The old guy in front of me was using one of those canes with four rubber tips at the base as he crept towards the hospital door. It was the last week of July in Washington DC. The temperature was at least 90 degrees with intolerably cruel humidity and he was wearing a tan golf jacket that, as I passed him, I saw was zipped up to the neck. It made me even hotter just to look at it. At least he had on a ball cap—one with “World War II Veteran” stitched on the front—to keep the sun off his head. Like me, he was carrying a large brown folder. Mine held my medical records, some service documentation like orders and award certificates, and notes from my combat deployments. It was my first visit to the VA hospital.
The Washington VA Medical Center is as charmless a building as one could imagine: a big white box in the center of half a dozen parking lots that are constantly in overflow. In short, it looks like most big hospitals in any major city. And in many ways, I suppose it is like any other hospital: filled with the sick and infirm, health care and administrative staff scurrying about, bad coffee. But in one very important way it is entirely different. It is where returned combat veterans enter the system for treatment of wounds both physical and psychological.
Walking in from the parking lot, I started to get all the familiar signs: the stress rising in my gut, vision focus narrowed, breathing short and irregular, the memories of five wars and images of the dead hovering just offstage.
Inside the door, there was an information desk with a guy in a wheelchair behind it wearing a DAV pisscutter cap. He looked me up and down and made some sort of judgment about me. I couldn’t imagine what it might have been. I stammered a bit explaining that I’d come for my first appointment. My hands were shaking, so I held them down below the edge of the counter. He quietly told me where the registration office was and pointed that way. Walking through the lobby, I imagined everyone in the lobby was looking at me thinking, “Look at the psycho boy, home from the war and broken—what a pussy.” I felt like it was my first day in high school and I was dressed in a bright pink tutu. I took a number and waited.
The waiting room was actually a part of the main lobby, so it was noisy and there were lots of people walking past. I kept my head down until my number was called. Inside the office a woman looked over my paperwork—I had brought some of my DD214s, the document that details a veteran’s military service showing training, awards and decorations, combat time served, etc.—then she started entering my data into the system. She was perfectly pleasant and did a good job of ignoring my symptoms, until she obliquely asked if I wanted to go to the emergency room instead of the green clinic. Maybe I should have.
At my psychological screening, upstairs in the mental health wing, away from the general medical patients, I was interviewed by someone new to the system, maybe a recent Ph.D. graduate, with a more qualified—I assumed—supervisor attending. I had to fully detail all my problems. I started at the beginning in Rwanda, then to Kosovo, then Afghanistan and my treatment there for PTSD, then Iraq, then Darfur and my failed suicide attempt, on and on through the drive to the hospital that morning. Staring at the floor, wringing my hands, I quietly described my memory loss, my unbridled fear and anxiety, my inability to control images of the dead appearing in my head at all hours of the day and night, my weird hypervigilance issues. I even included the wholly irrational things like my fear of driving. At that point, the supervisor sniggered.
There was an ugly silence in the small room for a few seconds with only the sound of the air conditioning blowing through the grate in the wall and someone’s heels clicking down the hallway outside the closed door audible. I looked up. The interviewer looked stricken and her supervisor quickly looked down at her notes.
Shame welled in my throat and my eyes. My humiliation was absolute; even the doctors were laughing at me.
For war veterans and particularly for service members who have posttraumatic stress disorder, the stigma of asking for help is an enormous, sometimes insurmountable obstacle. Standing up and admitting that one has psychological health problems is challenging in any culture, but in the military, admitting that you cannot control what is happening in your mind and that this loss of control is debilitating, can result in a career-ending reaction from ‘the system.’ Service members have been charged with cowardice for requesting medical treatment rather than following orders for repeat combat deployments. The fear of losing one’s security clearance permeates the culture and it is a common belief that admitting to mental health issue is sufficient cause for suspension of a clearance.
