“It’s good to know that I’m not alone.”
A half dozen dark-suited men nod somberly in fraternal understanding. They stand outside under a gray sky, clustered next to a cemetery in the quiet intimacy of the mutually bereaved. The speaker is one of their own, a decorated Marine veteran of multiple combat deployments to Iraq. He now struggles to assimilate into the genteel culture of a prestigious Florida university.
Combat had been difficult, but he expected that. That’s what Marines do. But school? School is an entirely different beast. School is where you chase girls, party, and maybe go to class once in a while. Fresh-faced kids straight out of high school do it by the casual thousands every fall. So what’s his problem? Why does he have such a difficult time fitting in?
The military does a fine job of training men to go to war. It does an awful job of training them to come home.
The gusting winter wind snatches a humorless laugh from the speaker’s lips and dashes it against the headstones. “Every night I drink myself to sleep. And I think that I have to be the only one—that no one else could possibly be having the same problems that I am. Panic attacks. Trouble sleeping. I push everyone away, only to realize how much I love them once they are gone. ” His downcast eyes focus on the gray pavement of the country church parking lot. A handsome, outgoing man like him is unaccustomed to feeling like an outcast.
“I talked to James’s mother last night at the viewing. She described his symptoms, how he fought against PTSD since he got back from Iraq. It sounded like she was talking about me.” He raises his head and jerks it in the direction of the gleaming casket.
“That could have been me.” Then, slowly, “that could be me.”
Killed In America
James “Rooster” Dixon III was killed by a State Police SWAT team on the steps of his house early on a quiet Sunday morning in Baxley, Georgia. The Purple Heart recipient left the Marines after his third combat deployment to Iraq and went on to earn his MBA at Georgia Southern University in the spring of 2011. But friends and family noticed a sobering difference in the once gregarious and still tousle-headed veteran: although James had left the service, the effects of his service hadn’t left him.
James sought treatment from the VA for his Post-Traumatic Stress Disorder (PTSD), but was unable to shake the constant anxiety and depression that are hallmarks of the disorder. On February 19, 2012 James decided to end his struggle by walking into the bullets of law enforcement: as much a casualty of the war as any service member who died in Iraq.
I served with James during the bloody desert campaigns of Al Anbar Province in the spring and summer of 2005. Although we served in different platoons, his thick drawl, easy laugh, and perpetual shock of unruly hair made “Rooster” stand out in my memory. He was a friend to many and a good Marine. The loss of such a dynamic, joyous personality to the cumulative effects of PTSD is a tragedy which should sound warning bells in a society that has very little idea how to properly reintegrate its returning legions.
Walking with a Limp
One of the reasons America fails to properly reintegrate returning veterans relates to a flawed understanding of the nature and effects of combat-induced PTSD. We—the military included—treat it like some strange psychological malady: as if it is a mystery why normal men sent into horrific, abnormal circumstances come back changed. Science documents and history affirms the cause and effect between combat and PTSD. Despite this ancient link, our medical and psychological professionals have only recently begun to understand the disorder in a way that might yield effective treatments.
Post-traumatic Stress Disorder classifies as an anxiety-producing disorder that is the result of exposure to a psychologically traumatic event. Its features last beyond 30 days and are often difficult to diagnose and even harder to treat. While anyone exposed to a traumatic event – such as a car wreck or sexual assault – can suffer from PTSD, combat veterans are a favorite case study of medical professionals due to the veterans’ prolonged exposure to terrible events.
Behavior modification is the signature “limp” of veterans who struggle with PTSD. I’ve walked with that limp for more than five years. Veterans with PTSD aren’t sure what’s “wrong”—we only know things aren’t right. As common situations trigger the same unbidden, unpleasant response, we adapt our behavior to avoid those triggers. When we can control a situation we feel safe. When we can’t, we avoid it or sedate ourselves. For veterans, PTSD is inherently an anti-social disorder.
You can spot veterans suffering from PTSD as they sit uneasily in the back of classrooms, shift uncomfortably on the edge of pews, and scan the room nervously at family gatherings. Alcohol often becomes the unofficial medication that allows veterans with PTSD to feel “normal” or to relax. The cultural stereotype of the drunken, homeless veteran rests squarely on many cases of sad reality.
