Healing Combat Trauma

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

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

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

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

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

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

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

...

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

...

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

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

...

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

...

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

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

From the book jacket:

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

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

Cast Adrift by Trauma in the Center of Your Own Universe...

I've been reading Belleruth Naparstek's book, "Invisible Heroes: Survivors of Trauma and How They Heal," and she makes an excellent point both about the safety and normalcy we unconsciously come to expect from life, and then the terrible way in which we find ourselves suddenly cut adrift from those same moorings through tragedy and trauma.

After first describing how the human toddler first takes sheer delight in realizing they are the center of their world and can "make things happen" -- by knocking over piles of blocks in play, again and again, or shouting and laughing at the sound of his or her own voice -- she the contrasts this with the sheer helplessness people feel because of a trauma-causing incident. Sagely, she describes the point:

"And because it is built into our human hard-wiring to love ourselves for being able to make things happen, the converse is also true: we lose self-regard when bad things happen that are beyond our control.  The essential insult of trauma is the helplessness it generates, and the inadequacy and powerlessness we feel in its grip.

Rational or not, we can't help but feel it's a reflection on our worthiness that, when confronted with a terrifying and terrible event, we didn't prevent it, escape it, or fix it.  So we somehow lose value to ourselves and, at a level we may not even be aware of, we feel guilty and ashamed."

This is a powerful and accurate description of what so many people go through after trauma. Good for Naparstek for bringing it to light.

"Let's Give 'Em Something (Not) to Talk About..."

We mentioned in a post yesterday about reading in the introduction to Belleruth Naparstek's book, "Invisible Heroes: Survivors of Trauma and How They Heal," how talking about trauma may actually re-trigger the traumatic memories of PTSD survivors. (That post is linked here.) Further on in the book, she goes into a little more detail:

"Trauma produces changes in the brain that impede a person's ability to think and talk about the event but that actually accentuate their capacity for imaging and emotional-sensory experiencing around it. Imagery [then] uses what's most accessible in the traumatized brain to help with the healing."

And further:

"...Too few survivors know this and, sadly, too few professionals as well.  So people are not only baffled and alarmed by their symptoms; they are more often than not seeking -- and getting -- the wrong kind of help from people accustomed to using discussion, thinking, and language -- help that often misfires."

(Help of a particularly left-brain-oriented rather than right-brain-oriented kind.)  She continues:

"It's not that talk therapy is bad.  The emotional support of a sympathetic listener is as critically important as it ever was.  It's just that it's not enough by itself.  If a person has been deeply impacted by trauma, it's more than likely that he first needs to find an oblique route through the imaginal realm, using metaphor and symbolic language, to help him manage his symptoms, find a sense of safety, recontact his wholest self, and make language a viable avenue again. Once the imagery has established a beachhead of safety within the survivor, then the tools of language and cognition can be enlisted to help with healing.  But without the imagery first, the thinking and talking can run aground and catalyze even more severe symptoms, such as flashbacks and nightmares."

Now Naparstek is well-known for her work with imagery (CDs and DVDs she's produced, examples of which are here and here, etc.), and in the course of the rest of the book, I'm sure she'll bolster her case quite effectively. But what she's saying, even to the untrained ear, is this: there's often another, more indirect (aka, oblique) "way in" with trauma -- where touching on the trauma directly would be just too...traumatizing.

That reminds me of two different experiences.

One with a combat veteran, at the point of suicide, who wanted to discuss his experiences. He had me promise that if we started to discuss what he'd been through, that I wouldn't let him down. I promised, but what happened in the months that followed is that we never actually discussed those experiences in depth, in so many words.  We talked in and around them, and kept circling back to them.  But we never just camped out and stayed there, in a painful way for either one of us.  There was movement: surging forward, but also retreating. And no constant painful pressure to "uncover" all that he'd been through. What impressed me was that even so, he began to do signficantly better. Was it someone really listening to him? Or was it his being able to talk about the parts that mattered to him?  I don't really know.  All I know is that it wasn't constant painful pressure on the sore spots. It moved around, and kept on moving. And yet it helped.

Another is an experience, more recent, with a type of bodywork. An Asian bodywork that we've talked about on the blog here in the past.  I got to experience it for the first time, in the "hands" of a veteran healer, whose training was extensive. It felt a little bit like wrestling.  We were in constant contact. He pushed, pulled; I pushed against; yielded; we kept going.  I noticed that he would push just to the point where it was getting really uncomfortable physically for me; then he would pull back; circle around; do something else; in essence, divert or distract me; then come back to the same spot, where suddenly he was able to go deeper, encounter less resistance, create more change.  Obviously it's hard to articulate about a kinesthetic experience precisely with language, but I was struck by the analogy to conversation about difficult topics with a loved one.  How the give-and-take with pressure on a sore spot could only be there for so long; before the same cycle of retreat; divert; distract; come back and find the spot would yield to greater depth; etc.

