I sat curled up on the sofa, trapped in the dream from which I had begun to awaken, but still lost in the reminiscence of our aphotic rendezvous.
-- Žakalin Nežić, Goodbye Serbia
Monday, April 30, 2012
Saturday, April 28, 2012
A Little Night Music
....
He quotes, using his fine voice.
"We are such stuff as dreams are made on, and our little life is rounded with a sleep."
EDMUND
Ironically
Fine! That's beautiful. But I wasn't trying to say that. We are such stuff as manure is made on, so let's drink up and forget it. That's more my idea.
TYRONE
Disgustedly.
Ach! Keep such sentiments to yourself. I shouldn't have given you that drink.
EDMUND
It did pack a wallop, all right. On you, too.
He grins with affectionate teasing.
Even if you've never missed a performance.
Aggressively.
Well, what's wrong with being drunk? It's what we're after, isn't it? Let's not kid each other, Papa. Not tonight. We know what we're trying to forget.
Hurriedly.
But let's not talk about it. It's no use now.
TYRONE
Dully.
No. All we can do is try to be resigned--again.
EDMUND
Or be so drunk you can forget.
He recites, and recites well, with bitter, ironical passion, the Symons' translation of Baudelaire's prose poem.
"Be always drunken. Nothing else matters: that is the only question.
If you would not feel the horrible burden of Time weighing on your shoulders and crushing you to the earth, be drunken continually.
Drunken with what? With wine, with poetry, or with virtue, as you will. But be drunken.
And if sometimes, on the stairs of a palace, or on the green side of a ditch, or in the dreary solitude of your own room, you should awaken and the drunkenness be half or wholly slipped away from you, ask of the wind, or of the wave, or of the star, or of the bird, or of the clock, or of whatever flies, or sighs, or rocks, or sings, or speaks, ask what hour it is; and the wind, wave, star, bird, clock, will answer you: 'It is the hour to be drunken! Be drunken, if you would not be the martyred slaves of Time; be drunken continually! With wine, with poetry, or with virtue, as you will.' "
He grins at his father provocatively.
....
--Long Day's Journey Into Night: Eugene O'Neill
************
He quotes, using his fine voice.
"We are such stuff as dreams are made on, and our little life is rounded with a sleep."
EDMUND
Ironically
Fine! That's beautiful. But I wasn't trying to say that. We are such stuff as manure is made on, so let's drink up and forget it. That's more my idea.
TYRONE
Disgustedly.
Ach! Keep such sentiments to yourself. I shouldn't have given you that drink.
EDMUND
It did pack a wallop, all right. On you, too.
He grins with affectionate teasing.
Even if you've never missed a performance.
Aggressively.
Well, what's wrong with being drunk? It's what we're after, isn't it? Let's not kid each other, Papa. Not tonight. We know what we're trying to forget.
Hurriedly.
But let's not talk about it. It's no use now.
TYRONE
Dully.
No. All we can do is try to be resigned--again.
EDMUND
Or be so drunk you can forget.
He recites, and recites well, with bitter, ironical passion, the Symons' translation of Baudelaire's prose poem.
"Be always drunken. Nothing else matters: that is the only question.
If you would not feel the horrible burden of Time weighing on your shoulders and crushing you to the earth, be drunken continually.
Drunken with what? With wine, with poetry, or with virtue, as you will. But be drunken.
And if sometimes, on the stairs of a palace, or on the green side of a ditch, or in the dreary solitude of your own room, you should awaken and the drunkenness be half or wholly slipped away from you, ask of the wind, or of the wave, or of the star, or of the bird, or of the clock, or of whatever flies, or sighs, or rocks, or sings, or speaks, ask what hour it is; and the wind, wave, star, bird, clock, will answer you: 'It is the hour to be drunken! Be drunken, if you would not be the martyred slaves of Time; be drunken continually! With wine, with poetry, or with virtue, as you will.' "
He grins at his father provocatively.
....
--Long Day's Journey Into Night: Eugene O'Neill
************
Enivrez-Vous - Charles BaudelaireIl faut être toujours ivre.Tout est là: c'est l'unique question. Pour ne pas sentir l'horrible fardeau du Temps qui brise vos épaules et vous penche vers la terre, il faut vous enivrer sans trêve. Mais de quoi? De vin, de poésie, ou de vertu, à votre guise. Mais enivrez-vous. Et si quelquefois, sur les marches d'un palais, sur l'herbe verte d'un fossé, dans la solitude morne de votre chambre, vous vous réveillez, l'ivresse déjà diminuée ou disparue, demandez au vent, à la vague, à l'étoile, à l'oiseau, à l'horloge, à tout ce qui fuit, à tout ce qui gémit, à tout ce qui roule, à tout ce qui chante, à tout ce qui parle, demandez quelle heure il est; et le vent, la vague, l'étoile, l'oiseau, l'horloge, vous répondront: "Il est l'heure de s'enivrer! Pour n'être pas les esclaves martyrisés du Temps, enivrez-vous; enivrez-vous sans cesse! De vin, de poésie ou de vertu, à votre guise." |
Monday, January 9, 2012
"Forgotten"
Forgot how to laugh,
Forgot how to smile,
Can't remember what it's like
...going out just a while.
Forgot all my dreams,
Forgot all my desires,
Can't remember what it's like,
...just feeling inspired.
Forgot all my friends,
Forgot how to be a friend, too,
Can't remember what it's like
...not feeling untrue.
Forgot waking without aching,
Forgot walking without pain,
Can't remember what it's like
...to not just sustain.
Forgot life before pills,
Forgot life before this,
Can't remember what it's like
...to not need more meds.
Forgot about the present,
Forgot all about now,
Can't remember what it's like
...without a creased brow.
But then suddenly that nuzzling,
That warm, gentle insistance?
Suddenly nothing else matters,
...except my companion dog's kisses.
------
Dedicated to the best Boxer ever
Walking this Earth on four paws
Who saves my life daily
"Miss Katie Wigglebum": Applause.
Tuesday, June 14, 2011
Sleep Disorder Research Studies Need Paid Volunteer Participants
The University of Pittsburgh is conducting several research studies related to veterans’ sleep disorders and is seeking paid volunteer participants.
The studies are non-invasive and you will be compensated for your time.
For more information: http://www.veteranssleep.pitt.edu/default.asp
U. Pittsburgh: Sleep Disorders
Insomnia
You may have insomnia if you:
-Have difficulty falling asleep
-Have difficulty staying asleep
-Are waking up too early
-Have poor quality sleep
A person with insomnia may also have the following symptoms:
-Feeling tired throughout the day
-Being easily irritated and grumpy
-Lack of concentration or memory
-Unable to stay awake during the day
-Decreased level of energy
-Lack of motivation
-Decrease in level of performance at work or in school
-Frustration about your sleep or about falling asleep
*If you are a military veteran and you think you may have insomnia, call/email us at 412-246-6409 / hakiman@upmc.edu
Links
Nightmares
*You might be suffering from nightmares if you:
-Wake up from sleep due to a disturbing dream
-Wake up in the morning with the memory of disturbing
dreams
-Have dreams that make you fearful, angry, sad, or upset
-Are able to think with a clear head and fully alert upon being
woken from sleep
-Remember specific and vivid details of a disturbing dream
-Have a great deal of difficulty falling back asleep after having
a dream
-Have dreams closer to the hours in the morning
-In veterans with PTSD, bad dreams may occur at all times of
the night, not only in the morning
*Nightmares invoke a variety of negative emotions including:
-Fear
-Anxiety
-Terror
-Anger
-Embarrassment
-Disgust
-Shame
-Sadness
*Nightmares can disrupt sleep
*Nightmares can increase your levels of fear and anxiety when
awoken and throughout the day.
*The loss of sleep from being continually woken up can lead to
more intense nightmares.
