Review: “At Hell’s Gate: A Soldier’s Journey from War to Peace” by Claude Anshin Thomas

A dear friend shared a long phone conversation with me right after I was diagnosed with PTSD last summer. I had thought PTSD implied war….shell shock. Turns out the second most common cause is sexual abuse. My friend came by his diagnosis more traditionally: Vietnam.

He recommended a book “At Hell’s Gate: A Soldier’s Journey from War to Peace” which struck a chord in me.  What follows is not a true review of the book, but a rambling response seen through my own trauma.

As I tried to describe my feelings and strange urges, my friend provided the words I struggled to find. And that his inexplicable sudden urges were the same as mine.

Those with PTSD have a common language, he told me, that those without it do not understand. Often they do not even see it in us. He said,

We are like ducks on the pond, you see them floating peacefully, but if you take a second and watch their feet, those little feet move so fast. People who have trauma are like that.

Even though we’d come by the diagnosis via completely different routes, I was amazed that our experience with it was the same. “We are brothers and sisters in this,” he shared gently.

The book he recommended was about a man who returned from Vietnam and after an emotional collapse, found his way towards healing as a Zen Monk. “At Hell’s Gate: A Soldier’s Journey from War to Peace” by Claude Anshin Thomas.

(Review date: July 2007)

I was crying before I finished the Preface. I finished the afternoon it arrived in the mail.

Although the book is about the author’s Vietnam experience, aftermath and recovery, I easily read it through my own filter of trauma and large chunks of it resonated strongly.

Everyone has their Vietnam.

So very sad that the side effects and aftermath of trauma are so similar even though the causes (war, violence, etc.) are so different.

A large focus in the book is on coming to terms with suffering, accepting that peace does not mean the elimination or absence of pain, but the ability to “live in relationship with it.” A lesson I have yet to learn. I am still stuck in this phase, as he describes it,

How can I feel such emotions? People tell me I should forget the past and move on. – but I couldn’t and didn’t.

Thomas continues,

[O]ur suffering is not our enemy. It is only through a relationship with my pain, my sadness, that I can reach the other side, that I can truly know and touch the opposite, which is my pleasure, my joy, my happiness.

My own emotions run the extreme – I have pockets of intense joy when I am completely immersed in some of my hobbies – my pleasure and happiness. But those pockets are encapsulated and hard to find. Perhaps that is why I recognize that my joy is so strong – contrasting it with the pain.

But I want that pain much more tempered than it is, so I am at a loss to see how I can embrace suffering, as Thomas counsels, without having it continue to rip me apart.

Before we can get to a place of peace, we have to touch our suffering – embrace it and hold it.

I am standing on the threshold of this … trying to let myself accept that it is okay to purposely reach out and touch the suffering. It is okay to hold it to the light, inspect it, pull apart the pieces. I can intellectualize without a problem, but I cannot feel it. I am not quite there, but his directive pulls me – that I need to do this to get through it and past it. I have to just let my self accept that it is okay to go there, but years and years of forcing myself to ignore it are hard to overcome.

He talks of dehumanizing the enemy…I dehumanized myself.

He said he just turned off his feelings and became a killing machine…the enemy was simply the enemy. I turned off my feelings and I became my own enemy.

Anger…I am currently on a search to find my anger. Oh, it is in there because it occasionally comes out inappropriately. Otherwise people do not see it but I feel it seethe in me every day. Nebulous. But I cannot locate that anger when I think about my attacker. I’ve lost time after the attack, but remember trying to maintain that perfect shell that everything was okay – get good grades, go to class.

Instead, I dissociated and walled off that anger and became numb. I was 16. I had no idea how the world worked. But after a while, I couldn’t stand, as Thomas relays, to be in my own skin.

Thomas advocates talking – people need to tell their stories. Talking in a supportive environment, around people who are familiar.

It is so hard…to take that step. Intellectually I can understand the following assertion, but not the final line:

Anyone who has experienced trauma needs to talk about it…I often hear people saying, ‘Oh, I could never talk about those things in my life. What would people think of me?’ I guess those people are trapped in shame and guilt. They may feel there is some safety in keeping things hidden, but keeping all the pain to ourselves does not heal anything; instead, it fosters abuse, abuse of self and of all sentient beings around us.

This seems to make me a bad guy for keeping things inside. I am serious stuck at “What would people think of me?” (April 1008 addendum: I now understand the last line. I have gotten past this “stuckness”…I have not been rejected, much to my amazement.)

I have been on a quest to find my anger..,but how? It is there, but not connected where it should be. After years and years of forcing myself to keep it under control, how, now, do I actually try to bring it out on purpose?

