Healing Combat Trauma

Army General and PTSD: The Courage to Admit All is Not Well

In honor of Veterans' Day -- hey, every day should be Veterans Day, but we're not so lucky -- there's an important story to let people know about, because it so stands out from the crowd, in more ways than one.

In the wake of a recent apparent suicide by a top military officer, Air Force Brigadier General Thomas Tinsley, from unknown causes, this general's admission about his personal struggle with PTSD is all that much amazing. 

"Officers just don't get PTSD," one combat-hardened Vietnam-era veteran told me recently, knowing full well that it's not so much that they don't get PTSD, but that there's no real way to admit that they struggle with it.

---

An Associated Press report from the weekend talks about Army Maj. Gen. David Blackledge's courage to come forward, after returning from Iraq, and getting psychiatric help to deal with the trauma of war.  As the article says, by doing so, Blackledge is (fortunately) "defying the military's culture of silnece on the subject of mental health problems and treatment."

Says Blackledge, quoted in the article, "It's part of our profession ... nobody wants to admit that they've got a weakness in this area," Blackledge said of mental health problems among troops returning from America's two wars. "I have dealt with it. I'm dealing with it now," said Blackledge, who came home with post-traumatic stress. "We need to be able to talk about it."

The article focuses on the perceived "stigma" in the military culture about admitting there is a problem, seeking help and getting treated -- as well as indications that some positive change is afoot in this area.  Blackledge, who served in Civil Affairs in Iraq, and now works at the Pentagon, is clearly leading by example.  He was involved in several traumatic incidents in Iraq -- his convoy was ambushed, his driver was killed, and he was in a hotel that was bombed by suicide bombers -- and he's successfully sought help dealing with the incidents, help which he believes has strengthened him.

Given that we all pretty much know the statistics of how few people seek treatment vs. the ones who should, as well as how pervasive the culture of silence and fear of retribution is, it's GREAT to see Maj. Gen. Blackledge's openness -- and on this Veterans' Day, we can only hope it encourages many other servicemembers to go for help. The article is linked here. (Thanks to veteran John M. for the heads up!)

Editor's note: That's Maj. Gen. Blackledge 2nd from left in the photo, standing just to the right of Bob Dole, in this picture from a charity fundraiser for the Jericho Project.

Marching for Suicide Awareness and Prevention among Veterans at Army's Fort Drum

NPR on its Weekend Edition has a good story today about a march held on Sept. 12th at the Army's Fort Drum in upstate New York, to highlight veteran suicide.  The article says that Penny Pierce, who works at Fort Drum, organized the march, in part because the taboo surrounding suicide makes soldiers vulnerable (to not asking for or getting the help that they need.) The article is linked here. Great work, Penny! (And NPR.)

You Never Knew What Somebody's Limit Was - WWII Vet Reflects on Combat Trauma

"Plus ca change; plus c'est le meme chose."  Translated from the French, that means, "The more things change, the more they stay the same."  All too true when it comes to combat trauma and PTSD, as well.

The other day I was reading an award-winning newspaper story by a colleague, where he profiled a World War II veteran, now in his mid-80s.  The Army infantryman veteran saw an awful lot of action with the 79th U.S. Infantry Unit liberating Cherbourg.  He says, "The casualties were fierce.  I ended up as the only officer left in the company.  One was killed, the rest were injured."  He continues, "I was just a little kid from college.  With my pink cheeks, I looked like I was about 12.  But I took over the company.  Then, I went to sleep, because I hadn't slept in three or four days, and I'd been injured." Tellingly, he adds: "There were 200 soldiers in the company," when he went to sleep, but, "when I woke up, I could only find six..."

Here's what the veteran said about combat trauma, as he became aware of it at the time, along with the lead-in to it by the journalist:

"The fear of coming home in a body bag could cause many men to tremble."