*Nightmares can prevent a person from being able to fall
asleep from constantly worrying about having nightmares if
he or she falls asleep.
*Nightmares not only seem real, but also become more
distressing as they are being had.
*If you are a military veteran, you are having bad dreams/nightmares, and you would like to participate in a research study on nightmares, call/email us at 412-246-6409 / hakiman@upmc.edu
Links
Sleep Apnea
*You might be suffering from Obstructive Sleep Apnea if you:
-Wake from sleep due to choking or gasping for breath
-Have been told by your bed partner that you snore loudly or
stop breathing
-Feel your sleep is not refreshing
-Are sleepy throughout the day
-Fall asleep during the day unintentionally
-Feel fatigued
*Obstructive sleep apnea (OSA) is a sleep related breathing disorder
*With OSA, the airway is blocked as tissues collapse in the back of the throat, which prevents airflow to the lungs.
*While sleeping and the muscles of the throat relax, the tongue falls back due to gravity, blocking the airways.
*This can happen anywhere from a few times to several hundred times in a night.
*Sleep apnea is a common disorder affecting both men and women
-Being overweight increases the risk of sleep apnea
*If you are a military veteran and you think you may have Sleep apnea, talk to your doctor about being evaluated/tested in a sleep clinic.
Links
Sleep Walking
*You might be suffering from Sleep walking if you:
-Walk around while you are sleeping
-Get up from your bed and perform task while you are still
sleeping
-Behave in a dangerous manner
-Confused upon be woken up from a sleep walking episode
-Lack memory of what happened
*Sleep walking is a parasomnia, meaning certain physiological
systems are activated when they should not be while asleep,
and cause undesired events to occur.
*Sleepwalking occurs while you are asleep, but get up and
wander around.
*Before walking, a person might sit in bed as he or she stares
around the room in a confused manner.
*Sometimes, the individual might dart up out of bed quickly.
*This could be from a distressing dream that occurred, but
typically people do not remember detailed, vivid dreams.
*You could even talk or scream loudly while sleep walking.
*Your eyes look glassy or clouded over.
*Activities that are typically done in the day light hours could be
conducted while asleep as well.
*Memory of events that occur when sleep walking rarely exist.
*Upon awakening from a sleep walking episode, extreme
confusion can occur.
If you think you may be sleep walking at night- talk to your doctor about it.
Links
Sleep terrors
*You might be suffering from sleep terrors if you:
-Wake up at night with a loud scream from fear
-Are sweating and have a change in breathing while asleep
-Are difficult to wake up from sleep
-Are confused upon being woken up
-Lack memory of what has occurred
*Also referred to as night terrors, sleep terrors is an event that
occurs during sleep that is not desired.
*In a typical episode, you will sit up in bed screaming or
shouting. You also may be kicking and thrashing. Things that
are shouted may be difficult for others to understand.
*There can be a look of sheer terror on your face, can be
sweating, breathing heavily, and be very tense.
*During a sleep terror episode, a person can be difficult to
wake up and fail to respond to voices. Upon waking, confusion
is quite common, as well as no memory of what has occurred.
*If you think you may be having sleep terrors- talk to your doctor about it.
Links
Other Sleep Disorders
Click on the following links for more information
Links
Clinical Sleep Labs
Locate a Sleep Center near you.
Links
------------------------------------
Sleep Disturbances Common Following Return from Combat
An article by Seth Robson of Stars and Stripes reports on a new military medicine study that found frequently reported sleep difficulties – particularly insomnia –- among returning combat veterans in at least the first several months they’re home.
“Soldiers in a combat environment have increased stress and have to be hyper-vigilant, both of which, along with the inherent noise and environmental disturbances result in poor sleep quality and frequent awakenings while deployed,” said Army Capt. Vincent Capaldi, the study’s lead author and a resident physician in psychiatry and internal medicine at Walter Reed Army Medical Center, in an interview with Stars and Stripes last month.
The latest sleep study shows the importance of regular, good sleep practices in soldiers upon redeployment and providing evaluations for those whose sleep difficulties persist, whether they have PTSD, TBI or solely sleep complaints, he said.
“A key takeaway (from the study) is that routine screening for sleep problems may be beneficial for all combat veterans, since many who suffer from sleep disturbance post-deployment are otherwise healthy,” Capaldi said.
The study did not find a connection between PTSD and TBI and obstructive sleep apnea, a diagnosed condition reported by some combat veterans.
The article did not discuss other common sleep disorders among combat veterans such as narcolepsy.
------------
Sunday, June 12, 2011
New Study Says Sleep Key to Cognitive Performance
(91outcomes.com) – A new study published in the current edition of the Journal of Sleep Research shows that proper sleep has a profound impact on the ability to learn.
Disturbed or dysfunctional sleep is a commonly reported symptom of Gulf War Illness (GWI), Post-Traumatic Stress Disorder (PTSD), and Traumatic Brain Injury (TBI) –- relatively common disorders among veterans of the last two decades of military service.
According to a USA Today article by Randy Dotinga about the study:
The research doesn't prove that sleep will help you learn more effectively. But it does provide more evidence that your brain doesn't just rest and dream when you're asleep, said study co-author Rebecca Spencer, an assistant professor at the University of Massachusetts at Amherst.
Dotinga’s article about the study suggests that important integration of learning takes place during sleep:
Sleep researcher Michael Anch, an associate professor at Saint Louis University, said the study "emphasizes the growing awareness of the importance of sleep for optimal cognitive functioning."
"This study is consistent with other studies suggesting that sleep allows you to integrate learned information from various brain regions, which is not allowable by instant decisions," Anch said. "This gives credence to the notion that if you have a decision to make, sleep on it!"
----------------------
---Anthony Hardie, Madison, Wis.
Wednesday, February 16, 2011
The Brooklyn Ink: Sleep Disorders -- Another Deadly Threat to Returning Veterans
By The Brooklyn Ink
Brooklyn Ink How We DO News Our Writers Follow: @TheBrooklynInk
Dr. Mohammad Al-Ajam in the new Sleep Center’s laboratory at the Brooklyn VA Hospital, where veterans come to get their sleep problems diagnosed. (Alysia Santo/The Brooklyn Ink)
By Alysia Santo
Last week, Joseph Jones, 43, nearly killed himself while driving home from his job as a welder for the Army. He fell asleep while barreling down route 9A from Camp Smith in upstate New York back to his home in Astoria, Queens, a 52-mile journey.
“I literally hit the concrete barrier but I woke up in time enough to turn the wheel,” says Jones. Turning the music up is his strategy to avoid drowsiness, but still, Jones says he falls asleep while driving, “like everyday”. Jones was able to avoid an accident, but this close call scared him. “I don’t want to kill nobody, and I definitely don’t want to kill myself,” he says.
Sleep disorders, like the sleep apnea that makes Jones susceptible to falling asleep without warning almost any time of day, must be added to the list of maladies affecting returning veterans as they make the adjustment back to civilian life.
The problems are so common that the Veterans Administration’s New York Harbor Healthcare System has opened a state-of-the-art sleep center at its Brooklyn Campus in Dyker Heights. The hospital sits on the edge of Fort Hamilton, which is the only active military base in New York City.
This four-bed facility allows veteran patients to come and spend the night so that doctors can diagnose their sleeping problems. Before the Brooklyn VA Hospital had its own Sleep Center it had a contract with Bellevue Hospital to use their sleep center. Patients had a long wait for sleep studies, sometimes over three months.
Dr. Shawn Knapik, the Sleep Center Director, says that while they see a wide range of sleep problems in veterans, 90 percent of patients are dealing with some form of sleep apnea. Congress asked the Department of Veterans Affairs to pay closer attention to sleep apnea among veterans in 2007. According the US Department of Veterans Affairs, the number of veterans receiving disability benefits for sleep apnea has increased by 61 percent in the past two years.
