By Bombs and Brainspotting Blindsided

“It’s finished, over. Everyone knows now. I’m a drunk, that’s it, face it, nothing more. I’ve lost everything.”

I can’t say this was the first time that I had heard such an opening line from a patient. Such regrets are pro forma among addicts who have, at least for the day, come to the end of the line. Sometimes everything changes with such statements, à la The Hallmark Channel, sometimes not. It’s the stuff 12-step meetings and skid rows are made of.

Granted, this particular soldier had “hit bottom” (as the AA folks are wont to say) in a particularly, shall we say, noteworthy way. He’d hidden his alcohol dependence well for years, even from those closest to him. He’d never done anything small his whole life, though, so why not expose oneself as grandly as one can? Would we still be talking of Icarus had he not taken that selfsame route?

Right around the time my patient and I met, the Irish actor Peter O’Toole died. His obituary in the New York Times was a fitting tribute to Life lived intensely and hard, a life in which one works hard to reframe regrets as opportunities—and woe to anyone who dares intimate they might be otherwise. It would be a stretch to claim that my patient resembled the man who made T.E. Lawrence alluring enough to fill a Cinerama screen for four hours, intermission notwithstanding. Yet in spirit, they could have been brothers: success, booze, the whole bit.

Who knows, perhaps I was thinking of the Shakespearean actor O’Toole as I was listening to the opening lines of my patient. To steal inelegantly from Queen Gertrude, I found myself musing, “The man doth confess too much, methinks.”

“You started out in the Marines, didn’t you?” I asked him.

“Yeah, but then I got out. When 9/11 hit, I had to get back in, but the Marines wouldn’t take me. The Army would, though. The rest is history.”

That much of history, I had already known, and thence my Hamlet-ian suspicion. For I had known that he had been involved in the initial fighting in Iraq, the “Shock and Awe” that did so much more than both for all those involved at that time, civilian or military.

You were in the initial invasion, correct?”

Still wrapped in his shame—not wallowing, mind you, just wrapped—he scarcely seemed to register the question.

“Yes.”

“Quite the time, eh?” I asked.

That, he registered. He looked directly at me, not with hostility, nor with anguish, but more with the detached empathy of a good 60 Minutes interview by Scott Pelley.

“It was hell,” he replied. “But we did what we had to. I don’t let it bother me that much.”

The Bard in me continued wondering.

“Did you drink this much before the War?”

For a couple seconds, he just stared at me, as if I’d just said something to him in Ukrainian, or Armenian, maybe. Then his eyes darted to the right, his head tilted ever so slightly, sort of like that puzzled dog you see looking at the gramophone in the old RCA Victor ads.

“Come to think of it,” he said as he looked back at me, “I guess not. I mean, I had my problems, but . . .”

“Nothing like that,” I filled in.

Another pause, his eyes apparently scanning the entire library of his frontal lobe one last time, just to make sure.

“No,” he answered, his eyes returning to mine empty-handed. “I guess not.”

I decided to go for it.

“So how do you know whether the War’s been bothering you or not? You basically haven’t been sober since you hit stateside some ten years or so ago.”

In a matter of seconds, that brought another eyes-darting, head-tilting to the right, not one this time of canine puzzlement, though, but rather one far more familiar to me from my past few years of working with combat veterans: the long look down a road marked “To Baghdad.”

“All I remember is a blast,” he said softly, to no one in particular, or so it seemed. “It was meant for me, you know. I was all hot-shot, gung-ho. I had the military experience, so my Command used me to help gather information from locals. I was always at the same spot, every day, and that day I just happened to turn back to check on something, wasn’t where I should have been, where I always was, right across from where that car bomb went off. I . . . I shouldn’t be here.”

He looked back at me, almost as if he were trying to refocus his eyes after having stared at the sun.

“God, so . . . so much happened.”

“You ain’t been soused all these years for nothing, eh?” I said, meaning it just as pointedly as I had said it.

As reality set in, he shook his head, just slightly.

“No one knew, my wife, my Command, nobody. I can’t believe I’ve hidden it all these years, the drinking. I . . . I just couldn’t take it any longer.”

I leaned forward. “It’s not just the drinking, you know. It’s the drinking and the War. You’ve got to face them both. No either-or here.”

For a few seconds, he didn’t even breathe, staring.  “How do I do that?” he finally said, quite genuinely, poised as if he dare not ask.

I looked  into his eyes. More often than not, the gaze of those who are coming off alcohol has a certain cloudiness to it, as if the entire brain behind it were stuck in a perpetual state of “Huh?” Not his, though: coordinated, focused, driven he still appeared, with the look that his Command must have seen so many years ago, the same look that somehow, through all the leftover remnants of the booze from the nights before, Command must still have been seeing day in, day out since.

