Odysseus in America (27 page)

Despite our proud boast to be at the top of the animal kingdom, we are not the only species that has ever responded to great danger and then failed to unlearn those responses after the danger has passed. Our vulnerability to being injured in this way goes very far back into evolutionary history. What the APA calls PTSD (and I shall call “simple PTSD”) is probably rooted in an array of changes in the physiology and anatomy of the central nervous system
³
—and may be irreversible. An injury, not a disorder! As with any injury, the symptoms can range from mild to devastating, depending on the severity of the wound, the robustness of health at the time of the injury, and the conditions—especially nutrition—under which recovery occurred. In the case of a physical wound what counts is physical
nutrition; in the case of a psychological injury what counts is
social
nutrition.

Like physical injuries, simple PTSD can lead to specific disabilities. For example, an infantryman may learn from horrible experience that any bunching up or dense gathering of soldiers, particularly in the open, offers a too tempting target to enemy mortarmen and snipers. Later, in peacetime, this same infantryman may have an unshakable and non-negotiable fear of crowds and open spaces. In civilian life this is a disability. It interferes with various social, economic, and political functions that the veteran may want to take part in. The collision between the old combat adaptation, such as fear of crowds, and the requirements of a current civilian activity, may cause him to engage in
further
adaptations to his disability that allow him to salvage something. For example, in order to avoid crowds, but still be able cast his vote in elections, this infantry vet may show up at the polls before they open in the morning, may urgently insist on being the first one in the door, and be almost frenzied, possibly rude in his haste to be out again. His family and the poll workers probably view his behavior as annoying or even deranged. However, the resiliency, energy, and will he puts into such adaptations are of the same species as the amputee puts into playing ice hockey.

We all know or know of people with physical injuries who nonetheless have been able to make a flourishing human life, despite their specific disabilities. There are many famous heroic examples of this, such as Helen Keller. I have the privilege of knowing United States Senator Max Cleland of Georgia, an Army veteran who lost two legs and one arm from a Vietnam War grenade explosion. My impression is that, despite his specific disabilities, he has a flourishing life. We can only guess at and admire the personal strength, resiliency, and struggle that enabled him to achieve this, and do not fault others with similarly terrible injuries who have been laid low by them. Not everyone is a Helen Keller or Max Cleland, nor should we require them to be.

Depending on their severity and the resources and resiliency of the survivor, simple PTSD injuries can be disabling in the same sense that physical injuries are. But they do not
necessarily
blight the whole life of the person that bears them. Some combat veterans shrug off their nightmares, startle reactions, avoidances, and so forth as things to adapt to and live with, again akin to physical injuries. Their life is changed, to be sure, and often limited in specific ways, but the possibility of it being a good human life is not destroyed.

However, when the injury invades character, and the capacity for
social trust is destroyed, all possibility of a flourishing human life is lost. I (and many others) call this “complex PTSD.”
⁴
Social trust is
the expectation that power will be used in accordance with “what's right.”
When social trust is destroyed, it is not replaced by a vacuum, but rather by a perpetual mobilization to fend off attack, humiliation, or exploitation, and to figure out other people's trickery. Veterans with complex PTSD see the civilian world in the same two dimensions as Homer's warriors saw warfare,
biē,
violent force, and
mētis,
cunning. Civil society, the world of the civilian at peace, is founded in a third dimension of trust that power will be used in accordance with “what's right.” In actuality, both
biē
and
mētis
play significant roles in the modern state. However, no
legitimate
government anywhere in the world or in any historical era has ruled purely by armed might and deceit alone. Trust that power will be used in accordance with “what's right,” however locally understood, is a key component of state legitimacy. This third dimension is invisible to veterans with complex PTSD, or they deny its existence. Claims of trustworthiness by any institutions of power—whether governments, employers, economic or educational institutions—seem to these veterans to be a deceptive veneer hiding a violent and exploitive reality.

