Healing Combat Trauma

Sexual Healing: Discovering the Ecstasy of Relating in Intimacy

As we touch back in with our recurring topic of "Healthy Sexuality and the Combat Veteran," it's interesting to read the always thought-provoking Arthur Egendorf, a Vietnam veteran and Ph.D. psychologist, with extensive personal experience with the veterans' "rap groups" of the 1970s on this topic as well.  Here's what he has to say, echoing the problem we've been learning combat veterans often have with one of the key basics of sexuality, "intimacy" between the partners.  Writes Egendorf:

"Almost every veteran I’ve seen in therapy has wanted help with intimate relationships.  In his own way, each of these men has been deeply committed to individual survival and to the ethos of the lone adventurer who has to make it on his own.  For such people, giving themselves to a relationship clashes with their long-standing refusal to let anyone get close enough to pose a threat."

Additionally, he writes:

"Virtually all troubled couples view sexual problems as part of their difficulty.  One of them will say that they ought to be having more sex.  From a healing perspective, what they’re missing is fulfillment, and they make it harder to achieve by thinking that more orgasm will provide it.  They don’t see that when sex is ecstatic it is never just the orgasm that does it.  The ecstasy comes with giving oneself in a shared embrace.  Although you can have orgasms alone or with any human being (some manage very well with animals), people seldom bother to do it with just anyone unless they can’t be with someone they deeply love.

It’s easier to have sex with a stranger than with a long-time partner who’s hard to get along with. This is the excuse many people use to sleep around.  But as long as they use the excuse, they don’t discover the ecstasy of relating is enhanced when one gives oneself where it’s no longer easy."

-- Source: Healing from the War: Trauma and Transformation after Vietnam, by Arthur Egendorf.

 

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

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

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

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

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

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

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

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

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

Marching for Suicide Awareness and Prevention among Veterans at Army's Fort Drum

NPR on its Weekend Edition has a good story today about a march held on Sept. 12th at the Army's Fort Drum in upstate New York, to highlight veteran suicide.  The article says that Penny Pierce, who works at Fort Drum, organized the march, in part because the taboo surrounding suicide makes soldiers vulnerable (to not asking for or getting the help that they need.) The article is linked here. Great work, Penny! (And NPR.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Belleruth Naparstek Seminars on Reversing PTSD

Belleruth Naparstek and The Conference Works presents:

Reversing Panic Attacks, Acute Stress and PTSD Powerful New Solutions to Formerly Intractable Problems

October 4-5 New Orleans, LA - Hampton Inn & Suites New Orleans October 11-12 Denver, CO - Ramada Plaza Denver North November 22-23 Salt Lake City, UT According to the seminar materials: If you, someone you love or someone in your care has suffers from panic attacks, acute stress or the symptoms of PTSD, you know the devastating impact it can have on body, mind, life and spirit. We now know that multi-sensory guided imagery and other simple mind-body tools hold the critical key to healing. Guided imagery is a kind of directed daydreaming, a guided meditation, usually set to soothing music. Although it has been called "visualization" and "mental imagery," these terms are misleading. Guided imagery involves all of the senses. Because imagery engages the whole person—mind, body and spirit—it brings to bear much more of a person's deepest strength and motivation to accomplish a desired end. Subtle and gentle as this technique is, it is very powerful, and becomes more so over time. Belleruth Naparstek (pronounced: bell-rooth´ nap´-pur-stack) is a psychotherapist known worldwide for her powerful guided imagery and her outstanding ability to help people rediscover their bodies’ innate ability to heal. Click here for more information about the seminar.

Belleruth Naparstek, LISW - Psychotherapist

Psychotherapist, author and guided imagery innovator Belleruth Naparstek, LISW, BCD, has practiced psychotherapy for over 30 years. She is best known as the creator of the popular, 52-title Time Warner Health Journeys guided imagery audio series. Naparstek's first book, Staying Well with Guided Imagery, (Warner Books) continues to be a widely used primer for medical professionals and health consumers. Her second book, Your Sixth Sense, (Harper San Francisco) has been translated into 8 languages and has been called one of the more thoughtful and sophisticated looks at intuition. She is also the author of Invisible Heroes : Survivors of Trauma and How They Heal, and Health Journeys: A Guided Meditation for Healing Trauma (PTSD).

Naparstek has helped to make guided imagery part of mainstream healthcare by persuading traditional healthcare organizations such as Aetna U.S. Healthcare, the U.S. Veteran’s Administration, GlaxoSmithKline,The American Red Cross, Blue Shield of California, Ortho Biotech, Roche, Medical Mutual of Ohio, Amgen, Kaiser Permanente, and nearly 2000 hospitals, clinics, spas and hospices to distribute her guided imagery recordings, in many instances free of charge.

A warm, dynamic and compelling speaker, Naparstek has lectured across the country and around the world, training thousands of health professionals, corporate leaders, counselors, performing artists and health consumers in the use of her powerful, ground-breaking guided imagery techniques.

Her imagery has been involved in 24 clinical trials, with over a half dozen studies completed to date. Efficacy has been established for several psychological and medical conditions.

Naparstek received both undergraduate and graduate degrees from the University of Chicago. For years she taught graduate students at Case Western Reserve University's Mandel School of Applied Social Sciences. She lives in Cleveland with her family.

A Mind-Body Medicine Approach to PTSD - Conference Oct. 11th and 12th - West Coast

The Institute for Transpersonal Psychology in Palo Alto, CA will hold a seminar on 

Mind-Body Approach to PTSD," October 11th and 12, 2008, featuring a Center for Mind-Body Medicine faculty member, Gjorgji Nikoloski, M.D..  According to the ITP's website, linked here, the program will be a 

"one and a half day workshop that teaches: the scientific basis for mind-body medicine; the depth and power of our unique small group approach; and the use of a range of the most effective tools for self-care and stress management.

Comprehensive materials and hands-on experience will prepare you to integrate our mind-body model into your work in a wide variety of settings, including private practice with individuals and groups, hospital work, educational programs and work with populations affected by war, abuse, terrorism and other forms of trauma.

Our approaches are fundamental to relieving the stress that contributes so significantly to all chronic illnesses, and to comprehensive and integrative approaches to the treatment of PTSD.

The featured presenter, Dr. Nikoloski is a Psychiatrist and Mental health clinician who has worked with child adolescent services and the Community Mental Health Clinic in Guelph, Ontario Canada. He began as Faculty of Mind-Body Medicine in Kosovo in 1999 and Founded the Center for Mental Health and Psychosocial Support in Skopje, Macedonia in1999. He is on the Board of Directors of the Coalition for Work with Psycho-trauma and Peace (CWWPP) in Vukovar, Croatia.  (A more extensive bio for Dr. Nikoloski is linked here.)

To purchase tickets to this event, click here."

Getting the Better Picture: Major Causes of Death and Injury for Vietnam Veterans from the War

(Well, other than suicide, that is...which certainly became more prevalent later on, after their return from the war; and still, unfortunately, goes on to this day.)

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It's true that my hero, Mark Twain, once said that "there are only three kinds of lies: lies, damned lies, and statistics."  A very funny line, but statistics still do have their place.  For one thing, even if they're slightly in error, they still manage to paint us a "bigger picture" of what's really going on.  War statistics are no different.

