From the beginning we establish the VIP culture of mutual respect for all veterans. No individuals branch of service, military function, battles, or suffering is more “significant” than any others. With one another’s support the veterans finally, decades late, experience the three forms of validation—substantive, institutional, and memorial—that every soldier, sailor, marine, and airman should receive after combat.12
Stage Two of recovery calls for the veteran to construct a cohesive narrative of his war experience in the context of his whole life—and to grieve.
VIP makes an annual trip to the Vietnam Veterans Memorial in Washington, which provides a focus for “memorial validation.” This is an opportunity for those veterans ready for it to grieve for and commune with dead comrades in a safe and sober fellowship. In this group there is no need to explain or justify the importance of keeping faith with the dead through authentic emotion, respectful remembrance, and honor.
A TRIP TO THE WALL WITH VIP
Three A.M. in the spring it is still very dark in Washington. The line of lights embedded in the walk along the Wall casts a soft glow. The brightest feature in the landscape is the floodlit obelisk of the Washington Monument, which reflects off the polished black surface of the granite panels, slightly blurred by the thousands of names incised in the panels’ surfaces. At this hour, with veterans who fought in Vietnam, one understands that this is a shrine in the full sense of a sacred precinct, where the power—the fascination and dangerousness—of the holy is present.13 The living and the dead meet here.
No veteran in VIP is required to go to the Wall, and no veteran who wants to go on the VIP trip can do so until he has firmly established his connection to the community, has safety, sobriety, and self-care firmly in hand. Prior to the trip he has also worked on of his own traumatic history to have a good idea what demons he might meet at the Wall. If a veteran is simply flooded with the trauma and drowns in reexperiencing, it does him no good—it retraumatizes. Obviously, we cannot forbid veterans to go to the Wall alone apart from the scheduled trip. However, we strongly advise any Vietnam veteran not to go alone, especially the first time, to go sober, and to go with people he or she trusts. We hold a series of group meetings in the weeks prior to the trip, during which each veteran is invited to talk about what he expects, what he’s heard from other veterans, and to hear from VIP vets who are going for their second or third time. We also obtain their agreement to the basic ground rules of the trip: strict sobriety, staying with the group, participation in the meetings while on the trip to process the repeated visits to the Wall during the two days in Washington. They also have the opportunity in advance of the trip to look up the locations on the Memorial’s panels of the names of their dead comrades, so that they don’t have to struggle to do this in the dark under the enormous emotional pressure of the visit. There is no haste or time pressure. We generally arrive at the Wall, for the first visit of the trip, at three A.M. and stay as long as anyone wishes and needs to.
For many the first visits are pure grieving. Some of the veterans are physically very large men. A six-foot-three Marine Corps veteran weeping his heart out in the dark, hugged by other veterans, is a profound thing to witness. The supportive presence of the trusted other veterans eliminates embarrassment. They do not have to go through it alone.
Some veterans fear the Wall because they fear the dead will reproach them—for having not done enough, for having survived when the man on the Wall—“in the Wall”—did not. The polished stone reflects the movements of the veterans along its surface giving sensory credence to the sensation that the dead are present.
Some do not feel worthy to be there.
For some, the only emotion is anger.
One veteran exclaimed, “It’s a grave!” There have been times I have walked down the slope toward the apex of the Wall and had difficulty breathing, as though the rising tide of names on my left was rising water and I was drowning.
Some ask forgiveness for something they did, or didn’t do.
For some, it is a sad, quiet chat and visit with the dead, with love as the predominant emotion.
The names—all 58,226 of them14—are a very powerful statement: each of these was a whole life.15 There are no et ceteras on the Wall.
Sometimes difficulty remembering a name, or enough of a name to find its location on the Wall, torments a veteran. People were often known by nicknames conferred before the young man—who decades later is our patient—arrived at his unit. The veteran may never once have heard his battle comrade’s given name, even after several months. This is where unit associations provide irreplaceable assistance, when the veteran is able to find others who were there at the same time as he, who might recall both the nickname and the man’s right name. Unit diaries and after-action reports record deaths day by day, so that if the date is known, the number of possible names can be greatly narrowed.
The agony of not knowing or not being able to remember names is captured in this poem, “Remembrance,” by Joan Duffy Newberry, a veteran of the Air Force nursing corps:
How is it possible that I remembernot one name on this tragic wall?
How is it possible?
After all, there are ten tall panelsthat represent the year I spent in Nam.
—Duff, 1/Lt USAF NC RVN 69-70 Left at panel 24W, Memorial Day 198716
Too many names … names like Smithand Herman and O’Brien and Siciliano …
I know you … your faces are foreverseared into my brain.
You were little more than childrenwhen you came under my care,
With wounds and illnesses thatno human should ever endure.
My God, I hated to see you so hurt, so frightened and so sick.
How is it possible that I cannotremember any of you dying?
