Healing Combat Trauma

Sometimes a Photo Just Says It All...

Libraries Across America Offer Veterans Information Next Week for Veterans' Day

The American Library Association (ALA) is spearheading a series of activities during the week of Veteran's Day, November 11, 2008 at libraries across the country to make information available to help veterans and their families better understand the education benefits available under the new Post 9/11 GI Bill.

ALA's Office of Government Relations (OGR) is working with a group of four national organizations in this effort, including the American Legion National Headquarters, the American Council on Education, the National Association of Federally Impacted Schools, and the National Military Family Association.

(Realistically, knowledgeable reference librarians are always happy to help veterans and their families with information at their disposal; next week, however, appears to be a special push to get this information into the hands of veterans and their families, in honor of Veterans Day.)

For more about the services available, click this very Wikipedia-looking link, provided by the American Library Association.

Books Fall Open, We Fall In: Reading to Better Understand the Vietnam War and Its Veterans

The kindly and indulgent boyfriend, GuvBoy, left for the local library book sale with instructions to purchase anything that looked good about the Vietnam war and several other blog-related topics. As a former journalist and all-around smart person, he knows how to figure that out, so I knew I was in good hands.  As it turns out, he returned with some good ones, that seem to have been lost to history.  So I thought I would point them out here, in case they help anyone else who's interested in digging deeper into what went on and what the combatants experienced. 

(In case it's never been clear what orientation the categories of books in the various columns flanking this blog have, here's the breakdown:

The column to the right here on this blog lists various books of poetry about war, any war; followed by a section of all sorts of excellent first-person narratives about various wars, the better to give us an understanding of what veterans went through.  Those first-person narratives are organized by war, to make it more self-explanatory.  The column to the left here lists therapeutic resources for dealing with combat trauma up on top; and various miscellaneous things that get mentioned on the blog further down).

For Vietnam-era veterans who want their families (i.e., children and grandchildren) to better understand what the war was like, I'm still recommending "Home to War: A History of the Vietnam Veterans Movement," by Gerald Nicosia, because while he's talking about the veterans movement, in 700 pages, he's capturing all sorts of history of the era and feelings for and against.  The book is actually pretty neutrally, historically written, and it's a very good resource.  I've blogged about it earlier, here.  Except for its oversight of the extremely impressive (to me, anyway) Lawrence Kolb, M.D., I can't say enough good things about Nicosia's book.  There's a fascinating wealth of information about the legitimization of the PTSD diagnosis in the book as well.

Here are a few others:

Stanley Karnow's Vietnam: A History, is also good.  The cover calls it "The first complete account of Vietnam at war" -- maybe it should actually say, the first complete account of Americans at war in Vietnam -- so it has its place.  It was written as the companion to the long-ago PBS series of the same name.

Plus three new finds, though, thanks to the pleasantly-disposed boyfriend and his handfull of small bills:

"Long Time Passing: Vietnam and the Haunted Generation," by Myra McPherson; "Healing from the War: Trauma and Transformation after Vietnam," by Arthur Egendorf; and "Vietnam: the Valor and the Sorrow" (from the home front to the front lines in words and pictures), by Thomas D. Boettcher.

Each of these books has a particular reason why it's good and worth perusing.  McPherson was a Washington Post and New York Times reporter who carried on 500 interviews with veterans and others to get her material; Egendorf, who Nicosia writes about in his history, was a Harvard graduate, Vietnam vet and psychologist who became one of the founders of the first rap groups to help veterans deal with the personal fallout from the war; and Boettcher was a graduate of the U.S. Air Force Academy who served in Vietnam in the press corps.  His book has more than 500 photographers, many never before published, which adds greatly to its interest (it's also very well-written and well-paced, not deadly.) 

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Additionally, we've already blogged about Lori Sekala's great bibliography on PTSD and war in the blog post entitled, "A Good Librarian is a Wonderful Resource," linked here.  (Sekala is the collection management librarian at the U.S. Army War College library).  But here's something we haven't talked about yet -- possibly THE definitive bibliography on books about the Vietnam war, to better understand the experience.  It's linked here.  Enjoy :-)

When Two Are Better Than One: A Relationship That Can Save You

Although at first glance, we should really save ourselves -- not be saved by others -- there's something wrong with looking externally for something that should come ultimately from within -- still, relationships can exert powerful forces for good in our lives.  It's painful reading about the Vietnam veterans, for example, who are "unable to touch intimacy," or who still clearly keep intimate relationships at a distance, because they're afraid of the weight of failure, among other things. 

