Treating Wounds You Can't See

He brought his wife in to see me one day. She complained that he was cold, withdrawn, hostile; he would sit in the darkened bedroom all day. She wanted to know why I wasn't helping him more. I'd been working with him for four months; what was I doing?

There had been some gains, I told her. His mood was brighter, and he was no longer weeping daily, but he was still in great distress. "Your husband has had severe trauma," I said. "It's going to take a long time."

'All You Have To Do Is Stay Alive'

Something that still surprises me is the fact that many soldiers wanted to go back to war. Some thought of the inexperienced soldiers who needed their guidance; some talked about providing for their families. But mostly, they told me the same thing about why they wanted to go back: "You get up every day, and all you have to do is stay alive."

Ordinary daily life -- sustaining once-stable relationships, seeing old friends, paying bills, shopping -- could seem excessively burdensome when they returned. Minds that had been on high alert for so long had become better adapted to war than life at home.

"We're subject to state, federal and military law here [on post]," a soldier said in group one day, though he had never been arrested and was considering going to nursing school. He feared both other people's unpredictability and his own reactions, and he was not alone. Generally, my patients had more control than they thought they did. But in that group, one person had received a recent DUI charge, and another had been demoted after a verbal confrontation with a Department of Defense police officer.

"But what do you think would happen?" I asked the soldier who was worried about running afoul of the law.

"It could be anything," he said. "You let your guard down in the States."

I pressed: "But what might happen?"

"Anything. You just don't know."

Like other soldiers, he was troubled by the changes he noticed in himself.

I told him then what I have said to my patients again and again, trying to explain what had happened to their brains in battle: "If you put enough stress on your back, 10,000 pounds on your back, it doesn't matter how strong your back is. It's going to break. The brain is the same way -- it can only take so much stress." A broken back may not seem like a reassuring analogy, but at least it addresses the shame that my patients so often harbor.

"The brain can't just change the channel, like a TV remote," I tell them. Why do people expect their brains to be endlessly pliable, to be able to heal rapidly and perfectly after such trauma? Perhaps it's because a mental injury is invisible, which encourages the fantasy that it will go away overnight. But the change in emotional reactions and behavior cuts so close to the sense of self. For my patients, the trauma isn't something that happens to you. It is you.

lblum101@verizon.net

Linda Blum is a clinical psychologist in New Jersey.