Some veterans say war changed them for the better

What didn’t kill them made them stronger: PTSD growth debated
by Michael Ruane, Washington Post

WASHINGTON — As Hilbert Caesar told his harrowing war story one night recently in the living room of his apartment, he patted the artificial limb sticking from a leg of his business suit. ”This, right here,” he said, ”this is a minor setback.”

Eighteen months after Caesar’s right leg was mangled by a roadside bomb near Baghdad, and after weeks of coming to terms with what he thought was the end of his life, the former Army staff sergeant believes he has emerged a richer person — wiser, more compassionate, and more appreciative of life.

Asked whether he would endure his war experience again, he replied: ”The guys I served with were awesome guys. . . . I would go through it again — for the guys that I served with. Yes. Absolutely. I wouldn’t change it for the world.”

Although the shattering psychological impact of war is well known, specialists have become increasingly interested in those who emerge from combat feeling enhanced. Some psychiatrists and psychologists think those soldiers have experienced a phenomenon known as ”post-traumatic growth,” or ”adversarial” growth.

Although war left him with a leg of plastic and steel, Caesar, 28, of Silver Spring, Md., appears to be among those who return home with psyche intact and a sense that they are in some mysterious way improved…

”I’m the same person,” he said, ”but I’m a different person now.”

Combat’s potential to inflict psychic wounds has been recognized as far back as the time of the ancient Greeks, but so has its ability to exhilarate, intoxicate, and instruct those who experience it, specialists say.

”If you think about all of the heroes and heroines in cultures across the world . . . all of them, in one sense or another, faced some sort of a dragon,” said Matthew Friedman, director of the National Center for Post-Traumatic Stress Disorder and a professor of psychiatry at Dartmouth Medical School. ”The transformation from that encounter has been celebrated from antiquity.”

Although doctors and scientists continue to worry about war’s impact on mental health, they say research now indicates that most people exposed to combat and other traumatic events do not develop chronic mental health problems.

”It used to be thought that virtually everybody who experienced these kinds of catastrophic events would go on to develop” symptoms of post-traumatic stress disorder, or PTSD, said Lieutenant Colonel Charles C. Engel Jr., a psychiatrist at Walter Reed Army Medical Center in Washington.

”That was kind of a post-Vietnam War assumption,” he added. ”What we’ve learned over time is that probably, on average, really about two-thirds to three-fourths don’t develop PTSD.”

Friedman, of Dartmouth, said that research on the issue has not been that extensive and that the ”deleterious” effects of trauma have received the most attention.

But that is changing. ”The whole field, in the last four years, has shifted to a certain extent [to focus on] resilience, on human potential,” he said.

Wounded veterans of the Iraq war say similar things. Adam Replogle, 25, of Wellington, Colo., a former Army sergeant and tank gunner who lost his left hand and the vision in his left eye in a battle in Karbala in 2004, said that he still has ups and downs but that after his experience in Iraq, not much worries him.

”Sometimes it takes people a lifetime to realize what it’s all about, and what’s important and what’s not,” he said. ”And you go through something like this and it grows you up a little bit and makes you realize that stuff a lot earlier in life.”

Caesar, a native of Guyana who grew up in New York City, was a six-year Army veteran and a section chief in a field artillery unit in Iraq. After he was injured in the explosion, he tried to hand his machine gun to a comrade but realized it was bent. He could hear gunfire and yelled for the hatches to be closed. He thought: ”Oh, man. This is it. My life is over.”

But it wasn’t. The insurgents who staged the ambush melted away. He was airlifted to safety, and six days after the attack, he arrived at Walter Reed.

There, he was all right, except when he was alone. Then he would worry about the pain — and the future. He was an athlete but realized that he might never run again. He wondered how women would react to a man with an amputated leg. It was depressing. Again, he said he would think, ”My life is over.”

Not all mental health specialists believe in post-traumatic growth. George Bonnano, a psychologist at Teachers College, Columbia University, is skeptical. He said such reactions to trauma are better explained by personal resilience.

”Most people are able to maintain equilibrium pretty well after a traumatic event,” he said. In addition, ”it’s fine to just recover. Bad things happen, and we get over them. We get better, and we put it behind us, and we move on.”

In the weeks after his arrival at Walter Reed, Caesar met other severely injured soldiers and heard stories about their recoveries. ”You start to build your confidence up,” he said. ”You start to shift focus.

”I’m a positive person,” he added. ”I try to look for the best. It could be worse. I lost a few friends out there. I made it back with just one missing limb, and I’m grateful for that. I’m thankful for just being here. Period.”

At the same time, he said, he believes he has changed. ”It makes me appreciate life a whole lot more. . . . I’m looking forward to settling down, having a family.”

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