Tuesday, October 9, 2012

Duty, Trust, and Betrayal

My last several posts have been about vulnerability and how it affects the re-deployed solider.  Returning to the BRAVE mnemonic of an earlier post, let's move on now to betrayal.

Some people are smarter than others and Jonathan Shay must be one of those.  He had the wisdom to see that the Homeric story The Iliad had much to say to the veterans of Viet Nam.  Specifically, about the betrayal they felt.

About five years ago, I re-read the Iliad after having last read it in high school.  I was astounded by it's relevance to what I had experienced in Viet Nam and to the South West Asia veterans I was working with at the time.  The Iliad is the story of Achilles's rage at his betrayal by Agamemnon.  King Agamemnon takes for himself Briseis, a queen who was rightfully Achilles's war prize.  Achilles sulks and refuses to fight until his friend Patroclus is killed, whereupon he slaughters the Trojans (Note 1). There were no beautiful queen war prizes in Viet Nam and I couldn't have sulked if I'd wanted to, but nonetheless this story had much to offer me.  It's story of the abuse of power by a leader and how that impacts the combat soldier was intimately familiar to me and many of the veterans I've worked with.

I have seen - with my own eyes, ears, heart, and mind -  other officers make decisions not for strategic or tactical reasons but to further their careers.  This criminal betrayal of duty was one of the main reasons I resigned my commission.  But this blog is not about my experience in Viet Nam, and I mention my experience only as I believe it is useful to help understand the experiences of combat veterans.  Specifically, when I heard about the betrayal experienced by the veterans of combat in SWA, my experience led me to listen carefully and openly, and not simply discount such accounts as blaming others to diminish one's own responsibility (though that was sometimes the case.)  Again and again I heard credible stories, often backed up by more than one source, of gross dereliction of duty by senior non-commissioned officers and/or officers of all ranks in the chain of command.

It's been said that to get men (and now women) to face arms in combat the soldiers need three things:  a belief in the justice of their cause, trust in their leaders and faith in their fellow soldiers.  Like a three legged stool, if any is compromised the stool will not stand and the soldier will not fight.  When a senior in any chain of command fails to do his duty or abuses his position for personal gain, he betrays the trust of all his subordinates in that chain and sabotages the moral, command legitimacy, and fighting spirit of all who serve under him.  Those under him will pay with their lives or with their peace of mind for this betrayal.  This is especially true when the stakes are life and death in combat and the duty not performed was the duty to look out for the welfare (lives) of your subordinates.

I was a at a conference once when another psychologist presented data about his work with a soldier with PTSD while still in SWA.  The psycholgist used Prolonged Exposure Therapy and showed a graph demonstrating the soldier's decreasing symptoms over mere days of treatment.  I had what I called data envy because while I had confidence in our program at Walter Reed, I knew our data showed no such quick recovery.  Struggling to understand the reasons for this difference,  I coined the term fulminating PTSD to describe what I thought our soldiers/sailors/marines/airmen came to us with.  They had been through horrific incidents much like the one experienced by the soldier above treated with PET.  But by the time they got to us, they had been through much more.  Their attempt to get help might have been refused.  They were unable to talk about their experience of betrayal.  Their weapons were taken from them and they were relieved of responsibilities for the merest mention of emotional difficulties.  Drinking let to fights, domestic altercations, insubordination with resultant disciplinary action. And more and more and more.

Most frequently a sense of betrayal was at the heart of such stories.  They had done their part: put their lives at risk to do what was asked of them.  But someone whose duty it was to look out for them turned a blind eye to their danger.  Or failed to do her part in the heat of battle. Or failed to provide help when it was asked for. This sense of betrayal becomes a gnawing wound, festering inside, preventing trust in anyone in authority, covered over by a self-protective cynicism that denies anyone is trustworthy thereby ensuring they will never be fooled again.  Unaddressed, this is a recipe for a functional loss of life.

I'll have more to say about treatment issues later, but here I want to emphasize that this is a relational issue.  It is about how a particularly vital (but not necessarily close) relationship between the soldier and a senior she needed to trust went awry and the consequences of that relational disruption.  It can't be fixed by addressing only symptoms. For treatment of such veterans to be successful, a new relational experience is necessary.  The veteran must have a corrective relational experience. A start is for them to encounter a helper who is willing to engage them at the deepest levels, communicates deep respect, and exhibits unwavering integrity.

Roy Clymer

Note 1: For an excellent article by Jonathan Shay about the Iliad and military leadership, what he calls complex PTSD, and other issues go here.

For the background and context for these remarks, please read my article on PTSD published in the Psychotherapy Networker which can be found here http://www.psychotherapynetworker.org/recentissues/1151-the-puzzle-of-ptsd or see a copy of it found on this blog titled "The Puzzle of PTSD."

Monday, October 1, 2012

When Johnny comes marching home

It's not just young men and soldiers who deny their vulnerability, it's all of us.  We all know that we can die or be incapacitatingly injured at any time but mostly we manage to keep that knowledge well away from day to day consciousness.  That's probably a good thing because otherwise we'd never get out of bed.

But for the combat veteran, life becomes more complicated.  "Death is a distant rumor to the young." (Andy Rooney)  After the young soldier has experienced the immediacy of death in his/her first fire fight, however, it is distant rumor no more but a hissing, in your face presence.  And unless you're very lucky, it isn't just a one time encounter you'll have, but a repeated affair you face each time you go "outside the wire."  So you have to find a way to deal with the vulnerability and associated fear that you used to, but can no longer, just deny.   Fortunately, laying right at hand, waiting for your call, is your new best friend: anger/rage.

It is, of course, no news that soldiers in combat get into rage.  It's also probably fair to say that anger/rage, more than any other "symptom" is what brings re-deployed soldiers initially to the attention of the mental health system.  I don't know it that's true, but the most frequent story I would hear is of altercations with the spouse, with neighbors, with superiors at work, and/or with strangers on the street (especially in cars.) But to understand anger, you must understand vulnerability.

Constantly living in fear is immensely wearying.  I remember describing to my therapist how sick and tired I became of being always afraid.  How I wanted to just put it aside, rid myself of the fear, and go on patrol looking to blast anything that moved.  And how ashamed of myself I was that I couldn't do it.  I was shocked and, ultimately, transformed when he responded, saying how glad he was that I hadn't done that.  I expected him to join me in my castigating myself for my fearfulness, my cowardice.  He, instead, told me how he believed that honoring my fear had kept me (and my men) alive, how it had kept me human in an inhuman situation and how it had led to his being able to know me.

I don't think I'm the only veteran who returns from combat "sick and tired" of feeling vulnerable.  Who makes it back, hoping, maybe believing, that he'll/she'll never have to feel that way again.  The awful truth turns out to be that while we were always vulnerable, but able to deny it, now, whenever something happens that stirs vulnerability, the veteran is all too likely to immediately react with anger/rage.  So his young daughter runs towards the street, and he is instantly screaming at her, grabbing her up, and maybe shaking her.  Neither her nor the daughter know why.  Or he's driving and someone "cuts (him) off" (which is, in fact, a danger to him) whereupon, in a rage, he blocks the other car in and beats in the windshield in righteous anger.  Or his wife asks him to talk to her and she persists even after being told "You wouldn't understand" and suddenly he blows up in a rage and storms out of the house, barely aware that her loving interest, if allowed in and responded to in kind, would put him right in the middle of all the pain, and terror, and longing; the vulnerability that he has worked so hard to keep at bay.

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 http://www.psychotherapynetworker.org/recentissues/1151-the-puzzle-of-ptsd or see a copy of it found on this blog titled "The Puzzle of PTSD."