Combat and post-traumatic stress disorders in military veterans are not new, though the conditions have been called many other names throughout the years: "insanity" and "melancholia" during the Civil War, "shell-shock" during World War I and "combat fatigue" during World War II.
Top military leaders are now addressing the lingering effects of post-traumatic stress disorder, (PTSD) which were ignored for many years because they were seen as a sign of weakness. Last week, Gen. George Casey, the chief of staff of the U.S. Army, called PTSD "the defining military health issue of our era."
Consider that statement alongside the much-recounted story from World War II, when Gen. George S. Patton infamously slapped a solider suffering from "nervous exhaustion" in a military hospital and ordered him back to the front.
That story, and others from wars stretching from the Civil War to the current battles in Afghanistan and Iraq are chronicled in a new HBO documentary, Wartorn 1861-2010, which combines footage, interviews and documents to examine the effects of PTSD on soldiers returning from the battlefield.
Directors Jon Alpert and Ellen Goosenberg Kent joined Fresh Air's Terry Gross for a discussion about the film, which features interviews with veterans of World War II, the Vietnam War, Operation Desert Storm and Operation Iraqi Freedom.
One difficulty the two directors encountered, Kent says, was trying to find information about combat trauma in the Civil War. Unlike today, there was little documentation of combat trauma. Instead, the filmmakers sifted through pension files to learn what soldiers' families said about them when they came home from the war.
"Those were really the only recognition that there would be something wrong with [the soldiers]," Kent says. "Their family would attempt to get a pension because their breadwinner came home from the war and wasn't able to function psychologically. Going through these really unsexy legal documents led to individual stories from Civil War servicemen."
One solider, Angelo Crapsey, wrote letters and kept a diary during his time in the service, allowing Goosenberg and Alpert to chart changes in his mental status. During his initial letters to family and friends in 1861, Crapsey sounds hopeful and confident. But by 1863, the tone of Crapsey's letters had changed.
"His father gets a call from the hospital that he needs to come pick him up and visit him because he's declining physically," Kent says. "But when Crapsey [eventually comes home,] everyone notices he's a completely different person than the one who left. He's paranoid, he's in and out of reality. He feels hated. He feels like he's a killer. And he attempts suicide several times and doesn't complete the suicide."
On a hunting trip several weeks later, Crapsey shot and killed himself. In order to collect his pension money, his family had to prove that he killed himself as a result of being at war. The incident, Kent says, parallels what many veterans face today when struggling to prove they have PTSD in order to obtain health benefits.
"It's really what the essence of the film is," Kent says. "If you have any doubt that PTSD is a real thing or you wonder what causes it or you think PTSD happens because the war is good or it's bad or you come home a hero or villain, it's really irrelevant. What's really relevant is that the experience of war -- and experiencing man's inhumanity to man -- causes psychological damage. And that's really what we wanted to show."
It was not until World War I and World War II, Alpert says, that military officials began to realize that soldiers were coming home with psychological ailments that weren't predicted.
"They didn't know what to do about it," he says. "They didn't know what to call it [and] they didn't understand completely why people were suffering like this."
And military veterans stayed quiet about the after-effects that lingered.
"Having battle fatigue was something nobody wanted to own up to," Kent says. "Because you were a coward. You were a malingerer. ... It was absolutely not okay to be unwell psychologically when you came home. And when you came home, you were expected to be a hero and you were expected to be somebody who marched forward in life. Nobody wanted to talk about it and the VA, as one of the veterans described in the film, was absolutely overwhelmed."
Some World War II veterans were not diagnosed with PTSD until decades later, when the symptoms of PTSD were finally recognized as a real psychological illness.
"Some [World War II veterans] were beginning to enter retirement age and they were starting to re-experience symptoms," says Kent. "And so they were kicked back to the VA and all of a sudden the VA said 'Maybe you have PTSD' and they were, in some degree, incredibly grateful for that diagnosis. They finally understood what the hell was wrong."
Today's military is trying to address the mental disorders and high suicide rates that have climbed since 2001, Alpert says.
"The military's made it easier to get diagnosed with PTSD. You don't have to prove that it was a specific traumatic incident. It could be the cumulative effects of being in a war zone," Alpert says. "That also means that many, many people are in need of treatment and the cost of treatment that society's going to bear is really going to be quite substantial."
Alpert explains that the military is trying to change the perception of PTSD from the top down.
"The generals -- for the first time -- are talking about this. You don't have somebody like General Patton" [any more] he says. "They're saying the right things. But this is something that's very difficult to deal with in a martial atmosphere, where you're supposed to be tough, you're supposed to be resilient and things aren't supposed to affect you like this. But they're saying 'It's okay to be wounded. It's okay to be psychologically damaged. We're going to try to treat you and send you back.'"
