* Warning: May Contain Some PTSD "Triggers" *
I am not the same person I was when I went to Iraq. I only know a few that didn't come back alive; almost everyone I know that went there returned physically intact-- for the most part. Modern medical technology is truly amazing at repairing the broken body.
But what I want to talk about are the ones that didn't fully come back emotionally or socially or mentally. Folks who never completely left there, mentally. One guy treated his little daughter like a recruit in Basic Training until she wailed, "Daddy, I'm just a little girl!" and caused him to break down. He was so wrapped up with getting back to Iraq he left the Reserves to go back into the regular Army.
Others just came back with memories that get in the way of transitioning back. A guy I know was blown up in an RG-31 MRAP. The three others in the car died; all he remembers is waking up three days later in Landstuhl, Germany. He had problems that involve legalities, so I won't detail them out of respect for his privacy. But he's recovering.
Others just got "attitudes". Some became detached, relaxed, too easy-going. The opposite of what one would expect, right? Others became intense, with eyes looking at something else that no one else sees, unless you were there too. There's drinking; there may be drugs, I don't know. I never felt comfortable asking one friend how he felt about using all his Combat Lifesaver training to put an Iraqi civilian's intestines back in his body, only to have a follow-on truck bomb blow over them again. We never knew if the civilian lived. I wasn't at the blast site; I always felt guilty about not going but I had no medical training worth mentioning, so I felt I'd be in the way.
So, there we stand.
PTSD, or Post-Traumatic Stress Disorder (and it's not quite as volatile cousin, Combat Stress Reaction) is a subject that should be very much on the minds of our citizens. Thousands of military personnel, and no few civilian contractors (both combat and not), have been coming home from ten-year+ wars that have, at best, a complicated relationship to the American psyche.
The big problem is, PTSD studies are few and far between, and understanding this affliction is still not even taken seriously across the board. It is still, in some peoples' eyes, seen as a weakness or pansy's way to deal with things, or a lack of intestinal fortitude. But we as a society created a monster by throwing people out there and cycling them back, sometimes two, three, six times (I was lucky; I went once). So now we're going to have to deal with the after-effects.
This isn't one of those trite-ass "vets are ticking time-bombs!" memes, this is something I want to talk about because it bothers me. It hurts people I know. And I think sometimes, "there but for the grace of God go I". Like I said, I'm different now, I can't always put my finger on how. Sometimes I feel angry inside; sometimes I feel "really Zen" about things, like I have a bigger perspective on problems other people are freaking out about. My wife says I'm a little too relaxed, like I just blow off things that probably deserve a bit of engagement... a sense of passivity. I can see that, too.
So I'm functional. Many of my friends are, with caveats; some are not. And PTSD and Combat Stress Reaction will continue to fester, society-wide, until it gets confronted honestly, diligently, with sobriety and a sense of respect for all who suffer.
PTSD and Stress Reaction is not just for war vets any more. Natural disaster victims suffer it; rape victims suffer it; people who've been in accidents suffer it. I wish I could go into detail about these, but I feel I cannot. My experience is with the war version, and for other versions I feel there are "similar-- but different" coping mechanisms. But what I find frustrating about PTSD as I know it, is that it isn't studied much, and that's because I think people don't want to get too deep into it. Society sent people over there, it's not like an accident or an attack where the moral clarity is more stark. But it can also just be a difficult topic to study, since the lack of participants in studies may be a problem.
Which is why I like the book I show here: Combat Stress Reaction, by Zahava Solomon. It was printed in 1993* and at the time was one of the few really in-depth, comprehensive studies on PTSD and CSR. It may still be one of the only real attempts to delve into it, certainly funded by a government defense ministry that was actually responsible for sending people into the thick of it.
* (1993 Plenum Press, New York, ISBN 0-306-44279-5).
