On The Eve of The Oscars

Birth of a Nation, All Quiet on the Western Front, Gallipoli, Patton, Apocalypse Now, Saving Private Ryan, Flags of Our Fathers, The Hurt Locker and now American Sniper- cinema has focused on war with varying degrees of accuracy, honesty, integrity, and intensity. The trend has been toward greater intensity and accuracy. I can recall my father’s angry utterances at some of the WW II movies- “what a bunch of b****shit; it’s nothing like that”. That is where his comments would end; he and his generation, for the most part, endured their burdens in silence. Despite a more verbal environment for today’s soldiers, silence still prevails. In addition, as my group members have stated over and over “no matter how good the movie they can’t capture the fear, nor can they capture the chaos, as well as the horrible, deafening sounds or the disgusting smell of death/burning flesh”.

One of my jobs as a clinician is to encourage veterans to find their personal voices. They are not encouraged to retell war stories, but they are challenged to create an emotional narrative- one that explains how they have been changed, displaced and confused by the horror/pleasure/insanity/meaningful experience of war. Keep in mind, you need not be shot at to be impacted; medics, surgical techs, critical care providers and others sustain the same invisible injuries, including anger, detachment, mistrust of others, hyper-vigilance and higher risk for co-occurring alcoholism.

PTSD is a complicated condition; it takes more than a recitation of symptoms to capture its power and transformative impact. There have been eloquent parts of this phenomenon captured in dialogue of some movies, even before we agreed on the ‘label’, PTSD. One example caught my attention last week, a film noir movie, Crossfire (1947) shown on TCM as part of their countdown to the Oscars. I found this movie very boring – short bursts of dialogue akin to a tabloid newspaper. I was dosing off after a long day listening to and absorbing PTSD ‘s contemporaneous, complex emotional toxins. However, a few lines from the movie crept through -their honesty and insightfulness compelled me to locate the script. I read the following lines to my group and several veterans were as impressed with their power:

CROSSFIRE 1947
“Well hate, Montey’s kind of hate, is like a gun. If you carry it around with you it can go off and kill somebody. It killed Samuels last night”.

“Soldiers don’t have anywhere to go, unless you tell ’em where to go. When they’re off duty they go crawling- or they go crazy”.

“It’s worse at night isn’t it? I think maybe it’s not having a lot of enemies to hate anymore. Maybe it’s because for four years now we’ve been focusing our mind on – on one little peanut. The win the war peanut. That was all; get it over! Eat that peanut. ( he eats and swallows the peanut) All at once no peanut. Now we start looking at each other again. We don’t know what we’re supposed to do- we don’t know what’s supposed to happen. We’re too used to fighting, but we don’t know what to fight. You can feel the tension in the air. A whole lot of fight, and hate, that doesn’t know where to go. A guy like you maybe starts hating himself. Well- one if these days maybe we’ll all learn to shift gears. Stop hating and start liking things again. Eh?”

Truth can transcend time and context. We need insightful narratives in cinema and at home. The challenge is not just graphic depictions of what the greatest generation called FUBAR. We need individual dialogues and narratives to ease the real pain of real wars. With that being said I do hope American Sniper wins; movies of similar intensity do more than entertain. They can encourage personal narratives that heal.

Five Tour Marine Articulates A Core Component of PTSD – A Must Listen

Young Marine corps veteran Elliot Ackerman discusses his new novel which gives voice to one of the consequences of war- a sense of meaning which he compares to crystal meth. He also finds common ground with his former enemies and speaks about the view Afghanistan soldiers have of Americans providing guidance and assistance. He quotes Keats from WWI and does a brilliant job articulating one of the vital aspects of the complex and invisible wounds of war. He also speaks about the ‘economics’ of ongoing war and provides insights that appear elusive to our command structure. I urge you to listen and reflect.

http://www.thetakeaway.org/story/green-blue-imagines-afghan-war-perspective-orphaned-soldier/

Gallipoli at 100: The Second Rewrite of Turkish History?

http://www.smithsonianmag.com/history/new-view-battle-gallipoli-one-bloodiest-conflicts-world-war-i-180953975/

