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 i am a retired american psychiatrist/psychoanalyst living and working in israel (commuting) for the last 40 years. i am married with 4 children and 9 grandchildren, all living in israel.
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MY ACCOMPLISHMENTS:
- graduate of tulane u., new orleans, la.
- graduate of u. of geneva switzerland medical school
- did my internship at bridgeport hospital in conn. residency at creedmoor state hosp. in queens, n.y.
- graduate psychoanalyst of the williaa a. white institute in n.y.c.
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MY RESIDENCE INFO:
City: 10/15 hess st., herzlia
State/Country: israel
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BOOKS PUBLISHED:
DYING TO LIVE: A book about getting there. by Irving Bronsky
Prologue
Life can be simply defined as the process of getting there: The movement of a body from one place to another in a given time, under its own power. For as long as I can remember I have had a powerful drive for moving towards challenge and adventure. But I almost didn't make it into this life, barely being the last-born. My mother had three children in the first four years of marriage and when she got pregnant with me before the end of the fourth year, she knew she was stuck in an unhappy relationship with my father.
The family story, often jokingly told, was that Momma wanted to abort me. She was talked out of jumping off a closet by a neighbor, the woman who had introduced my parents to each other four years before. This is my background: conceived in a bed of conflict and starting life as an unwanted child.
"Dying to live," was one of the expressions I often used to describe my zest for life. My mother was fond of using a negative variation of this phrase, a Yiddish exclamation that expressed her distress or excitement: "Oy, ich shtarb nisht." (Oh, I'm not dying.)
I have always been a zealous and fanatic searcher for getting there, wherever there was. I penetrated new spaces and places, motivated by a rich imagination and fueled by a deep curiosity. I had some peak experiences as well as plumbing the depths of suffering. On one fateful occasion I was this close to death, and it changed my life forever. Here's what happened.
My mother had her usual blind faith in me that day, when she sent me downstairs to play, her three-year-old "baby." She was too busy to be with me because she had no help with the innumerable household chores. My father never helped in caring for the four of us children: my brother Herby was eight years old, Nettie, seven, and Sid was five. We had her approval to roam our block, which included the park on the other side of the street. Her only condition for our unsupervised play was that we stay near enough to our tenement so that she could maintain visual contact with us from the fourth floor, front room window. Momma didn't consider it dangerous for me to cross Fulton Avenue, (the block we lived on in the Bronx,) not in the late 1920's. Most of the traffic on it consisted of horse-pulled wagons, slow moving trucks and the occasional transient car. I crossed and recrossed Fulton Avenue with complete confidence.
That hot spring afternoon in 1928 Sid and I were standing in the kitchen watching my mother begin preparations for the supper meal. "C'mon Itch," he said to me, "let's go to the park and make mudpies". Momma nodded her agreement, adding, "Go ahead, Itchaleh, go have a good time. Just be careful, the two of you? Okay?"
Sid picked up an empty quart milk bottle from the floor next to the icebox and filled it with water, then hurriedly left with me trailing behind. We ran quickly downstairs and out of the building, stopping for a moment on the top of the stoop. My friend Natie was sitting on the top step. He was four years old and my best friend. I liked him a lot because he was so strong, quiet and he had such a nice face. I asked him to join us in making mudpies and he nodded his agreement, saying, "Sure. Yeah. C'mon." Sid skipped down the steps with Natie and I following close behind. We ran across the street, eager to get started.
At the top of an earthy embankment bordering the sidewalk we sat down to dig. In no time at all we had used up the water and Natie suggested that I take the bottle and get some more. I picked up the milk bottle and moved speedily down the little hill, the momentum kept me running across the sidewalk and into the street. An insurance agent's speeding touring car hit me head on. The immense force of the impact threw me into the air and I landed on my head, fracturing my skull. I was taken to Fordham hospital in the North Bronx where I hovered between life and death for three days. One of the doctors told my parents that even if I did survive, I might have permanent brain damage.
The only memory of my month long hospitalization is that I was in a white crib, with thin, vertical, iron bars on the side of the bed away from the wall. There was a window high above my bed with sunlight streaming through. Every time I have this memory I experience a tiny, flickering, sinking feeling in the upper part of my chest.
Much later in my life I learned that the doctors told me to lie still and not to move or else I would die. I was strapped down to the bed and immobilized for the first two weeks of my hospitalization. Strapping me down was an additional trauma that added to my pain, suffering and helplessness. No one in my family continuously sat by my side, nor did they visit me every day and I'm certain that I felt abandoned. I physically healed but there were the beginnings of psychological and emotional wounds that would persist for many years.
In the years following "the accident," (the family label for the trauma), there grew in me the feeling that I was unwanted. Everyone in the family, except for my father, would criticize or make fun of me by calling me "crazy." It was only after I had returned from service in World War II that they stopped their occasional taunts: "Sure. What do you expect? The accident made him crazy." Or, "We're going to call an ambulance to take you to the nut house at Bellevue Hospital."
There is a humorous anecdote associated with my accident. When my brother Sid saw what happened to me, he ran upstairs to tell mamma. He came breathlessly into the kitchen and said to her, "Don't get scared Ma, but Itchy just got killed."
There was nothing funny about the nightmares I've had since the accident. The first one I remember occurred not long after I had returned from the hospital. I dreamt that I was lying prone on the roof edge of the five-story tenement we lived in. Peering over the edge, and not being frightened, I was looking down at Fulton avenue. I wanted to go downstairs to play on the sidewalk, or in Crotona Park on the other side of the street, but I didn't know how. I was stuck. Looking behind me, I saw a witch flying on a broomstick and descending in my direction. As she came closer and lower, I became more frightened. Her strange black flowing garment and high, cone-shaped black hat, increased my fears. When she was almost on me I panicked and fell over the edge. Having lost control of my body, I made jerking and convulsive movements in a vain effort to save myself.
I awakened with a loud banging noise exploding around me, sitting on the floor next to my bed. I began crying for Mama as I scrambled clumsily to my feet. It was hot and dark in the back bedroom where I slept in the same bed with Sid. Crying louder and continuing to call for Mama, I groped blindly in the bed, hoping to find my brother there. He wasn't, and there was no answer to my pleas for help. I became more frantic and rushed out of my room looking for someone, anyone. I was alone in the darkened apartment. I struggled open the heavy, metal-covered apartment door and rushed out onto the lit landing of the fourth floor. Dressed in my underwear, I scrambled down the long flights of stairs and out the glass-paneled front doors onto the stoop. I stood there sobbing and gasping, wildly looking around for my mother. Then I saw my family across the street, sitting on a park bench, "getting some air," (as I later found out), on this stifling summer night. My mother was wearing a white dress and was clearly outlined as she stood in front of the seated family, with the darkened park in the background.
"Mama,” I screamed, and rushed headlong across the street, unaware that I was crossing the same spot where a month before I had been run over. She turned and began to move towards me but I was already on her side of the street, and then nestled safely into her deep, soft protective embrace.
I became a problematic child. I bit my nails and cuticles so badly I sometimes drew blood. I fought frequently with Sid, about anything and everything, never winning but never giving up. He and I explored our neighborhood's alleys, backyards and cellars, looking for adventure and often came home late. One time he took me out of our neighborhood to the "Five and Ten" and we were caught stealing. We were severely scolded and threatened with being sent "Up the river," (Sing Sing), but we were released after being held for what seemed a long time.
On one occasion Sid took me to see how they were building the subway on the Grand Concourse, (about a mile from our block.) We stayed away for about six hours and when we came back we found that search parties went out to look for us. He was seven years old and I was five.
In school, I was restless, undisciplined, and got bad marks in "conduct." (The failing D mark was circled in red.) From time to time my mother was called to the assistant principal's office because of my unruly school behavior. In high school I was still undisciplined and my sister Nettie would come to speak with the school authorities.
In my relationship to my peers I had the reputation for being aggressive and I was sometimes called "Crazy Itchy." (Itchy was my nickname, derived from Itzchak, my Yiddish/Hebrew name.) I was often a clown, a crybaby, and super-sensitive to real and imagined injustices. I could be insulting, revengeful, and always imposed my need for attention on those around me.
World War II saved my life.
Because of my very low self-esteem and aggressiveness, by the time I was eighteen years old I was on a crash course with serious mental illness, a fatal accident or criminal behavior.
I was a radio operator in the Army Air Corps for almost three years, the last two of them in the Central Pacific. When I was demobilized, I was already into transforming my life: I had begun acquiring social skills that eventually led me to become a mature person, successful husband, father and professional. How did I make this turnaround? I began to function in a social context where the people didn't see me as disturbed or crazy. I was treated respectfully and given the opportunity to prove myself in my work. I met and became friends with a number of intelligent, intellectual and educated people. My social skills improved so much that I began to give advice to others. One of my first "clients" was Angelo, a thirty-year-old married man from Cleveland, who was a bank teller in civilian life. A gentle, quiet person, he surprised me one night in the mess tent when we were eating our midnight supper, prior to starting the graveyard shift.
We were on the island of Eniwetok in the south central pacific, eating spam and cheese sandwiches. With a hint of tears in his eyes he began to tell me about his problems with his wife, who had written him a "Dear John" letter, saying she wanted to divorce him. I don't remember the advice I gave him but he seemed very satisfied. I'll never forget that when he shook my hand at the end of our conversation, I noticed that the last joint on the little finger of his right hand was missing.
Eniwetok was a small island and there wasn't much to do with my free time except sunning and swimming. Then I found a small library and took out books by authors like Thomas Wolfe, Ernest Hemingway and the poet Walt Whitman. I read and reread them. I realized that being educated was vital for turning my life around and gradually I came to the conclusion that I had the need to help people. The choice of professions was simple: either I was going to be a lawyer or medical doctor.
At four in the morning one midnight shift I made my choice. I had a break and went outside to get some air and found myself standing in the bright light of a full moon, in front of the Quonset hut field hospital that was set up near the radio station. It was filled with the newly wounded flown back from the recent invasion of Guam.
The same curiosity that impelled me to search down alleys and backyards impelled me to go into the hospital. The ward was dimly lit and there were no medics around. The beds were jammed next to each other, filled with the wounded. They were covered by a variety of bandages and many of them were hooked up to infusions and other kinds of tubing. The cacophony of grunts, groans, snores and moaning was loud and I was amazed that most of the wounded were sleeping. I walked slowly down the aisle, excited, and thrilled. When I came to the end of the ward, I stopped in front of the last bed on the right.
The soldier's chest was bandaged and in the middle of it there was a large bloodstain. From the middle of this a tube came out, ending in a large bottle hung at the side of the bed. He was making wheezing and croaking noises with every breath. I stood for a moment at the foot of his bed, fascinated, but shaking my head as if to say "No," to my helplessness. I turned and walked out. I knew that my life goal was to help others overcome their suffering.
I stepped out into the cool, fresh air of the moonlit night and saw the medic walking quickly towards me. He knew I had just come out of the hospital but he didn't say a word to me. He was carrying an armload of bottles and I held the screen door open for him. He disappeared inside and I quietly closed the door behind him. But I had opened the door to my future.
Not long after that I discovered Freud and read his book, The Interpretation of Dreams. I was excited by what I read, and reread, though I only understood part of it. But my heart knew and the decision to be a psychiatrist rose spontaneously from this heart-felt reaction. One of my new friends had loaned me the book.
He was four years older than me, from the Boston area. His family was in banking. He had been a graduate student in philosophy at Harvard when he was drafted. We liked each other and became good friends. I loved his brains and culture and he loved my street smarts and love of adventure. My friend helped me to understand the importance of education and I sensed that it would also help me to become a mensch, a mature person. I was impatient to get started on my new career, (I was already nineteen years old), and with my friend's help and encouragement I wrote to Harvard. I applied for admission into their pre-medical program when the war will be over. The response came as a form letter, polite and rejecting. I wrote a bitter reply: "If my name had been Irving Bronsky III, (the third), then I would have been accepted." I got a personal letter from the dean of admissions regretting the misunderstanding but still rejecting my request for acceptance.
The second vital step in my rehabilitation came when I met my wife Riva, some ten years later. I was a senior medical student at the university of Geneva, Switzerland in 1955, when I came to Israel for the first time. I worked as an extern for six weeks in a Tel Aviv hospital and then I went to Haifa to board ship for the trip to Europe. In the customs shed I noticed a pretty young woman, zaftig, (full-bodied), deeply tanned, with a thick braid of copper-tinted brown hair halfway down her back. She was crying and hugging her parents, obviously a separation scene.
