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Frontline: The Soldier's Heart

Raney Aronson and Andrew Pomerantz, M.D.
Producer and Chief of Mental Health Services, White River Junction VA Hospital
Wednesday, March 2, 2005; 11:00 AM

As the war in Iraq continues, the first measures of its psychological toll are coming in. One medical study estimates that more than one in seven returning veterans are expected to suffer from major depression, anxiety, or Post Traumatic Stress Disorder. For those who have survived the fighting, the battle is not over. For some, the return home can be as painful as war itself. In "The Soldier's Heart," tells the stories of soldiers who have come home haunted by their experiences and asks whether the government is doing enough to help.

"The Soldier's Heart" aired on Tuesday, March 1, at 9 p.m. ET on PBS (check local listings). Then, producer Raney Aronson and Andrew Pomerantz, MD, Chief of the Mental Health Service at White River Junction VA Hospital, were online Wednesday, March 2, at 11 a.m. ET to discuss the report.


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Denver, Colo.: Why does the Army do such a poor job of taking care of its own?

It took Vietnam veterans years to get treatment for Agent Orange. The same for Gulf Veterans who were suffering from Gulf War ailments. The VA called it psychological for the longest time.

VA hospitals will get cuts under Bush proposals.

As a veteran, I have always been put off by this persistent trend, though I served in peace time and left the military without any problems/issues.

Veterans put their lives on the line for their country. But when they need help or assistance, the military is simply not there for them -- and it has been happening for decades.

When will the people in Washington commit themselves to doing the right thing for vets?

Andrew Pomerantz: Any previously unknown illness takes a long time to recognize and understand. When only a few people complain of a certain set of symptoms, it doesnt get much notice. As more and more people have those symptoms, the people who study patterns of illness in the whole population begin to describe the common symptoms and study begins in earnest. The medical profession does need to be more careful when it dismisses previously undescribed illnesses as psychological. As an example, HIV/AIDs, when first described, was thought to be psychological!

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Heath, Ohio: I am a Gulf War vet and want to thank you for your fine show. I work with a group called Point Man Ministries.

I just had a dream the other night about my experience. It was the first time I have ever had a dream about it.

Is that odd since it was 14 years ago?

Andrew Pomerantz: We still see veterans from as long ago as World War 2 who report suddenly having memories or dreams from combat after more than 6 decades. This is common and a normal response for most people. Like any difficult event, memories do come back from time to time. Seeing reminders of one's own experience in the news every day can trigger these memories and dreams.

Some people first develop clear signs of PTSD many years or decades after their trauma. I still see a new WW2 veteran, never before in treatment, from time to time. We've also begun seeing more Viet Nam Veterans having their first symptoms now. We also hear of many people, without PTSD, having dreams about their combat now.

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Hartford, Conn.: Has anyone done any research on returning female soldiers? Despite the "rules" many of them are in combat situations. My daughter-in-law rode convoy duty in the lead Humvee manning a machine gun while she was deployed.

And:
Has anyone looked at the effects on families when both parents have been deployed?

Andrew Pomerantz: Every soldier in Iraq is in a combat situation, due to the nature of the war. Past research on female veterans has demonstrated a high prevalence of PTSD in those who women who have been victims of sexual trauma and those who have been exposed to the results of combat (nurses, for example). Now that women are more involved in direct combat, we are seeing many with classic combat-related PTSD.

You might contact your local National Guard Family Support program for more information about resources for families. I'm not aware of any specific research looking at that question right now.

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Arlington, Va.: I am a trained counselor with an MA and some experience working with the military and their families. As I am currently working toward my license, I would like to take additional courses and training for PTSD and help. My questions are: how can I specialize in PTSD (are there programs and schools you would recommend) and obtain a certificate to practice? Also, once trained, I would like to volunteer if needed. How do I go about that?

Andrew Pomerantz: The VA sponsors many training programs throughout the country, some of which are open to people outside of the VA. You could contact the education office at the VA nearest to you.
Specialized treatment for PTSD includes many different modalities. It is likely that the best for returning soldiers are cognitive-behavioral treatments. The American Pychological Association is a good resource for finding out about workshops or training programs you might acess.
All VAs welcome volunteers, although the requirements for being an unapaid therapist are the same as those for a full time regular job. You could contact your nearest VA office of voluntary services for more information.

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Alexandria, Va.: Many military men have been socialized to believe that asking for help and seeing a psychiatrist are signs of weakness and shame.

How do you suggest approaching a soldier (a close relative) who recently returned from Iraq and is showing signs of post-traumatic disorder but is refusing to seek help?

Raney Aronson: Hi, thanks for your question - so many families and loved ones have asked me this question. I think Dr. Pomerantz can elaborate but here is what I've learned from the many experts I've interviewed -- listen, and be there for the returning vet. And gently suggest that they seek help at their local VA, or on base if they're still active duty. Across the country there are support groups for returning vets, and more are being formed and what many soldiers have told me is that it's next to impossible to really talk to folks who have not been to Iraq, but when they're in a room filled with other veterans it's a whole new world. I hope this helps.

