Voices and stories of veterans, their families, and their care providers, reveal what is necessary for postwar healing This book argues that the elements that contribute to healing war trauma—including safety, connection, community, dialogue, mutual respect, diversity, and compassion—can help build a stronger nation. But this message comes with a warning and a challenge not just for caregivers, veterans service organizations, governmental departments, Congress, and the White House, but for all Americans. War creates incalculable suffering—not only among those on the front lines, but also among those left behind. For every soldier killed or injured on the battlefield, countless others are affected—particularly relatives and friends—often in isolation and silence. As a nation, the U.S. must do everything it can to repair the injuries caused by war, whether physical, emotional, or moral, both for those who served in Iraq, Afghanistan, and elsewhere, and for the country itself. Only after the nation provides the top-quality care our veterans have earned will we be able to begin to end our reliance on war and truly build a durable peace.
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About the Author
Joseph Bobrow is a psychoanalyst, Zen master, and author of Zen and Psychotherapy: Partners in Liberation. He is the founding director of Coming Home Project, whose evidence-based programs for Iraq and Afghanistan veterans, families, and care providers have served thousands nationwide. He teaches extensively, and lives in Santa Barbara. The Dalai Lama, Tenzin Gyatso, is the world's foremost Buddhist leader. He travels extensively, speaking eloquently in favor of ecumenical understanding, kindness, and compassion, respect for the environment, and, above all, world peace.
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Waking Up from War
A Better Way Home for Veterans and Nations
By Joseph Bobrow
Pitchstone PublishingCopyright © 2015 Joseph Bobrow
All rights reserved.
Community Heals and Isolation Kills
* * *
In 2008, my friend Keith Armstrong arranged a meeting with his boss, Charles Marmar, chief of psychiatry at the San Francisco VA, one of the elite VA hospitals and medical centers in the country. Dr. Marmar began, "Joe, patients come in to our clinics but they don't stay. What have you learned that might shed some light on this?" His posing the question seemed to convey an openness that brought me up short. I replied, "There needs to be a 'there' there." An awkward silence ensued, which I soon filled with a superfluous explanation, "Something to connect to. Troops come home to a community, not a set of isolated services."
Sayings from many traditions covey this "there" that is always right here with us. In the Bible, "The whole creation groans and labors together." John Muir wrote, "When we try to pick out anything by itself, we find it hitched to everything else in the universe." My Zen teacher, Robert Aitken Roshi, always said, "Time is short and we are all in this together." No one knows this better than troops in the war zone, who frequently say, "We fight for the guy to our right and the guy to our left."
We share with one another and with all creatures a profound interconnectedness that is vaster and more fundamental than any one of us individually. My friend and Coming Home Project collaborator, retired Air Force chaplain Steve Torgerson, likes to quote the writer G. K. Chesterton, "We are all in the same boat in a stormy sea, and we owe each other a terrible loyalty." My friend Col. David Rabb often reminds us, "Community heals, isolation kills."
Service members understand this implicitly because it is their on-the-ground reality in the face of death. Military families get it without being told that their well-being is inextricably intertwined with the well-being of others. The fate of others is intimately tied to our fate. When the Buddha experienced enlightenment under the bodhi tree, he is reported to have said, "At this moment all beings and I awaken together." Pediatrician and psychoanalyst Donald Winnicott wrote of a particularly vulnerable stage of infant development where we cannot say the word "baby" without saying "mother" (and I like to add "father"). The Buddha expressed it with deceptive simplicity, "This is because that is." We interare.
Cultures in Tatters
The institutions responsible for caring for our veterans and their families have not, alas, incorporated this fundamental reality.
As I came to see how veterans, family members, children, and providers were all impacted by war trauma, I also began to understand that the institutions responsible for their care were also affected. During the last year of our major grant, I began to travel extensively to forge contacts at VA, DoD, Congress, the White House, corporations, and large foundations, searching for long-term funding for our program. By then we had more than anecdotal accounts and personal testimonials to prove its effectiveness; we had data.
Crisscrossing the country, I learned some important lessons. First, organizations did not communicate with one another, especially VA and DoD. Relationships, when they existed at all, were fragmented and compartmentalized. Everyone I met with would ask me the same questions: "Where have you been? Who have you met with? What did they have to say?" Relatively naive and guileless, I tried to respond to their questions. Then it dawned on me: these people and the institutions they represented did not actually talk with one another or share information, much less coordinate their efforts to benefit service members and veterans. In questioning me, they wanted to gather some intel, and I sensed another motivation as well. They seemed genuinely curious about their colleagues in other organizations and what they were up to. As an outsider, I found myself in the role of connector. Like veterans and others who are facing overwhelming circumstances, employees compartmentalize in order to survive in dysfunctional systems. Yet when given the opportunity, they wanted to learn what was happening on "the outside."
