War Trauma and Its Wake

Expanding the Circle of Healing

Raymond Monsour Scurfield, Katherine Theresa Platoni, Raymond Monsour Scurfield, Katherine Theresa Platoni

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781136457883
• Topic: Psicología
• Subtopic: Salud mental en psicología

Decades after Charles Figley's landmark Trauma and Its Wake was published, our understanding of trauma has grown and deepened, but we still face considerable challenges when treating trauma survivors. This is especially the case for professionals who work with veterans and active-duty military personnel. War Trauma and Its Wake, then, is a vital book. The editors—one a Vietnam veteran who wrote the overview chapter on treatment for Trauma and Its Wake, the other an Army Reserve psychologist with four deployments—have produced a book that addresses both the specific needs of particular warrior communities as well as wider issues such as battlemind, guilt, suicide, and much, much more. The editors' and contributors' deep understanding of the issues that warriors face makes War Trauma and Its Wake a crucial book for understanding the military experience, and the lessons contained in its pages are essential for anyone committed to healing war trauma.

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An expanding circle of healing: Warriors and civilians impacted by war

Raymond Monsour Scurfield (Vietnam) and COL Katherine Theresa Platoni (OEF-OIF)

We have been impressed by the challenges in providing services that are evidence-based, timely, relevant and comprehensive for our troops and their families. This was true during and following the war in Vietnam and continues to hold true during and following deployment to Iraq and Afghanistan. And undoubtedly this will be the case for all subsequent wars and conflicts.

I (Scurfield) arrived in Nha Trang, South Vietnam in the spring of 1968. At that time, I was a fresh 2nd LT (also known as a “butter bar”) some eight months out of my graduate MSW program and was assigned to be the social work officer on one of the Army’s two psychiatric teams in Vietnam. And by the way, a “butter bar” 2nd LT in the Army was the lowest of the low: even a PFC (Private First Class) had more credibility in the Army than did any 2nd LT.

Before arriving in Vietnam, I had two pivotal experiences that have infused my thinking and convictions about the impact of war and recovery from it. These experiences have remained central to some of the principles that I hope we will retain as we continue to forge partnerships to provide necessary assistance to our service members, veterans of prior wars and their families (Scurfield, 2006a).

MSW intern experience with a psychiatrically disabled marine

The first experience occurred during my MSW field placement in 1966–67 at the Sepulveda VA Hospital in the San Fernando Valley north of Los Angeles, where I was a social work intern. One of the psychiatric inpatients assigned to me was a young Marine who had a diagnosis of schizophrenia. In reading through his records, I found out that he had suffered a psychotic break. He had decompensated while on the battlefield and had been medically evacuated out of country. I might note that, later on, I came to realize that it is extremely rare for any troops to break down psychiatrically while in combat in a war zone. Usually, such breakdowns do not occur until some time after the battle is over—perhaps several days or a week or two later when back in base camp or back behind the wire after a mission, or perhaps not until some time after returning from deployment. And that “some time after deployment” can be weeks, months, years or even decades later.

As you might know, the condition of schizophrenia oftentimes is characterized by a waxing in and out of lucidity. It was during one of those lucid times that this Marine said to me, in a conversation that I will never forget: “Ray, you have to help me get back to Vietnam. I ‘deserted’ my fellow Marines on the battlefield.” He continued: “I have got to go back to Vietnam so that I can prove that I am a man.” He had seen his having suffered a psychiatric break during battle and being medically evacuated as desertion!

My heart was breaking as I heard this young Marine plead for me to help him return to Vietnam. Of course, he never again would be admitted for active duty into the Marine Corps, let alone be deployed to any war zone. What I learned from that poignant encounter was that nothing is more important to a deployed service member than the extraordinarily powerful peer relationships forged in the fire and danger of combat with the other members of his or her operational military unit. Nothing exceeds this level of significance. He felt that he had inexcusably let them down; his self-esteem had been sorely damaged and he suffered long-standing guilt over not completing his mission.

I also learned my first lesson about one of the primary mental health axioms of military psychiatry, although I didn’t realize it at the time—only as a matter of last resort do you medically evacuate someone out of a war zone. This is not only because the medical mission is to “conserve the fighting strength.” It is also because such a medical termination of one’s deployment might end up haunting one for years or decades—with no way to “go back and make it right …”

Experience on a civilian airline with a physically disabled combat veteran returning home

The second pivotal life experience happened after I had received my orders for Vietnam and had just come to the end of a stay at home for a couple of weeks prior to being sent off to Vietnam. I boarded a commercial plane in Pittsburgh bound for Philadelphia, and was to catch a connecting flight to Seattle/Tacoma. Because I was traveling on military orders, I was in my uniform. Once I was seated and it seemed like all of the passengers had boarded, the aisle seat next to me still was not occupied. I thought, “Wow, I have caught a break and can stretch out and not have to converse with anyone.”

