have courage. take heart. bear witness.
Tom: I couldn't afford to go to college full time in 1965, so I was drafted. And at the time, you could still join another branch of the service. So I served as a Fleet Marine force Navy Corpsman. I was attached to elements of the Third Marine Division, and I served in Vietnam off and on—because of several times I was wounded—I served off and on between October 1966 and June of 1968.
Jackie: Most of the men—and, I guess, there were some women who . . .
Jackie: . . . also were in the military—were pretty young.
Tom: The average age of the Marine in Viet Nam—they turned eighteen. On several occasions, people called me "the old man," simply because I was three years older than a lot of them. And so they thought I had this life experience above and beyond theirs, but I was just, you know, a 21-year-old boy from the Midwest who happened to have a little college and was interested in medicine at the time I was in college, and here I am.
You know, and I never thought about running away, going to Canada, or doing any of those sorts of things. Both of my parents were WWII vets. To me, it was my duty to serve my country, just as my parents had done, so I never really paid any attention to any of the early rumors or stories about people running away to Canada to avoid serving in Viet Nam. I . . . that just never occurred to me, in any shape or fashion. So, there I was.
Crazy place, particularly as a Navy Corpsman. We trained using a lot of information and instructors that had served not only in World War II, but in the Korean War. This was an entirely different type of war. And so I was totally unprepared for what I encountered in Viet Nam, in terms of the kinds of wounds I was treating, and the medical equipment and technology that was available at the time. They were still using stuff from World War II and Korea, basically. And, of course, the sophistication of weapons, all that sort of thing had changed drastically. So a lot of the equipment really didn't work as well on the kinds of wounds that our soldiers, and Marines in particular, were receiving.
For example, I found that one of the most effective ways of treating sucking chest wounds was to use the cellophane wrapper from my cigarette packages. By placing the cellophane over the wound, the gunshot victim could perhaps begin to breathe without that added hole in their lungs. if you didn't do that, the lungs didn't work, because you had this other airway to the outside.
As a result of the war in Viet Nam, the battlefield medicine changed and has had an impact on the way that our wounded soldiers and Marines are treated in the current conflicts in Afghanistan and Iraq. I wish we'd had this stuff, that they have now, forty years ago. We could have saved a lot more lives.
Jackie: Was there a particular incident, once you were in Viet Nam, that made you realize what the situation was over there?
Tom: Within a couple of weeks of having arrived at Chu Lai, we took a mortar barrage, or mortar attack, and I was pinned in a bunker that I was sleeping in—for quite a few hours, with a broken shoulder, it turned out. And it was the realization, when the bunker collapsed on me, that people were actually trying to kill me—kill us. And that was sort of a rude awakening to the next several months. In late 1967, I moved up north, along the DMZ [demilitarized zone]. Things were developing in regard Tet of '68. Firefights or major operations, when you encountered enemy elements, would just get absolutely crazy, chaotic. You know, I mean, the weapons going off all around you and people being wounded, killed in horrible, horrible ways. And yet, you know, my job was to respond to the cries of the wounded and try and help them the best I could under those circumstances. It's . . . can be unnerving, at times and overwhelming, at times. And even more so forty years later, when I think back about it—the kinds of situations I was in, my unit was in, when all hell would break loose, and so that's what I mean when I say it was absolutely crazy.
Jackie: You know, in the middle of this kind of chaos, what kinds of resources did you draw on, personally, to deal with the situation?
Tom: I just simply put myself on automatic pilot and divorced myself from any of the emotions that would go along with being in a traumatic situation. I had a job to do, and I focused entirely on doing that—listening for the calls for help, from my men, and taking care of business. That was part of dealing with it. I didn't allow myself to go on to the emotional side of things. I've been trained to do it, of course—somewhat. But each combat experience forced me even deeper in terms of my own numbing, which, obviously, is a symptom of PTSD.
In fact, one of the things that occurred—and I've talked to other corpsmen and medics about this—that the longer that you stayed unhurt in the field, the less you cared about your own safety, or in many cases you even quit carrying a weapon and carried more medical supplies—bandages and that sort of thing—as opposed to your weapon and ammunition, because, you just really got into your job, and your job was to keep people alive.
