Whatever You Did in War Will Always Be With You

This article, by Medic, was first published in the June 2006 hard copy edition of CounterPunch, and subsequently in CP online.

VA Shrink: Were you in Vietnam?
Vietnam Vet: Yes.
VA Shrink: When were you there?
Vietnam vet: Last night.

I’m kneeling. Tears streak my face, drip down, fall to earth. It’s only my second time in combat. Soon I’ll be different. Soon revenge for our dead and wounded will meld with fear and I will help with the killing and the killing will help me. We’re just regular grunts: We make too much noise, we have no special skills, we’re not elite. But after a time we get the hang of this war, the rhythm of it. Wait. Engage. Disengage. We call it contact or movement. We psych ourselves up. “Time to kick ass and take names,” we say.

And between contact and kicking ass or having our asses kicked, there is tension. It starts small, then builds and builds, until we secretly pray it will happen. That we walk into them, or them into us, or we mortar them, or they rocket us, then the tension explodes like perfect sex, and afterwards…we’re spent.

There are days, weeks when nothing happens, then terror, instant and deep, then relief, like paradise, since the killing is done and we have buried away the wounded and dead. Until it starts all over again.

That was thirty seven years ago. Or was it last night? A day, a year, twenty years home from war you may begin to act strange. The shrinks, social workers, group therapists, clinical researchers, each has a different take on what causes PTSD.

“It’s neurolingustic. It’s cognitive. It’s biochemical,” they chatter.

Who cares? Just stop the pain! Just stop it! But where does that pain come from? What’s going down?

Here is what I know: What you learn in combat you do not easily forget. In the jungle you live like an animal. On patrol, you drop at the first hint of an ambush, falling so fast your helmet still spins in the air above you before it crashes down.  You shoot first and ask questions later.  Why? Because the enemy is an unfeeling slippery bug to be stomped out. You learn to like killing. Learn to fear and hate the enemy. Hate civilians. Can’t trust the bastards. You hate taking prisoners. You’d rather kill them. Why? Because the enemy wants to fuck you up. Kill you, your pals, some new guy who doesn’t know jack shit; wants to waste your lieutenant, the whole damn platoon.

After a time you learn what war is: the fish-like iridescent gleam inside a brainless head. The sleek, gray caterpillar of pulsing human gut; the grotesque tableau of charred bodies frozen stiff; the impossible music made by voices howling beyond human form. Pure white bones piercing ruby ripped flesh; the strange oily feel of blood; the sudden slump of the man next to you. The business of flies on the mouths of the dead.

After a time, to a supernatural degree, you learn to live with terror, rage, struck-down sorrow, blocked- out guilt, or dumbstruck grief. Yes, the supernatural threat of catastrophe, and the ways to survive it, become preternaturally normal, second nature, a fully formed part of what you have become.

Then one day, you get shot, or if you’re lucky, complete the tour, return home intact. But for those who have seen their share the equation might go like this: Johnny got his gun + Johnny marches home = HEEEREE’S JOHNNNNY!!!!

And the good soldier John or the good troop Jane, who under fire never once thought of your civil rights, your silly flag, your doofus politics, Good Johnny or Jane, I say, feel and act a tad differently when the locked-down feelings, bottled-up memories, instinctive behaviors of Post Traumatic Stress Disorder unexpectedly kick in. The symptoms of PTSD, in plain bloody English, are as follows:

