"The Making and Un-making of a Marine"

A FALL 2008 ADVERTISING SUPPLEMENT SPONSORED BY FOUR WINDS HOSPITAL

Post Traumatic Stress Disorder

By Lawrence J. Winters, BPS, LMHC Senior Clinical Group Psychotherapist and Coordinator of Veterans Treatment Four Winds Hospital

Until recently in our society, a warrior held on to his identity when he had returned from war. His role remained as one who had and would continue to protect the society in which he lived. The warrior was trained to put his personal fears and needs aside for the others. He was the one called when there was danger. He was the one who would teach society what war was really about. This social role provided an identity for returning soldiers.

During the Vietnam War, however, many civilians did not see returning soldiers as warriors. Because of changing political and social perceptions, returning warriors were all too often seen as trained killers or, at best, misguided souls. As we all know now, this caused a grievous wound to the psyches of our soldiers. To have been asked by your country to risk your life-and to take the lives of others-and not be honored for your sacrifice when you return, is a soul wound.

Today, this is recurring with reference to soldiers returning from the Iraq and Afghanistan Wars.

I recently finished writing a book titled The Making and Unmaking of a Marine, which is about my journey from childhood through Vietnam to the present. I'd spent fifteen years working on that book and thirty years writing poems about my war experiences. Since my return from Vietnam, I had been in personal therapy for many years. I attended years of school to become a therapist. I enrolled in more workshops that I can list, from Robert Bly's men's groups to professional conferences concerning PTSD. I even went back to Vietnam in 1994 with a group of health care professionals to deal with my ghosts and to ask for forgiveness from the Vietnamese people.

This is a poem that I wrote shortly after returning from Vietnam in 1970. Listen for the confusion in it and you will begin to understand how many of today's returning soldiers feel.

CONFESSION

I'm ashamed that I may not have killed anyone in Vietnam;
I'm ashamed that I may have killed someone.

I'm proud that I was a Marine;
I'm embarrassed to tell anyone that I was in the Marines.

I grew up believing in God and country.
In Vietnam I lost my belief in God and distrust anything my country told me.

Vietnam was the most beautiful country I ever saw; vibrant colors, skies piled with cumulus clouds, beautiful women with silk black hair;
Vietnam was an ugly, blood-drenched, sweating inferno where women and children were, at times, weapons themselves,

Vietnam made heroes out of schoolboys;
Vietnam made traitors out of scared boys who hated what they were told to do but did it anyway.

I wanted my father to be proud of me for standing up and fighting for my country; My father never asked me anything about the War when I returned.

I missed my girlfriend and married her as soon as I got home:
I divorced my wife and for years could not father our child.

Nowhere in all my searching did I find any individual or group that understood what the war had done to me. I searched like a well-trained Marine looking for the enemy. No one seemed to want to know what the war did to my insides.

That is, until recently when I read Ed Tick's book War and the Soul. I lay in bed each evening for three weeks reading it. I wept so frequently that I stopped try­ing to hide it.

Ed Tick's thirty years of working with vets had opened his heart. His expansive scholarship on the topic of the warrior tradition was helping me pull my fragmented soul together. Finding someone who understood the interior of me as a Marine was deeply affirming. All the academic treatises I'd read on PTSD left out the fact that human beings have souls.

In my life of study and learning, I have never thirsted to take in anything as much as the teachings of War and the Soul. My eyes and heart opened when I read on page 108, "We have seen that classifying and treating PTSD merely as a stress and anxiety disorder fails to address its deeper dimensions. Moreover, while medication may rebalance biochemical functioning, it cannot heat the inner self. In the standard kind of treatment, the veteran feels pathologized and is expected to "get on with life". He feels encouraged to measure his progress against nonnative civilian functioning rather than to do what is truly needed, which is to embrace the experience of inner death and seek a new identity and spiritual rebirth. The common therapeutic model, that is, misses the point that PTSD is primarily a moral, spiritual and aesthetic disorder - in effect not a psychological but a soul disorder.

You may hear in this next poem some of the rage from PTSD that had disassembled me after coming home from the war.

AMERICA

"For all of you that live here during the Vietnam War" I killed for you. You may not have asked me to, But I killed for you.
I didn't ask to go to Vietnam.
I didn't support the war.

Still I killed for you and for me.
I killed for you, While you paid your taxes. You watched me kill on TV, While you were eating cheeseburgers.
I killed for you. While you were protesting that I was killing for you, I killed for you. While you were avoiding the draft, While running off to Canada,
I killed for you.

I killed for you
While you waited in line at the supermarket, While you were out getting drunk, When you got your first good job after college, As you enjoyed free love,
I was killing for you. I have carried pain for you. Guilt for you. Shame for you.
For all the killing I did for you. To get on with my life for you.
To be productive for you.
To marry you. To raise children for you.
And most of all to forget for you.

Often at these presentations, I am asked by clinicians questions like, "What tools do you have that I can use when a vet comes into my office and won't open up?" or "How do you deal with the anger that these men carry?" or "How do street drugs play a role in PTSD when you know drugs were a part of the war?" Of course, [ put on ll1Y clinician's hat and field these questions as best I can, but when I leave, I don't feel like I have got­ten my point across. Upon reflection, I think looking for new and unique tools to heal PTSD is not what is really needed. There are an abundance of toolboxes from many modalities that are used to treat PTSD ranging from exposure therapy to standard cognitive behavioral therapy approaches. Attention to this topic is good because it has forced the medical and psychological communities to focus on PTSD and its treatment.

