Healing Combat Trauma

Quotable Quotes -- Neale Donald Walsch on Integrating the Dark and the Light

"I realized then that all of these aspects of my being were qualities for which I had been praised at one time or another. No wonder I was confused! It was only then, when I looked at my "shadow side," and I saw clearly why others sometimes called these my "negative" behaviors, that I also saw the gift in each of them. All I had to do was use those behaviors differently. Not repress them. Not disown them. Simply use them differently.

I have come to understand the extraordinary importance of leading an integral life. That is, of allowing myself to first notice, then to blend, all the aspects of who I am -- those that I and others have called "positive" and those that I and others have called "negative" -- into a grander Whole.

Through this process I have made friends with myself at last. But, oh, how long it took to get there! And how much shorter the process (could) have been..." -- Neale Donald Walsch, author of "Conversations with God," in his introduction to "The Dark Side of the Light Chasers," by Debbie Ford.

Quotable Quotes -- Carl Jung on Integration

"Would you rather be whole or good?" -- Carl Jung, Swiss psychotherapist and author.

Quotable Quotes -- Artie Egendorf on Bearing Witness to the Past

"When people say time heals, they usually mean the passage of time, the rush of many things that happen. If enough new events crowd into our lives and capture our attention, we have no time to think of old pains, which thereby subside into a background gnawing. This is how we use time to dull pain, but it's not the same thing as healing.

Healing occurs as we express ourselves genuinely. In expressing how it was and is, we make ourselves the witness -- one who sees rather than one who has merely been tossed about by passing events. In reaching out to grasp a troublesome past, we cease to be at its mercy, and the more we reach to make ourselves a witness to the past, the less we are its victim." 

-- Arthur Egendorf, Ph.D., "Healing from the War: Trauma and Transformation after Vietnam." (Egendorf is a Vietnam veteran, Army.)

Serving the Dragon: The Power of Ritual in Men's Healing after Grief and Trauma

Yesterday we introduced African tribal elder, Malidoma Somé, and a brief excerpt about using ritual for healing in the West. In today's excerpt, we have an excellent, longer interview done with Some, which goes into much greater detail about the richness and purpose of ritual. Big thanks to journalist,  poet and playwright Reid Baer who graciously gave us permission to use his interview in full. (A veteran and advocate well-acquainted with Some's work calls this the best interview he's seen, to date.)

It's fascinating to hear him discuss how simple and powerful ritual can be in helping selves and others to heal after grief and loss. Enjoy...

An interview with Malidoma Somé

In the Dagara tribe of West Africa, the name Malidoma means “He who makes friends with the stranger/enemy.” One wonders if the parents of Malidoma Patrice Some sensed that the name they gave their son would portend so much of his life.

Rising out of his spiritually rich, yet materially impoverished village in Dano, Burkina Faso, West Africa, Malidoma has become a world wide friend, teacher, public speaker, and author of three books: Of Water and The Spirit (his autobiography), The Healing Wisdom of Africa, and Ritual: Power Healing and Community. With the permission of the Dagara tribal elders, Malidoma is now sharing the indigenous wisdom of Africa with the West. This amazing man from humble origin has earned three masters degrees and two doctoral degrees – the first from the Sorbonne (in Paris) and the second from Brandeis University. In a remarkable way, Malidoma bridges cultures like no one else I know.

As Malidoma speaks, his voice carries the excitement, passion, and palpable spiritual quality that befit a gifted medicine man. Only the most accomplished Diviners, Gate Keepers, Shamans, and spiritual leaders are invited into a special “Elder” initiation in the Dagara tribe. Due to Malidoma's accomplishments and importance to his community, he became, at the age of 42, the youngest ever to become an Elder; not to mention the first with a full Western education. He possesses a unique understanding of how psychological disciplines and spiritual rituals can be utilized together in assisting individual personal growth.

“Ritual is the most functional means by which archetypal energies are dealt dealt with,” Malidoma began. “Indigenous people have been aware of that for eons. In the modern era, we focus too much on psychological counseling, he noted. There is a tendency for people to ‘linger endlessly’ in therapy for without receiving significant help. The “shadow” parts of our lives “keep coming back.” Malidoma believes that dealing with “the things we cannot escape” is best accomplished within the sacred space of ritual.

“Ritual facilitates and provides us with a unique channel to access higher power,” he said. “Certain issues don’t want to be resolved mechanistically. We don’t have to know how the power works; we just have to show up and let the higher forces deal with the issues. The trap we feel inside ourselves is removed once we enter into sacred space. The energies know how to push obstacles out.”

Malidoma said we tend to “project a godly power” onto human beings with a resulting dependency on others. It is in the nature of humans to project, he added. The question is, where do we direct the projections?

“Humans can not become god,” he intoned. “So we have to step away from that for a moment and remember the only place where we are authorized to project is in sacred space. If it is divine, then we are healed; if we project onto humans, we are deeply pushed into turmoil.”

Malidoma suggested that men should learn to trust their own ability to create sacred space, where they can be “vulnerable in a sacred fashion and allow themselves to be dismantled so that the rebuilding can produce a lasting result. The sacred space to initiate men is not necessarily a physical place, but an energetic place.

“It’s very hard to do this as an individual thing,” he said. “This kind of healing requires community -- men with men. The healing begins with the destabilization of a man’s energy. When he starts to feel unstable, it is best put in that place where other men or humans are. And eventually he will let go.”

Men usually fool themselves into “serving the big dragon,” Malidoma stated. However, with the help of other men observing from the outside, an initiate will begin to see his own dragon. The collapse of the traditional internal structure can then begin, and the “great opportunity of rebuilding the self occurs.”

“That idea is a hard-sell in this culture because men like to stay in control,” he continued. “Men have no room for a place of risk. In the business of healing, more often than not, we paint over the problems. This danger place that we are obligated to move into is a sacred danger because it endangers the very problems we deal with; and when it endangers them, we feel it endangers us too.”

Modern men identify too closely with their problems, he added, “and we become the problems, not the solutions.”

Malidoma said he believes men use the need for “safety as a condition of healing” as an excuse not to deal with the problem.

“We must endanger the problem by confronting it,” Malidoma instructed. “It is to be dug out of its hiding and exposed to the air. It cannot breathe oxygen. The light of day is lethal to it. That’s why the dragon tells us that we should be safe, because the dragon wants to be safe. We end up actually serving the very thing we want to be rid of.

The creative process is essential in coping with dragons, the Elder noted. “In talking about expression, we have to visualize it as more than speaking English,” he said. “Creativity includes non-verbal expression and the ability to use the entire body as a means of discourse.”

Malidoma said the dragon wants us to be introverted.

“Expression rips open the hidden cages and blind boxes, thereby releasing all the information hiding in there unbeknownst us to us and others,” he said. “To speak constantly into sacred space is to give oneself the opportunity of transcending … taking our lethal pain and diluting it into the ether.”

Malidoma experienced pain early in life when he was abducted from his tribe by Catholic priests and forced into a foreign Western culture. After a number of years, he escaped and returned home, where he was initiated into his indigenous community.

“Ritual or initiation provides a safe place for the soul and body to affirm life over death,” he declared, “to affirm continuity over discontinuity.”

The author said he has found “hope and dignity” through the daily practice of his tribe’s ancient rituals. He prays at the shrine of his ancestors, offering them water or libation, and asking the spirit of nature to walk with him throughout the day.

“After 30 some odd years, everywhere I am, I don’t feel alone,” he said. “I feel like a patrol of powerful spirits surround me. They give me a certain sense of reassurance and pride, so I can walk in the middle of adversity really knowing that in order for the adversity to get to me it will have to get through all these forces. It’s quite reassuring.”

Men don’t need a “sophisticated construction” to participate in ritual. Malidoma recommends we “look up at a tree” or “go to a creek and see the flow of water.”

“There may be some powerful genie dwelling in the water,” he said. “Talk to him like we talk to each other.”

The response may not be the loudest one we hear, but if we’re willing to listen carefully, we can hear the “big noise or echo” of nature tell us that “we’re right and to go on and walk proudly.”

In Malidoma’s village, the men are the spiritual leaders.

“Why? Because this is the kind of power, this is the responsibility every male is born with, and when assumed properly, it becomes authentic,” he said. “Women and children find themselves reassured by the men’s true power. It is when we pretend to assume the power that in fact we are derogatory and chaos is created. True male power is very healing for everybody. And so, if a man is not a self-centered control freak, he is one that will be serving, protecting, and holding the sacred space …. holding the space for everything and everybody to live.”

So, what keeps Western modern man from being the spiritual leaders in their own homes? “Men get caught up in the socio-economic nightmare of giving away most of their time in order to survive,” he answered. “We didn’t come into this world to give all our energy to stay alive, we came here to live. The biggest dragon is the one that tells us we have to work eight hours a day … and we end up being so tired that the very thing our soul is yearning for we don’t have time for. We have to tell each other to take time, and we need to hold hands with each other. Men have to be willing to come together to express what they feel to each other as the first step toward moving into that sacred space so they can heal enough to assume true responsibility in their own household. If we find a little moment to get together to pound on this problem, then we can go back to our respective homes and our partners and children … and they can see us shining in our true glory.”

“Community” is a strong recurring theme in much of Malidoma’s work. He defines it as a “bunch of people willing to come together in a circle in which they are conscious enough to invoke the sacred, the divine … to be with each other so they can express their authentic self to one another.”

“If men are willing to come together and be with each other, knowing they need supervision of the divine in order that their being together is not limited to talking about current events and drinking beer, then they have become a community.”

The community is strengthened by “invoking the sacred,” he added, but not by making themselves exclusive.

“Once we start attacking and excluding other communities then we have become a club,” Malidoma explained, “and then we have taken the ideas of society into our club, and the dragon prospers in us as a community.”

People sitting around and talking about the faults of other people are not a true community.

Malidoma expresses his own sense of community and his personal spiritual creative process this way: “I draw from bone energy and the memories that come from the bone. I allow myself to surrender to the higher forces with the clear intention that I want to be as clear and precise as possible. What comes out is something almost independent of me. There’s something quite militant in it, because when I express myself, and not after heavy duty preparation, I know that spirit is speaking through me. When I feel that intensity coming out, when I feel it, I know someone else will feel it. Every time I have attached my own emotion or capacity, I have to stand back and get out of my way so higher forces can speak. That has been transforming. I like to call that spirit. Spirit expresses itself in a way we cannot map, cannot tell ahead of time, and has its own plan – a plan not known to us. To know it, we have to surrender to it. It’s a risky thing. And risk-taking in the business of feeling, is worth doing. Check out www.malidoma.com.

