Tag Archives: moral injury

June 11, 2012 · 23:47

The Uncomfortable Truth about the Rise in Military Suicides

The truth can be uncomfortable and truthfully most people don’t like to deal with uncomfortable things.  Suicide is one of those things that tend to make us uncomfortable.  Occasionally someone will demand the truth and when they finally get, the truth becomes a very uncomfortable thing and frankly many people cannot handle the truth. It reminds me of the exchange in the movie A Few Good Men where Colonel Jessup played by Jack Nicholson tells Lieutenant Dan Caffey played by the Tom Cruise: “You want the truth, you can’t handle the truth!”

The United States Military has been struggling with an upsurge of suicides and suicide attempts among its personnel since 2005.  Before that point military suicide rates were comparable or lower than comparable civilian populations. That is no longer the case, the military suicide rate is now higher than the civilian rate by a statistically significant percent.

The Associated Press reported a Defense Department report noting that in the first 155 days of 2012 that 154 active duty service members had killed themselves. That number is going up, I know of at least two at my base that have occurred since this report was released including a murder suicide committed by a Staff Sergeant who had recently returned from Afghanistan.

The military has tried to stem the tide. It has bolstered its mental health services and suicide prevention programs but the numbers despite leveling out in 2010 and 2011 have been rising. These numbers are reaching staggering proportions in the active duty, reserve and discharged veteran ranks.

A Veteran’s Administration Crisis line reported that in in 2011 it had received over 164,000 calls last year. It reported 6760 rescues and noted that 2300 self reported Active Duty personnel had called their hotline as well as over 12000 calls from family members or friends of veterans regarding their loved ones.

The rise in suicides particularly as the mission in Iraq has ended and Afghanistan is beginning to draw down has surprised many both inside and outside the military. While many of the men and women who committed or   attempted suicide even more have done so who have not deployed. People are speculating about the reasons for this and we know a lot of the answers and underlying causes.

First and foremost is the stress put on the force by 10 years of non-stop deployments to combat zones and fighting two major insurgencies at the same time and the resultant effects: Soldiers, Sailors, Marines and Airmen killed and wounded, combat stress injuries, PTSD, TBI, moral injury, family issues, divorce, infidelity, financial problems, domestic violence, sexual assault, alcoholism and drug abuse. As a Chaplain I know many young men and women who grew up in Christian homes and had what they described as a deep faith who after war have lost their faith. I see an increasing number of these young men and women.

An additional factor is the fact that we are entering a period of time where Soldiers and Marines and to a lesser degree Sailors and Airmen are being threatened with a massive drawdown in numbers.  This will force many to leave the military in the midst of a long term economic downturn that could get worse based on the precarious economy of the Eurozone which threatens the US economy.

There is the perception on the part of many in the military that they fight the war alone. There is a real lack of understanding in the civilian population as a whole about what is involved in going to war. Since only about one half of one percent of the American population is in the military at any given time this should not be a surprise. Finally there is a widely held belief among those that fight the war, no matter what sacrifices they make in Afghanistan that it will not matter in the end, that the war cannot be won. No one wants to admit this but the fact of the matter is that it is true because neither political reads history.

However as important as all of those factors are they are now joined by another factor that was not a factor in the early part of the war. The bond of unit cohesion which was a positive factor is eroding. Prior to the war and during the first few years of it unit cohesion was strengthened by seasoned and mature Staff NCOs, Petty Officers. These men and women had risen through the ranks and were seasoned by years of training, well rounded careers, combat experience and deployments. Many had some amount of college education. They dealt with their own stress well and were excellent leaders and mentors to junior personnel and the young officers that they helped to train.

I was at a training conference in March attended by a couple of hundred Chaplains and Mental Health Professionals. One of the seminars dealt with a program to train the young NCOs and Petty Officers to be first responders who could care for their Marines and Sailors. During the question and answer portion I decided to bring this up. I said that “the program would be great if we had the same force that we started the war with and that the men and women that we were depending on to do this job were themselves among the injured.” I said that the force was “hardened but brittle.” A number of people including the Subject Matter Expert agreed with me, others, mostly those who were relatively new to the military looked at me like I had gone off the reservation. I brought this up at another conference this month with a similar response.