But even for those survivors who do ask for help, another significant obstacle emerges: telling the story. PTSD changes the way the brain operates. It reshapes the parts of the brain that control communications, particularly oral communications, limiting the survivor’s ability to tell the tale. My personal story is only one of millions involving service members and veterans who struggle to express what we have experienced and how it changed us.
From the first time I admitted to a doctor my symptoms, through the repeated re-telling of my story at the VA hospital—the telling I mentioned at the start of this essay was only the first of a dozen or so—and now through an extended public discourse on the subject, writing has been the tool that made it possible for me to control the memories sufficiently to form them into a narrative, and through that to gain control of my life.
What I’ve hinted at above, I should detail here: I was a soldier and a Foreign Service officer for a combined 25 years. I served either as a participant or an official observer in five wars in ten years, moving from the war in Rwanda and Zaire (now the Democratic Republic of the Congo), to Kosovo, back to Rwanda, to Afghanistan, to Iraq, and finally to the Darfur region of Sudan between 1996 and 2006. I was treated for PTSD in Afghanistan in 2002, halfway through this odyssey, but medication and therapy didn’t work for me. My condition continued to worsen through the next four years until I could no longer function normally. During my last tour in Darfur, I was interrupted in a suicide attempt and medevaced home. Within two years I had lost my security clearance and was out of government service. How writing helped me, and how I now use it to help others, is the story.
There is a hastily scrawled sign tacked to the wall of my office that reads, “Either you control the story, or the story controls you.” The point of this is to remind me that in life, as in my writing, I have to take control of the story I’m telling. I write both fiction and non-fiction. My fiction ranges from short stories about a time in America, post-Internet, when books are again the dominant platform for reading, to a novel that takes place in the Sudan in 1916. My nonfiction is principally in two camps: policy commentary (for Time, Foreign Policy, The American Interest, and others) and memoir.
A few years ago, just after leaving government service, I was in a graduate writing program at night and working for a small research and advocacy nonprofit during the day. Each week I would bring to class some short piece of writing about my experience in Kosovo or Darfur, and my classmates would critique it in workshop. I know several of them found it disturbing: all stream of consciousness, profanity-laced, filled with violent images and descriptions of my collapse. But one suggested that I craft an essay about one aspect of my story for a magazine she edited. It would run in July, a traditional time for non-military-themed magazines to place patriotic or other military-themed articles. We had about nine months and used all of it.
Over a few weeks, I pulled together a thousand words detailing my collapse and the bureaucratic framework surrounding it. For the first time, I admitted openly my attempted suicide. I even joked about it a little. I wrote about the inherent contradictions in the military medical system—that doctors have divided loyalties, owing privilege to patient conversations but owing equal responsibility to the service to protect interests, security, and operational effectiveness. I wrote about service members’ anxiety about asking for help because they fear ridicule, loss of position and potential for promotion, or being charged with malingering or cowardice. But mostly I wrote about my own collapse.
Putting the words onto the page was hard, but sending those words out for publication was terrifying. It meant publicly admitting what I had tried to hide for so many years: that my mind was broken. To hell with it, I thought. I’ve lost my career, my marriage fell apart, I’ve moved on to a new life. Let’s air the laundry of the old and start anew.
But to tell the story of my weakness was to admit cowardice. Not the cowardice where one turns and runs in the face of a determined enemy onslaught. That kind is understandable, to me anyway. No, mine was moral cowardice: failing to take action to save the lives of the survivors of massacres or to prevent other war crimes from occurring. It seemed to me at the time that it was the mere memory of ten years of failure, of weakness, of all the dead I did not save, that broke my mind. The sane part of me wondered why I would want to expose my cowardice, my weakness, my failures.
But I did. I laid it out in the same language I had used in all the government reports I had written as a military intelligence officer and a diplomat: crisp, dry accounts of the moral failures of an individual, but also of the government. Then I waited. With every professional piece of writing there is editing and some back and forth with the editor. This is especially true for a peer-reviewed health policy journal. I was struck by the idea of finding peers to review my essay. How many others were there with a story like mine? Few, I supposed. But in time and after several rounds of editing, the journal hit the stands.
