combat PTSD

 
Back into the Heart of Darkness:
Combat PTSD

By Tom Joyce

Excerpted from the Spring 1994 issue of the Institute for Research in Metapsychology Newsletter

 

Foreword by Gerald D. French

In 1989, Dr. Gerbode and I [Gerald French] and Helen Burgess--a facilitator and professional member of IRM--were using Traumatic Incident Reduction (TIR) with a number of Vietnam combat vets who had been diagnosed as having PTSD. Tom Joyce, a freelance writer and a member of the Institute's Board of Directors, was a guest at that year's IRM conference where he heard an address by one of those vets-- "Jack", in the accompanying essay. Subsequently he sought Jack out, and the two spoke at length. As a result of that meeting, Joyce researched and wrote a penetrating article on traumatized Vietnam veterans and the attempts that the U.S Government and others have made to help them. We published a somewhat abridged version of it in the Institute's newsletter...ran out of copies...and as the topic he addressed continues to be one that we are asked about frequently, I asked Tom if he would produce an up-dated version of it for re-publication. He did, and I hope you enjoy it as much as I.
- GDF

Back into the Heart of Darkness, by Tom Joyce

It was a war without glory. It was endless nights of waiting in rain-soaked, mud-caked fatigues for death to strike from the bush, counting the hours till dawn, the days, the months, trusting no one, existing utterly alone. It was an enemy who rarely showed his face and murdered arbitrarily when he did, who used his school children as terrorists and brutally tortured his prisoners. It was bearing witness to countless mutual atrocities and concluding that the Geneva Convention was a joke politicians told to each other. It was the grunt who watched his friend's legs blown off by a booby trap, the helicopter nose-gunner presented with the gruesome aftermath of his handiwork on a village, the green private who killed one of his own with a fumbled grenade, the short-timer who fragged his field commander for ordering an impossible assault. It was the freckle-faced kid transformed into a steely-eyed killer by fear and rage and unendurable frustration, an ordinary human being so inured to unspeakable acts of violence that stories of hacking off the ears of old women, smashing babies against tree trunks and castrating prisoners during interrogation were met with icy indifference. It was cursing the ability to reason and wondering, in ever-suppressed horror, just how far one could push the envelope of sanity.

It was a peace without honor. It was walking point and dodging sniper fire along the Mekong Delta one morning, then stepping off an airplane in San Francisco 48 hours later, dumped back into America's lap and expected to act civilized. It was being spat upon by one's own countrymen who, angry and frustrated by an immoral and undeclared war, found it difficult to distinguish between vandals and victims. It was never knowing if your buddies made it back and living with the slow-burning fuse of survivor guilt, muted by the sheer magnitude of the experience, the onslaught of ineffable emotion, the dumbfounded expressions of those who hadn't been there and couldn't possibly understand. It was separation and divorce and dulling the anguish with drugs and alcohol, subsequent years of nightmares, embarrassing "startle" reactions, unrelenting memories, and uncontrollable tears.

It was an epic whose heroes were unsung....

My companion--call him "Jack"--lights another Marlboro and continues the account of watching his entire platoon wiped out by an nva [North Vietnamese Army] ambush during the first frantic days of the Tet Offensive in January 1968. It is a graphic description of sodden fear, bleeding men, and a human being left alone too long, pushed past the edge of sanity by endless taunting and enemy assaults. During the following 48 hours he would live through an inferno of napalm, artillery shelling and friends dying a few yards beyond his ability to reach them, before being medevaced out of the bush with malaria. Jack was 18 years old at the time.

As he recounts the conflagration, the wind outside causes the louvered glass windows in the room to slip shut with a loud crack. Jack's rugged face contorts with instantaneous alarm. His arms snap out in automatic defense; his lean body tenses like a steel spring. When he notices my startled expression, Jack relaxes and smiles in embarrassment. "There was a time," he says, "when that noise would have ruined my whole day." He isn't alone.

