Dear Doc/Dear Winston, 03.03.13

Dear Doc,

Dear Mom and Dad,

Just another day in Iraq, waking up wondering if today is the day I get to meet the Maker at this fuckin’ place.

I put a bullet in clip with HOMIS written on the side of it. Was thinking about you guys today, wondering what you’re doing.

I couldn’t sleep last night. The mortars just wouldn’t stop. It’s almost comforting, hearing the outgoing rounds blast out of the 120 (120 mm mortar round HEDP) (High Explosive Dual Purpose).

I lay in my bed thinking about being a little kid again. Where did the days go? Life is different here. I would try to tell you how, but I wouldn’t know where to begin.

I miss my baby girl. I will kill them all to come home to that sweet, innocent little baby. My heart is so cold, and she is like a spark burning deep in my chest. How will I ever tell her what I did here? I tremble at the thought of holding her. She is the only thing that scares me in this world. My breaths shorten at the thought of her.

Please don’t hate me for what I have done. I had no choice. I wished and prayed they would just stop and give up. I think to myself every time I pull the trigger, “Why don’t you just stop. Please. Don’t make me shoot you.”

But after awhile it turns to hate; the thought of one bullet not going through his chest upsets me.

Hope all is well. Maybe I will get to come home soon.

Love,

Your Son

Winston

__________________________________________________________

Dear Winston,

I’m sorry that it has taken me a few days to get back to you: I have been traveling this week, and life got away from me (much thanks to Chicago’s O’Hare airport, I might add, the number one exemplar of “chaos theory in action”).

I have pondered this letter often, however. After four years of working with the men and women who, like you, once served in combat, I still find myself surprised at how unprepared—how reluctant, even—I can be to experience the dramatic shifts in thought and emotion that you and so many of your brothers and sisters experience, sometimes hour by hour.

To feel at one moment a love for a child, a nostalgia for a family time, then to feel at the next a hatred that can easily conceive of killing, only to be followed by a sincere, pain-filled desire for all the hatred, all the killing to end, all of this happening day after day after day, on a busy city street in an Iraqi city, at a quiet kitchen table at your home, enduring another sleepless night: I have no clue, Winston. I have no clue.

I do mean this: thank you for trying to give me a clue. I don’t like knowing what I have to know as a result of your having done so. I don’t like the gut shifts that occur within me as I read this letter, the psychic handball marked “raw emotion” that ricochets inside me, wall to wall to wall, the soul-imploding pain that I only dare to imagine to imagine as I consider, dear God, what if this were my son writing me this?

I’m sorry, Winston. I know that you volunteered to serve. But I, as a citizen of this nation, sent you to the Middle East with the promise that it would all make sense in the end. Nobody sent me to jail for refusing to pay the taxes that go to support the military.

I’m sorry that we, as a nation, are still not only struggling to make sense of it all, but, even worse, are struggling—why??—with the (what seems to me to be the obvious) notion, based on justice and mercy, that we owe you and your brothers and sisters. We asked you to give up your youth, give up the innocence that we still so easily cling to as we sip our morning, bad coffee and check out the local weather, all so that, indeed, we can make sure that we avoid the freeway jam to get to work, only then to pour ourselves another cup of even-worse coffee and gossip about the previous evening’s cable TV fare.

Thank you, Winston. I wish we all were living lives more worthy of the suffering that you and your brothers and sisters continue to endure, even last night, even now.

It continues to be an honor to work with you.

Doc

Dear Doc/Dear Winston, 02.24.13

Dear Doc,

This pain that is inside of me will not go away.

I am so fucking tired. Some days I wish I would have just died alongside my brothers. I feel like they went the best way possible, killing the fucking assholes who caused this devil inside me.

It’s like a fire raging in my chest, and nobody can hear or see it. I ponder on the day I can walk into Hell and make those bastards’ lives even more miserable.

How do I continue to get up and live another day? Nothing makes sense anymore. The only thing I know has been taken from me, and now I’m left with scars and a constant state of paranoia and anger. I lay in my bed watching my trigger finger twitch, thinking of a way to make my heart pound like it used to.

I fear no evil. Death would be doing me a favor. HA!

And people . . . they are dust . . . people? Walking around with their faces stuck in computers and cell phones, playing their video games, talking about how they wanted to go to war, but couldn’t. Fucking pussies, if you ask me.

And people wonder why I stuck a needle in my arm and watched as the liquid went in and the pain . . . well, it just went away. The devil was at bay, and my mind at peace. WTF.

God sure has a plan for me . . . if You’re listening, come down and end this fucking pain.

Vibration from the 50 cal rattling through my arms. DIE, Mother fuckers, DIE! The smile of pure hatred pouring from my face. That’s living for those of you who know what I’m talking about.

Nothing ELSE matters?

Winston

_______________________________________________________

Dear Winston,

The power of punctuation.

It’s the question mark at the end, you.

We have no clue, do we, Winston, we civilians? It’s not only our computers, our cell phones, our video games that consume us, blind us. Our arguments, justifications, outrages: they do as well. We have so much to say about the War: “Support Our Troops!” “War Is Not the Answer!” “Thank You for Your Service!” We know why we should have gone to War. We know why we never should have gone to War.

We all want it to be so simple. “The Devil is on the outside: see what happens if we don’t go to War!” “The Devil ends up on the inside: see what happens if we go to War!”

You, your brothers and sisters: you are the ones who have had to face both Devils, one there, one here, both unrelenting, both demanding that you face a Reality right now—right NOW!—that the rest of us took a pass on, still take a pass on, whether with shame or with pride.

Dust. Yes, we all are, Winston: the brothers whom you lost; those who tried to kill you, who did kill them; the boy with the rotting leg; the father who risked a soldier’s ire to save his son; the soldier who writes late at night, hoping against hope that a doctor will not turn away from his rotting soul; the doctor who tries to reassure him, even as he has to cause that soldier some pain, that the rotten parts can indeed be debrided, that the living parts underneath can still become enlivened and enlivening once again.

