On the Battlefield of the Psyche
How to understand and heal trauma and PTSD in America's military veterans.
Posted May 25, 2015
Memorial Day is a time-honored occasion to remember and pay tribute to those soldiers who lost their lives in war. But it is also a day to bear witness to those in the military who returned home bearing not only the physical scars of battle, but the invisible wounds of war in the form of PTSD, or Post-traumatic Stress Disorder. How these undressed wounds affect veterans and their loved ones, how they change our understanding of war, the psychological differences between veterans of WW II, Vietnam, Iraq, and Afghanistan and how PTSD can contribute to violence in the culture and more are the subjects of my interview with Larry Decker, Ph.D.
A clinical psychologist in private practice, Decker first began counseling vets in the immediate aftermath of Vietnam, when he was asked to set up some of the early rap groups in Santa Barbara. The work, he told me, was a powerful experience and "hooked him immediately." He has worked for over twenty-five years for the Department of Veterans Affairs, where he is currently a federal contractor counseling veterans of World War II, the Korean War, the Vietnam War, and the wars in Iraq and Afghanistan. Decker is the author of the recently published The Alchemy of Combat, and in the following dialogue he reveals some of the approaches he adopts in working with vets in therapy, as well as what civilians and loved ones can do—and also must not do—for those friends, spouses, and family members psychologically wounded by war. The following interview is excerpted from my new book, America on the Couch: Psychological Perspectives on American Politics and Culture (Lantern Books).
Pythia Peay: Can you tell me how the psychological work around healing the inner wounds of war—if that’s even possible—first arose?
Larry Decker: Soldiers have been suffering the trauma of war for centuries. In his book Achilles in Vietnam, the author Jonathan Shay points out all the different instances in Homer’s Iliad that the warrior Achilles describes his own symptoms. During the Civil War a surgeon named Da Costa started seeing soldiers who exhibited depression, anxiety, nightmares, and intrusive thoughts. He originally thought it had something to do with heart problems, and so he called it “irritable heart,” or “soldier’s heart.” During World War I, these same symptoms were attributed to shell shock.
So it’s only recently that we’ve given this phenomenon a name: PTSD, or Post- traumatic Stress Disorder. Sigmund Freud was among the first to form some of our basic thinking about trauma. The French psychiatrist Pierre Janet also began to research how trauma affected psychic life. He described the human response to trauma as forming a membrane around the core of who we think we are, as a way of protecting ourselves from the horrible thing that’s happened. As a result, a part of us becomes lost, unconscious, and relegated to some place deep down inside ourselves. Nonetheless, according to Janet, these repressed emotions tend to come out in all sorts of odd ways, creating problems.
PP: So to sum up, when a soldier is traumatized by war, he seals off the part of himself that’s been psychically wounded?
LD: Particularly when he’s in battle, he doesn’t have a choice—because if he doesn’t, he risks getting everybody, including himself, killed. But sometimes the opposite happens, and soldiers deal with trauma by going berserk. They just go crazy and try to kill everybody, sometimes even somebody on the same side if he happens to get in the way.
To varying degrees, (most veterans) learn how to resist that option once they return to civilian life. At other times, they don’t really re-incorporate the relatively normal parts, and they stay repressed or split off, or they numb themselves through drinking.
PP: So although symptoms of war-related trauma have been recorded all throughout history, do different wars result in different symptoms?
LD: Yes. For example, one of the big differences between World War II and Vietnam was DEROS: the date of expected return from overseas. In Vietnam, everyone was given a tour of duty of one year, except for Marines, who were given thirteen months. In World War II, however, enlistment was for the duration of the war; this made for a very different experience. At one point during World War II there were actually more psychiatric breakdowns on the battlefield than there were people being drafted—soldiers fell apart because they didn’t know when they were going to get out and come home.
In Vietnam, a soldier knew when he was going to get out, and basically had to keep it together until then. But then when they got back to America, Vietnam vets suffered “sanctuary trauma”: they arrived home with the expectation that home would be a safe place, which turned out to be almost as dangerous as the place they left.
PP: I understand that Vietnam veterans suffered more coming home than World War II vets, because World War II was more accepted and honored in American culture.
