Internal Frontiers: Protecting Against a Post-Traumatic Future in a Time of War

By Emily Sogn

On May 8th, the 63rd unit of the 10th Mountain Infantry Division of the US Army returned from 18 months of combat duty in Iraq to their base in Fort Drum, New York. Their journey was a long one – roughly 18 hours of zig-zagging flight time, from Baghdad, to Kuwait, to Brussels, and finally to Drum’s small airstrip just 30 miles from the border of Canada. Troops arrive groggy, yet gruffly elated in the way that only infantry soldiers conditioned to discipline, danger, and each other, can be.

They stride in formation into the gym where family and friends have been assembled for a short arrival ceremony. Flashes of relief and recognition light up faces as parents, husbands, girlfriends, children, and friends meet eyes across the gym’s polished floor. Yet the soldiers are forced to remain in stiff formation for a few lingering minutes as their sergeant leads them through a rendition of “The Army Goes Rolling Along.” The soldiers sing full-throated, shouting almost as if in a parody of wired enthusiasm and pent-up frustration, finally breaking their posture in the last verses to clap shoulders and bob heads in the exaggerated cadence of the tune. The song is soon replaced by whoops and hollers, and the soldiers scatter into the bleachers to begin their reunions. Tearful embraces and longing kisses are exchanged, backs are slapped, and children are hoisted into the air.

After these first poignant moments of arrival, there will be countless abrupt changes that this group of soldiers will walk through in their transition from combat back to civilian life. Private bathrooms, home-cooked meals, the ability to spend time with loved ones and to walk down a city street without carrying the weight of 90 pounds of body armor are the affective artifacts of the spatial and temporal separation between deployment and the return home.

They represent a passage from a highly structured, yet infinitely precarious life-world to another that offers more personal autonomy, safety, and an abundance of small creature comforts that have a new and important value after so long in deprivation of them. Yet to many in the military and in the mental health community, these same signs of apparent normalcy can be read as a threat for a variety of post-traumatic stress reactions that may carry the effects of war’s violence’s into the future lives of service members and their families, friends, and communities for years after their time in active combat is over.

Since the deployment of the first wave of troops in 2001 inaugurating the US-led wars in Iraq and Afghanistan, medical experts and military advocates have warned that this group of veterans is a population uniquely at risk in what has been feared to be an “epidemic” of enduring mental health problems related to the experience of war (Hoge et al 2004).

In 2004, a comprehensive study conducted by researchers at Walter Reed Army Institute of Research concluded that a significant percentage of the soldiers surveyed who had experienced combat in Iraq were showing symptoms of or were at risk for mental health disorders, particularly Post Traumatic Stress Disorder, or PTSD, which is now considered by many in the military and mental health community to be the “signature injury” of the contemporary conflict. The seriousness of the problem was confirmed in numerous subsequent studies conducted by governmental and non-governmental agencies, all of which concluded that anywhere from 17 to 26 percent of the soldiers surveyed who had experienced combat were at risk for PTSD (Tanelien and Jaycox 2008; Auchterlonie and Milikin et al. 2007).

Furthermore, the studies claimed that the unique conditions of the combat in Iraq and Afghanistan compounded the risk. The relatively small size of the all-volunteer military has resulted in repeated deployments for longer periods of time, increasing both stress levels and the likelihood of exposure to violence, either inflicted on one’s own person, or witnessed being done to a comrade, civilian, or enemy. The scarcity of personnel has also necessitated the inclusion of more reserve and National Guard soldiers in active combat operations. While these soldiers do not suffer for lack of proper training for combat, mental health experts claim that their status as civilian-soldiers increases their level of distress at being away from families, jobs, and communities, making them more vulnerable to psychological injury.

