Healing Combat Trauma

Going to the Bunker: A Combat Veteran with PTSD on the Purpose of Protective Isolation

Every combat veteran with PTSD knows what is meant by their "bunker," or what "going to their bunker" means. It's a walled-off, isolated situation that allows them to get some space to themselves, away from other people (including family and friends), when they feel particularly triggered, and they need to stay in there for, well, as long as they're going to. They come out when they're ready, and not a moment before. Obviously this situation can be very frustrating to others in the vet's life, but for the vet it affords him or her some very necessary, protective isolation.

The rest of us who aren't combat vets with PTSD I suppose could think of it as the vet putting himself or herself in a time-out from the world, by taking themselves out of the mix, and away from people and stimulation, both bad and good. And the time-out will be over when it's over, because they decide when it's up.

The recent Fourth of July with its fireworks that remind many vets of combat was a classic bunker situation. Many, many vets were making plans before the Fourth for how to protect and insulate themselves from being triggered by the fireworks (noise, smoke, crowds). One Gulf War vet with PTSD who had already isolated himself, wrote of putting a pillow over his head and just wanting it to be over, so that he didn't have to experience it. The next day, fireworks all exploded, he was better. But during, he had to be in the bunker. Another combat vet with PTSD, from the Iraq war this time, talked about staying in her bunker for days, making brief provision runs, every fourth day or so, to the grocery store and then...back to her bunker. When she needed to be in her bunker...

The bunker concept/construct is so typical to combat vets with PTSD that I thought I'd ask one who I know fairly well how he'd describe it. He has decades of PTSD "experience" under his belt, and I've also seen him retreat to his bunker at various times. A month one time, a week another time, the last time, a day. Sometimes even a few hours. But however long the episode lasts, during that time: totally unreachable. And realistically, you better not even try...because it just makes the situation worse. 

The more chances I've had to experience this with him, the more certain I can be that, short time or long, he'll emerge from his bunker, when he's good and ready, and with a new and improved outlook on why he went in the bunker in the first place. (For those who don't know, the bunker can be anywhere...a shed, a garage, a spot in the woods, a room in a house, even a chair. But it's sacred, inviolate, untouchable space...and the vet goes there in retreat, partly to spare those around him, but also strongly to get control over what he's feeling. (He or she, obviously.) So I figured he'd be able to offer his personal/expert advice on this.

Here's how the conversation went.

Me: "What typically sends vets to their bunkers?"

Him: "Any situation -– losing a job, losing their cool, a fight with their kid -- that makes them lose control sends them back to their bunker, so they can regain control. It may not be much, but while they're there, at least they have control over that little room they're in."

Me: "What's the longest time you've ever spent in your bunker?"

Him: "A year."

Me:  "!!!"

And then he clarified. (Remember, this is just his opinion, but it's worth sharing, because of the number of vets he knows and has observed, as well as what he knows about himself.) "Each time a vet goes into their bunker, they go in for a longer period of time. Until one time they go in and they don’t come out." (He does know an awful lot of other vets who have sadly killed themselves. That happens in bunkers, too. No wonder families and friends are justifiably concerned.)

The progression he just mentioned...vets spending longer and longer times each time in their bunkers...is actually the opposite of what he's been doing, since I've known him (which coincides with his getting better). Each time he goes to his bunker, it's both less frequent, and for shorter and shorter times each time, to the point that the last "bunker" episode I observed him in was actually only about half an hour.

In the middle of a frustrating conversation, not quite an argument, but one where emotions were high and we weren't communicating smoothly, he "withdrew" to his bunker of self-enclosed, protective space -- without moving from the couch he'd been sitting on. I saw him cross his arms, very agitated, close his eyes, and start doing something that looked like huffing and puffing. Even on an animal instinct level I knew, give this person his space. All the body language was daggers. I stepped away, and a short while later, he bounced back, and resumed where things left off, able to manage the conflict without any undue strain. Turns out what he'd been doing during the huffing and puffing phase was actually deep breathing, to calm himself down and regain control. Very smart. On the outside, he looked furious. On the inside, he was doing what he could to get back under control. As a result, he was able to "emerge" from his bunker in record time -- which speaks to the tremendous benefits of learning coping skills and stress-reduction techniques, as he has.

