itting in his corner office at the Operational Stress Injury Clinic at Parkwood Hospital in London, Ontario, Mike Newcombe looked nervous; a soldier’s soldier, he was obviously uneasy speaking to a civilian about ptsd. In his late forties, compact, his hair brown and his face deeply lined, Newcombe was in the Canadian Forces for more than twenty years, mostly as an infantryman with the Royal Canadian Regiment. He deployed multiple times, including to the former Yugoslavia, and over the years became increasingly angry and anxious. Finally, he told me, one day “I was at a conference, and something went up on the screen and I completely blacked out. At that point, I realized this wasn’t going away.” By 2002, he knew he had to get out, and just a few years later he had a massive, near-fatal heart attack, which he attributes to a toxic accumulation of stress.“When I first came into peer support,’ Newcombe said, “I didn’t want to be there, but then I thought, ‘These guys are going through the same thing I am.’ It’s easier to talk to someone who has been in the military, and it gives you more confidence. Unless you’ve lived it, no one knows what it’s like. When I got back from my missions, people would shake my hand, but they didn’t know.” He eventually became a peer support volunteer, and then was hired on as a coordinator.
Newcombe’s office is down the hall from a full staff of nurses, psychologists, and psychiatrists, with whom he has a fluid relationship. Most patients come to him by word of mouth, and he talks to them individually and in structured group meetings. “About 75 percent of them are younger guys, but at least 25 percent come out of the woodwork,” he said. “The oldest is eighty-seven or eighty-eight. And there is no difference between the young guys and the old ones.”
Treatment at Parkwood, as elsewhere, tends to follow the program set forth by Herman’s seminal Trauma and Recovery, moving patients slowly through the stages of safety, remembrance, and reconnection. “It’s incredibly important to treat trauma,” says Anne Pepper, supervisor of the ptsd and addiction program at Bellwood Health Services in Toronto, “partly because it doesn’t just affect individuals; it affects all of society and future generations — look at the children of Holocaust survivors.” The first priority for doctors is stabilization and grounding. “By far, getting sleep is the biggest problem,” says Dr. Bill Jacyk, attending physician of the trauma and addiction program at the Homewood Health Centre in Guelph, Ontario. “We don’t do any exposure therapy at first,” in part because if a patient is not in a position to confront the trauma, it might make problem worse. “We first deal with ordinary life. Sometimes we have people who have been in the basement for a long time. We get people who say, ‘Why can’t we just talk about limbs being blown up?’ But it’s not spectacular things that entrap you; it’s ordinary things.”
Once a person has a sense of security, the next phase of treatment is trickier and subject to more disagreement among professionals. In an in-patient treatment context focused on both trauma and addiction — over fifty percent of ptsd sufferers also have addiction issues — therapy to address the trauma directly is often deferred until after the treatment program is completed, so as not to risk making the trauma worse. Once begun, though, the three principal therapies used in treating ptsd are exposure, cognitive behavioural, and emdr (eye movement desensitization and reprocessing). Exposure therapy involves working through the details of the trauma; cognitive therapy aims at developing better mental coping strategies; emdr focuses on specific traumatic memories and attempts to establish positive associations in their place. All three are, Pepper says, an effort to “change neural pathways, make it possible for them to interpret the world as safe.” And all three approaches to ptsd speak to a deceptively simple aim: learning how to relax and to manage stress, typically through meditation and breathing, before it spirals out of control.
One of the most disabling features of ptsd (and addiction, for that matter) is how it tends to shatter a person’s social support system. In fact, most psychiatrists in the field list strong social support as one of the indicators that a person who has suffered a traumatic experience will be less likely to develop ptsd. This concern can be especially acute for returning soldiers, who almost universally find it difficult to relate to people who have not been in a war zone. Newcombe tends to tear up when he speaks of his two children and his wife, from whom he is separated. (According to him, Grenier did the same when speaking about his family on a recent visit to the clinic.) “If I get back together with my wife,” he said, “it will be because of osiss.” Both osiss and the Joint Speakers Bureau have programs for families, because a solid and understanding family substantially increases an individual’s chances of recovery — though, according to Grenier, it remains difficult to get them fully involved.
Psychiatrists are fairly optimistic about the prospects for long-term treatment, especially given recent research advances. “As a rule, one-third recover, one-third remain symptomatic, and one-third don’t respond well to treatment,” says Dr. Don Richardson, a psychiatrist who works alongside Newcombe at Parkwood. “But if people follow treatment guidelines, you get 50 percent success rates.”
Both Newcombe and Grenier are circumspect about the prospects for recovery, however: they believe they live with a condition that can be managed but not cured, and that relapses into old triggers and symptoms and habits are inevitable. The condition also presents new challenges with every new mission. Steve Lively, who became a peer support coordinator some time after being deployed with Joint Task Force Two in Africa in the 1990s and now works with the jsb, told me they are already seeing people from the relief effort in Haiti. “I was talking to navy guys who said that in collapsed houses in Port-au-Prince, exposed body parts were being devoured by animals,” he said. “And family members were [the ones] cutting them off.”
For soldiers like Lively, or like John and Dave, these missions abroad are typically the culmination of years of education and training. They are, as a young reservist and student at the University of Toronto told me, soldiers’ best opportunity to employ the elaborate skills they have acquired. No one expects to come home from their adventure entirely changed. But as Ruth Lanius says, ptsd affects the whole person, and it remains hard for the afflicted and their peers not to believe that something in them is flawed or weak.
Lanius also points out that one of the characteristics of the disorder is a lessening of one’s capacity to identify the emotions that drive one’s behaviour — something that is also true of addiction. I could never explain to myself or anyone else why, when going to a polite, bookish cocktail party intending to have a glass of wine and casually socialize, I would end up being found splayed unconscious on the sidewalk outside. As a result, I felt more at home in dives among alcoholics, drug addicts, ex-cons, and, yes, a few veterans. Soldiers with ptsd often report that they have “no idea what is happening to them,” and they similarly isolate themselves from friends, family, and colleagues out of shame at what they have become. One decorated veteran Grenier told me about went so far as to change his name, out of fear of being discovered by someone he knew.
Treatment helps instill a sense of control, but in a way it never really ends; one has to remain vigilant, wary of triggers and relapses into old habits and patterns of behaviour. Like Grenier and Newcombe, I’m not optimistic that the sense of self-doubt and brokenness, the sense of one’s very self as shaky, that comes with the experience of both ptsd and addiction ever completely goes away. If elderly veterans are still finding their way into Mike Newcombe’s osiss groups, then despite all the current neurological research and soldier education, it seems likely that the veterans of Afghanistan will still be seeking help thirty, forty, fifty, even sixty years from now. That alone should give us pause when our politicians decide to send courageous young men and women off into harm’s way.
* The printed version of this story mislabels the Afghanistan conflict as Canada’s deadliest since the Second World War. The Walrus regrets the error. Return to the corrected sentence.
