Healing Combat Trauma

Making Darkness Visible - One Author (and Former Marine's) Attempt

I read the classic Darkness Visible: A Memoir of Madness, by William Styron, the other night.  It's a quick but melancholy read and takes about an hour. (What I didn't realize at the time, and it's completely tangential to his story, which is really about a four year bout the well-known author had with clinical depression, and the closeness he felt to suicide, is that Styron was a former Marine.)  Styron died of pneumonia in 2006, at 81 years old.

In an obituary printed about Styron on Martha's Vineyard, where he had a home, the following information about his military service is revealed:

Following high school [Styron] joined the reserve officer training program for the United States Marine Corps, and enrolled at Davidson College. He was unhappy there and through the Marines transferred to Duke University in June of 1943. In October of 1944 he was called to active duty and in late July 1945 was commissioned a second lieutenant. He was assigned to participate in the invasion of Japan; a month later the atomic bomb attacks forced the surrender of Japan and he was discharged. ... In 1955 he published The Long March, originally a novella about his experiences in the U.S. Marine Corps.

The same obituaryalso makes clear the trajectory that led to Styron's depression, and the resultant book that introduced this highly personal experience of the author's to the American public:

[Styron] drank heavily and smoked cigars until the summer of his 60th birthday in 1985, when he decided that alcohol no longer agreed with him and gave it up. But the abstinence triggered mood disorders which required medication, and the drugs in turn brought on a deep, enduring and suicidal depression that required him to be hospitalized for more than two months. The experience prompted him to write Darkness Visible: a Memoir of Madness, after he had recovered.

The book earned Mr. Styron a whole new set of followers. "I think it causes people to realize two things," he told the Gazette in an interview in 2001. "That this is a pain that afflicts a lot of people; it's universal and if I could describe it in this way and people could relate to it, it meant they weren't alone; and the second thing - almost as important or more important - is stressing the truth that people can get well, and that it's not by any means fatal."

Styron's book is interesting, to a degree, mostly because of his prominence as an author at the time he wrote it, and because it is so uniquely personal: One person telling the story of his own descent into "madness." I wasn't a complete fan: it's a little hard to keep reading how marvelous Styron's life was, yet how unhappy he was within it -- true though that might be.  And the entire book, while short, is one continuous slog through the same miserable territory, until his case finally improves towards the end (mostly thanks to hospitalization, it would seem.)

However, there are some intersting parts.  One is near the beginning, where he quotes the French writer Albert Camus, "There is but one truly serious philosophical problem, and that is suicide."  In Styron's hands, the problem becomes more physiological than philosophical.  He tries to put off suicide, while coping with his depression -- but first, cataloging his depression fairly exhaustively for the reader (or himself, it's never too clear.)  He covers some standard themes, such as how self-medication with alcohol kept his demons at bay for years, until he cold turkey gave up drinking, and watched his depression take on form and substance.  He explains how the common response of depression is to be more interested in injuring self than others (small comfort, that).  And he mentions the unique aspect we discuss here from time to time, about how psychological pain can manifest as, or at least be accompanied by, physical pain.  In Styron's words, about his own case:

"What I had begun to discover is that, mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain.  But it is not an immediately identifiable pain, like that of a broken limb.  It may be more accurate to say that despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room.  And because no breeze stirs this cauldron, because there is no escape from this smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion." 

(Hmmmn.)

Styron indulges in one of the book's only tiny moments of humor when he describes the loss of his libido, which he says happened pretty much as soon as the depression settled in.  Describing a conversation with a doctor he felt 'just didn't get it,' Styron writes:

"...I wondered if he seriously thought that this juiceless and ravaged semi-invalid with the shuffle and the ancient wheeze woke up each morning from his [sleeping pill-induced] sleep eager for carnal fun."

Styron helpfully delineates his personal symptoms and by so doing, provides an example for others about what depression can look and feel like.  He describes his sensations of pain, his loss of libido, his weakness, his weak and distant voice that made him sound much older than his years, etc.

