The following three interviews discuss veteran mental health issues.
The first interview concerns the topic of soldiers killing others, with comments from VA psychiatrist Andrew Pomerantz. The second interview, with retired Navy psychiatrist Dennis Reeves, is about the struggles soldiers face when they return home. The last article discusses why soldiers do not get the mental health counseling they need. Explaining the problems is Vietnam vet and Mental health counselor, U.S. Department of Veterans Affairs Jim Dooley.
All excerpts are from extended FRONTLINE interviews.
#1: The Impact of Killing & How to Prepare the Soldier
…Many soldiers have told us killing the enemy was one of their most haunting memories. Is that usually the case?
Pomerantz: I think it's one of the most powerful pieces for most of the people that I've treated who have been in close combat situations. I had one World War II veteran I remember -- to the day he died he could still describe the face of the man he was about to kill. He was that close, that personal, that he felt like he could read the man's entire life just in his eyes, and he was in a situation where he had no choice but to kill him. I hear this frequently.
I think the loss of faith, both in the safety of the world and the loss of faith in one's own humanity, is threatened when people kill other people, which is what we train them to do in war. I mean, it's how you win the war is you kill people, but you take somebody off the street who spent their whole life learning not to kill other people, not to harm other people and put them in a situation where it's his job to kill somebody else. I've not ever met a person who killed others who was not affected by that.
I was hearing a story from a World War II bomber the other day who talked about being able to see the people fleeing and still feeling that today -- you know, "How could I have done such a thing? Where was my sense of reason?" But we know how they did it. There are a lot of military training techniques which are based on dehumanizing the enemy and making people able to kill. I mean, you don't take somebody out of a Sunday school class and try to win a war with that person. You've got to go through some training in between
#2: When They Come Home
How do you prepare the soldiers for their return home?
Dennis Reeves: Before guys actually come home, primarily our Chaplain Corps has what they call a Warrior Transition Group, and they talk about "expect the unexpected." ... They've been through some pretty harrowing experiences together. They have been in a small group, for the most part about 40 guys, and that group becomes extremely close. Sometimes, because you're there 24 hours a day, seven days a week with those same people, you create a bond that is as strong as any family tie could ever be, and most of the time stronger. And you become very dependent on each other.
And also because you've gone through similar experiences together, when you talk to somebody, they know what you're talking about, and they can relate to it. Frequently I use [an] example: Before I left, I found a thermometer that read 140.8 degrees Fahrenheit, and when you get home and you try to explain to some[one] what 140 degrees [is], [what] wind with sand coming at you is, they don't understand. There's no way they can relate to it unless they've actually been there. ...
Now, what happens when guys come home is that they sometimes hold that stuff up and keep it in their head, and they don't really talk about it until they get home. And then if they're married, they try to tell their wives about it, and they start dumping all this stuff on the spouse. So the spouse goes, "Well, you know, that was really horrible, but gosh, let me tell you what happened at the office today and what so-and-so said about me; that was really awful, too." And [it's] apples and oranges. ...
Another problem that is commonly experienced when troops return home from an extended deployment in a place like Iraq is that they experience outbursts of anger. It occurs in Iraq, and it's usually settled down. But Marines yell at each other, and they're kind of a violent group, so it's not so abnormal for them, especially in a hostile environment. But when they come home and they're with their families, and they're used to yelling and screaming and hollering and things of that nature, if they start doing it at home, it can make some major ripples in a family unit. ...
But generally speaking, after a couple of weeks you start settling down, and those spontaneous outbursts of anger dissipate, and they go away. If you have Post-Traumatic Stress Disorder, they don't go away. And you are always hyperalert, hypervigilant, and your nervous system is just on pins and needles. You're hypersensitive to everything. And if you think about it, in the environment that you were in, the hypervigilance was survival. If you weren't watching and checking everything all the time, you could end up dead. And so after six months of that, your system has been turned up and turned on to the point where you've always got your antenna out and you're always scanning and monitoring for the enemy, and so little things can really irritate you because you're just at [a] peak emotional state. …
[Some] individuals start doing what we call self-medicating, and the most common avenue is alcohol. And they start drinking. A drunken Marine who is depressed and in crisis is extremely dangerous to themselves and others, mainly themselves, because they have ready access to very deadly weapons. …
In Iraq, alcohol is very hard to get. … [S]o most of these guys are coming back with very low tolerance, and they start drinking, and they can get really crazy. But if they start building their tolerance back up, and they've had stress and are using deployment as an excuse to continue to drink, and they continue to drink to the point where it becomes alcoholism and really alcohol dependence, they will do just about anything that a normal alcoholic, a person who is an alcoholic that wasn't in the military, will do.