Nothing ELSE matters? Question mark?

Thank you, Winston, that you are allowing me to find your answer to that question with you.

Doc

Dear Doc/Dear Winston, 02.23.13

Dear Doc,

It was just another day, waking up and getting ready to go on patrol, standing behind the truck, bullshitting with the guys, waiting on the op order. Early May in Iraq: it’s not too hot, not too cold, nice breeze blowing. The morning was great.

The lieutenant comes, giving us the brief. Time to mount up and get going.

My feet pressed against the bench, my body up out of the hatch, leaning back against the cases of ammo on the top of the truck. In front of me is the 240 Mounted, with the rounds fed into the chamber. It sits on a swivel, easy to maneuver and aim. I swing it around to my right side and leave it sitting tucked against my side.

Rolling down the road, dust flying, looking off into the distance, watching the road behind us, little kids run along the side of the road, hands in the air, yelling some bullshit you can’t understand. As we pull into the city, cars smash into each other, trying to get around us like they are in such a big hurry to go nowhere.

Watching the road behind me, there is a car that keeps getting closer and closer to the back of the truck. I wave the red flag and start yelling, but he doesn’t give a shit. I pull up my rifle and point it at his head, thinking he will get the picture. Nope, the dumbass just keeps creeping slowly up on us.

So I swing the 240 around, cock back the bolt, and get a round in the chamber. Leaning softly on the butt stock, pointing my sights at the front of his car, I squeeze the trigger and let a 10 round burst go into the hood of his car. He slams on his brakes as I lower the ramp.

Moving in formation, we come up on his car. I pull out my 9 mil and press the barrel to his fucking head and tell him “Etla oguf dishma ge inta to hal areid ah chic werack.” (Slowly get out of the car and come here. I want to talk to you.)

The man gets out and starts rambling on about how he needs to get his son to the doctor because he is sick. Well, I told him: get him out; my medic will take a look at him. The boy gets out; his flesh on his leg is hanging off the bone. Yellow puss seeps out of the burn. The flies cover it as they cut away at the flesh.

I have doc clean it up, cut away the dead tissue, and put creams on it. We give him antibiotics, bandages, cream, ibuprofen, and clean wraps. “Tell the man to bring his son by our base in 2 weeks, and we will take another look at it.”

He thanks us and invites us over for chai and dinner. We accept and arrange a day to come over. Just the simple choice to stop him instead of shoot him, and I became their hero.

But that’s just me. Thousands of soldiers make this choice every day, and they all aren’t heroes.

Winston

______________________________________________

Dear Winston,

I write this the morning after you and I have seen each other again, after you have talked of worrying about your grandmother’s health, of your plans for your daughter’s upcoming birthday. I am so glad that you have remained clean and that you and your wife feel more hopeful about your future.

I find myself thinking about you at the age you were when you were over there. I spent my early twenties in medical school. I was an emotional wreck, to be honest, although I did a fairly good job of hiding that from most folks around me (probably all, truth be told). I had a good intuitive feel for people and situations, but, honestly, that talent complicated my life as much as it eased it. I certainly saw my share of life-and-death situations, but I was always low on the decision-making totem pole, a well-educated orderly, for the most part. I did make some split-second, potentially-game-changing decisions, but I knew that within a few more seconds, someone older, someone at least slightly more experienced than I would be present to pick up the slack.

Odd, isn’t it, Winston: everyone from The New York Times to the Congress of the United States has—under quite the high-flying moral flag of “concern for others,” I might add—since then made darn certain that no other young twenty-something should have any such split-second moments in any hospital, any clinic, anywhere. Safeguards, safeguards, safeguards!

There are a lot of people, Winston, who are quite proud of themselves that they have succeeded in that endeavor.

But, of course, this is War, isn’t it, Winston? One panicked father gets the assurance that he’ll have an attending physician at the side of his son. Another gets the possibility that an unsupervised twenty-year-old will even allow him to exist with his son.

I have no clue whatsoever what I would have done at that age had I needed in that split-second not to decide whether a man’s breathing rate was worthy of calling a Code Team, but rather whether to fire a gun. Yes, I would have been trained well. Yes, I would have known the Rules of Engagement. Yes, I would have wanted to do the right thing, for my buddies, even for that man.

But I was so uncertain in life, so uncertain. I don’t know.

I can understand, though, why you might have mixed feelings about the word “hero.” I think I would have been with you on that one, Winston. No doubt.

Thank you again for your honesty. Thank you again that you force me one more time, one more day, to be honest with myself.

Doc

Combat PTSD, Pools of Emotion, and Putting the Truth Into Words (II)

Dear Sir,

Thank you for your kind response to the last post. It remains an honor to serve both you and the men and women with whom you have served, along with those from long before your time and those from afterward.

So let’s start talking today about cleaning up as much as possible The War Within, that toxic contamination in your emotional pool. I had thought that I’d be able to complete my thoughts in one more post, but I will again have to divide the ideas into two posts.

Put simply, you’re going to have to filter out as much of The War Within, the contamination, as is possible, which means that you’re going to have to get close to it, grab it, pull it out, and look at it for what it is, all for the purpose of letting the toxins seep out of the contaminants so that you can then put the contaminants aside on a shelf you’re going to have to build on the observation deck, where they will remain, to be looked at appropriate times, but without the stench.

In other words, the contaminants–the memories of the experiences–will always, to a certain extent, remain. The good news? They just don’t have to remain within your emotional pool.

For that whole process to happen, however, the toxins–the pain, the rage, the horror–they must find release. The questions is not whether they can be released. The question is to where they should be released. Your mission can succeed; you simply have to accomplish it in the right locale.