He also describes his troubling experience with several doctors (he calls them "careless") who overprescribed medications to him, including sleeping pills, at levels that were dangerous and could have provoked suicidal thoughts. It's unclear whether Styron ever considering a malpractice lawsuit against these doctors, but what he describes doesn't sound good -- and it sounds like he just took it in stride and was thankful he wasn't harmed, but didn't pursue any further action.  Ironically, eventually it's medication that helps him get well, once he is hospitalized.  Before he commits himself, however, he reaches the end of his rope and contemplates suicide.  When he finally realizes how sick he is, he heads for the hospital, and, there removed from other distractions, is able to (in his opinion) concentrate on his cure.From other things I've read since, it sounds like Styron continued to battle depression off and on for the rest of his life, and probably had struggled with it for many years beforehand, also.  At no point in the book is there any indication about his military service having an effect, pro or con, on his depression.  In fact, it sounds like his depression was both genetic and environmental -- but had nothing to do with being a Marine.

By page 84, the last page of the short book, there is finally a ray of at least faint light.  Styron is getting better, and he sums up -- neatly mentioning Dante, the subject of a previous post here on this blog:

For those who have dwelt in depression's dark wood, and known its inexplicable agony, their return from the abyss is not unlike the ascent of the poet [Dante], trudging upward an upward out of hell's black depths and at last emerging into what he saw as "the shining world."  There, whoever has been restored to health has almost always been restored to the capacity for serenity and joy, and this may be indemnity enough for having endured the despair beyond despair."

And then he concludes with a quote from Dante, mirroring the optimism that is finally able to see in his own situation:

"E quindi uscimmo a riveder le stelle.

And so we came forth, and once again beheld the stars."

Editor's note: If you want to read more about Styron's later work, referencing this book as well, there's a good article from 2003 in the Guardian, linked here.

The Vietnam Veteran as Exile: Missing in America, But Hidden in Plain Sight

My friend the veteran artist John Paul Hornbeck made this flag -- I just love it.  It carries forward the whole issue of POW/MIA into the present day, by asking in effect why the veteran is "still" Missing in America (that's the "MIA" part these days.)  He mocked up this flag, using the old and familiar symbol, to highlight the cause of homeless veterans in America -- a cause worth addressing.

I'm broadening the point, though, to something else:

Why ARE Vietnam veterans, in particular, still exiles in their own land?

And what should we, as a country, be doing about that?

Because failing to address that, failing to welcome back these warriors into their own land, perpetuating their exile both from what they've seen/done/experienced and how they were received when they returned -- has left a gigantic, gaping gash in the "fabric" of the American psyche; and decades worth of not addressing it has not resulted in any pain being healed.  Sure there are sporadic attempts made here and there, but they're relatively weak, lackluster, or involve too few people to really make a difference.

If you read Pat's "Welcome Home" story, or Claude Anshin Thomas', just to use the names of two representative Vietnam vets among thousands -- you find out that they are STRIKINGLY similar, almost verbatim copies of each other (and the rest who haven't written them, I suppose).  The hopes, the dreams, the flat-out fantasies (under the circumstances) of how they were to be received -- combined with the completely dashed, rejected and really shattered realities of how they were -- aie, the mind boggles.  It's surprising the whole generation of warriors didn't go postal, not just a few.  It also explains why so many of them are still living in pain to this day.  Turned into exiles by what they lived, that they had no possible means of integrating -- and shunned by the country they fought for.  If that woudn't give you issues, I'm not sure what would.

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So let's think outside the box on this, FAR outside the box.  (If the box is the status quo, that is, because that's not particularly impressive.)  What prevents us from giving veterans, in every city across America, down EVERY Main Street -- a true, genuine, and long-overdue "WELCOME HOME"?!

Couldn't we use that psychic energy we'd gain back as a nation -- from repairing the rent in our actual psyche -- to surge forward, and embrace our combat veterans from here on out, with all the services and the help they so desperately need?  We've seen the problem: it's been well-documented.  But even to go forward successfully, in this case, I think we also need to go backwards -- make use of the "invisible bridge" -- and welcome the group of veterans who are STILL waiting, 40 years out, for America to acknowledge their return.

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I learned a long time ago, that even in personal relationships, there's a big difference between the crappy/weak/self-serving apology -- "sorry IF I hurt your feelings" -- and an actual, gut-level, authentic and genuine apology, that takes responsibility, asks for forgiveness from the injured party, waits for the answer, or renegotiates the situation -- and then moves on, healed.  In the Bible, that's even called the difference between "worldly sorrow" (sorry I got caught) and "godly sorrow" (sorry that I did it, because I know it was wrong).  Without making a point about religion here, I'm merely trying to show that many traditions understand there's a difference between a heartfelt apology, a lame one, and none at all.  It's like the Oliver Wendell Holmes line from a few blog posts back, that "even a dog knows the difference between being kicked, and being tripped over."