Even the advanced technology and efficiency that has prevented so many war wounded from becoming war casualties is said to have increased the likelihood of developing PTSD. Medical experts are particularly concerned about a particular form of head trauma that has been termed “Traumatic Brain Injury.” The prevalence of traumatic brain injury in the current conflict is directly related to the particular kind of combat that exists on the ground in Iraq and Afghanistan. Improvised explosive devices, hidden in cars, roadside ditches, or on the person of an enemy militant are the makeshift, yet increasingly sophisticated weapon of choice among enemy combatants. Along with the potential for severe, often fatal flesh injuries, the high-pressure blasts provoked by improvised explosive devices, traveling sometimes 1,0000(?) feet per second for hundreds of yards, can damage vulnerable brain tissue, even when no formal injury has occurred. Victims of traumatic brain injury can experience a range of acute symptoms after the injury including dizziness, nausea, amnesia, sleep disturbances, and irritability. More distressing however, are a variety of long-term symptoms, many of which overlap with those of PTSD. Cognitive impairments, dramatic mood swings, chronic dysphoria (depression), and insomnia are only a few of the problems that can interfere with a veterans life, long after the initial injury.

Though not all of the many reports that have since been published agree on the exact causes or prevalence of PTSD or TBI, the public health consequences of the studies have been unequivocal: as the conflicts in Iraq and Afghanistan continue far longer and with more casualties than expected, mental health experts and military advocates can and should expect that the sustained conflict will inevitably produce an entire “new generation” of trauma survivors (Auchterlonie and Tanielian 2009). As the war stretches into its ninth year, and the number of veterans is expected to number 1.9 million by the end of this year, this prominent group is provoking a vast restructuring of military health infrastructures and bureaucracies around mental health concerns.

This threat of a distant, post-traumatic future is framed by the American public health community and the wider public culture  as an urgent social problem that requires intervention in an emergent temporal field that has taken on increasing significance over the eight years since the US began combat operations in Iraq and Afghanistan. This peculiar form of time, which exists in the indeterminate space between the foreign terrain of war and the safe confines of the homeland, has recently become an object of concern among an expanding community of mental health experts, military advocates, families, friends, and communities of veterans as well as veterans themselves. It is also the impetus for a growing field of specialized knowledge production and circulation that aim to delineate the boundaries and the contingent possibilities contained within what has been termed the “post-deployment” phase of a soldier’s combat experience.
The problematic character of this transitory space is plainly evident in the barrage of pamphlets, brochures, and briefings that the veterans at Fort Drum and elsewhere will encounter as their service draws near its end. These documents describe “post-deployment” as a time of crucial adjustments that must be negotiated with great care and self-awareness. Offering prescriptive guidance for nearly every aspect of post-deployment life, from how to reestablish healthy and supportive relationships with family and friends, to how to turn their military training into employable skills, they chart out a path towards the gradual domestication of the learned behaviors, skills, and responses that they acquired during their time in combat.

The ideal-typical veteran described in this literature is both lethal and vulnerable. Veterans are encouraged to be reflective, to assess their mental states vigilantly for signs of increased anxiety or aggression, to monitor their sleep patterns and dreams, to avoid excessive use of alcohol or drugs, and to consider carefully the situations in which it is appropriate to bring a weapon. Yet they are also told to be patient with themselves, to allow themselves to experience a certain degree of disorientation and discomfort, that such stress is a normal reaction to the abnormal situation they have emerged from.  In short, they are being taught how to identify and manage an emotional economy in which the future is imagined as always at risk of veering precariously into a space of pathology.

In addition to being objects of a new form of self-consciousness, members of this cohort of veterans are also the research subjects for an emergent epistemic community in which each veteran could be a potential patient or case study. To compound the detailed medical and family histories, psychological evaluations, and resilience training that soldiers must complete in the months leading up to their deployment, returning veterans must confront a new set of exit procedures. Before they are allowed to leave the base, soldiers are required to sit for the Department of Defense initiated Post Deployment Health Assessment (PDHA) the purpose of which is meant to identify those veterans that are currently experiencing deployment-related mental health problems, or who may be at risk for such problems in the future. It is accompanied by an interview with a mental health professional who then tabulates the survey, recommends a form of care if it is needed, and records the data into the veteran’s case history (Tanelien and Jaycox  2008). This survey is to be followed up by a similar one, the Post Deployment Health Re-Assessment (PDHRA) which every veteran is obliged to complete six months after their homecoming, and then again six months later.

