It is the best of times. It is the worst of times.

While I apologize to Mr. Dickens, I have to say, as a psychiatrist who works for the VA, that no truer words have e’er been spoken.

I have lived to see battlefield medicine reach a level from which many a man, many a woman, who otherwise might have become a name etched on a monument, has instead been able to return home to loved ones, to life.

And I have lived to see such men, such women struggle, claw their way, beg-borrow-steal to find a life worth returning to.

I have lived to see my profession, mental health, finally take seriously the long-term consequences of combat.

And I have lived to see some in my profession define “taking seriously” as prescribing pills as if there were no tomorrow; as manualizing protocols to get the job done in as few steps as possible, as if emotional healing were an advanced form of “Name That Tune” in three notes; as being oh-so-proud of itself for its evidence–its chi squares, p values, meta-analyses and all–while farming out the long-term emotional, the existential, the spiritual to the chaplains for them to clean up once the real work of psychological treatment is over.

The best, the worst.

If Dickens told us a tale of the London and Paris of old, then this week I had the opportunity (or the misfortune, rather) of reading tales from two publications that purport to represent (and proudly, I might add) less the best and the worst of today, but perhaps more the sublime and the ridiculous: The New York Times and The Onion.

Last Sunday, in the Sunday Review section, Nicholas Kristof wrote the essay, “War Wounds,” a devastating piece on the consequences of combat in the life of one man, Major Ben Richards, a 2000 honors graduate of West Point, who is, in Kristof’s words, “a brilliant man tracking his [own] cognitive deterioration.” Since having survived the explosion of two roadside bombs, Richards, fluent in Mandarin, who at one point pioneered cooperative work with Sunni Muslims in Iraq, has struggled to maintain enough adequate attentional focus to monitor the whereabouts of his toddler at his own home, let alone to write the papers in a Georgetown University graduate school class that he once would have breezed through without a second thought.

Kristof, who wrote earlier this year another excellent piece about which I commented in the blog, (In Memory of Ryan), pulls no punches as he sits down with this man and his wife, both only in their mid-thirties, in an Iowa home that became their refuge after Major Richards could no longer manage a teaching position at West Point:

[M]y take [says Kristof] is that whatever political leaders say in Washington, and whatever directives emerge from the Pentagon, not nearly enough is changing on the ground. Mental health still isn’t the priority it should be. Just about every soldier or veteran I’ve talked to finds that in practice the mental health system is clogged with demands, and soldiers and veterans are falling through the cracks. Returning soldiers aren’t adequately screened, diagnosis and treatment of traumatic brain injury are still haphazard, and there hasn’t been nearly enough effort to change the warrior culture so that getting help is smart rather than sissy.

The essay makes clear that both Richards and his wife have struggled with a dual obstacle course far more daunting than any that the good Major might have faced in his Army training maneuvers: the Department of Defense and the VA. Mrs. Richards struggled to find a kind word about anybody connected with either system, while, to his credit, Major Richards–Army loyal to the bitter end–tried to relate the best spin on his own tale that he could.

If Mrs. Richards somewhat held her tongue, however, other with whom Kristof spoke felt no compunction to follow suit.

“The V.A. certainly doesn’t care,” said Jim Strickland, who runs the V.A. Watchdog Web site. As he observes on the site’s home page, “This country is capable of drafting you, putting you in boot camp, teaching you to kill someone, and then putting you in a war zone within six months. So why can’t they process a claim that fast?”

What do I say after that?

Well, I did say something, the first time that I have ever commented on a Times article. I believe what moved me to do so was Kristof’s poignant one-,two-word descriptions of the Major’s struggle to maintain his composure as he related his disappointment over his injuries and his shortened military career. I wrote:

Sad to say, I can’t thank Mr. Kristof enough for his continued focus on the needs of our combat veterans. I’m sad to say precisely because I walk into a VA every day, trying not to lose hope, focusing day in and day out just on the man, the woman in front of me. Yes, we deserve a great deal of the calumny we get. Yet I’m still proud to work for Secretary Shinseki, for my Medical Center Director, for my Chiefs of Psychiatry and Mental Health Services. As a psychiatrist who sits with the tears, the rage, but also the hopes and the courage of these men and women, I’m honored to be allowed into their lives. And they keep coming,

We need your voice, Mr. Kristof, and the voice of brave men like Major Richards over and over. If not, the country will forget before it even has the decency to remember in the first place.

I agree with Mr. Kristof that the Major is anything but a failure. He’s still watching over his troops by refusing to live as if he were a failure. So many men and women have wept in my office because they had to give up a career that had finally given them meaning, all because of wounds that many would prefer to chalk up to some crazy notion of golddigging on the Government’s dime, as if men and women who volunteer in a time of war to do what they believe is right are the type who were really looking eventually for taxpayers to subsidize their cigarettes and bon-bons.

Keep calling all of us to task. Please.

So, all in all, one scrapbook-of-crummy-times essay should have sufficed for the week. But then came The Onion.

For any who might not know, The Onion is (allegedly) as far from The Times as mere mortals can travel. It’s an often-hilarious, always-irreverent newspaper spoof that has been skewering both the Right and the Left (although, admittedly, a bit more the Right) since 1988. Let’s just take a gander at a few of the “paper’s” lead stories this week to get a flavor of our publication here:

Putin Learns Putin is Behind the Plot to Assassinate Putin

Ugandan Powerball Jackpot Hits 31 Grains of Rice

Jennifer Aniston Engaged to a Guy Who Frankly Will Never Replace Brad

Need I say more?

