Healing the Wounds of War

33161243033_2745556f48_o.jpgSoldiers in Da Nang, South Vietnam march down a street following a farewell ceremony for some of the last US troops in the country's northern military region, March 26, 1973. Photo courtesy of the Associated Press.
Practitioners and veterans alike learned that incorporating arts and humanities resources in therapeutic work proved an effective treatment strategy.

The recent commemorations of the Vietnam War remind us how far the country has traveled in supporting our combat veterans.  Soldiers coming home from Vietnam found a country deeply divided about the purpose and legitimacy of the war, and almost as deeply divided about the veterans themselves.  Many veterans experienced embarrassed silence and indifference upon return, while some experienced outright hostility.  Perhaps more important to their long-term health and wellness, both military and civilian institutions were unprepared to help Vietnam veterans understand and cope with the consequences of prolonged exposure to the stresses of war, especially one as complex and politically fraught as Vietnam.  Most veterans returned to civilian life without any clear sense of the challenges they might expect or what to do about them.  All veterans – myself included – were expected to make their own ways as best as they could.

In the immediate post-war period, it started to dawn on military and civilian healthcare providers that something was wrong.  A substantial number of Vietnam combat veterans seemed unable to leave the war behind and resume their routine civilian lives.  Many experienced mental health problems, specifically depression and anxiety, and these conditions were often associated with debilitating forms of addiction.  Vietnam veterans also reported “life-adjustment problems” such as divorce and difficulties at work.  

nllbj-img-7049-30_a.jpgVietnam War protestors at the Veterans for Peace March on the Pentagon, 1967. Photo courtesy of Frank Wolfe.

As these issues became more obvious and widely discussed, clinical communities started to respond.  In 1980, the Diagnostic and Statistical Manual of Mental Disorders included an entry on Post Traumatic Stress Disorder (PTSD).  Alongside this diagnosis, new clinical practices emerged, aimed at helping veterans diagnosed with PTSD understand their condition and take the appropriate steps for recovery.  In 1983, Congress commissioned a national study—the National Vietnam Veterans Readjustment Study—confirming that a substantial minority of Vietnam veterans struggled with the lingering effects of combat trauma.

In more recent years, practitioners and veterans alike learned that incorporating arts and humanities resources in therapeutic work proved an effective treatment strategy. These resources included various forms of creative expression—writing and the visual arts, for example—and works of fiction, autobiography, and history about war and memory.  

Experimentation with these resources expanded considerably as a result of the conflicts in Iraq and Afghanistan. The country’s cultural agencies—the National Endowment for the Humanities (NEH) and the National Endowment for the Arts (NEA)—developed significant programmatic initiatives for veterans, both inside and outside the clinical setting. The NEA’s Military Healing Arts Partnership with the National Intrepid Center of Excellence at Walter Reed National Military Medical Center became a model for the incorporation of creative expression in clinical work, while NEH developed the “Standing Together” program to assist veterans in returning to their communities, often in partnership with state humanities councils around the country.

IMPART-Nathanael Bocker_PhotoBy JeremyTodd.jpgNathanael Bocker works in a metal forging studio at IMPart, a program of the Arts League in Alexandria, VA. IMPart connects recently injured military personnel with visual arts experiences. Photo courtesy of the NEA.

As the understanding and treatment of PTSD has matured, another powerful descriptive and diagnostic concept has entered the discussion. “Moral injury” seeks to call attention to the fact that combat violence damages the moral sensibilities that are fundamental to us as human beings.  Whether one is the victim or perpetrator of violence—and combat veterans are almost always both—moral injury focuses attention on the damage that war can do to our sense of moral worth and integrity.

Both PTSD and moral injury raise important questions of personal identity. The experience of war can alter identity in significant ways, and enabling veterans to ask basic questions about these changes is an important element in the healing process. It all begins with narrative, with the building of a story or stories that give form, shape, and meaning to one’s experience.  Personal storytelling of this kind is enriched and amplified by the vast reservoir of war stories that have been written down and preserved as part of our cultural legacy. That legacy is long and rich.

Most of the world’s cultures have epic traditions concerned with war, and many of these traditions still speak to us today—consider the Iliad, the Odyssey, and Greek tragedy. The Vietnam War produced some extraordinary literature, as have the wars in Afghanistan and Iraq.  Ancient or modern, literature gives us perspective, permitting us to see ourselves more clearly, and perhaps less painfully, through the experience of others, real or imagined. Veterans engaged in the literature of war often find powerful echoes of their own experiences and, as a result, are better able to extract the meaning of those experiences. The National Endowment for the Humanities’ program “Dialogues on the Experience of War” supports veterans’ discussions of humanities texts on war. At New York University, the NEH-supported Aquila Theater involves veterans in the staging of Greek dramas centrally involved with the themes of warfare and coming home.

Veteran Masks.pngMasks created by service members in their creative arts therapy sessions, part of Creative Forces: NEA Military Healing Arts Network. Photo courtesy of the NEA.

In addition to opportunities to make meaning, veterans should be given the opportunity and resources to understand the historical and political contexts of their personal experiences. Perhaps out of respect, or uncertainty about their feelings, and maybe both, we sometimes act as though our recent wars have no history, and that the journey to meaning is a solitary, individual, context-free endeavor.  

But of course wars do have histories, and knowing those histories and coming to terms with them is a part of the meaning-making work that veterans need and want to do.  For example, Vietnam veterans were recently given the chance to dive deep into the history of their war through the remarkable, NEH-funded documentary film The Vietnam War, by Ken Burns and Lynn Novick. It’s never too late for that kind of deep dive, but one would hope that we won’t have to wait so long for comparable treatments of the wars in Iraq and Afghanistan.

History supplies clarifying context for individuals, but it also provides a way for the country as a whole to come to terms with its collective experience.  For wars are as surely collective as they are individual experiences. In this sense, history has a hugely important role to play in the life of the country as a whole, and it’s yet another way in which the humanities are vital to our contemporary lives and essential to our public well-being.

In the crucial matter of supporting veterans, we’ve come a long way since Vietnam, both in clinical and in less formal settings. But we still have a long way to go. We must hope that the arts and humanities are given an even more substantial role as we continue to make progress.

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TheVietnam War, a film by Ken Burns and Lynn Novick

The documentary film, The Vietnam War, tells the epic story of one of the most consequential, divisive, and controversial events in American history as it has never before been told on film. 

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