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I’ve published a new post at Health Central, the second in a series on depression and related problems among veterans. This one looks at PTSD from the perspective of soldiers who’ve been through combat and also at innovative approaches to treatment. I hope you’ll have a look at it. I want to add here some links to sources providing insight about combat trauma to the those of us without military experience, though it’s impossible to really understand without having been through it.

The Mind of a Retired Shooter is a powerful record of the ongoing struggle for recovery of a twenty-year Army veteran. It’s a painfully honest account of the way behavior brought on by PTSD turned away all his friends and family and left him alone to find his way back to a productive life.

Healing Combat Trauma is a veterans’ site with numerous stories in its “Eyewitness to Combat” series. This post vividly portrays the turnaround experience of one veteran who spent years consumed by guilt at being the sole survivor a fire fight. The site also has an exhaustive listing of veterans’ memoirs and poetry as well as dozens of books on innovative treatments.

In Odysseus in America: Combat Trauma and the Trials of Homecoming, psychiatrist Jonathan Shay brings out the need for treatments of PTSD that go beyond the behavioral symptoms to deal with the impact of combat on a person’s fundamental character and sense of moral ordering of the world.

The psychologist Edward Tick looked into non-western spiritual traditions to find a new understanding of the classic warrior experience, one that talks in terms of damaged souls and a ceremonial path to healing. In War and the Soul, he describes a four-step process of healing that has proved to have great meaning and effectiveness for veterans with PTSD.

It consists, first, of a cleansing experience in order to come to terms with the trauma. Many have felt this during ceremonies honoring their dead comrades or in visits to the battlefields where the shock and loss took place. Telling the story of the past is a critical second step, partly to gain distance from traumatic experience but also to start reconnecting with the people who listen.

Third, mutual recognition and restitution with family and community need to occur. As Tick sees it, the individual shouldn’t have to bear the burden of PTSD alone, since the nation as a whole is responsible for sending soldiers to war and supporting those who need help on their return. The last step is the transition by the former soldier to a new role and sense of purpose in life, a change that occurs most effectively with the support of family and community as well as through the hard work of the individual.

Much of the prevailing treatment in the military ignores approaches with such a holistic view of life that help a veteran come to terms with the past. Instead, the emphasis is on putting that experience aside, on using cognitive therapy as a means to change habits of thinking and on focusing on re-integration into the normal routines of life. That simply doesn’t work for many veterans because it fails to address the deepest damage of all.

One of the best portrayals of the impact of combat is Operation Homecoming – Writing the Wartime Experience, a documentary featuring interviews and readings by such writers as Brian Turner (Here, Bullet), Tim O’Brien (The Things They Carried), Colby Buzzell (My War: Killing Time in Iraq) and Paul Fussel (The Great War and Modern Memory), among many others.

There are dozens of other first-hand accounts of combat trauma and resulting PTSD, but these are great resources to start with.

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Merely Me wrote a wonderful post on the importance of bringing play back into everyday life. It is the forgotten tonic among adults in general and depressed adults in particular. She paints a vivid scene of a group therapy session where she coaxed recovering addicts into playing rather than talking about themselves. Some brought in precious toys they’d probably had for years, and everyone got immersed in their games. It sounded like they felt the release of a long-buried instinct – for play is surely one of the basic human instincts.

Her post brought to mind one of the most extraordinary people I’ve known. He was a born teacher infusing his own life and the lives of those around him with imagination and play as a natural part of his instinct for life.

Steven and his lifelong friend Maria arrived in town one day, found a small space they could rent to start a school and dubbed it Little Earth. Its first citizens were both kindergarten age kids and the dozens of figures emerging from the imaginations of this gifted pair. The little kids referred to them as the grownup kids because they took the imaginative adventures and instinctive games of children as seriously as any event in adult life. They accepted kids on their own terms, could speak their language, play with them, win their confidence and teach them through play-adapted methods.