However . . .

Another story also appeared in this week’s edition:

It Would Be an Honor to Serve My Country, Return With PTSD, Sit On a Mental Health Care Waiting List, Then Kill Myself

We ain’t in Kansas no more, Toto.

Purporting to be a “commentary” by an Army private who is about to be deployed to Afghanistan, it takes “black humor” to realms unknown. Some (e.g., Time magazine) found it tasteless and even vile. Far many more, however (e.g., persons posting comments on The Onion’s Facebook page), found it disturbing, satire at its most truth-filled, its most gut-wrenching, its most awful. Here are excerpts:

It’s a matter of principle, really [why I joined the Army]. From a young age I was taught that throughout our history, Americans have had to stand up and fight for the freedoms we enjoy. I always knew that when the time came, I would serve with honor and nobly suffer from post-traumatic stress disorder until my only recourse was to end my own life. So it’s with eager anticipation that I head off to the battlefield to defend, be ignored by, and then—left all alone, with my personal demons closing in—kill myself for the land I love so dearly.

I know no greater honor than relying on an agency [the Veterans Benefit Administration] with a backlog of more than half a million claims that can’t get its sh** together enough to transfer its paper files to a central computer.

And to see the look on my child’s face as he watches his own father, fresh off the battlefield, crying in a fetal position in the corner of his living room because he can’t get the help he needs, even though he’s been calling doctors for three straight months—tell me, is there any feeling greater than that? I don’t think there is.

So when I finally can’t take it any longer and decide to check into a hotel to end my own life, please know that I have but one simple request: My agonizing struggle and tragically preventable death should be the last thing on anyone’s mind. Because the only thing that’s important for someone like me, who will be dedicating his life to serving his country, is that my government lets me waste away until I become a shell of my former self.

That’s what being an American soldier is all about.

God, I wish I could laugh at this. I always gladly take laughter over nausea. Not my lucky day, though–or maybe more accurately, my lucky life.

I read this as I ended a week in which, happily, good has occurred: Will Do, Sir is sincerely trying to communicate more openly with his girlfriend. Buddy, Got the Time? is doing his best not to get into the same old Abbott and Costello routines from Hell with his young-adult son. Inside, Outside, Anywhere is trying to find ways to get his energy back into the world and into the lives of others. Maybe a Letter was proud to help out a good friend with some remodeling work. New Year, Old Challenges is also going to help a buddy remodel–at least two states away, much to my patient’s relief. The new guy from 525,600 Minutes has decided that perhaps he doesn’t have to be ashamed to admit that he’s depressed after all and therefore that he doesn’t have to freak out about trying an antidepressant.

But I read this as I ended a week in which, sadly, No Trouble At All revealed to me some truths–not about himself–that have been haunting him for weeks, more than explaining why his combat trauma symptoms have been skyrocketing. Quite the Handful struggled with several of us treaters over proper medications–and not at all pleasantly, I might add.

And I read this as I ended a week in which, even more sadly, three men entered my life within a matter of about six hours: a mortician whose traumas span a lifetime, culminating in body of a peer after body of a peer after body of a peer; a scout who lost, at one point, nearly a buddy a day, “hanging in there” until a natural disaster destroyed every thing in his life, finally forcing him to remember every one who had been swept away from him; and a chemical weapons man, so tolerant of alcohol that he hadn’t even felt that drunk when his blood alcohol content was over 300, desperate to hold his marriage together, hoping that some Librium would be all it would take to smooth everything over, so not wanting to admit to himself that he had not been drinking himself into oblivion solely for kicks, so not wanting to whisper to me, in answer to my “One day you’re going to face this,” a tear-embroidered “You’re probably right.”

The Muppets Take Manhattan is a fun, no-brainer little romp from the Eighties that used to keep my kids in stitches long enough for me to catch a good half-hour of shut-eye back in the day. Kermit, Miss Piggy, and the whole crew vow to take their college senior variety show to Broadway, with thrills and chills ensuing along the way, culminating in Miss Piggy’s clobbering Kermit into kingdom-come to restore his memories and, with a cast of hundreds of chickens, dogs, rats, etc., etc., to keep the show going on. Moral of the story? Dreams can come true–even, for Miss Piggy, ones of marriage to a certain, dashing young frog.

I’m not quite sure whether The Onion took Manhattan or vice versa, whether “all the news that’s fit to print” ended up in an op-ed piece or in a devastating–what, parody? Truth that no one dares speak in polite, conventional company?

I ended up, though, with a moral very different from Kermit’s and Piggy’s, one that I have to sit with every day of my working life, one that I have to feel, even occasionally embroider with my very own tears:

Dreams can be killed, by an IED, by an indifferent public who dares to harrumph and tut-tut a biting farce, all the while living out every word of that farce every day.

I am thankful that dreams can nevertheless be re-formed. I am glad that I have the honor every day of being part of that reformation process for the children of my peers. As a society, as Londoners, Parisians, New Yorkers, Hoosiers: we all should be doing nothing less than the same.

Mr. Kristof, editors of The Onion: never let us forget that–especially before many of us even have the decency to remember that in the first place.

Please.