PTSD


Sorry I scamped out on you last week.   I missed you all, and I hope to do bettah.

Asia-Pacific:
♦ China suffers another product recall, and the WSJ says it is at least partly a design flaw that has nothing to do with China.  I have already blogged that it is partly a management failure that has nothing to do with China.  But now it’s also baby bibs.
♦ Highly contagious swine virus in China, international community on alert.
♦ One thing I missed last week and is beautiful for covering a region we don’t know well: The Strategist keeps on with some in-depth study of Melanesia, this time resource wars.
♦ Kevin Rudd on Australia’s campaign trail.  I heard Mr. Rudd speak at Brookings Institution this past April and I wish him well. 
♦ The ADB again announces inroads against extreme poverty in Asia, but a widening income gap.
♦ Hizb-ut-Tahrir conference in Jakarta is well-attended.
♦ A large amount of my attention this week has been the Shanghai Cooperation Organization summit in Bishkek and military games in Xinjiang & Chelyabinsk.  Check out the FPA Central Asia blog for the latest.  This is all so important, whether you are a Central-Asia watcher or not.  To wit, next entry:

Former Soviet Union:
♦ Russia’s new military budget: fat–means Russia’s new military might: formidable.  More on buzzing NATO.  More on Russia bombing Georgia.  More
♦ Kazakhstan has Parliamentary elections Saturday, August 18th.

Latin America:
♦ Peru’s earthquake has killed hundreds.
♦ Venezuela, the new Central Asia: Mr. Chavez wants to be perpetually re-elected.   Umm, can’t he find anyone in Venezuela who thinks like he does?
♦ Venezuela buys AK-47s . . . and we want to know why.
♦ Help for Argentina in procuring energy resources.
♦ Boz covers the stuffed suitcase that is getting attention everywhere better than anyone. . . in Bags o’ Cash series, 4 parts, easy read, gracious!

Middle East:
♦ Two respected foreign policy professors expand a controversial article into a soon-to-be controversial book about U.S.-Israeli relations.  This NYT article has links to the original piece and some background.  Whatever you might think of their opinion, one has to admire the courage of their convictions.  I’m glad that they have brought this to examination: everything important deserves scrutiny.
♦ FPA War Crimes reports on the verdict in the Padilla detention/terrorism case.  For more background, you can stay with that blog, because Daniel’s been covering it thoroughly.  The Conjecturer also analyzes it, by taking a look at the limits and mandates of the DIA in re: Padilla.

Afghanistan: [ edited down from FPA Central Asia ]
♦ Now that Britain is pulling out of Iraq, they plan to focus more on Afghanistan.
♦ An AP article that titularly is about Barack Obama is actually a report on civilian deaths in Afghanistan.  Though the U.S. or NATO does not keep figures on civilian deaths (either a mistruth or a mistake) AP does: 231 civilians were killed by militants; 286 by troops; and 20 in crossfire, unattributable to either party. 
♦ On August 15th, a New offensive started against the Taliban in Tora Bora. 
♦ Two S. Korean hostages released.  That means there’s 19 left.
♦ New Counternarcotics strategies sound the same as old counternarcotics strategies.  This is a must-read article by Mr. Weitz over at World Politics Review, complete with maps, and, new UNODC figures estimating another rise in opium production, this time by 15%.
♦ U.S. would certainly take out al-Q targets in Pakistan, but not in a way that would make Pakistan angry.  But Pakistan seems to be already upset at the prospect: a highly literate editorial at Pakistan Daily.
Australia’s work in Uruzgan, at My State Failure blog.

Iran:
♦ Is it semantically correct? I don’t know, but the Quds Force is going to be designated a terrorist organization by the U.S. of A.
♦ Mr. Ahmadinejad in Turkmenistan and Bishkek for SCO meetings.