That seasoned core is gone. In their place are younger, combat hardened veterans. Unfortunately many of these young men and women, charged with leading and training the new Soldiers, Marines, Sailors and Airmen are damaged goods themselves. They have been back and forth to war so many times that they bear unspeakable burdens. Many suffer from unreported PTSD, struggle with alcoholism and have pressing personal or family problems. Some of them take out these issues on the new troops, something that I think is directly related to the suicide epidemic and other problems. The attitudes of some have become poisonous to good order and discipline and actually compromise the trust of of service members to the chain of command. That trust was essential and helped get the military through the first part of this war but I see it being eroded on a daily basis.

A glaring example of this comes not from a NCO but a Army General, the Commander of the 1st Armored Division at Fort Bliss Texas, Major General Dana Pittard at Fort Bliss Texas. General Pittard wrote on his blog: “I am personally fed up with soldiers who are choosing to take their own lives so that others can clean up their mess. Be an adult, act like an adult, and deal with your real-life problems like the rest of us.”  His attitude serves as a reminder that for many that some leaders see those suffering from PTSD, TBI or other psychological conditions as ‘broken.” Ask any Marine, Soldier, Sailor or Airmen what what it is to be labeled as “broken.” There is still a stigma attached to mental illness, depression, PTSD, suicide and being “broken” that is not helped by statements of leaders like General Pittard.

As a result the resiliency of the force is at stake. Anyone who served in the years following the Vietnam War and the beginning of the all volunteer military can see similarities then and now.  We have not reached the point where the force is broken but the situation will not show much improvement until some point of stability is reached.

I cannot state with certainty the actual proportions of this factor, just my own observations that come from counseling and listening to Marines and Sailors every day. I’m sure that the same is true in the Army where judging by what I read it seems to be worse. The Army suicide rates are the highest in the military.

What has to be done is bigger than the military itself can do. There has to be a national commitment to both finding a way to lessen the stress on the force and to do more than offer platitudes about “supporting the troops.” The truth is that as a nation we refused to pay the cost of these wars and tried to fight them on the cheap. Political leaders after September 11th 2001 told people to “go back to normal” or “go shopping” and did not call the nation to war. The nation was untouched, no one paid a dime in extra taxes and no one was forced to join the military. The burden was placed squarely on those who volunteered. That burden has not been removed and unless the American people and Congress do more than telling the military to “do more with less” while lining the pockets of defense contractors who cannot seem to produce weapons systems without major production problems, cost overruns that are never produced in the promised numbers as well as the war profiteers of the military industrial complex, the lobbyists and Wall Street.

Of course that is just my opinion. It is an opinion formed by serving over 30 years in the military and having gone to war myself. It is an opinion of someone that has been involved with suicide prevention in the military for close to 20 years. It is an opinion based on conversations that I have every day with the young Marines and Sailors that I encounter. It is quietly shared by many leaders.

I have seen what has happened first hand and if anyone actually wants to do something to change the suicide epidemic they need to look at the whole problem. It is a national problem that needs a national solution. As a nation we have burdened a comparatively small part of or population with fighting our wars without a true national commitment to either winning the wars or supporting them.

Military Medicine, Mental Health Services and Chaplains are performing heroic work to care for our troops. Many leaders “get it” and are trying to build a culture where those suffering can get help without suffering the stigma and pain of alienation that comes from being “broken.” Yet despite increases in funding, numbers and emphasis the problem continues to escalate. That is the truth and it will not significantly change until the causes that I have listed are addressed, not simply by the military but the nation.

God help us.

Peace

Padre Steve+

2 Comments

Filed under History, iraq,afghanistan, Military, national security, News and current events, Pastoral Care

Tagged as , , , , , , , , , , , , , , , , , , , , ,

May 18, 2011 · 23:31

To the Edge of Darkness: Notes on a Conference

I’m home for a conference on Spirituality and Trauma at Naval Medical Center Portsmouth this week. The primary speaker is Dr. Robert Grant, author of The Way of the Wound a Spirituality of Trauma and Transformation.  I had the pleasure of meeting him last year when I coordinated his visit and speaking engagement when I was stationed at Portsmouth.

One of the ideas that Robert is willing to address is going beyond the symptoms of PTSD and what are the underlying causes of trauma including the understanding of evil and malevolence and the understanding of moral injury that stems from trauma.  Last year when spoke I was really beginning to integrate my own moral and spiritual injuries that were part and parcel of my battle with PTSD and I found his presentation quite helpful.

