Healing Combat Trauma

Quotable Quotes -- Former U.S. Senator Bill Bradley on PTSD

Former U.S. senator Bill Bradley (D-NJ), NBA Hall of Famer, and Rhodes Scholar, had this to say in a commentary published in Vanity Fair today about PTSD. The occasion was the premiere of the Tom Hanks/Steven Spielberg/HBO miniseries, "The Pacific," about U.S. Marines in the Pacific during World War II, also getting screened privately at the White House today.

Bradley thinks there are several things that the president and the first lady should be thinking about while they watch the miniseries. One of those topics is PTSD. Says Bradley:

"Both The Pacific and Band of Brothers focus on the horrors of the war and the emotional trauma that a soldier or Marine can endure. P.T.S.D. should be treated with as much seriousness as a gunshot wound. If the president is going to send tens of thousands more troops [into combat], he also needs to consider the emotional payload. With suicide rates up among veterans -- accounting for 20 percent* of all suicides among Americans -- the government must dedicate more money to support programs for our returning troops."

Editor's note: If 8,000 veterans kill themselves every year, conservatively, and the national suicide rate is close to 34,000, according to the NIMH, the percentage of suicides who are veterans is closer to *25%. They also represent almost 50% of the homeless population. So yes, please, let's do that...and sooner rather than later...

(The full commentary is linked here.)

Shneidman and Camus -- Suicide as "the Fundamental Question" of Philosophy

"Suicide is up in the military once again, and it's also up among veterans -- those who have been deployed previously. While "National Mental Health Awareness Month" may still be a few months off -- in May -- but it's interesting to note what existential philosopher Albert Camus wrote in his book, "The Myth of Sisyphus":

"There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy."

And also humanity, we might add...because it figures in there, too.

Dr. Edwin Shneidman, the compassionate genius considered the "father" of suicidology, who sadly passed away a few months ago, wrote about how suicide is a narrowing of the distressed person's field of vision, until they can see only two options: staying or going. Without broadening the options to three or more, the way that healthier people think, a distressed person may vacillate between these two options until the pressure in their life mounts, and they can only "see" the one option, and their timing suddenly becomes a desperate "now."

(Clearly, suicide is an event with much collateral damage, particularly to those around the person in pain, who can have an understandably extraordinarily difficult time coming to terms with how or why that decision was made. Read Shneidman; he understands. In one poignant passage, quoted here, he describes the mind of the suicidal person closing down in restricted vision until, not that the victim doesn't care, that he or she can no longer see who else is in the picture, so great is their personal pain.)

While there's much material on this website about suicide, particularly here -- and also help numbers to call if you're in distress, linked here -- I mention the Camus quote to give a certain backhanded respect to the topic as a whole. Many times people claim, rightly or wrongly, that suicide is the quintessentially weak move, "the coward's way out," reserved for those who can't, or won't, face their problems, others say judgmentally or even sometimes accurately. Yet for those who are suffering greatly, and contemplate it periodically -- as many honestly do -- it's "nice" to see someone with real cultural weight give the question some credence or respectability as a topic. To paraphrase Shakespeare, "to stay or not to stay" may turn out to be the real question, after all...

What the Camus quote implies is that even robustly mentally healthy people, if they're philosophically inclined, have dwelt on or wrestled with at least the abstract reality of the question. (Ironically,  Shneidman's obituary in the L.A. Times, linked here, mentions the same quote, and that Shneidman was a fan of Camus.) If we combine their perspectives imaginatively, true mental health might mean wrestling with the topic conceptually, but then enlarging the field of choices so that it doesn't have to become an option that is used. Could open discussions arise from removing the stigma around even broaching or discussing the topic? More on that later...

Editor's note: Cribbed directly from my friend Kathie Costos' blog, Wounded Times, here are the phone numbers and the information for veterans questioning suicide -- some of which support family members as well:

• Vietnam Veterans of America, Crisis Phone Number. Special Notice: If you are a veteran in emotional crisis and need help RIGHT NOW, call this toll-free number 1-800-273-8255, available 24/7, and tell them you are a veteran. All calls are confidential. http://www.vva.org/.
• Also, Veterans’ Crisis Intervention Hotline: 1-888-899-9377. A Crisis Intervention Hotline has been established by the VA Heartland Network to assist veterans who may be dealing with a mental health crisis or difficult issue in their lives. The hotline will also aid family members or friends of veterans who need help in assisting a veteran in crisis.

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.

