Healing Combat Trauma

Virginia Not Just for Lovers This Summer: Also for Vietnam Veterans and Their Families

The Virginia Historical Society is pleased to offer free admission for everyone this summer! From June 6 to August 30, the VHS is displaying three exhibitions about the Vietnam era. The society is offering complimentary admission as a way to honor military personnel who served in the Vietnam War and their families.

On Display / Current Exhibitions:

• Soul Soldiers: African Americans and the Vietnam Era through August 30, 2009

Soul Soldiers: African Americans and the Vietnam Era explores the issues, actions, reactions, and expressions of life and culture of African Americans as they were affected by the Civil Rights Movement and the Vietnam War. Over 160 artifacts, photographs, audio recordings, songs, oral histories, and an original documentary on display in this award-winning exhibition show how events in the 1960s helped frame African American political and social perspectives that extended beyond civil rights. The roles of Dr. Martin Luther King, Jr., Colin Powell, Jimi Hendrix, and many others are explored, as well as the 9,000 women who served as nurses and in clerical and support positions during the war. Soul Soldiers was organized by the Senator John Heinz History Center in Pittsburgh, Pa.

• Marking Time: Voyage to Vietnam through August 30, 2009

Marking Time: Voyage to Vietnam features a cache of Vietnam War soldier art of striking importance and poignancy. Soldiers and Marines on the ship USNS General Nelson M. Walker, bound for Vietnam in 1967, inscribed graffiti phrases and images on the bottom sides of canvas bunks in the troop compartments. Men wrote their name and hometown, the date they expected to leave the service, and kept day-by-day calendars to mark the progress of the voyage. Original graffiti-covered canvases—discovered in the process of scrapping the vessel in 2005—display messages of patriotism, politics, humor, anxiety, and love. Marking Time was organized by the Vietnam Graffiti Project in Keswick, Va.

• A Vietnam POW's Story through August 30, 2009

Bring Paul Home: Phyllis Galanti and Vietnam War POWs is based on the collection given to the Virginia Historical Society by Richmond resident Phyllis Galanti. Her husband, Paul, was a lieutenant commander in the U.S. Navy when his plane was shot down over Vietnam on June 17, 1966. Mr. Galanti was a Prisoner of War (POW) until February 12, 1973. Pictures, letters, pamphlets, buttons, and posters from the donated collection show Mrs. Galanti's efforts, and those of the National League of Families of American Prisoners and Missing in Southeast Asia, to publicize the plight of their loved ones and to secure their release. "I think these exhibitions will be of interest to visitors, especially those who lived through the 1960s and 1970s, because they will be able to personally relate to the topics covered in all three shows," Levengood said. "It is the perfect opportunity for parents and grandparents to bring their children and grandchildren to learn about events that had a huge impact on American society, politics, and culture—and they can see it all for free!"

The Virginia Historical Society is located at 428 N. Boulevard, Richmond, VA 23220 Tel.: (804) 358.4901. The Museum is open from Tuesday–Saturday 10–5 and on Sunday 1–5 (galleries & shop only).

The Story of Virginia, An American Experience, a 10,000-square-foot exhibition with more than a thousand objects covering all of Virginia history from prehistoric times to the present is featured in the Robins Center for Virginia History. Hours: Tuesday–Saturday 10 am–5 pm and Sunday 1 pm–5pm (Museum Galleries and Shop only). Admission: $5/adults, $4/seniors 55+ ($2/Tuesdays–galleries only), $3/children and students, free/members. Admission to the galleries is free on Sundays. For group tour information, call (804) 342-9652. For more information, please call (804) 358-4901 or visit www.vahistorical.org.

Editor's note: For further information about these and other exhibits at the museum, please click here. (And thanks, Merri, for letting me know about this!)

"My Body's Intact, but Not My Soul"

Periodically we talk on this blog about the catharsis of poetry -- as a reader, as a writer. Here's a poem about Vietnam, in the form of a song called "Don't Go There," by S.L. Ponciroli, USN, quoted in Frederick Graham's "The Bamboo Chest," which we discussed recently, here:

Don't Go There

"Night in the bush in the drivin' rain
Heard the rockets burst then the screamin' pain
Feelin' pretty good 'cause I'm still whole
My body's intact but not my soul.

