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I'm grateful to the National Library of Medicine and especially to Jeffrey Reznick
for reminding me about this fascinating film and inviting me here.
Seeing the film now with the personal and professional hindsight of many years
evokes layers of memory and reflection that I hope to share with you tonight.
When my father joined the Navy in World War II, our lives changed as they did for so many
families.
My mom and I moved back east to live with my grandmother so we would be nearer
to where my father was stationed in Anacostia, Maryland just down the road.
After very active war bond and USO work earlier
my father was assigned to the Navy's photographic unit to make training films.
I can remember him later joking about his magnum opus on how to assemble and disassemble
a rifle
but he also talked seriously about what it meant to him
to make films like the one we are highlighting this evening.
His experience framed our whole family's experience with service people from then on.
My mom and her girlfriends went out every week to the local VA hospital back in Los
Angeles
to dance with a particular group of anguished and withdrawn young men on the psychiatric
ward
trying to use music and movement and human involvement
to bring them back into contact with those who could help them.
My first college was Swarthmore near Philadelphia, which hosted a military rehabilitation center
during World War II where my father had spent some of his research time before making this
film.
From Swarthmore, my friends and I regularly went over to Fort Dix in New Jersey
to play board games and cards with young men in the hospital there.
So there's kind of a full circle feeling to my being here tonight to speak with you
as my father's daughter and as a mental health professional.
This film offers a platform for some thoughts about where we've been, where we are,
and where we might go as we think about the needs of service men and women and their families.
One question that's come up about this film concerns the underlying assumptions
and the treatment methods it depicts.
Are they still valid or effective?
How much have we learned since then?
What can we glean from the film that might be relevant now?
My colleagues who work in the VA and those of us involved in other efforts for veterans
and
their families, grapple all the time with many of the same issues raised in this film.
We're still debating what to call these phenomena.
Everyone knows what the descriptive picture is with its characteristics of insomnia,
irritability, rage, isolation, and physical complaints,
but what is the utility of a diagnostic labor like war neurosis or shell shock for PTSD?
These labels dignify it as an illness, but they also can generate stigma and a reluctance
in veterans to seek help, least they see themselves and be perceived by others
as damaged, weak, defective, and useless to their services.
A strength of this film is that it gives us a single sailor to focus on
reminding us, perhaps,
that considering each person's individual story is at least as important as their diagnosis.
I think what we are going to do now is pause to see some clips from the film
because our plan had been to show you some clips before hand, before I talked
because I think some of you have had a chance to look at the link and see the film online
but others of you may not have had a chance to do that.
And we do have about seven minutes of clips from the film,
some of them selected by Jeff Reznick and Mike Sappol from the library with some input
from me
and that will give you just a taste of the film.
So I'm going to pause while we look at the clips and then I will resume.
[music playing]
[United States Navy Training Film Restricted P.S.L 1945]
[music playing]
[music playing]
[Combat Fatigue Irritability] [music playing]
[Knock on door.] Come in.
>>Orderly: This is Lucas, sir. >>Doctor: Sit down, Lucas. >>Lucas: Thank you, sir.
>>Doctor: Cigarette? >>Lucas: No, sir. >>Doctor: You know, Lucas, I've been wondering about you.
During the week that you've been here, I've noticed that unlike the other men
you don't talk in our group session.
What is there to talk about, sir?
Lots. You hear the other men getting quite a few things off their chest.
You should be able to see that they feel better by so doing.
>>Doctor: What ship were you on, Lucas? The Montana, sir. >>Doctor: The Montana was sunk, wasn't she?
Yes, sir -- last May -- South of Mindanao in a high sea -- torpedo aft.
>>Doctor: And you were a fireman?
I am, sir.
>>Doctor: Certainly.
>>Lucas: And it's a tough job being a fireman, always below decks. You never see what goes
on.
That's why I'm fed up. Nobody gets it. Nobody.
>>Doctor: Maybe not. And, yet, there may be some of us
even among those of us who haven't been there who do understand.
