Your analyst wears combat boots by Nathan Szajnberg

Your Analyst Wears Combat Boots by Nathan Szajnberg, MD Aug 22, 2011

Bragin’s recent IP.net post on combat veterans suggests a belated call for analysts to lace up their combat boots.  The Veteran’s Adminstration has the largest mental health system in the United States; psychoanalysts are a shadow presence. Prudence Gourgechon encouraged more involvement at the January American Psychoanalytic Meetings.

This contrasts sharply with psychoanalysts engagement and dedication in WWI and WWII.  Simmel in WWI saw thousands of “shell shocked” soldiers and ported that information back to Freud and colleagues, influencing our initial ideas about trauma and mourning.  In WWII, Kardiner, Grinker, Spiegel and others were officers in the US Army and joined our men at battle.  Grinker, (one of my teachers), was analyzed by Freud, and developed the first effective treatment for acute stress disorder.  Grinker and Spiegel’s Amytal interviews are an extension of Freud’s early abreaction work.  These psychoanalysts returned to the U.S. with great credibility from  their scientific discoveries, clinical acumen and earned both military and societal respect.  They saw men at the front, most with diagnosable mental ailments; some not. And the soldiers saw these psychoanalysts who ventured from behind the couch to care for them at times of great pain and need: not just “care,” but return them to functional lives.

Further, these psychoanalysts’ involvement with the military extended analysts’ commitment to society. Aichhorn ran the streets with his delinquents (and influenced the early pioneers such as Anna Freud, Peter Blos Sr., and Erik Erikson). Erikson, to learn about the Sioux and Yurok, lived among them.  Anna Freud brought Jewish orphans from Theresienstadt and cared for them.  Fraiberg set her infant-parent program amongst the most indigent communities in Michigan and later in San Francisco.  More recently, Twemlow, seeking to decrease youth violence, succeeded in the most violent schools in Jamaica; Natti Laor, during the second Lebanese War, when one million Israeli refugees fled the North, moved his staff and clinic from Tel Aviv to Haifa and surrounding bombed villages; they migrated against the stream, closer to the war, closer to those in need.

Analysts carry valuable knowledge about inner life.  We construct a refuge in our offices as part of our analytic frame so that we can ease the difficult work of our analysands.  But, this analytic frame is also a frame of mind; a manner of listening. When I interviewed Israeli elite soldiers, several expressed surprise that so many were willing to talk with me  —  even confide — and recruit buddies. We can carry this listening and absorption outside the office to engage those in other settings.  This is another way both to serve society and to strengthen our presence in society’s mind. 

Meeting the soldier near the front, listening to those who are too stoic or not culturally prepared to come into an analyst’s office also increases our truer knowledge of the inner life of soldiers.  Jonathan Shay has written two compelling accounts of the mental flotsam from the wake of Viet Nam washed up on American shores: Achilles in Vietnam and Odysseus in America.   He is not an analyst He did not work in the battlefield; he interviewed those men who came to the V.A. severe PTSD program.   Yet, his accounts come closer to the soldier’s soul in distress.  Shay’s work was well-received in the U.S. Army War College and by the Secretary of the Navy. 

Analysts extend our understanding of the frontiers inner life by exploring them not only in our offices but also outside; we learn more about the vicissitudes of inner pain and how to ameliorate such suffering.  In such settings, we are stripped bare: we have no office, no stance behind the couch. In some ways this work is closer to working children and adolescents: they see us face-to-face, demand, hope and also battle against their hopes.

Stepping into the public arena, into the lives and settings of soldiers, strengthens our credibility as clinicians and scientists. But, there are other ways to learn about soldiers’ inner lives, such as asking them to speak to us.  A former student at the Hebrew University, Amit Goldenberg, was a member of Special Forces. For his Bachelor’s thesis, he interviewed all the (surviving) men in his unit: none had ever spoken to a psychotherapist; none planned to. But, all spoke with him; he is one of them. His findings are heart-compelling (and earned him an honors degree). He is now a journalist and has finished his first novel. He has agreed to write something about what he has learned for IP.net.  I hope that this is the beginning of a lively dialogue between analysts and soldiers, between ourselves and society.

 

 

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2 Comments on “Your analyst wears combat boots by Nathan Szajnberg”

  1. Tamar Schwartz Says:

    Comment from Amit Goldenberg

    In one of most moving moments from Ari Folman’s “Waltz with Bashir,” the film made by this war veteran from the Israeli-Lebanon war, the protagonist comes back to Tel Aviv from the battlefield only to discover that life in Israel is the same. People dance at clubs, sit in cafes and sip iced coffees on the beach, while the battlefield plays out in his head. A soldier, a fighter, experiences this sense of unbreachable distance when returning from battle, one of his most difficult moments. While inner tectonic plates are moving, creating new continents, life on the outside seems to be the same.

