December 2015 Philadelphia Chapter of Pax Christi U.S.A.

The Effect of Trauma

The effect of trauma on each soldier is different. As I speak with soldiers I often wonder what accounts for the variety of responses to trauma. Certainly the degree, intensity, and the frequency of exposure are factors. “How long was your deployment and how many times were you injured or saw others injured” is an essential question. While statistical analysis is important, it’s not the whole story. In fact it may not reveal the soldier’s story at all.

Some service members seem to sail through the exposure with minimal obvious effect arguing, “I just did my job.” Maybe they hold others responsible for the chaos to which they were exposed or even created. Others have continuing nightmares about a killing even when they found themselves in a “no choice” kill-or-be killed moment. A lot depends on how the soldier experienced the events, and that is often revealed in how the soldier tells his or her story.

The degree of emotional reaction in the individual experiencing the trauma becomes a critical component mediating the traumatic effect. The intensity of this emotional reaction is related to how “connected” an individual is to those involved in the trauma—whether oneself or others. For example almost everyone would be traumatized by actually seeing his or her best buddy or series of best buddies killed.

I have come to believe that the trauma effect on soldiers is connected to their relationship to the traumatized person or to the direct trauma experience itself. PTSD, a trauma reaction, is certainly a medical problem like cancer, hypertension, or cardiac disease, but trauma has to be approached and understood differently than other medical problems.

Understanding this crucible of relationship connections was emphasized in a recent New York Times article entitled “A Unit Stalked by Suicide, Trying to Save Itself.” The article is a riveting account of the effect of exposure to combat by one marine unit. The author skillfully weaves marine exposure to trauma, subsequent suffering, and frequent suicide to the nature of their relationship with one another.

The suicide rate for the marine combat-exposed unit is 14 times higher than for Americans in general. One soldier describes being angry about the first few post deployment suicides he heard about and then was confused after a few more. Eventually he became fearful that it was becoming inevitable, like a virus, and that it would kill everyone in the unit. Not only were these marines traumatized by the initial combat, but they were being retraumatized by each subsequent suicide and ensuing funeral. They began to understand that suicide for them was a post deployment “combat death.”

Listening to their stories or reading the article one hears the significance of the relationship connection. Tracking data and keeping statistics in the manner of the U. S. military actually keeps these relationship connections hidden. One report states deployment in a combat zone is not connected to an increased suicide risk. These studies include in one group all soldiers deployed including the large numbers of support staff not exposed to combat. The studies do not track suicides by individuals in the same unit or who were exposed to the same traumatic experiences. The studies preclude an examination of the relationship between the individual soldiers.

Let me tell you about two soldiers I recently worked with that further illustrates the importance of relationship. Later I will report on what the soldiers are suggesting as a way to possibly remediate this problem.

Sergeant Jones has had several deployments to both Iraq and Afghanistan. He was a squad leader responsible for a number of other service members. Exposed to mortars, artillery, machine guns, RPGs and I.E.D.s, he suffered only a few shrapnel wounds. “Constantly at risk”, “no front line, everything is fair game,” he grew weary bagging body parts of comrades to be sorted out later by others. Convinced he would not “get out alive,” he gained comfort by focusing “on effectiveness not safety.” Accepting the fact that he “was already dead” gave him “the relief to care for others.”

Now home reunited with his family, he cannot figure out “how to come back to life or how to be alive.” Feeling numb, empty, experiencing no joy, he tries “to play the part” of father and husband. A good soldier—whose relationships were so traumatized —he has lost the ability to relate to himself and to others. He is working on “remembering his colleagues.” He knows he cannot change what happened but hopes he can remember them for who they were and not for what happened to them.

Sergeant Smith has had multiple deployments to both Iraq and Afghanistan. He is a mortician and is responsible for finding, collecting, and putting together human remains. He believes he is in good health and has only minor complaints. While deployed he is rarely if ever exposed to combat fire. He works with human remains on a daily basis. He describes the “smell as unique” but believes he “has the stomach” for the work. He knows most of the morticians in the military and all those who have committed suicide. He believes that his military occupational specialty (MOS) has the highest rate of suicide of any job category.

He strongly advises colleagues to avoid anything that connects them personally to the human remains with which they work. He does not “want to develop any emotional relationship to the remains.” He believes he is doing his job for surviving family members so they can “pay their respects in the context of their beliefs.” He describes himself “as almost never having a bad

day.”

The subject of trauma is of course more complicated than just the stories of Sergeant Jones, Sergeant Smith, and those mentioned in the New York Times article. However their stories do illustrate the importance of one’s relationship to trauma and to the person traumatized.

The members of the Marine unit, described in the New York Times article, learned to depend on one another to survive in combat. Now they have banded together using new software and social media “to create a quick response system that allows them to track, monitor, and intervene with some of their most troubled comrades” at risk for post combat death.

They have organized their post combat relationships through social media with the same altruism as their combat relationships. They just might have something there--depending on relationships—that give them a way to reduce these “post combat deaths.” How can we best support them in their efforts to help each other?

Ted Beal, MD, a psychiatrist with the Department of the Army is also a member of the Georgetown Medical School faculty.

Drawing: Kearney

Ted Beal