I was public. The Washington Post and NPR had first dibs on interviews and a review of the essay itself. The Post was kind, complimentary even. Reading an excerpt from the essay into a microphone at the NPR studios was a struggle. Keeping the emotion out of my voice—not breaking down into tears—took a few takes. Afterwards, I rode the train home shaking and struggling not to collapse into a ball of goo on the floor. Forcing myself to remember, to say the words, had been sufficient to push me back there. Back onto the hill in Kosovo surrounded by 45 dead civilians, back onto a dusty path in Darfur outside a village the Janjaweit had destroyed.
The reaction of my friends and colleagues was the most surprising, particularly that of the colleagues from Darfur where I had nearly taken my life. “I never knew,” was the phrase I heard most often. “How could you not have?” was what ran through my mind in response. Surprisingly, none of my friends or colleagues from Afghanistan have ever commented on the piece. Maybe it’s because they aren’t NPR listeners or don’t read health policy journals and just don’t know.
Once the story was out, I continued writing and speaking about what I had experienced. I also pushed publicly for better treatment for returned service members and veterans by writing a serial blog about my struggle to receive VA benefits for Time Magazine and publishing a long essay for Foreign Policy called “The New Lost Generation.” A memoir of my experience in these wars and at home, Seriously Not All Right, is due out next year.
I also took the chance to give away to others what I’ve learned. I founded the Veterans Writing Project, a non-profit that provides no-cost seminars for veterans and their family members, and publishes writing by them both online and in a print journal called O-Dark-Thirty. VWP instructors now provide workshops and seminars at George Washington University, for the nonprofit The Writer’s Center, and as part of a National Endowment for the Arts program at Walter Reed National Military Medical Center.
We approach our work with three goals in mind. The first is literary. We believe there is a new wave of great literature coming and that much of that will be written by veterans and their families. The next is social. We have in the United States right now the smallest-ever proportion of our population in service during a time of war. Less than one percent of Americans have taken part in these most recent wars. Our WWII veterans are dying off at a rate of nearly a thousand per day. We’re commemorating the 50th anniversary of the beginning of the Vietnam War, the 60th of the Korean War. So we want to put as many of these stories in front of as many readers as we can. Finally, writing is therapeutic. Returning warriors have known for centuries the healing power of narrative. We give veterans the skills they need to capture their stories and do so in an environment of mutual respect and trust.
The healing part works like this. When someone, anyone, goes through a traumatic event, whether it’s combat or a car crash or a violent physical assault, the brain goes into fight-or-flight mode. It tells the body to release huge amounts of cortisol and adrenaline, big brain functions get pushed aside and the tiny little lizard brain, the amygdala, takes over. If you survive the event, the big brain stuff comes back and you move on.
It’s when you try to remember this stuff that things get really messy. When you access a memory, the brain tries to recreate the exact sequence of events, to recreate the exact, precise memory. It drags stuff out of the visual cortex and the auditory cortex, it tries to push the same synapses to fire in the same sequence so you should get a accurate a memory as possible. This is fine if you’re remembering a nice cinnamon roll, or playing catch with your dad. But if you’re remembering a violent attack, not so much.
Your brain will try to recreate the same sequence of events including pushing cortisol and adrenaline, the breathing, the heart rate and the sights and sounds. You will basically re-live the event. These flashbacks and intrusive images, are for many of us an inherent part of PTSD.
Writing helps, as would music or art or dance, any of the creative arts, by placing a learned skill into the mix. Writing requires using stuff lodged in the big part of your brain, not in the amygdala. Your body can’t simply create the same sequence of synapse firings and bodily reactions. By adding writing to the mix, you’ve just draped a wet blanket over a hot fire, or used gloves to pick up a hot pan (choose your metaphor). You’ve forced your big brain to play and that reduces the stress of remembering, a little bit at a time.