>>Lucas: What do you, sir, know about what it feels like to be a fireman?
What does anybody know what it feels like to be a fireman except a fireman?
You've got to be there to know. You've got to feel the God damn heat.
On the Montana, it was always 128 degrees below decks. A hundred and twenty-eight degrees of sweat and more sweat.
No place to go or to move to. Those guys topside have it soft. They can breathe air, move around, see the enemy.
Hell, we don't know whether the next minute will bring a bomb or whether there's a torpedo coming for us right now.
[Doctor: What was your job in the engine room, Lucas? I was striking for water tender. I watched the lines feeding water to the boilers.
That's why I couldn't move. I had to stay with those God damn valves. Guys topside can take it out on the enemy. They can shoot a gun. All I could do is wish I could twist a valve, but I couldn't
because I'd wreck the boiler. Christ, you guys say you've got to do something and all you end up with is a burning feeling in your guts and your hands shaking.
God damn it, look at me! This isn't me, Doctor!
>>Doctor: How did you feel, Lucas, when you knew you were safe in the water? >>Lucas: How did I feel? >>Doctor: Yes. I was damn glad to get out of that hole. Anybody would have been.
>>Doctor: No, Lucas, not everybody would have been. That's something you've got to face. Furthermore, you didn't really find relief did you?
>>Lucas: I said I was glad to get out of that hole. >>Doctor: Perhaps for awhile, but I doubt if for long. How about it, Lucas? >>Lucas: No, sir. I got the feeling I let my buddies down.
>>Sue: Hard to think what's it like in the summer. Leaves in the trees. It's hot and thunderstorms. Remember when we used to come out here for weenie roasts and all? Yeah, I wonder what's happened to that old hay wagon, that old boy? It was wonderful riding in that wagon. All of us singing and there was always a moon,
wasn't there? >>Lucas: Seems that way. That was a long time ago. >>Sue: Not so long. Back to senior year in high school. That time that we went crewing right over there. You proposed to me in the water. That's a silly place to ask a girl to marry you. >>Lucas: Well, I tried everywhere else.
Gosh, you were stubborn. We were two young and you knew it. You never said that then. No. Maybe I just knew it without realizing it.
I don't get you, Sue. It should have happened. Look what we've missed.
We'll have it, darling. It won't be very much longer. We can start all over again.
Come back here with the gang. Have a weenie roast and go swimming.
How is Burt Haskins is going to go swimming?
How do you know how many of the old gang will be around, including me?
I'm sure you'll be here.
I must be sure of that.
Oh, stop kidding yourself, Sue. Don't you know what this is all about? Don't you know we can't go back?
No, I don't.
I know that we've got to feel the way we did about each other or our marriage won't work. You've got to get a hold of yourself, Bob! Ever since you've been home, you've been snapping at me and --
Oh, for God's sake, Sue!
You just don't understand anymore! You've changed! Go on home, Sue. I want to be by myself.
>>Lucas: I never felt so low in my life as when I walked away from her, but there was nothing else I could do.
>>Doctor: Lucas, tell the class again about that torpedoing. >>Lucas: Torpedoing? >> Doctor: Yes.
How did you feel when you were in the water?
>>Lucas: I've told you over and over again!
For God's sake, I felt glad!
Glad I was out of that ship. >>Doctor: Is that all? >>Lucas: Yes, yes!
I don't think so or you wouldn't be so excited about it. >>Lucas: Well, it is.
God damn it, if I tell you it is, it is! [Crying.] Lots of them were dying all around me.
>>Doctor: Easy now, Lucas. We all understand. It takes a lot out of you to face bitter and unpleasant memories. Come inside with me. I'll be back in a moment.
What you have just witnessed has changed him. Started him toward a real understanding. He can now realize that all that disconnected, fed-up feeling
which showed itself as a fighting-bad temper comes from something underneath.
From a feeling of guilt, feeling of unworthiness. Feelings, which he twisted about
so that it looked as though everyone else were in the wrong. Everyone but Lucas himself.
That's why we have these group discussions.
