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.

Prevention Talk and Prescriptions Apparently Not Doing It: Army and Marine Suicides Both Up

"The grand essentials of happiness," Allan Chalmers wrote, "are something to do, something to love, and something to hope for." Those words echoed in my mind yesterday when I met a remarkable woman vet in Seattle, who ten years ago was homeless, suffering from MST and PTSD. (Today she's a vital, contributing member of her community, solving problems for herself and other veterans in need, on a large scale.) 

We were talking about suicide prevention, a cause close to her heart, because she'd lost a daughter to suicide, and recently a friend as well (Orrin McClellan, who we wrote about recently on this site.) We were talking about suicide, and how Army and Marine numbers are still up, despite prevention strategies. She said, pointedly, that she'd learned that veterans (and others) who are struggling with suicide need "three things" in their lives to keep from killing themselves. What they need are: "a reason to live, a way to live, and a purpose to live for."

Salon magazine had an excellent but gut-wrenching article earlier this week by Mark Benjamin called "A Predictable Suicide at Camp Lejeune," subtitled, "A doctor warned that mental health care for violent, disturbed Marines was inadequate. Sgt. Tom Bagosy proved it." The story profiled the violent death of Marine Sgt. Tom Bagosy, 25, on the way out of the Deployment Health Center. (Bagosy leaves a wife and two children.) Less than a year ago, Salon had run another article by Mark Benjamin about a Marine Corps psychiatrist, Dr. Kernan Manion, and his specific, whistle-blowing warnings about the inadequacy of mental health care at Camp Lejeune -- warnings he took all the way to the president, and seemingly for which he was fired a few days after voicing them. (Here's the link to that earlier article, including his warnings.)

Marines initiated a new suicide prevention program last year; but suicides have only increased. They lead the services at this point. Army numbers are up as well. According to a report released Thursday, and carried on CNN, 32 soldiers killed themselves in June, "the highest number in a single month" since Vietnam. Twenty-one of of the soldiers were active duty, 11 were inactive Guard or Reserve; and seven of them killed themselves while deployed. A quote from the article, "Army officials admit they still haven't answered the question of why troops are committing suicide at a record rate."

While Marines sometimes mock the Army's slogan of an "Army of One" -- preferring instead to focus on the group -- the reality is, both branches are seeing heavy combat and neither one is excelling at helping troops not commit suicide. New programs get trotted out, new initiatives, new videos. But none of them are getting the job done: not alone, not together. Troubled troops and veterans are simply not listening; or not hearing what they need to hear. And what would that be?

Well, Mass. General Hospital is having their second annual conference right now on the "Complexities and Challenges of PTSD and TBI," and they're doing a great job "Tweeting" the speakers' points in real time. Here are a few excerpts of note, starting with a crucial one: "Only 30% of troops self-identify as needing help before committing suicide -- despite all the proactive intervention points." And again: Only 42% of troops who screened positive for mental health problem actually sought help from doc or spiritual advisor." PTSD is initially difficult to distinguish in troops because upon their return home, "initial relief and euphoria" at being back can mask it. But over time,"After 8-10 weeks and adjusting to a different life schedule at home, symptoms start to present."

This fits right in with the stories you hear from people coming back, that they don't want to talk about it or think about it (PTSD); they just want to get on with their lives, and fit right back in to where they were before. It's later on, when this adjustment doesn't work, that things get more stressful. High unemployment can't help: veterans' unemployment is significantly higher, in the recession, even that the national average. And troops have gone from being highly focused on the battlefield and engaged in their warrior purpose to losing that and perhaps not being able to replace it immediately with another. They've also gone from a high level of camaraderie with their buddies often to being quite geographically separated from those they were close to when deployed. Marriages and family life can be rocky as well. The relationship they were dying to get back to on the battlefield may have evaporated by the time they got home; or not make the adjustment intact. Again from the MGH conference: "78% of marriages end in divorce for first-time deployment troops."

Against all these backdrops of difficulty -- and an awareness that the "gold standard" of treatment is still talk therapy and psychopharmaceuticals -- the problem persists, compounded by sleeping pills that can be dangerous, and the ever-present self-medication strategies of alcohol and street drugs. It's hard to get the formula right for the correct medication(s) at the correct dosage(s), and until that happens, veterans frequently talk about feeling numb, in a stupor, not feeling like themselves, etc. Vets don't necessarily want to talk about what they've been through -- except perhaps with one another, and even then, not that much -- and ignorant questioning about how many people they've killed while they were over there, etc., just exacerbates the problem. So enough of the bad news...of which there is plenty...what can vets possibly do to increase their chances of surviving and adjusting? Because I highly doubt it's gonna be another prevention video or poster that does the trick, however well-meaning.

