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"A Guy Burned Alive in Front of Me": Treating Traumatized Vets

The way we understand and use PTSD tempts all of us -- providers, society, and veterans -- to view the veteran as a victim, which may hurt them more than help.

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While in the hospital recovering, Ann discovered that the day after she'd left her base, a vehicle loaded with explosives -- in Army parlance, a Vehicle Borne Improvised Explosive Device (VBID) -- had crashed the base's gate, killing many of her friends. She still felt guilty for not being there to help. Then, taking a shaky breath, she added in a near whisper: "But I'd rather have been burned than gone through another VBID."

As we sat digesting the horror of such a choice, Ann continued. Two months earlier, she'd just come off watch when a VBID destroyed the tower she'd just left, killing, among others, the sergeant who was her mentor and best friend. "He'd protected me from harassment in the unit. He always stood by me," she explained. She'd given first aid to this sergeant, but he died in her arms.

While recovering from these horrors, she reached out to her family for support. "But every time I tried to explain what had happened and how bad I felt, my parents and husband got angry with me, telling me to get a grip; that what was past was past. So I shut up," she said. Not long afterward, she became deeply depressed.

Our Ambivalence

John and Ann's stories stirred intense feelings in me, as I imagine they do in you. Our reactions are the real topic of this article, because they determine how we think about people who've experienced horrific events, and how the mental health profession defines and treats their problems. Imagine now that these events happened to you or someone you care about deeply. Do you notice any attempt to avoid or move quickly away from the pain, fear, and horror these stories evoke in you? Do you want to distance yourself from the reality of what happened, to diminish or mute the feelings getting stirred? Are you aware of any conflicted feelings about how John and Ann have coped -- do you feel sympathetic, yet a little bit critical or judgmental? Are you asking yourself how you might deal with such horrors?

Ambivalence is at the core of our response to such stories. When we hear of a horrific event, we may try to understand it by imagining what it would be like for us to have that experience. We'd like to think that we could surmount such catastrophes, but if we're at all aware of our own vulnerabilities and limitations, we probably doubt that we could, yet we're aware of our internal judgments and how we tend to hold others responsible for their ability to manage life's challenges.

To complicate our feelings even more, we may fear that our struggle to get over something might engender negative judgments from others. Just hearing such stories can raise conflicting feelings, causing us to bounce from sympathy to implicit antipathy. Added to that is the uneasy feeling that we might someday be on the receiving end of other people's impatient remarks like, "Bad stuff happens to everybody, but they get on with life -- what's wrong with him that he can't get his act together after all this time?"

In subsequent work in the group and individual therapy, John focused on his anger at his chain of command. He felt deeply betrayed by his platoon sergeant's failure to come to his aid. "That son of a bitch! He let us all down. Because of him, Larry died. And I had to pick up another soldier's body and tuck his guts under my arm."

As a Vietnam combat veteran, I could easily understand his rage. I knew a thing or two about people's failures under fire. "If anything," I said, "you're letting him off easy. He didn't just 'let you down.' That's calling him on a misdemeanor, when you've got him on a capital offense. What he did was dereliction of duty under fire. Not too long ago, he could have been shot on the spot for that."

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