I found this book because I was living in Israel from 1998 to 2002, and the girlfriend I was dating at the time was studying Psychology, and she worked at the Israel Association of Psychotherapy as a means towards her eventual goal as a therapist. Through her connections I got to meet a lot of psychologists and the like, and had access to books and pamphlets that don't exactly make it to Barnes & Noble (or Steimatzky's, which is the Israeli book chain).
So I saw this book and picked it up, intrigued by the notion of a study on PTSD. To this day I cannot say why I was inspired to get it; this would have been 2001-2002. But now, I'm so glad I did.
See, the book was written by a woman who was a mental health medical care officer during the Lebanon War*. She was based at a mental health research facility with other female officers just outside of Tel Aviv. She says no one really knew what to do with them; as women they were not permitted to deploy beyond the borders and she says that "to wear a uniform in wartime and to feel that you are not needed is very unpleasant". So they started setting up a database of psychiatric casualties. Every Israeli citizen, from his pre-draft notification (men and women both) around 16-17, until their final release from Reserve service (age 55) has extensive records kept on them.
* (Interesting sidenote: Zahava Solomon was the psychiatrist portrayed as herself in the animated feature Waltz With Bashir)
Solomon writes that:
To the best of my knowledge, this was the first time in military history that a database of this sort had been established. The work was made possible in large part by a constellation of features unique to Israel: the relatively small area and population of the country; the small size and reserve nature of its army; the provision of free military mental health services throughout the country; and the availability of frequently updated, centralized computer records of information relating to every soldier's military service. Together, these features greatly facilitated locating veterans, enlisting their cooperation, and following them up over time-- tasks that were obviously preliminary to the longitudinal empirical research...
In other words, a small, contained population that is easy to follow up on, an advantage that, unfortunately, US veterans don't have, especially with our high rate of veteran homelessness, in which the VA system loses track of many people. But I think empirical studies can be done, have been done, and I further believe they can be replicated in the United States, where we are facing a critical need for them.
The fact that the Israeli population is smaller than the US population may seem to make this "easier" to accomplish in Israel-- a feat that couldn't be accomplished in the United States. But I don't see that as a valid dodge. For the most part, the military and VA are obsessive about paperwork, but still, many get "lost"-- frequently described as "falling through the cracks".
Some may ask, "why do veterans fall through the cracks?", but what I want to know is, "Why are there cracks?" -- especially in the computer age when information can be shared quickly? If a vet "disappears" in Seattle, and reappears in a shelter in Baltimore, his or her information should be a couple mouse-clicks away through the VA. Many might blame the vet him/herself for not being "engaged", but what if there are other attitudes at work? Something that may make the veteran feel disqualified from participating in the post-war support network? A sense that the veteran's experiences are not, somehow, relevant or meaningful to the home he or she returns to?
In chapter 6, Dr. Solomon expresses some thoughts on the society that the vet comes home to. She is initially writing about the number of suicides in the US veteran population, post-Vietnam, but there are some insights she points to that I think are interesting and worth looking at:
[One factor is] the freedom... with which the veterans of the Lebanon war could express their anger, both in direct criticism of the war, and in the form of diffuse aggression, which Israeli society permits.
While she is specifically addressing the topic of to PTSD-influenced suicides in the passage, Dr. Solomon says that while suicide is "anger directed at the self", the ability to externalize the anger allows the veteran to express feelings openly in a way that, inadvertently, saves their lives*. Being able to express anger of frustration openly, without fear of criticism, can help veterans overall.
Compare that to a society that treats veterans with lip-service respect, a sort of scripted adoration and paper-thin lionization that functions as long as the vet is "proud" to have served (even in a futile or questionable action) but crumbles if the vet criticizes the war they served in-- becoming a "hippie" or returning home "broken by the experience". I suspect that what many Americans want is a shallow sense of glory through vicarious living: they put their yellow ribbon magnet on their bumper and congratulate the soldier so they can feel like they had some part in the affair from the safety of their easy chair, and if the vet "ruins" it for them by questioning the motives behind their experience, then the vet, not the two-dimensional citizen, must bear the burden.