Dr. Knapik says the Sleep Center started as a proposal three years ago, “It was really based on a need for our veteran patients. [Sleep apnea] is a very common problem and it may be even more common in our veteran populations,” he says, “We now see 10-12 new referrals a week for patients suspected of having Obstructive Sleep Apnea (OSA).”
An apnea is defined as a cessation of breathing for ten seconds or more, which causes sleep deprivation and lack of oxygen. It can be exacerbated by drinking and weight gain, which are both common among returning vets. Those suffering from sleep apnea experience unexplained fatigue and excessive daytime sleepiness. It is life threatening, because untreated sleep apnea can cause damage to the heart, and it increases the risk of stroke, depression, diabetes and high blood pressure.
“The connection to veterans is that OSA afflicts men more frequently than women, especially those who are in middle age and moving from an active to a sedentary life,” says Dr. Mohammad Al-Ajam, a sleep medicine specialist at the Brooklyn VA. The large build of many veterans predispose them to sleep apnea, and weight gain, particularly in the neck area, can increase the risk.
Sleep apnea in combination with Post Traumatic Stress Disorder (PTSD) is an even more deadly. “The actual obstruction of the airway is not related to PTSD, but PTSD causes fragmented sleep. So when you have PTSD and OSA together your really in trouble,” says Dr. Al-Ajam.
Dr. Al-Ajam says that part of what these veterans experience in war, such as “sleep deprivation” and “exposure to chemical and to the dust” could be factors, but he adds, “We don’t have a cause and effect linkage yet.”
Jones was first diagnosed with OSA last year. He has an appointment to stay overnight at this lab in January in order to have a comprehensive sleep study completed. Jones says he first became aware that something was wrong in 2005 after he returned from Iraq. He said his then wife said that he would stop breathing periodically during the night and that he sounded like “a bear sleeping in a cave”.
Jones’ loud snoring comes from an obstruction in his upper airway due to the narrow architecture of his throat. As his body relaxes in sleep, he literally starts choking himself. Dr. Al-Ajam says that these choking episodes keep the patient from ever reaching a deep level of sleep, “Your brain has to go to back to shallow stages to give orders to the airway to open so you can take a breath,” says Dr. Al-Ajam,
The interrupted sleep at night translates into extreme fatigue and sleepiness during the day. Jeffrey Hamilton, 44, a veteran of the Army, says he thought he had some kind of fatigue syndrome, “I just had no energy compared to a couple of years ago. I got to the point where I used to fall asleep at the red light.”
His primary care physician recommended he go to the Sleep Center to be tested for OSA, “They had asked me about symptoms, and I just mentioned that my wife says that since I got back from Korea in 2006 she noticed that I snored really loud and stopped breathing a lot.”
Hamilton is being fitted for a breathing mask, called a CPAP. This device carries a stream of compressed air pressure to the windpipe of the sleeper, opening up their throat and allowing unobstructed breathing.
Dr. Al-Ajam shows how to put on a CPAP mask in one of the overnight rooms in the Sleep Center’s lab. (Alysia Santo/The Brooklyn Ink)
The CPAP mask is the most common treatment for people suffering from sleep apnea, Dr. Knapik says, and it is very effective, “They look brighter. In some cases it is the first time in years that they got good rest. They feel like their whole life has changed.”
The science of sleep has developed throughout the past century, and as technology improved, so has the recording of sleep patterns. The Sleep Center has a Polysomnography room, which makes a record of a person’s sleep functions, including brain activity, eye movement, heartbeat, and oxygen level. The screens that record all this information have a section that allows physicians and technicians to highlight every time a person is choking during sleep.
The most common symptom of sleep apnea is chronic snoring. “Culturally, snoring has been thought of as a funny thing,” says Dr. Knapik, “but it can indicate a serious problem.”
For Dr. Al-Ajam, it was during his work at a sleep lab in Arkansas that upped his involvement in sleep medicine and the importance of sleep labs. One of the nurses he worked with was married to a veteran, “She complained that he snored horribly at night and that she heard him choking,” says Dr. Al-Ajam, “I told her he probably had sleep apnea and to get him to the lab.”
But he refused the study, and shortly after, Dr. Al-Ajam got a phone call saying that this nurse’s husband just had a heart attack, “I was like, What are you talking about? He was in his mid 30’s, what kind of heart attack could be he having?” After the heart attack, he came in for the sleep study. “This was the worst sleep apnea case I had ever seen. He was choking three times a minute while he slept.”
Dr. Al-Ajam encouraged his sleep lab to take on more patients and eventually they got certification, “I said, you know, were going to make this into a project.” A few years later he is now at this brand new Brooklyn Sleep Center, and the goal is to diagnose these veterans before it causes permanent damage.
“Snoring is not something to ignore. This thing is really important,” he says, “Many of these guys come back from combat and drive or operate heavy machinery. They want to hold jobs and sustain themselves and their families, so we help them that way.”
-------------
SOURCE: The Brooklyn Inc., http://thebrooklynink.com/2010/12/01/20911-sleep-disorders-another-threat-to-returning-vets/
Sunday, February 13, 2011
Sleep Disorders: You May have …. If…
You may have insomnia if you:
-Have difficulty falling asleep
-Have difficulty staying asleep
-Are waking up too early
-Have poor quality sleep
A person with insomnia may also have the following symptoms:
-Feeling tired throughout the day
-Being easily irritated and grumpy
-Lack of concentration or memory
-Unable to stay awake during the day
-Decreased level of energy
-Lack of motivation
-Decrease in level of performance at work or in school
-Frustration about your sleep or about falling asleep
*If you are a military veteran and you think you may have insomnia, call/email us at 412-246-6409 / hakiman@upmc.edu
Links
*You might be suffering from nightmares if you:
-Wake up from sleep due to a disturbing dream
-Wake up in the morning with the memory of disturbing
dreams
-Have dreams that make you fearful, angry, sad, or upset
-Are able to think with a clear head and fully alert upon being
woken from sleep
-Remember specific and vivid details of a disturbing dream
-Have a great deal of difficulty falling back asleep after having
a dream
-Have dreams closer to the hours in the morning
-In veterans with PTSD, bad dreams may occur at all times of
the night, not only in the morning
*Nightmares invoke a variety of negative emotions including:
-Fear
-Anxiety
-Terror
-Anger
-Embarrassment
-Disgust
-Shame
-Sadness
*Nightmares can disrupt sleep
*Nightmares can increase your levels of fear and anxiety when
awoken and throughout the day.
*The loss of sleep from being continually woken up can lead to
more intense nightmares.
*Nightmares can prevent a person from being able to fall
asleep from constantly worrying about having nightmares if
he or she falls asleep.
*Nightmares not only seem real, but also become more
distressing as they are being had.
*If you are a military veteran, you are having bad dreams/nightmares, and you would like to participate in a research study on nightmares, call/email us at 412-246-6409 / hakiman@upmc.edu
Links
*You might be suffering from Obstructive Sleep Apnea if you:
-Wake from sleep due to choking or gasping for breath
-Have been told by your bed partner that you snore loudly or
stop breathing
-Feel your sleep is not refreshing
-Are sleepy throughout the day
-Fall asleep during the day unintentionally
-Feel fatigued
*Obstructive sleep apnea (OSA) is a sleep related breathing disorder
*With OSA, the airway is blocked as tissues collapse in the back of the throat, which prevents airflow to the lungs.
*While sleeping and the muscles of the throat relax, the tongue falls back due to gravity, blocking the airways.
*This can happen anywhere from a few times to several hundred times in a night.
*Sleep apnea is a common disorder affecting both men and women
-Being overweight increases the risk of sleep apnea
*If you are a military veteran and you think you may have Sleep apnea, talk to your doctor about being evaluated/tested in a sleep clinic.