Nearly a million individuals serving in the United States Armed Forces engaged in combat or were exposed to life-threatening situations in Vietnam during the years between 1964 and 1973. [1] According to a 4-year study conducted by the Research Triangle Institute for the Veterans' Administration, an estimated 480,000 of those suffer from a phenomenon known as Post-Traumatic Stress Disorder [PTSD]. Formerly accorded less clinical terms like "shell shock" and "battle fatigue", PTSD is hardly peculiar to the Vietnam war, but the circumstances of those who lived through combat in that particular cataclysm are unique in American history.

During World War II, even though the pre-induction psychiatric rejection rate was nearly four times higher than World War I, psychiatric casualties increased by 300 percent. [2] At one point, more men were being discharged for "war neurosis" than were being drafted. [3] Twenty-three percent of the men who suffered from battlefield psychological breakdowns never returned to combat. Owing to immediate on-site treatment provided during the Korean War, psychiatric evacuations dropped to 6 percent of total casualties. In Vietnam, however, psychological breakdowns were at an all-time low, twelve per one thousand. [4]

Several factors contributed to this apparent improvement. The "date of expected return from overseas" [deros] system was employed for the first time in Vietnam. A soldier's tour of duty lasted twelve months, or thirteen if he was a Marine. They served their time, tried to stay in one piece, and rotated back to the States. In the meantime there was a lot of alcohol and drugs; the "Fertile Triangle" along the borders of Laos, Burma and Cambodia supplied some of the finest substances in the world for numbing trauma. Those who were caught "self-medicating" or manifesting other character disorders, by any superior who cared, were given administrative discharges thus avoiding the whole question of psychological trauma. As a consequence of DEROS, drugs and discharges, the neuropsychiatric casualty rate in Vietnam was significantly lower than in either Korea or World War II. [5]

But the system had its down side. Wholly apart from the debilitating effects of drug addiction and alcoholism, the DEROS concept created a new set of problems. After the first few years of the war, it was rare that whole units were sent to Vietnam. Consequently, esprit de corps was practically nonexistent. A soldier would arrive in isolation as a "FNG" [f---ing new guy] ignorant of combat's horrifying reality. He was considered anathema by the experienced "short timer" who knew the best way to stay alive was to stay aloof. One learned quickly to trust only himself. His private war began the day he set foot "in country" and ended the moment he was lifted out.

But before his tour was up, a soldier was introduced to the grisly nuances of guerrilla warfare, where booby traps and incessant sniper fire accounted for an astonishing number of casualties, where "Victor Charlie" was rarely seen and ground rarely held, where the enemy included women and children, where the average age of combatants was under 20, and where the ideological basis for the conflict was difficult - if not impossible - to grasp. His only consolation was the knowledge that if he survived for 12 or 13 months, [6] he'd be out of the nightmare. Or so he thought.

Coming home often proved a barren source of relief. During World War II, men spent weeks, sometimes months, returning from the battlefield aboard ships, decompressing, sharing their experiences with understanding peers, and were finally honored with hometown parades and national acknowledgment. By contrast, the Vietnam veteran endured a solitary plane trip with strangers and a cool, if not hostile, greeting from his countrymen. It is not surprising that many of these degraded warriors had difficulty readjusting to their previous environments.

The sheer exhilaration and joy of survival suppressed the symptoms of PTSD for most veterans. But for some an unsettling change began to manifest years later, beginning with restlessness, mistrust, and cynicism, evolving into depression, insomnia, flaring tempers, and a morbid obsession with memories of combat. Many experienced grave anxiety over the sight of a green tree line or an open field, the sound of a helicopter flying overhead or the seemingly innocuous popping of popcorn. Perhaps worst of all was the feeling of guilt for having survived, and the price they had paid for that survival.

The Veterans Administration proved unsympathetic, refusing to recognize neuropsychiatric problems appearing more than one year after discharge as service-related. Consequently, treatment from the VA was difficult to obtain and disability compensation unavailable. [7]

It was not until the mid-1970s that the Disabled American Veterans funded the Forgotten Warrior Project, a ground-breaking study conducted by John P. Wilson, Ph.D. As a result, the DAV opened storefront Vietnam Veteran Outreach Programs in more than 70 cities across the United States, staffed by volunteer counselors. Once the concept proved successful, Congress established the VA Vet Center program. [8]

Post-Traumatic Stress Disorder was formally recognized in 1980 by the American Psychiatric Association, but its etiology is still passionately debated. Dr. Michael Cohen, an Army 1st Cavalry infantryman who served in Vietnam during 1967 and '68, is now a clinical psychologist and team leader at the San Francisco Vet Center. As a member of the advisory board for the PTSD Team at the Fort Miley Veterans' Affairs Medical Center, Dr. Cohen characterizes the opposing camps as "residualists" and "predispositionists."

