摘录

Introduction "Must you have battle in your heart forever? The bloody toil of combat? Old contender..." -- Odyssey 12:132f, Fitzgerald "I wish I had been untrained afterward...reintegrated and included. My regret is wasting the whole of my productive adult life as a lone wolf." -- Jim Shelby, Vietnam veteran "Doc, you're f -- -- ing crazy." -- One of my patients, a former Army Airborne sergeant, veteran of four Vietnam combat tours, upon hearing that I was going to lecture on prevention of psychological injury at the United States Military Academy at West Point Homer's Odyssey is the epic homecoming of a Greek fighter from the Trojan War. Odysseus' trick of the hollow horse got the Greeks inside the walls of Troy, a feat that ten-to-one superiority in troop strength had never achieved. He was the very last fighter to make it home from Troy and endured the most grueling travel, costing him a full decade on the way. Odysseus' return ended in a bloody, triumphant shoot-'em-up. It is now more than thirty years since the majority of American veterans of the Vietnam War have returned home -- physically. Psychologically and socially, however, "many of us aren't home yet," in the words of one combat medic. My portrait of the psychologically injured combat veteran is colored by respect and love. However, I shall conceal none of the ugly and hateful ways that war veterans have sometimes acted toward others and themselves during their attempts to come home and be at home. To the ancient Greeks, Odysseus' name meant "man of hate" or "he who sows trouble." Indeed, some veterans have sown trouble in their families. No one should ever hear from his mother, "You're not my son!" or "Better you died over there than come home like this." Yet veterans with severe psychological injuries have sometimes heard these terrible words. Odysseus, like Achilles, is remembered as a hero of Greek myth. Today we see our heroes as unmixed blessings, almost as though pure beneficence is part of the definition. When we call those firemen and police who rushed to the New York World Trade Center on September 11, 2001, heroes, we have reason to see them as intending only good and to an amazing degree accomplishing it, at the sacrifice of their lives. However, the ancient Greek idea of the hero was deeply mixed. As I just noted, Odysseus' name means "man of hate." Achilles' name means "he whose host of fighting men have grief" -- referring to his own Greek troops as well as to the enemy! Ancient Greek heroes were men of pain who were both needed by their people and dangerous to them. Achilles' withdrawal resulted in numberless Greek deaths; Odysseus' long return home to Ithaca caused more than seven hundred Ithacan deaths on the way or when he got there. Achilles harmed the Greek army during the war; Odysseus harmed his people after the war. They were both heroes in the ancient Greek sense. Almost everyone has somehow heard of Odysseus -- sometimes he's called by his Latin name, Ulysses -- but not everyone has read the Odyssey or remembers the details. I have tried to write this book in a way that will allow those who have never read Homer's Odyssey to follow it and not feel lost. A brief pocket guide to the epic in the style of a movie synopsis is offered in Appendix One. It's a complex story, easily muddled in memory. So I urge readers who are not currently familiar with the Odyssey to give the synopsis a quick reading before they start. While I hope that this book will ignite a desire to read or reread the Odyssey, no one should think it's required beforehand. Part One of this book invites the reader to hear the Odyssey as exactly what it says it is: the story of a soldier's wanderings and troubles as he tries to make it home. The first dozen or so chapters "decode" Odysseus' adventures in wonderland -- the most famous part of the epic -- as an allegory for real problems of combat veterans returning to civilian society. These are adventures that Odysseus himself tells as a story-within-a-story, to people who resemble wealthy, complacent civilians. Reading the Odyssey as allegory is not new, but I suspect and hope that this allegorical reading will carry a different emotional weight than those rendered in the past. In Part One, Odysseus appears, so to speak, on a split screen. On one screen, Odysseus as a veteran, trying to come home. On the other screen, Odysseus as a military leader who shaped the experience of others -- often in disastrous ways. All of my current patients, except a single Gulf War vet, are Vietnam combat veterans, men in their early to mid-fifties. When I first started working with veterans, they were perhaps the same age as Odysseus, returning home to Ithaca from ten years fighting in the Trojan War and ten years trying -- and not trying -- to get home to his wife, Penelope, and son, Telemachus. Television, not to mention schoolbooks and feature films such as Ulysses, have made Odysseus' encounter with the Cyclops, the Sirens, and episodes such as the contest of the bow familiar to even the smallest children. What adventures! How poignant the story of the old soldier struggling to get home to his family! How many trials and obstacles thrown in his way! Homer's epic is the earliest known and most famous account of a combat veteran trying to get home after the war, and of what he does after he gets there. In the last chapter of Part One, the narrative shifts from the world of fabulous monsters, witches, and ghosts to Ithaca, the real world of Odysseus' farms, home, and