Healing Combat Trauma

Busting Out of the Bunker at Last...Made to Be Social Beings, We Die in Isolation

Following up on the "Bunker" post of the other day, about the protective isolation of the bunker for the combat vet with PTSD, it seemed high time to write "the rest of the story," about what the subject of "Eyewitness to Combat" sees now about the bunker mentality, and how and whether it's possible ever to overcome it. (So here's a picture of his bunker in Vietnam, to illustrate it.)

What follows are direct remarks from the vet, from a few weeks ago, about this exact topic. I'll add a few words where I have to, to keep the flow going, but the thoughts and the wording are his:

On the problem of the bunker:

"We are made to be social beings. We die in isolation. And that’s why when we withdraw into a hole, we are withdrawing into a grave -– just one that isn’t covered up yet.

With me I wanted to get out and I wanted to be with people. I wanted to enjoy my surroundings. I wanted to go to parties. I really did. I wanted to do that. But I had this deep ingrained fear that if I was around too many people, too long I would talk too much, say too much, and they would figure out who I really was, and not like me. And every place I went, it seemed that I was always pissing somebody off. Making somebody angry at me, and that rejection was more than I could handle. So it was easier for me to decide that I just hate everybody, and don’t want anybody around me but animals. And crawl back in my bunker, and hide. But then I would die there. Because what I really wanted to do was go back and be with people who cared about me, somebody who would love and accept me and who I could have fun with. Every time that something would draw me out of the bunker, I would do something stupid, have my PTSD moment, and have everyone around me direct me back to my hole.

We are supposed to be social; we are supposed to belong. For those of us who are Marines, we belong to one another, we belong to the Corps, we belong to the men who came before us, and the men who will come after us. We belong to something bigger than ourselves, and that’s what makes us Marines for life. This is not unique to the Marine Corps however; for we all have an innate, ingrained need to belong to something bigger than ourselves; to something that accepts our faults, that builds upon our good deeds, good qualities, that involves people. Be it religion, be it Indian culture, be it motorcycle clubs, be it national associations. We all have a need to belong. The problem arises in our isolation creating a void that is filled with the wrong associations/influences. For we WILL belong to something, good or bad; harmful or helpful. Churches prey on that need to belong. (We've both had bad experiences with churches, so we give the secret fist-bump to each other at this point.)  

Now, all veterans belong to one another. Their bond is in their service, that transcends the specific branches and time.

People go back in the bunker to heal, to hide from being hurt; or to hide from hurting others. They stay there and depression sets in; and they cannot get out by themselves. Someone has to physically go in and bring them out, just like (my guy friend, a Navy seal) did with me; just like you did with me.

He encouraged me; he listened to me; he understood me; he had been where I was. He said, "I don’t know how to help you; I love you; I care for you. But I know if you don’t want to do something, you wouldn’t do it. So what I want to do is share a dream with you that I’ve had since I got out of the Navy. Reasonable or not. But I need your help to do this. And when you feel like you can come out, call me. And he left a stack of papers about a foot high. I spent a week staring at them, and it interrupted my depression! And he'd put one of the most interesting articles on the very top. He had made me a part of what he was doing. I just wanted to be and do something that people wouldn’t hate me for; wouldn’t criticize me for. Because the aftereffect of ‘Nam was so bad, because we gave so much; and received so little. And we had done MORE than we could do over there. I just wanted to do something where people didn’t hate me."

(That Navy Seal friend is someone he'd previously helped himself; stood up for him so he wouldn't go to prison for his third arrest.) "I’m the one who walked in there and walked him out of his depression. Blood brothers, combat vets. He was a friend."

I mention the name of another friend of his, who he served with in Vietnam, who was injured on his same kill day/alive day, and who used to call him up to see if they could go be mercenaries in South America together. It all sounded like an elaborate, not so cleverly-disguised death wish. Very Butch Cassidy and the Sundance Kid. When I first knew him, there was a real pull to that. Now, further down the healing path, not so much. I ask him about that guy. A lot more reasonable now, he reflects, though he knows the allure, "That’s not the way to go; it’s not the way to make you happy. It’s just another way to get yourself killed. Problem is, sometimes it works; sometimes it doesn’t."

How much time has he spent in his bunker over the years?

"Years. Probably spent 20% of my life in a bunker, hiding, wanting to die, not having the nerve to shoot myself; hoping that the diseases and the meds would finally do me in.