© 2005 Reid Baer. Used with permission.

It Takes a Village: Ritual, Power, Healing and Community

Ritual is another way that human collectives (tribes, societies, etc.) attempt to purge grief communally after trauma. While military tradition may be strong on tradition and ceremony, it's noticeably light on ritual. Ritual is more primitive, primeval, visceral. But it's also got a long, long background, anthropologically speaking, in helping human beings all over the world cope with the benchmarks of life on earth: birth, death, and everything significant in between. 

Recently we took a look at storytelling among Native American warriors as a way to address trauma after war communally. Here we hear African tribal elder Malidoma Somé, Ph.D., bridge the gap between first world and third world as he describes a ceremonial "cleansing" ritual in which various men participated. We'll go into more detail on this topic later, and hear about and from those experienced with the popular men's movement in the 80s and 90s, who followed examples such as the one Somé describes -- but in the meantime, let's use this excerpt from one of Somé's books to orient ourselves to some of the benefits of ritual after grief, such as that which warriors -- servicemembers and veterans -- experience:

"The cleansing was happening. So much grief surfaced that ... it was a success. I saw hot tears flowing from wet eyes. That felt good. I heard sincere groans and yells and screams that almost made me feel like I was home again (in an African village). The ritual was working.

Even though it was just scratching the surface, the scratch was at least opening something. In a way, there was an invitation to unleash grief. The experience left people empty, light, and -- above all -- miraculously prone to celebrate. I understood why, in the village, life rotates around grief and celebration. People celebrate because they have paid their dues to the dead. The other side of real grief is real joy. Unfinished grief translates into petty joy and silly amusement. The experience taught me a great deal. Without ritual, humans live in nostalgia.

When there is an opportunity for people to mourn their losses, the horizon for rites that heal will be pure and bright, and healing will come pouring into the souls in a great moment of reunion."

-- Malidoma Patrice Somé, from "Ritual: Power, Healing and Community: The African Teachings of the Dagara." 

Stop Just Talking about Suicide Awareness and Prevention...Find and Fund Programs That Work!

The numbers continue to get more shocking. First more suicides than combat deaths; then suicides on the rise in each branch that sees heavy combat (Marines, Army and the National Guard), despite millions spent/wasted in suicide prevention campaigns; now, finally, a figure to wrap our collection brains around: one military or veteran suicide every 36 hours. Ouch.

They cite the usual suspects for the shockingly high numbers -- operational tempo, not enough dwell time between deployments, etc., etc., etc. And in the same news cycle comes the idea that really what we need is a "Suicide Prevention Office." Really. Good place to stack all the posters, videos, CDs, DVDs, promotional materials, etc., about NOT killing yourself. In addition to all the pep=talks. Sure...suicide awareness and prevention programs help...some...but clearly, not nearly ENOUGH, or the statistics wouldn't continue to climb despite the best efforts thrown at it. And every suicide devastates the family who's left behind. Read just one tragic story to get a sense of that, linked here.

Let's take a different look at the same problem. Let's stop telling people under stress, hey, don't KILL yourself! It's a bad idea! (Don't you think they know that? But when the pressure gets too great, all the wonderful advice in the world goes out the window...however true it might be). Let's instead start looking at...veterans and servicemembers who struggled at one time, recently, WITH wanting to kill themselves, but who broke free of the grip. How did they do it? To what do they attribute their success? And let's replicate THAT, if it's reproducible. 

There's a whole concept called body psychology, where trauma is stored in the body, not "just" in the mind. The theory is "controversial," which means it has its adherents and its detractors (many things do). But if the theory is correct, it opens up ways for removing trauma from the body, other than the "gold standard" (aka, only thing practiced) of talk therapy and psychopharmaceuticals. Even VA admits that what they offer doesn't work for everyone; and that's of those who sign up to be treated, which isn't remotely all who need the help. And it doesn't even count those who are still serving. Trauma takes its toll. Let's be increasingly more open-minded about how to remove it from the body AND the mind. 

Clearly, the status quo isn't working. If it were, the numbers of servicemembers and veterans who kill themselves wouldn't continue to climb. All the awareness and prevention in the world doesn't help clear trauma from the body. Let's start exploring the ways that actually do. Talk therapy and drug therapy already have their place. Let's enlarge the conversation to include other modalities. We don't have much to lose; lives are already being lost, and the status quo clearly isn't working. A few more pep talks, a few more videos, an office of suicide prevention: NO. Let's find and fund things that WORK. Start here.

Self-Image in Veterans with PTSD after Combat: Same as Before, or Different?

We wrote an article on this site more than a year ago that was read very heavily, entitled "A Combat Veteran Asks Himself, Who Am I, on the Inside?" linked here. His response at the time to the question, "What's your greatest problem right now?" was very direct, raw and hard to hear: "I'm an exploding ball of hate," he said.

As tough as that "conversation" was to absorb, it might be time for a rematch, but on a slightly different topic. How does -- or does it actually -- a combat veteran with PTSD's self-image change, after combat, from what it was before combat? (Or before and after PTSD. Really, either question would produce interesting results.) 

It does seem that even in the literature, very little attention is paid to how servicemembers and veterans view themselves after combat. What was their self-image before -- and then did it change, or HOW did it change, after combat?

(By way of definition, "self-image" is different from "self-esteem." Self-image is basically how you look at yourself, pros and cons -- your sense of yourself and who you "are." It can be as simple as, I'm so tall and weigh such and such; I'm a good student or I'm good at sports; I'm social or I'm a loner, etc. Self-esteem has more to do with how highly you regard yourself (e.g., belief in yourself and/or self-confidence). It's also not the same as "self-worth," which is the value with which we regard ourselves. It's more purely "just"" how we see ourselves: bad, good or indifferent.)

Our self-image is who we see ourselves are -- how we would describe ourselves to others. "I'm fundamentally a good person." "I'm fun to be around." "I'm responsible." Ways we describe ourselves to differentiate ourselves from others. 

The illustration at left may help. It's a drawing a combat veteran with PTSD made based on an instruction to "draw himself as he saw himself, right now." Meaning, at this point in his life, not necessarily right after combat. He drew what amounts to a split personality, a "bad" and a "good" self, about equally weighted. He saw himself as both, at the same time. 

(Example from non-combat-related psychology, to further define what self-image is, by taking a look at what distorted self-image is: When an anorexic woman looks at herself in the mirror and "sees" herself as overweight, though she is underweight, we say that she has a "distorted" self-image. In other words, her correct self-image would be accurately that she is too thin. Instead, she projects onto the accurate image the distorted image she carries of herself, and she is able to see herself, wrongly, as not thin enough.)

I'm torn about including several quotes about war and the warrior, to get the discussion going...but I don't want to tip the scales one way or the other here. It's probably best to just think of the actual question: How did I view myself before combat/PTSD, and how do I view myself now, after combat/PTSD -- and have those two views of myself changed?

Quotable Quotes -- Suffering from What We Keep Silent within Us

"What is the source of our first suffering?" wrote philosopher Gaston Bachelard. "It lies in the fact that we hesitated to speak. It was born in the moment when we accumulated silent things within us."

(With thanks to Rob Breszny for highlighting a really cool quote.)

Quotable Quotes -- Half Full or Half Empty or Just...Right?

A wonderful quote from a longtime combat veteran from the other side of the pond, which expresses so well the "integration" we'd love to see for all veterans with PTSD. He writes:

"Sometimes my glass is half full... Sometimes my glass is half empty. I don't mind either view because when I sit back , have a think about stuff, I realize that my glass is really big. :-)"

Quotable Quotes: The Transition from Real Person to Soldier to Ghost

Every once in a while you run across a quote that just puts everything into perspective. Here's a combat vet, woman, with PTSD and MST, raped multiple times(!) in her deployment -- a form of hazing? A highly intelligent woman, coming to terms with what she's gone through, but it isn't easy, and it did involve unspeakable things. Here's how she describes it: 

"I remember so many things I want to forget. I remember once upon a time I was a real person. Then I was a soldier. Now I am a ghost."

Editor's note: For more on military sexual trauma, also known as MST, which affects equal numbers of men and women, despite their disproportionate numbers serving, click here. For more on PTSD, read the rest of this site :-)

Embracing the Warrior Spirit: Native Americans and Storytelling for Healing

Did you know that "large numbers of Native Americans enlist for military service and represent the highest per capita enlistment of any ethnic group in the United States?" It's true. 

According to the U.S. Department of Health and Human Service's Administration for Native Americans, "Tribes view service, sacrifice, and courage as important values and part of an individual’s journey to becoming a leader, protector, and agent of change for his/her family or tribe."

I'd heard through the grapevine that a national museum devoted to Native American culture had a special exhibit about warrior veterans telling their stories. The Smithsonian exhibit, "Native Words, Native Warriors," is still on tour, through 2011. (In January through July of 2011, it will be at the National Museum of the Marine Corps.) Find out more about the exhibit, here.

In the meantime, I've uncovered some good resources about Native American warriors as veterans, and the extent to which their culture celebrates them and welcomes them home.

From the National Museum of the American Indian (part of the Smithsonian), a "workbook" online called "Coming Home: Strength through Culture."

From a segment entitled, "Healing after the War": 

"According to American Indian traditional beliefs, war affects a soldier’s well being, and makes it difficult for him to live in the everyday world. For American Indians, returning home means returning to a place — a land, a community, a family, and a culture — that you are part of, a place that you have a special relationship with. Participating in war interferes with your ability to be part of this place. It upsets the balance of life. This is why American Indian cultures have special ceremonies to help bring the soldier’s life back into balance — to make it possible for the soldier to once again live in peace and to be physically, spiritually, emotionally, and mentally healthy."

From a segment entitled, "Giving Honor to Veterans":

"American Indian communities remember their veterans’ sacrifices forever. Veterans are always respected and honored. Sometimes they are remembered in special songs that are sung in their honor. Native people often go to veterans for advice because they have strong mental abilities as a result of their many experiences. Depending on the community, veterans are given special prominence at different kinds of tribal events. For example, at powwows veterans always lead the grand entry of dancers. They carry the American Indian Eagle Staff, the flag of the United States, their tribal flag, and other important banners. Veterans are recognized and honored on special occasions with ceremonies and dances that relate their sacrifices to the community. For example, the Comanche Gourd Dance honors veterans. Sometimes a family member or a friend might hold a special dance or ceremony to honor a veteran. These are the lasting traditions that show respect to veterans for what they have done for the people."