When I first knew this vet, he talked about what he'd learned at an inpatient PTSD program at the VA years ago. It was the cutting-edge program at the time, and he speaks of it with great appreciation, even though many of the guys he went through the program with sadly did not make it. ("Did not make it" is euphemistic code for "sadly, later killed themselves.") One of the biggest things he learned in the program, according to him, was about "red flags" and "triggers," and how to get away before you make things worse. Heading for the bunker, just like in the description of the vet with the pillow over his head,  is one way to keep things from getting worse. For the vet, that is -- for the family or loved ones, it's very difficult to experience, and hard to ignore, though one of the secrets seems to be, going on with your own life, while maintaining a compassionate (but not nagging) concern for how they're doing.

One of the distinctions he likes to make, though, between what he learned from the behavioral modification skills, above, in the VA program, and what he's learned since then, following more of a healing path, is that now he has some ability to not just "avoid" triggers but also "deal with" situations as they come up. The red flags still show that the problem is coming, but instead of being ONLY triggered, there are now new ways to deal with it that don't only involve avoiding or isolating.

The situation above, of being in conflict but being able to "be" with it, and breathe through it, meant that the conflict didn't have to explode into a multi-day saga or a physical exit to an actual bunker, which could last for weeks or months -- or even a year(!) Ahhh, progress is a beautiful thing...

Editor's note: For Part II, "Busting Out of the Bunker at Last," go here.

A Veteran's Journey from Suffering and Despair to a "Happy and Productive Life..."

Had this conversation just now with a Vietnam combat veteran, who struggled for decades with severe and chronic PTSD. (Read about him in the "Eyewitness to Combat" section. It's gripping...)

It's been almost two years now since we first started talking, and I was looking back on how very much he'd changed. The most noticeable thing to me is how consistent he is now, along with the much lower intensity of the darkness and despair. Back then, when he was suicidal, it was a constant feature. I never knew from one conversation to the next whether that would be our last talk, so close to the edge he was. But that was a phase...and the phase changed, and the "mood" of that phase "lifted," and now I can look back and think how very long ago that seems, even though it was "just" two years ago.

In trying to find words to convey how much I'd seen him changed, I found the analogy of a staircase, maybe one with gigantic stone steps. It seemed that though he was still climbing -- we all are, of course -- he'd cleared those gigantic steps found at the absolute bottom and walked up a few more as well. Now when he slides back down, as we all do, also to some degree -- he no longer hits rock bottom --- so it might still be low, but it's much farther up from where he was, and that progress he made, he gets to keep.

He agreed, and said that it wasn't so much that the demon of despair wasn't there anymore, as that it was something he could now overcome. "Healing," he said, "is when you're able to use what you've been taught" from all those hard experiences. And one of the most key, is not to give up, but to do what you know to do. Whether it's to stay on the lowest dosage of the medications that keep you functional; or the healing techniques you know can help -- whether by going to a practitioner, or even the ones you can practice yourself. And ideally both: appropriate medication AND healing work. Together: an excellent, therapeutic combination. Singly? Not so much. It's like there's something missing...and there is. Synergy, for one thing.

St. Patrick's Day is this vet's "Alive Day," or as he used to call it, his "Kill Day." The day that everyone else was shot or killed, and he was shot and almost died, and barely didn't. Not a major celebration in his life; one with a whole lot of guilt for surviving, and one guy in particular who died who was a short-timer, and went into the fight with him because of their friendship.

St. Patrick's Day last year, this vet was doing great. On his medication AND doing healing work. Pleasant, engaged, out in public (even in crowded places), managing, letting his whole personality out, the bad as well as the substantial good. Major progress.