Shortly after I returned from my second combat tour in Iraq, I visited a local home improvement store near Seattle. Carrying a list of needed materials—and filled with boundless enthusiasm—I thought nothing of entering the cavernous structure as I had a dozen times before. But this time, something felt different. I was uneasy, on edge. I pressed on, ignoring the increasing sensation that I was unsafe.
As I walked down a narrow aisle filled with tools and yard implements my entire world suddenly shifted under a pulsing wave of nauseous fear. The comfortable space around me disappeared as my self-confidence and sense of security crashed to the floor like abandoned armor. I felt unprotected and out of control. Every person became a threat. Sounds, smells, and the glaring overhead lights passed unfiltered through hyperaware senses to assault a brain in overdrive. One instinct overrode any rational thought: Get out! Shoving a few unpurchased items onto an unseen shelf I strode blindly to the exit. Ten minutes later I huddled in my truck, tears streaming down my face as I drove home—unable to understand what had just happened.
Episodes like this became more frequent in the ensuing years. I became a functional recluse—avoiding social situations and new experiences that might trigger a panic attack. Friends and acquaintances got accustomed to me declining their invitations to socialize. Eventually they stopped asking. I drank heavily and destroyed romantic relationships in a depressing cycle of thrilling novelty, fear of entrapment and cold dismissal.
After three years of struggling with the symptoms of my unknown malady, I chose to leave the Marine Corps. On my way out the door, the VA finally diagnosed me with combat-induced PTSD. I moved to Georgia and began working at a small nonprofit while pursuing a Master’s Degree at UGA. To my surprise—and frustration—education has become a grueling experience in endurance. Trapped in a classroom for hours at a time, I fight the urge to get up and pace. I find it difficult to focus and frustrating to deal with concepts and ideas when all I want to do is take action. When I look to my left and right and see students happily engaged in conversation and the process of learning, I fight the urge to compare myself with them. And yet we are different: I have a disability as a result of combat—they do not.
Pretending to be unaffected is like asking a man in a wheelchair to get up and walk.
A Wound by Any Other Name
Civil War veterans knew PTSD as “Soldier’s Heart.” The twentieth century saw a new type of total warfare that relied on intense shelling and close combat for weeks at a time. During the world wars, “Shell Shock” and “Battle Fatigue” accounted for more medical evacuations from front-line units than did physical wounds. However, in spite of the prevalence of PTSD, combat veterans rarely heard that what they experienced was normal. The military warrior culture—specifically, the infantry—had a difficult time stomaching the idea that combat has a psychological impact on even the toughest men. Soldiers suffering from PTSD were often ostracized as “weaklings” and sometimes disciplined for cowardice or dereliction of duty. As a result, many veterans simply returned home and never talked about their experiences. Alcohol became the socially-accepted drug of choice to numb the pain and get on with life.
The Department of Defense and the Veterans Administration—as stewards of our current and former combat veterans—have made admirable attempts during the current wars to educate and assist combat veterans who have PTSD. Unfortunately, the VA’s “National Center for PTSD” website downplays the seriousness or scale of the problem. It suggests that few people experience anxiety more than four weeks after a traumatic event, and that many of those who do will recover quickly. Such a minimization of the problem leaves open the idea that some—perhaps many—men in combat are able to return to society with zero physical or psychological repercussions. My experience—and the experience of hundreds of men with whom I served in the war—flatly contradicts such an idea.
The bravest and most competent combat veterans that I know suffer from PTSD. One friend is a Marine officer who was shot through the shoulder by an insurgent sniper during a firefight in Iraq. Picking himself up from the ground and dripping blood onto the radio handset, he calmly called in his own medevac. He was—and is—a tough, personally courageous man. He now serves at the Marine Corps’ professional-level school for company-grade officers and is concerned at the lack of dialogue about the reality of PTSD. “There are only two of us that have even talked about it, although there must be dozens of other officers in the class who suffer from it,” he says. We—he and I—share a concern that the military is continuing to promote a culture of denial about one of the basic consequences of going to war: personal combat against an enemy often produces PTSD.
