Understanding the Traumas of War

03/18/2010 05:12 am ET | Updated Nov 17, 2011

Below is a letter I received from Dr. Russell Carr, a military psychiatrist who has been treating soldiers and Marines suffering from combat-related emotional trauma. It speaks eloquently to the need of traumatized persons to have their emotional pain met with attunement and understanding. This is a need that is relevant to us all in an era that can increasingly be characterized as an Age of Trauma.

11 November 2009

Dear Dr. Stolorow,

I want to thank you for writing your recent book, Trauma and Human Existence (Routledge, 2007). Your willingness to share your ideas and personal experiences has helped me to treat military personnel suffering from the experience of combat. I am a psychiatrist in the military and have tried over the past several years to understand combat-related PTSD from a psychodynamic perspective. Most of my prior education had led me to position the problem that soldiers and Marines were experiencing solely within their individual minds. I approached their problems from a traditional one-person psychology perspective. I had not understood their problems as being embedded within a context, including their relationships with me. My work with them had not seemed to bring improvement to their lives, except for temporarily alleviating some symptoms with medications.

In late 2008, I was deployed to Iraq, working in a Combat Stress Control unit, and continuing to struggle with effectively treating combat-related PTSD. I came across some of your articles and then obtained Trauma and Human Existence. Reading it was literally life changing for me and my patients. Through your ideas, I was able to make sense of what soldiers and Marines had been telling me about their experiences. Your ideas simply made sense to me. I then began to recognize, for example, how a disruption of one's sense of time and "a shattering of one's experiential world" could lead to what my patients were currently experiencing, sometimes years after their combat exposure. Approaching each soldier and Marine through an empathic stance with your ideas in mind helped me connect with them. Our connection, based on emotional attunement, then helped them to reconnect with others in their present lives, to process their emotional experiences from combat, and to integrate these emotions into new meanings for their lives.

In light of continued deployments and the trauma inevitably associated with them, your ideas are enormously relevant to the military and Veterans' Administration mental health care systems. With continued operations in Iraq and Afghanistan, there will be more military personnel returning home with PTSD. And unfortunately, violent events also sometimes occur for service members outside of combat. The recent tragedy at Ft. Hood reminds the American public of the need for continued research into the effects of trauma and best ways to respond to its victims. Many of those in the room when Dr. Hasan opened fire will seek understanding and emotional support, or attunement, from mental health care providers in the coming months. I think that your ideas can lead the way in guiding future research and establishing standard practices for supporting future survivors of senseless violence. For instance, your view that "emotional experience is inseparable from the contexts of attunement and malattunement in which it is felt" can form the basis for practice guidelines about responding to survivors. Such practices might mitigate some of the long term effects of these horrible experiences.

I will never forget what a soldier with PTSD told me after I had read your work: "Doc, you get it more than anyone I've spoken to." I have found your writing enormously helpful, and strongly encourage anyone working with combat-related PTSD to read Trauma and Human Existence. I look forward to learning more from you in the future.


Russell Carr, M.D.