Thanks, Dad

His names first caught my eye, all three great: first, middle, last, like something straight out of Downton Abbey.

The man I saw in the waiting area could have come out of central casting for the same show, turns out. Imagine Ryan Gosling fresh out of Marine Corps basic training, but who’d managed to keep enough hair to make either a comb-back or a comb-forward look rakishly stylish. That pretty much summed him up. Dressed in his clean work uniform, his (admittedly non-boot-camp) beard well-trimmed, any photographer in his or her right mind would have been foolish to pass up the opportunity to shoot him in the latest from J. Crew.

It was our first meeting. He apologized for having had to cancel an earlier appointment. He’d had to make an alternative appointment that day, he said, one that he’d dared not miss.  I later learned with whom. He’d been right. Only after finding that out did I finally understand his initial tentativeness:  respectful, true, but guarded.  Most definitely.

It was not his first visit to our clinic, after all.  He was not a “regular” in any sense of that word, but he’d been there often enough, it would have seemed to me, to forestall the degree of hesitancy I sensed from him, even with his meeting the “new doctor” for the first time.  His medication needs were straightforward. A review of his records showed that he’d had a history of dealing with some combat issues, but in recent visits he’d assured other colleagues that he had been doing well enough.

And, indeed, in many ways, he has been. A relatively-new girlfriend, but one whom he’d fallen head-over-heels for: he smiled as he informed me that he was trying to think through how he was going to afford the aftermath of the proposal he was nudging himself toward making her. A good job, one that surprised him with its challenges, given how ordinary it might seem to some: the man who had taught it to him was funny, interesting, even, and not about to let him get away with a half-ass job, a compliment that, in a way, perhaps only a Marine can fully appreciate.

It was his father, however, whose psychological presence filled the room, a retired military physician—and a steadying hand. For, indeed, things had not been well after he’d returned from War.

“I can still get so angry,” he said to me, “over the stupidest things. I get so upset with myself. My girlfriend helps a lot, but I can’t tell her too much, you know? I can always tell my Dad, though.”

Yet I could see in his eyes that he was struggling more than he would have wished.

“How does the War still follow you around?”  I asked him.

“Oh, not that much anymore,” he said, in a non-defensive way, to be sure. There had been more nightmares, more flashbacks in the past, but the support of his family, his girlfriend, his Dad: they’d made a difference over time. He no longer took any “standard” medications often prescribed to those who suffer from combat PTSD. He’d never been a fan of them ever, given their side effects, and he was doing well enough without them. Seeing the presentation of the man in front of me, I had no reason to doubt that.

But, still, there was something.

“You talked of the anger. So how does the War still weigh on your heart?”

He shot me a look and didn’t skip a beat.

“The guilt,” he whispered, almost hissed, and then silence.

“So tell me about that.”

And so he did.  Two incidents, primarily, ones in which had situations just been altered just a bit, he would have been the one to have lost parts of his body. Not his teammates.

Each man of each incident survived, it turned out. In fact, it turns out, both men are thriving. I don’t even have to add the caveat “relatively speaking”: they are thriving. Period. He seemed genuinely happy to report that to me, that hint of a tear in the left eye notwithstanding.

He talks to them with some frequency. They always sound glad to hear his voice.  Semper fi, the tear stayed right where it lay.  All is OK with the guys, after all.

So no need for no tear to go mucking around some cheek where it has no business being in the first place.

“You were how old?” I asked.


“So,” I had to ask him, “do you imagine that you might ever be able to forgive him, that twenty-year-old kid?”

The look he gave me was genuinely one of puzzlement.

“You know,” I continued, “that kid who could have an attitude, but who would have done anything for his brothers, and his brothers knew that, who just didn’t happen to be where he might otherwise have been, and so who didn’t suffer what he might otherwise have suffered. That kid.”

He just looked at me. Or rather, he looked in my direction. I suspect that inside his head, he was looking somewhere much, much farther away.

“You’re the only one left who hasn’t done so, you know,” I said. “Forgiven him.  Truth be told, you’re probably the only one who ever blamed him in the first place.”