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Staunton, Va.: I have a soldier (friend) just back from Iraq. He is in the Army. What can I do to help him adjust to his return to the U.S.? I lived in the Middle East for four years, so I understand to some degree what it feels like to be there. Dealing with what I saw was difficult even without a war raging around me. I remember wanting to tell people about my experiences there, but they were busy with their lives here and could not really relate to my stories. So, I stopped telling them and most of my friends don't even know I lived overseas. What questions are appropriate to ask? Are there some that I should avoid?

Andrew Pomerantz: Sharing your recollections of your time in the Middle East will open the door for him to tell you of his. Asking general questions like "what was it like over there?" will give him an opportunity to talk. Overall, just staying general is best.

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Lyme, Conn.: With body armor, we have fewer casualties, but more survivors who have serious injuries, including limb losses. The good news is we have less deaths, but then we have more survivors with nightmares. Does the military have enough psychologists, psychiatrists, and counselors available to deal with this surge of soldiers needing assistance? What more, if anything, should the military be doing?

Raney Aronson: Such a great question - and you're absolutely right - advances in body armor has saved lives but brought home soldiers with injuries that are very difficult to deal with. There are places that do have incredible therapy for folks who have come home injured. One of those institutions is Walter Reade in Washington D.C. But there is much more that could be done - and the Army is the first to say that they could use more help. I interviewed a high ranking army psychiatrist who said over and over again that she really wished more mental health professionals would join the army to help our soldiers.

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Bowie, Md.: Your piece was really powerful. I've often wondered how soldiers and Marines -- those who are physically on the front -- deal with the carnage created by their own hands.

It seems to me that announcing a new program of "mandatory" assessments, as you acknowledge in your piece, isn't enough to change the culture of "suck it up and be a man." Has there been any discussion of the senior-most officers going for counseling, to set an example? Maybe there would be less abuse for the youngest members of the military who seek help if the older ones made it know they were taking advantage of those same services.

Andrew Pomerantz: Interesting idea. Counseling is best reserved for those who need it and would benefit from it.
More and more officers are becoming aware of the psychological effects of combat on their troops. Many are now putting effort into identifying those who are having difficulty or showing signs of acute stress.

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Bethesda, Md.: Dear Mr. Aronson,

Great program. Did you explore the role of spiritual health at all? I am wondering what role military chaplains, etc., play in helping soldiers with moral crisis?

Raney Aronson: We did not include any chaplains in our show - but they do play a very important role, especially during combat. They are often the people soldiers feel the most comfortable talking to. What we focused on were soldiers coming home and what is available to them here and while chaplains continue to be important, in the stories we told they were not integral to the healing process upon their return..but had we focused on other soldiers we could have found a very different story of course! One of our characters is a devote Christian, and his family is very involved in prayer groups for him and his well being. Thanks for your question.

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Southern California: What are the resources available to ex-military who might be suffering PTSD effects in Southern California, other than going to the facilities at Camp Pendleton?

Raney Aronson: On our website we've listed a number of resources..www.pbs.org/frontline

Hope that helps...

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Suffield, Conn.: I am a history teacher an we are talking about WWI right now and using "Johnny Got His Gun" for discussion. Any suggestions? Also my brother-in-law has been a Marine for 20 years, Gulf War, Iraq - he has to accompany soldiers who have died back to their homes and families -- (something new for him since Iraq) he has had no training. Any advice here?

Andrew Pomerantz: Two great books about combat PTSD (though not WW1) are Red Badge of Courage (civil war) and Slaughterhouse 5 (WW2).

If your brother-in-law is asking for advice, you might suggest he talk to his Marine chaplain.

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Arlington, Va.: The price of being an informed citizen is, in the case of your show, anger. Anger at this administration for waging an illegal war, anger at the lost of so much life, and incredible anger at the military and administration as they turn their backs on those who serve. Once again, as in Vietnam, Desert Storm, and now Iraq. It has happened over and over again. The VA is hard pressed to serve all who need it, even if they could ask. What can an average citizen do to help these soldiers since this administration is not?

Andrew Pomerantz: VA employees see themselves as pubic servants and on a mission to care who have served their country in the military. They always find a way to get the job done. One of the main strengths of the VA is its volunteer force. Any average citizen can go to the nearest VA and sign up at the voluntary services office.

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Colorado Springs, Colo.: A fairly new technique called EMDR was developed to deal with difficult post-Vietnam cases and is being used by the Israelis and Turkish military. Any thought of incorporating it into American military care?

Raney Aronson: We did come across EMDR quite a bit as we reported our story. We found that it has in fact helped many soldiers, but for the most part the research around it is anecdotal. Some VAs and Vet Centers are starting to offer EMDR, but right now it's a pretty new therapy. I'm certain we'll hear more about it in the future.

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Fairfax, Va.: How much does "truth" enter into the counseling? That is, the soldier feels guilty because he really did cause his buddy to die. Or, the memories of the innocent civilians haunt a soldier because he in fact murdered them for pleasure or for profit (his, Halliburton's, United Fruit Company's, etc.). At what point do we say to the soldier, you are a victim but also a perpetrator?

