Life after Trauma

The Vietnam War - PTSD becomes an official diagnosis

The hardest thing for me in Vietnam wasn't seeing the wounded and dead. It was watching the big transport jets come in, bringing loads of fresh new boys for the war.

                                                Johnny Cash  

                                  Marine in Vietnam, 1965

I grew up watching the Vietnam War on television and, by the time I was old enough to be aware of what I was watching, I hated the war and the men who were fighting it. My first boyfriend, who I only dated for several months, was drafted not long after we broke up - the reason, he wanted to have sex and I didn't. Although I agonized over my decision, I realized that I was too young and I was afraid to "go all the way," with someone older than myself. A good decision for me, but one he was unhappy about. Wartime brings out a sense of urgency in young men who are bound for an uncertain future.

My first serious boyfriend, who I began dating in the fall of 1969, was anti-war and anti-draft. In 1970, we wore the grooves out on our Woodstock album and listened to Country Joe McDonald's anti-war anthem over and over. In 1971, we marched in one of the last large anti-war demonstrations in Ann Arbor. We watched as others smashed windows at the Army recruiting office, although we didn't throw any stones.

     

Meanwhile, during those years, young men were coming home from Vietnam: some in body bags, some with physical injuries, all changed permanently. As Jose Narosky says, "In war, there are no unwounded soldiers." Those young men weren't our enemies. We didn't realize it then, but I know it now. The  year we graduated from high school was the last official year of the draft and my boyfriend drew a high number. Meanwhile, the husband of one of my Kentucky cousins wasn't so lucky: he was drafted in 1970 and ended up driving truck in Vietnam. We never spoke of it, but it's possible that he, too, encountered things that he would never forget. The times had changed since my uncles went to war and the returning Vietnam vets had changed with them. Protests were roaring through the country like wildfire and, while many soldiers responded to these protests with anger, others joined them under their own banner.

                      Vietnam Veterans Against the War, 1974

Vietnam Veterans Against the War (VVAW) was founded in New York City in 1967 and began speaking out about the atrocities of the war. Meanwhile, growing numbers of veterans were plagued by symptoms of the complaint known as "soldier's heart" or "shell shock" or "battle fatigue" in earlier wars. In the "speak out" climate of the 60s and early 70s, veterans held "rap sessions," and encouraged each other to share wartime experiences. Initially, veterans referred to their mental health problems as post-Vietnam syndrome.  In 1980, this condition was added to the DSM-III (Diagnostic and Statistical Manual of Mental Disorders), as Post-traumatic Stress Disorder. For the first time, veterans were given an "official" diagnosis for the cluster of symtoms that soldiers have complained of ever since there were wars. This was a landmark moment for veterans not just because they now had a diagnosis for their symptoms, but because having a diagnosis meant that they were more likely to be compensated and better able to organize to deal with the impact combat had on their lives. Watch the clip of Ron Kovic (real-life hero of Born on the 4th of July) below as he talks about Vietnam Vets and their struggle to heal from PTSD.

 

In his interview, Kovic mentions homeless veterans. This is a serious problem, not only for Vietnam Vets, but one already facing veterans of the Afghani and Iraqi wars. For more on Vietnam Veterans and PTSD check out the book Soldier's Heart. 

More next time on how communities can support trauma survivors and how PTSD has been extended to cover a range of other traumas. 

In a hazelwood - a visit to an old friend

It takes a long time to grow an old friend.

                                   John Leonard 

                                                  hazelnuts  

 N. and I met at university when we were in our 20s and soon became friends. N. and I are about as different as two women can be: I grew up in small-town Michigan and she grew up in Tokyo; she is Japanese and I am American; she loves experimental movies and literature; I love Tolstoy and large sprawling movies with a plot. We both love photography, however, the Sunday New York Times and good bookstores. 

This weekend my husband I drove down from Vancouver to the cabin that N. and her husband A. own in a wooded area near Mt. Baker. We stayed a little over 24 hours - a much-needed break from the stresses of our day-to-day lives. We had a delicious Thanksgiving dinner together, met their beautiful new dog, Morgan, caught up on each other's lives, and watched a documentary, Brasileirinho, about choro, a Brazilian musical genre that is a mix of jazz, overlaid with Afro-Brazilian rhythms, with a touch of melancholy thrown in for good measure. I'd never heard of choro, but I agreed that it is music worth loving. 