Links
*You might be suffering from Sleep walking if you:
-Walk around while you are sleeping
-Get up from your bed and perform task while you are still
sleeping
-Behave in a dangerous manner
-Confused upon be woken up from a sleep walking episode
-Lack memory of what happened
*Sleep walking is a parasomnia, meaning certain physiological
systems are activated when they should not be while asleep,
and cause undesired events to occur.
*Sleepwalking occurs while you are asleep, but get up and
wander around.
*Before walking, a person might sit in bed as he or she stares
around the room in a confused manner.
*Sometimes, the individual might dart up out of bed quickly.
*This could be from a distressing dream that occurred, but
typically people do not remember detailed, vivid dreams.
*You could even talk or scream loudly while sleep walking.
*Your eyes look glassy or clouded over.
*Activities that are typically done in the day light hours could be
conducted while asleep as well.
*Memory of events that occur when sleep walking rarely exist.
*Upon awakening from a sleep walking episode, extreme
confusion can occur.
If you think you may be sleep walking at night- talk to your doctor about it.
Links
*You might be suffering from sleep terrors if you:
-Wake up at night with a loud scream from fear
-Are sweating and have a change in breathing while asleep
-Are difficult to wake up from sleep
-Are confused upon being woken up
-Lack memory of what has occurred
*Also referred to as night terrors, sleep terrors is an event that
occurs during sleep that is not desired.
*In a typical episode, you will sit up in bed screaming or
shouting. You also may be kicking and thrashing. Things that
are shouted may be difficult for others to understand.
*There can be a look of sheer terror on your face, can be
sweating, breathing heavily, and be very tense.
*During a sleep terror episode, a person can be difficult to
wake up and fail to respond to voices. Upon waking, confusion
is quite common, as well as no memory of what has occurred.
*If you think you may be having sleep terrors- talk to your doctor about it.
Links
Click on the following links for more information
Links
Locate a Sleep Center near you.
Links
The Prozac, Paxil, Zoloft, Wellbutrin, Celexa, Effexor, Valium, Klonopin, Ativan, Restoril, Xanax, Adderall, Ritalin, Haldol, Risperdal, Seroquel, Ambien, Lunesta, Elavil, Trazodone War
As it approaches its tenth year, our nation’s longest war is showing signs of waning. Meanwhile, our soldiers are falling apart.
- Written by Jennifer Senior, New York Magazine
- Published Feb 6, 2011
- Photos by Louis Palu/Zuma Press, From a series of portraits documenting the stress faced by Marines patrolling Afghanistan's Helmand Province. The men in these pictures have no known health problems themselves.
The first time I meet David Booth, a 39-year-old former medic and surgeon’s assistant who retired this past spring after nineteen years in the active Army Reserve, I make the awkward mistake of proposing we go out to lunch. It seems a natural suggestion. The weather is still warm, and he has told me to meet him in the lobby of his office downtown, so I assume he wants to go out, not back to his desk, when I show up around noon. But it turns out that in the six months he has been at his job, Booth has never left his office in the middle of the day, except to run across the street, and he is simply too polite to say so. From the moment we step outside, it’s clear how unusual this excursion is for him. As we walk, he hews close to the buildings on his right (“If a building’s to my right, no one is going to walk by me on my right”), and when we arrive at the restaurant, he quietly takes a seat at the table closest to the door, his back against the wall. His large brown eyes immediately start darting around.
“How’s your sleep?” I ask him.
“I don’t,” he answers.
Depending on the war, post-traumatic stress can have many expressions, but this war, because of its omnipresent suicide bombers and roadside explosives, seems to have disproportionately rendered its soldiers afraid of two things: driving and crowds. Movie theaters, subway cars, densely packed spaces—all can pose problems for soldiers, because marketplaces are frequent targets for explosions; so can any vehicle, because IEDs are this war’s lethal booby trap of choice. Booth manages his driving anxieties by leaving his Long Island home every morning at 4:30 a.m., when there’s no risk of traffic (especially under bridges, which militants in Iraq are always blowing up), and avoiding the right lane (in Afghanistan and Iraq, one generally drives in the middle of the road to avoid setting off IEDs). Once he gets to the city, Booth parks around the corner from his office and has managed to arrange his life so that he never encounters more than a handful of people. The only real logistical challenge is lunchtime, which he handles by ordering in, picking up from a grill across the street, or skipping entirely. I ask if he goes to restaurants in the off-hours. “Not very much,” he answers, pointing to two sets of scars, one near his jugular and the other stretching down his spinal column. “I reach for a glass, and I can’t feel pressure, so I’ll knock the glass over. It’s hard not to feel self-conscious.”
On September 6, 2006, as Booth was returning from a mission in Kirkuk, his Humvee rolled over an IED. He spent three years in San Diego in a Warrior Transition Unit, or WTU, where most badly injured soldiers go to convalesce, and four surgeries later, though he’d broken his neck, he was able to walk normally again. He no longer has any sensation in his right hand, though, and he lives with back spasms, headaches, stiffness in his neck, tingling and numbness in his right arm, and pain radiating down his spine and right side. Once a week, he goes to cognitive-behavioral therapy near his home, and he follows a carefully scripted drug regimen: Valium for spasms, Lyrica for pain, Topamax for headaches, and, on occasion, Klonopin for anxiety. “And that’s a lot less than what I used to be on,” he tells me. “Percocet for pain. Ambien for sleep, but they don’t want you on it for a long time because it’s habit-forming. Flexeril for spasms, but that makes you drowsy. OxyContin. Zoloft.”
Zoloft was only one of the antidepressants he took. “I don’t remember them all,” he says. “In the WTU, people kept what they were taking to themselves, unless they were talking to a friend. It’s almost admitting …” Four seconds of silence tick by. “That you’re broken. And you don’t ever want to admit that. Because you’re used to being able to do things. And I was a medic. What I did was fix things.”
Spend five minutes in Booth’s company, and it’s hard not to be moved by the redrawn contours of his life. He’s in pain and can’t sleep (“You don’t realize how much you lift your head when you sleep”); he hasn’t set foot in a grocery store in well over three years and has gone to the movies just once, at eleven in the morning, when the theater was practically empty. But it’s also hard not to marvel at his resilience. He’s laconic and uncomplaining; he’s still golfing (he likes the peaceful sensation of the green, likes that it’s a physical activity he can still do); he is comfortable talking about his struggles. When confronted with the reality that he could no longer be a surgeon’s assistant—his right hand won’t permit it—Booth took several interview and résumé-writing courses and found a job across the country, at a security company, where he took charge of its human-resources department, overseeing hundreds of employees. If the Army’s Medical Review Board no longer found him fit for duty, he wasn’t going to protest. “You can’t spend the rest of your life in the Army, just trying to heal,” he says. “You’re going to spend the rest of your life healing one way or the other anyway.”
“I was very outgoing before. Now I keep to myself.”
I ask if being in New York is any better, since New Yorkers tend to be more open about their psychological pain than most people, discussing their drug dosages at dinner parties.
He gives me a pained, strained look that makes me realize how foolish—how cavalier and beside the point—this question is. “Yeah,” he finally says. “But it’s getting into the dinner party that’s hard. That’s not going to happen. I was very outgoing before. Now I keep to myself.”
Even at the lowest point of the Global War on Terror—in April 2004, say, when the number of casualties was spinning out of control and it looked like there was no end in sight—morale among our troops ran fairly high. Yet today, with casualties tapering and a slightly improved prognosis for stability, our troops, by every conceivable external measure, are falling apart. Veterans of the Iraq and Afghanistan wars make up a disproportionate number of the jobless; the Army’s divorce rate, which used to be lower than the civilian population’s, has surpassed it and is higher still among those who’ve deployed. A spokesman at Fort Drum, home to the 10th Mountain Division here in New York State, tells me by e-mail that one-quarter of its 20,000 soldiers have “received some type of behavioral health evaluation and/or treatment during the past year.” Defense Department spending on Ambien, a popular sleep aid, and Seroquel, an antipsychotic, has doubled since 2007, according to the Army Times, while spending on Topamax, an anti-convulsant medication often used for migraines, quadrupled; amphetamine prescriptions have doubled, too, according to the Army’s own data. Meanwhile, a study by the Rand Corporation has found that 20 percent of the soldiers who’ve deployed in this war report symptoms of post-traumatic stress and major depression.The number climbs to almost 30 percent if the soldiers have deployed more than twice.
