The best, most healing thing you can do is just listen. Don’t say “I know how you feel”, because you don’t. Don’t interject your feelings, don’t say you support the war or don’t support the war, because you don't know how we feel about it. Don’t say it’s just like "Call of Duty", because it’s not. "Om" and "kumbaya" don’t help.
The worst thing you know here is maybe a car accident or a mugging—that's not comparable. Put all your possessions and all the people you care about in one house, and then set it on fire and watch it burn while people are shooting at you from all around—then maybe you understand. And if you can go through all that without the memories tormenting you, then you’re stronger than any soldier.
Just listen, and say, "I wish I could have been there for you to help and support you".
--"Jason", veteran of tours of duty in Afghanistan and Iraq, wounded twice and now living on a disability pension
Source: http://1.bp.blogspot.com/-MX0OVAYrN1E/T0Lx4qkaGYI/AAAAAAAAAxA/0PWxeTFsPug/s1600/O+Brother+Where+Art+Thou-01.jpg accessed 10 March 2012
In the 2000 film, O Brother, Where Art Thou, filmmakers Joel and Ethan Coen borrowed the basic plotline of Homer's Greek epic story-poem the Odyssey: a small number of men, led by a charismatic main character, confront massive obstacles in a determined journey home from a traumatic experience.
Of course, in that film the journey was played for laughs. so much of the shocking violence and intense struggle of Homer's original story was watered down--even though the Odyssey's emphasis on building relationships and telling stories to one another was retained.
However, the film does resemble the original epic in one respect that's easily missed.
Odysseus and his shipmates are on their way home from the Trojan War (covered in Homer's other epic story-poem, the Iliad), an arduous experience that they surely spent time recounting during their many years' voyage back to Greece.
But in the same way that the characters in the film don't spend much time talking about their experiences in prison--it begins with them escaping from their chain gang--even the characters in the Odyssey aren't shown having those discussions about the Trojan War.
It's reasonable to assume they did have them, but Homer--with his fine eye for what ancient Greek audiences would have found sufficiently dramatic--concentrated on the high points of encounters with monsters, sirens, disasters, and politics back home.
Everyday conversations among the rank-and-file soldiers ended up on Homer's cutting-room floor. Even today, we're accustomed to the idea that such "ordinary" drama as how one is affected by the violence of war doesn't rise to the level of entertainment.
But for those of us lucky enough not to have known war, just because we're not typically shown such ordinary drama in our entertainments doesn't stop those events from being extraordinarily consuming for those who lived them.
Over the ten years of the Odyssey, the crew had a lot of time to talk, decompress, tell each other their stories, and deal with what had happened to them, and to those they cared about, during the war.
Even as recently as World War II (1941-1945 for American combat involvement), getting to and from battle took days or weeks on board troop carriers traveling to battle and then traveling home.
Source: http://upload.wikimedia.org/wikipedia/en/d/d0/USS_McCawley_landing_rehearsal.jpg accessed 10 March 2012
On the voyage home to people who had not seen what they had witnessed, the troops could talk with each other about it. They could validate each other's perceptions, express their feelings to one another, and, generally, prepare to reintegrate into a very different world from what had been their recent reality.
That process began to change during the Vietnam War, and it is now literally possible for returning veterans to be back in their home country within hours of having been on the battlefield, and back home to their friends and loved ones--few, if any, of whom have shared their experiences--within days or a couple of weeks.
Returning home from war can now be trivially easy, in the physical and logistical sense only. Someone else makes the arrangements, and soon you're on a plane heading home.
But what often goes unrecognized is that, in the relative ease and convenience of returning home compared to the case in previous wars, the opportunities for sharing stories, building and reinforcing relationships, and hearing your experiences validated by others who witnessed the same kinds of things you did--these are all lost in transit.
Like its simpler relative the dilemma (δι-/di, "two" + λημμα/lēmma, “premise, proposition”), a trilemma is a difficult decision point.
The difference is how many problematic options you have to choose among. Odysseus was confronted by a dilemma (two options) in trying to find his way home from war with his ship and his crew. As Wikipedia describes it:
Scylla and Charybdis were mythical sea monsters noted by Homer; later Greek tradition sited them on opposite sides of the Strait of Messina between Sicily and the Italian mainland. Scylla was rationalized as a rock shoal (described as a six-headed sea monster) on the Italian side of the strait and Charybdis was a whirlpool off the coast of Sicily. They were regarded as a sea hazard located close enough to each other that they posed an inescapable threat to passing sailors; avoiding Charybdis meant passing too close to Scylla and vice versa. According to Homer, Odysseus was forced to choose which monster to confront while passing through the strait; he opted to pass by Scylla and lose only a few sailors, rather than risk the loss of his entire ship in the whirlpool.