Picking up the Pieces of Shattered Lives: Treatment or Prison

The other day was a momentous day in the life of two different combat vets. One, an older warrior, Marine, from the Vietnam war, the other, an Army vet, from the war in Iraq. Each of them wounded in combat.  Each of them knowing  intimately the sufferings of PTSD. Each of them having failed, at various times, sometimes spectacularly, other times less so, at "keeping it together" or being the person they wanted to be, for themselves, their employers or their families, because of their PTSD.

Yet what brought the two together this day was the one taking the other to an inpatient PTSD program at the VA; the older bringing the younger to a program he’d gone through himself, years ago; and one vet to another, the Vietnam vet to the Iraq war vet, encouraging him to pay attention, and to begin the process of change.

 Nobody goes to an inpatient program because they're doing so astoundingly well with their life or with their PTSD symptoms. Sometimes it's a diversionary program offered in the place of jail, which is why the Iraq vet this week was going. Drinking heavily, he'd been arrested for domestic violence, and the older vet stood up for him in court, but requested that the judge send him to treatment, in lieu of further jail time. This time, the Iraq vet was "lucky." There was room for him in the program. Many other Iraq and Afghanistan war vets -- Gulf war vets -- Vietnam vets -- have not been so lucky. They end up with extensive prison sentences for being in the wrong place at the wrong time, and getting arrested when their finely-tuned combat-trained hair-trigger reactions are out of sync with civilian life.

Talking with some young Iraq and Afghanistan combat vets a few months ago, guys who were residents in another cutting-edge residential treatment program for PTSD, they told similar stories, of having been given the chance to do the inpatient program after being arrested for something they did, fully inappropriate for the civilian world, when they first returned from combat. One guy told a story of going with his wife and kids to Walmart, and having her touch him from behind, which startled him, and as he told the story, when he "came to," he had his hands around his wife's neck, choking her. An inpatient PTSD program seemed like a better choice than jail. And for what it's worth, it did sound like he was sorry, and it also sounded like his wife was still with him -- but, everyone involved acknowledged that he needed treatment, including him.

It's reasonable to ask, how do we know whether inpatient programs do much good for the combat veterans with PTSD who go through them? We'll have to wait and hear from the graduates, but also, watch their lives, so to speak, for years afterwards, and see how things really turn out.

The older combat vet, the Marine, who took the younger vet to the program the other day, recalls that from the graduating class of his own program, most today are dead: many took their own lives, despite what they'd learned in the program. At most, he credits the time in his own life with learning to recognize what many of the danger signals of PTSD are, the "red flags" that a situation is escalating. At this remove, he considers what he learned to be "behavior management" -- learning coping skills for managing a disorder that nobody really expected to be healed or cured, at least through conventional means. Hmmmn.

In other parts of the country, veterans are doing jail time for similar offenses, even some seemingly more light-weight. Whether a veteran goes to a treatment program or to jail seems at this point to be mostly the luck of the draw. There’s also some concern, among veterans advocates and others, that the way police arrest combat vets with PTSD can further escalate the vets’ reactions. Many first responders are military veterans themselves, sometimes with their own cases of PTSD – from combat or the job. Training is needed so that arresting a combat veteran in the throes of a PTSD-fueled reaction can go as smoothly as possible, with as little collateral damage as possible. Additionally, when combat veterans with PTSD are arrested and imprisoned, they lose their VA benefits – and are often left completely untreated. This only compounds the problem/tragedy further.

Jamie Keyes daily endures the struggle of knowing that her son, Nathan, jailed for a PTSD-fueled reaction, might have benefited from treatment, but instead is doing time. A highlight of her Christmas vacation was driving to another state, where he is jailed, to spend a few short hours with him. She worries what incarceration will do to her son, and even to her elderly father, who raised Nathan as a boy, and is heartbroken to know that he’s in jail.

The story of what happened to Nathan Keyes is here – but if you want to see a mother’s perspective even more strongly, watch the video she made about Nathan, here, before his trial.

Jamie Keyes writes, 

“This is a tribute to my son, Nathan Keyes, who is a veteran with PTSD. Nathan spent 8 years in the Army and two long tours in Iraq, before returning home bearing the mental wounds of war. Nathan is now incarcerated for an act resulting from his PTSD, and will spend three years in prison. The state of Florida wanted to give him more than 15 years for his offense, instead of giving him treatment. Instead he took a plea deal that will leave him with a felony record for the rest of his life and 3 years in prison without treatment. Nathan sought help from the VA but never got adequate treatment, and was subsequently failed by our criminal justice system. This is how we treat the returning veterans in this country. This type of incident is happening in epidemic proportions all over this country, and it is a dishonor to those who so selflessly served their country.”