They told dramatic tales with hand puppets and marionette shows, taking on the voices of all the characters as they either crouched behind the puppet theater or stood over it guiding strings that brought the flopping marionettes to life. The artifice disappeared as the puppets took on life in zany stories that always reflected back on what the kids were really going through. Drawing on their network of talented friends, they arranged visits by performers from street theater groups who taught the kids circus arts. Everyone learned to walk on stilts, perform acrobatics and turn into dangerous tigers and bears that challenged the ring master’s control and composure as he flashed his string whip. That intense training culminated in a public circus performance in a city park, the Greatest Show on Little Earth. Each kid, no matter how timid or bold, found a role to play and drew great cheers from the crowd.

Each year, All Species Day was celebrated by a parade around the downtown plaza, kids and parents together dressed as river otters, eagles, polar bears, and bearing signs about the endangered animals and how to protect them. Steven’s teaching, in particular, was filled with guitar accompanied songs for all instructive and fun occasions. Small and slender, he had a kid-like curiosity, wonder and imagination that saw the play and teaching possibilities in almost everything.

He also played the magician, appearing in his black top hat and tails over blue jeans. Coins, eggs, stuffed animals would appear and disappear, often with the tap of his magic cane over the upturned hat. Reaching for a handkerchief stuffed up his sleeve, he would be amazed as he drew forth an endless stream of red silk. And most miraculously, his assistant, Maria, would disappear in a huge smoke puff from his ever present flash powder. For Halloween evening, the two organized an outdoor extravaganza with bonfires, magic incantations, bursts of mysterious smoke, cauldrons of potions and a gentle witch and wizard presiding over all. There was a sense of instructive ceremony about all of Steven’s ideas. He cajoled the most reluctant kids into playing lead roles in dramas designed to stretch their ideas of who they were and what they could do.

This was not just dramatic flair. There were sound teaching principles woven through everything he created. Eventually, with the help of friends, he and Maria produced a book about Little Earth, and as the school grew into a much larger and more complicated place, they both retired to find new adventures. Steven fulfilled a lifelong dream of traveling to Egypt. There with his irrepressible personality, he befriended the sister of Gamal Abdel Nasser, the former ruler of the country, and persuaded her to support the establishment of a new school in Alexandria – based, of course, on Little Earth principles. After some years he continued his travels around the world and eventually found his way back to our small city.

But when he returned he brought the news that he had AIDS. Even then, he followed his instinct to teach through ceremony. One night he gathered a group of friends to share with them what the disease meant in his life and what his prospects were. After greeting many he had not seen in years and swapping many stories, he settled himself on the floor in the middle of the room and spread out in a semi-circle before him the dozens of small dark bottles that contained his daily regimen of pills. He swept his arm over all those medications and said simply: This is the umbrella of hope in the 90s. Always concerned that we know and learn, he described the symptoms he was living with, the impact of the medications and eventually made it clear that this chemical hope might not be effective.

He went through a long decline like most other AIDS patients of that time. Infections plagued and weakened him, minor strokes began to affect his concentration and memory, weakness kept him in a wheelchair, and his body started to shrink as eating became too painful. But he created one more ceremony before he died. He asked (and no one could ever refuse one of Steven’s requests) that a circle of friends join around him to be present for the end of his life. It was as if he wanted to be sure that his spirit would become one with our own. And so a small phone tree was organized, and one day my wife and I received the call to come.

He was unconscious by then and kept alive by means of an oxygen tank. One friend, who had come from San Francisco where he worked with AIDS patients, took a look at him lying on the bed and agreed that he was just about gone. He had seen a lot of this before. The attending nurse explained that Steven would probably go shortly after the oxygen tubes were removed. His sister, who had helped him through this long ending phase of life, said it was time, the tubes were taken out, and we held hands in a circle around his bed as he had wished. He managed a few rough-edged breaths, then a quiet one, then nothing. I doubt that anyone there thought of him as dead. We all took turns alone with him, saying personal good-byes. When I stood over him, his face still looked close to life, as if he might at wake any moment and start telling a story. All I could do was bend down and kiss him good-bye.

Naturally, we organized a costume parade to honor him. The procession around the central plaza was led by his off-white 62 Chevy with the fake feet sticking out of the half-open trunk – one of his trademarks -and followed by the rest of us in whatever costume pieces had come immediately to hand – along with a few of our musician friends playing familiar Little Earth songs. Then we packed ourselves into a church hall for an impromptu service, and each took turns reminiscing. The one I most remember was a story told by the AIDS worker from San Francisco.