Don't go there is what my Mama said
You're gonna get hurt, wind up dead
But I had to go, stand and fight
'cause I didn't listen, I died that night.

My tour was over, I was done
The battles fought, but the war not won
I caught that bird, took me to the World
See my home, see my girl

Don't go there is what my Mama said
You're gonna get hurt, wind up dead
But I had to go, stand and fight
'cause I didn't listen, I died that night.

John Wayne told me to be a man
Defend my country the best I can
My home had changed, my girl didn't care
Made fun of my clothes, ridiculed my hair

Don't go there is what my Mama said
You're gonna get hurt, wind up dead
But I had to go, stand and fight
'cause I didn't listen, I died that night.

Nights at home in the drivin' rain
I hear rockets burst and the screamin' pain
Feelin' pretty good 'cause I'm still whole
My body's intact but not my soul."

-- Song by S.L. Ponciroli, USN, Danang '68-'69

Editor's note: In the photo used to illustrate this post, the handsome guy on the right, with the faraway cold expression, is headed back to Vietnam for his second tour.  He's already had the dream in which he dies, and he knows from experience that his comrades who've had that premonition, invariably do. The guy on the left, with the much less wary or apprehensive expression, is headed elsewhere. The man on the right's premonition came awfully close to coming true, as it turned out. Read more about that, in a post linked here.

Escaping from the Bamboo Chest

Every once in a while I come across a book about war and healing combat trauma that's new to me, and such was the case recently with one by Frederick Graham, called "The Bamboo Chest: An Adventure in Healing the Trauma of War," linked here. Unfortunately, the subtitle is a bit of a misnomer, unless you interpret it in a particularly specific way, in which case it works.  But while it's far afield from actual "healing combat trauma," the reality is, it's an amazing true-life adventure story by someone who understands he's very lucky to be able to tell it. 

For those of us who grew up reading books like Papillon, by Henri Charriere, who uses the opportunity of his captivity in and subsequent escapes from the notorious French prison, Devil's Island, to teach himself some things about himself, or any of the wonderful high-adventure historical novels by James Clavell -- Shogun, Tai-Pan, King Rat, Noble House, etc. -- Graham's book fits right in.  It's a remarkable story about a guy whose dad was a Marine, who grew up in and around Vietnam and Southeast Asia, and then finds himself imprisoned in a South Vietnamese jail in the 1980s, with an absolutely frustrating roommate who he'd been arrested with and grows to really detest, for all the right reasons.  Graham uses the opportunity of his imprisonment to reflect and make adjustments to his character, finds and nurtures his inner strength, and experiences several important insights from his childhood around the war in Vietnam that helps his adult self integrate itself more completely. 

Unfortunately, though Graham is plenty psychologically adept with his own experience, because he wasn't actually involved in the Vietnam war directly as a soldier, the "war" in the subtitle is at a slightly larger remove than it was for the actual participants.  However, as a story about man against the elements -- particularly man against society, and in some ways, man against himself -- it's really quite an exciting tale, and one worth reading.

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

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

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

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

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

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

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

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

Who -- and What -- a Survivor Is

Quotable quotes:

"I define a survivor as one who has touched, witnessed, encountered or been immersed in death in a literal or symbolic way and has himself remained alive." -- Robert Jay Lifton.

LIfton, an American psychiatrist and pioneer in PTSD studies from the 1970s, is also the author of "Home from the War: Learning from Vietnam Veterans."

(Hat tip to Chris Lombardi, for pointing this one out.)

Helping Vets with PTSD: Rolling up Your Sleeves vs. Keeping an Arm's Length Distance

We've talked before on this blog about Paul Tillich's fabulous quote, that "the first duty of love is to listen." 

Here's a story that neatly conveys the polar opposite of that; or at lest how someone, a VA provider, got actually PUNISHED for doing that (thanks to Ilona Meagher for noticing the story). But first, an aside.