Treating combat veterans with PTSD who commit crimes in inpatient PTSD programs “sounds” a lot better, on the surface, than jail time – definitely. Questions still remain about how effective the inpatient treatment programs are, but it’s obvious that they’re preferable to jail – which takes away the opportunity for treatment, and further harms the veteran, on several levels. However – it’s also necessary that first responders learn how to arrest combat veterans with PTSD who may be in the middle of a PTSD episode when they’re arrested. No one knows right now how many police departments across the U.S. even recognize this is an issue to be addressed. Ideally, before too long, all first responders will be trained to recognize the signs and symptoms of PTSD and how to deal with combat veterans when they have to arrest them. Averting forseeable tragedies is always a worthy goal.

Holiday Gift: Rudy Reyes' Hero Living

If you're stumped for a holiday gift this year, think about the new inspirational book by Rudy Reyes, called "Hero Living: Seven Strides to Awaken Your Infinite Power," linked here.

Rudy Reyes is an inspirational "everyman" -- former Marine 1st recon, star of Generation Kill, who grew up admittedly hard and has honed, ever since, a set of internal values modeled on attributes of classical warriors. While Reyes, a former world martial arts champion, has honed his body to a superlative degree, it's his inside that's even more interesting -- how he's dealt with, and is still in the process of dealing with -- assaults on his soul, from childhood through combat.

Reyes has much in common with his childhood hero, Bruce Lee, from the unparalleled attention to fitness, to the equal attraction to the philosophical underpinnings of what success really is.

There's something for everyone in this book, and best of all, it reflects someone who's inspirational, yes, in his attitudes towards obstacles -- systematically conquering them all, in a focused way, one after another -- but is also, even by his own admission, very much "still a work in progress." Go, Rudy!

Editor's Note: For a recent article in "Military Times" about Rudy Reyes, entitled "The Hero Life: For Rudy Reyes, Inspiring Others is a Full-Time Job," click here.

43,000 Troops Found "Unfit to Serve": Non-Deployable but Sent Anyway?!

Several weeks ago I watched a wonderful Bill Moyers interview on PBS with Oliver Stone, noted filmmaker and Vietnam veteran. The whole interview was great, but a figure Moyers used at the beginning was just stunning -- for the implications it has for soldiers with PTSD and their families.

Moyers said:

"...I read a report based on military records which revealed that from 2003 to 2008 some 43,000 troops had been sent to Iraq and Afghanistan despite having been classified as "non-deployable" for medical reasons. In plain English, they weren't healthy enough to go, but were sent, anyway."

Yowser. It's hard to imagine a circumstance in which being considered unfit to serve for medical reasons, and being deployed anyway, improves your situation. It sounds like all it would do is reinforce the difficulties you were already having, or pile more trauma on top of the pre-existing trauma.

Additionally, troops who have fought in Iraq, when they're deployed next to Afghanistan, find that to be a completely different experience. So Afghanistan for them isn't "more of the same," it's new and different, with all the challenges that implies.

(See news report from November 29, 2009, entitled "Afghanistan, Iraq: Different Wars -- U.S. Soldiers: Afghanistan War Dramatically More Difficult, Challenging Than Iraq," linked here.)

Editor's Note: For the link to Bill Moyer's Journal and his excellent interview with Oliver Stone, shown on December 4, 2009, click here.)

Transforming an Addiction to ... Guilt, Suffering and Blame

Although it's been ten years since the book first came out, I've recently been reading "The Four Agreements: A Toltec Wisdom Book," by Don Miguel Ruiz. It's dynamic and interesting, and in places, he touches quite a bit on suffering and what he sees as our unfortunate lifelong addiction to it.

Because combat veterans and PTSD is what's frequently on my mind, it was hard to read what he wrote and not draw some parallels with our current topic. At the risk of minimizing the severity of what PTSD actually is, I still think it's instructive to consider what Ruiz says about suffering in general, and question ourselves about whether any of it applies. It's a short book, but much longer than I can do justice to here (so be sure to read it), but what I'm going to do is excerpt several passages that will at least introduce some key concepts. Also, the usual disclaimers. Ruiz is a philosopher, not a psychotherapist. That said, his insights are interesting, novel, and potentially also fairly valid. It's always worth turning over a concept that plagues us to see if there are any new ways of looking at it. That's what I hope talking about Ruiz' book here on this blog might do.

