Healing Combat Trauma

Teddy Roosevelt on Veterans - Give 'Em a Square Deal, Afterwards, for Serving

A quotable quote from the 26th president of the United States, who served as a legendary Rough Rider during the Spanish-American War, and also as an Assistant Secretary of the Navy:

"A man who is good enough to shed his blood for his country is good enough to be given a square deal afterwards. More than that no man is entitled to, and less than that no man shall have."

"The Black River of Loss, Whose Other Side is Salvation" - Poetry

An excellent poem about trauma, loss and -- ultimately -- survival -- with no implied reference intended to the famed/notorious American defense contractor of the same name (which coincidentally employs a number of combat-traumatized veterans, some of whom are looking for their own exit).

In Blackwater Woods

Look, the trees
are turning
their own bodies
into pillars

 

of light,
are giving off the rich
fragrance of cinnamon
and fulfillment,

 

the long tapers
of cattails
are bursting and floating away over
the blue shoulders

 

of the ponds,
and every pond,
no matter what its
name is, is

 

nameless now.
Every year
everything
I have ever learned

 

in my lifetime
leads back to this: the fires
and the black river of loss
whose other side

 

is salvation,
whose meaning
none of us will ever know.
To live in this world

 

you must be able
to do three things:
to love what is mortal;
to hold it

 

against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go.

-- by Mary Oliver

Ambrose Bierce on Grief

Reading, writing and thinking about PTSD, it's hard not to think about Ambrose Bierce, one of America's foremost short story writers, as almost a textbook case.  In another context in my professional life, I'm putting together an article (having nothing to do with PTSD) about Ambrose Bierce.  Reading some source material, including books in a California history reference library, I came across this quote, which just underscores the impression I already have about Bierce and his "truck" with PTSD.

(Bierce fought multiple heavy battles in the Civil War, and was grievously wounded with a head injury, among others, from which he almost died.  Bierce cycled through an obsession with his war experience through to the end of his life, when he disappeared off the face of the earth in his early 70s, allegedly having gone to Mexico to find one more battle to fight -- this time with Pancho Villa.)

As Bierce wrote of a character in one of his stories, almost word for word expressing "his own personal Vietnam":

"He had no experience with grief; his capacity [for it] had not been enlarged by use.  His heart could not contain it all, nor his imagination rightly conceive it.  He did not know that he was hard struck; that knowledge would come later, and never go."

-- Source:  Ambrose Bierce: A Biography, by Carey McWilliams.

Interconnectedness: We Get by with a Little Help from Our Friends

It's hard not to be a fan of the good quote: something that inspires us to rise above the gray grim bleakness of our particular misery (whatever it happens to be at the time -- maybe just the human condition would suffice) and see the shaft of sunlight that breaks through, illuminating the sky and giving us vision and hope for the future.  Okay, maybe I love these more than most, but I really do :-)

Here's one that should perk our spirits up a bit, for everyone who says healing is impossible, and that PTSD is something that will be with you forever -- how bleak, better just give in and give up (ack).  This from a veteran himself and a psychologist (now delicensed, sorry to say); and one of the originators of the first "rap groups" that helped Vietnam veterans to connect with one another about their experiences.  It's a great quote, and it brings back the words of that famous Beatles song, even by reference:

"With a little help from our friends, we can heal ourselves, even from war." -- Arthur Egendorf, from the preface to his book, Healing from the War: Trauma and Transformation after Vietnam.

Suffering to the Full - in Order to Heal

"We are healed from suffering only by experiencing it to the full." -- Marcel Proust (1871 - 1922), French essayist, writer, and former infantry soldier.

Venturing into the Mental and Spiritual Wreckage of War ... in an Attempt to Patch up the Survivors

I've been enjoying reading Gerald Nicosia's exhaustive chronicle, Home to War: A History of the Vietnam Veterans' Movement, which we blogged about earlier, here.  It's hard to read it without appreciating both the tendency of history to repeat itself (even this recently, from Vietnam to now); and also the quality of the few greats who really stood out for doing important work in bringing the PTSD diagnosis into the modern era.  One such great was Robert Jay Lifton, M.D., a psychiatrist, Yale professor, and author of Home from the War: Learning from Vietnam Veterans, about whom Nicosia makes this wonderful remark:

"It was to Lipton's credit that he took the step no one had yet ventured, wading hip deep into the mental and spiritual wreckage of the war to begin a systematic effort to patch up the survivors."

It's significant that at the time, no one had yet "ventured" that -- one wonders whether today much on that front has really changed.  There are a few, maybe, but the "mental and spiritual wreckage" continues both to abound, and to devastate the survivors.

Speaking of Catharsis: One Magnificent Quote

Catharsis:

The word comes from Greek katharsis, from kathairein, to purge, from katharos, pure. 

