As Times Goes By

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

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

“Good holidays?” I asked.

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

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

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

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

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

Taking Him On Home

I met with Athos last week, one of the “Three Musketeers” whom I had described in an earlier post, Merry Christmas, Reality Notwithstanding. Athos is the second of the two men I have had the chance to work with, the quieter one, the Tobey Maguire/Nick Carraway to my first patient’s, Porthos’, Leonardo DiCaprio/Jay Gatsby, as you might recall.

The third musketeer, Aramis, was the man they each mourn to this day.

“I sent the link of your blog post to my Mom,” Athos told me before either of us had even had a chance to consider sitting down. “She wanted me to tell you ‘Thank you for taking care of my boy.’”

As he finally did begin to lower himself into his seat, he flashed a hint of the smile that, no doubt, keeps him his “Mom’s boy” even to this day. Even after all that has happened.

“Well, tell her ‘thank you’ as well,” I replied. “It remains my pleasure.”

“I haven’t sent it to Aramis’ folks yet, but I’m planning to,” he then said, a bit sheepishly, even though at the same time definitively, if such a combo could be possible.

“You stay in touch with them?”

“Oh, yes. I talk to them a lot. I’d spent time with them, gotten to know them. I mean, at his funeral, it was like I was there in his place, like a son, you know?”

“They let you come home for his funeral?” I asked. That’s not the usual practice, after all, not by a long shot, especially during the period of the conflict in which Aramis was killed.

Athos hesitated a bit, as if he hadn’t quite been expecting my query.

“Yes, I . . .” His swallow betrayed less an impending tear than more an impending dread, the dread of here we go, one more time, remember, one more time. “Yes, I came home with him.”

For a moment, I couldn’t quite place the scenes in my mind again, Aramis’ death, Athos’ and Porthos’ positions, their responses.

“You were there, weren’t you, when he died?”

“Yes, sir.” He swallowed again.

“Porthos too, right?”

“Yes, sir. We were both right there. We’d all gone by the spot earlier, and we were on our way back. Somehow we missed those guys the first time through. They must have just sat there as we walked past them that first time, I guess, I don’t know. But then they opened fire, just like that. I mean, man, I went down for cover, but Aramis just charged ahead, shooting right at them. They hit him five times, last one through the head, the one that killed him.”

I didn’t pause. I’m not sure whether I felt his momentum or dreaded it.

“You saw it all?”

“Yes, sir. I just started shooting. I’d never shot at anybody before. I just shot and shot and shot. Then I started to run out to him. I heard somebody shout at me to get back, and all I can remember doing was shouting back, ‘F*** you, I just lost my best friend.’ Then all of a sudden, I felt a hand on my shoulder, and I whirled around, and there was my sergeant. He just looked at me, only could have been seconds, and he just said, not yelled, ‘I know, but not now, not now,’ and he pulled me back.”

Now there was a pause.

“You know,” he continued, in his mind perched on some rock thousands of miles away, in heat so real to him even I could almost feel it, “we couldn’t get his body out for about twenty-four hours, so we just stayed with him, Porthos and I, we couldn’t leave him. It was hot, it was . . . it was bad. The medic had covered his face, you know? So that . . . we didn’t see it. I took his gun, all his stuff. His blood was still all over everything. When the helicopter came, I climbed in one side and Porthos climbed in the other, his body in between us, and we were off to get him on the Blackhawk to get him out of there.”

“But what was even more crazy,” he then said, “was that when I got out of the helicopter, I just started walking–I mean, I didn’t even know which way was up, you know what I’m saying?–and then out of the blue this airman leaps right on me and starts screaming at me that I’d about walked into the propeller. And you know what, Doc, you know what?”

I figured that he was going to say what he finally did say. And even though he saw that I had already had it figured, no matter: he said it anyway.

“I wouldn’t have cared if it had.”

He meant what he said, of course, yet I have to say this as well: there was something less definite about him that day we spoke, less miles-away, less certain, as if somehow futile was slowly easing its way out of the centerpoint of his vocabulary.