hometown. When Odysseus arrives home at last, he is disoriented and does not recognize Ithaca. The fact that he doesn't recognize his own homeland is itself a metaphor that many veterans can understand. The first person Odysseus meets is an unknown youth who is the goddess Athena in disguise. The two exchange courtesies and Odysseus tells her a dazzling pack of lies. Dropping her disguise, the goddess teases him: A man would have to be cunning and thievish to surpass you in all your tricks -- even if he were a god. Wretch, with the mind of a chameleon, master of tricks, not even in your own land will you leave off your deceptive and thievish tales -- which you love from the bottom of your heart. (13:291ff, orig., Jenny Strauss Clay, trans.) Odysseus thought he had duped a civilian, but he was speaking to his own guardian angel who knew his trials and his tricks better than anyone. Finally at home in Ithaca, he finds himself in danger from the young bucks trying to win his wife's favor -- the suitors. He moves in disguise and concealment, surrounded by a bodyguard of lies. He is reunited with his wife, son, and father, but much of the time he is icy or cruel. And then he runs off again! Looking beneath the surface to what Odysseus, the master of disguise, has hidden in the stories he tells the civilians, we see not only the "what" of real experiences, but the "why" of a veteran's need to disguise his experiences at all. What is "home" anyway? Part Two explores recovery from psychological injuries. The basic message is that whether recovery occurs spontaneously or in a defined treatment setting, recovery happens only in community. We are habituated to the assumption that injuries or illnesses can only be treated one on one in a professional's office. I shall explain below that two people (no matter how well trained, well meaning, and caring one of them is) are not a community. I believe this one-on-one assumption is responsible for how frequently we have failed in the treatment of severe psychological injury, especially when it has damaged character. The American Psychiatric Association has saddled us with the jargon "Post-Traumatic Stress Disorder" (PTSD) -- which sounds like an ailment -- even though it is evident from the definition that what we are dealing with is an injury: "The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others." We do not refer to a veteran who has had an arm blown off by a grenade as suffering from "Missing Arm Disorder." But I am not going to fight it. "PTSD" it is, even though I much prefer "psychological injury." Combat PTSD is a war injury. Veterans with combat PTSD are war wounded, carrying the burdens of sacrifice for the rest of us as surely as the amputees, the burned, the blind, and the paralyzed carry them. Part Two explains the distinction between simple PTSD -- the persistence into civilian life of adaptations necessary to survive battle -- and complex PTSD, which is simple PTSD plus the destruction of the capacity for social trust. Then we shall come at recovery from two directions. The first, coming from the direction of organized health care, comprises the treatment concepts and practices of our small outpatient program in the Boston VA for Vietnam combat veterans with complex Post-Traumatic Stress Disorder. The second approach spans the poorly understood "spontaneous," or "natural," processes of recovery that happen in the native soil of a veteran's own community. Picture these two recovery models converging, like the two polished granite surfaces of the Vietnam Veterans Memorial in Washington, D.C. -- the Wall -- and meeting at a sharp vertical line. Veterans in our VA program and members of the treatment team travel to the Wall together annually. This trip joins the universally human potential for spontaneous recovery with our intentional VA treatment program for complex combat PTSD. The Wall itself is but one example of healing through community -- self-organized Internet e-mail groups are another. In Part Two, with their permission, we shall listen in on one self-organized e-group as its members attempt to come to terms with the suicide of Lewis B. Puller, Jr., whom some knew personally, but most knew from his Pulitzer Prize autobiography, Fortunate Son: The Healing of a Vietnam Vet. His suicide turned this upbeat book title into a kick in the stomach. Here we are able to witness one example of the communalization of grief -- no one in that Internet group had to go through it entirely alone. As a nation and as individuals we are still grappling with Vietnam, emotionally, philosophically, and spiritually. This is not a closed chapter. Homer's lyre is silent in Part Two, but memories of ancient Greece and veterans' wisdom from the intervening centuries are not far away. Athenian war memorial practices, such as inscribing names of the dead in the kerameikos, classical Athens's military cemetery, are reflected on the polished surface of the Wall and of community memorials all over America. Part Three calls for prevention of psychological and moral injury in military service. The public needs to know not only what measures will prevent psychological and moral injury, but why, and also how these measures will affect the ability of our military services to do what we ask of them. In the course of my travels in the active duty armed services as a missionary on prevention, I have learned that the very same measures that prevent injury are also combat strength multipliers. So why aren't we doing them? The