The next time I saw her was on the prow of the ship as it was leaving the port. We began to talk and exchange information about each other growing increasingly excited by the coincidences. I was a medical student and she was a registered nurse. I was returning to Geneva to the obstetrics department to deliver five babies, and she was going to Geneva, to the same department, for a post-graduate course in pre-matures. When I asked her where she was going to stay, she mentioned the nurse's residence, which was one block away from where I lived with a Swiss family.
Beshert, (Fate).
The following year we were married and we have been living together, (mostly happily), for forty-five years. We had five children -- Now we have four. Our first-born son Yussie was seventeen years old when he got leukemia and in three months he was dead.
He looked strikingly similar to me, with a round face, bright hazel eyes, curly black hair, chubby cheeks, full lips and a slightly cleft chin. He was solidly built, almost six foot tall and weighed two hundred pounds. He was physically very strong, well coordinated, a good athlete and a natural leader. Because we looked so much alike, occasionally I was identified as Yussie's father by people who knew him, but not me. "Aren't you Yussie's father? You look so much like him."
When Yussie was four years old we were living in a garden apartment in Queens, New York. One morning I was walking to my car that was parked in the street outside of our court. Yussie was playing in the court with a friend and when he saw me leaving for work, he ran over to kiss me good-bye. When I got to my car a neighbor asked me if I saw what had just happened and I said I didn't know what he was referring to. He said that after we had kissed good-bye Yussie had quietly walked behind me, perfectly imitating my walk.
He was an average student and did not study very much, rationalizing his casual attitude by saying that he was only doing what I had done when I was his age. He knew that I did poorly in high school and matured late. Since he was a child he had made up his mind that he was going to be a medical doctor and psychiatrist, "Just like Abba," (papa).
He had proven leadership ability among his peers and was socially very active in his high school. He was on the student council which regularly met with school authorities. There was a nationwide program of peer support for the high school students from Kiryat Shmona, a town on the Lebanese border under constant terrorist attacks. He was the leader of a group of students from his school that went there, as a gesture of support. He had organized and led a five man rock group, writing music and being the lead singer. The group had made several appearances at school dances and were getting offers for private parties when he got sick. (The noise of the rehearsals in our home occasionally made me angry and critical, and once in a while, I simply left home until the practice bedlam was over).
He was following in my footsteps, and I gave him my full approval. Occasionally I would chide him for not studying enough but my heart wasn't in it. One of my fantasies, which I frequently indulged in, was that he was going to be even better than I am.
And then...
This is my story, Crazy Itchy's from the Bronx, who was mostly rehabilitated. And then I had to learn to cope with a terrible death in the family. But that is only part of this story.
The other part of this story is Rina. She is a woman who came for therapy one year after Yussie died. Twenty years before she had been a normal nine year old and then her brother died in an accident and she was unjustly accused by her parents of having caused his death. Her way of coping with this guilt was to go crazy, to act as if she was retarded and to stammer.
I found that she and I were more similar than different, in spite of the fact that she was a Moroccan Jew, uneducated, primitive and ignorant. We both suffered from feelings of inferiority, incompetence and we were rejected and humiliated. And finally, we both suffered an overwhelming childhood trauma which made us both “crazy.” When I met Rina I was still learning how to better cope with dying and death. She helped me to do this. And I helped her. I was only able to see her eleven times but we "got there," the wounded healer and the stammering psychotic. Where? To a better ability for living life more fully, more maturely, as we learned how to cope with dying and death.
Hopefully, by the end of the book you will know more about your way of getting there, wherever your there is. Maybe then, you'll be dying to live, just a little more.
Chapter 1
Losing Yussie started out simply enough. I awaken this Saturday morning in July, and keep my eyes closed. I become aware of feeling tenseness in the back of my neck and shoulders. My closed eyelids flutter once. I change my head position slightly, and my wife, warmly cuddled against my back, adjusts her position. I open my eyes and the morning light is soft and diffuse. I am enjoying my dream-like state when I suddenly I hear the trees rustling in the wind and the sunlight fades from the room. I look to the foot of the bed and Yussie is standing there in his underwear.
I sit up and Riva sits up with me. Yussie says, "I had stomach cramps and I just came back from the bathroom. My stools are black."
That was the beginning of the end.
Chapter 2
The fall day I meet Rina more than a year later, started out as a nice day but in the early afternoon there was a storm and power stoppage. Now the tree outside of my office window has glistening leaves from the cold drizzle that has been steadily falling for the last hour. The sun shines brightly through a break in the gray-black billowy clouds, lighting up the part of my office I am sitting in. Despite the slanting sunlight, I feel cold this mid-winter afternoon. I look down at my stricken, beloved, little electric heater, wishing I could see the small, bright red glow of the light, indicating that it is on. I miss feeling its caressing hot wind, the soft hum of the motor which sounds so pleasant, and which also mutes the noises from the busy street below my window.
I have just come back from having lunch in the small restaurant around the corner. It was almost empty today and I felt lonely eating in the misty grayness of this usually bustling and well-lit eatery. I sat at a counter stool at the end of the row and ate my lunch without talking to the counterman, who was
silent today, as he quietly looked out at the steady rain.
Leaning back in my leather swivel chair, I enjoy the warm, full feeling in my stomach. I call through my open office door to Nily, my secretary and the Institute receptionist, to ask her if she thinks the new patient is coming. She responds by coming to the door of my office, pokes her head in and smilingly
says, "She'll be here. It's the weather." She is fifty years old, a sabra, (native born), gray-hairdo, plain looking and plump. She is also bright and bustling.
Nily lives on a moshav, (a small farming community,) an hour's bus ride south of Haifa, in the direction of Tel Aviv. She doesn't mind the tediousness of the drive since she loves working in my Institute. She is the first one to see the new patients and her small office often serves as a warm, safe place to sit in, for patients and staff alike.
My Institute has ten professionals working there, psychologists, social workers, counselors and a psychiatrist. It is one of the largest private psychotherapy institutes in Israel, serving the northern third of the nation. I am the founder and clinical director.
Nily is the source of the new referral. She has been telling her friends and neighbors in the Sharon Plains, around Hadera, about the Institute and me. As a result, we had a number of referrals from this area which is unusual because most patients usually travel the shorter distance south to Tel Aviv. She is friendly with a Moroccan family on the moshav and the mother asked Nily if the Institute could treat her daughter, who is a stutterer.
Nily told me something of the background of the family. They came to the moshav almost twenty years ago from a development town on the Lebanese border in the north, Kiryat Shmona. They are farmers, growing vegetables and keep a small herd of milk cows. The family immigrated to Israel from Morocco just after the War of Independence in 1948. They are an unusual Moroccan family because they only have two children, the patient, a twenty nine year old unmarried woman, and a son, seventeen years old. Almost all sephardic families, Jews from North Africa and the Middle East, average from six to ten children.
Nily lowered her voice slightly when she said that there is a rumor on the moshav that there was an older son who died in tragic circumstances just prior to the family joining the farm settlement. The family had never talked to her about it. The mother of the patient called me a week ago to make the appointment. She said that her daughter stutters and she was anxious for me to treat her. "Nily, God bless her,” she says, "told me so much about you."
I reply that I did have some experience in treating stuttering and in most cases the patient learned to stutter much less. Then I say, "But you must know that the treatment will emphasize working on the cause of her stuttering as well as techniques for stuttering less."
"May God be with you. That sounds fine to me. Can I make an appointment so I can explain to you about Rina's problem? My daughter, you know."
"Have her call me directly to make the appointment. You see that's -"
She interrupts, saying firmly, "I'll tell you right now, she won't do it. She never spoke on the phone and she won’t start now. She can't talk because of the stuttering. Besides, she’s so shy that if I don't bring her in she won't come."
"It sounds like you are talking about a little girl, maybe five, six years old."
"Exactly. We've had a terrible life, you have no idea. Only God in heaven has really helped us." She pauses for a moment and when I start to say something she speaks louder. "I'd appreciate it if you'd see me first because you won't get nothing from her. Not at the start. God knows, we've gone through so much therapy and so much disappointment that I am about ready to give up. From what Nily told us about you" - - She pauses for several seconds. I can hear her lightly blowing her nose. She says quietly, "You are our last hope. I hope and pray that you won't disappoint me."
"Thank you for the compliment, but I don't see it that way. Just give me a moment to think about what you asked me to do."
I put the phone down, close my eyes, and breathe slowly several times, relaxing myself. I get a picture in my mind of an army transport ship sailing under the Golden Gate Bridge, coming into the San Francisco harbor. It is a cold, rainy winter day, early in January 1946. I am returning from almost two years of overseas duty in the South Pacific during World War II. I open my eyes, pick up the phone, and tell the mother I will see her for a few minutes before I interview Rina. We make an appointment and then we say good-bye.
Nily tells me that when there are heavy rains there is flooding of the roads in her area and she reassured me that they would show up. Fifteen minutes after the appointed time of the session the electricity is restored. The red light of the heater glows brightly, and I hear the reassuring hum of the motor. Soft, warm air begins blanketing my legs.
A minute later Nily buzzes me over the intercom that they have arrived. I go to the door and as I reach for the doorknob, the door is opened and the mother is standing in front of me. She is holding a wet raincoat over her arm and a closed, dripping umbrella in her hand. She appears to be in her late fifties, dressed in a dark gray coat, black dress, and knee length dark brown rubber boots. She is not wearing any jewelry or makeup.
She is short and obese. Her shiny red cheeks are prominent in her round face, thick, black eyebrows, unplucked, seem to rest heavily over her dark brown eyes. Her dyed black hair is pulled back tightly in a bun behind her neck. She smiles as she extends her hand to shake mine. As I shake her hand she says, "I’m Rina’s mother. We are here. She is waiting in Nily's office and I think it is best to let her sit there. I have a lot to tell you about."
"I hear what you are saying. Just give me a moment to think, okay?" Without waiting for her approval I look up at the ceiling and think for several seconds. Then I look down at this concerned looking mother and I say, "What I would suggest is that you hang up your raincoat in the waiting room. You will find an umbrella stand there too. Meanwhile, I'll go and say hello to Rina."
As I go past her I take her gently by the arm, and smile at her. I lead her into the waiting room, and say to her, "Let me take over. I know what I am doing." I leave her and walk into Nily's office. Rina is standing there, twirling a wet curl of her black hair. She had been watching her mother and myself but now she is looking down at the floor. She is rain-soaked, from her full head of curly hair to the pants bottoms, partially inserted in her short, black rubber boots. She is wearing an old army hooded winter coat, at least three sizes too big for her. Under her open coat she wears a blue work sheet, black pants, and she is without jewelry and makeup.
Her eyes are violet, and her nose is small; her cheeks are chubby, her lips full, and her chin is small and round. Her skin color is dark, a Mediterranean cast. The overall impression is that she just misses being pretty, yet there is some resemblance to Elizabeth Taylor. She is less than average in height, chubby but not obese. I think, "If she lost weight, and if she dressed better and learned to use cosmetics, then -" I shake myself back into here and now awareness.
"Hi. I'm Irving. You're Rina, right?" I extend my hand and she takes it with a limp grip in her small hand. "Did your mother tell you that I will be speaking with her before I will speak with you?" She nods yes. "Would you like to come into the office first, to talk to me?"
She shakes her head almost violently from side to side.
I ask, "Is it so hard for you to talk?" She nods her head and then makes an effort to say "Yes." Nothing comes out of her throat but a small, staccato, guttural sound.
I say, "Yes," slowly, emphatically. "Notice how I said that. I'll repeat it." I close my eyes, breathe in and out once, quietly, slowly. Then I open my eyes and speak with a low timbre to my voice. "Yesss," I say, stretching the word. "I want you to do the same thing, Rina. Breathe once, in and out, slowly, deeply. Then, when you speak, deepen your voice and say, 'Yes'."
She nods her head, breathes heavily, noisily and quickly. Then she stutters, "Y-Yes,” in a tight, high-pitched voice.
"That is not what I asked you to do. Just lower your voice as if you are trying to sound like a man."
"Yes." She does it! No stutter. She looks surprised, and then she smiles. She looks at the doorway and sees her mother standing there. She stops smiling, tenses her shoulders and looks down at the floor.
"Okay,” I say, "we'll leave you here with Nily and I will talk with your mother in my office. She'll give me some background on you. After that, I will talk with you. All right?"