“I want you to talk to my colleague tomorrow,” I answered. “She works with a form of treatment called Brainspotting. It’s an off-shoot of something they call EMDR, Eye Movement Desensitization and Reprocessing. You might have heard of that one. It’ll sound totally wacko, Brainspotting, I’ll warn you: it’s based on the idea of presenting the brain with alternating stimuli via hearing, touch, while having you find a spot in your visual field that, believe it or not, does seem to be almost a nodal point for the body’s experience of emotion. Most of the soldiers around here are skeptical as all get out about it—until after they’ve done it once. Give it a chance. With your detoxing, I’m not sure you’re ready for it, but we’ll see what she says.”

He gave me the smile of someone waiting for the punch line.

“This something like voodoo hypnosis?” he asked.

“Talk to her,” was all I replied. “See for yourself.”

When I spoke with him the next evening, after he had worked for a couple hours with my colleague, he had neither the clouded look of the alcoholic nor the steely look of the up-and-coming sergeant. It was a look well-familiar to me since I have been working here at the unit in Nashville: the look of someone who’s just ridden the park’s meanest roller coaster ten times and somehow, in some way is actually feeling . . . calm.  Exhausted. But calm.

“So how was it?” I asked, barely able to keep the “I told you so” off my face.

“My God,” he stage-whispered, just tired enough not to have the energy to slap that look off my face, just with-it enough to let me know how lucky I therefore was. “What was that? I mean, she had me dredge up stuff I hadn’t thought of in years, and . . .”

“And you’re OK enough with it,” I replied, well familiar with this conversation. “Not ‘OK’ in that you’re fine and dandy, but OK enough, exhausted, but OK.”

Apparently after my words had found their correct spots in his cortex, delayed a bit more than usual by some routing neurons that were still shaking their heads at each other and asking “What the hell . . .?” he simply said, “Yeah.”

I love that moment.

“You’re going to need to put together a solid recovery plan,” I said to him, “and you’re going to have to keep talking to her—and then keep talking to someone after you leave here. It’s both, not one or the other. You’re not ‘just an alcoholic.’  You’re not just another veteran with PTSD.  Don’t let anyone tell you otherwise, even though you’ll find a few who’ll try.”

After a few seconds, neurons apparently having decided to get back to work, he leaned forward. “So there’s hope?” he asked.

“Sounds as if your body is saying so,” I replied.

He half-smiled, half-grimaced. “My body is telling me to get some sleep.”

I love that moment as well.

“Sounds like a good idea,” was all I could say.

Techniques aside, established or controversial, we all now respect the brain for what it is: in the words of Dr. Samuel Wang from Princeton, it’s a “survival machine, not a computer.” It does what it needs to do in order to keep us doing what we hope to keep trying to do, day in, day out. It will lead us down one path of destruction if by doing so it senses that it can avoid what, to it, appears to be an even worse path. Our brains and our bodies are efficient, not necessarily wise. Sometimes we don’t know a good path until it’s laid out before us in neon chartreuse, long after we’ve exhausted every other, even blatantly ludicrous alternative.

Thank goodness we sometimes can be hit from our blind side, whether having been previously blinded by the light of an explosion or the darkness of an addiction.  Thank goodness that some Icarus’s can learn, can take the risk of flying just a bit lower than their energy might otherwise take them, for a while, for a purpose, until an AA sponsor can be found, until certain memories can be processed with words and without, until a body can find more internal order, until a life can create more external order, until such Icarus’s can land on a safer shore, only then to take off one more time, not as a desperate escape, but simply as a way to get to the next challenge. And the next.

JD/rjsd

To Remember, Not Relive

I have written about him before, most recently in the posts Merry Christmas, Reality Notwithstanding and Taking Him On Home. He’s Porthos, the fun-loving rake to the quieter, more relaxed Athos–and their deeply-loved, fallen comrade, Aramis.

Porthos and I have known each other for a while. Our relationship has always been warm–though, shall we say, complicated as well. As the middle of three strong-willed sons born to a strong-willed father, he knows how to make his wants and wishes known. Fear not that, I can assure you.

And I might add: I wouldn’t get into a scuffle with him. Some of the more foolhardy in his time have. They learned. Forthwith.

Yet can that boy pour on the charm, or what. His is a perfect mixture of the quite genuine and the quite consciously manipulative. He’s had more than his fair share of practice through the years.

He actually leaves me reeling much of the time, truth be told. I’m never quite sure whether I want to give him a warm rub on the top of his head or smack the living daylights out of him. Usually both.

Porthos, in other words, is one of those individuals about whom no one–and I mean, no one–can feel nonchalant.

