When Corporal Christian McEachern returned to Edmonton in 1996 after peacekeeping missions in Croatia and Uganda, he felt awful. He couldn’t sleep, had a racing heart-rate and severe chest pains. A doctor prescribed pills, but nothing worked. Over the next four years, McEachern’s symptoms escalated: he suffered memory loss, crying spells, nightmares, and was constantly fighting off panic attacks. “I started to get a real feeling of despair,” he told reporters. “I think if I’d had a gun in the house I would have committed suicide.”

Early one morning in March 2001, McEachern snapped. He rammed his Nissan Xterra through the front doors of the garrison headquarters and drove the SUV around the empty military offices, demolishing desks, computers and file cabinets. He was found weeping and incoherent behind the wheel, and claimed not to remember anything. “The first memory I have,” McEachern later said, “is the female sergeant knocking on the hood of my truck.”

At the trial, McEachern’s lawyers blamed his actions on post-traumatic stress disorder (PTSD), a diagnosis his military psychiatrist had already made in 1997 (McEachern was still on sick leave during his driving rampage). From the witness stand, the thirty-one-year-old soldier fought back tears as he described the desperation that followed his 1994 tour in Croatia, where he watched friends lose limbs to landmines. When he was in Uganda in 1996, he witnessed a woman being raped outside his compound but was forbidden from intervening. “The screams just started cutting into my head,” he said, “and they’ve never left.

 

”The court rejected McEachern’s PTSD defence, giving him a conditional sentence for impaired driving. A year later, Military Ombudsman André Marin released a sweeping report prompted by McEachern’s complaint that he was “ostracized, stigmatized and abandoned” by his unit after his PTSD diagnosis (“Anyone considered to be anything but an ideal soldier,” McEachern said, “is considered weak”). The 229-page report not only confirmed the discrimination (the day before the SUV incident, McEachern received a medal for his African service in a parking lot rather than alongside his unit), but found it rampant. “There was a distressingly common belief,” Marin wrote, “among both peers and leaders that those diagnosed with PTSD were fakers, malingerers or simply poor soldiers.”

This perception isn’t new. The first medical paper on the psychological trauma of combat was published in 1678, and during the American Civil War, tormented veterans were said to have “soldier’s heart.” It wasn’t until the carnage of the First World War that symptoms were documented on a mass scale. The term “shell shock,” coined by British psychologist Charles Myers in 1917, was based on the early belief that the occurrence of men returning from the trenches blind, deaf, mute or paralyzed was caused by the physical impact of exploding shells. Soon, shell shock was interpreted as a sign of emotional weakness, even cowardice, with many doctors referring to their patients as “moral invalids.” Treatment was often extreme, and included solitary confinement and electric shock.

By World War II, “combat fatigue” was grudgingly accepted as a consequence of warfare, though no treatment was offered to veterans wracked by readjustment difficulties when the war ended. Serious study of the condition had to wait until Vietnam Veterans Against the War and other veterans’ groups took up the issue in their push to raise public support for the anti-war movement. In 1980, the American Psychiatric Association finally included “post-traumatic stress disorder” in its official list of mental disorders.

In Canada, the turning point for recognition of PTSD in the Canadian Forces was the case of Lieutenant General Roméo Dallaire. As the UN’s Force Commander in Rwanda in 1994, Dallaire watched as machete-wielding government-sponsored forces went on a killing spree, murdering eight hundred thousand people in one hundred days. His book Shake Hands with the Devil: The Failure of Humanity in Rwanda (2003)—which stayed on the bestseller list for nearly a year and inspired a 2004 documentary, The Last Just Man—describes the mental collapse he suffered after he left Rwanda, culminating in two failed suicide attempts. A devoted soldier, Dallaire became a symbol around the world of what can happen when you bear witness to events you don’t have the psychological capacity to absorb.

But by exposing in damning detail how UN member countries failed to intervene in one of the twentieth century’s most blatant atrocities, Shake Hands with the Devil also put the spotlight on a little-appreciated hardship of UN peacekeeping: rules of engagement that emphasize impartiality and prevent soldiers from taking action unless fired upon. The effect of such operations on foreign policy made the nineties an era of unprecedented paralysis. The humanitarian will to send aid and stabilize explosive areas was never higher, but the de-Spartanizing mindset of institutions like the UN made intervention ever thornier. Global dithering worsened local instability. In Rwanda, the former Yugoslavia and elsewhere, soldiers were ordered to stand by while women were raped and children slaughtered. Like Dallaire, they were traumatized by what they couldn’t do, as much as by what they saw.

