Month: July 2014

Coming home, being even more distant…and not having sex

MatthewHoh Recovery , , , , , , , , , , , , , ,

Journalist Sean Langan provides a brave and wonderful service by sharing with readers the difficulties he faced, in particular his inability to maintain closeness or intimacy with his loved ones upon returning home from his imprisonment by the Taliban in 2008. The article is here in The Australian.

Sean’s circumstance as a prisoner, like Sergeant Bowe Bergdahl’s, is extreme and, fortunately, rare. However, many of the symptoms Sean shares in his article, are those symptoms that those of us, returning home from the wars, face in our lives, and, by extension, our families and friends suffer through as well.

I find the loss of intimacy, the distancing of oneself from others, and the general numbing of emotions and murder of relationships that many inflicted with PTSD, depression and moral injury experience, are the least spoken of and the least understood. In particular, the distancing from one’s partner, both physically and emotionally, is an affliction that ravages many of us and is one of the key reasons that professionals speak of PTSD as a relationship-killer. Tragically, but not surprisingly, the ending of a relationship is often a trigger for a veteran’s suicide.

I certainly went through those experiences and it cost me relationships and hurt people I loved. Looking back, it seems so odd, so foreign, but that was certainly me: sharing so very little about myself, letting no one know I was hurting. I was afraid to confide in someone, anyone, for fear of exposure and because I thought my peers, friends, family, strangers…would see me as weak, ill and not a leader. Never mind that I would ever apply such framing to a friend that came to me with such problems; double standards always exist for yourself.

I’m not even sure I understood that I was being distant or cold, my mind was so overwhelmed with stress, with noise, as if 1000 TVs were playing at once, (that seems such a right description to me, although I can’t remember where or from whom I heard it). The alcohol was key in all of it too. Each day was a measured exercise to get to my first drink, my first hit of medication to sooth the sadness and the guilt, and placate the fury my whole life was wrapped in, like a taut barb wire eco-skeleton stretched along my skin, never letting me move or act without some connection or thought to the wars.

And I lived like that in silence, for years, with a few exceptions. An ex-girlfriend who expressed concern at my state was told she was out of line and that SHE was the crazy one. Traveling on my own, I would sometimes get to a state in a bar where to others it was clear I was emotionally distressed, so drunk I was visibly sad, muttering to myself and drinking doubles of bourbons or Irish whiskey as fast as they could be poured. In Paris, San Jose, Louisville and so many other hotels and bars in Europe and the US, I’d be approached by a kind hearted stranger, if they persisted past my first silent responses, they would get a polite but firm request to fuck off. Sometimes I can recall the guy being a veteran himself, saying he understood and knowing he did, we’d buy each other drinks, make introductions and then drink aggressively, in silence, in mourning, in anger. Anger at what? Everything. Ourselves and the people all around us who didn’t measure up. Plus, we didn’t belong.

In Arlington, I would drink at a bar, late, right near Ft. Myer. You could get pitchers of beer there, along with your side of Jame-O or Jack.  The bar would be full of soldiers and vets, just sitting there, not talking to one another. All in pain, all dying inside, but all quiet, none of us willing, wanting, able to break through the encasement we lived in. Like a womb or a cocoon, alone inside that encasement, you could revel in your anger and your isolation, and make co-misery with your guilt and your sadness.

To your friends, your family, your partner, not a word, not a god-damn sound. And to Him? Well, I was in a wasteland.

The hardest thing to share, the most humiliating, is the loss of physical intimacy. Lust and sexual desire are still possessed, but the ability to make love to your partner and achieve that special intimate connection is gone. I’m at a loss for how to describe it and this post has gone on much longer, and in a much more rambling manner, than I intended, obviously, I’m not terribly comfortable expressing it, but this is the point I am trying to make: If you are suffering from PTSD, depression, and/or moral injury, it is very likely you are not having sex with your wife/girlfriend or husband/boyfriend. That happened to me. In multiple relationships. There were many reasons for those relationships dying, but the PTSD induced loss of intimacy seems to have had the longest knife.