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Let's harness or leverage the momentum from the current groundswell of public "enthusiasm" for veterans' rights, exemplified by support for passage of the new GI bill, and the continuing emphasis on not settling for less in healthcare, particularly PTSD and TBI.  Let's expand that, though, to other issues of concern to veterans, before the "mood" passes -- as it surely will -- to be eclipsed by other different, pressing concerns.  Let's settle our largely unspoken national shame with how we treated Vietnam veterans, while a few of them are still alive to appreciate that our apology is genuine, and acceptance would heal us all to be able to move forward.  What we don't want to do is to create two different classes of veterans: the ones we care about, who get the right treatments for the right reasons; and the ones we don't, because we frankly made such a mess of it it's just easier to overlook it than apologize and move on.  It's time to make things right for ALL veterans.  Let's have those Welcome Home parades NOW...

Editor's note: John Paul Hornbeck is the artist (and veteran) who made "Shattered Soldier," the lifesize scultpture of a veteran with PTSD, that we blogged about earlier, here.  He is the child of an American Vietnam war veteran Army father, and a Vietnamese mother.

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."  And he made the point, too, that these guys did it -- sometimes the only thing they could adequately focus on was that:

"He did it for the kid next to him; he couldn't let him down.  They needed one another so bad." 

So don't get up on your high horse and be horrified by what Pat's saying, if he has to say something that strikes you as terrible.  War IS terrible; it IS never moral; and it DOESN'T make for perky stories told in three points with a snappy introduction and a great takeaway message to mull on with your popcorn.  It's dirty, messy, evil business that often breaks those who participated in it, who rarely even come to terms with what went on while they were.  And we just stand by and WATCH that, and wonder, or criticize them, for not being able to cope "better" with what they went through.  What would be "better" be, exactly?  Would WE know it if we saw it; would THEY?

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Remember too, you weren't there.  Our "Representative Veteran," Pat, was -- and he's still trying to process why he had to experience that, and what it means to him that he did.  The remiscences, of which we'll only be sharing some, took 40 years to get down in transmissable form.  That's a lot of painful "elephant" being fed through a very small aperture, so that it can be understood by the rest of us -- and hopefully taken to heart, so that we treat this generation of returning warriors better, and don't make them beg for the services, and the appreciation, that they deserve.  Remarkably, scratch a Vietnam vet -- lonely, neglected, cast off by society, EXILED in his own land -- and you find someone who would give half a paired something to see the current generation better than they were.  Not bitterness, a desire for betterness.  Well, most of them at least.  And the bitterness is easily understood, where and when it exists, as to why.

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And by the way -- we never did give these guys an offical, actual "Welcome Home."  Chew on that instead, if you want to point fingers about who should have done what in war.  WE should have done THAT.  And in some small way, by making one combat veteran's experiences known in this manner, on this blog -- heh -- that's exactly what we're doing now. 

Welcome Home, Pat, Rob, Claude, Grif, Jeremy's dad, Ray, Shad, John Paul's dad, Steve, the other Steve, Congressman Thompson, Max Cleland, Kathie's husband, Bet's husband, Cecil, the cute flirty guy with the eye patch, who sat next to me at a photography exhibit (still learning!) and who'd just survived a stroke -- everybody else who didn't get that at the time, and we can guess with great certainty hasn't been able to since, either.  Oh, and that would certainly include the abandoned and forgotten guys on the streets (homeless), and the various guys lolling off to sleep in wheelchairs at the veteran's homes, with their little American flags staked into their chairs, who I am pretty sure aren't having visitors, and are dying by the score every month, lost to us for good. 

I had a conversation lately with Pat: how many of those guys are you still in touch with?  Because it sounded like very few.  This is what he had to say:

"The problem with being attached to [that group of] Marines is that very few of each deployment survived long enough to ever get together.  1/9 tried reunions for a while but too few [were alive] to meet so they suspended it.  2/9 still is trying but no one from my days are there.  The thirteen guys I went into the Marines with were either killed in action; died of their wounds; committed suicide later; [or] were so severely wounded that they are still in VA mental hospitals and don't recognize anyone [so there'd be no point].  Only two of us are still alive 'n kicking and we got together for eleven years on what we called our "kill day".  He drifted up into Canada, I drifted to Texas; we have not spoken for over 20 years so I don't even know if he is still around." Yikes.  See bolded statement for emphasis... 