I came to see first-hand how hunkered down and compromised our institutions are; how "tribal" identifications override the collaboration and coordination that could bring clear benefit to veterans and families. This was the case not just among different organizations. Within the same system, say a military branch, the disconnects were equally startling. The left hands did not know what the right hands were doing. One leader I met with genuinely thanked me when I asked him for more information about a major grant specifically designed for those his department served. He had not even heard about it. How could our institutions help veterans repair damaged connectivity when these institutions themselves were so fractured and their staffs so overwhelmed?
During a discussion with a senior military chaplain, I learned about a new program he was directing with the mission of harnessing spirituality to help fellow chaplains. We explored how Coming Home might help support the alarming number of chaplains buckling under impossible workloads. Due to staffing shortages, they were serving multiple tours and helping thousands of service members. It's not commonly known that military chaplains are the only helping professionals in the military required to maintain strict confidentiality. They therefore had no one with whom to share the horrific stories they were hearing from service members.
I thought it would be supportive to have a dedicated retreat for chaplains from this particular branch. The director asked me how many breakout groups there were at a Coming Home retreat. I said about six to twelve groups, and asked him how many chaplains he was considering sending. He repeated my words, "six to twelve." I didn't understand at first, but then I caught on. Constant trauma and threat without support had bred an organizational culture of paranoia and a fear of retribution so pronounced that there could only be one unit chaplain per group. The organizational dynamics were so toxic that a chaplain couldn't trust his colleagues to maintain confidentiality. The director confirmed that the esprit de corps was so compromised that offering a retreat just for chaplains would actually be counterproductive.
Troop camaraderie and morale, unit cohesion, and esprit de corps are military analogues of community. Community in the broadest sense is each of us, inasmuch as we constitute the sectors of civic life that veterans interact with on a daily basis: employment, education, housing, legal, law enforcement, health, and the government institutions responsible for implementing policy and caring for our veterans and families. Community also encompasses the leaders we elect and send to Congress and the White House to represent us, the leaders responsible for formulating policy, funding programs, and overseeing their operation, effectiveness, and integrity.
Why is community so critical for us to grasp? Because the effects of an absent or dysfunctional community compound and exacerbate the injuries veterans sustain in theater. Moreover, at the national level, the lack of community "buy-in" to war decisions and policies (having "skin in the game") disenfranchises ordinary citizens and deprives policy makers of vital feedback. This can contribute to a slippery slope that leads to further ill-advised wars that create additional loss, devastation, and more injured and killed veterans — wars from which we have to continuously dig ourselves out at enormous expense.
The knee-jerk reasons often given for this generalized institutional dysfunction are: "That's how bureaucracies work, especially in the federal government, especially inside the Beltway." I challenge this response. It has become clear to me that the role of war trauma and our conscious and unconscious reactions to it cannot be overlooked. These are potent factors — hidden in plain sight — contributing to the spate of scandals that have plagued our veteran-care systems and the institutions responsible for their policies and performance. I am convinced that the way war trauma is actually transmitted — along multiple dimensions at once — contributes mightily to individual, collective, and institutional dysfunction, extending all the way to the highest levels of leadership. Our leaders are not exempt: in function of their response to war trauma, their capacities can also become compromised.
On May 15, 2014, I watched the lengthy hearings of the Senate Veterans Affairs Committee. Then VA Secretary Eric Shinseki was grilled about reports that some clinics had "cooked the books" on wait times and covered up secret waiting lists containing the real data while publicly substituting made-up lists that falsely reflected exemplary performance. A number of veterans may have died while waiting for an appointment. Shinseki said he was "mad as hell," and the others who testified — government officials, leaders of congressionally chartered veteran service organizations (VSOs), and well-established community-based veterans organizations (CBOs) — seemed concerned if not outraged. It turns out that the problem that was now creating a media firestorm had actually been festering for up to fifteen years. And it was only one of many scandals over the years regarding timely adjudication of veteran benefits claims, quality of services, accuracy of data reported, access to care, and other problems. While senators and others routinely used the word "systemic" to describe the problems at VA, they seemed to not have a clue, as they minimized and misunderstood the degree and the type of problems they were investigating.
It was eerie listening to Shinseki respond to questions. If the secretary was so passionate, why was he using life-sucking bureaucratic doublespeak, referring to possible related deaths as "adverse events," rather than speaking plainly? We could give him the benefit of the doubt, even chalk it up to personality style, were he not to describe himself soon after as "shocked" to learn that whistleblowers' allegations had been confirmed by the VA inspector general's investigation. Shocked? Wouldn't such a distinguished military man get the intel he needed before initiating a critical mission? Did Shinseki's recon fail to reveal the chronic brokenness of VA systems? David Wood, the esteemed Huffington Post journalist, called him "too trusting," which I found perplexing, given the general's decorated military career.