I was at a dinner a while back that concluded a week's worth of focused training for health care providers, mostly psychologists, psychiatrists and social workers -- many of whom dealt with combat veterans.  Seated across the table from me was a VA provider, a Ph.D. psychologist who, to his credit, was of the Vietnam era but hadn't served, and who had gone into working with the VA so that he could "help" his generation of veterans, who he saw as being tremendously underserved.  True and good, so far.

As we sat at dinner, he told the private practice psychiatrist to one side of him, and the veterans service officer (and Iraq War combat vet/single mom) to the other side of him, about something "new" called "EMDR," that neither one had ever heard of, and that he had just learned about, and  was fairly enthusiastic about himself.  EMDR, for "Eye Movement Desensitization and Reprocessing," for one thing, is NOT new.  It's been in existence for years -- since the 80s, when it was developed by Francine Shapiro, Ph.D..  Something like 16 clinical trials have shown its efficacy. Heck, we've got several blog posts about it, from two years ago. So it's not really great news that the provider was "just learning about it" recently.  EMDR was one of the first quasi-"alternative" treatments offered in the psychological community for PTSD.  It's been widely studied and fairly widely recommended for PTSD ever since.  It's also something I've personally tried, so my ears perked up when I heard it.  "This stuff is so great," the VA psychologist enthused, warming to his true point: "You can treat people, and you don't even have to hear their stuff!"

Ohmigoodness.  If that isn't just the gold standard of what we want to be doing.  I'm holding out hope we'll find an arm's' length cure for healing combat trauma (kidding, absurd).

In this article, a VA provider who seems like a serious, intense, and concerned practitioner -- as well as a favorite among the veterans who were her patients -- gets fired and reprimanded for "talking an Iraqi vet down off the ledge," so to speak.  It's a pretty shocking story.  The provider has yet to be re-instated, and the OIF/OEF veteran who narrowly survived killing himself, thanks to her intervention, also has been left scarred by the situation, and more antisocial/less trusting than before.  Ugh.  Is this the kind of care we really want to be delivering?

The VA, particularly now (as in, these days) is supposed to be "very concerned" about its reputation, and really adamant about "no more bad PR."  If that's the case, maybe it's time to examine some of the decisions that get made, and why they get made -- from what happened in this story, to the psychologist above who was so thrilled to learn about a treatment mode that he could practice without having to get too involved.

Somehow, this seems to be the EXACT OPPOSITE of the care and concern and COMPASSION that someone like Sarah Haleyexhibited, herself a VA psychiatrist, through whose landmark work the shame of My Lai was able to come forth and be addressed, etc. A true hero in the pantheon of those who addressed PTSD at its roots -- and, coincidentally, ALSO someone very well loved by her patients.  Hmmmn.  There might be a not-so-subliminal message in that. 

Here's what Gerald Nicosia, author of Home to War: A History of the Vietnam Veterans' Movement, says in part about Haley (to whom he devotes more than a dozen pages of narrative):

"The other horn of this troubling dilemma was that the traumatized person, especially if he was a Vietnam veteran, would almost never come in and spill his guts to a perfect stranger.  Trauma patients need to establish trust with a therapist, and the Vietnam veterans coming into the VA clinic were never being given the chance to do this.  It was by the merest lucky chance that the My Lai veteran had seen something in Sarah Haley that made him believe he could confide in her, thereby opening the door not only to his own dark secrets, but also to possible help for a whole generation of trauma victims."

 

And, separately:

 

"What Haley did not realize was that John [the aforementioned patient, who spilled the beans on My Lai] had come to her initially because he had been told she was trustworthy by his friend Mike, whom she had treated previously.  A year later, John showed up in her office again under the pretext of bringing Mike back for further counseling.  At this time, John confessed to her that "he had needed to believe that just one person cared, that one person could be trusted to know what he had done, and not reject him.""

 

Hmmmn.  Food for thought, all the way around: but most especially for the VA, and their apparently quite shabby treatment of psychologist Sidney Ornduff, and by extension, the other veterans whose lives she could have been helping.

 

Shocking Statistics and Veterans: When "9" Is Not So Lucky a Number...

Here's a shocking statistic I ran across today, in some material online provided by the veterans' charity, Swords to Plowshares:

"It took an average of 9 years post deployment for Vietnam and prior era veterans to fall into homelessness. Today, Swords to Plowshares and our homeless veteran service colleagues throughout the nation are seeing an alarming influx of homeless OIF/OEF veterans, sometimes just months after separating from the military..."