His look shifted into one of self-reflection, his eyes dropping down, flashing side to side, looking, interrogating, maybe. He then looked back at me.

“Yes,” he said. “Yes. I think I could forgive him.”

Now I’m sure my look turned into puzzlement.

“Really?” I asked. “That easily? You haven’t done so before, you know.”

Ever so slightly, he smiled.

“I never thought about it that way before.”

I suspect I too moved from puzzlement to self-reflection as he added, “It might have been different, had they not been doing as well as they are. But we’re all doing the best we can now. Yes, I think…maybe I could, one day. Forgive myself, that is.”

In the few seconds afterwards, so much flashed through my mind, happy stories, not-so-happy ones. At one level I knew he was so fortunate: to have friends who survived, who still wanted to reach out to him, to have a girlfriend who is willing to give him space when he needs it, a family who loves him and welcomes him back into their raucous, multi-child world.

To have a Dad who still comforts his heart even when Dad literally cannot do so as regularly as both of them might like, yet who psychically—spiritually, maybe?—can, without regret, whisper into that young Marine’s heart and keep an embarrassing tear from revealing too much too soon to a new doctor.

Medication issues managed, we soon prepared to part. I started to stand. He did not.

“So, I guess,” he said, “if things should change—because of that other interview, you know?—we wouldn’t be able to see each other anymore. Right?”

That, I wasn’t prepared for.

“You were honorably discharged, right?”

“Oh, yeah. Medically retired. I didn’t really want it, but…I see now that it was for the best.”

I smiled.

“Then we’re fine.”

He smiled then.

“Good.  That’ll make my Dad happy.”

“Your Dad?”

“He kept telling me that I needed to get hooked up with the VA. He’ll…he’ll be glad I finally did what he told me to do. I can be stubborn sometimes.”

I’m sure my smile back radiated the rolled eyes inherent in the phrase, “No kidding”

On this Thanksgiving Day in the United States, let me simply recognize the fathers, mothers, husbands, wives, lovers, children, brothers, sisters, grandparents, grandchildren, aunts, uncles, cousins, old friends, new friends, future friends—all who do what they can, in the best way they can, to bring home men and women who have gone to War, changed irrevocably, and yet seek to create new lives for themselves and for those whom they love.

And from one particular psychiatrist who is glad that one particular father has made the life of one particular son calmer, at least more days than not, let me simply say:

Thanks, Dad.

All Saints Sunday 2016–and Remembering

Four years ago now, Veterans Day 2012, I wrote a piece remembering men who had died in combat, as I had come to know them through the combat vets I’d then had the honor to work with. A year later, I re-published the piece, remembering the three men with whom I’d worked in Indianapolis who had died that previous year.

A mere year ago, I wrote a piece on All Souls Day about another combat veteran, Sergeant First Class  (Ret.) Jonathan (JD) Downing.

A year.

This past Tuesday was All Saints Day in the Western Christian calendar,and Wednesday was All Souls Day, days to remember those who have died, to be thankful for their lives, to have them rekindled in our souls. The church I now attend also recognizes these days by offering a time on the following Sunday to light a candle to remember, to give thanks, to rekindle.

Given that in my day-to-day work I am now back to listening to the lives of combat veterans both younger and much older, I found myself this morning, as I was approaching the front of the sanctuary, so very aware of all the deaths of War, of those who fight it, of those who are caught up in its horror, of those who suffer from its complexities for months, for years, for decades.

Have I really been listening to them? I have been asking myself these past few posts. Will I really listen to them? I must keep asking myself.

Yet as I reached the front of the church, took the candle and lit  it via  one of the candles previously lit—lit it via one of the lives already remembered, thanked, rekindled by someone who had just stood before me—only one phrase could come to my mind.

Pro tibi, JD.

For you, JD.

And as I lodged the candle into the sands spread out to hold it, another line came to me, one typed into that post one year ago, one whispered at a coffin in Indiana over three years ago, one that still, I hope, in some way shows JD now, as I hope it did Porthos then, whether in spiritual truth or in material memory only, that I honestly tried my best.

To listen. Not to War. To him. To them.

