March 31, 2013

I Have a Partner Not a Caregiver: I Would Be Lost Without Her But I Don't Want Her to Become My Nurse

This is the QB armband I wear to help me remember chores.
The last thing I would ever want to be guilty of is calling for a ubiquitous model for the household division of labor, but the breadwinner family model doesn't always match my values. When I left the Army I never cited PTSD, but I did cite the inflexibility of the Army's career track for officers. Specifically the common process of moving every three years made it impossible for me to support my spouse's career ambitions. Despite the fact that my first wife left me while I was hospitalized for PTSD and mTBI, I am still grateful that this decision has ultimately let me support my wife's career.

Despite my best ambitions I am terrible at doing my share of the household chores. I think that this is common amongst veterans. Terms like caregivers have arrived primarily because some injuries are so severe that they do require full time support, but also because PTSD makes it hard value non life threatening phenomenon. Let's face it, after war most of our brain power is used to analyze perceived threats. Doing the laundry on time is hard when we constantly feel threatened.

But we have learned to never to make excuses and this was the very reason I left the Army. I have always wanted to support my partner's career as much as my own. A breadwinner model family may work for most veteran caregiver relationships, but this does not always recognize how our country's values have changed to provide equal career opportunities for each sex. More importantly, I prioritize values and this is an area in which I am falling short of my own expectations.

Like many mTBI sufferers I often find myself in a room with no idea why I am there or on the trail alone with no idea how long I have been there. I have come to realize that my memory is only reliable when I consistently pattern my behavior and have constant reminders. Specifically, I have had the most success by replicating the way I inspected equipment prior to combat. My mind's focus on threats still recognized this need and the behaviors I designed after suffering from mTBI work well. I have tried cell phone alarms, an iPad calendar, chalk boards, a PDA etc., but none worked in long term. I think it is because my battlefield mind doesn't focus on those that I never used in combat.

Recently, I have gained a better awareness of my memory lapses. My watch broke and I temporarily borrowed my wife's. While it had the date, it did not have the day of the week on it. Sometimes I used my phone, but more often I would simply forget what day it was. I missed numerous appointments until I got a new watch. I was still forgetting household duties because I had a written schedule that wasn't readily available. Keeping my syllabi open on my desktop prevented schedule mistakes with my course, but this did little to help outside of the classroom.

My ROTC Cheat sheets helped me with memory.

Like the difficulties I have grasping my own identity and my forearm tattoos, I realized that I always kept important tasks and grids on my non-firing forearm with my watch. Any graduate of Ranger school knows how to constantly check their watch, no matter the stressor, so they can get off the objective before artillery is called on your position. I began to realize that I constantly lose track of tasks because I am startled, but no matter what I checked my watch. If I used the same quarterback style armband that I did on raids (I actually rested my map there most often), then I might do a better job keeping up with my chores.

I don't know how this going to work, and I was reluctant to embrace method because it would visible to everyone. However, I have done more permanent things to my body to fight for other aspects of my identity. Being a supportive husband is also a vital aspect of my identity, and I have begun to realize that I need to do whatever it takes. For me it is more important to have a partnership with my wife than have someone who cares for all of my needs. I may not be able to keep up with her all the time, but it is important to me that I do all I can. If I can write this blog and display my life bare before this audience, then I can wear something on my wrist that might be a little embarrassing.  If I want to be great partnership, then I have to employ the same strategies, with the same vigor, that I do to define who I am or use to support my comrades in arms.

The home cannot be a front we leave closed simply because it is harder to care about washing the dishes when you've held human viscera in your hands. Our partners can be so important to our well being and we should not concede this ground even when they are rushing forward to care for our needs and support us however they can. Most importantly, we can't let our spouse become our nurse at the expense of intimacy, romance and spontaneity. I personally value the deeper connections that are made in a partnership more than I could benefit from any treatment regime, and I am hesitant to ever yield the title of wife/partner. Some veterans will never be able to contribute to their household chores and I am lucky to contribute: it is a privilege I should appreciate rather than abandon just because it has become difficult to make it a priority. Growth doesn't make a lot of highlight reels or montages in action movies, but the way we manage our homes is vital to our relationships. It is not the stuff of movies, but is the substance of a healthy relationship. In a pragmatic sense, my relationship with my wife is what kept me going when things started getting dark, and all I could think about was suicide. Though it requires work and daily effort to support her, the payoff is significant for both of us. More importantly, making my wife happy makes me feel good and real achievement is measured in how you treat your family, not medals, scare badges, plaques, number of combat missions, etc. Mission focus can never make us forget that we have no greater mission than supporting our loved ones whatever family model reflects our values.

March 3, 2013

Fighting the Battle For Your Indentity One Tattoo at a Time

The work of Jonathan Shay, on the Odyssey and the Iliad, illustrates the long history of the phenomenon of PTSD. Shay cataloged Odysseus's effort to return to an immemorial sense of home. Though I value the majority of Shay's claims, and I applaud his life long commitment to helping veterans I am however, troubled by a few of the approaches he has taken into his study of PTSD. He seems to wipe away all of the chauvinism in the Odyssey and in veterans as if it were caused by PTSD. This has real problems because, as this blog shows, women in combat are actually more likely to have PTSD because the increased risk of sexual trauma. Moreover, he portrays PTSD as a completely determinate condition that a veteran cannot be self aware of or win his internal battles. Certainly these symptoms are hard to shake and are permanent, but as veterans we do have power to fight for our identity and preserve themselves.

