The folks over at ePluribus Media are preparing to end the week on a strong note. ePMedia writer/editor Cho and I (and others behind the scenes) have been working together on a review of the massively readable, incredibly researched book Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War.
PTSD researcher and author Penny Coleman (whose husband committed suicide after returning home from another generation's combat zone: Vietnam) agreed to give me an interview a few weeks ago. I'm giving you guys the scoop here before it goes wide at ePluribus Media later this week.
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Ilona Meagher: In your book, you write that the story of the Vietnam war widow is invisible -- and one reason for this is the way "women's history and family history are commonly erased in the 'official' versions of events." Could you explain this in a little more detail?
Penny Coleman: The phrase "the personal is political" came out of the Women's Movement in the '70's and reflected a growing awareness that the circumstances of individual women were not necessarily of their own making. They were instead to be found in systemic, politically constructed institutions of power that delimited and limited available life choices and probable life experiences.
When I used the term, I meant to indicate that the individual experiences of the women whose stories are included in the book, and their families', were not necessarily due to our personal inadequacies, but were, in considerable part, politically determined and widely shared. The details may have varied, but the suicides we survived were neither unique nor an indication of our failure to adequately love or notice or intervene.
Unfortunately, there is a stigma attached to suicide in our culture that places the blame for such a death on the survivors. On top of that, there is an age-old belief that only weak or cowardly men fall apart in combat. Both assumptions are cruel as well as inaccurate. Flashback is an attempt to push back against those prejudices.
If we had known then that there were others out there whose lives had been similarly devastated, perhaps we would have been empowered to advocate for our veterans and for those yet to come. But we didn't. Our guilt and shame both isolated and silenced us. The government exploited our silence.
And so, more than thirty years after our troops withdrew from Vietnam, as veterans of that war continue to take their own lives, and as the suicides of soldiers in and recently returned from Iraq and Afghanistan relentlessly appear in the media, the relationship between combat, PTSD and suicide still has not been acknowledged.
IM: How do these emotions you mention -- guilt and shame, along with isolation -- affect those left behind following the suicide of a loved one? How do they get in the way of the usual grieving process?
PC: We were communities of one and we believed that we had failed. We had as well to deal with an inexpressibly conflicted anger, because the one we were angry with was the one we needed to mourn. And on top of that, the fear that what had happened once might happen again continued to infect our lives and our relationships.
IM: In your interviews with military family members, did any of them have opinions on what should have been done -- what services or programs should have been offered -- once their troop returned back home? In a perfect world, what kind of reintegration care should a returning combat veteran receive when they arrive home?
PC: Before 1980, most PTSD veterans just thought they were going crazy, and their families blamed them and themselves when they couldn't cope. When PTSD was finally included in the DSM-IIIR in 1980, that began to change-- somewhat. At least there was an awareness, however limited, that the war was responsible for the symptoms. The families I spoke with, however, consistently described the VA as an adversarial, rather than a supportive, gatekeeper. PTSD diagnoses were hard to get, treatment options over-emphasized drugs, and disability compensation was usually so limited as to be an affront.
Despite what you may have heard from the new VA director, there is still no known cure for PTSD. There are only tactics for the management of symptoms. Those seem to be of limited use if they are not immediately available, and under the best of circumstances, they only work for some people some of the time. Almost all of the women I spoke to said their husbands were under VA care when they died.
In a perfect world, a great deal more energy would be put into solving international problems other than with soldiers. The military keeps experimenting with prophylactic measures (pre-induction screenings, in-service therapies, deployment durations, unit organization, training variants, post-service questionnaires, etc.), and hoping they have finally solved the problem. They have not. But their optimism has consistently translated into a lack of preparedness, a lack of resources, and a lack of commitment to preventive rather than curative measures.
That said, all of the following would be an improvement--which is to say that the suggestions on this list are not currently being done. Deploying soldiers should be thoroughly screened for any sign of past or current mental or emotional problems. Soldiers in a combat zone who express concern about their mental state should not be shamed and ignored, but sent immediately for counseling, if not home.
Psychotropic drugs should never be used in a combat zone. Every effort should be made to protect troops from injury, either mental or physical, and that would include putting them in situations where civilians are routinely killed. When they come home, psychiatric evaluations should be mandatory and de-stigmatized, and there should be periodic follow-ups, perhaps for the rest of their lives.
Treatment for all war injuries, physical and psychiatric, should be absolutely free and compensation should be paid to those who can no longer work. Every candidate for the military, every soldier and every veteran should be thoroughly warned about the predictable incidence of PTSD and the statistical likelihood that it will end in suicide.