Cruciatus consumptus est, mi amice. Requiesce in pace.

The torment is over, my friend. Rest in peace.

Yes, mi amici, my friends.

Rest in peace.


Very Different Journey, Very Different Hero (IV)

So, no longer fully comfortable in the Land-of-Those-Who-Know-and-Heal, our psychiatrist takes up the challenge of listening to War, traveling with the combat veteran to find out, in some small way, what War has been, is, and likely ever shall be.

Or so he says.

“So,” says the combat veteran, “let me tell you about me and War.”

“Thank you. Yes, so how bad was it?” the kindly psychiatrist inquires.

“How easy to fall into old habits, eh, Doctor?”

Our good psychiatrist turns to his right to see not Dr. Edward Tick now, but someone even more commanding in presence and tone: an Elder Warrior.

So I have to ask you, Doctor: what is it?  Are you going to walk with this veteran as s/he tells this story, or are you just going to watch him/her do so?

“I beg your pardon?” the psychiatrist asks.

Remember, like any good military man or woman, that veteran got into all this precisely because of a desire to protect, protect their families, their nations, the victims of aggressors, their fellow fighting brothers and sisters. Combat veterans will protect you, as well, if you ask them to, whether in word or in deed.

“And your point?”

The veteran has been clear to you, whether or not you fully heard it or understood it. Do you want to know of War, the vet has asked you, or do you really want to know of War?  By your asking the veteran how bad it was, you are already telling the veteran’s story by assuming you know an ending that the veteran has yet to reveal to you. The veteran has not yet told you it was bad. You told the veteran.

If at any point  you take control of a veteran’s story, start making assumptions and acting on them before the veteran has reached that ending, s/he will assume that you’ve decided that you’ve gone far enough on this journey with him/her, and whether or not there might be more to say about War, the veteran will fall back in line and assent to your rank of professional authority, just as the veteran would have assented to a chain-of-command superior.  All will once again appear as if it were in order. The veteran will act as if your ending is the one true ending. Whether or not it is. All will, once again, appear to be on the right track.

For a few moments, the psychiatrist and Elder Warrior look at each other.

And as you know, dear Doctor, more than one battle has been lost precisely because those with the rank set up situations in which those without the rank protect those in power from truths that the ranked ones might have been less-than-willing to hear, let alone believe.

It’s a time-honored tradition, good sir.

A few more moments.

Always remember, this is supposed to be your story, Doctor, with you as the uncertain Protagonist. The veteran, however, will always follow your lead. The veteran will make it his or her story whenever the going might get too tough for you, when whatever the veteran has to tell you might be a little too challenging to hear. He or she will take that heavy rucksack of “protagonism” off your back, in other words, and carry it for you so that you can breathe more easily in the long, flowing robes of the Wise Mentor.

A few more.

“War is messy, sir. As is recovery from it. As a civilian, your job indeed is to pave a road back for this veteran to return to hearth and home. That construction project, however, does not automatically grant you the authority—or even the power—to guide that veteran back on that road.

Elder Warriors do not mince words. They’ve met too many doctors.

Remember, good doctor:  helping to diminish fear is not the same as guiding home. Lest we forget, this story started at the point at which you had already done for this veteran what you could about fear. You’d already signed your prescription. Many of your colleagues had already done their therapies. You were the one, sir, who asked what more you might be able to do with the remaining time on your hands.

Not the veteran.

Given the choice, the veteran might very well have said “Thank you for your time, Doc,” and walked out.

After all, sometimes the old insult is indeed true:  seen one shrink, seen ’em all.

The psychiatrist shifts in place.

Guiding is our job, sir, the job of those who have gone to War before and found a way to re-live our life stories in light of it. We appreciate all your work on moral injury. We’re living with it, after all. We’ll be glad to let you know when you’ve hit pay dirt.

Not the other way around.

You’re a civilian, sir. On this road back, long after all the meds and therapies have done what they can do, your job is simply to accompany and to welcome.

Ultimately, for this veteran, in order for him or her finally to come home,  we, the Elder Warriors, get to wear the long, flowing Mentor robes.