If you want some great current ones, by someone who loves statistics, check out my friend Ilona's blog, and in particular, this recent post.  However, what I'm hoping to do here is contribute to the "bigger picture" on injury in the Vietnam war.  I came across this passage earlier today, and it's remarkable in its ability to demonstrate who was killed by what, and who was injured by what, on the American side.  There's going to be a different distribution from the OEF/OIF conflicts in Afghanistan and Iraq -- and we already know what the signature wounds of those wars are: TBI, PTSD, and eardrum damage from the blasts.  But if you want to look back and better understand what Vietnam was like for our veterans, check this out.  I don't think I've ever seen a better list to give us a "picture" of what combatants went through and suffered, albeit externally:

"There were three major causes of American combat deaths during the Vietnam war.  Fifty-one percent were killed by small-arms fire; thirty-six percent by fragments from artillery fire; and eleven percent by booby traps and mines.  The percentage killed by small arms during Vietnam fighting was a substantial increase over that of earlier U.S. wars.  During both the Second World War, and the Korean War, only thirty-three percent were killed by small arms. 

The Vietnam percentage was much greater, because of both the fact that ambush was a major tactic of the Vietnamese Communists, and the Communists’ use of a Russian-supplied rifle, which was high-velocity, rapid-fire, light and extremely effective.  American soldiers suffered wounds from four major sources: sixty-five percent from artillery fire; sixteen percent from small-arms fire; fifteen percent from booby traps and mines; and two percent from punji sticks.

Of those soldiers killed in action, thirty-nine percent were hit in the head; nineteen percent in the chest; eighteen percent in the stomach or groin area; seventeen percent in the legs; and one percent in the shoulder or arms; with sixteen percent suffering multiple location wounds.  The percentage that died due to head wounds is considered high, and is attributed to the reluctance of many GIs to wear a helmet because of the heat; quite a large number wore floppy cloth hats instead.

 

Americans who survived their wounds were hit in the following locations: thirty-six percent in the legs, eighteen percent in the arms or shoulders, fourteen percent in the head, seven percent in the chest, and five percent in the stomach or groin; twenty percent suffered multilocation wounds.

 

Many who were wounded during Vietnam fighting survived because of both the helicopter and improvements in medical treatment.  In Vietnam, only 2.6 of those who survived long enough to reach field hospitals died; during the Second World War, almost twice that many died on hospital tables – 4.5 percent."

-- Source: Vietnam: The Valor and the Sorrow, by Thomas D. Boettcher.

Editor's note: Hope you don't mind the sick humor of the beef diagram, above, but it comes from years of working in law firms, where personal injuries are graded according to worth of the body part harmed, and the age (and therefore future life expectancy/earning power) of the injured.  Speaking of lists that need to be revised...

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

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

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

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

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

Here are a few others:

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

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

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

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

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

Interconnectedness: We Get by with a Little Help from Our Friends

It's hard not to be a fan of the good quote: something that inspires us to rise above the gray grim bleakness of our particular misery (whatever it happens to be at the time -- maybe just the human condition would suffice) and see the shaft of sunlight that breaks through, illuminating the sky and giving us vision and hope for the future.  Okay, maybe I love these more than most, but I really do :-)

Here's one that should perk our spirits up a bit, for everyone who says healing is impossible, and that PTSD is something that will be with you forever -- how bleak, better just give in and give up (ack).  This from a veteran himself; at the time, a psychologist to veterans; and one of the originators of the first "rap groups" that helped Vietnam veterans to connect with one another about their experiences.  It's a great quote, and it brings back the words of that famous Beatles song, even by reference:

"With a little help from our friends, we can heal ourselves, even from war." -- Arthur Egendorf, from the preface to his book, Healing from the War: Trauma and Transformation after Vietnam.

NonCombat Deaths: Opportunities for Unresolved Grief, and Lingering Concerns about Betrayal

CNN, which in my opinion really doesn't win any awards for great reporting these days -- having inexplicably still never covered the Travis Twiggs PTSD murder suicide, for example -- has a decent story today about one family's struggle to cope with their young Army son's noncombat death.  The article is linked here.

Noncombat deaths are on the rise, and they take place for a multitude of reasons.  Some are suicide, some are murder, some are friendly fire, some are just plain accidents -- but all must be incredibly frustrating to the families and loved ones of those who suffer them.  And increasingly they are a number that needs to be kept as a separate statistic about combat.  There are killed in action, wounded in action, and now, noncombat deaths as well.

An additionally painful part, that the CNN article details well, by reporting on conversations with the family, is the difficulty families face when little or no information is forthcoming, which they desperately need a) to understand what happened to their loved one; b) so they can feel the loved one's death is not in vain; and c) so they can have closure, at some future point, about the death of their loved one.  All three of those points become important.

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I was sitting in a newsroom recently when I got a chance to hear a local reporter talk to the family of a woman who'd recently died in Iraq, another noncombat death.  She was just a few days from coming home for an extended visit, and her family was obviously distraught.  The first day, they talked with the reporter, through their grief.  The second day, as the reporter followed up more, trying to get more details and present a better story, the family came back and said that the military had contacted them and told them NOT to talk to reporters because...ta dum dum dum (fake drum roll here)... the military was "doing an investigation."  As though that could possibly be compromised, at a distance!  And then to further show the conflicting, misery-inducing feelings of the matter, the family turned around the next day and asked that reporter to write the woman combat soldier's obituary -- because she was in the best position to do that, having talked with the family at length, and additionally being (genuinely) trusted by them.

Ahhh...the conflicting motivations and interests at work here.  Now the daughter is laid to "rest," and a month or so later...who's to say that the family has any more information, knowledge or understanding of what happened to their daughter...what really happened to their daughter...than they did then.  And they lost a stellar opportunity to process their feelings in conversation with someone (the reporter) who could translate their grief to a wider community: others who are also grieving parents, or who have fought in wars, or who care about those who have.

It reminded me of the story we talked about on this blog a few months ago, first reported in the Washington Post, about Gina Gray, a whistleblower at Arlington National Cemetery who lost her job over her expressed concerns that the military brass was keeping reporters out of veterans' burial ceremonies, even over the objections of their families -- and instructing the families to forbid reporters from attending. Yikes.  It really seems like the war machine is fully revved up and wanting to just hear one side of the story: its own, brooking no opposition, and no interference -- or even other points of view.

And we're not talking about PROTEST here -- we're talking about COVERAGE -- two very different things.  Anyone can protest the war(s); reporters are supposed to take an evenhanded, impartial approach and just COVER it.  So the rest of us can know what's going on. 

The day the local servicemember died in Iraq of a noncombat injury, another American servicemember died elsewhere in Iraq, also of a noncombat injury.  I'm not sure what the statistics are -- and I would bet they're somewhat subject to change -- but TWO noncombat deaths in one day, in different parts of Iraq, not good!  I'm sure the families' grief is every bit as deep, sometimes maybe even more so, for noncombat deaths as for combat.  And sometimes with even more of a feeling or a suspicion that their loved one "died in vain" -- something no one wants to go through.

Are there really any answers to this?  Probably not.  But as the dad in the CNN story says, based on a conversation he had with his own son shortly before he died, sometimes even the jumpiness, youth, and unpreparedness of one's fellow troops becomes a hazardous menace.  His son, a married father of four, expressed his own concern that he felt at greater danger from his fellow soldier than from the insurgents.  Argh.

And what of the vaunted military investigations into these senseless, needless death.  Do we, the families, or the public, have full or even substantial confidence in them?  My guess is they'd rank behind comparable civil investigations, with the added disincentive that the military has a pretty vested interest in NOT finding themselves to be at fault: or at least, a significant conflict of interest.  (The Pat Tillman friendly fire death and subsequently "botched" investigation comes to mind as a fairly embarrassing example.)  And if the military can't substantially prevent noncombat deaths from happening -- ones that don't involve vehicles, let's say -- why should they be able to investigate them somehow more successfully?  The same thought process is at work in either situation: thinking through risks and managing them.