Complex PTSD veterans usually suffer this along with their adaptations to war, so complex PTSD usually includes simple PTSD. At least this is true of the veterans we see in the VA clinic. Possibly a veteran like Odysseus with no simple PTSD, only injuries to good character, would never come to the VA. In
Achilles in Vietnam,
I observed that the World Health Organization (ICD-9/10) diagnosis “Enduring Personality Change After Catastrophic Experience” yields complex PTSD when added to the DSM diagnosis of (simple) PTSD. However, I was baffled by the WHO assertion that “Enduring Personality Change After Catastrophic Experience”
excludes
PTSD. This diagnosis fits Homer's Odysseus quite well, but in our clinical experience, symptoms of simple PTSD are present even in the most Odyssean veterans we work with.

Lying and deceit are valuable military skills, for which Odysseus boasted, “Men hold me formidable for guile.”
⁵
In war, “they”—the enemy—really are out to kill you. The modern soldiers own military organization propels the soldier into the presence of that enemy and holds him captive in the war zone. This happens in all modern wars. Added to that in the Vietnam era were multiple violations of good military practice and betrayals of “what's right.” After such experience, any friendliness and cooperation may only look like manipulations to trick innocents into a position where they can be exploited or hurt. One often hears veterans
describe themselves as “paranoid” when speaking of their vigilance against harm, humiliation, or exploitation. Mental health professionals frequently agree with this label, although I believe that nothing is added to our knowledge about the veteran by using this psychiatric jargon, and much is lost in prejudicial stigmatization. It suffices to say that a given veteran does not trust anyone.

Acts of war generate a profound gulf between the combatant and the community he left behind. The veteran carries the taint of a killer, of blood pollution (perhaps what Dennis Spector described above as a need for rebirth) that many cultures respond to with purification rituals. Our culture today denies the need for purification and provides none, even though in the past it has done so. Both the veteran and his community may question the wisdom of return. The community worries about the veteran's self-control. The veteran, knowing what he is capable of, may also fear losing control. He may fear that if people knew what he has done, they would reject him or lock him up in a prison or mental hospital. Both the veteran and the community collude in the belief that he is “no longer one of us.” Many Vietnam combat veterans with complex PTSD express the feeling that they died in Vietnam and should not have returned.

The anguish of guilt drives some away from life with others, but some, like former Senator Bob Kerrey, seem motivated by it to devote their lives to the service of others. The next chapter presents a good deal about what might be called medical-psychological therapies. They often help manage guilt, but they are not, and should not be, the only therapies available for moral pain. Religious and cultural therapies are not only possible, but may well be superior to what mental health professionals conventionally offer.

In the medieval Christian church, everyone who shed blood in war had to do penance. If you committed atrocities, you had to do more penance, but even if you wore a white hat and were a perfect model of proper conduct, you had to do penance. Most warrior societies, as well as many not dominated by warfare, have historically had communal rites of purification of the returning fighter after battle—the purifications in Numbers 31:19ff, for example, in the Hebrew Bible.
⁶

The performances of the Athenian tragic theater—which was a theater of combat veterans, by combat veterans, and for combat veterans—offered
cultural therapy, including purification. Aristotle famously said that tragedy provides
“katharsis.”
Scholars tell us that three meanings of
katharsis
circulated in Aristotle's time and were used by him at various places in his work: (1) religious purification of a ritual taint and expiation of a religious sin; (2) medicinal purgation of something unhealthy, poisonous, or impure; (3) mental clarification, removing obstacles to understanding, the psychological equivalent of producing clear water from muddy.
⁷
The ancient Athenians had a distinctive therapy of purification, healing, and reintegration of returning soldiers that was undertaken as a whole political community. Sacred theater was one of its primary means of reintegrating the returning veteran into the social sphere as “citizen.”

