James is an E7, a Platoon Sergeant in the National Guard Infantry. He signed up over twenty years ago when he was just 17. Most of the time the National Guard don't get called up, but that changed with Iraq. James has been on many tours of duty, spending the best part of the last three years away from home. He has a wife and three children here in Virginia. When I first meet him he's fast asleep in a reclining chair. He's actually snoring. He's wearing earphones and has a set of electrodes stuck to his head. On a desk against the opposite wall is a computer monitor showing pulsating coloured bars. Apparently these represent the brain wave activities of his two frontal lobes. Through the headphones, I am told, James is hearing a sequence of tones that correspond to those waves and are designed to gradually calibrate them, even them out, optimise them in his resting state. It's not clear whether James being asleep has any impact on the process. Gary, the Speech Pathologist running the session says not. I ask if the effect is similar to that of meditation. Gary says it might well be. He says that sessions on the machine have cured one of the other guys, a younger man, of a neurogenic stutter. 'It was really bad,' he says, 'it was there all the time. Then, after a few weeks having sessions,' he snaps his fingers 'it just went away.' The system is called Brain State Technologies. Looking at the company website (www.brainstatetech.com) it's clear that much of the claims made for the technology in fact come directly from research into meditation. The site also answers the sleep question, and attempts a clarification of the difference between this and other biofeedback techniques :
"Brainwave optimization with RTB (Real Time BalancingTM) is based on brain observance. It is based on a Quantum Physics vs.a Newtonian Physics understanding of the individual, and this philosophical difference cannot be too heavily stressed. Brainwave Optimization with RTB seeks to show the brain itself – be a mirror for the brain in its ever more optimized state. The client is not trained with learned behavior. In fact a client may sleep through a session and still realize results because the brain can view itself without direct client participation. While not optimal, it is always more efficacious to have the client participate, it is not mandatory."
I'm at the Lakeview Virginia Neurocare Therapy Centre for military personnel. This is another service I've come across in Charlottesville by chance - one that is repeated in only a few other centres throughout the US. American service men and women come here from all over. James wakes up and goes out for a cigarette. He seems relaxed, a little puffy-eyed. I ask him about the brainwave stuff. 'I don't know what it does,' he says 'all I know is it's some of the best sleep I ever had.' Next he does a session on an attention-training video game that requires him to click on happy-looking faces in an array that variously switches, disappears, moves around and otherwise tries to fox him. When that's over he seems a lot less relaxed. 'I hate you're stupid games,' he says to Kellie, the Occupational Therapist. Kellie says it's OK - it's frustrating because the game is making him do something he isn't necessarily good at. James crouches down and strokes Cousteau, Kellie's therapy dog. Cousteau (or Cous) is a cross. Half German Shepherd, half Chihuahua. He's nice looking and amazingly good natured. I don't inquire as to which of the breeds was the mother. I assume it wasn't Chihuahua. Either way his existence is surely a kind of miracle.
James gives me a quick tour of the houses where the men live - both of them within a few hundred yards of the clinic. We stand outside for a long while and he tells me about his experiences on tour. He was hit three times on three different occasions by IEDs (Improvised Explosive Devices) while inside army vehicles on patrol. He explains that the vehicles were badly damaged, 'but we still drove out of there all three times. Nobody was hurt. But I guess the shock waves do something to your brain. Also I don't know how many times I smacked my head up on the inside of the Humvee. When you hit a pothole you bounce up pretty hard. I spent a few weeks walking around like this,' he draws one shoulder up to the side of his head, as though he's slept funny and got a crick. 'Eventually it went away, though.' I ask how close together the IED events were - thinking about the critical period of recovery between repeat concussions. He says maybe two months. It doesn't seem as though getting hurt has ever bothered James. 'Nobody wants to be in the Infantry. Most people do what they can to avoid it. To be in the Infantry you basically have to like being in pain.' The things that seem to bother James are the times he's seen other people getting hurt. He's clear about the point of his work, about the rules of engagement: 'If I kill an enemy I doesn't bother me. I don't enjoy it, but I don't worry about it. But a couple of times my platoon was involved in civilian shootings.' There was a woman who got caught in cross fire. 'I went over there to try and help the medics. The other guys stayed back but I went over there.' Another time there was a car that ran through a check point. 'They were trying to get out of the way. We were already in the middle of a fire fight. They were in hurry. I'd have done exactly the same thing if I was driving that car. But where we were we couldn't let them through. It wasn't our fault. We didn't have a choice. At that moment it was our job to stop them getting through the check point.' But that doesn't mean he feels OK about it. A few months after getting home from his most recent tour he started having nightmares. 'There was a time we were watching fireworks and - I didn't notice it but my wife told me I was shaking. I've been in situations on duty, explosions, under fire, never once shook.' He had begun losing his temper with the kids. He only shouted at them, but it worried his wife. The final straw came one day when a stranger bumped into James at a local store. He took the man by the throat and threatened to kill him. After that his wife insisted he get help. James seems uncertain how he should feel about these things. He's maybe a little conflicted. The culture in the army definitely doesn't make much time for discussing feelings, reactions, the psychological effects of the work. I say I think it's a good sign. If he wasn't bothered by some of the experiences he's described, then I'd be more worried about him. I say the fact that he is bothered is a sign of his humanity - it's a normal reaction. He says he learned things in Afghanistan that gave him perspective on some of his own problems. 'You see little kids walking around with no shoes, with the snow up to here. You realise some of the things you've been complaining about? They don't really matter.' I like James. He seems like a serious person, somebody who cares about his work, about the people he's responsible for. He explains how he makes a point of checking all his men's body armour before every patrol, being sure to discipline anyone found missing anything. 'They complain it gets in the way, it's annoying. I tell them I don't care. I wear the exact same stuff, you get used to it.' In all his tours James has never failed to bring anyone back. Nobody has been killed. 'I'm called Platoon Dad. That's my job.' He's talked to some counsellors about the civilian deaths, he says, but they don't understand. 'They ask me "did you pull the trigger? Did you make the order?" but that's not the point. It's my men did it and I'm responsible.' After the car shooting he was investigated. 'I got a call from command to say we were in the clear. They said it was a good shoot. It wasn't a good shoot. I told them that. Even if we did it right, even if we weren't accountable for those deaths, it wasn't a good shoot.'