Of special interest to me, and maybe to others as well, is a particular type of noncombat death: the suicide of a senior officer whose pain becomes, at one point, for any number of reasons, too great to bear.  Shockingly, there are a few of such deaths, acknowledged to be just that, in and among probably quite a few more that actually were that, but for one reason or another haven't come to light.  These deaths hold in themselves real kernels of "things we should know" about combat, responsibility, and PTSD.

(If you've read the Travis Twiggs story, which we broke on this blog, you know how he struggled ceaselessly with the death of two of his men.  He didn't seem to be able to get past that: it was a defining grief to him, and his hard feelings about it, realistic or not, poured out every time he mentioned it.  He felt, likely wrongly but nonetheless tremendously deeply, entirely responsible for this event outside of his control, and nothing, seemingly, could move him from that interpretation.  In the end, he ended his own life and that of his brother.)

There are several cases in point of senior officers taking their own lives, from all branches of the service, while deployed, or after they get back.  Granted, not many, but these cases are still instructive in terms of what we can learn about the price these people have paid that was perhaps higher than they could afford.  There's a story I remember reading about around Memorial Day this year, where a senior officer in the National Guard went to a cemetery and shot himself to death, unable to cope with the ravages of PTSD that followed him home.  He was married, he was getting treatment, but whatever it was, wasn't enough, and he ended his life.  I'm looking in vain right now for that reference; I'll add it back in when I find it again.  In the meantime, two others, from further back.  The sad stories of Marine Major Michael Stover, 43, who took his life during his second deployment in Iraq -- and the Army's Col. Ted Westhusing, 44, one of its foremost military ethics scholars, who also took his life in Iraq.

All three of those last cases mentioned, and Twiggs' as well, involve suicide: which technically is only one form or one portion of the total noncombat deaths.  However, as we've seen elsewhere about suicide, it comes from an extremely whittled-down, stripped-down vision of how many choices there really are: basically one, and one only -- how to end it all, and stop the suffering.

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I've been interested for a while to learn whether the concept of "betrayal" on an abstract, philosophical level, is ever involved in suicides, and particularly ones of servicemembers, either during or after service, as veterans.  It might be hard to explain quickly what I mean here.  And more than anything it's just an idea I have, that I wish could be tested -- not a conclusion, in advance.  

What I wonder about is this.  If part of going to war is believing in the "rightness" of the cause, which is essentially a "black and white" concept -- us vs. them -- what happens if later something comes about to challenge or dilute that ideal?  If the after-effect that we can see in someone's life is bitterness, we can sometimes back up -- rewind the tape -- and see what illusion they had earlier on that was somehow shattered or tainted.  One of those instances of "every action having an equal and opposite reaction" things.  (Think about adult survivors of pedophilia in the church, for instance, and how their shame is often compounded by anger at themselves for trusting religious figures, and at God and organized religion for providing the setting for violation.)

To talk about betrayal (of ideals?) in the context of the combat environment, we can think about it this way. Let's say you go to war believing you are fighting for God, motherhood and apple pie -- but then when you get there, you end up doing things you don't believe in, or actively oppose (from a moral, ethical or religious point of view); or, come to believe that you're being taken advantage or used as pawns in a bigger picture that has little to do with what you initially believed.  Let's further suppose you are injured, or watch others suffer horrifically in such combat.  As a thinking, feeling person -- how do you come to terms with that?  It seems that you have very few choices.

If you want to get angry, and want to feel "had" by the powers that be, that creates bitterness, which works against healing; and it also implies that you were "dumb enough" (also known as innocent enough, or trusting enough) to be "had."  That creates some self-hatred or self-loathing, as well as some hatred of whatever the established authority was that you followed when you signed up.

Why this interests me has really everything to do with the PTSD topic, which is the focus of this blog.  With that as the setup, prologue or intro, what interests me is wondering -- do combatants suffer more PTSD in a war they come to look at as unjust -- either while they are there, or afterwards?  Or does this have no effect at all on the rates of PTSD.  World War II is often though of as the last obviously "just" war we fought -- and it does seem that rates of PTSD have been climbing since.  But that's not conclusive by any means.  Still, an interesting thought to ponder...

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And what's a just war, by the way?  Well, probably one you wouldn't have any moral obstacles to fighting in, because you would so totally believe in the "rightness" of your side, as to not have any significant issues with why you were committing your resources to it.  As a New Englander, it's easy to say that the Revolutionary War would have felt like a just war.  Damn that King George!  Toss that tea!  Freedom for the colonists, and all that.  In the Civil War?  Probably both sides felt that it was a just war.  World Wars I and II seemed to have that cachet. But starting with Vietnam, for one reason or another, all of a sudden the concept of the "just war" seems quite diluted.  My personal feeling is that must have some effect on the combatants.  It's always that much harder to justify any decision in your life, particularly one that causes suffering (really doesn't matter much to whom: could be yourself, could be others), if you are (or become) of two minds about participating.  Morally, that type of ambiguity leaves you hamstrung where you'd like to be decisive, and always second-guessing your own involvement.  It interests me a great deal to know whether and how much that affects psychological turmoil and recovery, such as we see with PTSD.

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In trying to find anyone enlightening to read on this topic, I was hoping Sissela Bok might have some answers.  In the '80s, she wrote a seminal volume about ethics called "Lying: Moral Choice in Public and Private Life."  I was hoping she'd speak directly to this topic, but as it turns out, she barely mentions anything like it, and this was the best I could come up with -- and it's really tangential, at best. It basically says, there are several professions, the military included, where lying is a good shortcut to accomplishment, which is pretty neutrally driven by the need to achieve and face crises resourcefully.

"There are a number of professions where crisis situations are not isolated incidents but frequent occurrences.  Doctors, lawyers, journalists, secret-service agents, and military personnel, for example, may repeatedly find themselves in straits where serious consequences seem avoidable only through deception.  Their chosen work exposes them frequently to such crises; their professions, moreover, reward competition and unusual achievement.  Cutting corners may be one way to such achievements; and if deception is pervasive and rarely punished, then it will be all the more likely to spread.  The accepted practices may then grow increasingly insensitive and abuses and mistakes more common, resulting in harm to self, profession, clients, and society." -- Lying: Moral Choice in Public and Private Life, by Sissela Bok.

The only other mention of military personnel in her book is a separate example about using untruthfulness judiciously in order to promote people such as career military officers whose professional livelihoods depend on regular advancement.  She calls this a "deceptive practice where not much may seem to be at stake but which has high accumulated costs..." Much like colleges have been criticized for grade inflation (including Harvard University, where Bok's husband Derek was president for years); the military can be criticized for inflated job performance assessments, so that the career military person can keep being promoted.  Hmmmn.  "The entire practice," she says, "is unjust for those rated and bewildering for those who give and make use of ratings.  It also robs recommendations of whatever benefits they are intended to bring."

Another neat, but highly tangential point.  I guess for a deeper, fuller discussion of a sense of betrayal and its effects on the mind and psyche, we'll have to check out Jonathan Shay, M.D., Ph.D's work in greater detail, or even Judith Herman, M.D.'s.  In the meantime, the best we can offer is that betrayal families and loved ones must feel (that's an apolitical comment, just a philosophical one) about servicemembers dying an unjust, noncombat death -- either at their own hand, or at someone else's, on the same side - must truly just add to the difficulty of their grieving.  The more unresolved the grief, the longer it lasts, and the deeper and more far-reaching its effects.  Unresolved grief, as we've noted recently in the material from William Styron, linked here, is truly a risk factor of sorts for depression.  And unresolved grief with anger intact...ahhh, that spells a future of bitterness, hatred, and inability to reconcile with the facts as they happened, which is truly painful for all concerned.

