Healing Combat Trauma

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, discounting motives and pain quotients alike -- so who better to understand which types of wounds really "count" than those who have cruelly suffered both? My guess is it's going to be from this corner that the rest of us learn how to more properly weight the stunning, substantial and frequently lifetime effects of this so-called "invisible wound" we refer to as PTSD.

When the Marine Corps Misses the Bigger Picture -- Zoriah, Eric Acevedo, and Censorship

It's discouraging to even have to post about this, but there it is.

In a fight between the Marine Corps and freedom of the press, the Marine Corps seems like it wants the win.  According to Google Playfights (see gimmicky graphic illustrating this post) it already has.  (Learn more about Google Playfights elsewhere: it's not central to this post.)

Following the recently embedded independent photojournalist Zoriah's travails recently, on his blog, it seems he's being kicked out of Iraq, and risking being completely blacklisted, because of at least some higher up Marine Corps officers displeasure with images he posted.  Images that centrally could help America to really get a better grip on the true cost of war for its participants.  If you believe the experts (and the poets), no one comes back from war, unchanged.  Whether it's what you've done/seen/participated in or not been able to do/see/participate in, it exacts a tremendous psychic cost.  That doesn't mean we should stop fighting in them - just that we should be more aware of the actual costs.  For every combatant killed, so many more are injured, and will come home with injuries that in many cases will profoundly transform their lives, and that of their families, for decades to come.  It's a shame the Marine Corps doesn't really want to let us, Americans, wrap our brains around this concept more fully.  It would help make us better empathizers with the true cost of war to its participants.

I had my own experience with Marine Corps censorship, earlier, on this blog.  In an attempt to humanize the story of an apparent PTSD sufferer who'd killed his girlfriend, I dug through the Marine Corps (public) archives on their website, and found a little backstory about the Marine, Eric Acevedo, who'd been accused of the crime.  In and amongst the materials were some very key items: a photo that showed the human side of his grief and pain; and some material -- if you knew where to look -- that explained just what he'd been exposed to, in terms of combat trauma, while he was on the deployment that apparently harmed him the most.  It was a tragic tale, but it was public knowledge -- at least, information accessible by the public, that could be pieced together by someone like a journalist, who knows how to dig, and highlight the important parts of the story.  I posted what I found, in an entry linked here -- and within three days, the Marine Corps had taken pains to scrub ALL identifying information about this poor guy, Acevedo, from their site.  The photo was gone, the article about the memorial service he attended, for the multiple guys KIA from his battalion on the tour in question -- all gone.  I learned about this new development when a reporter from the Dallas Morning News contacted me and said that all my links were down (I'd included them in the original piece, so anyone could follow and see what my sources had been).  Together, we backtracked through the Marine Corps archives, and found NOTHING -- the site had been scrubbed clean of multiple mentions of the accused -- and has stayed that way, since then.

Nobody likes bad publicity, but really, there's so much more at stake than that.  When it comes to combat trauma and PTSD, the focus of this blog -- it's important as a society that we see, learn, and otherwise come to understand what veterans go through -- or we won't have the compassion that we need to, and we won't pull for them to get the services they deserve, otherwise.  We also need to see more clearly the link between instances of combat trauma, and ultimately developing PTSD.   Not so "no one else will join the military" -- not at all.  So that those who do can get the help they need, and those in charge will allocate their resources accordingly.

It's my firm conviction that combat veterans don't "give" PTSD to themselves.  They "get" it from what they've experienced.  And this is a true cost of war, for the Marine Corps and others to "count" in advance, so that the right opportunities for treatment and ideally recovery can be provided.  We can see from the late SSgt. Travis Twiggs' battle with PTSD -- or many others like him -- just how powerful, thorough, and deadly an opponent it really is.  What we're not seeing, unfortunately, from the Marine Corps -- in these two instances -- is a reasonable, big picture view on how the horrors of war are not something the American public needs to shy away from, but embrace.  And where the two may be linked up, as in the Eric Acevedo story, it's crucial that the Marine Corps not distance itself from its warriors, even when they're dented with significant wounds, visible and invisible. Sanitizing war?  Why bother... Actually supporting the troops who go? Oh, definitely.  If knowledge is power -- we need more, not less - in order to do so, more effectively.