Chris, an Infantry medic, one of the younger men, is doing a Brain State session. Each programme lasts about fifteen minutes. At the end of each one, Chris opens his eyes to look at his cell phone. He's waiting for messages from a girl he wants to see later.
Cory was a sniper. He wears an eye patch to help with his double vision. He is in a wheel chair. Outside in the smoking area he tells me he'll never work again. He says he has no vestibular balance, which means he falls easily. 'All of my skills are physical, and I can't use them any more.' He says he'll be OK because the army will give him a pension. Won't he get bored, I ask? He says he would like to collect antique books and restore them. He would work out hobbies, ways to stay active.
Mike is on the porch. He's the one who had the stutter. He is wearing fatigues. He goes to work at a place called JAG, a military law firm where he's on placement. He's being transfered to back to regular army base next week. They'll test him there to see if he can handle it, then maybe redeploy him. He has a wife in Iraq. He wants to get back to her.
The men I meet all seem intelligent. They're sharp, witty, quick to find people out, make a joke, see the absurd in a situation. They test the boundaries of subordination the whole time. But I get the impression they are all thoughtful people, reflective. I wonder if this is a risk factor for Post Traumatic Stress Disorder. It seems to make sense in a way, that people who think more, who are more awake to the moral or emotional effects of their work, would have a harder time moving on. What also stands out is this: I can pick up nothing in any of them that indicates brain injury. The exception would be Cory, with his wheel chair and eyepatch. But even he seems in absurdly good shape, cognitively. And they don't talk about it either (again, except Cory) - they don't refer to difficulties remembering or thinking, concentrating or multitasking. I am aware that the symptoms of neurological impairment can be subtle. I'm aware also that the people I've worked with at Headway have tended to be those with more profound injuries. The less severe ones don't report to us nearly so often, or stick around as long. But even so. I feel like I can spot even the fairly low-key indicators: verbal repetition or stereotypy, loss of train of thought ('drying up'), deviation ('poor topic maintenance'), little failures of recall or processing that give away even milder injuries. And even if someone has, technically, had a brain injury, if they have none of these problems, what would you be treating? In conversation with Don Nidiffer, the programme's Director, he mentions someone called Colonel Hoge, a senior researcher at the Walter Reed Army Institute of Research, who's studies indicate a strong relationship between PTSD and the symptoms of Mild Traumatic Brain Injury (MTBI). Once people are treated for PTSD, says Hoge, the symptoms of MTBI seem to clear up (read the article). And people can certainly be helped with PTSD - it's a problem that can be readily cleared up with talking therapy, relaxation techniques, graded exposures. I've been told that this centre's remit is to take people with the milder injuries. And perhaps Hoge is right, perhaps a large percentage of military MTBI is PTSD in disguise. What seems to come through, and what is borne out in my own experience, is that whatever the severity of a person's injury, their state of mind can't be taken out of the equation.
A recent conference entitled Virginia is For Heroes placed emphasis on the fact that the process of returning home for people on duty is now radically contracted. In earlier conflicts, soldiers would spend weeks at base and in transit with colleagues before arriving home. Now they go from battlefield to civilian life in a matter of hours. And perhaps this is a mistake. The transitions involved are important. The opportunity to talk to people who understand, to decompress, to reflect on what has happened in a neutral environment. It is understandable that a person might find it difficult to simply switch from one mode of life to another, to leave behind them the experiences and attitudes of urban warfare without so much as a blink. James puts it this way: 'If I did the things here that I do over there, I'd be in prison. The rules are totally different.' He says he's feeling better now. He goes home at weekends. He's not shouting at his kids so much now. He hasn't felt angry lately. His wife wants him to retire from the army. He says he doesn't want to. He loves his job. But he probably will. I ask him if there's anything else he could do that would be similar. James finishes his cigarette. 'There isn't anything the same as what I do. Except being a mercenary.'
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