LD: I think that’s part of the mythology around World War II: that it was a good war, and that they were all praised when they got home. But World War II vets suffered just as much; there was just as high an incidence of suicide after World War II among combat vets; and just as high an incidence of alcoholism, homelessness, unemployment, and domestic violence as among Vietnam vets.
It’s just that the effects of war began to be more talked about among Vietnam vets, and that didn’t go over well with the veterans of World War II. For example, one Vietnam vet told me about his experience getting up and speaking to a veterans’ group. After he’d finished speaking, an older World War II vet stood up and said, “You know, sonny, what you went through was real tough. But it was nothing compared to what we went through and we never talked about it.” That was a very common rejection by those men of the Greatest Generation: they didn’t think anybody was supposed to talk about what happened during war, and anybody who did was a crybaby, drug abuser, and loser.
PP: Is this difference between the two generations due to the fact that Vietnam vets were more sensitive to feelings and psychology, simply because of the times they were born into?
LD: I think so. At the time, there was much more openness in our culture to express what was real, truthful, and honest about who and what we are; that’s what our generation was supposed to be about.
PP: Were there other differences between the two generations of soldiers?
LD: During World War II, soldiers stayed with the unit they were assigned to throughout the war, so there was more of a sense of a cohesive fighting unit. But in Vietnam, men went to boot camp with one group of people, then transferred to advanced infantry with a different group of men, and then went to Vietnam with yet another group. If they formed a relationship with someone in their unit, that soldier might get killed. So they learned not to form relationships; they learned how to exist on their own, how not to trust, and to be hyper-vigilant.
Many soldiers left Vietnam without knowing what happened to the unit or platoon they’d been assigned to; some were even pulled out of action in the middle of a firefight—suddenly a helicopter descended, and off they’d go. Then one or two days later, they were in San Francisco, perhaps in uniform, and people were yelling at them and calling them “baby killers.”
PP: So it’s veterans’ sudden and abrupt transition from war to civilian life, with no chance to integrate what they’ve been through, that can exacerbate the traumas of war.
LD: That’s it exactly. Even today, Vietnam veterans still wonder what happened to their platoon. During the seventies, returning vets in VA Hospitals were told to just forget about it all. Many of them bought into that myth that if they just held down their memories of war they’d go away—so they didn’t even try to contact anyone from their units, and they didn’t want to talk about it.
But back then, PTSD didn’t even exist: it was called combat fatigue. The idea behind that was simply to give the soldier a bit of rest and treatment in order to make him a competent soldier again and get him back to the front line. The military didn’t want men using this as a way to get out of combat.
PP: What are some of the differences that you’ve seen between Vietnam vets and younger vets returning from the Iraq and Afghanistan wars?
LD: Vietnam vets are now an aging population; they’re all in their sixties or older. Their PTSD is chronic and has become a way of life. Whereas for younger veterans, regardless of whether they were warned in advance about PTSD, they’re still unprepared for the kind of difficulties they experience when they come back.
Getting along with civilians is also challenging for many of these younger vets. They see us as being asleep; they feel that if we just woke up, we’d begin to understand what life is really about. They also deplore our individualism and lack of being united around a common mission, which was what they experienced during combat, and which meant an enormous amount to them. To this day, every single vet I see wants to go back to Iraq and Afghanistan.
PP: I confess I’m completely taken aback by what you just said. Why would these vets want to return to a place where their lives are in constant danger?
LD: It’s important to understand how meaningful their work was over there. And what do they do when they come home? They stock shelves in a grocery store, or something similarly banal. It’s a telling statement about the meaninglessness of our culture: that we can’t provide something better than being in a war zone!
But another way of understanding the Iraq veteran’s wish to return to the theater of operations is the fact that war requires you to be completely present. Without this sense of urgency that being in a war zone necessitates, soldiers find their attention wandering to the comparative emptiness of their lives. As a result, they feel a desire a return to what engrossed them. Veterans’ sense of a lack of meaning on coming home is reflected in the many suicides after each war, including our current ones. These feelings of meaninglessness combine in the combat veteran with the traumas of friends dying, killing the enemy, and believing that in the killing a line (with God) has been crossed, which is irrevocable.