You know, the other thing, though, that I have to say is that it's really interesting to talk about this kind of stuff forty years later, because I've been thinking about it off and on for forty years. And I'm not sure that I would answer your questions the same way forty years ago than I'm answering them today.
Jackie: Like, how so? Can you give an example?
Tom: Well, I can be very, very detached now and very analytical about the kinds of things I did or saw. And I have forty years of thinking about it—forty years of therapy, too. So I wonder if all of that hasn't had some impact on the way I think about those experiences and the way I retell them or talk about them.
Jackie: In a good way?
Tom: Sometimes in a good way. I . . . you know, I do occasionally still have flashbacks and extremely disturbing nightmares. I have sleep disorders. I have all the classic symptoms—you know, not necessarily at the same time, thank God. And some of those nightmares, in particular, are very, very disturbing to me now, much more disturbing than they were forty years ago, because I'm back there again. It's very . . . extremely real. And they usually involve a life or death situation—either my own, or someone else's. I guess what I'm trying to say here is that the forty years of thinking about it, that in some cases, it's made it worse, simply in terms of my dreams, my recollections, at times, under certain kinds of conditions.
Jackie: You know, it seems like, in hearing your descriptions of some of the symptoms of PTSD, in hearing references to your own witnessing of really horrific kinds of events—even without describing what they are—it seems like that is a lot to ask of someone who is very young.
Tom: It is.
Jackie: Do you think there is sufficient informed consent?
Tom: I'd step back, because I start from the premise that I believe in national service. That can take many, many different forms. And it may not necessarily be at a particular time in one's life. Simply because the draft was associated with people eighteen years of age and older, doesn't mean that all national service programs have to focus on an age-specific group. But I do think that required national service would be of great assistance in turning around, quite frankly, America's culture. And, I would like to see something like that. I think that would instill a greater spirit of pride in oneself, as well as that of the individual for our country.
Jackie: What do you think would be helpful to know, understand, about someone who had symptoms of PTSD or had been struggling with it for many years?
Tom: Tom: First of all, seek help. It's not a weakness to seek help. What you saw or underwent simply was an abnormal event or an abnormal situation happening to a perfectly normal person. There are ways coping, and I would strongly, strongly urge anyone who's suffering any of the symptoms of PTSD to seek treatment, where they can learn to cope with their traumatic experiences and the results of those traumatic experiences.
You know, we don't need to go into all the neurochemistry or the neurobiology of the impact of that stuff on your brain, because if left untreated, it can change the structure and function of your brain in certain areas. And it does change you as a person. And, sometimes, that change is not positive. And that's what I'm talking about in terms of seeking treatment. Treatment programs should be very individualized. There's no cookie-cutter approach that's going to work for everybody.
Exposure therapy is recognized, generally, in all quarters, as being the most effective, to this point in time. There's more evidence to support that than any other kind of cognitive behavior therapies. And if an individual has the opportunity to utilize that particular type of treatment, they need to look carefully at the kind of exposure therapy, because there are several different programs out there.
The older type of exposure therapy takes you back, in time, and you work through the traumatic events, eventually reaching a point where they don't set off those neuro and biological responses in your body. There are also a couple of newer types of exposure therapy, where you work with just the present. And, working with present elements, figure out a plan to deal with future elements or events, so you don't focus on those things from your past. There's not as much clinical evidence, at least on military veterans regarding the type of exposure therapy I just mentioned. But it has a record of being extremely effective in rape victims and small segments of the veterans population.
The difficulty is that the newer type of exposure therapy does require active participation by those undergoing the treatment. There's homework lessons that you have to do. You know, it's sort of like a 12-step program—unless you work the program, it doesn't work. You can't just go to meetings.
Jackie: Can you just describe a couple of the steps that you're referring to?
Tom: Well, perhaps I'm having difficulty with anger, which I think is one of the elements that many veterans suffering from combat-related PTSD have to deal with. Everybody gets angry, all right? A lot of the traditional, older anger-management programs do not deal with treating the emotions involved in anger. Now, a way of looking at this is simply to say, look, the military way of dealing with situations, particularly when they are challenging or difficult, is to deal with the business at hand and take care of it at the least number of casualties. There's no time for thinking about the emotions.