Iraq:
♦ Targeting the Yazidi sect in Nineveh near Mosul.  Four hundred are dead.  Do we call this genocide?  As Iraq increasingly settles in sectarian patterns, every bombing will be a kind of genocide or sect-killing; yet Yazidis have been a deliberate target since at least April.  al-Q is blamed immediately, but the reasons haven’t been divulged.
♦ Abu Aardvark’s Marc Lynch reports that the last-ditch political rapprochement for September’s Benchmark Report and ultimately for Iraq’s political viability is dead in the dirt.  h/t: FP Passport. RFE/RL has a slightly different take, citing Mr. Talibani: “Sunni are welcome to join our coalition.” It ends up the same, however: Sunni have not joined the coalition.  In my newsletter this month, I’ve discussed the way Sunni concerns have been sidelined. . . in the oil law. . .
Iraq-Iran pipeline deal signed.
♦ Iraq Slogger special report on the Bridges of Baghdad.

U.S. Politics:
♦ Mr. Rove waltzes on out of the White House, ostensibly to avoid Congressional investigation.  No doubt he will write a book that exculpates him from all wrong decisions, minimizes his impact on poor outcomes, and maximizes his genius in those extraordinary outcomes, and dishes against all those who tried to block his progress.  uh, sure.  . . Can’t wait.  They store a lot of extra, non-partisan, all-purpose whitewash in the White House, and I’m sure he took a bucket of it with him.
♦ Candidate Romney says the way his sons support U.S. efforts in Iraq is by campaigning for Dad.  Oh, Bleah.  Vanity to the max.
♦ U.S. military suicides are running very high.  Twenty-eight soldiers in Iraq or Afghanistan this year.  Such deaths denote despair, and that despair radiates outward into the military community: their close associates, who also must deal.  ♦ Related to my many comments on the U.S. Farm Bill: CARE International is finding USDA aid too much trouble, too expensive, and way counterproductive in meeting famine in poverty-stricken countries. 

Political Economy:
Selling to Islam at the Public Sector Development blog.

Energy:
♦ Oil prices: USD 69.84 for Brent crude, USD 71.76 for West Texas Intermediate, as of August 16th. 
♦ The EBRD pulls out of Sakhalin-2 investment.

This is from Anthony Swofford’s memoir, Jarhead, first published in 2003 by Scribners.  Like many accounts of war, it details the problems of sleep disturbance, and how sleeping pills and extra physical activity don’t have the same effect on sleeplessness as they would away from a battle zone.

Once the air campaign begins, I never sleep through the night.  Three hours is the longest stretch of uninterrupted sleep I experience, and this occurs during a bogus patrol when Johnny says, “Let’s get some sleep,” and we take off our helmets and flaks and sleep in wet sand.  If a Scud altert doesn’t interrupt our sleep, someone screaming from a nightmare or wide-awake anger and fear will awaken the entire hootch.  Doc John Duncan passes out sleeping pills to those who want them, but I’m afraid of sleeping through a valid alert, and anyway, the guys who take the pills wake up just like those who don’t.  The synthetic chemical for drowsiness is not as strong as the naturally occurring chemical called fear. (pp. 185-186)

Mr. Swofford describes young people doing the best they know how with the situation they are given:

Another night, after we return to the hootch from a Scud alert, Dettmann starts weeping and won’t stop.  We tell him to stop, but he won’t or can’t.  Combs, near the breaking point himself, takes [him] outside and thrashes him for a good hour, but throughout the exhausting cycle of bends-and-thrusts and push-ups and bear crawls, he continues to cry.  Goerke, a bit of a humanist, joins Dettmann outside and insists that Combs thrash him as well, because even though Goerke isn’t crying, he wants to cry, and isn’t it the same thing? he asks.  (p. 186).

So, same place, different decade: longer tours, a more differentiated battle environment.  Yet military personnel in the U.S. are being asked to serve longer tours with less rest and relaxation.  And there is no really good program for PTSD treatment at the VA, nor is the existing program ramped up to meet a new demand.

Write your Congressional Representative . . .

Much of the great war poetry comes from World War I.  I’ve already posted one of the great Wilfred Owen’s poems. 

Repression of War Experience

Now light the candles; one; two; there’s a moth;
What silly beggars they are to blunder in
And scorch their wings with glory, liquid flame—
No, no, not that,—it’s bad to think of war,
When thoughts you’ve gagged all day come back to scare you;
And it’s been proved that soldiers don’t go mad
Unless they lose control of ugly thoughts
That drive them out to jabber among the trees.

