Odysseus in America (31 page)

Talk about different!

The Vietnam Veterans Memorial is the single most frequently visited monument in the capital. On a spring afternoon this is very easy to believe. However, the sense of sacred ground is still palpable and takes hold of the crowds of tourists and schoolchildren. They walk and talk quietly—probably more quietly than in their own churches. I think they know they're in someone else's church.

VIP veterans, if they go to the Wall at all, generally go more than once over the years. We encourage this for several reasons, the most important being that they report that they get something different out of each visit. The presence of veterans who have been to the Wall before is also enormously valuable to the veterans going for their first time. And on a second or third visit, the veteran is much more likely to engage with the schoolchildren or other visitors at the Wall. On a spring afternoon, standing still for an hour at the far edge of the walk, they become aware of parents, brothers and sisters, wives, children, cousins, aunts and uncles, school friends, neighbors of the people on the Wall. This has an oddly consoling effect on many veterans. It is another previously unfelt dimension of knowing that they are not alone, not freaks. A second- or third-time veteran may offer to help these other mourners find the names or make rubbings of them on the strips of paper that the Park Service provides.

Other veterans have found great solace in watching groups of schoolchildren, and sometimes speaking with them. The children's “Thank you” and the poems and stories they leave at the Wall do not provoke any of the bitter reactions that the same words from adults sometimes bring: “Where the fuck were you thirty years ago?”

Adult tourists who are unconnected with anyone on the Wall sometimes bring out that bitterness and generate a raw, unpleasantly conspicuous feeling of being gawked at, “What are we, zoo animals?” Fortunately, these reactions are rarely intense enough to disrupt the veteran's purpose in being there or to spoil the trip for him. The same can be said for xenophobic reactions to the foreign tourists who come to the Wall. The reactions occur but they don't ruin things, because of the opportunity to talk about them and to have support from the other veterans.

While reactions to the Wall trip are many and varied, the predominant
theme is grieving. This is an essential element in the second stage of recovery from complex PTSD after combat. When a member of VIP has tested the trustworthiness of the community and of the team sufficiently, he is often able to venture beyond the safety of we-all-went-through-the-same-thing into the particularity of his own experience, and
his
contribution to both events and to the course that his life has taken. The process of constructing a narrative invariably arouses intense emotions, particularly of grief. They grieve not only for comrades lost during and since the war, but almost always for irretrievable losses of prewar relationships, with parents, siblings, wives, and children. They mourn:

• Relationships, ideals, and ambitions blighted by alcohol and drug abuse, and its consequences.

• Relationships, ideals, and ambitions blighted by violence and its consequences.

• Relationships, ideals, and ambitions blighted by the avoidance symptoms of PTSD.

• Lost innocence.

• Lost youth and health.

• Waste.

Ruptured relationships are sometimes irretrievable, or have been made so by death. As we saw in Chapter 9, when Odysseus meets the ghost of his dead mother in the Underworld, he learns she died of grief during his long inexplicable vagrancy after the end of the Trojan War.
¹⁹
This can be taken as a metaphor of all such irretrievable losses that veterans must now face after their protracted, tormented
nostoi,
“homecomings.” Grieving and constructing a narrative is not a smooth process. It often cycles through periods of renewed testing, sometimes with breaks in safety, sobriety, and self-care, which must then be restored.

In the group therapies, leaders serve to assure “airtime” and to safeguard the VIP value that every person's suffering is significant and cannot be measured against any other person's suffering. VIP tradition strongly discourages “pissing contests” over whose misery is worse. We monitor the emotional state of the veteran making the disclosure, as well as that of other veterans who may be triggered by it, or may be dissociating. Very often, the disclosure of traumatic material occurs first in individual therapy, and is only later taken into a group. In imparting fragments of trauma narrative to the group, veterans can start to believe that, for example, “My story has meaning and value to others. I can trust them to understand and remember it. They are trustworthy witnesses to my grief,
rage, and guilt and they experience enough of these emotions with me that I know I am understood.”

The first two stages of recovery turn the veterans inward both toward themselves and toward the other veterans in VIP. In the third stage, veterans selectively reconnect with people, activities, ideals, ambitions, and group identities from which they had become isolated, and make new connections. The core of this is the negotiation of safe, nonviolent attachments in the family. This often entails reunion with, or renegotiation of relationships with, long-estranged children and now elderly parents. The veterans of VIP strongly support a therapeutic culture in the program aimed at
preventing
the intergenerational transmission of trauma
²⁰
—support born of guilt and sorrow at the damage that they did in past years to parents, spouses, and children.

Some veterans, by no means all, have taken satisfaction in educating youngsters on war, or in active peace advocacy. Several engage in regular volunteer work with homeless veterans, particularly those who have recently been homeless themselves. A great many have participated in educational activities for mental health professionals at various levels, as well as for medical students and psychology interns.

Stage Three of recovery starts with the small community of veterans in VIP and works outward to the veteran's family, military unit associations, church, neighborhood, and nation.

Dr. Mary Harvey's account of the dimensions of recovery
²¹
has influenced ours:

• Authority over the remembering process.

• Integration of memory and affect.

• Affect tolerance.

• Symptom mastery.

• Self-esteem and self-cohesion.

• Safe attachment.

• Meaning making.