To help you and Lucas see yourselves as others as others see you.
And to see problems like yours that other men have.
Furthermore, you and Lucas can now put your new knowledge to use in a variety of constructive ways.
Occupational therapy will provide Lucas with a profitable physical outlet for his feelings.
It will teach him that he can work while solving his problems and do a better job of both.
And physical training will keep him in shape in the meanwhile.
What goes for Lucas goes for you, for your irritation is only a symptom.
A symptom of feelings which you bury or try to deny.
Like insomnia or being depressed or sulky or believing that you're no good,
bad temper is a sign of something, something deeper
something which has to be faced and understood and worked out.
When you can do with your problems what Lucas has done with his
you will be free of all of your symptoms.
[music playing] [The End Bureau of Aeronautics 1945 MN-3428c]
It's sort of a hard act to follow.
I think as I had just said before we saw the clips, what this film does
is give us the story of an individual and thinking about his dilemma
then gets generalized in the film, but his story and the story of each person
who undergoes what our veterans undergo is tremendously important.
And thinking about that highlights in vivid terms a culture-wide tendency
to view emotional, psychological, mental troubles as weakness or failure
in contrast to medical issues that are perceived as no one's fault.
General Omar Bradley's insistence on describing his soldiers' difficulties as combat fatigue
might be seen as a way to avoid the stigma for his troops.
The kindly, slightly aristocratic officer psychiatrist depicted in the film
articulates what was surely considered state-of-the-art understanding and treatment then.
Many of the things his character says feel accurate, but all too often to my ears
he undercuts his promising perceptions with cringe-worthy patronizing
or just not listening, culminating right after the scene we just saw
in his short-circuiting *** Lucas' breakthrough by sedating him.
Dr. Bush, the officer psychiatrist repeatedly recurs to one explanation:
that fear was not handled properly. When the ingredients for a different
more complex and maybe more accurate story do seem available in the movie.
There's an interesting intersection for me at this point. When I think of the force
of wanting to know more, go further, find a solution to the problem, master the obstacle
understand better and more deeply, as I experience that in myself , I realize that
this was a lesson from my father. He didn't just accept this script and shoot this movie,
he actually had himself admitted to military psychiatric facilities, so he would know
what it was like for himself and others.
When my parents bought their first house after the war
and their savings had all been spent on the down payment, my dad built the furniture.
He decided to learn to ski when he was 45.
Within five years, he was practicing with the US Olympic ski team.
When break-dancing flowered, he spent hours hanging out on street corners in Haarlem
learning from the kids what they were experiencing and why it was important to them.
What these reminiscences have in common is my father's capacity to meet challenges
with problem-solving and work. What my husband Jack and I,
writing as developmental psychoanalysts about child rearing have called emotional muscle.
When people feel helpless and frustrated, it's hard for them to develop emotional muscle
and resilience, and they'll do anything, even resort to magical thinking
to stop feeling powerless and get a sense of control and effectiveness.
Let's look at *** Lucas' story through that lens.
He tells it well himself, as he describes his sense of powerlessness and futility
in his post monitoring valves in the engine room, immured below, unable to see the enemy,
uncertain of the value of his efforts, feeling less worthy
than the guys manning the turret guns, he felt helpless.
Helplessness is the sine quo non condition for experiencing trauma.
Lucas longed to escape his dungeon. Then his wish came true, but in the worst possible
way,
at the terrible price of his buddies' deaths all around him in the water.
Rather than continue to feel helpless in the face of such awful feelings,
Lucas took an active stance as he began to think that his wish to escape and survive
had caused their deaths, violating personal moral values, as well as the military virtue
of caring for one's fellows feels unbearable.
Burdened by terrible guilt, how could he let himself be happy?
He set out to prove to everyone else that he was as bad outside as he felt inside.
I find it interesting that all of my father's later films, the musicals that we all know
and love
resolve their plot conflicts and the characters problems through fantasy sequences.
This may reflect my father's insight about the power of thoughts and feelings
to make real changes for good or ill in people's lives.