Now light your pipe; look, what a steady hand.
Draw a deep breath; stop thinking; count fifteen,
And you’re as right as rain…
Why won’t it rain?…
I wish there’d be a thunder-storm to-night,
With bucketsful of water to sluice the dark,
And make the roses hang their dripping heads.
Books; what a jolly company they are,
Standing so quiet and patient on their shelves,
Dressed in dim brown, and black, and white, and green,
And every kind of colour. Which will you read?
Come on; O do read something; they’re so wise.
I tell you all the wisdom of the world
Is waiting for you on those shelves; and yet
You sit and gnaw your nails, and let your pipe out,
And listen to the silence: on the ceiling
There’s one big, dizzy moth that bumps and flutters;
And in the breathless air outside the house
The garden waits for something that delays.
There must be crowds of ghosts among the trees,—
Not people killed in battle,—they’re in France,—
But horrible shapes in shrouds—old men who died
Slow, natural deaths,—old men with ugly souls,
Who wore their bodies out with nasty sins.
. . . .
You’re quiet and peaceful, summering safe at home;
You’d never think there was a bloody war on!…
O yes, you would … why, you can hear the guns.
Hark! Thud, thud, thud,—quite soft … they never cease—
Those whispering guns—O Christ, I want to go out
And screech at them to stop—I’m going crazy;
I’m going stark, staring mad because of the guns.

Siegfried Sassoon

.

More of Mr. Sassoon’s poetry, and a short biography, are available here.

There are many literary commentaries on World War I: by Ernest Hemingway, Erich Maria Remarque, Ezra Pound. . . and here are two poets and two poems of that literature:

The Survivors by Siegfried Sassoon

No doubt they’ll soon get well; the shock and strain
  Have caused their stammering, disconnected talk.
Of course they’re “longing to go out again,”—
  These boys with old, scared faces, learning to walk,
They’ll soon forget their haunted nights; their cowed
  Subjection to the ghosts of friends who died,—
Their dreams that drip with murder; and they’ll be proud
  Of glorious war that shatter’d all their pride …
Men who went out to battle, grim and glad;
Children, with eyes that hate you, broken and mad.

CRAIGLOCKART,
    Oct. 1917.

And Wilfred Owen’s poem about the partially-anonymous S. I. W. :

    And offer him consolation in his trouble,
    For that man there has set his teeth to die,
    And being one that hates obedience,
    Discipline, and orderliness of life,
    I cannot mourn him.”
                             W. B. Yeats.

Patting goodbye, doubtless they told the lad
He’d always show the Hun a brave man’s face;
Father would sooner him dead than in disgrace,—
Was proud to see him going, aye, and glad.
Perhaps his Mother whimpered how she’d fret
Until he got a nice, safe wound to nurse.
Sisters would wish girls too could shoot, charge, curse, . . .
Brothers—would send his favourite cigarette,
Each week, month after month, they wrote the same,
Thinking him sheltered in some Y.M. Hut,
Where once an hour a bullet missed its aim
And misses teased the hunger of his brain.
His eyes grew old with wincing, and his hand
Reckless with ague. Courage leaked, as sand
From the best sandbags after years of rain.
But never leave, wound, fever, trench-foot, shock,
Untrapped the wretch.  And death seemed still withheld
For torture of lying machinally shelled,
At the pleasure of this world’s Powers who’d run amok.

He’d seen men shoot their hands, on night patrol,
Their people never knew. Yet they were vile.
“Death sooner than dishonour, that’s the style!”
So Father said.

                          One dawn, our wire patrol
Carried him.  This time, Death had not missed.
We could do nothing, but wipe his bleeding cough.
Could it be accident?—Rifles go off . . .
Not sniped? No. (Later they found the English ball.)

It was the reasoned crisis of his soul.
Against the fires that would not burn him whole
But kept him for death’s perjury and scoff
And life’s half-promising, and both their riling.

With him they buried the muzzle his teeth had kissed,
And truthfully wrote the Mother “Tim died smiling.”

Three excerpts over eight days: they come from an American ambulance driver for the American Hospital, Leslie Buswell in 1916:

32nd Division in TrenchesSaturday. [July 3, 1916]
The bombardment going on now is terrific —I have been standing about a hundred yards from my little house and looked across the valley on Montauville — Bois-le-Prêtre — and watched the shells exploding by the dozens.