We speak to the veterans of these dimensions as expected results of treatment. All of our patients struggle against chronic despair. There is no way to “give hope” of recovery without giving understandable
content
to that hope, and over time veterans readily understand Dr. Harvey's dimensions of recovery.

Social trust requires at least
three
people. Dyadic trust between two people, no matter how many times it is pair-wise created, does not make community. A community begins with the addition of the third person, and
with all three trusting that the other two when alone together will continue to safeguard the interests of the person who is absent.
²²
The trauma world assumption is that they will plot some exploitation or attack, or utterly forget the third person's existence. Good-enough nurturance in childhood produces social trust as a matter of course; bad-enough trauma at
any
age destroys it. Our task is its restoration.
²³

It is not enough to talk about trust and tell patients verbally what they need to do. Vietnam combat veterans, like veterans of many other wars and other traumatized populations, have great suspicion of words. They were deceived by words as part of their trauma. Our patients were told many idealistic things about war service, but were not told of its sorrows and suffering or that the personal cost could be so high. They were told about codes of conduct, but they then saw that the rules did not apply. They were told the enemy was weak and ill equipped, but then they saw how skillful the enemy's tactics and how well suited their weapons were. They were told in many voices that it was noble to be a warrior and that they would come home as heroes, but then they learned they were not wanted. Veterans learned not to trust words, but to observe behavior. They observe the behavior of mental health professionals who profess to offer treatment. They constantly observe us and test us for trustworthiness.
²⁴

The VIP veterans now have evolved a strong system of rules, devoted primarily to safety, sobriety, and self-care, developed over many years by the veterans, and mainly enforced by them in cooperation with the treatment team. The community rules are continuously a work in progress.

What we do is political in the richest senses of the word. Our patients all took part in the exercise of state military power in and around Vietnam between 1965 and 1972, and their injuries trace to this participation and to how power was used in military institutions. The dominating element of power makes the
cause of injury
political; the
forms of injury
are in part political; and you have seen here how the
treatment of injury
we provide is political—we foster an empowered community among the veterans that we work with. The task is to create
trust.
In a fundamental sense, our treatment is a form of democratic persuasion. We are in this together and are parts of each other's future as fellow citizens.
²⁵

We foster community among the veterans and join that community to the community of the treatment team. In doing so we establish the possibility of attachment to the larger social world because we (the treatment team) sincerely believe in that larger world and show that it is possible to participate in it with perceptive good judgment. We must do this as
rhētor—
a citizen openly and undeceptively seeking the trust of fellow citizens
and sharing in their fate—not as hireling-sophist or as a slave of the institution and its rules and its institutional agendas. We speak to the veterans as free fellow citizens, not hired agents of social control or slaves of the state. This is our idea of ourselves.

During the first five or so years I was in VIP, I encountered numerous worries and angry denunciations to the effect that everything said in a VA therapy group or office was “reported to the government,” that we were doing experiments on the veterans, that VA staff was specially selected to carry out the government's need to geld or defang the veteran. I cannot explain why such talk has disappeared. It has been years since I have heard any of it.

Our work is political also in the sense that we vigorously encourage the veterans to participate in the democratic political life of the country that they fought for. Unhealed combat trauma disables the basic social and cognitive capacities required for democratic participation:
²⁶

• Being able to show up at an appointed time and place, possibly in a crowd of strangers.

• Being able to experience words as trustworthy.

• Seeing the possibility of persuasion, negotiation, compromise, concession.

• Seeing the possibility of winning without killing, of losing without dying.

• Seeing the future as real and meaningful.

For any mental health professional to work with American combat veterans injured in the service of their country, and
not
to find incapacity for democratic participation to be a meaningful clinical issue, strikes me as odd, to say the least.

In various ways and with varying intensity, members of the VIP team role-model participation in public life. We are active in education of other mental health professionals on trauma treatment in general, and on combat veterans in particular. The veterans participated with great satisfaction in video education projects for mental health professionals—two such videos formed presentations at professional meetings. As a team we have presented at professional meetings and published in professional books and journals, with full knowledge of the veteran community. I have publicly testified on veterans' concerns at congressional hearings, done media appearances on the themes of combat trauma and on prevention of psychological injury in military service, written for the trade press (this book, for example, and
Achilles in Vietnam
), and lectured or
organized conference panels on prevention of psychological injury for many active duty military audiences. The VIP veterans are particularly supportive of these “missionary” activities to the active military. They don't want other young kids to be wrecked the way they were wrecked.

In the traditional world of the health professional, such activities are regarded as a hobby, or a distraction from the “real” work of seeing patients one at a time in a health care institution. I believe that these public and political activities are integral to the treatment of complex PTSD after combat. That's my view, at least; not everyone in the VIP team agrees. As a team we earn trust on the basis of our character, and our public activities are
evidence
of our character.
²⁷

I have attempted here to sketch a portrait of an intentionally created and mindfully maintained community of combat veterans within a Department of Veterans Affairs clinic. The health professions in general have a long history of acting like the rooster who claims to raise the sun above the horizon each morning with its crowing. Much recovery from injury or illness is the body's own work, which the skilled physician can only cooperate with. Likewise, recovery from complex PTSD sometimes happens “spontaneously.” I contend that self-organized or preexisting communities—that we have not yet found a way to notice and encourage—nourish such “spontaneous” recovery. Whether intentionally constructed or self-organized, the conditions required for recovery are the same: a trustworthy community.