#3: The Obstacles in Getting Help
Talk to me about just the military culture and how that actually … [affects] getting the help that you might need.
Dooley: The military career is based upon being powerful and being in command at all times. I have a picture of John Wayne on my wall, because we as men are taught to be John Wayne from about 2 years old onward by our mothers. I think that's really cool, and yet the problem with attempting to be John Wayne is that you can't be yourself. You can't be expressive; you can't have weaknesses; you can't have reactions; you can't have sadness; you can't be grieving; you can't be confused, lost.
When you look at soldiers in the command structure, how people make advancement is on their fitness for duty, their readiness, their ability, their successes. If a person is struggling, that's not necessarily good for their career. I've had soldiers come in quietly, not wanting the military to know, asking me directly, "Does the military have access to my records here?" There is a concern that they will not be made for the next promotion. They will not get that next job based upon the perception that we have a weak link.
Is it a realistic fear that if they do turn to mental health professionals, ... their careers [may] be affected detrimentally?
Dooley: I think that it's a very gray area, because the soldier is not necessarily an employee that can say to their employer: "I have a right to privacy. You can't see my records." A soldier is part owned by the military. If you hurt yourself in the military, they can charge you with destruction of government property. I love that one. So at some point, the military can require that you provide those records, if they know about them. And that becomes a dual-edged sword. So I think there's a real disincentive for coming in for counseling and to admit that you have a mental health issue to begin with. Even in American society in general, it is the most discriminated[-against] disability that there is.
Why don’t soldiers seek out help for their mental health issues?
Dooley: The issue of talking to somebody when you're having problems I think really is a major problem. I think we don't do any kind of real assessment of after-action. We don't do debriefing. The best case is that if the unit is pulled off the line for resting time, alcohol will be available, and you and your squad of eight men can all get drunk and be stupid and sloppy and talk to each other and reveal. And that's probably as close to what will be expected, permitted, structured as the military will provide. I think that to do otherwise would be to really invest heavily in this area. They have MASH units that are fully equipped to deal with blood; the military, I think, avoids emotional blood. I don't think they see it as real problems. And I think that's the problem. …
…When I was in Vietnam, there was a man walking point before me by the name of Schwartz, and Schwartz lasted three days walking in minefields. And on the fourth day we said, "Saddle up," and he just started crying. He said, "I can't do this anymore." The commanders made him into a cook at base camp. I thought that was a humane treatment of a man that really, really tried.
We have to look around at what ... it means to have a reaction to trauma, to seeing a dismembered body and internalizing that: It could be me, I could be next, or maybe I'll do that to somebody. At some point, we can't make those kind of judgments for somebody else's view. And I think that we need to be open to allowing the soldiers to be human and not to be a machine, because when they become a machine, they're not human anymore. That's part of the problem.
Your command made the guy a cook, but that's not what I'm hearing happens in most cases. Tell me what really happens.
Dooley: What really happens is that the command looks around and says, "If we let this guy loose, we're going to have a herd going in the same direction, and therefore we're going to have to set real limits." And they set limits that are really not respectful. It's a trap. Once you're in, you're in, and no amount of whining will get you out. Yet that doesn't really address the issue of real people struggling and emotionally bleeding and not being able to function. …
So, the second that you have an issue or a problem or have an adverse reaction to something horrible that you just saw, you're just sort of kicked out? What's that about?
Dooley: It has to do with the unrealistic expectation that you can take anything -- anything -- and not break. We are deluding ourselves on that issue. We all have breaking points. All you need to do is be presented with it, and you'll break. Will you break in the future? Not necessarily. But then again, maybe yes.
That's really what it's about. We assume that the military is omnipotent and ever strong and made of steel. [But] it's struggling human beings. That's what it's about. …
…The Army now does offer combat stress control [to] people who are actually in combat: trained therapists, counselors, psychologists, even psychiatrists. [But the anecdotal evidence] is that [for] soldiers who actually seek help, the stigma is so huge, most won't seek help in the field, in combat, in theater. And if they do seek help, the stigma that happens to them and their careers afterwards is so detrimental that it just sets an example for all the other folks who might use [the resources].
