Every war has left us with a hard core of spiritually injured veterans who subsist somehow on the margins of society. With the unprecedentedly high incidence of subtle brain injuries, Post-Traumatic Stress Disorder, and similar conditions in our new crop of veterans, combined with our failure to evaluate and treat them during the Bush years, I suspect that we may be facing a set of problems that will profoundly affect the character of our society for many years to come.
The vast majority of vets from previous wars have managed to reintegrate themselves into society, not always quickly, and usually painfully, but nevertheless in some measure successfully. What's different about the ones who didn't make it, the ones living under the bridges or sleeping on heating grates or freezing to death in an abandoned basement somewhere, dressed in tatters, hand locked around the neck of a liter of rotgut?
Well, most of those people are addicts or alcoholics or both. Some are psychotic as well. Most of them began their addictions when they were still in the military. The psychoses mostly showed up a little later.
A funny thing about addictions and addicts--people say "He's an addict" and lean back as if they have not only explained something, but have given themselves an excuse not to get emotionally involved. They treat the addiction as if it were the root cause of the problem, then they assume that the addiction arises because of some moral failing in the addict, so it's really the veteran's own fault that he's sleeping under the bridge, and that relieves us of the obligation to be concerned. What a wonderful, comforting blanket of self-justification for inaction one can weave.
The problem is, addictions don't just arise out of thin air. People start using drugs and alcohol for a reason. And, incidentally, the addictions are not primarily physiological problems. Cut off the supply to one drug, and they will simply switch to another. The meth epidemic began when people could no longer get cheap cocaine.
Addictions are not about poor moral fiber, and they are not primarily about physiological dependence. They are about something else. They are about drugging away psychospiritual pain. People do drugs for the most part because the drugs quiet the demons in their heads. People get those demons, for the most part, as the result of experiencing severe, emotionally damaging abuse, neglect, or trauma. The dry psychiatric term for these demons is Post-Traumatic Stress Disorder, or PTSD for short.
There is nothing quite as effective as a war for creating psychospiritual demons. Thousands of veterans are still living with the demons they acquired in Vietnam, and we are about to be flooded with hundreds of thousands of new demon-haunted veterans from Iraq.
Most drug and alcohol treatment programs are quite ineffective. One massive study of inpatient VA programs showed that only 20 to 25 percent of the graduates were still abstinent after one year. The reason for this is that the treatment programs work on what is often termed a "medical model." They believe that they are dealing with physiological problems, that the major issue for the user is coping with physical cravings for a substance to which his body has become habituated. But the physical habituation is only part of the problem, and in most cases is the least part of the problem. Conventional treatment does not address the real issues, which are the psychological ones.
We have a new generation of techniques for coping with PTSD and related emotional problems brought on by exposure to extreme abuse and trauma. One such method is called EMDR (short for Eye Movement Desensitization and Reprocessing). Another involves a combination of brainwave biofeedback and talk therapy. However, these methods are relatively expensive because they are conducted in series of individual treatment sessions and require extensive training on the part of the therapists.
Thus the veteran problem is by no means an easy one. Most of these individuals will require a combination of expensive psychotherapy and substance abuse treatment. Some of them, particularly those with severe mental illnesses, will require hospitalization while treatment is provided. They will need help learning new job skills. They will need housing, food, clothing, medications, training, and jobs.
We will only manage to cope with the problem of homeless veterans when we own up to its enormity and commit ourselves to providing the care and help that they need. Are we willing to do that? Are we willing to do that at a time when we find ourselves trembling on the verge of a new global depression?
The vast majority of vets from previous wars have managed to reintegrate themselves into society, not always quickly, and usually painfully, but nevertheless in some measure successfully. What's different about the ones who didn't make it, the ones living under the bridges or sleeping on heating grates or freezing to death in an abandoned basement somewhere, dressed in tatters, hand locked around the neck of a liter of rotgut?
Well, most of those people are addicts or alcoholics or both. Some are psychotic as well. Most of them began their addictions when they were still in the military. The psychoses mostly showed up a little later.
A funny thing about addictions and addicts--people say "He's an addict" and lean back as if they have not only explained something, but have given themselves an excuse not to get emotionally involved. They treat the addiction as if it were the root cause of the problem, then they assume that the addiction arises because of some moral failing in the addict, so it's really the veteran's own fault that he's sleeping under the bridge, and that relieves us of the obligation to be concerned. What a wonderful, comforting blanket of self-justification for inaction one can weave.
The problem is, addictions don't just arise out of thin air. People start using drugs and alcohol for a reason. And, incidentally, the addictions are not primarily physiological problems. Cut off the supply to one drug, and they will simply switch to another. The meth epidemic began when people could no longer get cheap cocaine.
Addictions are not about poor moral fiber, and they are not primarily about physiological dependence. They are about something else. They are about drugging away psychospiritual pain. People do drugs for the most part because the drugs quiet the demons in their heads. People get those demons, for the most part, as the result of experiencing severe, emotionally damaging abuse, neglect, or trauma. The dry psychiatric term for these demons is Post-Traumatic Stress Disorder, or PTSD for short.
There is nothing quite as effective as a war for creating psychospiritual demons. Thousands of veterans are still living with the demons they acquired in Vietnam, and we are about to be flooded with hundreds of thousands of new demon-haunted veterans from Iraq.
Most drug and alcohol treatment programs are quite ineffective. One massive study of inpatient VA programs showed that only 20 to 25 percent of the graduates were still abstinent after one year. The reason for this is that the treatment programs work on what is often termed a "medical model." They believe that they are dealing with physiological problems, that the major issue for the user is coping with physical cravings for a substance to which his body has become habituated. But the physical habituation is only part of the problem, and in most cases is the least part of the problem. Conventional treatment does not address the real issues, which are the psychological ones.
We have a new generation of techniques for coping with PTSD and related emotional problems brought on by exposure to extreme abuse and trauma. One such method is called EMDR (short for Eye Movement Desensitization and Reprocessing). Another involves a combination of brainwave biofeedback and talk therapy. However, these methods are relatively expensive because they are conducted in series of individual treatment sessions and require extensive training on the part of the therapists.
Thus the veteran problem is by no means an easy one. Most of these individuals will require a combination of expensive psychotherapy and substance abuse treatment. Some of them, particularly those with severe mental illnesses, will require hospitalization while treatment is provided. They will need help learning new job skills. They will need housing, food, clothing, medications, training, and jobs.
We will only manage to cope with the problem of homeless veterans when we own up to its enormity and commit ourselves to providing the care and help that they need. Are we willing to do that? Are we willing to do that at a time when we find ourselves trembling on the verge of a new global depression?
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