The VA Shrink
by Peter McShane
The innocuous label in the lobby said “Behavioral Health.” Standing in an elevator full of people, I didn’t want to be seen pushing that button, but there I was at 60 years old, seeing a shrink for the first time in my life.
I had heard vets talk about the eighth floor of the VA Medical Center, that it was for the nut cases who made civilians nervous. I thought they might have been joking until I stepped off the elevator. There weren’t any examining rooms or weight scales in the hallway, and no hospital smell. It looked like a floor in an office building, far removed from the typical clinics and the daily bustle of the hospital, except for the VA cop stationed near the front desk. After checking in, I sat in a waiting room with vets who didn’t feel dangerous, rather pensive and subdued. One of them kept rubbing his hands together like he was cold. Another, with long greasy hair and dressed in old fatigues, just stared at the floor. There was no eye contact and no conversation.
I kept asking myself why am I here. Once I get labeled with PTSD, I might as well say I’m mentally ill. But after listening to my medic buddies, I knew something was wrong with me, that there must be a reason for all the things that had happened in my life since returning from Vietnam. I never considered that I could have a problem. Green Berets don’t go mental, I told myself. But after a few conversations with my medic buddies, I began to think otherwise. I realized that their symptoms weren’t just the ravings of two crazy GIs. VA counselors had told them that Green Beret medics had a high incidence of PTSD, and there is nothing shameful in admitting it. Unlike other medics in the service, we carried weapons and were expected to use them. Anyway, I’d have to cop to the symptoms if I had any hope of getting more disability compensation. I had been at 40 percent since 1969, based on my wounds. Agent Orange diabetes pushed it to 50 percent in 2002.
Doctor Moffett, a retired Army psychiatrist, came out to the waiting room to meet me. About my age, he was also a professor at the medical college, common practice at the VA. His specialty was addiction, and I wondered how I had wound up in his office. It was large for the VA, and the memorabilia of his life filled it. His medical degree was displayed prominently on one wall next to a doctorate in chemistry, and a master’s in something. Three or four board certifications, accolades, and photos absent any evidence of military service covered the rest of the wall, a mosaic of plate glass reflections. There was no couch or recliner in the room.
Standing in front of a bookcase displaying the tools of his trade, he was chatty and contemplative in a way I hadn’t expected. There was regret as he talked about the routine of his military career counseling drunken soldiers. I couldn’t tell if he was feeling sorry for himself, or regretful that he couldn’t have done more for his patients. We had Catholicism in common, both of us having had a vocational calling to the priesthood earlier in life. He had abandoned the church for Native American spirituality, while I had simply fallen away.
My first session occurred in August, 2005, before a reunion of my medic classmates. Since I had been referred by my primary care physician at the VA, the doctor asked me what was on my mind.
“I think I have PTSD.”
He gave me a curious look. Then he started firing questions like, “Are you hypervigilant?” “Are you angry or depressed?” “Have you tried to kill yourself?” I felt like he was reading from a checklist of symptoms, marking the ones that applied to this veteran. I didn’t know how to respond, and was getting agitated. I gestured with my arms outstretched, palms opened wide.
“Where do I start? I’ve talked to buddies who have PTSD, and their problems are familiar—they’re my problems.”
Sitting at a small round table in the middle of the room, Moffett was momentarily distracted by someone’s knock at the door. I thought that it might be some predetermined signal, that if he didn’t answer, the cop would burst in with weapon drawn. He yelled “I’m with a client,” and looked at me. “Sorry. Alright, can you be more specific?”
I felt the room closing in.
“OK. I have no friends. My employment history is checkered. I don’t trust anyone. I pushed my wife away; we hadn’t had sex in at least 10 years, now we’re divorced. I’ve suspected for some time that there’s something wrong with me.”
He smiled, as if relieved.
“You’ve just told me symptoms that could apply to every human being on earth.” He chuckled.
What the fuck is so funny?
“Let’s drill down on specifics. Do you have trouble sleeping?”
“I don’t know. I…I guess I do. I used to grind my teeth. I think I still do. Sometimes I’ll wake up at night drenched in perspiration. I have some bad dreams.”
“Do you get upset easily?”
“Oh yeah. I’m intolerant, especially of incompetent people.”
“Tell me about your employment history.”
I told him how I couldn’t trust my bosses. They lied to me, but they expected me to trust them. They made me angry. I either bailed, was asked to leave, or was fired. Moffett looked at me like I was crazy.
“Sometimes we have to do things we don’t like. That’s why they call it work,” he said, smiling. I felt like punching him.
“What’s your definition of trust?”
I thought for a few seconds.
“I think of my buddies in Special Forces, men who watched my back, men who put their lives on the line for me. I did the same for them.”
Moffett pursed his lips, his eyes shifting to the ceiling for a moment.