 

 

We arrived at N.'s in the afternoon, not long before sunset. On Sunday morning, I had more light to explore the house. I admired the view out the front window of a large hazelnut tree and N. told me that there were several other hazelnut trees on their property. A huge stump - probably of a Douglas fir - could be seen from the window of our bedroom and I imagined what the property must have been like before it was logged. I found the wild turkey feather that N. had found on my father-in-law's land more than 20 years before, sitting in a place of honor on a niche in the living room. I wasn't surprised that she still had it because N. was always a person to be attracted to the flotsam and jetsam of the natural world and to hold onto the treasures she found. A Steller's jay feather and a small hawk feather sat on the same shelf. Together, these ephemeral objects told me that N. was still - at heart - the same woman I met so many years ago. 

 Steller's jay (below)

Later that afternoon, when it was time to go, we stood talking by the front door looking out at the hazelnut tree. I was surprised to see that the tree already had catkins on it. It blooms in February, N. told us, yellow blooms that are a welcome break from winter darkness. Earlier in the fall, N. said, the Steller's jays fly back and forth between the hazelnut trees gathering hazelnuts and the air resounds with their calls. As I write this, I love to think about N. looking out the window at the hazelnut blossoms in the spring and enjoying the color and clamor of the jays in the fall. I also smile about her ambition to learn to speak Brazilian Portuguese well enough to travel to Rio and listen to choro in its native habitat.

I expect we'll be back to the cabin someday, but it's hard to say when. It had been more than five years since our last visit. My husband and I had been busy with our growing son, our dying cat, aging parents, health issues and more. N. and her husband were busy with a dying dog, financial worries, and N.'s own health problems. That's the great thing about old friends, even when time passes, as long as you stay in touch, it isn't difficult to pick up the thread of each other's lives. Such rooted friendships provide solace for the losses that often come with growing older. 

 

Thanksgiving - A tough time for some parents

They say everything can be replaced

[But] Every distance is not near

                    Bob Dylan, I Shall Be Released 

 
                                                Mother and daughter 

Another holiday is here and with it, for parents like myself, comes another day when we don't hear from children who are no longer in our lives. It shouldn't make a difference that today is Thanksgiving. After all, my daughter - who I relinquished for adoption when she was a baby - and I have never spent Thanksgiving together - although we had been in reunion for almost 10 years. But it hurts just the same. It hurts that she won't be phoning to wish me a Happy Thanksgiving and is probably eating Thanksgiving dinner with the mother who raised her and her biological father. An unconventional arrangement, to be sure. How it happened is too complicated to explain in this post. In a nutshell, I live on the West Coast and her biological father lives only a few minutes drive away from my daughter. Last year, my daughter's husband died suddenly and things slid downhill from there. Before that, we visited each other most summers and remembered each other on holidays. Now, all that is gone.

Welcome to the heartbreakingly uncertain world of parents with estranged adult children. According to experts like Dr. Joshua Coleman, this type of estrangement is a growing epidemic. And it is never tougher than on holidays. Read  Strangers at the Table for Dr. Coleman's take on why the holidays are so hard. It helps when you realize you're not alone. Still there is no getting around the painful uncertainty of never knowing when the phone might ring and it will be your son/daughter on the other end of the line. When Family Ties Unravel discusses this issue and offers some light at the end of the tunnel. The fact is that many estranged adult children and parents eventually reconcile. On the other hand, others do not.

My grandmother never lived to see the son who left home at 18. Junior was the boy sandwiched between my mother and her older sister Eve. He was a handsome young man who, as can be the way with middle children whether you are the middle of 3 or 12, felt that his father didn't treat him fairly. I don't know whether there was a final argument that made up Junior's mind or whether he meant to come home and never did. All I know is that when he walked out the door of my grandparents house one day in the 1950s, he never came back. Grandma never spoke about it. She was a loving mother, however, so I'm sure she thought about it and, as a Nazerene, I'm sure she prayed about it. I hope those prayers gave her comfort.

The fact is, it doesn't matter how many children one has, the one who is "gone" will always be on your mind. There are stages in the grief of "losing" a child to estrangement, just as there are in losing one to death. However, unlike death there is still hope. This hope can break your heart sometimes and it can also be that tiny spark of love that hasn't gone out. So, on Thanksgiving, if you're grieving for a "missing" child it's okay to feel sad. But even if you're sad, give yourself a break and listen to the Bob Marley song below (sung by Tracy Chapman). I know it always puts a smile on my face. And take a moment to read the poem below. It's not necessarily about estranged parents and children, but it could be. 

 

 

The Place Where We Are Right

From the place where we are right       

flowers will never grow 

in the spring.

 

The place where we are right

is hard and trampled

like a yard.

