Therapy for PTSD: Whose Search for Meaning? (Part II)
David S. Harrington, LCSW, Washington, DC
The Healing is in Telling Our Stories of Vietnam
The relevance of these moral, social and political questions to successful therapy with Vietnam veterans unfolds in the telling of stories about Vietnam. Let me share my story.
Personal integrity, a love for people, and a commitment to excellence were core values guiding me on my arrival in Vietnam. Fluent in French and Vietnamese, trained in counterinsurgency and prepared for leadership of small combat units, I wanted to help the Vietnamese people defend themselves and determine their own course. I was willing to die for that cause. However, within weeks, I understood the fraudulent nature of our role in Vietnam. My goal changed from securing Vietnam for democracy to getting the Marines under my command home safely. At the same time, I gained respect for the Viet Cong and the North Vietnamese and admired the deserters and war protesters at home. From their standpoint, they were acting from a stronger value base than I was; from my perspective, their political or economic foundations enabled them to express their values in a clearer and more effective manner.
I wish this were everything for me to tell about my Vietnam war. It is not. There is much more. R.D. Laing described this dilemma in his Politics of Experience: "If I could turn you on, if I could drive you out of your wretched mind, if I could tell you, I would let you know." Let me share one story.
Every day I remember Michael Jay Warren. We met on a chilly, rainy morning in November 1967 in Phu Bai. The day before, my first in-country, had been difficult. No matter how hard I tried to "look cool, act cool, be cool," I failed miserably. A second lieutenant in stateside fatigues, unarmed, confused and carrying a too-full duffel bag just did not blend in well. Like a tow truck approaching a stranded motorist, Mike greeted me with a firm handshake, a friendly "welcome aboard" and a warm smile. He understood my discomfort immediately. Later he was to kid me often: Had I been in a firefight or on a binge on my way from the airport? As he walked with me to requisition combat equipment, I found myself relaxing. At each stop, he'd introduce me, state my needs (boots, fatigues, canteens, etc.) and make sure I was given the best available. His command presence, his experience and his ease with others all impressed me. Could I measure up? Would we be friends?
At lunch the same day, Mike and I shared more about ourselves: His upbringing as a Presbyterian in Moline, Illinois, and mine as an Irish Catholic in Dorchester, Massachusetts. The Marine Corps was definitely not a career for either of us; more to the point, the status of Marine Corps officer gave each of us a chance to escape the confines of our youth. Vietnam was a hurdle we needed to get over. How high? Mike worried. He'd had a close call. The idea of his death struck him as ridiculous. I was the next one to worry. Mike had done well in combat and would be transferred in a while to a safer staff job.
Our time together was all too brief. I remember a day in mid-January 1968, when our company had been sent out to secure an area in front of Khe Sanh. My platoon was to establish a defensive position--in eight-foot elephant grass along a deep ravine. I was furious, cursing out stupid staff officers who constantly endangered us with unreasonable assignments. Mike walked into my platoon command post just as I was finishing my last string of epithets. He held up the latest issue of Stars and Stripes for me to read the headline: "Paris Peace Talks Stalled; Debate Shape of Table." Mike drew an analogy between tables, Paris and staff officers and ravines and Khe Sanh. He laughed at the irony. From there, we were off talking about France, planning to drive around Europe together.
Our last conversation took place while sitting in elephant grass outside Khe Sanh. The night was dark, chilly and damp, typical of the monsoon season in that part of Vietnam. Mike recalled the fun he'd had at Coe College and fretted about a career direction. He was fond of a young woman back in Moline but worried that he was too young and inexperienced for marriage. He was happy to be leaving our infantry company, but wondered whether we would keep in touch.
Mike was committed to our friendship. Several times after he left he managed to send us socks, beer, extra whatevers. He had a sixth sense for the shortage of the week and knew several helicopter pilots who were willing to make an extra trip for him. I got a couple of notes: he was fine but missed the excitement and the friendships. Seven weeks after Mike's transfer, the morning helicopter let off a Marine returning from the rear with a note for me from the company First Sergeant. "Lt. Harrington," he wrote, "I regret to inform you that Lt. Warren was killed last night in a helicopter crash. Top." Just like that, Mike was gone.