That is a wholly incomplete list, but it includes some of the true costs of war that are being currently ignored. If it seems prohibitively expensive, then perhaps we can no longer afford war.
IM: How about the Veterans Administration? Are they doing better than the DoD?
PC: I am not the right person to answer that question. I can't get past the stories of trying to charge wounded soldiers at Walter Reed for their lunches; or trying to have all of the 100% psychically disabled vets go through the process of recertification; or commissioning the Institute of Medicine to come up with a new definition of PTSD that will surely be less, rather than more, inclusive. I understand that VA surgeons are impressive and I know from personal experience that many of their psychiatric health care providers are self-selected truly caring human beings who work under difficult circumstances with a constantly shrinking support staff.
IM: Should the American taxpayer pay for counseling that may be needed for military family members following the return of a loved one suffering with PTSD -- or should the taxpayer only be responsible to foot the bill for the veteran?
PC: I don't understand why veterans' benefits aren't thought of in the same vein as workers' compensation. Why should a New York City police officer be treated better than a U.S. soldier? If a soldier goes into the service in health and comes out with an injury, what conceivable argument can be made for not providing for his or her care?
Since the Revolutionary War, Americans have promised to take care of their wounded soldiers. If we decide we can't afford to do that, if we decide that the cost has simply become too high, and I would suggest that it has always been too high, then what we are saying is that we can no longer afford to use soldiers to solve our problems.
IM: How best can average, concerned citizens help our returning troops? What
should they do to get their elected officials and the media on board to ensure programs and resources are in place for our returning veterans and their families?
PC: The social safety nets that most Americans assume to be in place have been systematically attacked over the past six years. The survival needs of soldiers and citizens alike have been sacrificed to a war that has made us more isolated and less secure in the world. That war has also been used as an excuse to undermine the civil liberties that have traditionally protected those of us who would object or protest.
Republican and Democratic politicians alike, with very few exceptions, have failed to push back against this erosion. I understand that there are many Americans who see this war as necessary and legitimate, and who would disagree with me on many points, but what I am concerned with here is something about which I believe all Americans can, or should, agree: namely that we have an obligation to those we ask to risk their lives in our name.
It is astonishing to me that anyone who speaks out against this war risks swift-boating, including the families of casualties and of deployed soldiers. Supporting the war is a litmus test for patriotism under this administration that few politicians and few media outlets have been willing to denounce. It is our obligation to convince them all that they are safer with us than with them.
Military Families Speak Out's website posts links to groups that are actively trying to bring public attention to the needs of soldiers and veterans.
The 2006 election campaigns also promise to be forums for debating the war and its prosecution, and specifically what it means to support the troops and veterans. In New York, for example, Jonathan Tasini recently lost his bid for the Democratic nomination for Hillary Clinton's Senate seat. Tasini, an avowedly anti-war candidate, is supported by Cindy Sheehan, who said of Clinton, "I will resist her candidacy with every bit of my power and strength...I will not make the mistake of supporting another pro-war Democrat for president again." Tasini probably stands no real chance of beating Clinton, but he is mounting a grass-roots petition drive to get his name on the primary ballot, which would allow him to rip into her in front of her supporters, family and the national media.
Nationwide, similar local and state-wide protest campaigns are being mounted, some with a real chance of unseating an incumbent; some with no chance of winning, but the possibility of influencing party platforms and priorities. This election season politicians of all stripes will be forced to talk about how the troops are being supported. It is a critical time to be involved.
Not everyone wants to knock on doors, lick envelopes or speak at rallies. But when it comes to supporting the troops, the rhetoric has been high-jacked by the same people who are cutting the healthcare budget for the VA, allowing recruiters to cut corners, re-deploying troops beyond the military's own safety guidelines, using self-reporting questionnaires in place of pre- and post-deployment mental health evaluations, and on and on. We need to reclaim what it means to support the troops. For many, myself included, there is only one meaningful way to support the troops, by bringing them home immediately. But whatever our positions are on the war, all of us can make an effort to be more visible in our lives and more vocal in our concerns and opinions, especially where the welfare of the troops is involved.
Thank you, Penny, for the great opportunity to hear your thoughts on these important issues, and for adding a fine reference to our libraries (which won't have much time to collect dust). We Americans do need to do a better job of advocating for our troops and ensuring that they have the best resources to pick up their lives once they return home to us.
Thanks for showing us the way.