Without looking up, she nods her head. Nily says, "We'll get along fine, Nana." Apparently, that is Rina's nickname. "We have been friends for a long time and we know how to talk to each other." The mother asks Rina if she will be all right, pointing down with her index finger, indicating that she means the office. Rina nods her head. I call Rina's name softly and she looks up at me, surprised. "I'll be in my office. Will you be here?" She blinks her eyes, hesitating before answering. Then she seems to understand what I have said. She says, "Yes,” very gently, with a slightly deepened tone of voice.
I say cheerfully, "I got it. See you later." I nod at the mother and walk out of the office. Rina's treatment has started.
The mother is sitting on the edge of her chair, anxious to start talking. She has a tense expression on her face and she is nervously touching the bun on the back of her neck. Nodding at her, I say, "Why don't you start by telling me what you would like to achieve from the therapy here?"
"I don't know what we are going to do with her, it is so difficult. She's going to a rehabilitation center in Hadera every day and getting nowhere. Nily spoke so highly of you that I was curious." She pauses for a moment, and then she says, "With God's help, we were hoping that you could help her." She touches the fingertips of her right hand to her lips and then kisses her hand in the direction of the ceiling.
She says, "She stutters something terrible. It takes her forever until she finishes a sentence. That's the help I want for Rina. If you will do that, then God bless you." As an afterthought, she adds, "You know that we are religious, don’t you? Not fanatics from Meah Shearim, but we believe in God, blessed be His name."
"No, I didn’t know that. Thank you for telling me. How long has Rina been stuttering?"
The mother hesitates, stroking her bun. She purses her lips, frowns, and begins to speak in a formal tone of voice. Her brother drowned when she was nine years old, twenty years ago. Her uncle was watching her instead of her brother. They were visiting him in Kiryat Shmona and he took them for a swim in the natural lake of the Jordan river. "
Before she finishes the sentence I feel a twinge in my upper chest and I quietly gasp. I am nodding my head as I say to myself, "Welcome to the club." I focus back to the session and ask her how old her son was when he drowned. Her eyes narrow and she frowns, then she says that he was fifteen years old. I ask her how Rina reacted to his death.
"Ever since then she has stuttered,” she says tonelessly. "For two weeks after he died she didn't say one word and when she started to talk, she stuttered so badly we couldn't understand what she wanted to say. Before the tragedy she occasionally had trouble with a bit of stuttering but nothing really bad. She was a good student in school and she read a lot. Now she hardly reads anything."
She pauses for a moment, having a faraway look in her eye, then she shakes her head and says, "She began to wet the bed after that. And she was dry since she was two years old. She seemed so unhappy. She always acts as if she is waiting for something." I begin to ask her something and she raises her voice over mine. "She's very childish for her age as you saw in Nily's office. She never finished public school and has been in different institutions and special classes. When she was eighteen years old she didn't go into the army like any normal girl but we had to put her into a mental hospital because she was acting crazy. Like she had a dybbuk in her. And she was having nightmares. The last straw was that she took some aspirin, eight of them. She tried to commit suicide. May God forgive her.”
"Has she ever had any psychotherapy or medication?"
"She was in treatment at the hospital and in the clinic afterwards. She got all kinds of pills but they just made her confused and sleepy. She went to Kupat Cholin, (the Sick Fund, a health Plan), in Tel Aviv and saw some psychiatrists but each one gave her different pills."
The mother is becoming more tense and uncomfortable. "I had to do all this alone. Run with her to the hospital, visit her. I took her to the clinics by myself because her father is so busy on the farm that he doesn't have time for anything but work. And besides, in Moroccan families the man doesn't do things like that. It's a woman's work. Do you know that?"
Without waiting for an answer she waves her index finger at me, saying sternly, "Don't forget, we have to make a living. What do you think?" She looks at me as if she is waiting for an answer but goes on before I can answer. "All the years I was the one to go to the different schools because she had trouble reading and writing. Before the accident she was all right. But afterwards, she wasn't normal. She was in special classes for disturbed children, and for two years she was in an institution for retarded children. But she wanted to come home so much that we had to take her out." She sighs deep and long. "She can read not bad but her handwriting is terrible. You can't read it. But then she has no reason to write. What for?"
I am not thinking about her rhetorical question but about Rina's father. I know that in Moroccan families the father is the patriarch and the mother serves him and then the children. He does nothing in the home and no one challenges his authority. The mother has barely mentioned him. I start to ask her about her husband but the moment I speak she begins to speak in a loud voice. She complains that Rina is a problem for her and her younger son, who is seventeen years old. She is jealous of him, and she picks on him.
"She acts crazy, that girl, and it upsets her little brother." The mother smiles for the first time as she describes him as being a beautiful “but sensitive boy." She goes into detail, describing him as an excellent student and socially successful. Her dark eyes light up. Suddenly, there is an outpouring of frustration and pain, as she bitterly details Rina's shortcomings. Then she stops as suddenly as she started and looks at me, waiting. I am surprised. I quickly recover and ask her a question.
"It sounds like your son was a change of life baby, is that right?"
"Yes. After our beloved Itzchak died, blessed be his memory, we tried to have a child but it didn't happen for some years. You must know that we are sephardic Jews from North Africa and for us -” She kisses the fingertips of her right hand and then moves it in the direction of the ceiling. "For us, sons are so much more important than daughters. I come from a family of eight brothers and sisters and my husband is the oldest of ten. "I don't know why but we always had trouble in my getting pregnant. So when I was forty years old God blessed us with our beautiful baby son. He has been our pride and joy ever since."
I tell her I'm going to ask some personal questions about Rina and she shrugs. She is not embarrassed as she answers my questions. Rina had her first period when she was twelve years old. When she was eleven her breasts began to develop and over the following year hair grew in her pubic area and armpits. Since that time she has had regular periods, every twenty-seven days, with a normal flow. "Do you know if she had had any experience in sex,” I ask?
She looks at me through narrowed eyes and vigorously shakes her head. "Never. "She never had a date in her life."
"Has she ever had any serious physical illnesses or injuries?"
"No. She's as healthy as a horse. A little overweight but then so am I."
"How about your son? Does he have any physical problems? Now? In the past?"
"He has always been normal." She makes three rapid, dry, spitting sounds and then says, "Without the evil eye. There is nothing wrong with him. Maybe I spoil him a little, but it is not so terrible. That's another reason you might want to do something about Rina. Her brother is threatening to leave home and go to a kibbutz, (communal farm settlement). They fight a lot and I keep telling her to stop. He's very sensitive and delicate, but she doesn't listen to me." After a moment's pause, she adds, "Understand?"
I am becoming aware of feeling more and more uncomfortable with the mother and I decide to do something about it. I do not answer her immediately. I put my hand in front of me, with my palm facing her, in the "STOP" gesture. She sits back in her seat, surprised. I close my eyes and speaking softly, say that I want to think a little about what she has said so far. I cover my eyes with my hand and think for a number of seconds. When I take my hand away and open my eyes I look out the window. The sun has gone behind the clouds, the room is dark, and a steady rain is falling. I turn on the desk lamp and a warm yellow light bathes the area we are sitting in.
"I am sure that there are many more things you would like to tell me and I have many unanswered questions. Now I choose to make time for Rina. I don't know if you will be accompanying her here for her sessions but we will surely meet again." I get up and leave the office indicating that she should follow me out. As we get close to my secretary's office, I hear Rina speaking, and she is barely stuttering. When I walk in she stops speaking. I ask her to come into my office and she slowly gets up from her chair. The mother moves quickly to Rina and begins taking off her wet coat, Rina waiting passively until her mother has finished.
I go into my office and a few seconds later Rina comes in and slowly, carefully closes the door behind her. I wave her to the easy chair next to my desk and she sits down. It is low enough so that her feet touch the floor. She settles in, sitting upright, her hands in her lap, her eyes looking past me in the direction of the window. I have come to the conclusion that I will work with her on her stuttering and on the terrible tragedy that almost destroyed her life. I think about my accident that almost destroyed my life and then I think about the death of my son. Perhaps by helping Rina I will also be healing myself a little.
In the year since Yussie's death I have finished with the active grieving. From time to time I get sad when I realize that I'll never see him again but I've accepted the fact that he is gone from this world. But I'm still not used to the sudden attacks of a peculiar pain in the area of my heart when I'm reminded of how he suffered for those three agonizing months
I'm ready to begin speaking to her in my PASA voice that is slow, rhythmic, relaxed and quiet. PASA is the acronym for Positive Altered States of Awareness. In the PASA condition there is relaxed awareness and occasionally a dream-like state. It is a technique that I developed for inducing a positive altered state in the patient, and myself. When her body, mind and emotions will be in a relaxed state then the positive parts of her mind, conscious and unconscious, become more accessible to her. I call the back of the mind the positive unconscious. (There is a negative part to the back of the mind but in the PASA exercises only the positive is emphasized.)
I briefly explain some PASA theory to Rina in order to prepare her for the exercise I am about to do with her. “When you're relaxed physically and you have positive thoughts, then you'll have positive emotions. In this state you're letting the back of your mind help you find better ways of solving problems."
She is staring at me and seems to be unaware that she is nodding her head, "Yes."
"This is a technique I've developed which will help you get in touch with your unconscious mind, the part that has in it your intelligence, knowledge and experience. For example, if you try to remember where you put something important and you can't recall, it's frustrating."
"Y-Yes," she says excitedly. "Once I t-thought I lost a d-d-doll -” She is stuck for several seconds. With an effort she finally says, "Then after t-two days I-I remembered where it was w-when I woke up in the morning." She smiles as she says this.
"That's a good example of letting the back of your mind solve the problem without forcing yourself. And another thing, I’ll be going into a positive altered state of awareness along with you. This way the combination of the best of both of our minds makes PASA even stronger."
When the therapist creates trust, understanding, respect, and communications, in the session, the patient will usually respond in kind leading to intimacy in the session. Then, there is a "therapeutic atmosphere," and in my opinion, the patient will heal himself. It is my belief, based on faith and clinical experience that the positive unconscious minds of the therapist and patient communicate with each other. PASA is a technique that enhances the bridging of the best that is in the therapist and patient. I explain this point to her and she shyly asks, "I-If you'll be in a t-trance then w-who will w-watch over us?"
I reassure her that even though I'll be in PASA, a part of my mind will still be alert to handle any emergency situation. From time to time I'll open my eyes just to check that everything is okay. "And you can do the same thing, open your eyes whenever you want to." She nods again, indicating that she understands what I have said. Now I am ready to do the full PASA exercise with her.
(The PASA exercise will be in italics. The use of three dots [...] as punctuation indicates that my speech includes rhythmic pauses. Rina's stuttering will be indicated by the use of the hyphen, [-].
"We will be doing the PASA exercise soon, and you can choose to close your eyes when we do...and you have the right to open them...be open...and you can talk whenever you want to." I pause a little longer and then I continue to speak. I tell her that after the PASA exercise will be over she'll continue to be relaxed.
"In addition, Rina...we will examine what we have to do to help you overcome... the memory of your brother’s death." She looks down at her interlaced fingers which are moving slightly. "I will also go into PASA...the both of us…at the same time and when the exercise will be over...we will speak freely about it."
I sit up in my chair, put my feet flat on the floor, my hands in my lap and I lean my head back lightly on the headrest. I ask her to do the same and she does, easily. I suggest that she can imagine that I am holding a flower in my hand and I will be breathing in the delicate, sweet perfume. I demonstrate this for her by holding my closed hand with the imaginary flower in it, close to my nose. I ask her to do the same thing and she does, surprisingly well. I tell her to continue breathing the same way and to imagine that with every inhalation, "the positive in -” I pause a little longer for dramatic effect, "and with every exhalation, the negative out". I say the emphasized words in English.
I do this so she can more easily remember: piano: positive in and negative out. She smiles as she mouths the word piano, without sound. I indicate that she should close her eyes and she does. I tell myself that I do not have to be surprised at how cooperative she is. Her mother had painted such a bleak picture of her that I assumed she would be limited in her intelligence and ability to understand. Feeling more reassured and optimistic I continue, with my eyes closed.
"With your eyes closed to the outer light, you will see your inner light...shining more brightly...and your imagination will give you, me, us... the ability to relax." I tell her that she is becoming more relaxed, especially when she breathes in using piano. Her breathing is more rhythmic, slow and quiet.
"Now, here, you can successfully imagine that you are at the beach...with clean white sand, cool blue-green water...fresh air and a hot sun in a blue sky."