As you can well imagine, the 9 years must have involved a steady deterioration of resources and ability to cope.  Unfortunately, today the problem is taking place at an even more accelerated rate -- hence the need for more awareness and more care to be taken with the topic.

As the foundation says, "We prepared the following paper for the National Coalition for Homeless Veterans to help decipher why this new generation are becoming homeless so quickly in the hope that, by understanding the issues, we may prevent or at least mitigate the kind of long suffering our older clients have endured. The paper looks at bureaucratic, social, economic, and physical and mental health issues impacting our new veterans. It is up to us, as providers, as neighbors, and as citizens to prevent homelessness and truly support our military and veterans with the services and support they have earned."  The link to the presentation, in PDF form, is here.

Editor's note: For more posts where we've covered the topic of homelessness and veterans with PTSD, click here, which takes you to an index of posts on that subject.

Another Hidden Cost to Veterans: Decades of Suicide Watch for Your Peers with PTSD

I had an interesting conversation with a treasured Vietnam veteran the other day -- interesting in the sense that the Chinese mean it.  I thought he was planning on being one place and then when his plans changed at the last minute, I found out why.  He was, in his words, "taking the loaded gun out of the mouth" of one of his dearest friends, a Silver Star winner who also served in Vietnam -- and not for the first time, either. I've heard some of the other stories, too, as they were happening.

Just out of curiosity I asked him, having recently heard that although he's usually "successful" at this particular task -- a combination of skill and luck, I am sure, and I've heard how he does it, it's really pretty cool -- he's also "gotten there too late," in about five people's cases -- how many people has he actually tried to "rescue" over the years in the same way?  Literally "taking a loaded gun out of their mouths" (although that really amounts to persuading the fellow vet to lay it down, not physically trying to take it.)

"About 100," he said, and wasn't too happy to have to say it, either.

Just think of that for a minute.  His odds are probably pretty good.  I'm sure some of the 100 were actually different tries by the same people, but even so...five dying, 95 successfully averting...but 100 attempts?  From your peer group?  That would seriously suck.  And I know he's made a few himself.

So when we as a country try to estimate and analyze the "hidden costs" and the "lifetime costs" of struggling with PTSD, let's remember the psychic costs as well.  I'm not sure any of us are particularly well-suited to be taking loaded guns out of each other's mouths...for decades.  And the irony to me of this whole situation is that of course, he does what he does out of love: because he can't let them do it.  And yet...he's often not much more than a few steps ahead of where the other person is, at that moment.  Granted, he's sharing everything he's got.  But really: is this a solution?  I'm sure if he hadn't been there for those guys, the suicide toll among Vietnam combat veterans would be that much higher.  Which would be a tremendous loss, and a continuing disgrace (that they have to, not that they did.)  But at the same time -- think about it from a mental health standpoint.  How great would yours be, if decades after a war, you could also look forward to THIS grim duty?  Good grief...The poets and the politicians both agree, sometimes: War is Hell.  But so can the aftermath be, sadly. Even for those who survive.

Editor's note: For veterans in crisis, call the National Veterans Foundation.  Staffed with crisis counselors -- other vets, just like you.  As their website says, "The NVF is standing by to provide you with personal assistance and advice. We are staffed by veterans with experiences from Vietnam to Iraq.  We are trained not only in Veterans issues but also in crisis management for PTSD and suicide prevention. If there is anything we can do for you, please ... simply call us at (888) 777-4443."

The Double-Edged Sword Called "HOPE"

"Got hope?" the Obama bumper sticker asked.  (Hey, we're non-partisan here, it's just an illustration to make a point.)

The reality is, hope turns out to be VITAL, not optional, in someone's struggle to "heal."  And "healing," of course, is not specifically an end-result, a "one and done" event -- but a progress along a continuum. 

Even the Bible talks about how, "without vision, the people perish."  Emily Dickinson, who it's easy to imagine as a profoundly depressed, but nevertheless highly imaginative New England poet, referred in one of her more famous poems to hope "as a thing with feathers."  Meaning, pretty airy, light-weight, and able to fly away.  Hard to trap and catch, hard to hang onto.  If you put the two concepts together, though, hope is both necessary AND hard to hard to hang onto.  No wonder it's so important.