“I feel like people with my symptoms are becoming the majority of the Army,” says a major from the New York area who recently started taking Effexor, an antidepressant, and a variety of sleep meds after a second tour in Iraq. “Feeling anxious when you don’t have a reason to, being a little depressed, having low-grade anhedonia, not sleeping well—this is the new normal for those of us who’ve been repeatedly deployed.”
The Army’s own research confirms that drug and alcohol abuse, disciplinary infractions, and criminal activity are increasing among active-duty service members. Most ominously, a growing number of soldiers can’t handle the strains of war at all. Until three years ago, the suicide rate of the Army, the branch with by far the most men and women in this war, was actually lower than the American population’s—a testament to the hardiness of our troops, given that young men with weapons are, at least as a statistical matter, disproportionately prone to suicide. But in 2008, the Army suicide rate surpassed that of the civilian population’s, and the Marines’ surpassed it shortly thereafter. So grim is the problem that this summer, the Army released a remarkably candid suicide report. “If we include accidental death, which frequently is the result of high-risk behavior (e.g., drinking and driving, drug overdose),” it concluded, “we find that less young men and women die in combat than die by their own actions. Simply stated, we are often more dangerous to ourselves than the enemy.”
In other words, nearly as many soldiers are dying at home today as are dying abroad.
For most of the past decade, the Army has downplayed the collateral damage this war has had on our soldiers’ nerves. Until The Nation brought the practice to light last spring, the Army sometimes assigned the label of “personality disorder” to those suffering from post-traumatic stress, often rendering them ineligible for disability; Warrior Transition Units have continually earned harsh scrutiny, most recently from the Army’s inspector general himself. Under the direction of Peter W. Chiarelli, the four-star general and vice-chief of staff, the Army has at least made an effort to lend some transparency to its troubles and to address them more aggressively. The problem is that the Army woke up to its mental-health crisis quite late, and the more closely Chiarelli looks into the issue, the more confounding it seems to be to solve.
How serving in the military can pack all of life's stressors into a single year.
For starters, the United States has never had an all-volunteer corps of soldiers who’ve spent a whole decade in battle—men and women who, by turns, have repeatedly subjected themselves to the horrors of war and the trials of reintegration back home. “Don’t ever underestimate what three, four, five deployments does to you,” Chiarelli tells me this November, as we fly down to Fort Stewart, Georgia, whose 3rd Infantry Division was just returning from Iraq. “It’s uncharted territory, as far as I’m concerned.” Even without repeated deployments, the life cycle of a soldier is a model of brutal compression and, therefore, almost certain to cause distress. “At 24 years of age,” says a striking footnote on page one of the Army’s suicide report, “a Soldier, on average, has moved from home, family, and friends and resided in two other states; has traveled the world (deployed); been promoted four times; bought a car and wrecked it; married and had children; has had relationship and financial problems; seen death; is responsible for dozens of Soldiers; maintains millions of dollars’ worth of equipment; and gets paid less than $40,000 a year.” Now consider what happens when this cycle repeats itself for a decade. “Moving, divorce, death, financial turmoil,” says Lily Burana, author of the memoir I Love a Man in Uniform. “Those are the top stressors in a life. And this is what you get every freaking year in the Army.”
“I didn’t want to be one of those soldiers who wound up shaking a baby.”
It took a long time for the Army to concede that repeated deployments may be lurking behind its escalating suicide rate. Initially, it seemed to argue that the newest generation of soldiers was less psychologically stable. (From 2004 to 2009, the suicide report noted, the Army waivered in a large batch of kids with drug and other criminal records in order to meet its recruitment targets.) But now, based on a more granular analysis conducted by the National Institute of Mental Health and a team of researchers from Columbia, Harvard, the University of Michigan, and the Uniformed Services University, Chiarelli believes that it’s not the marginal characters in the Army who are committing suicide in greater numbers. It’s the old hands. “I’ll tell you point-blank,” he says, “though I’ve avoided this conclusion for two years: Where we’re really seeing the increase in suicide is in the population that would never have contemplated suicide—but because of successive deployments, or a single deployment, or an event in a deployment, they go into this danger area.”
The nature of this conflict is also quite unusual. As in Vietnam, the enemy blends in with civilians, rendering everyone a potential threat; but unlike in Vietnam, this war is fought in cities as much as in the hinterlands, which means soldiers are never allowed to mentally decompress. There’s no front in this war, and no rear either, which means there’s no place to go where the mortar rounds aren’t. “I was up at Walter Reed the other day,” Chiarelli tells me on the airplane, “and I ran into a young kid who lost both his legs, wayyyyyy up. I asked him, ‘How did it happen?’ You know what he said?” He pauses, looks at me intently. He’s big and barrel-chested, with crow’s feet so pronounced they look like they’ve been stamped into his temples with a fork. “He said, ‘Sir, I was standing in line at the PX to get shaving cream, and a 120-millimeter mortar came in and took off both my legs.’ ”
And on top of this unremitting combat anxiety, our soldiers have to cope with unremitting domestic anxiety of a sort that previous generations never knew, because these soldiers are Skype-ing with their families several times a week, even from the mountains of Afghanistan. At first, the Army believed this constant contact might help mitigate loneliness. Now, Chiarelli frankly acknowledges, he’s not so sure, “because technology just drags you back home, where your 22-year-old wife is having trouble finding a job and has a couple of kids she’s taking care of on her own.” Many soldiers are also addicted to Facebook, whose tagging function is proving a mixed blessing. “Soldiers are seeing pictures of their loved ones in bars, pictures of their loved ones in outrageous behaviors with sexual overtones,” says Colonel Kathy Platoni, a clinical psychologist in the Army Reserve who’s been deployed four times. “Everything they’re hanging on to is demolished. What’s sustaining them is torn away.”
Even with an intact marriage, the challenge of repeated reintegration into the home front can be dislocating. Soldiers come home to find their sons doing chores they once did, their wives with independent lives, their professional duties in flux. It’s no accident that 80 percent of all Army suicides in 2009 happened Stateside, after the euphoria of homecoming had worn off. It’s why the Army now requires follow-up visits to a behavioral-health specialist six months after soldiers return. Complicating matters, nearly half of today’s Army comes from the National Guard and Reserve, whose soldiers return from each tour not to an Army base but to small towns or big cities, where their jobs are hardly assured and their peers are far less likely to identify with their experiences. “They go back to a community that says, ‘Oh, you were in Iraq. Did you kill anybody?’ ” says Thomas H. Bornemann, director of the Carter Center Mental Health Program, who treated soldiers at Fort McPherson during the Vietnam War. “They’re dealing with voyeurs wanting to know intimate things, things they’re going to find hard to talk to their wives about.” Nor do they necessarily see doctors who know anything about combat medicine. “The Guard and Reserve, that’s the population I’m really scared of,” Chiarelli says. “I’ve got 45 more suicides in the National Guard this year than last year. Forty-five.” And in fact, the Army would later release data saying the number of suicides from the National Guard and Reserve nearly doubled between 2009 and 2010.
Are soldiers more distressed when they're fighting less?
Feelings of idleness and inutility aren’t unique to the home front, of course. They can also descend on a soldier while he or she is still in theater. Platoni notes that she spent the last quarter of her most recent tour on a quiet installation in northern Afghanistan, where the soldiers saw little combat. She suspects that’s precisely why she saw so much of them. “Monotony, boredom, a lack of value and meaning and purpose to your mission—these are factors,” she says. “Especially that loss of a sense of purpose: What am I doing here? I’m not suffering like my buddies in the south. There’s a tremendous feeling of guilt.”