Early on in the book, Ruiz mentions the in-justice of having to pay, in our minds, many times over for the same "mistake" or bad act, and how different it would be if we could act badly once, suffer guilt once, and be done with it. It's not the case, though, and he describes it:

“How many times do we pay for one mistake? The answer is, thousands of times. The human is the only animal on earth that pays a thousand times for the same mistake. The rest of the animals pay once for every mistake that they make. But not us. We have a powerful memory. We make a mistake, we find ourselves guilty, and we punish ourselves. If justice exists, then that was enough; we don’t need to do it again. But every time we remember, we judge ourselves again, and again, and again.  If we have a wife or husband he or she also reminds us of the mistake, so we can judge ourselves again, and find ourselves guilty again. Is this fair?”

The problem with this is not only the lack of balance, but also what Ruiz emphasizes is the "emotional poison" that affects us:

“How many times do we make our spouse, our children, or our parents pay for the same mistake? Every time that we remember the mistake, we blame them again and send them all the emotional poison we feel at the injustice, and then we make them pay again for the same mistake. Is that justice? The Judge in the mind is wrong because the belief system, the Book of Law, is wrong. The whole dream is based on false law. Ninety-five percent of the beliefs we have stored in our minds are nothing but lies, and we suffer because we believe all these lies.”

A conversation I had earlier this year with the head of trauma research for the National Institute of Mental Health still stands out in my mind, regarding what he said about blame: that those who blame others, or themselves, are the slowest to heal from tragedy and trauma. The fact of affixing blame, and not being able to move past it, apparently becomes an obstacle. We certainly know people (you and I both do) and sometimes we are people who are fixated on and obsessed with actions in the past. We may even be in a cycle of constantly churning over past events, constantly recycling and reliving them in our minds, always seeking a possibly different ending -- and perhaps this invades our sleep, not only our awake lives. The constant churn with no possible solution is exhausting, and it's numbing. It's also hard to break. But it's also important to break, because without it, there's no moving on.

Back to Ruiz:

“From the point of view of the Victim we can say that something sad happened to us, and from the point of view of the warrior, we can say that what happened to us is normal.”

And why that could be vitally important:

 “Letting go of the past means you can enjoy the dream that is happening to you right now.”

Ahhh.

And then, most to our point (intention) here on this blog, what I hope we're all about:

“Awareness is always the first step because if you are not aware, there is nothing you can change. If you are not aware that your mind is full of wounds and emotional poison, you cannot begin to clean and heal the wounds and you will continue to suffer.”

“There is no reason to suffer. With awareness you can rebel and say, ‘This is enough!’ You can look for a way to heal and transform your personal dream.”

The Four Agreements: A Toltec Wisdom Book. A small book with some insightful philosophical thoughts that just might start us on the path -- or lead us closer to -- personal transformation for dealing with suffering, loss and guilt.

"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.

After Combat: Too Much Time on My Hands, Missing the Action

Among the many first-person narratives to come out of the wars in Iraq and Afghanistan, a few start to address their growing awareness that they came back from the war with symptoms of PTSD. The recent warriors, now writers are just beginning to come to terms with the their experience, and both figuring it out and giving it effective voice is a difficult task that may get somewhat easier to accomplish in the years ahead. It's remarkable and positive to see the shortened cycle time in play as these warriors realize they may have PTSD, and it's also educational to hear how they describe what their concerns are, and what their adjustment has been like.

In former Marine sergeant Clint Van Winkle's recently published autobiographical work, "Soft Spots," he talks in one section about the experience so common to warriors -- that back in the "safety" (and boredom) of civilian life, they both have more time on their hands to think and revisit the past; and also an increasing sense that they miss tremendously the amped-up experience of war and their buddies -- the living and the dead.

Van Winkle, a Marine sergeant who first went to war on Valentines Day, 2003 was, according to the book jacket, "among the first wave of troops that crossed into Iraq, and his first combat experience was the battle of Nasiriyah, followed by patrols throughout the country, house-to-house searches, and operations in the dangerous Baghdad slums."