If everyone wants an easy answer, maybe they won't like this. But it seems to be that it's time to return to replacing one purpose (warrior) with another (warrior on the homefront), and putting some time and thought, effort and resources into what that will be. One veteran who made the transition from serving to the fire department, felt he literally replaced his one purpose, and one set of buddies with another; and that "substitution of purpose," as it were, was what helped him survive. But not every vet will be so lucky, or have or make that opportunity. 

If we take a look back at the Chalmers quote that opened this discussion, what are the three "grand essentials" for happiness (i.e., well-adjustment) that he cites? Something to do, love and hope for. And what are the three things that help a vet prevent suicide, according to the suicide counselor vet? Three very similar things: a reason to live, a way to live, and a purpose to live for. Veterans are warriors...and cast aside from their purpose, without an effective way to replace that immediately, it's possible they flounder. As a society, as those who "support" our troops -- whether professionally or personally -- what can we do to make sure that they have all three? With a little reflection, we can see where they had them in combat. Something to do (be a warrior); something to love (family, country, buddies, the mission); and something to hope for (winning; getting back home alive; reuniting with family and friends; keeping your buddies alive). What I suspect, sadly, is that from those adrenaline-charged heights, life on the home front, potentially unemployed, over-medicated, and disconnected from family and friends, there can become a time when there's not enough "reason" to live; there's not enough way to live; and there's definitely a loss of purpose to live for.

A better use of resources than more videos, etc., though would be: focusing on what would it take to give veterans their purpose back? And not entirely how could be do it for them, but how could they join in that mission themselves? Every veteran affects the lives of 50 other people, minimum; so whatever happens with them back on the home front is a ripple effect. Let's focus some energy on the topic of continuing life with a purpose; versus watching on with sadness and despair the continuing tragedy of young vets (and older) taking their own lives. They've given too much; and they deserve so much better. So while pep talks on prevention and prescription pharmaceuticals don't seem to be doing the total job when it comes to suicide prevention, maybe it's time to bring back talk about purpose -- and how to continue that successfully, after the deployment is over and the uniform is hung up for the time being.

In a related side note, apparently mental health plummets when distressed individuals can't "do" to solve their situations with personal effort. There's been talk in the news lately about mental health issues soaring in the Gulf states after the BP eco-disaster, and that money needs to be set aside to help with those; but in that, there's also discussion of what happened after Hurricane Katrina. Apparently, after the hurricane hit, those affected started immediately to do what they could to restore their lives. (Think of all the news footage we've seen of residents after large-scale disasters, sawing up downed trees, hauling lumber to shore up makeshift housing, etc.) What's now surfacing anecdotally are stories about while this busy-ness after the disaster was therapeutic for people -- helped them to get their minds off the tragedy by putting themselves back to work -- when FEMA came through and made everything grind to a halt while they inventoried the situation -- people's grief and despair rose up in waves, with nothing to "do" to distract them.

Much is made of the "adrenaline rush" of combat, and how it's very hard (hmmn, likely impossible) to match that in civilian life -- but at the same time, there's also definite "purpose" -- of getting the job done, of keeping your buddies alive, etc. After combat...it's suddenly very quiet, and boring by comparison. "War is hell, but peace is boring!" some veterans joke. Cast adrift without the shared common and energizing purpose of combat, in their early 20s, veterans need quickly to find something to "do" that matters to them -- something they can live for, love and enjoy, that satisfies them and makes life worth living. Sadly, far too many people are checking out when they can no longer find a reason to live, and in tragic stories like that of Marine Sgt. Tom Bagosy, or Orrin McClellan, you get the impression they don't feel like they had any other choice. Tragic. Not just for them, but for the people they left behind, whose lives will also forever be marked by this experience. Such a tremendous loss...and possibly, preventable: If not for them, at least for some others. Let's try.

Paying Tribute at "The Tribute Wall..."

One of the most remarkable experiences, at last week's third annual "The Brain at War" conference in San Francisco, was visiting the Marines' Memorial Club & Hotel in Union Square, where the conference was held.