I’ve taken my share of hits from VA colleagues about him. We’re a bit of a known pair, again, truth be told. Some have made it clear, for example, that they think that I “coddle” him. Many have intimated that I should be more “firm” with him, although none has been able to tell me exactly how such “firmness” should look.

Our struggles with each other have usually been around two subjects: medications, i.e., which kinds, how much, how often, etc., etc.; and psychotherapy, i.e., which kinds, how much, how often, etc., etc. Simple.

Although he and I have had our disagreements, he certainly has not been one merely to “demand” something and then pitch a fit if he were not to get what he’d wanted. Quite the contrary: he does his research, and our negotiations around various regimens have reached points of complexity that I can only call “admirable” on his part. Still, disagree, we have, and sometimes strongly. In the end, though, he has always acquiesced to the fact of life that ‘tis I, not he, who has the MD behind the name.

For example, about ten days ago.

Details are not relevant, but it had been one of our more intense, so-called discussions. He let me know in no uncertain terms that I had not started his weekend out on a pleasant footing. I let him know in similar terms that even though that had not been my intention, I could only be so upset thereabout.

We met the following Monday.

He had agreed to come in twice a week, at least for some focused, therapeutic contact, and he had agreed to hook himself up again with one of our intensive group programs. He had also agreed to two-week supplies of his medications, and he had agreed to the dosages I’d recommended.

But that was only a small part of the story.

He’d thought a lot during the weekend, about himself, his family, his sadness, his frustration over the physical limitations that have been plaguing him post-deployment. Of that, I had no doubt: when I opened the door to my office, he was standing there, with just enough of an impatient, “can we get going here, please?” edge to him to keep me on my toes, but with a countenance that more implored me to notice how worn-down he was, how very, very worn-down.

“Hey,” he said, most definitely without the exclamation point.

“Hey.”

“Do you mind if I put my leg up?” he asked, eyes darting to his left, my right, to the second chair in the room which often does its part to relieve his lower back of the pressure that can gnaw at him whenever he sits for any length of time.

“Of course. No problem.”

Soon we were both situated. For a few moments we just sat there, looking at each other, the semi-grin, semi-skepticism on his face, I’m sure, only a mirror of the same on mine.

“We still on speaking terms?” I finally ask, my semi-grin having turned full.

He rolled his eyes.

“I understand,” he replied, full-smiled as well, although for only briefly. “I know I’ve got to do something about myself. I . . .”  Suddenly, he shifted forward.  “Please, Doc, you understand, don’t you? How hard it is without her?”

“Her,” of course, is the young woman to whom he’d deeded not only his heart and soul, but a goodly portion of his every quantum of thought as well. They’d talked of marriage, of having children together, but then finally she’d decided that she could not make it work.

“Dad tells me that I’ve got to move on, but . . . I just can’t get him to understand. It’s not that easy. I don’t want to move on. I know that if she just knew how hard I’m trying . . . But she won’t return my calls, texts, nothing. I’m not going to be a stalker-type. I’m not going to go over to her place. No one’s going to accuse me of that, no one. But if she could just see me, see how hard I’m trying, see how much she means to me–God, Doc, she’d understand, wouldn’t she? Wouldn’t she? I mean, Doc, am I wrong? Can you understand why I just can’t give up yet, why I just can’t move on? Please, tell me you understand, please!”

Porthos is quite a handsome man. How we think the attractive never have to suffer, don’t we? How wrong we are. Anguish is just anguish, whether on the good-looking or on the plain.

“Porthos, here’s what I would say: don’t give up until you’re ready to give up. When it’s time, if it’s ever time, you’ll know. What you’ll then have to do is live out what you will already know. That will be the hard part.”

He looked at me, with a face both steeled and tear-stained. He has all the gear in place for “Leading Man” status, yet I’m hard-pressed to come up with a modern exemplar for him, given that most A-list stars today are simply too “pretty.” Perhaps a young Mark Harmon as the surgeon on the St. Elsewhere of the 1980’s, even then oozing the NCIS Gibbs-attitude that would one day make him America’s favorite Marine, back then painfully walking down that hospital hall for the final time, his character well-aware that he might soon die of AIDS.

“I sometimes just don’t know if I can do this, Doc,” he finally whispered. “I’m not going to kill myself or anything, but sometimes I’m afraid I won’t make it. It just hurts so, her, Aramis, the War, everything. It just so, so . . . hurts.”

The final word had plopped out of him, as if it had been teetering on his lip all the while, not wanting to risk the reality that would result from its mental equivalent having found voice, sound, transmitted out to a world, to me, to . . . what?