Jon Alpert and Ellen Goosenberg Kent previously worked together on the HBO documentary Addiction. Alpert has made films for NBC, PBS and HBO and received 15 Emmy Awards and three DuPont-Columbia Awards. Kent has received three Primetime Emmy Awards, a Peabody Award and other honors for her work on films for HBO, A&E and children's television.
Copyright NPR. View this article on npr.org.
TERRY GROSS, host:
This is FRESH AIR. I'm Terry Gross.
Combat and post-traumatic stress disorders are nothing new, but in earlier times, they were given other names - like insanity and melancholia during the Civil War, and combat fatigue during World War II. Last week, General George Casey, the Army's chief of staff, called PTSD the defining military health issue of our era.
A little later, we'll hear from Dr. Craig Bryan, who advises both the Air Force and the Department of Defense on preventing soldiers with PTSD from committing suicide.
My first guests, Jon Alpert and Ellen Goosenberg, directed a new documentary about PTSD called "Wartorn: 1861-2010," that will be shown on HBO this Thursday, Veterans Day. It's about how the recognition and treatment of PTSD has changed from the Civil War to the wars in Iraq and Afghanistan. "Wartorn" uses historical letters, photos and film, as well as contemporary interviews, some of which were conducted by James Gandolfini. Alpert and Goosenberg also collaborated on the HBO documentary "Alive Day Memories: Home From Iraq." I spoke with them about their new film, "Wartorn."
Jon Alpert, Ellen Goosenberg, welcome to FRESH AIR. The movie early on has Civil War letters from a soldier named Angelo Crepsy, who enlisted at the age of 18. Before we hear an excerpt, tell us how you found these letters.
Ms. ELLEN GOOSENBERG (Filmmaker, "Wartorn: 1861-2010"): Trying to do a piece about combat trauma in the Civil War is really difficult because there was no documentation of combat trauma back in the Civil War, and there was no real psychiatric diagnoses in the Civil War except for insanity. And so you have a couple of options.
You can go to the records of insane asylums, or you can go to pension files. And those were really, the only recognition that there might be something wrong with someone - is, their family would attempt to get a pension because their breadwinner came home from the war and wasn't able to function psychologically. And so going through these really unsexy legal documents led to a number of stories. And as we began to research them, we were really looking for first-person accounts - because we thought that would make it a lot more compelling -and we came across a number of those.
And in delving into them, we found Angelo Crepsy. What was extraordinary about him is that his descendants kept all of his letters, and he was an incredible letter writer. And he kept a diary, and there were photos. And all of those were available to us.
GROSS: Well, let's hear an excerpt of the first letter that you use from him, and this is after he's enlisted. It's 1861, and he sounds pretty confident. It's addressed to a friend named Leroy(ph).
(Soundbite of film, "Wartorn")
Unidentified Man #1 (Actor): (As Angelo Crepsy) Dear Leroy: Camp life is not home. A sergeant of Company D committed suicide. He seemed to be a little shattered. He took his rifle and loaded it when there was no one about, and put the muzzle into his mouth and tugged the gun off with his toes.
There has been 100 or more of the boys who have gone home. They are cowards. I won't disgrace my parents by deserting or turning back. A soldier's life is hard, but I should be able to take care of myself.
GROSS: Okay, so that's a soldier's letter from 1861. He sounds pretty confident - you know, he should be able to take care of himself. But after more than two years, he writes a letter saying: No one who has been a soldier can imagine what a fighting man has to endure, how many men are ruined by this war.
And he's taken to an Army hospital feverish and delirious. And let's hear that letter that's addressed to Leroy.
(Soundbite of film, "Wartorn")
Unidentified Man #1: (As Crepsy) October 12th, 1863. Dear Leroy: I am not so well. I am clear off the hooks. They took me before the board, and they decided to discharge me from the service. They say I will not be fit for the field this winter.
GROSS: Ellen, let me ask you what happens after that letter.
Ms. GOOSENBERG: His father gets a call from the hospital, saying that if he hopes to see his son alive, he needs to come pick him up, come visit him because he's declining physically.
So the father goes, and he gets well enough to come home. But when he's home, everyone notices that he's a completely different person than the one who left. He's paranoid. He's in and out of reality. He attempts suicide several times, and doesn't complete the suicide. And then his friends are going hunting, and he's in they're all crack shots. I mean, this was what their unit was known for.
And the friends don't want to take him because he's unstable, and they have no idea what's going to happen. And the true story is he follows them, and one of the guys kind of lags behind and says, you know, why don't you hang out in this blind here and, you know, we'll let you know when it gets interesting up ahead.
And he takes that opportunity, alone in the woods, to shoot himself to death.
