Working with Veterans:
Getting Started

On Monday, December 4th, BPSI’s Andrew S. Berry will be joined by Captain Nate Emery, MS, who served 22 years in the Marine Corps, to discuss a psychoanalytic approach to treating veterans. You can register for the workshop here. Continuing education credits will be available for clinicians.

by Andrew S. Berry, PhD, PsyD, ABPP

 

“The First Step”

I have worked with combat veterans for a while, mostly Marines and Navy Corpsmen with PTSD and related issues, and it occurs to me that there are two kinds of “messed up” they come home with. The first is PTSD (and, by the way, I don’t believe there are PTSD experts: we’re all still students of it) but the second kind comes from the ever-changing rules of engagement which have become progressively more complex as objectives became more political than military

Under the current rules of engagement (as opposed to those applied during invasion or in the early days of occupation), a Service Member can witness  comrades being hurt or even killed yet have to wait for certain criteria to be fulfilled before responding with force.  That waiting can go beyond harrowing into agonizing.  So troops can come home with not only the tell-tale thousand yard stare but with an aggravated sense of unfinished business, survivor guilt, mistrust of leaders and visceral frustration and rage.

The first step? Get them talking about it. All of it.

 

“Listening Without Judgment”

Many moons ago, I heard a Viet Nam era veteran say something that, I think, rings eternal: “We want to be heard. We don’t want to be judged.”

When we, as clinicians begin to hear what combat veterans have to say about  what they had to do to keep themselves and their buddies alive, what they remember and how they feel about it now, it may be unlike any other clinical material we  have ever be exposed to. Some clinicians may feel traumatized by what they hear — perhaps the point where they wonder if they could ever deal with stark facts of war, let alone help their patient. We cannot say we understand, because we never will. We can only stand ready to witness the thoughts, memories, and emotions of these men and women as their experiences are put into words, often for the first time. We may flinch — which simply means we are truly listening, but we cannot judge.

Service members come home to their families who often wonder what could have changed them so fundamentally.  A young girl once remarked to me “My Daddy went away to war, and something else came back home.” These warriors do not want to burden their families with what they have seen. They can only speak of their experiences with their brothers and sisters of the battlefield first, and we clinicians, secondarily, if we are lucky enough.

I say “lucky enough” because I have never felt burdened or disturbed by what I have heard. I have actually felt honored to have been “let in” as it were, to the inner circle, after which deep healing can begin. I believe that, above and beyond everything else, telling their story to a trusted other allows the warrior to memorialize the dead even as they deal with survivor guilt which, incidentally Freud wrote of in his earliest conceptions of “war neurosis.”

These warriors are often deeply pained by the civilians they are sworn to protect. By this I mean pained by ignorance, indifference, or scorn. John Q Taxpayer tends to think of having PTSD symptoms as being “crazy.” This kind of thinking perpetuates the treatment of veterans as the chattel of society. Most civilians are unaware that a large percentage of emergency management technicians, firefighters and law enforcement officers are also veterans. In short, America has little true knowledge of what it takes to defend their homes, their neighborhoods, their cities, their states, and their very nation, and this ignorance leads to premature judgment and discrimination

Veterans do not want to be judged by what they had to do to survive and overcome. They wish to be understood, validated, and allowed to speak freely of their brothers and sisters in arms — some of whom are no longer here; in other words, they wish honor the sacrifices which war demands.  As clinicians, we have a unique opportunity to join and support them in an honor rarely shared.  We sit with these veterans as fellow citizens and fellow human beings looking directly into the face of war.  To judge is to re-traumatize but to join in bearing witness is to honor — and, often, to help.