OK, so after all that metaphor, how do we translate that into real life?

3. Decontamination and “Putting the Truth Into Words”: Loved Ones, Psychotherapy, Journaling (A)

The problem with any trauma–but especially with combat trauma–is that the experience itself can be so overwhelming (and given the high, natural emotional intensity of most combat veterans, heightened by the adrenaline surge of combat engagement, so “neuron-imprinting”), the traumatic experiences, if you will, “bypass language” and simply exist as raw sensory experience and emotion. In all their horrific Truth, they are “without words.” I’m sure that you, like many of your brothers and sisters in combat, struggle day-in and day-out with so many such experiences that just “were” when they happened and still “are” to this very moment. Nothing else, up to this point, can be said about them.

The Truth and Loved Ones

The first order of business: acknowledging where the full Truth should not be put into words.

I’m sure that many loved ones have said to you, “Just tell me about it,” and all you have been able to do is stand there speechless, a part of you shouting on the inside, “Look, you don’t really want to know!”, with another part of you whispering “Because I can’t even tell myself.”

Always remember: it’s not the telling per se of the trauma that makes the difference. It’s the telling of it with the right person. If you find the right person, don’t worry: you’ll find the right time.

Now, the hard part . . .

You have my full permission to tell your spouse, your lover, your family, your friends the following, which, for most combat veterans, is the truth and nothing-but the truth, and feel free to put the blame on me: the RIGHT PERSON IS RARELY, IF EVER, THE ONES YOU LOVE MOST DEEPLY IN YOUR DAILY LIVES.

This is so hard for most loved ones to understand, let alone accept. They say to you over and again, “if only you would tell me . . .”

You know better. So do I.

So feel free to share this with your loved ones:

Dear Loved One,

Sometimes the horror of War so changes a warrior, that warrior cannot speak the Truth of War to those with whom he or she wishes to return to live the remainder of his or her life.

It is not, as Jack Nicholson so famously shouted to Tom Cruise in A Few Good Men, that “You can’t handle the truth!” It’s not about the strength of the spouse, the parent, the child, the friend, i.e., your strength. It’s about what happens when the realities of War infiltrate a relationship, any relationship.

War spreads its toxins to whoever gets close to its contaminants. In many ways, you know this already, for all households of combat veterans have, at least to some degree, experienced War’s poisons.

As every combat veteran knows, though, “to some degree” isn’t even close to the full degree.

Even though the goal of combat trauma/PTSD treatment is to get the contaminants of The War Within out of the combat veterans as much as possible, i.e.,to reduce the continuing emotional impact of the traumatic experiences, the emotional toxins of those contaminants, those memories have to go somewhere. They will not just “disappear.”

Instead, for true healing to occur, those toxins have to “sit within a relationship, but not overwhelm it,” i.e., the listener has to feel what the combat veteran is saying, but must not “absorb” the pain. Instead, both veteran and listener must reach a point where each can acknowledge the ultimate Truth, i.e., how rotten life can be, and then come to some moral/spiritual/existential peace with that Truth. One can never be “at peace” with how rotten Life can be. One can, however, find enough peace to live a meaningful-enough life in spite of that Truth. The toxins do not go away, but no longer does the combat veteran have to be alone with them.

Think of it this way: the toxins–all those painful emotions of despair, rage, horror–“lie on the ground” between the listener and the veteran, no longer hurting the veteran, not hurting the listener, but not exactly going away either.

The closest Real Life example I can give is how two people feel about each other after a break-up that has been hard, but that has not made the two people hate each other. “Between them” lies all the pain of what had been and what could have been, all the hurt, disappointment, shame. Both parties know it’s there. Yet for the sake of the kids or for the sake of civility, both parties will just let it sit there. It’s not, as some might say, “an elephant in the room,” i.e., something that the couple refuses to talk about. Quite the contrary: much has been said about it. There is simply no longer anything more to say. Neither party feels great, yet both parties feel relieved, because all has been said, all has been felt. And both parties then move on.

So can you see how just as the contaminants of War, with their toxins, change a man or a woman, so do they change all the relationships of that man or woman?. When two people look at each other and both know that the other knows The Truth, when the “toxins” of War’s horrors are there between them, a certain spontaneity of Life has to disappear.

I once had a very wise teacher, Dr. Max Day of Boston, tell me, in essence, that there is only so much Truth that Love can bear. Combat veterans understand that better than anyone.

Combat veterans can look at each other and see The Truth in the others’ eyes, and that is indeed comforting. Yet if my experience is any measure, most combat veterans tell me that they feel comfortable with other veterans precisely because they don’t talk to each other about The Truth. In other words, being with other veterans doesn’t usually release the toxins. Instead, they just know that the others know, so it goes without saying, and so the veteran no longer feels alone. That in itself is good, but he or she can still never be sure that The Truth can ever be talked about safely as a result.

In other words, if you, loved one–precisely because you love your veteran–attempt to absorb those toxins, much as a parent tries to absorb the pain of a beloved child, this will only lead you to what is called “secondary trauma,” a condition in which you end up feeling not much better than does your combat veteran. The combat veteran will see that, will immediately regret the decision to share, and no good will come from any of it.

But even if somehow you can avoid absorbing the toxins, you are in no “safer” a position. If your veteran releases them into your relationship, your relationship will have to hold them. Horror doesn’t go away. True, when it’s “out there” between two persons, it’s much easier to ignore most days. But there will always be a time when it cannot be ignored: whenever the two persons look at each other knowingly and know again that each of them “knows” what never should have been known by either of them in the first place.

It’s quite simple, really: you can’t make love over a pool of poison.

So don’t take it personally, loved one. We humans are not built to share War with our loved ones and then be able to enjoy intimacy with those same loved ones to the same degree we had before. Even if your beloved combat veteran could tell you about The War Within, trust me: he or she should not.