When we track this sailor through the course of his experience
we see that this central idea pervades the film.
*** Lucas' troubled though understandable emotional logic
actually interferes with all of his functioning and his relationships.
Instead of leading to resolution of the issues, as it does in the musicals,
his terrible moral dilemma traps him in a persistent negative loop of guilt and despair.
This brings us to another aspect of the film that I think remains instructive for us today.
In the early 1980s, a colleague consulted me about a number of children in her practice
who were all showing similar configurations of anxiety, phobias, difficulty sleeping,
school problems, and withdrawal alternating sometimes with out-of-control, wild behavior.
As we talked about the children and their families, some common factors emerged.
All their fathers had served in Vietnam, several for multiple tours,
and these vets had struggled on reentry to civilian life. We heard about volatility,
alcohol
and drug misuse, physical violence, nightmares, irritability, suicide and more in the grownups.
It seems commonplace now to be able to characterize such difficult experiences
in terms of sequelae of war, but it was new territory then
to understand the fathers' troubles and their generational impact.
A growing literature at that time was clarifying and validating.
It told us that we were not alone in indentifying the phenomena
nor in attributing the family fallout to issues arising from combat service.
With these insights, we could begin to offer more effective
and thoughtful interventions for multiple generations.
In the film, there's a scene with his girlfriend Sue's little brothers
and it poignantly demonstrates the problematic interactions that can develop
between returning adults and the children in their lives.
I am impressed again here, cinematically, with the economy of depiction
that indicates both sides of the potential problems.
The kids are just being kids, in the scene in the movie, throwing paper airplanes around,
but Lucas startles excessively, then yells and blames the child.
The children are bewildered and startled in turn.
We can extrapolate such a pattern to chronic, repeated interactions
that could lead to sad and ominous scenarios
such as mutual avoidance between parents and children,
over-harsh discipline, children's internalization of blame,
and loss of an image of a parent to admire and emulate, among many others.
I'm reminded of the children of the Vietnam vets I described earlier.
One of the enduring strengths of this film, as I see it,
is the inclusion of family and community in the picture.
The idea that *** Lucas is not living in isolation,
but affects and is effected by those around him.
His return home on leave brings these issues alive
as we see him interacting with his parents and his fiancée Sue.
The film, economically again, gives us both the challenges confronting families
and the predicament the serviceman feels.
Lucas' parents and Sue in their love and nostalgia declare that
everything can be the same again now that he's home, but he knows it can't be.
He is forever changed by his experiences of war.
We see their well-meaning but clumsy efforts to understand what he went through.
In many ways their efforts are no worse than the smoother attempts of the psychiatrist
when he claims that there are some who do understand.
To me it seems disingenuous, perhaps even prideful
to think that we can really know what it was like.
Creative and sensitive imagination can only take us close.
Knowledge, empathy, and information can push us to expand the framework of our assumptions,
to make different and better models to understand what happens.
Rather than basing our ideas on what we wish could be true,
thinking that ordinary expectations should apply in extraordinary circumstances like
combat
we can use the reality to shape our understanding, which in turn determines
how we respond to the real needs of combat vets.
Although there are many literary and historical examples of aspects of that understanding,
going back to the Iliad for instance, those realities are becoming much better
encompassed nowadays than in the model advanced in the film.
The Army's Battlemind program recognized what used to be seen as pathological symptoms
as necessary adaptations to combat conditions.
Hypervigilance, shallow sleep, hair trigger reactions, these are all
important survival mechanisms in the context of threats to life.
Psychoanalysts recognize that repeated experiences get internalized
and become permanent structures in the personality over time.
What is adaptive in conditions of extreme stress such as combat or in an abusive childhood,
or in chronic pain may not continue to be adaptive when conditions change,
for instance when a soldier or a sailor comes home.
When we ask a serviceman or servicewoman to adapt for too long
or for too many deployments, we can predict that reentry will be rocky,
things will not be the same as before, internal resources have been depleted
and cannot easily be retrieved simply by application of mom's swell apple pie.
