FACES OF COMBAT: PTSD & TBI: A Review

There are two kinds of people: those who divide everyone into two kinds of people and those who don’t. One way to divide people into two kinds is according to the way they react to evil, pain and injustice. Some turn away and pretend it’s not there. Others go straight towards it with the intention of doing something about it, if only to get an accurate description. Eric Newhouse, a Pulitzer prize winning reporter for the Great Falls Tribune, is one of the latter. I guess I am, too, which is why I read “Faces of Combat: PTSD & TBI.”

This book, produced entirely outside the Manhattan book machine and published in the Seattle area (see info at end), has the immediacy and clarity of local news, though it is relevant to our entire nation, pressed into a war fought by the National Guard and mercenaries while our formal military struggles to keep up. It focuses on the terrible consequences to the men and women involved, who return home (IF they do) changed in ways that make ordinary life impossible, so much so that many commit suicide.

We are used to stigmatizing suicide by blaming it on weaklings, losers, and loners, but the lead case in this book is that of Chris Dana, a much loved young man, a cheerful Montana kid who tried to help others. Combat changed him entirely. The damage leaks over into all our lives.

Newhouse sketches out the symptoms of Post Traumatic Stress Syndrome, once called battle fatigue, and vividly describes the kind of ghastly experiences that create the syndrome, situations both psychologically and morally unbearable. Then he takes us through the symptoms: nightmares, hallucinations, flash-backs, hatred of authority, and explosions of inappropriate violence that endanger everyone nearby. These are people who can no longer sleep, who keep a gun at hand at all times, who have cut so many throats that they could do it in their sleep if they could approximate that state, and who trust no one. They are unemployable and may live in little wilderness camps both because they feel safer that way and because they are afraid of what they might do to others. The numbers are impressive: more soldiers have died of suicide than have died in combat. Got that?

Mysteriously, some of the people exposed to the events that throw some soldiers into madness can adjust to normal life and return to their old selves relatively unchanged. They are “resilient.” No one knows why, but it is vital to find out since ending the Iraqi war will mean bringing the National Guard home in great numbers. They will be living in our neighborhoods again, riding the bus with us, maybe walking the streets at night.

TBI is less discussed but equally troublesome. It refers to Traumatic Brain Injury, which Newhouse calls the “signature” injury of this war because of the many explosions. Also, we have the tools to actually detect some of the internal bruising that comes from the Jello-like brain “sloshing” inside the hard skull meant to protect it. This holds my attention because of three family members (father, brother, cousin) whose personalities have changed for the worst after forehead blows. On this reservation many people have suffered such blows and I’m convinced it contributes to disordered behavior. Studies of prison populations show a very high percentage of head injuries, none of which are treated or even regarded with much interest since the outer physical symptoms are minor. Violence is simply thought of as their personality.

The most subtle injuries of all may come from both PTSD and TBI: changes in the molecular reciprocal interactions that operate our brains and damage to the tiny sensitive structures that sort and shunt our sensory memories. The hippocampus, a tiny seahorse-shaped organ over each ear, is measurably smaller in soldiers suffering from PTSD. This little gizmo is responsible for classifying and organizing incoming perceptions, then sending the significant ones on to the amygdala and cortex where conscious “thinking” happens. If it gets “stuck,” it can replay the same perceptions over again or mislabel and misdirect them. No one knows whether trauma makes the hippocampus shrink or whether the people with small hippocampi develop PTSD as a result. With proper treatment, it can grow again. The brain is far more variable than anyone suspected.

But the most disfunctional system of all is the military itself: bureaucratic, hierarchical, denying and underfunded, it uses and discards soldiers with impunity. One of the great values of this book is that it describes what progressive leaders can do: Governor Schweitzer, Senator Tester and Senator Baucus -- reacting to public pressure -- put the levers on the Montana National Guard to improve vet care. Newhouse lays out the specifics: better medical care but also mobilization of the vets themselves to monitor and support their fellow vets. “Operation Standdown,” for instance, called the anonymous people to come from their hidey-holes (one of them was living under the end of a bridge within eyesight of the Great Falls Tribune building without Newhouse ever having a clue) to get basic health triage (blood pressure, dental work) and to register for entitlements. The bait was a huge mound of surplus gear such as sleeping bags and tents, warm clothing, socks and boots.

The saddest kind of trauma is that of women soldiers who were sexually assaulted by their fellows so often and treated with such impatience by officers that Newhouse recommends females be kept out of the military. In Montana the kind of strong women who know weapons and identify with brothers will not react kindly to this opinion, but even the cartoon “Doonesbury” has been pointing out with heart-breaking humor that it exists.

Soldiers suffer in extreme forms of ways we all suffer in ordinary times and places. Advances in prosthetics, trauma care, and technology are often triggered by war, but we also ought to be paying attention to the social reforms necessary for a better society. I’m particularly worried by the acceptance of mercenary soldiers, highly paid and out-of-control, operating for private or corporate interests. They will be looking for police jobs.

To give us hope, Newhouse describes some of the strategies and treatments that seem to help traumatized people. Things like “eye-movement desensitization and reprocessing” or gentle brain-wave entrainment or religious ceremonies or talking cures all seem to help individuals to various degrees. Acupuncture and a variation based on tapping seem effective in some cases. But the training and money for them isn’t there.

Newhouse concludes with a practical list of people to call to get help with housing, employment, legal problems, health and so on. If I were struggling with this stuff personally, I’d tear out those pages, take them someplace to be laminated in plastic, and refer to them daily. Isolation is an enemy. A book is a friend. Eric has done us all a major service.

“Faces of Combat, PTSD and TBI,” by Eric Newhouse. “Issues Press,” an imprint of Idyll Arbor, Inc, 39129 264th Ave. SE, Enumclaw, WA 98022. ISBN 9781-930461-06-2.