All my best, for your future and for your love,

Rod

So with whom can you safely, Sir, put “The Truth Into Words”? Let’s talk about that in the next post.

Combat PTSD, Pools of Emotion, and Putting the Truth Into Words (I)

Recently I received the following comment to one of the posts of The War Within (TWW) series, in the Thoughts section, above.

Doc,

I can’t thank you enough for putting this website together, it may have just saved my life. You have really got something here. I find this article a very accurate narrative of my personal existence. After reading this I’m an introvert for sure, and I feel like I’m losing it again.

I was doing very well for a while. I went from being homeless to completing a program at the Chillicothe VA hospital (during which time my wife divorced me) and getting a great job. I did so well there I got picked up by another company and now I have a bright future. From the day that I left I the VA hospital I felt great but TWW, as you call, was always right there.

I went to counseling and met with my doc for a few months after until I got my job and then I focused on that and the counseling went by the wayside. The echo of my past was always right there but I was able to focus on my job. It was very fast paced and revolved around helping others and working with highly motivated people. I recently ended a relationship and switched to a new job.

The new job is super slow paced corporate job. People, quite transparently, whine and complain at this job and make up excuses to avoid doing work. I feel myself getting lost and falling back inside of myself. My apartment used to be immaculate and now it’s a mess, and I am finding it harder to go to work even though it’s ridiculously easy and pays very well. I feel unworthy of asking for help from anyone, but I feel like you really get what’s going on. What can I do? What should I do?

Thank you,

The veteran who wrote this comment has given me permission to answer it via a regular post. As I have a lot to cover, I will be dividing the posts into two. Here goes:

Dear Sir,

Thank you very much for your courage in sharing with me some of what has been happening in your life and heart. I do hope these thoughts can be of some help.

First, let me share with you an analogy I often use with both patients and trainees. I like to think of the emotions as an indoor pool within each of us. When functioning well, there is a certain temperature variation to the pool’s water, but nothing drastic or too uncomfortable. Like a well-running whirlpool, it also has a certain circulation going on within it all the time, again nothing too drastic or too uncomfortable, yet enough to keep the water from stagnating. Some pools are brightly lit. Some are less so.

Next to the pool is a deck for observation. This is where we “get out of the emotional water” and from where we can “observe” our emotions and take actions vis-a-vis them (e.g., change behavior, alter ideas, consider medical intervention).

Second, let me share a passage from the book that I’m writing, The War Within: Different Veterans With PTSD, Different Missions To Recovery:

I would have you consider the usefulness of thinking of certain combat veterans as kinetic-energy veterans. Like the extroverts that most of them are, kinetic-energy veterans are energized/rejuvenated by movement, literal or figurative, usually via participating in group interactions. Talk = Life for them. If such a veteran feels emotionally empty, depleted, then it’s time to slap a few backs, make a couple calls, gather ‘round ESPN, head down to the local pub.

In contrast, think of other combat veterans as potential-energy veterans. Like the introverts that most of them are, potential-energy veterans are energized/rejuvenated by stillness, literal or figurative, either via solitary or one-on-one activities, or via watching group interactions. Quiet = Life for them. If such a veteran feels emotionally empty, depleted, then it’s time to sit back, make one call at most to a close friend, open a book or fire up a computer, sip a glass of wine or a nice Pilsner and take a deep breath (even if you find yourself in the middle of the pub!)

With that as background, let me say this:

1. The Role of Medications

Although my “role” at the VA is “prescriber,” I do not see myself as a “pill pusher.” Instead, I believe that my job is to help combat veterans understand what, at least for most individuals, medications can or cannot do.

Medications are about “pool management,” nothing more, nothing less. They can warm up overly-cool water, cool down overly-warm water, add a certain flow to stagnant water, calm down waters that are too stirred. In other words, they manage the physical part of emotions: the muscle tension that will not go away, the emotional heaviness that will not relent, the pit-in-the-stomach sensation that accompanies the loneliness of rejection and despair.

Traumatic experiences–the worst that Reality can offer, whether in combat or in any other of Life’s events–are, in this metaphor, pool contaminants that continually release toxins. The toxins they release can change the emotional water’s flow, temperature, volatility. Thus, as these are physical-like phenomena, the effects of the toxins open up the possibility that medications (also physical “phenomena”) can be of partial (although, hopefully, significant) help.

Genetics and environment–Nature and Nurture, if you will–play their role in setting up the basic “chemical structure” of the emotional pool before any traumatic contaminants have been introduced. Some pools are naturally more “active,” for example, some more “still.” Some have a temperature that always runs on the warmer side, others on the cooler side. Some have already had other Life-contaminants added–abusive homes, assaults, poor educational experiences, drugs and/or alcohol– that have already been releasing toxins into the mix.

In a word, it’s complicated, this emotional-pool “stuff.”

Two important take-home messages, therefore: first, particular emotional states most likely arise from a complex mixture of traumatic toxins with the inherent qualities of any particular individual’s emotional pool. Cleaning up certain toxins with certain medications might or might not help the inherent qualities of the emotional pool, and vice versa. In other words, medications can often help a lot–yet at the same time, paradoxically, can sometimes help only so much with any particular physical manifestation such as tenseness, emotional heaviness, and physical despair.

Second–and for combat veterans, more important–medications are almost always detoxifying agents, not decontaminating agents.

I ask my patients to understand the “emotional pool” as located within their whole bodies, not just their heads. Anger, terror despair, shame, even joy: these are full-body experiences, not just head-ones. Detoxifying agents can often help relieve the body of the consequences of those contaminants, their “toxins,” by reducing the effects of external triggers and by putting a damper on the emotional volatility and reactivity that can destroy the interpersonal lives of so many combat veterans.