It is not a physical or sexual dysfunction, you can still operate and act, and it does not mean you do not find your partner attractive or that you lack feelings for her/him, but it is a mental block, something so hard to explain, so embarrassing and so, so very frustrating. For both you and her/him. Understandably, for a young woman and through no fault of her own, the loss of sexual interest in her by her husband or boyfriend is devastating.

If this is happening to you, or if it is happening to your partner, please address it. Trust me, like other symptoms of PTSD, depression and moral injury it is something that can be helped and managed. But without attention, without treatment and care, and without love, it will destroy everything you ever loved and wanted in your life.

I can be reached at matthew (@) matthewhoh.com if you’d like to talk about this.

 

Senators Graham and Menendez’s Iranian Black Comedy

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From today’s Huffington Post: Whenever I sit down to write something about war, particularly about the lust for war so often found in the halls of Congress, I have to stop myself from utilizing phrases such as “hard to believe” or using words like “inconceivable.” As the United States has not waged a successful military campaign of greater than a few weeks in almost 60 years, I continue to choke on these thoughts, but, time and again, military force, with all its attendant death, loss and ineffectiveness, is promulgated by members of both political parties as a remedy for overseas ills, real or imagined. The repetition of Washington’s call to arms manifests as a form of black comedy: it is funny until you realize its horror. Iran, and its civilian nuclear program, is a continuing target for the self-stylized warrior-diplomats of this Capitol Hill farce. The folly and uselessness, let alone the blood, cost and counter-productivity, of recent U.S. military campaigns in Afghanistan, Iraq and Libya, plus the seemingly endless U.S. targeted assassination campaign, primarily through a fleet of drones that kill far more innocents than actual terrorists, have obviously had little effect on the reason or intellect of the war-crazy in both the House and Senate. Several times a year, various members of Congress, prompted by the consistent and substantial donations of the Israeli lobby, rise to denounce a non-existent Iranian nuclear military program, offering pieces of legislation that would bind the hands of American negotiators and ultimately force us into military confrontation with Iran’s nearly eighty million people. Senators Lindsay Graham (R-SC) and Bob Menendez’s (D-NJ) latest letter to President Obama, occurring as our professional diplomats negotiating with Iran are reaching an important point, signal Senators Graham and Menendez’s willingness for war and rejection of any sane or intelligent attempts at peace. Now the Iranian people are cursed with a regime that is oppressive and authoritarian. Iran must reform, but it also must be brought back into the community of nations. Likewise, Israel has a right to exist in peace, absent of fear. These conditions are not contradictory in peace, but are impossible to attain in war. A war with Iran would unleash circumstances within the Middle East that would greatly threaten Israel’s well being, eliminate opportunity for democratic development in Iran, cost countless American lives, and engender global economic collapse. Attacking Iran would set into motion events beyond our control. War is a breeding ground of unintended consequences; please see Afghanistan and Iraq if you have any doubt. Such desire for war in our nation’s capital is rooted in the pursuit of power, wealth, resources and because many in Washington, DC believe in the romantic fairy tale of war: a modern myth of smart war conducted with precision missiles and bombs, governed by all knowing intelligence systems and led by camera friendly generals with PhDs. Of course, war, albeit only initially, polls very well with voters, and there are no greater attacks against a political opponent than to insinuate he or she does not support the troops or that he or she is somehow weak-kneed and unable to measure up to America’s frontier, John Wayne, tough guy persona. Needless to say, many of the most vocal in the push for war have never been to war or, if they have, have been billeted in such outposts as military law offices. Senator John McCain (R-AZ), with actual combat experience, is one of the few exceptions to this Capitol roost of chicken hawks. But to understand Senator McCain’s passionate and personalized fever for the imaginary glory of war, I must fall back on the all too discerning, simple and perfect final words of David Lean’s Academy Award winning war epic, The Bridge Over the River Kwai: “Madness.”