Jonathan Shay, M.D., Ph.D., is a big believer that community keeps warriors sane; and other authors too who I've been reading recently on this topic (veterans and combat trauma; and/or suicide) make much of the point of affiliation -- the one with the others; the one in the midst of the others.  My sense is that betrayal drives each person who feels it further within themselves, and apart from others -- whose camaraderie becomes essential to healing.  If any of this fog ever lifts with any sort of clarity, I'll be sure to post about it.  Until then, from deep within the fog... :-)

Postscript: Oddly enough, CNN (of all places!) has a separate, psychological-ish article on the topic of betrayal, from the other day, and in it they have this quote, which somewhat underscores what we were talking about earlier: betrayal is hard on the health, and it postpones or prolongs healing:

"According to a University of Zurich study published in May that examined how the brain adapts to breaches of trust, people who have experienced betrayal sometimes steer clear of future social interactions, and in extreme cases develop social phobia."

In other words, someone who feels betrayed as part of a "system" (e.g., the military) is often less interested in being part of any other type of group thing, which might actually be able to help them heal, through the affiliative nature of groups.  Ahh...more on that later...

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

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

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

 

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

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

Making Darkness Visible - One Author (and Former Marine's) Attempt

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

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

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

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

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

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

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

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

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

(Hmmmn.)

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

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

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

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

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

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

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

"E quindi uscimmo a riveder le stelle.

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

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

Suffering to the Full - in Order to Heal

"We are healed from suffering only by experiencing it to the full." -- Marcel Proust (1871 - 1922), French essayist, writer, and former infantry soldier.

Go to War, Do Art - Afghanistan and Iraq Combat Art Show Opens in DC

You are invited to visit the new show opening on "Afghanistan and Iraq: Combat Art," from the United States Navy and United States Marine Corps Combat Art Programs.  

Pictured here is USMC Warrant Officer and Combat Artist Michael Fay, with his unfinished canvas for "Between Sunset and Moonrise, Wazir Pass, Afghanistan" (oil paint on gessoed watercolor paper). 

Fay is one of the combat artists featured in the exhibit, and we've written about his powerful work before on this blog: here,  here, and here, among others.  Marine Sgt. Kristopher Battles is another U.S. Marine Combat Artist whose work will be featured in the exhibit.  Both come from a long tradition of those told to "Go to War, Make Art" -- both in the Marine Corps and in the other branches of the military.

See the superb PBS series, "They Drew Fire," for more on combat artists.  Abbott Laboratories has its own magnificent collection of war art.  For more on the Marine Corps combat art program, and its permanent inclusion in the new Marine Corps Museum, click here.  For a look at Mike Fay's personal blog, Fire and Ice, click here.

We're going to assume that the combat art show is going to be in the same place the opening for it is: in other words, the (irony) Cold War Gallery, Building 70, at the Navy Museum, in the Washington Navy Yard.  My guess is it's moving later to the permanent digs at the new Marine Corps Museum. If this information later on turns out to be different, I'll update it when I know for sure.  In the meantime, here's a link to the Cold War Gallery: there does not seem to be a page up yet for the show itself (bummer).

In the meantime, at right is a look at Fay's finished work for "Between Sunset and Moonrise, Wazir Pass, Afghanistan."  His artwork, which the BBC and the Wall Street Journal have both profiled, contains any number of extremely moving images, particularly his sketchwork, and recently his bronzes.  Amazing stuff.  If you're in the DC area, do yourself the favor of catching this show, and acquainting yourself with the rich tradition of combatants who clarify through art what it's really like to be a veteran of war: the bad, the good and the ugly.

And while you're at it, be sure to check out our extensive collection here of links to art and war, and also art therapy -- a modality that doesn't work for everyone, but for those whom it helps, including combat veterans, a true blessing as a way to process the images lodged in the subconscious through a means that releases them therapeutically (i.e., catharsis).

The Veterans' Cry - Love Me, Love My Pain (But Maybe That's a Bad Idea)

(This is a photo of a different type of veteran -- a sculpture of a concentration camp survivor in an outdoor garden at the Holocaust Memorial in San Francisco.)

With someone who has suffered greatly, at what point does their identity, especially their sense of their self, begin to fuse and become identified with what they have suffered?  Creating a "love me, love my pain" situation that is hazardous for the trauma survivor, as well as his or her intimates, to endure?  Clearly, although suffering (and pain) may be substantial, we are "more" than our pain.

Some wisdom on the topic, paraphrased for our purposes here:

"Healing requires the active participation of [veterans]. They need to listen to themselves to the point where they don't need symptoms of discomfort in order to be heard.  Healing comes from within."

-- Healing from Within with Chi Nei Tsang, by Gilles Marin.

What that remarkable quote points out is that there are times in our lives when we're tempted to identify ourselve as our illness, despite the contraction of self that really means.

While Descartes is famous for introducing the Mind-Body "split" as a way to differentiate aspects of health and identity, in fact it is a construct that others argue with wisdom against: suggesting that the two are really not separate at all, but integrated. And if integrated, what affects one can affect the other, positively and negatively.

Years ago when I was plagued with, and then wrote extensively about, chronic fatigue syndrome, there was an analogous illness, fibromyalgia, that shared some similarities, but troubled health care practitioners who treated patients with it.  These days there's some pharmaceutical remedy on the market that may show promise for it -- great if it does -- but I distinctly remember the difficulty practitioners had with those patients -- something they would express to me, but suggest I not quote them as having said in print.  The upshot was that fibromyalgia sufferers seemed to have, as a group, a particular way of looking at their bodies as not the same as themselves -- more like a shell that they could "hand to" practitioners to "heal," and then receive back, without participating much in the process.  The sense from these practitioners was also that fibromyalgia sufferers were eager to please, "nice" people, whose response to significant stress was to locate the problem pretty much exclusively as bodily illness (which on some level must have made it acceptable to them).  Again the theme was, let's not take total responsibility here -- let's not experience the pain and process it.  Let's locate it externally (our bodies?!); then "remove" that shell for treatment, by a qualified health care type, without ever addressing the integrated issues between stress and pain.

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In another past life experience, managing a mediation program that provided attorneys to settle litigants' cases on the eve of trial.  We primarily handled personal injury cases, and most of those were motor vehicle accidents -- but not always car with car; sometimes car with pedestrian, or worse.  A common theme, since many of the accidents resulted in "soft tissue injury," a painful but frequently amorphous condition -- was to beware the litigant who'd had a series of prior injuries, but tended to focus on "this latest accident" as the reason for everything going wrong in his or her life.  Seriously, not even a substantial settlement would be able to set "that many wrongs right" -- because the problem was often magnified in the mind of the litigant.  An auto accident suddenly was made to be the single explanatory reason for a marriage going bad, the inability to keep a job, the loss of friends, the loss of sexual relations, headaches, bad moods, etc.  Doubtless there were many cases in which the participants were incapacitated by what they had experienced, even when medical science couldn't substantiate fully what had happened -- but there were also the many cases where simply too many things were piled as consequences at the feet of fairly weak causation.  Even if the "victim" "hadn't seemed the same since" the accident, it's also entirely possible that the accident was only the latest in the series of life misadventures that had finally piled up to the point of critical mass, and finally surpassed the participant's ability to cope.  That wasn't the same as meaning, the accident actually caused all that suffering, which often stretched back for years (and predated the accident!)