Then after a few seconds, “And it was right after that that the big guy pulled me aside and asked me.”

“Asked you what?”

He snorted, although hardly at all, truthfully, and certainly not at all one of contempt, but more like one of a person’s somehow still not quite believing that what happened actually happened. He looked right at me.

“He asked me if I wanted to take Aramis on home, back to the States, to his family. And I didn’t hesitate for a second, not a second. I just said, ‘Yes, sir.’” Slowly his gaze left mine, wandered past my head, toward the window, out. “Yes . . . sir,” he then whispered.

I’m sure the next silence was only seconds long, but with his looking through the window, he pushed me back a good six psychic inches from him, not too far, mind you, but far enough to privilege me only with the sharing of his story, but not with participating too closely in it. He was in a world that was his and Aramis’s, theirs alone.

“When they put him in the plane to take him back, I just crawled in and lay down next to him. I didn’t leave his side the whole way. We’d heard that the escorts sometimes would do s*** like putting their feet up on the bodies. No way, man. No way.”

Those last words were not spoken to me, were no mere descriptions of what was or was not going to happen. Those words were a vow, spoken to a best friend who, though not hearing, would nevertheless know that Athos had not only had his back, but finally also his whole body, to the end, the very end.

Then, all of a sudden, he smiled, just enough to bring us both back to my office, to each other and to each other’s gaze.

“You know, Doc: that’s when I found out what happens when you’re lying on the bottom of one of those planes as it’s coming in for a landing. I mean, the presssure?” He gave me a are-you-kidding-me look well worth the price of admission. “Not good, Doc, not good.”

Freed from the reverie of his final one-on-one trip with his “bestest buddy,” he returned to a more steady, though still thoughtful narrative pace. He talked of his time with Aramis’ family, the funeral, the motorcade to the national cemetery, the graveside service.

“But you know what I’ll never forget?” he then said. “I’d just gotten out of the limo, and I was like standing there, not even sure where I was, who I was, nothing. And so I look up, and there he was, the big guy, the senior man himself, looking right at me. It took me a few seconds, but then I saw what he was looking at: I had something hanging from my uniform. But before I could even react, all he did was walk toward me, take a pin off his own uniform, and then pin mine back together. He put his hand on my shoulder and just said, ‘There you go, son. There you go.’ And he squeezed my shoulder and walked on. I . . . I couldn’t believe it.”

We talked more, about Aramis still for a while, but soon we were talking about his own girlfriend and his (quite funny) memories of trying to keep Porthos in line while they were back in the military. By hour’s end, he had already stood up to leave, our plans for our next meeting having been made, when he paused and looked right at me.

“I don’t know if I’ve ever told anybody all that, Doc. But, you know: I made it through without crying. That’s . . . that’s a start, Doc. That’s a start.”

With that, he walked out.

A week later, the pictures in my mind that I cannot shake are two. One is the picture of a young man, barely into his twenties, lying on the bottom of a cargo plane next to a box, vowing to remain faithful until the landing at Dover, protecting another man’s honor that, in one way, was only a memory and that, in another way, was the only bit of Aramis that no one–no one–would ever take from him. No one.

The second is of a senior officer looking into the eyes of a young enlisted man, quietly saying, “There you go, son. There you go.”

There is no glory in War. Only days before that officer took Athos’ shoulder, a family over in the Middle East had buried another man, a man perhaps who had died with hatred and malice in his heart, a man perhaps who had, instead, merely died wanting only to get these armed strangers out of his country. I will never know.

I do know that Athos, Porthos, Aramis, each believed he was “born to protect.” Each believed that 9/11 was an Act of War. Each believed that their mission was part of a greater mission to assure that 9/11 would not happen again. What others believed or to this day believe about that mission, that never was the point. They believed honorably. They acted as men, real men capable of rage and love. Their commanders saw them as men, real men capable of respect and even worthy of the title “son.”

One of them did not come home alive.

He did not, however, come home alone.

For it was, to the end, as Alexandre Dumas put in the mouths of his famous trio, “One for all, all for one.”

All for one.

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,


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

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