But the contaminants themselves, those actual traumatic memories that either linger or are reignited by a particular scene, sound, smell: rarely, if ever, do medications remove them. That’s where psychotherapy comes in.

The tasks of the different therapies are usually quite distinct, then. Medications, something physical, detoxify. Psychotherapy, something interpersonal, decontaminates.

Bringing this back to your case, Sir, I do wish to say, therefore, that I am concerned that you may be becoming increasingly physically depressed. Depression as a physical illness is much more than simply sadness. It is a physical tenseness, heaviness, interpersonal loss that can be felt in the musculature and the gut. When the body gets involved in that way and does not recover after a few days, one is more often than not in a physical depression–and physical depressions often do respond at least somewhat to medication interventions. Not always, of course, and sometimes the side effects of the medications are not worth what little relief they might provide to the physical aspects of depression.

Yet you wrote that you’re finding it hard to keep up with activities that you once did without much thinking (e.g., maintaining a clean environment), to start activities you once had little trouble starting, whether or not you particularly liked them (e.g., going to work). You find that you’re feeling “unworthy” in a deep, physical sort of way. These sound, to me, like indications that you might benefit from speaking with a prescriber–a psychiatrist, a clinical nurse specialist, a physician assistant, a primary care provider–about either a medication trial or a re-examination of your current medications, if you are already on some. I’d recommend that you check back with your former counselor to see to whom she or he refers–or if your former counselor is prescriber, to see what that person would recommend vis-a-vis more physical (i.e., medical) responses to your challenges that might be available.

2. Potential-Energy/Introvert Veterans and the Contaminated “Inner Spa of Rejuvenation”

As to issues particular to your being a potential-energy/introverted combat veteran, let’s get back to the metaphor of the “observation deck” surrounding the emotional pool.

For kinetic-energy/extrovert veterans, this “area” is not a particularly large one. It is an “area” that is large enough to allow them to take the time necessary to reflect adequately on their emotions–but that’s it. Again, they want to be back out in The Real World, using their knowledge of their changing emotional states to get “moving” into activities and relationships for the purpose of rejuvenation, of getting the energy/intensity they need to live out those emotions in the ways they most desire.

It’s a totally different world for potential-energy/introverted combat veterans.

For those of us who are potential-energy/introverts, the emotional pool sits in the middle of a figurative “inner spa” that is not solely about emotions. Like kinetic-energy/extroverts, we too need a space near the pool to reflect adequately on our emotions. However, we then need to move to an “adjacent” area in order to sit quietly within ourselves and reflect not only on what we feel, but also on what we know, whom we know, what we might wish to do with such knowledge, all for the purpose of rejuvenation, of getting the energy/intensity we need to live out that knowledge in The Real World in the ways we most desire. In other words, for potential-energy/introverted combat veterans, their pool of emotions is an integral part of that rejuvenation spa, but it is not the only part of the spa.

Kinetic-energy/extroverted veterans go inside primarily for reflection on the emotional pool in order to focus on rejuvenation efforts out there in The Real World. Potential-energy/introverted veterans go inside primarily for rejuvenation efforts, stopping by the emotional pool as a first step in those efforts, in order to live more effectively and meaningfully in The Real World.

So what do you, as a potential-energy/introverted combat veteran, do when a dump truck called The War unloads a few tons of painful experiences–some of which may be inhumanly horrifying–into your emotional pool, creating a toxic quasi-cesspool called TWW, or The War Within?

Rule Number One:

NEVER, ever forget, no matter what or how you feel: your emotional pool has not turned into a cesspool. It may look like one. It may smell like one. It may feel like one. But it is not one. In other words, it has changed its state (i.e., how it is now), not its trait (i.e., it has not turned into something different permanently).

As I said in an earlier post, many veterans feel that The War Within was all that returned from the combat theater. That is never the case. Always two “people” return: the troop/veteran and The War Within. Nothing has changed inside the troop/veteran in function, even though a lot has changed in form.

Rule Number Two:

NEVER forget that you are military; that once you are military, you are military; that those lessons you learned in boot camp about focused energy are no less true today than they were on the day of your graduation ceremony. While TWW smells so bad that it is hard to remember anything, your not remembering your capacities for focused energy does not mean they are no longer so. Yes, you have a very hard mission ahead. Yes, The War Within is contaminating not only your emotional pool, but your whole place of rejuvenation. Yes, you’re going to have to find a way–temporarily, but likely a long temporarily–to rejuvenate the best you can in the midst of stench.

But think of it this way: you survived those God-awful latrines (if you were lucky enough to have even them) in the middle of Hell-temperatured nowhere without showering for days. You’ve been there. You’ve done that. True, this one’s inside you now, so in some ways it’s a totally different ball game. I know that. You know that. But in many ways, it ain’t different at all. It’s just another fun-time day in Paradise. You had what it takes to make it through the first ones. You have the same to make it through this one.

Rule Number Three:

Accept that this day, i.e., this day in which you have to reduce your activity in The Real World and face The War Within, is going to arrive one day, whether you want it to or not. Ask many of the Viet Nam vets: sooner or later, Life catches up with you. If the day is here, take it. It ain’t ever gonna be fun. See Rule Number Two: you’ve got what it takes, whether or not you feel like it.

Therefore, Sir, for you: although this job is hard for you, in that the relative quietness has brought you to this point, my advice is to stick with it for now, get started on your road toward recovery, and then play it by ear day-by-day. No, you won’t like that. But remember: that’s often how missions go. You’re military. You know that. You keep focused on your goal–and you adjust. Granted, this is the longest mission you’ve ever had to or will ever have to go on.

Again, see Rule Number Two.

