I told my story, lifting off in a Super Stallion stuffed with gear and Marines, seeing the window across from me suddenly turn bright green with tracer fire, the contractor next to me seizing my arm in panic, the helo swinging wildly in the air, the two crew chiefs returning fire, the spent brass rolling around the floor of the cabin, the sound of the incoming mixing with the outgoing, taking my helmet off and sitting on it.
Across from me, Sarah sat with her binder perched at ninety degrees in her lap like a high school student trying to prevent her answers from being stolen. My body was ramping up, going back, even as the rational part of me tried in vain to race ahead. My body was in the helicopter. The higher parts of my brain were trying to tell the story. Sarah was cooler than me, protected behind the battlement of her binder, her pencil calmly hovering over the pages.
The rest of the interview went smoothly, as smoothly as a string of real-life horror stories can go. Something in me had decided to like Sarah despite her naiveté, despite all the reasons I was supposed to hold her in contempt: her innocence, her inexperience, all the privileges her remove gave her, a remove that made her a kind of royalty, free to care as little or as much as she wanted. She was like a number of VA trauma workers I would meet, all of them seemingly young women: bright, almost terrifyingly sweet, their faces unmarred by cynicism.
A part of me still wanted, almost needed, to live by a line Jack Nicholson delivers in The Two Jakes, the sequel to Chinatown: “You can’t trust a guy who’s never lost anything.” But another part of me knew that a time was coming when I would need to start making exceptions to this rule.
And I thought maybe that time was now. And so I did.
I could see that it wasn’t her job to make me feel better or to collect my life story or political philosophy. Her mission was to complete a form, filling in the bubbles as she had been trained, as efficiently and with as little drama as possible. She was a census taker. I could see as well that this wasn’t cakewalk for her. She was a trained professional doing her job, but it didn’t take much for me to see that hearing these stories for hours, day after day, had to take a toll.
Later, I would see that the CAPS, whatever else it did, took a huge load off the interviewer. As a morally neutral instrument, it possessed what amounted to an antibiotic quality. It kept the blood, the filth, the squalor, and the trauma off the interviewer and kept the contagion of PTSD from spreading. It was as if Sarah were a laboratory technician administering a throat culture—putting on a latex glove and, without contaminating the sample or infecting herself, carefully placing the contents into a plastic tube and sealing them inside.
After a while, I found my mind drifting, and I began to describe other things that had happened in Iraq that had nothing to do with the Sea Stallion. There were other, more important things that needed airing, and being forced to limit my answers to just one isolated event felt wrong, like reading pages from a novel at random. She had told me we would talk about a couple of events, but so far we’d just spent an hour working our way through the story of the helicopter over Fallujah.
And so I told her a story that had happened in Saqliwiyah in 2007. One evening, shortly after embedding with 1/1, I had been talking with a young Marine sergeant when he stood up and told me that he had to get ready for his first patrol in-country. An hour later, I sat listening to the radio traffic in the company operations center as his patrol ran into one IED after another, killing one Marine and wounding six others. A “TIC” was declared. A “TIC,” which stood for “Troops In Contact,” meant that every available aircraft in-theater would divert to the incident to provide support, an eventuality that would lead to a dozen sections of birds being stacked in the air, one upon the other, awaiting instructions from the ground. In time, a second patrol from 1/1 was launched, a patrol that also hit an IED, wounding another six Marines. Six Marines, all first-termers, who had been in-country for all of a week. Teenagers, in other words.
After another hour, the Marine I had been talking to was evacuated back to the company area. As I walked over to his litter to see if I could get him anything, a cigarette, a Red Bull, some water, he began cursing at me, a long stream of obscenities that echoed in the lobby of the large commandeered hotel that served as the company command post. For years, I had puzzled over this and the long conversation we’d had before he’d left on patrol. Toward the end of this conversation, he’d confided that one of his biggest goals this deployment was to find a way to tell his wife everything that happened in Iraq.
