Tall, broad and intimidating, he enters my office reluctantly, watchfully. His lack of eye contact suggests both distrust and a muted vulnerability. We begin to discuss what brought him in, and he states that the only reason he is here is that his wife told him that if he didn't get help, she would leave. He describes, with prompting, the nightmares and lack of sleep which contribute to him feeling irritable most of the time, his lack of patience with his young kids, and the fact that he feels distant and just doesn't care about most of the things that upset his wife. "She says I don't have any feelings, except anger, and she's right."
His brother has also told him that he's not the same guy he was before his deployments, and has expressed concern about how much alcohol he drinks. He is embarrassed about the low-wage job he has had to take, yet also fears losing it, because he knows his style and reactions make people uncomfortable. He keeps to himself to avoid any questions, and has no desire to go anywhere or do anything besides the work he's paid to do. He can't imagine things getting any better and wonders if it's all worth it. His quiet despair fills the room.
He's willing to consider medication to help him sleep, and perhaps to help with anxiety, but he is reticent about the treatment I also recommend, called exposure therapy. This entails talking about specific traumatic events repeatedly and in detail, in order to put the memories in context and to emotionally process them; things you are unable to do when existing in survival mode. You can't fully take in what has just happened when you have to do it again the next morning. You can't really feel your terror or grief or guilt or anger, because it would get in the way of the mission. But they wait for you, those powerful memories. They haunt you and clamor for the attention that needs to be paid, to allow your brain to put it together, to understand it in its entirety, including the feelings that are attached to it. I explain to him that if he doesn't process what he's been through, then the feelings that belong with those experiences go where they don't belong.
Now that he's home, his fears of being in crowds or having to stop in traffic have been triggered by unprocessed (and truly dangerous) past events that have very little to do with now. I tell him his job is to separate those things out, and the only way through that is to do the unfinished work: talk about it, think about it, integrate it, feel it, and perhaps even be able to look at it a little differently. Perhaps get some peace with it. And practice doing things that you don't want to do, to teach your brain that it's okay here and now.
Your brain needs to learn to discriminate between the levels of danger then vs. now. He says, "But I think about it all the time. Why would I want to put myself through that?" I explain the difference between opening a book to a page, reading a few lines, and slamming it shut because it's too painful, versus opening the book and reading the chapter in detail from start to finish. With everything included. Perhaps get some peace with it.
He recounts memories to me, in depth. We focus on the most painful parts, the pieces he has carefully avoided for so long. The emotions are strong and very hard for him to allow, it's not how he's been trained, but he does it. It is heart-wrenching at times. I respect his strength. He remembers details that were very relevant to how things played out that day. He is able to acknowledge what a no-win situation he was placed in, how no one should ever have to be in the position to make those kinds of decisions...the life of an innocent child being used as a shield by insurgents, or jeopardizing the lives of his fellow soldiers. And finally, how he did the best he could with what he had in that moment. That people lived and came home to their families because of that decision. That it will always be tragic for a child to die in war. That it wasn't all within his control, nor was it all his responsibility. That he wishes it could have been different. That he doesn't want to lose the part of him that feels sad about that. That it's his responsibility to live his life now.
Since he's allowed himself to talk and feel about this, he notices he can feel some other things too, some good things that he thought might be gone forever. The camaraderie, the bonds that meant so much, love for his family now. Hope that maybe it can get better. Perhaps get some peace with it.
This post is part of a special Huffington Post series, "Invisible Casualties," in which we shine a spotlight on suicide-prevention efforts within the military. Every weekday in September, we'll feature a different blog post by someone who is either an expert in the field, who has been affected by a suicide, or who has contemplated suicide. To see all the posts in the series, as well as original reporting, audio and video, click here.
If you or someone you know would like to contribute to our series, send an email to impactblogs@huffingtonpost.com.
And please, if you or someone you know needs help, call the national crisis line for the military and veterans, 1-800-273-8255, or send a text to 838255