This year, St. Patrick's Day, not so much. Kinda "backslid," as the old churches would say. Had abruptly stopped his medication, because he wanted to "feel again," or "feel more." And what he felt wasn't so pleasant for him or anyone he was around. His personality was coming out then too: but it was the dark side, with only glimmers of the light.

That was a learning experience, for everyone. Get back on the meds, but don't stop the healing work either. They're BOTH important. They both produce the synergy necessary. With both, he says, he's able to stabilize; see the triggers and the red flags for what they are, but not react in the same way. Without the medication? As he describes it, "I'm looking for the switch..." to turn off the triggers "but there is no switch." Together, it works. And together with support from others: WE all work better too :-)

(Interestingly, though, he was still able to do one major thing THIS St. Patrick's Day. He told the story, in a powerful, moving and very public way, of the last seven days of his friend's life, leading up to his tragic death on that infamous "Kill Day." He said he'd never before had the strength to tell that story, and this time he did. Fellow combat vets eyed him nervously, preparing for the big crash...that never came. How well did he make it through? With an enormous sigh of relief. He went to bed and slept deeply, finally able to lay that burden down that had dogged him for 43 years. He was able to let the haunting memory go, without giving up the love of his friend. And that's what you'd call...healing. Bonus points were when the dead friend came to him in a dream that night, and they saluted one another. As though it were safe to let that memory go...but let the love remain.)

---

"Life for me ain't been no crystal stair," the great American poet Langston Hughes wrote in his poem, "Mother to Son."

It's had tacks in it,

And splinters,

And boards torn up,

And places with no carpet on the floor --

Bare.

But all the time

I'se been a-climbin' on,

And reachin' landin's,

And turnin' corners,

And sometimes goin' in the dark

Where there ain't been no light.

So, boy, don't you turn back.

Don't you set down on the steps.

'Cause you finds it's kinder hard.

-- "Mother to Son," by Langston Hughes.

The same could be said by so many veterans who suffer. But yet there is still hope, and it's in the climbing, not the "setting" down :-)

Returning to the conversation with the Vietnam vet, I told him how much I appreciate the consistency since he's been back on the low dose of medication he takes. Failing to find a better word, I said how much I appreciated getting to see his "charming" personality again, instead of the roller-coaster of pain, frustration, anger and despair. "ALL of these guys have charming personalities," he reminded me; "That's why their wives married them...And that's what we've got to help them return to."

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

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

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

And further:

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

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

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

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

That reminds me of two different experiences.

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

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

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

Triggered by Talking about Trauma

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

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

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

"Anything is Subject for a Poem" -- Even Combat and Its Aftermath

It's hard for me to believe I haven't already posted this, but that's what the blog search says -- and I must believe it. Here's an interesting item from the always-fabulously-insightful Deng Ming-Dao, on how "anything is subject for a poem," and why a regular discipline of "writing down the bones" can be advantageous to any of us, even -- or especially -- combat veterans.  He writes:

Anything is subject for a poem:
A catalog of boxing equipment, a collage of other poems,
Serpentine trail of incense, raised deer fur, old shoes pointed pigeon-toed,
Glass and steel cityscape, almond eyes of a saint, weeping tiny flowers,
Sunlight on whitewashed walls, blue shadows of stooped women,
A spring mousetrap, a trickle of blood in the gutter,
The homing swoop of a gull, chill white-capped bay, scent of eucalyptus.
Green lawn of broken blades, clods of fat earth.
Anything is subject for a poem.

Even in sleep, write a poem.
When waking, write a poem.
While loving, write a poem.
Even voting, write a poem.
When angry, write a poem.
While dreaming, write a poem.

The sages say quite seriously that those who wish to know Tao better should cultivate the poet in themselves.

-- 365 Tao: Daily Meditations, by Deng Ming-Dao.

Pulling the Pin: Combat Vets, PTSD and Troubled Personal Relationships

Combat veterans with PTSD often have tremendous difficulty with their closest personal relationships: marriages and families.  Divorces, multiple marriages, and short-term relationships that end unhappily are very common: All situations that compound the pain and suffering that already exists with PTSD.