All of our work is really focused on one objective: to give veterans and their family members the tools they need to bear witness and to make sense of what has happened to them. Consider this quote from WWI British nurse and poet Vera Brittain:
Only, I felt, by some such attempt to write history in terms of personal life could I rescue something that might be of value,
some element of truth and hope and usefulness, from the smashing up of my own youth by the war.
~Vera Brittain, Testament of Youth
Writing helps us make sense of what has happened to us. It gives us the skill to shape our stories. But then what do we do with the stories? Consider this:
The generation that carried on the war has been set apart by its experience. In our youth our hearts were touched with fire. It was given to us to learn that life is a profound and passionate thing. While we are permitted to scorn nothing but indifference, we have seen with our own eyes, and it is for us to bear the report to those who come after us.
~Oliver Wendell Holmes
We stress to our participants that by self-selecting writing as a medium they have chosen to write their story, or at least a story. And by doing so, they are bearing witness. Even if the only objective is to put the story away in a closet for the grandkids to read at some later date, it is bearing witness. Putting the story out into the public eye through publication is further bearing witness and doing so adds the author to a long line of writers who have written about personal and societal trauma in war.
Bearing witness is also an important way veterans can remain connected to service and other veterans but also to reach an audience and possibly develop new circles of friends. Isolation, whether physical or emotional, is a significant issue for returning veterans. Imagine serving in combat with a small group of men and women and then watching that group dissolve on return to the United States. The absence of proximity to comrades, the lack of a sense of mission, and the diminished level of adrenaline producing activity can all be partially addressed by bearing witness.
Encouraging veterans to bear witness through telling their stories publicly gives them a mission. It can reinforce the idea that they remain a part of the war effort, that they remain important to winning the war. It might give them a voice in exposing the shortcomings or folly of a certain policy. Or, in a postwar environment, it may offer them a chance to memorialize the effort, to provide clarity and understanding. Warriors are patriots. Leaving service, whether by choice or because of wounds or injuries, is traumatic in itself. Staying engaged or reengaging can help to assuage feelings of guilt or abandonment.
This is difficult work. It might challenge the participant to confront painful and disturbing memories. It is sometimes traumatic in itself to open these memories up and re-live them. But it is important to do so. Consider these few lines from Siegfried Sassoon’s poem “Remorse”:
Remembering how he saw those Germans run,
Screaming for mercy among the stumps of trees:
Green-faced, they dodged and darted: there was one
Livid with terror, clutching at his knees. . .
Our chaps were sticking ’em like pigs . . . “O hell!”
He thought—”there’s things in war one dare not tell
Poor father sitting safe at home, who reads
of dying heroes and their deathless deeds.”
Sassoon is clearly addressing the divide between the soldier in the field and those sitting safely at home. But he is also getting at something more. The things that poor father sitting safe at home most needs to know are the things that keep the warrior up at night in remorse and guilt, fear and unforgetting. These are the things that noncombatants most need to understand and that warriors need to forgive themselves for lest they, we, suffer an even deeper and longer-lasting moral injury. These actions and the horrific memories, remorse and anxiety that follow them are part of the human cost of war. Like Sassoon and Brittain, I and many other veterans write about these things to make sense of them.
I’m lucky, every week I get to sit with a new batch of returned veterans struggling to heal—some so they can stay in service and in the fight, some so they can go home—and with their family members. We also work with older veterans like the guy I walked into the VA hospital with. All together we talk, we write, we heal.
by Ron Capps
Ron Capps, of Washington, D.C., is the founder and director of the Veterans Writing Project, (veteranswriting.org). He was a soldier and Foreign Service officer for a combined 25 years. His memoir of service in five wars, Seriously Not All Right, is forthcoming in 2014 from Schaffner Press.
Mr. Capps was selected as the “Featured Writer” for The Delmarva Review, Volume 6, published in October 2013 by the Eastern Shore Writers Association. His personal essay was republished by Spy with the permission of the author and the Review, www.delmarvareview.com.