Nadle: Troubled vets need a better therapy

A study released last week found that nearly 1 in 4 veterans returning to New York from Iraq or Afghanistan suffers from post-traumatic stress disorder or depression. We need to find a more effective way to treat our veterans who come home with emotional wounds. The previous failure to help many psychically wounded soldiers can be seen in the gray hair of the Vietnam vets still suffering decades after their war ended, some sitting in the streets with a begging cup.

If Iraq and Afghan vets are to avoid the same fate, the greater society must be involved in their healing. While many will need better individual therapy, they also will need a communal cure. Americans must reach out to those soldiers who come home fundamentally changed. Civilians should urge vets to tell them of their war horrors, and let them know that society takes part of the responsibility for what the soldiers did in our name.

In ancient warrior cultures, there were formal rituals to transfer the guilt of the individual fighter to the whole tribe. We can borrow some wisdom from those societies, which understood the need for a communal cure. Elders immediately tended the returning fighter instead of letting him wander the landscape alone, unable to function. It's possible to turn every church, synagogue and community center into a healing space. Help can happen in a living room even if the gathered group is only family and friends.

In the tending offered, in the willingness to listen to their war stories, the community gives emotionally damaged soldiers a welcomed place in society again when those veterans carry feelings of shame for their actions during the war. In validating their pain, it creates a safe place for them to begin their search for catharsis. The most important thing for healing is the community's willingness to admit its collective culpability in the behavior soldiers carried out as servants of the nation.

One of the main proponents of the communal cure is the psychologist Edward Tick, author of "War and the Soul" and founder of Soldier's Heart, a project of the International Humanities Center, who has worked with psychically wounded vets for 30 years. He and others go further in reshaping treatment for these vets.

Their approach to individual therapy tosses out the orthodoxy of the American Psychiatric Association, which defines PTSD as an anxiety disorder. It breaks with current treatment's habit of mainly managing symptoms, often by merely dulling feelings with drugs or desensitizing a vet's reactions to the sight and sounds of battle with computer-aided virtual therapy. Mainly, they reject the prevailing therapy's pragmatic emphasis on rushing vets to their future without much looking back at their actions in the war or at moral issues.

Instead, Tick and the new practitioners see the core of the problem as the moral trauma and identity disorder caused by the soldier's behavior during the war. Their therapy, rather than deadening feelings, encourages soldiers to go into the pain of their moral trauma, to re-experience all the original emotions, to shed tears, to grieve and, ultimately, to forgive themselves.

"Many people are impressed with Tick's commitment to treat the whole person instead of just one aspect," says Dr. Ganesan Krishnamoorthy, program manager of the PTSD residential unit at Northport Veterans Affairs Medical Center.

One of those people is Robin Becker, an associate professor at Hofstra University, who has invited Tick to speak at the campus in April. Another is Jo Postetivo, a specialist in the PTSD unit of the Brooklyn VA hospital. "In combat," she says, "vets are expected to do things that are the opposite of everything they have been taught is moral. That is especially true in Iraq and Afghanistan where they cannot always identify the 'enemy' and kill a lot of civilians. I don't think they can recover unless the moral or spiritual issues of guilt and forgiveness are dealt with."

This therapy also focuses on fixing the shattered identity caused by war actions that make soldiers no longer feel like the people they once were, or like good people. It encourages vets to do acts of service or atonement, to repair their identity. The goal is to expand soldiers' positive sense of themselves so much that their war behavior shrinks into just a small part of who they are.

With individual therapy that addresses the core of the problem instead of the symptoms - and the active role of society in the healing - psychically wounded Iraq, Afghan and Vietnam vets will have the possibility of a cure, instead of just endless suffering.