 

But doubts and loves

dig up the world

like a mole, a plow.

And a whisper will be heard in the place

where the ruined

house once stood.

                Yehuda Amichai (translated from the Hebrew by Stephen Mitchell)

For more on parents and estranged adult children see When Parents Hurt.  Also see 3 Tips for Successful Reunions. 

History of Combat Trauma - Combat fatigue in World War 2

 War is delightful to those who have not experienced it.

                            Erasmus

 

                    World War 2 soldier at rest camp, New Guinea

In World War 1, combat trauma was referred to as "shell-shock." In World War 2, the most commonly used term was combat fatigue or battle fatigue. Unlike World War 1, soldiers were not executed for desertion if they exhibited the symptoms of combat trauma. Indeed, American psychiatrists, J.W. Appel and G.W. Beebe, wrote that, in their opinion, "There is no such thing as 'getting using to combat' . . . Thus psychiatric casualties are as inevitable as gunshot and shrapnel wounds" (quoted in Judith Herman 1997:25). A great deal of data was collected about trauma in World War 2, but treatment doesn't appear to have changed very much since the previous war. Treatment focused on soldiers resting at camps as close to the front as possible and returning to combat within a fairly short time. Following in WHR River's footsteps, psychiatrists also recognized the importance of the bonds between soldiers and the role of leadership, in preventing or minimizing combat trauma. 

Even though soldiers, like my Uncle Dellous, were treated humanely by medical staff, soldiers with a diagnosis of "combat neurosis" or "combat fatigue" continued to be stigmatized by both the military and the larger society. In August 1943, General Patton was involved in two incidents where he humiliated soldiers hospitalized in Sicily for combat fatigue. He called them "yellow bastards" and said they should be sent back to the front immediately. In one case, he even slapped a recuperating soldier. Even though the head of the hospital didn't report these incidents, word eventually got back to General Eisenhower who severely reprimanded Patton, although he did not remove him from active service. 

 

                General Patton in Sicily, 1943

No wonder, then, that men like my uncles returned home and rarely, if ever, spoke about their war experiences. Both men were haunted all their lives by these experiences, but, as far as I know, did not receive any treatment or medical support for the traumas they incurred in combat. Thousands of other soldiers were in the same situation and rarely spoke about their war experiences. Some were even hospitalized with diagnoses of mental illnesses unrelated to their war experiences.  It is only after the diagnosis of Post Traumatic Stress Disorder became well known that World War 2 veterans have been comfortable telling their stories. The video below shows poignant footage of World War 2 veterans sharing their combat stories in a supportive group setting, most for the first time. 

  

 

As World War 2 veterans near the end of their lives, others have come forward to tell their stories. Michigan veteran John Landry was compelled to tell about his experiences in the Battle of Okinawa after his memories were stirred up by images from the war in Iraq. Sadly, my uncles never shared many war stories. They were probably too ashamed or felt that such stories weren't suitable subjects to speak about. Dellous, apparently, never talked about his war experiences at all and Wesley only when he was drinking. These stories have gone with them to their graves: the stories of two young men whose lives changed forever on the battlefields of World War 2. 

                                                Uncle Dellous, circa 1957

Why do you think it is so difficult for veterans to speak about their war experiences?

Rumi & dogs wearing coats

Seeds feed on ground awhile, then lift up into the sun. So you should taste filtered light and work toward what has no personal covering.That's how you came here, like a star with no name. Move in the night sky with those anonymous lights. 

                                    Rumi

                                                Bubble galaxy viewed from Hubble

 Yesterday wasn't a good day. It was my father's birthday and I phoned to wish him a happy birthday My mother answered the phone. She was feeling terrible, she said, and I tried to talk to her about the things the doctor had suggested doing to cope with the anxiety attack she was having and her arthritis pain. She didn't want to listen and handed the phone to my father who told me that he didn't want to listen either, that he knew better, etc. etc.  It was another frustrating call with my parents. 

After I hung up the phone, what started out as a good day became a "dark" day. I now felt terrible too. For people with PTSD this kind of upset, often out of proportion to an event, is referred to as "triggering." Triggers can be internal or external. Internal triggers can be emotions triggered by an argument or a conversation or any other event that leads to a spiral of negative feelings. External triggers are things like anniversaries, smells, sounds, or people.