It’s an agonizing paradox, but one that many mental-health professionals now entertain: Our troops may be in such horrible distress right now because the operational tempo of this war has slowed down, and they’re fighting—doing—less.
Chiarelli is sitting in the chow hall at Fort Stewart, having lunch with eleven soldiers who’ve just returned from Iraq. “When I was growing up in the Army,” he tells them, “if anyone wanted to see a psychiatrist or psychologist, they’d have to go to the fifth floor. So nobody wanted to go in the elevator and press five.” Everyone smiles nervously. It’s not every day that a four-star general joins you for burgers. “So now we have behavioral-health people in the primary-care clinics,” Chiarelli continues. “You don’t have to go to the fifth floor. But I know the stigma’s still there, believe me. How about screening?” Psychological evaluations are supposed to be mandatory. He’s checking to see if they’ve happened. “Have you had any screening since you’ve been back?”
He looks around the table. The soldier nearest him replies yes, he had one, but it was perfunctory. Chiarelli purses his lips. “Anyone else?”
The table’s silent for a few moments. Then a 26-year-old staff sergeant named Douglas Johnson, who just spent twelve months as a chaplain’s assistant in Mosul, speaks up. “I had some issues prior to deployment,” he says. “I had aggression, I had no patience with people. When I got back, they did another screening just to check on me. And it was pretty good.”
This answer seems to relieve Chiarelli. “Are you in a good place now?” he asks.
“Yes, sir.”
“Taking medication?”
“Yes.” Paxil, an antidepressant.
“Is it helping?”
“Yes, sir. I can always tell the days I forget to take it.”
The group laughs. Then Chiarelli asks a more loaded question: “Anyone ever hear of those who are overmedicated?”
The group is silent again.
During Vietnam, soldiers famously used a combination of dope and Jimi Hendrix to chill out and psych up. Today’s soldiers essentially listen to both Prozac and Metallica to achieve the same balance. Drugs are very much part of the program—DOD-approved, the exact opposite of countercultural. Johnson, in fact, got his Paxil in a clinic in Mosul, three months before his tour was scheduled to end. “I was having some severe temper issues,” he told me, “and I had a brand-new baby waiting for me at home. I didn’t want to be one of those soldiers who wound up shaking a baby.” If he ever went on a mission and forgot his Paxil, he adds, he’d just ask his friend, who took it too: “It was pretty likely that someone was, if not on the same dose, then on something pretty close.”
Walk into any of the larger-battalion-aide stations in Iraq or Afghanistan today, and you’ll find Prozac, Paxil, and Zoloft to fight depression, as well as Wellbutrin, Celexa, and Effexor. You’ll see Valium to relax muscles (but also for sleep and combat stress) as well as Klonopin, Ativan, Restoril, and Xanax. There’s Adderall and Ritalin for ADD and Haldol and Risperdal to treat psychosis; there’s Seroquel, at subtherapeutic doses, for sleep, along with Ambien and Lunesta. Sleep, of course, is a huge issue in any war. But in this one, there are enough Red Bulls and Rip Its in the chow halls to light up the city of Kabul, and soldiers often line their pockets with them before missions, creating a cycle where they use caffeine to power up and sleep meds to power down.
Because of the value the Army places on mission focus, however, doctors in theater are generally reluctant to prescribe anything that could seriously compromise it. Rather, it’s when soldiers return home that prescription-drug use and abuse spikes sharply upward: Depression and boredom set in, suppressed pain surfaces with a vengeance, hypervigilance morphs into insomnia, and meds are very easy to access, because they’re the most expedient way to treat pain and distress. Roughly one in seven soldiers at Fort Hood were on antidepressants or antipsychotics alone at some point last year, according to USA Today—and those were just the soldiers the Army knew about, the ones who weren’t discreetly seeking treatment off-post in downtown Killeen. (Nor did that number include sleep meds, amphetamines, or painkillers.) More troubling, nearly one-third of all active-duty Army suicides in 2009 involved prescription drugs, according to the report released this summer. Some of the case histories Chiarelli sees are eerily reminiscent of the toxicology reports one reads after a celebrity suicide. (From a 2009 Salon story about the suicide of Timothy Ryan Alderman: “0.5 mg. of Klonopin for anxiety three times a day; 800 mg. of Neurotin, an anti-seizure medication, three times a day; 100 mg. of Ultram, a narcotic-like pain reliever, three times a day; 20 mg. of Geodon for bipolar disorder at noon and then another 80 mg. at night; 0.1 mg. of Clonidine, a blood-pressure medication also used for withdrawal symptoms, three times a day; 60 mg. of Remeron, for depression, once a day; and 10 mg. of Prozac twice a day.”)
Next: American medicine's greatest failing, and why it's especially hard on soldiers.
“We’re very anti-medication,” Chiarelli is told at one of our final stops in Georgia, by a neurologist at Eisenhower Army Medical Center at Fort Gordon.
“I hear this everywhere I go,” the general replies. “ ‘We’re anti-medication, we’re anti-medication.’ But why do I get these sheets of paper”—profiles of suicides—“with twelve medications listed on them?” He mentions that he’s had two- and three-star generals confide in him that they were addicted to pain medication in the aftermath of their service, and that it took their wives to point it out to them. “Are you guys different?” asks Chiarelli. “Is this place a soda straw that no one else passes through?”
In fact, this residential facility that Chiarelli is visiting is different. It treats alcohol and substance abuse, PTSD, traumatic brain injuries, depression, and pain management all under one roof. Stephen N. Xenakis, a psychiatrist and former commander at Eisenhower, was an early proponent of this kind of integrated program. Like many doctors, he believes that one of American medicine’s greatest failings is its fragmentation into narrow-caliber silos, with doctors seeing ailments solely in the context of their own specialties. No population, says Xenakis, suffers more outrageously from this structural deficiency than returning soldiers. Doctors seldom take the totality of their extraordinary experiences into account. “Soldiers are in an environment that has dust particles and toxins we don’t even recognize,” Xenakis tells me. “There are pressure waves and blasts. They’re carrying packs, at altitude, that weigh 90 pounds. They’re in a different sleep cycle than normal. They’re in situations that are almost always stressful, if not traumatic.” Yet when they return home, he says, they’re shunted into all those individual silos, with each specialist seeing only what he or she is trained to see: A headache. Insomnia. Paranoia and irritability. A ruined knee. “So as doctors,” Xenakis continues, “we say, ‘Okay. We’re going to track this psychological problem, and we’re going to track this immunological problem, and we’re going to track their headaches and their musculoskeletal pain and their insomnia.’ ” He slowly breathes out. Though he retired in 1998, Xenakis has been urging the chairman of the Joint Chiefs to consider integrated medicine for quite some time. “When in fact it’s a system problem we’re dealing with,” he says. “And that’s how you get this poly-drug problem.”
Chiarelli’s not unsympathetic to this kind of logic. He’s a systems guy. “If the general were a doctor, he’d be a surgeon,” says Richard W. Thomas, the assistant surgeon general who frequently accompanies Chiarelli on his trips. “He’d be hot lights, cold steel.” The trouble is that mental-health questions don’t lend themselves to precise, technical fixes cost-engineered to reflect limited resources. In theater, the Army relies on a highly subjective psychological questionnaire that most of the experienced officers can ace, knowing just which boxes to check in order to avoid further observation by mental-health professionals. The Army is so short on mental-health personnel that Chiarelli is pushing telebehavioral therapy, whereby soldiers disembark from their tours abroad and debrief with psychotherapists via satellite. It’s not a very orthodox form of treatment, he knows, but his response to traditionalists is: As opposed to what? While few people are trying harder to make the Army a less psychologically destructive place than he is, Chiarelli has little patience for the kinds of open-ended, searching questions that are posed by doctors like Xenakis. “Psychiatrists—they’re the worst,” he blurts out at one point while we’re at Eisenhower, as his meeting with doctors there draws to a close. “I once had a meeting with a bunch of psychiatrists and psychologists where I had to kick every single one out of the room. Everybody had an opinion.”
