Healing Combat Trauma

Unlikely Bedfellows: Sun Tzu and George Washington on How to Treat Veterans

It's remarkable that through the ages these two leaders and military strategists yet had expressed such a similar thought about the heart behind how to care for veterans. See if you don't agree:

"Regard your soldiers as your children, and they will follow you into the deepest valleys. Look on them as your own beloved sons, and they will stand by you even unto death!" -- Sun Tzu, from his martial classic, "The Art of War"

- and -

"The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive veterans of early wars were treated and appreciated by our nation." -- George Washington.

Editor's note: Chaplain Kathie Costos, familiar to many as "Nam Guardian Angel," and a true source of wisdom and compassion at her site, Wounded Times and beyond, uses the George Washington line as her email signature, an ever-present reminder of the importance of doing just that.

Quotable Quotes -- Carl Jung on Consciousness and Pain

"There is no coming to consciousness except through pain." -- Carl Jung, Swiss psychotherapist.

(With thanks to Kayla Williams, author of "Love My Rifle More Than You," for a great quote...)

Quotable Quotes -- Dwight D. Eisenhower on Inner and Outer Peace

"There can never be peace between nations until there is first known that true peace which is within the souls of men." -- U.S. president and five star Army general Dwight D. Eisenhower.

Quotable Quotes -- Helen Keller on Overcoming Suffering

"Although the world is full of suffering, it is full also of the overcoming of it." -- Helen Keller

Quotable Quotes -- e.e. cummings on Unbracketing Death

In honor of April being "National Poetry Month," a wonderful excerpt from American poet e.e. cummings (1894-1962) about the continuity of life beyond life. Cummings was no stranger to war and its aftermath: he's one of several famous writers and poets who served as ambulance drivers, in his case, in World War I. This snippet of his poem, "since feeling is first," (Cummings was a big fan of unusual capitalization and punctuation) neatly conveys the impact of a life that goes on past its close, in the memory of the survivors left behind. In the right context, these words offer some small comfort, whether you're thinking about your own legacy, or remembering those you love who've gone before you:

"For life's not a paragraph And death I think is no parenthesis."

Quotable Quotes -- Hippocrates on Healing

"Healing is a matter of time, but is sometimes also a matter of opportunity." -- Hippocrates, the father of Western medicine. (460-377 B.C.E.)

Martin Luther King Jr Had a Dream for Combat Veterans, Too

Martin Luther King Jr., from a speech delivered exactly one year before he was assassinated in Memphis, Tenn.:

"This business of burning human beings with napalm, of filling our nation's homes with orphans and widows, of injecting poisonous drugs of hate into veins of peoples normally humane, of sending men home from dark and bloody battlefields physically handicapped and psychologically deranged, cannot be reconciled with wisdom, justice and love." -- Martin Luther King Jr, speech at Riverside Church in New York City, April 4, 1967. 

Editor's note: A link to the online text and audio of his full speech is here.

"Not Victims, but Veterans": Max Cleland Writes an Open Letter to Other Combat Veterans

Max Cleland, decorated Vietnam war hero, triple amputee, head of the Department of Veterans Affairs under President Carter, and PTSD sufferer, who came to that knowledge in later life, decades after his military service, has written a new book, called Heart of a Patriot: How I Found the Courage to Survive Vietnam, Walter Reed and Karl Rove.

There was an interview with Cleland on NPR's Morning Edition yesterday, October 6, 2009, linked here.

But most interesting for our purposes -- since this blog is about combat veterans and PTSD -- is the "open letter" to other veterans that Cleland writes, and which is excerpted as part of the NPR piece.

"As combat veterans," he writes, "we have been through some of the most traumatic life experiences possible. War is as close to hell on earth as anything ever could be. That does make us different from our loved ones back home. War marks us all, some more deeply than others."

There's some wonderful, heart-felt expression in this letter:

"The soldier's lot is to be exposed to traumatic, life-threatening events — happenings that take us to places no bodies, minds, or souls should ever visit. It is a journey to the dark places of life — terror, fear, pain, death, wounding, loss, grief, despair, and hopelessness. We have been traumatized physically, mentally, emotionally, and spiritually. Some of us cope with exposure to hell better than others. Some are able to think of their combat experiences as but unpleasant vignettes in a long and wonderful life. It is not to those veterans I am speaking. I love them, but I am not afraid for them.

I am speaking to the rest of my brothers and sisters, those who find themselves trapped in the misery of memories as I was for so long. For them, I am afraid.To those veterans I say, you are not alone.

Many of us have been overwhelmed by war. Many of us have been unable to cope on our own with what has happened to us or with what we have done. Many of us have been left hopeless, lost, and confused about ourselves and our lives in ways we never thought possible.

That does not make us victims. It makes us veterans."

The rest of the open letter is equally wonderful, and well worth reading. In it, Cleland talks about his own personal highs and lows, what he understands about PTSD and his own case, and what has helped him get through. It's clear the concern and caring he feels for other combat vets. The letter is linked here.

"Ding, Ding" -- Pavlov's Comment on PTSD

Famous Russian scientist (physician and psychiatrist) and Nobel Prize winner Ivan Pavlov -- famous for his experiments with ringing bells, feeding time and dogs that evoked the characteristic "Pavlovian response" -- also had some things to say about PTSD.  Bessel van der Kolk, M.D., a Harvard-trained psychiatrist, writing in his scientific paper, "The Body Keeps the Score: Memory and the Evolving Psychobiology of Post Traumatic Stress," mentions that Pavlov thought that "individual differences in temperament account for the diversity of long-term adaptations to trauma."  Interesting!

Editor's Note: The item van der Kolk appears to be citing is Pavlov IP.  Edited and translated by GV Anrep.  "Conditioned reflexes: An investigation of the physiological activity of the cerebral cortex."  New York: Dover Publications (1926).

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.