Normally, I am pretty good at managing my response to triggers. However, sometimes I'm not so good. The last time I saw my doctor, she said that having "bad" days was part of the PTSD terrain and that it was important to accept that. After more than a week of good days, I wasn't in an accepting mood. I felt frustrated and helpless in the face of my unpleasant emotions. No, I didn't feel like: going for a walk, reading a book, or just about anything else my husband suggested. Luckily for me, my son was more insistent and urged me to come and watch a DVD with him. We watched an episode of the wonderfully-produced Wallander Swedish-detective series together. And, oddly enough, watching Kurt Wallender lurch from one crisis to another lifted my spirits. 

The next morning I still wasn't feeling great. When I got up, my husband had made blueberry pancakes and sausage for breakfast and I ate a good breakfast, then felt like going back to bed and I did for a while. Then, my husband suggested that we go for a walk, so we went to Kitsilano and strolled along a stretch of Broadway that we both particularly like. I found a beautiful book of Rumi's poetry in  one of my favorite used bookstores (where I found the poem above). We had hot chocolate and muffins at Uprisings, a new bakery in the neighborhood, and sat by the window and people-watched. Some people were alone, some had children with them, and some had dogs, many of which were wearing small coats or sweaters. It was a cold day for Vancouver, and when it actually gets below freezing here, many people - and their pets - dress as though it was the Arctic. I once lived much closer to the Arctic than here and it always cheers me up to see people behaving as though it were terribly cold, when it really isn't.

 

                    dogs wearing coats 

Then we went home and I read Rumi and found the poem above. I can't say that I understand it, but I love the images of seeds lifting to the sun and people "tasting the filtered light." That's how it is sometimes. I get by on dark Swedish mysteries, Rumi, hot chocolate and little dogs dressed in funny coats. And life goes on.

What sorts of things cheer you up or help you cope with "bad" days? 

The Healing Power of Song

Those who wish to sing will always find a song.

                                Celtic Proverb

 

 Growing up, singing was as much a part of my life as breathing. My mother loved singing, and sang to us children often. The song that still sticks in my mind was one called The Chocolate Ice Cream Cone, which told the story of a child sent to the store to buy a chocolate ice cream cone. The ice cream cone meets a tragic end and the song's last lines go, "And now I'm lost can't find my home/And all because of that chocolate ice cream cone." My mother sang that song so much, that she thought she'd written it, when it was really the legendary country singer Rose Maddox who did. But I didn't care; I loved that sad, sweet song. 

 In junior high, I went to a school with equal numbers of white and African-American children. We sang in the locker-room and the halls and, summers, my girlfriends and I sang along with Motown songs, as we walked the neighborhood sidewalks carrying tiny transistor radios. At school, I was in choir, a lively affair conducted by an African-American woman. After Grade 8, my family moved away to a mostly white neighborhood with no choir and, sadly, my "formal" singing days were over. 

 

After high school, in the dark days I've written about in an earlier post - Bereft - I bought a guitar and began singing again. Only to myself. This singing helped to sooth the intense grief that I'd buried so deep that I didn't even let myself think about it. Years passed and I had a son who I sang to until he decided singing wasn't "cool" anymore. Then, for a long time, I let singing drop out of my life. In the summer of 2010, after an intense reunion with my ex-boyfriend - the father of my daughter - I picked up singing again like an old friend. I sought out workshops and that's how I found myself during a week in August sweating in a small church in East Vancouver with about 40 other singers of all ages and levels of experience at a  workshop in a cappella singing with two members of the No Shit Shirleys, Karla Mundy and Dawn Pemberton. When it came time for my favorite song - Moses Smote the Water -  I would take off my shoes and stand up and sing with all my heart. "Sister ain't you glad?" we'd belt out and I could feel the wood floor warm under my feet as I danced and sweat run down my back. For a little while, my sorrow moved further away. (Take a minute to enjoy the video below showing part of The Shirleys concert at the 2010 Vancouver Jazz Festival. (Karla, 2nd from left; Dawn, 4th from left))

 

 

 After the workshop, I got into one of the choirs Karla directs. This is my second season with the choir and the singing we do together feeds my soul. When I'm singing, there isn't any room in my mind for worry or in my heart for grief. In 2010, I also started working with a new therapist and when she heard about my singing she said, "Great, you're really getting your voice back." She meant that literally and figuratively. I agree becauseI have been silenced by people who didn't want to hear my story or see my grief.

Other people with PTSD, including Vietnam Vets, are also discovering the healing power of music. 

Has music or singing helped you with grief or processing trauma?  What's your story?

World War II: a tale of two brothers

I hate war as only a soldier who has lived it can.