    I agree with Martha Bragin’s observation that “civilians … often “forget” that these are their wars as well as those of the people who volunteer to fight them” (“Myth Memory and Meaning: Psychoanalytic Reflections on Treating Combat Veterans in Time of Hidden War”; IP.net). What bothered me, as well as my veteran friends, when returning home from battle was the sense that people preferred not to ask questions; preferred not to confront their guilt that it was their war we fought. I found the same in soldiers I interviewed both as a volunteer in the organization “Breaking the Silence” and as a researcher at the Hebrew University.

    I discovered that a veteran yearns for listening, not “understanding.” The returning soldier craves a non-judgmental acknowledgment of his suffering, caused by an extreme reality which involves violence as well as many other experiences. I found that a veteran may not be willing to talk about his war experience or his personal trauma, but in most cases he will be willing to talk. Non-judgmental listening enables the veteran’s acceptance by society and pushes forward the long inner voyage back from soldier to civilian. The veteran asks not for forgiveness, nor condolences nor pity when telling his story: these responses contain a certain judgment made by the inexperienced. The different opinions of Dave’s peers (in Bragin) about what he should do in order to get better, and the guilt and pity of his mom, are the reasons he seeks the ear of fellow veterans who do not judge him.

    Bragin proposes coping with the difficult experiences expressed by the patient by ‘keeping the violence in mind’. This solution may be somewhat useful; however, it contains two critical misunderstandings of the experience of war and trauma. First, she assumes that violence is the only component of traumatic war experiences. Second, she seems to suggest that not ‘keeping the violence in mind’ is the only thing hindering society from being able to understand a veteran.

    A world of experiences exists in war. Not only violence dominates the traumatic experience of a battlefield. It is also chaos, existential loneliness and long, long hours of boredom, as well as many other complex sensations. We often think only about violence when we think of PTSD, but how can we wrap our heads around eight hours of standing on a guard tower at night, alone with your thoughts; how can we understand what it is like to be looking at the darkness hoping that nobody will surprise you and at the same time hoping that somebody will surprise you, not being able to stay awake and yet not being able to stop the racing of your thoughts? One thing I learned from my soldier experience: there is much more trauma in the experience of battle than just violence.

    The ability to listen exists only by acknowledging an inability to understand. Being aware that trauma is a complex state comprised not only of violence, but by a variety of thoughts and experiences, will fulfill the need of those who live to return, to tell their stories.

    Amit Goldenberg has worked as a Journalist for Israeli daily newspaper Maariv. He is currently on the process of publishing his first novel and applying to graduate schools in the U.S.

    See this link for Martha Bragin’s article.
    http://internationalpsychoanalysis.net/2011/08/19/can-anyone-here-know-who-i-am-co-constructing-meaningful-narratives-with-combat-veterans/

  2. Prudy Gourguechon Says:

    Nathan’s post is a call to action we are having difficulty heeding en masse. His reminders of the extensive psychoanalytic involvement in the treatment of soldiers and veterans during and after World War I, II and Vietnam is valuable. My former father in law, Moses Frohlich, was a psychoanalyst in Ann Arbor Michigan in the 1950’s. Nothing in his long career was described with more pride or intensity than his work at the Veterans Readjustment Center there.

    A number of individual psychoanalysts have made incredible contributions to to the care of soldiers, veterans and their families, including Judith Broder and those who have worked with her on the Soldiers Project, and the SOFAR project established by Jaine Darwin and Ken Reich. And a certain number of psychoanalysts are employed within the VA system, and some in the military. Yet we are far from in a position to have the kind of impact within military mental health that prior generations of psychoanalysts did, for a vast number of complex reasons, from the dominance of evidenced based, manualized and behavioral/biological paradigms to the shear unfamiliarity of our thinking in today’s world.

    A few years ago, we established the Soldiers and Veterans Initiative (SVI) in APsaA. We have some pages on the APsaA website where we have collected a bibliography, resources, and news about what analysts are doing in this arena. We have written and promulgated several position statements that APsaA has issued. Please visit the webpages at http://apsa.org/Programs/Soldiers_and_Veterans_Initiative.aspx. You will see the pages need some invigorating and updating (any volunteers?), but there is much interesting material there.

    Jim Pyles, APsaA’s lobbyist, has arranged visits for APsaA representatives to senior DOD officials where we had a chance to urge consideration of the issues of relationship, narrative, individualization of treatment and other psychoanalytically derived concepts in the treatment models adopted by the Defense department. Hopefully, some seed was planted. But one thing that struck me personally in visiting these doctors trying to think about the care of thousands of psychically wounded–their job was unimaginably immense and daunting.

    What more can we do as a national membership organization of psychoanalysts? We continue to struggle with the answer to this question. How can we contribute to what is a broad public health problem, using our specialized knowledge but being humble too about the realities involved? We now have a regular meeting at the APsaA national meetings (open to all attendees). All interested in this area are welcome and wanted–we need to form a far flung but united community of practice and care. The next meeting of the Soldiers and Veterans Initiative will be at the APsaA January meeting in New York on Wednesday from 12 to 1:30. Please join us.


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