Thursday, May 08, 2008

Dr. Estés On The Anatomy of PTSD

Few people have the breadth and depth of experience with victims of Post Traumatic Stress Syndrome than Dr. Clarissa Pinkola Estés, a dear friend with over 40 years of clinical work with veterans of several different wars.

Dr. E notes that every veteran she encounters is different:

"In my mind no two psyches are alike. Each one has a customized configuration, tolerances, weaknesses and superior traits. Some hold, some help, some crash, some go invisible when suffering from a severe trauma or shock or an ongoing series of griefs and shocks."
She delineates six contributing factors or traits to the post trauma cases that she sees. Three, she explains, are common with all wars, including World War II, Korea and Vietnam. One shares an extra element with Viet vets, and two seem peculiar to the nature of combat in Iraq and Afghanistan.

Any significant issues that a soldier has before being deployed are left unresolved and put on hold, but carry an underlying anxiety.

These issues can be exacerbated by a soldier's experiences and include an unstable marriage, a sick child, a loved parent who has their own issues, debts and other financial burdens, the recent loss of a friend, disapproval by loved ones, a sense of grandiosity, perfectionism or a sense of inferiority. These issues cannot be buried during deployment and these "graves" have a way of opening up when the psyche is punctured by a war-related trauma.
The more naive, impressionable, unquestioning and unsuspecting a person is before they become a soldier, the easier it is for the brutal realities of war to rip them apart.

For many soldiers, the reality of what really is versus what they have been told dawns only gradually. In war, naivite is ripped away in minutes or days, not months or years. No matter how strong a soldier is, the psyche records this as a shock and sometimes as a wound.
The need to prove oneself can create impossible situations in wartime.

Love for one's fellow soldiers and the imperative of keeping everyone alive is a laser-like focus and raison d'être. But no soldier can control the twists of fate that occur in battle that maim and kill the hearts and souls with whom a soldier has grown closer to possibly more than anyone else in their entire life. The sense of failure can deepen the post trauma.

The following trait is trait is shared by Vietnam, Iraq and Afghan vets:

Vietnam was the first televised war, while Iraq and Afghanistan are the first fully connected wars because of the Internet, meaning that news, including news from back home, flows so quickly and unceasingly through laptops and over cell phones.

This creates a giant "clang" that cannot be reconciled easily with the old exhortations to fight "for freedom, mom and apple pie," and so on. Soldiers are far more alert, educated and analytical. A post-trauma victim can suffer more deeply when they believe they were lied to about their mission, risked their lives, but nothing was ever settled.

The last two traits are specific to Iraq and Afghan war vets, particularly those in close quarters with insurgents who blend into local populations:

There are too few troops, too short recovery times and too little space for healing psychic wounds. A soldier is capital and is sent to hospital not as a respite but to be put back together again as quickly as possible and sent back out onto the battlefield.

Is true medicine to treat a man or woman with anti-depressants or psychotropic drugs so they won't feel pain and can be rushed back into action? The military says it is, but most therapists cannot abide that. Once a veteran is back home, the wait for help is long, the medications are soon gone and the veteran can spiral into a suicidal din so loud that they can hardly hear help even when it finally comes.
The length of a tour is like a promise. "We promise that if you go out and risk your life we'll bring you home after 8 months, or 13 months, or however many months."

A soldier counts the days until he or she will be reunited with family, can eat favorite foods, dance with their sweetheart, sit on the porch, mow the lawn, get laid. But when the commander says that the soldier must remain deployed for 3 more months or 6 more months, it is not just a simple tour of duty extension. It can be a death sentence. A soldier will laugh and do their very best, but their heart is dying. I was promised!

Dr. E says that one of the most remarkable things that she has found in post-trauma vets is the strength they share.

She explains that:
"I've only seen this as deeply in two other populations -- people who have experienced a huge natural or health disaster such as men and women early in the AIDS epidemic when people were dying so swiftly and often horrifically, survivors of earthquakes when so many people are crushed to death, with many of the 9/11 survivor families, and and in any parent who has lost a child.

"There's a saying in my refugee family: 'The wounded are called to tend the wounded.'

"Although there is the room of self pity, the room of who gives a damn, and the room of maybe I should end it all . . . there's also the room of reach outside yourself, attach yourself to something besides your wound, go find others who are still sitting in one of the rooms in hell you just vacated.

"I think that's what a good number of vets with post trauma are rowing toward, a new life that they attach meaning to that no one can take away from them, and in so doing leaving a record of how to walk through hell, to leave behind roadsigns for others. These are profound acts of mercy toward others by wounded-healers."

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