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Living with Wartime Wounds

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American soldiers have been fighting in Iraq and Afghanistan for over four years now. Tragically, some have returned home in coffins. But because of advances in military medicine, many more have come home alive but wounded, with embedded shrapnel and missing limbs serving as permanent reminders of their time serving our country. What will their lives be like?

Last time we were caught in a brutal battle like this, our wounded soldiers were returning from Vietnam, reentering a country that was polarized over the direction the war was taking. In our popular imaginations, wounded Vietnam Veterans are forlorn creatures, shunned by their country and mired in mental health clinic appointments receiving care for post traumatic stress disorder (PTSD).

With such an image in mind, it is easy to imagine new Veterans returning from the Middle East and facing even worse fates. Their level of stress in Iraq and Afghanistan easily matches that of most soldiers in Vietnam: wondering, at all times, whom they can trust; whether that Iraqi police car is really an insurgent vehicle; whether that innocent looking family is harboring a cache of weapons.

And the wounds, the physical wounds, that current Veterans must learn to live with are more severe than the wounds that Vietnam Vets had to live with. We can keep soldiers alive now whose wounds would have been fatal 30 years ago, meaning that many survivors are left to cope with unprecedented disabilities.

So how will they cope emotionally, with their return to civilian life and their entry into the world of disability?

I have been practicing medicine within the VA system for over a decade. So far, I have taken care of only a few Iraq and Afghanistan Veterans, none of whom have had serious physical injuries. But I've taken care of dozens of Vietnam Veterans, and although a number of them struggle with PTSD, the vast majority are happy. Amazingly happy in fact. A typical patient of mine might have emphysema, diabetes, hypertension, a touch of congestive heart failure, and chronic pain from a wartime wound. Most of us probably imagine that a miserable list of health problems like this would make us . . . miserable! But that is not what I see in my clinic. Instead, the vast majority of my patients are thriving despite their health problems.

How can that be?

I was so intrigued by the amazing emotional resilience of my patients that I began doing research on happiness and illness. The result is my new book, You're Stronger than You Think, in which I write about five people who experience serious illness and disability and manage to thrive. I weave their stories together with discussions of the science of emotional resilience. I try to show why people systematically underestimate their emotional resilience, imagining that difficult circumstances would lead to misery, when in fact most people thrive in the face of adversity. But enough of the shameless plug. If you want to check out the first chapter of my book, click on PeterUbel.com.

So what can returning soldiers expect? Like I said before: their wounds are more severe than their Vietnam colleagues. But the country supports them in a way that they did not support Vietnam Veterans. Back in the time of the Vietnam War, many people opposed to the war blamed the soldiers in part for what was going on. Now, even the most strident anti-war activists recognize that what is good or bad about this war is a result of decisions made by people in the White House and the Pentagon, not a result of decisions made by most of the 19 year-olds enlisted in the armed forces.

Eventually, most Vietnam Veterans recovered, emotionally, from their wartime wounds and wartime experiences. Some still haven't recovered, unfortunately, converging on our PTSD clinics every week, the shattered remnants of the young men they used to be.

We can expect most new Veterans to thrive, too. We can also expect a certain number of them to suffer from chronic PTSD. But hopefully, with a more supportive country to return to, there will be even fewer who suffer long-term emotional damage from their wartime wounds than there were after the Vietnam War.

Now let's hope that we can get the rest of our soldiers back here soon, with as few physical and emotional wounds as possible.

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