Monday, 29 February 2016

Lessons from Combat Trauma

     Shay, an experienced psychiatrist, writes (in italics) about his experiences treating many Vietnam vets with PTSD. 
     I suspect that a surprising proportion of us, though never having physically been in an actual war, have nevertheless accumulated, not the same, but similar trauma over a perfectly imperfect lifetime. And have probably never received any timely counseling.

     “The child’s inner sense of safety in the world emerges from the trustworthiness, reliability, and simple competence of the family.”
     Children who grow up feeling unwanted, know no safety - have definitely been traumatized:

     “… moral injury is an essential part of any combat trauma that leads to lifelong psychological injury. Veterans can usually recover from horror, fear, and grief once they return to civilian life, so long as ‘what’s right’ has not also been violated.”
     Children expect unconditional love, but none of us receive it. The greater the gulf between what we ardently need and what we feel we receive, the greater the sense of betrayal - the 'moral injury':

     “Another veteran in our program wrote: ‘In my wildest thoughts I never expected or wanted to return home alive, and emotionally never have.’ 
     The sense of being already dead may contribute to the berserker’s complete loss of fear … It may also be the prototype of the loss of all emotion that defines for combat post-traumatic stress disorder the prolonged states of numbness – the inability to feel love or happiness or to believe that anything matters.” 
     How does a child appear when the expected source of unconditional love repeatedly says wildly hurtful things to the child? S/he may not reveal any change in expression. But there's inner amazement & profound confusion - 'Is this a Martian pretending to be my mother?' Also internally, there are earthquakes & aftershocks, with new layers of concrete hastily lathered around the heart.

     “What I want to emphasize here is the rapid transformation of grief into rage. For many of the (Vietnam) veterans in our treatment program for combat post-traumatic stress disorder, replacement of grief by rage has lasted for years and become an entrenched way of being. Much therapeutic effort aims at reawakening the experience of grief, which we regard as a process of healing, painful as it is.” 
     “I believe that the emergence of rage out of intense grief is a biological universal and that long-term obstruction of grief and failure to communalize grief can lock a person into chronic rage.” 
     I suspect many 'angry young men', as well as women, express their grief through rage.

     “There is growing consensus among people who treat PTSD that any trauma, be it loss of family in a natural disaster, rape, exposure to the dead and mutilated in an industrial catastrophe, or combat itself, will have longer-lasting and more serious consequences if there has been no opportunity to talk about the traumatic event, to express to other people emotions about the traumatic event, to express to other people emotions about the event and those involved in it, or to experience the presence of socially connected other who will not let one go through it alone. This is what is meant by communalizing the trauma.”
     It may not be until the late teens, when children of dysfunctional parents move away from home, and finally have the courage & safe opportunity to explore, and perhaps vent their grief.

       Jonathan Shay. “Achilles in Vietnam. Combat Trauma and the Undoing of Character.” Scribner, NY, 1994.


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