Along with this mandated survey, many veterans are asked, but not required to participate in studies by independent research organizations. These forms ask similar questions to the PDHA and PDHRA, but are aimed at amassing much more detailed sets of data. Questions regarding combat experience are broken down into measurable categories of danger and distress. Soldiers are asked to estimate in detail how often they were ambushed, whether they received enemy fire or witnessed the death or injury of an enemy or comrade.

Such techniques of expert and self-surveillance aimed at preventing a post-traumatic future will follow these soldiers into the post-war lives that they build upon whether they continue on in their military careers or depart for other ventures. Many of those who have not yet completed their service will likely be redeployed, possibly accumulating new traumatic experiences which, according to mental health experts, will make their risk of later mental health problems even greater (Tanelien and Jaycox 2008).  Those entering civilian life will enter a contemporary public culture in which the association between violence and pathologies of the future have acquired what Didier Fassin has called an “intellectually and emotionally obvious common sense (2009).” For alongside the public health crisis presented by actually increasing diagnoses of post-traumatic ailments, the idea of trauma itself has become a socially resonant heuristic with which to understand and articulate the affective range of war’s violence outside of the location in time and space in which it occurs.

Historical accounts of militarism and warfare have long acknowledged that the experience of battle can sometimes leave psychic scars on soldiers, even when their physical bodies have emerged unscathed. Yet, while the terms such as “soldier’s heart,” “effort syndrome,” and “battle fatigue” attest to the correlation between traumas endured in the theatre of war and recurrent forms of distress in individual sufferers, none of these previous conceptualizations of the aftereffects of combat have gained the codified and culturally resonant meaning that the “post-traumatic” has in today’s contemporary U.S. public culture.

In the nearly thirty years since PTSD appeared in the third edition of the Diagnostic and Statistical Manual (DSM III, 1980), a large and multifaceted culture of expert knowledge, diverse therapeutic techniques, institutional protocols and public and private mental health structures has grown around the study and management of trauma and its durable aftereffects (Young 1995). While the disorder emerged in a context in which war veterans, Vietnam veterans in particular, were the prototypical subjects, in the following years the possibilities for what can be considered traumatic experience have dramatically expanded, ranging from the most extreme somatic shocks, to child abuse, to the routine psychic injuries caused by enduring structures of racism, poverty, and other forms of extreme social exclusion.

Yet this clinical codification of trauma cannot entirely account for the striking social currency of the ideas about the relationship between experience and memory that make post traumatic states so “thinkable” in this particular historical moment. Indeed, as Kieth Bracken has argued, “the concern with psychological trauma is not only a clinical issue, it would appear that it is also a cultural event,” that presents itself as both an individualized pathology and a new way of interpreting everyday life (2001).

There are many possible genealogies that could be called upon to tell the story of how the twentieth century has become what Shoshana Felman has called a “post traumatic century (Felman 2002).” Anthropologists and other social theorists in the interdisciplinary field of trauma studies have described the emergent social resonance of trauma as a “shared truth” that frames contemporary constructions of social memory. This “paradigmatic discourse” provides a ”dominating metaphor for characterizing the historical epoch of a present” haunted by the pathological iterations of past violences (Fassin 2009).