It was also worth noting that the participants who labeled an auto accident as the likely cause for decades' worth of pain, often had very poorly-developed sense of humor about it.  In other words, they were deadly serious about their being only reason for the destruction in their lives: and they had nothing to do with it!  I didn't get to sit in on too many mediations, but I do distinctly remember one which summed this up.  A lady who developed severe soft tissue injuries by colliding, as a pedestrian, with a Metro bus -- yes, she walked INTO the bus, as the bus was moving -- on her way OUT of an "anger management" program at the courthouse, mandated for some prior offense. So essentially she was still so distracted, she didn't see the bus, ran into it on foot, and had a litany of complaints, bodily and psychological alleged to be caused by this "accident," but apparently zero sense of humor, or the sense that she was even partially at fault.  Litigants like this were always difficult to reason with.

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Talking to a combat veteran the other day who had seen intense combat, he talked about the frustration of support groups for other combat veterans -- and how though he started attending, years ago, he later stopped.  The process he described reminded me a bit of both of those situations, as well as even more so a quote by Andrew Weil, M.D., which we will introduce shortly.

What this veteran said he experienced was that each veteran, individually, had something or someone he labeled as the "problem," and the locus for all the (psychological) pain he felt from the war (Vietnam, in this case).  He had polished this particular "focus" of his pain for what might even have been decades.  In the "safety" and the sanctity of the group, among other (equally troubled) veterans, he got the chance to share what was on his mind and bugging him.  But he was doing that in a group where every other veteran there had an equivalent focus for his own pain.  So the process this veteran described is he would take out his "ornament" and polish it, and hang it on the joint "Christmas tree" of pain for the group, and each veteran in turn would negatively reinforce how much he'd been done wrong by whoever or whatever he'd mentioned, but then go on to mention his own hurt and pain, and hang THAT ornament up on the tree, and pretty soon, this figurative Christmas tree was just filled with ornaments to each veterans' pain -- essentially becoming a memorial to hurt and being done wrong, etc., -- but with no healing.

It put me in mind of the Andrew Weil, M.D., quote I read years ago when I was researching chronic fatigue.  He wrote then, and it applies today, perhaps to this case as well.  "Regarding the efficacy of support groups," I wrote, "Andrew Weil, M.D., cautions strongly, "Avoid support groups for people with chronic fatigue syndrome. They often give you ideas for new symptoms and convey the impression that the disease will be with you for the rest of your life." -- Andrew Weil, M.D., Natural Health, Natural Medicine.

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Does support from other combat veterans for what you've experienced have its place?  Certainly.  But beware of things that seem to reinforce stasis not growth; and especially things that reinforce people's sense that either pain IS them; or that pain has little to do WITH them; and basically has a life of its own.  The remarkable nature of the Gilles Marin quote above, at the very beginning of this post, is that sufferers should be able to reach a point where they can identify themselves as separate from the pain they experience, and expect to be acknowledged for themselves, not just for what they endure. "Love me, love my pain"? -- Could be there are much better ways to handle that difficult and draining problem. 

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Editor's note: Besides the mind-body medicine references mentioned and linked in the category of the same name; one specific book that explores this relationship explicitly is "The MindBody Prescription: Healing the Body, Healing the Pain," by John E. Sarno, M.D. 

Three Quotes Worth Knowing about the Hard Work of Healing

 "Only with a reconciliation between our mind, our emotions and our spirit can we get to true healing."

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"It takes a tremendous amount of energy and an absolutely trustworthy support system to be able to stay with an emotional issue and allow the healing process to take place."

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"We can only help people that are ready to heal.  Timing is esssential.  People need maturity and a support system to go through their healing process.  Generally, when people feel that they need healing, it is a sign that they are able to get in touch with something they were not able to handle until now.  They are then able to use their sickness as opportunity for change.  Most of the time we need to attain an advanced age to have the perspective of life experience, to have a sense of self-worth and [of] mercy [this turns out to be so true: even in terms of having mercy on yourself...] Then all the conditions can be gathered for a successful outcome."

Source: Healing from Within with Chi Nei Tsang, by Gilles Marin.

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

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

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

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

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

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

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

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

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

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

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

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

Wisdom, indeed.

"Only Connect!": The Elusive but Nonetheless All-Important Quality of Simple Affection

The dictionary defines "affection" as: "A tender feeling toward another; fondness;" and more elaborately, via the thesaurus, as: "The condition of being closely tied to another by affection or faith - attachment, devotion, fondness, liking, love, loyalty.  See "connect."

Ahh, "connection."  The feeling that we two are moving together towards a common goal - are yoked together in care and consideration and fellow feeling.  Sounds so good.  "There's a real connection there," we say; "I feel connected to you."  If only combat veterans also could rely on this, themselves.  It seems pretty clear they establish it with one another; but the question remains, are they able to sustain that, or to find it with anyone else?

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Back in the days when I had other things on my mind besides combat trauma -- ahh, the halcyon days of youth ;-) -- I remember going to hear Hal Holbrook as Mark Twain at the Opera House in Boston, right before he finished his run.  Holbrook, parroting Twain, had a very interesting remark, that echoes in my mind today about the plight of veterans, and whether (and how much) we show them that we care.  The remark came towards the end of Holbrook's performance, and it was meant to symbolize an elderly Twain, winding down the course of his life, and wrapping it up for public consumption.  In that context, this is what he said (writeup mine):

Seating himself in the easy chair and stretching his long legs before him, Twain lit the last cigar of the evening.  As he drew steadily on the cigar he reflected out loud on the hundreds and hundreds of letters that he’d received throughout the length of his career from his accumulated audience.  “These letters,” he said, with gratitude animating his face, “have contained compliments, and pride, and a note of affection.  And the last of those is the last and final and richest reward that a man can have.”

The last and richest reward a man can have?  Sounds pretty good to me.  I wonder if that's how we're treating veterans, though -- or marginalizing them to the edge of society with their scary stories we can't relate to, and their trauma we just want to ignore?  Hope not.  This New Yorker cartoon I saw recently reminds me of the plight of veterans on the subject: still waiting to be brought into the conversation with America, still waiting to be heard.  Let's hope it isn't so, or won't continue to be so. 

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More on the "affection/connection" front:

A few years ago, again living in Boston, I took the opportunity to see a documentary at an independent movie house called "Darshan: the Embrace," about India's "hugging saint," Ammachi, a.k.a. Amma, a.k.a. Sri Mata Amritanandamayi Devi (Sanskrit for "Mother of Immortal Bliss").  There were only two people in the movie theater (my being one), which goes to show you how little pull the concept had, but the movie was most mystifying to me.  It was a documentary about the apparently considerable impact of an Indian woman whose sole raison d'etre was that she would dole out hugs to those who wanted them.  Really. 

At the risk of insulting someone's religion, and I hope I don't (but probably will), that really was all there was to it.  Amma has apparently hugged hundreds of thousands, perhaps literally millions, of people worldwide; she hugs for a prodigious number of hours a day, when she's on task; and people who are eager for one of her hugs line up for literally hours -- maybe even days -- in India's sweltering heat (and elsewhere, when she's on tour), for just...a hug. There was so much buildup about her hugs in the movie, and about her being the human embodiment of divine love, that I really was...set up for a disappointment.  They were just...hugs.  Nothing more, nothing less.  She had a few rules for them, too: women should de-smear themselves of makeup, lest they rub too much off on Amma while hugging, and a couple of other ones that I forget. 

But two things really struck me about the experience, as portrayed in the movie (again, forgive me, it's just my opinion; you can have yours).  One is that we as a society are WHACKED if we are this desperate for what amounts to unconnected affection at such a low level; and two (minor point) that people who give up everything to go and FOLLOW someone like this are even more embarrassingly whacked on the topic than should be safe to admit.  And there were quite a few who were compelled to do so. (For a more sympathetic portrayal of the "Amma Phenomenon" than mine, I would refer you to an article in USA Today, linked here, from July of 2006.)