I am relaxed as I open my eyes and see that Rina is sitting quietly. Her eyes are closed and she has a peaceful look on her face, looking prettier than she usually is. I close my eyes and continue with the exercise.
"Now...as you continue to see, to be... A, B, C...it becomes as simple as learning the ABC...to relax...just as it is so simple to stand on the wet sand, erect, strong, sure...and as you go into the water...up to your knees...you know that you will be safe if you stay, stand...on firm sand under your
feet...and then you can float, swim… and let the water take some of the extra weight off of you...that you've been carrying for so many years."
After a pause of five seconds I continue to speak slowly, rhythmically, calmly, quietly. "Now you can return to being in touch with what is, in the water...and standing firmly on your own two feet...you can have positive thoughts, emotions and body sensations for the next two minutes of silence...soon to come."
I explain that I will stop talking for the next two minutes and she can think of the PASA exercise or anything else that is positive for her. During the two minutes of silence I open my eyes once and see that she is quiet and relaxed and there is a small smile on her face. When the two minutes are up I say, "Now I will count from five to zero and when I finish you will open your eyes...Rina... relaxed, calm, peaceful and tranquil."
I begin to speak in my regular voice. "You will be fully awake, alert, clear-minded." I count slowly, louder and louder, from five to zero. She opens her eyes, looks down at the floor. "You are the one who decides now, Rina, so that if you choose to look at me," she looks up, "you can tell me what your
reaction was to the PASA exercise we have done."
"Th.-this exercise w-was interesting."
There is a silence of about thirty seconds and she slowly raises her right hand and wipes it across her eyes. She is tearful.
I say, "Together with your feelings and tearfulness...I too sense a sadness in me...as I hear and feel your difficulty in speaking."
Quietly I say, "I'll be sharing some of my feelings with you because I've been there, Rina. That's one way for you to know that I'm with you." I add that if I expect her to give of her deepest feelings then she has a right to expect the same from me. I won't share all of my feelings with her, only those that are relevant to the situations she is working on. I ask her to share her feelings with me now but she shakes her head, No," and looks away from me.
I say, "But I have no doubt that your ability to speak...my ability to speak...is based on letting the air out as we do so." I pause for a moment and then I ask her if she knew that fact.
"No," she says.
"Try to say something when you are breathing in air."
She looks confused for a moment and then she breathes in and out, making small movements of her lips, but no sound. She swallows and then says, "I can't."
I ask her to tell me what is her father's name.
"My father's n-name is Eli, and m-my m-mother's n-name is M-Malka.
"Did you notice that as you spoke you were breathing out the air?" She nods "Yes."
"Say it again, and notice how you breathe out and let go when you speak."
"My father’s name is Eli and my mother's name is Malka." She smiles fully for the first time.
"Good. What's your younger brother's name?"
"My brother’s name is David." I ask her to repeat the names of her parents and brother and she does this without a stutter. Then she smiles again and I smile back. Her smile broadens. After a few seconds I begin to speak in my PASA voice and tell her that we are going to close our eyes again. We will
do this at the end of a count from one to five. Before I can finish the count her eyes are closed.
"Now...here...you...I...the two of us, as one...we will continue to be relaxed, peaceful, breathing slowly, deeply...and I can ask you to tell me the name of your dead brother."
She grimaces, takes a long breath and says, "Itzchak,” without a stutter.
For the next five minutes, while keeping her eyes closed, she does the exercise of saying her brother's name in five different ways. At first she stutters badly but as time passes she becomes more relaxed and at the end of five minutes she can say Itzchak without a stutter.
It is time to end the session and I say, "Soon, very soon, we will end the exercise when I will count...just as you count...from five to zero, and then we will open our eyes and continue to be in touch with what is...and not in touch with what isn't ...Five, four...the difference is one, and you are one... a special one...just as three, two and one brings us to one...and zero...Your thoughts are clear, the heaviness is gone...there is alertness, energy, more understanding." I finish using my normal voice, louder than usual. "The exercise is over and we open our eyes. Now!"
I stretch and groan, opening my eyes. Rina opens her eyes, smiles. I ask her how she feels and the smile disappears. She stutters badly, saying that she feels "good." I suggest that she do breathing exercises every day for at least five minutes. She should breathe slowly, rhythmically, effortlessly, quietly, starting the exercise by imagining she is smelling the flower. From time to time she should use the word piano.
The session is over. I ask her if she can come by herself next week and after a moment's hesitation she says, "I-I can. I w-will."
We make an appointment for next week at the same time. She follows me out and into Nily's office, her mother jumping up when she sees me. Her hand goes to the back of her head, touching her bun. When she sees Rina she takes the damp army coat and begins to put it on her. Rina feebly resists and the mother easily finishes putting the coat on her. Nily and I look at each other and say nothing. I tell the mother that Rina has an appointment to come next week at the same time, along. The mother looks at Rina, at me, and back again at Rina. She takes Rina under the arm and saying, "God bless you, good-bye," she leads Rina out. I say good-bye and Rina waves her hand briefly before disappearing out the door.
I look out of the office window and see that the sky is clear and it is dusk. I have the strange thought, "This day is dying a little." I decide to tell it to Nily. "Do you know, this day is dying." I pause and then add, "A little."
She cocks her head to the side and raises her eyebrows in an expression of inquiry. I say, "I suppose you would like me to explain what I mean. Each day that ends is like a little dying. It's true that it will
also lead to the birth of a new day, each time. But when all the days end it will all be over."
"What are you talking about," she asks? "You are a healthy man and I am sure that you will live to be one hundred and twenty. T'foo, t'foo, t'foo." She makes the symbolic spitting sounds meant to ward off the evil eye.
I say, "Since I made the first contact with this family I have been thinking a lot about death. I am very much involved with them personally. That's for sure."
Chapter 3
His illness started in an ordinary way four days before. He complained of a headache, stomach pains and weakness, and his temperature was a hundred. We assumed it was a virus and we didn't worry. Yussie had always been a healthy baby, child and teenager, and the usual childhood diseases. The worst thing that happened to him was that he had a hernia operation when he was three months old. Our internist who took some blood for lab tests and made the preliminary diagnosis that he had a virus. He prescribed bed-rest and lots of fluids, with aspirin if his temperature went up or he had any pain. Two days later the doctor called me and said that the lab tests were within normal limits.
Now, on this bright Saturday summer morning there was a complication. I knew from my medical background that the abnormal black color of his stools was most probably from digested blood. So Yussie was bleeding from his digestive system. He had been taking some aspirin during the last four days and I thought that it irritated the lining of his stomach and produced some minor bleeding. I called our internist and tell him of Yussie's new symptom.
He suggests that we bring him to Rothschild Hospital where he can examine him and make some new blood tests. We get there in less than a half hour and our doctor is waiting for us. He tells us that all the tests will take several hours and we can wait around if we want to.
"Why don't you go back home", Yussie suggests. "I'm not feeling that bad. Besides, you two should be with the family". He is referring to my brother Herby and his wife Clare, along with their son Gilbert and his wife Merri, who are visiting us from the U.S. We go home, being reassured by the doctor and my son, that our presence is not needed. We are to wait for a call from the doctor and then come to the hospital to bring Yussie back home.
Chapter 4
It is a week later, and Rina is coming by herself to the second session. It was not easy achieving this concession from the mother. I had to call her twice, convincing her more with charm than logic, that Rina was able to travel unaccompanied. The mother said, "She will get into trouble, may God help her." She hinted that Rina was retarded, and she feared that she might be seduced into some sexual activity, "which might make her pregnant or something like that. God forbid." Rina is a virgin, never had a date in her life, has never been touched or kissed by a man.
During our phone conversation I told the mother that the family is entitled to a partial refund from their Health Plan. I was also able to get more background information on her. Since she was in her middle adolescence she traveled alone to Tel Aviv and to Haifa for various tests, examinations and
therapies. During a two year period of being institutionalized in the Negev she traveled alone, to and from the Hadera area for weekend visits. She never had any trouble with the frequent bus changes, or the long ride and was never accosted by any sexual deviants or other males.
Now she is sitting in my office, looking at the paintings on the wall opposite her, waiting for me to start. Her overly large army coat is unbuttoned and she is wearing a bulky, black knitted sweater, unpressed work pants, and short rubber boots. She is tense looking. I clear my throat lightly and she looks up at me, pulling her coat closer around her. "Is there anything that you would like to say about the first session you had here last week?" She turns her head away from me and mumbles, "No."
"I imagine that you thought about it."
"Y-Yes, I-I did, a little."
"About the exercise that we did?" She nods. "Did you try to do the exercise by yourself this past week?" She shakes her head and I say that we will do another PASA exercise today which will help increase her self-awareness and to put her in closer touch with her intelligence. She reddens slightly. I remind her that during the exercise she will become more relaxed physically and she'll have positive thoughts and emotions. This will put her in touch with the best part of her mind, especially the back of it, her positive unconscious.
She raises her eyebrows slightly, starts to say something but stops. I ask her what she wants to say and she makes an effort to speak but the words are stuck in her throat for several seconds. She unblocks and says, "I d-don't have a-anything to say."
I begin the PASA exercise by putting my feet flat on the floor, my palms face down on my thighs. I sit up straight with my head facing forward. From the corner of my eye I see her sitting in the PASA position, with her eyes open. "The two of us, Rina...each one alone, both of us together, will become aware of our breathing." I breathe slowly, rhythmically, three times, and she does the same.
"As we breathe in and out...and you are making piano...positive in and negative out...piano, the word, the musical sound, so sweet, that you are hearing...here...now...with me, in this room."
She is motionless, staring at a point on the opposite wall, her eyelids beginning to close. Her facial muscles are relaxed. I suggest, "You can let go...yes, let go so that as you go deeper, much deeper...you will find yourself going higher and higher into a positive altered state of awareness...of letting your eyes close." She moves slightly, changing her position, and I say, "And make the change that is important…” She closes her eyes. "Gently, easily, successfully, Rina...able, cape-able, willing to become aware of the closeness, warmth and intimacy...you find in the space under your palms, on your thighs."
Her body is relaxed, her breathing is rhythmic and slow and there is a peaceful look on her face. I close my eyes and speak about going down ten steps. I suggest that she can build this staircase in any way she wants from whatever materials she chooses. The stairs will be strong, secure, well designed,
with a beautiful banister, and they will be covered by a colorful carpet. From time to time I "string" a series of positive words, and I relate them to her.
I say, "Using your knowledge, wisdom, experience, warmth, respect...you will succeed, Rina... successfully… to use your imagination, creative ability...for going deep, very deep, down to the seventh step...and then going down the last three steps...eight, nine, ten." Voices are heard in the corridor and I refer to them, saying, "You are hearing, here, the sound of my voice...and the sounds coming from outside of the room... and you can hear those sounds without listening."
In the next part of the exercise I suggest that she imagine a beautiful, sunny day and a walk in the woods: Trees, flowers, bushes, the hot sun, a cool breeze, fresh air. There is a little brook with cold, clear, streaming water and next to it a big tree, deeply rooted. From the top of the tree a leaf detaches, floats down, rocking to and fro, as if on a cushion of air, until it settles smoothly on the gently flowing current.
“The leaf is carried downstream… and a big rock is in the middle of the flow...The leaf and the water do not try to go through the obstacle...they slide successfully around it...and there is a continuation, advancing forward, progress...until the leaf, you... get to a lake, quiet, deep, clear and clean...around it, a white sand beach...over it blue skies, and a golden sun...The breeze keeps you cool, thoughtful, creative, ...so that way down deep, very deep, an underground stream flows to the sea." I say there will be one minute of silence and after it I will bring us out of the PASA exercise.
After a minute of silence I bring us out of the exercise with suggestions that we will be wide awake, full of energy, with clear minds and a willingness to share. I stretch my muscles and groan softly as I do this
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PTSD In The Bronx, New York and Tumpalega, Alabama – A New York Psychiatrist (with his own PTSD) Journeys to Alabama to Help Vietnam Veterans recover from their Post Traumatic Stress Disorder.
by Irving Bronsky M.D.
CHAPTER 1.
Fifteen veterans are in the group at the Tumpalega VA hospital and they are waiting impatiently for it to start. My assistant in the group, Chaplain Mike Dills, the administrator of the PTSD program is in no hurry. He is a ground war Viet Nam veteran, a pastoral counsellor, and in the US Air Force active reserve. Mike starts this morning's group by collecting the attendance forms from the 15 patients and signing them. He is a gentle man, in his late forties, slim build, pleasant of face; his wire-rimmed glasses set low on his nose are his most distinctive facial feature. He is polite in manner but from time to time he can be tough in his speech and behavior. He is that way now, as he signs the attendance form and talks about the rules of the program. He talks to them about maintaining discipline in the program and following the rules.
