Saturday, March 17, 2007

PTSD - What does it want from us?

The classical image of the uniformed solider returning from war is a shower of affection that honors their courage and dedication to the greater good of a nation. Those who didn’t return become memorialized as fallen heroes, the making of legends in the collective memory. One creates the posters for future recruitment, the other the monuments and somber holidays that aim to immortalize the nobility of war.

Warriors are supposed to be heroes. Where do today’s veterans at Walter Reed, and every other VA facility, fit next to the supposed pride in our history? If they aren’t being treated as heroes, what is the fate of the returning warrior wounded in our war?

America claims to be the world’s source of technological ingenuity, always on the steady march to improving the quality of life. And the “can do” confidence of the military is supposed to be an exemplary model where failure is never an option. So what reason could there possibly be to deny our wounded soldiers the proper care they need?

To understand the possibilities of any contentious, complex and even confusing situation, we have to look hard at more than the facts as they appear. The obvious is often a distraction, and the easily imagined causes and solutions may do nothing more than sugar coat the more serious nature of the problem. But we have to begin with what we see, which is failure yet to be explained.

Once the problem at Walter Reed was finally exposed, the cry came from all corners of the country that there’s no excuse for the ill-treatment of our troops. The word scandal comes with every news story feeding itself to an outraged public. So the scapegoat procession begins. Maj. Gen. George W. Weightman, Dr. Francis J. Harvey, Lt. Gen. Kevin Kiley, three career casualties of the failure at Walter Reed Army Medical Center.

Scandals deliver focus to the issue, which is then supposed to enable the fix. Get the right people on the job. Extra funding for the medical needs of our wounded fits right in with the rest of the skyrocketing defense spending for our national security. It can’t cost that much next to the price for the weapons and overseas deployments of soldiers who vastly outnumber the ones suffering at home.

Where is the money needed? The situation which sparked the Walter Reed controversy wasn’t in the inpatient wards where the most seriously injured are treated. The news stories suggest the hospital itself is an example of the best care possible. While the place in the normal spotlight shines, the outpatient conditions many were living in combined with the bureaucratic insensitivity caught the nation’s attention.

According to Washington Post reporters Dana Priest and Anne Hull, the troops on the outside outnumber the patients in the main wards 17 to 1. If we go beyond Walter Reed and Washington DC, we’d also find similar stories, most especially when it comes to mental health care and Post Traumatic Stress Disorder (PTSD).

In a Washington Post interview, clinical social worker Joe Wilson said the breakdown of care “creates resentment and disenfranchisement. These soldiers will withdraw and stay in their rooms. They will actively avoid the very treatment and services that are meant to be helpful."

Sgt. 1st Class John Allen, injured in Afghanistan in 2002, testified to congress that the conditions and neglectful attitudes “result is a massive stress and mental pain causing further harm. It would be very easy to correct the situation if the command element climate supported it.” It’s almost as if their healing was intended to be incomplete.

As soon as we imagine that the words “command element” allude to a systematic failure, the problem becomes much bigger than the three terminated careers. Can their replacements make a difference on the same budget, or will they seek an increase in funding to make the necessary improvements?

Money issues turn us to Congress and the administration, our elected leaders who are mere miles from Walter Reed. Don’t they visit the wounded in the hospitals out of genuine concern? Shouldn’t they have ample opportunity to assess the effectiveness of the staff, equipment and programs intended to care for the soldiers? Why haven’t they already funded the care the troops deserve?

It seems so obvious that with best care imaginable for our returning wounded vets they would they be then better equipped, mentally and physically, to transition back to civilian life? Yet by zeroing in on money and personnel, other questions might be forgotten under the assumption the problem has been solved? And we don’t have to look back far into our history to see the pattern of neglect may be just as likely to continue. Why?

Is doesn’t seem possible that Congress was in the dark on these problems. In fact, at least one congressman appeared to have spoken to hospital administrators about concerns. The day after Weightman was fired the Washington Post reported that Rep. C.W. Bill Young (R-FL) had been voicing complaints about inpatient treatment since 2004.

The next day, the Young and his family had to explain to the media in Florida why he didn’t take his complaints to the floor in Congress. Young argued that he was unaware of the outpatient issue, and stood by his consistent dedication to the wounded. His accounts seem to speak to his personal concern, as if he was detached from his congressional duty. Did his immediate connection to the soldiers suffering create a compassionate reaction that removed him from his political persona?

Young also claims his attempts to raise concerns were rebuffed by the higher level officials he spoke to. And soon after the scandal broke, the military brass enflamed it further by attempting to silence the soldiers who had begun to speak out. What are the administrators trying to avoid?

Clinical psychotherapist Edward Tick has worked with veterans suffering from PTSD for many years. In his book War and the Soul he explains that “Warriors need elaborate rituals cleansing them of pain and stain. They need to express their stories and related feelings. They need to transfer responsibility for their violent actions to the society in whose name they acted.”

Society is also a system of individuals. To imagine a soldier’s trauma is the “pain and stain” of war’s horror on the individual soul, we’d also have to imagine the transference Tick is talking about must move to other individual souls one at a time rather than to society en masse. If so, Young perhaps had begun to absorb the guilt but was also keenly aware of the political system’s resistance to it.

Tick also points out that the “recovery of each individual is no longer a priority of the larger social system because the system functions even with the loss of significant numbers of its adult population.”

