 

It is difficult to go through life alone.  We all need support and the sense of belonging that comes from working toward shared goals with another.  For such a relationship to work, there must be a basic compatibility of values, outlook and purpose.  It is an inadequate cliché that husband and wife must be friends as well as lovers.  Two mates can know a loyalty found in no other type of relationship.  Yet even in the face of such strength, Tao reminds us of the need for moderation.

 

Ultimately, all relationships are temporary.  False attachments to another can become an addiction, a voluntary bondage detrimental to clear perception.  We should not bind another to ourselves, should not define ourselves by marriage, should not force another to stay with us.  But if chance allows us to walk together, who is anyone to challenge our choice of walking companions?

 

When it is time to part, then it is time to part.  There should be no regrets.  The beauty of marriage is like the fleeting perfection of a snowflake.

 

Source: 365 Tao, by Den-Ming Dao.

 

 

The Tao on What It Takes to Be a Hero: Being Yourself

Hero.

Chinese character: Ying.  Hero, heroic, brave.  Above is the character for “grass.”  Below is a phonetic.  This word originally indicated the highest tip of a stalk of grass, which was not only the tallest part, but the part from which the plant continued to grow.  Later, the word was borrowed to mean “heroic.”  Be heroic, but be smart too.

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Why do we have heroes?  Because it is part of what is most noble in the human heart.

 

Life is difficult to confront.  Chance and ruin are overwhelming; the heart and mind are fragile.  Those who manage to assert their will against the odds are admirable.  When we are the ones who are able to triumph over adversity, we have reached a rare and fleeting moment.

 

No one can set out to be a hero.  No one can fake being a hero.  Being a hero is a matter of being prepared for a gift in time. Time will give you the opening.  It is how you then respond that will decide whether you have taken advantage of your opportunity.

 

Having any less than heroic aspirations is to settle for mediocrity, and the mediocre never develop the perceptions and reflexes needed to follow Tao.  But if you want to be extraordinary, concentrate only on perfecting yourself.  Don’t think about being a hero.  In actuality, the degree of a person’s heroism is often decided afterward.  We needn’t care about how others judge us.  As long as we grasp the importance of a moment, meet the opportunity, and respond to it with the whole of our being, then we can consider ourselves heroes.  This, then, is the true meaning of heroism: you met whatever came your way with every bit of yourself.

 

Life is simple, Tao is hard.  By being heroic in life, we can make a beginning in Tao.

-- Everyday Tao, by Deng Ming-Dao.

The Tao on Celibacy - A Life Without Sex - Why?!

Celibacy.

“In winter, animals do not mate.  Preserve your Tao by preserving your essence.”

 

We follow the Tao of the universe with great effort, but Tao is within us too.  It is not something abstract, not something conceptual.  Our personal Tao is our very life force.  This energy begins with the physical and extends into the spiritual.

The source of this energy is partly chemical: our hormones, nutrition from food, and genetics.  Followers of Tao call this the essence.  Preservation of this essence through sexual conservation is crucial.  This doesn’t mean suppression of sexuality, for the impulse to make love is natural and irrepressible; it means to harmonize sexuality with spirituality.

The follower of Tao makes love according to the seasons.  In winter, it should be less or not at all; in spring, it may be at its most frequent.  The young should restrict themselves to about once every three days, while the middle-aged should reduce to once a week, and the elderly even less than that.  The secret is not to indulge too much, without killing one’s sexuality altogether.  Overindulgence is to waste one’s resources.  Suppression kills the body at its most basic level.  Find the proper balance, and you will have a happy life AND full spirituality.

Source: 365 Tao, by Den-Ming Dao.

The Tao on the Power of Love: Trying to Get Things to Match

 

Love.

“to delight.  To love is natural.  To understand the variations of love is wisdom”

Love is perhaps the most powerful of human emotions.  It is also the most overstated and most abused.

We need to let love be as simple as the word indicates.  It is as simple as the beating of our hearts.  It is expressed as easily as an embrace.