Unbeknownst to me and many of the other conferences' participants, the Marines' Memorial is both swoon-worthily fantastic as a venue AND happens to house a one-of-a-kind tribute to OIF and OEF veterans who have been killed in action. The so-called "Tribute Wall" is on the 10th floor, mezzanine, and Major General J. Michael Myatt, USMC (Ret.) encouraged us all, during the conference, to take some time and pay honor to those servicemembers who had given the   ultimate sacrifice. 

True to my nonexistent personal GPS, I first mistakenly went to the wrong floor -- the library, on the 11th (which was cool, but not the same) -- and finally found my way to where I was supposed to be. The polished black plaques, listing fallen warriors by name, branch, and date of death, cover the four walls of the memorial room, and then stretch out beyond it, covering a "fifth" wall completely in the adjoining room, and continuing to advance.

If you know when a friend or loved one died in combat, you're able to find the plaque's general location by scanning the wall to find the correct year, then reading vertically to find the approximate location of the date.

If you know only a name, but not the date, it's safest to look up the name of the servicemember in the frequently-updated list kept in a binder in the center of the room, again listing by name, branch of service, and date of death.

In my case, I went to a section of the wall to find those who died on a certain tour of Marines in the Sunni Triangle, back in '05/'06, then went back to find the names of friends of friends and take photos for them of their loved ones' plaques.

There are some surprises. One is, see photo at left, that two "major league" departed heroes, among all the rest of the great departed heroes, Pat Tillman (Army) and Jason Dunham (Marines) died on the same day. Until I saw their plaques resting above each other on the "Tribute Wall," I can't say that I realized that. 

There's also a guest book which people can sign, to leave their memories and condolences; and there's a flag display of the flags of all the branches in the center of the room. There's also a framed photograph of Marine General James T. Conway, (at this writing, current Commandant of the Marine Corps) from the front cover of a Marine magazine, visiting the wall; and another framed "thank you" note he wrote, expressing his appreciation to the Gold Star families for the exhibit.

I found myself returning to this generation's "Wall" time and time again during the conference, sneaking away from the (great) presenters to put myself back in touch with the very great losses of these wars, in terms of men and women who were dearly and deeply loved by those they left behind. I racked my brain and texted friends for the names of friends they had lost on their tours, to make sure I got photos of their loved one's plaques.

In numerous trips to the Tribute Wall ("Room" is more like it, since the plaques cover at least five walls by now), I rarely saw another visitor. Only one couple, the wife or girlfriend tagging behind the husband or boyfriend, who looked like a veteran, searching out key names on the wall. I heard that a number of conference participants also went to pay their respects. I didn't run into them, which doesn't mean they weren't there. What the hushed and reverent silence in the room did mean, though, and the literally thousands of plaques, each representing a servicemember important and loved to many friends and family, is how little we typically recognize the ultimate sacrifice of those who   gave their lives. I feel blessed and honored and frankly, grateful, that I got to pay my respects at the Tribute Wall for those who gave so much.

If you're ever in San Francisco, and you can handle seeing the sheer enormity of OIF and OEF deaths honored in one single "room," you owe it to yourself -- nay, them -- to go by the Marines' Memorial Club & Hotel, head to the 10th floor, Mezzanine, and pay your respects, so that their sacrifice is not in vain.

Editor's note: Servicemembers who were KIA from all branches of the Armed Forces are represented on "the wall," not just Marines.

"The Brain at War" Conference in San Francisco

Last Thursday I had the opportunity to attend the third annual "The Brain at War" conference, put on by the NCIRE, The Veterans Health Research Institute, in San Francisco, CA. More on that later, because things are really busy around here right now. But it was a great conference, and the second excellent training I'd been able to attend, within the past 30 days. (The first being the superlative clinical training program in PTSD, put on by the National Center for PTSD in Menlo Park, CA. An article about that program is linked here.)

Some personal recaps and observations:

The Brain at War featured a number of interesting speakers, including Heidi Kraft, Ph.D., the author of "Rule Number Two," whose presentation was really the emotional anchor of the day. (Kraft now serves as the Deputy Director of the U.S. Navy Combat Stress Control Program.) She talked compellingly about her experience in Iraq, and in particular the events and emotions surrounding holding the hand of a dying Marine, who later became famous to the nation as Cpl. Jason Dunham, who was posthumously awarded the Medal of Honor. (He's also the subject of an excellent book, "The Gift of Valor," by Wall Street Journal reporter Michael Phillips.) 

