08 February 2010

Let's talk about what no one wants to talk about: PTSD

This started off as a comment/response to an old law schoolmate's blog entry, but it started getting rather lengthy and out-of-control, so I migrated it to a full post here.  A rather gifted Jarhead, she somehow manages to balance being a mother, spouse, lawyer and Marine all at the same time.  I won't do her the injustice of trying to summarize her entry, so read it, then come back (she flatters me in her first paragraph -- skip on down to the main body text for the substantial stuff!)

Okay, you're back.  So this post is meant to directly address the feelings of -- I don't know what they are: anxiety, maybe -- that we feel when confronted by disturbing images or events.  I think these feelings in and of themselves are not so strange in the narrow context of following exposure to bad shit: most people would call it a normal reaction.  I think what makes those feelings difficult to reconcile is when, just as Colleen writes in her entry, you are a professional warrior trained to fight, and ultimately to kill if necessary.  We're supposed to be immune to those feelings, right?  We're supposed to just lock them away in a box somewhere, and save it for later!  Save it for all of the yummy and tasty goodness of PTSD, right?!

That works for some people.  But not everyone.  And this is where my discussion is going to probably start jumping all over the place, so bear with me: just buckle your seatbelt and enjoy the ride.

Rewind a year and some change: December 2008.  I'm on pre-deployment block leave, just a few weeks away from getting on the bird and heading to The Big Show (i.e., Iraq).  I'm drinking with an old ROTC buddy of mine, John: an Army infantry officer who deployed to Afghanistan at the same time I left for Iraq.  It was probably late in the evening, and we both had undoubtedly had a few too many drinks in us.  John was one of the few peers I had in ROTC that was truly on the same page as me: we both understood very well the grave and substantial responsibility we were shouldering.  We were both going to be in charge of 20 to 30 people.  Lives.  Fathers, husbands, sons, brothers.  Anything our platoons did or failed to do...well, that would be our responsibility and ours alone.

So, John and I both being drunk and on the verge of embarking on the great adventure known colloquially as war, we start talking about the shit that you don't generally share with other people, namely normal civilians.  What worried us?  Losing soldiers.  Competence.  Ability.  Courage/fear.  Everything.  How would I react in any given situation?  Am I ready?  Am I ready right now to lead soldiers in combat?  Has the Army given me all of the tools and training I need to ensure that I can lead soldiers effectively and not squander their lives?

Neither of us joined the Army with our eyes closed.  We knew what we were getting into: if you're active duty Army, and if you're a combat arms officer, then you are virtually guaranteed to deploy to Iraq or Afghanistan within a year of arriving at your first duty station.  And we knew what was going on.  I was an undergrad at NYU in 2001 when the World Trade Center turned into The Pile (and later The Pit) -- or Ground Zero as the rest of America calls it -- and we kicked off military operations in Afghanistan.  And I was still in college in 2003 when we marched into Baghdad.  I was old enough to be cognizant of what war can do to people: it kills them at the worst, or mangles them physically, or scars them psychologically.

Anyway, so there we are, drinking and sobering each other up with our insecurities.  I remember looking at John and saying, "Hey dude -- this is gonna sound weird, but...I've been looking at fucked up shit on the internet to get myself ready."  To my relief, he responded with, "Yeah bro, I've been doing the same thing."

This was the rationale: we didn't want the first time we saw something terrible or horrifying to be on the streets of Iraq or the mountains of Afghanistan.  I wanted to take care of the shock value ahead of time -- in essence, pop the psychic cherry.  I was hoping to desensitize myself in the hopes that if I was ever confronted by the real-life horrors of war, I wouldn't be paralyzed and I'd still be able to make decisions properly.  I was jealous of my other ROTC buddy Ian, who as a paramedic/EMT, had seen all sorts of fucked up shit.  Hell, I had seen a dead guy with his head cracked open on the curb back when I was living in Bushwick, Brooklyn: but that was only once, and it was at night, and I was drunk at the time.

So almost like we were fulfilling some kind of perverted fetish, we both had ended up scouring the internet for the most disturbing images of war we could find.  I'll spare the detailed descriptions, but you can guess: the kinds of photos that were easy to take back in 2003 and 2004, in the early parts of OIF (Operation Iraqi Freedom): dead civilians, dead insurgents, etc. etc.  We were hoping that it would somehow prepare us for what we could possibly see first-hand.

So, all that being said, did any of my extracurricular research help prepare me any for what I saw in the year that followed?  Answer: not a damned bit.

The first time you see something bad, it's scenes of people running around, maybe bleeding from their head or their arm or whatever.  That's palatable.  Your brain can handle that: big boom, people hurt, little bit of blood.  Got it.  I'm okay, let's charlie mike ("continue mission").

The next time, maybe it's kids instead of adults.  Okay, little bit worse now.  It really tugs at your heart when you see some grade schooler walking around with an almost cartoon-like bandage wrapped around his head a day after a VBIED (vehicle-borne improvised explosive device, i.e., carbomb) blows up in front of his school.  But you can handle it.  The kids are alive, some are a little bit hurt, but everything's going to be okay.