Many people want to interfere with love.  Ascetics want to deny it.  Perverts want to distort it.  Kings want allegiance for it.  Merchants want to sell it.  Poets want inspiration from it.  We need none of this for our hearts to beat or for our hands to reach out.

Most people would agree that love is important to them.  Yet it is also one of the most vexing preoccupations in many lives.  People suffer disappointments and think this is the fault of love.  It isn’t.  Disappointments have to do with things not being perfect, with things not matching.  That happens.  It’s hard to get things to match, even some of the time.  But that has nothing to do with love.  Love is all about continuing to try to get things to match.  If you love, you’ll continue to do that, even if that sometimes means sacrifice on your part.  That’s all right.  Hurt and pain come as part of life.  No one is exempt from it.  But that is no reason not to love.

Suffering accompanies life, but love is affirmation.

 

Source: 365 Tao, by Den-Ming Dao.

Marine Corps Combat Operational Stress Control Conference Starts Tomorrow

Headquarters Marine Corps Combat Operational Stress Control (COSC) Program is pleased to announce the 2008 Marine Corps COSC Conference to be held on August 12-14, 2008 at the Manchester Grand Hyatt, San Diego, CA.

Purpose of the Conference: The purpose of this conference is to bring together subject matter experts and stakeholders in the Marine Corps COSC process, and to present, examine,
and become informed on COSC policies, programs, and practices specifically
tailored to Marines and their families. Topics will be of interest to Marines, leaders, researchers, treatment providers, Family Readiness staff, chaplains and family members. This is a warfighting issue. Representation
from command leadership is essential to improve Corps-wide efforts to
maximize force preservation and readiness. This year our goal is to introduce the new Marine Corps COSC Continuum Model, which emphasizes the importance of leadership roles in promoting wellness, prevention and early identification of combat stress.

Who should attend: The conference is designed to benefit Marines, leaders of Marines, mental health professionals, Family Readiness staff, chaplains, medical providers, policy makers, family members, veterans, and their advocates.

Information about the conference is linked here.

A Terrible Beauty is Born: The Poetry of War, and Its Moral Ambiguity

James Anderson Winn, an English professor at Boston University, has come out with an anthology of war poems, entitled The Poetry of War, linked here.

Winn laments that there aren't more poems emerging from Iraq and Afghanistan, other than Brian Turner's Here, Bullet that deal with larger themes than just combat veterans' personal pain (I'm paraphrasing.)  At the risk of sounding glib, that's still fine with me because we've got to start somewhere, and reasoning from the specific (a veteran's own hurt and pain) to the general (the group of warriors, the country, or the wars themselves) will get there, in time.  He also makes the point that much of the best war poetry in our lifetimes, speaking generally, came out of World War I, whereas World War II generated excellent novels.  There's an article on Professor Winn and his new book, linked here; and a video of his discussing three war poems, linked here.

From the article:

Like many people in my generation, my most immediate experience with war was the war in Vietnam. Although I was lucky enough not to go there, I did get drafted in 1968 and found my time in the Army pointless and frustrating. So it was instructive to read poems by soldiers who genuinely believed in the rightness of the wars they were fighting. I remain deeply skeptical of war as a means of bringing about change, but I respect the determination and heroism of soldier-poets from many eras, and I have tried, in my book, to honor their memory.

Also from the article: Winn's best answer, in response to the best question asked him:

What can poetry tell us about war that news accounts or history books cannot?

For journalists, and even for historians, war is a contest. One side wins, the other loses; the balance of power in some part of the world may change as a result. But poetry is an ideal form for expressing ambiguity, and thus for describing the heroism of the vanquished, the intolerable cost of so-called victory, and above all, the complex and contradictory feelings of all those touched by war.

Editor's note: The post title is taken from a great line from Irish poet W.B. Yeats about the Easter Uprising of 1916.  Now I'd like to find the source of a great line Winn uses in his videotaped talk, which says "...the hot lips of liberty which kiss men cold."  That's a great jumping-off for something: not sure what yet.  I guess I'll have to buy Winn's book to find out who said it first.