Hidden Battles on Unseen Fronts

by Patricia Driscoll

  While we cannot expect every relationship to survive, we owe it to our wounded troops and partners to give them the support they need to have a fighting chance to avoid unnecessary dissolution of marriages and committed relationships. A lack of healthy intimacy can significantly impair recovery and contribute to ongoing mental health problems. Healthy intimate relationships add meaning to life in the face of substantial loss, and can contribute to a person’s recovery from physical and mental trauma. Those who have sacrificed for our country deserve our full support in their battle for love.

  “Men and women are returning from Iraq and Afghanistan, in many instances emotionally scarred or horribly disfigured, only to find a veterans’ system that is stressed to the max. Sophocles was Mr. Doerries’s way to underline the issue, which obviously affects all Americans, civilians and military alike. ‘A modern play about Vietnam,’ he said, ‘wouldn’t have the effect of an ancient narrative that draws attention to the fact that PTSD, even if it wasn’t called that, was very much a problem that plagued humanity from way back.’”

  —“Like War Itself, Effects of War are Hell, Ask the Greeks,” Clyde Haberman, The New York Times, September 18, 2008

  37

  ONE FOOT IS BETTER THAN TWO

  The Story of Army Corporal Nicholas Firth and His Mother, Faye Firth

  “I’ve announced to the world that I have this mental condition and it’s not the end of the world. I know a lot of soldiers who are receiving mental health care, but I also know a lot who are reluctant to admit that they need it. That does them no good in my opinion.”

  Twenty-five-year-old Nicholas Firth had only one request for the doctors at Walter Reed Medical Center: Amputate his foot. “I was getting really tired of limping around with a cane. I was on so many pain meds I felt like I was in a mental fog. He was getting married to Krystil in two months in his hometown of Charlotte, and he wanted to stand at the altar on a prosthesis instead of what currently passed for his right foot and ankle—a tangled mass of titanium plates and damaged nerves that kept him in constant agony. He’d witnessed the remarkable improvements medical science has made in prosthesis for just about any part of the body except the trunk and neck for the past eight months.

  “I couldn’t understand what they were waiting for,” he recalls. The doctors kept telling him to put off an amputation for as long as four or five years to see if the pain diminished. “They said I might regret my decision when I got older, but they underestimated me. I was ready to get on with my life.” The one other person who understood exactly what Nick was demanding and advocated every day on his behalf was his mother.

  Nick’s “Alive Day” was June 8th, 2006. Eighty miles north of Baghdad, the vehicle he was riding in as a gunner was hit with an IED. The blast occurred directly beneath his feet. His scalp was torn off and both of his ankles were broken; the right one severely crushed. “I felt like my head split apart and then I lost consciousness.” Florita (Faye) Firth got the call early the next morning from a captain at Landstuhl Medical Center telling her that her son was alive but badly injured. She rushed up from North Carolina in time for Nick’s arrival from Germany to Walter Reed Medical Center. What the captain hadn’t mentioned were the 47 staples on Nick’s scalp. When Faye saw Nick his head was so swollen she could barely recognize him. “But I never let on that I was shocked, or fearful, or angry or depressed,” Faye says, “Because I knew he was watching me. He was measuring his condition by the look in my eyes. I had to stay positive for Nick.”

  “I knew what had happened to me, even though I wasn’t lucid,” he recalls. “I was determined not to die.”

  “The first thing I did after giving him a hug was to remove his shoes (his feet were in casts) and clean each toe. ‘You’re going to heal with dignity,’ I told him.” Except for three quick trips home, Faye never left her son’s side. She lived in family housing the military provides for relatives of injured soldiers. Week after week, month after month, she would appear, carefully dressed and made up, ready to help Nick cope with his injuries. “He wouldn’t tell me that he was watching me, but months later I overheard him say to another soldier,’ I’m doing so well because of my mom… because of her strength.’” The orthopedic ward was understaffed so Faye gave Nick sponge baths and brushed his teeth. She bought him special foods, one day more than $20 worth of fried rice, because it was what he wanted to eat. When his headaches started, she brought them to the attention of the medical staff.