Among other definitions, "catharsis" means: "a purifying or figurative cleansing of the emotions, especially pity and fear..."; "a release of emotional tension, as after an overwhelming experience, that restores or refreshes the spirit;" and "a technique used to relieve tension and anxiety by bringing repressed feelings and fears to consciousness; also, "The therapeutic result of this process."

Catharsis is the unspoken theme, hope and dream for veterans on this blog, but periodically we make it more explicit, as we did here, in a blog entry about art therapy's surprisingly potential for purging combat trauma and PTSD in veterans.

At virtually the same moment I was posting this, friend and apparent psychic twin on all things veteran, Chris Lombardi, was posting this remarkable quote on her blog.  Lombardi is writing a book for the University of California Press on soldiers and dissent (watch for it), and here she is quoting Walter Kirn in the New York Times, reviewing The March, which Kirn called "E.L. Doctorow's heart-squeezing fictional account of Gen. William Tecumseh Sherman's fiery, rapacious last campaign through the cities and countryside of the Confederate South". 

The quote that Lombardi pulls from Kirn offers a stunning perspective on how great catharsis can really be, when veterans (and others) decide that "the only way out [of their suffering] is through":

The rampant destructiveness of Sherman’s march is, of course, the stuff of high school textbooks, but what isn’t so obvious is the way that destruction transfigures and transforms, pulverizing established human communities and forcing the victims to recombine in new ones. Inside the churning belly of Doctorow’s beast, individuals shed their old identities, ally themselves with former foes, develop unexpected romantic bonds and even seem to alter racially. Yes, war is hell, and “The March” affirms this truth, but it also says something that most war novels leave out: hell is not the end of the world. Indeed, it’s by learning to live in hell, and through it, that people renew the world. They have no choice.

From the blog post, "What We Write About When We Write About War,' by Chris Lombardi, at her blog, Incredible Panic Rules, linked here.

Veterans Can Be a "Powerful Force for Healing in the World"

Again from Claude Anshin Thomas, a lovely quote about the true power of the combat veteran's experience.  For every veteran who suffers whether silently or with loud cries and tears; or who ends his or her life because they simply can't take the pain anymore (and I wish they wouldn't -- they have so much to give), here's a reflection on what their experience can really communicate:

 

"At the retreat Thich Nhat Hanh said to us, “You veterans are the light at the tip of the candle.  You burn hot and bright. You understand deeply the nature of suffering.”  He told us that the only way to heal, to transform suffering, is to stand face-to-face with suffering, to realize the intimate details of suffering and how our life in the present is affected by it.  He encouraged us to talk about our experiences and told us that we deserved to be listened to, deserved to be understood. He said we represented a powerful force for healing in the world.

 

He also told us that the nonveterans were more responsible for the war than the veterans.  That because of the interconnectedness of all things, there is no escape from responsibility.  That those who think they aren’t responsible are the most responsible.  The very lifestyle of the nonveterans supports the institutions of war.  The nonveterans, he said, needed to sit down with the veterans and listen, really listen to our experience.  They needed to embrace whatever feelings arose in them when engaging with us – not to hide from their experience in our presence, not to try to control it, but just to be present with us.”

-- From At Hell's Gate: A Soldier's Journey from War to Peace, by Claude Anshin Thomas.

Uncomfortably Numb in Combat: "It's Best to Shut Down, Block Out, Give Up Being Yourself"

Continuing our periodically recurring current theme on eyewitness to combat, this telling snippet from Generation Kill about how troops attempt to cope with the mundane frightening rigors of combat:

When [Marine Captain Nathaniel] Fick passes the word that the men in Second Platoon are to remain in place, Espera turns to his men in the next Humvee over from our and says, "Stand by to die, gents."

The twenty-two Marines in the platoon sit in their vehicles, engines running, as per their orders, while blasts shake the ground beneath them. Everyone watches the sky. A mortar lands ten meters from Espera's open-top Humvee, blowing a four-foot-wide hole in the ground. It's so close, I see the column of black smoke jetting up from the blast area before I hear the boom. I look out and see Espera hunched over his weapon, his eyes darting beneath the brim of his helmet, watching for the next hit. His men appear frozen in the vehicle as the smoke rises beside them. Before leaving on this mission, many of the men in Colbert's platoon had said good-bye to one another by shaking hands or even hugging. The formal farewells seemed odd considering that everyone was going to be shoulder-to-shoulder in the cramped Humvees.

The good-byes almost seemed an acknowledgment of the transformations that had taken place in combat. Friends who lolled around together during free time talking about bands, stupid Marine Corps rules and girlfriends' fine asses aren't really the same people anymore once they enter the battlefield. In combat, the change seems physical at first. Adrenaline begins to flood your system the moment the first bullet is fired. But unlike adrenaline rushes in the civilian world -- a car accident or bungee jump, where the surge lasts only a few minutes -- in combat, the rush can go on for hours. In time, your body seems to burn out from it, or maybe the adrenaline just runs out.