In another section it describes how a Native American Marine Corps veteran of World War II, Navajo Code Talker Carl Gorman, experienced a ceremony upon returning home that helped allow him to put the past behind him and move on with his life:

"After the war, Carl Gorman returned home to Arizona for a short time. Even though he had been raised as a Christian, he talked about how the traditional Navajo ceremonies for warriors became important to him: "I didn't have a ceremony when I came home," he said. "I didn't quite believe in it anymore. A medicine man that was an old friend suggested that I have one, but I didn't have the money to pay him to perform it. He agreed to do a one-night sing over me for free. I participated in the sing and felt a great weight leave my mind and body. I felt very rested afterwards. I realized then that I needed to make peace with what I had experienced during the war." (Navajo Weapon by Sally McClain, 2001)

And from the U.S. Department of Health and Human Service's Administration for Native Americans, an entire resource guide online about storytelling for Native American veterans. Segments include:  

• The healing power of stories;
• Tips on using storytelling for healing (with facilitation questions);
• Native American service in the U.S. military;
• Resources for Native veterans; and a
• Native American Veterans: Storytelling for Healing DVD that can be ordered, here.

We'll be developing this segment more in the weeks and months ahead, but for now this should provide some useful resources to start thinking about Native Americans and ceremony -- particularly storytelling -- for healing in community.

Editor's note: The painting at top is "First Furlough," by Native American artist Quincy Tahoma.

Veterans Remember, Survivors Relive: Ken Jones on Vietnam, PTSD and Beyond

Ken Jones, @AKVet on Twitter, is a Vietnam veteran, Ph.D. psychologist, and trail runner, with much to say to our current generation of veterans, starting with "been there, done that" -- and come to terms with it. He's a joy to "follow" on Twitter, but recently he took the time to really spell out what a few of his combat experiences, and coming to terms with their resulting PTSD, had been like. (He's also the author of two free, downloadable e-books on combat and PTSD, which are mentioned in the piece, with hyperlinks that take you to them.)

Another Twitter fan, @BillNigh, took the time to collate some of Ken's recent stream-of-consciousness utterances about being a Vietnam veteran and his own experiences with PTSD into something we can all learn from. Thanks, Bill, and thanks, Ken. Here is Bill's condensing of what Ken wrote on the Web in early August:

"Ken Jones has several chapters in his life that relate to his military tour of service. He suffered battle wounds and PTSD. Now, from a healthy place, and a giving heart, he wants to help fellow, contemporary, vets return Stateside. He offers two free ebooks to anyone interested in the combat experience and in PTSD, "Life After Combat" and "When Our Troops Come Home". Listed below is a stream of consciousness set of posts that he did recently on Twitter on Friday August 6, 2010."

Herewith Ken's reflections:

"We have a "Support Our Troops" effort going on today to get the word out on the two free e-books I wrote about combat induced PTSD. I thought I'd give you a bit of background about how these books came to be.

I was a grunt with the 11 Cavalry in VN in 67-68. We operated in the Iron Triangle, Central I Corps, the Cambodian border, helped retake Bien Hoa in 68 Tet then the Triangle again. We worked with the 173rd, 25th Inf, 101st, 3rd Marines, Korean Marines, 196th Lt Inf, then with the 101st again during Tet. 

In "When Our Troops Come Home" there's a description of the first time I got blown up. This photo was taken after I had been dusted off to the Second Surgical Hospital. The people I talked with later said it looked like a booby-trapped 500 lb. bomb we detonated. What saved us was that most of the force of the blast exited out the side of the embankment we had just come over. 

During Tet 68 our mission was to retake Bien Hoa. We went in with the 101st and retook it. The last time I got blown up was 8 days before I was due to leave country. We got into a fight on our way out of the Triangle. I was a track commander on 32. We took a direct hit by an RPG through the front of the track. The blast blinded my driver and loaded me up with shrapnel. My driver was incredible. He was seriously wounded but did exactly what I told him on the intercom. Like we were in the motor pool.

I got my wounded off, picked up another driver and gunner and we went back in. Turned out to be a long day and night. "The Army sent my body back to Oakland in 1968. It took me years to understand that I died in Viet Nam." I turned 20 in Jan 68. on the Cambodian border. I came back to the world in March. I was 100 years old. 

I learned very quickly never to talk with a civilian about what I had seen, and heard, and smelled, and done in Viet Nam. There was no such thing as PTSD in 1968. There were just a bunch of crazy, whacked, dope-smokin' vets coming back. All the papers said so.

So I sucked it up. Got married. Eventually started a company at 23. Made it work. Looked "successful" to the community. I had an edge. I didn't sleep more than 3-4 hours. I filled my business life with frenetic activity so I didn't have time to "think." I remember driving alone from Salem to Portland on I-5 and screaming as loud as I could over and over to keep the memories away. 

I took up distance running thinking that if I ran far enough and fast enough that I wouldn't be able to think and maybe I could sleep. I was married to a wonderful woman who did everything in her power to try to understand what was happening. I wouldn't tell her anything. I'd wake up screaming in a cold sweat. All I ever said was it was a bad dream. Then I would get dressed for the office and leave for the day. It was usually about 0430. I'd drink coffee and have breakfast at an all-night restaurant. I read a lot: Ed Abbey, Alan Watts, DT Suzuki, others. Many others. 

By 1977 or so I felt like my chest was going to explode all the time. I couldn't run far enough or long enough to keep that "gripping fist" feeling out of my chest. I went to my doc. He looked for symptoms. I never said anything about being Viet Nam. My doc was a civilian. 

By 1980 it was very clear to me that something had to change. The choices I had were insanity or suicide. For some reason I began to write. At first it was poetry of a kind. Short, abrupt blasts of thought put to paper. Then a paragraph and a page. I found that I could get some relief from the grip on my chest if I sat and wrote something so, I kept writing - for three years. 

During that time I began to do business with clients in Anchorage, Alaska. And I wrote. But there was no let up in the constant chest grip. On a trip to Anchorage I heard a radio blurb about something called a Viet Nam Veterans Outreach Center that had opened. I took a chance. I kept a copy of my writing with me all the time. I took it with me to the Vet Center. 

It was a truly eerie sensation walking through the Vet Center door. I was pin-striped, button-down for business all the time. My civy camo. The vet at the desk took a look at me, then my eyes. He said, "Welcome" and got up and walked to an office in the back. 

The guy who came back with him looked like a cowboy, really. He asked me to come on back. His name was Farrell Udell. He was the team leader at the Vet Center. And he really had ben a cowboy in New Mexico before Viet Nam. Farrell was a Marine. He had been a door gunner on a Marine gunship in I Corp. He was the first combat vet I had met since 1968. I told him what it felt like in my chest and asked him to take a look at what I had written to see if it looked like I really was going crazy. 

He looked at the manuscript for awhile and said that, no I wasn't going crazy, and I had come to the right place. I believed him. Being able to look into another person's eyes who knew not only my words, but all the impacted feelings gave me hope again. 

That was in late 1980. At the time the only approach to treatment of PTSD was rap groups. Vets would meet once a week at the Vet Center and talk and listen and try to help each other with our pain. For some that brought relief. For me and others it just opened a massively infected wound, and we couldn't get the feelings to stop. 

In mid-1981, after several months of rap groups I went back to the team leader and told him we had to do something different. We talked for awhile and decided that we would co-facilitate a combat debriefing group. The purpose of the group was not going to be just to talk about what happened, but to find a way to bring some closure to our experience. We had no idea how we were going to do it, but we did know that it had to be done. 

Fareel went through his client list and identified the most serious PTSD cases he was working with. There were 20 of us. We put out the word that we were going to have a combat debriefing group, and what the intention was. There were 17 of us that formed that group. These were some hard-core folks. 
If I recall correctly in that group of 17 there were 28 Purple Hearts, 23 Bronze Stars, 4 Silver Stars, and a Congressional Medal of Honor. 

These were folks who had danced with the Banshee. 

The first night together everyone gave some background on their trigger time and how their life had been since. Basically it sucked to be us. We all got to look into each others' eyes. At the end of the evening we agreed that we were going to do this this thing, whatever it was. Farrell and I covered one wall of the conference room with butcher paper. Each week when the combat debriefing group met. I would read a short section from (what is now) "When Our Troops Come Home". Then we would go around and talk about how each of our experience was similar or different from what I had read. 

The stories began to be told. The anguish began to flow. Vets held vets while they wept their rage, and loss, and guilt for surviving. We kept a plastic trash can in the center of the circle. Sometimes a vet would need to puke to get through the rest of his story. At each session, before we closed, we went through a lessons learned, like an after action report. We made notes on the butcher paper we had taped to the wall. At first they were just notes about dates and times and events. 

Over the 15 months our combat debriefing group was together we realized that there were patterns in our experiences. There was a timeline from when we arrived in country to the point when we passed through the Acute Trauma Threshold and became survivors. 

We began to create a sort of map of our common experiences. Finally we had a physical diagram of the process of being traumatized in combat. It was an extraordinary accomplishment for this group of warriors. I was the scribe. I copied down what we learned together.

From that diagram we were able to flesh out and describe the process of going from an 18 yr old American kid to the initiation into the military that is basic training. "Then to Viet Nam and the "Immersion in Absurdity" of combat that nothing could actually prepare us for.

Then there was the one specific event that changed us forever. The day when feelings became more lethal than a Claymore mine. That was the day that we turned off all the breakers on all the feeling circuits. From then on "It don't mean nothin'" We became Survivors. The model that was developed by the group of Viet Nam Veterans in that combat debriefing group is what is described in the free e-book "Life After Combat".

So that's how it started, not just in our combat group in Anchorage, but all over the country. Vets helping Vets. It's why Viet Nam veterans, and those that lived through those years, are absolutely committed to today's warriors and their loved ones. 

We remember when there was no help. We remember the years of bitter, self-imposed isolation.  We remember the nightmares and the desperate need for the adrenalin fix to confirm that we were still alive. We remember the utter boredom of being away from combat and the fear of going back in. This is the difference between veterans and survivors: 

   Veterans remember.

   Survivors relive. 

There is all the same concern now as there was among my generation about being man enough to take the pain. How manly do you have to be to take the pain of an impacted tooth before you have a root canal done? A day. A week. 10 years. That's the thing about PTSD. It's impacted anguish. It rubs a blister on your soul. 

I refused to ask for help for 13 years. Many of my bros have waited longer than that. Some still wait. 