His parents, Clarence and Ruth Warren, wrote: "Lt. Harrington, Mike did not write often. We have him home with us. But we know so little of what his life was like those last few months. Could you tell us something more?" I involved the whole company in this project. We collected pictures of Mike and many of us wrote notes. We mailed our large manila love letter to the Warrens. A few weeks later they wrote back, "Thank you all so much for your kind words and pictures. It will always be so important to us that Mike had so many friends."
In mid-January 1969, while I was on my way back to Vietnam for a second tour, my plane landed in Quad Cities Airport. Clarence and Ruth met the plane. Mike had his dad's physique and his mom's warmth and ease. Each of us worked hard to keep our emotions in check. As I set down my bag, a small one this trip, in Mike's room, his mementos blurred through my tear-filled eyes. Ruth came up to the room to suggest plans for the evening. "David, there's a high school basketball game tonight. It's Mike's old high school team. We've been ticket holders for years. We'll have dinner afterwards. Would you mind wearing your uniform? Are you hungry enough for a hot dog now?"
Was I impressed! In Boston, the public high school had old uniforms, small gyms and poor attendance. Here in Moline, the gymnasium was bright and large, the crowd filled every seat; the band played as cheerleaders pranced. Spectators, mostly family friends, came over to say hello; Clarence and Ruth swallowed their pain and smiled. "We are delighted David could be here with us," Ruth said over and over. Suddenly, the crowd hushed, stood and faced one end of the gym where, as the building darkened, a single spotlight shone on the American flag. Everyone sang. Immediately afterward, as we all sat down, the spotlight glared in my eyes; the announcer's voice boomed in my ears: "Lt. David Harrington, would you please stand? Ladies and gentlemen, Lt. Harrington, a friend of Mike Warren, visiting with Clarence and Ruth. Would you give him a warm round of applause?"
I don't know who won the game, even though I pay attention to such things. I do know dinner the next night was rough. Clarence took out maps, pictures and letters and wanted me to retrace Mike's footsteps. Clarence and I left the room several times. Only Ruth persevered.
A year and a half later, as I stood in the receiving line at my wedding in another midwestern city, my attention drifted momentarily and my eyes fell on Clarence and Ruth. I was overcome with pain. Only the tears in Ruth's eyes and her gritty smile helped me pull myself together.
The legacy of what Mike and I had in Vietnam is unfulfilled if left only to Mike's name etched in the black granite of the Vietnam Memorial Wall. Each day since Mike died has sharpened the personal pain of the memory and the loss. I cannot lump Mike's death into the memory of our war dead. War's cost must remain personal, painfully so, to deter us from it. Mike and I cannot let go of each other. Nor do we want to. However, the effort to maintain our friendship strains me. I'm alive. Mike can't develop and change alongside me.
Is our dilemma that of all Americans after Vietnam--forget about it or be damned to wallow in it? I would prefer to understand and accept what happened as well as to learn and to grow from the experience. To do that, I realize, means I must share my experience as fully as I can with you and invite your interest and questions. Ask me about Mike Warren, even if it hurts us both. Beyond that, we must work through the implication, both personal and societal, of the Vietnam war experience. I cannot understand and accept Grenada, Lebanon and El Salvador. My reasons go far beyond what happened to Mike Warren. But that is where they start.
This day, as it has every day since 1968, a picture of Mike and me--well worn by now--sits on my dresser. As on the day we first met, his helmet and flak jacket are on straight and buttoned. I'm unshaven, without a helmet, and my flak jacket is open. Often I visit with him at the Vietnam memorial. But I can't call Mike long distance and tell him how I feel or how all of us have lost something in the aftermath of Vietnam and the divisiveness of the 1960s. Perhaps it was the capacity to care for each other in a special way. Mike and I thought that our friendship might do for you what it did for us: we were enriched with a deep understanding of the value of human life, and I, with an understanding of the absolute cost of its loss in wars of any kind.