I just didn’t know how to be happy. There was no joy in my life. There’s no reason to live. My family used to ask me, 'How can you look at what you’ve done, and tell me that you have no purpose in life? You don’t understand.' Problem was, I didn’t understand. I did not know why I didn’t have the capacity to have joy, to love anyone or to have fun. I just know I’d tried religion, I’d tried everything the VA could throw at me, in-house therapy, group therapy, self-help, medication, I tried working myself to death, I tried getting rich, I tried doing stupid things to harm myself (go back into combat situations), where maybe if I revisited it; I tried going to The Wall; and something would just not allow to want to live, or be happy, or enjoy being in my life. I couldn’t look around and see the flowers, let alone smell them. All the roses in my life were wilted; not because they were, but because of my vision of them was wilted."

My self-esteem, my sense of self-worth, my self-pity, and sense of total uselessness overwhelmed everything else. No matter how hard I tried, everything I touched was going to turn to shit. I heard it from my dad, and then I began to believe it was a generational curse. A curse is only a curse if you decide it’s going to be a curse. I understand the Universe. I understand me and the necessity of believing in yourself and believing in others. Politically the world may seem like a shitty place; but it’s always seemed like a shitty place. World’s always been a bad place, and it’s always been full of good people, and bad ones. And we have the right to choose the ones that we’re with. And we have the right to choose whether we’re going to be happy or sad, or doing something that’s worthwhile or not. Money is essential but money’s not the end. Money is only the means to an end, and yet we lose that perspective.

I’m no longer willing to let other people and their misery dictate whether I’m happy or sad. It’s up to them to walk through that door. Sick and tired of being sick and tired, that they’d rather die than continue on. Then they’ll walk through that door and want help and accept it. As long as they have one ability to resist, they will."

We talk about two guys we know, combat vets from different eras -- Gulf War and Vietnam. Neither one seems to really "get" where they need to go with this recovery stuff. When they're doing well, they're broadcasting their healing to the world; when they're down, they're completely off the grid, hospitalized for suicidal ideation and attempts. My mind reels from this. I wish when they were doing better they'd put more time into actually finding a way out; not just broadcasting it, so their lows wouldn't have to be so low, since their highs seem...unnaturally, or at least unsustainably high. It reminds me of a friend who says, about people who complain but do not attempt to solve, "It must not be bad enough for them yet." 

He weighs in: "They haven’t lost ALL their resistance. One of two things happen when people reach that level: they either commit suicide, or they get help. What makes the difference? A friend. A friend who can walk in under that and take them by the hand and walk them out. Just like in combat, if you get wounded, you can’t walk yourself out. Someone to grab you by the nape of your neck and drag your ass out of there. You can’t do it by yourself."

He continues: "If vets who have been healed don’t go and get vets who haven’t, then no one else will. In this situation the Marine Corps phrase of “we take care of our own” is literal; if we don’t, no one else will: not the vet’s family, not his relatives; no one. Only a vet can walk out a vet."

But yet, I helped you...and I'm not a vet. But you came looking for the help, too. He replies, "But you were a friend, a sincere, concerned friend. A friend like that, another vet; not the government...."

Editor's note: The photo above is of the "Eyewitness to Combat" Marine with two of his buddies, very Three Musketeer-y, circa 1966 or 1967.

Victimology -- The Temptation to Stay Stuck

Every behavior has a potential payoff, or we wouldn't engage in them. This is particularly applicable to people who have suffered for years, not months, with their situation, and where the groove has most definitely become a rut.The subject of "Eyewitness to Combat" talks about how being a "f*cked-up Vietnam vet" was a mask he could wear at times -- not that those times were always under his control -- in order to get other people to back off or keep their distance. Carolyn Myss, author of the New Age classic, "Why People Don't Heal and How They Can," talks about how attached people can get to their "wounds" -- to the point that they introduce them almost immediately into conversations with strangers, or overly bond with their friends and companions over them, with the ultimate experience being that it becomes very difficult for them to move on. "Love me, love my wounds" seems to be an unspoken demand of those too attached to their victim-hood.

This isn't to say that everyone who suffers becomes a victim -- nothing of the sort. Or that everyone who flaunts their wounds, so to speak, is doing so intentionally. But for any of us who have suffered, it's important to examine the unconscious temptations behind victim-hood, lest we accidentally fall into the quicksand and get stuck. 