Monday, July 5th.
I was called away suddenly — an emergency — and this is the first moment I have had to myself since. I doubt if I shall ever forget the last thirty-six hours — they have been so full of work, apprehension, and horror.

Sunday, [July 11th].
. . .   I could tell you a multitude of stories — stories so horrible I cannot forget, so pathetic that tears are not rarely in my eyes. On Friday night, I was on Montauville duty —and a new regiment arrived — “Bon camarade ” to me at once — “How many wounded?” etc., — they asked. I could not tell them that they were going to a place where between their trench and the German trench were hundreds of mangled forms, once their fellow-citizens, — arms, legs, heads, scattered disjointedly everywhere; and where all night and all day every fiendish implement of murder falls by the hundred —into their trenches or on to those ghastly forms, — some half rotted, some newly dead, some still warm, some semi-alive, stranded between foe and friend, — and hurls them yards into the air to fall again with a splash of dust, as a rock falls into a lake. All this is not exaggerated. It is the hideous truth, which thousands of men here have to witness day and night.
Saturday night they came back, some of those poor fellows I spoke a cheery word to on Friday — no arms — no hands — no feet –one leg — no face — no eye — One glorious fellow I took had his hand off, and although it was a long trying drive to Dieulouard he never uttered a word. I touched his forehead when I arrived and whispered, “Bon courage, mon brave!” He looked at me a moment and answered, “Would God he had taken my life, my friend.”
To-day I went to take three wounded officers to Toul, some thirty kilometres, away, and before starting I went into the hospital to see if I could do anything for any of those butchered by “civilization.” I saw a friend — the man who had offered me a German bayonet. He beckoned me with his eyes and then — “Have they forgotten me? I have been here for five hours and both my legs are shattered.” It was true that every bed was full of wounded waiting to be dressed, but I went straight up to the médecin chef and told him that a friend was over there with both legs broken and could he be attended to? “Ah, we have been looking after the others first, as he must die, but I will do what I can.” I stood there and watched his two legs put into a position that looked human and then I bade adieux to a newfound friend. I think I am glad he will die. I would prefer to die than to be crippled for life, and if my turn comes I only hope I may not recover to be helpless.
It is no good trying to make you understand what horror really is —you must see a bit of it as we see it here to be able to semi-realize what that place, the Bois-le-Prêtre, is like. It was known by the Germans when held by them as ” Hexenkessel” (witches’ cauldron) and as “Wittenwalden” (widows’ wood).
I wish you would cut out and keep for me anything mentioned in the official reports about the Bois-le-Prêtre, Pont-à-Mousson, Quart-en-Réserve (probably the most mutilated, unthinkable place in the world), La Croix-des-Carmes, etc.

Shell Shock PatientA summary of a 2004 BBC program on World War I shell shock states that officers in the First World War would find men reeling from shock, hunger, and illness, and punish them for desertion or for straggling (I have some pictures in a book called Over There of such punishment).   According to Johanna Bourke, Great Britain treated 80,000 people for shell shock by war’s end, and the mental health system in the country afterward had to find capacity for its mentally wounded, not to mention a treatment program that would be of help.

The ambulance driver above had the advantage over soldiers stuck in the trenches: a place behind the front to live (although his shelter was frequently bombed); to look upon, touch, and aid casualties but not to live next to them for days;  better food and recourse to medical treatment; and a job which was to preserve life and not end it.  Yet he still describes the conditions that lead to so many being shell-shocked in World War I: the constant noise and bombardment; the loss of comrades and persons one admired; the lack of personal security; little sleep; the lack of facilities for those in need.

The conduct of war has changed markedly since World War I.  For one thing, we are assured that supply lines are better, although we face current equipment shortages and have faced problems for our troops in obtaining body armor.  Hospital facilities are greater, but we still do not understand all the preconditions, stresses, and treatments for shell shock or PTSD as it is now called.  In addition, no conduct of war by definition can guarantee that death and killing, wounds, maiming, sleeplessness and insecurity and horrible waste of life does not occur.  Our military endures these conditions of war; it should not surprise us that they frequently bring them home as well. 