PP: Someone I know who’s a Vietnam vet confided that he was petrified of dying, because of the immense guilt he felt around those he’d had to kill during the war, including, by accident, civilians. I felt strongly that his heavy cross of guilt shouldn’t be his alone to bear, but that it belonged to me, and to all those Americans he’d gone to war for.
LD: That’s very true; we sent them there. At the time, your friend was doing the best he could with what he had. If he’d hesitated, his whole squad might have been killed. Soldiers at war can’t hesitate; they have to shoot. That’s war, and that’s what happens.
I once had an interview with the Tibetan Buddhist leader, His Holiness the Dalai Lama, about my work. When I asked him for his advice on how to work with veterans he said that two things were important: first, they had to have some kind of spirituality. And secondly, they had to know that it was their job—their duty—to kill people. He also made a distinction between having to kill during war, and committing murder.
PP: So did Vietnam vets want to go back to Vietnam, like Iraq vets wanted to return to Iraq, for the same reasons you listed above?
LD: The vets that I saw didn’t give voice to that; most guys just wanted out of the military. But they did report feeling aimless, with no clue what to do with themselves. In his book Escape from Freedom, the German psychologist Eric Fromm wrote about the paradox of those who escape repressive regimes—yet who, once they’ve escaped, can’t bear the amount of choices they have to make, because they’re used to having their choices made for them. Most returning vets face that dilemma; Vietnam vets especially. And then there was the very negative reception they got when they came home, with the name-calling and harassment.
PP: That was a shameful period in our history.
LD: I believe it was an actual crime. But as a result, Vietnam vets hid; they rarely talked to anybody about the war, and they were very secretive, because it wasn’t acceptable to let their experiences be known. But for all vets, the reason they don’t want to talk about what they did during the war is because they’re afraid that people are going to hate them, or that someone might say, “God! How could you have done that?” That’s the worst possible thing they could hear, besides “What did it feel like to kill somebody?” It’s surprisingly common how many people ask returning vets those kinds of thoughtless questions.
PP: As we’re talking, it sounds to me as if America hasn’t changed that much with regard to its wounded veterans. Have you seen any kind of shift toward our veterans returning from the Iraq and Afghanistan wars?
LD: We didn’t spit on them, and we didn’t throw things at them when they came back. Now it’s more a matter that nobody really cares. As one Iraq war veteran said, “Yeah, it’s better than being spit on. But all these people that want to buy me a drink, and tell me what a good job I did—they don’t know what I did. If they knew what I did, they wouldn’t be buying me these things.” So vets returning from the wars in Iraq and Afghanistan still have that sense that civilians just don’t get it, and that they will never get it. As a result, they’re very isolated and stuck in a kind of “Never Never” land: they’re no longer in the military, but they’re not civilians either.
PP: Because they’re never going to be the same person they were before they went to war?
LD: Right. While they’re away they suffer horribly from homesickness—but when they finally return, they’ve changed so much it isn’t home anymore. But home hasn’t changed: they’ve changed. All veterans returning from war go through this. But nobody has a clue how to help them, and nobody cares anyway, except for those who are very close to them, and who are affected by all the problems around anger, alcoholism, and violence.
PP: So how do you, as a psychologist, work with vets with PTSD?
LD: The work is primarily about integrating what happened. Basically, veterans are struggling with how to handle a hugely significant and new experience that won’t fit into their old system—so they have to form a new system. For the majority of people, things change incrementally, in very slow, linear ways that are basically safe. But trauma isn’t like that. Trauma is a huge, violent, abrupt change.
Most of the vets I work with say that their first understanding of what they’d gotten themselves into was when they first came under fire: it was only then that they realized people were trying to kill them. Prior to that, war had been just a concept, so they didn’t really grasp it. But trauma is like that: until something enormously horrible happens to us, it’s just a fantasy.
So in my work with veterans, I’ve found that healing trauma comes out of connecting to an “innate self” that goes much deeper, and that has nothing to do with the interactive senses that connect us to the external world. This innate self could be called an essence, or our spirit or soul; it’s something within us that was present when we were born. In order for veterans to begin living in the world again, there also has to be a kind of purpose to the trauma they suffered. So it’s very important in recovery to develop a theory of meaning around what happened to them: “What was the purpose?” “Why did it happen to me?” and “What does it have to do with who I am?”