"One of the company executive officers went into a catatonic trance.  Boom!  The first day," said [the veteran].  "You never knew what would set somebody off or what their limit was.  You got guys who can handle it all and others who struggle and struggle and then just go over the edge and they're gone."

"Crying, weeping and lying on the ground and hugging your feet.  You had to be careful not to judge them.  Everybody reacts different[ly] to a situation."

Wisdom, indeed.

Three Wars, Three Voices: PTSD and the Catharsis of Writing about What You've Seen

Two Marines and a soldier from different eras, separated by generations, write about what they've seen in different wars, and find their way to catharsis, through writing.  At just over 500 posts on this blog, over the last two years, we take this occasion to also take stock on what catharsis there can be through attempting to touch the darkness, and come away unscathed.

We've been reading the superb "Eyewitness to Combat" recollections of one young Marine Vietnam veteran, Pat, who spent 40 years trying to put together his story -- ostensibly to leave it to his family, but I believe, equally as much, in an attempt to explain what he endured to himself.  Pat was kind enough, and courageous enough, to send me his story -- and it was hard not to be affected deeply by the story that he told, about his wounds of war.

Another former Marine, Nathaniel Fick, is whose inspiration I followed to start this blog in the first place, when he came back from war -- in his case, Afghanistan and Iraq -- and kept on caring about the state of his Marines, setting a powerful example in that regard which still echoes today.  Fick is a great writer, and a great leader, and it's hard to settle on just one inspirational aspect of what he has to say.  But here's an excerpt from a little-known original essay he wrote for the bookstore, Powells, in Portland, Oregon, linked here, that talks about some of his motivation for writing the exceptional, award-winning, "One Bullet Away: The Making of a Marine Officer."  See how he talks about catharsis, the theme of this blog:

One Bullet Away started as a personal collection of stories. I wanted to write them down before they faded, and thought I'd slide the stack of papers into a desk drawer to show my kids someday. Gradually, though, I realized that something more than an archival instinct inspired me to wake up every morning and write. I began to see the book in terms of what it could mean for four concentric rings of people.

Perhaps self-indulgently, I put myself at the center, at least in the beginning. Writing was cathartic. There were days when I could barely see the computer screen through my tears. In time, I was able to look at the story more objectively, but I hope the emotional immediacy of those early days remains.

Next, I felt that my family and friends had to know about the things I'd done, how I'd changed. Otherwise, there would forever be a gulf between us. Many of the stories in the book don't lend themselves to dinner-table conversation, so writing became my way of telling the tale.

I was also thinking about the hundreds of thousands of soldiers and Marines who were in Afghanistan and Iraq with me, or will be there in the future. I hoped to write a book that any one of them could hand to a friend and say, "If you want to understand what it's like, read this."There are older combat stories I feel that way about, books like "With the Old Breed" and "The Naked and the Dead." You read them and feel that you've glimpsed something that transcends a particular time and place. Their human stories are identical to the human stories in Afghanistan and Iraq, and probably to the human stories at Thermopylae and Cannae, too.

The last and largest group on my mind was the huge body of American citizens who care about what's happening in the Middle East but are dissatisfied with the perspectives available to us. As a junior officer, I had just enough rank to see a bit of the big picture and to feel the weight of responsibility. But I was far enough down the food chain that One Bullet Away is still very much written from a grunt's point of view, where life is invariably hot and cold, dirty and dangerous. I think many of the tactical problems we faced ... continue to resonate at the strategic and political levels. In fact, I've already found the book to be a catalyst for discussion about topics like these. It's a jumping-off point, and people are eager to talk about what's happening ...[in the war].

Finally, a warrior from a third war, the Gulf War, Scott Lee.  Social work graduate student, familiar with PTSD from his own case, son, boyfriend, dad.  Scott has a lot on his plate these days, but he chronicles his struggles, victories and defeats with PTSD at this blog, linked here.  Scott is at that very difficult juncture in the road, when you wonder how much truth you should really tell, and at what cost (primarily, to your own psyche).  While you may long for release, each sentence takes its toll -- and ultimately needs to be paced out over time, balancing the desire for purging the horrors of war with the need to retain some semblance of wholeness for tomorrow.  Rob Honzell, like Nate Fick, a First Recon Marine, but from the Vietnam war, understands that intimately: writing his book over the course of two painful years could not be done without setbacks in his own struggle with PTSD.