As relatively empty as the experience nonetheless seemed to me, do you get the big picture on this?  Possibly millions of people worldwide feel basic-affection-deprived to literally stand in line for hours to have a stranger with allegedly mystical properties hug them -- none of whose mystical properties are actually the draw of the visit?  Just the hug.  The irreverent, possibly sacrilegious side of me felt a little like Jay Leno, astonished by Hugh Grant's dalliance with Divine Brown, while he was dating supermodel Elizabeth Hurley: Just how badly DID you want it?  Yikes.

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A little closer to home, we can revel in the safer, non-religious, amystical "Free Hugs" campaign, portrayed on YouTube, linked here, which was filmed on the streets of Vancouver, B.C.  As one respondent wrote on YouTube, essentially, "hey, I tried to imitate that in my local mall, and they kicked me out!" -- "Is that any way to spread love and compassion in the world?" (Watch the video, linked here, it's totally uplifting and fun. You may even shed an actual tear...)

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We've talked a lot about "healthy sexuality and the combat veteran," and we will continue to talk about that all-but-forgotten, way-too-overlooked, thoroughly neglected topic more in the months to come.  But interestingly enough, as much as healthy sexuality and intimacy may be hard for the combat veteran to find/take part in, so too may a far more basic experience - simple human affection.

"Only Connect!" - two such all-important words, from prose or poetry, come flooding back from the days of English literature.  But from where?  From E.M. Forster's Howards End, published in 1910:

"Mature as he was, she might yet be able to help him to the building of the rainbow bridge that should connect the prose in us with the passion. Without it we are meaningless fragments, half monks, half beasts, unconnected arches that have never joined into a man. With it love is born, and alights on the highest curve, glowing against the gray, sober against the fire."

and again:

"Only connect! That was the whole of her sermon. Only connect the prose and the passion, and both will be exalted, and human love will be seen at its height. Live in fragments no longer. Only connect, and the beast and the monk, robbed of the isolation that is life to either, will die."

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Mark Twain, Amma the Hugging Saint, the Vancouver "Free Hugs" man on downtown Robson, E.M. Forster: the message is the same: simple affection is crucial, nay vital, to life -- only connect.  See what you can do today to bridge that gap yourself, help others feel understood and connected, and appreciated.  A gift that changes the giver and the recipient...a bridge between human beings.  Only connect.

The Power of Love (and Sex): Healthy Appetite v. Unhealthy Cravings

Continuing our on-again, off-again series on "healthy sexuality for the combat veteran," here is an interesting contrast, from a bodywork tradition, about the difference between love and lust, appetite (healthy) and cravings (unhealthy).

First, this piece of information, according to their tradition:

"The sexual center (enjoyment/ creativity/ playfulness) is ... the center of drive, creativity, and enjoyment of life.  When the center allows a free flow of energy, one is happy, very creative, enthusiastic, and has a sense of optimism.  When the flow becomes restricted there, one finds it hard to enjoy life and becomes self-destructive."

And now the comparison/contrast of the two states of being, one healthy and one unhealthy:

Love and Lust; Appetite and Craving

Appetite is known in all traditions to be the sign of good health and appreciation of life.  Unfortunately, a lot of people are afraid of their appetite because they mistake a desire for certain foods for craving.  In a civilization of plenty where diets rule, appetite has become a synonym for sin.  The desire for food, a desire rising up from the deep, has also been associated with the desire of the flesh, the desire for sex, and the sin of lust.  In my opinion, we need to differentiate between appetite and cravings, which relate to each other in the same way as love and lust.  Our inability to differentiate [between the two] leads us to [mis]take one for the other.

Love = Appetite = Good Health

Lust = Cravings = Poison

Love involves, among a lot of other things, a healthy desire for sex in a fulfilling and satisfying relationship.  Yielding to love results in immediate improvement ofhealth.  Then, sex becomes healing.  In it is in fact the most potent and efficient health enhancer in the world.  Cultivating our potential for love involves the ability to satisfy ourselves as well as others, and radiates the healing energy developed within us toward others. 

Appetite means good health.  It means our body lets us known what it needs, in what proportions, and when.  Appetite changes according to seasons, weather, geographical location, mood, physical and mental activity, food availability, and even gender, blood type, body type, and ethnicity.  It is the result of an extremely sensitive and sophisticated inner network of communication that can be refined.  It tells us what kind of food we need to nourish ourselves, and when we get it, we feel satisfied.  Yielding to our appetite is the gateway to love.  How we eat generally is a reflection of our sexuality. 

Lust is sexual craving.  It is born out of the inability to satisfy our sexuality.  We try over and over again, often with different partners, with the sad result that every unsuccessful attempt builds a potential of failure that inevitably will end up in depression.  A lack of knowing better in matters of sexual satisfaction and an overload of pent-up energy, are usually the different factors that lead to lust.  Yielding to sexual cravings leads rapidly to a huge loss of vital energy and is destructive to oneself and others.

A craving is a sure sign of imbalance in our health and points precisely to our poison.  When our health is out of balance, our whole life has a tendency to lean in that imbalanced direction.  A craving points to what we shouldn't have, because if we have it, we can't stop desiring more of it.  We are never satisfied, and we are able to stop only when we get sick.  We never get satisfaction from yielding to cravings, and that is one way of distinguishing cravings from appetite. Cravings can, and often do, lead to intoxication and addiction.  As we saw in the chapter on detoxifying, addiction is the attempt of the body to prevent oneself from going through the suffering of detoxifying.

This does not necessarily mean that the objects of our cravings are all toxic for everyone and that everyone should stay clear of them.  What is poison for you can be the right food for someone else.  In any case, yielding to food cravings leads to metabolic imbalance due to not getting the energy we need.  In addition, a huge loss of energy experienced from the overload of work results in poor processing, overload, becoming toxic, and the flooding of stress hormones from our dissatisfaction.  Paradoxically, when we indulge in our cravings we might feel that we do it for compensation or reward, but yielding to cravings and eating too much is a form of self-abuse that sends the inner message that we don't deserve to live.  Yielding to cravings is also a gateway to lust and resulting ill-health.

Unfortunately, in our distressed industrialized world we easily lose faith in ourselves and look for approval through mass consumption.  I personally associate pornography, the over-exposure of sexually-explicit material designed to induce craving for sex, with over-exposure to food products designed to induce food cravings.  Both originate from greed and seeking short-term rewards, and both only provoke disgust in the healthy person.

-- Source: Healing from Within with Chi Nei Tsang, by Gilles Marin. 

Editor's note: If you can't help hearing the words, "The Power of Love," without thinking of ... Celine Dion... Andre Bocelli ... or Luther Vandross -- help is at hand.  Videos of each of them pitching their aural woo are on YouTube.  Enjoy :-)

Avoiding Intimacy: Passion is Frozen Out, Along with Every Other Good Emotion

In our on-again, off-again series on "healthy sexuality and the combat veteran," here are these words of wisdom from someone involved in a healing profession, who's been married to a combat veteran for more than 25 years now.  Together, they are the parent of one child.

The veterans' aversion to intimacy, she believes, can be traced to one thing, most of all:

"It's the wall," she says -- not meaning the "Vietnam wall," that's for sure; although they may have some inadvertent relationship (poor attempt at humor, I know."  Veterans, she says, "build this emotional wall: the body, mind and spirit join together to "protect" the person [the combat veteran].  Much like the immune system kicks in to fight off illness, the mind sets off a red alert to fight off and keep bad feelings from invading.  Unfortunately this also fights off good feelings. 

