Broken Bodies, Shattered Minds: A Medical Odyssey From Vietnam to Afghanistan
Page 10
And that was the problem. These beefy mostly ex-military men with their beards and flack vests carrying government-issued M-4s and M-16s did what the Marines did without any obvious supervision and apparently no rules of engagement. They pretty much did what they wanted to do, including in some cases getting involved with the U.S. forces in their own firefights. Tom could see for himself that there were more contractors than military in some areas and that they had absolutely no accountability for what they did or didn’t do. Apparently the military, not having enough troops, needed them, or someone thought they were needed. But it confused all the confusing things even more and certainly didn’t lead to any sense of respect for the regular U.S. forces. It didn’t matter if you were shot up or had a friend or family member killed by a contract security guard or a marine—an American was an American.
Tom actually heard that a squad of marines had joined in a chase—along with coalition forces and Iraqi police—of a convoy of these contract guards that had been shooting up cars and into homes along a major street in Mosel, finally stopping the convoy by shooting at the black SUVs that had become the signature of these security companies. It seemed to Tom that these amateurish trigger-happy private security contractors were screwing things up for everyone, including the Marines. It was crazy and everyone knew it, but nobody seemed to be able to stop any of it.
Not sure exactly what his own parents were hearing at home, Tom tried to write or send an email home every day. For the most part, he would write about the other marines in the unit, how they were all doing what they’d been trained to do, how they made sure they took care of each other as well as taking care of themselves. That seemed enough. You don’t lie in the Marines. But you don’t have to tell the whole truth.
They pushed their tanks well past maintenance guidelines. They had no choice. There were no tanks left in reserve, they were forced to just keep moving with what they had. But the constant wear, as well as the sand and dirt that got into everything, began to cause breakdowns. The heat only made it all worse. By midday you could fry an egg on the tank’s armor plate. After nine weeks, the hubs on the drive wheels and the main bolts holding the wheels to the treads would begin to lock up.
Late one morning, they had to pull over and work on the gear train. Exhausted, having pushed on for days, Tom and the gunner, grim and drained, took the main spanner out of the toolbox. Climbing down from the tank, they started to work on the hubs. A couple of grunts set up a mini-roadblock at the nearest intersection to give them some cover. Pressing down on the back of the spanner for leverage, the head of the spanner slipped off the hub, shearing a piece of metal from the neck of the bolt. There was a moment when the pain left Tom stunned. A spasm of nausea swept over him as he grabbed his face and fell to the ground.
Even weeks later, it would be impossible to know exactly what happened. It could have been anything—a heat-expanded bolt, an overworked bearing, not wearing the prescribed eye protection, too much force on the spanner, a weakened piece of metal from weeks of taking the occasional sniper round denting the rotor mounts. But a piece of metal had come loose and tore through his left eye.
A Humvee took him to an FST, a Forward Surgical Team, set up about a kilometer outside the town they had just swept. The surgeon examined his eye and, putting on a simple bandage, called in a chopper that took him to the 24th Surgical Hospital at Ballad, forty miles north-northwest of Baghdad. An hour later, his eye was patched and he was being flown to Landstuhl Regional Medical Center in Germany.
At Landstuhl, they sewed up the major laceration of his eye and within half a dozen hours he was on a C-5A with a number of other med-evacs to Bethesda Naval Hospital in Bethesda, Maryland. A CAT scan in Germany had shown metal fragments embedded in the globe of his eye close to the retina, as well as in the tissues at the very back of the socket near the optic nerve.
It hadn’t been lost on Tom, listening to the doctors talking among themselves, that if it had been a splinter from a round ricocheting off the side of the tank or a piece of shrapnel from a mortar or a roadside bomb, the metal fragments would surely have penetrated his skull and entered the frontal lobes of his brain.
There was some initial hope that the retina had remained basically intact and that the globe of the eye that had filled with blood would eventually clear, so that some sight might return to the damaged eye. Still, there were problems outside of the traumatic injury itself. One of the problems was infection, another was getting out the fragments without making things worse.
The surgeons decided to wait, to give the damaged parts of the eye a chance to calm down while allowing more time for the blood to clear, to give them a better view and if necessary better access to the fragments. Tom was told the risks and the benefits of waiting. He did not call his parents. Once committed to the battlefield, the old world, if not gone, is clearly no longer of use. Familiar customs lose importance and familiar rituals their power. At age eighteen or thirty-five, a marine decides for him or herself.
Tom took a deep breath and decided to wait. When he finally did call home, it was only to tell his parents that he had been wounded, but that he was fine and healing and that the doctors were confident that he would be all right. But the doctors weren’t quite right.
The vision in his eye did not return to normal. He could see well enough to get by. There was always a haze when he looked to his left and it was difficult to see at night or in the dark and distances were out if he closed his good eye. Besides, Tom liked what he was doing and while the Marines would discharge anyone who could not see well enough to qualify with a rifle, the Army was different and would accept for active duty a wounded Vet if that soldier could pass the physical and waved all disability claims.