Valiant warriors, all.  All with a story to tell.  All deserving of our various attaboys: for their courage in battle, for their desire to help the next generation and their fellow warriors, and their bravery in facing down their own demons to tell the story only they could tell.  Is writing, on balance, an effective way to achieve catharsis? Only somewhat.  At the very least, it puts the past into some sort of perspective, to allow the combat veteran to approach tomorrow as a brand new day, where he may make another survivors's attempt to touch the darkness, and return to tell us what he saw.

Moving Violations, or the Needle in the Red Zone - Combat Veterans and Adrenaline Addiction

Adrenaline in combat helps the servicemember stay alive, and execute the plan.  Being addicted to the same adrenaline rushes after combat, though -- back on the home front -- can go from being an asset to a liability -- especially behind the wheel or on the motorcycle, and contributes to the sad phenomenon known as "non-combat deaths" from various origins.

Enough returning combat veterans kill themselves through reckless driving that different steps are being taken to warn participants of the semi-obvious dangers:

The Guardian (UK) newspaper has a story in today's paper, previously published yesterday in the Observer (UK), about the the British military's current advertising campaign to warn returned servicemembers about the dangers of amped-up, reckless driving.  The article, "Ads warn soldiers back from war zones against reckless driving," is linked here.

Says the article, "British soldiers are twice as likely as civilians to die as a result of reckless driving, because they have difficulty adjusting to normal life after returning home from active duty, according to official statistics."  The ads feature catchy slogans, such as "Drive Carefully.  You're Tough, but Not Invincible," and one directed to motorcyclists, "You're An Accident Waiting to Happen."  Hmmmn.  Those ads are likely to catch people's attention -- in fact, almost 60% of troops surveyed said they would think about slowing down, said the article, after considering them.

---

Rick Roger's article in the May 23 issue of the San Diego Union-Tribune talked about the rash of non-combat fatalities among Marines at Camp Pendleton, many of whom had died in motorcycle fatalities.  Five Marines had died in the past eight days, where the "confirmed or probable causes" were homicide, suicide and traffic accidents. The article described Marine commanders and commands "backtracking to see if we need to do anything different to avoid these things happening again.”

It also clarified:

“Two of these deaths were caused by apparent motorcycle accidents, an area of deep concern for our Corps as motorcycle fatalities continue to rise at an alarming rate,” the statement said. “In a recently released All-Marine Message, the commandant outlines guidance and directives designed to curb motorcycle injuries and fatalities.”

Motorcycle-related deaths in the Marine Corps have risen every year since 2004, when there were seven. Last year, there were 19, according to the Naval Safety Center.

As for efforts to minimize combat stress and substance abuse, Camp Pendleton officials said the base has programs, policies and officers devoted to outreach and education. They also said each unit conducts monthly random drug tests on a mandated percentage of its Marines."

(Since that article was published, even more Marines have died as a result of motorcycle accidents.  See the article by Trista Talton in Friday's Marine Corps Times, linked here.  She writes, "Twenty Marines have died in motorcycle wrecks since Oct. 1, making this fiscal year the deadliest on record despite the Corps’ efforts to reduce two-wheel fatalities."  YIKES.

---

From an article in the May 13, 2008 edition of the Marine Corps Times:

The new order, a work in progress for about six months, was initiated because of the number of motorcycle fatalities and injuries occurring within II MEF. From October 2007 to January 2008, more II MEF Marines died in motorcycle wrecks than in combat.