However, as we saw last year, when the Sunday morning talks shows fought with one another to host one politician louder than the next arguing for American entry into the Syrian civil war, public opposition, in the way of phone calls, emails and letters to members of Congress, stopped American bombers from taking off towards Syria, Marines wading ashore its beaches, and American paratroopers from landing among Syria’s multitude of fighting factions. War, as much as politicians want it, is by no means a certainty. The daftness that blankets members of Congress and their war junky enablers residing in the media, in think tanks and in industry, does not extend to the American people. You do not need to have served in Afghanistan and Iraq to know those wars were worthless, and to say so, nor do you need to possess any special title or degree to know a war with Iran would be ruinous. After you read this, do as you did with Syria, step forward and tell Washington, DC, we are not going to war with Iran. Peace and prosperity lie in negotiations and diplomacy and not in the black comedy of Senators Graham and Menendez. Call your members of Congress and tell them today: Enough. No to war.

Shakespeare, PTSD and Moral Injury

MatthewHoh Recovery, War and Conflict , , , , , , , , , , , , , ,

Two of the more important works on PTSD and moral injury are Jonathan Shay’s Achilles in Vietnam: Combat Trauma and the Undoing of Character and Odysseus in America: Combat Trauma and the Trials of Homecoming. Shay, a great proponent of the concept of Moral Injury, something I recognize in myself, explains the difference between PTSD and moral injury in this excellent piece from Public Insight Network:

Moral injury, Shay says, can happen when “there is a betrayal of what’s right by someone who holds legitimate authority in a high-stakes situation.”

That person who’s betraying “what’s right” could be a superior — or that person could be you. Maybe it’s that you killed somebody or were ordered to kill. Or maybe it was something tragic that you could have stopped, but didn’t. Guilt and shame are at the center of moral injury. And, as Shay describes it, so is a shrinking of what he calls “the moral and social horizon.” When a person’s moral horizon shrinks, he says, so do a person’s ideals and attachments and ambitions……

….“Shay, a psychiatrist who has worked with combat vets for twenty years and authored two books about PTSD — or psychological and moral injury, as he insists it should be known — told me by phone from his Newton, Mass., office, ‘It’s titanic pain that these men live with. They don’t feel that they can get that across, in part because they feel they deserve it, and in part because they don’t feel people will understand it.’

“‘Despair, this word that’s so hard to get our arms around,’ he said. ‘It’s despair that rips people apart [who] feel they’ve become irredeemable.’

“I told Dr. Shay about Noah’s experiences in Iraq, in particular the killing, the loss of comrades, the nightmares. He sounded saddened on the phone, but unsurprised. ‘The flip side of this fellow’s despair was the murderous rages he experienced on his second tour,’ he said. ‘In combat, soldiers become each other’s mothers. The rage, need for revenge, and self-sacrificial commitment toward protecting each other when comrades are killed [are] akin to when a mother’s offspring are put in danger or killed.’

“Dr. Shay explained the nightmares and sleeplessness were one of the major issues. ‘The lack of sleep contributed directly to a loss of control of his own anger, a loss of control of things he felt morally responsible for.’”

And importantly:

“Peers are the key to recovery — I can’t emphasize that enough,” he said. “Credentialed mental health professionals like me have no place in center stage. It’s the veterans themselves, healing each other, that belong at center stage.”

Shay, demonstrating that PTSD and moral injury has been common to warriors since the creation of civilization by identifying PTSD and moral injury in the great Homerian works, also identifies PTSD and Moral Injury in William Shakespeare’s Henry IV. From Public Insight Network, again, Shay places the corresponding PTSD symptoms alongside Lady Percy’s lines from Act II, Scene 2:

O my good lord, why are you thus alone?      (Social withdrawal and isolation)
For what offense have I this fortnight been
A banished woman from my Harry’s bed? (Random, unwarranted rage at family, sexual dysfunction, no capacity for intimacy)
Tell me, sweet lord, what is ’t that takes from thee
Thy stomach, pleasure,          (Somatic disturbances, loss of ability to experience pleasure)
and thy golden sleep?            (Insomnia)
Why dost thou bend thine eyes upon the earth     (Depression)
And start so often when thou sit’st alone?          (Hyperactive startle reaction)
Why hast thou lost the fresh blood in thy cheeks      (Peripheral vasoconstriction, autonomic hyper-activity)
And given my treasures and my rights of thee
To thick-eyed musing and curst melancholy?    (Sense of the dead being more real than the living, depression)
In thy faint slumbers I by thee have watched,   (Fragmented, vigilant sleep)
And heard thee murmur tales of iron wars,
Speak terms of manage to thy bounding steed,
Cry “Courage! To the field!” And though hast talk’d
Of sallies and retires, or trenches, tents,
Of palisadoes, frontiers, parapets,
Of basilisks, of cannon, culverin,
Of prisoners’ ransom and of soldiers slain,
And all the currents of a heady fight.
Thy spirit within thee hath been so at war,
And thus hath so bestirred thee in thy sleep,   (Traumatic dreams, reliving episodes of combat, fragmented sleep)
That beads of sweat have stood upon thy brow
Like bubbles in a late-disturbed stream … (Night sweats, automatic hyperactivity)