And then it happened: in the middle of his anguish, he started to look as if he were ready to fall asleep, to look as I imagined he must have looked at the end of that twenty-four hours he and Athos had had to stand watch over the body of Aramis, waiting for the helicopter to arrive: too exhausted to run, too charged to collapse.

And I realized: he wasn’t with me. He was in Iraq.

“No one has any idea, do they?’ I finally asked, too exhausted, too charged myself. “You’re there, right now, aren’t you.”

He was staring off to the side, grudgingly allowing one tear at a time past the checkpoint, his eyelids in a bizarre, internal arm-wrestling, the upper halves determined to shut this show down, the lower halves determined not to give in ever, do you hear me, ever!

“I’m sorry, Doc,” he whispered, his tears, few as they were, so robust, so proud to be Army-strong, his eyes fixated miles away. “I’m trying, really I am. I hope you believe me. Please believe me, Doc. Please.”

“I do,” I answered, hoping perhaps that some information, meager as it was, would jar us both out of the grip of those tears. “Listen, this is neurologic, Porthos. You see, trauma separates the part of the brain that feels, sees, hears from the part that makes sense of events, of Time, of those very feelings.

“They then stay separated, physiologically. You can only ‘remember’ if the front part of your brain can pull the ‘you that’s you,’, that is, your experience of the trauma, of yourself–your ‘Self’–away from the trauma enough to get the whole brain on the same page, the page that says ‘OK, this has happened, but that was then, this is now.’ Until then, it’s as if your brain is experiencing the trauma in an eternal present. You’re reliving it, not remembering it.

“That’s where the nightmares come from, the flashbacks. When you hurt because your girlfriend’s gone, you’re hurting not only because she’s gone, but because Aramis is gone, because all your buddies who died in the convoy are gone, because you had to pick up what was left of them, all of them. It’s as if your brain is saying, “Oh, my God, here we go again! We’ll never escape!

“Even when the front part of your brain knows–knows without a doubt–that it’s today, not back then; that it’s about your girlfriend, not about Aramis; that you’re in Indianapolis, not the desert: even then, it cannot yet grab onto that other part of the brain that is still feeling, hearing, seeing, smelling, tasting the destruction, the confusion, the adrenaline. The death.”

Pretty good, eh?

One problem, though, a big one:  with each of those words, I knew that I was both helping and hurting him, both assuring him that he was not crazy, yet reminding him that he felt crazy even so. His energy, his intense drive, his inner push never to give up, never: there they were, torturing him, yet keeping him alive, simultaneously, right in front of me, with my every verbal reminder of the truth, the Truth.

It was horrible to watch.

All I could think at the moment was, “My God, this is what they all go through, isn’t it, all these men and women, the ones whose Facebook posts, whose blogs I read, who talk of being walloped back and forth through Time, through emotion, psychically miles away from the loved one before them, then within nanoseconds careening right into them, then back, then in, tethered to a yo-yo only Satan himself could have manufactured–with a smile.”

I had to stop. Had to.

I had learned in a new way what I had never wanted to know. I was Katniss at the end of The Hunger Games, wasn’t I, gazing down at Cato, her nemesis, he nearly devoured by unearthly hounds, begging her, with his eyes only, to end it all, now, please, please.

Like Cato, Porthos looked at me, fortunately not devoured, yet no longer charged. Just exhausted.

“Will it ever get better, Doc?” he asked.

Fortunately, I am not Katniss. I have more than arrows to work with.

“Yes, it can,” I said as I leaned forward. “I’m learning a technique, EMDR, that stands for ‘Eye Movement Desensitization and Reprocessing.’ I’ll give you a website to read about it. Check it out. Go ahead and read other stuff about it on Google, too. I’ll promise you: you’ll find a lot of hot-shot people with M.D. and Ph.D. degrees who’ll swear on a stack of Bibles that it’s hogwash and witchcraft. I once thought that myself. But I was wrong. The technique can help link that experiencing part of the brain with the contextualizing part, maybe not perfectly, but for many veterans, well enough to allow some real, meaningful healing to begin. You’d be one of the first that I try it out on, but I work with a smart teacher, and together, the three of us will find a way to discover how that powerful intensity inside you can save you, not destroy you.”

Still exhausted, but somewhere, unbelievably, still rakish, he closed his eyes, took in a deep breath, opened his eyes back up, looked into mine, and merely whispered, “If you say so, Doc. If you say so.”

I do say so. And I do believe so.

As best as I can determine, remember comes from a Latin root for memory. Yet there is something about the English word, re-member, as if member were a verb to mean “piecing together, putting the members of a body, a group back together.” Horror and grief without context are horror and grief eternal. When re-membered, though, sown back into the tapestry of Time, they hurt no less, but they need hurt no longer. Re-living can then become mere living. How good.

Yes, Porthos, how good.

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