It is Friday morning and the vets are complaining that they aren't allowed to leave for the weekend home visit before two p.m. He swings his finger-pointed arm around the group, speaks crisply with his soft southern accent, he says, "Listen up you guys. Friday is a therapy day and we don't want you to lose it, you hear? There's precious little enough time as it is, with only five weeks to the whole darn program.” He signs the last of the forms and looks sternly around the group, frowns and says, "You all know you've not been policing up the room after groups.” He looks towards me and adds, “ Dr. Bronsky and I don't want to go around picking up after you guys, cause you leave your coffee cups and soda cans behind you."
"Me too."
I am sitting quietly, watching and thinking about how I will start the group. I'm sixty-five years old, bald, with a handlebar mustache, a straight nose and hazel eyes. I'm six foot two, overweight, and I have an ease and confidence about me that is obvious when I work with patients, or in groups. After working with the vets for more than a month I came to realize that the American PTSD is different in some ways than the Israeli form of PTSD.
I learned to treat PTSD by working with hundreds of Holocaust survivors and their families, and with the Israel Defense Forces soldiers, some of whom suffered from PTSD. I was a psychiatrist in the active reserve and served in four wars. A few months ago I journeyed from Haifa, Israel to the Tumpalega VA hospital in Alabama, to set up and run the PTSD program. I “came home” after living and working in Israel for twenty-five years.
The Israelis never suffered the humiliation of being rejected and neglected after they fought for their country. They were not political scapegoats and they were given immediate psychiatric treatment soon after they began to shows signs of PTSD. The southern American vets grew up with an abundance of violent activities: hunting, fishing, sports, drinking, fighting. Many of them were frequently beaten as children. I heard the following sentence from many of them: “My daddy was real mean when he was drunk. Sometimes he made me go out and cut a big switch to bring him so he could beat my butt. If it wasn’t big enough then he’d go out a get a really big one.”
All veterans suffering from PTSD have recurrent nightmares, flashbacks, rage reactions with frequent violent outbursts, anxiety and panic attacks, paranoid attitudes and depression with suicidal tendencies. But the Israeli vets have almost no history of alcohol and drug abuse; the American vets have had frequent arrests for drug abuse and violent behavior.
In Nam they faced death and destruction almost every day; they lost close friends as well as comrades-in-arms in tragic and dramatic fashion. For example, two marines were bringing supplies on to the shore in the Mekong Delta when one of them had his head blown off, spraying his buddy with blood, bone and brain. Since then this survivor has nightmares three to four times a week in which he relives this terrible trauma.
Many of them have killed enemy soldiers and Viet Cong, but they also shot innocent civilians. “We couldn’t take no chances in the some villages so we shot up all the hootches. If there were women and children in them that couldn’t be helped.” One vet lost two of his buddies to a booby-trapped Coca Cola, sold by a nine year old girl. The next time a Vietnamese girl came near his squad to sell the thirsty GI’s a cold drink, she was cut down by three of the squad when she was 15 meters from them. A few committed atrocities such as running over civilians who slowed them down while in a convoy. One technique the VC used was to push civilians, including women and children, in the path of a convoy to stop it for an ambush.
These traumas are alive in their conscious minds, and repeatedly haunt them in their nightmares. During their waking hours they have flashbacks, (nightmares occurring in the form of a violent daydream,) triggered by any loud sudden sound or someone suddenly coming up behind them. If they go to public places such as restaurants they sit with their back to the wall, facing the door; they do their shopping at 2a.m. when there are few people in supermarkets. One vet was cruelly taunted at his place of work by a group of his co-workers; they would drop a large piece of metal and his inevitable reaction was to duck for cover or run out the factory in panic. He was a quiet, introverted, a good worker but had to quit because management also thought it was a lot of “fun to see him run.”
They are survivors in real or imagined situations where they feel the least threat, showing it in their cursing, in the threats of violence, and occasionally being violent. A common way for some of them is to release their rage and anxiety was by going into a bar, pick a fight, very often winding up the loser, punched out, or in jail. I treated three vets who went to jail for manslaughter because of bar fights that ended in murder.
It was only after I came to Tumpalega that I realized that I too suffer from PTSD. When I was three years old I was run over by a car and suffered a fractured skull. The doctor told my parents that I have a fifty-fifty chance to live. I was hospitalized for one month, tied down to the bed for the first two weeks: "for bed rest,," they said. The "accident" was the label applied to me by my family to describe my behavior when I did something wrong or they thought I misbehaved. "Sure, it's the accident that made him crazy." Sometimes there was an additional zinger: "I think we should call the ambulance to take him to the Bellevue Hospital crazy ward." Before the accident I was a curious, bright child nicknamed Little Jack Dempsey. When I came home from the hospital I was hyperactive, aggressive, frightened, a nail-biter, and had recurrent nightmares about dying. I still have occasional nightmares but I am able to get out of them more quickly. And I not only survived but I overcame a lot of my PTSD.
Suddenly, I am aware of the silence in the room, embedded in the loud thrumming of the air conditioning. Out of the corner of my eye I notice that one of the vets is nervously tapping his finger on the notebook sitting in his lap. Mike asks the vet, T.J., "You all ready to talk about your flashback?" Today is T.J.’s third session in the group and he has yet to speak of his PTSD symptoms. Yesterday afternoon he was watching a cowboy picture on TV on the back porch of the ward with the rest of the group. When the shooting started he had a flashback and began acting as if he was back in Nam, crying, in panic, hiding under the table, shouting “Incoming, incoming.” The other vets calmed him down and took him to the nurse. She sent him to see me and I worked with him in an individual therapy session. I had interviewed him on admission a week before: he was in his early forties, had been a pre-med student who quit the university after two years to enlist in the marines so he could fight in the Viet Nam war. In the interview he was anxious, cooperative but very reluctant to go into any details of the traumas he suffered in Nam.
Now, in the group, T.J.'s hands are shaking and his body is very tense. He is a tall and thin, with a shaggy mustache which partially covers his mouth and a neatly trimmed Van Dyke beard. He wears thick-lensed glasses that tend to fall down his nose. In a voice crackling with tension and rhythmically wringing his hands, he answers Mike’s question. “Yes, I am ready to talk. I had a session with Dr. Bronsky yesterday and we talked about it."
He pauses, takes a deep breath and lets it out slowly, putting the pen and notebook down on the floor besides his chair. He takes off his glasses, wipes them slowly with a crumpled, soiled handkerchief that he pulls out of his back pocket. Putting on his glasses and clearing his throat quietly, he says, "I saw how some of the guys got help when they talked about some of the stuff they're hung up on and I think it helped them. But I'm a little afraid."
After a brief silence my voice sounds loud as I say, "I know you're afraid because you're probably going to talk about something you kept bottled up in you for almost 25 years. It was only yesterday that you spoke to me about it. I don't think you'll have a flashback and if you did, you'll get plenty of support from Chaplain Dills and me. I'm sure the guys in the group will also be available ‘to protect your back.’ Besides, I believe you have too much strength to let it blow your mind." He nods his understanding and agreement, as does the Chaplain, along with most of the vets in the group.
Raising my hand slightly off my lap in a ‘stop sign’ I say, "Before you start, I'd like to ask the guys here I have already worked with if they thought that sharing the experience of their traumas from Viet Nam was worthwhile." I look around the group and make eye contact with each patient who had taken the risk and talked about a traumatic experience in Viet Nam.
Tim, sad-eyed, slow talking, clean-shaven and very neatly dressed, relived his experience of handling many hundreds of bodies, bagging them, tagging them, shipping them back to the U.S. He had mind-promised the bagged bodies that he would never forget them. Since returning home he has been obsessed with his promise, that has become intrusive and obsessive thoughts. He describes them as being "like a like a broken record, going round and round in my mind, especially when I try to sleep." He visualizes the body bags a number of times a day but if he feels threatened by someone, he imagines him dead and puts him in a body bag. Tim sits very straight in his chair, clears his throat and says to T.J., “Do it man, I know it helped me.”
Bobby is small and thin with a high-pitched voice. In Nam he had been a ‘tunnel rat’: he explored Viet Cong bunkers and tunnels. When he worked in the group he sweat profusely as he relived the experience of being in the middle of a platoon, his two best friends walking point, the lead man and the second man. They were ambushed and the point man was killed immediately and the other one seriously wounded. He was crying out to Bobby for help, but he couldn't get to him because he was pinned down by the murderous crossfire. It would have been sure death for him if he had tried to get to his friend. After his platoon broke the ambush Bobby found his second friend, dead from a bleeding wound in his leg. If he had been able to get to him on time he could have saved him with a tourniquet. He has been suffering from survivors guilt ever since. He barely raises his head to look at Tim and mumbles in a little voice, “You done said it for me, okay?”
Kyle, obese, is emotionally labile. He was an army corpsman. When he talked in group he cried, grimaced, walking around as he relived the trauma of losing his best buddy in a fire fight. He was unable to help his friend because he was too far away to answer his cries of "Medic," and he was too busy caring for the many wounded around him. The next day he found his dead friend with bamboo sticks in his eyes and his genitals in his mouth. He leans toward T.J., then points with his head in my direction, “Trust the man. You’re my brother. We were both there. We’ll watch your back.”
Don is grey-haired, very big, muscular and very suspicious. His eyes are usually half-lidded and he glares aggressively at the person he is talking to. He often describes himself as a ‘trained killer.’ He is very bright but hides his intelligence by saying, “I’m just a little old country boy.” He didn't allow himself to cry when he shared his experience with the group. He raged and then crushed an empty soda can under his big foot before he stomped out of the room. But he was back in five minutes to finish up. His talked about his buddy ‘The Wildman,’ saying "We was both wildmen in them days. You better believe it. When we come off patrols we’d get drunk, fight, tear up whorehouses." His buddy was gravely wounded when he took a grenade hit that tore off his face, leaving a pulpy red mass, his blond hair stayed clean and bright. Don had the same bright blond hair. “Shit T.J., you can trust this damn Yankee. Just a little, hear?”
Bubba, looking like an All-American football player is a chronic alcoholic and has a long history of being violent, in and out of jails, and in and out of jobs. When he shared with the group he was grim, almost growling in a low voice; his white-knuckled fists pounded rhythmically on the chair arms when he talked about his buddy on the navy river gunboat. After the war they were going to his friend's hometown, Chicago, to visit the Playboy Club. His friend was a member of the club and often told Bubba what they would do with the big-busted bunnies. The day his friend bought it, Bubba was at sick call because he had a fever. His friend, who was usually the after gunner, replaced him at his forward post on the fifty-millimeter gun. He took a direct hit with a rocket that disintegrated him. Bubba has an almost overwhelming survivor’s guilt. He points his finger at me and looks at T.J. “Dr. B. is okay. He’s one of us. Go to it. It don’t mean shit anyway.”
T.J. is different in his demeanor and speech than the others in the group. Almost all of them grew up poor in rural areas, didn't finish high school, were driving farm vehicles, cars and motorcycles before they were sixteen years old. T.J. came from a large southern city; his father was a college graduate and a high level civil servant. He begins to speak tensely but clearly, telling the group that he had been a pre-med student but quit after two years to join the marines. "In those days I was a patriot and I joined up to serve my country.” He met his friend Richard who joined around the same time and they became fast friends. T.J. took to calling him Dicky Lee, a private joke between them, christening his Boston catholic friend into the southern Baptist faith. In the individual session the day before, he spoke tearfully and lovingly of Dicky Lee, whom he described as "my best friend, like a brother, the best partner anyone can have in life. We went out bar hopping, to whore houses. We had plans that after the war that we'd go to medical school together and open a private practice. We were going to be partners.”
"For two years we were together all the time, studying and then working as medical corpsmen in navy hospitals. We were really good and got to be qualified operating room technicians. When we got our orders to go to Viet Nam we made a pact. If one of us got hit bad " - He stops speaking because he is choked up. He gulps, resettles his thick glasses on his nose and then he says, "Like if one of us loses a leg or something, then the other one won't let the dying man suffer. We had seen so many wounded marines, without arms, without legs, burned, blind." Very quietly he adds, "Neither of us believed we would have to use this euthanasia agreement."