Special Forces was even less concerned about disabilities. If you could do what they asked and passed all the physical and mental tests, you’d be in. They clearly understood that anyone trying to get into Special Forces had to have overcome something along the way and a little dimness in an eye was not viewed as a problem anymore than not being able to carry a 100-pound bag of cement up and down a hill with a 30 percent grade a dozen times before breakfast.
Three months after being wounded in Iraq, he was discharged from the Marines and a month later the Army accepted his re-enlistment and, pushed forward by his time in the Marines, he was able to apply and begin Special Forces training.
Tom quickly found out that he couldn’t sight his weapons well with his bad eye, but no one seemed to care. There was still Iraq out there. The general view in the military was that the lid would eventually come off no matter what America did or how many troops we had on the ground. But that didn’t mean that we wouldn’t keep troops there for the next few years. And there was Afghanistan looming again in the distance. The Special Forces understood that they would need more well-trained and committed men, even those who might not be able to see clearly.
10.
SHELL SHOCK/THE SHATTERING OF MINDS
Armies are fragile institutions, and for all their might, easily broken.
—Joe Galloway, War Correspondent
Psychiatry and psychology have never had an easy time of it in the military. It is hard to convince an army that you are injured when there are no visible wounds. But there is a toll to wars that has not gone unnoticed. During the early years of World War II, one of every four soldiers evacuated from a combat area was med-evac’d out as a neuropsychiatric patient. Approximately half of the medical discharges granted during those years were for psychiatric disability. Whatever else might be said about the battlefield, it is a fearful place, not only for the brain but also the mind.
No army is willing to admit that war is a frightening, and at times, terrifying business. Going into battle or being in a fire-fight the first time is difficult enough. Doing that same thing over and over again can become an impossible task. During the Marines’ brutal December winter retreat from the Chosin Reservoir in Korea, an exhausted and freezing marine huddled in a f
ox hole was asked by a correspondent what he would like for Christmas, which was the next day. The marine answered simply, “Tomorrow.”
The military understands that kind of dread and foreboding. The best of the field grade and general officers, remembering their own times on the front lines, continue to feel it themselves. It was clear to those who knew of General Norman Schwarzkopf’s history as a twenty-four-year-old captain in Vietnam and adviser to a South Vietnamese Ranger Battalion, that his refusal, during the 1991 Persian Gulf War, to let the Marines land on the heavily-mined beaches of Kuwait, was because of his own paralyzing experience in the Central Highlands of Vietnam.
In the spring of 1965, he and a company of South Vietnamese Rangers walked into a VC minefield during a night attack. The first they knew they were in a minefield was when Rangers started blowing up across the skirmish line.
Those who survived the initial blasts, including the future General of the Army, had to work their way inch by inch, slowly and painstakingly, on their bellies, feeling in the darkness with knives and bayonets for a wire or detonator, friends and comrades dying around them. It took those who survived, including Schwarzkopf, all of the night and part of the next morning to clear the field.
When asked by a reporter at a press briefing following the first days of Desert Storm why he had not let the Marines come ashore, Schwarzkopf snapped angrily, “Have you ever been caught in the middle of a mine field and had to work your way out of it?” Schwarzkopf, as Commander and Chief, was simply not going to let his Marines go through what he had gone through some forty years earlier. Instead, the Marines were used solely as a decoy. General Schwarzkopf remembered. Everyone in combat remembers. The only question is how personally they remember and how deeply.
Yet, no army wants to lose its soldiers because of something as universal and as apparently vague and personal as fear. It is not a soldiers’ fear that worries the military. Everyone who has been in combat understands that much about war. What worries the military is that the individual fear might spread and become a kind of contagion that will lead to large numbers of troops simply giving up or refusing to go forward.
In the same way that physical wounds are easily seen and easily explained, military leaders have always tried to dismiss the anxiety and desperation of the battlefield as something physical. They have explained away those fears as something that happens to soldiers; something that is palpably real and not something that is either fanciful or what soldiers do to themselves. It is explained away as something physical, it is treatable, not something that can mysteriously spread to other soldiers.
The Greeks took a more reasoned, as well as a more humane view. In the Fifth Century B.C, the Greek historian Herodotus tells of a Spartan Commander who excused soldiers, though of proven bravery, who were “out of heart and unwilling to encounter danger.” Herodotus also mentions a soldier called “The Trembler” who hung himself after a major battle.
At the beginning of the Civil War, the first war after the industrial revolution, where there was universal slaughter on an industrial scale, thousands of Union soldiers were suddenly diagnosed as suffering from nostalgia. It was a term coined during the Seventeenth Century to describe psychiatric disorders being experienced by civilians when they were far from home, but was quickly generalized to mercenaries, and then regular armed forces fighting distant wars. The idea was generally held by physicians during our Civil War that a soldier from Pennsylvania marching through Texas or Georgia could become so homesick that he would suddenly become dysfunctional.
