September 2011 Philadelphia Chapter of Pax Christi U.S.A.

Caring for the One Percent Who Bear the Burden of War

I served in the Vietnam War and I am working now with soldiers involved in our current wars in Iraq and Afghanistan. These wars are different from Vietnam. In the former war men were drafted, society was involved, and the war became largely unpopular. The Afghanistan and Iraq wars have an all-volunteer Army. In essence our society elected to launch these wars without having to participate in them. The vast majority of us are uninvolved. There is little of the direct societal-wide financial and emotional impact in these wars as compared to the Vietnam War.

A few months ago I wrote that I had reservations about war but not about helping soldiers. I wondered, however, if by helping soldiers I was not contributing to the war effort. On my job I help make decisions as to whether a soldier is suitable for returning to combat. Recently I presented this dilemma to my Wednesday morning prayer breakfast group. We, a group of psychiatrists, meet monthly to discuss spiritual/religious issues as they relate to the practice of psychiatry.

I asked them if by working to help active duty soldiers, I am not in fact helping with the war effort. I realize it's now a soldiers’ choice to go to war but it's also my choice to help with the war effort. Soldiers would not be going to war if we, the American people, had not made a choice to respond to terrorism by war. What should my choice be? This question is one the 99% of us (those not directly affected by the war) might also deliberate.

The discussion with my psychiatric colleagues was difficult. I find it hard to talk about psychiatric trauma dispassionately. No matter how often I retell soldier’s stories, I become tearful. Chronic exposure to this trauma for me has been a bit "mind numbing" for self-preservation. PTSD by proxy is the casual comment. I noticed myself being less sensitive to "regular" patients. Those "worried well" who comprise a significant percentage of our society. I am more tempted now to think but not say a bit impulsively "get over it." Yet everyone sees his or her problem differently and is that not part of the problem? We worry for the most part about what is in front of us.

These soldiers are by and large not in front of us. At The Walter Reed Army Medical Center cafeteria there are tables and tables of young soldiers missing one, two, even three limbs. They stand in line, get their food, and have animated conversations with family members. Most of us do not see these injured men and women.

At the end of the prayer breakfast, the group was specific and helpful. I should continue what I was doing but also to keep on writing and talking to others about the experience. Part of my service regarding the war effort is not only to help others but also to communicate to those less involved with war.

I have learned that soldiers want to do their job. They don't want any pity and they don't want patronizing special treatment. "Thank you for your service" (a phrase I have used too many times) simply does not cut it. Many say that ‘thank you’ creates a problem for them. They went to war to do a job, not for you. They want to be treated as equals not heroes, as individuals who ‘would die’ to make a living doing their job. One soldier said ‘I am not special because I chose to pick up body parts and see friends die. If I had not done that, I probably would be in college.’

Allow me to describe the trauma experiences that some of our soldiers endure.

One soldier described the difficulty of not being able to save every wounded buddy. How could his wife comprehend his trying to save a young man with his "guts hanging out" having been blown apart, yelling for his mother as his eyes go blank?

Another soldier described killing a teenage boy who jumped on the front of his truck. The soldier misidentified him as a terrorist. After a little reflection, it’s possible the boy was just interested in getting a better look at the TV monitor mounted on the dashboard. Now that his own son is the same age as the killed teenager, the soldier is suffering. He does not know how to tell his wife.

Recently I spoke with a "first responder" who rushed to the Pentagon on 9/11. He was there within the hour. His group secured walls and ceilings to make it safe to search for bodies and survivors. Over the next hours he rescued individuals and collected body parts. Seven weeks later he was walking through a Halloween store and saw a box of plastic body parts. His wife casually asked if that was what the inside of the Pentagon looked like on 9/11. Suddenly his eyes began to water; he could not breathe or move. He began hyperventilating. He was scared and had no idea why! One month later his family was celebrating Thanksgiving. He was delegated to carve the turkey. With his bare hands he grasped the juicy bird and was overcome with dread, sweat, and hyperventilation. Only later did he make the connection between the freshly roasted turkey and those human bodies from the Pentagon.

Another soldier complains at being overcome by the smell of "rotting flesh" when he is near overweight civilians. He eventually pieces together that this sensory experience is related to a deployment in which he and others uncovered a grave of 4,000 bodies. Having seen no flesh on 4,000 skeletal remains he cannot tolerate excess flesh on his fellow citizens. He describes this experience as being exposed to a level of human hatred that he never knew existed. His journey is complicated, but with a sense of humor he is working it out.

A soldier was referred for getting drunk and firing his rifle in his home in the middle of the night. His nightmares and bipolar problem got the best of him. Now months later, sober and virtually asymptomatic, he has been court marshaled for his behavior. He faces imprisonment or being sentenced to hard labor. He and his wife have a two year old and a one month old child.

Recently a soldier reported that two of his buddies were convicted of killing a girlfriend. One did the killing and the other was an accessory to the crime. He was called in the middle of the night to help clean up the body parts- just like they automatically did while deployed. My patient agreed his buddies should be punished but he said, ‘the judge just doesn’t understand.’

A few months ago a soldier with a profound stutter and rapid mood changes came for help. Placed on medication for bipolar problems the mood changes were gone and the stutter almost disappeared. Recently he stopped the medication and all his symptoms returned. Someone had told him he could not be deployed in the war while taking this medication. He wants to go to war-he needs the extra money.

These stories are not easy to read or to hear. Are the soldiers correct that the 99% do not want to hear or are unable to hear what they have experienced. Many soldiers rightly believe that civilians will be too traumatized by what they have to say. If we all knew and ‘heard’ their experiences, would we continue the war? Are there other ways to deal with terrorism? I don’t have the answer.

Soldiers don’t want to be forgotten. When they leave the service they want to be treated fairly. They ask why the unemployment rate for veterans is higher than for non veterans. They ask why their leadership and supervisory skills developed in the military don’t translate into civilian life. One soldier put it this way. ‘Am I thought of as just someone at the other end of a rifle?’ Would you hire someone who would die to make a living? They wonder why they have to pass civilian certification courses when their military developed skills might qualify them to teach the civilian course. They wonder why more civilian employers don’t take advantage of the tax credits and government offers to subsidize veteran’s salaries. And they worry about homelessness. The Veterans Administration estimates there are currently 100,000 of them without homes. Has the 99% forgotten the service of the 1%?

If you are opposed to or in favor of the war, do what you think you should do. Above all, however, talk with soldiers. Many believe that you do not want to hear or are unable to hear what they have experienced. Many soldiers believe that civilians will be too traumatized by what they have to say which makes it all the more important to engage them in conversation. When you encounter them, ask where they are from, and when and where were they deployed. How did their spouse and kids manage? What is their MOS (military occupational specialty). Ask them to describe what they do and what they hope to do when they are home.

Soldiers are unfailingly respectful and polite. I do know being invited by a soldier to get on an elevator ahead of him is an experience you will not forget - especially when he is a quadriplegic in a wheelchair by himself.

Ted Beal

Ted Beal, MD, a faculty member of the Georgetown Medical School is also a Psychiatrist for Department of the Army