While there are a few books out there that provide some helpful advice about the difficulty of combat vets with PTSD sustaining good relationships, some insight is also in order.  While many obstacles could be mentioned, we'll stick to just a few important ones.

1.    Needing to have a constant enemy. Combat veterans will tell you that their training requires a constant enemy for alertness, vigilance, what amounts to staying alive. Once combat ends -- or between episodes of combat -- that "role" needs to be filled by somebody.  The most obvious candidate to fill that role?  The combat veteran's usually unwitting, and unwilling, partner. If the spouse or partner isn't available, the next best candidate is a child. The combat veteran is often unaware that he or she is using this tactic at all, and the one victimized by it can often tell "something is wrong," but isn't always clear on exactly what that is.

2.    Pestering and teasing doesn't feel like love, but it does feel like irritation. Let's say the coast is clear.  It's a sunny day, everything seems (temporarily) all right in the combat veteran's world. But he or she teases and pesters a spouse, partner or family member (e.g., a child) incessantly, until that person gets fed up and walks away.  "But I was just teasing!" says the combat veteran.  Yes, but the frictional nature of the allegedly good-natured teasing has a predictable effect: it drives close others away, much like bad behavior also does. Now the combat veteran can be left alone: But is that what he or she really wanted?  Perhaps.  Perhaps not.  The main thing, combat vets say informally, that inspires this strategy, even on an unconscious level, is that too much peace and calm is off-putting, and creating (or re-creating) a little "chaos" in interpersonal relationships puts the combat vet with PTSD back where he or she is more likely to be comfortable.

Now factor either (or both) of these two behavioral patterns (among several others that could have been discussed) with the combat veteran's periodic desire for intimacy -- and imagine the realistic toll that such behavior, even if unintentional, takes on the spouse or partner's desire for intimacy.  More likely, either one or both of these behaviors is more likely to shut down or numb the spouse or partner, who then is more tempted to resist attempts at intimacy.  Is turning down intimacy the problem?  Is it the only problem, or even the central problem?  Probably not, if either of these fairly typical behaviors are an issue.

Helping Vets with PTSD: Rolling up Your Sleeves vs. Keeping an Arm's Length Distance

We've talked before on this blog about Paul Tillich's fabulous quote, that "the first duty of love is to listen." 

Here's a story that neatly conveys the polar opposite of that; or at least how someone, a VA provider, got actually PUNISHED for doing that (thanks to Ilona Meagher for noticing the story). But first, an aside.

I was at a dinner a while back that concluded a week's worth of focused training for health care providers, mostly psychologists, psychiatrists and social workers -- many of whom dealt with combat veterans.  Seated across the table from me was a VA provider, a Ph.D. psychologist who, to his credit, was of the Vietnam era but hadn't served, and who had gone into working with the VA so that he could "help" his generation of veterans, who he saw as being tremendously underserved.  True and good, so far.

As we sat at dinner, he told the private practice psychiatrist to one side of him, and the veterans service officer (and Iraq War combat vet/single mom) to the other side of him, about something "new" called "EMDR," that neither one had ever heard of, and that he had just learned about, and  was fairly enthusiastic about himself.  EMDR, for "Eye Movement Desensitization and Reprocessing," for one thing, is NOT new.  It's been in existence for years -- since the 80s, when it was developed by Francine Shapiro, Ph.D..  Something like 16 clinical trials have shown its efficacy. Heck, we've got several blog posts about it, from two years ago. So it's not really great news that the provider was "just learning about it" recently.  EMDR was one of the first quasi-"alternative" treatments offered in the psychological community for PTSD.  It's been widely studied and fairly widely recommended for PTSD ever since.  It's also something I've personally tried, so my ears perked up when I heard it.  "This stuff is so great," the VA psychologist enthused, warming to his true point: "You can treat people, and you don't even have to hear their stuff!"

Ohmigoodness.  If that isn't just the gold standard of what we want to be doing.  I'm holding out hope we'll find an arm's' length cure for healing combat trauma (kidding, absurd).