Here's how Van Winkle describes this collection of feelings and impressions, in an extended passage we've cut and spliced together somewhat for easier reading. The phrases in bold for emphasis are ones you hear again and again from combat veterans, in one form or another. With love and appreciation for the recent combat vets who are still processing these issues, and may be for years to come, here's what Van Winkle had to say about his own struggles to re-adjust:

“In war, no one asks you if you killed anyone.  You don’t have to say anything after a firefight.  You just come back and sit around with your fellow Marines. All you have to do is nod and they know. The questions are answered because you were there together.  They know and you know.  Nobody asked why one of us shot into that window or why the unit in front of us ripped into that bus or why I shop the group of men hiding behind that wall.  Everything was understood.

Maybe it wasn’t the war itself but the people who were in the war with me that I missed. Perhaps all I really wanted was to know it was all right and worth it and that my actions were justified.  I wanted to be back in the company of others who understood what it’s like to pull the trigger.  Wanted to get away from the questions and the made-up answers – to get back to a place where I felt normal again.

...

Names of the war dead for the week scrolled across the bottom of the big-screen television. … No matter how many times I saw the different list of dead troops, I never got used to it or the feeling that maybe I should have been included.  I wasn’t familiar with any of the names, but that hardly meant anything to me.  I didn’t have to know the dead personally to know what kind of stuff they had participated in.  I mourned each as if he had been a personal friend, and the grief took a toll on me.

...

I had too much time on my hands.Even though I was taking classes…I was bored – like being stuck in Kuwait without anything to do.  It was easy to understand why Gunny always had us doing something…. He must have known that boredom brings problems, allows too much time to think….

In some messed-up way, being home produced withdrawal symptoms. I’d experienced the most exciting events of my life. Nothing could ever compare to the feelings war induced.  Nothing. I’d never get the same adrenaline rush or create the kinds of bonds we Marines had with each other.  Civilian life was dull compared to what I’d done.

...

But I wasn’t being unappreciative. If anything, the war had made me appreciate life more, helped me see what was important. It was just hard to express that appreciation when all I could think about was Iraq.  There was no escaping it.  Iraq was everywhere.

...

True, it was over.  But in some respects the war had become more real than it had been while I was in Iraq.  There wasn’t much time for reflection while we were in country. I never stopped to think about what it all meant, or really even cared.  It wasn’t until I got home and started to talk to the dead, revisiting the war, that anything started to sink in. Was it worth it? I don’t know. That’s up to the dead to decide.

When I’m an old man and all the dreams and sights have left my head, when the memories are stolen from me, then historians will tell us whether it was worth it or not – if the war really helped anybody.  Until then, I’ll live with the dead.  We’ll carpool together.  Do lunch and late-night snacks.  Slumber parties and drinking binges.  It really won’t matter what anyone says, or if the whole stinking operation finally gets labeled a “good war.” It was too late for me. The dead and I were together.

From the book jacket:

Clint van Winkle, Soft Spots: A Marine's Memoir of Combat and Post-Traumatic Stress Disorder. Winkle was a sergeant in the U.S. Marine Corps. While in Iraq he served as an Amphibious Assault Vehicle section leader attached to Lima Company 3rd Bn 1st Marines. After completing his enlistment, he earned a B.A. in English, and then a Master's in Creative and Media Writing.

Editor's note: The illustration for this post is a wonderful drawing by Marine combat artist Michael D. Fay, of Lance Corporal Nicholas G. Ciccone, who suffered from PTSD and later sadly took his own life.

Cast Adrift by Trauma in the Center of Your Own Universe...

I've been reading Belleruth Naparstek's book, "Invisible Heroes: Survivors of Trauma and How They Heal," and she makes an excellent point both about the safety and normalcy we unconsciously come to expect from life, and then the terrible way in which we find ourselves suddenly cut adrift from those same moorings through tragedy and trauma.

After first describing how the human toddler first takes sheer delight in realizing they are the center of their world and can "make things happen" -- by knocking over piles of blocks in play, again and again, or shouting and laughing at the sound of his or her own voice -- she the contrasts this with the sheer helplessness people feel because of a trauma-causing incident. Sagely, she describes the point:

"And because it is built into our human hard-wiring to love ourselves for being able to make things happen, the converse is also true: we lose self-regard when bad things happen that are beyond our control.  The essential insult of trauma is the helplessness it generates, and the inadequacy and powerlessness we feel in its grip.

Rational or not, we can't help but feel it's a reflection on our worthiness that, when confronted with a terrifying and terrible event, we didn't prevent it, escape it, or fix it.  So we somehow lose value to ourselves and, at a level we may not even be aware of, we feel guilty and ashamed."

This is a powerful and accurate description of what so many people go through after trauma. Good for Naparstek for bringing it to light.