In nightmares you reproach mefor making you live when you weredetermined to die …
And you curse me for being so slowto help your best buddy …
“There are others I must tendto before him,” I say in my dream …
Sweat covered, I awake and wonder justhow far my mind will go to absolveme of your buddy’s death.
My God, it was terrible to be so responsible …
I was too young and too inexperienced a nurseto make such wrenching decisions.
No matter what I did it was never enough …and no matter what I did, it will neverhave been enough,
For there are too many names forever etchedon this wailing wall.
I grieve for you my nameless patients.and I grieve as well for your loved ones.
I also grieve for myself, for I willnever be free of tormenting uncertainty …
What should I have doneand what could I have done
To keep you from joiningthis heart-breaking roster of the dead?
In the very early morning—“0-dark-30”—the veterans have the Wall entirely to themselves, which is the main reason that we go at that hour. The intimate presence of the dead—for those who are well prepared for it and meet the dead with the support of a community—has been paradoxically a breath of life for many. The famous line by Wilfred Owen, “These are the men whose minds the Dead have ravished,”17 seems relevant here, although his experience was in the Craiglockhart military psychiatric hospital while World War I still raged in France. The dead have pursued the men we work with for thirty years. Actively going to meet them in their sacred space, with living brothers at their shoulder, seems to make a great and positive change in their relationship to the dead.18
After the sun rises (often a wonderful moment standing on the steps of the Lincoln Memorial facing east up the Mall), we go to breakfast, go back to our billet on whatever military base has offered us hospitality. We hold a therapy group to encourage the veterans to talk about what they have just done and what it was like. After a nap, we return to the Wall in the early afternoon.
Talk about different!
The Vietnam Veterans Memorial is the single most frequently visited monument in the capital. On a sp
ring afternoon this is very easy to believe. However, the sense of sacred ground is still palpable and takes hold of the crowds of tourists and schoolchildren. They walk and talk quietly—probably more quietly than in their own churches. I think they know they’re in someone else’s church.
VIP veterans, if they go to the Wall at all, generally go more than once over the years. We encourage this for several reasons, the most important being that they report that they get something different out of each visit. The presence of veterans who have been to the Wall before is also enormously valuable to the veterans going for their first time. And on a second or third visit, the veteran is much more likely to engage with the schoolchildren or other visitors at the Wall. On a spring afternoon, standing still for an hour at the far edge of the walk, they become aware of parents, brothers and sisters, wives, children, cousins, aunts and uncles, school friends, neighbors of the people on the Wall. This has an oddly consoling effect on many veterans. It is another previously unfelt dimension of knowing that they are not alone, not freaks. A second- or third-time veteran may offer to help these other mourners find the names or make rubbings of them on the strips of paper that the Park Service provides.
Other veterans have found great solace in watching groups of schoolchildren, and sometimes speaking with them. The children’s “Thank you” and the poems and stories they leave at the Wall do not provoke any of the bitter reactions that the same words from adults sometimes bring: “Where the fuck were you thirty years ago?”
Adult tourists who are unconnected with anyone on the Wall sometimes bring out that bitterness and generate a raw, unpleasantly conspicuous feeling of being gawked at, “What are we, zoo animals?” Fortunately, these reactions are rarely intense enough to disrupt the veteran’s purpose in being there or to spoil the trip for him. The same can be said for xenophobic reactions to the foreign tourists who come to the Wall. The reactions occur but they don’t ruin things, because of the opportunity to talk about them and to have support from the other veterans.
While reactions to the Wall trip are many and varied, the predominant theme is grieving. This is an essential element in the second stage of recovery from complex PTSD after combat. When a member of VIP has tested the trustworthiness of the community and of the team sufficiently, he is often able to venture beyond the safety of we-all-went-through-the-same-thing into the particularity of his own experience, and his contribution to both events and to the course that his life has taken. The process of constructing a narrative invariably arouses intense emotions, particularly of grief. They grieve not only for comrades lost during and since the war, but almost always for irretrievable losses of prewar relationships, with parents, siblings, wives, and children. They mourn:
• Relationships, ideals, and ambitions blighted by alcohol and drug abuse, and its consequences.
• Relationships, ideals, and ambitions blighted by violence and its consequences.
• Relationships, ideals, and ambitions blighted by the avoidance symptoms of PTSD.
• Lost innocence.
• Lost youth and health.
• Waste.
Ruptured relationships are sometimes irretrievable, or have been made so by death. As we saw in Chapter 9, when Odysseus meets the ghost of his dead mother in the Underworld, he learns she died of grief during his long inexplicable vagrancy after the end of the Trojan War.19 This can be taken as a metaphor of all such irretrievable losses that veterans must now face after their protracted, tormented nostoi, “homecomings.” Grieving and constructing a narrative is not a smooth process. It often cycles through periods of renewed testing, sometimes with breaks in safety, sobriety, and self-care, which must then be restored.