Whatever the case, after a while you begin to almost lose the physical capacity for fear. Explosions go off. You cease to jump or flinch. In this moment now, everyone sits still, numbly watching the mortars thump down nearby. The only things moving are the pupils of their eyes. This is not to say the terror goes away. It simply moves out from the twitching muscles and nerves in your body and takes up residence in your mind. If you feed it with morbid thoughts of all the terrible ways you could be maimed or die, it ges worse. It also gets worse if you think about pleasant things. Good memories or plans for the future just remind you how much you don't want to die or get hurt.

It's best to shut down, to block everything out. But to reach that state, you almost have to give up being yourself. That is why, I believe, everyone said good-bye to each other yesterday before leaving on this mission. They would still be together, but they wouldn't really be seeing one another for a while, since each man would, in his own way, be sort of gone."

-- Evan Wright, Generation Kill: Devil Dogs, Iceman, Captain America and the New Face of American War.

Editor's note: the 1st Recon Marine platoon that Wright profiled in Generation Kill included Nate Fick and Rudy Reyes, each of whom have been mentioned multiple times on this blog.

The Final Score of War: Brotherhood 1; Humanity 0

Periodically we come across great quotes (and poetry) that serve to illuminate the human condition in combat.  One is the Augustine of Hippo quote we learned about from Nate Fick, which we blogged about here, in 2006:

"Anyone who looks with anguish on evils so great must acknowledge the tragedy of it all; and if anyone experiences them without anguish, his condition is even more tragic, since he remains serene by losing his humanity." -- Augustine of Hippo. From One Bullet Away: The Making of a Marine Officer, by Nathaniel Fick.

Another one is the great Tim O'Brien one, which Jonathan Shay, M.D., Ph.D. wrote about here:

"As Vietnam combat veteran Tim O'Brien wrote in his novel, The Things They Carried: 'A true war story is never moral. It does not instruct, nor encourage virtue, nor suggest models of proper human behavior, nor restrain men from doing the things men have always done. If a story seems moral, do not believe it. If at the end of a war story you feel uplifted, or if you feel that some small bit of rectitude has been salvaged from the larger waste, then you have been made the victim of a very old and terrible lie. There is no rectitude whatsoever. There is no virtue. As a first rule of thumb, therefore, you can tell a true war story by its absolute and uncompromising allegiance to obscenity and evil ... You can tell a true war story if it embarrasses you. If you don't care for obscenity, you don't care for the truth; if you don't care for the truth, watch how you vote. Send guys to war, they come home talking dirty'." -- Achilles in Vietnam, by Jonathan Shay, M.D., Ph.D.

Do you see where this is going yet?  If a war story isn't brutal, isn't ugly, it isn't true.  People do unspeakable things to each other in combat; and the way they survive is focusing on how to get through (the band of brothers, for whom they fight -- the wet bond of blood -- fighting for the one who stands at your shoulder); and numbing themselves out so that they can keep going on, putting one foot in front of the other, but feeling ... nothing... that they can manage to feel at the time, because there simply isn't psychic space, isn't room.  If they feel at all, that will come later.  But not during.  God help the ones who feel, during.  They're likely to not even be able to go on.

To put this another way, they focus on what they can control (almost nothing, literally) -- like being there for the guy or gal next to them; not what they can't control (everything else, including why they're there, whether the mission now or ever did make sense, whether they'll survive, whether they'll ever see home again.)  By putting one foot in front of the other, by continuing to stand shoulder to shoulder, somehow, they make it through, often, just barely, and are left -- usually alone, I might add, and it's shameful that this is the case, these people we ask to fight -- to deal with the repercussions themselves, when they simply aren't capable of integrating such a great (as in mighty), all-encompassing, horrific, and horrifically graphic experience on their own.  Imagine trying to put these pieces together, yourself.  You simply could not; or you'd be the ridiculously rare and most likley superhuman individual if you could.  That's just not a realistic (or fair) expectation at all; so let's dispense with it, and get on with the business at hand: understanding what they actually went through, and developing some compassion -- fellow feeling -- for it.

As you read Pat's reminiscences -- the series of accounts of this young Marine, 17, in Vietnam, which I'm titling "eyewitness to combat" -- think about these things. 

Remember what Ernie Pyle, the greatest and significantly most humane American war correspondent called it?  "The Powerful Fraternalism of the Ghastly Brotherhood of War."

"Anyone who looks with anguish on evils so great must acknowledge the tragedy of it all; and if anyone experiences them without anguish, his condition is even more tragic, since he remains serene by losing his humanity." -- Augustine of Hippo. From One Bullet Away: The Making of a Marine Officer, by Nathaniel Fick.