Yes, I’m alive, and yes, so much for the “1K a Day” flash pieces, I know, I know…
I can blame my absence on many easy targets—work, kids, flu shots, polar vortices, the usual, all true—but I actually do have two legitimate reasons as well, believe it or not.
First, I am starting to submit some longer essays to literary journals to see if I can get a nibble, who knows. Unfortunately, the rules of the game require that I not have published my submissions anywhere prior to submission, including on-line. So longer pieces will still be coming, but they might be a bit more sporadic. (Don’t worry: after I get all my rejection letters, I’ll put them on the blog!)
Second, though, and more pertinent: I am seriously embarking on writing a book, no lie. My previous project, Listening to War, is still simmering on the back burner as I consider possibilities for expanding some of the blog entries into other media. My new project, though, is going to happen and it is going to happen this year (not published, of course, which may be another pipe dream, but it will, at least, get written!) In early January I learned of a book-writing course by the therapist Bill O’Hanlon, who is big in the positive psychology movement and the author of over thirty books. I decided to go for it, and it has turned out to be worth more than the price I paid for it. Through a series of guided exercises, published over the course of about eight weeks, he guides would-be authors quite masterfully through the book writing process. I will get it done. No “1K a Day” promises. I will.
But that’s where family, work, and polar vortices come in.
Much of my writing over the coming weeks will therefore be book-focused. However, I plan periodically to publish excerpts on the blog (or perhaps summaries of the exercises that O’Hanlon has us students do), not only to make a public commitment to keep myself on track, but even more to get whatever feedback people might have about the project. Any comments, suggestions, critiques, rants will be welcomed. I mean that.
The tentative title of the book will be Therapeutic War Stories. Subtitle is coming later, as will be summaries of the book’s premise and outline (those are the exercises I’ll be working on.) The book will be geared toward mental health professionals, whether they work in the military, at the VA, or in the community, and whether or not they are currently seeing (or hope to be seeing) post-9/11 combat veterans in their therapeutic practices. What I am posting today is my “homework” for the section O’Hanlon entitled, “Your Origin Story”: the background “story” that helps begin to explain to both myself and, maybe, to readers why I am passionate about my subject and about the ideas in my book. I am, in fact, considering that I might use this indeed as a preface. As I’ll probably say repeatedly in these periodic posts: thoughts?
So, here we go. And, as the title of this post says, let the reader beware.
As I closed my VA office door behind me, my final young patient of the day having wiped away his tears sufficiently to permit himself to stumble out of my room with adequate dignity to face that hothouse of veteran discontent known otherwise as “The Pharmacy,” I, his much-older psychiatrist, dared gaze over at the Dell monitor on my desk long enough to ask myself—one more time, dear God—those three questions that had been attacking me (for how many years, now?) after almost every such patient encounter; like three well-positioned snipers on a dark Afghan street, each managing somehow to ambush me, even though I knew—I knew—they were there, not only poised, but destined to fire every time, every damn time:
1). Dare I look at his therapist’s assessment or most recent notes and risk seeing—one more time, dear God—some reference to his “narcissistic traits,” his “noncompliance with treatment goals,” maybe even (ah, mightiest of all) his “sense of entitlement,” epithets disguised as clinical observations, memorialized forever in an electronic record immediately available to any clinician at any VA in the country with just a click on the “Save,” all describing some twenty-eight year-old dude with an attitude, sure, he knows it: no surprise, given that on his twenty-first birthday he was wandering the hills of the Afghan-Pakistani border (“not there,” of course), a “narcissistic (i.e., cocky) character” who, six weeks later, before he’d even had a chance to play a decent game of legal beer-pong with his buddies, was cradling his best of his best in his arms, praying to catch one last word from him, hearing instead only gasps that seemed to be flowing out of his friend far more slowly than was his blood, a buddy whose very memory had, only minutes before, caused this wisecracking tough-guy to shed tears in my office that flowed just as rapidly as blood, while gasping just as slowly as death rattles, “Why him, Doc? Why not me?”
Or . . .
