In the 1980s I was doing a psychiatric interview with a young man who had been in Vietnam. This was at the VA hospital in Palo Alto. After his return to California he "went to pieces" and spent a night on the beach trying to figure out how and when to kill himself. Now, in the hospital, he describes his unit laying artillery fire on a hill occupied by the enemy and seeing them crawl out of their holes "like ants" and being blown apart. Alright, pretty horrible. But then he described his nightmares and they struck a responsive chord in me because, in his recurring dreams, he wasn't undergoing the same combat experiences -- exactly. They resembled what he'd been through but differed in details. Events were seen from another perspective, or different personnel were involved, or one dead friend was changed to another. Similar yet not the same.
The reason it resonated with me is that I'd been in an airplane accident. The engine quit, the interior filled with acrid smoke, and we had five minutes to glide downward before hitting the ocean off Montauk Point. I thought I would die. And over the course of the next month I had four or five vivid dreams about it -- but not quite the same. Instead of being IN a single-engined airplane, I might be watching a four-engined airplane dropping. My nightmares and the veteran's fit the same template -- and mine was the result of only five minutes of terror.
This documentary, which is really essential watching, mostly for the people least likely to watch it, takes us from the Civil War through Iraq and Afghanistan. I wasn't looking forward to seeing it because hearing people talk about their combat experiences is always upsetting. Nobody should have to go through that. But this one doesn't take an easy way out. None of the interviewees weeps on camera while melancholy music swells in the background. It's not sentimental in any cheap way. And it does what it promises to do. It focuses on PTSD itself, not the situations that triggered it.
As hard as it is to believe, there are still some people who consider a disabling fear and depression to be a sign of moral weakness. One Iraq veteran, who ultimately committed suicide, was described by his Army psychologist as "lacking intestinal fortitude." That was pretty much General George S. Patton's view too. He slapped two soldiers and booted them out of the hospital in Sicily because they hadn't shed any visible blood. (One had PTSD, the other malaria.) And in his massive work, "History of Naval Operations in World War II," Samuel Eliot Morison describes a ship that numbered patients with PTSD among its passengers. When taken under fire, "the poor neurotics" scurried for cover. He meant it sarcastically. No guts, you know?
The chief problem with public acceptance of PTSD as a genuine disorder is a simple one really. You can't see anything wrong with the guy except in his behavior. He doesn't have any broken bones, and you can't open up his skull, take a screwdriver to his brain, point to some subcortical structure that's out of whack, and say, "See? There's the problem. A screw is loose and we have to tighten it." Instead, as with most mental illness, nobody knows exactly what causes it. So far, psychiatry has been just nibbling around the edges. The fundamental neurological problem blends insensibly into the pre-existing personality. He's the same guy he was before, only now he's moody and wants to kill himself. Our ignorance is admitted by the Army's Chief psychiatrist in one of the interviews.
The movie doesn't get into it -- how could it? -- but it's interesting the way symptoms have changed over the years and the wars. The "shell shocked" veterans of World War I went through jittery contortions that you couldn't voluntarily produce unless you were an acrobat. None of that now, when the chief symptoms seem to be depression and explosive aggression. Audie Murphy was the most decorated soldier of World War II. He had recurring nightmares of firing at Germans while his M-1 fell apart, piece by piece. He showed paranoid tendencies and slept with a pistol at his bedside. He attacked someone with a pool cue. But he never complained of having "combat fatigue" because, after all, it's not manly. A real man says, "Bring 'em on," as if combat were a high school football game or a schoolyard fist fight.