But as our Civil War continued, the ferocity of the fighting grew worse and the carnage ever greater, with tens of thousands dying or being wounded within hours of the beginning of a major battle. An increasing number of soldiers, unwilling or unable to continue to go forward or becoming lost in the middle of the chaos and bloodshed, stirred the military and its physicians to find something more dramatic to blame as an answer for the trembling and fear than simply being homesick.
Those soldiers were finally given a definitive physical diagnosis. They were suffering from an “Irritable Heart.” No need for magic here; no need to conjure up missing familiar places, malingering, satanic possessions, or cowardice. No need for any sense of personal failure or public embarrassment. The problem, whatever the symptoms, was clearly physical, the end result of an overly-stimulated heart. When the hearts of these men were examined, the hearts were indeed racing.
The shift in “diagnosis” did not make sense. Even to the most casual observer, the bizarre behaviors, including the psychological symptoms of depression, agitation, inability to sleep, mental confusion, and terrible startle reactions, appeared to have little to do with the actions of an ailing heart.
In World War I, that diagnosis was changed. The explosions themselves were said to create “shell shock.” By 1915, those soldiers, shaken and trembling, removed from the brutality of the trenches, but still filled with dread, unable to sleep as well as to function when awake, were given the diagnosis of “shell shock.” The medical focus had finally shifted from the heart to the brain and central nervous system.
By the beginning of the Twentieth Century, damage to the brain made more sense. The brain had clearly been damaged, shocked by the close proximity to the ongoing and unrelenting barrages of exploding shells that had become so much a part of this new kind of static trench warfare. Those blasts were enormous and they were continuous.
If a soldier came out of a battle or bombardment unwounded, but disoriented, paralyzed with fear, or simply unable to go on, he was diagnosed as having been too close to the shelling. The symptoms were the result of neurological damage caused by exposure of the body to the created shock waves. The blasts themselves didn’t have to be explained. After all, anyone under a bombardment could feel the force of the exploding shells.
There were documented deaths in the Civil War and during World War I from artillery bombardments where the soldiers were found dead without any obvious wounds. If large explosions could actually kill a soldier without leaving a mark on his body, then certainly smaller blasts could injure the body’s most delicate organ, the brain. The diagnosis was obvious. The soldiers’ brains had clearly been seriously rattled.
It was, of course, a handy theory. If the shell-shocked patient recovered, the concussion had not been very severe. If the soldier did not fully recover, the damage was considered to be more extensive, but not severe enough to be permanent; if the patient never improved, the initial injury had been severe enough to be irreversible. If the patient intermittently lapsed back into bizarre or depressive behaviors, the damage was said to lie somewhere between the two different extremes. Once again, the importance of a physical diagnosis was that the soldier himself was not at fault, while the army, the family, and the country were spared the onerous task of accusing one of their own of cowardice.
Yet, during the “Great War,” even that diagnosis did not stop some three hundred British soldiers, many clearly suffering from “shell shock,” from being executed for cowardice. Though in 2006, the United Kingdom did finally grant those soldiers, and of course their families, posthumous pardons.
Still, it was difficult to admit to the crippling psychological effects of the battlefield during the Civil War, World War I, World War II, Korea, or Vietnam, as it is now.
Like all parts of medicine, from infectious diseases to neurosurgery, psychiatry too—along with its theories of mental illness—developed and progressed throughout the 1920s and 1930s.
Faced with the new understandings of psychology, less fashionable ideas about battlefield stress were proposed, though there remained the desire to maintain a completely physical version for those soldiers who simply could not continue. And for another sixty years, the physical explanations won out, even though symptoms continued to occur in soldiers not exposed to exploding shells nor those who had not been involved with sustained combat.
In World War II, the symptoms, along with the diagnosis of “shell shoc
k,” simply and quietly morphed into “battle fatigue.” Fear and anxiety was now the result of physical exhaustion, of having been out in the field too long. A little rest, a little R & R and all would be well again.
In 1943, U.S. Army Lt. General George Patton visiting wounded soldiers in a hospital in Sicily, asked a wounded soldier to describe his injuries. When the soldier explained that it was “his nerves,” the General slapped him across the face and called him a coward. It is a view that continues today, among those officers and enlisted personnel, who despite severe symptoms of PTSD, refuse to seek medical or psychological help for fear it will detrimentally affect their military careers.
Still, the idea of battle fatigue was carried forward into Korea, with its hard hills and even harder winters, morphing within a year of the beginning of the conflict into “combat exhaustion.”
Sleep deprivation was now presented as a large part of the whole picture. Once again, there was nothing ominous or mysterious going on. Once again, exhaustion was something that was understandable and acceptable to those afflicted, to the culture, and to society in general. The stress of war was nothing more than fatigue, exhaustion, sleep deprivation, and a difficult job. Everyone could relate to that.