PTSD thus emerged, according to Marin, as “a fact of modern peacekeeping missions.” He estimates close to 20 percent of returning soldiers are affected—but adds this is “only the tip of the iceberg” because many refuse to admit they’ve been psychologically hurt.

In his book Empty Casing: A Soldier’s Memoir of Sarajevo Under Siege (2008), Fred Doucette describes the devastating emotional toll of his peacekeeping mission in Bosnia and his subsequent struggle to acknowledge his PTSD without contradicting the principles of stoicism and self-discipline that governed his military career. “If on a scale of 10—1 being great and 10 being horrible—I was asked to rate my sleep,” he writes, “I put down a 3 when in actual fact it was 10.” Doucette’s inclination to “minimize symptoms” continued even after he visited a military nurse and psychiatrist about his bouts of uncontrollable anger that were tearing his family life apart. Often years can go by before a veteran decides to seek help; by that time, a good deal of damage has already been done.

Poor treatment—in the form of well-meaning counsellors and psychiatrists ill equipped to handle the unique after-effects of peacekeeping—can also make things worse. Almost immediately after arriving home from Rwanda in 1995, Lieutenant Colonel Stéphane Grenier fell apart; six months later, the forty-four-year-old career soldier tried to kill himself. He checked himself into a military hospital but didn’t get the help he thought he needed. He felt “disconnected” from his therapist, who seemed reluctant to link Grenier’s anguish to his time in Rwanda, and so Grenier stopped treatment, flushing his medication down the toilet. In 1997 he became, in his own words, a “disciplinary issue,” often acting out in defiance. As with so many soldiers, PTSD created a vicious cycle of anger that just increased his alienation from the military and his peers. Grenier barely managed to keep his job.

His rescue came in 2000 when his Superior Officer, Corporal Chris Corrigan, gave him “tacit permission to get better.” Recognition of his illness from the military chain-of-command proved exactly the boost Grenier needed. He immediately noticed a significant improvement in his mental well-being. “I became treatment compliant,” he explains. Grenier launched Operational Stress Injury Social Support (OSISS) in 2001, a network of about forty PTSD-diagnosed Canadian Forces veterans who act as peer counsellors for soldiers with war-related mental traumas. OSISS also extends similar support to soldiers’ families.

Grenier coined the term “Operational Stress Injury” (OSI), and its embrace by military culture has proved phenomenal in breaking down the stigma of PTSD. Unsurprisingly, most soldiers don’t take well to being told they have a “disorder.” Suffering Canadian Forces members are, by and large, victims of the circumstances of their mission, and overly medicalized terminology has the effect of suggesting that something is inherently wrong with them. So rather than singling them out for PTSD, OSI refers to any non-physical injury—depression, alcoholism, substance addiction—they’ve sustained in combat.

But there are certain realities nomenclature can’t wash away. Michael Mathieu, an OSISS counsellor working in Pembroke, Ontario, is frank: “From a military standpoint, PTSD can’t exist.”

A soldier’s soldier, Mathieu is a muscular thirty-six-year-old former corporal with the 2nd Battalion Princess Patricia’s Canadian Light Infantry (the same infantry McEachern served in). He isn’t suggesting the military refuses to treat PTSD, but that there’s a fundamental contradiction at play. “The forward momentum,” he says, “needs to keep going.” In other words, if the military paused to consider its soldiers’ mental wellbeing at every juncture, it would lose its ability to function as an efficient fighting force. It’s hard to imagine a situation where a soldier isn’t taught—outright or implicitly—to “put a cork on [his] problems.”

Still, given the overstretched situation in Afghanistan, where roughly 2,800 Canadian soldiers are in combat, advocates are spearheading what Mathieu calls “preventative maintenance.” The OSISS recently launched the Joint Speakers Bureau, focused on educating soldiers before they deploy, while Critical Incident Stress Debriefings (CISDs) allow soldiers time to discuss in groups their emotional reactions to high-intensity operations.