"I think it's both," he maintains. "The extent or duration of combat has a great deal of influence on the readjustment problems of the veteran, but I also think that pre-military experience and development sets someone up to react to the chaos and horror of the war around him. We do know that the problem continues with time. It does not go away by itself and we have to deal with both the developmental and war issues in order to treat it."

The official criteria for diagnosis of PTSD is that an individual has developed "characteristic symptoms following a psychologically traumatic event generally outside the range of usual human experience." [9] Veterans who can show service-connection for delayed psychological disabilities are finally able to collect compensation. But establishing that service-connection is not an easy matter. According to a number of vets, the VA claim forms demand the veteran's ability to succinctly describe what is wrong with him, and someone who cannot articulate his distress stands a slim chance of being compensated. One who communicates well, and understands the rules of the game, fares much better.

"Vince", a decorated veteran of Korea and two tours in Vietnam, entered the VA Hospital in Helena, Montana in 1986 and subsequently the PTSD Treatment Unit in Menlo Park, California, where he spent nine months as an inpatient and another four in an outpatient self-help program. "I have run into psychiatrists who don't believe in PTSD," Vince claims. "They're used to shell-shock victims - comatose, catatonic - and anything else is bullshit. Everybody's reading different books. If they can show this guy is a slow learner, a bit dyslexic or came from a screwed-up environment before he was in the Army, then the government's off the hook."

But Vince admits that some vets abuse the system. "Working your claim" in order to profit by bureaucratic snafus is not uncommon. "The VA is paying you to be sick. If you're service-connected and you go to the hospital, you get 100 percent when you're there - $1461 a month. So these guys get a lump sum of $10,000 for being in the hospital all this time and they abuse themselves and use up all the money. And when it gets cold under the bridge - about November - they have a 'relapse' and go back and do it again. The longer you're into this behavior pattern, the harder it is to break out of it. You have this invisible umbilical cord attaching you to the VA for the rest of your life."

Vince found his own outpatient program frustrating for different reasons. "I learned soon enough that you can't really get into anything because you only have an hour. You're in the middle of stuff and the therapist would say, 'Hey man, hold that thought, I'll see you next Monday.' So I just ended up saying, 'Look, I'm really sorry, but I haven't got years and years to spend here doing this.'"

The "fifty-minute hour," upon which so many practitioners base their professional lives, may well prove of scant therapeutic value for veterans suffering from PTSD. Once revivified in a session, the horrors of war cannot wait until next week to be addressed. Vietnam veterans have been staying with the feeling for 20 years, and that is their problem.

According to author and Vietnam veteran Larry Heinemann, "the Veterans' Administration - now kicked up to the Cabinet level - has never been regarded by Vietnam veterans as an advocate of their health and well-being." [10] Luckily, Vietnam veterans have founded grass-roots organizations which provide alternatives to VA treatment.

"The Vet Center system is based on getting out into the community and reaching the vets," explains Dr. Michael Cohen. "Where we can't, we subcontract with a clinician who is well-versed in the area of PTSD. For many of us, this is a mission. We're helping each other." But he goes on to explain that outreach programs - such as Vietnam Veterans of America and Swords to Plowshares - while focusing extremely well on social services, "dabble in treatment. Essentially they hire someone who is a clinician. That person becomes the clinical coordinator and maybe starts a group, sees one or two clients for counseling, but it's not extensive and by no means is it the primary focus of the agency."

Within the last two years, a movement has been developing around a technique which was originally focused on areas other than PTSD. A synthesis of several classic disciplines, this method, according to those vets and others who have worked with it, may provide a new model for the treatment of post-traumatic stress - one unencumbered by government bureaucracy or political agendas, and sometimes as high-tech as it is "high-touch".

"Frank" stares down at the tubular electrodes he is holding. His eyes are narrowed and his face ruddy, like a man who is exerting an enormous amount of effort to escape from something dark and terrifying that breeds in the murky outback of his mind.