  She managed to hold back the tears except for one brutally hot day in August when she was pushing Nick in his wheelchair across the Walter Reed campus. “It must have been way over 100 degrees and a double amputee was wheeling himself toward us. He was so young and all alone. And I started to cry because where was his family? Where was his mother?”

  Besides her son’s recovery, Faye’s biggest problem was money. She was in the process of a divorce and living off her dwindling savings. She’d been too proud to go to Family Services, but in November when the $2,000 property tax bill on her home came due she had no choice. It was the Armed Forces Foundation that paid $1,200 of the tax bill, and helped her negotiate payment of the rest, the reprieve Faye needed until she could find a job. By the end of the year she was working at a computer firm in Falls Church, Virginia, close enough that she could commute from Walter Reed. When Nick got a $25,000 insurance payment and offered to share it with her, she turned him down. “You keep it,” she said. “As long as I can make my own payments, one car payment, one month’s house payment, and pay one electrical and water bill, I’m fine.”

  And she keeps remembering Psalm 91. Faye’s former husband was deployed with the Air Force during Operation Desert Storm. Faye and her two children, Nicholas, and Rena, then ages 10 and 7, would watch television images of Scud missiles raining down and pray. “I’ve never allowed myself or my children to live in fear,” Faye says. “Not then and not now.”

  Five months after being admitted, Nick was diagnosed with mild Traumatic Brain Injury and PTSD, conditions he still struggles with two years later. He suffers from both short and long term memory loss. “I don’t remember most of my childhood in the Philippines or when I was a teenager back in the states. My past is just gone. But also sometimes I can’t remember what I’m supposed to be doing right now or why I’ve walked into a room or who I’m supposed to meet.” He has acute anxiety, nightmares and flashbacks, all symptoms of PTSD that he discusses with his therapist at Walter Reed, and, at times, his wife. “She was my best friend for six years before we decided to get married. She probably has PTSD herself. I’ve put her through hell!”

  Nick would be married on February 5, 2007 and become a father for the second time before his leg was amputated eight inches below his knee on January 7th, 2008 at Walter Reed Medical Center. “It’s all about my leg now,” he says from his apartment in Silver Spring. “In having to wait to get it amputated I appreciate it more. At least now I know I’m the best I’m going to be.” He will spend the remainder of the year at WRMC receiving daily physical therapy for his leg and mental health care for his PTSD. “I have an amazing therapist. She’s helped me and I’ve become a sort of spokesperson for soldiers like myself who have PTSD. I’ve been on CNN. I’ve announced to the American public that I have this mental condition and it’s not the end of the world. I know a lot of soldiers who are receiving mental health care, but I also know a lot who are reluctant to admit that they need it. That does them no good in my opinion.”

  He is philosophical about his TBI. “The only real cure for that is time. I just have to roll with it.” On May 28, 2008 he “rolled” by running a quarter mile on his new prosthesis. Nick has plans: “I have two kids, Cameron, 18 months, and Kylie, 6 months, and I need to get on with my life.” Nick still has hopes of returning to duty as an infantryman, although he’s fairly sure that’s impossible. “I love this country, and I serve at the pleasure of the President. If someone like me can come here and become a citizen, then anything is possible i
n America.” His alternative to the Army is to open an auto customization business with his best friend and take up his position in the heavy metal band “For Hope and Revenge,” along with his buddies from high school. “I remember talking to the doctors about my foot and I said,’ Look, let’s get this done so I can start my life again. There’re forty operations I could have or there’s just this one. Let’s do it.”

  PSALM 91

  1 You who live in the shelter of the Most High, who abide in the shadow of the Almighty,*

  2 will say to the LORD,’ My refuge and my fortress; my God, in whom I trust.’

