Making the Darkness Conscious

She thought the bittersweet ordeal of her VA internship was behind her, but a slip of the tongue made it clear that the Vietnam experience had become an integral part of this psychologist’s life.

PTSD

Shiny-eyed serpents, bodies intertwined, not threatening, but oh so vigilant.

By Ali Price

Dark, musty, enclosed. I can’t see where I am, but it is at once confusing and confronting. I feel fear. Slowly, as my eyes adapt to the faint light, I begin to see a cavern, perhaps a small room not unlike the burial chambers under the pyramids of ancient Egypt. I sense that I’m not alone. I’ve entered someone’s lair. The confirmation of that premonition is in the slithering movement, the flick of the tongue. Before me are hundreds of shiny-eyed serpents, bodies intertwined, not threatening but oh so vigilant.

My body tightens in resolve, ignoring the beating of my heart, engaged in the task before me. But the truth is that I don’t know what to do next. As I try to make sense of this scenario – how did I get here, why I am here – I see them inch ever closer, gathering, gathering. But suddenly it is becoming brighter and – I awaken.

Only a dream. With an immense sense of relief, I relax. But was it only a dream? As a believer of signs, symbols, and other such synchronicities, the meaning is clear. I have escaped the snake pit. Only three days ago, I had completed a year-long internship in clinical psychology at a VA medical center. It was the most tumultuous year of my life, considering the demands it had exacted personally and professionally. Thankfully, it was all behind me now. Or so I imagined. How quickly we forget the very lessons we teach.

Only a dream. With an immense sense of relief, I relax. But was it only a dream? As a believer of signs, symbols, and other such synchronicities, the meaning is clear. I have escaped the snake pit.

“Will I ever forget?” came the anguished cry from many of my VA patients. I answered, “No, you won’t. This is part of you. It will always be with you. But it is what you do with that memory, that knowledge, that understanding – what you do with it is what matters.”

PTSD“It was the best of times, it was the worst of times.” Apologies to Charles Dickens, but I cannot find more fitting words to describe the time I spent at that VA medical center, first as a practicum student, then as an intern in the psychology department. That introduction to Dickens’ literary masterpiece embodied my experiences – a contradiction of wisdom and foolishness, belief and incredulity, light and darkness, hope and despair.

The scope of what the VA offers in terms of health care is quite impressive. Within the grounds of the main medical center one can get medical-surgical and psychiatric treatment. This particular hospital is located in a large metropolitan center serving a demographically diverse population. It provides care for both acute and chronic medical and psychiatric illnesses in a variety of in-patient and out-patient settings. There are rehabilitation and nursing home facilities, plus numerous satellite clinics within the area, which offer continuing care and outreach work. Additionally, future physicians, psychologists, and pharmacists are completing training internships and residencies on-site. The training I received as a psychology intern was outstanding.

The VA building is a towering monolith. Most VA medical centers are similar in construction, with similar functional floor layouts and general approach to medical care design. A standard plan. It echoes the use of standard designs the military has employed for quarters, barracks, and other such facilities.

Unfortunately many corridors within the hospital are reflections of what can also be a bureaucratic monolith. A place replete with rules and regulations, employees just doing their jobs as they punch time cards. There is no flexibility, no creativity, but instead a harsh and unfeeling environment. I feel sorry for those whose physical or emotional conditions have, by serendipity, relegated them to those cold, hard places, where care might meet a standard, but where no one will go the extra mile to comfort or truly heal those in need.

And just like Simba, the Lion King’s counterpart, she challenged the men to reclaim their place in the world, prior to the time when drugs, alcohol, and mental illness took them away from all they loved and cherished.

Yet for as many of those corridors you encounter, there are pockets of warmth, professionalism, dedication, understanding – people who work with individuals, not a diagnosis. Within the monolith, one can find microcosms of community and care. And like begets like. Compassionate people seem to be surrounded by other compassionate people. Like a sunflower following the sun, if you can sense that energy, you are guided toward it – it welcomes you. These places are havens for staff, patients, and interns alike. Such was the case for a unit headed by a devoted elderly physician, “The Officer And The Gentleman.” All were welcome in his office, where he quietly lunched every day. He was loved and respected. Some men wrote poems and letters, others songs, and gave him copies – presenting them humbly but proudly as a child hands over his scribbles to his parents. My supervisor in that unit was beautiful Nala, feisty and spirited, whose compassion, but above all, humor, made her stand out among the rest. And just like Simba, the Lion King’s counterpart, she challenged the men to reclaim their place in the world, prior to the time when drugs, alcohol, and mental illness took them away from all they loved and cherished.