Perhaps Bradley was right in identifying this deep, bone-weary, empty exhaustion.
Another dimension is particularly well illustrated in the film.
Despite the psychiatrist's emphasis on fear, *** Lucas and his fellow patients
show us the predominance of guilt in their troubles.
This brings us to the perennial and complex experience in war
of what is now being moral injury by Navy and VA psychologists and clinicians.
These are wounds to the soul, the effects of having done something
that conflicts with the moral code the person was raised in or from the feeling of guilt
for having failed to do something, again violating their moral code.
Wanting to live is natural, but it is also the opposite of the military creed
in which you believe it is your duty to lay down your life for others.
Freud talks about this in his memorandum on the electrical treatment of soldiers from
World War I.
He suggest that the conflict between the wish to preserve your own life
and the wish to be a good soldier and save others before saving yourself
produces a good deal of the so-called war neurosis.
The symptoms include feelings of shame, guilt or rage just as we see in *** Lucas.
He had lived when others around him had died, and he had partial recognition
that he was glad he was living when others were dying.
We could see him as suffering from the effects of a tortured conscious.
He has to maintain his guilt to protect against ever feeling so helpless again.
As long as he is guilty, he has some agency.
This helps explain why my father's character goes on a campaign dedicated to prove
that he is so awful that he has no right to live or attain happiness
with his family or his fiancée or even at the local bar.
We come back around to the experience of helplessness
as Lucas does not see any way out of his situation.
We know from clinical experience that people kill themselves at times of desperation,
when they fell they have no other options, cannot tolerate their powerlessness
to change their situation and turn to destructive action as a way out.
Everyone is heartbroken by the current rate of suicide in returning service people.
The human cost and collateral damage is enormous.
Helplessness, rage, and guilt can bring the war home and devastate a family,
a community, a whole society if they aren't understood and addressed.
I quite like the character in the film of the corpsman orderly who offers Lucas
some pretty good advice when he suggests that Lucas is just fighting being afraid,
denying the feeling instead of doing something about his feeling.
The opposite of feeling powerless is finding authentic, alternative actions.
Helping *** Lucas work actively to find meaning in his feelings is a beginning step.
The orderly makes another useful point when he
describes every crew member as fighting together. The whole ship is the unit.
This reminds me of how movies are made.
It's a team art form where every person is essential to the finished product.
In the movie, the psychiatrist is the authority figure who has the answer
and prescribes the medications, but the corpsman offers a different model of health
through teamwork, what we clinically call working alliance,
the partnership that makes treatment effective.
We can extrapolate from this point the importance of peer and social support for veterans.
The citizen services created from the draft meant that
everyone in the society was involved and had a direct stake.
Public support for military efforts in earlier wars didn't obviate all reentry problems
but did offer community welcome and ongoing respect.
The scale of the mental health needs of our country can be daunting.
It could make us feel overwhelmed and helpless, but we don't have to be.
There is a lot of good work ahead for us all.
Mental health parity puts all aspects of care on an equal footing,
acknowledging also the interconnectedness of emotional and physical health.
The integrated initiatives of the VA system that include a range of psychotherapeutic
modalities, the research efforts of NIH and NIMH, the tradition of humanistic care
derived from psychoanalysis and the growing body of knowledge
of early development that supports prevention,
the efforts of many from the president on down to de-stigmatize
psychological troubles and mental illness all offer hope
that we can do ever better in taking care of our veterans and their families.
I doubt if many people know that my father majored in economics in college
and maintained a lifelong interest in history, especially American history.
This evening represents a wonderful melding of histories for me:
the personal history of my father's example in this quite special early film of his,
the history of efforts to understand and deal with the aftermath of war,
what we can retain from this window into therapeutic methods of 70 years ago
that can help us not reinvent the wheel, but integrate what's useful with newly developed
techniques of prevention and treatment, and, lastly,
the importance of supporting efforts to preserve our shared historical legacy
as represented in the work of the National Library of Medicine and its dedicated staff.
So thank you for having me.
[applause]