Diagnostics: A Chaplain Reflects 2 Years Later

I've been concerned about diagnostics for a long time. You know: the observation of symptoms, the evaluation of those symptoms vis-a-vis some long standing collection of knowledges, and then the naming of whatever those symptoms appear to be in their totality. My problem is that 'totality' is rarely taken into account, not in a social way that is. The criteria and framework for diagnostics and the practices of diagnosing feel dangerously isolated and individualistic to me.

This morning, while walking with my mom around the marshes on the island of Sandwich in Cape Cod, the veterans of Palo Alto flooded my memory, infusing my thoughts with their faces, stories, and languages. PTSD (post-traumatic stress disorder), Kidney Failure, TBI (traumatic brain injury), Bi-Polar, Drug-Addicted--whatever. These are hardly the things I remember. I remember the stories about war time, about why they signed up in the first place, what they saw and did on the battlefield, who they saved, who they let down, the poignant events & moments that carved a never-ending narrative into their minds be it about shoulda-coulda-woulda or I'd-do-it-all-over-again. I remember the stories about becoming a civilian again, about the struggles, pain, and relief of reentry: the stories about cheating wives, jealous siblings, weeping mothers and proud fathers, stories about how hard it was to look your kid in the eye knowing you'd shot someone else's kid somewhere else, stories about feeling like a foreigner in your own bed and like a zombie at work, stories about feeling your spouses' skin for the first time and feeling like everything was gonna be alright. And I remember the stories of their today's, stories not so racked with soldier-drama: stories of men grown old, now just trying to be good husbands and fathers and grandfathers, stories of mortages and financial woes, stories of disgust with government and a lazy society, stories of how they felt so emasculated by the health-care-system, stories of how they couldn't wait to go home and see their dog and drink a beer and watch football. I remember all that, but if you asked me their diagnosis I'd probably struggle to recall. Why? Because that's not the totality of a person.

What I learned (because of the privileged positionality of being chaplain) is that whatever diagnostic accompanied their hospital stay, it usually had  a lot to do with their social experience, be it in the family, on the battle field, with religion, whatever. The mind-body connection is never isolated from the social ties that bind. And so I grew increasingly frustrated with what I saw as a devaluing (or perhaps denial/minimization) of the role social relations play both in creating phenomena and in healing that phenomena.

For instance, war is social. Wars usually happen in response to some kind of social conflict in the first place: there's social violence/threat that predates war-based conflict 9 times out of 10. Wars happen because people in relationships make decisions. Leaders decide together. Military personnel suit up and begin working with another in a coordinated effort to carry out incredibly complex operations. Society (to varying degrees, of course) participates in the feed-back loops of the ethics of war by voting for/against the candidates that promise to do something about them. What happens to an individual soldier on the battle field hardly belongs to that soldier alone. So why on earth, when soldiers get back, are they observed, evaluated and diagnosed as if the symptoms of their injury belong to them and them alone? PTSD doesn't arise in someone just because. It arises because one's experience of a relational environment has been traumatic. Yet diagnostics rarely take environment and relations into account when labeling the "problem." The problem gets attached to the (already fucking traumatized!) individual, as if he/she is the only one exhibiting symptoms. Do I need to emphasize how unbelievably unethical this is? Someone is hurt and then we add insult to injury by labeling them in such a way that they become the sole geography of that hurt? Please...

My guess is that if we started observing, evaluating and diagnosing environments and relationships as much as we do this unto individuals, the symptoms under analysis would be much more difficult to treat. A recommended exercise routine alongside some medicinal suggestion would barely cut it because said practice does nothing to cut off the injury-causing system itself and it certainly requires nothing of those who could potentially heal this soldiers's mistrust of his/her current social environment. If social environments are the location of injury, then the only hope for healing comes with repeated exposure to non-injurious and healing social environments. How many of us, leaders, civilians, family members, fellow church goers, feel compelled to create a non-injurious social environment for returning military personnel? Not many of us. Not many at all. Because we are never considered part of the problem and therefore never required to be part of the solution. For shame.

Now that I no longer work in the VA hospital I have zero contact with returning soldiers. Part of that is because they're being redeployed at such a high rate that few of them are actually in country. Part of this is because they are stuck up in hospital rooms by themselves, much like our senior citizens and mentally ill, being asked to shoulder the weight of war and diagnosis by themselves. If you don't circulate in and through the hospitals, or more militarized environments--which i don't--it's hard to see/hear/interact with them. Given the gratitude I have for the memories of faces, stories and languages that came flooding into my mind this morning, I can't help but grieve this disconnect between soldiers/vets and civilians. I might think tomorrow or next week about solutions/bridges, but today I'm just grieving.