Passion is frozen out along with every other good emotion.  Joy, love, hope, excitement, all trapped out.  They can act as if they have all of them but they are unable to really feel any of them. 

 

Men will have one-night stands and visit hookers for the act of having sex, but they also do it because it is safe. There is no chance of emotional involvement.  In their minds, they know there isn't supposed to be one [the chance of getting emotionally involved].  But if they decide to have sex with someone they are supposed to be connected to, it's a letdown because they are not really attached to them. 

 

When you make love to someone you really care about, you feel the passion between you because all of the "human" is participating in it.  With PTSD, the wall stops the unity between the two people.  Physically they are there but the rest of them is not.  When they touch you, it's as if there is no psychic energy in their hands.  When they hold you, their muscles are there, but there is no heat from their embrace.  When they kiss, it's a kiss of a stranger.

 

A lot of this has to do with their age at the time they were wounded by trauma.  Most were under 20 at the time the rest of us were finding ourselves, developing the "unity" of the elements that make us who we are.  Practicing and forming of development of the "unity" comes with experience and if that is subjected to emotional disconnect, it is broken off.  Usually it does not mend.

 

When they are older and trauma hits, they have already developed the connections of the unity and they tend to not have as much of an issue, using the other parts of "them" to compensate for their lack of unity.  Even with age as a factor, there are still the missing elements trapped behind the wall."

In future posts, we will continue to explore this topic further.

Three Wars, Three Voices: PTSD and the Catharsis of Writing about What You've Seen

Two Marines and a soldier from different eras, separated by generations, write about what they've seen in different wars, and find their way to catharsis, through writing.  At just over 500 posts on this blog, over the last two years, we take this occasion to also take stock on what catharsis there can be through attempting to touch the darkness, and come away unscathed.

We've been reading the superb "Eyewitness to Combat" recollections of one young Marine Vietnam veteran, Pat, who spent 40 years trying to put together his story -- ostensibly to leave it to his family, but I believe, equally as much, in an attempt to explain what he endured to himself.  Pat was kind enough, and courageous enough, to send me his story -- and it was hard not to be affected deeply by the story that he told, about his wounds of war.

Another former Marine, Nathaniel Fick, is whose inspiration I followed to start this blog in the first place, when he came back from war -- in his case, Afghanistan and Iraq -- and kept on caring about the state of his Marines, setting a powerful example in that regard which still echoes today.  Fick is a great writer, and a great leader, and it's hard to settle on just one inspirational aspect of what he has to say.  But here's an excerpt from a little-known original essay he wrote for the bookstore, Powells, in Portland, Oregon, linked here, that talks about some of his motivation for writing the exceptional, award-winning, "One Bullet Away: The Making of a Marine Officer."  See how he talks about catharsis, the theme of this blog:

One Bullet Away started as a personal collection of stories. I wanted to write them down before they faded, and thought I'd slide the stack of papers into a desk drawer to show my kids someday. Gradually, though, I realized that something more than an archival instinct inspired me to wake up every morning and write. I began to see the book in terms of what it could mean for four concentric rings of people.

Perhaps self-indulgently, I put myself at the center, at least in the beginning. Writing was cathartic. There were days when I could barely see the computer screen through my tears. In time, I was able to look at the story more objectively, but I hope the emotional immediacy of those early days remains.

Next, I felt that my family and friends had to know about the things I'd done, how I'd changed. Otherwise, there would forever be a gulf between us. Many of the stories in the book don't lend themselves to dinner-table conversation, so writing became my way of telling the tale.

I was also thinking about the hundreds of thousands of soldiers and Marines who were in Afghanistan and Iraq with me, or will be there in the future. I hoped to write a book that any one of them could hand to a friend and say, "If you want to understand what it's like, read this."There are older combat stories I feel that way about, books like "With the Old Breed" and "The Naked and the Dead." You read them and feel that you've glimpsed something that transcends a particular time and place. Their human stories are identical to the human stories in Afghanistan and Iraq, and probably to the human stories at Thermopylae and Cannae, too.

The last and largest group on my mind was the huge body of American citizens who care about what's happening in the Middle East but are dissatisfied with the perspectives available to us. As a junior officer, I had just enough rank to see a bit of the big picture and to feel the weight of responsibility. But I was far enough down the food chain that One Bullet Away is still very much written from a grunt's point of view, where life is invariably hot and cold, dirty and dangerous. I think many of the tactical problems we faced ... continue to resonate at the strategic and political levels. In fact, I've already found the book to be a catalyst for discussion about topics like these. It's a jumping-off point, and people are eager to talk about what's happening ...[in the war].

Finally, a warrior from a third war, the Gulf War, Scott Lee.  Social work graduate student, familiar with PTSD from his own case, son, boyfriend, dad.  Scott has a lot on his plate these days, but he chronicles his struggles, victories and defeats with PTSD at this blog, linked here.  Scott is at that very difficult juncture in the road, when you wonder how much truth you should really tell, and at what cost (primarily, to your own psyche).  While you may long for release, each sentence takes its toll -- and ultimately needs to be paced out over time, balancing the desire for purging the horrors of war with the need to retain some semblance of wholeness for tomorrow.  Rob Honzell, like Nate Fick, a First Recon Marine, but from the Vietnam war, understands that intimately: writing his book over the course of two painful years could not be done without setbacks in his own struggle with PTSD.

Valiant warriors, all.  All with a story to tell.  All deserving of our various "attaboys": for their courage in battle, for their desire to help the next generation and their fellow warriors, and their bravery in facing down their own demons to tell the story only they could tell.  Is writing, on balance, an effective way to achieve catharsis? Only somewhat.  At the very least, it puts the past into some sort of perspective, to allow the combat veteran to approach tomorrow as a brand new day, where he may make another survivor's attempt to touch the darkness, and return to tell us what he saw.

Getting Stuck to Get Unstuck: Army Studies Acupuncture for PTSD

An article from March 6, 2008 talks about the "Army PTSD Study on Track to Present Findings This Year."

Findings from a study on the effectiveness of acupuncture as a treatment for PTSD among military personnel may be reported later this year, according to research officials at the US Army’s prestigious Walter Reed Medical Center in Washington, DC.

According to the government web site www.clinicaltrials.gov initial report on the study, untreated PTSD “leads to decreased force readiness and increased health care utilization. Yet, service members with the disorder may be resistant to traditional treatments or find them undesirable because of side-effects, stigma, and long-term commitment.

“Acupuncture, which has few known side effects, holds promise as an effective treatment option for PTSD. Acupuncture has been shown to improve well-being and has been successfully used to treat stress, anxiety and pain conditions.”

Col. Charles C. Engel , principal investigator of the project, reports that data collection and primary statistical analysis have been completed and secondary analysis is currently underway. He says that the project intends to report data at upcoming professional conferences. These include the Force Health Protection conference in Albuquerque and the International Society for Trauma Stress Studies (ISTSS) in Chicago.

According to the web site, the project was intended to enroll up to 75 subjects, all active duty personnel. Researchers were to gauge the subjects’ PTSD status and response to treatment with the PTSD Checklist during a 12-week, randomized, waitlist-controlled trial. Participants were to receive an eight-session course of acupuncture treatment, and were to be evaluated throughout the study by way of clinical assessments and an independent assessing acupuncturist.

According to the study staff, all subjects were to receive a standardized protocol, based on Chinese medicine principles, for “clearing and calming” during the first four treatment sessions. During the fifth through eighth sessions, individualized treatments were to be given according to Chinese medicine diagnosis. All acupuncture services were to be performed by licensed acupuncturists who were graduates of the TAI Sophia Institute located in nearby Laurel, Maryland.