"Have another look," says the man with a silver beard, sitting opposite Frank. He is big and benign, his features almost elfin, and he operates an Electro-Dermal biomonitoring meter [EDM] wired to the electrodes in Frank's hands.

Frank recounts the story for the third time and there is a perceptible edge to his voice, as if his boredom is curdling into frustration. "The district manager and I had this verbal agreement concerning the percentage of sales I would receive. But he decided to rearrange the commission structure before I was paid. We're talking about nearly seven thousand dollars here. Damn it, I earned that money." Frank breaths deeply and closes his eyes. His square jaw clenches tightly, and when he continues there is a slight trembling in his voice. "I know that I have to confront him. But every time I even think about doing it, my stomach just knots up." Frank's face flushes with the pigment of rage and humiliation. "Here I am, this bad-ass former Marine, black belt martial artist, scared shitless over the thought of demanding money that's owed me. I don't know why people always take advantage of me. I don't know why I let them."

Frank stops and swallows hard. He looks up, angst radiating from icy blue eyes, and shrugs resignedly, signifying that he's once again reached "the wall" - a barrier beyond which he cannot penetrate.

The bearded man nods in genuine empathy. The EDM has registered only a steady needle movement to the left, indicating an increase in Frank's electrical resistance. "Okay," he acknowledges. "Now, take a look and tell me if there is an earlier, similar incident."

Frank pulls a deep breath into his lungs, closes his eyes and attempts to pierce that tenebrous cloud of the past, where unspeakable phantasms lurk and disturb the sanctity of sleep. Suddenly, there is a sharp needle drop to the right. It rests idly on the holding pin and the bearded man has to work the calibrated dial beneath his left thumb to get it back on the meter. "Yeah, there," he says, "What do you see right there?"

Suddenly, Frank is a 25-year old Lance Corporal, walking through the bush near Chu Lai. It is January of 1967, and he is on his ninety-second patrol in Vietnam. There is the smell of rain-soaked foliage and warm, redolent earth. It is dusk and the mosquitoes are beginning to swarm at the smell of human sweat. There are the sounds of jungle life signaling the ingress of night and, above them all, there is the sound of his own heart pumping adrenaline into his veins. It is not like a recollection, some vague distant memory. He is there, in the grip of saline fear which has possessed him from the moment his boots touched Vietnamese soil. He has nearly eleven more months of this hell to live through before they will lift his feet out of that fetid green nightmare.

When the sniper fire begins, Frank drops to one knee and wields his 3.5 rocket launcher, instinctively aiming toward the outcropping of trees he believes to be the enemy position. He calls for his first gunner to stand by for loading, but the 18-year-old balks and runs for the nearest cover. Frank, fuming with anger, rises up and in that moment is hit in the shoulder by AK-47 fire. Pain excoriates reason; no emotion survives but rage. As soon as Frank can reach the tree line he fully intends to beat the living shit out of the callow grunt who left him with his ass in the breeze.

It is all in slow motion now, the loping run toward the trees, the sound of "popcorn" and the rush of wind as bullets rip past his ears. There is the blood drenching his flack jacket, the numbing in his arm and the overwhelming anger rising in him with the pressure of an erupting geyser. And now he spots the gunner, a solid grey silhouetted against the variegated grey of the bush, barely human in appearance, his hands shaking with a spastic intensity of fear. And in those hands is an M-16 automatic assault rifle, safety thrown, aimed directly at Frank's chest. Frank exhales an expletive, and only then realizes he's been holding his breath a good fifteen seconds. "Christ! I just backed off, real easy. 'Only a flesh wound, man. No problem.' I knew if I even looked cross-eyed at this kid he would blow me away."

The bearded man nods, signifying understanding. "I got that," he says. Frank knows he has. "Go to the start of the incident and tell me when you've done so."

Frank does so, three more times. At first it is painful, then boring, and then, on the fourth recounting, Frank chuckles to himself. It is a small escape of air which accompanies a great explosion of clarity. The EDM needle has fallen sharply to the right and is now loosely sweeping back and forth across the dial. According to the meter the electrical resistance has dissipated. The bearded man nods and queries, "How are you doing?"