Even though this does appear to be a distinction that you and some of your colleagues sometimes have a challenge accepting as valid.

Both veteran and Elder Warrior stand at the Threshold of the Journey and look at the psychiatrist.

Apparently stories of War are harder to get going than what the good doctor might originally have imagined.

The psychiatrist turns to the veteran.

“Let’s start again, shall we? Tell me…really…of War.”

And now the real story begins.

More to come.

Very Different Journey, Very Different Hero (III)

“Well sir, with all respect: do you really want to know about War?”

“If I say yes, veteran, then what?”

Talk about a couple of questions that can turn an average day into one anything but so. For the answer to the latter comes not from the veteran, but from Life itself.

“Then, Doctor,” says Life, “your story might begin.”

Remember: any well-made story starts with a problem and ends with the Hero’s somehow resolving (or not) that problem, after having faced the problem head-on. Ideally, by solving the problem, the Hero makes life better not only for him/herself, but for others as well. A little communal healing is a good thing for all concerned, after all.

So,given that our psychiatrist really knows little about War, about what War itself–being around it, in the middle of it, from it—feels like, in body, in mind, in soul, we might ask: how can that knowledge end up being helpful, for him, for others, for anybody?

Here, let’s get back to Dr. Ed Tick.

In his works, Tick takes three strong positions.  First:

Only Warriors can fully bring Warriors home. Non-warrior professionals might be able to help restore the Warrior, at least somewhat, in body. But only Elder Warriors can show Younger Warriors what has to happen in order to put War in its proper place in the heart, in the soul.

He doesn’t mince words. Professionals are free to disagree. Therein begins the discussion.

But he’s not done there. Second:

If only Elder Warriors can guide the Younger Warrior back home, only Civilians, those who have tended the hearth fires, can let them know, in body, mind, and soul, that to Home they are welcome.

And why is that the case? Third:

War is an experience beyond others, even other traumas. Natural disasters carry with them the dread of how unpredictable and short life can be. Violent attacks carry with them the horror of how selfish and cruel people can be.

War, on the one hand, brings with it both truths, held together in a dread and horror that is so personal, yet so impersonal; so one-by-one, yet so massive-all; so human, yet so god-like; so vulnerable, yet so powerful; so pitiably worthless, yet so astoundingly worthwhile; so one, yet so the other, adjective after adjective after…

War is something that one can only stand before, stand within, and then, if one is still left standing, turn and stand outwards toward a very different world, knowing that behind one is the most perverse Garden of Eden imaginable, a World unto itself, awful and awe-filled. One rejoices that one has been banished East of it. And one wonders whether that angel with the fiery sword might not be open to a small bribe, no biggie, just a little something to let one vet back in, just for a quick…

So, we must ask ourselves, this psychiatrist must ask himself: do we want to welcome that veteran back to the Home hearths?

Do we prefer to tell ourselves that the veteran has become, because of War, who we could never become had we gone there ourselves, had we not let him go in our place?

Or do we dare imagine that, yes, even we—even I—having entered War, might have considered a quick turn back  and might have eyed that angel with the same thought?

If we, if I dare to imagine that? Then, my friend, we have a story on our hands.

More to come.




Very Different Journey, Very Different Hero (II)

“So whose journey should this be, Doctor? Do you really want to know about War?”

I ended my post yesterday with a hypothetical veteran asking me this question. Time to come up with an answer, non-hypothetically.

Funny thing about stories: they don’t even start until something goes wrong. Otherwise, you have nothing more than running commentary on a bad home movie: this happened, and then this, and then this, and then…

As a psychiatrist, I’m well-trained in how to tell the “standard” story of a patient:

Once upon a time, a person was fine, until one day s/he wasn’t. Desperately did s/he want to return to her/his former state of well-being, and so s/he set out on a journey of healing.

Behold! A message comes to her/him: seek out the Wise Mentor with the script pad. He will lead you to Understanding and grant thee the Elixir that will help you find your way back home, whole again.

Mentor met. Elixir prescribed. Celebration upon the return home (after therapy adventures faced and overcome, naturally).