Now 8 months after that I have come to understand more about what he talked about back then.  For me it is that what I experienced changed me and that I had to deal with things that I saw and that I know that make me radioactive to many people, especially fellow ministers and many Christians. I found that when I came back to faith and began to write about it that I was asked to leave my former church.  Evidently being an agnostic despairing of life was fine as long as I didn’t question non-creedal social issues and right wing politics.  I now ask questions that make many people uncomfortable and I have become much more sensitive to seeing things that many people want to pass over.  Recently this was the case when I suggested that legendary preacher David Wilkerson may have committed suicide by car.  But such is life when you have passed into the abyss and come back different than when you began the journey.  Thankfully I have come back.  Now I hope to be there and walk through the valley of the shadow of death with those who are walking where I have walked.

I also found that there is a good reason that I am still taking medications to help me sleep.  I inadvertently left my medications or “docile pills” as I call them in North Carolina and had to try to sleep last night without them. I was hyper-vigilant as hell and got almost no sleep.  Today I got up, forgot my hearing aids and left the front door open on my way to work.  I was absolutely exhausted and to stay awake I drank entirely too much coffee, Coke Zero and Diet Dr. Pepper.  I was tired and wired. Thankfully one of my psychiatrist friends prescribed me enough of what I take to get me through the week.  However, I was funny especially toward the end of the day when I got myself slapped by a friend when a question was asked about a book title.  The book was Odysseus in America: Combat Trauma and the Trials of Homecoming and as people searched their brain housing groups for the title I leaned over to my friend Duke and said “isn’t that that book Oedipus in America.”   Duke paused for a second, realized that I was pulling his leg and slapped me, not that there is anything wrong with that.

While at the Medical Center I saw a good number of friends that I had worked with for two years. It was a genuine joy to see each of them again and to realize that the most important part of any assignment is the people that you have relationships with.  I am blessed. I have a couple more days in the symposium and look forward to what I will learn as well and seeing people that mean a great deal to me.

Peace

Padre Steve+

2 Comments

Filed under faith, Pastoral Care, PTSD

Tagged as , , , , , , , , , , ,

September 29, 2010 · 23:58

Suicide isn’t Painless: The Epidemic of Suicide in the Military

I leave the Naval Medical Center Portsmouth Virginia tomorrow and toward the end of October report as the Command Chaplain for Naval Hospital Camp LeJeune North Carolina. My last time at Camp LeJeune was as part of the Portsmouth SPRINT (Special Psychiatric Rapid Intervention Team) mission to care for Emergency Department personnel at the Naval Hospital and Base Fire/EMS responders to a particularly gruesome suicide of a young Marine who had recently served in Iraq and was preparing for another tour.

As a Chaplain and in my previous life as a Medical Service Corps officer commanding a Medical Company in Germany and Brigade Adjutant in Texas I have dealt with a lot of suicides, attempted suicides and the lives left shattered by suicide.  Likewise I have seen the results of suicide attempts as a trauma, emergency and critical care chaplain in major medical centers. I have attended the DOD Suicide Prevention Conference on a number of occasions and gotten to know many of the experts working in the field.

As I said I began my career as an officer in the Army Medical Service Corps. We had a close connection to the movie and television series M*A*S*H and the theme music to that movie is emblematic of the feelings of many combat vets who continue to deploy even after making many combat deployments. http://www.metacafe.com/watch/3444418/suicide_is_painless_johnny_mandel/

Through early morning fog I see
visions of the things to be
the pains that are withheld for me
I realize and I can see…
[chorus]:

That suicide is painless
It brings on many changes
and I can take or leave it if I please.

I try to find a way to make
all our little joys relate
without that ever-present hate
but now I know that it’s too late, and…
[Chorus]

The game of life is hard to play
I’m gonna lose it anyway
The losing card I’ll someday lay
so this is all I have to say.
[Chorus]

The only way to win is cheat
And lay it down before I’m beat
and to another give my seat
for that’s the only painless feat.
[Chorus]

The sword of time will pierce our skins
It doesn’t hurt when it begins
But as it works its way on in
The pain grows stronger…watch it grin, but…
[Chorus]

A brave man once requested me
to answer questions that are key
‘is it to be or not to be’
and I replied ‘oh why ask me?’

‘Cause suicide is painless
it brings on many changes
and I can take or leave it if I please.
…and you can do the same thing if you choose.

Last week four soldiers, one a highly decorated senior NCO and all combat veterans are believed to have committed suicide at Fort Hood Texas.  The base which has already seen more than its fair share of tragedy with 14 confirmed suicides this year is stunned that these occurred in one weekend.

