When I have presented and discussed cases to colleagues of combat trauma over the past few years, I have often seen reactions that bothered me. Seasoned therapists have found my patients “hard to empathize with.” I was even advised before a major presentation last year to remove the frequent references to loss of life that were in descriptions of combat scenes. I was advised it might bring up “too negative of reactions” for listeners. Frankly, I had not expected or accepted negative reactions. I have ample exposure in the military to the madness of combat. Don’t people know this is happening every day? They don’t know this is the world we live in? I realized not. I chose, instead of removing the references to killing, to emphasize them so people would feel the pain of my patients and the shattering experience of combat a little more. I felt like I understood and could bear better than them. But I soon found myself face to face with a patient’s experience that was unbearable to me.
Following that presentation, I began treating a Soldier with severe post-traumatic stress disorder (PTSD). I encouraged him to share his experiences with me, and helped him feel that maybe I could understand them. I soon found myself hearing a level of violence I had never encountered before. I didn’t want to hear what he had experienced. I found myself disgusted that he could have lived such a life, and that he felt nothing about the experiences at the time. He described how he enjoyed combat, how he missed it. I couldn’t go there with him. I couldn’t hear the graphic details. I could feel his never-ending accounts of killing after killing shattering what was left of my sense of a just, sane world. I couldn’t bear hearing anything in those moments. I could not understand such madness. I froze and became numb. I disappeared from our dialogue. He continued on without me for several more moments. I looked for an escape, and luckily for me, I realized our session time was coming to an end. I spent the rest of that day after he left feeling numb and uneasy. My ability to listen and tolerate horrific experiences had been surpassed. I found myself, humbly, in the same position as my colleagues: human and also unable to bear the traumatic experiences of combat. But I also realized that I had left my patient alone in his hell of guilt and shame. At least I hope I had not outwardly rejected his actions. I dreaded his return to my office in a few days. How could I tolerate sharing with him such experiences, and how could I tolerate the changes I feared it would bring in me? I envisioned myself becoming more traumatized as I attempted to provide him a relational home to process such feelings during our future appointments. But could I?