In this article, a VA provider who seems like a serious, intense, and concerned practitioner -- as well as a favorite among the veterans who were her patients -- gets fired and reprimanded for "talking an Iraqi vet down off the ledge," so to speak.  It's a pretty shocking story.  The provider has yet to be re-instated, and the OIF/OEF veteran who narrowly survived killing himself, thanks to her intervention, also has been left scarred by the situation, and more antisocial/less trusting than before.  Ugh.  Is this the kind of care we really want to be delivering?

The VA, particularly now (as in, these days) is supposed to be "very concerned" about its reputation, and really adamant about "no more bad PR."  If that's the case, maybe it's time to examine some of the decisions that get made, and why they get made -- from what happened in this story, to the psychologist above who was so thrilled to learn about a treatment mode that he could practice without having to get too involved.

Somehow, this seems to be the EXACT OPPOSITE of the care and concern and COMPASSION that someone like Sarah Haley exhibited, herself a VA psychiatrist, through whose landmark work the shame of My Lai was able to come forth and be addressed, etc. A true hero in the pantheon of those who addressed PTSD at its roots -- and, coincidentally, ALSO someone very well loved by her patients.  Hmmmn.  There might be a not-so-subliminal message in that. 

Here's what Gerald Nicosia, author of Home to War: A History of the Vietnam Veterans' Movement, says in part about Haley (to whom he devotes more than a dozen pages of narrative):

"The other horn of this troubling dilemma was that the traumatized person, especially if he was a Vietnam veteran, would almost never come in and spill his guts to a perfect stranger.  Trauma patients need to establish trust with a therapist, and the Vietnam veterans coming into the VA clinic were never being given the chance to do this.  It was by the merest lucky chance that the My Lai veteran had seen something in Sarah Haley that made him believe he could confide in her, thereby opening the door not only to his own dark secrets, but also to possible help for a whole generation of trauma victims."

 

And, separately:

 

"What Haley did not realize was that John [the aforementioned patient, who spilled the beans on My Lai] had come to her initially because he had been told she was trustworthy by his friend Mike, whom she had treated previously.  A year later, John showed up in her office again under the pretext of bringing Mike back for further counseling.  At this time, John confessed to her that "he had needed to believe that just one person cared, that one person could be trusted to know what he had done, and not reject him.""

 

Hmmmn.  Food for thought, all the way around: but most especially for the VA, and their apparently quite shabby treatment of psychologist Sidney Ornduff, and by extension, the other veterans whose lives she could have been helping.

 

Writing Workshop Planned on "Trauma, Art & Writing" for June, 2009

Plan ahead for this writing workshop, June 15-26, 2009:

Sponsored by the William Joiner Center for the Study of War and Social Consequences and the Creative Writing Program of the University of Massachusetts Boston.

This workshop - open to writers of fiction and nonfiction, poetry, playwriting and translation - involves one or two weeks of working sessions and individual consultations with distinguished writers. The faculty includes Vietnam veterans and others whose lives have been altered by the experience of war, but applicants with diverse interests and backgrounds are encouraged to apply.

Visiting writers will join the teaching staff in a series of readings, seminars, and panel discussions. Special events held at UMass Boston and at other Boston locations will be open to both workshop students and the general public. This year's faculty reading series schedule will be posted.

Editor's note: Additional information about the writing workshop, including faculty bios, course schedule, accommodations, and application (as well as other materials) are linked here.

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. Egendorf's in-depth work at the time with veterans, and his motivation behind it, really seem 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 pounding 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 had.  I can’t work now.  They messed up my head.  How the hell are you supposed to concentrate after all I’ve been through?  Reality sucks.  It’s not what you know, it’s who you know.  That’s why a nineteen-year-old acidhead or college guy gets out of it.  Who do I know?  My shrink from before the war said I was fine.  Now the VA says I was always cuckoo and my problem’s got nothing to do with the war.  My wife is scared of me.  My family thinks I’m nuts.  We were supposed to be over there fighting for freedom, killing people who never did us any harm.  What are you supposed to do after that?