Maybe you need to wait because of your career, or your security clearance, or nobody will understand, or until you get sober, or straight. We understand that. You can run, but you can't hide from an impacted tooth. Same Same with PTSD. Do what you have to do. But when the time comes know this: 

• There are thousands of us who understand what you and your loved ones are living through. We will help. 
• There are now trained counselors both in and out of the military. They will help.
• There are resources online, in your local community. Unlike 40 years ago. Help is right here, right now.
• By the same code that you live by: "No warrior left behind. Ever. Ever", we are all here. Waiting for you. It's your choice; it's your turn. 
• There are new warriors taking the field, filling the ranks every day. They will carry on the fight and the code. 
• At some point a warrior must choose to turn from the past and prepare to come back Home.
• Of course your guilt comes with you. That's part of the PTSD. 
• I can tell you from my experience that survivor guilt is also an easy excuse to avoid doing the really difficult work necessary to recover 

Consider this: There is a generation of warriors that we will not allow another generation of warrior to endure what we endured. Warriors are recovering and returning to their loved ones every day. Like everything else we do, undertaking the journey requires a decision 

Our mission is simple: Our mission is to Bring Our People Home. You are our mission. Semper Fidelis. 

Sometimes You Have to Choose to Love -- A Love Story after PTSD

Into the dearth of "good news" about combat veterans with PTSD and their partners comes the remarkable love story of Josh and Helen, who met and fell in love AFTER his service, his suicide attempts, and his PTSD diagnosis. While PTSD can seem like the "third partner" in a relationship -- the ever-present elephant in the room -- in Josh and Helen's story, it's what brought them together, and love, wisdom and maturity is what keeps their union intact.

I had the pleasure of getting to spend a few days recently with Josh and Helen, and was impressed by both of them, and the sheer fun of their relationship, which can be too rare among partners where one has PTSD. I was struck by Helen's clear-eyed, open-hearted approach -- the education she sought about PTSD, as she was falling in love with Josh -- and the way in which she's really becoming a wise "spokesperson" for how love is possible after PTSD. For all the broken relationships out there, and all the partners barely enduring and tolerating one another, I felt like Josh and Helen's story needed to be told, so I asked Helen to tell it. Just as a point of reference, Josh served in the U.S. Army from 2002 to 2008. He was honorably discharged in 2008, and served in Iraq from 2005 to 2006.

Here is Helen's story:

"I met my husband Josh on December 27th, 2008. That's about two years after he returned from Iraq and about two months after he tried to commit suicide for the second time. He was at my house attending an after-Christmas-before-New-Years party that my then roommate Chris was throwing, and he was there against the medical advice and wishes of the team of specialists overseeing his psychiatric care at a well-known men's inpatient program for PTSD.

He was home for the weekend to visit his family and in order to do so he was required to fill out a schedule of where he'd be, what he'd be doing, and with whom. If they'd known he'd be at that party, they more than likely wouldn't have let him go home. And if they knew he'd meet me, they'd probably have chained him to the wall. Of course I don't know that for certain because it's not the way things happened. He did come to the party, I was there even though I had other tentative plans that night, and we did meet each other.

Josh told me later that he wasn't looking for anything other than to feel normal for a few hours. He hadn't really expected to feel comfortable at all and certainly had no intention of telling me that he had PTSD. Again, not the way things happened. He started by telling me that he was a soldier which really intrigued me. In my head I can't help but equate military service with nobility, honor, and authority, probably because the only other people I knew that had been in the military were my grandfather -- who had served in the Navy in World War II -- and a family friend who took unfair advantage of my googly eyes at the tender age of 15, later dubbed "evil Army guy" though I never really associated the service with the man.

I had heard of PTSD and sort of knew what the letters in the acronym stood for. It was a pretty basic concept; formerly known as "shell shock" which Great Uncle Paul, Grandpa's brother had. I remember thinking when it became apparent that Josh and I were going to have a relationship that I should probably be concerned, but I wasn't. I don't know why. I had also heard that men with PTSD could be violent and do harm to the people they most loved. But then again, so can most of the people I know. I knew I'd have to educate myself on what exactly PTSD is, a fact that was compounded when I came up against some opposition from a friend of mine who thought Josh would kill me and then take his own life. She thought this because a friend of her grandmother's had been murdered by her husband, a veteran of either Korea or WWII. I started with the basics (the basics being the extraordinarily reliable source of Wikipedia....you can't tell, but that was written in a sarcastic voice) which actually gave me a pretty decent base.

From there I moved on to other sources including the VA, National Institutes of Mental Health, and last but not least, Josh's therapist. Josh took me to see him because, he said, "I want you to know what you're getting into". Among other things, what I learned was that, aside from the fact that Josh's PTSD was focused inwardly and therefore he wouldn't hurt me, he was being monitored by so many mental health professionals as well as regulating himself that he was the least likely person in the world to do so.

We got lucky. One of the most interesting things I learned was that PTSD is, for lack of a better word, normal. When a person is placed in an extremely traumatic and/or stressful environment, their mind enacts hyper-vigilance, paranoia, insomnia, etc. to enable survival. In a war zone, PTSD is useful. It's when the soldier comes home in time of peace that there are problems. Actually, many people with PTSD have it because of domestic violence. Some people get it from car accidents. The list goes on.What Josh told me really helped him was that I didn't push. When he told me about Iraq, I didn't launch questions at him that he probably wouldn't want to answer. I waited. I focused on him as best I could, I listened carefully.

Eventually he opened up to me, but the fact that I fostered an environment where he felt safe to talk about it, without judgment, without questions, without a sense of urgency helped him immensely. Communication is not our weak point because both of us took a chance at being safe with one another. At first it was scary, but it was completely worth it. One of the most important lessons I've ever learned thus far is that sometimes you have to choose to love. I took on the attitude (I was newly in love so it wasn't too hard for me...plus he's awesome) that he was (and is!) the most incredible, sexy, wonderful, manly man on Earth. I tell him frequently that he is an excellent provider, that he takes good care of his family, that he satisfies my basest urges (*giggle*), that I choose him and marry him every day and will have only him for the rest of my life, and most importantly that I love him so much and love him for who he is. I mean every syllable of it, it's completely true, and I stand by my bold statements and declarations. My heart melts every time because I see him sheepishly look down or puff his chest out, or I notice that he's walking just a little bit taller. He loves it, and his life is made easier and he is made happier knowing that I adore him and that I'm there for him (and he responds in kind).

This is not to say that it's always a cake walk. It isn't. Marriage is hard enough work without mental illness in the mix. His anxiety will act up, he'll get scared, he'll feel depressed and useless and insecure and jeez, we haven't even gone in to MY issues. But he knows that I'm always there for him. We made the conscious decision to put in the effort to speak, to care, to look out for one another, and to work through our arguments and disagreements. Sometimes that is damned hard. But in the end, loving him is easy because of it.

I know that our relationship is different than many other spouse-vet relationships for a variety of reasons. First, I met Josh after he came home from Iraq, after his suicide attempts, after he started treatment for PTSD. I never had to wait for him, never had to live away from him during deployment, never had to worry that the phone would ring or I'd get a knock on the door. I didn't have children to be both mother and father to while he was away, never had to experience my husband being a different man now than he was when he left me. I don't pretend to know what that must have been like.

But if there's anything that I can offer, anything that WE can offer, it's that there is hope. Josh was convinced once that the only good thing he could do was destroy himself; get rid of the burden. Find peace in death, in drinking, in drugs, ANYTHING. He had a plan in place to move to Seattle with just some basic gear with which to live on the streets, and he chose Seattle because their Department of Public Health has a clean needle exchange program. Almost two years later, he's married with a loving wife, a service dog who needs him, two cats who love to annoy him, a sound support system, and more and more he is learning that he's not alone. I am, and by choice always will be, his biggest fan, his cheering section, his advocate, his confidante, and his partner. As his wife, my job, my goal, my honor, my privilege and my pleasure is make sure he never feels otherwise."

Editor's note: The photo of Josh and Helen is used with their permission.

Let Us Now Praise...Vietnam Veterans

Had an amazing "coffee" the other day with Gerald Nicosia, author of the exceptional "Home to War: A History of the Vietnam Veterans' Movement." What I thought would be a quick meet-and-greet with his signing my copy of his remarkable book turned out to be an almost four-hour marathon of information sharing and gathering about the players in his exhaustive, highly-readable record of what went on with the Vietnam veterans' movement. The book took him 12 years to write, went through four publishers, involved 600(!) interviews with participants, and still needed 800 pages cut before its current length, 800 pages in paperback. Remarkable. And it's put me very much in a "Vietnam" frame of mind ever since, following up on threads of what Nicosia talked about in person and remembering yet again how much the Vietnam veterans gave, for so little -- in the way of public acknowledgement and support for their contributions. I always get a little wistful -- even more than a little wistful -- wishing they had so much more recognition for their true generosity of spirit, and character...

So I've been chasing down Memory Lane here -- more Nicosia's than mine -- learning more about some of the Vietnam vets who had such worthwhile points of view, and made such a difference. Some are still alive, some sadly gone before their time.

Ironically, two of the ones who've captured my attention are, not surprisingly, Marines. Marines occupy more than their fair share of this site, maybe because in so many ways they embody the "tip of the spear." They see so much and do so much. Very often idealists, frequently combined with a balls-to-the-walls attitude, they come in for more than their fair share of difficulty. Is their incidence of PTSD higher than other branches? Perhaps. They've done so much for so long with so little they've just learned to live with it, but their numbers seem over-represented in both trying to get some help, and also in trying to do for their fellow veterans, both then and now. (I'll omit the examples here for now, but it's been true in my experience so far that this is the case.)

One of the Vietnam vets I've been trying to learn more about is National Book Award-winning Larry Heinemann, whose quote about war and the veteran's heart we highlighted the other day -- followed by a quote of his wife about the man she married, before and after war.

Another is Jack McCloskey, a Marine medic in Vietnam, who's talked about at length in Nicosia's book, but who died an untimely death at 53 from heart disease, perhaps brought on by both his exposure to Agent Orange and also his tireless work on behalf of other Vietnam vets, not to mention a few bad habits.

Photos of McCloskey are still on the Web, here and here, taken by his longtime friend, Eric Schwartz. And there's a wonderful obituary of him as well, here, though it doesn't talk about how he was shot on the street, and almost killed -- perhaps by someone trying to suppress his activism -- which is mentioned in Nicosia's book. I loved the obituary, and I loved the photos, but more than those, I loved the story conveyed in poetry about who McCloskey really was, and how deeply he loved his fellow veteran. When I read those words, they resonated not "just" about McCloskey -- who I never knew -- but also about another Vietnam vet, Marine, the subject of "Eyewitness to Combat," here -- who's also taken the guns out of the mouths of countless (hundreds? thousands?) of other Vietnam vets, over the years. He's been the one the wives have called, and he's gotten there, mostly, in time -- but not always. Sometimes he's gotten there too late. McCloskey knew that pain himself.