                        Dwight Eisenhower

                   Kentucky

Dellous was the first word my mother ever spoke. She was a year old and her oldest brother Dellous and her second brother Wesley were swimming in the creek. They were goofing around and hooting and hollering and having fun. My mother was too young to understand that they were playing and she yelled out "Dellous" because she was afraid he was in danger. About ten years later, Dellous was drafted. It was 1943 and he was only 18 years old. He and my grandfather walked up to the highway and stood waiting for the bus that was coming to take Dellous to war. When the bus arrived my uncle picked up his suitcase and got on, leaving the only world he had ever known: the close-knit farming community in southern Kentucky where his ancestors had lived for generations. 

Dellous was sent to New Guinea. At one point, the soldiers in  his division ran out of ammunition. The commander chose 125 of the strongest swimmers to swim to bring back ammunition; Dellous was one of them. The swimmers were beset by snipers, fatigue, and crocodiles. They swam almost continuously for three days and nights. Dellous contracted pneumonia, but kept swimming until he collapsed, delirious with fever. He was evacuated and sent home, shell-shocked and sick. Apparently, the South Pacific had the highest rate of combat trauma in World War 2: 44 men per 1,000. (This story was told to me by Dellous's younger brother who heard it, not from Dellous, but from one of the men he served with, who attended Dellous's funeral.)

 Wounded soldier, New Guinea (at right)

Dellous's war was over, but Wesley's was just beginning. Wesley volunteered when he was 17, was sent to Europe and fought there until the end of the war, when he was involved in the liberation of a concentration camp in Germany, quite likely Dachau. When I was young I found pictures of a concentration camp in a drawer of my grandmother's dresser. "Mom," I asked with horror, "what are these?" Pictures from when Wesley was in the war, she told me and that was all. Whichever camp Wesley was at, it changed his life forever. The things he saw there were so horrific that he re-upped after the war and remained behind in Germany to help with the execution of Nazi war criminals. He only spoke of those days when he was drinking, and hated Nazis until the end of his life. The Holocaust Memorial Museum in Washington, DC has a website with a wealth of information on all aspects of the Holocaust. 

Execution, Landsberg, Germany, circa 1946

 

 

Aftermath

Wesley, far left, Dellous back right, holding baby, circa 1950

Everyone agrees that Dellous and Wesley were never the same after the war. For one thing, they both drank and Dellous, who lived in a "dry" county, would go away for days at a time and come back subdued and contrite. Dellous stayed in Kentucky and built a house near the spot that he'd waited for the bus to go to war. Wesley went north to Michigan with his wife Kathy. Even in his 70s, Dellous would go out digging 'sang, as it's called in the South, and he told me that some of the places he went were so remote that if he fell or was snake-bit they'd only be able to find him by looking for the vultures circling. I think he craved the solitude those kinds of places offered. The last time I saw Uncle Dellous, we had taken my young son to visit his Kentucky relatives. It was hot and we walked out into the yard in search of shade. My son found a toad in the tall grass at the side of the house. A toad-frog Dellous called it. He picked it up and gently placed it on my son's hand. My uncle probably already had the lung cancer that would kill him in about a year or two, but no one knew it yet. 

Uncle Wesley and Aunt Kathy lived in a small house and had a series of little dogs, including a chihuahua that was fiercely jealous of me and tried to nip me whenever Wesley hugged me. I ate snapping turtle and other wild game at their table and he came to my wedding in 1976. He was about 50 then and a strong, vital man. The second 50 years are supposed to be the best, he told me that day. He made it for about another 25, then developed dementia. At the end, he fell into a coma. Then, one day, he spoke out of his coma: "Soldiers!" he called out. "There's no mercy here, no mercy at all. There's dead bodies lying everywhere." Those were his last words.

Do you know any stories about relatives who served in World War 2?  I'd love to hear them. 

 

Poet Wilfred Owen: Bearing Witness to World War I

My subject is War, and the pity of War. . . All a poet can do today is warn.That is why the true Poets must be truthful.

                    Wilfred Owen 

Wilfred Owen is considered by many scholars to be the greatest poet of World War I. His gritty poems could only have been produced by someone intimate with the horrors of the World War I trenches. Owen was born in England on March 18, 1893 and began writing poetry in his teens. He enlisted on October 21, 1915 and was commissioned as a second lieutenant in June, 1916. When he first enlisted, perhaps, he believed in the myth of the glory of war. That romanticism didn't last long. 