Bev Smallwood, Ph.D., has a book called, "This Wasn't Supposed to Happen to Me: 10 Make-or-Break Choices When Life Steals Your Dreams and Rocks Your World." She talks about how different survivors of the same experience (say, Hurricane Katrina) might all suffer, but won't all adopt the same attitudes of victim, surviver or thriver. In a chapter entitled, "Poor me," she mentions several of the potential payoffs for over-identifying with the "victim" point of view: "'Victims' don't have to be responsible for their attitudes and actions;" "'Victims' get others' sympathy and support...for a while;" and "'Victims' feel self-righteous and justified." There's even a short quiz: "After all I've been through, I've learned that you just can't trust people;" "I admit that I have a tendency to blame others when things go wrong in my life;" "I often have pity parties;" "People have told me that I complain too much;" and "I feel angry when people try to get me to make personal changes and begin to move on. They just don't understand."

Contrast those self-defeating sentiments with those in the "Survivor's Pledge," which we wrote about several years ago, here: 

The Survivor's Pledge:

I will not be a victim.

I will rise above.

I will give back.

I will change the world.

There's also an ultra-fabulous chart comparing and contrasting the states of "victim," "survivor," and "thriver" -- with "thriver" being obviously the most desirable state, linked here. A wonderful OIF vet, with MST and PTSD, shared it with me a few months ago, and it's a keeper. When I shared it with the subject of "Eyewitness to Combat," another overcomer, he loved it too, and said, "PTSD is on the left, surviving is in the middle, and healing is on the right." As someone who's experienced all three states, that's how he chose to describe them... Not everyone is at the same place in their healing trajectory, but at the very least, it could serve as some inspiration for what improvement would look like, and how to get there...incrementally.

Too Long a Sacrifice Can Make a Stone of the Heart: The Tao of Self-Care

"Too long a sacrifice can make a stone of the heart," wrote Irish poet William Butler Yeats. He wasn't necessarily a caregiver to anyone, like a veteran, with PTSD -- but he sure seems to understand the predicament. 

The "365 Tao" book that I'm so fond of -- what's not to love about an item at Amazon that has 65 ratings, and they're ALL five stars?! -- had a wonderful item today about how caring for another appropriately is wonderful, but that there is "too much" of a good thing, and it can backfire terribly on the caregiver. Read what it says:

CARING

"Don't go out looking for good deeds to do

But if one comes your way, do not refuse.

If you meet someone who is suffering, you must help them."

And then, importantly:

"Those who follow Tao believe in using sixteen attributes on behalf of others : mercy, gentleness, patience, nonattachment, control, skill, joy, spiritual love, humility, reflection, restfulness, seriousness, effort, controlled emotion, magnanimity, and concentration. Whenever you need to help another, draw upon these qualities. Notice that self-sacrifice is not included in this list. You do not need to destroy yourself to help another. Your overall obligation is to complete your own journey along your personal Tao. As long as you can offer solace to others on your same path, you have done the best that you can."

It's so crucial to note what the author says about "notice that self-sacrifice is not included in this list." (And, previously, that non-attachment was.) So many people on this path or journey, trying to help vets with PTSD, in their own families, their brothers and sisters they served with, etc., are bound to follow the completely self-sacrificing path. We understand that impulse...but see where it leads? It leads to personal disaster. Please take better care of yourself than that. It's not necessary to give your complete and entire all to do your best, to give your best. There has to be a "you" left at the end of the day, or the night. Please find and treasure that self...and don't let it be destroyed, even in the guise of being...the care-giver. 

What can you do for yourself today to improve your health and stress level? What nurtures you and gives you peace of mind? Is it exercise, spending time with friends, having alone time -- what is it? There are many things you can do for yourself that are inexpensive and take good care of you. Please make a list for yourself of what those are, and find a way to bring them back into your life. It will make a world of difference. Some of the very same recommendations or suggestions for veterans with PTSD are ones you might like yourself. A simple exercise like Qi Gong, which creates a feeling of being "relaxed, balanced and energized" -- is just one example of positive self-care, and there are many others.

At the opposite extreme, of not taking care of yourself, what can we guess happens with too long a sacrifice, for others, no matter how worthy, needy or deserving? According to the poet, it can "make a stone of the heart." And following this along...what happens to a stone heart? It shatters and breaks. Keep a soft heart...take care of yourself first...so you can continue to care for others. Not instead of yourself. Importantly, after yourself. So that you can give the best care of all...and not be depleted, broken or crushed. 

Quotable Quotes -- the Oft-Neglected Role of the Caregiver in Illness

"As little as we know of illness, we know even less of care. As much as the ill person's experience is denied, the caregiver's experience is denied more completely." -- Arthur Frank, "At the Will of the Body."