Her speech was probably the first time, in almost five years of writing and editing this site, that I got to let the power of the stories I've heard, from various suffering servicemembers, vets and their families, really sink in. As Kraft told her story, of pain, empathy and loss, and the bond it built with Dunham's family, that continues to this day, I tapped into my own reserve of painful memories of stories I know, and couldn't stop crying. Looking around the large conference room, I saw I wasn't remotely alone in that, though; even men in suits were dabbing both eyes with their handkerchiefs and napkins. She also had a powerful, powerful poem that she wrote about the highlights and lowlights of the Iraq tour, called "The List," that she read to those assembled, and which is featured prominently in the book she later wrote, above.

There were many highlights of the program, including hearing from the National Guard about what they're doing to secure better mental health for their servicemembers, who don't have the same access that other branches do. The California National Guard has a good "Combat Stress Control" program, with handouts like this tip sheet, "Helping a Soldier Buddy in Distress," linked here. They've also got a superlative poster, "Never Let Your Buddy Fight Alone (against PTSD)" that emphasizes the importance of Guardmembers in one another's lives. An U.S. Army National Guard leader, Major Paul E. Gonzales, from Kansas' National Guard, talked convincingly about the challenges Guardmembers face after deployment, accessing mental health services, when they're frequently hours away from the nearest facility. 

Another true highlight was, through the miracle of Skype, hearing and seeing USAF Major Jennifer J. Hatzfeld, Ph.D., R.N., report in from Afghanistan about her tour of duty there and what it's been like. And Chris Loverro, a UC Berkeley grad now filmmaker, and part of the U.S. Army's Stryker Brigade from Ft. Lewis, Washington in Iraq, talked openly about his struggles with PTSD upon returning from war, and showed a short film he's made about the "Hidden Casualties" among veterans. The short film's message was raw and powerful, and hit home with many in the audience.

Hidden Casualties from chris loverro on Vimeo.

(Army) Brigadier General Loree Sutton was in attendance at Thursday's program, and seemed to be an enthusiastic supporter of all things health and wellness related to the military and PTSD (and TBI). Sadly, in news that went over the wire yesterday, Sutton resigned her position as the head of the Defense Centers of Excellence (DCoE). See news item, linked here. The timing was significant: it's the same week that the privately-funded National Intrepid Center of Excellence for Psychological Health and Traumatic Brain Injury opened on the Navy campus in Bethesda, Maryland for the treatment of TBI and PTSD. Although the opening was a big deal -- and the fact that the money was raised privately also is -- apparently no cabinet members, no White House representatives, no senators and only two congressmen showed up. So the "war" ... on the brain... at war... appears to continue.

It was gratifying to see a certain portion of the event, as well as a small-group discussion afterwards attended by maybe a dozen participants, devoted to the discussion of integrative medicine and PTSD. (The discussion leader, an M.D., said she was also in the process of leaving the military.) Let's hope that despite the apparent setbacks and detours that progress can still be made on treating PTSD with integrative medicine. 

The building the conference was held in -- an A+ facility called "The Marines' Memorial Hotel & Club," in San Francisco's Union Square -- was fantastic. "Like the Harvard Club for Marines!" I exulted, to anyone who'd care. It's worth a return trip to San Francisco just to revel in the exhibits on each floor. (The food was also superb.) There's an excellent library on the 11th floor, many things on other floors I didn't get to see, but a true "draw" and it's quite powerful is the "Tribute Wall" on the 10th floor, Mezzanine, which honors the fallen heroes of every branch who have given their lives in the OIF and OEF campaigns. I'll probably have to reserve writing about that for another time, but I kept stealing away from the presentations to go back to that memorial, taking photos of the plaques commemorating those who died who were important to vets who are special to me. The memorial has black stone plaques, engraved with the servicemember's name, branch of service, and date of death, and they're embedded into the walls (the exhibit covers five walls by now, one full room and stretching outwards from that) roughly chronologically, vertically. There's a guest book in the room to sign, and also a guidebook, which must be updated regularly, listing servicemembers KIA by name, branch of service, and date of death. Once you find the date of death, you know approximately where their plaque on the wall will be located, and you just go looking for it. Pretty impressive, and moving, exhibit, giving honor to those to whom honor is very much due. (For more on that, see link here.)