 
I listened, particularly to what was left unsaid.  He had just started to find some direction in life when the war crashed in.  Then it was “pussy,” as his drill instructors called him, and thirteen months of being constantly threatened with death, and seeing a dozen guys he knew pulverized into heaps of bloody flesh.  Others made fun of him, mocking a grunt from New York who resented the practice of calling Vietnamese “slopes” or “dinks” or “gooks.” When the time came to go home and he looked forward to leaving the mess behind, he found that things didn’t work as he expected.  After coming back he wasn’t anybody’s hero, the afterimages of shattering brutality stayed fixed in his mind, and the business-as-usual reality at home had no room for what he carried inside.

For Jim and many like him, it was not them but the world that was crazy.  What was keeping all of it from blowing up, just like the people and placed he had seen “wasted”?  Presidents give the orders and people die.  It’s like a primitive ritual with human sacrifices to bloodthirsty gods.  Jim was sure about only one thing: The people pulling the strings didn’t care what happened to him.

 
“How’d you get it together? That’s what I want to know,” he kept asking.  Our backgrounds were different, but the war gave us a common bond.  Jim was a ghetto kid who didn’t finish high school before entering the service, whereas I had gone to private school, Harvard, and then Europe for a year of postgraduate study before my draft board notified me.  Unlike him, I never saw a psychotherapist while growing up and was never seriously upset until after I came back, and then never so bad that I couldn’t go to school and hold a job, too.  All the same, he knew.  “Something got to you too, huh?”

 
He tested me to see if I’d open up with him. “People like you go into psychology to straighten themselves out, right?”  Yes, I told him, he was right about that.  After years of taking pills and hearing therapists interpret his past and try to modify his behavior, Jim wanted to “relate.”  It was the same hunger that led a dozen of us to form the veteran rap groups that began meeting in New York City in 1970.  In these groups we asked each other and the therapists who volunteered to assist us in gaining the same openness Jim now wanted.

 
After a few meetings Jim asked to be a regular client.  At the beginning he couldn’t take much – he would miss appointments and “forget” to return my phone calls. Eventually, though, we met more regularly, and he began to thrive on the questions I raised.

What had gotten to him?  What was so troubling?  What made him so vulnerable?  What was he going to do about it now?  How was he going to handle his life?  I didn’t intend for him to answer my questions the way elementary pupils answer their teacher’s drill.  Rather, the idea was for him to use the questions to orient himself, to direct his energies where the questioning pointed.  It was time for Jim to stop telling the same story over and over and to begin living out a new one.

 
The more we worked together, the more he saw opportunities to make himself useful – a gesture that would help his wife, an odd job to pick up some cash, a game he could play with his kids.  He studied enough to distinguish his sensitive reactions from his deluded flights of fancy.  And when he was ready, he acknowledged that his suffering would never make sense o its own.  It would only be valuable if he took it as a lesson, something he could use to remind himself that how he handles his life is up to him.

 
After a few months of groundwork, Jim was out of the VA for good.  Then he got off tranquilizers and stayed away from pot.  In the next year, he and his wife stopped fighting and started talking, and soon after that he was holding a job for the first time since he left the Marines.  Two years after we began meeting he bought his own house and was holding down two jobs.  Instead of complaining about his two kids, which is all he had done when we first met, he’d brag about them.

 
The time came when he raised a more ambitious question.  Given his suffering, and what he’d learned, what purpose would he devote himself to?  “People, I want to do something for people,” he’d say.  One of his dreams was to save enough money to start a summer camp for ghetto kids.  In the meantime, he began seeing the people in his daily lives as the ones to serve.

 
Jim still has bad days and times when his kids get to him, but he no longer doubts that his life is workable, which gives him a certainty that makes him proud.  He’s especially happy about the way men who live on his street now listen to him.  “They figure I must know something after I’ve been through.  They ask me how they can straighten themselves out.”  He volunteers at the local Outreach office for veterans, run by the Veterans Administration. “If a high school dropout ex-cuckoo like me can do it, anybody can.”