Marjorie Shovlin, a licensed acupuncturist in Washington, DC, was one of the acupuncturists providing treatment during the 18-month study period. She gave a presentation on the study methods and goals at the 18th annual NADA conference in May of last year.

Reservists, Guard Personnel at Risk for Alcohol-Related Problems

Higher Risk of Alcohol-Related Problems for Reserve, National Guard Personnel

Younger service members and Reserve and National Guard combat personnel returning from the wars in Iraq and Afghanistan are at increased risk of new-onset heavy drinking, binge drinking, and other alcohol-related problems, according to a recent study in The Journal of the American Medical Association.

Isabel G. Jacobson, MPH, of the Naval Health Research Center in San Diego, and colleagues examined whether military deployment to the wars in Iraq and Afghanistan is associated with new-onset or changes in alcohol consumption, binge drinking behavior, and other alcohol-related problems. Data were derived from questionnaires completed by participants at the beginning of the and follow-up. After the researchers applied exclusion criteria, the analyses included 48,481 participants (active duty, n = 26,613; Reserve or National Guard, n = 21,868). Of these, 5,510 deployed with combat exposures, 5,661 deployed without combat exposures, and 37,310 did not deploy.

The researchers found that among Reserve or National Guard personnel who deployed with combat exposures the rate of new-onset heavy weekly drinking was 8.8%; the rate for new-onset binge drinking was 25.6%; and for new-onset alcohol-related problems, 7.1%. Among active-duty personnel, new-onset rates were 6.0%, 26.6%, and 4.8%, respectively. Among Reserve/Guard personnel, deployment with combat exposures was associated with increased odds of new onset of all three drinking outcomes compared with nondeployed personnel, with heavy weekly drinking (63%) and alcohol-related problems (63%) showing the strongest association.

Among active-duty personnel, those deployed with combat exposures were at increased odds (31%) of new-onset binge drinking at follow-up. Those born after 1980 were at 6.7 times increased odds of new-onset binge drinking and 4.7 times increased odds of new-onset alcohol-related problems. Those with PTSD and depression were at increased odds of new-onset and continued alcohol-related problems at follow-up.

“These results are the first to prospectively quantify changes in alcohol use in relation to recent combat deployments. Interventions should focus on at-risk groups, including Reserve/Guard personnel, younger individuals, and those with previous or existing mental health disorders,” the authors concluded.

— Source: American Medical Association 

Sleep and Selective Preservation of Emotional Memories

A study led by researchers at Beth Israel Deaconess Medical Center and Boston College offers new insights into the specific components of emotional memories, suggesting that sleep plays a key role in determining what we remember and what we forget.

Reported in Psychological Science, the findings show that a period of slumber helps the brain selectively preserve and enhance those aspects of a memory that are of greatest emotional resonance, while at the same time diminishing the memory’s neutral background details.

The authors tested 88 study participants who were shown scenes that depicted either neutral subjects on a neutral background (a car parked on a street in front of shops) or negatively arousing subjects on a neutral background (a badly crashed car parked on a similar street). The participants were then tested on their memories of both the central objects in the pictures and the backgrounds in the scenes. In this way, memory could be compared for the emotional aspects of a scene (the crashed car) versus the nonemotional aspects of the scene (the street on which the car had crashed.)

Subjects were divided into three groups. The first group underwent memory testing after 12 hours spent awake during the daytime; the second group was tested after 12 nighttime hours, including their normal period of nighttime sleep; and the third baseline group was tested 30 minutes after viewing the images, in either the morning or evening.

The results revealed that study subjects who stayed awake all day largely forgot the entire negative scene they had seen with their memories of both the central objects and the backgrounds decaying at similar rates. However, among the individuals who were tested after a period of sleep, memory recall for the central negative objects (i.e., the smashed car) was preserved in detail.

“After an evening of sleep, the subjects remembered the emotional items [smashed car] as accurately as the subjects whose memories had been tested only 30 minutes after looking at the scenes,” explains study author Elizabeth Kensinger, PhD, an assistant professor in the College of Arts and Sciences at Boston College. “By contrast, sleep did little to preserve memory for the backgrounds [i.e., street scenes] and so memory for those elements reached a comparably low level after a night of sleep as it did after a day spent awake.”

— Source: Beth Israel Deaconess Medical Center

Last Exit: The Ten Commonalities of Suicides

Also from Edwin S. Shneidman, known as the "father of suicidology," who by the way developed his own interest in the topic from work he did at the V.A. (read his story elswhere, for example in his obituaries, to confirm this) He also also developed the concept of the "psychological autopsy," where you could go back from the point of a person's suicide and attempt to reconstruct the reasons why the person got there/stressors that they found too much to bear. 

For educational purposes, here are what he considered the "top ten commonalities of suicide.":

1.  The common purpose of suicide is to seek a solution;

2.  The common goal of suicide is cessation of consciousness;

3.  The common stimulus of suicide is unbearable psychological pain;

4.  The common stressor in suicide is frustrated psychological needs;

5.  The common emotion in suicide is hopelessness;

6.  The common cognitive state in suicide is ambivalence;

7.  The common perceptual state in suicide is constriction;

8.  The common action in suicide is escape;

9.  The common interpersonal act in suicide is communication of intention;

10.  The common pattern in suicide is consistency of lifelong styles.

-- Source:  The Suicidal Mind, by Edwin S. Shneidman.

Suddenly Others Just Not in the Picture: The Narrowed, Black and White Focus of Suicide

In a far cry from the last post about how a relationship of two can sometimes "save" a person, here's a look at suicide which ultimately narrows the focus down to "just one": the suicidal person. (In this case, a veteran. Veterans kill themselves at a rate between two and four times that of the civilian population, according to a CBS News investigative report from 2007, linked here.)

With suicide, as experts note, it's not that friends and family members have ceased to exist, it's just that they are no longer in view to the person struggling with suicide.

"Once a man decides to take his own life he enters a shut-off, impregnable but wholly convincing world where every detail fits and every incident reinforces his decision.  Each of these deaths has its own inner logical and unrepeatable despair." -- A. Alvarez, The Savage God.

From The Suicidal Mind, by Edwin S. Shneidman:

"The single most dangerous word in all of suicidology is the four-letter word, 'only.'" (Because suicidal thinkers have narrowed life down to "only" one way of looking at things, and only one option for coping, through exit.)

"The image of the diaphragm of a camera closing down on its tightest focus.  In suicide, the diaphragm of the mind narrows and focuses on the single goal of escape to the exclusion of all else -- parents, spouse, children.  Those other persons in the life are not forgotten; they are simply not within the narrow focus of the suicidal lens.  Suddenly they are just not in the picture."

About what Shneidman calls "the closed world of suicide":

"One of the first tasks of any aspiring helper or therapist with a highly suicidal person is to address the constriction, to "widen the blinders," to let some light in so that the person can now see new angles.  And, as we will see, the therapist must gently disagree with the death-laden premises of the suicidal person.  The suicidal person's thinking pattern has constricted: often it is dichotomous with only two possibilities: yes or no, life as I want it or death, my way or nothing, greatness or annihilation -- the desperation of seeing only two alternatives, and not three or more choices  as we do in ordinary life.  In the camera of the mind, the suicidal film is limited to stark black and white."

For veterans: The National Veterans Foundation provides a hotline for veterans, which is open 7 days a week, from 9 am to 9 pm PST, and specializes in talking to vets about serious problems in their lives, of all kinds (1-888-777-4443). A friend who made use of the hotline this week said it was a very positive experience, where he was able to talk "brother to brother" to the combat veteran on the other end of the phone.

For more on our series on suicide and the combat veteran, click here.