A Primer on the Whys and Wherefores of PTSD: Whatever You Did in War Will Always Be With You
By Marc Levy
VA Shrink: Were you in Vietnam?
Vietnam Vet: Yes
VA Shrink: When were you there?
Vietnam vet: Last night.
I'm kneeling. Tears streak my face, drip down, fall to earth. It's only my second time in combat. Soon I'll be different. Soon revenge for our dead and wounded will meld with fear, and I will help with the killing and the killing will help me. We're just regular grunts: we make too much noise, we have no special skills, we're not elite.
But after a time we get the hang of this war, the rhythm of it. Wait. Engage. Disengage. We call it contact, or movement. We psych ourselves up. "Time to kick ass and take names," we say. And between contact and kicking ass or having our asses kicked there is tension that starts small, then builds and builds until we secretly pray it will happen. That we walk into them or them into us, or we mortar them or they rocket us, then the tension explodes like perfect sex, and afterwards... we're spent. There are days, weeks nothing happens, then terror, instant and deep, then relief, like paradise, since the killing is done and we have buried away the wounded and dead. Until it starts all over again.
That was thirty-seven years ago. Or was it last night? A day, a year, twenty years home from war you may begin to act strange. The shrinks, social workers, group therapists, clinical researchers, each has a different take on what causes PTSD.
"It's neurolinguistic. It's cognitive. It's biochemical", they chime and chatter.
Who cares? Just stop the pain. Just stop it.
But where does that pain come from? What's going down? Here is what I know: what you learn in combat you do not easily forget. You drop at the first hint of an ambush falling so fast your helmet still spins in the air. You shoot first and ask questions later. The enemy is an unfeeling slippery bug to be stomped out. You live like an animal. You learn to like killing. Learn to fear and hate the enemy. Hate civilians. Can't trust the bastards. You hate taking prisoners. You'd rather kill them.
Why? Because the enemy wants to fuck you up. Kill you, your pals, some new guy doesn't know jack shit, wants to waste your Lieutenant, the whole damn platoon. After a time you learn what war is: the fish like iridescent gleam inside a brainless head; the sleek white caterpillar of pulsing human gut; the grotesque tableau of charred bodies frozen stiff; the impossible music made by voices howling beyond human form; pure white bones piercing ruby ripped flesh; the strange oily feel of blood; the sudden slump of the man next to you. The business of flies on the mouths of the dead.
After a time, to a supernatural degree you learn to live with terror, rage, struck down sorrow, blocked out guilt or dumb struck grief. Yes, the supernatural threat of catastrophe and the ways to survive it become preternatural1y normal, second nature, a fully formed part of you.
Then one day you get shot, or if you are lucky, complete the tour, return home intact. But for those who havc seen their share the equation might go like this. Johnny got his gun - Johnny marches home - HEEEREE'S JOHNNNNY!!!!
And the good soldier John or the good troop Jane, who under fire never once thought of your civil rights, your silly flag, your doofus politics. Good Johnny or Jane, I say, feel and act a tad differently when the locked down feelings, bottled up memories, instinctive behaviors of Post Traumatic Stress Disorder fervently, unexpectedly kick in. The symptoms of PTSD, in plain bloody English, are as follows:
• Flashbacks: seeing and feeling a combat event as if it were happening right now.
• Hyper Vigilance: being always on guard, always looking for where the next shot, next grenade, next rocket, ambush or IED will come next.
• Survivor Guilt: feeling bad, feeling real shitty for having survived, where others in the platoon or squad didn't.
• Moral Guilt: wrestling with actions one did or did not take on.
• Startle Reflex: dropping, flinching, turning fast at a sudden noise or unexpected touch.
• Suicidal Ideation: thinking of killing oneself.
• Homicidal ideation: thinking of killing people. Friends or complete strangers.
• Homicidal Rage: anger way out of proportion to an everyday event. It comes quick, down and dirty.
• Sadness, depression, anxiety, crying spells: Staring into space, saying nothing.
• Nightmares: violent dreams related to combat. Sometimes it's the same dream. Some vets make strange noises. Thrash in bed. Wake up scared, or sweaty.
• Ritual Behavior: at night checking the lights, locking the doors, maybe keeping a weapon at hand.
• Alienation: a vet feels as if no one understands him, doesn't fit in, feels as if he or she should have never retuned
• Panic Attack: for a short time the combat vet becomes suddenly and intensely afraid. He or she sweats, breathes hard. has a pounding heart, might gel dizzy, choke
• Social isolation: staying alone for long periods of time. Or in public saying very little. To the point of being noticeably very quiet
• Drug and alcohol abuse: whatever works to dull the pain glowing inside one"s head
•Fear of emotional intimacy: combats often won't let anyone get close 10 them. If someone gets too close. the vet backs off or pushes them away
• Employment: a lot of vets can't keep a job. Every couple of months quit or get fired
• Psychic Numbing: not have the ability to feel emotions. Vets talk about feeling hollow, blank, empty.
• Denial: Problems'! What problem? ] don't have a fuckin' problem.
•High Risk Behavior: doing daredevil stuff to re-live the rush of combat.
These symptoms are normal responses to extraordinary events outside the range of normal human experience. Most civilians are clueless about combat and its aftermath.
Some types of treatment:
• The talking Cure: a vet talks to a therapist who is skilled in treating war stress and is not a paid bullshitter.
• Group therapy: seven to ten vets meet once a week for an hour or two. A good group leader is essential. That person knows when to talk, when to listen, how to keep the vets focused. Otherwise, group therapy can get lame fast
• EMDR (Eye Movement Desensitization and Reprocessing): a form of hypnosis in which the vet is fully awake.
• Exercise. Meditation. Meds. A friend who will just listen. An artistic endeavor.
One other thing. This is real important: a lot of vets fear talking about war. They fear losing control. Breaking down. Crying. My advice to those who have seen combat; face yourself. Chances are good you will learn to live less in the past, more in the present, but you will never be the same. WW II. Korea, Panama. Vietnam, Iraq, Afghanistan, Central America, wherever you were. whatever you did in war will always be with you. A]ways.
Marc Levy served with Delta Company 1/7 First Cavalry Division as an infantry medic in Viet Nam and Cambodia in 1970 His dccorations include the Combat Medic Badge, Silver Star, two Bronze Stars for Valor, Air Medal, Army Commendation Medal. He was court-martialed twice and received a General Discharge. He can be reached at firstname.lastname@example.org
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