Allen Cohen wrote a poem, "Three Lines and Some Hippy Truths," about McCloskey's death and two others. It should resonate with us today because things aren't very different now. Only a few stand up for the many. "After the war," Cohen writes about McCloskey, "he learned the necessity of healing the mind that survived the broken bodies, and then the souls that were left helpless before the void of meaningless pain. In this way he gave his heart away to the veterans who needed it." From the poem:

Sometimes I get the feeling 
that I'm disappearing behind 
the glaring spotlight of media-
the political circus, TV, 
and Sports, and Movie heroes
In this world of 6 inch and 20 foot tall 
images who do nothing for humanity 
except sell sneakers or make empty speeches,
or appear in the dream world of sex and violence,
and get paid millions of dollars
despite their marginal and illusory existence,
in this world our own lives, 
the lives of those whose acts 
come within the scope of their talents,
their intelligent daily decisions,
their unrewarded kindness and love.
seem to dissolve in frustration and toil
against the silence of the calculus of history.

But look closely at those lives 
with their true heroism of every moment,
fulfilled through the sustenance of friendship,
the love of the children and one another.
For each other they become larger than life, 
far larger than movie screens,
in the singing of a song
the reaching out of a hand across the emptiness,
the drawing of a picture, the writing of a poem
even in the washing of a dish, the repairing 
of a fence or car, the sewing of a loose button.

I am sitting at the memorial for Jack McCloskey,
at the Family Dog Ballroom.
Jack was the Vietnam Veteran counselor
whose life starting in that war
that so defined our era,
was given to reaching out to others.
First to their bodies when as a front line 
unarmed medic, he gave aid to the wounded.
He would overcome the fear of witnessing 
death's witless massacres each time 
he hurled himself into the line of fire.
After the war, he learned
the necessity of healing the mind
that survived the broken bodies,
and then the souls that were left helpless
before the void of meaningless pain.
In this way he gave his heart away
to the veterans who needed it.

There was no People Magazine for Jack McCloskey
No "Jack McCloskey dies News at Eleven."
Country Joe McDonald is playing Sweet Lorraine.
The light show vibrates the air and his friends dance.

Quotable Quotes -- A Spouse's View on How War Changes the Veteran

We wrote about Vietnam veteran, Marine and National Book Award-winning author and poet Larry Heinemann yesterday, and his quote about "War and the Veteran's Heart," linked here. And we've certainly written quite a bit -- as in very often -- about the spouse or partner's point of view, of living with the combat veteran with PTSD. Those articles are linked here. Today we bring those both together, with an excerpt from Larry Heinemann's wife, Edie, about how war and combat changed him. We're sure that many spouses and family members can relate. From a long article about his writing:

"They met at a college dance almost 26 years ago, six months before Heinemann left Fort Knox, Kentucky, for Vietnam. Edie Smith, from Long Island, New York, was doing her undergraduate work at Nazareth College in nearby Bardstown. "He was a clown, very funny and very easygoing," Edie says. "He told some good stories, about his family, about his grandfather." Edie Heinemann says everything about her husband Larry, including his complicated relationships with women, his moods, his present sense of humor, and why he became a writer, was forged by Vietnam.

 "I don't think I've ever told this to anybody on the record, but I married a completely different man than the one I met. Larry had a warmth, a genuineness, a humor about him, even a naivete that was completely stripped away when he was in Vietnam. When he came home all I saw was the bitterness and the edge and the distance. For so long he held so much of this inside, and I don't think I ever fully realized how much pivoted on his experiences in Vietnam. Only recently, with the work he's done, the writing and the other things, has he begun to shed what happened to him, revealing more humor and everything else that was taken away in Vietnam."

Source: "Heinemann's New Style," by Patrick Z. McGavin in the Chicago Reader, (date unknown, but possibly July 23, 1992), linked here.

Quotable Quotes -- Larry Heinemann on War and the Veteran's Heart

"Any soldier returning home must rediscover his humanity and establish a livable peace with the discovered, liberated, permanently dark places in his own heart -- the darkness that is always with us." -- Larry Heinemann, Vietnam combat veteran (Marine) and author, winner of the National Book Award for Paco's Story.

The PTSD Veteran Parent or Spouse: Occasionally Disconnected at the Source

Gayook Wong, who writes about PTSD occasionally in her own blog, focused on Qi Gong -- which we've written about, here -- talks about the disconnect she regularly experiences with her own children, because of her own longtime PTSD. The scenario she describes should be very familiar to spouses, significant others and family members of those with PTSD.

She writes:

"I have suffered from PTSD since I was a child, even though I never knew what it was. I couldn’t understand why I had so many nightmares, why awful moments of terror would suddenly come upon me accompanied by dry sweats and rancid fear in the pit of my stomach. 

Many of my clients have expressed similar outrage at what they are going through. Some have even told me they felt were being punished, but didn’t know why.  When a survivor is enveloped in PTSD symptoms, he/she cannot even begin to consider anyone else. 

 When these symptoms come upon me, I am not my chronological age. I’ve stepped back into the past, where I feel terrorized all over again. I am no longer here. Unfortunately, my children feel most the brunt of my trauma. I am not the mother they know and trust.  I become a stranger to them. They have told me that they feel abandoned, that I don’t carry through what I’ve told them I would do. They have accused me of lying to them, that they can’t trust me, so they feel they have to take over the role as adults and figure things out in a crisis. 

 My children have told me many times over the years that when I have bouts of anger or periods of regressing back to a terrorized child, they feel absolutely helpless. They don’t know what to do to help me. Over time, this helplessness has turned into resentment. They don’t understand why I can’t just get over it -– it’s been so long. 

There are times, I’m sure, that they feel I’m using this to control them – which only adds to the resentment.It is only after some recovery that I am able to hear them, to see how my trauma has affected them. And, how the effects of the trauma gets yet passed onto the next generation. My children learned that, when I “space out”, as they label it, they have to be the adults. In many ways, this has happened since their childhood. As for me, I just want them to understand that the symptoms appear sometimes out of nowhere, and I feel like I’m defenseless, that no one and nothing can help me. But, of course, they don’t. And, logically, I can’t expect them to. 

I want them to understand that it’s not something that I want to have happen, that I feel like I’m going to die in there.  I really make an effort to return to the present moment. Some times are easier than others. It depends on what gets triggered. Even as I am learning more about PTSD and how these symptoms have defined my and the lives of so many others, the labeling of my periodic states  brings up another scare for my children, my daughter especially. She reacts angrily when I label myself. She is afraid that the label gives me more reasons not to heal, that I am using the symptoms to control.   

However, for me, understanding  what has been happening to me all these years and why,  has helped me to name the symptoms faster. Once I name them, I am able to come out of it much quicker.  And, the quicker I can come out, the less adverse affect it will have on my family and friends."

She also recommends counseling:

"Close family members, especially if they are caregivers, need to also have a support system,. Find others who are undergoing similar circumstances. It helps to know that you’re not alone. I strongly urge counseling to families, either together and/or individually. When tragedy befalls one family member, there is no way that others will not also be affected. My family and I have all gone through counseling through the years, together and individually. Now, they know what’s happening to me, we have a code that helps me to come back into the present moment. This helps me to recognize what’s happening to me. And, even better, my children don’t feel as powerless because they are part of the solution."

Gayook Wong makes so many good points in this post. Most of all, she is doing a good job of describing the disconnect that PTSD can connect, the unreachability of the sufferer when he or she is in the throes of their symptoms. Afterwards, of course, things can improve, but sometimes too the damage has been done. The "not being able to consider anyone else" truly takes its toll on friends and loved ones. Others may come to regard the sufferer warily, and the sufferer himself or herself wonders if they can be trusted again, when there are no guarantees.

While few programs offer resources for family members of veterans suffering from PTSD, some do. Check out the Vet Centers in your geographical area, and also The Soldiers Project, which offers free, confidential counseling to family members as well as veterans.

Transpersonal Psychology, PTSD and Spirituality: A Therapeutic Approach

From a brochure about a now-past seminar given by Dr. Marius Koga, a look at the transpersonal therapeutic approach to PTSD and spirituality. I shared his comments with a friend, an Iraq veteran with PTSD, and she affirmed how completely his remarks fit with her impression of her situation. In her words: "He explained the exact reasons why I thought God hated me and was punishing me and why I turned to drugs. I always thought I was the only one who thought that way, and so it was nice to hear that from him."

In Dr. Koga's words:

"It is common for PTSD clients to seek religion and spirituality as part of their healing process. However, most psychotherapies are focused on the ego and personality constructs, while religious or spiritual considerations have been traditionally ignored. It is only in recent years that a therapeutic modality known as “transpersonal psychology “ has emerged which reintegrates psychology and the personality with the soul. The client is encouraged to actively maintain his/her individual self-concept in order to participate actively in his/her recovery. Concurrently, the client is guided to incorporate his/her individuality into the larger plane of the collective identity (including family, community, and religious and spiritual helping resources) to undergo personal transformation and growth. Our military especially, coming home from Afghanistan and Iraq, are seeking answers to painful questions about the gruesome realities of warfare, the value of personal faith, and the worth of human life itself. Many find that their faith in a God that is always available to respond to one’s personal tragedy can be utterly shattered. Soldiers and others who are unable to resolve such challenges find themselves lost in a spiritual flatland, which can take many nightmarish forms. They may feel abandoned by God, they reject or curse God, and they feel that God was powerless to help or even non-existent. They may even rationalize that their body mutilation, PTSD, or Traumatic Brain Injury was deserved punishment from God, or, in extreme, believe that their eternal damnation is God’s ultimate punishment. All too often, they feel they have no recourse but to numb their pain with drugs and alcohol. Their families suffer with them. By providing the opportunity for introspection about the meaning of trauma for the client’s life, transpersonal psychology helps soldiers, their families and friends, and others who have experienced PTSD and other traumatic events, to renegotiate the passive and silent state of the sick role and regain a sense of journeying, integrating, and healing." Marius Koga, MD, MPH, is a Diplomate of the American Academy of Experts in Traumatic Stress and an Associate Clinical Professor of Public Health at UC Davis School of Medicine. He is also a Professor at the Institute of Transpersonal Psychology in Palo Alto where he is directing a pilot center for trauma studies. Dr. Koga has developed courses in mental health and spirituality for Chapman University and has been the Course Director for Transcultural Mental Health and Spirituality at Tulane Medical School. A former political prisoner, torture survivor, and refugee from communist Romania, Dr. Koga’s interest is on PTSD in refugee populations and US military who are Afghan and Iraq war veterans. He has given numerous presentations, and workshops on spiritual dimensions of trauma in US and Europe.

