Healing Combat Trauma

The Pain of Injury - "Weakness Leaving the Body," or Outrageous Endurance Contest Few Can Win?

I've known enough Marines to know they all love that saying, "Pain is just weakness leaving the body," or something like that.

Personally, that just sounds like something a particularly sadistic high school gym teacher or coach might have thought up, to help his students puking in the bushes after a particularly hard race or fight, to "reframe" what had really happened, so he wouldn't lose them on the team when they suddenly wanted to run away and quit. 

I don't have any real expertise in the area, but my gut-level sense is, that's just a quote; not a truth.  And a sufficiently-inspiring "quote," that those who hear it can hold onto their status among other people who learn to handle pretty outrageous amounts of pain, all in the guise of being warriors.  (And the congregation said, "OoRah.")

Here's how Pat, our Marine from Vietnam who we've been excerpting material from in the "Eyewitness to Combat" series, and who was seriously wounded in combat, described his own experience with that.  See if you "read" it as "weakness leaving the body," or else, as I do, as tremendous courage that someone could endure that level of outrage/assault and not lose their mind.  If it still isn't shocking/impressive enough, maybe additionally picture that this is happening to someone still in his teens at the time, and functionally cut off from all possible love, support and comfort -- except his other warriors, and, erm, supposedly the hospital staff -- but they're seeming none too warm and fuzzy:

"When I was shot in the arm and leg they were both "through 'n through wounds": meaning they went completely through the limbs.  I also had a head wound and therefore could not (would not) have any anesthesia or pain medications to reduce the intense, awful pain. 

Each morning they would roll me into the cleaning room, put me onto a stainless steel table completely naked (no one had any clothes on except the bandages and a blanket in this field hospital -- a MASH unit in the Army).  The corpsman would then take a stiff brush and dip it into iodine and run it through each wound to the other side to scrub out all dead and infected flesh.  I would pass out from the pain. 

On the first time, I started to cry, tears rolling down my cheek, and looked over to my side.  There was another Marine about my age who almost had no flesh on one side of him.  They were doing the same procedure on him and he just stared up and let the tears flow.  He made no sound, no quiver, just laid there and stared at the ceiling.  After that, I got calm and did the same from there on out. 

I remember a general coming through the cleaning area on one of the occasions and the head of the medical doctors present, probably a colonel, was explaining how each of us "felt no pain" while this was going on, the general was pleased: BullFuckingShit.  But we were MARINES.  "Take pain and embrace it and make it your friend" kind of shit thing.  Oh well, it gave me a perspective of how much physical pain I could endure and I have actually had to endure it several times since leaving Nam.  It never bothered me after that because I knew I could "hack it".  I did and I have..."

Really, what is even possible to add to that?  Just about nothing, except certain and really involuntary respect for what it took to undergo that, and not just shatter into a million pieces, like the shards of a mirror.  "Courage": the dictionary defines it as, "The quality of mind enabling one to face danger or hardship resolutely."  I think that's what we have here, multiplied by every combat veteran who ever endured it, but maybe didn't have the ability of Pat to describe it for you, so you could if not relate, at least possibly understand and respect or admire it for what it is.

Is Pain Really the Enemy? The Tradeoff between Suffering and Awareness

We're starting to look at a very important topic to veterans (and their families): managing acute and chronic pain with PTSD.

Earlier today, I ran across some interesting thoughts in a book about the ancient Eastern healing art, Qi Gong (there are multiple spellings, including Chi Kung and other variants.)  I include it here for several reasons: One, it helps us to look a pain in a new way -- in terms of the encoded lessons it may have to teach us.  Second, it sets up the balance between pain and awareness, and how awareness without the ability to address a particular condition might be more difficult than the pain itself.  Third, it reinforces what Claude Anshin Thomas, a decorated Vietnam vet and now Buddhist monk, said about how it's not really our suffering that's the enemy, anyhow.  Fourth, it suggests there is definitely a "payoff" to the body for not addressing physical pain until we are ready, which probably perpetuates the state of chronic pain. And finally, this passage lists a number of beneficial conditions to have in place before healing can be addressed. 

It's nice to see these spelled out, and it may help you to just see them in print.  There's an old faux-Asian saying about, "When the Student is Ready, the Teacher Appears" -- and if there's any truth to that, it just might be, that nobody's really ready to address their own healing, no matter how badly they might want it, until they have some key supportive conditions in place first -- to make the journey somehow softer and better.  We need all of that we can get.  Here's the passage, and I'm going to go ahead and highlight some of what stood out to me when I read it, including those supportive conditions. 

In my opinion, we hold onto toxicity mainly for protection.  It is an automatic response from ourselves comparable to muscular armoring.  Muscular armoring is an involuntary contraction caused by emotional charges.  These contractions allow one to mobilize the body's stress response, bringing up involuntary avoidance reactions before any emotion can be felt.  In the same way, there is a strong tendency to accumulate toxicity: we hold onto it because there is only so much that we can allow ourselves to feel, given our mental state, level of emotional maturity, and our support system.  Accumulating toxicity, along with muscular armoring, is a strategy of protecting oneself from getting emotionally hurt.