Do you recognize this in a loved one? Do you recognize this in yourself? I wonder who in the great bard’s life inspired him to relay such pain through Lady Percy’s words. And note, that Lady Percy’s pain is as deep, tormenting and disabling as that of her husbands’. PTSD and moral injury is, in effect, contagious, and wrecks relationships and families. True now and true over five hundred years ago.

Before admitting my injury and getting help, from friends, family, peers, strangers and professionals, I would have silently and reluctantly recognized these words in myself. I would loathe myself for such recognition and would find solace in alcohol and suicidality. If this is you now, there is no shame, open up, admit your pain and get help. Your pain is as old as war and I promise you, you will find strength in others when you seek help and in that you will find strength in yourself.

Afghanistan Election and the Limits of American Power….

MatthewHoh War and Conflict , , , , , , , , ,

I had this op-ed today in US News and World Report on the current situation in Afghanistan:

Afghanistan’s Ongoing Nightmare

For the third time in five years, an electoral crisis faces Afghanistan. However, unlike the fraudulent Afghan presidential election in 2009 and the equally crooked parliamentary elections of 2010, the United States no longer maintains more than 100,000 troops in Afghanistan. The United States’ policy of artificially upholding political order with the presence of large numbers of soldiers and massive infusions of cash in order to prevent complete fracture across the nation of 30 million was never a sustainable course of action in Afghanistan and the inevitable breaking of that short-sighted policy now appears underway.

This month, after no candidate achieved a clear majority in the April general election, the Afghan Independent Election Commission – of which there has never been evidence of its actual independence or objectivity – released preliminary results from the June 14 runoff of the top two candidates. Ashraf Ghani, an ethnic Pashtun, academic and World Bank executive who lived outside of Afghanistan from 1977-2001, had defeated Abdullah Abdullah, a Tajik-Pahstun and a doctor who participated in the war against the Soviet Union and then served prominently alongside Tajik warlord Ahmed Shah Massoud during the Afghan Civil War of the 1990s. Abdullah had finished second and Ghani fourth to President Hamid Karzai in the 2009 election.

Both Ghani and Abdullah had previously held positions of prominence in Karzai’s government, one of the most corrupt in the world. Ghani served as finance minister, while Abdullah served as foreign minister. Additionally, both Ghani and Abdullah’s running mates are warlords accused of war crimes and complicity in mass corruption and drug trafficking. But to, to be fair, at least to an American audience, these are not the worst candidates. Abdul Rasoul Sayaf, the man who brought Osama Bin Laden to Afghanistan in 1996 and mentored 9/11 mastermind Khalid Sheik Mohammad, finished fourth in the general voting in April.

Abdullah, citing mass reports and evidence of ballot stuffing, has decried the preliminary results and threatened to form a parallel government. Such an occurrence could further fracture Afghanistan along ethnic lines and engender a wider civil war.

Sadly, for many of the Afghan people, a broken and illegitimate elections process is the least of their worries. The Afghan economy, despite the infusion of nearly $100 billion in foreign assistance since 2001, is incapable of supporting itself. Indeed, the only industry that has flourished and provides any form of income and occupation on a macro scale is Afghanistan’s drug trade. Year after year, bumper crops of poppies have been harvested despite the presence of hundreds of thousands of foreign troops and billions of dollars invested in anti-narcotic and anti-corruption policies. With no electricity and no cold storage infrastructure, Afghan farmers that do engage in licit agriculture must sell their produce to neighboring countries, only to have to repurchase at a later time at much greater cost. Young Afghan men who seek employment not with the Afghan security forces, in a warlord’s militia or with the Taliban, must travel to Iran or Pakistan to find work.