Theories of trauma have also been treated to a strikingly diverse range of scholarly inquiry, ranging from ethnographic investigations into “social suffering” (Daniel 1996; Kleinman et al. 1997; Das 2008), to studies of traumatic representation and narrative (Pelligrini 1992; Caruth 1996; ; Cvetkovich 2003; Felman 2002) to critical theories of history and memory (LaCapra 2001). In the words of trauma theorist and literary critic Cathy Caruth, theories of trauma naturally lend themselves to the social sciences, because they have the capacity to “extend beyond the question of [the] individual and ask how we can have access to….historical experience, to a history that is in its immediacy a crisis to whose truth there is not simple access (1996).”

The model of the traumatic provides a way to understand the temporal relationship between history and subjectivity, mediated by the delicate framework of narrative as a form of witnessing the repressed truths of the past. For trauma, in essence, is always about time, and the ways in which a specific kind of event carries within it the possibility of disturbing the normative (non-traumatic) flow of time.

Yet, few who write about trauma have turned their gaze towards the temporal plan of future, either the receding horizon of macro-historical teleology or the more tangible terrain of the near future. Theories of trauma, however, always gesture toward a time to come, in the indeterminate temporal space of delay between an event and its meaning.

In psychoanalytic constructions of trauma, pathologies are born out of a collusion between a subject and “any experience which calls up distressing affect – such as those of fright, anxiety, shame, or physical pain. (Freud and Breuer[1895] 2000). Though the subject’s exposure to a traumatic event occurs in time, the shock or pain provoked in the subject are so overwhelming that they are not able to be metabolized into the subject’s experience contemporaneously. As the psyche’s defensive processes are activated, the idea or memory associated with the “intolerable” event is repressed, or “rendered incompatible with the subject’s other conscious ideas and is thus separated out from them (Grosz 1990).” The idea remains, however, in a state of “preconsciousness,” unintegrated into the rest of the conscious self. The effects of the traumatic experience thus, do not present themselves immediately. Knowledge of the event is inscribed on the body and in the mind, becoming a “center of crystallization for the formation of a psychic group divorced from the ego (Freud and Breuer [1895] 2000).” Yet the cognitive and emotional apprehension of the event remains partial, incomplete. These deferred elements of the trauma appear later, and only then through presenting symptoms which surface when ideas or stimuli “retroactively recall the first scene (Grosz 2000).” This tendency to “re-experience” parts of a traumatic scenario is a characteristic of all forms of traumatic neurosis, representing the intrusion of the event into the present, and its insistent demand that its meaning be recognized and integrated into the rest of the subject’s historical consciousness.  Ruptured by the event, the temporality of the post-traumatic is continually in thrall to a past that has yet to be mastered.

Freud famously described the traumatized subject’s compulsion to repeat traumatic events by recounting the tragic fate of Tancredi, one of the heroes of Tasso’s epic poem Gerusalemme Liberata (Jerusalem Delivered). In the fable, Tancredi unknowingly kills his beloved Clorinda in a duel, while she is disguised in the armor of an enemy soldier. After burying her, the grief stricken warrior leads his army into a magic forest. When his army panics, terrified by arboreal spirits, he slashes with his sword into a tall tree. Just as he strikes, he hears Clorinda’s voice cry out as blood gushes from the cut. Tancredi is horified as he realizes that soul of his beloved has been imprisoned in the tree, and that he has unwittingly killed her once again (Freud [1920]1989). Theorists of trauma have seized upon Freud’s allegorical description of repetition to emphasize the relationship between trauma and forms of witnessing or truth telling (Caruth 2009). After all, it is not only Tancredi’s guilt and horror that are unleashed when he kills his lover a second time, but Clorinda’s voice as well, crying out. In other words, it is through the “unknowing (unbewusst)” repetition carried out in the second symbolic murder that the truth of the first one can finally be spoken.

The pattern of trauma and its repetition creates a peculiar temporal horizon, in which the present and the near future can be seen as the mimetic enactment of past wounds. Yet models of trauma not only create a form with which to delineate time, they also provide a unique phenomenology of daily life, predicated on the idea that experience itself can be delineated into neatly contained categories of normal and pathological. Might one ask whether the ways in which one distinguishes between these categories have a historicity and a common sense of their own, opening up to “history of the present” whose reach extends beyond the contemporary into the beyond of future imaginings and expectations?