Our best hope in aiding current veterans are:

1. to insist upon furloughs that aid a soldier in recovering from shock and trauma and may alleviate symptoms of sleep deprivation;

2. to give soldiers as much equipment as they need in order to protect themselves and each other;

3.  to reflect upon the conditions that they are under so that we might partially understand what exposures they may have had, and to be able to listen and understand if they want to discuss it;

4. to insist that our governments make adequate provision for treatment of any serviceman who is suffering greatly.

In Over There, from the introduction:

. . . Usually death was frightful.  A brave officer who had been through too much told Dr. Harvey Cushing in October 1918: 
“The chief trouble now is the dreams–not exactly dreams either . . .  right in the middle of an ordinary conversation, the head of a Boche that I have bayoneted, with its horrible gurgle and grimace comes sharply into view. . . . But the worst of all are the dying faces that come to me of the men. . .

All the supply chain in the world will not take away the moral dilemmas and the bad memories.  For our surviving servicemen with PTSD,  we can provide home and a way home.

From 1862 to 1865, the poet Walt Whitman worked as a nurse in D.C’s Civil War veterans’ hospitals.  At that time, nursing did not have the same educational requirements: as Whitman put it, he would “visit the sick and wounded of the Army, both on the field and in the Hospitals in and around Washington city.”  He kept memorandum books of his experiences; ten years’ later, he edited the number of entries down and published them as written.  In the introduction, he wrote:

In the mushy influences of current times the fervid atmosphere and typical events of those years are in danger of being totally forgotten.  I have at night watch’d by the side of a sick man in the hospital, one who could not live many hours.  I have seen his eyes flash and burn as he recurr’d to the cruelties on his surrender’d brother, and mutilations of the corpse afterward.        . . . .

Such was the War.  It was not a quadrille in a ball-room.  Its interior history will not only never be written, its practicality, minutia of deeds and passions, will never be even suggested.

This interior history of U.S. military engagement lives on most acutely in veterans who have suffered battle fatigue, or post-traumatic stress disorder. 

The National Coalition for Homeless Veterans estimates that on any given night, 200,000 veterans are without a home–and a total of 400,000 veterans homeless for at least a portion of the year.  Twenty-three percent of all homeless people in the U.S. are veterans.  Others estimate that it is more.  In 1998, one census carried out at Gospel Missions identified more that 40% of its population was former servicemen from Vietnam.  In 1996, and again ten years later, a one-day survey of 139 homeless shelters nationwide took a poll.   Here are the stats:

Korean War Veterans:  10% in 1996; 4% in 2006
Vietnam War Veterans: 43% in 1996; 39% in 2006
Gulf War Veterans:  10% in 1996; 16% in 2006.
Total veteran populations: 63% in 1996; 59% in 2006.

With a significant population of veterans already in the worst economic straits, the returning veterans of the current conflicts in Afghanistan and Iraq will continue to put a burden on the systems of the VA, homeless shelters, local mental health and emergency medical practices,  and other city services.  For these veterans, I believe we should expect numbers of distressed military personnel very similar to those of the Vietnam War.   Vietnam was an insurgent war, with guerilla forces that blended into countryside, villages, and cities.  So too, Afghanistan, with unrelenting community diplomacy required; large numbers of civilians affected by Taliban measures and by miscalculations/collateral casualties.  The same can be said for Iraq, with an even more bewildering array of political alliances, hostile forces, and chaotic community fighting.

Sometimes one reads that PTSD started with Vietnam: as Whitman’s passage above shows, this cannot be true.  The name of the affliction has changed, but our veterans have always suffered from it.  And the community at large also remains much the same.  Whitman’s “fervid atmosphere”– we now call “at the mall”, or “at Wal-mart.”   In the end, the only remedy for the veteran’s painful, interior history of war  is Whitman’s solution: to be involved, either as advocates or personally, for the Veterans whose lives are at risk in combat and then return home to find that combat memories still leave their lives, and potential, in continued grave risk.  Whitman knew:

May 12 [1863]–A Night Battle, over a week since.–We already talk of the Historics of the War, (presently to accumulate)–yes–technical histories of some things, statistics, official reports, and so on–but shall we ever get histories of the real things?—-There was part of the late battle at Chancellorsville, (second Fredericksburgh,) a little over a week ago. . . 

