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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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Fear is a powerful emotion, but it comes and goes: vulnerability, however, is an unchanging, existential fact of life. As thinking, feeling human beings, we all suffer and die, sooner or later. At the same time, if we're young, healthy, and cocooned by privilege (as we tend to be in the West), we can ignore our susceptibility to pain and death. Young males especially seem to wear the invisible armor of assumed invulnerability. But genuinely terrifying experiences -- close calls that directly threaten life and limb -- evoke the undeniable feeling of fear, which, if intense and sustained enough, can pierce that armor, often permanently. It's common for combat soldiers to hold lost-their-cherry ceremonies for inexperienced soldiers after their first firefight. The change in perspective celebrated in these events is at least as profound as that of the physical loss of virginity, if not more so. Never again will that young man walk quite as freely, with quite the same sense of careless invincibility.

When you're being shot at, you're vulnerable and you know it, but getting angry and shooting back is more adaptive than cowering in fear. After a tour of duty, when his vulnerability has been repeatedly rubbed in his face, a vet frequently has a low tolerance for feelings of vulnerability back in the world. When he reexperiences those feelings by seeing his children running into the street, or even by recognizing his affection for his wife or girlfriend, memories arise of other times he felt vulnerable. If he's unwilling to tolerate the fearfulness associated with vulnerability, he may become angry -- yelling at his children and scaring them -- yet remaining unaware of what caused him to do so. After such incidents, feeling confused and ashamed, he's likely to withdraw from his family "to protect them."

Then there's killing per se. In his 1995 book, On Killing: The Psychological Cost of Learning to Kill in War and Society, Lt. Col. Dave Grossman presents evidence suggesting that humans are strongly disinclined to kill others of their species, and must be trained to do so. Other evidence indicates that war encourages altruism and cooperation because it causes individuals to "selflessly" risk their own lives to fight those who threaten the well-being of the whole group, thus furthering the evolution of the species. However, killing others is probably the most proscribed human behavior -- except, of course, when it's justified by self-defense or war. In the fog of battle, these justifications can become extremely tenuous. John's story suggests a conflict within himself about the legitimacy of killing and the justification for dying when he perceives that he and the other soldiers are being forced to fight, not for the common good of the group, or even for their individual survival, but to further their commanding officer's personal agenda.

Another problem a veteran may face when returning to civil society is rage. Combat is a powerfully ambivalent, emotional experience. Being threatened evokes an intense consciousness of personal vulnerability, which usually triggers some degree of fear. However, fear feels, and often is, disempowering, so during combat, soldiers are likely to tap into their anger, choosing to fight, rather than freeze or flee. In the immediacy of a life-and-death firefight, anger can quickly elevate to an all-consuming rage. Take the need to avenge a fallen comrade, add lethal weapons operated by a soldier whose only constraining authority is that of his immediate comrades, and the result is an intoxicating, powerful, often deadly cocktail, with little accountability because what a soldier and his buddies say happened is usually accepted as what did happen. That's a lot of power, with a lot of potential for abuse.

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