Really and truly, America -- don't you dare criticize these people.  You haven't walked a mile in their shoes -- and until you do what YOU need to do, and uphold YOUR side of the bargain -- you really haven't earned the right.  If anything, read and learn -- and recognize how very human the motivations, compromises, and eclipsing of characters is.  And just be glad that you didn't have to be there; and do what you can to provide a measure of comfort, acceptance and acknowledgement to those who were.  Don't NEGLECT America's warriors; FAIL to welcome them home; STAND BY and watch them be crippled from what they experienced, for which they have often have no HEALTHY RECOURSE WHATSOEVER; and then have the NERVE to point out their moral turpitude, as if you knew.  You don't; they do.  Point, theirs.  And that's the only point worth hearing on this one; sorry.

"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.

Would Expanding Awards of the Purple Heart to Include PTSD Help End the Stigma?

A few months ago, a debate began in military and veteran circles that may continue for years: Whether the Purple Heart, traditionally reserved for awarding to those killed or wounded in battle, should be extended to include also "invisible wounds" of battle, like PTSD.  There are no easy answers.

Said an article at the time, in the Wall Street Journal:

"The dispute reflects a broader question roiling the military: Can psychological traumas, no matter how debilitating, be considered equivalent to devastating physical wounds?

Supporters of awarding the Purple Heart to veterans with PTSD believe the move would reduce the stigma that surrounds the disorder and spur more soldiers and Marines to seek help without fear of limiting their careers.

“These guys have paid at least as high a price, some of them, as anybody with a traumatic brain injury, as anybody with a shrapnel wound,” Dr. John Fortunato, who runs a military PTSD treatment facility in Texas, told reporters recently. Absent a policy change, Fortunato told reporters, service members will mistakenly believe that PTSD is a “wound that isn't worthy.”

Opponents argue that the Purple Heart should be reserved for physical wounds, as has been the case since the medal was reinstituted by Congress in 1932. Military regulations say the award should go to those with injuries “received in action with an enemy.” Some opponents also note that PTSD can be faked, which can't easily be done with a physical wound.

“The Purple Heart was meant to be a badge of honor to show you were wounded in battle,” said Bob Mackey, a retired Army lieutenant colonel who fought in the first and second Iraq wars. “I've been in combat three times. There's stuff I've had to deal with. But it's substantially different from being physically hurt.”

Mackey said the biggest difference is that some veterans may be diagnosed with PTSD even if they never saw combat or fought an enemy – requirements, historically, for receiving a Purple Heart."

Military.com also conducted a poll on its website about the issue (see graphic), and only about 1/3 (33%) of the respondents voted "yes" to awarding the purple heart for PTSD.  58% voted "no," and another 9% rode the fence, saying "perhaps" -- but only if PTSD were diagnosed in the war zone, which really affects far fewer people.

The IAVA's Ray Kimball wrote a good op-ed piece at Military.com in favor of expanding the award -- that's linked here.

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The more you talk with veterans who have PTSD, the more you realize how long the effects can be -- vets who are still struggling mightily with events that occurred 40, 50, sometimes even 60 years before (as well as a lot more recently than that.)  The sheer extent of the suffering, to me, puts this allegedly "invisible wound" on a par with ones that can be more clearly seen.  Though seriously, I bet if you ask a knowledgeable spouse or family member, the so-called "invisible" wound of PTSD is fairly easy to "see" in the the effect its had on the life of the veteran, and his or her family.  Studies like the one conducted on Vietnam veterans in Australia even shows residual effects on family members of veterans with PTSD into the second generation.  It may be "invisible," though I don't think it particularly "is," but it's certainly also "the gift that keeps on grieving," as one veteran so aptly put it.

It's weird and a tad unpleasant to see a divide developing (or perhaps the divide was always there, and is just now being articulated) between those with external and internal injuries -- especially since the ones injured externally seem to be the ones "pooh-poohing" the validity of the more internal injuries. Then, of course, there are those who've suffered both kinds.  Max Cleland comes to mind, the former Secretary of the VA, who decades after Vietnam learned he had PTSD, in addition to his obvious physical wounds as a triple amputee -- we blogged about him, here -- as do some other veterans who have unfortunately passed on.  Perhaps we need to hear more from those veterans who understand both types of injuries, and learn which side they argue in this debate. 

Typically, suffering begets compassion -- people can be fairly un-feeling about topics they've yet to have experienced personally, discountin