Consequences of war trauma can extend to the civilian world as well. Canada has participated in virtually every UN peacekeeping mission since 1948, but only recently re-entered the world of heavy combat. It’s safe to say that the number of innocent lives lost in “collateral damage” has yet to seep into the wider Canadian consciousness, though it’s an everyday reality for the country’s soldiers. Mathieu, who served as a peacekeeper in Bosnia and a combat soldier in Afghanistan, claims public support for the war would plummet “if the actual unsanitized reports reached us.” This watered-down, abstracted sense of war is surely endemic to most developed countries with troops stationed overseas, but for a country proud of its peacekeeping reputation, it takes on a heightened significance.

Mathieu loathes the term “peacekeeper.” When he joined the Canadian Forces in 1990, he accepted that he could die in service. But after his experiences in Bosnia, he lost any positive ideas of his role. Other soldiers told him to “let it go” when he witnessed atrocities, yet the non-interference mandate created devastating conundrums. Serving with a transport platoon, Mathieu would deliver blankets to a warehouse full of refugees, even if his unit knew the building would be blown up the next day. The temptation with PTSD is to seek out one horrific story to zero in on, but it’s rarely that simple. “It’s not this firefight, or this girl getting blown up,” Mathieu says. “It’s cumulative.”

In 2002, he returned from his second tour of Bosnia in deep emotional distress. (Mathieu wasn’t alone: of his platoon—about thirty soldiers—only two didn’t exhibit PTSD.) For some reason, despite being diagnosed with PTSD, he was given “all green lights” for redeployment. Barely nine months after returning from Bosnia, he was in Afghanistan as part of a mop-up crew that exhumed enemy bodies and rounded up surviving Taliban members after

US Air Force bombings. Worn down by the work, his condition deteriorated.
His reception back home only made things worse. “Nobody wanted to treat me,” Mathieu says, explaining how his anger intimidated social workers and other professionals. In order to finally get treatment, he had to act on his own.

He looked into Homewood in Guelph, Ontario, a mental health facility that featured a live-in trauma support program. The cost was $30,000 for the two-month program. There was no guarantee CF would foot the bill, but Mathieu persisted. One day in Afghanistan, he explains, his platoon shot a missile that cost $45,000. If the armed forces could spend that much money on ammunition, they could certainly afford to treat him. In the end he inspired a military ombudsman to launch a report that raised the necessary funds for his treatment.

Mathieu’s Afghanistan mission exacerbated his condition, but does the combat scenario there avoid the non-interventionist “peacekeeper’s injury” that plagued soldiers in Rwanda and Bosnia? Would heavy fighting quell the anxiety of having one’s hands tied despite being trained to kill?

The answer doesn’t seem so simple. Lieutenant Colonel Rakesh Jetly is a psychiatrist who has been in the Canadian Forces for twenty years and has travelled to the base in Kandahar twice. He’s now an advisor with the Mental Health Directorate in Ottawa, responsible for the treatment of OSI for veterans. Jetly describes an almost no-win situation that sees new circumstances trigger different kinds of PTSD. Afghanistan may be free of the helplessness of classic peacekeeping, but it provides an equally potent trauma paradigm.

Not only does active combat add the grief of seeing comrades die, as opposed to unfamiliar civilians, but the unique rules of engagement in a counter-insurgency war create a new form of stress. The Taliban specialize in suicide attacks, blend with civilians and enjoy the element of surprise. “Things are very calm,” says Jetly, “and all of the sudden [they’ll] throw five rockets at the camp.” In a war of unexpected attacks and an indeterminate enemy, a new—almost existential—helplessness works its way into the minds of soldiers. The question shifts from “Why can’t I intervene?” to “Why are we here?”

Grenier’s OSI categories are a useful way of understanding this new anguish. The first category of war-related psychological injury is “trauma,” referring to an identifiable “impact injury.” The second is “fatigue,” caused by burnout. The third is “grief,” caused by personal loss. And the final category is “moral,” referring to the clash between a soldier’s norms and values and the perceived irreconcilable demands of his or her deployment.

The first three categories are common to all warfare, but the fourth has unique resonance for a force grappling with an unconventional combat role in the unpopular Afghan war. This “moral” trauma is further proof that not only does PTSD need to be accepted by the Canadian military as a legitimate medical problem (and according to Jetly, we are “light-years ahead of where we were a decade ago”), but it’s a fight few soldiers can win on their own.

(See the rest of issue 35, Winter 2009)

Related on maisonneuve.org:

—Why Afghanistan is Canada's Next Korea
—Iraq's Walking Dead
—Behind the Firewall

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