Healing Combat Trauma

Therapeutic Resources - Books on Healing Combat Trauma and PTSD

Just an "FYI" to say, we've hit 100 books listed as therapeutic resources now on this blog -- look left to see them, they're in a column of their own, starting in the upper left of the page here.  All are recognized as reasonable sources of information -- or sources of reasonable information! -- with some therapeutic utility -- by reputable authors and experts, as well as some up-and-coming ones -- and all have been rated at least four stars, if not four and a half or five -- by their readers on Amazon.com.  Click on any of them to go right to the book on Amazon and purchase.

On the right hand side of the blog are lists of first person narratives from the various wars that adhere to the same standards.  If you're trying to understand the mind and "back story" of a combat veteran with PTSD, how better than to learn what they actually went through in the time they served?  That's where those lists of book come in handy.  All will give you a feel for what combat veterans actually went through during their time of service.

There are many other resources on this blog as well, including "healing* multimedia" (look to lower left for that list) -- but at 100 therapeutic books listed, it was time to highlight what these resources are.

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Editor's note: We'll discuss the term "healing" shortly, but healing should be understood to be a continuum towards health, in which every incremental improvement brings satisfying relief, rather than a "goal," or a single event/result. 

News from Hell before Breakfast: Journalists, War Trauma and PTSD

"I hate newspapermen. They come into camp and pick up their camp rumors and print them as facts. I regard them as spies, which, in truth, they are. If I killed them all there would be news from Hell before breakfast." -- attributed, perhaps erroneously, to Civil War General William Tecumseh Sherman.

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A different quote:

"On Thursday, June 26th, I witnessed the immediate aftermath of an Al-Qaeda suicide bomb attack.  Several dozen people lost their lives... children, old men, civilians, police, and military men.  The scene was horrific beyond words, even for someone like me who has a fairly high threshold for such things.

I found it nearly impossible to look through the viewfinder.  What I saw was abhorrently graphic, yet far too important for the world to ignore.  I present images that provide an uncensored view of a terrible event, and some small measure of dignity to those who lost their lives."

-- Zoriah, international humanitarian photographer, whose gripping images from that event were later censored by the U.S. military, and he was evicted from his embed assignment with the Marines. (The link to the post where he talks about those images, and shows them, is here.)

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PTSD from being a combat journalist of photographer, embedded or otherwise:  Not everyone who's exposed to combat trauma develops PTSD, as we know.  Recently, Kimberly Dozier, CBS correspondent and author of Breathing the Fire, says she didn't develop it from her horrific near-death incident in Iraq in May of 2006, though ironically -- according to Dozier -- almost everyone she interacts with believes thatshe must have.  (See article to that effect by Dozier, linked here.)  However...many do; and for others, the signs and symptoms take time to manifest themselves. 

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Journalists bear witness, both to some of the most savage atrocities of wartime, though without the training and the mindset of combatants, and also to the suffering of the survivors, military and civilian.  Says one photographer who served in Vietnam:

It has been very difficult for me [to recount some of his memories from the past] as it has brought back many of the horrible nightmares that I had thought that I had finally put away. It did get them out in the open and off my chest so to speak and now my family now knows why I sometimes have to take those walks out into the woods alone to just get away. Hard to explain. I do have severe survival guilt as I have lost far to many friends in combat in up close and personal confrontations. I have many photos of me smiling and yes there were many good times. However; there were enough bad times to more than compensate for the good ones. I have learned to cope with this new world that I came home to only because I still feel a great need to help my fellow veterans. We 'Nam veterans are all but forgotten in my eyes.

Two significant resources: Dr. Anthony Feinstein's work, and the Dart Center for Journalism and Trauma.

Two excellent books:

Dangerous Lives: War, and the Men and Women Who Report It, by Anthony Feinstein (2002); and Journalists under Fire: The Psychological Hazards of Covering War, by Anthony Feinstein. (2006).  (Recommended by Jonathan Shay, M.D., Ph.D., noted PTSD expert.)  Shay wrote: "the first and only book about the occupational [psychological] hazards of being a war correspondent.  Published in Canada, will come out in the US next year from Johns Hopkins UP with a new chapter on embeds."

Dr. Anthony Feinstein is a professor of psychiatry at the University of Toronto and a neuropsychiatrist at Sunnybrook and Women's College Health Sciences Centre in Toronto. He is an expert on Post-Traumatic Stress Disorder in war journalists. Feinstein received a 2001 Guggenheim Fellowship to pursue his research. Dr. Anthony Feinstein's bio is linked here.  Much better bio, linked here.

For reporters: War, Journalism and Stress: The Self-Assessment Test, linked here. (General description of the test, linked here.)

What Feinstein has to say:

More than anything, says Feinstein, he’s learned that, “War is not good for journalists. They suffer from it.”