I was also struck during the hearing by how easily everyone, savvy devoted veteran advocates included, fell prey to oversimplifying the extent of the problem, reducing it to a simple concern over "access," while touting the quality of VA health care. As if "access" and "quality," two of many elements that constitute the "system" of care, could be unhitched. I thought, "Tell the family of a veteran who died while on the secret waiting list that this was 'just an access problem.'"
One after another, those who gave testimony agreed with this incorrect assessment. I thought they sounded like sheep in an echo chamber, repeating the meme that "VA health care is terrific and access is the real problem." The brilliant and indefatigable Tom Tarantino of Iraq and Afghanistan Veterans of America (IAVA) observed that veterans' experience with the VA was problematic, before he too joined the chorus. The sudden spell of amnesia was startling; certainly many knew of the reports by Aaron Glantz and others regarding suicides, over-prescription of opiates, inept pain management, ineffective veteran outreach, insufficient programs for families. In 2008, McClatchy News Service reported that a U.S. senator had charged the VA with lying about the number of veterans who had attempted suicide, citing internal e-mails that put the number at 12,000 a year, when the department was publicly saying it was fewer than 800. This discrepancy created quite a furor, but it was short-lived, like our sputtering memories.
During this scandal and Senate hearing, the terms used by investigators, government officials, and journalists to characterize VA culture ranged from dysfunctional and corrupt to broken, corrosive, and punitive. A June 15, 2014 article in the New York Times details how VA administrators routinely punished employees who spoke out in the interest of improving patient care. The article provides pictures and names and interviews with real VA employees who, after speaking up on behalf of patient-care issues, were punished and made to feel as if they were "crazy," and in an "alternate universe." I had heard scores of similar stories during Coming Home Project retreats adapted to serve overworked service providers in VA, DoD, and CBOs. I found this exposé an important step in breaking the iron grip of a pervasive culture of silence and intimidation. Recent assurances of governmental protection for VA whistleblowers may also be cause for cautious optimism. This stagnant closed system may be opening itself to new information and real feedback about its functioning.
While on the road fundraising and networking, I had my own close encounters with dysfunction. In 2007 I gave testimony at California State Senate hearings in Sacramento, California. Bucking the anti-VA tide of most speakers and legislators, I testified that there are some in VA who were working collaboratively with CBOs to explore innovative ways to effectively serve large number of veterans. Within two weeks the leader at the VA with whom I had initiated discussions, and whose name I did not publicly reveal, was nearly fired and cut off all discussions in fear for his job. This was not simply dysfunctional; this was a paranoid system in action.
In 2012, a newly appointed national-level VA lead in DC expressed enthusiasm about collaborating with Coming Home Project and instructed me to speak with a respected VISN (Veterans Integrated Service Network) employee who could explore details. I happened to know this person and we collaborated to draw up a very modest proposal, which was submitted for review. After months with no word, I finally received a call back and learned that for the first time during this employee's long tenure, a proposal had been rebuffed. No clear reason was provided, only scant details about the likelihood of "getting into trouble" with Congress.
At the time I had also been meeting with congressional leaders who expressed their frustration with, not surprisingly, the VA. As I pieced things together, I realized that this person's boss was afraid of repercussions from a powerful legislator whom they feared would cause funding trouble for their VISN if they worked with an out-of-state, though more established, group. It was suggested that I contact the head of their unit in DC again. After doing so I was shocked to receive an e-mail saying that they too could not help, "due to the same reasons" given at the VISN level. I was aghast: a national-level VA lead was confirming that the fear of "getting in trouble" was the reason they would not be able to support exactly the kind of evidence-based CBO the VA claimed to want as a partner.
It reminded me of my meeting at the Pentagon with a chaplain and administrators from DoD's controversial Comprehensive Soldier Fitness (CSF) resilience program, who were interested in learning about Coming Home Project retreats and their suitability for CSF and the woefully neglected Wounded Warrior Transition Units. The meeting seemed promising, until I used the phrase "spouses and partners," rather than just "spouses." This was in the "Don't ask, don't tell" era. Later I received an email from CSF that I keep to this day. "It was great to meet you and hear about your program. After discussions, however, we cannot work together because our program does not do direct service for people but rather is a training platform."
Excerpted from Waking Up from War by Joseph Bobrow. Copyright © 2015 Joseph Bobrow. Excerpted by permission of Pitchstone Publishing.
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Table of Contents
ContentsForeword by H. H. The 14th Dalai Lama,
I. Community Heals and Isolation Kills,
II. Turning Ghosts into Ancestors,
III. Resilience, Trauma, and the Limits of Plasticity,
IV. We Are Family,
V. Moral Injuries and Restoring Integrity,
VI. All the Way Home,
Three Poems of Love and War,
About the Author,