I cannot strongly enough recommend that you read and follow the blog of Max Harris, Combat Veterans with PTSD. Max is an Army veteran from early in the current conflict, an Arabic linguist who saw more than his fare share of what War can bring. Max is as intense a potential-energy/introverted combat veteran as you can get, and he’s been brave enough to share his life and struggles in all their ups and downs in his blog, both for his own sake and for the sake of his fellow combat veterans. Recently Max has begun his own personal psychotherapy with a private therapist who volunteers for The Soldiers Project, as well as has been participating in a Cognitive Processing Therapy (CPT) group at his local VA clinic. Max has been struggling these past six to nine months quite honestly with his emotional intensity and symptoms, and he has demonstrated how looking honestly at his employment–and dealing honestly with his employers–have made a difference in his life. I know that he’d be more than happy to share privately with you about his challenges and about how he is learning–day-by-day–to meet them.

In the next post, then, I want to talk about what it means to take all this and then apply it to the problem of how kinetic-energy/extroverts and potential-energy/introverts approach differently the combat veteran’s task of “putting The Truth into words.”

Veterans’ Day 2012

Today is Veterans’ Day, the first since I began writing the blog. This time of year is always a colorful one at our VA: we get  more than our usual share of visits from bagpipers (I’d never quite heard “The Marines’ Hymn” sound similarly) and Future Farmers of America (great flowers). Cute kids hand out cards with a squeaked “Thank you for your service!” and there are some great sales in the PX (Oscar de la Renta sweaters, seriously!)

They say that if you’ve seen one VA, you’ve seen one VA. In theory, they could also say that if you’ve met one veteran, you’ve met one veteran. One cannot deny the fact, for example, that at least for a few veterans, their military experiences were somewhat akin to an extended Oktoberfest in Germany, Korea, Alaska, etc.

Yet that would not be at all fair, for in a very important way, if you have met one veteran, you have met all veterans, no matter when they served, where they served, how they served, in what branch they served.

I’ve said it many times before: there are much easier ways to get an education than by going through boot camp, a statement as true in times of peace as in times of war. In basic training one learns–body, heart, and mind–that one may have not only to kill, but also to die, and furthermore that one may have to do both precisely because one is not the center of the universe, because one has chosen to become part of a group that has volunteered to defend a larger group from those who would harm the innocent.

Some persons in this world will voluntarily choose martyrdom to promote the cause of peace, i.e., will choose their own deaths rather than inflict death on another.

Many, if not most persons, however, feel no need whatsoever to make a similar choice. Those who choose to serve in the military take up a different calling, therefore: they choose to serve the “many” such persons, if necessary, unto death so that the innocent will not have to be forced into martyrdom–or, perhaps better put, will not have to be slaughtered.

Every veteran knows that and can look another veteran in the eye and know that the other veteran knows that as well.

And so today is November 11. Because of this blog, however, because of the men and women I have been privileged to serve, this year I remembered Veterans’ Day early, on November 4, three days after November 1, All Saints Day.

We in the Mennonite tradition are more of the “Low Church” ilk, meaning that we have, through our history, tended not to take much notice of such “High Church” occasions  as Advent, Lent, Epiphany, etc. At our Indianapolis congregation, however, we have for several years now chosen the Sunday after All Saints Day to remember those in our congregation and in our lives who have, in the words of the writer of the Epistle to the Hebrews, joined our “great . . . cloud of witnesses.”

In recent years we have done so in a visually striking way: at the front of the sanctuary, on a table before the pulpit, small, flat votive candles are floated in glass bowls filled with water. Initially, as a member of our pastoral staff reads off the names of all members of the congregation who have died during our church’s nearly sixty years of existence, another staff member lights a candle as each name is read. Afterwards, we in the congregation are invited to come forward as we would like to light a candle for those whom we remember and whom we honor.

This year, as the members of the congregation came up front, the rest of us sang a song from the Taizé Community of France with the words, “Within our darkest night, You kindle the fire that never dies away,” a simple melody accompanied by organ, a solo flute, and a solo violin, the congregation and the instruments performing a canon of sorts again and again until all had lit their candles.

As I sat there, four names came to my mind: Danny, TJ, Mike, and Donald, the names of the best friends of four of the men I’ve had the honor to serve. All four men died in front of the men whom I’ve come to know. All four of the men I’ve come to know pause at the mention of these names, no matter how often, no matter when.

I walked up to the table and took the long, fireplace match from the women who had been standing in front of me. The match had burned down about a third of the way, still quite afire, ready. I lowered the flame down to one of the white votives floating in the water. It bobbed ever so slightly, requiring that I hold the match steadily, right at the tip of the wick, to await the few seconds until the flame recreated itself, fire one more time symbolizing lives engulfed, spirits rekindled, light continued.

For a moment I stood there, match now burned nearly halfway down, still alighted, nonetheless, both flames, match’s and candle’s, reflecting in the water below.

I lifted the match near my lips and blew. The carbon remains fell into the water, not scattering, merely floating, remnants, reminders that none of these four men ever reached his twenty-second birthday.

It was time to go back to my seat. Others were awaiting their turn. Death waits for no one.

Tonight I see that floating candle in my mind. Yet on this Veterans’ Day I also recall that life waits for no one as well. The dead float in our souls not simply to be remembered, but even more to be revived, reborn, remade. Life goes on for each of the men whom I continue to serve. Danny’s buddy struggles to keep his emotions under control long enough to feel a future. TJ’s buddy is coming closer every day to accepting that he must take time to grieve so that he will find the time to rebuild. Mike’s buddy is taking that time even as we speak.

And Donald’s buddy finally got his old job back.

Thankfully, though death and life do not, hope waits for us all.

If we only dare hope that it will.

To Danny, TJ, Mike, Donald, and now well over two thousand men and women from OEF/OIF/OND, I say “thank you.” To my Uncle Raymond and those who died in Europe and the South Pacific over half a century ago, I say “thank you.” To the best buddy of Danny’s father and those who died with him in Southeast Asia now almost a half century ago, I say “thank you.”