It’s a nice gig, truth be told, the Wise Mentor. I even had an Emmy nomination or two, some seasons back. Got the plaques to prove it.

Now, also truth be told:  to play this gig adequately, I don’t even, technically speaking, have to know that much about War. I just have to know about biology.  You’ve seen one USS Enterprise, you’ve seen them all. The crews might vary here and there, but basic roles are covered, and a drone is a drone is a drone, as long as you program it correctly from the start.  Offer meds, offer therapy, get the show on the road.

That was sort of the whole point of Beam Me Home, Scotty!

But my hypothetical vet invites me to participate in a different story, not as a substitute story (for many, if not most, are quite happy to journey with a psychiatrist if the relationship is a respectful one), but rather as a supplement, a story in which, well, the veteran is the Wise Mentor.

In other words, in that supplement, that Wise Mentor, the vet, is telling me that I am the one who is no longer fine—or who at least should no longer be fine.

Pray tell:  how would that story go?

How about something like this:

Once upon a time, an aging psychiatrist  was living his life in a Society, contributing to it, but also drawing advantages from it.

One day, that Society went to war against another Society. As it happens, when the call went out to to fight this war, many others in his Society answered that call, and the Society had no need to recruit the psychiatrist or any of those whom he loved.  So instead, the psychiatrist kept on contributing to Society and drawing advantages from it, paying for his own little part of the War through his continuing contributions (taxed income) and advantageous withdrawals (monetary support for a commerce system similarly taxed).

One day, however, the psychiatrist turned around, and there standing in front of him was a combat veteran, returned from the War.

“I’m back,” said the veteran. “I took a journey in your stead, in the stead of the ones you love. I lived where you did not have to live. I saw what you did not have to see, heard what you did not have to hear. I did what you did not have to do.”

The veteran then looks at the psychiatrist, who looks back. For a few seconds, nothing, then the veteran simply says, “Nice to meet you, sir. I did the best I could.”

But wait, where’s the problem? Where’s the story-starter?

Good question. Answer? There doesn’t have to be one.

Our good psychiatrist can simply say:

“Thank you for service, brave veteran. Are you having a good day or a bad one?”

And we’re back to the standard, psychiatrist-patient story.

But what if we imagine a slightly different exchange:

“Thank  you for your service, brave veteran. But what do you mean: ‘you took a journey in my stead’?”

“I went to War, sir. So you and your loved ones didn’t have to.”

“What if I didn’t want you to go to War?”

“Did you stop paying taxes, sir? Did you stop participating in the commerce of the land?”

“No, veteran. I did not.”

“Then you agreed that someone needed to go to War, sir, for Those-in-Power declared that War, sir. I did that. For you. Went to War. Whether either of us thought it was or wasn’t a good idea, I did that.”

So now, the psychiatrist must choose: is he (i.e., the psychiatrist) having a good day—or a bad one?

A good day for the psychiatrist:

“My goodness.  Thank you, veteran. I never realized that before.  Thank you. So…are you having a good day or a bad one?”

In contrast…

A bad—or, shall we say, a not-as-good day—for the psychiatrist:

“My goodness. Thank you, veteran. I never realized that before. Thank you. So…what was it like, taking my place?”

Which, of course, brings the question that got this whole post started:

“Well sir, with all respect: do you really want to know about War?”


Long pause.

So the psychiatrist sits there. Meds prescribed. Nothing but time left on the clock.

A decision. Might the world not be as good as our psychiatrist had thought?

His world, that is?

“If I say yes, veteran, then what?”

The veteran looks at him. The psychiatrist looks back.

Then what, indeed.

More to come.

Very Different Journey, Very Different Hero (I)

So with such a title: just what’s that supposed to mean?

Well, any good “Hero’s Journey” tale needs a good setting, after all, so let’s start there.

In my current job, I have been hired primarily to work with combat veterans to determine whether medications might help them in their journey toward healing.  Easily stated.

