Healing Combat Trauma

A Combat Veteran Asks Himself, Who Am I, on the Inside?

The combat veteran, one with decades of severe PTSD, asks himself that question, and the answer that comes back isn't pretty.  "What's your biggest problem right now?" he was asked, and then handed some implements with which to draw his answer.  Describe what you've drawn, he was asked.  "My biggest problem?" he said, "It's that I'm 'an exploding ball of hate'...on the inside." (Comment and drawing, used with permission.)

Now, on the one hand, this doesn't tend to give you a lot of hope.  Forty years out, still thinking about life this way.  Ugh.  That's intense.  And so, so very tragic.

On the other hand, the story has a "happier" ending -- or at least, progress report.  The same person who said that is doing much better now (and has the drawings to prove it.)

But I was reminded of this story again today when I read of the terrible story of Marcus Luttrell, the former Navy SEAL, awarded a Navy Cross for his heroism, whose entire team was wiped out in a horrendous firefight in Afghanistan, and who suffered greatly because of that experience.  (Luttrell is also the author of "Lone Survivor," about that experience.) This past week, his lovely yellow Labrador retriever therapy dog -- who he named DASY, after a combination of the initials of his SEAL team buddies who were killed and himself,  who, parenthetically, says he also died on that mountain, with his team that day -- was shot in cold blood outside his house, apparently in a pointless thrill-killing by some heartless local punks.

From articles about the incident in the Houston Chronicle and on MSNBC, which described the 40 mile high-speed chase an injured (he was recently hospitalized) Luttrell went on to capture the perpetrators, assisted by the police:

"I did everything right; I didn’t do anything wrong," (Luttrell) said. "Make sure everyone knows they cold-bloodily murdered."

In other words, he was heavily provoked. (It's remarkable the self-control he exercised, just helping to capture, but not kill, the jerks who shot and killed his beloved therapy dog.)

The saddest part for me, after reading and hearing about this story, were these poignant lines from Luttrell, after the incident, no doubt disillusioned, despondent, as well as totally triggered.  Reportage said that Luttrell "said he had left his Huntsville home and [like Vietnam veterans before him, who took themselves out into the woods rather than deal with society that was hard for them to navigate anymore] was in "the middle of nowhere," adding that Dasy's killing -- of course! -- was a "huge setback" in his life. (A huge and completely unfair setback, too...cruel beyond cruel, and so completely pointless.)

Here are the heartbreaking lines of Luttrell's, as he's trying to come to terms with what just happened, not that he had any fault in the matter:

"I was trying to talk myself out of being who I am," he told the Chronicle. "Talking to myself about not doing the one thing I am good at."

Those are the words that should stick with people on this, who care about the topic of healing combat trauma, that is.  War -- and even training for war -- breaks people down and builds them back up in the mode of the warrior, in which they have a new, and very authentic skill set -- but one which they won't find much use for in civilian life, or are basically constrained by society from using.  Nobody wants to talk about it much, but the ability to kill, and the confidence and esteem that gets created by being "good at what you do," even if it's very much relegated to the combat experience, is a very hard thing to shake afterwards.

I can come back later and supplement this with references, but read the literature, watch the interviews with people who have combat-based PTSD.  There's a very uncomfortable relationship with killing: it's a high that's hard to deny, but also hard to live with, about yourself (no pun intended).  And that dilemma is at the basis of the combat veteran's, above, remark about what his biggest problem is: being "an exploding ball of hate," on the inside. 

It's very hard to get a grip on that, particularly when killing has become a significant skill set, and very hard to unwind from.  In many cases, veterans covertly mention, mostly to one another, it's become an addiction of its own.  Perhaps just the feeling of being amped up and in command of the situation, not necessarily the killing part, but whatever: it's a way they say they felt truly alive for the moment, and hard to replace in civilian life, which operates according to completely different rules, and is often ridiculously boring and unfair, by comparison.

No judgment intended: far from it.  It's the reality of the situation.  And it's part of why, as much as the military concentrates on breaking someone down to become the perfect warrior, there needs to be an equal and opposite side of the coin -- how to help someone reintegrate, so they can keep their skills, but become a whole person again who, most importantly, can look at himself or herself with appreciation and respect, for every aspect of their personalities.