“Potholes, lately. Those have been a big deal.” I caught up with David Booth two weeks ago—at his office, this time—where he is wearing a TENS Unit, or transcutaneous electrical nerve-stimulation device, in order to blunt some of his pain; the cold weather’s made his body even tenser than usual.
Potholes? I ask. “I got blown up, and my vehicle rolled,” he explains. “It’s the shake of the vehicle.”
Booth continues to lead a cloistered life. He still arrives at the office before the sun’s up, still stays in at midday, still hasn’t gone to the movies, still gets his groceries delivered, still isn’t seeing anyone. (“Someone said to me the other day that I’m ‘unapproachable,’ ” he says, “and I was like, ‘Yeah, I can see that.’ ”) But he was recently promoted to director of operations, and his workplace, a gleaming mini-NORAD that could double as a set for CSI, is filled with former policemen and servicemen. “My personal life … there isn’t one, and I’m not happy with it,” he says. “But my professional life is a different life. I’m busy, I’m working, I’m providing a service.”
Next: “I would have gone back again and again and again, if I could have.”
I look around the room. He’s brought me into a training space, filled with model suitcase bombs and other types of explosives. I mention the irony in a soldier recovering from an IED injury spending his time surrounded by fake explosives. He shrugs. “If the point is that I’m trying to get back to where I was before I was injured ...”
So this normalizes things, I say. Provides continuity. He nods. He remains identified with those in Afghanistan and Iraq. “I would have gone back again and again and again, if I could have.”
For all of his difficulties, David Booth is a success story, adapting as well as is humanly possible to circumstances that most civilians would find unimaginable. He hasn’t vanished from sight, or pretended he’s fine, or numbed himself with whatever substances he has at his disposal. He hasn’t totaled his car or crashed his motorcycle; he isn’t hitting his kids or screaming at his wife. Yet even those who have the wherewithal to seek help can lose heart. Healing can be a glacial process. “I sometimes make excuses not to go to therapy,” admits Booth. “Because it’s like opening wounds, you know?”
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SOURCE: New York Magazine, http://nymag.com/news/features/71277/index5.html
Wednesday, October 7, 2009
Max Cleland: Heart of a Patriot
Foreword
An Open Letter to America's Veterans
America sends the flower of its youth abroad to fight its wars. Because of that, America's military is always staffed with the stoutest, finest, most courageous people in the country. If as soldiers we are not that way when we enter the military, the military makes us that way by the time we get out. In the end, the military is still made up of everyday people like you and me. As such, most of us have no special skills to cope with the challenges wartime military service presents. Regular life simply cannot prepare a person for the brutish sensory overload of combat.
Coming back from military service in a time of war, we may be wounded in ways that don't show to the world at large. Some of the deepest wounds we suffer may be inflicted without leaving so much as a scratch. No matter what you are feeling when you come home, no matter how crazy you feel inside, know that you are not mentally ill. As combat veterans, we have been through some of the most traumatic life experiences possible. War is as close to hell on earth as anything ever could be. That does make us different from our loved ones back home. War marks us all, some more deeply than others.
As veterans, we have paid a price to serve our country. We have suffered. And we may suffer for a lifetime. The soldier never gets to choose his or her war. The wars choose us, and not all are just. I believe the emotional casualties of the misguided wars may be the hardest of all to bear.
The soldier's lot is to be exposed to traumatic, life-threatening events — happenings that take us to places no bodies, minds, or souls should ever visit. It is a journey to the dark places of life — terror, fear, pain, death, wounding, loss, grief, despair, and hopelessness. We have been traumatized physically, mentally, emotionally, and spiritually. Some of us cope with exposure to hell better than others. Some are able to think of their combat experiences as but unpleasant vignettes in a long and wonderful life. It is not to those veterans I am speaking. I love them, but I am not afraid for them.
I am speaking to the rest of my brothers and sisters, those who find themselves trapped in the misery of memories as I was for so long.
For them, I am afraid.
To those veterans I say, you are not alone.
Many of us have been overwhelmed by war. Many of us have been unable to cope on our own with what has happened to us or with what we have done. Many of us have been left hopeless, lost, and confused about ourselves and our lives in ways we never thought possible.
That does not make us victims.
It makes us veterans.
As veterans of war, we are vulnerable to the memories of those experiences for the rest of our lives. Movies, the nightly news, the death of a loved one, even simple stress can serve as a trigger that reminds us of the hell we were once in. Just that remembrance can sometimes be enough to undo all the buckles we used to put ourselves back together when we got home.
Our bodies, minds, and spirits react automatically to these memory triggers. They feel the hurts and fear and horror anew each time. The curse of the soldier is that he never forgets.
Having once felt mortal danger and pure terror, our bodies prepare for it again. That helped us survive on the battlefield. However, what saved us on the battlefield doesn't work very well back here at home. It is impossible to forget our experiences in the military. But it is possible to deal with them positively. It is possible to take control of them.
That's what I've had to do.
I've found in my own life that I had to exude positive energy into the world in order not to be overwhelmed with sadness and grief over what I have lost. My body, my soul, my spirit, and my belief in life itself were stolen from me by the disaster of the Vietnam War. I found solace in attempting to "turn my pain into somebody else's gain" by immersing myself in politics and public service. In particular, I devoted myself to helping my fellow veterans and disabled friends heal. This was a great help to me in my life. But when I lost my reelection bid for the U.S. Senate in 2002, my life fell apart. The staff that had helped me politically and physically so I could keep on running with no legs was gone. The pleasure of having a job worth doing and the money to keep me afloat were gone.
My relationships began to crumble, especially the one with my fiancee.
I went down in my life in every way it is possible to go down. Massive depression took over. I went down with a grief over my losses that I had never known before. I went down thinking that God was not for me anymore. I no longer wanted to live. With the start of the Iraq War, my own post-traumatic stress disorder came roaring back nearly 40 years after I was in combat. I never saw it coming. Thoughts of war and death simply consumed me. I thought I was past that.
It taught me that none of us are ever past it. But all of us can get past it enough to be happy.
When I went down, my sense of safety, organization, structure, and stability collapsed. My anxiety went sky-high. My brain chemicals, which had helped me stay hopeful and optimistic, dropped through the floor. My brain stopped working. My mind, which I had counted on all my life to pull me through and help clarify challenges, fell into despair. My spirit dropped like a rock as all hope I had for a good life went away. I was totally wounded and wiped out — hopeless and overwhelmed. Just like I had been on that April day in 1968 when the grenade ripped off my legs and my right arm. Emotionally, spiritually, physically, and mentally, I was bleeding and dying. I wound up at Walter Reed Army Medical Center almost 40 years after I had been treated there the first time. This time around, I was in search of being put back together again in my mind, heart, and soul. When I was there the first time, the doctors didn't really treat our hearts and minds, just our broken bodies. Post-traumatic stress disorder didn't officially exist. Neither did counseling for it. What a world of difference several decades make!
Recovery is possible. There are people who can help.
Through weekly counseling, medication for anxiety and depression, and weekly attendance at a spiritual Twelve Step recovery group, I began to heal. My personal recovery and renewal have taken years. I still talk to my PTSD counselor at Walter Reed occasionally when I need to do so. I still take a low dose of antianxiety and antidepression medication. I still stay in touch with my brothers in my Tuesday night Twelve Step group at the "last house on the block." As a brother in that group, I lean on my fellow attendees, especially my fellow veterans, and feed off their experience, strength, and hope.