And to all of you who survive, “thank you.” No matter whether one agrees with the wisdom of violence, we all agree to its existence, and on this day that was supposed to have marked the end of the “War to End All Wars,” I thank those who wish to find meaning in protection, even protection unto death. War may or may not ever be justified, ever be wise. War is never a good. Yet its end has not come, nor, sadly, will it.

Thank you to all those who have been and are still willing to live faithfully in light of that.

An Amputee’s Hope, A Soldier’s Mission

This post is not one of my usual ones. First, with his written permission, I write about a man whom I will identify by name. Second, I write about him so that others may know specifically not only what has brought him so much hope, but even more what has restored his sense of mission. That which has brought him this hope, this mission, I can neither endorse nor criticize. But the very fact that it has brought him both, that it has transformed a man before my very eyes in a mere matter of weeks?

Well, I’m a shrink, after all: the chronicling of hope and mission is my specialty.

I first met Zach Holland (or, perhaps better put, “Army Strong Zach“)in June of this year. He is now twenty-eight years old, from the town of Paoli, in southern Indiana, famous throughout the state for its much-heralded ski park, Paoli Peaks. (Readers of a Western US ilk, just smile and be kind, OK? This is Indiana, after all, and it’s a big deal for us.)

Zach served in the United States Army, Infantry, 11 Bravo, stationed in Iraq from October 2006 through May 2007. He saw a lot of combat action, up close and personal. He has been awarded the Purple Heart. He received an Honorable, Medical Discharge.

He was med-evac’ed out of Iraq, where he had received multiple injuries in an IED (improvised explosive device) explosion. Eventually he underwent a left, below-the-knee amputation. There has been much pain, physical and emotional, for a long time. We met over Suboxone.

But our story begins long after that.

This past summer Zach attended a program to help with his PTSD symptoms, but while there, he developed an infection of his amputated leg. He returned home, and I saw him soon afterwards.

His leg looked terrible.

“And you should have seen it before, Doc,” he told me. “It was so much worse than this, just a couple weeks ago. They said that all I can do is keep draining it.”

I will spare the reader the details, for they are not pretty. To know that his leg had looked worse only heightened my anxiety. I was fearing—as was he—that he was heading into chronic osteomyelitis, i.e., a persistent bone infection that is essentially untreatable with antibiotics, the only treatment for which therefore is more amputation. More amputation translates into more pain, more rehabilitation, more prosthetic fittings, more sorrow before happiness (if then, even), more of the same, over and over.

I knew that. He knew that.

Then this past Thursday I looked out my door and saw him and his wife  in the waiting room. He was jabbering away with our clinic secretary, looking as if he hadn’t a care in the world.

For a moment, I forgot what had happened to him.

He marched right into my office, just as big as you please. He’s a stocky guy, “hefty” in the best sense of the word, a respectable cross between “give me a hug” and “mind your own business, if you know what’s good for you.” He plopped himself down into the government-issue chair and pulled up his pant leg.

“Check it out, Doc!”

And so I did. The words then just rolled out of me, showing my age far more than do my paunch and baldness.

“Good God, the Bionic Man!”

Truth be told, if I were actually to show my age, I couldn’t be sure whether the prosthesis I saw before me was worthy more of Lee Majors or of Mark Hamill at the end of the fifth Star Wars. Either way, it was impressive.

“Isn’t it amazing, or what?” He wasn’t so much grinning as he was sporting the look of someone who’d just glided a Lexus off the lot after having negotiated the deal of the century.

If I were one of those gifted writers who can snap a photo with words, I’d wow you right about now. But as I’m not, all I can say is this: there was this prosthesis, and around it there was plastic tubing and at the end there was something like a really cool little engine, and . . .

I’m embarrassing myself. I repeat: impressive, leave it at that.

At that point I’d recalled that he’d told me something about this prosthesis the last time we’d met.

“Is this the leg you got fitted for around the last time we saw each other?” I asked.

“Yup, this is it. Remember how they just hooked me up to a computer and a matter of minutes later they came up with the model?”

I did. I mostly remembered his telling me both how impressed and how incredulous he’d been at the process, start to finish.

“Well, here it is. Absolutely perfect.” ( I about wrote “so he beamed,” but really, that’s too gushy. His tone was more along the lines of “check out the shoes, why don’t ya, real leather, can you believe it?!”)

“Where’d you get it again?”

“The Rehabilitation Institute of Indianapolis,” he continued, “Remember, I told you about that Marine who lost his leg in Nam, the guy who went on to become this big-time prosthetic limb maker? He and his son run the place. It’s crazy, man, crazy: this guy still carves out wooden legs for people by hand, and then he has these computer models of arms and legs that blow your mind. I had no clue a guy like this and technology like this existed.”

In the previous visit he had indeed spoken of the man, James Goff, told me the story of the teenage Marine who had come back from Viet Nam minus a leg, who had then vowed to become the best prosthetist ever (could a Marine be otherwise?), who continues to give depths heretofore unthinkable to the phrase walk the walk. Zach didn’t speak of him with reverence, but rather with  a voice that pulsated, “he can do it, so can I.”

“What’s happened with the infection?” I asked.

Now that got the boy animated.

“That’s the craziest thing of all,” he–and now I indeed can say –beamed. “It’s actually getting better. This thing works on a vacuum system. It keeps circulation pumping in the stump, and that’s helping the healing. Jim told me that he’d had the same thing happen to him once, got a really bad infection, but when he started using this limb, his skin and infection got better, too. It’s wild, man, wild!”

I looked over at his wife, who was watching him with a smile that was actually quite nonchalant.

“It looks better?” I asked her, betraying my still too-good-to-be-true fears.

“Oh, yeah,” she replied. “You can’t even imagine. He’s been walking better. His mood’s completely changed. It was no big deal getting it measured and fitted. I mean, he’s back. And he can go snowboarding again!”