Sometimes, a trilemma (τρί-/tri, "three" + λημμα/lēmma, “premise, proposition”) is nothing more than the addition of one more monster to choose among.
But often, the special nature of a trilemma lies in the nature of the relationships among the options themselves, and what those relationships do to the decision-making process.
There's a saying in the software industry that illustrates these relationships among options to choose from:
"Fast, cheap, and good: pick any two."
What that saying means is that the combination of any two of those options automatically excludes the third.
So if you want your software to be released fast, and to be of good quality, you can't have it be cheap, because you will have to put a lot of expensive extra resources into getting good quality in a short time.
You can have your software be good and cheap, but in that case you can't have it fast--instead of investing those expensive extra resources, you will have to demand a lot of extra work in quality assurance on the part of the regular team, and that extra work will necessarily take a great deal of time.
Or you can skip that quality assurance, and have a fast release of cheap software, but in that case, you skimp on quality and sacrifice good.
That's a classic example of the nature of a trilemma--not usually so much that you have to choose one of three bad options, but that you have 3 desirable options that conflict with each other, and you have to choose which option to sacrifice in order to keep the others.
But what if you're in a much worse situation, and rather than getting two out of the three things you want--a frequent enough situation in the course of normal life--two of the three things you want have gone away, and it's a struggle just to hold on to the last one remaining?
In a workshop in Seattle yesterday, sponsored by the Veterans Training Support Center at Edmonds Community College and led by Lori Daniels, we talked about what we civilians back here at home can do to be supportive of veterans returning from war and dealing with physical and psychological trauma.
Lori presented a view of multiple dimensions of loss experienced during trauma, such as, among others, the physical loss of friends to violent death, as well as multiple losses on an emotional level. She brought up the book Loss of the Assumptive World: A Theory of Traumatic Loss by Jeffrey Kauffman as a useful resource.
I'm paraphrasing her interpretation of a book written by someone else and that I haven't read myself, but I think this description is pretty faithful to our discussion yesterday.
Kauffman writes about the loss of self-worth that happens in trauma, describing it as a trilemma facing the person who has experienced the trauma, although I would be surprised if he actually uses the word "trilemma".
He states (again, paraphrased and filtered through 2 different people) that, as humans, we tend to share 3 foundational assumptions about the world around us:
The world is organized in some capacity, and events in that world happen for a reason;
The world is benevolent and good, and good things happen to good people and bad things happen to bad people; and
The self is worthy of being loved and accepted.
He proceeds to describe how trauma "annihilates" (Lori's term for his description) 2 of those assumptions:
Trauma is random and unpredictable; uncontrollable and unorganized; and
Bad things happen to good people.
It is impossible to prepare emotionally and psychological well enough for that—we're just not wired that way.
So something has to be done on a psychological level in order to bring the system back into order.
In the old days, in the company of others who knew what each other had been through, there used to be an opportunity to validate each other's perception over time in the sharing of stories. Now, when you can be home within hours of being on the battlefield, that particular opportunity is no longer there, and other opportunities have to be found or created.
Kauffman describes how, if a trauma survivor contains the experience and feelings inside without disclosing, or if that survivor gets shut down by others for disclosing, then they have to contain experience and solve the conflict among the three foundational ideas all by themselves.
Their task is to navigate the ordinary world with this trauma experience behind them. But there is now an inherent conflict in the 3 ideas, because what they've seen makes it clear that bad things do happen to good people.
That realization means facing the prospect of the horror that is a chaotic, unpredictable, uncontrolled world around us, where bad things happen to good people, and undeserved good things go to bad people, for no reason at all.
But the image of the world as a reasonable, organized place, where the correct things happen to the appropriate people can be regained--but that restoration comes at a tremendous price.
If the trauma survivor lets go of the assumption that their self is worthy, they can regain the other two assumptions in that way.
If you judge yourself as unworthy, someone who failed by making the wrong decisions, that bad things happened to good people only because you yourself blew it, then you can regain other two assumptions, recapturing the idea of a fair world, by sacrificing the idea of yourself as worthy of love and acceptance.
A large part of recovery, then, is the problem of how to bring back the worthiness of one's own self while still managing to navigate a random and crazy world around us.