Quotable Quotes -- Nate Fick on Combat Veterans, PTSD and Reintegration

"It took me a year to adjust after coming home from Iraq. Afghanistan was different -- it wasn't very violent and we came back on a ship. I had a month, including some vacation time in Perth and Sydney, before getting back to the States. But I left Iraq on a Sunday night, and was in San Diego on Tuesday. It was surreal. I had all the stereotypical little signs of post-traumatic stress disorder -- jumping at loud noises, nervous in crowds, short-tempered, insomnia. And you know what? I came back to a loving family and supportive friends. I had a good education and solid prospects for the future. This experience almost unhinged me. What about all the men and women who don't have the support I had? What happens to them? This is a question the military -- and our society more generally -- should be addressing. We'll have something like half a million combat veterans trying to reintegrate into American society over the next few years. They can be a source of wisdom or of destruction. It depends on how well we care for them." -- Nathaniel C. Fick, former Marine captain, author of "One Bullet Away: The Making of a Marine Officer."

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."

Holiday Gift: Rudy Reyes' Hero Living

If you're stumped for a holiday gift this year, think about the new inspirational book by Rudy Reyes, called "Hero Living: Seven Strides to Awaken Your Infinite Power," linked here.

Rudy Reyes is an inspirational "everyman" -- former Marine 1st recon, star of Generation Kill, who grew up admittedly hard and has honed, ever since, a set of internal values modeled on attributes of classical warriors. While Reyes, a former world martial arts champion, has honed his body to a superlative degree, it's his inside that's even more interesting -- how he's dealt with, and is still in the process of dealing with -- assaults on his soul, from childhood through combat.

Reyes has much in common with his childhood hero, Bruce Lee, from the unparalleled attention to fitness, to the equal attraction to the philosophical underpinnings of what success really is.

There's something for everyone in this book, and best of all, it reflects someone who's inspirational, yes, in his attitudes towards obstacles -- systematically conquering them all, in a focused way, one after another -- but is also, even by his own admission, very much "still a work in progress." Go, Rudy!

Editor's Note: For a recent article in "Military Times" about Rudy Reyes, entitled "The Hero Life: For Rudy Reyes, Inspiring Others is a Full-Time Job," click here.

After Combat: Too Much Time on My Hands, Missing the Action

Among the many first-person narratives to come out of the wars in Iraq and Afghanistan, a few start to address their growing awareness that they came back from the war with symptoms of PTSD. The recent warriors, now writers are just beginning to come to terms with the their experience, and both figuring it out and giving it effective voice is a difficult task that may get somewhat easier to accomplish in the years ahead. It's remarkable and positive to see the shortened cycle time in play as these warriors realize they may have PTSD, and it's also educational to hear how they describe what their concerns are, and what their adjustment has been like.

In former Marine sergeant Clint Van Winkle's recently published autobiographical work, "Soft Spots," he talks in one section about the experience so common to warriors -- that back in the "safety" (and boredom) of civilian life, they both have more time on their hands to think and revisit the past; and also an increasing sense that they miss tremendously the amped-up experience of war and their buddies -- the living and the dead.

Van Winkle, a Marine sergeant who first went to war on Valentines Day, 2003 was, according to the book jacket, "among the first wave of troops that crossed into Iraq, and his first combat experience was the battle of Nasiriyah, followed by patrols throughout the country, house-to-house searches, and operations in the dangerous Baghdad slums."

Here's how Van Winkle describes this collection of feelings and impressions, in an extended passage we've cut and spliced together somewhat for easier reading. The phrases in bold for emphasis are ones you hear again and again from combat veterans, in one form or another. With love and appreciation for the recent combat vets who are still processing these issues, and may be for years to come, here's what Van Winkle had to say about his own struggles to re-adjust:

“In war, no one asks you if you killed anyone.  You don’t have to say anything after a firefight.  You just come back and sit around with your fellow Marines. All you have to do is nod and they know. The questions are answered because you were there together.  They know and you know.  Nobody asked why one of us shot into that window or why the unit in front of us ripped into that bus or why I shop the group of men hiding behind that wall.  Everything was understood.

Maybe it wasn’t the war itself but the people who were in the war with me that I missed. Perhaps all I really wanted was to know it was all right and worth it and that my actions were justified.  I wanted to be back in the company of others who understood what it’s like to pull the trigger.  Wanted to get away from the questions and the made-up answers – to get back to a place where I felt normal again.

...

Names of the war dead for the week scrolled across the bottom of the big-screen television. … No matter how many times I saw the different list of dead troops, I never got used to it or the feeling that maybe I should have been included.  I wasn’t familiar with any of the names, but that hardly meant anything to me.  I didn’t have to know the dead personally to know what kind of stuff they had participated in.  I mourned each as if he had been a personal friend, and the grief took a toll on me.