“If I keep stuff from her, it just makes things harder in the long run. I need her to know who I am,” he’d said. Among my various CAPS-worthy moments in the war, this story had come to symbolize so many things: the mystery of wartime love, the paradox of intimacy, the impossibility of explaining the war to someone who’d never been there, the secret feeling that every soldier carries with him, learned through hard, searing experience, that every time you let your guard down and acted like a human, you got fucked.
He had revealed a small part of himself to me. An hour later, his legs were full of shrapnel. There seemed to be a pattern, a sequence, one thing leading to another thing, a linking of ideas, a connection both in form and content: the sergeant talking to me about talking to his wife. Then: boom, him seeing me and yelling “Fuck you, motherfucker!”
I wondered if there was a relationship between the sergeant and Erica. Had I made a connection in my head without realizing it? Was there something that had happened at Saqliwiyah, some other clue that I had missed? Was I remembering it right? Why didn’t I tell Erica about it when I got back? Why didn’t I tell her anything at all? Why did I keep so many secrets from her? Did I need to keep her as a kind of haven, untouched by the war?
It took me a few minutes to get through the Saqliwiyah story and what I thought it meant. It felt good getting it out. I’d never told anyone that story before. Something inside felt that Sarah, or someone like her, needed to hear it. In fact, I needed her to hear it. When I looked back at her, her face was blank, as if she had been waiting for me to finish. Her pencil, I noticed, was not moving. Later, I would learn that because my story about the wounded sergeant from 1/1 wasn’t the moment I’d selected at the start of the CAPS, Sarah would not be including it in her bubblings.
“So, how many times in the last thirty days have you been reminded of the . . . helicopter event?”
This went on for another hour, as we made our way through the seventeen symptoms listed in the DSM-IV, one by one. Every question began “In the last thirty days, have you . . . had recurrent distressing dreams about the event . . . had difficulty falling or staying asleep?” and so on. Followed immediately by an identical set of questions, which began “How many times in the last thirty days . . .”
Then suddenly we were done. Leafing through her binder, Sarah seemed to be checking my answers. “You must be tired,” she said.
I was exhausted. I thought about trying to give her something else for her binder, but I felt like I’d spilled enough blood for one day. I left the interview room in a kind of delirium. Later, I would think back on all the things that hadn’t made it into my CAPS. The week at a remote Marine outpost between Ramadi and Fallujah where we’d been mortared every day, the bridge at Karma, walking into the battalion command post at Dora and seeing eighteen pictures on the wall, one for each soldier who had been killed, all those no-contact patrols in bad country where the Marines looked at me like I was crazy for not carrying a weapon. The peace I’d felt when I knew I was going to die among Marines from my old regiment. The disappointment I’d felt when I didn’t.
I didn’t hear anything from the VA for several weeks until Mark phoned to apologize and explain that because of a clerical error, they’d allowed a month to go by, a fact that invalidated my CAPS. I would need to come in and do it again. So I went back in and spent another afternoon with Sarah, this time selecting the Saydia attack as my moment.
A week later, Mark called back and explaine
d in his usual brisk manner that because I’d reported in one of their surveys that I occasionally had more than three drinks in one day that I had been disqualified from the study.
“People with PTSD drink,” he said, laughing. “Anybody who does research, or I should say, anyone who does good research understands why people with PTSD drink, or why people drink more than they did before they had PTSD. We know that people with PTSD drink and use other kinds of drugs because the period of time they’re under the influence of those drugs is literally the only break they get from their symptoms unless they’re fast asleep and not having nightmares. So, the bad news is, you’re out for our study but there is another very good study starting up that is looking for people who fit your profile. Just make sure for this study that you don’t underreport your drinking. The other bad news is that you’ll have to do the CAPS again.”