There is, of course, a great deal of complexity to that subject, requiring an understanding of the body’s chemistry and function that I must continually keep current. Researchers do their job to learn more about those chemistries and functions. I do my job to keep learning what they learn, complete with tables of data, graphs, and long Graeco-Latinate words attached thereto. (And, admittedly, some very ingenious trade names that would make any Don Draper of any Mad Men episode quite proud).

Yet even with that complexity, my job is relatively straightforward. Sad to say, while researchers continue to work hard, they are tackling a subject so complicated, they are not setting off fireworks of new practice and insight with every monthly journal publication. We’re all doing our best, but there you have it.

That means that topics for my medication discussions are certainly worthy of consideration, but they are anything but unlimited. Mechanisms of action and side effect profiles tend to cluster in certain groups, with particular trade/generic names within such clusters tending to differ from each other more in degree than in kind.  Jointly with the combat vet, I discuss the highlights of the groups, the pros and cons, the particular applications of possible meds to their particular cases and, once the vet decides what he or she wishes to do with his or her body (my gold standard), I type into a computer to notify some distant pharmacy, and voilà, there we go: we give medication A (or E or K or…) a try.

Or not. Not everybody is into meds. That’s their right. And I mean that.

All together, that does take time, but just some. Time does not march on during our sessions, in other words. It may just shift in place. Slightly.


What else do we have to talk about?

Well, how about psychotherapeutic treatment focused specifically on combat trauma?

Another complicated subject.

In most of the systems in which I have worked, my particular job has not been to provide such particular treatments, although I have been expected to understand them and to be able to work jointly with those who do such treatments.

Trauma-specific psychotherapies focus on helping combat veterans confront, in some way, memories of the experiences that still distress them so that the vets can begin to feel such experiences to be less “live,” less tormenting in the here-and-now.  Practitioners of such treatments are expected to have specific training in such modalities and are expected to use their clinical judgment in doing so in a gentle, yet sustained manner.

Again, easily stated. Or at least easily enough.

Trauma-focused treatments are not things to dabble with. Combat vets who have done them know that far better than many of the rest of us could ever imagine.  One does not revisit intense emotional experiences for an hour or so and then head off to a round of Putt-Putt afterwards.

In other words, given my limited time after a medication discussion, I do not delve into that prototypical Pandora’s box. Unlike the myth, if I were to do that, it is quite likely that neither the combat vet or I would get to the Hope that the story claims is at the bottom of that box.

So I leave that for others.  Happily, for many combat vets, such treatments can be life-changing.

Interesting thing, though: many of the combat vets I get to serve have already “been there, done that” with such treatments or, having considered doing so, have concluded with a “thanks, but no thanks,” sometimes hesitantly, sometime anything but.

In other words, much of my day is spent with individuals who have either decided not to try that particular life-change or, more sadly, have found themselves less-than-satisfied customers of the changes those treatments did not—or even worse, did—produce.

Thus, I am faced with a choice.

I could, for example, urge them to give another, good-old college (re)try at trauma treatment. That can work, sometimes. Emphasis on the some.

Or I could assume the role of Wise Mentor in their Hero’s Journey toward healing and begin offering sage advice on life, love, and Hope after War.  Yes, I, the Mennonite who has never worn the uniform.

You’d be surprised at the number of combat vets who would be kind enough to listen to my “professional wisdom” if I were to offer it. I guess most of them were so used to enduring ridiculous platitudes, having nothing to do with real-life, coming out of their military superiors’mouths, my pathetic attempts at such platitudes would be for them just memories of another day at the office.

Or, I guess the combat vet and I could look at each other and honestly ask each other, “”So whose journey should this be, Doctor? Do you really want to know about War?”

Come to think of it: if my combat vet friend hadn’t taken quite a journey already, would s/he even be sitting there? So if one of us already taken a journey, isn’t it at least fair that the other should be willing to consider a journey of his own?

Maybe, for example, as a “hero” who willingly takes a chance and who has to make active decisions along the way, rather than just comment on the plays on the field like some quarterback who’s seen better days?

Well, come to think of it: I guess that would indeed be a different journey for a different hero.

My, my. We’re back where we started this essay.

My, my.

More to come.