...

I had too much time on my hands.Even though I was taking classes…I was bored – like being stuck in Kuwait without anything to do.  It was easy to understand why Gunny always had us doing something…. He must have known that boredom brings problems, allows too much time to think….

In some messed-up way, being home produced withdrawal symptoms. I’d experienced the most exciting events of my life. Nothing could ever compare to the feelings war induced.  Nothing. I’d never get the same adrenaline rush or create the kinds of bonds we Marines had with each other.  Civilian life was dull compared to what I’d done.

...

But I wasn’t being unappreciative. If anything, the war had made me appreciate life more, helped me see what was important. It was just hard to express that appreciation when all I could think about was Iraq.  There was no escaping it.  Iraq was everywhere.

...

True, it was over.  But in some respects the war had become more real than it had been while I was in Iraq.  There wasn’t much time for reflection while we were in country. I never stopped to think about what it all meant, or really even cared.  It wasn’t until I got home and started to talk to the dead, revisiting the war, that anything started to sink in. Was it worth it? I don’t know. That’s up to the dead to decide.

When I’m an old man and all the dreams and sights have left my head, when the memories are stolen from me, then historians will tell us whether it was worth it or not – if the war really helped anybody.  Until then, I’ll live with the dead.  We’ll carpool together.  Do lunch and late-night snacks.  Slumber parties and drinking binges.  It really won’t matter what anyone says, or if the whole stinking operation finally gets labeled a “good war.” It was too late for me. The dead and I were together.

From the book jacket:

Clint van Winkle, Soft Spots: A Marine's Memoir of Combat and Post-Traumatic Stress Disorder. Winkle was a sergeant in the U.S. Marine Corps. While in Iraq he served as an Amphibious Assault Vehicle section leader attached to Lima Company 3rd Bn 1st Marines. After completing his enlistment, he earned a B.A. in English, and then a Master's in Creative and Media Writing.

Editor's note: The illustration for this post is a wonderful drawing by Marine combat artist Michael D. Fay, of Lance Corporal Nicholas G. Ciccone, who suffered from PTSD and later sadly took his own life.

Rudy Reyes Has a New Book -- Hero Living -- Coming Out

Rudy Reyes, former Marine recon, multiple tours of duty, and consistent inner warrior, has his first book out, called "Hero Living: Seven Strides to Awaken Your Infinite Power."  You can pre-order it now on Amazon, here.

Editor's note: We've talked about Rudy Reyes before on the blog, here and here. To his credit, as a warrior who's seen intense combat, Rudy understands that not all wounds are physical -- and he's done what he can, throughout his life, to strengthen and balance his inner self with his outer. You can find Rudy's own web site, here. (The slideshow of his life is really quite striking. That's linked here.)

The Real Meaning of Memorial Day: Remembering the Sacrifice

For the real meaning of Memorial Day, remembering the sacrifices that have been made, there's a powerful essay written by a trauma surgeon in Iraq about the tragic death of one Marine he treated that might be worth your while to read.  Beware: it's completely gruesome, and spares no detail, though is done respectfully.  And it has an even doubly tragic ending (you'll have to read it to see what it is.) If you have been to war, you might not need to read this -- you're already plenty in touch with what carnage and sacrifice are all about.  If you haven't been, though, it might be a little more eye-opening about what those who serve go through and ultimately sacrifice.

The most impressive part of the story to me, besides the great care the trauma surgeon takes with every battlefield injury, is his love and respect for those he's working for -- and on, a love and respect shared by everyone involved in the course of his workday.  The sheer magnitude of what they go through, and its power to numb the human heart and psyche, is astronomical.  The fact that they fight through for it not to numb them is even more remarkable.  It's a complex human reaction, best expressed by the doctor himself, but it's also summed up centuries ago in the following quote, which we've used before on this blog:

"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, quoted in One Bullet Away: The Making of a Marine Officer, by Nathaniel Fick.

If you want to read a gory but powerful reflection on the true cost of sacrifice, read "A War Surgeon's Perspective on Memorial Day," by John P. Pryor, M.D., quoted in full on the blog, The Kitchen Table. The reflection is linked here.  It's well worth reading, though completely sobering and sad.

Editor's note: For more material along the same lines, there's an OEF/OIF memoir by another doctor who served, "On Call in Hell: A Doctor's Iraq War Story," by Cdr. Richard Jadick, which is linked here.