Over the last few months, I've been watching as a hardened combat veteran, with severe PTSD, has stepped out of his comfort zone, and put his "hope" to the test: Hope that there was a life for him outside the realms of severe combat trauma.  It's been incredibly interesting and refreshing to see what's happened to him since.  And hope shows up at every turn.  Without going into it in much depth here -- there'll be another time and place for that -- I've been able to see his physiology as well as his psychology change, in just a few short months -- and I've seen the renewal of "hope" this has caused within him.  For one thing, hope to be considered more than just another "crazy, effed-up combat veteran" -- the mask he's apparently worn for society for years (decades, in his case).  Hope that he can have an actual life and happiness beyond what he had been reconciled to, by virtue of "throwing off" some of what's hindered him (the Biblical wording here is purely incidental.)

The deal about having a mask that you wear, as a combat vet, because it's what society expects of you -- and it's also what allows you to keep other people at bay -- is a very interesting concept in its own right.  It helps, but it also hinders. It frees, but it also constrains.  And suddenly, with better health, comes the realization that it may be time to consider laying that mask down, at least part-time.

Whoa.  Strangely...that turns out to be a tad problematic.

Because there is comfort to be found behind that mask, and safety, and worst of all -- familiarity.  We all struggle with, "better the devil you know...than the devil you don't know."  And even a self-imposed mask offers a modicum of comfort, though at great cost (what you miss out on, wearing it).

The combat veteran and I had a conversation the last few days that mirrors several others we've had over time, as he's received extremely positive -- surprisingly positive -- news from his medical providers.  The sum of it is, he seems to feel he had an easier time picturing he was going to fade out and die...than actually revive and live.  Strange, isn't it -- the rest of us just want to get well.  But to the combat vet with PTSD, sometimes there's a fair amount of comfort (from the familiarity) of knowing things are bad...and likely to stay the same or keep getting worse.

What I've seen with this very courageous individual, as I've watched him fight to take this new hill, called health, is how hard it's been to reconcile himself to having hope now for an actual future, unmarred substantially by the PTSD that's dogged him so much from the past.  Not that he'll ever be "over" it completely -- but getting quite a bit better, and healing both on the outside and on the inside?  On the one hand, priceless. On the other hand, definitely scary.  Stay tuned...this has been an incredibly interesting journey to watch, and it will continue to be.

Vietnam Veteran Turns to Acupuncture, Qi Gong and Yoga for Relief from PTSD

We've been discussing various forms of Complementary and Alternative Medicine, or "CAM" for short, which seem to have potential therapeutic usefulnessness for treating PTSD.  Here's a mention in a recent article in the Salt Lake Tribune of March 14, 2008, of other Eastern methods, including the energetic medicine, "Qi Gong," which appear to have brought some relief to one Vietnam war-era nurse.  From an article by Matthew D. LaPlante:

Mary Jane Shipley is a 62-year-old former trauma nurse who was stationed at a mobile Army hospital in Vung Tau, Vietnam. 

Shipley's "eyes well with tears," LaPlante writes, at the recollection of the young men she watched die there, burnt and broken and missing pieces of their bodies as they faded away." 

He continues, "Shipley says she knew almost immediately after returning home there was something wrong with her. In part, it was the helicopters. She could hear them, even smell them, ferrying patients to the Salt Lake City hospital where she worked - sometimes minutes before any of her associates could."

Her other symptoms are hallmarks of PTSD: "She had trouble relating to other people. She was restless. She was constantly afraid. Perhaps to the eyes of today's doctors and nurses, Shipley's illness would have been obvious. But back then, no one reached out."

In Shipley's case, according to LaPlante, "It took her 30 years to realize she wasn't alone. Now in treatment for post-traumatic stress disorder, the Western-trained nurse has found Eastern therapies to be most helpful. She practices yoga and qigong. And at least twice a week, she undergoes acupuncture. "It took me so long to figure out what works for me," Shipley laments, "and I still have so much trouble."