* (By the way, for the curious, Dr. Solomon's data on US Vietnam-veteran suicides? She cites a 1985 article by a Dr. Deborah Golomb that says that 115,000 Vietnam vets had died since returning to the US, twice more than the casualty rate in-country, and evidence pointed that 30% of those deaths were suicide.)
In contrast, Dr. Solomon goes on to discuss that the Lebanon veteran returned to a largely supportive environment, and that while voices were certainly raised against the Lebanon
war, it did not coincide with abuse or condemnation of the soldiers who fought it. She also dwells on how memorialization of the dead is institutionalized into Israeli society: every year, at the Israeli version of Memorial Day, air raid sirens are sounded throughout the country. Everyone, every where, stops for the one-minute blast to contemplate and internalize the losses borne by society. Every veteran can see, for a moment each year, the schoolgirl and the soccer star, the policeman and the retail worker, the cabbie and the college student, stand in silent contemplation and remembrance, even if those people don't know the individual names of the veteran's comrades who don't come home. This makes his or her experiences important --validated-- without necessarily giving props to the war itself, or the politics surrounding it. Needless to say, it is not cheapened by barbecues and flag-bedecked ads for "sales". On the other hand, welcome-home parades may seem trite, or even criticized as "glorification", but they may be a powerful tool in re-integrating the returning vet to a society that appreciates the
veteran, at least, if not the war.
The study goes into other points that are too relevant to leave out, but also too many to get into exhaustive detail without essentially re-creating the book here. How a war is perceived by the home society --just or unjust-- plays a factor in returnee symptoms or of susceptibility. The longer debate drags on about the ethics of the war can also leave veterans in a sort of hanging state, where they are waiting for society to judge the war they participated in, and can drag out their tension and increase PTSD and CSR occurrences.
The salient point to the book, and the point I'm reaching for here, is that how a society treats its returning veterans is as important as the veterans' ability to return home in the first place. What good does it do to come home to a society that feels like you have failed them, or to be ostracized, or that the whole purpose you served was ultimately futile? To this end, I'd hazard a guess that the returning Iraq and Afghan vets have an advantage that the Vietnam returnees did not have: a society that (hopefully) learned that you don't deal with an unpopular war by discriminating the soldiers who had the misfortune to be the generation who drew the short straw to fight in it. It is a lesson hard-learned.
The caveat to this is that this war is more ethically ambivalent than Vietnam. Unlike the Vietnamese, American were directly attacked. Certainly the events of 9/11 add a degree of rationale to the Afghanistan front that cannot be easily dismissed, even if the American reaction to it may be argued as inappropriate. The Iraq war is a little harder to square, though. Will the two wars (and their veterans) be seen as different, different but equal, or two sides of the same war?
Another caveat to take from the Iraq and Afghan Wars is that today's soldiers are volunteers. The draftee army of Vietnam can argue "I didn't really want to be there", whereas that is more difficult for the returnee from Iraq or Afghanistan to rationalize. Do they bear some of the fault, then, for their participatory decision? Will that factor into how society treats them in the long run? The long-term sociological effects of that remain to be seen, but for now it can be hypothesized that the returning veterans of both fronts will be waiting to see how society internalizes their sacrifice-- and it is a sacrifice: in time, in psyche, in sense of self... an alert and self-aware soldier will be asking him or herself, at every minute on the battlefield, "what will this do to me in the long run?"
Every day I was there I bore in mind that I'd have to live with the forever effects. I'd read Solomon's book before going; before even knowing if I'd ever face a war, I tried to steer the kids in my squad in that direction, even if they didn't go through it consciously. Years from now, they'll have to wake up and look at themselves in the mirror. Can they stomach what they see? They do, at least, have the luxury of being alive to ask those questions, so time will tell. Will the rest of us, as a society, be able to deal with this all as well?