Thomas spends much time talking of Buddhist teachings which sound good and healing, but a little too completely passivist for me. Perhaps because I am still searching for the anger that has escaped and is poking me with a stick when I’m not ready for it, and hiding somewhere inside me when I am.

Overall, the memoir was a wonderful and emotional read. A quick read. Solid writing, open, honest and bare. His journey was incredible, and his ability to find peace, priceless.

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1 Comment»

  Dolores Wilhelms wrote @

I hope this helps you understand what has happened to you and your friend and others suffering. There is hope.

PTSD is Biologically based.

Dolores
___________________________

FIGHT or FLIGHT
Evolutions’ Biological Imperative

[Ed note: Research by Dolores Wilhelms, while a student in the English Department at Raritan Valley Community College, under the direction of Professor K Nihichi in March 2007.]

1. Primal Instinct: Lessons From Nature
2. The Soldiers’ Heart: Our Biological Response
3. Invisible Death: Effects of Trauma
4. Hope Springs Eternal: Restoration of Self
________________________________________

Primal Instinct: Lessons From Nature
Throughout its evolution, the human brain has acquired three components that progressively appeared. The oldest, known as the primitive reptilian brain is responsible for self preservation aggression and repetitive behavior. Developed there are instinctive reactions of the so called reflex arcs which provide immediate withdrawal from dangerous stimuli. Certain functions are controlled in this unit of the brain such as cardiac, pulmonary, intestinal, etc, which are indispensable to the preservation of life. The development of the olfactory bulbs(sense of smell) made possible an accurate analysis of olfactory stimuli and the improvement of answers oriented by odors. Answers, such as approach, aggression or retreat (fight or flight) and mating. With the emergence of inferior(primitive) mammals, next came the old mammalian brain. Three important components located within this unit are the Amygdala, Hippocampus and Thalamus these command certain behaviors that are necessary for the survival of all mammals. They give rise and regulate specific functions that allow the animal to distinguish between the agreeable and the disagreeable. Here specific emotional functions are developed, such as the one that induces the females to nurse and protect their young, or the one which induces these animals to develop playful moods. The combination of these structures, the primitive and old mammalian brain, would later be called the Limbic Lobe. Emotions and feelings, like wrath, fright, passion, love, hate, joy and sadness, are mammalian inventions, originated in the limbic system. This system is also responsible for some aspects of personal identity and for important functions related to memory. When superior mammals arrived on Earth the third cerebral and outer most unit of the brain was finally developed. The rational brain, a highly complex net of neural nerve cells capable of producing language and corresponding mental processing connected with memory and memorizing, as well as a wide range of emotions, of feelings, of care and affection, the capability for objective, logical thinking and evaluation, symbolic language and mathematical skills.(Julio Rocha do Amaral, MD, Jorge Martins di Oliveria, MD, PhD)

To more fully understand how the limbic system works we need to identify with our animal roots and dare to inhabit. the Serengeti plain that dwells in our collective soul. There, we will become aware of many things. Our senses will rise from their slumber, and we will behold the crouching cheetah as it readies itself to attack the swift, darting, impala. Track your own responses as you watch the fleet cheetah in a seventy mile an hour surge, overtake its prey. You notice that the impala falls to the ground an instant before the cheetah makes contact. It is almost as if the animal has surrendered to its pending demise. The fallen Impala is not dead. Although on the ‘outside’ it appears limp and motionless, on the ‘inside’ its nervous system is still activated from the seventy-mile-an-hour chase. Though barely breathing, the Impala’s heart is pumping at extreme rates. Its brain and body are being flooded by the same chemicals (e.g. adrenaline and cortisol) that helped fuel its attempted escape. It is possible that the impala will not be devoured immediately. The mother cheetah may drag its fallen (apparently dead) prey behind a bush and seek out its cubs, who are hiding at a safe distance. Herein lies a short window of opportunity. The temporarily ”frozen” impala has a chance to awaken from its state of shock, shake and tremble in order to discharge the vast amount of energy stored in its nervous system, then, as if nothing had happened, bound away in search of the herd. Another function of the frozen (immobility) state is its analgesic nature. If the impala is killed, it will be spared the pain of its own demise. (Peter A. Levine, Ph.D.)