  3 For he will deliver you from the snare of the fowler and from the deadly pestilence;

  4 he will cover you with his pinions, and under his wings you will find refuge; his faithfulness is a shield and buckler.

  5 You will not fear the terror of the night, or the arrow that flies by day,

  6 or the pestilence that stalks in darkness, or the destruction that wastes at noonday.

  7 A thousand may fall at your side, ten thousand at your right hand, but it will not come near you.

  8 You will only look with your eyes and see the punishment of the wicked.

  9 Because you have made the LORD your refuge,* the Most High your dwelling-place,

  10 no evil shall befall you, no scourge come near your tent.

  11 For he will command his angels concerning you to guard you in all your ways.

  12 On their hands they will bear you up, so that you will not dash your foot against a stone.

  13 You will tread on the lion and the adder, the young lion and the serpent you will trample under foot.

  14 Those who love me, I will deliver; I will protect those who know my name.

  15 When they call to me, I will answer them; I will be with them in trouble, I will rescue them and honour them.

  16 With long life I will satisfy them, and show them my salvation.

  MEDALS

  Combat Infantry Badge, Army Commendation Medal, Purple Heart.

  “We found the most powerful postwar predictor of resilience to PTSD symptoms was an element of social support that we called Interpersonal Connection. When men felt they could talk to someone—and more important that they were listened to and that people believed them—they tended to do better than men who felt they could not.”

  –“When Close Feels Far Away–Helping A Family Member Come Home,” Dr. Thomas N. Dikel, giveanhour.org

  38

  FACING OUR FEARS

  By Barbara V. Romberg, PhD

  Fear affects those who experience the invisible wounds of war, their loved ones, the mental health professionals who offer assistance and our country itself as we watch the broken return home.

  Anxiety is a common emotion we all experience, most of us in mild forms. Who hasn’t felt an uneasiness of mind caused by the anticipation, whether rational or not, of some misfortune. By contrast, fear is defined as a distressing emotion aroused by impending danger, evil or pain. Even small amounts of fear can cause significant disturbance and can lead to a number of negative consequences.

  Specifically, fear immobilizes our decision making and leads us to avoid situations that elicit that feeling in our bodies and minds. When we’re afraid, we are reluctant to accept help from others since accepting assistance requires that we trust, which is difficult to do when we are afraid. Fear keeps us locked in old habits. Afraid to change, we hold on to maladaptive and destructive patterns of behavior. And fear stifles motivation and initiative—it prevents us from believing in our capacity to become fully functioning and healthy. When we’re afraid of the pain of disappointment, we refuse to reach for what might have been and settle for the dissatisfaction of what is.

  “Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt.”—William Shakespeare

  Much has been written about the struggles of the Vietnam veterans who came home from the war. Dr Jonathan Shay worked with veterans who suffered from complex Post-Traumatic Stress Disorder as a result of their combat experience. He observed that fear had a tremendous impact on the interactions these men had with the mental health professionals who attempted to help them. As a result of their fear, Dr. Shay explains, these veterans constantly tested, pushed and challenged those around them—looking for confirmation of the betrayal they suspected. The cumulative effect of years of repeated disappointment and mistreatment resulted in the destruction of their basic capacity to trust.

  Vietnam veterans feared unleashing emotions that were too painful or difficult to feel, let alone express. Afraid they might experience overwhelming shame, or guilt or pain, these soldiers tried to protect themselves by avoiding all triggers and all associations. Unfortunately, as they numbed themselves to avoid the pain they feared, they severely limited their capacity to feel the love, the caring, the safety that others offered.

  They also feared being deceived or used and even harmed by the incompetence of others.

  Those coming home from today’s war—some who suffer from complex PTSD, others who suffer less severe but still profoundly disabling consequences—also experience fear. They are afraid to appear weak to themselves or others. They are afraid of feeling weak. They are afraid to ask for help because they might be labeled “crazy.” In many cases they don’t understand what is happening to them and so they fear that they actually are “crazy.”