Editor's note: For a video of Marcus Luttrell being interviewed by Matt Lauer, several years ago, about his book and the incident fighting the Taliban that inspired it, click here.

(Also, the second drawing, above, is done by the same combat vet mentioned in the first illustration, but it's not the one that shows improvement. It's another from the same day, where he answers the question about drawing himself "as I am now" -- in other words, with two very distinct sides to himself, darkness and light.

Upcoming Workshop on Using Art Therapy in Treating Trauma - Boston, MA

Beyond Words: Creating a New Language for Healing; The Use of Art Therapy in Trauma Work

Date: Friday, November 14, 2008

Time: 9:00 A.M.-5:30 P.M.

Location:The Trauma Center at JRI, 1269 Beacon Street, Brookline, MA

Cost: $160

Presenters: Erika Lally, LMHC and Michelle Harris, LMHC

Trauma survivors are often challenged by the use of words in communication. The very nature of trauma and the inherent qualities of dissociation may leave the client struggling to articulate his or her exprience. Reliance on a verbal language approach in treatment may, at times, generate even more frustration and distress. With art materials and the art process, it is possible to access the inner experience without reliance on words as the starting place. Art therapy is a treatment modality that utilizes art media, art process and art products as communication within therapy. Art therapists learn to attune to the nonverbal cues of their clients and have a lexicon for the kinesthetic properties of art that help them in the formulation of individualized media interventions and art therapy treatment approaches. The Trauma Center is pleased to offer a one-day training to introduce both these basic art therapy concepts and specific considerations crucial to using an arts-based aproach in trauma treatment. This training is a hands-on, highly experiential workshop with information also presented through slides, case examples, and discussion.

This training will:

-- Integrate the basic tenets of effective trauma treatment within an art therapy framework.

-- Highlight the potential of retraumatization when including image making as part of trauma therapy work.

-- Address safety through increased attunement to client and clinician responses to artmaking.

-- Bring all the senses, movement, and creativity into trauma work with affect regulation as the goal.

-- Structure a creative process that is strength-based for problem-solving, organization of thoughts, naming "what is" and meaning making.

This training is intended for both the art therapist looking for a trauma treatment framework as well as the trauma clinician who is drawn to using art within their treatment. Previous art making experience not required. Participants should be prepared to immerse themselves in art activities and dress comfortably.

About the Presenters:

Erika Lally, LMHC, ATR-BC, holds a Masters in Art Therapy from the School of the Art Institute of Chicago. She is a Licensed Mental Health Counselor in Massachusetts and a Registered, Board Certified Art Therapist as recognized by the American Art Therapy Association. She has provided trauma treatment for both children and adults for fifteen years. Ms. Lally is a clinician, supervisor and trainer at the Trauma Center. She additionally coordinates the Trauma Center's Child Evaluation Services and consults on the Multidisciplinary Assessment Team at the Cambridge Department of Social Services. Erika also is an adjunct faculty member at Lesley University, teaching in their Master's Level Expressive Therapies Division. Erika specializes in treating complex trauma and she is EMDR level two certified.

Michelle Harris, MA, ATR-BC, LMHC, is an art therapist specializing in trauma work with children, adolescents, and adults. She is clinical intake coordinator at the Trauma Center and has been leader of the Positive Sensory Group, a structured skills-building group focusing on self-care and safe alternatives to numbing, avoidance, and shut-down responses in daily life. Ms. Harris also specializes in collaborative community art projects such as the Coast Miwok/Southern Pomo tribe's quilt on faith and tribal identity. She is currently creating a traveling quilt series with incest survivors called "Speaking Truth" to address intergenerational trauma and how trauma survivors can be preventative and proactive when telling their history in a developmentally appropriate frame for children in their life. Ms. Harris is an art tutor at Harvard University and faculty at Lesley University in the Expressive Therapy Department and in the Trauma Center Certificate Program.

For more information or to register, click here.

Editor's note: to read more blog entries about art therapy and combat trauma/PTSD, click here.

Catharsis: Art Therapy, Trauma and PTSD

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Hontz writes:

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

 

Additionally, Hontz writes:

 

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

 

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

 

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

 

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

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

 

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