Which is why I am writing this open letter especially to those who have suffered what Shakespeare referred to as "the slings and arrows of outrageous fortune" by getting blown up, shot up, or otherwise wounded in the service of our country. For me, the physical wounds were the first to heal and the easiest to deal with. It is not easy to run for political office or try to run forward in life with no legs. But I've been able to do it. The mental and emotional wounds — and a whole suite of spiritual wounds — have been far more difficult to overcome. They are the most subtle of all, and the hardest to heal. From time to time, I am overwhelmed by the sense of meaninglessness I feel regarding the Vietnam War, in which I was a young participant, and the Iraq War Resolution, which I voted for as a U.S. senator. To keep my sanity, I must not dwell on my part in those disastrous episodes in American history. I try not to blame myself too much. I work on my own recovery and renewal knowing that I can't help anyone else unless I get, as Hemingway put it after his war, "strong at the broken places."
I try to get enough sleep so my mind can regenerate. I exercise. I still walk with no legs, putting my stumps on pillows and sliding across the floor to get my aerobic workouts. Occasionally I do sit-ups and push-ups and curls with weights. I stay in touch with the members of my group and read literature like the Bible, which guides my prayer and meditation and helps me remember that God is with me, not against me. I work on my physical, spiritual, and mental recovery and renewal every day.
Recovery is possible from even the most grievous wounds of war, politics, and life. But we veterans remain painfully aware of our experiences. As my trauma counselor tells me, it is fine to look in the rearview mirror from time to time to see where you've been, but it is much more important to look through the windshield to see where you want to go. We can't let where we've been dominate and control where we are headed. Otherwise, we live an upside-down life.
In addition to trying to muster the courage and the faith to move forward each day, I try to remember that I am blessed to have the grace of God and the help of friends to point the way and help me along my path.
I wish you the same.
Max Cleland
Atlanta, Georgia
2009
Copyright 2009 by Max Cleland
Sunday, September 20, 2009
That Medal
By Anthony Hardie
What does that medal mean you ask?
That one there
On your chest
I request
You tell me what
It means
I hesitate again
Faltering, haltering, then feeling
Obligated
To say something
Of what it means
It means that I…
It means that we…
Well, it was over in…
Well…
No wait, this time,
This time I don’t know why, but I will
Tell it how it really is
Not the official story
Not the military’s story
Not the citation hanging there on the wall
What that medal really means is this:
It means I’m a dreamer…
A dreamer, what? A dreamer, Huh?
A dreamer…
You see, I was so young, and dreamed a dream
Of imaginable ideals
Of democracy, and liberty,
Freedom,
And Justice for all
I dreamed a dream
Of smart starched uniforms
And medals with stories
Bigger even than their brass brilliance
I dreamed a dream
Of a better life
The way to which was paved with just
A degree and
A little
Service
I dreamed a dream
A dream deferred
For just
A few years
While in the dust and desert heat
The dust and oil and stench
Of unwashed bodies
Us
Me
Didn’t feel so romanticized
So I just daydreamed
I dreamed a dream
I dreamed of home, bigger than the moon shining
On those cloudless desert nights
I dreamed a sweet dream
Of someone waiting for me
Puffing up our love like a cloud
Through letters and emails and once in awhile
Calls
And dreams
I dreamed a dream
Of life beyond
The camaraderie closer than any brotherhood
Where sweat and tears and dreams and blood
All mixed and shared and mingled until
They had no words, only images
Home
Mom
Love
American People
Home
But wait, this is a story
About that medal on my chest
Tightly woven round
The little brass bar in the back
Pinned to my breast
Sure it’s about dreams
Yes, that’s what I mean
Dreams night after night
Looming large
Or small
Dreams of that brotherhood
Broken
Lost
Alone
Dreams of killing, now possible in so many abstract ways,
And being killed, in more ways than imaginable,
And dying, inside, for real, but what is real in these dreams?
And not.
Which is it? Which was it? Which happened first?
Who was where? When? Why?
It’s restless dreams
And sweat-soaked sorting
It all out, getting it right
This time
Changing just one thing
Or every thing
A dream deferred
Exchanged for other dreams
Of just making it through one more day
Of a mind that is lacking because of some of those dreams
And a body
That isn’t
Of tossing and turning
Between wakefulness and sleep
Not sure which is the dream
And which is less painful
Of dreams exploded
When brought out into the sun
Dreams of idealism and commonality
Of shared dreams made alive by
Commitment
Dedication
Determination
And Drive
But now, these dreams
They just won’t stop
Looming over me in the night
Or flashing back in the day
Not restful now wakeful
Just vigilant and sorting and sifting and seeking
The dream evolves
As only dreams can
Shifting and changing
Until the end is nothing like any of the rest
No rest
My medal
Means
Well…
It means, as I said…
With a wry smile…
It means that I
Am just
A dreamer.
What does that medal mean you ask?
That one there
On your chest
I request
You tell me what
It means
I hesitate again
Faltering, haltering, then feeling
Obligated
To say something
Of what it means
It means that I…
It means that we…
Well, it was over in…
Well…
No wait, this time,
This time I don’t know why, but I will
Tell it how it really is
Not the official story
Not the military’s story
Not the citation hanging there on the wall
What that medal really means is this:
It means I’m a dreamer…
A dreamer, what? A dreamer, Huh?
A dreamer…
You see, I was so young, and dreamed a dream
Of imaginable ideals
Of democracy, and liberty,
Freedom,
And Justice for all
I dreamed a dream
Of smart starched uniforms
And medals with stories
Bigger even than their brass brilliance
I dreamed a dream
Of a better life
The way to which was paved with just
A degree and
A little
Service
I dreamed a dream
A dream deferred
For just
A few years
While in the dust and desert heat
The dust and oil and stench
Of unwashed bodies
Us
Me
Didn’t feel so romanticized
So I just daydreamed
I dreamed a dream
I dreamed of home, bigger than the moon shining
On those cloudless desert nights
I dreamed a sweet dream
Of someone waiting for me
Puffing up our love like a cloud
Through letters and emails and once in awhile
Calls
And dreams
I dreamed a dream
Of life beyond
The camaraderie closer than any brotherhood
Where sweat and tears and dreams and blood
All mixed and shared and mingled until
They had no words, only images
Home
Mom
Love
American People
Home
But wait, this is a story
About that medal on my chest
Tightly woven round
The little brass bar in the back
Pinned to my breast
Sure it’s about dreams
Yes, that’s what I mean
Dreams night after night
Looming large
Or small
Dreams of that brotherhood
Broken
Lost
Alone
Dreams of killing, now possible in so many abstract ways,
And being killed, in more ways than imaginable,
And dying, inside, for real, but what is real in these dreams?
And not.
Which is it? Which was it? Which happened first?
Who was where? When? Why?
It’s restless dreams
And sweat-soaked sorting
It all out, getting it right
This time
Changing just one thing
Or every thing
A dream deferred
Exchanged for other dreams
Of just making it through one more day
Of a mind that is lacking because of some of those dreams
And a body
That isn’t
Of tossing and turning
Between wakefulness and sleep
Not sure which is the dream
And which is less painful
Of dreams exploded
When brought out into the sun
Dreams of idealism and commonality
Of shared dreams made alive by
Commitment
Dedication
Determination
And Drive
But now, these dreams
They just won’t stop
Looming over me in the night
Or flashing back in the day
Not restful now wakeful
Just vigilant and sorting and sifting and seeking
The dream evolves
As only dreams can
Shifting and changing
Until the end is nothing like any of the rest
No rest
My medal
Means
Well…
It means, as I said…
With a wry smile…
It means that I
Am just
A dreamer.
Anthony Hardie: Changes
by Anthony Hardie
None of this feels real
Which is how I know it is
Since the most real things of all
Never feel that way
None of this feels real
Which is how I know it is
Since the most real things of all
Never feel that way
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