  The list of possible fears is long. Many returning warriors report that they are afraid of the stigma attached to seeking mental health care. Associated with this fear is humiliation for not being strong enough or tough enough to “gut it out.” As depression sinks in, these returning warriors fear being overwhelmed by darkness and despair. Fearing a life filled with hopelessness, yet unable to connect with others, many withdraw from friends, family and their community. Eventually some turn to suicide to end the pain.

  In addition, the men and women who serve fear for those they love. They are afraid that they cannot live up to the needs or expectations of those waiting at home. They fear intimacy—closeness makes them feel vulnerable and exposed. With so much chatter in their heads, they fear sex. One young marine told me that he had trouble holding his girlfriend’s hand and couldn’t imagine being intimate with her. He was terrified that he would lose her but had no idea how to talk with her about his fear. Those who return with physical disabilities have the added struggle of learning how to engage in intimate relationships with missing limbs or scarred flesh.

  Some who return are afraid of harming those who welcome them home. They fear that they will be angry, aggressive, depressed, impulsive or disengaged. They also fear the numbness that sometimes replaces feeling. Being unable to feel is a blessing for some—but relationships rarely withstand the emotional detachment necessary to maintain this level of numbness. Parents of returning warriors have written asking for help in reaching their son or daughter. They report that their child returned physically intact but emotionally and spiritually vacant.

  At a conference on combat stress I spoke with an Iraq veteran who had lost his leg in the war. He was unassuming, polite, articulate and very concerned about the men and women returning home from the current conflicts. I had just completed a presentation on fear. He was very interested in the topic and asked if I might consider adding another type of fear to my list. He wanted me to add the fear of dishonor. He explained how a soldier’s fear of dishonoring his unit, his service and his family often keeps him silent about his nightmares, flashbacks, anxiety and depression. He expressed the hope that we would be able to help those returning from combat—some with invisible wounds such as post-traumatic stress and traumatic brain injury—find honor in seeking and receiving the help they need and deserve.

  “Courage is resistance to fear, mastery of fear—not absence of fear.”—Mark Twain

  Family members have fears when loved ones return from combat. I have spoken with many adults whose fathers served and fought in World War II. They tell a similar tale. Th
eir fathers were good men who believed in service to others, honor and integrity. Many of these good men were clearly affected by the war. They rarely if ever spoke about their experience, and their children never asked. Their children were afraid to raise the issue. They were afraid to bring up potentially painful memories and afraid to unleash the rage that sometimes seemed to hover ever so near the surface.

  Some family members of those returning home today report that they too “walk on eggshells.” Some have become receptacles for their loved ones pain. They are distressed and burdened but they don’t know how to stop the pattern. As we now know, secondary trauma is a very real phenomenon that often affects family members of those who suffer from Post-Traumatic Stress.

  Family members are often afraid to speak about the changes they observe in their loved ones. Understandably, they continue to hope that their husband, wife, son or daughter will “come back” eventually. But by not acknowledging the changes, however, the warrior and the family member remain disconnected from each other. Their relationship is unable to evolve or heal. Indeed, sometimes relationships are not able to withstand the changes or the pain that accompanies the warrior home, and dissolve.

  “You gain strength, courage and confidence by every experience in which you really stop to look fear in the face.”—Eleanor Roosevelt

  One fear often expressed by our military leaders is associated with the need to recruit and retain new warriors. If we expose the horrors of war by discussing the psychological consequences of combat, won’t we risk decreasing the number of men and women willing to join an all-volunteer force? Many of us in the mental health field will argue that as long as the need for war exists, we will be better served by working to educate the men, women and families in the military community—to prepare them for the psychological realities of war. They will be better prepared for war and better able to return from it if they know the possible consequences.