Best Defense comment of the day: Jim Gourley on spelunking through PTSD

While Tom Ricks is away from his blog, he has selected a few of his
favorite posts to re-run. We will be posting a few every day until he returns.
This originally ran on July 28, 2010.

This was posted yesterday by Jim Gourley in response to Blake
Hall's guest column. Like Blake's terrific essay, this comment really struck
me as thoughtful. I told my wife about the cave analogy over dinner. 

Of Lepers and Caves

By Jim Gourley

I'm going to say quite a few things that I can't immediately qualify, because
the views build on each other. I wish I could give you a clear line of
reasoning, but if I could then PTSD wouldn't be a problem. So I'm going to do
this the only way I know how -- create the ball of twine and then unravel it.
Bear with me.

I am an expert on PTSD. So is every other Soldier/Sailor/Marine/Airman
(avoiding diatribes against the all-inclusive "warrior" here) who has felt
and/or suffered (because feeling and suffering are distinct from each other)
from PTSD. I know we are all experts because no one else does, or can,
understand the condition without having gone through it. Army psychologists and
counselors who have not felt it or suffered from it only scratch the surface of
the problem.

PTSD is very difficult to deal with for two reasons. One reason is the
misconception that it is a psychological condition. It's not. It's a spiritual
condition. Yes, I know that you cannot anatomically identify the human spirit or
sedate it with valium and that, for all its complexities and mysteries, we find
the brain much easier to "treat", but I'm telling you right now that trying to
understand PTSD under a psychological paradigm is like trying to conduct an ACL
surgery at an auto-body shop. I've met David Grossman, and even he speaks about
it in metaphysical terms on a frequent basis. If you don't believe me, I'll go
dig up the quotes from all the shrinks-in-chief that declare the cause for
spikes in suicides in 2008 and 2009 and 2010 was "due to the weather." I give
all due respect to the shrinks and counselors. They're doing their best. But
with all due respect, their best is nothing but best guesses. Because this isn't
scientific. It's spiritual.

The second reason it's difficult is that, even when we acknowledge the
spiritual nature of this condition, we are woefully inept at dealing with it.
Blake Hall hits on all the things we do wrong -- ridicule, ostracize, and ignore
those with the disease. Treat the guy like a leper.

You want to know why we do that? Because deep down underneath all that
type-A, testosterone-driven, state-of-the-badass-art Spartan warrior bravado
that we exude, we are scared to f---ing death that we'll catch it. PTSD in the
Army is like cooties in a third-grade classroom.

If we want to treat PTSD, we've got to do exactly what Blake did. We've got
to learn how to hug lepers. We've got to get past the condition and see the man
or woman we've always known. We've got to embrace them and hold them tight, tell
them that we're here and we're not leaving them. And we've got to mean it. We
have to be there. At the office, on the steps of their house, on a swollen
riverbank out back of a Chili's on a Saturday night, on the floor of a living
room where there used to be furniture at 2 o'clock in the morning. These people
don't need us 24/7, but when they do, we've got to answer the call. And we've
got to be the kind of leaders and peers that instill enough confidence in them
that they'll pick up the phone and call us.

Hotlines and VA administrations can't help. They weren't there in the s--t
with you when it was all going down. They don't know. They didn't see. And they
don't really care. Yes, I know that many of these people really DO care, but I
only know that now. When you have PTSD, you DON'T know that. You certainly won't
believe it. Let me back up.

Here's what PTSD is like, and why people kill themselves over it. Think of
life like a cave. If I send you into a cave with a lantern and tell you there
are no bears in the cave, you feel safe. You will walk around the cave and enjoy
yourself. Now what if I give you a lantern and a gun and tell you that there is
a bear in there? You can still go down, but you'll be careful to look for the
bear and ready to run or shoot if you see it. Now, what if I send you down there
with a gun but no lantern and simply say "bear" to you? Pretty soon, you're in
there, you can't see the way out, and every rock you bump into feels like a
bear. After a long enough time being down in the cave, you realize you don't
have enough ammo to shoot everything that might be a bear. It has nothing to do
with running out of food or water or feeling like you're fighting some
unwinnable battle with the bear. You just get sick and tired of the uncertainty.
Are you going to live through the night? Are you going to wake up to a bear
gnawing your intestines? You get to the point where you just wish the bear would
come along and end it. And when he doesn't come, you decide to do it yourself.

Suicide isn't a surrender, it's a reassertion of power. These guys' lives
have spun out of control, and the decision over whether they live or die is the
last thing they have the power to determine. Think about it. You ever met a
Soldier that wasn't a "take charge kind of guy?" That's my warning bell. I've
seen lots of "cries for help" where a guy said "life is meaningless." I don't
put much stock in those. But when he says "life is scary"? That's the guy that's
going to do it.

So, back to the moment of choice. You've got that gun on your bed or your car
keys in your hand and a good cliff in mind. What's going to get you out of that?
Some slick-sleeve doc you've never seen before asking you how many times you've
been deployed, or a buddy putting his hand on your shoulder and saying "you
alright, bro? you look like you're hearing bears."

