Odysseus in America (30 page)

The veterans we treat, who were all enlisted men, treasure the memories of the officers who were more devoted to their substantive military tasks and to the men under their command than to the career system. More to the point clinically, any sign of careerism by a clinician is liable to be a traumatic trigger, bringing back memories of having been put in lethal danger to get body count—or worse, to fill out the denominator of a kill ratio, where the
presence
of American casualties was rated as positive evidence of the commanders “aggressiveness” and “balls.”

These veterans' worldview is based on an expectancy of
exploitation for other people's advancement.
The urgency of fear lies behind the veterans' need to know that we are working in VIP because we want to, because it gives us personal pleasure and satisfaction for its own sake.

Expectancy of exploitation leads veterans to assume that we are only interested in them as vehicles to get a graduate degree, to write a book, or to earn VA salary money. In the last fourteen years, James Munroe
did
earn his doctorate,
⁶
and I
did
publish a book—periods of intense anxiety followed both of these events, while veterans watched to see if we each would leave, having accomplished our “real” purpose in being there.

Vietnam veterans experienced lethal incompetence at the hands of officers and bureaucrats who had all the right credentials but whose competency in passing through career progression schools did not equip them for the reality of war against an observant and resourceful human enemy who figured out how to turn every school solution into a death trap. The veterans insist that there is something
personal
that makes someone trustworthy as a combat leader or as a clinician. Our institutions treat professionals who have the same credentials as fungible—absolutely substitutable—for one another. The veterans reject this. Their trust is personal, nontransferable.

Essential to this trust is the clinician's willingness to listen to the particularity of the veteran's own experience, and not treat them as subsumable examples of an abstract category of psychiatric or even PTSD patients.
⁷
They don't ask us to be universal experts, and will not trust a widely read clinician who is smug about his knowledge, and neither listens nor learns.

Trust can only be earned, never assumed from job titles or degrees. In VIP we
assume
that veterans must test the trustworthiness of anyone claiming good intentions, particularly where power is involved. We don't take offense when they test us.

VIP has taught me how to work with crisis-ridden patients who have learned to survive through violence and intimidation. Amazingly, the veteran community in the Clinic provides both physical safety—the VIP veterans do not tolerate even the smallest threat against the team—as well as psychological safety.

Among ourselves and in speaking with veterans we use the three-stage description of recovery developed by Judith Herman:
⁸
Stage One, establishment of safety, sobriety, and self-care; Stage Two, trauma-centered work of constructing a personal narrative and of grieving; Stage Three, reconnecting with people, communities, ideals, and ambitions. Although we think and speak of these stages, the VIP is not programmatically built around them, and each veteran progresses at his own pace.

I cannot emphasize too strongly that safety, sobriety, and self-care are the essential foundation upon which recovery is built. We are not an anything-goes therapeutic community that is infinitely “understanding” of drinking and drugging and wild behavior. There's no way to skip safety, sobriety, and self-care and go right to the trauma, no matter how logical the veteran's claim: “Doc, Vietnam
caused
all that drinking, and drugging, and fucking people up. You fix the Vietnam stuff and I can stop all the rest.”
⁹
Never happen, soldier!

We work with the veteran, in Judith Herman's words, starting with the body and moving outward, to help him lay down weapons, maintain sobriety, meet health and nutritional needs, terminate current violence as perpetrator and/or victim, and eliminate danger-seeking behaviors.

While most VIP veterans are also in individual psychotherapy and request medications,
¹⁰
the heart and soul of the program is its group therapies and the ideas and rituals of the VIP veteran community. The core idea is “You are not alone; you don't have to go through it alone.” From the beginning, other veterans provide what military social scientist and historian Faris Kirkland and his Army colleagues
¹¹
called “substantive validation,” a knowledgeable audience (even if they were not in the same specific units or operations), to whom the veteran's experience matters, and who are able to support him through the confusion, doubt, and self-criticism that seem intrinsic to having survived the chaos of battle. The team provides practical support for veterans to obtain their military records, unit diaries, and after-action reports when the situation demands. Surprisingly, this often provides the first “institutional validation” that the
veterans have had, sometimes learning for the first time of awards and decorations for valor that they had earned, but had never been presented to them. In group therapies with Stage One veterans, we are active and educational as group leaders, assisting members in gaining authority over the pace of trauma disclosure, so it is safe. We seek the delicate balance between silencing the veteran and allowing him to become flooded with bodily sensations, emotions, and images by reliving the trauma, which only retraumatizes him. There are no theatrical cures where the veteran screams, vomits, bleeds, dies, and is reborn cleansed of the war. Recovery is much more like training for a marathon than a miracle faith healing.

From the beginning we establish the VIP culture of mutual respect for all veterans. No individuals branch of service, military function, battles, or suffering is more “significant” than any others. With one another's support the veterans finally, decades late, experience the three forms of validation—substantive, institutional, and memorial—that every soldier, sailor, marine, and airman should receive after combat.
¹²

Stage Two of recovery calls for the veteran to construct a cohesive narrative of his war experience in the context of his whole life—and to grieve.

VIP makes an annual trip to the Vietnam Veterans Memorial in Washington, which provides a focus for “memorial validation.” This is an opportunity for those veterans ready for it to grieve for and commune with dead comrades in a safe and sober fellowship. In this group there is no need to explain or justify the importance of keeping faith with the dead through authentic emotion, respectful remembrance, and honor.