PP: So if handled by a wise and skilled counselor, veterans can be guided out of the hellish kind of limbo they find themselves in after war. They might even discover the potential contained in their suffering to widen their consciousness.
LD: Yes, but it’s also important to remember that there are certain things we can’t do in working with survivors of trauma, such as blaming the victim, or seeing them as psychologically deficient if they show any emotional difficulties. There are also different forms of “spiritual blame”: the concept of original sin, karmic payback, or telling veterans that they went through trauma in order to become emotionally stronger.
A key factor in working with vets who are in treatment is to give them an anchor—one person that they can feel safe with in talking about their experiences. Talking about things that they never thought they’d be able to say gives vets back their power. It’s also an enormous relief to discover that they’re not alone.
I also help vets I work with to rediscover and reconnect with a sense of innocence, nurturing, and safety that they’d experienced at some point in their lives. Then, once they’re anchored in this firm foundation, they can go back into the trauma.
PP: So before the trauma can heal, there has to be this initial strengthening, then reenactment and reintegration.
LD: Right. I also encourage them to look toward the future, and to see the future as a stronger pull than the past—because how they are now determines what’s going to happen next. And so I ask them, “How do you want your future to look? What do you want to have happen next in your life?” This allows for a new self to emerge, with new beliefs, capabilities, and a sense of identity. A sense of relatedness and camaraderie comes back, and they take huge steps forward. This can also be very scary; there’s a tendency to relapse at that point, and to go back into the symptoms. A lot of vets will drop out at that point. So it’s a very tricky process that has to be gone through very slowly and carefully, and by giving people the time they need.
PP: Turning from our vets to the wider culture, where does America come in to all this? For example, as you’ve just described, one way that vets can begin to heal from war’s trauma is to turn toward the future. And although that part of America that is very future- and horizon-oriented might aid their recovery, I also wonder if our resistance to the past might also contribute to our cultural inability to really take in and accept the trauma and suffering that these vets have endured. There’s that attitude in American culture toward anyone who is suffering that basically says, “What’s your problem? Just get over it, go on, and move forward.”
LD: Right; we just don’t want to know about it. We’re all so tired from our everyday jobs and responsibilities, we just want to numb out—and then get up and do it all over again. We don’t want to hear about somebody else’s stuff. If people think about what our veterans are going through at all—which I’m sure ninety percent of the population doesn’t—they think about it in a surface way, like “Can I buy you a drink?” or “You went over and kicked some butt—you really showed ’em!” Like war was some kind of a football game.
PP: So what do our vets want from us?
LD: One of my patients for three or four years was Karl Marlantes, the author of Matterhorn and What It’s Like To Go To War. During his appearance on “Moyers & Company,” he told Moyers that veterans don’t want a cheering section, with people yelling “Yeah America!” What they really want, he said, is meaningful work. They also, he said, don’t want to be forgotten or ignored. And they want to taste some of life’s wonderful beauty and gorgeousness. Those are a few key things we could do to help our vets when they come home; it’s not about glorifying war, but simply appreciating what our soldiers went through.
PP: So I’m assuming that, even after all the wars of the twentieth and twenty-first century, there’s still no real psychological or spiritual preparation before soldiers are sent off to war, and no preparation when they return to help them assimilate back into culture?
LD: It’s gotten a little better. Soldiers are told about PTSD before they leave. When they return, they’re read a cursory checklist of symptoms. One marine returning from Iraq told me that, after hearing the list of symptoms read out loud, he raised his hand. The sergeant then took him into a back room and yelled at him, calling him a “dumb shit” because now his discharge was going to be delayed. The marine apologized, the sergeant had him sign off on a piece of paper, and off they went. And that’s what happens. It’s just a very masculine, military approach.
PP: After the war in Vietnam, I recall that a discussion arose around providing some kind of a coming home ceremony or ritual for our returning warriors—something to help purify them from what they’d been through, so that they could re-enter society once again.