In Viet Nam the two buddies separated, corresponded regularly. They didn't see each other for almost a year. T.J. was stationed at a big field hospital that received helicopter loads of wounded and dying. Because there was a shortage of medical doctors when the wounded and dying came in he did Triage. He explains this to the group, saying, “This is a fancy word we use in emergency situations where usually the doctor has to use his clinical judgement to decide what to do with the wounded. There were three kinds of wounded: those you knew were going to die, no matter what. We eased their pain and we left them to die; the lightly wounded didn't need immediate care and were ignored.” He pauses for a moment, looking up at the ceiling and then says bitterly, "It was the big in-between group we had to treat first so that we could get them back to the killing fields as quickly as possible."
T.J.'s voice breaks and the dam of tears breaks and he cries. There is some stirring to my left and I am handed a tissue box to pass to T.J. He pulls one out and with a shaking hand, wipes his eyes without removing his glasses. He crumples the soggy tissue and carefully puts it into his lap. I ask him if he wants to stop and he responds by taking off his glasses, wiping them with a clean tissue saying "I'm going all the way."
Yesterday I taught him a relaxation exercise and now I speak, using the same voice, slow, rhythmic and quiet: "Why don't you take a deep breath...and then let go...slowly...as you breathe out." He starts to do it but then says angrily "I was playing God and I didn't want it, but what could I do? We had too many wounded and dying and not enough doctors. They said I had to do the triage so I had no choice." His anger disappears in a new flood of tears and sobbing. Several vets make a move to go to him but I shake my head no. They are angry with me but do nothing.
Slowly, he stops crying, sitting with his head hung down. I tell him, "Time out." He looks up at me, surprised and then he understands, nodding. In the private session I taught him the meaning of a "Time out": Stop what you are thinking about or doing and regulate your breathing to be slower and deeper. Then you relax any tense parts of the body you are able to. At that point you can choose to go on or to stop.
There is no movement in the group and the silence in the room is almost perfect. Through the closed window behind T.J. I see a tractor lawnmower clumsily moving in and around the scattered trees; it is cutting the weedy lawns. I hear the distant hum of the air-conditioning, faintly intruding. T.J. begins to talk and cry, talk and wipe, occasionally choking up with anger and helplessness as he describes what happened. Three medivac choppers come in. bringing many wounded and some dead. T.J. is running from marine to marine, efficient and effective, smoothly triaging the wounded, ignoring the dead and the lightly wounded. Then he trips over a squirming, moaning marine and he falls to the concrete. He begins to get up when he notices that it is a legless, dying Dicky Lee.
A moan-wail is torn from T.J.'s mouth. The vets on either side of him reach out to him as he folds into himself, putting his head down, bringing his knees up a little, hugging them to his chest, rocking rhythmically. I fight back my tears, hesitating about intervening, and then I remember that T.J. wants to go all the way, and I decide that he can make it. I don't intervene. The group is restless, most of them tearful, some crying, none loudly. Mike is concerned and looks questioningly at me. I indicate that I am in control and he sits back in his seat, sighing. I wipe my wet eyes, look around the group. Most of them do not make eye contact with me. The intensity of T.J.'s reaction has waned. I speak quietly, emphatically. "T.J.? Can you look at me?" He nods. I lean towards him and ask, slightly more emphatically, "Here? Now?" Slowly, he unfolds and looks up at me. I ask him if he knows who I am and what's happening and he nods, almost imperceptibly. "Do you want another time out?" He shakes his head, no. "Fine. By the way, we are all here, if you need us." I make a sweeping gesture that includes everyone in the room. There is a responsive, quiet chorus of yeses and heads nodding in support.
"Why don't you finish the story," I say and then pause... "Here...now...you...us...all of us together." I take a deep breath, hold it for a second, and let the air out slowly. He takes a deep breath and lets out the air, loudly, into the heavy silence. He begins to speak, unmindful of the tears raining steadily down onto his shirtfront. "Dicky Lee was semi-conscious but he knew it was me. I put him against a mango tree and then I did what I had to. I gave him enough morphine to put him out of his misery and he relaxed right away. Then he stopped breathing." He looks at me with unseeing eyes, the tears streaming down his face. Three patients go to him, one hugs him, and the other two put their hands on his shoulders. One of them whispers something to T.J. and he nods his head. He is still crying quietly. The three return to their seats.
He stops crying and looks at me, indicating he wants to say something. I nod at him and he says, "I wrote to his parents that he died quietly in his sleep but I never told them the whole truth about the injection. Five times in the last twenty years I went to his home in Boston. Each time I got to the door but I couldn't ring the bell."
I say, "I've got an idea I'd like to share with you." He nods almost imperceptibly and in a quiet, soft voice, says, "I'm with you. Go." "In my imagination I heard you speak about God to Dicky Lee, in three different ways. In the first way you said to him, 'Thank God I was able to keep my part of our pact.' In the second way you said, ‘Thank God I was with you so you didn’t die alone.’ And the third way, 'Thank God you've gone to heaven and your suffering has stopped.'"
In child's voice he says, "Do you really thinks so, Dr. Bronsky?"
"You bet your ass that I do. And I'll tell you something else. I had a wild thought a few minutes ago and I’m going to show you what it is. I might get hurt but I'm going to do it anyway." I get up and whisper in the ear of the patient sitting on my right, "What I am going to do has nothing to do with you. I'm going to use you so be ready and above all don't feel guilty. I know exactly what I'm doing." I take a step in T.J.'s direction, and I purposely trip over the patient's foot and fall heavily to the floor. The rug cushions my fall and I roll onto my back, shaken up, momentarily confused, but unhurt. I take a deep breath and as I let it out I say, "I purposely made myself trip to illustrate a point. After the fall I know I can get up and I can stand on my own two feet." I pause for emphasis and then I say, "Dicky Lee, through no fault of his own, couldn't stand on his own two feet because his legs were gone. But you can."
T.J. begins to cry and some of the group murmur about stopping but T.J. says, "No, no. Let him go on." I say to T.J., "Your legs are okay, and you can stand on your own two feet. I am asking you to use them to help me get up." He gets up, unsteady on his feet. Hands reach out to support him. I say loudly to the helping hands, "Let him stand on his own two feet." He sits down heavily in his chair. For a moment I have some conflicting thoughts about stopping but then I feel a big lump in my throat and my eyes flood with tears. With a voice near cracking, I say, "Choose to do it, T.J., or choose not to. Either way is okay with me." What I am really saying is that I too need help from him, but it doesn’t come out that way.
He gets up, swaying, and then staggers towards me. I reach out my arm and he takes my hand in his. I use his support to sit up. For a moment I rest my head against his thick thigh. Then I look up at him and say, "Either you got the strength or you don't." He takes a step back and still firmly holding my hand in his he pulls up strongly. I am surprised by the ease with which he helps me to my feet. We hug, T.J. squeezing tight and patting me on the back. I hold him gently and stoop down a little to rest my head on his shoulder. Then I feel weak and begin to sway. He tightens his embrace and I stand more firmly. He says loudly, "Thank you, thank you, Dr. Bronsky." Tears choke me but I manage to say, "Thank you, T.J.."
After a few seconds we separate, he strongly squeezes my arm and he goes back to his seat, walking steadily. I speak to his back, saying, “You’re coming home, T.J. Welcome home.”
I sit down, bent forward from the waist, my head down, staring at a small imperfection in the carpet. My lips are quivering and the tears are filling my eyes but I can't let go. Don, big, muscular, ham-handed, gets up and walks to T.J., who stands up. Don says, "You’re a man, god-damn it. You sure are one hell of a man." He takes T.J.'s small hand in his huge one, pumps it up and down several times, shaking the dry-eyed T.J. They hug and rock, separate for a second and then hug and rock again. Don goes back to his seat and a number of veterans go to T.J. and shake his hand. He is peaceful, breathing quietly.
The tears in my eyes overflow and the chaplain asks me if there is something he or the group could do for me and I let go and burst into tears, deeply sobbing. I have wanted to cry like this for many years but was unable to let go. Sixteen years ago our first born, a son, almost eighteen years old, died of leukemia. Since then I've cried a number of times but I never let go as I do now. For a minute I have spasms of sobbing, and a growing sense of purging release. When I regain some of my composure I tell the group why I let go. Don gets up and we hug. Then Tim comes to shake my hand, saying slowly, gently, "Doc, I got to hand it to you. You're okay. But don't you think you have to come home too?"
The man on my left holds my hand. The man on my right puts his arm around my shoulder and I put my head on his shoulder and I am racked by a new burst of sobs. After a minute I stop crying, feeling peaceful and sad. Mike nods at me, says quietly that it is time to stop the group. Everyone gets up except me. Several vets come over to shake my hand, one tells me, "You're a man." Another says, "Even though you ain't been to Nam you belong with us, Doc." I look up, seeing that Mike is the only one left and he's standing a few feet away from me, waiting. I get up and we hug and I say to him, "Thanks, Mike." He says, "God bless you, sir."
Later that afternoon, after I finish my outpatient clinic I come out of my office, and T.J. is sitting in the empty waiting room. I am uncertain, thinking that something is wrong. "What're you doing here, T.J.? Are you all right? "He smiles softly, saying, "I'm fine. I came to see if you are all right." I sigh loudly, nod my head, tears in my eyes, and then say, "I feel as if I've been walking around with a heavy weight on my shoulders and now it's not there anymore." He takes my arm, holding it gently and says, "Me and the other guys were talking about you. Like we were worried about you." We sit down in the waiting room and I tell him the details of my son's illness and death. We both cry quietly. He offers me his hanky but I shake my head, wiping my eyes with the back of my hand. He takes my hand and wipes it with his hanky.
He says, "I'm glad for you Doc. Another reason I came over was to tell you that I called Dicky Lee's parents, told them what happened and said I'll be coming to visit them after I get out of the hospital." He nods his head vigorously and says, " I feel much better.”
"Me too."
Twenty-four hours later I get a letter from T.J.
Much of yesterday's group is unclear in my mind. I was mostly locked in on you and the pictures I was seeing in my mind. During the early part I was only vaguely conscious of the other people in the room. When you called a "time out" and asked if I would help you was when the group came back into focus. When you fell to the floor and asked me if I would help you, I looked around the room. There were many with tears in their eyes and others with concern. There were a couple that showed anger but somehow I knew the anger was not directed at me. I felt caring and kinship and understanding. I wanted very much to help you up but I had a strong feeling that I wanted to run. I didn't know where I would go and something was telling me I had to stay and help you. I think it was then that Tim whispered to me to go to you, which I did. When I got you up I felt like I was going to fall myself and I held on to you. You hugged me and it seemed all of my strength left me for a moment. When I started back to my chair Tim, said, and then you said that I was "going home." I felt a release of tension and a strong feeling of support. After I returned to my chair, members of the group came to me and offered support and then I saw that you were broken up too and that the group was offering support to you as well. This created an even stronger feeling of belonging in me.
A letter from Tim received two days after the group, (copied verbatim).
To Whom Concerned!,
I am a VietNam Veteran and recent patient of ATU, [Addiction Treatment Unit], & the P.T.S.D. Program, would like too bring to the attention of, not only Patients trying to recover but to all concerned, that God has led me too this Hospital of the V.A. Medical Center, Tumpalega, ALA. I would like too share an emotional experience that I saw yesterday with a friend and Dr. Irving Bronsky, while in Group (Vietnam). This Veteran (T.J.) whom I found as a friend & a man suffering from an experience from Vietnam! a Nightmare that like so many vets has suffered and used too destroy there lives & there Loved ones! Dr. Bronsky pushed T.J. into confession of that experience (The experience is of Great Importance too Release) A memory that has been haunting T.J.
My emotions was at first too stop Dr. Bronsky, but I also know from my own experiences that this pushing must be done if We veterans are to begin to stop torturing ourselves! Dr. Bronsky kept Pushing & and I began praying for T.J. to ask God too allow him the Freedom of this Nightmare! & Immediately after Dr. Bronsky's attempt this was accomplished. God through Dr. Bronsky honestly was able too succeed! I found afterward that not only T.J. but myself and Dr. Bronsky, Chaplain Mike Dills, & the rest of the group was sharing Release of Pain & this was being shown by crying from most all of us. A event that was truly a blessing from God. Thru a wonderful man, very Concerned for all Vietnam Veterans & the human race! I personelly Love & told this man, Dr. Irving Bronsky, a friend & a Professional that is truly sent to us from God!
Sincerely with God's Love, A friend, a Vietnam veteran
P.S. Dr. Bronsky, My Love & Respect goes to you. From myself A friend in Christ
. 5 Years later, May 1995.