Defense Secretary Robert Gates commented about the stress on the all-volunteer force: “No major war in our history has been fought with a smaller percentage of this country’s citizens in uniform full-time — roughly 2.4 million active and reserve service members out of a country of over 300 million, less than 1 percent,” as a result the wars have been fought by a small proportion of the country, for many they are “a distant and unpleasant series of news items that does not affect them personally.” While the distance grows between those that serve and the general population military families are under even more stress, with anxiety and disruption inflicted on children, increased domestic strife and a growing number of suicides. Divorce rates in the Army have doubled since the wars in Afghanistan and Iraq began.

In the years prior to about 2004-2005 the military suicide rate was almost always below civilian rates in all demographics.  This is something that we took legitimate pride in.  That began to change as the war in Iraq shifted from a “Shock and Awe” campaign to a rather nasty and intractable insurgency this began to change as the deployment tempo increased and the Army increased its “boots on ground” time from a year to 15 months with a one year dwell time between deployments. Even as Iraq calmed down and the US role shifted many troops remain and Afghanistan has become a much more difficult war than it was even a few years ago. The Marines retained a 6-7 month deployment schedule but as the war went on and personnel requirements increased many Marine units were doing 6 months in country and 6 months home.  The difficult of what was described as “dwell time” for the Army and Marines was that for all intents and purposes it wasn’t. The units would get a few weeks leave and stand down time on their return home and then begin preparing for their next deployment. These preparations out of necessity entailed much time in the field training including trips to the Fort Irwin National Training Center (NTC) or the Marine Corps Air Ground Combat Training Center at 29 Palms.  Speaking from experience before 9-11 I can say that a Marine battalion going to 29 Palms in reality makes a short but intense deployment which is taxing on the organization even as it sharpens combat skills.  The same can be said for Army units going to NTC.  Thus the time that is nominally considered time at home to recuperate is not that and instead serves to keep the pressure on already stressed units, leaders and soldiers/Marines.  In the intervening time those that present to mental health providers or chaplains are provided with care to get them back in shape for the next deployment but never really get to deal with the deeper psychological and spiritual wounds. These include “moral injury”  which often involves unresolved grief for the loss of comrades and real or imagined guilt for their own actions in war.  Such wounds ultimately create despair, loss of faith and eventually cause some service members to make attempts on their life with varying degrees of “success” in “completing” the suicide.

The result is that those who have experienced the moral injuries that come as a result of combat, seeing comrades killed and wounded, participating in actions where they are directly or indirectly involved in killing the enemy, see the “collateral damage” of civilians, including children killed and maimed go right back into to fight.  Since this war has now gone on longer than any war in US history and we are fighting it with an all volunteer force of limited numbers with many making multiple deployments, some as many as 5 or more these wounds are pushed aside.  The effect of this is a cumulative grinding down of those that serve in harm’s way. Many suffer from some form of psychological, neurological or even spiritual injury that in combination with other life stressors make them particularly vulnerable to taking their lives.  In regard to moral injury “Many of the troops kill themselves because they feel that those kinds of experiences have made them unforgivable,” said Dr. William Nash, a top PTSD researcher. “It’s a lot harder for most people to forgive themselves than to forgive others.”

Unfortunately there is a stigma attached to seeking treatment or admitting that one is suffering from depression, anxiety or any other condition associated with either seeking help on their own or being “command referred” for psychological/psychiatric help.  Since that stigma is real many war fighters don’t seek help and take “refuge” in destructive behaviors such as alcohol abuse, drug abuse (to include prescription drugs) and risky behaviors.  One wonders how many of the single vehicle accident fatalities that occur late at night to combat vets are not accidental at all but are suicides by another more “socially acceptable” means.  If a forensic psychological profile was done on every service member that dies in such events I would guess that the finding would be a lot more suicides not an accidental deaths as we would like to believe. Yes all of these deaths are tragic but it is far easier to rationalize death in an auto accident than death by gunshot, knife wounds, overdose or hanging.