With that, Zach hyperdrove (speaking of Luke Skywalker) from “beamed” to “sky-lighted.”

“Man, you should have been there when they told me that they can fix my snowboard so that I don’t have to wear a special boot and can just attach this prosthesis directly to the board. I about started balling like a baby. I love snowboarding, Doc. And to think that I’m going to be able to go back to it, no big boot, nothing, just me and the board? You can’t even begin to know, Doc. You can’t even begin to know.”

With that last sentence, I fully agree.

“I mean, more vets have got to know about this,” he continued. “I had no idea Jim was right in my back yard. This is a game-changer, Doc, a total game-changer.”

I smiled at him. “You know, when you were out there, as you were walking in, I actually forgot about your amputation.”

Zach leaned forward and actually, as I recall, semi-winked at me. “Doc,” he practically purred, “sometimes I forget about my amputation.”

Even after having worked in psychiatry for a good thirty years now, I can find myself taken aback by the impact of life-changing events in people, whether those changes come out of psychotherapeutic conversations or out of life events that simply will not let hope swirl down the psychic garbage disposal. In a way, Zach was not hugely different from the man I’d seen in months previous: effusive is a word that I’d never have associated with him in the past, and effusive ain’t the word I’d use now.

The word I would use is enlivened.

Zach is an extrovert’s extrovert. He hated being stuck in his head. Yet his body was hurting him so much, he couldn’t escape it–and thus couldn’t escape the War Within inside him long enough to feel his life. He was an amputee with PTSD.

No more.

Now he’s a combat veteran who is trying to find a way to use his experiences to enable others to live better lives.

In the mental health field, we have phrases such as “manic defenses” and “flight into health.” While not the same, both phrases do imply that sometimes an individual’s “improvement” indeed deserves to be within quotation marks. Improvement in such circumstance is false hope, a dash into happiness in hopes that reality won’t have enough wherewithal to catch up.

It always does.

Yet from my experience as a psychotherapist, I’ll say that it’s relatively easy to spot such “defenses” and “flights,” simply because they have an anxious desperation associated with them. Words say “all is fine”; bodies say “Don’t ask.” I know those defenses when I see them–or better yet, when I feel them.

I neither see nor feel either in Zach Holland.

“I wish more vets could know about this. I really feel I owe it to my brothers and sisters to get the word out.”

We talked briefly about Facebook, about the various pages that combat veterans and their loved ones are creating and following. He admitted that he’d never considered taking advantage of them.

“But, if you’d like,” I said, “ I’d also be glad to write a blog post about you and your experiences. I can try to spread the word for you. But would you want people to know your story?”

“Absolutely.” Now if I were to say that he didn’t hesitate with that answer, that would be true. Yet that answer relayed so much more than lack of hesitation. So much more.

“You might get a lot of e-mails, you know,” I continued, “or you might get nothing at all. You never know with these things.”

“Doesn’t matter, Doc. If one other vet could feel like I’m feeling right now, that’s all I’d need.”

“How about Jim and his company? They could get a lot of interest as well–or, as well, nothing at all.”

“Let me check with him. Are you serious, though, Doc: would you do that, write about me and Jim, maybe so that other vets could feel like I’m feeling?”

I had to smile.

“Well, true, I can’t endorse Jim, or anything like that. And certainly I can say nothing about the VA or its policies. But just as certainly I can say whatever I want about the man who is in front of me–and the look in his eye and the intensity in his voice that I’ve not before seen.”

He shot that hand out to me in a way only an Army man can. I shook it.

“I’ll get back to you, Doc. Trust me. Real soon.”

It took him twenty-four hours.

Once again I walked out of my office, and there he and his wife were. That day, though, he was wearing shorts, quite proud to show me something that was, well, quite impressive.

“Look here!” he said, as he pointed down to a new prosthesis that was adorned with quite an array of Army memorabilia. “This is the final thing they were getting ready. It’s actually made out of a kind of cloth, and it’s even flexible. Feel it!”

Indeed, it was.

“I talked to Jim, Doc. He’s fine with you writing about him. And I really hope you will. I’ve been up most of the night, you know, thinking about what you said, about you wanting to help other veterans know about this. I’m trying not to be mad, Doc. It’s nobody’s fault. The people here at the VA have been great to me. But more veterans have got to know about this option they have. It’s crazy, Doc, crazy, I mean, crazy. I don’t know where I’d be now if I’d have had this earlier. But it doesn’t matter: I’m here, and I need to make sure other veterans can feel like I do.”

For a few seconds, I stared at him, quite the bemused smile plastered on my face, I suspect. I turned to his wife.

“Boy’s gonna be setting up a tent pretty soon and having himself a veteran camp meeting, huh?”

She only rolled her eyes.

“If anybody could do it,” she said, “it’d be him.”

“Hey, man,” he said, again in one of those beams-that-don’t-gush, “if that’s what it takes, I’m there. Preach on!”

Preach on, Zachary, indeed.

If you’re interested, Zach Holland can be reached at his e-mail, zjholland7612@gmail.com. He’s told me that whether it’s one e-mail or one thousand, he’s ready.

In addition, here is the website for the Rehabilitation Institute of Indianapolis, which also has its own Facebook page. Apparently they’re ready for one or a thousand as well.

I repeat: I can neither endorse nor criticize the work of Mr. Goff and his staff. It’s even probably worth a standard repeat of the standard line: my writing about Zach and the Rehabilitation Institute represents solely my interests, without any endorsement or criticism by the Department of Veterans Affairs, the Department of Defense, or any other branch of the federal government.

But this I can say: Paoli Peaks prides itself on snowboarding. And I suspect that this winter, Zachary Holland will be proud of himself on Paoli Peaks.

Cowabunga, dude.

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