As Times Goes By

As I walked through the outpatient waiting area, I passed one of the young guys in the civilian program, I thought, communing with his smart phone. Upon reaching the nurses’ station, though, I realized my error, walked back, and for a few moments stared at the soldier unobserved, at his stocking cap with the chic, mirrored sunglasses perched thereon, sunset orange, at his technicolor tennis shoes facing no visual competition from the all-gray track suit that most likely cost a fraction of the shoes’ price, from Target, likely.

Texting completed, he looked up and smiled. “Hey!”

“Good holidays?” I asked.

Shifting to a frown that spoke volumes, “We need to talk,” he said.

Marital tensions, again. Similar ones had brought him to me only weeks ago with a near-suicide story worthy of the name. Today, though, he was only angry, willing to keep trying, but only for so much longer.

In the ensuing weeks, you see, he’d begun to forgive himself for imagined errors and real deaths. No longer was he feeling unworthy of happiness because he’d happened to have decent-enough numbers in War’s lottery.

“I’m not a bad man,” he said to me. “I deserve better.”

Music to my ears, my young friend, to my ears.

Dark Shadows

‘Twas The New York Post, (ah, venerable news source), that published the review of Demon Camp, the story of a combat veteran who sought to rid himself of War’s demons—the “Destroyer,” shadow of Death—via a husband-wife exorcism team in eastern Georgia. The book’s author postulates that whatever good the soldier experienced must have resulted from a mental “virtual exposure therapy” that still allows him to fight his demons and “always win.”


I write with no interest in exorcisms. In an age of statistics, pills, and cognitive techniques, though, I sometimes wonder how many of my colleagues believe that their words, printed or spoken, adequately contain the horror of even the metaphorically demonic, confident that by exclaiming “Prefrontal Cortex!” in lieu of “Be Healed!” they have given superior succor to a war-tortured soul.

How many, I can only wonder, have abandoned words long enough to allow their own prefrontal cortices to absorb the limbic horrors of the veterans before them, enough so that the dark shadows of soldiers’ nights invade them just enough to feel in their depths, even momentarily, one whispered word: “Die!”

Talk about cognitive restructuring.


After thirty years as a psychiatrist, I have come to a certain detente with my field. Experts smarter-than-I gladly inform me, in press or in person, of what constitutes adequate “evidence” for the identification of maladies, the efficacy of treatments, the title of “best practices.”

Oh, so lucky am I.

I always look forward to the day when a combat veteran first encounters “Brainspotting,” a trauma recovery technique so unworthy of notice by the scientifically rigorous. How can a patient’s gaze at a pointer, stalled at a particular point in the visual field, lead to anything but a feel-good parlor trick, after all?

“What was that Houdini s*** she just did with me?” my patient asks, a mere hour after his session with my colleague. “How can just looking at a particular spot cause my mind, finally, to stop racing down godforsaken alleys?”

Just yesterday he sobbed before me, despairing that Life could get better. Now he flashes a smile that seems both to fear and to dare Fate’s vengeance for his hopeful hubris.

“So many meds, so much therapy, all these years—and after two hours, I feel a calm I’ve not felt in years. Seriously?”

Nothing up my sleeve, I only reply, also smiling, “Seriously.”

Grand Opening

I still recall Dr. Hook’s The Cover of the “Rolling Stone,” my generation’s lament over what it takes to get noticed around these parts. What lyrics might have been spawned had BuzzFeed, The Daily Kos, and YouTube then been available?

Sean Azzariti, cannabis activist, twice-deployed Marine with PTSD, got his notice as he made his purchase of Colorado’s finest Bubba Kush yesterday, before God and all news outlets, as the cries of hurrah and humbug began wafting their way around the globe.

If only I could decide which way to waft.

Intoxicants are dangerous. There are successful PTSD treatments.

Yet the existence of treatments does not entail their availability. Sadly, even the available is sometimes the incompetent.

“Bird’s ready to land, green light’s on,” the soldier tells me. “You see it in each other’s eyes, no need to talk, the fear, Death. I still see them, those eyes.”

No hymn to weed here. But I see those eyes, too, of the so-called living.

So many eyes. So much to be done.

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