The military and VA label PTSD a “service connected disability”—just as they do for carpal tunnel syndrome and sleep apnea. This does little to validate veterans who suffer from the long-term effects of their combat service. Combat-induced PTSD is not simply a service-connected disability or an unpredictable mental disorder: it is inflicted by the enemy during combat and results in biochemical changes to the brain. It is, in fact, a physical wound with psychological effects. Mislabeling it leads to a perpetuation of stigmas, the marginalization of its sufferers, and misdirected treatments.
Why do we fail to classify veterans with PTSD as combat wounded? I suggest that the reason has less to do with logic and more to do with the emotions surrounding a small bronze portrait suspended from a narrow purple ribbon.
Purple Hearts for PTSD?
I often heard Marines jokingly refer to the Purple Heart medal as an “Enemy Marksmanship Badge.” It signifies neither valor nor exceptional performance under pressure; yet it has been coveted by combat veterans since its inception because it serves as a visible symbol of contact with the enemy and of the cost of that contact. To receive the Medal, a recipient must meet stringent requirements.
It was not until midway through the wars in Iraq and Afghanistan that the requirements were modified to include Traumatic Brain Injury due to the prevalent use of Improvised Explosive Devices. Most of us who experienced combat in those wars also know of individuals who faked a concussion or failed a cognitive test after proximity to an explosion, in order to earn the Purple Heart. Such individuals are sad and repulsive—they do not deserve the lifetime of benefits that accrue to Purple Heart recipients. But far more veterans earned the Medal by dint of personal sacrifice at the hands of the enemy.
Would it be appropriate to award the Purple Heart to veterans suffering from combat-induced PTSD? I argue that it would. One of the only treatments that consistently reduces the effects of PTSD is community. That’s why combat veterans gather at reunions, over drinks at the VFW, and sometimes next to sad little cemeteries in rural Georgia. Interaction with others who share a common, unseen malady promotes healing through identification and the ability to safely emote.
Communities are where we feel safe. The military—a place where a common culture and purpose unites members from various backgrounds—stands as perhaps the greatest community of all. When veterans with PTSD leave the service, they often leave the only community where their condition is common and their service honored. While it is difficult to maintain that sense of community after leaving the service, veterans with PTSD could be afforded a permanent, visible badge of pride—a stamp of approval—and identification with that community which they have served so well. We could award them the Purple Heart for their wounds suffered in combat.
Some will argue that awarding the Purple Heart to those with combat-induced PTSD will “water down” or make the medal less meaningful. Really? Franklin Roosevelt’s Executive Order 9277 in December 1942 stated that the medal was to be awarded to persons who “are wounded in action against an enemy of the United States, or as a result of an act of such enemy, provided such would necessitate treatment by a medical officer.” Denying that combat-induced PTSD fits Purple Heart award criteria is disingenuous and misleading. I pray that our leaders in government and the military come to see the real cost of war. I pray that society will have a visible means to identify those who have sacrificed in defense of our Nation, rather than relegating them to the fringes or sequestering them to the shadows.
Until we correctly label combat-induced PTSD as a “wound” suffered from contact with the enemy, we as a society will continue to view its sufferers as a shadow legion of men with strange habits and questionable character. We will not methodically identify the trauma, apply medical treatments, and provide appropriate rehabilitation and therapy during the recovery process. In short, we will draw distinctions between segments of combat veterans based on an arbitrary and antiquated determination that only the visible wounds of war are worth recognition, honor and treatment. Such a view will not be helpful to the thousands of combat veterans waging a daily war within, nor prevent some from ending that struggle before victory is won.
In the meantime, those wounded with PTSD—men just like James Dixon III—should take comfort knowing that you are not alone. We—you and I—march together as a Legion of Shadows.
Let’s help each other to the light.
(Note: For those suffering from PTSD, there is help and hope. We will explore PTSD and its treatments in greater detail in a future article. If you feel hopeless and lost right now, reach out to a trusted friend and allow them to help. Or call the Veterans Crisis Line at 1-800-273-8255 and press “1”. We are all in this together and we can win this fight.)