Specifically, they suffer post-traumatic stress disorder, substance abuse and anxiety disorders. One in five journalists, over the course of a long (15-plus-year) career, endures significant PTSD, says Feinstein. That means, among other things, bad dreams, flashbacks, numbness, an overly sensitive startle response and an inability to get close to others emotionally. One in four experiences depression. “And a number drink very heavily as well,” says Feinstein, “but I don’t know how many, because I never know for sure what they’re telling me.”

The most surprising revelation of the research for Feinstein? “I didn’t realize that the journalists were in such great danger. You see them when they report the news: cool, collected, with everything seemingly going on behind them. But these people are really right in the middle of it all.”

He is particularly sympathetic to still photographers. More than anyone, he says, these professionals have no choice but to get into the thick of things to do their jobs well.

The Dart Center for Journalism and Trauma, located on the campus of the University of Washington in Seattle, is a particularly good, targeted resource for journalists about reporting and trauma: both externally reporting, and internally experiencing trauma from reporting in war zones.  Click here to look through their extensive offerings, which are really superb.

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Who's the handsome young man in the photo? 

That's Robert W. "Grif" Griffin.  Griffin says, "I was a combat photographer with the 1st Cavalry Division Airmobile from 1966 to 1968 and 1970. I was in country [in Vietnam] as a photographer from 1966 to 1968, and back again in 1970."  (He was shot down near Quan Loi in 1970.)  He adds that he "spent 20 years in the Army mostly as a photojournalist/motion picture and still photographer."

According to Griffin, "the photographer who took the photo is Jere L. Smith, a fellow combat photographer and a Specialist E5 at the time. We were both assigned to the 13th Signal Battalion, which was part of the 1st Cavalry Division Airmobile."  At the time the photo was taken, Griffin was duplicating some slides for his Command for a Division briefing that was to take place in several locations at the same time: hence, the dupes.

Why Soldiers Rape - Helen Benedict on Military Sexual Assault

If you've been following our recurring coverage on military sexual trauma (MST), here is an important addition to it: Helen Benedict, a professor at Columbia University's Graduate School of Journalism, currently on sabbatical, has a book coming out next year from Beacon Press called "The Lonely Soldier: The Private War of Women Serving in Iraq."  (You can pre-order the book at Benedict's own website, linked here.)

On Memorial Day weekend, she published an OpEd recently on the subject, in the New York Times. The piece, which was entitled "For Women Warriors, Deep Wounds, Little Care," is linked here.

A few months later, in August, she published another OpEd, called "Why Soldiers Rape," in a different outlet, which is linked here. Compared to the NYT piece, this one is more overtly politicized, both in thinking and in language.

While that strategy can have pros and cons, one positive is -- whether you agree with it or not -- that it's a useful stance to take to provoke thinking and/or discussion.  (Although I'd also like to compare the two essays side by side to see how Benedict treats the same material slightly differently, for different audiences.)

Decades ago, feminist authors and filmmakers were able to accomplish traction by taking on topics like rape (Against Our Will: Men, Women and Rape, by Susan Brownmiller) and pornography (Not a Love Story: A Film about Pornography, by Bonnie Klein, with Susan Griffin and others) as aspects of the culture that harm women substantially, yet are frequently overlooked.

(Benedict's website indicates that a previous article published in Salon last year, "The Private War of Women Soldiers," was awarded the James Aronson Award for Social Justice Journalism in 2008. That article is linked here.)

Some of the terms Benedict uses, like "misogyny" (literally, hatred of women) are very strong indeed.  How big a problem is this really? My hunch is less so than what Benedict suggests.  But by using such volatile language to communicate similarly incendiary thinking, Benedict succeeds in drawing greater attention to the problem.  Doubtless what she portrays, however, is not "everywoman" servicemember's experience in the military.  (The comments to the NYT piece make that abundantly clear.) But for those who are harmed by military sexual trauma, no doubt she makes some very good, and thought-provoking points -- even if you don't end up agreeing with everything she says, or how she says it. 

Another difficulty is the topic is so polarizing, based on individuals' own experiences -- that those who have suffered from it tend to see the pervasive nature of it; whereas those who haven't personally experienced also tend to believe their experience is the norm, and shut out the other point of view.  (See the comments section in the NYT piece for examples of this "all or nothing" thinking.) In this way, both sides run their own risk of illustrating the cliche that "when all you have is a hammer, you tend to see everything as a nail."

The following is an excerpt from that piece:

"Rape in civilian life is already unacceptably common. One in six women is raped or sexually assaulted in her lifetime, according to the National Institute of Justice, a number so high it should be considered an epidemic.

In the military, however, the situation is even worse. Rape is almost twice as frequent as it is among civilians, especially in wartime. Soldiers are taught to regard one another as family, so military rape resembles incest. And most of the soldiers who rape are older and of higher rank than their victims, so are taking advantage of their authority to attack the very people they are supposed to protect.