Again, this is not my original interpretation. I am paraphrasing Lori's presentation of Kauffman's work, and any errors in representation here are totally my fault and not theirs, since I have not read the book for myself in order to interpret and present it. I will put it on the task list, so that my informed interpretation can serve as a resource here at POEM in the near future.
My interest in taking this series of free workshops (and I will put an enthusiastic plug in here for them as they are an excellent and fully-open resource; if you're anywhere near enough to Seattle or Lynnwood to attend, I recommend them whole-heartedly) is in learning how MTs can be of more effective service to returning veterans, and in making that knowledge freely and openly available here at POEM.
Lori is an experienced social worker; she has training and a scope of practice that is not the same as ours, so I asked her several questions about how we could translate this information into something MTs can use knowledgeably, ethically, and within our scope of practice.
The first question I asked was when she said we can provide a service by letting them tell us about their nightmares. I asked what an MT needs to know in order to make sure that we could do that without exceeding our scope of practice and bordering on practicing psychotherapy ourselves.
She responded that we are not practicing psychotherapy if we just listen supportively, without trying to structure the discussion. or to interpret it, or to try to draw out disclosure from the veteran.
If they bring it up of their own accord, during an assessment/history or during a massage, we can reasonably and ethically:
Reflect their disclosure back in a sympathetic and non-judgmental way: "That must have been a very difficult thing to have lived through."
Reassure them that they are safe in disclosing to you--not only will you not betray their confidences and secrets, nor will you reject them for what they went through, but also that they don't have to worry about protecting or shielding you.
Only tell them this if it is actually true, however.
If you really need to believe in a benevolent world to the degree that you are going to meet their self-disclosure with a response like "everything happens for a reason", then it is better to work with different populations.
This is, after all, a population where many of its members need to find their way back to self-acceptance after already sacrificing their own self-worthiness to the ideal of a benevolent world.
If they disclose to you, and then experience that you can't handle it, or that you are judging them, then you can actually contribute to a setback on their part.
Refer calmly and matter-of-factly to our own limitations in scope of practice for being able to help them: "What you're telling me is very moving, and I can see that it's having a profound effect on you. I want to help and be supportive of you, but what we're talking about is outside of what I have been trained to help you with. Have you ever thought about talking to someone who is in a position to help with issues like these?"
Of course, you'll find your own words, but the point is that you are not shying away from either what they tell you (you are not rejecting them), or from your own professional limitations (scope of practice).
What you need to have prepared in advance is a list of resources in your area they can draw upon.
Sometimes, people are skeptical of professional therapists for various reasons, so it is a good idea to include informal peer-support groups, as well as professionals, on your resource list.
You can also have brochures in your office, so that if someone doesn't yet (or ever) feel safe disclosing to you, they can discreetly take one for possible use later on.
Never let anyone just "dump and run", because that reinforces isolation and feelings of unworthiness.
Don't solicit disclosure (because that would be practicing psychotherapy without a license), but if someone does disclose, then acknowledge it, communicate that you appreciate their trust in you, that you do not judge them, and that you want to be supportive (including referring to someone else with a different scope of practice, if that's appropriate).
Don't just let them disclose, and then hurry past it in an awkward way, or laugh it off and change the subject, because what you have communicated then is that you don't want to hear it--and that reinforces their previous injury to their self-worth.
The big secret of trauma survivors is the feelings of unworthiness that accompany the event.
By letting them tell you their nightmares, or other disclosures, if they bring it up and want to talk about it, you can help them to start chipping away at that secret, by letting them know they don't have to keep it anymore.
If it's more than you can help them deal with while staying in your scope of practice, don't be afraid to say so.
It is perfectly ethical to say I care, I want to help, I can do this but not that because I am not trained for it, but if you like, I can help you to look for help from people who are in a position to help you in ways that I can't.
We have the privilege of (literally) reaching people, many of whom--veterans or not--will be trauma survivors.
By learning how we can use our touch skillfully and ethically, we have the potential to be of great service to an increasing number of people living with the aftereffects of trauma.
I hope more of us step up to that challenge, and I hope we share our stories with each other about how we are doing so.
Source: Still picture from the film "now, after (a PTSD/VA autobiography)" by Kyle Hausmann-Stokes, available at http://www.youtube.com/watch?v=NkWwZ9ZtPEI accessed 11 March 2012
(I recommend this film most highly, but before you watch it, you should know that it contains very violent scenes of death and dismemberment where the person's face is visible. You should consider, before you watch it, whether a film with such vivid potential triggers is right for you or not. There is no shame at all in deciding that such a film is too violent for you personally, and deciding not to watch it for that reason.)