Wednesday, November 11, 2009

SOLDIER STRESS AND PTSD

It’s Veteran’s Day and a good time to consider the plight of Our troops – especially given what they’ve been tasked to do in the service of The Greater Southwest Asia Co-Prosperity Sphere.

Tara McKelvey has a readable and substantive article in ‘The Boston Review’: is religion an obstacle to therapy for PTSD?

I’ve Posted on this recently, but it’s worth approaching the subject again from this slightly different angle.

She starts with the case of an Army chaplain (!) who had to report for PTSD treatment because he had reached a spiritual abyss after his recent tour over there and could no longer stomach hearing the phrase that ‘God is watching over you’. His wife and children afforded no effective consolation to him either.

I am always a bit wary of clergy – this one appears to be some flavor of Protestant – who ‘lose their faith’ when they run into the rough waters. Clergy – especially in the military – are supposed to be sort of like a spiritual Coast Guard: they’re always ready for the rough weather and boiling waves ‘out there’, and indeed sort of imagine that being able to provide service in precisely that dangerous and roiled environment is what the Coast Guard is all about.

So when one says that after running into some really rough weather s/he has lost the faith, then I begin to wonder if the individual was really clergy-chaplain material to begin with.

But then again, especially in this country of late, a sort of happy-face ‘summer sunshine’ sort of God, a glorified concierge there to fulfill one’s every wish, has been the usual image of the Divinity, and a sort of happy-face ‘summer-sunshine sort of life has been the usual expectation about the type of world such a God would set up (sort of like the Flower Children imagining that all of life was basically a dope-and-booze-and-sex-filled summer afternoon in San Francisco or Southern California).

But as a lot of folks and a lot of traditional theology and religion could have told them: it ain’t necessarily so … not hardly.

She refers to a recent study of Vietnam vets that indicated how many of the ones who had ‘lost their faith’ in God (and apparently the war) were most liable to return to the States and seek psychiatric counseling.

But of course, if you’ve lost your faith – to use the phrase – and thus don’t believe in God or religion any longer (and perhaps not in the goodness of the nation’s policy or the military brass) then you already defined ‘God and religion’ as being no longer of any help, even though what you have (your loss of faith) is primarily a spiritual problem.

Former students of a certain age may recall being taught that there are different types of fires, and so different types of extinguishers, so that – say – if you find yourself faced with an electrical fire, it won’t do any good to be putting water on it from the trusty water-based extinguisher.

But here, in this combat-stress matter, you have an electrical fire for which – since you’ve lost your faith in chemical powder – you’re going to try to put water on, turning to the water extinguisher by default as it were. Indeed, it may be a magnesium fire, for which water is not only an ineffective extinguishing agent, but will actually aggravate the fire and make it much worse.

This is a primarily a problem in the ‘rectification of Names’, as the ancient Chinese would say. Before you come up with the solution, you’ve got to accurately classify the problem.
But this has always been the problem of the ‘stress’ diagnosis from its inception about 30 years ago.

At the moment, the VA administration is still home to many hold-overs from the days of Bush and the ‘faith-based’ approach. That approach was a neat synergy between a government that didn’t want to waste money on cleaning up the consequences of its own actions and a Fundamentalism that essentially identified the country and the military and all their pomps and works with God: if you believe in ‘God’, the Fundamentalist whackery has it, then you believe in the country and the military and the war(s) and you shouldn’t be having any ‘stress’ at all. Your discomfort, in this approach, indicates a lack of faith.

Thus many chaplains – and they are so often Fundamentalists now - will start giving lectures on the Bible or – for those who are ‘with it’ – such current popular works as ‘The Purpose-Driven Life: What you need, soldier, is simply a stronger sense of purpose, not simply your own but the one God – through the President and your chain of command – has thoughtfully provided for you. So stop whimpering and start believing.

Oy. Oy gevalt. Oy and frak.

But accurate as it is to note the obnoxious and almost looney ‘ministry’ of Fundamentalist whackery, it is insufficient to stop the analysis there.

This ‘stress’ problem is a doozey of entangled developments: cultural and medical and political as well as religious and spiritual.

The VA hierarchy notes even now that the ‘stress’ diagnosis is a dubious one, and one that has unsavory political roots. There’s something to that.