The Soldiers’ Heart: Our Biological Response
Important lessons can be gleaned from the account of the Impala and the physical reaction to the fight or flight reaction. Heart pumping at extreme speeds, brain and body being flooded with adrenalin and cortisol, the frozen state. These are the same reactions that happen within us when faced with life threatening and extremely distressing events. The Impala apparently able to “shake off” the ravages of extreme stress and bound back to the herd. Man has no doubt faced the Saber Tooth Tiger, protected his family and villages from marauders and fought battles for eons. But, something has come to light regarding this fight or flight response regarding those with the inability to just “shake it off.”

After the Civil War people were looking at returning soldiers and recognizing that they had been changed and not always for the better. Some called it Nostalgia. The notion was that a Vermonter who found himself with Sherman marching through Georgia who exhibited psychological symptoms was doing so because he was nostalgic for being back in Vermont. Medical observations during this time noted that the cardiovascular system, blood pressure and pulse rate seemed to be altered. These physiological symptoms effecting those with “Nostalgia” came to be known as “Soldiers Heart”. (Matthew Friedman, MD)

World War I and World War II troops quickly began to recognize the symptoms of extreme stress. Shell Shock and Battle Fatigue were names given to symptoms of anxiety. Imagine this dilemma for some. During war time it is uncommon for officers and fellow comrads to shoot deserters. For fear of cowardice or fear of death those who remained on the battle fronts in this state of anxiety having lost the ibility to fight or flight experienced a total mental and physical paralysis. Much like the Impala.

Let’s look at some facts about the Vietnam War. “The average infantryman during World War II saw about 40 days of combat in four years. The average infantryman in Vietnam saw about 240 days of combat in one year, thanks to the mobility of the helicopter. Although the percentage who died is similar to other wars, amputations or crippling wounds were 300 percent higher than in World War II”.

Do crippling wounds take into account the psychological casualties? Statistics show that 20% of our homeless are Vietnam Veterans.(The National Coalition for Homeless Veterans). What happened to these men who were deeply affected causing profound changes in normal life. The diagnosis given this complex health condition that can develop in response to traumatic experience was made, Post Traumatic Stress Disorder(PTSD). Thanks to pressure from the Vietnam veterans’ advocacy groups that really pushed the mental health community into defining PTSD, it was widely accepted that PTSD can result from a single, major, life-threatening event. Bu, with further research there bacame growing awareness that PTSD can also result from an accumulation of many small, individually non-life-threatening incidents. To differentiate the cause, the term “Complex PTSD” is used. It seems that Complex PTSD can potentially arise from any prolonged period of negative stress in which certain factors are present, which may include any of captivity, lack of means of escape, entrapment, repeated violation of boundaries, betrayal, rejection, bewilderment, confusion, and – crucially – lack of control, loss of control and dis-empowerment. It is the overwhelming nature of the events and the inability (helplessness, lack of knowledge, lack of support etc) of the person trying to deal with those events that leads to the development of Complex PTSD. Situations which might give rise to Complex PTSD include bullying, harassment, abuse, domestic violence, stalking, long-term caring for a disabled relative, unresolved grief, extreme stress over a period of years, mounting debt, contact experience, etc. Those working in regular traumatic situations such as police, fire and EMTs are also prone to developing Complex PTSD. Women and children seem to be the most vulnerable to fall prey to the disorder.(www.bullyonoline.org)

Typical problems in recognizing the symptoms and diagnosing are as follows:
A. People who have experienced an extreme traumatic event may hope, or even expect, to be able to “handle it” and “get over it” on their own.
B. Sometimes people feel guilty about what happened and may mistakenly believe they are to blame or deserve the hurt and pain. Sometimes the experience may be to personal, painful or embarrassing to discuss.
C. Some people avoid dealing with anything related to the trauma, especially as they try to get back to the “normal” activities of their daily lives.
D. PTSD can make a person feel isolated or alone, making it difficult to reach out for help.
E. People don’t always make the connection between the traumatic event and the emotional emptiness, anger, anxiety and sometimes physical symptoms they unexpectedly find themselves feeling months, even years, after the trauma. (The PTSD Alliance)

Because of it’s insidious nature Complex PTSD is often mis-diagnosed by the Primary Care Physician as depression, bipolar and at times personality disorder. The patient is usually started on medications for one these conditions. Anxiety medications are also generally prescribed.