Bodywork and therapeutic conversations: maybe both prefer the circuitous, rather than the head-on way in. Trust is crucial, but also the sense that the glaring spotlight of pressure isn't there to crumple underneath. Sideways makes better headway, sometimes.   

More Vietnam Veteran Suicides Than Combat Deaths -- Poem

Miles of Bones

"58,000 suicides
is a lot of bullets

wrecked car's
ruined veins

dead bottles
kids without fathers

American flags

& miles of dirt dug

58,000
the number of Vietnam

veteran suicides...
it equals the names

on the Wall
today: 7/09/91 8:10 p.m.

tomorrow
we'll exceed it

more suicide
than combat death

If you can't feel
this pain

you're already
dead

all these
bodies

floating
home."

-- by Bill Shields.  Anthologized in "From Both Sides Now: The Poetry of the Vietnam War and Its Aftermath," Edited by Philip Mahony.

Editor's note: Sadly, of course, since the time this poem was written, many more Vietnam veterans and other combat veterans have taken their own lives.

No Easy Answers: Guide for Survivors after a Loved One Commits Suicide

The Mayo Clinic has produced a short, readable, highly useful guide, available online, to how to handle a particularly painful topic: "Survivors of Suicide: After a Loved One's Suicide," which is linked here. As they write, "Bereavement after a loved one has taken his or her own life is often more complicated, intense and prolonged than it is with a death from natural causes. Although as a survivor of suicide you may never fully recover and always feel a loss, you can learn how to cope better and eventually move forward in a way that's healthy." The short, succinct guide encourages the reader to: "brace for powerful emotions after a suicide;" expect certain "physical reactions after a suicide;" as well as "emotions in the weeks after a suicide;" ways to "find support and treatment;" and "healthy coping strategies" after a suicide, finishing up with "the future after your loved one's suicide." Worthwhile guide to bookmark. 

Barrenness of Survival

"I'd sooner be a fallen pine cone this winter
In a cradle of cold New England rock,
Less hurt in it than nineteen years.
What an exit! Stage left, fronds waving,
Cut down running my ass off at a tree line.
I'm thinking, as I hear my chest
Sucking air through its brand new nipple,
I bought the ticket, I hope I drown fast,
The pain is all in living."

-- Excerpt from "Morning -- A Death," by Basil T. Paquet. Anthologized in "Carrying the Darkness: American Indochina -- The Poetry of the Vietnam War," edited by W.D. Ehrhart.

In the Meantime: Between Combat and Death

"Listen:

Death is a goddamned disgrace.

It has no respect

for beauty or for wit

or for a lifetime

of survivor’s experience –

so why should I show

any respect for it?

          Death will catch me

          in due time,

          but until then

          the time is mine."

-- from "The Peace Monument," by Jan Barry. Anthologized in "From Both Sides Now: The Poetry of the Vietnam War and Its Aftermath," Edited by Philip Mahony.

Wry Reminscence of Combat Vet on His Peer Group

Peer Group

"me & the boys got the highest rate

of alcoholism & drug abuse & divorce

& mental illness & suicide

than any other group

in America.

It’s good to see us win

for a change."

-- by Bill Shields. Anthologized in "From Both Sides Now: The Poetry of the Vietnam War and Its Aftermath," Edited by Philip Mahony.

Trust and Mistrust -- One Combat Veteran (and Poet's) Point of View

"On all sides of the issues
on both sides of the ocean,
veterans mistrust anyone in a position to lie;
Wives, girlfriends, government officials,
salesmen, lawyers, and the rich.

Veterans trust dogs,
children under twelve,
masturbation,
the chair facing the door
and any weapon in the dark."

-- From "In Victory or Defeat," a poem by Steve Mason, Vietnam combat veteran, former Army captain, former "poet laureate" of the Vietnam Veterans of America. Mason passed away in May of 2005. (His obituary from the L.A. Times is linked here.)

Triggered by Talking about Trauma

It seems a bit paradoxical that the very act of attempting to talk about trauma might actually trigger trauma, and turn out to be "too much" for the traumatized person to handle, but this can be the case, according to Belleruth Naparstek, in her well-regarded book, "Invisible Heroes: Survivors of Trauma and How They Heal." She writes:

"This is because with PTSD, language can be a trap. If a deeply traumatized person is prompted only to speak and think about the events that created his distress, without enlisting help from the imaginative, emotional, sensory and somatic capabilities of his right brain, his symptoms can actually get worse instead of better.  Encouragement to "talk about it" -- a therapist's and, for that matter, a good friend's stock-in-trade -- can catalyze a tailspin of flashbacks, nightmares and overwhelming anxiety."

Clearly, we're just scratching the surface here of a much larger topic.  But while the case can be made that listening to another deeply is often quite therapeutic, having to talk about (relive) something traumatizing might have adverse effects.