I think a key obstacle in retaining the best parts of our identity is breaking away from the aspects of the immemorial homeland. Certainly at war we use the concept of home as place for our minds to escape the harsh realities that we lived in. I often wish that instead of the figure of Odysseus we looked at the life of Aeneus. He was a Trojan figure who lost his homeland and was forced to rediscover and redefine one after the Trojan war. I wish that instead of trying to regain a sense of the immemorial home, we would struggle to redefine our home after war has changed our lives, and preserve the best parts of our identity and our values.

One way that I have fought for my identity, both consciously and intuitively, has been with tattoos. After the suicide bombing I slowly recognized that I could not feel anything but anger. I noticed that I could not develop a close relationship with anyone (accept other people in my unit) and I was becoming an individual obsessed with instincts and self preservation. I tried to go to church, but all of the silent prayer made me have flashbacks (my first serious flashbacks came at services) and all I could do was sit there and be angry. I could sense that I was loosing who I was and my value system. I had experienced other veterans who began to think of all Arabs or Muslims as terrible. I feared that I might lose my moral compass because of how angry I consistently found myself.

Team RWB
I had seen and experienced what it was like to watch a man's life end and I was afraid that I could never forgive myself if I ever took an innocent life. As a person raised in a religious evangelical family, I was a faithful person. I could no longer endure church services, but I wanted to express my values in a way that would constantly remind myself who I was. I started by expressing the hopes that I would never taken an innocent life by tattooing a double edge sword and the words god's breath on my firing arm. I could effect what I could effect, but I desired divine intervention every instance that I used my weapon. I had a great desire to never be the agent of the horrible things I saw after the suicide bombing.

There was something really freeing about that experience and it made it easier to grasp who I was. PTSD as a culturally negotiated and defined soul challenges our ideas about our self, but as a simple neurological phenomenon it damages the place in our brain that manages conscious memory, and identity. Both have extreme impacts on our lives so tattoos can become powerful reminders of who we are when the world that we know falls apart. I recognized the utility of wearing my values on my sleeve so when I was having trouble conceiving of them so I permanently placed on my body.

I recognized that with grace and perseverance that any storm could be weathered. There was a simple solution. I tattooed the words on my forearms and recognized that my greatest resource was myself. The left forearm would be perseverance because "the first rule in a knife fight was that you are gonna get cut, get cut in the left forearm" and reinforced my desire for divine help with grace on my firing arm. I deployed again and it was the worst year of my life. I had serious PTSD and mTBI, but I was officer and lives depended on my performance.

I was broken and worn down, but I had my values on my sleeves. My attitude was terrible but my performance never waned. I could perform my job, but everything was painful. I left the Army bitter and alone. I began blaming myself and thinking that is my fault that I had succumb to an invisible wound. I began to believe that I was letting soldiers down in Afghanistan. I should be better by now, right? No one would ever concede that I even had any problems because I was articulate and I was in shape. No visible wounds.

I began to really despise myself and believe that it was my fault. I was weak, a coward, or immoral. Three tours in Iraq as infantry platoon leader and Iraqi Army Operations officer was not enough service. I was letting my country and soldiers down. I was training Cadets and no matter how well I did by winning the top instructor award, I was not doing enough. I was not on the line fighting, keeping soldiers alive, bringing drinkable water to villagers, and safeguarding civilians. I could do more, I thought it was my fault that I was no longer fighting. Their was something wrong with me.

But this was bullshit. Sure the feelings were strong and survivor guilt is unshakable, but my logic was absurd. I had done everything I could, fought as hard as I could, and longer than most in my situation. An army officer who fought on the line for 20 months before company command is more than rare. An ROTC instructor who despite serious medical issues won the top instructor position has done enough. A historian working to challenge the notion that PTSD has existed and been a problem for every generation of American veterans is still producing fruitful work and still serving soldiers. Nothing was good enough so I  had to step outside of my emotions and look at what I contributed on paper. In writing.

Just like when my world first collapsed I had to give myself a visualization, on my body, that this was not my fault and in a lot of ways I am better. I was beginning to become open unashamed and even in ways proud of my struggles after my service in Iraq. I read Hemingway's "The world breaks everyone, and afterwards, many are strong at the broken places." Though I did not yet feel strong, I again decided to fight for that idea. To place it on my body as commitment to myself and my identity. I also wanted to to use Hemingway because, in the end, he lost his battle with mental illness and took his life. I wanted to be reminded that even in a victorious idea that we, who have had our identity challenged by the crucible of war, have to fight everyday to preserve ourselves in spirit and in body. That this is both a neuro-chemical battle and fight for our own souls.

There is nothing wrong with anyone of us who struggle to come home. Tolkien's famous "not all who wonder are lost," is such a fitting metaphor for the long road home. I think it is a never ending battle to preserve our identities and I would challenge others by stating that the fight is worth it. If you have this conflict your are not alone, this is not a new problem, you are not weaker and the world needs people who have been broken by trauma. Tattoos are culturally ubiquitous in our generation but they can be a kind of cognitive therapy. An idea that you choose to embrace, even when you don't initially feel it, that changes patterns of behavior and eventually emotions. We can only spend so much time with our therapists, but our greatest resource is ourselves. So fight for yourself as hard as you fought for your country.

I would urge others to share their tattoos stories in the comments.