Invisible Death: Effects of Trauma
Not everyone responds to trauma with the PTSD pattern of mental change. Genetic studies are inconclusive of inherited and or acquired predispositions but the facts remain some will and some will not develop PTSD after very similar traumatic events. And, once the circuits in the brain are affected by the PTSD pattern a survivor has the following problems: First, their memory is seriously impaired. Often the trauma comes back in subtle ways – a fleeting feeling, a vague sense of dis-ease. This may not be terrifying, but when it occurs frequently it changes one’s whole sense of being the person they once were. Secondly, a person with PTSD feels like a shadow of their former self. The mind and body are in emotional anesthesia. Some have no feeling and some retreat from human touch. Many become distant and detached. They wish they had more zest for life, but the genuine desire to socialize just isn’t there. Numb and avoident the person is just not fully alive. The disorder can bring on an episode of depression. It is not uncommon for some to fear that they are going crazy. And last, PTSD makes a person anxious. The usual pattern includes irritability, impaired concentration, sleep disturbance, being “jumpy” (easily startled), and worried about threats and threatening individuals. This last element of the PTSD pattern anxiety is called “hypervigilence.” Cognitive processes are impaired. Disfunction in the Amydagala causes too much adrenalin making them less efficient, less effective and less able to control their behavior. They aren’t sleeping restfully, can not concentrate and loud noises make their hearts jump. If spiritually oriented before the trauma the sufferer becomes completely devoid of faith. Some survivors have additional medical and psychiatric conditions that complicate and prolong PTSD problems and recovery. Common among these are preexisting personality disorders, alcohol and drug abuse, depression, chronic pain, and bereavement issues. Memory problems play a large part, patients report deficits in declarative memory, fragmentation of memory and dissociative amnesia, which are gaps in memory lasting from minutes to days that are not caused by ordinary forgetting. Dr. J D Bremner faculty member of Diagnostic Radiology and Psychiatry, Yale School of Medicine has shown that victims of childhood abuse and combat veterans actually experience physical changes to the hippocampus, that part of the brain involved in learning and memory, as well as in the handling of stress. His research with MRI (magnetic resonance imaging) has confirmed patients who have sustained chronic trauma to have smaller hippocampal volume. Damage due to this shrinkage to the hippocampus can also impair new learning.

Hope Springs Eternal: Restoration of Self
For some this “living death” can last for years. Some may end up being institutionalized. It is not until a person excepts and understands the factors involved with “what happened” to them rather than “what’s wrong” with them that true healing can begin. It is important to locate medical professionals familiar with PTSD and to have relationships with others who are willing and able to be supportive. Good news from Dr. Bremners’ research published July 2006, in an initial study it was discovered that a year of treatment with paroxetine(Paxil) led to a 5% increase in hippocampal volume and a 35% increase in memory function. Talk Therapy along with medication can be very beneficial. A new therapy which has proven to be effective is EMDR (Eye Movement, Desenitization and Reprossesing)a psychotherapy treatment that facilitates the accessing and processing of traumatic memories to bring these to an adaptive resolution.

Often people suffering the negative consequences of stress, in an attempt to “feel better” may indulge in activities with negative consequences such as drinking and drugs also hurting themselves, taking life treating risks(i.e.driving too fast, sexual misconduct) and eating lots of junk food. Alternatives to such behavior proven theraputic are the simple tasks such as making of art and journaling. Moderate regular exercise such as dance, walking or sports help calm stress and bring oxygen to the organs as does singing and Yoga. Yoga is particularly helpful with restoring life. As to not hinder the healing processs an important component to restoration is CBT(cognitive bahavior therapy) to recognise those “triggers” that will reactivate the sensations of the fight or flight response; anxious, sweaty, rise in heart rate to process the event more rationally and without fear. An emerging field in mental health is with the help of horses and how and what they can teach us about our natural capacity for awareness, confidence, courage and trust. They help us re-connect to life.

Anyone who feels they or someone they know could be struggling with symptoms of PTSD should talk to their primary care physician and get help from professionals who specialize.

Works Cited
1.Dr. Matthew Friedman MD. Ph.D,VA National Center for Post-Traumatic Stress Disorder. Soldiers Heart and Shell Shock;Past Names for PTSD.2005.Frontline.
2. Stress Injury Health Trauma, PTSD.2005.UK National Workplace.
3. Dealing With The Effects Of Trauma-A Self Help Guide. A service of the National Library of Medicine and the National Institutes of Health. National Center for Biotechnology Information.
4. Peter A Levine, Ph.D. Nature’s Lessons On Healing Trauma. 2006.Foundation for Human Enrichment.
5. David E. Dillon, Ed.D.,Louise Maxfield, MA, RCC, CTS, .Eye Movement Desensitization Reprocessing .2004.
6. Dr. JD Bremner. Emory University.
7.Chris Irwin. Horses Don’t Lie. New York: Marlowe&Company,2001
http://www.chrisirwin.com
8.B.F.P.Broekman, M.Olff, F.Boer

Contact: dwilhelms3@yahoo.com


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