In my opinion, we are missing the target when we look for new tools. In my experience, there is no tool that can put the soul into a box so it can be examined. There is no blueprint for how to treat PTSD that works any better than the caring, listening, and compassionate truthfulness of a clinician. By putting the trauma of war into a diagnostic category, we remove responsibility from our society for having traumatized our soldiers by sending them into war. In addition, PTSD therapeutic tools are nothing more than diagnostic armor working to protect us from the painful, dehumanizing, soul wounding events our clients report to us. These tools come from the heads of scholars and keep us one step removed from the souls that may be withering before us. Yes, tools are important and are useful, but they insulate us from feelings, which should, in my opinion, be a central source of information on how we work as therapists and healers.

The best tool I know for speaking with a war veteran is to know that one cannot speak to a vet about war if one hasn't listened first. I mean the kind of listening that uses more than the ears. I would call it deep listening; Ed Tick would call it soul listening. It's easy to hear the facts, assess the circumstances, and analyze the difficulties and even devise a game plan to help. However, there are few who take the time needed to hear a soldier. If a soldier is going to speak about war, it will be within his or her own time frame, not yours or managed care. Most of what gets said about war is in the punctuated silences. However, if one listens long enough, open up wide enough, one may hear the oblique tenor of war. Mother Teresa understood when she said, "Kind words can be short and easy to speak, but their echoes are truly endless."

Human souls have many forms of communication, and words can only hold so much. Silence, if heard as simply empty moments needing to be filled, only closes the treatment door. Taking time, tolerating silence, waiting, witnessing the presence of another human being in pain, and staying in the room are the skills needed to communicate with a war veteran. It has so much more to do with being present than speaking. You should know that it is an honor if a veteran speaks to you about war, and if it happens, please share with them that you're honored. What I have just said could be summed up by the famous anonymous who said, "When you walk the walk, people listen."

When I returned to Vietnam in 1994, I was visiting a Vietnamese Cemetery. Afterwards, I wrote this poem:

VIETNAM
Cemetery Worker at Viet Cong Memorial

I called to you. "Come here, I have something for you". You mumbled back.
I called again. You mumble again.
I wave for you to come. You looked away and spoke clearly. "I no come here".
I wanted to give you money. You who takes care of my enemy's graves. But you turned away. Both of us knowing it could never be enough.

Charles Swindoll, the evangelical Christian pastor said, "Forgiveness is not an elective in the curriculum of life. It is a required course and the exams are always tough to pass."

In 1980 PTSD became a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders or DMS II at that time. This was seen by many health care professionals as making great strides tor combat veterans; they would now be eligible for the treatment they had urgently needed since the ending of the Vietnam War five years earlier. Finally, the effects of war trauma 'on soldiers ~ which in previous wars had been called "Shell Shock" or "Soldiers Heart" ~ became legitimized and the VA was held responsible for its treatment.

When declaring PTSD an illness and listing it in the mental health manual for the treatment of individuals, we effectively isolated the problem into the category of mental illness. This, in turn, placed the onus of healing on the patient and the patient's treatment team.

All of this misses the point that war wounds the soul, and soul wounds are not listed in the DSM.

There is a reason that such a large number of Vietnam vets are coming to the VA with PTSD symptoms some 37 years after the war. They have hidden from the society that shamed them for what they had done. With the change in attitude towards our current soldiers or at least the use of politically correct language such as "I don't support the war but I support the troops," these Vietnam vets now have come for help with symptoms that have become a way of life for them and their families.

Another thing we miss when we see PTSD as an individual disorder is the fact that it is an infectious illness. We may treat the individuals with PTSD but ignore that it has spread into their families and their communities where it goes largely untreated. The VA is not responsible for the veterans' families, so who is there to help them?

Unless we accept our responsibility as a society in the healing of PTSD, our veterans will not find peace and nor shall we.

Our social responsibility means seeing and listening to our vets when they come home from war. But when we send our soldiers to isolated VA hospitals, we don't have to sit next to them in our waiting rooms. When we bring our war dead home under the cover of darkness, we won't have to watch. When we put IPod plugs in, we don't have to listen to our veteran's war stories.

We are also protecting ourselves when we use the word "hero" because we don't have to see the depth of pain in the soldiers we are pinning the medals on. They stand erect, proud to be acknowledged, and later implode at the bar or with family or when they are alone.

What can we do to help heal those who have protected us from the furies of the outside world? I believe that first, we must understand that we can heal our soldiers and our society, that the damage we are confronted with is not insurmountable. Somewhere in our makeup are patterns or instincts left that can guide us towards opening our arms to each other, towards opening our ears to human pain and allowing compassion to return to the social equation.

When Abraham Lincoln said, "With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let 118 strive on to finish the work we are in, to bind up the nation's wounds, to care for him who shall have borne the battle and for his widow and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations," he was pointing the nation towards its obligation to help and heal its returning soldiers and their families. He knew that this would, in turn, heal society.

Our obligation to veterans goes beyond parades, VA hospitals, and military medals. Only when we watch our willingness to help heal our soldiers in their commitment to go to war will we begin to stop their suicides, their relief from pain with addiction, their spilling of rage in domestic violence, and in short, their self destructiveness within our midst. I would like to end with a poem that I wrote and read to the Vietnamese in 1994:

WAR

If a man kills another man,
He must dig two graves --
One in the earth for the dead man,
And one in his heart
For his own spirit,
Or he will not return.