But that's really the extent of "okay".  Next incident: SVBIED (suicide VBIED) blows up next to an ESU (Iraqi Emergency Service Unit) pickup truck carrying five Iraqi Policemen.  Firefighters are pulling blackened, twisted and mangled things that are totally unrecognizable as human.  In fact, the only thing that makes it apparent that this is a dead body they are pulling out of the molten wreckage are the following: (a) they are loading it onto a bright orange spine board; (b) as parts of the thing catches on corners of the truck's wreckage, strings and ropes of burned meat or tendon or tissue are pulled back to reveal yellow and pink shit underneath, and I know enough biology to know that the yellow shit is the fat in your body; and (c) some of the black, charred things have these big lumps in the middle, which upon closer inspection appear to be all twisty and loopy, which is when you realize that you're looking at a dead dude's intestines.

Pretty horrible, but your brain can still process it.  Because there is still a tangible process to it all.  Those dudes are dead.  I know they're dead because those are their bodies that are being carted away right now.  Got it.  Was it a gross and disgusting sight?  Yes.  Shocking?  Sure.  But I'm over it.  Charlie mike.

Okay fast-forward to the next incident.  SVEST (suicide vest) in the southern part of the city.  Roger, we're moving time now.  Just go south.  Follow the sirens and police trucks and ambulances.  Go go go!  There, one o'clock: two, three hundred meters by the big building on the west side of the street: gaggle of emergency vehicles.  Stop!  Where's the cordon?  The Iraqis have no cordon.  Okay, I see a shitload of people standing around by those fucked up cars -- we'll move in a little closer and establish a cordon around the blast site.  Okay, this is good, stop here.  Button-hook to the right a little bit...yeah, that's good.  Stop.  Hey gunner, face over to our seven o'clock.  Driver, call it up to battery and let 'em know we're stopped, dismounting and give 'em the grid.  Tell the other trucks to conduct survivability moves every now and then, but maintain cordon.  Okay, I'm dismounting now.  Interpreter, let's go.

Hit the handle, grab your weapon, lean into the heavy door with your shoulder, slip the right arm and M4 out, look down for a second (no boobytraps) and let the right foot down onto the pavement.  Take a few steps out, scan your sector, move over to the next piece of cover, take a look around and figure out what the hell's going on.

You see two, no three cars parked near each other: two sedans and a white pickup truck.  Windows all blown out, and all of the vehicles are peppered with paintball-sized holes.  Two of them have streaks of blood all over their front ends.  You've never responded to an SVEST before, and you don't know what to expect.  Once you determine that security is set, you make your way to the gathering of first responders near the blown up cars.  It's morning -- only zero-nine-something -- but the summer heat is already starting.  Next to the cars is a very shallow, but rather wide crater.  More like a gentle dip in the ground, but it's just covered in all of this brown shit -- brown shit just smeared all over the place.

You turn around and scan the area, and you see these little brown splotches all over the street, radiating out from the crater for a good bit -- all the way to the other side street on the other side of where your vehicles are at.  You kneel down to look at the ground, closer at a brown splotch, and realize that it's a piece of human meat that has made the ground wet.  These meat chunks are all over the place.  Hell, your whole platoon just drove right into the crime scene.  Nice job, asshole: now what?  There's no way to walk around without stepping on the splotches.

You look around, and some of your soldiers are starting to realize what they're looking at, too.  Your mind is racing in a dozen directions at once.  The rational part is analyzing the scene, adjusting vehicles, talking to IPs (Iraqi Police), trying to figure out what happened here.  Another part is trying to understand that all of these brown chunks used to be people: real people that had real lives.  Another part of your brain is trying to wrap itself around the sobering reality that an entire life -- all of those experiences and memories and friends and family that's affected by that individual's existence -- can be snuffed out in the time it takes for an SVEST to explode.  And yet another part of your brain is wondering if that strange smell is the odor of all this meat cooking on the ground in the summer Iraqi heat.

So what's the point?  Why did I laboriously take you with me on a perhaps too-detailed description of some of the weird shit that occurs overseas?  During my platoon's response to the SVEST, I believe my mind erected some kind of wall: okay, that's weird, but ignore it, still got a job to do.  Defense mechanism that enables continued performance, perhaps?

But later on: and I don't even know how long it took.  Hours...days...weeks...but later on, I did find myself thinking about that scene over and over again.  And I found myself disturbed by it.

Which brings us full circle to our original topic: the feelings and emotions we feel following exposure to any kind of terrible sight.  And whether it's okay to feel these things if you are a part of our storied institution of warriors.

Let's be blunt: PTSD has become a meaningless, empty label nowadays.  I would argue that it's an unnecessary label.  The stigmatizing label of PTSD is nothing more than the human body's normal physical and mental reaction/response to a traumatic stimulus/event.  Whether it's being shot at in combat, or surviving a car accident on the interstate, I would argue that what we today call PTSD is just a normal physiological and psychological set of responses.  If you go through some fucked up shit, of course you're going to go through some kind of process.  Of course you're going to feel some weird things.  This is normal.