Feelings compel us to react and process, but if for some reason (lack of energy, maturity, safety, or a weak support system), we can't afford to let ourselves feel something, then the unprocessed issue has to be stored until we can afford it.  This is the reason why we "forget" about childhood traumas and other overwhelming stressful situations in our lives.  The body does not forget: it just makes the choice not to remember.  The information is still there,  held in different areas, in different ways in our bodies, protected by tension and the accumulation of toxicity.  A part of our self is in charge of making sure that an emotional charge is not accessible unless an opportunity presents itself to access it safely enough.

Elsewhere the same author writes, somewhat repetitively but with some new emphasis:

The Price of Awareness:

The power that keeps us unaware of tensions in our bodies and the underlying emotional charges is our mind.  It tries to protect us from getting in touch with places that don’t feel so good.  It will not let us feel anything that might make us remember a traumatic experience too hard to handle.  Our minds help us organize ourselves to avoid bumping into painful spots, facing them, or touching them when we don’t have sufficient energy, maturity, or an adequate support system.  We avoid any movement in these areas of our bodies, which includes not allowing movement of the breath.

 

Our bodies hold patterns of tension, or involuntary contraction, which generally reflect emotional charges coming from unprocessed states of feelings.  That’s how we are recognized as angry of scared, enthusiastic, joyful, worried, and sad; how we hold our bides reveals our feelings.  After many repetitions of the same kind of emotion, if they are not processed, the patterns of tension become familiar, and we are unable to remember how it feels to be free of these tensions.  We experience a numbing that paradoxically expresses very clearly to others what we generally don’t want to admit to ourselves. It becomes a posture, an attitude that typifies and characterizes our personality.

 

Awareness is information and, as we very well know in the Western world, information is the most expensive item you can find.  There is a good reason why we don’t let ourselves be aware of certain things: awareness has a price and we need to be able to afford it.

 

So part of it, even if it’s an unconscious part, is always thinking about how much awareness will cost.  We have a financial adviser and bookkeeper hiding within us.  The bookkeeper within holds us back when we are about to invest ourselves in something we can’t afford in terms of some vital force, support system, and emotional maturity.  But without some kind of inner protective mechanism no healing process would be possible, and the human mortality rate would be much higher.  The art of the practitioner is to recognize that this bookkeeper, keeper of the door to our feelings, protects us from being asked to pay more than we can afford.  It is an ally in the process of healing.  Recognizing its role, giving it credit, and making that guardian feel safe will let [people] become more in touch with parts of themselves they have had to hide.

 

Source: Healing from Within With Chi Nei Tsang: Applied Chi Kung in Internal Organs Treatment, by Gilles Marin.  Berkeley, CA: North Atlantic Books (1999). 

(To learn more about Chi Nei Tsang, or to find a practitioner in your area, go to the main website, linked here.)

(To be continued...)

Jagged Little Pill: Pain, Chronic Pain, Pain Control, Pain Management and PTSD

I feel like I'm a little late to the party on this one, because I'm not clear yet why chronic and/or excruciating chronic pain would be a hallmark of PTSD, but according to the veterans I know, it's one of the most difficult conditions they face.  So, obviously, one worth discussing and learning more about.

The VA's site has some information about chronic pain and PTSD linked here, but it seems like fairly generic information, and not much of it is related to combat trauma specifically.  So I guess we need to "tie a string" around this topic and come back to it, when we learn more.  My guess is there's something about "adrenaline gone wild" in combat that sears these graphic memories into the body as a form of pain, and then the pain gets "refreshed" whenever the adrenaline gets refreshed.  Obviously, this is pretty rudimentary (and possibly even, completely wrong...) but, stranger things have happened; and I've personally heard odder things from medical specialists who later just threw in the towel on things that weren't as obvious as they seemed at first.

Certainly there are landmark books in the Mind-Body Medicine spectrum of approaches, such as the "The MindBody Prescription: Healing the Body, Healing the Pain," by John Sarno, M.D., (recommended by Andrew Weil, M.D.); and "Wherever You Go, There You Are: Mindfulness Meditations in Everyday Life," and other books written by Jon Kabat-Zinn, Ph.D., that address mindfulness meditation as a coping strategy for chronic pain (whether physiological or psychological in origin.) (Patience Mason's husband, Vietnam veteran Robert Mason, the author of Chickenhawk, apparently thinks Zinn's work is great.)  And there are other forms of "energetic medicine" (e.g., acupuncture, in particular) are good at lessening the experience of pain so that it can be managed, sometimes also reducing the source. 

And on the topic of is pain really the enemy, or is it more likely actually part of us -- there's almost nothing better than the Claude Anshin Thomas quote, excerpted from his book, At Hell's Gate: A Soldier's Journey from War to Peace, that we blogged about back in March of 2006.  If you're not familiar with what he said, go here and read that entry.  His perspective is sensational, and as often-wounded Vietnam veteran, his experience counts on this matter.

So it will be interesting, over time, to see where this goes, and take a look at "different strategies that might work" for pain control and pain management.  All I know for sure, from the veterans I've talked to, is that it's a MUST to cover, because it's a crucial, nonstop, searing reality of their lives.  And that's nothing to take lightly.