T.J. successfully finished the program and three months later he travelled to Boston, met Dicky Lee’s parents and told them the entire story. They were very grateful. Six months after he finished the program Dicky Lee’s parents travelled to Tumpalega on their way to Florida. They stayed with T.J. He arranged a memorial mass at the Catholic Church in town that was painful, tearful and therapeutic for the three of them.
A year after finishing the program T.J. was accepted into the local college’s nursing school and graduated with top honors as a Registered Nurse. He has been working at the Tumpalega V.A. hospital for the last four years, at first as a Nurse’s Aid and after graduation as an RN on the PTSD ward. He has begun to study for his M.A .in nursing and counselling.
Chapter 2
Letter to my family a month after I started work.
It is 10p.m., and I am physically tired, emotionally happy, and mentally alert, at peace with myself.
I have just taken a long, relaxing shower in the communal area of the bachelor apartments. I have been living in this tiny apartment, with a makeshift kitchen and a small refrigerator; it is dark as not much light comes through the two small windows. This afternoon, at work, I made a schedule of activity for my free time after work and I followed it: I looked at apartments to rent, I shopped in the large supermarket near the hospital; I had a good cup of coffee at a coffee shop in the mall; I browsed in the bookstores. When I returned to the hospital I took a long walk around the grounds, working up a healthy sweat. As I am writing this I listen to a new tape I bought about losing weight, the subliminal messages encased in easy listening music. I've decided to watch less TV and do more writing so this letter/diary to give you an idea of my life in Tumpalega
TUESDAY
I went to sleep at 11p.m. and awakened at 3:30a.m. I haven’t been sleeping well since I have been here. I had several of the “old” nightmares where I think I am going to die. In spite of the fact that I feel very sure of myself at work I am still learning how to work with the horror stories from Viet Nam. They have touched a raw nerve in me and reawakened a part of my own PTSD from “the accident.” I have increased the amount of PASA exercises I do and I think I am getting a handle on my nerves. I am also on a good diet that reduces my stress a little bit. After I woke up I did a PASA exercise that relaxed me. I read a little and at 5a.m. I went to the Waffle House. I had a cup of coffee, enjoying the atmosphere there. The early risers were beginning to come in and the place was filling up. I like watching the cook keep all the orders in his head. I wish I had his memory.
WEDNESDAY
Today Donny had a confrontation with me in the group and left angrily, "because you don't let me say anything." He had spoken more than anyone in the group and I told him I have to take care of all the vets and not just him. Before I came into the program he had dominated whatever group he was in. In our confrontation most of the group supported me, a few said I was too aggressive with him. I held my ground and Donny came back in the group and apologized.
Today, Dee, also a “God-damned trained killer," had a confrontation with me. He and Donny are one of a kind. Both are very bright, natural leaders, but neither finished high school. They were very successful in the killing game in Viet Nam. They are both used to getting their way, especially in the VA system. I decided to use an indirect way with Billy. I gave him an exercise to teach him the difference between trying and doing. Trying as I define it is a state of mind, an attitude. Doing is an action in the world around us. I used an empty Coca Cola can, asking him to try and pick it up. Each time he picked it up, the can sitting on his lap, I reminded him that I asked him to try and pick it up. Then he had a glimmer of what I was after and grasped the can so tightly it bent in the middle - but he didn't pick it up. I told him, "Trying only gets you trying, but doing gets you to do it. He got so frustrated at this point that he threw the partially collapsed can on the floor, stomped on it and walked out.
One of the other patients went to get him and when he came back he explained that he had flashbacked to seeing the wallet that he took from a Viet Cong he had just killed. He agreed to talk about this flashback that he had never talked about before. There was a picture of the VC's family in his wallet that didn't bother him until he married and had children. Then the flashbacks and nightmares started.
He felt a little better after he heard feedback from the other vets who had similar situations of late-onset guilt. In the private session this afternoon we established good communications and he responded well to the PASA exercise I taught him. He said that last night many of the Vets slept well for the first time since they've been in the hospital, and said it was because of my working with them on their nightmares.
I got dressed up this morning with the new white shirt I bought at the mall, put on a tie and went to the doctors meeting with the Chief of Staff. Several doctors commented on how well I look especially since I am losing weight. A neurologist on our staff, whom I had met once casually invited me and the Chief of Psychiatry to lunch with him at the Tumpalega Country Club. The invitation surprised me, but I readily accepted. Later today the Chief told me that the neurologist likes me because I am like a fresh "windstorm" blowing some good in this musty VA.
I mailed some money home today and what little I had left over I put it in the Money Market, like CD's but available anytime I will need to cash it, without penalty. I am going to save some money every month, by hook or by crook. We have lots of debts, i.e. $5000 I had to borrow from my brother-in-law. Then there are the monthly car payments, the rent, plus other expenses. Still, things are working out well.
I spoke to Ima this afternoon and she is not coming to stay for a year. I accepted it, seeing her side, plus the advantages of being by myself for the next year. I'll move into a one bedroom apartment off the grounds which I know I'll be able to manage, to eat there plus keep it clean. I like living alone, eating when and how I want, having time for writing, TV, doing lots of PASA.
I found out that there is no reciprocity between Alabama and New York so I will not get a local license. I'll have to find other ways of earning more money. Perhaps it will be by doing workshops. I'm doing one next week at the local Mental Hygiene Clinic. It's without pay but my name and ability will spread further out. Last week a social worker at the hospital said that someone at the Birmingham VA told him about me, "the new doctor who has begun to do some good work in the PTSD program."
The day before yesterday, and tonight, I walked around the hospital grounds and worked up a good sweat. I enjoy the walking and especially like the tired feeling when I finish. I am getting a key to the rehab institute in the hospital so I'll be able to work out with weights. When my accreditation comes through from the university then I'll be able to use their gym and swimming pool.
I've started keeping track of all the money going out to see where it goes. I also want to know what my basic expenses are for an average month. I'll do it for three or four months, including the 2 months Riva will be here.
SATURDAY
Blossoming, fruitful, greening and growing, the positive experiences in my new life multiply, expand, and grow in intensity and significance:
1) I have been approved by the Dean's committee and am now a member of the faculty of the university. I will be teaching, supervising and training medical students and residents. This will further emphasize my involvement with psychotherapy, and consequently, I'll spend less time working on things like Compensation and Pension exams, committee work, and consultations.
2) The lunch with the neurologist and my Chief was interesting, exciting, and the food was good. The neurologist said he asked me to lunch because we are so similar: he is over-qualified for the VA, very intelligent, sophisticated and this roly-poly Southern Baptist aristocrat loves Israel.
3) I was called by a being staff psychiatrist who asked me to the theater with him and his wife. I had to refuse because I was busy but I liked called.
4) Donny, the trained killer, was feeling so much better that he kissed me on the top of the head in the group yesterday after I had worked with him. He has softened and relaxed, accepting me as his therapist, just as Billy has along with the rest of the group.
6) The psychiatrist running the Addiction Treatment Unit has been asking for me to consult with patients on his ward.
7) A black nurse on the ward gave me a gift of a black ink pen because she liked how I handled one of the vets who had been cursing and threatening everyone. I joked that "Of course, I'd get a black pen from you." It got a good laugh. Then I added, "With me, everything is black or white." Another laugh.
Yesterday I began to lift weights in the basement gym of our building. I haven't weighed myself in the last 2 weeks but my pants are getting big on me.
I'll be seeing an accountant this Tuesday to get help with my taxes, expenses and other things so maybe next year there will be refund.
Today I visited a garden apartment complex to look at 1-bedroom apartments. I stopped a man I didn't know, to ask about the complex. He said he knows me; he is a pharmacist at the hospital. I spent two hours with him, in his apartment, and we talked about the apartments, we talked about ESP that he's into, Edgar Cayce. He thinks he is a medium, having discovered some talent for healing in himself. He told me about his life, why he's unmarried at age 34. He's good looking, has a pleasant, polite personality. When I left his apartment he repeated three times that living in his apartment complex is the best buy for the money.
He gave me the address of a man who does meditation groups, healing seances, who runs a group every Thursday. I think I'll go.
MONDAY
The time is 4:30a.m.; I've been up for almost an hour. Stomach cramps and a bad dream awakened me, probably the result of my excessive eating of fried food and carbohydrates at a fast food fish restaurant, all you can eat for $7.99. Actually I paid $9.99 because I inadvertently took the salad bar along with the fish/shrimp, and I paid in more ways than one.
The dream was that I was asked if I want to live, sat up suddenly, scared, but still in the dream. After a slight hesitation I said I did and then woke up, upset.
I am still struggling with my diet. For most of the week I am fine, living and eating as if I was normal. Then comes the weekend or a situation like eating at an all you can eat buffet and I go off the deep end. Still, I am continuing to lose weight and I am sure I'm below 280 lb. I shall weigh myself today.
Yesterday morning I awoke at 8:30, had a leisurely breakfast and then wrote the article for the Alabama Veteran’s Newspaper, that the Chief asked me to do. It is about our PTSD program, entitled "PTSD or PTDD", the latter being Post Traumatic Distress Disorder. I defined stress and distress, gave some examples, and then I discussed my experience with PTSD in Israel, citing the differences between the disorder there and here.
I mentioned to one of my colleagues that Ima has decided not to stay for a year, and his response stuck in my mind: "She chose the children over you." But then I realize that that is the way she is. It is hard for her to change, just as it is hard for me to change. Her first choice in life is the family and my first choice is work. Who is to know who is right?
TUESDAY
Today is Chagit's birthday, 17 y.o. a young woman: mature, beautiful, intelligent, sexy, creative, warm, loving and complicated, (like me a little.) I will write her a letter today.
My life as a psychiatrist at the Tuscaloosa VAMC is mostly ups with some downs. The positive about working here is that I am doing exactly what I want to, concentrating on psychotherapy, making my own schedule, left on my own without any great pressures or demands on me. The patients in individual therapy with me are getting better. I have created the beginnings of a PTSD program that might be one of the best in the US. I am earning a good living, beginning to save some money, sending money home once a month, and preparing to move into an apartment off the grounds.
I have lost almost 40 lbs., feel great, look good, and continue to dress better than I have ever done before in my life. I'm going to buy some more clothes this week so that I will have more choices in the way I dress.
Socially I continue to make friends and influence people. This weekend I met Arlene and Lester Kaplan, from Birmingham. I met them through the phone, calling them in the mistaken notion that Lester was the Kaplan who had an institute for helping professionals prepare for professional boards. I was looking into places where Riva could study for the Nursing Boards if she decides to come to Alabama. I spoke to Arlene and we hit it off very well over the phone. She from Brooklyn, an M.A. clinical social worker and he's a professor in the UAB school of optometry.
They invited me to dinner last Saturday night and I met her parents, in their middle 80's, who live next door to them. There was another couple there, Adam and Sally Gordon, in their middle 30's, he is Jewish and a professor of optometry and she is an optometrist in private practice. She is a catholic from Mississippi, pretty, blonde, blue-eyed, energetic, very bright, strong-minded.
It was a love affair with the Kaplans. I was entertaining, serious, sophisticated, and worldly, an author, analyst, Israeli/American, and more.
I gave an excellent seminar/workshop at the M.H.C. and the feedback was superb. One woman is doing her M.A. thesis on PTSD and wants to learn from me. Another one wants me to start a supervisory group. A consultant for the clinic is finishing her Ph.D. at UA in counselling thought I was great and wants to have me to her home in Birmingham. She is in her 40's and her husband is a successful lawyer.
The big problem for me at work is pushing too hard and not knowing how deeply disturbed some of the vets are. I am having trouble with one of them, “Sarge.” He was in the infantry, was out in the boonies all the time he was in Viet Nam. He suffers continually from guilt, depression, rage reactions, anxiety reactions, flashbacks, nightmares, and super-sensitivity to loud noises. He is very threatened by people in crowds, malls, and stores. Sarge was a great leader of men and functioned very well in the killing fields. For the last twenty years he has been in and out of jail, a chronic alcoholic, in and out of VA hospitals. He took an immediate disliking to me, feeling I don't know and can't know anything because I wasn't in Viet Nam. He complains about the VA, he creates conflicts and disruptions in the group.
Example: yesterday morning I told the group I had a dream that I was overrun by the NVA who shot and killed me and in the dream I accepted dying. He said I have no right to identify with the vets who have PTSD and suffer. He went on and on and I kept trying to communicate with him and not succeeding. I kept asking the group for help and finally Sarge dismissingly waved his hand at me and walked out in anger. Most of the group defended me but several were critical and I was a little depressed. A number of group members told me not to give up, because I was helping them.