In the Zoriah situation, it sounds like someone may have snapped under the strain and started a bad ball rolling with that -- created a polarized position that no one could retreat from, gracefully.  If that's the case, that's a real shame.  There's a much bigger picture here, and finding a workable compromise would be greatly important.  I remember reading one Marine officer's published dispatches from Iraq, which got progressively darker and unpleasantly snappier as his tour went on, to the point that it sounded like another person writing them.  I commented about this to someone who knew that Marine, who told me a little side story that explained a lot.  Things had been going well until that Marine's superior, to whom he was very close, was seriously injured and almost died, taking part in a humanitarian mission with the Iraqi government.  At that point, the junior officer hit a wall, got bitter, and got very angry with the Iraqis who could have done that, while the Americans were just trying to help.  What I had been picking up in the Marine officer's writing reflected the personal struggles he was genuinely going through -- struggles which are highly understandable to anyone interested in human nature.  My guess is here, someone who felt very stressed and angry because of Marines he cared about being injured and dying, snapped down on the whole situation instead of privately (or publicly) processing his natural grief -- and the ultimate impact might be, if this continues to go wrong, to keep the rest of us from being able to experience war a little bit more, even vicariously - in order that we better understand, and grieve, with those who suffer.  I hope the Marine Corps finds a way to resolve this situation that respects the points of view of all sides involved, including the American public, which does have a need to know.  The same goes for the Eric Acevedo situation, and scrubbing the information from their archives.

The American public pays the bill for these wars: we have a right to know what they're like for those fighting them.  And those who fight them pay the ultimate price: and we respect their efforts and the character it takes to be warriors, very much.

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I shared a very bleak, grim quote with a Marine Corps Vietnam vet the other day, from an Italian in the Middle Ages who said, "Life is a voyage on uncharted waters, ending in shipwreck.  There are no survivors."  The former Marine, still struggling all these years later with PTSD, said the quote was almost right, but would be better if we switched out "life" with "combat" or, "war."  Then, he said, it would be more accurate, because, quoting him, there are no true "survivors, only shipwrecked lives..."

Editor's Note: You can read about Zoriah's developing situation on his blog, linked here.  You can also read previous entries on this blog where we've mentioned him, here and here.  You can read about the Travis Twiggs story here, and in many other entries on this blog; and the Eric Acevedo story here; both as I've blogged about them. 

And while you're at it, considering asking the Marine Corps to put the Eric Acevedo material (and anyone else's they've removed, in similar circumstances) back on their publicly-searchable archives, as it was before.  I'm sure his defense lawyer would appreciate it, because any good defense of this client is going to need to advance theories that involve his extenuating circumstances (combat) and things that speak to his state of his mind (PTSD), both of which it's hard to picture were NOT service-related.  Acevedo's crime?  A  truly terrible one.  The combat trauma he experienced, and the PTSD he likely developed?  Also terrible.  Without war coverage like Zoriah's "tragic and amazing" photography, also a big picture we're likely to miss.

What the VA Needs Is "The Odwalla Effect"

[If this blog were a newspaper, which it isn't, this particular blog post would be an editorial -- found in the opinion section, separate from the rest of the paper.  The editorial section is where the editor "puts together" what the news means to him or her, and sets out a point of view, about what we should do or feel, think or believe about something, based on what else has been in the news lately, that they've been keeping people up to speed on.  It's the opinion section, essentially -- but from the editorial management's point of view.]

Here's ours:

Kathie Costos has a great series of posts over at her blog, linked here, but there's one in particular we'd like to talk about - and we'll leave you the link to it in a minute, so you can read it for yourself.  First, the discussion.  Kathie is conducting a question and answer session with Paul Sullivan, head of Veterans for Common Sense, clearing up "rumors" about the veterans' lawsuit against the VA.  Sullivan's answers are clear and to the point, and contain some fairly galvanizing statements, pro or con.

[I should insert the caveat here, in an effort to be balanced, that I DON'T believe the VA is "all bad," nor do I imagine Costos or Sullivan does.  Every once in a while you DO read about people who are extremely thankful and grateful for the care they're received through the VA - I read an item the other day where a veteran was reminding us that they have one of the best healthcare systems in the world.  True.  But that