Psychologist Paula J. Caplan has sent me the following article which was published in the Washington Post in 2004. It discusses the difficulties facing returning vets, expected, as they are, to forget the horrors they’ve experienced and return to “normal life.” The essence of her point:
For Anguished Vets, the Listening Cure
By Paula J. Caplan
Washington Post, Sunday, September 5, 2004; Page B02
In 1996, in his late twenties, Robert joined the Army Reserve to get help with college tuition. The reserve’s demands weren’t much of a hardship — until 9/11, when his life was turned upside down. First assigned to full-time duty as an airport guard, he was sent to Kabul eight months later. In Afghanistan, he counted the minutes until he could get back home. But when he did, half a year later, he found himself “all at sea.” The people around him, he felt, “acted like I’d never left. For them, nothing was different.” His feelings of turmoil were exacerbated by an uneasy sense that he had no right to them, as his unit had been shot at only once.
When he couldn’t shake feelings of depression after nearly a year at home, his sister finally suggested that he see a therapist. It seemed like the obvious solution to her, and I can see why. After all, we sent many Vietnam and Gulf War vets behind psychotherapists’ doors to deal with their anguish, and we’ve come to think it’s the best thing to do. Unfortunately, in our over-psychologized society, we’ve also come to think that it’s the only thing to do.
We’ve failed to learn what the vets of previous wars have taught us — that although therapists clearly help some soldiers, there is only so much emotional damage from war they can fix. Leaving this work to psychotherapists alone may be not only harmful to the soldiers but also dangerous for us as a nation, because it helps hide the consequences of combat, making it easier for us to go to war again the next time.
Simply sending frightened, angry soldiers off to therapists conveys disturbing messages: that we don’t want to listen, that we’re afraid we’re not qualified to listen, and that they should talk to someone who gets paid to listen. The implication is that their devastation is abnormal, that it is a mental illness, and this only adds to their burdens. Yet since there’s intense debate even among experts about the definition of mental illness, it’s all the more important for the rest of us to let returnees know that we don’t consider them weak or crazy for having problems.
According to U.S. Army reports, the suicide rate for American soldiers in Iraq is 17.3 per 100,000, nearly five times the rate for the Gulf War and 11 percent higher than for Vietnam. As of March this year, seven soldiers had committed suicide after returning from Iraq. Clearly, the emotional casualties of this war are already extremely high, and it is likely that the longer troops remain in Iraq and Afghanistan, the worse they will get.
Many soldiers’ first instinctive response to witnessing the horrors of war is to repress their feelings and never talk about them. Traditional prescriptions for men to be tough intensify the expectation that, no matter how soldiers suffer, they should handle it alone. As more women take on combat roles, the same expectations now also apply to them. So, having seen a buddy blown to bits or realizing that they have killed an Iraqi child, many soldiers choose to suffer in silence. Some do so to protect their loved ones. Others fear the pain of telling their stories and not being understood.
That’s what happened to one soldier serving in Iraq with whom I talked. He described how hard it was to sympathize with his fiancee in Dubuque when she wrote about daily frustrations like her car overheating, even as he was reeling from the shock of being reviled as an invader and occupier by the Iraqis around him. “It’s hard to have any long-distance relationship,” he told me, “but from Dubuque to the war in Iraq is impossible.” After a three-week leave, he was headed back to the war zone, his engagement ended.
Help for traumatized troops must really begin on the battlefront. Yet the military’s response has been largely inadequate, even misguided. When soldiers have breakdowns in combat, military therapists give them a little rest and a chance to talk with a counselor, then send them back into the fray, rationalizing that this helps prevent “survivor guilt.” But sending psychologically fragile soldiers back into combat is wrongheaded; they’ll likely feel guilt no matter what. Instead, therapists should advise commanding officers that these are the last people who should be sent back into battle. They should also seek ways to help the soldiers handle survivor guilt, such as pointing out that their deaths would not guarantee that others would live.
One military program, called Operational Stress Control and Readiness, or OSCAR, provides treatment in combat zones that includes antidepressant medication, usually Prozac. Though no one would begrudge a soldier anything that might dull the terror of combat, the truth is that the feelings they experience don’t disappear and will have to be dealt with eventually. And there’s something Brave-New-World-like about sending people into situations where they’re endangered and feel helpless, and then when they crack, giving them drugs to change their brain chemistry so that they can return to battle.
The military also touts its debriefings for soldiers heading home. With these programs, which often last 10 days or fewer, it hopes to decrease the violent behavior some soldiers exhibit when they get back home. The Army increased its counseling after three soldiers back from fighting in Afghanistan were accused of killing their wives in 2002. Returnees are alerted that they may have nightmares and short tempers, reminded that their wives have been making all the decisions and may not want to give up that power, and warned that their young children might not recognize them. That’s a good beginning, but for many, the debriefings are inadequate, and their very brevity can imply that this should be all they need to “get over it.”
But even with forewarning, the reality of having your child fail to recognize you can be devastating. Some counseling may work for some soldiers, but other advice — buy some flowers for the wife, take the kids to Chuck E. Cheese — may fail to smooth the troubled waters of homecoming. It’s no easy matter to know what will help, but even though the answers are neither simple nor obvious, the ongoing project of seeking them is a social responsibility.
Every one of us needs to shoulder a bit of the burden of helping our soldiers and our returning civilians with their reentry into ordinary life back in the United States. In June, I was at the bank when I heard a customer with red crew cut hair boast, “We were with the 82nd that got Saddam.” When the bank teller expressed awe, the soldier retreated a little, saying, “Well, I didn’t actually see him. But some of our guys did.” Another customer said, “Thanks for keeping us safe,” and the soldier straightened up and boomed out that he was headed for Afghanistan soon. “Gonna get bin Laden,” he declared loudly.
As he walked past me on his way out, I remarked quietly that I was frightened for him. His straight-as-a-board posture vanished, and he said, “I got stabbed in Iraq. We’re sitting ducks. And it’s weird being home. Can’t stop watching my back.” Given a chance to voice anything other than the expected bravado, out came his natural feelings of vulnerability. We need to let returnees say they were scared and let them know that’s not crazy. We must also allow them to tell proud war stories when they want to. When they wish to talk, we must find non-psychiatric, non-pathologizing opportunities for them to do so openly, while also supporting them if they choose to see a therapist. And when they need silence, we must respect that, too.
In any case, a recent study in the New England Journal of Medicine revealed that enormous numbers of soldiers won’t see therapists. It showed that 38 percent of soldiers thought to be mentally ill did not trust therapists, 50 percent worried that seeing one could harm their careers and a full 65 percent feared being seen as weak. Realistically, these barriers to therapy won’t be overcome anytime soon.
So we citizens must accept the social responsibility of telling returnees not only that we will listen but that we will listen for as long as they want to talk about how it felt to be over there and how it feels to be back. We need to tell them not to censor themselves for fear of upsetting us, offending our sensibilities, making us feel helpless to help them or making us angry at them. If we fail to do this, then we become complicit in concealing some of war’s most devastating consequences. And to refuse to face these fully is to increase the chances that we will go to war again.
Author’s e-mail:
paulajcaplan@yahoo.com
Paula Caplan is spokeswoman for the Association of Women in Psychology and the author of “They Say You Are Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal” (Addison-Wesley).