GROSS: And then you have people reading the court testimony following his suicide. Why was there a court procedure following a suicide?
Ms. GOOSENBERG: Back in the Civil War, there was an opportunity to collect a pension if you lost the breadwinner in war. In his case, he wasn't married, but his father wanted to make a claim that the family was in need of the income he would have provided.
And so there was a court procedure, and you had to marshal everyone that knew the person to talk about whether or not they were a drunk before they went to the war and whether they, in fact, you know, would have been capable of making money, and whether or not they were psychologically intact - and all of that kind of stuff. You really had to plead your case, and so this was basically a pension hearing.
GROSS: Let's hear an excerpt of the testimony given by friends and family at that hearing. And this is being read from the court papers.
(Soundbite of film, "Wartorn")
Unidentified Man #2 (Actor): (As character) I found him lying on the ground on his back. His gun was between his legs, muzzle on his breast.
Unidentified Woman #1 (Actor): (As character) I remember that when my brother Angelo came home from the Army, he looked wild. And when he was raving, it took my father, mother and half-sister to tie him down to the bed.
Unidentified Man #3 (Actor): (As character) It seemed that something he did in the Army preyed upon his mind and wounded him.
Unidentified Woman #2 (Actor): (As character) He seemed to be worried, and he said everybody hated him because he had killed people.
Unidentified Man #4 (Actor): (As character) If ever a man's mental disorder was caused by hardships endured in the service of his country, this was the case with my son.
GROSS: So that's an excerpt from Jon Alpert and Ellen Goosenberg's movie "Wartorn."
I think what interests me in the Civil War letters, and in the court testimony that we just heard, is how well it seems to parallel what we're hearing now from Iraq veterans - and what we heard from Vietnam veterans.
And you know, even the fact that they had to prove, in order to get the pension money, that he killed himself as a result of being at war, and now vets have to prove that they really do have PTSD, and it's difficult to prove sometimes. Were you struck by the parallels?
Ms. GOOSENBERG: I think we all were. If you have any doubt that PTSD is a real thing, or you think maybe PTSD happens because the war is good, or it's bad, or you come home a hero, or you come home a villain, it's really irrelevant. What's really relevant is that the experience of war causes psychological damage.
GROSS: Jon, you've included a World War II training film in the film "Wartorn," and this is a film about psychiatric procedures in the combat area. It's an Army film from 1944. Do you want to describe why you've used an excerpt of this film in your film "Wartorn"?
Mr. JON ALPERT (Filmmaker, "Wartorn: 1861-2010"): I think starting in World War II, they began to realize that people were coming back from these wars with psychological ailments that they hadn't predicted. And they sort of didn't know what to do about it.
They didn't know what to call it. They didn't understand completely why people were suffering like this. And it was a rather crude attempt by the Army to try and interview these people, and begin to get an understanding of why they were so badly damaged from the wars.
GROSS: Well, let's hear an excerpt from this 1944 U.S. Army film, called "Psychiatric Procedures in the Combat Area." So this is a series of interviews with active-duty soldiers during World War II.
(Soundbite of film, "Wartorn")
(Soundbite of film, "Psychiatric Procedures in the Combat Area")
Unidentified Man #5: (Unintelligible). My last time up there, I broke down. I was sectioned to leave (unintelligible) to them.
Unidentified Man #6: What do you mean, you broke down?
Unidentified Man #5: Well, during the last shelling we took up there - had me crying all night.
(Soundbite of music)
Unidentified Man #6: What's your trouble?
Unidentified Man #7: I just can't stand seeing people killed, sir.
Unidentified Man #6: I can't hear you.
Unidentified Man #7: I can't stand seeing people killed.
Unidentified Man #6: Did you see people killed?
Unidentified Man #7: Lots of them.
Unidentified Man #6: What?
Unidentified Man #7: Lots of them.
Unidentified Man #6: What does that do to you?
Unidentified Man #7: Wounds me.
GROSS: So that's an excerpt of the World War II training film "Psychiatric Procedures in the Combat Area."
So you did your own interviews for your movie, with World War II veterans who were still feeling the effects of the war. And one of the men says to you: In the old days, it was called battle fatigue, lack of intestinal fortitude. And no one wanted that on their records.
What did some of the men tell you in the interviews about how they dealt with the effects, whether they tried to cover it up, whether they felt there was anyone they could talk to about it?
Ms. GOOSENBERG: Well, absolutely having combat stress or battle fatigue was something that nobody wanted to own up to because you were a coward. You were a malingerer. You were a goldbrick. You were somebody that was making it up.
And so it was absolutely not okay to be unwell psychologically during World War II - and certainly when you came home and you were expected to be a hero, and you were expected to, you know, be somebody who was going to sort of march forward in life. Nobody wanted to talk about it, and the VA, as one of the veterans describes in the film, was absolutely overwhelmed.
