Saint Crispin’s Kindergarteners

In yesterday’s New York Times, columnist David Brooks wrote a fascinating piece entitled Honor Code, and even at the writing of this post, almost twenty-four hours later, it remains the most e-mailed article of the day for the paper.

Using an ingenious example, King Henry V of England, or rather his literary embodiment, Henry V, as immortalized by Shakespeare–ingenious on Brooks’ part, in that Shakespeare had already given his audiences a glimpse of a much younger Henry in two earlier plays, Henry IV, Parts I and Part 2, as the, shall we say, wild “Prince Harry,” or (as he’s more affectionately known by his portly, somewhat wayward, older friend, Falstaff) “Hal”–Brooks makes a passionate argument that modern education (and perhaps even modern social mores) takes passionate boys and turns many of them into angry, confused, and self-loathing “problems” (or as we in the mental health field might say, “clients”).

The guy pulls no punches.  We in the medical and mental health fields take our customary hits, given our semi-acquiescence in the apparent outbreak of attention deficit disorder (ADD) among our young, especially the boys.  In truth, he provides a succinct, quite plausible narrative that had Henry indeed been raised in the finest schools of modern America, he might easily have become a male poster child for my well-Googled bugaboo, Cluster B Traits.

One can easily argue that Brooks overgeneralizes, and I suspect even he would admit that on occasion he leads his argument down a more showman’s path.  ADD, for example, does exist, and I can provide you the references on request.  Yet the article ain’t Number One for nothing–and I tell you, if you work daily with combat veterans, you know exactly why it is.

I’ve discussed this topic already in a several earlier posts, most recently Buddy, Got the Time? and Quite the Handful.   Brooks, however, through Henry, adds an interesting embellishment, quite appropriately using the word people, and thus describing passionate boys and passionate girls.  He writes:

Schools have to engage people as they are. That requires leaders who insist on more cultural diversity in school: not just teachers who celebrate cooperation, but other teachers who celebrate competition; not just teachers who honor environmental virtues, but teachers who honor military virtues; not just curriculums that teach how to share, but curriculums that teach how to win and how to lose; not just programs that work like friendship circles, but programs that work like boot camp.

For those of you who might be a bit rusty on either your British history or your Shakespeare, wild young Prince Hal grew up to be thoughtful, charismatic, and brave King Henry, leading a relatively small “band of brothers” (hmm, combat vets, sound familiar?) to an amazing victory over the French at Agincourt on St. Crispin’s Day.  In the play, he agonizes over the role of the king, of the one who himself is only a man, yet who must make decisions that will affect the lives of many men.  Finally he stands before those men, all vastly outnumbered by the French forces, and Shakespeare has him speak the words that so many actors have endeavored to inhabit with passion for hundreds of years:

And Crispin Crispian shall ne’er go by
From this day to the ending of the world,
But we in it shall be remembered,
We few, we happy few, we band of brothers.
For he today that sheds his blood with me
Shall be my brother; be he ne’er so vile,
This day shall gentle his condition.
And gentlemen in England now abed
Shall think themselves accursed they were not here,
And hold their manhoods cheap whiles any speaks
That fought with us upon Saint Crispin’s Day.

Some today indeed see those words as glorifying the bellicose, the worst of the human spirit.  Perhaps they are right.  Some see today’s emphasis on the mutual, the ordered as finally attaining the humane, the best of the human spirit.  Again, perhaps they are right.

Yet every day I sit with men–and women–who desire peace in the world, in their lives, but who are anything but “peaceful” by nature.  They have a warrior’s energy.  They had a warrior’s energy in kindergarten.  They didn’t do circle time well.  They were often the outsiders, the problems.

Indeed many of them do feel that they are still “outsiders” in a world, a nation that tells them to live mutual, ordered lives after training them impeccably well in the bellicose, taking complete advantage of their passion and fire when necessary, demanding complete extinguishing of both when later deemed “necessary.”  They are more than aware that they’ve had to turn in the title “soldier” upon arrival onto US soil and then head off to the next debriefing station to pick up their new title:  “client.”

Brooks has an excellent point, one made not only by him, but by others: in a globally-interrelated, technological world, the mutual and the ordered may indeed flourish.

Yet, friends and neighbors: we have warriors in our midst.  Many of them were made to feel “problematic” as children.  Many finally found that life could have coherence and even meaning when their warrior nature flourished in the military.  They did not want to kill, but they did so if they had to, not for sport, but for the protection of those they loved.  They grieve those who died unnecessarily.  Warrior certainly does not equal monster.  It shouldn’t even necessarily have to equal client.  End of story.