Patrick Marius Koga, M.D., M.P.H.

Dr. Patrick Marius Koga is an Associate Clinical Professor of International Health at UCD School of Medicine, Dept. of Public Health and the President of the Veteran, Immigrant, & Trauma Institute of Sacramento (VIRTIS ). Dr. Koga was trained in Romania and at Tulane and his work in the past 20 years has focused on cultural and spiritual modulators of posttraumatic stress disorder due to armed conflict, complex emergencies, forced displacement, and immigration. His current international research work includes a cross-cultural psychometric evaluation of the reliability and validity of the Civilian Version of the Mississippi Scale for Combat-Related PTSD in the present Kyrgyz-Uzbek conflict in Kyrgyzstan, and a resilience study of the Iranian refugees in Turkey. At UC Davis Center for Healthcare Policy and Research, Dr. Koga is focused on needs assessments and epidemiological surveys of the psychosocial reintegration of OIF/OEF veterans with PTSD and of the disparity gap in mental health services available to Eastern European, Afghan, and Iranian refugees in the Greater Sacramento Metropolitan Area.

More about Dr. Koga, from his bio at the Institute of Transpersonal Psychology in Palo Alto, CA:

Patrick Marius Koga, MD, MPH

• MD, University of Timisoara, Faculty of Medicine, Romania, 1984. Specialization: Adult Psychiatry, 1988 
• MPH, International Health & Development, specialization in Cross-Cultural Mental Health & Medical Anthropology, Tulane School of Public Health & Tropical Medicine in New Orleans, Louisiana, 1999
• Board certified and Diplomate of American Academy of Experts in Traumatic Stress, 2006.

Marius is a Professor at the Institute of Transpersonal Psychology. A psychiatrist and a former political prisoner, torture survivor, and refugee from communist Romania, Marius’ professional interest focuses on the cultural, religious, and spiritual dimensions of PTSD in war refugees from Eastern Europe and the Middle East who have resettled in California. His spiritual path unfolds out of over two decades of practice of Advaita Vedanta, Zen Buddhism, martial arts (5th degree black belt in Karate-Do, 4th degree black belt in Judo and Jujutsu) and out of several years of monastic living as an initiated disciple of the Ramakrishna Order of India.

For the past ten years Marius has also been promoting cultural, religious, and spiritual competencies in medical student education in various capacities such as Dean of International Medicine & Development, Cambridge Overseas Medical Training Programme, Cambridge, UK, Course Director for Transcultural Mental Health and Spirituality at Tulane School of Medicine in New Orleans, and currently as an Associate Clinical Professor of International Health at the UC Davis School of Medicine. 

Marius believes that in an increasingly globalized world, ridden with disparities, conflicts, and violence, ITP has a unique opportunity to partner its expertise and leadership in transpersonal psychology with public health, medicine, government, policy makers, donors, educators, and factors of social change to reduce suffering and mental illness, and to promote individual and collective growth and well-being. 

Editor's note: For more on Dr. Koga's work with VIRTIS, which also focuses on veterans, click here.

Please Support Healing Combat Trauma

If you've ever contemplated donating to the work of Healing Combat Trauma, this would be a great time to do so. Please use this link, here. Thank you...

We want to bring healing to combat veterans suffering from PTSD through integrative medicine. It does work. We are in the process of building a program to do just that, with vets mentoring one another through the process. We have the protocol developed, the practitioners on board, the vets interested, and the nonprofit status. What we need is the ability to make this happen, and that comes down to financial support. If you're able to give, or you're able to pass this information on to someone who cares about vets and might be able to do, please do. We appreciate your support.

How important is the work? Every vet who experiences healing is a vet who is returned from despair to hope, who doesn't have to become a statistic -- 18 veterans a day kill themselves, but not the ones who feel they have renewed hope and a future -- and who can lead a productive, whole life with their families and loved ones and community. We know that it's possible. (The success story is here; the film version is here.) We just want to make it happen. Please give.

An American Veteran -- After Combat, Unlucky in Love

"Ann," Eddie Livingston, the subject of our "An American Veteran" series writes to Ann Landers in the summer of '65, "you cannot possibly know how the help and comfort your column brings to people like myself. Many times I have found things in your column that seemed to apply to me, specifically." In characteristic Eddie fashion he adds, "I hope you are never alone, or lonely, Ann."

(Click on the photo to read the letter in its entirety.)

A comment like that stands out because being alone and loneliness are clearly important to Eddie as well.

His niece, who's brought his writings to light, comments that Eddie believed "because of all of his problems stemming from the war and his POW experience [both creating his PTSD] that no one could ever love him."

Fortunately he found someone later who did, but in this letter you can clearly read the pain and frustration of the 41-year-old Eddie at striking out too many times in the same way, where other men with less baggage from the war are clearly succeeding. Eddie was 41 at the time but a recent combat veteran I ran into the other day, in his 30s, was able to use the experience of having several women break up with him in a row as his "wake-up call" -- that it was no longer all of their problems but it was his PTSD as the common denominator, and he started to go get help so that he could change his future. I commend his efforts but also Eddie's plaintive authenticity on this front. I'm no "Robert Taylor," he bemoans, citing a celebrity of the day, but knows that he's still worth loving. Veterans with PTSD may have rocky relationships (see the divorce rates) and plenty of alone time (see the series on living in the bunker), and these problems with others may stem from the difficulty they find in loving or accepting themselves. It's certainly true that I've recently seen spouses not have the easiest time with the experience, either. Difficult or hard to love? Yes, probably. Worth the effort? We believe so. Stay tuned for a very positive story on just this topic...

Editor's note: For a set of articles about the fuller topic of sexuality and intimacy in the combat veteran with PTSD's life, click here.

Resources on Military Sexual Trauma: VetWow's Short Podcasts for Survivors, Friends and Family

Military Sexual Trauma, like PTSD another "invisible wound," is unfortunately more prevalent in the military than we would want to believe, though little discussed officially. It's different though when combatants get together who have experienced it. Among female servicemembers in particular, it is all too often a common experience; and whether among male or female servicemembers, the after-effects can be devastating. 

At its root, it is a betrayal of trust -- the military is designed to be a "family unit," so assault within this context can feel to survivors like incest -- and many survivors describe the hazing by their command as more difficult in its own way than the actual assault (ugh). Civilians in particular have a hard time wrapping their brains around how prevalent the problem is, how light or nonexistent the penalties (despite official "policies" to the contrary), and how devastating the aftermath is for those who suffer -- who then have to navigate an often-byzantine system of claims and benefits for their care. (Fortunately, MST survivors are able to access VA in a very direct manner...it's worth watching Susan's discussion, linked here, to understand how.) Family and friends -- who may find themselves supporting the survivor -- also need education about how best to offer support, in ways that are constructive and not counter-productive or further traumatizing.

We've written about military sexual assault on the site before, here. "Military sexual trauma (MST) is the term that the Department of Veterans Affairs uses to refer to sexual assault or repeated, unsolicited, threatening acts of sexual harassment –- that occurred while the veteran was in the military."

Susan Avila-Smith, a former Army linguist who suffered her own sexual assault in the military, is now a formidable MST/PTSD advocate and the founder of VetWow, where she advocates for others who have experienced MST and PTSD, and focuses on resolving their claims. A settled claim can provide the MST survivor with financial independence, which is important also in healing. Avila-Smith does not charge for her services, though she does encourage the male and female survivors to pay this service forward in their own lives, once they have stabilized enough to do so, by contributing to others in various ways. 

Recently I got a chance to work with Avila-Smith on creating a "channel" on YouTube for short, one to three minute podcasts about various aspects of MST for survivors, their families and friends, their advocates and the media. The videos/podcasts are organized into the following categories. Please watch them, and share them with your friends and colleagues. Particularly let those in the military (active duty) and veterans know about this resource. As Avila-Smith herself says, it's important to get the word out about military sexual trauma, because "you can't tell by looking at someone" if they've ever been sexually assaulted. For those who have been, these resources can be tremendously reassuring, constructive and helpful.

For MST survivors:

• Symptoms of MST in Veterans;
  
• What PTSD Feels Like to the MST Survivor;
  
• Difference between "Traumatic Stress Syndrome" and "Post-Traumatic Stress" Syndrome; 
  
• For the MST Survivor: Thoughts of Death and Self-Harm;
  
• Interested in Becoming an MST Advocate?;
  
• For Female MST Survivors, Hoarding Can Be Typical;
  
• For MST Survivors: "Hitting the Wall";
  
• For the MST Survivor: Working with Your Therapist Effectively;
  
• For the MST Survivor: Working with the Veterans Service Officer ("VSO") Effectively;
  
• For the MST Survivor: Achieving Satisfaction with Your Advocate;
  
• MST Survivor May Fit VA's Expanded Definition of "Homeless";
  
• For the MST Survivor: Learn to “Pay it Forward";
  

For male survivors of MST:

• For Male Survivors of MST;
  

Self-care and healing resources:

• For the MST Survivor: Good Self-Care Habits;
  
• Alternative Therapies for PTSD.;
  

For friends and family:

• Welcome Friends and Family!; 
  
• What PTSD Feels Like to the MST Survivor;
  
• For Friends and Family: When an MST Survivor Wants to Share Their Story with You;
  
• For Friends and Family: How to Help and How Not to Help an MST Survivor;
  
• When the MST Soldier Comes Home: Best Practices for a Good Outcome;
  

For active duty:

• Why Active Duty Advocacy is So Important;
  
• Active Duty / Filing a Restricted Report;
  
• Active Duty / Filing an Unrestricted Report;
  
• Filing an Unrestricted Report: What GENERALLY happens;
  
• Filing an Unrestricted Report: What SHOULD happen;
  
• Unrestricted Reports: the Danger of "The McDowell Checklist";
  
• For Active Duty: More on the Administrative Discharge;
  

Dealing with the VA:

• Accessing VA Services as an MST Survivor;
  
• Guide to Navigating the VA;
  
• When You Get a Letter from the VA;

Filing and winning a claim:

• Why Filing the Claim Quickly is in the Veteran's Best Interest;
  
• How to File a Claim for Military Sexual Trauma: The Key Items Needed in Your VA Claim File;
• Winning an MST Claim, Part I;
• Winning an MST Claim, Part II: How Long It Takes, Strategies for Self-Care While You Wait, etc.;

For advocates:

• Interested in Becoming an MST Advocate?;
  

For prospective donors:

• For Prospective Donors;
  

For the media:

• For the Media: When You Want to Interview an MST Survivor;
  
• For Media Who Want to Interview MST Survivors and Veterans;
  

General interest:                                                   

• Why MST is a Problem and Why the Solutions Don't Work;
  
• Explaining a Few of the Myths Surrounding Military Sexual Trauma;
  
• Which is Worse for the MST Survivor: The Rape or the Command?;
  
• Why the Current System Needs an Overhaul;
  
• Strange Facts about MST and the VA: Offenders and Victims;
  
• What I Envision in a Perfect Future: Blue Sky Thinking on MST;
  

Editor's note: For more resources about military sexual trauma, particularly filing and winning a VA claim, head for Susan Avila-Smith's website, VetWow; to support (i.e., donate to) those who advocate for victims of military sexual trauma, go to PackParachute; or to follow the legislative progress on this issue, go to Service Women's Action Network for information on the legislative angle. Remember, this is a problem that affects both men and women in the military. And most of all, watch the videos linked above -- and share those with family, friends and veterans' advocates. Thank you.