There's a nice segment of a poem from T.S. Eliot that speaks to this.  Eliot was a famous Modernist poet, from the school that developed around World War I, and while he wasn't sensational about this in his own life -- his first wife, Vivien, to whom the words "My nerves are bad to-night.  Yes, bad.  Stay with me." are attributed in Eliot's famous poem, The Waste Land, is also a woman he institutionalized; still, he is able to write these comforting words, which perhaps he practiced himself, and perhaps did not.  (They could also be about his marriage to his second wife, which was apparently much happier, though shorter-lived.  He was married to her at the time he wrote these lines.)  In any case, they can still serve to inspire us with their truth:

"If a man has one person, just one in his life,
To whom he is willing to confess everything --
And that includes, mind you, not only things criminal,
Not only turpitude, meanness and cowardice,
But also situations which are simply ridiculous,
When he has played the fool (as who has not?) --
Then he loves that person, and his love will save him."

-- T.S. Eliot, The Elder Statesman (1958).

Editor's note: For our ongoing series on "healthy sexuality and the combat veteran," go here.

The Other Purple Heart: For Wives, Husbands and Partners of Those with PTSD

The Bible, in the section known as Proverbs (from the Wisdom Literature tradition), has a stunning description of a woman known as the "Proverbs 31 Woman," or the "wife of noble character."  Here's just one sampling of what she's said to be like: "A wife of noble character who can find? She is worth far more than rubies. Her husband has full confidence in her and lacks nothing of value. She brings him good, not harm, all the days of her life."

From the spiritual to the secular, we have another example of the same in the praise that well-known philanderer Ben Franklin (and yes, that's a man who collects paramours, not stamps -- in his case, on two sides of the Atlantic) heaped on his wife, Deborah, for being the highly-cliched but apparently in their case, true, "wind beneath his wings."  While Franklin became famous for, among other things, his witticisms about wealth in "Poor Richard's Almanac," he often credited his wife and her good habits with being the reason they saved any money at all. (I'll find the reference later, but it's true.)

Well, if you scratch the surface of PTSD and veterans, you quickly find how many of the perhaps less famous (guys get famous) , nonetheless vitally key players, heroes and and true angels, are women.  There's Sarah Haley, who we read about the other day; Kathie Costos; Patience Mason; Aphrodite Matsakis; the list goes on and on.  (We fully expect that Kellee Twiggs was that kind of woman, too; as is Bet Ison; as is the highly-impressive Jennifer Briest, though that's TBI not PTSD.) And now, there's Pat Kemm Mann who we can add to the list.  (Not the same "Pat," whose wonderful insights and recollections into his time at war we've been reading about in the "Eyewitness to Combat" series.)  This lady is one impressive person, in her tremendous caring for her husband who she met and married when he had PTSD, as well as her remarkable smarts and strength of character in being the support he and their subsequent family needed.  Just an amazing woman. 

Not saying she's likely to be the only one out there -- actually, she reminds me very much of Kathie Costos, through whose blog I learned about her story, and secured permission to reprint it here -- but she IS very much worthy of our admiration, and she is also articulate and organized enough to tell her story in a compelling way: a story she's willing to share in the hopes that it helps younger wives and women learn what it takes to "love someone with PTSD" and be a real support to them in the life they build together.  As we read about yesterday in the Tao of Caring for Others, sometimes caring for someone else can be just an expression of who you are.  In Pat's case, that's the story.  Here it is, in her own words, about "loving someone with PTSD":

"At the age of 32, I met a man who wasn’t intimidated by my independence or education. A man who made me laugh, introduced spontaneity into my life and who cherished me. He was a 30 year old Nam vet...and twice divorced. But we shared the same family values and dreams for the future. When he proposed, I told him that I was not going to be his third wife; I would be his LAST wife. I only intended to get married once.

He told me that he had a dark side. I had no idea what he meant. I was to find out within months of our marriage. He was driven at work. Always put in more than was required. Naively, I just assumed he had a strong work ethic. I didn’t realize he was trying to escape demons. He had warned me about nightmares; told me how to wake him so he wouldn’t inadvertently hurt me. As a GI Brat growing up in a family with a strong, military tradition, I didn’t think it that unusual since I had several uncles with the same problem.

3 months after we married, however, his behavior began to change noticeably. He began “self-medicating” with alcohol. And he began seeing things that weren’t there. Hearing people calling him for help. Sometimes hearing a child cry would make him jumpy. The smell of urine would bring flashbacks. He had to sit with his back to the walls in restaurants. Anxiety attacks in crowded places. Sudden noises, like party balloons popping or a car back-firing would make him jump or even “hit the deck”. He would be embarassed and apologetic, telling me it sounded like small arms fire.

I was to learn that he had entered a 6 month period of “anniversary dates”. Not pleasant anniversaries. Anniversaries of the Tet Offensive, of being left for dead under a pile of bodies, of being a VC POW (until he managed to escape), of ambushes, being overrun, of being shot down, wounded and crawling and hiding for 7 days until he reached a friendly LZ. All of them crashing down on him like an avalanche of horror.