One day he visited Steven and found him putting up on the walls a series of portraits, each surrounded by his fanciful painting. They all looked like small celebratory shrines. As he looked at the portraits, the visitor recognized each one. He turned to Steven and said: Steven, all these guys treated you horribly – they abused and betrayed you and left you in agony each time. Why are you putting all this up as if you’re honoring them? Steven answered quite simply: Yes, it’s true they hurt me – but they were all angels who brought love into my life, and I want to celebrate each one.

That was pure Steven, who died when he was 36. There is no forgetting him or the spirit he shared with everyone he knew – a spirit that might appear in a sudden flash of light tossed from his magic hand.

Who is that special person in your life who has helped in whatever way to wake up a sleeping part of your spirit?

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Have you heard it, felt it? In the sound of a human voice there may come a wave of healing. Of course, it could also be a scarring knife edge or shriek of pain that can hurt or terrify, but here I want to talk about the power of voice to restore lost harmony. Let’s put it as a question: in your experience can the human voice help move a depressed, disordered being closer to wellness?

The voice, after all, comes from deep sources. It finely carries the emotions, reflects the slightest change of feeling, broadcasts the intention of a speaker and can load the simplest words with complicated meanings. It is a big part of all the nonverbal bonds we form with people that are the real basis of relationships

Once I heard a speaker of the Dine (Navajo) Nation give a prayer and blessing to a conference room packed with almost one thousand people. He sent his prayer out slowly at first, the English words and separate phrases clear, much as you would hear in any invocation, but then he picked up the pace, building to a chant in the rapid rhythm and intonation of a ceremonial singer.

The single words and phrases blended into a stream of stirring sound. It was mesmerizing, transforming something palpable inside me. I felt a kind of vibration in my bones that seemed to come through this speaker’s voice from a source far more ancient than anything his suit-and-tie appearance would suggest. The resonant voice flowed in waves, awakening hidden awareness in me that responded, unwilled, with its own silent reverberations and matched the harmonic of the incoming prayer. In a surprising conversion of experience, I felt this blessing and entered a timeless spiritual moment in the midst of the most ordinary of conference rooms within a vast and sterile convention center.

I had heard, before that moment, the prayers and songs of medicine men performing ceremonies in the high, arid plateaus of the Dine Nation in northern Arizona. But that was the Dine culture in its own setting with ceremonies performed for people in need of their curative powers. I had been a witness, not a participant, focused on the new experience, feeling self-conscious about my different culture. Here the sound and form of Dine chanting had been put into my own language and shifted to a setting I was used to but one completely unlike a place or time of spiritual insight. Caught off guard, I could finally get a sense of what such healing was all about – and this was only from a brief invocation, not the days-long ceremonies where, surrounded by family, friends and many reminders of the harmony of the Dine world, a deep restoration and curing can take place.

The scholars of Dine culture and ceremonies, like Witherspoon and McNeley, have tried to explain Dine beliefs in a metaphysical way, drawing a core set of beliefs from the specific practices they have observed. I can’t do justice to their ideas, but roughly in the beliefs of the Dine, wind is the great creating force of life that has instilled and structured the inner forms and souls of all things. Air is a bearer of knowledge, and the healing songs, in their repetitive patterns, physically order the air and through that medium touch and move the inner life of a troubled person. The songs and chants help reorder and restore the soul to a harmonious beauty that complements the order of the world and Dine society. There are many other dimensions to these ceremonies, but the role of the voice and songs is central to the healing process.

Years ago, I knew many Dine activists who would succumb to the stress of dealing with the Anglo world. They would disappear for a time, then come back, restored and able to work again. What had happened to them in the interval? While never going into detail, they had referred to ceremonies and traditional cures. Doubtless, they had spent time in ceremonies specifically designed to remove the influence of living and working in the alien culture of the Anglo world and restore them to their place in Dine life.

What news does your own voice convey about the state of your feelings and soul? Can we feel a greater inner harmony by using our voices more fully, letting them flow from greater depths? Can we find a way to learn and benefit from the healing uses of voice from other cultures?

I only ask these questions because I have felt the power of the human voice to move me, purely by its rhythms, patterns, intonations even more than by the meaning of the words it carried.