“And you apply that standard to choosing friends and people in the workplace?”
“Don’t you think that you’re being too critical? After all, we’re all human. We’re not infallible. Can’t you give people a break?”
My answers befuddled him. I suppose it’s difficult for anyone to understand the extraordinary level of personal commitment my teammates made to one another. Anything less than that threatened our mission. It’s no wonder that people back-on-the-block continually disappointed me. His brow furrowed as he took a deep breath.
“Can you tell me about your worst memory of Vietnam?”
His intrusive questioning annoyed me. He knew my branch of service and that I had served in combat, and was wounded. Why did he need to ask me detail that was already in my medical record?
“You mean other than being shot in the chest and wondering whether I was going to live?”
“Ok, good,” said Moffett.
“And then, I’m hanging in a McGuire rig below a chopper and the winch malfunctions. I’m watching muzzle flashes from the jungle below, the NVA guns trying to finish me off.”
Moffett never twitched as he made notes on his legal pad.
“How did that experience make you feel?”
“I can’t remember having any feelings.”
Deeply embarrassed, I never discussed what happened that day with loved ones, much less total strangers. The doctor leaned back in his chair and paused for a few seconds.
“Sounds like Post-traumatic Stress Disorder—you present the symptoms.”
Hearing him say the words was a bit of a shock, even though I knew they would come. It was the realization that I was certifiable. Summarizing my symptoms for Moffett had brought the memories of a lifetime into focus: I had lost my family. I cared for no one. I couldn’t keep a job. I was bankrupt. I was a failure.
Moffett said until 1980, Post-traumatic Stress Disorder wasn’t considered a medical condition. Up until then, if a veteran had the symptoms, he was given antidepressants and sleep meds, and told to get some rest. If he persisted, he was labeled a mental case.
“Problem is that we don’t have any medications to treat the condition, specifically. We have to treat it symptomatically. I can prescribe Welbutrin for anger management, Celexa for depression, and Ambien for sleep.”
He went on about how Celexa, Welbutrin and other SSRIs have been shown effective in helping slow patients’ reaction to stimuli. As he was explaining the chemical reactions and their effects on the nervous system, I remember buddies having said that the VA simply threw drugs at the problem. Now I believed them. It sounded to me like things hadn’t changed any since 1980.
”While these medications don’t necessarily affect the libido, I can also prescribe Viagra. What do you think?”
I pushed my hands through my hair, clasping them at the base of my skull, and glanced at the ceiling. This is therapy? Take drugs?
“Doctor, I need to think about all of this. For 35 years, I’ve rejected the thought that there’s something wrong with me. I just figured that my life was all about bad luck. When my buddies told me their problems, I thought they were weak. They’re fucked up, not me. But now I know differently.”
He got up from the table with a flourish, like the hard work was finished, and sat behind his desk.
“We can treat your symptoms, but that’s the extent of it. PTSD doesn’t go away. Over time, a successful treatment modality should provide you with the tools to manage the symptoms.”
“That’s it? You’ve told me about the drugs. What about counseling?”
“Our clinical psychologist, Doctor Walden, is starting a new vets group, all Vietnam-era. Would you like to call her?”
I shook my head. “I’m confused. This sounds like a self-treatment regime.”
He leaned back in his chair.
“It’s up to you to follow through. Group therapy is a good place to start. You and I can meet again in 90 days and see how you’re doing. And we can talk about meds then, if you like. How’s that?”
What kind of counseling do you get every 90 days?
“Doctor, frankly I was expecting more today.”
“Well, your symptoms suggest that you’re not a threat to yourself or others. Under those conditions, group therapy can be very effective. Why don’t we try that before we move on to individual counseling?”
Before I left, he showed me how to do deep breathing exercises if I got anxious or angry, and he wrote me a script for fish oil capsules. I thought it was a joke—so much for psychiatric counseling. So much for the VA’s behavioral health program. I’m on my own.
After the appointment, I remembered the drugs a fellow medic told me he had taken, like Prozac, Zoloft, Celexa, Wellbutrin, Ambien, and others. Some of them weren’t even on the VA formulary. He’d get them from a civilian doctor, or on the street. I kept thinking about the term Moffett used, “Manage the symptoms.” For whose benefit? Keep the lid on crazy vets like me—dumb us down with drugs? No thank you.
Pete McShane served as a U.S. Army Special Forces medic during the Vietnam war, 1967-1968. He has completed a collection of short stories, a novella, a number of personal essays, and is putting the finishing touches on a memoir about his life as a Green Beret medic and its aftereffects. His work has been published in Ginger Piglet, Syracuse University’s Intertext Magazine, The New York Times Warrior Voices, Syracuse Peace Council Newsletter, is forthcoming in Fear of Monkeys, and can be found on the Syracuse Veterans’ Writing Group website.