For me, the most intense, demanding, yet fulfilling work was with veterans who were dealing with the aftermath of combat trauma. It was certainly the most difficult. As a psychologist attempting to forge a working relationship with a patient, you were invariably met with anger and suspicion – and usually you were grilled, questioned, and scrutinized up and down. “Why do you care?” was frequently asked. In psychoanalytic fashion, we psychologists should respond with another question, “Why does that matter to you?” That was never my reply, but I’m pretty sure that the replies I gave were satisfactory to neither the patient nor to myself.

A wise man once told me, “You teach what you need to learn.” I believe that a certain part of me needed to do that work, to help those men face their deep, dark fears – their grisly nightmares. In essence, to face what Swiss psychologist Carl Jung refers to as one’s “shadow self.” Jung offered: “One does not become enlightened by imagining figures of light, but by making the darkness conscious.” I came across this wisdom during my time working with combat veterans. I shared this with them as we worked toward healing the spiritual and emotional wounds. But I have come to adopt it personally. Face the darkness and you will find yourself moving toward the light. An honest, unflinching approach to life.

“Will I ever forget?” came the anguished cry from many of my VA patients. “No, you won’t. This is part of you. It will always be with you. But it is what you do with that memory, that knowledge, that understanding – what you do with it is what matters.”

Extraordinary experiences, some vicarious, are shared with all our patients, but especially those dealing with combat trauma. Some – most are hauntingly painful. The pain of the war, the pain upon returning home. Battles fought, comrades’ deaths, loss of family, loss of health, loss of an inner compass, loss of hope. Some – well – a few, are miraculous. But it is for the chance of encountering those few that we keep at it. For some it is the ability to talk about a horrifying, terrorizing memory after years of being mute, or the ability to remember fondly after believing joy was never again to be felt, or simply regaining the ability to cry. Other miracles are more pragmatic, and they are a confirmation that one has decided to join the living. Being able to be out in public without succumbing to a panic attack or a flashback, reunions with children who have not been seen in decades, holding down a job, having an intimate relationship with another. Moving through the cold, hard, unflinching darkness, toward the light.

PTSDAfter completing my internship at the VA, I returned to an academic setting to continue my studies in a post-doctoral position. Government budgets limited job availabilities at the VA. This, together with personal and family time constraints did not allow for the possibility of continuing on as a member of the psychology staff. I continued to work with patients in different settings such as clinical research, private practice, and nursing homes. The work was compelling – but my heart was never far from the combat veterans.

I also began to teach at the university. One semester, a colleague was putting together a course on “The Psychology of Traumatic and Stressful Events.” I persuaded her to let me lecture on combat trauma, specifically in the population I had worked with, Vietnam veterans. It was with a greater purpose than simply conveying information on Post Traumatic Stress Disorder (PTSD) that I put together this presentation. It needed to be factual but with great emotional impact. I wanted them to have a visceral reaction to the lecture, to leave with unease about war and its often-unseen aftermath. The lecture began with a music video of Billy Joel singing “Goodnight Saigon,” accompanied in the chorus by a group of Vietnam veterans. “We said we’d all go down together. Yes, we will all go down together.” The class watched at the same time that they read the song lyrics. Compelling visuals together with poetic language that spoke of lost innocence.

The quotes from the soldiers brought to life what I could only list – issues of betrayal, loss of trust, issues of grief. The words were harsh and powerful. And full of curse words. I felt at home as I delivered that lecture.

After lecturing on the diagnostic criteria for PTSD, the symptoms and history of the long sought-after diagnosis, I read from Jonathan Shay’s Achilles in Vietnam. The quotes from the soldiers brought to life what I could only list – issues of betrayal, loss of trust, issues of grief. The words were harsh and powerful. And full of curse words. I felt at home as I delivered that lecture.

Several years later, I guest-lecture in my son’s fifth grade class. His class is learning about war. His teacher asks if any parent or family member has had any related experiences they could share with the class. I mentioned my work with combat-related PTSD. She thought it would be a good idea to introduce that topic to the class, especially since some of the boys were thinking of war as all honor, glory, and heroics. I had my lecture ready, I would just have to tone it down a bit, adapt it to make it appropriate for fifth graders.

So the lecture commences. Again, I begin by playing the “Goodnight Saigon” video. I provide information on PTSD, explaining the types of events that cause us to have intrusive thoughts, dreams, and to avoid the very same situations. The kids are interested and they are getting it. We hear of incidents that they have experienced that have caused them to have similar symptoms. A rottweiler bit one boy, another was in a car crash where the vehicle turned upside down, and he still has dreams of the crash. A third student tells us that, as a young boy, his father was scared by a black snake that crawled up his leg. After the fright, he didn’t go outside of his house for weeks. To this day, the father is still afraid of snakes.