Hopefully readers can access the Smithsonian Magazine link above for a well written and vivid overview of a military horror replete with hubris, poor Allied leadership, mind boggling carnage and an attempted rewriting of history. There are many, many lessons we can derive from Gallipoli in terms of tactics, logistics, military planning, grandiosity, nationalism, destroyed reputations, as well as Churchill’s spectacular redemption that decades later helped save the Western world. As distressing as it was to learn that in a few months 180,000 Allied troops and 230,000 Turks had been killed or wounded (the horrors and disproportionate deaths of Anzacs has been well articulated in old and upcoming movies), I found the most distressing part of the article is the second Turkish rewrite of history. Most enlightened readers are well aware of the Armenian Holocaust where the numbers might be debated but whose reality was as unmistakable as so many other hate crimes , historical and contemporary. The current Turkish leadership’s rewrite was that Gallipoli was an Islamic victory, not an Ottoman and German one. Erdogan is trying to usurp the modernist Turkish icon, Mustafa Kemal, (Ataturk); Erdogan’s minions are not troubled by artifacts- they claim the beer bottles in the Turkish trenches were from the Germans, after all the heroic fighters were devout Muslims. As often saved “everyone is entitled to their own opinions, but not the facts”. I guess when you have enough power facts are malleable and lessons of history are lost. The Smithsonian article brought the details of carnage I hear daily into sharper focus. What truly distresses me is hearing the machine guns of mis truth reload for the next wave of carnage, the hints of which we hear on the evening news. Let us hope the rewrite of Gallipoli do not reignite the Ghosts of Gallipoli.

The Clay Hunt Suicide Prevention for American Veterans (SAV) Act

http://iava.org/savact/

Some correspondence with colleagues:

My opening comment: “Opportunities for upgrade in MH services might result…all depends upon who and how utilizes the $$$ and power.”

JB
Unless we have a spontaneous zeitgeist or a challenge via the ‘external review’ aspect of the new bill I do fear the extra $$$ will buy sand boxes (yes, that is what an Air Force clinician was using) or more expensive, useless toys (how about that marvelous Virtual Iraq), as well as poorly trained, useless new clinicians. I keep hopeful and would love the opportunity to challenge the current ineptitude. However, it remains a dream without access to the very highest political processes. Sadly, that path is not viable within the conventional paths; had I taken the administrative route returning to VA I would have become another soulless zombie dithering over meaningless and phony measures (body count). I remain focused on the clinical art form which keeps me sane but I also remain hopeful that someday the spirit of the new law permit sane voices to determine how to better deliver the balanced and artful skill set our clients desperately need and deserve.
(This past Friday one of my clients came up to me and said about our VN Veterans PTSD group “I really wish we had the help we are getting now when we first came home; it would have made such a difference in how I treated my family, the first two women in my life, my kids, everything. I sure do hope these young guys are getting what we’re getting now.” I felt some pride he was progressing after 40 years of drifting but I could not give him the vapid reassurance that our systems and providers were delivering anything close to what he was wishing for younger vets.)

HK

Would be so amazing if improvements would occur because of this…
I need to work on my attitude… I sadly feel like most veterans won’t get what they need just based on HX.
Keep the dream alive and keep moving forward- that is what will help change to occur!

KN
I have to say I’m not hopeful it will do much more than increase “access” without improving quality or scope of practice and make our lives miserable with BS “accountabity” oversight that will result zero in improving real care for these guys and gals. I also don’t think the answer is simply hiring more and more staff… I think we must need a drastic revisionism of how recovery is conceptualized and implemented and an explicit articulation of moving away from a private practice model or standardized group heavy model with too many meds. I have never heard articulated what a systems based recovery model can look like… Interested at some point to talk with you about it. Maybe creation of small focused highly trained recovery teams that can be flexible, creative, comprehensive in a relatively short period of time. Maybe again going back to the idea of a boot camp equivalent but with recovery, readjustment, independent identity goals. I have to say its kind of a mess right now! Sorry, just thinking out loud right now ….

HK
Your PTs are a few of the blessed soldiers who actually get quality, therapeutic care and their feedback to you is priceless, I am sure. That is why we are supposed to “show up” and I know that feedback is what pulls you along when the frustration is so awful. Thank you for what you do- there are not enough like you that are caring and conscious to the art of recovery!

Clinicians- email me your comments for potential posting…

The Psychological Factors of An Elite Military

http://www.washingtonpost.com/news/checkpoint/wp/2015/01/23/new-top-marine-corps-general-releases-plan-to-shake-up-the-service/

I hate to sound so skeptical but it sounds like the Marine Corps wants to use psychological tools to find more ‘resilient’ troops so they can beat the hell out of them before they destroy them forever. This myth that we have √úbermensch straddles lines of reality and humanity. Instead of using troops for one or two tours we are moving more toward the hardened selection and elitism that reminds me more of KGB and SS. I do support training and use of elite soldiers but I fear the resilience factor will select for sociopathy as well. On the one hand I feel like a paranoid survivalist- the elites could become forces of juntas or Beer Hall Putsches and the humanist worrying about the destruction of many of our best, brightest and most resilient troops overused and destroyed by the overhyping, brainwashing and delusional culture elitism can cultivate. (I doubt any Pentagon or VA folks have studied the way PTSD impacts special ops guys with 10 deployments. After that much carnage return to civilian life would seem impossible.) Perhaps I am slow to adjust but .75% of population further narrowed to a select few used until broken sounds like a fiscally and politically appealing short term security solution but one with unforeseen hazards and consequences. Editorial ended.