I am not proposing any solutions for this problem.  I do believe that somehow the deployment tempo needs to be slowed down to allow troops to actually recover and get help.  This is one of the suggestions of the DOD Suicide Prevention Task Force.  Their report is linked here: http://www.health.mil/dhb/downloads/Suicide%20Prevention%20Task%20Force%20report%2008-21-10_V4_RLN.pdf

When I go to LeJeune I know that as a Chaplain at the Naval Hospital I will be collaborating with our mental health professionals to provide care to Marines, Sailors and their families that are living this daily.  The Marine situation is poignantly show in this article: http://www.nctimes.com/news/local/military/article_3dc03ec3-6a37-5608-8563-aca88f635271.html

I have served with the Marines almost 6 years and from what I see the Corps has changed.  It is battle hardened but less resilient than it used to be.  The Marine Corps’ suicide rate has reached 24 per 100,000, a rate that surpasses all the other services. The rate was 13 per 100,000 in 2006 when I finished my tour at Marine Security Forces. The latest available figures put the civilian suicide rate at 20 per 100,000.  The problem extends past active duty as Veterans Affairs Secretary Eric Shinseki, the former Army chief of staff, said the suicide rate for men aged 18-29 who have been discharged had gone up by 26% from 2005-07. Likewise, “of the more than 30,000 suicides in this country each year, fully 20% of them are acts by veterans.” This means as Shinseki said “on average 18 veterans commit suicide each day. Five of those veterans are under our care at VA. So losing five veterans who are in treatment every month, and then not having a shot at the other 13 who for some reason haven’t come under our care, means that we have a lot of work to do.”

There is also an effect on military health care providers of all kinds and chaplains. These individuals not only have to deal with their trauma but the trauma and hopelessness that they see in many of their patients or parishioners. These caregivers have no respite between deployments because their reason for being is to care for the Soldiers, Marines, Airmen and Sailors that present to them be they deployed or back in a military hospital or clinic.

The work will be hard and long after the last Marine, Sailor, Soldier or Airman leaves Iraq and Afghanistan we will be dealing with this for years to come.

Peace

Padre Steve+

3 Comments

Filed under healthcare, iraq,afghanistan, Military, Pastoral Care, PTSD

Tagged as , , , , , , , , , , , , , , , , ,

August 15, 2010 · 16:54

Rehab Assignments

There are times in life that many of us experience some kind of injury; physical, emotional or spiritual that puts us in the position that we cannot function at the level that we are accustomed to doing. For some people this might be the result of some kind of traumatic event, perhaps a serious illness or physical injury or even something that causes us to lose faith in God or in whatever higher power that we ascribe meaning in our life.

As any regular reader of this site will recognize I interpret or frame much of my life experience through baseball and baseball analogies. In my case I frequently frame that through pitchers or older ball players that have encountered injury or rough spots in their careers.  I think about pitchers a lot because the craft of pitching involves such a degree of connection between the physical and mental dimensions of the game.  There are many times when a pitcher suffers a physical injury that requires changes in his delivery or the kinds of pitches that he throws.  When this happens it also affects his mind as he may lose confidence or over think what he is doing as he tries to make adjustments, also while experiencing residual physical pain.  Some pitchers are able to make the adjustment, for others the adjustment is more difficult and they are not as effective as they were previously. Still others either cannot recover from the physical injury or never make the adjustments and end up out of the game.

Those that experience injury as they recover are sent back to the minor leagues, or if they are in the high minor leagues to a lower level league in order to get back to the level that they were before the injury.  Even when they get back to the majors or to triple-A the pitching coach and manager may still go easy on them in order to ensure they are 100% and do not re-injure themselves.  This is called a rehab assignment and it is part of the game.

In the military we seldom get that chance unless the injuries are so significant that we need to put on some kind of limited duty and a placed in a non-deployable status until they are considered fully fit for duty. I returned from Iraq in February 2008 with several nagging chronic physical injuries to my ankles, knees and shoulders and an elbow which coalesced to sideline me from much physical activity. Even worse I was dealing with PTSD which was not recognized or diagnosed until late June of 2008 when I was falling apart having flashbacks, night terrors, chronic anxiety, insomnia and moods that alternated from anger to despondency.  When I left EOD Group Two I for my assignment to Portsmouth Naval Medical Center I was still in denial of sorts, though I knew that I was in ragged shape I went into the assignment trying to act as if and perform as if I was uninjured.  I threw myself into the job pouring working on the average 65-75 hours a week for almost a year mostly on the ICU and PICU before my boss finally stopped me and put me on more administrative duties with minimal clinical duties and plenty of time to get back in physical, emotional and spiritual shape.  Not many senior officers would give a subordinate that kind of grace nor would they rate an officer under them with an eye on their potential versus what they were doing for them at the moment.  Mine did, I will be forever grateful to Chaplain Jessie Tate for giving me that grace.