leading preventive psychiatry recommendation is to keep people together through training, into a fight, and home again. Most citizens know very little about the administrative side of the military, but if they know one thing about personnel policy in the Vietnam War, they know that individual soldiers were rotated into the war zone with strangers and home again with strangers, to catastrophic effect. Yet with the partial exception of the Marine Corps, we are still shuffling and reshuffling our units like decks of cards, just as we did in Vietnam! Army Major Donald Vandergriff's compelling and meticulously researched history of the American military personnel system, called The Path to Victory: America's Army and the Revolution in Human Affairs, gives the full history of how we got where we are, shows the dangers and incredible human waste of the present system, and explains how the system can be renovated. The most compelling need for renovation comes from the mismatch between the units and leaders that the system creates and the changing face of warfare in the twenty-first century. The most fervent wish of the veterans I serve is that future kids not be wrecked the way they were wrecked. The public must hear about matters of military personnel policy that are rarely discussed with outsiders. The most effective prevention lies almost entirely with better military practices, and does not place mental health professionals in center stage. Health professionals may often be able to stop injuries from becoming fatal, disabling, or permanent, once they've happened. Preventing the injuries in the first place is beyond their power. That is in the hands of the line leaders and trainers and of the policymakers. By the end of this book I hope every reader will know the mantra -- cohesion, leadership, training -- and demand policies that produce skilled, cohesive units and competent, ethical leaders. Since their voices were heard in Achilles in Vietnam: Combat Trauma and the Undoing of Character, my patients are intensely proud of contributing to public knowledge about war, particularly the measures that can be taken to reduce and partially prevent psychological injury in war. While Homer has little to contribute to our understanding of modern military training, the poet is brilliant on the subject of military cohesion and leadership, two critical legs of the prevention tripod. Homeric scholar Johannes Haubold goes so far as to say that the relationship of leader and his people is the common theme linking the Iliad and Odyssey. Part Three compares Achilles and Odysseus as military leaders, and Odysseus comes off very badly. The details of Odysseus' performance as an officer read like the charge sheet for his court-martial. The problem was not competence, but character. So even here, in the most improbable setting of a call to renovate modern military institutions, we shall discover new meanings in a poem more than twenty-five centuries old. The great scholar of the Odyssey W. B. Stanford wrote, "One must be prepared in advance for some remarkable differences of opinion on the moral worth of Ulysses. No other classical hero has been the subject of so much moralistic controversy." I add to the "moralistic controversy" in this book, both because I see the figure of Odysseus through the eyes of those who might have served under him, but also of those officers today who are responsible for selecting, training, and promoting American military leaders. Their judgments on his conduct are likely to be even harsher than my own. You already know that this book is written in a "personal voice." I don't, or won't, or can't hide behind an expressionless mask of professionalism. But this personal voice is somewhat different in each of the three parts of the book. The voice of the first part is the labor-of-love voice, telling readers about veterans, about the Iliad and the Odyssey. In Part Two I notice that my voice changes because I am also trying to persuade my professional colleagues in psychiatry to think differently about what psychological injury is and how best to assist in recovery from it. At the same time, I have seen the enormous value that basic education on trauma can have for veterans and their families. Part of my personal voice here is influenced by the immensely moving experience of seeing a veteran or his wife grow visibly lighter as the burden of freakish stigma lifts. In Part Three, I address military professionals and the policymakers who are their bosses, and, most important, the American people, who are their boss's bosses. It is an effort in democratic persuasion -- because I have authority over no one but myself. Part of this effort stems from the soul satisfaction I get as a missionary for the veterans I serve, and part comes from my determination to be a citizen, not an idiot. According to classical scholar Tom Palaima, "Originally, the Greek word 'idiotes' meant 'a man who attends to his own concerns.' The Athenian leader Pericles, according to Thucydides, used the term 'idiotes' of citizens who focused on their own affairs and were ignorant of the important issues facing the city of Athens." All of these audiences -- high school and college students, teachers, combat veterans, veterans' families, mental health professionals, and military professionals -- are fellow citizens, vital parts of one another's future. Copyright © 2002 by Jonathan Shay Excerpted from Odysseus in America by Jonathan Shay All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.