Flashback: Posttraumatic Stress Disorder, Suicide and the Lessons of War; by Penny Coleman (Boston, MA: Beacon Press, 2006)
Author Penny Coleman is baffled. How is it that in a mere 30 years' time we've forgotten the lessons of the Vietnam War? We seem to be suffering from a strain of national amnesia, where we casually approve of going to war without adequately considering the burdens it will place on our troops, their families, our communities, and the fabric and future of our nation.
A chronicle of pain and passion, stress and suicide, Coleman's masterwork, Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War, demands our attention - most especially now as we embark upon what our leaders tell us will be war as far as the eye can see. In reading her tapestry of cold data and intimate recollections of one of America's most painful eras, we gaze backwards. Unfortunately, we find the familiar: the present - and possibly the future. The same stigma and camouflage used to hide the Vietnam War's invisible wounds and scars from public view can be increasingly seen - if we only look - in the way we treat our newest generation of veterans. We find ourselves reinventing the wheel, caught off guard in the early years of this new century's wars. As troops slip through the cracks, the military - and nation - struggles to relearn previous and costly lessons. Flashback asks, "Why?"
Coleman, whose late husband Daniel committed suicide in the wake of the Vietnam War, reveals her own private journey through darkness and shame in the years that followed. But she goes further; she invites others, military wives and family members, to join her via the interwoven interviews that retell of the pain and struggle of suicide in war's wake. Coleman writes in her Introduction, "In repeating my own and the stories of the other women in this book, I hope to bear witness to one of the true costs of war, one that is rarely considered when passions are hot and patriotism becomes a code word for uncritical support of government policy - namely collateral damage. ... The collateral damage I am talking about is here, in this country, and it has been effectively hidden from sight. It consists of those soldiers whose names are not included in the MIAs or WIAs or KIAs, though they are in a very real sense missing, wounded, or dead, even if by their own hands. And it includes those of us abandoned when they chose not to go on. Together we became collateral damage when they brought their wounded bodies and minds home to us" (p.7).
But Flashback isn't merely a collection of interviews and deeply moving narratives, as compelling and important as they may be. It's also an immensely readable and extensive exploration of the topic of combat-related posttraumatic stress disorder, or PTSD.
Coleman focuses on the personal trauma of the individual and his or her family, but she also explores the more public impact of PTSD on military effectiveness. She traces how "irritable heart" can destroy the army itself, insidiously from within, especially in the theater of war.
Chronicling the history of diagnosis from the first descriptions of melancholy, insanity and nostalgia, Coleman outlines the "cures" instituted by various fighting forces to keep their armies in line: use of the afflicted as decoys to draw enemy fire; ostracism as malingerers and cowards; and execution and burial in unmarked graves. To avoid such terminal cures, in the past, soldiers often self medicated through desertion, "drunkenness," drugs, and in the case of Vietnam, fragging.(1) These desperate responses corroded the military itself, and, in Vietnam, may very well have ultimately destroyed our armed forces' ability to fight. Yet, as Coleman demonstrates, research into PTSD during and after World War II (and the resulting treatments which had been effectively put to use in Korea) could have reduced the mayhem of future combat operations, especially in Vietnam, had the military and the government paid attention.
Instead, as Coleman documents throughout this exceptional book, government studies have a remarkable capacity for collective amnesia about combat stress; The National Vietnam Veterans Readjustment Study (NVVRS) published in 1990, for example, never mentions suicide (p. 120). The recent Operation Iraqi Freedom (OIF) Mental Health Advisory Team (MHAT) report identifies "seeing dead bodies or human remains, being attacked or ambushed, and knowing someone who was seriously injured," as the "most often reported combat stressors," but as Coleman points out, the report considers "none of these factors in its analysis of the etiology of solider suicides"(p.2). (2)
Even in Korea, Coleman tells us, the military command initially ignored the lessons of the past. One year into the conflict, psychiatric casualties were seven times higher than in WWII, a fact which forced the military to recognize their "fight or else" policy wasn't working. Under military psychiatrist Albert Glass, prompt forward mental health care based on treatment successes from WWI and WWII were reinstituted (p. 55). Believing "that psychiatric casualties were inevitable and universal, given enough stress" and that there was a "correlation between combat stress and unit cohesion and effective leadership," Glass incorporated elements that addressed the physical needs as well as the soldiers' guilt over abandoning their comrades. And indeed, his forward treatment reduced the 23 percent psychiatric casualty rate of World War II to just 6 percent in Korea (p. 56).
Central to treatment success in Korea was the soldiers' sense of loyalty to their fellow battle buddies. According to Coleman, psychiatrist Jonathan Shay suggests that one of the key requirements of a successful military is "themis" - or a sense of "what is right" (p.. 22) -- a term he uses to include the troop's need for a "trustworthy structure" in his military relationships with his closest friends within a loyalty circle, his or her peers, and the military chain of command.
Soldiers need to be grounded in the belief that they have been appropriately trained and supplied and what they are fighting for is "right." When they don't or can't have these needs met, the psychological trauma is as real as a bullet through the heart or head. Suicide is often the delayed physical manifestation of the earlier psychological wound.
Reading Coleman's book ultimately leads us to questions about the nature of war, morality, and civilization. Her chapter titles provide a context to the breadth of her discussion: Irritable Heart to Shell Shock; PTSD and Modern Warfare; Why Vietnam was Different; Collapse of the Armed Forces; and Aftermath of Vietnam. Throughout, she shows how "the rich men's wars" engender propaganda in order to make them "the poor man's fights." This propaganda effort or, to use the current administration's preferred terminology of "perception management," not only seeks to hide the data about casualties - physical and psychiatric - but now often doesn't even collect it. Managing reality and discouraging honest examination of war's total costs, then, becomes the agenda, taking away any chance that we as a society may support our troops adequately and learn from our mistakes - or successes.
[Disclosure: ePluribus Media initiated its PTSD Timeline to document incidents of suicide and violence by returning combat veterans (with fact checked and documented records of over 129 events as of June 18, 2006) to address this very lack of information.] (3)
The five years the author devoted to researching her topic clearly reveals itself in every word, in every expression, and in the detailed Notes sections provided at the back of the book. This is the type of volume a researcher or historian will love, allowing those interested in pursuing certain issues the clear pathway to do so. Taking the reader through a history of a disorder which is as political as it is painful, Ms. Coleman reveals that, though referred to by many a name through the centuries (shell shock, soldier's heart, battle fatigue), PTSD has and always will be with us as long as war is waged on earth between humans.
Why are we so disconnected from war and its aftermath? Penny Coleman tackles that issue head-on and delivers up a book every American should read.
About the authors:
Cho is a writer, editor and board member of ePluribus Media.
I.L. Meagher is an activist and citizen journalist with ePluribus Media. She holds a Highest Honors A.A. in English, and is planning to complete her B.A. in Journalism at Northern Illinois University. She is the owner of a Midwest content development and online publishing firm and is currently researching the 1956 Hungarian Revolution as well as cataloguing cases of combat-related post-traumatic stress disorder. Her new blog, PTSD Combat: Winning the War Within, offers the returning combat veteran resources, news, research, and a listing of the latest veteran events.
ePluribus Media contributors include: JeninRI, roxy, standingup, wanderindiana, rba
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