According to the order, released April 29, most of those deaths involved junior Marines and included things such as reckless behavior, blatant disregard of orders and policies, lack of proper training, little driving experience, alcohol and willfully disobeying state and federal traffic laws.

Information about the order is linked here.

 ---

"Adrenaline addiction" is a familiar concept but by no means an official diagnosis (there are, however, informal support groups for it, on the Web, although I wonder if they're not just catchy names for invitations to drag racing and hang gliding events :-).

Sgt. Chad T. Jones wrote about it, back in April of 2004, in an article called "Flipping Off the Switch Can Save Your Life," linked here, first published in a Fort Bliss military publication, called the NCO Journal.  He introduced the article by saying:

A Soldier who has recently returned from Iraq might experience a need for a combat-level rush, called adrenalin addiction. The cravings for this excitement could kill him, but a patient, informed leader can intervene to save the Soldier’s life.

This information is a little on the generic side (in other words, seems like common sense) -- but apparently it's worth thinking about for those who haven't already considered it.  (It would be interesting, too, to learn the age ranges of those surveyed, above, who thought that just seeing the ad's message would reinforce their behavior towards slowing down and being more reasonable.  My guess is those were the older survey participants, because with age comes wisdom -- or so they say -- and/or the change to experience a few close calls with reckless behavior, which also has an impact on slowing us down.

From the same 2004 article:

Adrenaline addiction is something Soldiers returning from deployment are susceptible to, and is described as the need to engage in excitement-seeking behavior, said Col. Robert Gifford (Dr.), associate professor of psychiatry, Uniformed Services University of Health Sciences.

“Soldiers, when they come back from a deployment, have often been observed engaging in ‘excitement-seeking behavior.’ It includes a lot of people who liked excitement before and
Soldiers who come back [from a deployment] and miss the excitement, and sense of purpose that comes with a deployment,” Gifford said.

Usually, Soldiers are able to adjust their lifestyle or compensate for the lower operation tempo, but unfortunately other Soldiers “can’t find adequate ways to fulfill themselves, and they become excitement junkies,” said Lt. Col. (Dr.) David M. Benedek, associate professor of psychiatry, Uniformed Services University of Health Sciences.

Specific evidence stating why a Soldier seeks danger is not existent, Gifford said. But a popular opinion among medical professionals is that Soldiers are trying to replace the constant adrenaline needed to be successful in a combat environment.

“Operational or combat environments require a sense of alertness all of the time and it is very difficult to turn that off when you return home. Even though Soldiers are glad to be home, many found features they enjoyed while deployed,” Gifford said. “Sure it’s hot and miserable, but there is a sense of purpose. Suddenly, you’re home and those senses of purpose or excitement are suddenly gone, and people may not want to give that up so quickly.”

One way emotion leads to the reckless behavior is that Soldiers feel indestructible when they get home because they survived combat. That carelessness or sense of being indestructible can be dangerous, Gifford said. “Clearly any person who gets involved with risky behavior puts themselves in a position to get hurt, or killed,” he said.

While "adrenaline addiction" or being an adrenaline "junkie" isn't a true "addiction," as defined by the experts, there are some obvious similarities, including developing cravings for the environmental stimulants that provide the adrenaline rush -- many of which were available in combat situations, but not on the home front.  It's hard for many returning servicemembers to calm down -- and this is understandable -- after the rigors and the scares of combat.

Says the article:

"Upon detection [of the problem], leaders have many options they can use to help the Soldier. “There are a variety of mental health sources,” he said, but many Soldiers feel more comfortable talking to Chaplains or someone else. The important thing is to get the problem surfaced.”  Once the problem is brought to light, it’s important to figure out why the behavior is occurring. “Reckless behavior may be a signal of a number of illnesses or situational things that might resolve itself on its own or it might take a medical professional to figure out what to do,” [Col. Robert] Gifford said."