Frank looks up and his eyes sparkle with amusement. "I'm doing fine." His face has relaxed as if some emotional pillory has been lifted from his neck. "It's a stupid thing, really. It just occurred to me that not all the people I have to confront in life are armed and dangerous. I guess its safe to be pissed off if you've got a good reason to be."

The bearded man returns Frank's broad smile; its hard to judge which of them feels a greater sense of accomplishment at this moment. "Thanks. We'll end right here."

This particular session of Traumatic Incident Reduction (TIR) has lasted one hour and twenty-two minutes. But for Frank, it represents a partial resolution to many painful years of despair.

By 1986, twenty years after his tour of duty in Vietnam, Frank had sunk into a complete, self-imposed isolation. His marriage had failed, several business deals had fallen through, his girlfriend had recently deserted him and he was drinking heavily. He called the local VA Hospital and was told to speak with a counselor from a local veterans' outreach program. After two emotionally turbulent hours, the counselor determined that Frank was probably suffering from PTSD. He suggested Frank join a 90-minute Thursday evening rap group for combat veterans.

"It was not as advertised," says Frank. "Of the eleven that were there, only 3 were combat veterans. I think that the program was compensated by head count. There was never any therapy given or suggested or directed. It was evaluative; they would encourage other people in the group to give their observations, corrections and opinions to you directly. The deeper you can dig your traumatic hole, the better it is, and that's 'working your program'. I got into drinking heavily again. I finally quit going."

Shortly thereafter Frank was introduced to TIR by a fellow Marine combat veteran --Jack-- who had once been unable to imagine passing a single hour in unmitigated happiness. "The changes have been remarkable." Jack leans into his words with a fierce desire to drive home his point. "I can't describe what I went through for twenty years, but I know very much what it's like when I see another guy sitting in it."

The process of TIR was developed by Dr. Frank A. Gerbode and a number of colleagues as an alternative to psychotherapy. An Honors graduate from Stanford in Philosophy, Gerbode received his M.D. from Yale Medical School and completed his psychiatric residency at Stanford Medical Center in the early '70s. "I also worked at the VA on a psychiatric ward. They were completely eclectic. They're honestly searching and groping and trying to find an answer, and they sorely need to find a fast, effective and systematic approach to PTSD. That, I feel, is what TIR may have to offer."

According to Gerbode, "The purpose of TIR is to trace back sequences of traumatic incidents to their roots and thereby to reduce or eliminate the charge (repressed, unfulfilled intention) contained therein by completing the unfinished business that was interrupted by acts of repression. Each sequence of incidents depends for its force on the root incident from which it stems... In most cases, however, it is not possible to proceed directly to the root incident of a sequence. So much charge is usually contained in later incidents that memory of the root incident is partially or totally blocked. It is therefore necessary to proceed backward from present time, addressing later incidents first and discharging them somewhat before looking for earlier ones." [11]

This technique, which Dr. Gerbode calls "retrospection" rather than "regression," nevertheless has its roots in the early work of Freud. In the late 1800s, Josef Breuer, a Viennese physician used an abreaction procedure which came to be known as the "talking cure" or "a recalling or re-experiencing of stressful or disturbing situations or events which appear to have precipitated a neurosis." [12] His young colleague, Sigmund Freud, found the procedure fascinating and, using it as his working model, developed psychoanalysis. Freud noted that the key to a recent disturbance lay in an earlier, similar trauma, sometimes an entire chain of incidents. [13]

Far from exclusively Freudian in his approach, Gerbode also incorporated repetitive and gradient aspects of "desensitization," a procedure arising from Behavior Therapy developed by Joseph Wolpe and Arnold Lazarus, and elements of the "person-centered" concept of Carl Rogers, wherein a therapist refrains from offering any interpretation of his client's personal experiences.

