Friday, September 14, 2012

The tip of the spear

One more post on the collision of vulnerability and combat violence.  I heard this from a Operation Dessert Storm Vet who had come to our program.  This matters to a degree because it wasn't uncommon for some veterans of other campaigns, especially Viet Nam, to put down ODS vets.  In this view this was a quick and "easy" war and to be affected by it, especially, clearly put you in the "weak" category.  Perhaps some will think differently after hearing this story.

He came to the program when it was mostly focused on the medical symptoms veterans of the first Gulf War were reporting, what was then called Gulf War Illness or Gulf War Syndrome.  Except he didn't have any of the usual complaints of joint/muscle pain, headaches, difficulty breathing, etc.  He complained of feeling nothing.  Now five years after the war, he described how ever since he has just felt "blah".  He described no interest in much of anything, never feeling excited or happy, maybe an occasional instance of fear, but not much of that and not really depressed.  He said he couldn't find work he wanted to do and didn't have friends or relationships that lasted any length.  He didn't really even have much energy for complaining either, but thought he'd check out the program "'cause why not?"

When asked he told this story.  You may recall there was a huge buildup of forces in Kuwait before the invasion of Iraq.  He was part of that and when the order to invade was given, he was in a unit that was one of the very first to enter Iraq.  The battle plan had them entering through a purported mine field, which, because the Iraqis wouldn't expect that, was supposed to provide a critical element of surprise and advantage.  The plan called for Engineers to arrive first and sweep a path through the minefield that the battalion could enter through.  But when they got there, the engineers were no where to be seen.  The battalion commander radioed back to HQ and he was told to cross anyway and attack.  Per Army doctrine at the time, the Commanding Officer told his Sargent Major to order the most junior member of the battalion to walk across the mine field, forging a path that others would follow.  And shoot him if he refused or turned back.  My patient was that junior soldier.

He was able to pretty vividly describe his terror: literally shaking in fear, barely able to haltingly put one foot in front of the other, sweating profusely, moving only when yelled at by the Sargent Major.

But suddenly, a miracle, something changed.  One second terrified, the next, he amazingly felt no fear at all.  He started walking, then skipping through the mine field, turning to hail his fellows, shouting back, "Come on in, there's nothing to be afraid of." And he laughingly lead the way across.

You don't need to be either a rocket scientist or a psychologist to know that he was somehow able to trick himself.  By throwing some mental switch he was able to not-know what he knew, convince himself there was no mines (or no danger) and push away his overwhelming fear.

This (probably uniquely) human capacity to not know what we know is a last ditch method of dealing with the intolerable, a way to continue living in the face of realities that challenge our reasons to live, a way to push away feelings that would make living impossible.  It works and most of us have used a variation of it or two in our lives (Scarlett O'hara: "I can't think about that right now. If I do, I'll go crazy. I'll think about that tomorrow.")  But the ability comes with a high price tag and this Dessert Storm veteran was paying it.

You can't go to war and come back unaffected.  No one can.  Experience changes people and there are very few more powerful experiences than combat.  But affected doesn't mean damaged.  We do what we do to survive. But what we do may incur a cost that must be paid or the interest adds up.  By suppressing his feelings, this ODS veteran was able do what he had to do to keep from being shot.  But the history of human experience indicates that the mechanism we use to suppress negative feelings is blunt.  It can block fear, distress and anger, but also blocks excitement and joy.  We may rid ourselves of the lows but at the cost of the highs.

A switch turned off can be turned on and the history of psychotherapy since Freud strongly suggests that the way to do so is to make the decision to tolerate the very feelings we believe we can't.  To choose to feel that which feels intolerable: all the fear, and pain, and loss, and rage, and shame that we have worked so diligently to keep at bay.  Nothing in life is easier said than done than this.

This struggle, this conflict within that I've outlined here is central to almost everything I've ever said or will have to say about PTSD.  It is the reason I object to the name we give this struggle, post traumatic stress disorder, because I believe the name itself tempts the veteran to see himself/herself as not what he/she really is, a person struggling to endure the unendurable, make sense of the incomprehensible, and let go of the unforgettable: no, not that but instead a far lesser being: someone "traumatized," damaged, diminished by what they have experienced.

The work of all, veteran, therapist, society, is to keep this distinction every in mind and for each to do their part to hold to the extremely difficult, but ultimately freeing path of compassionate accountability.

Roy Clymer

For the background and context for these remarks, please read my article on PTSD published in the Psychotherapy Networker which can be found here or see a copy of it found on this blog titled "The Puzzle of PTSD."

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