In his influential analysis of medical epistemologies, Georges Canguillhem described the difference between normal and pathological phenomena as a matter of differential perception. “The normal,” he claims, “is symptomless and is not perceived. Only the pathological is defined as a deviation from the normal ([1943] 1991).” Canguillhem was specifically describing the terms by which medical knowledge operates to define the chains of pathological causality that distinguish the healthy body from the sick one. Identifying and isolating the symptoms of illness from the body whose orderly functioning is taken for granted, reveals the pathology that lies below the body’s opaque surface. In addition, it enables an understanding of the body as a coherent system, comprised of interdependent parts that operate in harmony and simultaneity in order to preserve normal bodily vitality.  Within this framework, identification of a pathology in any part of the system can dramatically change the horizon of expectations for the body’s functioning in the future.

Ideas of trauma offer a similar systematic approach to understanding the ways in which forms of experience are constituted, in relation to normal or pathological relationship between an event’s occurrence and its integration into a system of meaning. In other words, embedded in the threat of the pathological future posed by widespread concerns over PTSD is a near future in which the relationship between and event and its truth-value has yet to be formed. It would seem then, that part of what is at stake in the rigorous management of the temporal plane between the space of war and the space of peace is the arrival of meaning in the violent encounter with another.

In his book, War is a Force That Gives us Meaning, journalist Christopher Hedges writes about the particular conditions that distinguish the particular experience of war from the perception of war as it is represented in narrative accounts. Though he is not a soldier himself, Hedges’ perspective has been gleaned from spending decades attempting to report war’s violence from the closest possible proximity, even at his own peril. Over the course of his career, he has been “locked in firefights in southern Iraq,” “beaten by Saudi military police,” “shot at by Serb Snipers” and “imprisoned in Sudan.” Yet he recounts these experiences not to testify to his bravery or his fear in the face of these dangers, but to describe a kind of “dark beauty” tinting the operative logic in life or death scenarios.

Hedges condemns the political forces that create these violent struggles for power, yet he admits that despite this, part of him is nostalgic for the “simplicity and high” of war. “War,” he claims, “creates its own culture,” with its own “purpose, meaning, and reason for living.” Yet for Hedges, the unique reality witnessed by those who have experienced life in war zones stands in stark contrast to what he sees as a sense of unreality created by the myths and narratives that dominate the representation of war in the homeland. War in a combat zone is primarily a sensory experience, consisting of the visceral immersion in sights, sounds, smells, and tastes that are unique to combat zones. War from abroad, however, exists in narratives

which imbue events with meanings that they do not have. We see defeats as signposts on the road to ultimate victory, We demonize the enemy to that our opponent is no longer human….It allows us to believe we have achieved our place in human society because of a long chain of heroic endeavors rather than accept the sad reality that we stumble along a dimly lit corridor of disasters.

Hedges’ construction of war as a problem of meaning provides a compelling perspective from which to view contemporary public concerns over the reintegration of soldiers returning from combat in Iraq and Afghanistan. It would suggest that what is at stake in the reintegration process is not only the distribution of mental health resources for individual traumatized soldiers, but also the potential collision of two different, and potentially opposing ways of assigning meaning to the same event. Hedges claims that the myths that make war meaningful for soldiers during their recruitment and training can rarely endure through the experience of combat. Often, the “messiness, confusion, raw brutality, and elephantine fear” elicited in combat zones strip war narratives of their coherence and certainty, producing new logics in their place. The return home then, contains the possibility that every attempt at re-adaption to the quotidian realities of a civilian life might contain the possibility of a confrontation between the mythical meanings given to war in the homeland and the meanings produced in the space of war itself, now embedded in the body and mind of the veteran soldier.

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