In the practice of Traumatic Incident Reduction, the client is called a "viewer" and the therapist a "facilitator." The strategic nomenclature tends to forestall rebellion against an authority figure. "I do not refer to people as 'patients,' nor to people who render help to other people as 'therapists,'" Dr. Gerbode maintains. "I concur fully with Thomas Szasz, who has brilliantly shown that the concept of 'mental illness' is a mere metaphor, and a useless and destructive one at that." [14]

Critical to the technique's successful application are the concepts of a safe environment and "end points". "TIR requires a great deal of attention and concentration, and so the environment in which it occurs must be very safe.... Flexible session lengths are essential to the creation of a safe environment. It is vital for the facilitator to be able to end a session at an end point, where the viewer feels good because something has been resolved. If the viewer feels confident that he will have time to resolve anything he encounters during a session, he will allow himself to get into highly charged areas." [15]

Dr. Robert Moore, a clinical psychologist in Cognitive and Behavioral Therapy from Clearwater Florida, has used the technique on his own patients, with impressive results. "I went to San Francisco and took the opportunity to get acquainted with it because it sounded good, and found out that it didn't just sound good. There isn't anything going on in the professional community among my colleagues in psychology, or psychiatry, or counseling, or psychotherapy, that is its equal. My experience is that if somebody is willing to persist with the procedure, it is virtually inevitable that he gets relief. I'm quite convinced that Traumatic Incident Reduction is the state-of-the-art handling for post-traumatic stress disorder."

Over the past several years, Gerbode, Gerald French [Jack's Facilitator], Moore, Lori Beth Bisbey [see the Bisbey column] and others have presented case studies on their work with TIR and conducted workshops at numerous professional conferences in Europe and the U.S. A growing number of clinical practitioners in the field have been sufficiently impressed with the technological simplicity and logic of the approach to have become trained in TIR themselves.

While use of the EDM enables a facilitator more readily to enter areas of memory just below the level of consciousness which are occluded to the viewer, the electronic aid is by no means mandatory to the success of a session. "Most of the people I have worked with don't have any trouble locating key incidents; they're sitting in them when they walk in the door," observes French, a non-veteran. When asked if his own lack of status as a veteran made the work he has done with vets more difficult, French responds that "it isn't a problem for the facilitator as long as he or she has the viewer's trust. And a lot of the TIR training involves the creation of the sort of precisely the sort of 'space' that permits trust to occur."

Vince's facilitator is an attractive woman in her forties who has never been anywhere near a boot camp, let alone a battle field. Yet Vince feels comfortable telling her things he could not even admit to other vets. "I probably feel a lot better now than even before I went into the service," Vince admits. He adds a note of cynicism; "Many vets will hesitate to use TIR because it might interfere with their disability claim--because they get better."

"Art", a veteran of the 864th Army Engineers at Cam Rahn Bay in 1965, spent eight months in the Menlo Park VA's PTSD Unit. Although he felt that he got something out of the program, he soon found himself back in the Palo Alto VA Hospital with a lot of unresolved issues, a broken relationship, and flashbacks. In June of 1989, Art began working with TIR. "I had almost two years of straight hospital time, and I have done more in two weeks with TIR. It's the first time in twenty years I truly feel like I've got some direction back in my life. I've resolved these things. It's not just that they're gone from my attention. I mean...they're taken care of. I'd just about given up hope."

Gerbode believes that the facilitation of TIR can be taught to veterans without any specialized backgrounds, enabling them to effectively co-facilitate, if they are so inclined. The same 4-day workshop that French and others use to train professionals has been employed with gratifying results in the training of vets themselves, as well as other lay survivors interested in helping their peers.

To date there have been only a few dozen veterans who have worked with TIR (Ed. Note: this was as of 1989, many more have been exposed since then) and clearly a great deal more needs to be done. Lori Beth Bisbey, a former Vet Center volunteer and counselor with the Federal prison system is currently conducting the first methodologically sound study of TIR. Her doctoral dissertation, for the California School of Professional Psychology in San Diego, will contrast TIR results with those of "imaginal flooding", a popular technique currently being applied to the problem of post-traumatic stress, and the consequences of non-intervention on a control group placed on a waiting list.

Acutely aware of the credence accorded double-blind studies by members of his profession, Dr. Gerbode is quick to express caution in his evaluation of TIR's efficacy. "We want to be fairly modest in our claims at this point. It seems that the one thing we can be sure of is that the specific symptoms of PTSD, the nightmares, the free-floating anxiety, the flashbacks, the severe emotional distress, are basically handled. Usually, these people have other things upsetting them that don't necessarily have anything to do with PTSD. I think those could be handled but it would take a more extensive program."