The next week, I went back and completed another CAPS with a different interviewer, along with an hour-long battery of cognitive assessments for which I was paid twenty dollars. This study, like the one before it, was being conducted by the National Center for PTSD with support from the Department of Defense. This particular study, which would take eight weeks of my time, was looking into combining a therapy known as Prolonged Exposure with counseling designed to curb drinking.
Finding out that you are suffering from post-traumatic stress is often surprisingly anticlimactic. The fact that Mark kept calling me back and describing for me the next step of the process confirmed what I suspected. Most of the trauma survivors I’ve spoken to met their diagnosis with a mixture of relief and excitement: their suffering has a name. One Iraq veteran I met later told me, “When I started to read the symptoms online on the VA website, I started to cry because I was like oh my God, all this stuff is happening to me, it’s not in my head. It’s real. Other people have that numbness. I remember telling friends ‘I know I love my daughter but I can’t feel it. I can’t feel anything.’ And sensing that my thoughts were disorganized and that I couldn’t keep them straight, I was going right down the checklist saying ‘Yep, yep, yep.’ I felt relieved that there was an explanation for it, that it wasn’t just me losing my mind.”
Several years after being raped, Alice Sebold sat in the main reading room of the New York Public Library, working her way through the literature on PTSD. She had struggled with her symptoms for years but didn’t really pay much attention to labels like PTSD, dismissing them “as so much psychobabble.” Nevertheless, reading about sleep disturbances in Judith Herman’s Trauma and Recovery, she wrote, “Paragraphs like this began the most gripping read I had ever had: I was reading about myself,” she said. “There was a collection of first-person accounts of Vietnam that I read over and over again and kept on reserve. Somehow, reading these men’s stories allowed me to begin to feel.”
Back at Two North a week later, six months after I had first contacted the VA, I met with Scott, my new therapist.
Scott was a graduate student, finishing his PhD in clinical psychology. Serious, but with a quick smile and a single stud earring, he was the son of a retired air force officer. One of his grandfathers had served as a medic in Korea. Working with veterans, he explained, was his “way of giving back.”
He had worked with vets before, but one of his first acts was to admit his inexperience. “Now, I’m gonna make mistakes and say some stupid things. Are you gonna be okay with that?” Like a young salesman, he turned every other statement into a question, as if to underline that these sessions were to be about me, my experiences, my responses, my choices. Underlying his questions was an awareness that he needed to convince me. Given my bad experience with the CAPS, I was guarded at first, determined to say as little as possible. Having spoken to a number of trauma workers at the VA by this point, I’d come to believe that they were almost completely illiterate about the War on Terror. So, for our first session, I brought with me a copy of Fiasco, a history of the Iraq War, as a gift for Scott. To me, this seemed only fair. I was being asked to take part in their study and learn some things about their world, was it too much to ask that he learn a little bit about mine?
After the usual introductions, we chatted briefly about rock climbing and Chicago, where he had done his graduate work. Then we dove in.
Prolonged Exposure, one of the VA’s “gold standard” PTSD therapies, has two major components, both of which are designed to extinguish fears arising from trauma and allow the patient to regain control of their environment by ridding themselves of “avoidant” behaviors. A form of flooding therapy, “PE,” as it is known, is based on classical learning theory, which has its origins in the work of Ivan Pavlov, the famed Russian physiologist, who noticed, by accident, that dogs became conditioned to salivate when they heard the sound of a bell they associated with food. The first part of the treatment, to be done at the hospital, was known as “imaginals” and would involve me closing my eyes and retelling the story of a traumatic event of my choice a number of times. This would continue until I was no longer afraid of it, and it no longer activated a fear response in my body, until in the sometimes-confusing language of conditioning it became “habituated.”
For the second component, known as “in vivos,” I would be asked to do things in the real world that in some way resembled the traumatic event in question. The theory behind this was that by reactivating the fearful memories in the safety of a therapist’s office and in the relative safety of the real non-Iraq world, I would unlearn bad trauma-related behaviors and learn to incorporate new information about the world. I would unlearn the trauma in a way not unlike the way that Pavlov trained his dogs to associate food with other, unrelated stimuli.
