Last spring, when I visited Major Tony De Stefano at Malone House, a guesthouse converted into an inpatient unit at Walter Reed Hospital in Washington, D.C., Tony had been there for close to a year. He was undergoing treatment for a lung disease contracted in Afghanistan, probably from inhaling fine sand in the scorching desert winds. Tony is an Army Reserve officer who, after the terrorist attacks of Sept. 11, 2001, served with the Signal Command, which laid the communication infrastructure for troops bound for Afghanistan and then Iraq.
As we chatted, Tony did not dwell on physical injury. What worried him was his mental statethat he slept most of the day, was listless yet agitated and feared he was losing his memory. Once when he and his wife were eating out at a restaurant, a sudden noise triggered a panic in which he began screaming, Two seconds, two seconds, the missile is two seconds from killing us. Talking about that anniversary flashback, Tony pulled a Palm Pilot from his pocket. The screen displayed a digital photo of a missile, a scud, like the one with a 600-kilogram warhead that had missed his warehouse roof by two seconds, thanks to a Patriot interception. If it had hit, I would have been annihilated, Tony said. There would not be enough of me to find to bury. The image of the scud seared itself into his memory; the photo is for those lucky enough not to have to live with the image.
Tony slumped in his easy chair as we talked, often rubbed his head, stared out the hospital window and several times said that he didn’t feel sharp. He worried that he might not be on the ball enough to return to his private-industry job in telecommunications. He said that he often curled up into a ball at night, cried at the drop of a hat and let his appearances go. He was pretty sure he suffered from some form of post-traumatic stress disorder (P.T.S.D.), and he had received some helpful treatment from the Deployment Health Clinic Center at the hospital. But he had limited access to that unit. His primary physician, an officer of higher rank than he, had evaluated him and said Tony did not suffer from P.T.S.D. When Tony asked for a second opinion, the doctor chewed him out and threatened, If I order tests and they come back negative, I will charge you with malingering. Tony complained, and the doctor offered his own diagnosis of narcissism and rated him zero percent for disability.
The threat was delivered around the time Tony learned that although he was selected for promotion to the rank of lieutenant colonel, he would have to retire before he could be pinned. I was a medical file, he said, that had to be pushed out of Walter Reed and active duty care, into the V.A. [Veterans Affairs] hopper. The period from selection to pinning can, even at the best of times, involve long delays. Still, Tony felt he was being deprived of something that was his due. This, on top of the doctor’s denial of his psychological condition, was humiliating. He had fought for his country with honor, Tony said. He loved the Army. Now he was being punished. I understand we still have to be soldiers, but we fought for this country, Tony told me.
A Stoic Culture
Part of what Tony struggles with is the stoic culture of the military: the myth of the soldier who is invulnerable both on the battlefield and off. According to Walter Reed Army Institute of Research reports, however, 30 percent of soldiers will come home from Iraq with emotional problems. (Among 222,620 Iraq veterans, 31 percent had at least one outpatient mental health care visit within the first year after deployment, a figure that is based on Post-Deployment Health Assessment Forms conducted between May 2003 and April 2004.) With casualties at 20,000 since the start of the Iraq war and with a survival to death ratio of 8 to 1 (compared with 3 to 1 in Vietnam), the number of soldiers who will need medical and mental treatment is high. From all reports, it is straining the system. The signature injury of this war is traumatic brain injury, a concussive disorder caused by roadside bombs and explosions; some of its symptoms can overlap with those of P.T.S.D.
Stoicism among the military is nothing new. It reflects the ancient philosophy that shaped military and public culture in Rome, and it has survived in popular form throughout the centuries. At its core it is a doctrine of self-control. As Epictetus, a first-century Stoic put it, Some things are up to us and some are not up to us. The control of emotions is within our power; the ultimate state of our bodies, reputations, power and wealth are not. Within military academies and R.O.T.C. programs, at both of which I have taught, Epictetus is read widely.
Taken to the extreme, Stoicism counsels that we can suck it up, even in the face of extreme suffering and loss. But wise military leaders know better. At a conference I recently attended with naval and marine military senior officers, one young R.O.T.C. female student asked a Marine colonel whether he ever referred his troops to therapy. He replied indirectly: Never underestimate what combat can do to your troops. P.T.S.D., the yips, or whatever you want to call it, it’s real. He knows it intimately, he said. His own best buddy, with whom he served in Iraq, suffers from it and is about to face a medical board. The colonel speaks to him every other day, in part to remind him that what he suffers from is real, that he is not morally weak and that they both made the best choices they could in the fog of war. Another Army major I know, an Army social worker and former Green Beret in charge of a stress-relief clinic for soldiers in Baghdad, regularly offers Stoic Resilience Training, an eclectic brand of Stoicism and cognitive behavior psychotherapy aimed at the therapy-resistant stoic warrior. His goal is empowerment, not denial or numbing of emotional hurt.
When Grief Struck Cicero
The ancient philosopher Cicero struggled with the limits of Stoicism. In the throes of grief for his daughter Tullia, who died in childbirth, Cicero turned to ancient Greek Stoic texts as consolatory literature. He considered the teaching on anticipation, which the Stoics call prerehearsal, whereby we remind ourselves regularly of our human mortality. He considered the teachings of the pre-Socratic philosopher Anaxagoras: Say to yourself daily while your child is alive and then again, when you learn of her death, I always knew my child was mortal. Cicero repudiated the teaching; he found it offensive not to give himself permission to grieve. I should be sinning if I failed to do it, he wrote. Other Stoic techniques he tried are to remember that you are not the only one to have this happen and to believe that this is not such a great evil. Cicero’s reply to these is brusque: It is not within our power to forget or gloss over circumstances which we believe to be evil, especially at the very moment they are piercing us. They tear at us, buffet us, goad us, scorch us, stifle usand you tell us to forget about them?
These lessons come from one who knew well that the pressures of the day require us to put on a public persona of stoic composure and emerge quickly from mourning. Cicero’s absence from Rome, 10 years after the fall of the republic and Caesar’s rise, was cause for suspicion. Only a month after his daughter’s death, Cicero needed a formal note of excuse to explain his absence at a function in Rome. He feigned physical illness. A week or so later, he wrote to his friend, Atticus, I seek the lonely places; though if anything happens to bring me back to Rome I shall do my utmost, if it lies in my power (and it will), to make my grief imperceptible to everyone but you. But Cicero was still posing; the self-help, consolatory literature of his time has reduced the outward show of grief; grief itself I could not reduce, and would not if I could.
Permission to grieve in one’s heart and, to the degree appropriate, in public display is a critical part of facing losses in peacetime and in war. To fail to do so in war is to be a stoic warrior who has lost one’s humanity.
Caught in the Grip of Guilt
On another visit to Walter Reed shortly after Memorial Day last spring, I met a National Guardsman from Wisconsin, Walter Clark, an adjutant general in tactical operations. He stood by a grassy knoll under a flagpole where a soldier at the hospital base had recently had a ceremony for his lost leg. As Walter spoke, he choked up: What civilians don’t get is that war is traumatic. It is not about politics. You are there to survive. You’re there to ennoble each other, to support each other. At the hospital, Walter has been helping roommates who smell like burning fleshone had his armpit blown off, another his right leg. I cleaned them up. I bandaged them. Walter Reed is like being on the Battlestar Galactica, he said. It is removed from life as we know it. Like many with whom I have talked, Walter saw his own injuriesthree ruptured disks and visual impairment in one eye from getting shot atas minor next to the injuries sustained by those in wheelchairs with stumps. Some feel profound guilt that their losses are not greater.
Walter is compassionate; but by his own self-description, he is a stoic. His stoicism is selective: fears that he has knocked out. When you are trained to face the impossible, like getting blown up or the things that most of us would never think aboutyou become inoculated, you become numb. Time will tell, but I thought some of these things would go away, like I would regain normal fear of things, and it hasn’t. Walter is ambivalent about his stoicism: Every day I feel there is another layer of the onion being peeled away, another layer of the stress of having been there. Being adrenalized for war, he says, is not the way to live as a civilian.
For other veterans, stoicism comes whole cloth; it is an all or nothing matter. And it can cripple. A Navy captain who is a colleague must have been thinking this when he asked me to inscribe a copy of my book, Stoic Warriors, for a close buddy, a fellow officer who found it hard to show a softer side to his family. My colleague wanted the family to remember their father, after he was gone, as a compassionate man. And so I wrote, exhortatively: To John, who is a stoic and compassionate warrior. In the back of my mind stood Shakespeare’s archetypal stoic war leader, Coriolanus, who acknowledges in a moment of self-empathy, It is no little thing to make mine eyes to sweat compassion. And yet Coriolanus does it, in just the way needed for military leaders who must care for their troops and care for their own souls. Veteran’s Day is a time for soldiers and civilians alike to remember this lesson. It is a time to remember those who have not returned from war and those who have, bearing war’s scars and its emotional residue. It is a time to remember how great the sacrifices have been.