Department of Defense reports show that nearly 90 percent of rape victims in the Army are junior-ranking women, whose average age is 21, while most of the assailants are non-commissioned officers or junior men, whose average age is 28. . . "

Benedict ties rape to misogyny -- literally, hatred of women -- and what she suggests is the systematic, institutionalized degradation of women in the military:

"Two seminal studies have examined military culture and its attitudes toward women: one by Duke University Law Professor Madeline Morris in 1996. . . and the other by University of California professor and folklorist Carol Burke in 2004 . . . Both authors found that military culture is more misogynistic than even many critics of the military would suspect. Sometimes this misogyny stems from competition and sometimes from resentment, but it lies at the root of why soldiers rape. . .

Morris and Burke both show that military language reveals this "unabashed hatred of women" all the time. Even with a force that is now 14 percent female, and with rules that prohibit drill instructors from using racial epithets and curses, those same instructors still routinely denigrate recruits by calling them "pussy," "girl," "bitch," "lady" and "dyke." The everyday speech of soldiers is still riddled with sexist insults. . .

The view of women as sexual prey has always been present in military culture. Indeed, civilian women have been seen as sexual booty for conquering soldiers since the beginning of human history. So, it should come as no surprise that the sexual persecution of female soldiers has been going on in the armed forces for decades. . ."

Benedict then goes on to suggest why rape is under-reported in the military:

"Having the courage to report a rape is hard enough for civilians, where unsympathetic police, victim-blaming myths, and the fear of reprisal prevent some 60 percent of rapes from being brought to light, according to a 2005 Department of Justice study.

But within the military, reporting is much riskier. Platoons are enclosed, hierarchical societies, riddled with gossip, so any woman who reports a sexual assault has little chance of remaining anonymous. She will probably have to face her assailant day after day and put up with resentment and blame from other soldiers who see her as a snitch. She risks being persecuted by her assailant if he is her superior, and punished by any commanders who consider her a troublemaker. And because military culture demands that all soldiers keep their pain and distress to themselves, reporting an assault will make her look weak and cowardly.

For all these reasons, some 80 percent of military rapes are never reported, as the Pentagon itself acknowledges. . . ."

And then Benedict suggests two reasons, not exactly complimentary to recruiting, about how violence is perpetuated in and by the system.  Hmmmn.

"Misogyny has always been at the root of sexual violence in the military, but two other factors contribute to it, as well: the type of man who chooses to enter the all-volunteer force and the nature of the Iraq War.

The economic reasons behind enlistment are well understood. The military is the primary path out of poverty and dead-end jobs for many of the poor in America. What is less discussed is that many soldiers enlist as teenagers to escape troubled or violent homes.

Two studies of Army and Marine recruits, one conducted in 1996 by psychologists L.N. Rosen and L. Martin, and the other in 2005 by Jessica Wolfe and her colleagues of the Boston Veterans Affairs Health Center, both of which were published in the journal Military Medicine, found that half the male enlistees had been physically abused in childhood, one-sixth had been sexually abused, and 11 percent had experienced both. This is significant because, as psychologists have long known, childhood abuse often turns men into abusers. . .

Worse, according to the Defense Department's own reports, the military has been exacerbating the problem by granting an increasing number of "moral waivers" to its recruits since 9/11, which means enlisting men with records of domestic and sexual violence.

Furthermore, the military has an abysmal record when it comes to catching, prosecuting and punishing its rapists. The Pentagon's 2007 Annual Report on Sexual Assault in the Military found that 47 percent of the reported sexual assaults in 2007 were dismissed as unworthy of investigation, and only about 8 percent of the cases went to court-martial, reflecting the difficulty female soldiers have in making themselves heard or believed when they report sexual assault within the military. . ."

(Those last statistics are perhaps most troubling of all...)

Benedict also has an essay on her website that's worth reading, called "For Women Warriors, Deep Wounds, Little Care," which is linked here. (Same title as NYT piece, slightly different content.)  Watch for her book to come out in the Spring of 2009, from Beacon Press.

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

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

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

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

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

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

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

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

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

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

I've recently started reading a very interesting book from the Vietnam era, by Arthur Egendorf, a Ph.D. psychologist who was first a veteran - and later tried to piece together what he had experienced in a way that could also help others.  There may be a sad professional end to the story -- it appears that Egendorf has since lost his license to practice -- however, his work at the time, and the motivation behind it, really seems exceptional. 

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

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

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

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

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

 
Ever since he came back, his mother and his wife had been trying to tell him that something was wrong,  For the first year all he did was stay in the apartment, smoke dope, and listen to music.  Then one day while looking out the window he saw a junkie trying to steal the radio from his car.  Jim grabbed a baseball bat, ran after him, and started po8unding the guy so fiercely it took three people to tear him away.  After that he knew he was out of control and went for help.

 
Seven years after coming back, Jim described his burdens this way: “Before I went, I worked for six years.  I was the best assistant manager Martin’s Bargain Store ever ha