Flashbacks: seeing and feeling a combat event as if it were happening right now.
Hypervigilance: being always on guard, always looking for where the next shot, next grenade, next rocket, ambush, or IED will come next.
Survivor’s guilt: feeling bad, feeling real shitty for having survived, where others in the platoon or squad didn’t.
Moral Guilt: wrestling with actions you did on one or more than one occasion.
Startle Reflex: dropping, flinching, turning fast at a sudden noise or unexpected touch.
Suicidal Ideation: thoughts of killing yourself.
Homicidal Ideation: thoughts of killing friends or complete strangers.
Homicidal Rage: anger way out of proportion to an everyday event. It comes quick, down and dirty.
Sadness, depression, anxiety, crying spells. Feeling empty. Feeling dread. Feeling that life is an infinite crater, an eternal abyss. Occasionally, given to weeping.
Nightmares: violent dreams related to combat. Sometimes it’s the same dream. Some vets make strange noises. Thrash in bed. Wake up scared, or sweaty.
Ritual Behavior: at night, checking the lights, locking the doors, maybe keeping a weapon close at hand.
Alienation: Many vet feel no one understands him. They feel separate from everyone else. Don’t fit in.  Believe they should have never come home.
Panic Attacks: For a brief period, a sudden intense feeling of losing control. Or an overwhelming fear of dying. Physical symptoms include sweating, breathing hard, a pounding heart, feeling dizzy, coughing or feeling choked.
Social Isolation: Keeping to oneself for long periods of time. In public, saying very little, or staring into space and being eerily quiet.
Drug and alcohol abuse: whatever works to dull the pain glowing inside one’s head.
Fear of Emotional Intimacy: combat vets often won’t let anyone get too close to them. If someone does or tries to, the vet backs off or will push them away.
Unemployment: A lot of vets can’t keep a job. Every couple of months he or she will quit or get fired.
Psychic Numbing: The inability to feel emotions. Vets talk about feeling hollow, blank, empty.
Denial: Problems? What problem? I don’t have a fuckin’ problem! What’s your problem!
High-Risk Behavior: driving at high speed, gambling, parachute jumping, hunting, survival training, robbery, anything to re-live the rush of combat.

These symptoms are normal responses to extraordinary events outside the range of normal human experience. Most civilians are clueless about war and its aftermath.

Some types of treatment:

The Talking Cure: a vet talks to a therapist who is skilled in treating war stress and is not a paid bull shitter.
Group Therapy: seven to ten vets meet once a week for an hour or two. A good group leader is essential. That person knows when to talk, when to listen, how to keep the vets focused.
EMDR: A form of hypnosis—using rapid eye movement, the patient is fully awake—to relieve emotional distress.
Transcranial Magnetic Stimulation: a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.
Exercise: all kinds. Take your pick. Sometimes the hard work makes you feel good.
Meditation: all kinds. Whatever works.
Accupuncture: safe and helpful.
Medication: I’m skeptical here. Credible research indicates the placebo effect plays a  significant role in pharmaceutical symptom reduction.
MDMA/Ecstasy: once a party drug, the documented therapeutic use seems a safer and more effective bet than whatever big pharma has on offer. As of 2019, MDMA is in phase 3 clinical trials (see MAPS.org). Projected clinical availability, three to five years.
Ketamine: the known party drug is now administered for surprisingly rapid relief from depression. Can be pricey.
Marijuana/CBD: Many vets anecdotally say a good joint provides temporary relief from physical pain and/or emotional stress. CBD may also be helpful. Caveat emptor. It’s not yet regulated for quality
A Friend Who Will Listen.
An Artistic Endeavor.

Finally, many vets prefer not to talk about war. They fear losing control. Breaking down. Crying. My advice to those who have seen combat: find the right way to face yourself. Chances are good you will learn to live less in the past, more in the present, but you will never be the same. WWII, Korea, Panama, Vietnam, Iraq, Afghanistan, Syria, Somalia, etc; take your pick: Wherever you were, whatever you did in war will always be with you. Always.


GIs talk about PTSD

PTSD/MDMA therapy in DAV Magazine

The Psychedelic Revolution Is Coming. Psychiatry May Never Be the Same (New York Times)

Top image: The Lord Answering Job From the Whirlwind, by William Blake. Pen and ink and water color over pencil on paper. Circa 1750. The Old Testament Book of Job tells the story of a wealthy and devout man who is tested by a series of catastrophes and afflictions yet remains devoted to god. Repeatedly, he has asked, “What have I done to deserve such suffering?” The image depicts the moment where Job, at the height of his agony has a mystical vision. Blake’s deity ignores the irrelevant question and simply gestures I am. Job, seeing clearly, cowers in awe. source: National Galleries Scotland