In January 1917, Owen wrote to his mother. "I can see no excuse for deceiving you about the last 4 days," his letter says. "I have suffered in seventh hell. . . . Those fifty hours [in the dug-outs] were the agony of my happy life. I nearly broke down and let myself drown in the water that was now slowly rising over my knees." (from First World War Poetry Digital Archive) In April of the same year, he, again, wrote his mother. "For twelve days I did not wash my face, nor take off my boots, nor sleep a deep sleep. For twelve days we lay in holes where at any moment a shell might put us out." (Ibid.) Not long after, Owen developed shell-shock and was sent to Craighlockhart War Hospital in Edinburgh, Scotland where he was under the care of Captain A.J Brock. 

   

 Captain Brock treated shell-shock patients through encouraging them to take on projects, such as the production of the hospital-based literary magazine, The Hydra, which Owen edited. Owen's first war poems were printed in its pages. Also at the same hospital was poet Siegfried Sassoon and the friendship between the two poets had a major influence on Owen's work. After one visit with Sassoon, Owen wrote another friend that Sassoon had advised him to, "Sweat your guts out writing poetry."

 
Siegfried Sassoon, circa 1915 (right)                                                          

from Exposure by Wilfred Owen 

The poignant misery of dawn begins to grow . . . /We only know war lasts, rain soaks, and clouds sag stormy./Dawn missing in the east her melancholy army/Attacks once more in ranks on shivering ranks of grey,/But nothing happens.

Tonight, this frost will fasten on this mud and us,/Shrivelling many hands, puckering foreheads crisp./The burying-party, picks and shovels in shaking grasp,/Pause over half-known faces. All their eyes are ice,/But nothing happens. 

At the hospital, Owen and Sassoon were encouraged to talk about their combat experiences and praised for their poetry. This was an unusual treatment for those times. WHR Rivers (Sassoon's doctor) wrote that, "The advice which has usually been given to my patients in other hospitals is that they should banish all thoughts of the war from their minds." It was a gift that both Owen and Sassoon were treated by doctors who respected the healing power of bearing witness to trauma. 

Owen's Anthem for Doomed Youth  and Dulce et Decorum Est were written at Craiglockhart. Both poems were a far cry from the serenely measured stanzas of "In Flanders Fields", which has become the most famous poem written about World War I. Owen would have had little use for such lines as those in the final stanza of "In Flanders Fields." Take up our quarrel with the foe:/To  you from failing hands we throw/The torch, be yours to hold it high. By contrast, the final lines of Owen's "Dulce et Decorum Est" show the poet's outrage over the meaningless deaths of the men under his command. The poet writes, that if they had seen with their own eyes the horrors of the trenches, "My friend, you would not tell with such high zest/To children ardent for desperate glory,/The old Lie: Dulce et decorum est/Pro patria mori."  (How good it is to die for your country.)

Tragically, that is exactly what Owen, himself, did - die for his country. He was killed on November 4, 1918 only one week before the end of the war. He was only 25. The last letter he wrote to his mother told her that, "You could not be visited by a band of friends half so fine as surround me here." (First World War Poetry Digital Archive) 

                                    Wilfred Owen's regiment

For more on war poetry, check out the splendid anthology, Against Forgetting. The friendship between Owen and Sassoon, and their treatment at Craighartlock Hospital,  has been brought to brilliant life in Regeneration by British author Pat Barker. 

For yet more readings go to Small Wars. 

The History of Treatment for Combat Trauma - Shell Shock in World War 1

What passing bells for those who die as cattle?

Only the monstrous anger of the guns.

Nor any voice of mourning save the choirs, - 

The shrill, demented choirs of wailing shells.

                    Wilfred Owen, from Anthem for Doomed Youth 

 

British soldiers, The Somme, 1916 

World War 1 was one of the deadliest wars in history. Approximately 16 million soldiers from over a dozen countries were killed in the field and many more were injured. Soldiers in World War 1 faced horrors that were, in many ways, unique to that war, including mustard gas, using men as cannon fodder in the wars infamous trenches, and execution for soldiers who broke under the strains, which were immense. The sister of one man who was traumatized during the war could still remember when she was 95, how distressing his symptoms had been, waking the entire household up on many nights. "It was absolutely terrifying when he woke up screaming, screaming and screaming," she remembered. (See the Liddle Collection for more). The article below describes the brutal conditions soldiers fought under. 

Trench Warfare

Shell Shock

Shell shock was the name given to combat trauma in the First World War. This was a name that stuck through World War 2 and it wasn't until the Vietnam War, when veterans played an assertive role in their own treatment, that the diagnosis of PTSD was applied to the condition of combat trauma. Initially, officers of the Allied Armies, particularly the British Army which I'll focus on here, disciplined, shamed and even executed soldiers who developed shell shock. However, soon the problem grew to such proportions that execution was no longer an option. In five months in 1916, for example, 16,000 cases of shell shock were diagnosed in the British Army, during and following the Battle of the Somme. Some speculate, that one of the reasons there were so many cases was because of the conditions soldiers faced in the trenches: trapped for weeks or months at a time, never knowing when they would come under attack or be struck by shells. 