The early Romans had a ceremony of purification for returning armies, the details of which we know little. It apparently involved passing under a beam erected across a street, with head covered, as well as other ceremonies, purifications, and sacrifices. The French scholar Georges Dumézil writes,

The legend of Horace—victorious, furious, criminal, and purified—served as myth at the annual ceremony which marked the end of the military season, in which the warriors of primitive Rome passed over from the domain of Mars [the Roman god of war] unleashed to that of
“Mars qui praeest paci”
[Mars who is in charge of peace] thus … thereby desacralizing themselves, and also cleansing themselves for their acts of violence in battle which, if not “involuntary,” were at least necessary.
⁸

One of my patients, a Vietnam vet, was greeted by his father, who was torpedoed in the World War II Merchant Marine, with a $50 bill on his return from Vietnam and the words, “Here. Get drunk. Get laid. And I want you at the union hall on Monday morning.”
That
is not purification after battle.

Over the years, I have said to my patients (who are almost entirely Roman Catholic because of the demography of the local veteran population), “If the Church's ideas on sin, penitence, forgiveness of sin, and redemption are about anything, they're about the real stuff. What the Church offers is about cruelty, violence, murder—not just the sins you confessed in parochial school.” My clinical team has encouraged many of the veterans we work with to avail themselves of the sacrament of penance. When a veteran does not already know a priest he trusts to hear his confession, we have suggested priests who understand enough about combat neither to deny that he has anything to feel guilty about nor to
recoil in revulsion and send him away without the sacrament. We also recommend service to others and the doing (not simply passive consumption) of the arts as ways of living with guilt.

Have we learned nothing about the importance of judging separately a war and the people who fight it? Yes, the Nuremberg Principles on war crimes are crucial. But do we condemn the inexperienced young Navy lieutenant Bob Kerrey for not refusing an order because it
could
lead him into the illegal act of killing unarmed women and children if the mission failed in some specific way, but not if it went off as conceived?
⁹

While it is true that rapid social changes took place while many Vietnam veterans were in the military and away in Vietnam, I have pointed out repeatedly that this gulf between veteran and civilian is generic, and was experienced by returning combat veterans of prior wars. It is historically typical for returning American war veterans throughout our history to be ignored by the communities they returned to, rather than to be celebrated and cherished by them.
¹⁰
The experience of the World War II veterans—the fathers of the Vietnam veterans—is the historical
anomaly.
Toward the end of World War II, politicians with fresh memories of the Bonus Army of World War I veterans worried about so many returning soldiers looking for jobs. Willard Waller, the World War I veteran whom I have quoted so many times in this book, did his best to see that they
were
worried, warning of the social and political nitroglycerine that millions of returning veterans could present to civilian society. Congress appropriated unprecedented benefits.

Farmers from the Revolutionary War returned to find banks foreclosing their farms because the money the government gave them was no good. These first American veterans encountered a Platonic/Stoic/Puritan view that yes, what they had done in the Continental Army was virtuous, but virtue itself is sufficient to well-being
¹¹
—so why are they asking for money? Implicit in this philosophic position is the reasoning that if the veteran does
not
have well-being, his virtue is somehow defective. Therefore, logically, misery and disability must be his own fault, his own deficiency of virtue, and therefore unworthy of compassion.

Sound familiar?

Only in the period after the War of 1812 did the nation awaken to its duty toward the veterans of the War of Independence. In his 1999 book,
Suffering Soldiers,
historian John Resch examined wealth and number of children for all the men of a single New Hampshire town from 1792 to 1823. He found that on the average, those who never served, or who joined the short-service militia, held their own economically, and had stable
economic success and that the reproductive success of the two groups was similar. However, during the same period, the long-service Continental Army veterans got poorer. On average, the long-service veterans had started out the beginning of the period 11 percent poorer than the militia vets or never-served, but ended up a startling 66 percent poorer than the other groups thirty years later.
¹²
The number of living children in the household, which in that era was strongly influenced by the quality of year-round nutrition, and thus dependent on wealth, shows an average of 6.5 children for Continental Army veterans, 7.5 for militia veterans, and 9.4 for those who never served.