Robert Weller of AP wrote an article on military responses to PTSD prevention.  Specificially, a Department of Defense task force recommended that  that active-duty personnel receive one month of in-theatre R & R for every three months on the line.  Instead of following this recommendation, they will get two-to-three days for every eight in a combat zone.  They cite personnel deficits in a time of crisis, and they are right on both counts–the deficits and the crisis.  All the more reason to take care of who they have. 

The “weekend approach” works out to about the same number of days, but it’s not the same thing.  We can think about this in terms of our own, far-from-the-front lives.

Personal business:
Most people that work in non-combat settings barely get their errands done with a weekend off.  For our troops in combat theatres, you can take away the part about having to shop for groceries, but then you have to add in the problems of doing business entirely over the Internet or by long distance telephone.   You also have to add in the problems of keeping your personal relationships by Internet, long distance telephone, and letter.

Varied existence/varied ambitions:
Those of us with jobs get to leave them and go home and sit with our own people and our own stuff.  We change our venue and we change our clothes; we can take a walk, play with our children, go meet people with different outlooks and different values.  We have a choice to stay home, take small forays, or a weekend long trip to another place.  Any of these choices we make on our free time allow us to have a more varied existence, multiple perspectives–and recharged energy.   Time off in a battle theatre does not change one’s venue, or, for that matter, the variety of people with whom one can interact.  When we blow off steam, we often pick people that don’t have the same pressures on them to complain to: in a battle zone, everyone has the same pressures. 

Loss of sleep
Accounts of battle I have read concerning World War I, World War II, Vietnam, the 1991 Gulf War, and the current conflicts, no active-duty personnel has uninterrupted sleep.  This is one of the biggest reasons I see for having the full month off.  Getting only two, four, an occasional six hours of sleep wears on a person’s strength, emotional stability, and anxiety levels.  Inability to sleep is psychologically and biochemically damaging.  Adrenaline runs out just as patience does.  When this becomes chronic, a person is ill-equipped to deal with daily matters in a calm way–that’s here, state-side–and so much worse, in combat theatre.   And I imagine the term “theatre” is in itself a clue: like dramatic theatre, an exhausted soldier or Marine ends up donning a mask and playing the part s/he has both sworn to play and that the situation demands, without relief.  A longer furlough out of harm’s way would go a long way to reestablishing sleep patterns, or at least, a long enough time to get somewhat caught up on sleep: more naps more often.  And a corresponding restoration to his or her personality.

What about the constraints?
We are frequently balked by experts just when we shouldn’t be.  Next to the claims of military leaders who cite necessities and shortfalls, the above sounds perhaps soft in heart and soft on data, and certainly not a comprehensive list of problems for those in combat.  Yet in our daily lives we constantly confront the lack of Managerial Will to make a change in work procedures, work settings.  In such cases, we complain, or from the other side of the counter, we demand service.  That’s my point: we already know enough, if we stop to think, just what kinds of things are required when we read about a policy for R & R, or for counseling in military zones or afterwards in the U.S. at the VA or elsewhere. 

Every time we feel stressed at our jobs, or furious with some idiot on the road, or angry with our neighbor who parties all night when we have to go to work the next day, or find ourselves hoping for Friday:  that’s the appropriate feeling for us to have–we should have it.  It’s also the appropriate feeling that helps us understand why our service men and women need a heck of a lot more than what they’re getting.   And that would be: time off to break the lack of sleep problems; to start some new project unrelated to one’s job, in sports, study, a hobby; to conduct some sustained personal business, or relationship repair; and maybe even to get some breadth of time to mentally process the three months before. 

Even as onlookers, we know enough to look at these policies and evaluate them.  And we can and should expect our military leaders to take care of the people they command.  Period.  And if we choose to do so, we can insist upon it. 

To write your Congressional representative, check here.
House Armed Services Committee
House Committee on Veteran’s Affairs

To write your Senator, check here
Senate Armed Services Committee
U.S. Senate Committee on Veteran’s Affairs

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