This past week, the United Nations issued its most recent report on casualties. For the fifth consecutive year, since President Obama escalated the war in 2009, Afghan civilian casualties have increased. This is not surprising, as the Taliban insurgency, despite assurances from American generals and politicians of military victory in 2009, has not been diminished, but rather grown in size and capability. The Taliban have launched more attacks every year since the American surge and now occupy a strategic political position that allows them to enter and withdraw from negotiations at their choice.

In effect, in southern and eastern Afghanistan, the Taliban are in control, while in the rest of the country no one appears to be in control, at least in a recognized or legitimate sense. For the average Afghan, the much-heralded promises of political freedom, economic opportunity and physical security that accompanied the American war effort have failed to be realized.

Rewind the newsreels back over the last 13 years and you will hear praise from American politicians over “modern” Afghan leaders as Jeffersonian-Democrats, you will hear generals preach of counterinsurgency principles that were to vanquish an enemy by winning the hearts and minds of an occupied population, and you will marvel at the largess of the billions of dollars earmarked by our Congress for education and infrastructure programs for a faraway people. None of these noble imaginings ever became reality. Rather these dreams have manifested as a collective ongoing nightmare for the Afghan people. The current crisis in Afghanistan at the unrecoverable cost of far too many lives and limbs, is a tragic lesson on the true limits of American power.

Stop Persecuting Bowe Bergdahl

MatthewHoh Recovery, War and Conflict , , , , ,

Politico published a piece today I wrote on Sergeant Bowe Bergdahl and how his treatment by politicians, the media and the public ties into the current state of veterans issues. Please give it a read and let me know your thoughts.

Stop Persecuting Bowe Bergdahl

When you go through the military’s Survival, Evasion, Resistance and Escape (SERE) School there are a number of things that are literally beaten into you. You are hit in the face and slammed against walls. Rifle butts and barrels strike you in the head. You are placed in small wooden boxes and deprived of food and sleep, and some of you are water-boarded (yes, it is torture). But the most important and beneficial aspects of the training are the psychological pressures and forces you are subjected to. You are taught what you should expect and what it is you should do to mentally survive captivity as a prisoner of war. You learn through practice to depend on your fellow prisoners and, most importantly, to hold fast in your faith and the knowledge your country will never forget you and the United States will always come for you.

I went through SERE training in southern California in 2000. It was April, so the hot desert days quickly became cold desert nights. With little water, no food, (you do, however, get to eat bugs, cactus and rabbits) and only a piece of parachute and a fellow Marine for warmth and shelter, you are forced to put your training into practice and rely upon not just the physical strength of your fellow trainees but their mental strength. Implicit in that reliance is the understanding you will support one another and that, in turn, you will not be abandoned. The core concept of SERE is “Return Home with Honor,” and again you are holding faithful to the conviction you will not be forgotten. To finish off your training, American commandos rescue you from the prisoner of war camp in a simulated raid. The contract is clear: Never give up, because you will never be forgotten and you will never be left behind.

A few years later, I went to war in Iraq. I saw friends die and took part in a process and system of killing that that was justified by a non-existent, made-up threat to American national security. A foreign nation, innocent of any crimes against the United States, was plunged into a barbaric and horrifying civil war, a war that is still slaughtering its citizens. Even with all of the mendacity and madness of the Iraq War, coming home plagued with survivor’s guilt and moral injury, you still believe in the institutions, you still believe in the ideals and principles that say you will not be forgotten, that your nation owes you a debt and that debt will always be met.