That does not work well in terms of human-to-human, personal relationships, you know? You've got to take into account other people's feelings, as well as your own. And so that, what I'm saying here is that, unless you do deal with the feelings behind your anger, just going to anger-management classes—where, you know, you tap your wrist every time you feel that pulse rising or the temperature going up because somebody says something you don't like—is not really an effective program. You need to get involved in one where you deal with the emotions behind the anger, because anger is a perfectly normal response to certain kind of situations.
Trust issues are very, very important in terms of recovery from traumatic events. So, perhaps the reason that you get angry at a person is that, the bottom line is that you really don't trust this particular person, in terms of whatever the situation is and your roles in that situation.
Jackie: Are there similar kinds of programs for family members whose, you know, relative is undergoing some therapeutic process for PTSD? Is there something for them?
Tom: There are programs that have specifically been developed to assist children, for example, in dealing with abuse, and that sort of thing. But they're not, to my knowledge, part of the military's response—either DoD [Department of Defense] or the VA's response to treating veterans and their families. Now, I know that DoD offers some programs, particularly on military installations around the country, where there's family counseling available for situations. That's not what I'm talking about. What I'm talking about is if I'm an Iraq/Afghan vet, and I'm in a situation where I have a family, I go into my VA or my Vet Center, I want the whole family to go through the treatment program. There'll be, perhaps, modules that the kids go to; there'll be modules that the partner, or the spouse, goes to; there'll be individual modules that I go to. The point is that we're all going through it at the same time, and parts of the program are interconnected, so that you're all doing it. You're all working together on it. And I think that's the answer, in my humble opinion.
It's family stuff now. It's not just individual. We gotta get away from that. Unless you're a hermit, living, you know, in an ice cave some place, you have to interact with other people. And those people that you interact with most frequently, and care about, need to be part of your treatment program.
Mental health issues don't fit the standard medical model. They may be long-term, very costly treatments, but that does not mean that they should be put in a box and stigmatized, simply because it takes a long time to recover from a mental illness, or you're always recovering from mental illness.
You know, we've known for seventy years that AA [Alcoholics Anonymous] works, if you're willing to work it. Now, people who have alcohol-related problems are much more accepted than they were seventy years ago. Mental health is a very similar kind of situation. You don't necessarily lose your schizophrenia, but you can bring it under control, in some respects—or in a lot of respects—if you find and follow the correct treatment that works for you.
I think the mental health stuff is one of the biggest issues that the American public doesn't understand. And then when you slap a uniform on it, there's a further tendency to ostracize it. "Well, look at Uncle Joe over there in the corner. You know, he was wounded in the war, and that's why he sits over there and he drinks," or "that's why he chain-smokes," or "Don't go near him on Veterans Day, because he's thinking, you know, about when he was in France," or "in WWII," or "in Viet Nam." We need to overcome those kinds of things, if we can. Then it will help everybody.
Learning more about the veteran is a good place to start. And, you know, it takes some effort to do that. But the mental health issues out of this war are going to be a problem that this country is not dealing with in a very realistic fashion at this point. There's been some efforts made, in isolated pockets, by individuals and some agencies, but, there's never been an overall mental health plan in this country, because we don't like to deal with mental health issues.
Part of it is, I think, simply due to the stigma associated with mental illness. We're afraid of people that exhibit behaviors that are different from our own. And so we kind of panic when we see those different behaviors, when in fact we don't stop and recognize they're simply different behaviors and there are ways of dealing with those different behaviors. It's just that we don't think about them.
Jackie: and let's say somebody is undergoing counseling. What would be helpful for friends of their to know about how to related to that person?
Tom: If you're really a caring friend of someone who's been through a traumatic situation and suffering from PTSD, number one, I think you have to understand some of the things I've been talking about—that there is a change in the person, and it could be, actually, long-term change, depending on the severity of the event and how long it's been since the person attempted to seek treatment. Lots of stuff enters into that.
But you try and understand. Learn about PTSD yourself, and then approach your friend, or whatever, and say, "Look, I'm interested in helping you. Is there anything I can do?" Let them suggest what may be helpful. Maybe you don't need to take them to that Vietnamese restaurant anymore. Or maybe they just want to talk sometimes. Maybe they want to just tell a story because of something they saw or smelled, or what have you. So, there's lots of things you can do, but try and individualize it, as opposed to saying, you know, treat all PTSD vets the same.