Andrew Pomerantz: All of us make mistakes from time to time and they have no real consequences. In combat, a tiny slip can have disastrous consequences and soldiers bear these consequences, psychologically and spiritually, for the rest of their lives.
Others have participated in events that they could never have done in civilian life. It is important to see these events as the product of a combat environment and not of the integrity of the soldier him(her)self.
One problem in combat is that the soldier's understanding of events is affected by all the adrenaline flowing and many wind up feeling responsible for things that were not their fault. Some of the newer therapies help to correct these distorted memories and are the best treatment for PTSD

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Colorado Springs, Colo.: Did you see any evidence of unfair treatment because a soldier/airman/marine went to the psych services? I think a lot of soldiers are under the impression that by going to the psych. they will be viewed differently and it can affect their promotions.

In the same vein -- is this why more people use the chaplains -- because of the privacy concerns?

Raney Aronson: This is a terrific question - and something we look at in our film. In a study that was commissioned by the Army they found that the soldiers who feel they need psychological help often don't ask for it because they are concerned about how they will be treated. This study really opened up a discussion inside the military about the stigma to receiving mental health care. We also did find in our own reporting that soldiers felt they were treated differently by their commanding officers when they asked for help, and by their peers. But one of our characters, Jacob Martin, says that one guy who was making fun of him ended up saying to him, "if this therapy thing works let me know because I could use some help too!"

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San Antonio, Tex.: I'm interested in the behind-the-scenes on your heart-wrenching program last night on PBS. Any problem getting cooperation from the military on your subject matter or the families? Did other families other than the ones you portrayed want to participate?

On a sad note, I dated once a Vietnam vet but I didn't want to take the relationship further when I saw that he was so damaged by the war. Last May in Connecticut, I ran into two buddies who still rely on each other for support after meeting years ago in a PTSD support group after Vietnam. Kudos on your show!

Raney Aronson: Thanks for your question. We found an incredible amount of participation with the soldiers' families...most of them were open, honest and welcomed us into their homes. We talked to many people as we reported this story, so yes, many families did wish to participate who were not in the program last night. But if you log onto our website www.pbs.org/frontline you can read some of the soldier's stories we didn't include in the film. There's a touching account by a WW2 Vet, a vet from Vietnam and other soldiers from Iraq who tell their stories.

One of the most surprising and eye opening experiences for me as the producer of this show is what you speak of - vets who talk to vets. And what I found from our reporting is that oftentimes it makes all the difference. Many of the Marines we filmed in the Camp Pendleton Support group say that they before they joined the group they were skeptical of the entire "therapy thing" but after being in the group they found themselves really dealing with their PTSD much better...and they formed deep, and significant friendships in the process.

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Los Angeles, Calif.: Why do some veterans return troubled and others not? One's internal constitution is one factor and what type exposure a soldier had is another. Can you explain this further?

Andrew Pomerantz: This is a question that has been asked in many research studies and the answers are still not fully known. There are many factors affecting response to trauma of any kind (war, hurricanes, fires, auto accidents, sexual assault,etc). Given a severe enough trauma, almost anyone can develop PTSD. That's why an increasing number of emergency rooms now have immediate counseling or screening available.

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Silver Spring, Md.: Are there self-mitigation techniques to counter the development PTSD in combat currently being used by the military? Why hasn't the military updated their training to include such self-mitigation techniques? Additionally, why has the military addressed stigma issues associated with mental health/PTSD issues like they have with sexual harassment?

Andrew Pomerantz: PTSD has been studied intensively only for about the past 20 years or so. We still have a long way to go to better understand what techniques might be helpful to people in combat.

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Los Angeles, Calif.: Thank you for taking questions. I had marked my calendar to watch the program last night here in Los Angeles then never looked at my calendar! I'd really like to see it, can you tell me when PBS will re-air?

Thanks so much.

Raney Aronson: I'm not certain when it will rerun, but you can watch it online on our website: www.pbs.org/frontline

Thanks

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New Iberia, La.: In the 1950's my brother was in the Marines stationed at Camp Pendleton training for action in Korea. After about two years though, and following on some training specifically for Korea (cold weather survival or some such), he was given an (honorable discharge) early release. It was something we never spoke about in the decades afterwards. He died about 22 years ago after a successful career in business. My sisters and I believe that he may have been unfit for combat because his discharge papers say he is not eligible for reinlistment. Did the Marines somehow find that he was lacking in some way to fight? I have his military record which I wrote for, but frankly I don't understand the "military mumbo-jumbo." Is it important that we continue to pursue this? The program on Frontline last night got me to thinking.

Andrew Pomerantz: You might contact your local Veterans of Foreign Wars, Disabled American Veterans or American Legion service office. They should have someone who is able to help you decipher the records.

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Murfreesboro, Tenn.: An excellent program that reinforces the fact that the war is not over after all the shooting stops or someone says "mission accomplished."

Andrew Pomerantz: Everyone in combat is forever affected by the experience. Most do not develop PTSD.

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