I continue lecturing, explaining to them how situations outside the combat arena also caused trauma in Vietnam veterans. Issues such as feelings of betrayal by superiors, loss of trust, the use of lies and euphemisms, that all served to erode moral certainly. One example was getting medals for killing civilians – increasing body count so to speak. The quote I was going to use would address this. I begin to read from Achilles in Vietnam, trying to be careful to leave out the many curse words that peppered the quote. The violence and trauma and betrayal were evident in the narrative, no need for expletives.

Ahead of me is a long quotation. It sets up the scene of boats coming in at night and the American soldiers believing that the boats are occupied by enemy soldiers, not fisherman and children. They find this out later when the sun rises the next morning.

I paraphrase some of the earlier material, then begin to read – ”And we opened up on them – aaah.”

I glance forward to the next line, there is the F- word, so I’m looking at the text and thinking “Skip the F, skip the F.” My eyes are on the word that follows, I can see the word “firepower” – and I proceed to “skip the F” except I skip the wrong F. I see the word “firepower” but hear myself say, “And the f**king was unreal.”

A collective gasp is heard among the fifth graders. My poor son looks stricken! I immediately realize what I have done and I cover my mouth, not believing what just came out of it. Amy, the teacher, is sitting at the corner of the room. I look at her like a little girl who has been caught doing exactly what she has been asked not to do. Amy has a broad grin on her face. “Everyone makes mistakes,” she soothes.

So I continue: “And the firepower was unreal.”

How can I explain the embarrassing, though amusing, faux pas? I’ve been thinking about it and have come up with three possible explanations. The first two are rooted in psychology. From a Freudian point of view, I had an unconscious desire to not edit the curse words, to shock perhaps, and thus succumbed to a “Freudian slip.” A seemingly meaningless slip of the tongue that revealed that unconscious thought. My wish was fulfilled as I uttered the wrong “F word.”

Trying not to think a certain thought (or a word in this case) can backfire and lead to preoccupation or obsession with that very same thought.

My doctoral dissertation was on the topic of thought suppression and subsequent thought intrusion, thus explanation number two. As psychologist Dan Wegner has found, trying not to think a certain thought (or a word in this case) can backfire and lead to preoccupation or obsession with that very same thought. Try to not think about a white bear for the next two minutes and see what happens.

And thus, as I mentally repeated: “Skip the F word,” that very thought was actually causing me to focus even more on the “F.”

However, the third explanation, and the one I believe, came from a friend. He was a patient at the VA and we met within the first few weeks of my internship. Our first meeting lasted only a few minutes, but was quite memorable. I was there just to introduce myself. This combat veteran was the original “Why should I trust you, why do you care, what business is it of yours?” kind of guy. Thin, taut, a physical and emotional tightness held together by the power of anger and suspicion. He would not allow himself to express any warmth or welcome for fear that, here again, was another so-called professional who would ask and take, and give nothing in return. Except perhaps platitudes and euphemisms about how they understand and empathize, and how his actions and consequent reactions were “normal” given the circumstances he had endured. Repentant sinners want to be forgiven but they do not want to be told that they didn’t sin. Their souls know the truth; you are being condescending if you offer shortcuts to redemption.

His questions came out sharp and pointed, like the bullets he had used in war. I couldn’t flinch or I would not be allowed in. The use of questions was the obvious defensive tactic; however the atmosphere he created was the most powerful weapon aimed at my disarmament. A gifted artist, he was working on a drawing of a naked, buxom woman in a very suggestive pose. He set the sketch aside as we spoke, although it remained glaringly visible to both of us. He complained of the meds he was currently taking, the overriding concern was the very rare but nevertheless documented side effect of priapism, a persistent, usually painful erection. All this was delivered without softening that intense gaze. I was spared nothing.

We worked together long and hard for over a year. It was – well, again, Dickens said it first and said it best. We continue to correspond frequently thanks to e-mail. I knew he would get a laugh over this story. He read my account of the incident and he offered his insight. He wrote, “I think that we just revert to what we know are basic communication principles, when we get caught up in the passion and try to convey the intense feeling to others after first getting their undivided attention with a concussion word.”

But my favorite part is: “You hang around us long enough and your mind just assimilates the feelings we have shared with you and our pain becomes yours.”

I reflect and think, yes, their pain has become mine, but so have their triumphs. I have come full circle to remember my own teachings. It’s not about forgetting or escaping. All you have done, all that you let in will always be with you. It is what you do with it that matters.

 

blurbalipriceAli Price is a clinical psychologist with an interest in creative writing.