Lieutenant Colonel (Ret.) Chris Christensen both gave and received TIR for 3 years before his untimely death in Germany in 1992 while organizing humanitarian aid to Eastern Europe. Himself a veteran of combat in Vietnam, Chris was not very interested in the "scientific" imprimatur of double-blind studies. He'd heard about TIR from a friend who'd heard "Jack" on a radio talk show in early 1990. When he learned subsequently that his son had been murdered in Texas, Christensen loaded enough armament into the trunk of his car to "take out half of San Antonio". But on his way through California, he had the good sense to call Jack instead of continuing south to seek revenge. After a few TIR sessions, Christensen underwent a full course in the procedure with French before returning to Idaho, where there are a million people - 110,000 of whom are vets. A veterans job placement counselor at the time, Christensen immediately went to work applying what he called "Wildcat TIR" to his clients and comrades in PTSD.

"When I arrived at Job Services in Lewiston, Idaho back in April of 1985, there were in excess of 150 disabled veterans on my rolls, seeking employment. They remained there ... "recycling". With the skills learned through TIR training - and I'm talking the one week, forty-hour intensive course - I would estimate that I have worked with sixty of those people, anywhere from two to twenty hours, max ... the average probably running close to fourteen or fifteen hours. And out of those sixty people that I worked with on TIR, I had two - that's one, two - left on the rolls, seeking employment, when I left Idaho for Germany."

But Christensen took no credit for his extraordinary work. "They did it - the folks I worked with," he maintained. "What a wonderful gift: to walk into a VA hospital - to be able to take one of the rejects that they haven't been able to help in twelve, fourteen, eighteen months and, in a period of two or three weeks, give them a tool they can use the rest of their lives, and see a marked improvementx. I don't know what this stuff is, but gosh, it works! It is wonderful."

"This is not a panacea," cautions the pragmatic Jack, who gave Chris Christensen the sessions of TIR which literally changed the course of his life. Jack appraises the window that slammed shut in the wind; remembering, with a wry smile, the single hour of happiness he'd once considered a lifetime beyond his reach; then adds, "I think that 50 hours would handle most people."

Besides what has been done to them, human beings do unto others, within the context of war, things of which they are not proud. In Vietnam, there were no winners to prosecute war criminals, no one who could righteously point the finger. There were only losers - countries left without dignity, children without parents, parents without children. The survivors found themselves, in the twilight of the slaughter, desperately searching for a way to make some sense out of the insanity in which they had taken part. Many never found a way.

According to Joe Fegan, Public Information Officer for Chapter 464 of the Vietnam Veterans of America, "66,000 Vietnam veterans, particularly combat veterans, committed suicide within the first years of returning home from service. It exceeded the total number of deaths in the war. To date there's close to 100,000 deaths. A variety of implements were used, but the cause was the trauma suffered."

Those men and women who remain carry with them forever the mental image pictures of what they have seen and done, and, like all soldiers, steel themselves against those disturbing memories; store them in the armored lock-box of their dignity--until the anguish can no longer be contained. But sooner or later, all warriors must acknowledge and confront that darkness within their own hearts. It is the ultimate battle--one which cannot be averted but need not be fought alone.

Postscript: April, 1994

When Gerald asked if I would update "Back Into the Heart of Darkness" for this newsletter and IRM's annual conference, I thought it might be of interest to professionals in the field of post-traumatic stress disorder to know what sort of response I have had to this piece as a writer.

Between the autumn of 1989 and winter of 1991, I submitted the full-length article, complete with graphic descriptions of several of the Veterans' Administration treatment programs which have been expurgated from the present manuscript, to Rolling Stone, Atlantic Monthly, Penthouse, Playboy, Mother Jones and Harper's magazines--in short, where I thought it had a chance to reach the people who needed to see it most. Only Penthouse even considered it, finally determining that the material was already covered by their monthly column devoted to Vietnam veterans. Rolling Stone labeled it "politically correct" while the Atlantic thought it "far too biased." The rest rejected it out of hand.