With both of these activities, the governing principle was uncoupling the fear response that had been created by the event from another stimulus, whether it be driving down an alley that subliminally reminded me of driving in Iraq or riding on an airliner that subliminally reminded me of the Sea Stallion over Fallujah. Finally, I would be asked to listen to a recording of our sessions at home at least once a week.
At this point, Scott, ever the salesman, started in fast and heavy with the similes. PE was like knee surgery, he explained. It was like physical therapy, it was like unlearning a dog phobia, it was like learning to surf, because at first you got swamped by the white water, but eventually you learned how to stand up on top of it. Trauma, he continued, was like having a folder full of papers thrown up into the air. “What we’re going to do is collect all those papers up and get them sorted and into neater piles.” The keys, he said, were working up in intensity and repetition. We would start slow, with me telling my story, and keep at it.
“Think about it like the gym,” he said before letting me go.
For our second session, Scott began by describing how the autonomic nervous system worked with respect to PTSD. “Something triggers you, whether it’s driving or walking into a crowd, something that reminds you of Iraq and you get that fight-or-flight response going, right? And your autonomic nervous system can only maintain that for about forty minutes. And then that’s when you crash, right?” I agreed. To help me control this involuntary response, he took me through what he called a “rebreathing drill,” a progressive relaxation technique that reminded me of yoga.
Instructing me to close my eyes, he walked me through several repetitions, slowing my breath down incrementally. “This is your homework for this week. When you’re feeling activated, I want you to give this a try. Okay?”
Our sessions, ninety minutes twice a week in a shabby office filled with furniture from Ronald Reagan’s first term, were focused on the involuntary aspects of post-traumatic stress. Basically, anything beneath the realm of conscious thought was on the table. Although I didn’t know it at the time, what we were doing was zeroing in on the animal aspects of trauma, trying to fix what had happened at the mammalian level of stimulus and response, all the survival instincts that can go awry in the aftermath—sensing stimuli learned in a survival situation and at
tending to them in a nonsurvival context, the brain making patterns where there are none.
“The body knows things long before the mind catches up to them,” novelist Sue Monk Kidd wrote in The Secret Life of Bees. The problem is that once the brain learns something in a survival situation, it becomes very difficult to unlearn it, as if it cannot disobey its first commandment: Thou shalt attend to danger. Prolonged Exposure is essentially designed to force the brain to do just that, to unlearn the first commandment. This is not an easy task, to be sure, because when an intense life-threatening event happens even once, it is etched into the brain in a way that nonthreatening events aren’t.
Joe Simpson, the British mountaineer and author, describes undergoing a crude, real-life version of Prolonged Exposure in his book Touching the Void. After being diagnosed with PTSD, he was told he’d have to wait six months before seeing a therapist. “In the meantime I experienced eight weeks of mild panic attacks, a tendency to cry unexpectedly and a persistent feeling of vulnerability. Then I gave a corporate motivational presentation recounting the ‘Void’ story and within days the symptoms had disappeared . . . Telling and retelling the ‘Void’ story had inadvertently proved to be a good treatment for the condition. Apparently it is a common practice for psychotherapists to make a victim recount as vividly as they can the full horrors of their experience. With each telling of their real story it gradually becomes a fiction, becomes someone else’s experience, and they can separate themselves from the trauma.”
After discussing some of the basics of the treatment and what to expect, Scott and I started in on the imaginals. He asked me to close my eyes and put myself back in the Humvee in Saydia, narrating it all in the present tense, as if I were actually there again. I described driving down the boulevard, turning onto the smoke-covered street, seeing the burning houses, realizing we were in a dead end, hearing the Bradley ahead beginning to turn around, the Humvee starting to back up, and the boom. After this first “repetition,” he asked me how I was feeling, if my heart rate and my breathing were up. They were.
The Evil Hours Page 21
