Veterans are living on another planet

**from Peter Yeomans' forthcoming book, Reclaiming Integrity After Moral Injury from War: Insights and Interventions to Support Veterans (Routledge, in press)

   Perhaps a creature of so much…deep memory is almost bound to grow alienated from his world, his fellows, and the objects around him. He suffers from a nostalgia for which there is no remedy upon earth except as it is to be found in the enlightenment of the spirit.

-      Loren Eisley, The Immense Journey

Dr. Russell Carr in his paper “Combat and human existence: Toward an intersubjective approach to combat-related PTSD” (2011) provides a framework for appreciating how completely different life can feel for a Veteran returning from deployment. Most therapists who have not lived through a comparably disorienting experience will struggle to understand how transformative this can be. Often too attached to ensuring “normalcy” or wanting to facilitate a smooth return to the Veteran’s prior life, the therapist fails to acknowledge the extent of the challenge of homecoming. They might hesitate to suggest to the Veteran that while they have returned home in a physical sense, the sense of “home” and their relationship to the people there are forever changed. By that measure, you can never go home; you can never return to who you once were. Therapists might ask: how could emphasizing that possibly be helpful?

By failing to reflect how completely different life feels for a returning Veteran, you fail to close the gap between you and your client with sufficient empathic understanding. Carr, drawing on the work of Dr. Robert Stolorow, offers us a set of assumptions that are so germane to civilian life that we do not recognize them. They are the air we breathe. Imagine having taken tremendous risks, assumed sacrifice, and perhaps committed moral transgressions, in order to return back home, and yet, upon arrival, feeling as if you no longer belonged here. Fundamental assumptions that provide us with the (false) certainty that we need to function calmly are now shattered. The Veteran is home, but as Stolorow writes, is “living on another planet.” (Stolorow refers to people who have not truly experienced trauma as the “normals”, and to those whose lives have been transformed by trauma as “aliens”). What are these shattered assumptions that leave Veterans feeling like aliens in their own communities?

The first is the assumption of predictability. We believe that we can make plans, influence the future, and pursue our ambitions. In a moment of reflection, we invoke the truism “tomorrow is not promised,” but we then operate as if tomorrow is promised. We assume that tomorrow will more or less resemble today, and that we will be able to continue with our plans. Carr writes, “most people assume that when they go to bed at night that they will wake up in the morning. People also usually believe that when they say goodbye to family members and go to work in the morning, they will see them again upon returning home in the evening” (2011, p. 475). Veterans may have experienced firsthand that this is not the case. Leaving home to go to work in the morning can provoke daily doubt that you will ever see your family again.

The second is the assumption that the past, present, and future are distinct and separate. We experience time in a linear fashion. The past is behind us; the future is coming. The present is now. However, an activated traumatic memory can so powerfully overwhelm our present awareness that it feels like now, or more to the point, it is now. This is a useful way to think about flashbacks or dissociation. When traumatic memory is activated and then reawakens the visual, auditory, kinesthetic, and olfactory sensory elements of that memory, the past is not the past. Can you imagine how experiencing past memories, especially terrifying or horrific ones, as present moments would change your fundamental relationship to the day and to your perspective of time? Take a moment now and choose a memory of tremendous loss or fear you once suffered. Try to recall what that felt like emotionally and kinesthetically. Imagine that you were just going about your day, when you suddenly experienced the onset of this state without warning, and possibly with the visual component to the memory as well. You would never believe that the past is the past again.

A third assumption is the promise of safety. In the abstract, civilians are aware that “anything can happen.” While we can refer to close calls that could have led to more severe consequences, and while we know others who have suffered sudden deaths or seemingly random accidents, we still operate on the general assumption of safety. This is what makes it so easy to leave our homes, to let down our guard at night to sleep restfully, or to interact with strangers in unfamiliar places. Yet, some Veterans have experienced the fragility of life and the suddenness of death. Not only is tomorrow not safe; it is also not promised. Without the promise of tomorrow, we easily lose motivation, ambition, and the sense of purpose that often fuels our energies for life. Can you imagine how frozen and incapacitated you could feel if you lost confidence in the safety of your choices, or doubted that tomorrow is waiting for you? If you lost the sense of meaning that carries you forward? Without an experience that shatters these old beliefs, you cannot.

Carr (and Stolorow) also write about the tremendous experience of isolation that stems from this altered reality. The loss of these assumptions about life and time completely changes the landscape of one’s lives and generates a profound experience of aloneness. All around our returned Veterans, even in their own home or family, people are living according to intact assumptions of safety, predictability, temporality (past, present, future), and the promise of a future worth planning. Veterans think “how can they be so naïve?” and worry that they must assume responsibility for the safety of the “normals” who seem to live with their heads in the clouds.

Drs. Carr and Stolorow’s themes closely align with what was summarized in this book’s introduction about the essence of existential psychotherapy. Yalom writes about four existential truths: 1) aloneness; 2) the certainty of death; 3) the meaningless of life; and 4) and that facing these realities is up to you alone. Many Veterans have now lived through experiences that have profoundly sharpened these perspectives, and they cannot go back. Meanwhile, the people they love most, who have not faced these same realities, can feel like they are a million miles away.

Dr. Ed Tick writes, “the warrior has learned what we did not want to know – the brevity of life and love, our human capacity for destruction, our smallness and helplessness against existential forces” (2005, p. 253). He suggests that Veterans must now live “according to these truths,” but it is impossible to live this way alone. Tick affirms that this can only be accomplished by surrounding yourselves with others who have also stepped through this portal. Civilian therapists have rarely had comparable experiences of transformation, but they must try to project themselves into this new reality.

One step we can take to reduce the chasm between ourselves and Veterans is to avoid offering cheap reassurances of recovery or of return to the prior worldview. Too much reassurance of the safety of the world or the predictability of tomorrow only widens the gap between therapist or family member and Veteran. Instead, try using the language of “shattered assumptions,” of “tomorrow is not promised,” of “death feels imminent,” and of “living on another planet,” and see what kind of response you receive. The more you can articulate these new lived realities and the impossibility of returning to the assumptions we once had, the more connection you provide.

Best not to underestimate the transformational nature of trauma when trying to relate to your Veteran. Risk using what might sound like exaggerated language to someone whose life had not been irrevocably altered by a traumatic event. Be aware that if you have not lived through an experience like this, you might easily understate its impact. Carr and Stolorow emphasize the idea of living on another planet and feeling like an alien in the very place that used to be home. For a minute, take this metaphor as literal truth. Be sure to reflect and affirm any language your client uses to describe this experience of being an alien visitor. Additionally, try using language that speaks to the irreversibility of the experience — “shattered,” “transformed,” “devastating,” “unbearable,” “gone forever.” These words communicate that you are standing in the abyss with them, that they are not alone even as their world has been transformed and feels unrecognizable. Better to aim for communicating extremity and totality then to aim too low with banal language such as “so hard,” “so difficult”, and “pretty tough.” The more you affirm to another how alone they must feel, the less they are alone. And with that reassurance that someone actually “gets it,” that they make sense, comes the possibility of a fuller return.

References

Carr, R. B. (2011). Combat and human existence: Toward an intersubjective approach to combat-related PTSD. Psychoanalytic Psychology, 28(4), 471-496. https://doi.org/10.1037/a0024174

Eisley, L. (1957). The immense journey. Vintage Books.

Stolorow, R. (2007). Trauma and human existence. Routledge.

Tick, E. (2005). War and the soul. Quest Books.

Yalom, I. (1980). Existential psychotherapy. Basic Books.