Eventually his patience as well as my hard work and a lot of God’s grace were rewarded. Things started to turn around in December of 2009 in what I call my “Christmas miracle.”   Slowly my physical injuries healed and I can now say that I am in as good or better shape than when I went to Iraq. I had to make some adjustments to my physical training regimen as well as confidence to believe that I was not going to re-injure myself.  My mindset in my physical training went from timid to confident as I gained in strength, speed, dexterity and endurance.  This was coupled with the loss of 16 pounds and a body fat percentage that went from 32% (when I ballooned from 167 to 194 pounds between April and November of 2009) down to 22% as of last week.  Spiritually I began to believe again. Most of the time after Iraq I struggled with faith sometimes even doubting the existence of God or at best feeling alienated and rejected by him and many of his people.  My spirituality has changed as has the way I approach my faith being much less doctrinaire to relational focusing on the grace, love and mercy of God and to trying to show that to others as St Francis said “preach the Gospel at all times, use words when necessary.”  Psychologically I was able to come to grips with my PTSD and make the adjustments that I needed so that I might be able to function.  I am much more in touch with feelings and what is going on in me than I was before and my observation of other people has improved, I guess once a person has had everything fall apart that they become more sensitive even to the unspoken things when they are around others.

In a sense this assignment became a rehab assignment for me. I was able to come back and become not only functional but able to be in the game again.  When I was selected for promotion my boss had no hesitancy in nominating me for the supervisory Chaplain at Naval Hospital Camp LeJuene. I can see the future again and it is good.  My plan was for Portsmouth to be an “All-Star” game for me where my clinical and academic skills would enable me to be a water walker but it was different, it was a fight to remain in the game a fight to regain confidence, overcome injury and return to relatively normal life.  My rehab assignment is over and I am back in the game performing at a level that I expect.

For those that are in similar circumstances I hope that you have a boss with the grace to help you through the difficult times and not abandon you as “broken” or of little use to the organization. I know that happens in the military and outside of the military, even in churches.

Peace and blessings,

Padre Steve+

2 Comments

Filed under Baseball, christian life, faith, Pastoral Care, philosophy, PTSD, Tour in Iraq

Tagged as , , , , , , , , , ,

August 31, 2009 · 22:54

Star Trek the Next Generation: Captain Jean-Luc Picard Deals with PTSD

Counselor Deanna Troi: Interesting.
Captain Jean-Luc Picard: Counselor…
Counselor Deanna Troi: I just find it interesting. Captain Jean-Luc Picard, the man who couldn’t be pried out of his seat for a vacation for three years!
Captain Jean-Luc Picard: It’s Earth. It’s home. Do I need another reason?
Counselor Deanna Troi: I don’t know, what do you think?
Captain Jean-Luc Picard: Your help has been invaluable during my recovery, but…look, I’m, uh…I’m better! The injuries are healing.
Counselor Deanna Troi: Those you can see in the mirror.
Captain Jean-Luc Picard: The nightmares have ended. All I need now is a little time to myself.
Counselor Deanna Troi: I agree. In fact, I’m delighted you’re going. It’s just that…the choice of where you’re going could stand some scrutiny.
Captain Jean-Luc Picard: If you wish to believe my going home is a direct result of being held captive by the Borg, be my guest.
Counselor Deanna Troi: Is that what you believe?
Captain Jean-Luc Picard: I hate it when you do that.
Counselor Deanna Troi: Captain, you do need time. You cannot achieve complete recovery so quickly. And it’s perfectly normal after what you’ve been through, to spend a great deal of time trying to find yourself again.
Captain Jean-Luc Picard: And what better place to find oneself than on the streets of one’s home village.
Counselor Deanna Troi: Interesting.

I have always found the Star Trek TNG episode Family quite compelling.  The episode (Season 4 Episode 2) deals with Captain Jean Luc Picard’s return home following his capture and assimilation by the race known as the Borg during The Best of Both World’s Part 1 and II (Season 3 Episode 26 and Season 4 episode 1.)

The story is interesting because it deals with some of the issues that people traumatized in combat deal with as they try to find themselves again.  In the story Captain Picard, in a very typical manner of someone traumatized by combat believes that his injuries are healing.  His counselor, Deanna Troi who serves as the Ship’s “Counselor” challenges him on his belief that he has recovered and his choice of where he wants to go to find himself again.