One day he came home from work and instead of coming into the kitchen where I was washing baby bottles, he went downstairs to the basement. That was unusual but I didn’t think too much about it. Then suddenly I felt an overwhelming sense of panic. I dropped the baby bottle and ran down the stairs. He was standing under them, in the dark, with a pistol in his hand. He was exhausted and terrified of going to sleep because at least when he was awake, he could see what was happening around him as well as the “film” his mind was playing. But he couldn’t make himself blow his brains out because he didn’t want me to have to live with that image forever burned in my brain.

The term PTSD wasn’t known then, or at least not known by many. But I knew my husband was suffering from “Combat Fatigue”. He didn’t want to believe that. Hell, he was a Hillbilly. A rough, tough coal miner. A combat hardened Marine. A third generation Marine... But one who’d been on Valium (through a civilian doctor) since he finished his second tour of duty.

He ended up starting therapy before our first anniversary. The man I had fallen in love with was slowly disappearing, being overshadowed by an often cold, uncommunicative loner. Sometimes I felt like a Life Guard, hanging on to a drowning man, refusing to let him go under.

But I had an advantage that many of the younger wives of combat vets didn’t have. Growing up on military bases. A brother and friends who’d gone to Vietnam while I was in college. I was 33 years old. And I had enough psych courses under my belt that I was able to "deal" with the nightmares, hallucinations, rages, and suicidal ideations as well as monitor and administer the massive quantities of anti-psychotic medications the VA was doling out... (and to eventually question the efficacy of most). Even so, the pain of seeing him look at me, with total confusion in his eyes - knowing he doesn’t know who I am but thinks he should... the pain and sorrow was indescribable.

His cup of stress was full to the brim from memories alone. Anything at all, no matter how minor, was like that one extra drop that causes the cup to overflow. Every car “accident” - always single car accidents, one near fatal - happened immediately following his 6 months of anniversary dates, when he had reached the limits of his endurance.

At one point, we lived on the Texas coast. Driving to the Houston VA was a challenge. It’s a nice, straight highway but for long stretches, it has rice paddies on both sides. He drove hunched over the steering wheel , knuckles white. Eyes darting constantly left and right. Muttering about damn rice paddies. I knew what he was doing and finally told him “I’ll drive. You watch for Gooks.” After that, I always drove that stretch.

I found myself “interpreting” other people’s actions and comments to my husband so he wouldn’t deck someone who had merely glanced our way but whom he thought was challenging him. He was quick to anger and quick to fight. But he was mostly able to keep his promise not to get in fights after I told him I knew he could take care of himself but no matter how the other guy looked, it hurt me to see him with scraped and swollen knuckles.

It wasn’t easy. And it wasn’t fun. But the man I loved was still in there and I was determined to beat back the demons that were dragging him down. We lost some friends who just saw him as crazy or irrational or scary. I remember once asking “Who are we not friends with this week?” His head kind of jerked, he looked at me for a moment and then he laughed. It stopped another rampage over an imagined insult or slight.

He had no patience at all. If we decided to go somewhere, the girls and I had to be ready to go the second he was. I’d remind him that no one’s life was in jeopardy if we were slower than he wanted. The thing that did the trick, though, was the time I finally took the car keys from him, handed over our two small daughters and told him that this time, HE could get them ready to go. I’D sit in the car and honk the horn.

He started group therapy and we found friends who understood because they were going through the same thing with minor variations. Almost all had done the “geographical tour”, moving from job to job or state to state as they tried to escape what was inside them. Some had used alcohol, prescription drugs or even street drugs to escape the psychological pain. And, like so many of the guys, his previous marriages didn't last simply because he couldn't let himself care that much and did everything he could to protect his fragile emotions from being fully engaged. A lesson he learned too well from losses in combat.

For some reason, he trusted me enough to open up about a few things that happened in Nam - things that clawed and burned in his mind. Which was both a good and a bad thing for him. He knew he had a safety net but letting those painful memories out (those he hadn't completely blocked, anyway) ripped the scabs off some horrendous memories.

Our two daughters were old enough to know that their Daddy was different from most of their friends’ daddies. But our daughters maintain that the thing that helped them understand their dad the most was that I always explained his behavior to them in terms that were age appropriate. One thing I'm especially proud of was when a VA Therapist asked me how I'd managed to raise such normal kids. While they didn't always LIKE him or what he was doing, they always loved him and knew that he loved them in return, even when he would "go bush", miss out on important events in their lives, or self medicate to excess.

And yes... he went to counseling and group therapies. We went through marital counseling and family counseling as well after one particularly rough patch. All of which were extremely helpful only because he was able to get outside his comfort zone, accept the validity of our feelings and make the effort to change certain behaviors.