2). Dare I open up my email Inbox instead and risk reading—dear God, one more time—another bevy of accolades about the latest data disguised as wisdom, heralded by experts both East Coast and West, assuring me that the newly-published study or (ah, mightiest of all) recommendation will make my evidence-based treatments even more precise and veteran-centered, studies done on veterans who do share, indeed, with my young patient the clinical-research tags of “OEF/OIF veteran” and “PTSD,” but who (for reasons of scientific study design, of course) do not share tags such as “severely depressed” or “with TBI (traumatic brain injury)” or “abusing substances” or “unable to commit to an eight-week, uninterrupted course of treatment because I can’t find anyone to take care of my kids on a reliable basis or because I’m too freaked out to take the second bus down to the VA, since most days the driver is some guy who looks just like that Iraqi I shot only seconds before he would have shot me, and the researchers can’t afford to pay my cab fare for eight weeks, and I’m still not sure how I’m going to make up last month’s rent, let alone this month’s, so I might have to drop out at a moment’s notice to take that job repainting the insides of those scummy, repossessed houses if my uncle calls”?
Or how about my personal favorite: “not suicidal for at least three months”? Seriously? And they’re seeing me?
And, of course, out of that group who did meet the study criteria, how many of them dropped out before the study was completed, you say? 40%? Did I just read that right—forty per cent?
Or . . .
3) Dare I this time—dear God, one more time, but this time I mean it, I really do—just wheel around, take a right, and then make a beeline straight down D Hall, full sprint, out the door, over the White River Bridge, into the setting sun, all the while screaming at the top of my lungs “I can’t take this any more!”, thereby, in my final triumphant act, providing my colleagues, both present and future, the ever-ready, casual query at Holiday and retirement parties, caffeine-free Diet Coke and oatmeal raisin cookies in hand, “Hey, remember that shrink who went over the edge that one time? Odd duck, what was his name again?”
So, at that day’s end, I too stumbled, reached my desk, plopped down in front of said screen, bleeding from my three bullet holes all the while, and asked myself—dear God, one more time—”Am I about to keel over and die of a heart attack?”
For guilt has a way of doing that, you know.
You see, some of those colleagues who had dropped the occasional epithetic clinical observation were, I knew, wonderful people, passionate, yet exhausted; eager to learn, yet overwhelmed; committed to bringing some semblance of peace to the lives of the men and women who have served in combat, yet frustrated by treatment approaches that sometimes hit the nail smack dab on the head and other times just whack thumbs, leaving therapists confused and self-doubting, veterans angry as all get-out.
Moreover, some of those researchers and recommenders were people whom I’d heard speak, whose sharp minds and passion for the best care possible for veterans had been quite evident, who were simply trying to figure out what’s going on, enough so that not only veterans, but investigative reporters and Congresspersons can get at least some tentative answers to their questions of “Why?” and “So now what?” I had even had a national leader in the field, a complete stranger to me, try more than once to call me on my cell phone to see what he could learn about the comments (not too dissimilar from the ones above) that I had left on a webinar evaluation.
War is war. We’re all doing the best we can with what little we have. Nobody, including psychiatrists who can wisecrack with the best of them, gets a free ticket out.
So that day, progress note completed, screen logged off, I sat back in my chair and had to ask myself, “What’s going on? Why are I and all these good, well-meaning people seemingly stuck on this hellacious merry-go-round, recriminations popping out of the center calliope in a never-ending 4/4 meter, data bobbing up and down, never going anywhere, always daring us to figure out how to surmount their never-ending motion without falling off onto our heads?”
I’ve thought much about that since then. I’m nobody special: privileged to have been well-trained at excellent university programs, yes, bright, yes, but so are most of my colleagues. I’ve had my successes and failures, fortunately more the former than the latter, but (I hope) I am smart enough not to take too much credit for that happy imbalance. People have told me—combat veterans and clinicians—that I am “not like most of the psychiatrists that they’ve met.” I take that as the compliment it is usually meant to be, but I have to admit that since I have had the honor of working with—and even more, learning from—many superior psychiatrists, psychologists, social workers, and mental health clinicians in multiple settings, both VA and non, I am not quite sure what to make of that, either.
That day, though, I knew that I was going to have to put into words what I was living as a psychiatrist trying to guide post-9/11 combat veterans to more meaning-filled lives, to add understanding to experience, my own, certainly not as a way to prescribe “the” best way to work with these veterans, but rather as one way to share with other clinicians some habits of thinking about and being with those veterans that appear to be working for me more often than not, as well as a way to tame my sometimes acerbic tongue so that I can become another person trying to solve the challenges, rather than be one simply harping on them.
I figured there had to be a story behind it all.
And thus, this book.
And thus, I should probably add: Valeat scriptor. Translation: let the writer be brave. Amen to that.
Thanks again to all.