 

Treatment

• Soldiers with shell shock were first sent to clearing stations near the front
• After two weeks, if soldiers didn't recover, they were sent home to England
• Treated at a number of hospitals designated for this purpose
• Treatments varied from shaming, use of electric shock, isolation and even withholding food
• More humane techniques were developed by people such as W.H.R. Rivers, William Brown, and others 

W.H. R. Rivers (below)

 New approaches to treatment

    Prompt treatment
    Opportunities to share traumatic memories
    Emphasis on finding meaning in these     experiences
    Use of cognitive therapy
    Partnership between therapist and patient

 

Today, scholars who specialize in trauma and PTSD, give credit to Rivers and others for pioneering treatment for PTSD. Rivers, as we will see in my next post, treated poets Wilfred Owen and Siegfried Sassoon. Trauma scholar, Judith Herman, writes that "River's treatment of Sassoon was intended to to demonstrate the superiority of humane, enlightened treatment over the more punitive traditionalist approach" (Herman 1997:22). For more on these new approaches to treating shell shock go to, The treatment of shell-shock by Peter Howorth. Rivers work is commemorated in the novel Regeneration by Pat Barker. Go to W.H.R. Rivers for a moving tribute to the man and his work. 

(Next posting, more on Rivers, Sassoon and poet Wilfred Owen.)

What is psychological trauma and what causes it?

May 22, 2011 is the day my life changed forever.

                            Joplin, Missouri tornado survivor 

Today, I want to take a step back to define two of the terms you will encounter on this site: psychological trauma and traumatic events. Today's post will be the first in a series that will explore the range of traumatic events that people experience and the physical, psychological, and emotional responses they have to these events.

Traumatic is a word that you may have heard people use when describing an event that was unpleasant, such as a bad day at work, a difficult exam, an awkward date, or giving a public speech. In the world of trauma survivors, the words traumatic and trauma have precise meanings. Traumatic refers to an event that is so outside of the ordinary life of most people that it is completely overwhelming. Renowned trauma researcher, Judith Herman, eloquently describes the state of psychological trauma in her landmark book, Trauma and Recovery. "Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning. . . . They confront human beings with the extremities of helplessness and terror." 

These women are responding to the 2008 earthquake in Sichuan, China.  Whatever the women are responding to, whether finding out about the death of loved ones or the loss of homes, has already happened and, as is true of psychological trauma, there is nothing they can do - the harm has already occurred. As Herman writes, "Traumatic reactions occur when action is of no avail."

"Oh my God, it was hell," a Hurricane Katrina survivor told a reporter, about the hurricane that affected thousands of residents of New Orleans. "We were screaming, hollering, flashing lights. It was complete chaos."

An English-speaking man who was in Japan during the 2011 earthquake and tsunami, put together this detailed account of how people were feeling immediately afterwards.  You can read an interview below with a survivor of the Rwandan genocide of 1994. 

Examples of Traumatic Events

• Natural disasters
• Genocide
• Sexual violence
• War-related events
• Combat trauma
• Terrorist attacks
• Torture
• Child abuse
• Domestic violence
• Accidents
• Medical trauma

Common physical, psychological, and emotional reactions to traumatic events include:

• shock
• extreme helplessness
• intense fear
• loss of control
• amnesia and dissociation 
• hyperarousal
• numbness
• extreme grief

Another hallmark of many - although certainly not all traumatic events - is that they are sudden, unexpected and may last from mere minutes to only hours. 

Length of Selected Traumatic Events

• Bombing of Nagasaki on August 9, 1945   approximately one minute
• Joplin, Missouri tornado May 22, 2011  about 38 minutes 
• Japanese 2011 Earthquake and Tsunami: several hours 
• 9/11  Events in New York City: about 8 hours
• Rwandan genocide, 1994 about 100 days 

 

Joplin, Missouri tornado report

My life changed suddenly too. First, on July 25, 1971 - the day my daughter was born.  And, then, on November 12, 1991, the day I nearly died from a ruptured ectopic pregnancy. Both traumatic events took place over the course of about 10 hours. The aftermath of the loss of my daughter has lasted most of my life. I processed most of the grief, terror, and anger related to the ectopic pregnancy within several years, although I continued to have panic attacks related to the event for nearly a decade. In both cases, my life changed irrevocably within the span of about half a day. 