In the later 1970s the Vietnam vets organizations started to carve a small place for themselves among the wider feminist push for ‘sensitivity’ to ‘pain’ – whatever pain a person (for the radical feminists, always a woman; for the multiculturalists anybody not ‘white’ and ‘mainstream’) might say that they felt.

This was considered to be a form of ‘empowerment’: instead of being told by a doctor (so often in those days a ‘man’) what your problem was and how to make it better, you would get to be listened to, and then your wishes as well as your pain would be ‘respected’ and you would thus be ‘empowered’.

Whether you would actually get better is another question, but then again this theory worked best with stuff that you ‘felt’. Broken legs and ruptured appendixes weren’t the best type of problems for this theory to prove itself; ‘pain’, however, worked very nicely: you felt it and you could declare when you no longer felt it (which was an outcome that didn’t seem to happen very often).

So the Vietnam vets started to get involved with this, casting their board on the rising surf.

Not that they didn’t have some frightening experiences. War itself, for the combat soldier anyway, is a frightening and awful cauldron. You can suddenly wind up ‘seeing’ an awful lot: not only carnage, but the darker side of nations, militaries, soldiering, and even your buddies.

And perhaps even yourself: if ‘seeing’ awful things is certainly a pressureful experience, even more so is ‘doing’ awful things – a cause of PTSD that, especially nowadays, isn’t mentioned much. Although I, for one, wonder just how many sufferers haven’t just ‘seen’ awful stuff but are haunted by what awful stuff they themselves might have done.

(A certain stock response to that insight is that it’s really just a form of ‘blaming the victim’, but if you can’t get an accurate cause of the pain (which is itself mostly self-reported and not accessible to scientific testing) then you can’t really devise an accurate treatment. If somebody, say, reports terrifying nightmares and crippling ‘depression’, and says that it is all from what s/he has ‘seen’, but you as a therapist don’t know that the person actually ‘did’ some really upsetting stuff as well as ‘saw’ stuff, then things aren’t soon going to get put right. And if you ‘witnessed’ some awful stuff but can’t report it because you want to be ‘loyal’, yet you still need to make the pain and stress go away … well, ditto ditto. You see where these things can go.)

So there was always a certain political element to this entire ‘disease’ called PTSD. Indeed, while the Diagnostic and Statistical Manual’s 1980 3rd edition put down some careful parameters for the particularly awful stresses generated by the combat experience, the 4th edition in 1994 expanded and diluted those parameters (to include some stressors, especially those connected with ‘men’, that the feminists’ clients – reputedly ‘all women’ – had to put up with). And the band played on.

But then there is a host of scientific problems with the diagnosis.

First, it has to be clearly isolated and differentiated from such other problems such as micro-sized brain damage (a current injury rampant in the current combat theaters): explosions such as those caused by IEDs and mines can cause tiny bits of damage in vital elements of the brain, causing all manner of physiological and psychological consequences. These injuries can now be seen on scanning equipment.

This is not PTSD, which is a far more fuzzy problem, since it appears to be a purely psychological and emotional response – by some soldiers but not others – to experiences they have had in the combat theater. Yes, the stress-released neurochemicals can, especially if the patient is exposed over a long period of time, cause physiological damage, but the neurochemicals are released by the individual’s sense of being ‘stressed’ in the first place. And we’re back to the individual and his/her ‘sense’ or ‘feeling’ of being ‘stressed’.

And then there’s the problem of self-reporting: if you can’t independently verify the existence of the ‘pain’ that the soldier is claiming, then you can’t really be sure of what you’re dealing with. The ‘solution’ to this conundrum – so popular in the victim-oriented 1980s and 1990s – was the simple and simplistic rule: believe the sufferer, since sufferers – through some metaphysical Law not previously published – do not lie or make mistakes.

This is conceptually a piss-poor professional standard of therapeutic practice. And especially in a situation where a putative patient stands to derive financial benefit – or in a military combat setting where a patient might be able to avoid ‘returning to the front’, then the possibilities for – ummmmm – mischief are huge. And of course, as victimism took hold in American culture, simply claiming the status of ‘victim’ was some sort of ‘benefit’, and to some might appear an actual achievement.