So I get passionate when I think that we are taking one percent of the population, a percent that we allowed to volunteer and fight, exposing them to horrors on our behalf (and don’t you dare give me that “not my behalf” bit: did you give up lattes and/or Bud Light to stand against George or Barack?), with our then now doing nothing to find a way for them to fit into our society.  Talk about the ultimate bait and switch: You’re a problem!  No, wait, you’re a hero!  No, sorry, you’re a problem again.

Brooks is right.  We do have to rethink “problematic” boys–and girls.  We do have to rethink problematic combat veterans.

For many of us, then, we have to keep writing, keep pounding on doors, keep shouting.

His Majesty, Henry the Fifth of England, would have done no less.

And, boy, when he was a kid?  Let me tell you. . .

Quite the Handful

I’d first heard about him several months ago.  His has been a complex story, and truth be told, he shouldn’t be alive.  He has had several near-misses, although there has apparently been much-heated disagreement among him and some of his treaters as to where “accidental” ended and “purposeful” began.  Still, he’s pretty much the straight-shooter: he readily admits that sometimes the latter is the only adjective worthy of at least a few of his tête-à-têtes, shall we call them, with the Great Specter from Beyond.

He came to me for Suboxone, the new opiate substitution regimen that has proven so helpful for many combat veterans who have struggled with addictions to painkillers and heroin since their return from The War.  Like many of his fellow veterans, he has endured chronic pain both of a physical variety and of an emotional one.  He has also long complained of very marked, almost continuous anxiety, an anxiety that, true, sometimes has had the quality of the hypervigilance so characteristic of the combat veteran who just can’t seem to get off guard duty, but at most times has simply seemed to be (to me, at least) a dramatic, post-combat upsizing of the chronic tension and energy that has been his hallmark since toddlerhood.

He has not been, what, particularly enamored with us at our VA.  He’s willing to admit, though, that he’s not always been, what, particularly enamoring himself.  When so much pain is ricocheting through a room as a combat veteran struggles with the acute emotional challenges of posttraumatic stress injury, both veteran and treaters can sometimes get caught up in the tornado-esque swirls of suffering.  We treaters do our best not to get so caught up, but indeed, we’re human, and humans catch emotions from each other, especially powerful ones, and since most of us went into the field precisely because we are good at experiencing the emotions of others, even the most calm and patient of clinicians can, at times, feel a bit unhinged in the midst of tense situations.

We had no such experiences together when we met, though.  He was pleasant, though (appropriately) wary.  I had no doubts whatsoever as to the sincerity of his desire to find a more satisfying solution to all his pains, for his relationships have suffered tremendously because of them.  I also had no doubts whatsoever that he can get quite ugly quite quickly, and both he and his wife had no problems whatsoever acknowledging that very fact.  He knew he needed help.  His wife knew it.  I knew it.  We came to a “meeting of the minds” quickly as to the medication.

But I will remember my encounter today with him not because of Suboxone.

Several months ago I wrote a post entitled Cluster B Traits.  Only one other post, The Killing Floor, has received more hits.  As of today, that post has been visited a total of 557 times.  In fact my new claim to fame is that if you Google “cluster B traits,” my post comes up fourth (some days, third) on the list after Wikipedia, Answers.Yahoo.Com, and another blog post!

I’m kind of impressed with myself, if do so say.

All these months later, I still have my reservations using that label (“cluster B traits”) with combat veterans.  My patient today, for example, has been the recipient of that label more than once.  He has, in fact, read page after page of his medical record, and he has more than noticed how frequently he has been given the honor of that quasi-diagnosis.

He has not been impressed.

Quite the contrary: he told me that he now finally understands why so many treaters at our VA have been, in his words, “less than supportive,” especially of his medical concerns.  “If you have a ‘personality problem,’” he said, “people just assume you’re trying to get something over on them.  I mean, that’s what I would think if I read that, you know what I mean?”

And . . . well . . . while I might say that he may be being a bit harsh and overgeneralizing with that claim . . . well . . .

I wouldn’t say that too vociferously.

Instead, I had him consider an alternative interpretation.

“But isn’t it a fact that you’ve felt this inner tension ever since you were a boy?” I asked.

“Yeah.  So?”

“So wouldn’t it make much more sense to call it for what it feels like, that is, lik too much adrenaline flowing through you all the time?”

That stopped him cold.  Apparently he’d not been expecting that from me.

“I’ve seen it with a lot of you guys in the military,” I continued.  “Ever since you were kids, you’ve had a motor running.  People usually called you ‘hyperactive,’ but that wasn’t quite right, was it?  It wasn’t so much that you couldn’t focus as it was that you couldn’t focus on the routine or the trivial.  If you found something that really interested you and allowed you to work out your energy, live it, love it, you could actually be quite focused.  True?”