As powerful as that is, here's something I like just as much: Egendorf's own description of his participation in the dance between patient and practitioner:

“How did you do it?” was the question Jim kept asking.  I knew he wouldn’t be satisfied with some formula or set of rules.  He wanted me to open up, to make it safer for him to open up to himself and to me.  And so I told him about myself, but not to give him know-how.  I simply related bits of my story as they became relevant.  For example, I told him how sensitive I was when I came back.  At first, little things would get to me. I’d be overwhelmed by seeing a dead dog lying on a highway, or the picture of a mourning woman in a magazine, or newspaper listings of the soldiers just killed. Strangers halfway around the world, especially dead ones, seemed closer to me than anyone had ever been except my family and one or two lovers.

 
I also told him about how I threw myself into issues connected with the war.  Before Vietnam I had read newspapers casually.  In the months and first years after coming back I would tear into the pages to see what new horrors I needed to absorb and to find out which people in high places I would cheer that day and which ones I would scream at during the hours I spent raging in my head.  I was more deeply moved by tenderness than at any time in my life, and I was also more easily angered. I’d write scathing letters to editors, congressmen, and the President.  I’d blurt out slogans to old friends and family, who didn’t know how to talk with me anymore.

 
I didn’t tell Jim only about matters that weighed me down.  I made sure to tell him some things that were hard to admit to myself at first, things I needed guts to say, but once said would leave me feeling lighter. I told him it wasn’t just the pain that had surprised me; I had also begun to catch glimmers of some secret joy.  I was happy I had made it through the war when others didn’t, which was hard to acknowledge.  But something else delighted me even more.  Strangely, I was glad to feel so much hurt, as if having allowed something to tear me open meant one day I would give birth to something I might treasure.

 
Jim would compare himself to me and decide that I was so much better off that I had to know something that made life easy. So I also let him know about my awkwardness – the many times I flip-flopped back and forth, from wallowing in my distress to trying to hide from it.  But I also told him I learned more from my mistakes and weaknesses than from anything else.  In fact, my about-faces, in which neither wallowing in the pain nor turning my back on it satisfied me, eventually led me to the realization that I was searching for the third way.  I couldn’t say what it was at first, but I figured somebody had to know or there wouldn’t be such people as counselors and therapists.  They must know, I thought, and so, hungering to find out what they knew and daring to think I’d know too once I joined their ranks, I took a job as a crisis counselor.

 
Jim grasped the irony of my story.  Contrary to what he had initially thought, I wasn’t useful to him because of any information I had.  What I had to offer lay in my willingness to admit that I don’t have anything in particular to tell people until I hear them talk.  I’m willing to be with them without answers, so that I can assist them with their own search.  I told Jim that I’m as surprised as anyone when this works.  The moment when someone trusts me enough to tell  me his troubles a change takes place in me.  I suddenly have more wisdom for them than I usually have for myself. I listen, make comments, and without having to think or plan in advance, ask questions they find helpful.

 
In the end, what Jim accomplished by being with me wasn’t new information to pass along, something he could go out and tell someone else.  He developed an approach to life that transformed his experience of the war from a burden to an opportunity for healing.  The shift happened as a result of our being together, and by our pursuing a joint quest that fostered trust, respect, appreciation and the openness that is healing in itself.

Most crucial is the openness.  I’ve noticed this not only with Jim but also with hundreds of others I’ve worked with since, and with dozens of therapists I’ve trained.  In this book I intend to convey what I mean by openness, in such a way that healing from war dawns as a possibility for you.”

 
-- Source: Healing from the War: Trauma & Transformation after Vietnam, by Arthur Egendorf.  Boston: Shambhala Press (1986)

(Shambhala Press is what published Claude Anshin Thomas’ excellent book, At Hell’s Gate: A Soldier’s Journey from War to Peace, which we have mentioned frequently on this blog.)