When his PTSD, appointments and hospitalizations began to interfere with his ability to support his family, we began the torturous process of applying for disability. And we had to do it all over again for Social Security. Writing to every doctor he’d ever seen, every hospital he’d ever been in and trying to locate witnesses who had made it home, up to ten years after the fact.

I had to help him with the VA claim statement. I remember sitting, after the girls were in bed, writing down what he said as he spilled his guts and his pain all over the dining room table. Crying inside because of the horrors he went through and yet not daring to show any emotion on my face because it would have made him stop talking - for fear of upsetting me, disgusting me, or making me think less of him. And then having to sort through the jumble and make complete, intelligible sentences out of it.

I am eternally grateful to the PVA (Paralyzed Veterans of America) service rep who took the 13” thick stack of documents covering 10 years and went to bat for my husband.

In spite of one VA doctor who attempted to keep me out, I sat in on every appointment with my husband after I realized that the doctor didn’t know half of what was going on. This was something I felt very strongly about. I had to play an active role in his treatment. No one knew him better than I did.

The doctor would ask “How have you been since I last saw you?” And my husband would reply “Fine.” Then I’d jump in and tell the doctor what I’d observed. He WASN’T “fine”. And the fact that he couldn’t recognize his actions as irrational proved my point! Reactions that can keep you alive in combat are not always appropriate Stateside. Asking some of these guys how they are is like trying to get a blind person to describe the color yellow.

And I remember the anger I would feel each time a new doctor was assigned to my husband. The dreaded First Three Questions: Have you ever seen anyone killed? Have you ever been in fear of your life? Have you ever killed anyone? Check his records! 3 Purple Hearts. Siver Star. Bronze Star. Presidential Unit Citation. Combat Air Crew Wings with 3 or 4 devices. You don’t get those sitting behind a desk!

We've had our share of difficulties and I've often been asked why or how I stuck it out with him. My answer was always very simple: He's a good, kind, and decent man with serious problems. I wouldn't leave him if he had Cancer; I won't leave him because he's got emotional or mental problems. With close friends, I laugh and say "Because I'm strong, stupid or stubborn. Haven't figured out which yet!"

After almost 30 years, we're still married. Our family is stronger and closer than ever. The grandchildren all love their Pa-Pa and he adores them. Both daughters have chosen careers in medical fields where they can help others and are totally comfortable dealing with what some of their co - workers call "crazy Nam vets". And they're quite vocal in the defense of these guys. I'm proud of them. But then, almost all of our best friends are men (and their families) that we met while they were in the “Nuts and Flakes” wards at various VA Hospitals.

And I'm proud of my Marine, a crew chief and door gunner on med-evac choppers who served two tours (during which he endured being shot down 13 times, left for dead 3 times and 58 days as a POW of the VC). Once, he apologized to me for "being so weak". I told him he was the strongest man I'd ever met and that I would never want to be with a man who saw and went through what he did... without it bothering him.

My husband is worth the effort it’s taken and the rewards are immeasurable. He’s not “well” by any means, and he may never be because serious help came too late. But we have a good marriage filled with humor, love, respect and trust that goes both ways. Even with the problems, that’s still more than many have.

I have hope for our new Walking Wounded. No one questions the reality of PTSD anymore. More help is out there. I just hope that those who need it are informed that it is available... without the stigma my generation had to fight and without the delays that make it less successful.

Pat Kemm Mann
Fruitland Mesa
Crawford, CO 81415

Helping Military Families Cope and Heal from Stressors of Deployment and Combat

(From a press release)

Helping Military Families Help Themselves

For a civilian, it’s hard to fathom the stress a military family faces when a parent or spouse is sent to combat zones. Long and often multiple wartime deployments take a toll not only on the service member on the front lines but on family members back at home. According to recent figures released by the RAND Corporation, one in five veterans of the Iraq and Afghanistan wars may suffer from psychological health problems, which can add the strain on military family members.

Now, a program initiated at the University of California, Los Angeles (UCLA) and supported by the U.S. Navy’s Bureau of Medicine and Surgery is reaching out to military families to help prevent the personal and family problems such stress can bring. Project FOCUS (Families OverComing Under Stress) is now being rolled out to nine military bases across the nation and in Okinawa, Japan.

“There is increasing awareness that military families, especially the children, can be significantly affected when a parent is deployed, and there is even greater psychological wear and tear when there are multiple deployments,” says Patricia Lester, MD, an assistant professor of child and adolescent psychiatry at UCLA and the director of the FOCUS program. “The spouse left behind is suddenly thrust into the role of being a single parent; routines are interrupted; the children may not understand where their mom or dad has gone; and the service member on the front lines is constantly worried about how their family is doing back home.”