So why the label in the first place?  My cynicism is going to show through here, but I would say because a label makes it easy to categorize.  And the military is all about labels and categories.  Quality medical diagnoses and treatments have been replaced by compartmentalized, quick-fix mass programs that are just ineffectual attempts to preserve the appearance that the Army is helping its (psychologically) wounded warriors.  Dear sir or madam: have you ever been deployed?  While deployed, did you ever see dead bodies or wounded personnel?  Did the sight of these things disturb you?  Okay, well, regardless of your answers, here's a 30 minute PowerPoint presentation, and if you feel like seeking additional help, we'll put you in touch with a mental health professional who has never deployed in a combat status and will likely not understand anything you tell him or her.

Whoops: soldier's acting up?  But he was such a good soldier in Iraq!  Well either he's an asshole that needs to be chaptered out of the Army, or he's got PTSD.  Oh wait, he has PTSD?  Well, he's no good to us -- put him on medical profile and let the head-shrinkers deal with him.

You see -- it's easier to label people because when you do, it makes the immediate problem go away.  No matter how much the military tries to sell its newfangled programs for helping out returning veterans, the sad truth is that the military (especially the Army) is astonishingly ill-equipped to properly handle or treat an entire generation of soldiers who have been exposed to multiple tours of combat and overall bad shit.

So, let's get back to talking about me.  Here I am, safe and sound, deployment complete.  The sights, smells, sounds of all the bad stuff: thousands of miles away from here.  Do I still think about these things sometimes?  Sure.  Am I totally desensitized to the horrors of war?  No, and I doubt I ever will be.  I'm not sure anyone can ever truly be desensitized or made immune from these normal feelings.  At least not with the way the Army deals with reintegration upon redeployment back home.

The Army (and the Marines and everyone else) spend an untold number of dollars and weeks or years of its time training you, Soldier or Marine, to be a warrior.  You will move your selector switch from safe to semi, scan your lane, and kill any green motherfucker that pops up in your sights.  You will pick up your radio, map and binoculars and call in some 155mm artillery HE (high-explosive) and smoke the shit out of that grid.  You will put your thumbs on the butterfly trigger of that M2 .50-caliber heavy machine gun and blow the shit out of any dumptrucks that attempt to breach that IP checkpoint 500 meters to our north.  This is what you were trained to do.

But when you come back, all of a sudden it's "Stop!  Wait, just kidding.  We wanted you to be warriors and we want you to be turned on and on red alert all the time, but not anymore.  It's not okay to be on high alert anymore."  Because if you're on high alert, guess what: you might have PTSD.  Or you're crazy.  So get over it, the Army tells us.  Re-adjust, reintegrate.  So you do it.  You reintegrate.  To only have to re-learn how to ramp yourself up again when you find yourself in the desert or mountains again a year later.

Why can't we just accept that yeah, people are going to be amped after deployment.  Why can't we accept that as normal and go from there?  Why label it?  Why stigmatize it?  Why force our warriors to shun the very warrior culture that very possibly kept them alive for 365 days?  Why can't we teach them to hang onto it -- even if it's just a little bit of it -- so they don't have to feel like they're crazy for it?

Now let me be clear: I'm not saying that it's okay to have brigades of soldiers running around in the U.S. pretending like they're still in Iraq.  However, the process of reintegration is too rushed.  And it's too superficial and empty.  Have you watched the PowerPoint on reintegration?  Yes?  Okay, you're good.  Next soldier.  Have you watched the PowerPoint?

So, my colleague Colleen wonders whether the feelings of disgust/anger/remorse, etc., at seeing images of violence and war or whatever are normal or common -- even in the face of her professional background as a Marine.  I would say yes, this is normal.  There will of course be a large subset of military folk that will continue to toe the party line of machisimo, exhorting an invulnerability to quaint things like feeling or emotion -- but those dudes are just lying to themselves.

Whatever you end up feeling in response to some out-of-the-ordinary shit -- whether it's the shock of seeing destruction, or the grief of losing a soldier, etc. -- is a completely normal reaction.  Everyone's reacts in different ways, and everyone has a different timeline for how long they are affected: for some, it's measured in seconds, and for others it can be years.  The biggest thing is being aware of the fact that your body and mind are going through a process (regardless of how brief or prolonged it may be), and that it's completely normal.

To readers who've seen the shit: I hope this helps.  You're not alone, and don't let anyone make you think  you're crazy.  Be aware of what's happening to you, and be rational enough to think about it and analyze it and if it's a problem, then attack it.

To readers who haven't seen the shit yet: there's nothing I can say or write that will prepare you.  Nothing you look at on the internet is going to simulate the sensation of seeing and smelling and touching the fucked up shit that goes on overseas.  Just trust in yourself, and trust that whatever reaction you have is normal.  Trust your training and trust in your ability to overcome whatever intense shit you feel right at that second to do your job and take care of your soldiers.

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