Healing Combat Trauma

In Medication We Trust - The Pills and Perils Veterans Face after Combat

I had the opportunity to hold a 100%-PTSD disabled rated combat veteran's "morning" set of medications and supplements recently (as opposed to his or her "evening" set), and it reminded me of another piece of artwork done by Iowa artist John Paul Hornbeck, a veteran whose dad is a disabled Vietnam veteran.We've blogged about John Paul's artwork earlier, particular his sculpture, "Shattered Soldier," about PTSD.

(The handful shown represents a variety of medications to control psychological symptoms of PTSD, as well as to medicate the various physiological ailments, some of them quite serious, which often accompany PTSD in a combat veteran.  Then there are medications to control side effects of other medications, and some supplements to replace nutrients the medications destroy. The handful shown is really just a sample of what this combat veteran takes throughout the day; and other items, such as a pain patch, are not shown. But you get the general idea...)

John Paul has done some other provocative artwork, too: a modified rendition of the classic POW/MIA flag to remind us that homeless veterans are "missing in America" -- meaning, missing in plain sight -- and another lifesize image of a disabled veteran, done as a sculpture, where the face of the veteran is composed entirely of pills.  Pinned to an outside pocket of the vet's camouflage jacket is a pill case, reminding him when to take his medication, and John Paul has depicted it in patriotic colors, resembling the American flag.  Interesting, edgy stuff, from a veteran who is very familiar with his own father's dependence on VA-supplied medication for alleged "quality of life."

(Fortunately, there are other methods for reducing dependence on medication, including mind-body medicine, which we've blogged about earlier -- indexed here.  And there are also ways to evaluate the effectiveness and potential side-effects of common prescription medications, according to other PTSD sufferers. We've blogged about that earlier as well -- linked here.)

John Paul Hornbeck's sculpture, "The Veteran," follows:

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

Just Remember Our Sacrifices, Veterans Plead

 

A quote about sacrifice:

"When we come home, either standing or dead, to know you remember we fought and we bled is payment enough, and with that we will trust. That we mattered to you as you mattered to us." --  quote from USMC OIF/OEF combat veteran, perhaps quoting someone else (and perhaps not!).

Artwork done by proud Marine wife Christie, whose husband just got back from yet another deployment, days ago.  This is her artistic vision, created with photo imaging software, of an imaginary building facade she'd like to see, somewhere in America.

Find the Cost of Freedom, Buried in the Ground

It's an old Crosby, Stills & Nash song, by Steven Stills. Many of us who were there in the 70s still remember the words. I know I can recite them from memory: "Find the cost of freedom, buried in the ground. Mother Earth will swallow you; lay your burdens down."

Tomorrow is the Fourth of July.  Not only my favorite holiday the whole year through -- sorry, I'm a New Englander, we're just born that way -- but also another opportunity - along with Memorial Day, and Veterans Day - to stop and honor the service of those who sacrificed their lives for freedom, or at least, responded to what they saw as the call of duty that they responded to, while others did not. Those whose blood was shed on American soil -- in Lexington, Massachusetts, in the Revolutionary War -- and also, more recently, in the jungles of Vietnam, in the mountains of Afghanistan and in the sands and urban jungles of Iraq.

I'm thinking today about censorship -- and the power of an image to convey, in a single instance, what those of us who labor over our words perhaps never can.  The picture, they claim, is worth 1,000 words -- perhaps because it communicates, in an instant, across barriers of language, space and time -- what human beings instinctively understand, nonverbally.  With war: that there is a price; that it is never really glorious; that those who give their lives often do so -- as the poet W.H. Auden wrote about the famous art masterpiece, the "Fall of Icarus," by the Dutch painter, Brueghel -- in a depressingly inglorious context:

"About suffering they were never wrong,

The Old Masters; how well they understood

Its human position; how it takes place

While someone else is eating or opening a window or just walking dully along...

If you don't remember the Greek myth of Icarus you might need some refreshing.  He's the pre-Wright Brothers son of Daedalus, whose father built him a pair of wings, in order to take flight and escape from the island of Crete.  But the father glued the wing feathers in with wax, and then warned his son not to fly too close to the sun (probably without explaining actually why.)  Icarus partially succeeded in his goal -- he was able to fly, but in flying, did get too close to the sun -- at which point the sun's rays melted the wing feathers' wax and he literally dropped out of the sky, into the ocean -- having succeeded in his fabulous quest and also painfully failed, all at the same time.  That's not the parallel with the armed forces: the parallel worth drawing here is that sometimes death on a glorious "mission" turns out to be a most pedestrian thing, and the rest of us, unless we're apprised of it, don't even notice or celebrate.  On a deeper level, it brings up the question: as Americans, how exactly do we "support the troops," if we're not even really aware of what they're up against?

Unlike Vietnam, where grainy black and white news footage of U.S. soldiers fighting and dying in foreign jungles was often watched during dinner, with Walter Cronkite narrating -- in Iraq and Afghanistan, we're reduced to very little coverage and certainly not much that could "upset" our "overly tender sensibilities."  No flag-draped coffins being offloaded at Dover Air Force Base, instantly communicating that for every loss in combat there's a grieving, distraught family and a hole in the community, left by that veteran, that will never be filled.  Even those, like me, who don't exactly excel at math -- we're more than dimly aware that for every servicemember KIA -- or killed in action -- there are scores more wounded and disfigured for life -- emotionally scarred (invisibly) as well as visibly.  The human costs are staggering: those are daddies and mommies, sons and daughters, brothers and sisters, employees and employers who come home different: maybe unable to work, maybe unable to function - initially or long-term; maybe unable to take care of their families while they struggle with their own wounds of war.  This is the human cost of war: it exists whether we are personally dialed in to it and aware of it, or not.  It is, to use the words of Hedley Peach, a "generic effect of combat."

And while the news media gives scant coverage to what is happening in the conflicts in Afghanistan and Iraq, as surely as the hands of our clock tick daily the minutes and the hours, somebody's sons, daughters, brothers, sisters, fathers, and mothers are dying, and being injured -- somewhere.  We can be for or against the wars -- forget that noise for now -- but at the very least, we ought to be for the veterans.  And their families.  If what happens is fully what they signed up for: so be it.  I'll say this for