He just stared at me.

Then I saw it.  His eyes began to well up.

He turned away from me slightly, looked down.  He brushed the edge of his right hand against the edge of the corresponding eye, swallowed.  Still he still looked down.

“Isn’t that true, though?”  I asked again, though a bit more genly this time.  “That it’s always just been so much to handle on the inside of you, that the military took care of that, gave you something meaningful to do with all that, rewarded it?”

He looked up.  Whether he was fighting the tears or just not caring what happened anywhere north of his lips, I couldn’t quite tell.

“I wish other people understood that,” he whispered.

“Not even your wife does?” I asked.

He was still looking right at me, every microfiber of muscle still.

“I don’t know,” he finally said.  “I think she tries, but I don’t know.  Nobody else does.  You don’t know how I fought to stay in the military.  They tried so hard to med board me out, and I fought it and I fought it and fought it, until finally I had to go.  You don’t know what I’d give to get back over there.”

“Because it all fit over there, didn’t it?”

“God, yes.  I loved what I did.  I was good at it.  I didn’t want to kill people, hurt people, destroy things.  I didn’t try to do it.  But I protected myself, protected my men.  We did what we had to do.  We saved a lot of lives over there.  Now I’m just here.”

“And inside you, the motor keeps running, on and on and on,” I said, myself whispering now.  “And it’s eating you alive.”

He just nodded.  What else could the guy have done.

He’s quite the handful.  Always has been.  Yet character-disordered?  Cluster B traits?  Oh, sure, I could make the argument as well as colleagues could: the veteran’s longstanding difficulties, his interpersonal challenges, his “persistent unwillingness” to look inward and “fix” it, whatever that it might be, “tame” it, “reflect” on it, “soothe” it.

Unwilling?  Or unable?

Yes, he loves his energy, his adrenaline, his push, push, push into the world, now, again, again, harder.  He feels alive with it.  He feels real.

But he’s no fool.

He knows that we don’t cotton too much to such energy back here in the civilian world, even if we say that we like our boys or girls to be “Army tough”, Semper Fi.  You leave that out on the playground, child, you hear?  Run that out of you and then get back in here and get to work.

You go do your military thing, man, woman.  Run that out of you.  “Thank you for your service,” we’ll say.  Shoot, we’ll even give you a parade or two (the Fourth’s coming up, you know).

Then get back in here and get to work.

And we wonder why he turns to pain pills to ease the pain.  All that energy, we say, if he would just use it right, ‘tis a pity .

Use it?  Really?  Where?

You gonna put up with his constant edginess, Mr./Ms. Civilian?  You gonna give him that opportunity to punch that bag, run that ten miles, pump that iron–even if maybe you might lose an hour of work out of him to let him do so?

You gonna tell him he’s a good man, that even when he’s a handful, yes, even when you’ll exhale quite the sigh of relief whenever he’s bounces out to do whatever it is he needs to do “get that out of you, boy, go on, go, go, go!, you’ll tell him that  you’re so glad that he’s here, that you wouldn’t want him any other way?  (Well, all right, most times . . .)

They just want to be understood, you know, these men and women with that Army-tough, Semper-Fi drive, energy, passion.  They know they’re a handful.  They know they’ve got too many hormones and neurotransmitters hurtling through their arteries and veins, banging on the doors of their neurons as if there were no tomorrow, ordering every cell within the vicinity to “move this sucker, baby, and I mean now!”

They know they’re not “normal,” i.e., not like most of us on the remainder of the bell curve.  You think you’re gracing them with some eye-popping epiphany when you label them “hyper” or “emotionally dysregulated”?

Actually, I’ve found them to be quite a forgiving bunch, if you want to know the truth.  You can label them whatever, from my experience–just as long as you can smile and like them, give them the space they need, the passionate direction they need to allow them to burn up a few of them inner chemicals so that, maybe, tonight?  We could just chill a bit, you know?  Be friends?  Talk?

“Now, true,” he or she might then say, “I’ll do most of the talking, but . . .”

Please don’t blame them for their bodies’ chemical composition.  Please don’t abandon them to some poor spouse or some few kids who cannot deal with this all on their own, who are are just going to need a break every once in a while–and not just talking every few weeks here.

It takes a village, a village that’s willing to adjust its work schedules, willing to say up front “We understand.  We’ll work with you.”   Willing then to do just that.  I can’t help but wonder what would happen to those veterans’ “Cluster B Traits” if that were to happen.

Well, actually, I don’t wonder, but then . . . I’m one of those types, you know, unwilling to call pathology when I see it, unwilling to set limits that must be set in order for an individual to learn to function in society, after all.

Yes, indeed.  I am.

%d bloggers like this: