Happy Fourth of July, Soldier

On the evening of the most recent Fourth of July holiday I was at work in a substance abuse treatment setting. A young man was brought in by his father and was attended by a security guard. The security guard is typical accompaniment for new patients and does not necessarily indicate any behavioral problems with the attendee. I did notice immediately that the young man was huge, like professional football player huge. He was a statistical anomaly of muscle laid over a monster frame. And he was loud.

Within moments it became clear there was a problem. The young man wanted help, but didn't want help in our program. Attempts to explain how the process worked for substance abuse treatment fell on deaf ears because he was too agitated to process auditory information. He explained quickly he was a veteran of the current war in Iraq and had PTSD. This information was either a warning or an excuse for the coming behavior, I do not know which.

He quickly decided he wanted to leave, and bolted when one of the two locked doors was opened for a staff person. Security followed him into the hall and a seasoned staff working the scene identified the man as hostile and perhaps dangerous to the staff and other patients. The staff called for help.

I worked to get the other patients to the safety of their rooms and returned to try to be of some help. I saw that the young man was in the hallway between the two locked doors letting fly the F-bomb and generally posturing in a very threatening manner to the security guard, who was sweating and seemed to be cowering a few feet from the soldier. And just for the record, anyone not fighting heavy weight in the UFC would have been scared shitless, too. Even with a tazer and mase, the first few men to try to control this soldier, if it had come to that, were likely going to the ER with injuries.

This huge, reportedly specially-trained soldier was a kind of physical threat to our safety like I had never seen before. If a human being can be considered a weapon, this young man would be one. And he was making verbal and nonverbal threats.

The staff on the floor were able to deescalate the situation and get the young man to sit down and consider his situation. His father, who had witnessed the scene, but did not seem particularly effective at controlling his son, seemed unhappy with the staff suggestions for the next step. However, the soldier considered his options, made up his own mind, and agreed to get the help he needed in a setting appropriate for him. The situation ended as well as it could.

In all, it took two hours to address the situation and everyone, including the other patients, had been stressed out by the goings on. The young man reported he had been in treatment for PTSD for several months. If his behavior was explainable by the PTSD, then the treatment needed to continue, perhaps for several more years. This guy had a ways to go.

After the fact, I spoke with people who had dealt with him before he came onto our floor as well as the staff on my floor. Most everyone suspected the man had been doping. The steroids would have helped explain his aggression and his unnaturally large size. Others offered that he was a bully who enjoyed frightening us. Whatever the deal with this soldier, we were not equipped in our community setting to deal with his level of threatened violence and probable skill in causing physical harm.

Reintegrating some of the veterans from the Iraq wars may end up being a profoundly difficult challenge. None of us want a repeat of what happened to many Vietnam vets who did not get the psychological treatments or the community support that they needed to successfully begin life again as a civilian. But the challenges we may be facing with these newer vets are quite different in some ways than from previous wars. Access to help has been spotty at best. Even in parts of the country where sophisticated treatments are available, they may not be sufficient for getting these people back on track.The brain trauma many soldiers have sustained has been highly associated with PTSD and treatments for those traumatic brain injuries may not yet be adequate.

Also, there are new dangers to people trying to heal their minds as well as their bodies after tours, particularly repeated tours, in Iraq including availability of drugs and other substances that have been manufactured by drug companies to be of help and make money, but have ended up being just another albatross on the shoulders of soldiers. And those are legal drugs available through docs, which doesn't begin to address illegal drugs and booze. Even the seemingly innocuous activity of playing video games has known negative neurological effects as it can activate the parts of the brain associated with aggression.

We need a strong VA system that can take these soldiers in and help them get better. There must also be the expectation that they do learn how to be in the world again in non-violent ways. We need them to contribute in positive ways to our nation and in our communities both for the betterment of us all, but very importantly, in order that their lives and what they have been through have meaning and purpose.

I would hate to think of the soldier who shut down my workplace for a couple hours becoming a drag on society. Instead, I hope he keeps up the work on healing his psychological and substance abuse issues and goes on to become an invaluable member of his community. It would not be fair to him and to the service he provided our country if he is lost to the war wounds that we cannot see. I hope very much that he gets better and gets on with it.

His apparent ability to make a tough call to accept help even when he knew someone he loved might not understand or agree may have been a sign of his internal fortitude. That could be the strength he learns to draw upon when life gets tough and scary instead of the threat of his brute, physical force.