As I'm typing this out, though, I'm reading an email from a favorite Vietnam vet, telling me about the battle for Hill 881, and saying, in part, "without masses of adrenaline rushing through us, we couldn't have done this..." Aye, there's the rub.  Sometimes it's a total asset to have it; and just as easily, it becomes a grave liability.  Context is everything.

If you remember watching the Kellee Twiggs video (SSgt. Travis Twigg's wife, speaking after his death from PTSD), you will recall her talking about how jumpy her husband was -- how he couldn't sit still long enough to watch a movie with her and the kids; that his legs were always twitching.  To a certain degree, this must be a conditioned response from combat -- all that hyper-alertness turns into just plain jumpiness, with nowhere to go.  No wonder people try to bleed it off, doing risky things -- it keeps the feedback loop primed.

Sad to say, though, it's a feature of post-deployment life that servicemembers will need to get a handle on, through any reasonable means necessary -- and with good advice from practitioners they trust -- because failing to do so will prolong their suffering, and put their safety and sometimes that of other people's at risk.  Good for the British to be doing these ads, but as the popular saying goes, you can't really regulate human behavior. Suggesting that there might be a problem, though -- may be what amounts to a start.  An attempt to get the needle back out of the red zone...

We Made History Together: The Oral and Written Histories of Combat Veterans

Combat veterans - where did your memories go?  Not as in, "have you lost your memories?" but more to the effect of, "how are you saving them or transmitting them, for posterity?"

This marvelous photograph was taken by photographer Jeremy Hogan, and is used with permission. Hogan wrote the "Poem for My Father" which we blogged about earlier, and in his free time, he's helping to document the history of his father's squadron in Vietnam.  He says about this photo, taken over Memorial Day weekend, that the subject is, "Ron Klus, who served with my dad at Quan Loi, and received a Distinguished Flying Cross with an Oak Leaf Cluster. Unfortunately, Klus died due to issues related to his PTSD and now the VA is now denying his widow death benefits."

Recently, I've been privileged to receive several veteran's memoirs, bound up in book form -- one is a work in progress, the other already published.  I know that Jeremy is working with at least one of the guys from his dad's old squadron (13th Signal Battalion, part of the 1st Cavalry Division Airmobile), a combat photographer who did multiple tours of Vietnam, on cataloging his old photos, and creating some sort of archive for posterity.  That photographer says he's been interviewed as well, and is the subject of an upcoming article in a military magazine, but admits that dredging up the memories has been extraordinarily painful, because all those memories just come rushing back, from where they've been suppressed all these years.  That situation is challenging enough -- but what of others, who will die before they set anything down on paper, or on tape, about what they went through?  Those memories, painful and otherwise, which capture who the person was, will forever be lost to time. Unless...they're preserved some kind of way.

We've written on this blog before about the exceptional StoryCorps project -- click here for that link -- but what else is there out there, that archives veterans' recorded stories of their adventures and misadventures in combat?  (By recorded, we mean "set down" -- which could be on paper, digitally, or taped.)  One thing I've run across -- and please let us know if you know of other things like this, that are national in scope, not just regional or local -- is the "Veterans History Project," a project of the "American Folklife Center" at the Library of Congress, linked here. 

To participate in the project takes a few easy steps (their words, not mine), and seems pretty straightforward.  You register for the project, print the project field kit, prepare f the interview, conduct the interview, and send the resulting work product to the collection at the Library of Congress (of course keeping at least one copy for yourself).  Students and teachers can make this an educational project for school credit, -- that information is linked here -- but veterans themselves should think about getting involved. There's even a very cool place on the site where you can search for histories by other people who've participated -- for all you know, you might find a wartime buddy via that search engine, which is linked here.

I recently shared a quick conversation and a hug with longtime Friend of Veterans Maxine Hong Kingston, and asked her my one burning question, which was how long it took veterans before they were willing to talk about their experiences.  She said, "20 years."  I'm hopeful it doesn't always take that long -- or won't take that long, for the current crop of veterans -- but when you read some individual's war experiences you can see exactly why that would be.