Discouraged by this lack of interest in a topic that had been the subject of several well-received films, I showed the piece to a friend who is a Freudian psychoanalyst of some international renown. Fascinated by the study of PTSD, he eagerly read the manuscript and promptly wrote me a letter. Although I'll refrain from using his name, I will quote from his response:

"I can imagine why the piece didn't get published: it doesn't really go anywhere. As it now stands you essentially develop a blurb for PTSD treatment methods and programs, particularly TIR, that have impressed you. Certainly, one can applaud any effort to help the guys you introduce us to; but your enthusiasm for the creativity and the idealism of the therapists--and the contrast to the distant establishment that you implicitly portray--strikes me as naive (even if they're your friends!) "What comes across to me is that the psychologists, et al are glamorizing themselves and their results in order to make a living and feel effective--they're working their counter-claims just as the vets are working their claims. It's a tragedy--humanly and understandably corrupt. One can be sympathetic without sentimentalizing it.

"I'd rather see you work it into a short story that captures the painful, relatively hopeless reality. Something in the spirit of Last Exit to Brooklyn, for example."

I found that letter to be bleak, cynical, and despairing. I am glad I never showed it to Col. Christensen. Such an action on my part might well have resulted in his flinging the respected psychoanalyst from an open window of his Victorian office building. But no... I'm probably mistaken. Knowing Chris, it's more likely that he would have stalked into the psychiatrist's chambers, handed him a couple of the Institute's earlier Newsletters containing his own descriptions--post-intervention --of a number of the traumatized vets and others with whom Chris himself had worked as a facilitator, leveled his steely blue eyes at the analyst, and growled:

"Tell these folks it's hopeless, doc!"

Then he would have laughed.

In Memoriam
by Gerald French: November 1992

Just two weeks before he was to join us as one of the principal speakers at the European Conference on Metapsychology in Munich, Lt. Col. Chris Christensen died suddenly and unexpectedly. Chris trained with us in TIR in 1989, subsequently devoting hundreds of hours of his own time to working with fellow combat vets, their families, and other trauma survivors, to take away their pain. Earlier newsletters have carried his reports. His body failed him while he pursued the duties of his formal work, arranging the transshipment of humanitarian aid to the desperate peoples of Eastern Europe. His death occurred in Germany on the morning of October 29th, 1992, and was of "natural" causes... if such a word can be employed to describe the loss of this kind and gifted man to whom so many grateful people surrendered so much hurt.

Notes:

1. Goodwin, Jim, The Etiology of Combat-Related Post Traumatic Stress Disorder (Cincinnati: Disabled American Veterans, 1987) p.11
2. Figley, C.R., Stress Disorders among Vietnam Veterans: Theory, Research and Treatment (New York: Brunner/Mazel, 1978)
3. Tiffany, W.J. & Allerton, W.S., "Army Psychiatry in the Mid-60s" (American Journal of Psychiatry, 1967, 123: 810-821)
4. Bourne, P.G., Men, Stress and Vietnam (Boston: Little, Brown, 1970)
5. The President's Commission on Mental Health, 1978
6. The Regular Army's tour of duty was 12 months, but the U.S. Marine Corp, not to be outdone, spent 13 months "in country".
7. Ibid. (See Footnote 1.)
8. Williams, Tom, Post-Traumatic Stress Disorder: A Handbook for Clinicians (Cincinnati: Disabled American Veterans, 1987). See Nat. Commander's address.
9. From the Diagnostic and Statistical Manual, Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980).
10. Heinemann, Larry, "The Road From Afghanistan," (Playboy, July 1989, p.163)
11. Gerbode, Frank A., M.D., "Handling the Effects of Past Traumatic Incidents" (Journal of the Institute for Research in Metapsychology, 1988, Vol.1, Issue 4, p.6).
12. The Oxford Companion to the Mind, (Oxford: Oxford University Press, 1987.)
13. Freud, Sigmund, Two Short Accounts of Psychoanalysis, (tr.) James Strachey (Singapore: Penguin Books,1984), p. 37.
14. Gerbode, Frank A., Beyond Psychology: an Introduction to Metapsychology (Palo Alto: IRM Press, 1988), p.215.
15. Ibid. (See Footnote 14)