I saw the episode when I was in Seminary not long after completing the Chaplain Officer Basic Course and then saw it again when I was going through my Clinical Pastoral Education Residency.  It was during that process, one in which I was trying to find and define what “home” was, that it really caught me.  I was Captain Picard, the brother who left home to explore and travel while serving in the military.   My brother Jeff was Picard’s brother Robert.  He is the one who stayed home and minded family business.  The parallels then got me and even more so now.  My Residency Supervisor used this to good effect during that time in dealing with the issues of home, but the post combat and PTSD part was yet to come.

Back in the days of my residency I struggled with another of issues related to being a military brat and having begun a career in the Army.  In a sense I was a nomad.  I had lived a lot of places but none were really home, even where I had spent all of junior and senior high school.  Like Picard my eyes were set on far horizons of exploration and adventure of military life.  My brother Jeff on the other hand like Picard’s brother was content at staying at home, being near our parents, getting established in the school district and taking care of his family.   We both chose our own paths and both were right for us.  I still long for adventure and exploration but have begun to settle down.

When it came to the placement of the PTSD in this picture it was after Iraq that I had a crisis in a number of areas in my life and every time I thought that I was doing better and maybe even “getting well” that there was always something that could trigger the memories, bring back the dreams and keep me from sleep.  I can say that a year and a half after my return from Iraq I am doing better in a lot of ways but still having struggles with anxiety insomnia and hyper-vigilance.  I did find out that there is one thing that does not evoke a startle reflex is a foul ball that comes back against the screen in from of me in Section 102 at the Church of Baseball Harbor Park Parish.  Last night while taking pictures right up against the screen I had several balls that hit within a couple of feet of me, one of which hit my camera and knocked it out of my hand.  Anywhere else loud noise, unexpected crashes, things flying past me sends me into a hyper-alert status.

picard familyPicard Meets His Family after Many Years and Wounds Away

When Picard goes home it is not the confident Starship Captain who returns, but a man unsure of himself and where he fits in life.  His encounter with the Borg has changed him and he contrary to assurances to Counselor Troi is still wounded.  When I returned from Iraq I wondered where I fit, I felt like I had abandoned my advisers in Al Anbar when I returned because my relief had to be sent elsewhere do to circumstances beyond my control.  I did not feel a part of my own unit as nothing was the same when I came back.  I felt weak, useless and at the end of my rope after having completed incredible tour in combat of my then 26 years in the military.  Physically I was falling apart; I had several nagging injuries from Iraq that caused chronic pain.  I was flashing back with every moment, fires burning in the Great Dismal Swamp had turned our air the color of an Iraq sand storm while the smell was like that of the ever present burn pits, both military and Iraqi.  Walking out the door one morning with my neighborhood shrouded in smoke I began to melt down.  That day we had a seminar done by a nationally known speaker dealing with trauma and combat with the associated feelings and emotions.  At the end of the day I was a wreck.  My Unit Doctor, Chris Rogan looked at me and said “Chaplain you don’t look good, are you okay?”  I said “no I’m not, I’m losing it and I’m scared.”  That was the place where I finally began to get help.  It has been about 14 months since I started and it is still a process.  We made a trip home that summer and I did not do well.  It was painful and I had great difficulty both in the travel as well as the visit.  When I hear fellow vets talking about the surreal and often painful times that they experience I can understand.  The fact is that you can be with a hundred friends and family members and be totally alone when you return home because it is something that you cannot really share and that they usually don’t understand.  Once again I have been fortunate.  My little brother actually listens to me and lets me vent when I need to.  Of course dealing with our family’s stuff this is a two way street.

not a happy camperVisiting Home and not Doing Well

In the story Picard is offered a chance to leave Starfleet and go to work on a project under the ocean on Earth.  He is sorely tempted to take it but before he can he has an encounter with his brother who challenges his decision.  They exchange words and Captain Picard feeling picked on starts a fight.  During the fight he breaks down about his experiences sobbing in his brother’s arms.  “His brother then said: So – my brother is a human being after all. This is going to be with you a long time, Jean-Luc. A long time. You’ll have to learn to live with it. You have a simple choice now. Live with it below the sea with Louis, or above the clouds with the Enterprise.”

In a sense that is something that all of us who serve after having been traumatized by the experience of wart have to deal with, the physical as well as the psychological and spiritual wounds.  For me it was the realization that I was human after all and the slow realization that this will be with me a long time.  The choice is how I choose to live my life and where I do so.