While there are many lessons in this story, there are three I wish to highlight today. First, for me, as a Vietnam veteran, the process of starting with myself and sharing my story with others has been therapeutic. The healing is in the telling. Second, the story of Michael Jay Warren did not come out coherently the first hundred times I told it. Only listeners, careful caring people, were able to help me sift through all my thoughts and feelings and begin to make sense out of just this one story. And I have many more. For you, the therapist, then, listen not for clues as to the structure of my personality but hear my words in your own well-defined social, political and moral context. Third, because trauma creates so many confusions, the therapist alone cannot unravel all the stories but must instead empower the Vietnam veteran to move the telling from clinical setting to home, office, community and beyond.
Acknowledging the Context: Therapist as Artist/Helping is in the Listening
What does it take to listen to stories of trauma? Therapists who rely on theories of personality and therapeutic technique are tone-deaf to the task of making symphonic music out of the cacophony of war. The role of the therapist is not to probe and poke into the veteran's psyche. Instead, the responsibility of the therapist is to furnish the context for what emerges about the trauma and its aftermath. "You're not crazy," becomes a very important statement in the course of therapy. However, the therapist must be prepared to add, "This part of your story does not makes sense to me as you tell it, but does connect well with something you said two weeks ago."
The goal of therapy is to draw out the client's vision and place it on the canvas for, first, the client and then others to see. Do not go inside the client's head to mix the paint. No. Listen first. Determine what kind of painting the client wants to paint--abstract expressionist or realist, with crayons to oils and gels. As therapists, we must know all these artistic styles and apply the client's paint in ways which persuade the client that we truly understand the pain.
Without a relationship that emerges from the conversations between therapist and client and absent a painting of what has occurred in the therapy, the victim of trauma remains condemned to chronic ambivalence. Simply put, the aftermath of trauma when the client is left to his or her own devices is not a coherent vision but a brilliant, ever-changing, and ultimately debilitating kaleidoscope.
Central to personal and social meaning is the ability to interpret context, i.e., we need to reaffirm our identity through feedback from our environment. The questions for Vietnam veterans is how can we know who we are if we don't let in, or don't trust or easily overwhelmed by the feedback we get? The veteran is left alone to figure out what happened in Vietnam, and why he keeps failing in what he does at home, at work, and at play. This is the hell of ambivalence.
To relieve the ambivalence, to hear the music and to paint the picture, there are four contexts that frame the story of the Vietnam veteran:
I. The tension of power, trust and control--that governs all human relationships--become reasons for the Vietnam veteran to reject or be overwhelmed by relationships. Since the I-Thou at the core of all therapeutic relationships hinges on both parties participating, we cannot proceed any further than allowed by the evolving dynamic between therapist and client.
II. The personal story of the Vietnam veteran is told in three parts: a) identity (who we are, based on feedback from others); b) intimacy (who we are closest to), and career (what we do). The capacity of the Vietnam veteran to mature into a generative stage hinges on resolution of these three elements. Indeed, the emergence of a crisis for Vietnam veterans most often manifests itself in an uncontrolled, replicated failure in friendships, marriage or work. The inability to reach a generative stage prompts a larger mid-life anxiety often diagnosed as PTSD.
III. Family, community and society are the interpretive contexts for all of us. They tell us when we are good and when we are bad. We try out our views in the family and then express them in the community or to the larger society. For the Vietnam veteran, the dilemma is that society does not want to discuss Vietnam but will label the vet sick or crazy. The veteran feels frustrated, isolated and angry. Our families become the battleground in the search for meaning. All the pent up rage and resentment, sadness and cynicism of Vietnam, and our shabby return find expressions in the tensions and dramas of our living room, kitchens and bedrooms.
IV. The concerns of the Vietnam veteran must be sorted into the time context of Vietnam, the years since, and now into the future.
The struggle for the therapist is first to have one's own views sorted out on each context and second, to gently guide the veteran's experience into these contexts. Only then can there be hope for understanding. But understanding is only a first step. The therapist will move from teacher to ally, to friend and ultimately, to colleague in the struggle to rise from the traumas of war. In that process, the veteran learns to trust and to care. To be sure, the therapist will not be alone in this task.
Vietnam veterans and their loved ones identify a variety of resources beyond the therapist. Let me cite a few examples:
Vet Centers are a Resource:
Spouses Work Things Through:
Other Trauma Sufferers Understand Vets