In the group therapies, leaders serve to assure “airtime” and to safeguard the VIP value that every person’s suffering is significant and cannot be measured against any other person’s suffering. VIP tradition strongly discourages “pissing contests” over whose misery is worse. We monitor the emotional state of the veteran making the disclosure, as well as that of other veterans who may be triggered by it, or may be dissociating. Very often, the disclosure of traumatic material occurs first in individual therapy, and is only later taken into a group. In imparting fragments of trauma narrative to the group, veterans can start to believe that, for example, “My story has meaning and value to others. I can trust them to understand and remember it. They are trustworthy witnesses to my grief, rage, and guilt and they experience enough of these emotions with me that I know I am understood.”
The first two stages of recovery turn the veterans inward both toward themselves and toward the other veterans in VIP. In the third stage, veterans selectively reconnect with people, activities, ideals, ambitions, and group identities from which they had become isolated, and make new connections. The core of this is the negotiation of safe, nonviolent attachments in the family. This often entails reunion with, or renegotiation of relationships with, long-estranged children and now elderly parents. The veterans of VIP strongly support a therapeutic culture in the program aimed at preventing the intergenerational transmission of trauma20—support born of guilt and sorrow at the damage that they did in past years to parents, spouses, and children.
Some veterans, by no means all, have taken satisfaction in educating youngsters on war, or in active peace advocacy. Several engage in regular volunteer work with homeless veterans, particularly those who have recently been homeless themselves. A great many have participated in educational activities for mental health professionals at various levels, as well as for medical students and psychology interns.
Stage Three of recovery starts with the small community of veterans in VIP and works outward to the veteran’s family, military unit associations, church, neighborhood, and nation.
Dr. Mary Harvey’s account of the dimensions of recovery21 has influenced ours:
• Authority over the remembering process.
• Integration of memory and affect.
• Affect tolerance.
• Symptom mastery.
• Self-esteem and self-cohesion.
• Safe attachment.
• Meaning making.
We speak to the veterans of these dimensions as expected results of treatment. All of our patients struggle against chronic despair. There is no way to “give hope” of recovery without giving understandable content to that hope, and over time veterans readily understand Dr. Harvey’s dimensions of recovery.
Social trust requires at least three people. Dyadic trust between two people, no matter how many times it is pair-wise created, does not make community. A community begins with the addition of the third person, and with all three trusting that the other two when alone together will continue to safeguard the interests of the person who is absent.22 The trauma world assumption is that they will plot some exploitation or attack, or utterly forget the third person’s existence. Good-enough nurturance in childhood produces social trust as a matter of course; bad-enough trauma at any age destroys it. Our task is its restoration.23
It is not enough to talk about trust and tell patients verbally what they need to do. Vietnam combat veterans, like veterans of many other wars and other traumatized populations, have great suspicion of words. They were deceived by words as part of their trauma. Our patients were told many idealistic things about war service, but were not told of its sorrows and suffering or that the personal cost could be so high. They were told about codes of conduct, but they then saw that the rules did not apply. They were told the enemy was weak and ill equipped, but then they saw how skillful the enemy’s tactics and how well suited their weapons were. They were told in many voices that it was noble to be a warrior and that they would come home as heroes, but then they learned they were not wanted. Veterans learned not to trust words, but to observe behavior. They observe the behavior of mental health professionals who profess to offer treatment. They constantly observe us and test us for trustworthiness.24
The VIP veterans now have evolved
a strong system of rules, devoted primarily to safety, sobriety, and self-care, developed over many years by the veterans, and mainly enforced by them in cooperation with the treatment team. The community rules are continuously a work in progress.
What we do is political in the richest senses of the word. Our patients all took part in the exercise of state military power in and around Vietnam between 1965 and 1972, and their injuries trace to this participation and to how power was used in military institutions. The dominating element of power makes the cause of injury political; the forms of injury are in part political; and you have seen here how the treatment of injury we provide is political—we foster an empowered community among the veterans that we work with. The task is to create trust. In a fundamental sense, our treatment is a form of democratic persuasion. We are in this together and are parts of each other’s future as fellow citizens.25
We foster community among the veterans and join that community to the community of the treatment team. In doing so we establish the possibility of attachment to the larger social world because we (the treatment team) sincerely believe in that larger world and show that it is possible to participate in it with perceptive good judgment. We must do this as rhētor— a citizen openly and undeceptively seeking the trust of fellow citizens and sharing in their fate—not as hireling-sophist or as a slave of the institution and its rules and its institutional agendas. We speak to the veterans as free fellow citizens, not hired agents of social control or slaves of the state. This is our idea of ourselves.
During the first five or so years I was in VIP, I encountered numerous worries and angry denunciations to the effect that everything said in a VA therapy group or office was “reported to the government,” that we were doing experiments on the veterans, that VA staff was specially selected to carry out the government’s need to geld or defang the veteran. I cannot explain why such talk has disappeared. It has been years since I have heard any of it.
Odysseus in America Page 22