When the individual soldier’s health is imagined as statistical irrelevancy, it becomes apparent that something larger than the individuals who make up Congress and our government may be at work. The monetary solution is reduced to treating nothing but the symptoms while leaving the disease to fester. If the collective self preservation of a large group is about power, what is it about soldiers who find their way beyond the trauma of war that is threatening?

David Connelly served in combat in Vietnam and tells his story through poetry. He explains in an interview for the film Voices in Wartime that he wants to expose the “absolute inhumanity of combat” and to debunk the myths of war glorified in our textbook histories and pop culture’s imagined heroes.

The truth of war’s horrors has the power to undermine notion that war, especially modern warfare, can be fought humanely. Truth to power is what the wounded warrior brings to the table. It is a truth beyond what the peace activist community alone can muster. Only the ones who have seen it can grasp it.

But we are also part of the society that they were sent to fight for. Do we also have to allow then to transfer their pain and stain to us? Isn’t it our turn to fight for them, to ensure they are healed so their stories can be told beyond those of us ready to listen?

Healing implies a return to what was normal before the wound. But it also means change. Tick explains that “After war and other traumatic loss, we are different forever. We can neither get the old self back nor return to a state of innocence. We have been through a psychospiritual death. But like the mythological phoenix, from death we attain a rebirth.”

We in general, and family members especially rightly want their loved ones to be whole again, to be the person they knew so well before the war. How does this natural expectation remedy itself with a spiritual rebirth?

Human beings are naturally uneasy in the face of change. If there is comfort in the security of what we know and trust, then there is also a discomfort when confronting what we don’t recognize. Whether we respond with a steady dose of resistance or confused apprehension, we can become stuck in the role of secondary victims when it comes to watching a family member or friend struggle through psychological turmoil.

In his bestselling book “Care of the Soul”, Thomas Moore explains when “we are the observers of depression and are challenged to find a way to deal with it in others, we could abandon the monotheistic notion that life always has to be cheerful, and be instructed by melancholy. We could learn from its qualities and follow its lead, becoming more patient in its presence, lowering our excited expectations, taking a watchful attitude as this soul deals with its fate in utter seriousness and heaviness.” (emphasis mine)

We’re back to wondering about the fate of the warrior returning wounded from our war? Perhaps the wounds of war that our soldiers seek to heal are larger than physical and mental wounds suffered on the battlefield. Might they be larger than life, the call of fate? Could there be no return to normal because more is wanted of them?

To hear our soldiers’ truths aren’t we going to be changed as well? Our fate too may be calling to let go of the normal life we wanted to return to? We can’t go back either. Would we even want to if normal means our children and grandchildren will relive their horror and our anguish through another war?

Our political establishment, including the high ranking military officers, is entrenched in itself and corrupted by power. Its focus is self preservation, resistant to change to maintain their idea of normal, their comforts, and their sense of security. The system seems to want to marginalize and ostracize our wounded soldiers so that no one will listen to their truths.

The power rests with the establishment. The truth rests with those who have lived it. The healing of our wounded warriors might shift the balance of power to where the truth leads the way.

In the stories of those suffering from PTSD the promise of change has a beating heart. Edward Tick believes that nations need to allow the “survivor to come home and serve the causes of peace, justice and healing”. Maybe then we might all find our “mythological phoenix”, and perhaps the end of political warfare.

1 comment:

RoseCovered Glasses said...

We need to be careful to differentiate between the Active Service Hospitals and the Veteran’s Administration. There are major differences.

I am currently a resident in a Veteran’s Home after having undergone treatment through the VA for PTSD and Depression, long overdue some 40 years after the Tet Offensive that cap stoned my military 2nd tour in Vietnam with a lifetime of illness.

My blog has attracted the stories of many veterans such as myself and other sufferers from PTSD who were victimized by elements of society other than the VA system of medical and mental treatment. I, for one, became trapped in the Military Industrial Complex for 36 years working on weapons systems that are saving lives today but with such high security clearances that I dared not get treated for fear of losing my career:

When my disorders became life threatening I was entered into the VA System for treatment in Minneapolis. It saved my life and I am now in complete recovery and functioning as a volunteer for SCORE, as well as authoring books and blogging the world.
When I was in the VA system I was amazed at how well it functioned and how state of the art it is for its massive mission. Below is a feature article from Time Magazine which does a good job of explaining why it is a class act:,9171,1376238,00.html

I had state of the art medical and mental care, met some of the most dedicated professionals I have ever seen and was cared for by a handful of very special nurses among the 60,000 + nursing population that make up that mammoth system. While I was resident at the VA Hospital in Minneapolis I observed many returnees from Iraq getting excellent care.
I do not say the VA system is perfect but it is certainly being run better on a $39B budget than the Pentagon is running on $494B.
We have bought into the Military Industrial Complex (MIC). If you would like to read this happens please see:

Through a combination of public apathy and threats by the MIC we have let the SYSTEM get too large. It is now a SYSTEMIC problem and the SYSTEM is out of control. Government and industry are merging and that is very dangerous.

There is no conspiracy. The SYSTEM has gotten so big that those who make it up and run it day to day in industry and government simply are perpetuating their existance.
The politicians rely on them for details and recommendations because they cannot possibly grasp the nuances of the environment and the BIG SYSTEM.

So, the system has to go bust and then be re-scaled, fixed and re-designed to run efficiently and prudently, just like any other big machine that runs poorly or becomes obsolete or dangerous.
This situation will right itself through trauma. I see a government ENRON on the horizon, with an associated house cleaning.
The next president will come and go along with his appointees and politicos. The event to watch is the collapse of the MIC.

For more details see:

by Rich in Juneau