Trust Betrayed: Sexual Assault in the Military Gives Rise to Increased Levels of PTSD

"Military sexual trauma ("MST") is the term that the Department of Veterans Affairs uses to refer to sexual assault or repeated, unsolicited, threating acts of sexual harassment -- that occurred while the veteran was in the military."

Some comments to orient you, the reader, to what MST survivors go through/think like:

• "While in (the Middle East) I was gang-raped by fellow soldiers. They told me if I talked they would kill me, and they would always know where to find me. I went to the MP anyway. They asked me what I expected being a female in combat..."
• "I never told anyone about the rape until I started therapy..."
• "I was very aggressive in trying to prove my 'manhood.' I tried in all ways to prove I was not weak and I that I was not homosexual. I did not feel like I was a real man. I carried the shame and guilt with me always. I felt I was at fault. I was weak."
• "I have attempted suicide six times because of the rape."
• "I spent two years attempting to track my perpetrator so I could kill him."

Some facts and figures about Military Sexual Assault, which affects roughly equal numbers of male and female servicemembers (despite the differing percentages of those who serve.)

From a just-released Army report (August, 2010): "One of the more disturbing trends from FY 2001 – FY 2009 is a clear and steady rise in the number of sexual offenses, which have essentially tripled since FY 2003."

From the 2006 Department of Defense Survey of Active Military: Annual incidence rates of sexual harassment: 34% of women; 6% of men; for unwanted sexual contact: 6.8% of women; 1.8% of men. (Of course, anecdotally, the figures are MUCH higher.)

Other statistics from VA: "Approximately 1 in 5 female patients and 1 in 100 male patients report MST." (Source: MST Screening Report, FY 2005.)

Total number of veterans who have reported MST in VA (2002-2008): 61,126 men and 59,690 women. (Source: HEC Eligibility Center National MST Report.)

Consequences, according to VA: "More readjustment problems after discharge; more physical health problems; more anxiety, depression and PTSD; more substance abuse; can exacerbate stress reactions to war-zone exposure." 

MST "is associated with increased risk for mental health conditions including, PTSD, depression, substance abuse disorders." The prevalence of MST among OEF/OIF veterans is 15.1% among females;l 0.7% among males. (These statistics are typically under-reported because of shame and fear of reprisal.)

MST Consequences and PTSD:

Male Gulf War veterans: MST = 6x risk for PTSD; combat = 4x risk for PTSD;

Female Gulf War veterans: MST = 5x risk for PTSD; combat = 4x risk for PTSD;

(Source: Kang, Dalager, Mahan & Ishii, 2005.)

Among VA patients who report MST: 28.1% of women and 18.4% of men report PTSD; 45.6% of women and 28.2% men report depression; 5.9% of women and 9.5% of men report alcohol disorders; 5.2% of women and 7.3% of men report drug disorders." (Source: Kimerling, R., Gima, K., Smith, M.W. et al., 2007.)

VA Rules:

A veteran does NOT need to be "service-connected" nor have previously reported a sexually traumatic event to be eligible for MST services through the VA. Even veterans who do not meet general eligibility requirements for VA health care are treated for health and mental health consequences of MST (coded 'ineligible' or 'humanitarian'). The veteran with a dishonorable discharge may want to consult with the local MST Coordinator.

The VA uses two questions to screen for military sexual assault:

• While you were in the military, did you receive unwanted sexual attention, such as touching, cornering, pressuring for sexual favors or verbal remarks? 
• While you were in the military, did someone ever use force or threats of force or punishment to have sexual contact with you when you did not want to? 

If you have been assaulted while serving, please educate yourself about the problem and go to the VA and get help. Maybe bring a trusted friend with you because the process can be difficult to navigate (VA bureaucracy not specifically MST care) "even for healthy people," according to one veterans' advocate.

One Very Easy, Doable Meditation Exercise: Soft-Belly Breathing

There's a very simple, straight-forward meditation that those of us who attended the "Healing the Troops" program as part of the Center for Mind-Body Medicine's practitioner training and advanced training sessions learned. It's called "Soft Belly Breathing," and in a few minutes you can master it. All meditation helps with stress reduction, so whether you want to pursue learning meditation more thoroughly as a practice, or whether you just want a simple tool you can use to reduce anxiety and stress, this meditation is worth trying...if only to see how simple it is. The instructions are linked here. 

Editor's note: The Center for Mind-Body Medicine's "Healing the Troops" program is linked here.

Quotable Quotes -- Jon Kabat-Zinn on Meditation -- and -- Healing

Jon Kabat-Zinn, Ph.D., is familiar to viewers of the Bill Moyers' PBS series, "Healing and the Mind," from the early 1990s. He brought "mindfulness" or "mindfulness meditation" to the attention of the U.S. public through that series, focusing on his work at the University of Massachusetts Medical Center. He's also the author of a number of books, including "Arriving at Your Own Door: 108 Lessons in Mindfulness," from which the following two quotes are taken.

And here's what he has to say about healing:

"Healing is a coming to terms with things as they are, rather than struggling to force them to be as they once were, or as we would like them to be, to feel secure or to have what we sometimes think of as our own way." -- Jon Kabat-Zinn, Ph.D.

And here's what he has to say about the power of meditation, which is part of how we are able to reach that equanimity:

"More than anything else I have come to see meditation as a radical act of love, an inward gesture of benevolence and kindness toward ourselves and toward others, a gesture of the heart that recognizes our perfection even in our obvious imperfection, with all our shortcomings, our wounds, our attachments, our vexations, and our persistent habits of unawareness." -- Jon Kabat-Zinn, Ph.D.

Editor's note: Kabat-Zinn founded the Center for Mindfulness in Medicine, Health Care, and Society, an outgrowth of the famed Stress Reduction Clinic, "the oldest and largest academic medical center-based stress reduction program in the world." About that clinic: "Since 1979 more than 18,000 people have completed our eight-week mindfulness-based stress reduction (MBSR) program, an intensive training that asks participants to draw on their inner resources and natural capacity to actively engage in caring for themselves and finding greater balance, ease, and peace of mind."

The Center also has an outstanding bibliography of material about mindfulness-based approaches to various medical conditions, linked here. If you'd like to search their directory for a mindfulness-based stress reduction practitioner in your geographical area, click here.

More on Meditation: Learning How to Meditate

Learning to meditate is a powerful tool in the arsenal of self-care. We talked about it yesterday in a post linked here about tools that veterans with PTSD could learn to manage their stress and attempt to gain some inner peace (and sometimes freedom from pain).  

The current issue of the magazine at left, Shambhala Sun, on newsstands now, is directed toward beginners in mediation, and has a cover story entitled, "How to Meditate," linked here. It also has helpful articles about "beginner's mind," "why meditate," "getting started," and "mindfulness: the most direct path." Most of the material seems to be available online. Enjoy!

Editor's note: There are also CDs and DVDs about meditation, such as Gaiam's "Meditation for Beginners," linked here, in the "healing multimedia" section of this website, in the lower left hand side of the far left column of books and multimedia.

Tooling Up...Low-Key Ways to Cope with Some of PTSD's Challenges

Another observation from the recent retreat, written about earlier, here:

There was somewhat of an attempted mutiny among the younger male OIF/OEF combat veterans that they had come to the retreat to learn "tools," but felt that they weren't actually come away with any. Gathering tools wasn't the focus of the retreat; building community was. However, their frustration was real, and it seemed that what they meant was tools for reintegrating with their families, and tools for dealing with their PTSD. But here's something that really stood out, and spoke well of the Vietnam veterans who were there in the process.

Two of the "tools" that were being offered at the retreat were qi gong -- which we've written about at length on this site, and encouraged many veterans with PTSD to try, always with positive results -- and meditation. Meditation is an important mind-body skill, and eminently teachable. The classes were offered, optionally, first thing in the morning, and sometimes later in the afternoon as well, for non-early-risers. At one point during the retreat, classes in both were offered for the whole group, during a mid-day session that everyone could attend (and childcare was offered, every time -- making it possible for anyone who wanted to attend to be able to go.) As the graduate of two week-long sessions (the practitioner training, and the advanced training) at the Center for Mind-Body Medicine in Washington, D.C., in a track called "Healing the Troops," I know that these skills, among others, are both worth learning, because they increase resilience and promote internal peace, better stress management and balance. In other words, good tools for any of us to learn, including combat veterans with PTSD or their families, who are under a lot of stress.)

The early morning sessions were well-attended by a broad cross-section of the retreat's participants, and you could see people responding to various degrees to these new experiences. But one thing happened that puzzled me.

Right after I learned of the frustration of some of the younger vets about not having access to the "tools" they were looking for, the mid-day session of both qi gong and meditation was offered. Many of these same guys sat in the back of the room, not participating, and generally (though lightly) mocking the goings-on of the other, more interested participants, some of whom were also vets, until they were asked to leave the room so the others could better concentrate. Those who stayed appreciated the renewed ability to concentrate without them, and after the sessions wrapped up, they gave some important feedback. One veteran apiece from the older generation had gravitated to each of the new practices. The qi gong had helped one to begin to feel more peace than he had in a long while (according to him), and while qi gong didn't resonate with another older vet, meditation really had. He said that he found while he practiced it, it allowed him to go within and get some much-needed peace from a long-term chronic pain. 