In the series and subsequent Star Trek: The Next Generation films Picard is forced to deal with his psychological wounds from the encounter with the Borg culminating in the second of those films Star Trek: First Contact. In it Starfleet Command leave Picard and the Enterprise out of the battle leading to this exchange between Picard and his First Officer which deals with the stigma associated with such an injury.

Cmdr. William Riker: Captain, why we are we out here chasing comets?
Captain Jean-Luc Picard: Let’s just say Starfleet has every confidence in the Enterprise and her crew – they’re just not sure about her Captain. They believe that a man who was once captured and assimilated by the Borg should not be put in a situation where he would face them again. To do so would introduce “an unstable element to a critical situation.”
Cmdr. William Riker: That’s ridiculous. Your experience with the Borg makes you the perfect man to lead this fight.
Captain Jean-Luc Picard: Admiral Hayes disagrees.

The stigma associated with psychological injuries is far greater than that of physical injuries.  The unseen injuries are not as well understood and those who suffer them often are broken down by the system as they try to get help and many simply go underground and self medicate.  Last year two Army Generals opened up about their struggles with PTSD. I was fortunate to have people come alongside of me when I went down hard.  People who did not give up on me and kept faith by caring about me when I was and still get down.

See the article at: http://edition.cnn.com/2009/HEALTH/03/06/generals.ptsd/

Despite this and the efforts of many in the Military to help those with PTSD and other “unseen” injuries, to include medical conditions brought on by exposure to toxins in the combat zone, there is still the stigma.  As the young officer suffering from a rare and eventually fatal pulmonary condition acquired in Iraq as well as yet untreated PTSD “I squarely wish I had lost my legs then than the lung function that I have lost!”

Captain Picard’s story of course is fictional, but it demonstrates to some degree what those who experience the psychological and spiritual wounds of war face when they “come home.”  This stuff doesn’t go away.  Here are some of the comments that I have had from readers who deal with their own or a family members PTSD.

Australian Vietnam Veteran who wrote me said:  “As an Australian Vietnam Veteran with PTSD, I find these articles fascinating. I long wondered why the world had to be such a hostile mongrel place. Then 30 years later I was diagnosed with PTSD and I can now relate to why I have the condition but the world has not changed and medication is of limited use. There are many of us who are still very isolated and have to limit our social contacts. I recently started a Vietnam Veterans group, for members of our small unit, on the web and I found men who were relieved to be part of something and someone they could relate to as they had all but withdrawn from society. Sadly a few of them refuse to take any medication for their medical conditions as they see that as prolonging their miserable existence.”

A family member of a WWII veteran said: “thank you. It’s really needed for women to read articles/memoirs like that. It’s easy to say someone has PTSD, but another to live with and love who has it. I come from a family with rich military history and this is an everyday issue. Never goes away, even after 40 – 60 years.”

A USMC Vietnam Vet that I know wrote: “It’s a bitch at times, and the sleep, or lack of will eventually come, although it will never be a fully restful sleep. The Hyper vigilance seems never to go away. Yes it could be good, but eventually it can be bad…. well do I know both.”

An Army Chaplain from Iraq noted: “I too am a chaplain who felt that he and his assistant were the best equipped to handle the horrors of war – just to find out after being home for about a year just how much I had changed. I was sitting with my daughter in my lap one weekend afternoon when she asked, “Daddy, why don’t you play and laugh with us like you use to before you went to Iraq?” It was the key event that brought everything to a point where I could get help. In the months since there have been good days and definitely bad days – however, my faith remains strong….”

I run into people like this every day in the course at work who deal with this and sometimes it spills over into my stuff.  However I am glad to know that I am not alone.  To those who have helped me since I have be back, Chris, Two Feathers, Limey, Greg, Jesse, Jeff, Elmer, my longsuffering wife the Abbess of the Abbey Normal Judy and my brother Jeff, Colonel P and Janet, the folks I work with, the people at Harbor Park, especially Ray, Charlie and the Vietnam Veterans of America who man the beer stand on the concourse behind home plate and all the others who have come alongside I am grateful.  It is my sincere wish and prayer that all veterans will have such fine people there for them when they hit the wall.

Peace, Steve+

Leave a comment

Filed under iraq,afghanistan, PTSD, star trek

Tagged as , , , , , , , , , , , , , , , , , , , , , , , , ,