But then, I noticed a late-arriving passenger appear at the front of the plane. He was obviously a veteran, judging by the hat and insignia on his clothing, and he shuffled into full view at the front of the cabin. He slowly moved down the aisle with the assistance of two forearm crutches. I also noticed the patch over one eye and what looked like two prostheses where his legs used to be. As he slowly made his way down the aisle, my gaze was transfixed on him. And then, suddenly, I realized that he was heading, inexorably, toward the empty seat—next to me!

I don’t remember a lot about what happened next. I do remember that I felt extremely awkward, thinking “what am I going to say to him?” And I found that I was preoccupied with my own self-centered thoughts about how ironic it was that I was on my way to Vietnam and a blown-up Vietnam vet was going to be seated next to me. He sat down, and we said hello to each other. After we had taken off, I found myself awkwardly silent. And then, I remember that this young soldier turned and he started talking to me.

What stood out were two comments he made. The first comment was that this was his second trip home from the hospital on convalescent leave, part of the rehabilitation process of adjusting to his prostheses outside of the hospital setting. And I will never forget what he then said to me: “Sir, I am not looking forward to this second visit home. The first time I went home on convalescent leave, several of my high school buddies told me that it was a shame that I had lost my legs and eye for nothing … That really hurt.”

I have no recollection of how or if I responded to this intimate revelation. However, I do remember what this brave young Marine then said to me: “But you know, sir, I’m the lucky one. No one else in my foxhole survived …” I didn’t realize it at the time, but I had just learned two remarkable lessons. First, that one of the worst things that can befall anyone who has served their country is to be told or to believe themselves that their sacrifices and those of their battle buddies have been in vain—let alone that they are not honored and recognized positively for their service to our country. The second lesson was that this young, severely physically disabled Army veteran had taught me, long before I started reading decades later about “the strengths approach” to mental health and the principle of “post-traumatic growth,” that someone who had lost and suffered so very much had somehow been able to reframe that loss and suffering into something celebratory.

Hopefully we are being guided, indeed driven, to be engaged in serving today’s military, veterans and their families fueled by some of these very same lessons that I first came to understand through these two fateful encounters even before I had arrived in Vietnam—one with a psychiatrically disabled Marine veteran, and a second with a physically disabled Army veteran.

I had yet to learn that this special population of warriors (those wounded or injured in battle and medically evacuated, and their families) face a remarkable series of additional trauma, stress and challenges. Such challenges occur throughout the medical evacuation process, hospitalization and stabilization Stateside, and continue as a lifelong journey of healing for many. The distinctive experiences of healing for this important special population of warriors is discussed at length in Chapter 8 (see also Scurfield, 2006b).

Colonel Platoni also had two pivotal experiences that have had an indelible and profound impact.

Bringing survival guilt home from Afghanistan

It was almost ten months to the day that my unit redeployed back to the States. I received a surprising call from one of the NCOs in whose platoon we had been embedded with in the Taliban stronghold of the Zhari District of southern Afghanistan. We had become brother–sister soldiers early on in our deployment. He had poured his guts, his heart, his soul out to me in the chow hall one day; just one time, but the ministry of presence of our small three-person combat stress control team had become well-established no sooner than our boots hit ground.

These precious moments bond those of us too familiar with the torment of the combat zone together for life. He had reached the end of the line, the end of his rope, battering himself with all the self-blame and guilt he could muster. He survived. The younger soldier, of a lower enlisted rank, did not. His mortal wounds at the hands of the insurgency and their improvised explosive device of the day assured that almost no one would get out of the MRAP (Mine Resistant Ambush-Protected Armored Vehicle, weighing between 32,000 and 38,000 pounds) alive. Their cunning technology often outweighs any armored vehicle we can design, build, and ship overseas in sufficient time to save lives.

He had nowhere to unload his guilt, his blame, or the intrusive piece of information that his buddy had sustained unsurvivable wounds. What outlet would allow him to purge himself of such horrific burdens? He was convinced that those who had not lived in his boots simply could not understand the magnitude or depth of his anguish. He begged me to listen, insisting that no one else could help him. I was “the ma’am” who had been through it with them in real time; all as if I was the only voice that he could hear. And I tried to arrange for him to travel to my home state so that I could treat him pro bono and to set up service for him at his current military installation. Sadly, neither of my offers for assistance ever materialized into an intervention by the time of our last contact. I fear that the cost of his apparent inability to follow through will be far too high for both of us.

This experience has had an overpowering impact on me. It has taught me that if one is willing to provide little more than a brief moment to offer a listening ear, this may very well influence the life of a suffering soul for months or years or even a lifetime. This is also a compelling indication that regardless of rank or training or age or gender, it is possible to offer up the indisputable belief that it is vital to share one’s unforgettable and life-altering experience, to be heard, and to be appreciated. This is essential to healing and moving forward in the trauma recovery process.

Immersed in the killing rampage at Fort Hood while preparing to deploy

It is the expectation that those of us on scene during the shooting rampage at Fort Hood, Texas may be steeped in abject horror for the remainder of our lives to one degree or another. Those surreal moments of sheer terror, shock, revulsion and disbelief may diminish in time. However, for many, they are doomed to repeat themselves—the high cost of loss of a fellow soldier produces no less of a reaction.