What traumatic events have you experienced that changed your life?

Accepting life with PTSD and other chronic conditions

Ring the bells that still can ring

Forget your perfect offering

There is a crack in everything.

That's how the light gets in.

        Leonard Cohen    

This morning before I even had my coffee, my husband said that we needed to talk about money. Money is not a subject that I enjoy talking about at the best of times. Now, is anything but the best of times. My therapist and doctor have both advised me to work part-time while processing my grief and trauma. And so, for now, I'm working about 20 hours a week as a freelance writer and editor and selling books online. Neither job is bringing in much money and times are tough right now because I'm waiting to be paid for a project I've just finished.

Which brings me to the discussion about money that my husband and I had - or tried to have. It started out reasonably enough, then, as is so often the case, he lurched into my sorest spot - the fact that he is working full-time and makes much more money than I do. I don't think that he meant to poke me in my sore spot, he just forgot how sensitive about this financial imbalance in our relationship. To be blunt, I hate being financially dependent. When I'm being unkind to myself, that's what I call it dependence. 

I don't think anyone with a chronic condition, whether physical or mental, relishes not being able to work as much as they once could. I have a cousin with fibromyalgia, a friend with MS, and several other friends with cancer, all of whom face this challenge. Complex PTSD is no exception. Working full-time is simply too stressful. I used to be able to do it when I was younger and when I was not aware of the grief and trauma I was carrying. Awareness and acceptance are not the same thing. Most days, I'm okay with my limitations. Today, brought face-to-face with money issues and my own feeling of inadequacy because I'm not "well" and can't make more money, I felt terrible. I felt terrible for most of the day. My self-talk was unkind. To be honest, it was brutally unkind. Apparently, this is a problem that others with PTSD face. 

See PTSD and self-compassion for more on how the way we feel about ourselves has an impact on our ability to heal. 

 

Beating ourselves up, isn't the answer. Kindness and self-compassion are. Once those small but powerful words crept into my mind - probably while I wasn't looking - I began to slowly feel better. After a while, I came downstairs from our bedroom, where I had been lying and thinking dark thoughts for most of the afternoon, ate dinner with my family, and then sat down to write this post. I'm not suggesting that self-compassion comes easily. Far from it. All too often I blame myself for having PTSD, even though I did not traumatize myself. This desire to be perfect is an obstacle to psychological and physical healing. See Letting Go of Perfection  for more on perfectionism. 

What challenges related to PTSD or another chronic condition do you find the hardest to accept?

Women of the Congo show resilience in the face of trauma

You can fall, but you can rise also.

                Angelique Kidjo

Yesterday was my birthday. I had planned to write a post today on gratitude because I was grateful for the many gifts of the day. However, before going to bed I was looking for videos on women in the Congo for a future posting when I found a video that I liked so much that I decided to build this post around it. The video is a moving testimony to the power of life to transcend unimaginably difficult circumstances.

This quality is known as resilience: the ability to adapt in the face of adversity. Once I decided to write about resilience, I discovered a blog with a posting on resilience and trauma. Rocky Reichman, who describes himself as a "young entrepreneur, writer, and dancer" who is "passionate about helping people be more resilient," writes that about 85% of all people are resilient "even in the face of trauma and PTSD."  Go to his post,  Lessons from the Resilience Experts, to find out more about trauma and resilience. His posting gave me a lot to think about. For example, the difference in thinking of oneself as a survivor, rather than a victim, is a huge one and can create one of those paradigm shifts that change lives; it has changed mine.

Which brings me to the Congo. After the 1994 genocide in Rwanda, thousands of Hutus, many who are members of the notorious death squads, the Interahamwe, entered the Congo and brutal fighting has been going on ever since. So many women have been raped by soldiers, that the Congo has earned a reputation as the "rape capital of the world." There is no doubt that terrible things are going on in the Congo. However, rather than focusing on the terror, we should also focus on how the women of the Congo are going on with their lives in the shadow of death and rape. Beauty grows in the least likely places and we should celebrate it and support it. The opposite, focusing on the horrors of such situations and viewing the people involved as helpless victims can paralyze us and overwhelm us, making it nearly impossible to hope or to act. 

Congolese Queens by tvnpo

To find out how you can support resilient women who are working to survive the trauma of war, check out the links below:

Women for Women 

Run for Congo Women

City of Joy

How have you shown resilience in the face of trauma or other difficulties? I'd love to share your story.