Today I’m not sure if I know any veterans who still believe such platitudes. Most of us cringe at the yellow “Support the Troops” bumper stickers that still adorn some cars — mostly they are the non-magnetic kind that are pasted on and not easily removed. Many Americans would be surprised to know America still has 33,000 troops in Afghanistan, twelve of whom, including two teenagers, were killed this past month in what is America’s historically most unpopular war. We veterans are among the few the few who still pay attention to the mostly unnoticed and pointless dying in a war that 84 percent of Americans are against, andwe also find ourselves cursing under our breath during the cheers and ovations for the veteran without legs in the wheelchair who gets free tickets to a baseball game, but who can’t get timely or thorough physical and mental health care and who has a pretty good chance of killing himself someday. According to Veterans Administration figures, some 22 veterans are now committing suicide every day—and the average hasn’t fallen below18 a day since 9/11, which means that something like a total of 100,000 veterans have killed themselves since then.  Loud clapping, free food and your face on the Jumbo-tron during a rousing rendition of a Lee Greenwood song seems to be what you are owed, not health care, disability assistance, adequate job training or a public and truthful accounting of why these wars were fought and why they were lost. Our youngest veterans, those who bore the brunt of the death and mutilation in these wars, have a 22 percent unemployment rate. The generals who lost these wars teach at Stanford, USC and Yale.

Into this environment Sergeant Bowe Bergdahl has returned from five years as a prisoner of war. I am a friend of his mother and father, Jani and Bob. They are wonderful, kind and loving parents. I hope someday they tell their story of how they survived five years of suffering, unsure if they would ever have their son back, while waging a practically unacknowledged campaign to win his freedom. Without their strength in each other and their commitment to their son, I seriously doubt if Bowe Bergdahl would now be back home in the United States.

Nearly 7,000 American families have not had their sons and daughters return from these wars. You would expect with such losses over the last thirteen years, as a nation, we would rejoice in the end of the Bergdahls’ anguish and grief. However, in complete defiance of any obligation to our men and women in uniform or the thousands upon thousands of family members of the uniformed dead of these wars, Sergeant Bergdahl and his parents have been victimized and demonized in a horrific display of politically inspired hate and vitriol.

For five years Jani and Bob lived a parent’s worst nightmare, fearful every day for the knock on the front door from a man in uniform on a mission to tell them their son would never come home. As any parent would be, the Bergdahls were overjoyed for Bowe’s return. They weren’t expecting parades and a hero’s welcome, but neither did they expect a whole new nightmare—the one they are now living. Imagine what it’s like to see your son demonized, and without any evidence, every time you turn on the television. Every day they must endure hateful innuendo while wondering what the future holds for their son, his name and his chances for a normal life.

We do know, based on the Army’s investigation of Bergdahl and subsequent news reports, that he left his base voluntarily, but he had done so previously, always returning to the base. We know he left his base without a weapon or any of the items he likely would have taken if he had intended to desert, ,– such as food, clothing, a sleeping mat, etc. We know Bergdahl was taken as a prisoner of war in a struggle and that he tried to escape multiple times from his Taliban captors. Nothing other than the words of his fellow soldiers– soldiers he characterized in emails printed by Rolling Stone magazine “as pieces of sh*t” and who were members of a unit widely acknowledged to have leadership and discipline problems– indicates desertion. The Army investigation in August 2009 did not find Bergdahl guilty of desertion, and I am confident the current investigation, which I fully support, will not conclude desertion either. Yes, reckless, dumb, crazy behavior, but not desertion. Yet, in a shameful and disgraceful manner that reminds me of Vietnam Veterans being spat upon, Sergeant Bergdahl and his family have been labeled as traitors, and their suffering and sacrifice buried beneath partisan hate highlighted by grandstanding politicians and ratings-obsessed pundits.

For those who are still in uniform and any of those considering enlisting, realize and recognize this reality. You are taught you won’t be abandoned, that you will be taking care of and the pain of combat worthy of the costBut the truth is your war may quickly be forgotten, your sacrifice will likely become a poltician’s talking point and your care will be no better than third rate..

In SERE school the conviction is ever-present that if you become a prisoner of war you will not be abandoned and you will always be brought home. But future prisoners of war should know this certainty: Your value as an American service member, and the treatment of your family, will not be measured against a code of conduct you may believe in or any of the trite and hackneyed platitudes bandied about by generals or politicians. Nor will large swaths of the public or media show any degree of sympathy or appreciation for your mother and father’s loss. Instead your release will be measured against public opinion polls. I trust the military is updating its SERE course curriculum.

Matthew Hoh, a senior fellow at the Center for International Policy and a former Marine Corps captain, worked as a State Department official in Afghanistan until he resigned in protest in 2009, saying U.S. policy was not working.