Three
A.M.
in the spring it is still very dark in Washington. The line of lights embedded in the walk along the Wall casts a soft glow. The brightest feature in the landscape is the floodlit obelisk of the Washington Monument, which reflects off the polished black surface of the granite panels, slightly blurred by the thousands of names incised in the panels' surfaces. At this hour, with veterans who fought in Vietnam, one understands that this
is
a shrine in the full sense of a sacred precinct, where the power—the fascination and dangerousness—of the holy is present.
¹³
The living and the dead meet here.

No veteran in VIP is required to go to the Wall, and no veteran who wants to go on the VIP trip can do so until he has firmly established his connection to the community, has safety, sobriety, and self-care firmly in
hand. Prior to the trip he has also worked on of his own traumatic history to have a good idea what demons he might meet at the Wall. If a veteran is simply flooded with the trauma and drowns in reexperiencing, it does him no good—it retraumatizes. Obviously, we cannot forbid veterans to go to the Wall alone apart from the scheduled trip. However, we strongly advise any Vietnam veteran not to go alone, especially the first time, to go sober, and to go with people he or she trusts. We hold a series of group meetings in the weeks prior to the trip, during which each veteran is invited to talk about what he expects, what he's heard from other veterans, and to hear from VIP vets who are going for their second or third time. We also obtain their agreement to the basic ground rules of the trip: strict sobriety, staying with the group, participation in the meetings while on the trip to process the repeated visits to the Wall during the two days in Washington. They also have the opportunity in advance of the trip to look up the locations on the Memorial's panels of the names of their dead comrades, so that they don't have to struggle to do this in the dark under the enormous emotional pressure of the visit. There is no haste or time pressure. We generally arrive at the Wall, for the first visit of the trip, at three
A.M.
and stay as long as anyone wishes and needs to.

For many the first visits are pure grieving. Some of the veterans are physically very large men. A six-foot-three Marine Corps veteran weeping his heart out in the dark, hugged by other veterans, is a profound thing to witness. The supportive presence of the trusted other veterans eliminates embarrassment. They do not have to go through it alone.

Some veterans fear the Wall because they fear the dead will reproach them—for having not done enough, for having survived when the man on the Wall—“in the Wall”—did not. The polished stone reflects the movements of the veterans along its surface giving sensory credence to the sensation that the dead are present.

Some do not feel worthy to be there.

For some, the only emotion is anger.

One veteran exclaimed, “It's a grave!” There have been times I have walked down the slope toward the apex of the Wall and had difficulty breathing, as though the rising tide of names on my left was rising water and I was drowning.

Some ask forgiveness for something they did, or didn't do.

For some, it is a sad, quiet chat and visit with the dead, with love as the predominant emotion.

The names—all 58,226 of them
¹⁴
—are a very powerful statement: each of these was a whole life.
¹⁵
There are no et ceteras on the Wall.

Sometimes difficulty remembering a name, or enough of a name to find its location on the Wall, torments a veteran. People were often known by nicknames conferred before the young man—who decades later is our patient—arrived at his unit. The veteran may never once have heard his battle comrade's given name, even after several months. This is where unit associations provide irreplaceable assistance, when the veteran is able to find others who were there at the same time as he, who might recall both the nickname and the man's right name. Unit diaries and after-action reports record deaths day by day, so that if the date is known, the number of possible names can be greatly narrowed.

The agony of not knowing or not being able to remember names is captured in this poem, “Remembrance,” by Joan Duffy Newberry, a veteran of the Air Force nursing corps:

How is it possible that I remembernot one name on this tragic wall?
How is it possible?
After all, there are ten tall panelsthat represent the year I spent in Nam.

—Duff, 1/Lt USAF NC RVN 69-70 Left at panel 24W, Memorial Day 1987
¹⁶

Too many names … names like Smithand Herman and O'Brien and Siciliano …
I know you … your faces are foreverseared into my brain.

You were little more than childrenwhen you came under my care,
With wounds and illnesses thatno human should ever endure.

My God, I hated to see you so hurt, so frightened and so sick.
How is it possible that I cannotremember any of you dying?

In nightmares you reproach mefor making you live when you weredetermined to die …
And you curse me for being so slowto help your best buddy …

“There are others I must tendto before him,” I say in my dream …
Sweat covered, I awake and wonder justhow far my mind will go to absolveme of your buddy's death.

My God, it was terrible to be so responsible …
I was too young and too inexperienced a nurseto make such wrenching decisions.

No matter what I did it was never enough …and no matter what I did, it will neverhave been enough,
For there are too many names forever etchedon this wailing wall.

I grieve for you my nameless patients.and I grieve as well for your loved ones.
I also grieve for myself, for I willnever be free of tormenting uncertainty …

What should I have doneand what could I have done
To keep you from joiningthis heart-breaking roster of the dead?

In the very early morning—“0-dark-30”—the veterans have the Wall entirely to themselves, which is the main reason that we go at that hour. The intimate presence of the dead—for those who are well prepared for it and meet the dead with the support of a community—has been paradoxically a breath of life for many. The famous line by Wilfred Owen, “These are the men whose minds the Dead have ravished,”
¹⁷
seems relevant here, although his experience was in the Craiglockhart military psychiatric hospital while World War I still raged in France. The dead have pursued the men we work with for thirty years. Actively going to meet them in their sacred space, with living brothers at their shoulder, seems to make a great and positive change in their relationship to the dead.
¹⁸

After the sun rises (often a wonderful moment standing on the steps of
the Lincoln Memorial facing east up the Mall), we go to breakfast, go back to our billet on whatever military base has offered us hospitality. We hold a therapy group to encourage the veterans to talk about what they have just done and what it was like. After a nap, we return to the Wall in the early afternoon.