I thought about how wonderful it was that both these veterans had persevered, tried something new, opened their hearts and minds to an unfamiliar experience, and yet had their lives blessed by that. They were literally leaving the retreat with new "tools" to practice...while the ones who had been so vocal in their frustration about not getting tools had actually missed the opportunity to learn the same. It's not that the tools didn't work...they had only to look to the experience of the older vets to see how. But unfortunately they missed the whole experience. And it made me wonder whether there's something about being an older vet...and suffering for decades, not just months or years...that somehow also creates a great openness and humility when it comes to trying new things that just might have a blessing encoded within them. Two sets of combat veterans, each with PTSD. Two sets of different frustrations. But one successful experience when it came to accessing new tools. There's a lesson in that for all of us, I'm sure.

Editor's note: If you want to know more about meditation, click here.

A Cheerful Heart Does Good Like a Medicine: The Struggles of Living with PTSD...in Your Spouse

I went to a retreat recently for combat veterans and their families. The retreat is in its third or fourth year of existence, and did a fine job with its core mission, which was providing community for veterans who had lost the camaraderie they'd experienced with other vets in combat. In theory it would also have been a supportive experience for family members who ordinarily might not find anyone else to talk with about living with and loving a combat veteran. PTSD wasn't the focus by any means -- it rarely came up -- but of course because of the demographic, many of the people at the retreat were struggling with the experience of having, or living with, someone with combat-based PTSD. And since the focus of the retreat was building community, not therapeutic counseling, the PTSD topic was somewhat of the elephant in the room, at least to me. So many people experiencing it, on one side of the aisle or another (veteran or spouse), yet few addressing it directly and certainly no one officially. 

Here are a few observations, based on the experience of spending almost five days with the group. The observations are my own; your mileage may vary. 

In addition to the things done well -- community-building, family support (particularly for the children), recreation opportunities, good food, and neat opportunities for bonding among the participants and creative expression -- there were some difficulties, which I think speak to the topic as a whole these days, or the state of affairs on PTSD and the military. Despite the numerous initiatives addressing the topic of PTSD and the military, based on what I saw and experienced, I questioned how much was really getting through. Family members seemed to be living in the midst of PTSD but not being really aware of what PTSD was or how it could affect their relationship. 

Civilian spouses, predominantly women, talked about their husband's unpredictable violent tendencies, unwillingness to communicate, or withdrawal, sleeping and crying, without being aware that those were elements of the PTSD he suffered from combat. 

Younger spouses appeared justifiably frightened and unsure of how to "read' the signals -- often fearing that they were now bookended by two violent men in their lives -- the father they'd grown up with and left young to marry their husband, and now their husband, returned from combat but without enough progress under his belt in addressing his own PTSD, either through medication or therapy or any other means. The experience was highly raw, and still unfolding. The dominant theme among these young women seemed to be FEAR and CONFUSION, as well as a certain amount of co-dependency. Fear over not understanding their husband's PTSD and confusion over how to interpret the signals or how best to manage the chaos. And co-dependency in contributing their reaction as part of the problem. Their best solutions? My guess: love, support, and EDUCATION -- primarily about the main topics of concern to them. What PTSD is, and issues around co-dependency and safety (domestic violence, safety planning, communication skills, etc.)

Older, theoretically more "mature" spouses, who had endured decades of their husbands' military service and repeated deployments, were sadly not much to look up to for the younger women. The primary theme of their communication seemed to be RESENTMENT. And a pronounced tendency to locate all their problems externally: the slacker husband, his terrible family, the town they lived in to be close to his family, etc. If you were looking for a genuine sense of love and appreciation for the combat vet, despite his shortcomings, well, that appeared to be in short supply. (Which is not to gloss over the exceptional difficulties of living, for years, with someone unpredictable, violent, or withdrawn -- or having to cope single-handedly with the considerable demands of keeping the family on track by yourself. However...)

The trouble with resentment is that it festers, and is a good emotion/reaction to address/move through/and move on -- not a great place to camp out, somewhat indefinitely. It's a short hop from resentment to bitterness, and neither of those are about communication and growth. Prescription? A growing focus, daily, on GRATITUDE -- things to be thankful for and appreciative of, not things to pick apart. Wherever your focus is...that's what you get more of. So why tempt fate with only criticism, when gratitude is also an option? Even the book of Proverbs talks about a "cheerful" (or joyful) heart being "good medicine," but a "crushed spirit dries up the bones..." (Proverbs 17:22.)

(Years ago, when Oprah was doing her "Remembering Our Spirit" segment, one of her consistent tools was the gratitude journal...and the challenge to every day, before bed, find one, two or three things to be grateful for. Many people found the (corrective) experience had the power to change their lives. That on top of addressing the legitimate issues and concerns? Much more positive...Here's a link to what's involved in keeping a Gratitude Journal.) 

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I remember two years ago when the subject of the "Eyewitness to Combat" series contacted me through this site, and shared that his own family (in his opinion) were frustrated with him and his search for healing, and basically tired of listening to him on the subject. I remember him saying a version of this, that in their opinion, "You were only in combat for two years...how is it possible that you're not OVER it yet...how has it dogged you all these years?" But the reality is, it had. It's not what we want, sometimes, it's the hand that we're actually dealt. And that was his hand...and that was theirs. The same is true today.

What I wish for these spouses is comfort, understanding, good communication, and ultimately JOY. I think of the great women I know, like Kathie Costos, who DO get what it's like to be married to a combat vet with PTSD, and who have excelled, not crumpled, under the strain, and who do what they do with LOVE. (Here's a link to her downloadable book about living with and loving her husband, "For the Love of Jack.") I think of the woman spouse who wrote the post several years ago, linked here, and used with her permission, which absolutely taught some truths about being married to a vet who you still LOVE and BELIEVE IN, but who is suffering on his own path with PTSD. I think of Britta Reque-Dragicevic, who I've written about before on this site, who wrote the wonderful (and real) book, "Close to Home: A Soldier's Guide to Returning from War," available here. I think also of the great resources in Patience Mason's work and Aphrodite Matsakis', and how their work has helped all of us to understand the dilemma of what a combat veteran struggles with, from the spouse's perspective, so much better. I think of the ongoing guidance I get from people like Kathie Costos (mentioned above), who has such a great understanding of the communication skills needed to interact with a combat vet with PTSD, but from the important perspective of loving them for who they are. And don't forget the resources on this site: communication skills, caring for the caregivers, sexual intimacy, and a fabulous resource list of books and articles for military spouses and family, broken down by topic, linked here.

On Healing: Is it "Too Late" for the Vietnam Vets?

"Throw in the towel, close the barn door, give up the ghost." It's too late for them...or us. Even the Tao expresses how it's more difficult to watch someone you love suffer than it is to have the same suffering happen to you; perhaps because you have to look on in empathy and concern, unable at last to save the person you love from the fate that surrounds them.

Two years ago last week, when I first started talking with the then-suicidal subject of "Eyewitness to Combat," a hardened Vietnam vet, Marine, with 40 years of severe, chronic PTSD, one of the harshest things he'd say was, in utter (but angry) defeat that it was "too late" for the Vietnam vets -- that they'd missed their chance to be healed. The country had passed them by, true, but what he was really alluding to was that they themselves -- starting with him -- had given up. So much has happened in the meantime, it's hard for me to remember all the specifics, but I know that this phrase went through my heart like a dagger. We'd struggle so hard to get him back on track and back into the fight, and then some setback would happen -- and always this refrain. "It's too late for us." In other words, just give up on us -- we've already given up on ourselves.

Fortunately, over the last two years and the progression towards healing that this vet has experienced, this phrase has come up less and less, to nowadays not at all. And I'm very thankful for the change. It's NOT too late for Vietnam vets. If anything, the process should start with them. They've been waiting...in neglect AND in humility the longest. We should support them in their hope for healing at long last...and not keep them at the back of the line, to which they've become accustomed. Vietnam veterans are and can be a total treasure...and a vital, vibrant element in pursuing healing for all combat veterans with PTSD. Let's just also make sure to include them as an important part: honoring those to whom honor is due.

Out of the Bunker and Walking Back to Life...

Had a wonderful talk the other night with the subject of "Eyewitness to Combat" -- Vietnam combat vet, Marine, 40 years of chronic, severe PTSD who overcame -- and we were talking about the lessons of the bunker that we've been sharing with you recently.

He said that the biggest lesson of all for PTSD vets is that "it's safe to come out of the bunker," because it's fear that keeps people in it. And if they decide to venture out, it's important to remember that the bunker is always there, and they can go back to it at will. It will always be there for them, but they don't necessarily have to "live" there all the time to get the benefits of that. It's the back-up plan, the safety net. 

"You can take one step at a time" out of the bunker, he said, "putting one foot in front of the other."

It takes two things to leave the bunker, he maintains. Those two things are "HOPE and a POINT MAN, to lead you out." Here's hoping you find -- and sustain -- both of those in your life.

Editor's note: If you want to learn about his success in climbing out of the bunker, read about it here, or watch a short, three-minute film about it, called "A Veteran's Healing Journey," linked here.

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© 2010 by Lily Casura / Healing Combat Trauma. All rights reserved. Use with attribution.

Quotable Quotes -- Friedrich Nietzsche on "The Abyss"

Although I'm more a fan of the concept of "the hand across the abyss" -- reaching over to grab the hand of the one who wants to climb out -- and we've written about that quintessentially therapeutic relationship, here, before -- still, this is a great quote from Nietzsche, that could very easily apply to combat and its aftermath:

“He who fights with monsters might take care lest he thereby become a monster. And if you gaze for long into an abyss, the abyss gazes also into you.” -- Friedrich Nietzsche

Quotable Quotes -- "Battle Is a Joyous Thing"

We've written over the years about the close camaraderie of servicemembers with one another, something that veterans (both those with PTSD and those without) very much miss upon their return to civilian life. One of the articles was this one, a poetic reference to the "wet bond of blood" in combat relationships, linked here. The following, though, is a quote I ran across today from the Middle Ages, referencing almost the same thing:

"Battle is a joyous thing. We love each other so much in battle. If we see that our cause is just and our kinsmen fight boldly, tears come into our eyes. A sweet joy rises in our hearts, in the feeling of honest loyalty to each other, and seeing our friend so bravely exposing his body to danger in order to fulfill the commandment of our creator, we resolve to go forward and die or live with him on account of this love. This brings such delight that anyone who has not felt it cannot say how wonderful it is.  Do you think that someone who feels this is afraid of death? Not in the least! He is so strengthened, so delighted, that he doesn't know where is. Truly, he fears nothing in the world." -- Jean de Breuil, 1465.