I'm out with a buddy a while back. We're talking about brands of beer. He
hears a car backfire, and suddenly he's scanning ridgelines. He's not here
anymore. He's all the way in Afghanistan, and he takes me halfway back to Iraq
with him. I think about saying something, telling him that he's here, not there.
That I'm with him. That everything is okay. But that would be the wrong thing to
say. A couple of minutes pass as we walk. He keeps scanning, I just stay by him.
After that, we go back to talking about beer. We don't mention anything about
the event.

A couple of days later we're walking along and he says "you know, I really
freaked out the other day." I tell him that I know, and I was right there with
him. That's all that needs to be said. He knows my story. We don't need any
elaborate cathartic rituals or long discussions about it. It's no different than
strapping on armor and walking outside the wire. I trusted him to be able to
take care of himself, and he trusted me to catch him the moment he couldn't.
We're Ranger buddies, not baby-sitters. Giving him dignity and letting him fight
the battle on his own is just as important as helping him get up when he gets
knocked down.

Our best therapists are our brothers and sisters. The medicine is the very
spritual bond of the profession of arms. But you've got to give that medicine in
a heavy, constant dose. I'm talking about full-on morphine drip here. When
you're in the cave with that bear, you're aware that something is wrong with
you. You can't help but feel that. Because of that, you become acutely
suspicious of EVERYONE around you. You begin to hate yourself. You have very
good, rational reasons for hating yourself. You don't understand why everyone
else can't see these reasons and why they don't hate you. Or maybe they do.
Maybe they're secretly drafting personnel action memos to move you somewhere
else. Maybe they're talking behind your back. It seems like the only people who
don't hate you are your wife or kids or parents. Well, it's obvious why. They
weren't out there with you. They didn't see. They're all idiots. You start to
hate them for not understanding you and not hating you. They keep telling you
it's going to be okay and to calm down, and if they say that one more time
you're going to scream and wring their necks because it's just not true because
so help-me-god-i'm-down-inthiscavewiththisbearandit'sgoingtogetmeAAAARGH!!!

"Jim, where's your furniture? Where's your wife? What's going on?"

"I've ruined my life, Sir."

A Lieutenant Colonel sits down on the tile floor of an empty house beside a
sobbing Captain. He's a Brigade XO who's had a long week and only has about a
month before he takes Battalion Command and goes to Iraq. His wife is waiting
outside in the car and his kids are waiting for him at home. But he takes time
for this guy, because he's been down in the cave. He knows this guy is terrified
of bears right now, and the Captain might not make it through the night if he
doesn't show him there's no bear. He doesn't just refrain from ridicule. He
starts telling stories. Stories he'd rather not remember. Stories told in
confidence that probably won't be told many more times in his life, but will
never be forgotten. That Lieutenant Colonel says lots of things, but it all adds
up to one important message.

"There is nothing wrong with you."

He doesn't mean that in a "you ain't hurt, drive on", Patton way. He means it
in a very genuine, spiritual way. There is nothing wrong with that Captain
because EVERYONE feels that way. We are either all lepers or we're all fine.
Either way, there is no reason for that Captain to feel like he's untouchable,
outcast, damaged goods. The Lieutenant Colonel chooses to believe we're all
okay. On this night, he's successful in convincing the Captain that this is
true.

"Is there a gun in the house?"

It's the right question to ask. There isn't one. But the Captain is holding
his car keys in his hand and has a bridge in mind. That the Lieutenant Colonel
cares enough to ask is all it takes to remove the notion.

"I'll see you at work tomorrow. We'll figure this out-- together."

And that's how my long, slow crawl out of the cave began.

That Lieutenant Colonel said all the right things in all the right ways. You
can't train a doc to do that, or write it down in a field manual. You can't
teach it to Cadets at West Point or illustrate it on a power point slide. How do
you get more leaders to be like that Lieutenant Colonel? The answer, sadly, is
that we've got to save as many people going through it as possible, and keep
them in the fight. They're the ones who are innoculated against it. They can
recognize it, acknowledge it, and help others to fight it. They possess a
compassion and empathy no one else can. How do we save the ones currently
dealing with it when we have so few who are innoculated? I don't know, but I
wish to God someone figures it out. In the meantime I keep watch over my buddy
while he watches ridgelines. So much for the extent of my PTSD expertise.

I know how people here feel about Sassaman's memoir, but there was one
passage in it that is worth reading the whole book to see.

"A part of me will always be a broken-hearted 40-year-old Battalion
Commander."

He says that in reference to the death of Captain Eric Paliwoda, an event
that shook him to the core. I suppose it resonates with me because part of me
will always be a broken-hearted 26-year-old Captain. I've learned how to keep
that part of me from causing the great suffering that nearly destroyed my life,
but I still feel it. I feel it every time I see a friend scan ridgelines, or
listen to someone talk about watching another human being bled out and die in
some godforsaken wheat field that no one will ever remember or care about. I
feel it, and by feeling it I'm able to relate. And while we relate to each other
and share the heartbreak, that person is able to breathe easy in the cave,
because there's one thing in there that they can be sure isn't a bear. It's
another leper holding onto them. Life isn't scary, and it's worth living another
day.