LD: To have a returning home ceremony would be relatively meaningless because there’s nothing in the culture to back it up with. There is no true warrior culture in America—no preparation or training for soldiers. There’s none of that.
PP: Given our bloated defense budget, I think the statement that we’re not a true “warrior culture” would come as a surprise to a lot of Americans.
LD: We have a warlike culture—but we don’t have a warrior culture. If we’re going to go to war, we should know something about warriors, and we don’t know anything about them. It’s very secretive. The Department of Defense has an annual budget of approximately $550 billion, a budget so huge it dwarfs all of the other departments in the Federal Government. The Veterans Administration has the second biggest budget, approximately $150 billion. But there’s nothing of a genuine warrior culture in any of these military institutions.
Millions of dollars are spent, however, on programs that train soldiers to become psychologically resilient, so that they don’t have emotional responses to killing. Basically, this just removes their conscience, as well as a sense of empathy for the enemy. Instead, soldiers are taught that in order to kill they have to dehumanize their enemy. Thus in Vietnam, they were called “gooks,” and in Iraq they became “Hajis” or “sand niggers.” By contrast, the Greeks and other ancient warrior cultures understood the concept of the “honorable enemy,” or “honorable foes.”
PP: What’s the psychological difference between killing an “honorable foe” and killing a “gook” or a “Haji”?
LD: As has been well known in the field of psychology, and as I’ve seen in my own clinical experience, the effects of dehumanizing the enemy can lead to serious problems when soldiers return from war; their PTSD symptoms can become very, very severe. Essentially, when veterans attempt to re-enter the civilian world they eventually have to come to grips with the fact that their enemies, whether Vietnamese or Japanese, are human beings—not just “nips” or “gooks.” This realization creates enormous grief over the killing, torture, and mutilation the soldier may have been involved in. He was able to do those things in the war because he had convinced himself that the enemy was not really human. Now how can he forgive himself?
PP: So it’s as if we send our soldiers to war with all the weapons they need, but nothing of the kind of psychological and spiritual training that you’re describing. On some level, do you think that the vets who are returning from the battlefields with PTSD, and who are suffering this terrible disconnect between themselves and their psyches, and between themselves and the country, are like the proverbial canary in the coal mine, alerting us to something that’s missing from our culture?
LD: I like that question. Yes, of course they are. But we’re not paying any attention to them, because nobody really gets it. Whenever I tell people that every Iraq veteran I’ve ever seen wants to go back to war, they’re shocked, just as you were.
But think about it: they’re twenty years old, armed to the teeth with sophisticated weapons and equipment, alongside an enormous amount of men who are armed the same way, and who are all looking out for each other. Everyone has been incredibly well trained, they all have a mission, and they’re all in agreement about how to do things. These young soldiers have the power to go out into the population and kill people if they don’t do what they want: if someone comes too close to them, they can kill them. If they argue with them, they can kill them.
PP: It’s like being given the power of the Gods.
LD: That’s what the Vietnam veteran Karl Marlantes said. He said that these sorts of activities should be left to the Gods, but instead we give them to nineteen-year-olds.
PP: You must get very angry sometimes.
LD: No. More than anything, I can become overwhelmed by grief. That’s when I know I’m burnt out, and have to get away for a while.
--More information on PTSD can be found at the Veterans Association <http://www.ptsd. va.gov>.
According to Decker, one of the explanations of shell shock was that it “was caused by the inhalation of carbon monoxide that was produced by the explosions. So the term is shell shock and one of the explanations was that it was the inhalation of carbon monoxide that created the symptoms of a lack of self control, an unwillingness to continue to fight, and a general muscle weakness or neurasthenia.”
--You can read about Karl Marlantes on “Moyers & Company,” with host Bill Moyers, at <http:// billmoyers.com/guest/karl-marlantes/>.
--Department of Defense annual budget for 2012: 553.Billion. The DOD’s budget comprises 45 percent of all global military spending, and is more than the seventeen largest militaries combined <http://www.whitehouse.gov/omb/factsheet_department_defense>.
--Department of Veterans Affairs annual budget for 2014: 152.7 Billion <http://www.va.gov/ budget/products.asp>.