The solution precipitated out of the interaction with another development of the latter half of the 20th century: the development of numerous powerful drugs (and, it has to be said, the expansion of the drug and pharmaceutical industry). The most ‘efficient’ solution for a practitioner – and the one least likely to cost him/her a job – was to prescribe some drugs and get on to the next case of the day.

But as I said, if you’re dealing with primarily a spiritual or moral crisis – perhaps one induced by doing – rather than merely ‘witnessing’ – some awful stuff, then drugs were not really going to get to the cause of the problem. And if you’re dealing with a personality already weakened by immaturity or poor parenting and childhood experience (an increasing if disturbing probability in this country nowadays), then the introduction of drugs (and all their side effects) could only complicate an already complicated and somewhat nebulous situation.

And there is an organizational element to all of this in the military setting: a therapist is him/herself a sworn Service member, perhaps even a commissioned officer. So when the chain of command says that You will do this or You won’t do that … then your professional judgment has to take a back-seat to your orders. Unless you want to get court-martialed or be dismissed from the Service (which never looks good on a resume).

And in the current setting of combat operations the chances of ‘stress’ are very high indeed.

First, the nature of the combat: we are more or less losing, or at least involved in precisely that “long twilight struggle” that no American military commander has ever welcomed (We are a quick-and-total victory sort of nation). Worse, this is a war with no ‘front-line’: there is no in-theater ‘safe zone’ where you can be sent for a little R&R. Nor can the military afford to be shipping big bunches of troops to Europe or wherever for such R&R (it isn’t the Golden Age of 1945-1970 any longer). So the stress-inducing experiences never stop.

Second, the average American munchkin is not really conditioned to a lot of pressure. Preserved from a childhood of drinking water from garden hoses or riding bicycles without helmets, alert to the smallest official disregard of their ‘rights’ or their preferences, and wayyyy too sugared-up, there are just a whole lotta munchkins and munchkas that aren’t used to running up against a stern and implacable reality, like – oh, sayyyyy – war and combat.

And for far too long the military has catered to that cultural shift by watering-down the ‘stern and implacable’ side of training. Indeed, the feminist lobby insists that military service is primarily an ‘employment opportunity’ and since ‘it isn’t your father’s or grandfather’s (fill in the blank: Army, Navy, Air Force) any longer’, then it isn’t their type of ‘war’ either. Although if the lobby imagined that War itself – that awesome and aweful Horseman – was going to be as easily cowed as the US Congress, they were laboring under a delusion of truly world-historical proportions.

And then, coming full circle, there are now the Fundamentalists, who under the Bush Administration swelled to an Ascendancy in the military chaplaincies. They did so because they were far more government-friendly than any other faith-group, including the Catholics: in the simplistic Fundamentalist schematic, God appointed and deputized ‘the powers that be’, which is the government and the military chain of command, and so all the soldiery has to do to ‘get right with God’ is to follow orders. Ach!

Unfortunately, the same Congress that breezily pandered to ‘youth’ and other pushy lobbies over the course of decades, also signed off on a ‘war’ that bids fair to force all of the favored demographics into that “long twilight struggle” on the darkling, blood-red fields of Ares Ferox et Atrox.

Hence the possibilities for stress are legion.

And to complicate it all with one last infernal twist, the Fundamentalist chaplainry is actually making some good noises about self-discipline and responsibility that have been sorely deconstructed of late. (Which is not to say that I subscribe to any Fundamentalist vision of ‘maturity’, especially since their idea of history stops about 6,000 short years ago and their vision of the earliest hominids has those bipeds sharing turf with the dinosaurs, as was proven by that decisive historical evidence, “The Flintstones”.)

So it’s not hard to see where military therapy providers as well as service personnel are under a lot of pressure.

But the elements of the whole thing are numerous, convoluted, and present a massive and molten cauldron of complexity. And Americans have never been known to handle that type of challenge well.

If all this gives you a headache, I recommend that you don’t take an aspirin, but instead stay with the pressure and the pain and try to work through it. The more folks that get into that habit, the better the chance that somehow the country can come up with a reasonable analysis and some modestly effective solution.

Do it for the troops. God knows We owe it to them.

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