At the time of writing this book, the (alleged) shooter’s court martial has yet to take place. Though the Article 32 investigation hearings (similar to a grand jury in the civilian sector) concluded in the fall of 2010, I (COL Platoni) remain on the witness list and am prohibited from providing specific details of those events that occurred at the soldiers’ Readiness Processing (SRP) Site at Fort Hood, Texas on that fateful day of 5 November 2009. Having departed the building shortly before the rampage began and because I am the colonel who refused an escort based solely upon rank in order to move to the head of the line, I was steadfast in insisting that I would wait at the end of lines that were hours long, just as everyone else is required to do. Call it humility or stupidity, my own obstinacy may have saved my life. I bear no shortage of guilt for having removed myself from the line of fire, literally, as there is little doubt in my own mind that there was a round (bullet) with my name on it that day. (I was later informed that I was to have been the shooter’s direct supervisor at the first forward operating base to which I was assigned in Afghanistan and that the shooter had marked me for death that day.)

Having completed the medical portion of the SRP after being sent to the overflow building (next to the building where the actual shooting occurred), I reported back to the Soldiers’ Dome, the building (built by Elvis Presley many years earlier) in which we both initiated and concluded the SRP process. Subsequent to hearing someone screaming repeatedly that there was a shooting in the other building, I shoved as many people out of a door of the facility as I could push with both hands. Then I ran towards the door and the building in which five of my beloved friends and fellow soldiers had lost their lives. A more likely instinctual survival response ingrained in human behavior would be to move directly for safety. However, soldiers, firefighters, paramedics, emergency medical services and law enforcement are programmed to rush toward danger and straight into whatever fire or line of fire lies ahead.

Before I could exit the door, I witnessed the dying and wounded being carried inside and away from the scene of the rampage by our very own soldiers. To date, there are no adequate or accurate words to describe the impact of the terror and the alarming sights that followed. All of us, in split-second time and on scene, engaged in lifesaving measures in one form or another and became eyewitnesses to the most ruthless killing of soldiers by one of their own in American history.

The night of the massacre, after a day that will be engraved in time for all our days to come, we had been released from “lock down” inside the building, in which many of the wounded and dying were carried to safety, as far from the shooter as possible. Following required interviews with CID (The U.S. Army’s Criminal Investigative Command), we were reunited with the remainder of our soldiers at the Iron Horse Dining Facility. Those who were not on scene were directed to this chow hall for accountability purposes and their own protection. It would not be until the next morning that we would be informed of the actual toll of our losses, as many of our soldiers had not yet been accounted for and could not be located.

While waiting to be bussed to this chow hall, I was confronted with waves of near panic. I was realizing that years of sleepless nights would be a continuing blight upon our lives in the face of an event of such catastrophic magnitude, as we waited for the news of the casualty and body counts. There could have been no more devastating a task to face for any and all of us.

I decided that enduring this very night alone and accompanied only by gruesome and sorrowful thoughts and images of the day’s events would be conducive to nothing advantageous. I passed the word that everyone was welcome to return to the female barracks in which we were housed at North Fort Hood so that no one would need to be alone or to feel abandoned. Being together, regardless of all else, was essential to recovering from our own trauma. We tossed wall lockers and mattresses on the floor, a living room of sorts created with the bare essentials to provide some modicum of comfort to exquisitely pained souls. Everyone placed what food they had on the tops of lockers for sharing. I made pot after pot of coffee. Pizzas were ordered and the costs shared. There was no agenda, other than to remain together in the face of a tragedy of unparalleled proportions.

It seemed natural not to discuss the events of the day, but rather to forge and solidify bonds based upon the most dreadful of almost all possible life experiences, to guarantee that we would support and bolster and simply be there for one another for the duration of the deployment and perhaps the rest of our lives. No one understands better than someone who has been there in the very trenches of our own experience. It is also quite noteworthy that some of us chose to debrief ourselves many times over in the months that followed, informally and sometimes with no more than two of us at a time, often without planning or forethought. Frequently the only means of doing so was by internet or phone, as we were scattered throughout the combat theater of operations in 13 distinct teams. It would happen time and time again on our own restorative journeys and will no doubt continue well into the future.

This experience impacted my learning that the war accompanies us home in our ruck, our duffel bag, and whatever else we drag home with us. Departure from the wartime theater is geographic in nature only. And no one gets out unscathed (Platoni, 2006). The powerful and enduring bonds among and between those of us who deploy...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword
• Preface
• Acknowledgments
• 1 An expanding circle of healing: Warriors and civilians impacted by war
• 2 Myths and realities about war, its impact, and healing
• PART 1 Warriors impacted by war
• PART 2 Special populations of wounded warriors
• PART 3 Civilian populations impacted by war
• PART 4 Military and resiliency initiatives
• Epilogue
• Index