Editor's note: We have a section entitled, "Caring for the Caregivers." Click on this link to expand.

Quotable Quotes -- Nate Fick on Understanding War and the Warrior

"This country needs its professional warriors. It also needs people in other walks of life who know what the decision to go to war means." -- Nathaniel C. Fick, former Marine captain, author of "One Bullet Away: The Making of a Marine Officer."

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.

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.)

Social Support a "Powerfully Protective Factor" Often Not Available to PTSD Sufferers

A quote about PTSD and its impact on the individual sufferer's ability to receive support from those around him or her:

"Social support is a powerful protective factor (Brewin, Andrews & Valentine, 2000) that includes the capacity of an individual to accept or utilize social support when it is made available (Benight & Bandura, 2004). This may be especially problematic in PTSD where symptoms such as avoidance, alienation and detachment impair affected individuals from benefiting from available marital, family, and social support."

Source: Oxford Handbook of Anxiety and Related Disorders, by Martin M. Antony, Murray B. Stein, linked here.

"I Have PTSD," But "I Am Not PTSD"

This conversation goes back a while ago with a combat veteran of the Vietnam era, who has been trying various therapeutic methods for addressing his decades-long case of severe PTSD, and finding, by degrees, some actual and substantial relief.

Over the past few months, as his situation has greatly improved, aspects of his PSTD have fallen away, symptom-by-symptom.  But lest this lead you to believe that such progress, or success, is all "positive" -- the reality is, it doesn't always feel that way to the veteran, who has become habituated to seeing the world through the context of their having PTSD.  PTSD, of course, affects virtually every important aspect of their lives: from how social they are, to relations with their family, to how they can hold a job, how much pain they are in on a daily basis, how much stress they can manage, and how many medications (with their attendant side-effects) they take.  Psychological symptoms, physical symptoms, even "social" symptoms: they're all there.

And after a lifetime of identifying yourself as a "crazy, f*cked-up Vietnam vet," f'r instance, if that "identity" should start to fall away -- as you progress towards actual health and wholeness...mmmmnn, what do you replace it with?  Because there needs to be something.  Having relied on one identity for years (even decades) to manage life, and keep others at bay, suddenly that "crutch" or that "coping system" is no longer there.  And with all the other problematic pieces stripped away, piece by piece, what's actually left is a raw, brand new...baby. At least in terms of trying to cope with who you are in the world.  Amazing stuff.  And as great as it might be to get some symptom relief, and some ultra-positive life changes, at the same time...fear comes into play.  Who will I be without this shell I've learned to rest upon for so long?

Even the Bible talks about, in a slightly different context, how if you're going to sweep a place clean and remove all the demons, you have to immediately replace the empty space with something good, lest more demons come by (boy, the Bible is awful cheery; I'd forgotten...) and, finding the place vacant, immediately seek to fill it up with something "ten times worse" than what had been removed.  Mmmm. Lovely.  But the principle is a worthy one: If you're been relying on one thing, for a long, long time -- and you suddenly remove it -- you'd better find a way to be comfortable with the new self, because it's what's you have from here on out.

Having been privy to these struggles with one veteran as he walks his path, it's been surprising to me to see how "upsetting" the concept of healing can be -- initially upsetting, that is.  There's an old Tony Robbins line that human nature will do much more to avoid pain than they will to seek pleasure, and I think that comes in to play here, too. Change is painful; growth is painful; heck, even healing -- in that context only -- can be painful.  It's all new; it requires new skills; a new outlook; even new hope.  But ultimately, it's (obviously) the best way.  Most ironic of all is when the combat veteran, for example, has been the one to pursue the healing so radically -- and then when it starts to happen, in shock, he draws back, startled, as if realizing, ahhh, this is going to be my new life: how strange. I wonder if I recognize me in this at all.

Of course, over time, the progress coming in waves, as more methods are tried and proven useful, the experience gets better, and the veteran gets to be more at peace in his own skin.  Symptoms with which he has lived for decades start to abate, and be replaced by ... peace... and better experiences with himself, his family and loved ones. Overall, though the process is bumpy, the progress is sure.  There's no turning back: the combat veteran continues to WANT his healing, and his healing is happening.

And suddenly, the revelation, at least in his mind: "I have PTSD," he declares, decades into the fight, "but I am NOT PTSD."  Previously, of course, the unspoken assumption was that there was no distinction.  PTSD so consumed his life than in fact he WAS PTSD.  Now, he can say that he has it -- increasingly, even better, that he HAD it -- but that it is not him.  Wow.