Larry the motorman, (his nickname because his legs keep tapping, bumping and pumping on the floor like a motor, is very conflicted about me, wanting my help, but afraid that I'll be too pushy. Yesterday I helped him relax, teaching and demonstrating to him that he has choices when he feels his PTSD coming on. There are four simple things to do (but oh so hard to learn): 1) be aware of the here and now; 2) slow, rhythmic breathing; 3) body relaxation; 4) do something he can succeed at, anything, such as combing his hair, tying his shoelaces, getting a drink of water. (Nothing beats success even if it is simple, mundane.)
He did that yesterday and stopped the leg-shaking, saying he felt more relaxed. Yet last week he was "ready to hit me," according to the psychologist who sees him in individual therapy. She has been seeing him for years and is like a mother confessor to the vets. She said I pushed him too far in "trying to force him to come to a session when he didn't want to." I explained to her that Larry refused to come to a session with me at my office in the MHC because there is a Philippine-American psychiatrist who works there. Larry called the doctor a "gook", a derogatory term used in Viet Nam for any oriental. I said he could come on Friday when that particular doctor is off and he agreed. But he didn't show up. While I was walking around the hospital yesterday, I met the psychologist who lives on the grounds. She told me she was worried about me; she was told by Sarge and Larry that they barely restrained themselves from hitting me. I thought she wanted me to justify my behavior and I didn't, saying that she could come see me work to know what's happening in the group. She was non-committal in her answer.
The Chief sent me a memo stating that after working 3 months at the hospital he is recommending me for permanent employment. That will be a relief when I get it.
I speak a couple of times a week to Riva and the children and yesterday she said her decision is firm: She will not spend this year with me at Tumpalega. I can see her point as we have a daughter who is a senior in high school and a son in the army (non-combat). This will give me the chance to learn to be more independent with day-to-day things such as doing washes in the Laundromat, furnishing the one bedroom apartment I will soon move into. I have vacuumed the apartment a number of times and enjoyed seeing the clean rug.
I went to a Psychic Fair in Birmingham over the weekend, on Saturday and Sunday. There were about 15 readers/psychics and I had 5 readings. They all said the same that I have a lot of power, creative ability that I'm in a good space and I should continue to go with the transformation in my life. I realized that what I discovered about "seeing" things is what these people have been doing for years and they call themselves psychics. I was encouraged by several of them to use my intuitive ability to "see" things in my work. I have begun to do this in the group and in sessions: talking in a trance, summarizing, speaking spontaneously in my PASA voice.
Chapter 3
Frank Waffle
I have been a “regular” at the Waffle House since I came to Tumpalega seven months ago. My wife spent the summer with me and she is back in Israel for the last month. She wants to be with the children, grandchildren and her family for the holidays. Almost every day after work, late in the afternoon or early evening, I stop at the Waffle House to have a cup of coffee, to read the local newspaper and to schmooze with the locals and the staff. I am sitting at the counter drinking a cup of coffee and Frank the cook has been chatting with me.
He says, "That's the reason I'm so darn depressed, you know?'
"No I don't, Frank, maybe you could explain it a little more." He is in his early forties, blonde hair, partially bald, with deep facial creases. A paper Waffle House cap sits tall on his head, pushed towards the back. He is average in height, is stocky, with thick forearms and upper arms. He is graceful in movement, speaks slowly, in fact, he does everything with a slow, steady rhythm.
He nods, turns away from me to reposition the big knife and to wipe the clean cutting surface one more time, carefully placing his white rag on the edge, pushes his Waffle House cap more tightly on his head. "You see," he says turning to face me, "I got two things that get me down. Firstly, I’m a Viet Nam vet and I got it all, nightmares, anxiety attacks. When it’s busy here I don’t mind the noise and all, but if someone drops a cup then I act like I was in Nam with incoming. Scares the hell out of me. But I been living with these here problems for more than twenty years. Now secondly, that’s the one that breaks my balls - oops, sorry Doc. I ain’t supposed to talk like that to an educated gentleman like you.”
My smile and nod encourages him to go on. “All I earn is five dollars an hour and by the time I pay taxes, my food bill here for the week and my insurance, all I come home with is one hundred and forty three dollars a week. That ain't much to live on, even though I'm living alone. My ex-wives got the kids. I love to gamble at the dog track but all I can afford is thirty two dollars a week." He pulls the napkin box towards him, stares at if for a moment and then daintily pulls out a napkin, carefully folding it so that the printed logo of the Waffle House is hidden. Pulling a pencil stub out of his back pocket, licking the point lightly with the tip of his tongue, he begins to write slowly as he explains.
"Two dollars for each Quinella, which makes twenty four dollars cause there are twelve races, right? Then I bet a two-dollar Suspecta on the third, sixth, ninth and twelfth races. Let's see. Uhm...That's another eight dollars. So all told thirty two, you see?"
I say that I do though I really don’t because I have no idea of what a Quinella is, let alone a Suspecta. The Waffle House is not busy; two waitresses are whispering together by the coffee machine, there are two customers silently eating in a booth at the back. The big jukebox is blaring loud country music and there is a strong, vibrating thrum from fan over the grill. Frank continues to speak.
"If I had a bankroll of say, a thousand dollars, I'd be able to go to the dog track every day and in two years I'd triple the money."
I finish my coffee, slightly raising the cup off the counter in the direction of Pat, my waitress, and she comes over immediately, smiling easily at me showing her prominent buckteeth. She gives me a refill while Frank and I watch her movements.
I am excited. One of the reasons I came to Tuscaloosa was to improve our financial condition. Israel was in a serious recession and I was getting deep into debt. I had known too much poverty during the big Depression of the ‘30’s when my father couldn’t make a living and we had to go on Welfare. One time we couldn’t pay the rent and we were “dispossessed,” all our furniture and belongings were put out in the street. I felt as if I was put out into the street, naked. Now I am hoping this is the miracle I have always been waiting for. If Frank was right, and he sounds so sure of himself, and says he has proof, then I could scrape together a thousand dollars and give it to him. He's serious, dependable, reliable, compulsively clean and he works with a slow, steady rhythm, regardless of the terrible pressures he's under when the place is busy.
Suppressing my excitement I lean towards him and in a stage whisper I asked him to into the restaurant and I feel a slight irritation and frustration. Here I am going to make my fortune and this man comes in to bother Frank and me. Frank, Pat and the other waitress greet him warmly. He sits in a booth by the window.
Meanwhile, Frank has pulled today's newspaper from under the counter; it is folded to the sport's page and the columns of yesterday’s results from the local dog track. He tells me that he mind bets the dogs every day and he's ahead.
"Then why don't you go to the track every day," I ask naively?
"I can't because I don't get off from work until nine p.m. and the races start at eight. I could make the bets in the morning. They have advanced betting, did you know?"
"No I didn't. So?"
"I ain't got enough money for gas to get there, besides, I'm riding a pickup that ain't registered because the guy who sold it to me didn't register it and he ain't about to pay for it now." His explanation sounds funny to me but my excitement shrugs off my doubts.. I only have eyes for the big bundle he is going to make for me.
He pauses to look at the man at the window and then over at the whispering waitresses, indicating that he wants one of them to take the order. Then he grins at me, exposing the gap where his four upper front teeth used to be; he nods slowly and says that he can show me how well he would have done yesterday - if he had gone to the track. He pauses dramatically and then says apologetically, "But I won't. I'll tell you which are the winners today."
My imagination almost lifts me off my seat, while my heart beats like a rocket engine revving up before takeoff. Everything seems normal in the Waffle House: The man in the window booth is reading a newspaper and drinking a cup of coffee, Pat attends to the couple who are standing at the register. I suddenly realize that Frank’s voice has stopped. I have been daydreaming all the way to the bank and I haven't been listening to Frank.
"I'm sorry but my mind was wandering, could you repeat that?"
"Don't you mind any, Doc I know about that. I'm depressed too because of my money situation. I can't work on another job cause I ain't got the energy or the time. Where was I?"
"You were explaining about today's winners."
He circles his choices with his pencil stub and I ask him to write them down for me as I might go to the track tonight. He says he’ll be glad to and does it, mumbling, shaking his head from side to side, nodding, and grimacing. When he's finished Pat is speaking loudly above the loud music and the exhaust fan noises. The man has ordered and she is calling it out to Frank. Without looking at her he turns to the grill and prepares the order. In two minutes it's done and he's back, leaning on the counter, pushing back his cardboard Waffle House cap.
"I'll write it down for you." He pulls another napkin, and laboriously writes his picks. He hands the napkin and I take it, saying that I'm not sure if I'll go. I don’t know why I lied but I did. I know I am going. He reassures me that he knows I'm busy and I shouldn't worry. I thank him, leave a tip for Pat, pay my bill. Frank is scraping the grill that looks clean to me. I go out, light-footed and light-hearted: It’s money in the bank as far as I am concerned.
I go to the track and win the first bet. I begin making plans for a contract with Frank and what I'll do with the money.
The second race loses.
The third race loses.
I lose all of Frank’s touted races, losing twenty-two dollars.
The next day I am back in the Waffle House for my late afternoon coffee. Frank smiles at me when I come in. He is busy all the time and we don’t get to talk. I’m glad of that as I am reluctant to burst his pretty balloon also. As I leave I tell Frank that I didn’t have time to go to the track. I add, lying with a smile, "Maybe some day we'll go out together."
"Sure Doc, he answered, as he slowly wipes his clean counter. “Anytime. With you it’s money in the bank. You just name the date."
I walk out of the Waffle House, saying silently to myself and Frank, “Don’t bank on that, you hear?” explain what the terms Quinella and Suspecta mean. As he explains he gets excited; he carefully pulls another napkin out of the box and for the next five minutes explains, very slowly and methodically what they are, occasionally writing on the napkin. A Quinella is picking the first two dogs in a race to come in first and second, or second and first, in an eight-dog field. A Suspecta is picking the exact order of the first four dogs in an eight-dog field.
"You know, in the last two years I picked twelve Suspectas and the most money I won was more than two thousand dollars."
I am getting more excited, as I lick my own imaginary pencil and make fantasized napkin calculations. I am having trouble keeping myself from shouting exuberantly, "This is it." A customer comes
Chapter 4
"About that appointment..."
It was five to nine when I walked into the group therapy room and T.J. and Jim are the only ones in the long room, in a far corner. One week has passed since T.J. "worked" in the group and he is feeling much better. This morning while I was making rounds on the ward, T.J. took me aside and told me that the new patient Jim had been an army medic.
T.J. said, "He has something bad eating away at him that he wants to talk about but he's afraid you might push him too hard." I thanked T.J. and said I'd keep that in mind. I arrange two chairs to be separate from the rest of the group: one for me and one for the "hot seat" which is for the patient I will work with. I am about to sit down in my chair when T.J. theatrically clears his throat, getting my attention. He says to me, with a serious voice and a smile in his eyes, "Hey Doc, you better tie your shoelace because if you trip over it Jim and I will have a mess of trouble picking you up off the floor."
I looked down at my black sneakers and a long lace extended at least six inches out from my right foot. "Well you know, T.J.," I smile and wink at him, "you and Jim were medics in Nam and I'd be in good hands. Don't you think?"
T.J. smiles broadly and Jim put his hand up to his mouth and shakes his head from side to side. Then, as I sit down, I say, "I'm not going to be your fall guy." T.J. laughs, remembering how I fell down in the group a week ago, as part of my working with him, and he helped me to get back on my feet. And how that helped him get back on his own two feet. I tie my laces and ask Jim, "Why're you shaking your head? You don't agree?"
Sighing long and slow Jim wipes his mouth and then dry-wipes his shaggy mustache and strokes down on his full beard. He is wearing thick-lensed glasses and has a round face, the face of a wise man or a guru. His baldhead is crowned by thick gray hair. His hand again goes up to his mouth and in a quiet, deep voice thick with a southern accent, he says, "I don't much feel like talking." Jim has been in the group for only a few days and he hasn't spoken more than a few words. After his first group I approached him and said, "About an appointment with me, Jim, I usually see all the new patients for at least one session to get to know them." I took out my appointment book and pen and asked him if he can come to a session with me that afternoon.
He is depressed and heavily medicated with tranquilizers and anti-depressants. After several seconds of slow rocking from side to side he answers me. He speaks with his hand covering his mouth and says apologetically, "
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