And they were sort of, the guys were sort of dispensed some kind of a sleeping pill or whatever - and told to go home, and they'd be fine the next day.
So I think that what happened is that these men kept it inside. Some of them drank, and some of them had huge marital problems, and they were unemployed. And, you know, they suffered in all kinds of ways without realizing what was wrong with them until this diagnosis came to be in 1980.
And sort of coincidentally, some of them were beginning to enter retirement age, and they were starting to re-experience symptoms, which is now documented -that this happens. And so they were sort of kicked back to the VA, and all of a sudden the VA said: Ah, maybe you have PTSD. And they were, to some degree, incredibly grateful for that diagnosis. They finally understood what the hell was wrong.
GROSS: My guests are Ellen Goosenberg and Jon Alpert. They directed the new documentary "Wartorn: 1861-2010." It will be shown on HBO this Thursday, Veterans Day. We'll talk more after a break. This is FRESH AIR.
(Soundbite of music)
GROSS: If you're just joining us, my guests are Jon Alpert and Ellen Goosenberg. They directed the new HBO documentary "Wartorn," which is about post-traumatic stress disorder now and in the past, before the name actually existed.
I want to play the excerpt of the interview that you do with the mother of a soldier who committed suicide. His name was Noah Pierce(ph). Her name is Cheryl Softich(ph). And she's talking about how her son couldn't escape the horrors of serving two tours in Iraq, and how he couldn't forgive himself for some of the things he did, and that he still had the urge to hurt and kill people. And I'll let her pick it up from there. And she's describing her son and his suicide.
(Soundbite of film, "Wartorn")
Ms. CHERYL SOFTICH: The United States Army turned my son into a killer. They trained him to kill to protect others. They forgot to untrain him, to take that urge to kill away from him.
This was found in his truck, the last letter he ever wrote, one he never planned to leave, and one I never planned to share. And it says: I never planned to be that one to leave a note. I am writing it sober, but I won't be for long.
Mom, I am so sorry. My life has been hell since March 2003, when I was part of the Iraq invasion. It has nothing to do with anyone. Don't stress about this. I am freeing myself from the desert once and for all. I thought (BEEP) would get better, but I was wrong.
(Soundbite of shuffling papers)
Ms. SOFTICH: Well, I'm getting drunk now, so I'm more opened up. I have been planning on doing this a long time. Time's finally up. I am not a good person. I have done bad things. I have taken lives. Now, it's time to take mine.
GROSS: That's Cheryl Softich, reading an excerpt of the suicide note that her son, Noah Pierce, left after serving two tours in Iraq.
Would you describe how Noah Pierce actually killed himself?
Mr. ALPERT: Noah Pierce took a pistol, got in his truck, drove to a remote location, wrote a suicide note, took out all the photographs that he had of himself and stabbed his stabbed the photos on his driver's license; he stabbed his picture on his ID cards. He took out his face because he couldn't stand what he looked like; shot out the mirrors in his truck because he couldn't stand to look at himself anymore - then put his dogtags to his temple and killed himself, shot himself right through the dogtag.
GROSS: And his mother asked the police for the dogtag, and she has that now.
Mr. ALPERT: She has the dogtag as part of - basically, a memorial that she created for her son, in which she believes through a series of photographs shows his transformation from a normal boy from Minnesota, to somebody who came back from the war in Iraq haunted by what he had done, couldn't escape it. And the only way to put an end to the things that were inside his head was to shoot himself in the head.
GROSS: Pete Chiarelli, who is the person in the Army who's overseeing the new suicide-prevention program for the Army, says in your film that he's trying to establish the idea that invisible injuries, like post-traumatic stress disorder, are as important as physical injuries, like losing a leg. What is the military doing that you know of, to try to establish that - and to try to prevent vets from killing themselves?
Mr. ALPERT: Well, the military has made it easier to get diagnosed with post-traumatic stress disorder. You don't have to prove that it was a specific traumatic incident. It could just be the cumulative effect of being in a war zone that has affected you in a way that you can't deal with.
So that makes it easier. That also means that there's going to be many, many people who are in need of treatment. And the cost of treatment that society's going to have to bear is really going to be quite substantial.
They have instituted perhaps the largest rollout of any psychological training program in the history of the world. They have hundreds and hundreds of psychologists who are being trained in some of the therapies that they think will fix post-traumatic stress. So that's something that's unique and unusual.
They're sending health-care monitors out with every unit, and they're also trying to set the tone from the top, in which the generals for the first time are talking about this.
So you don't have somebody like General Patton, who sees somebody with post-traumatic stress and says that they're yellow-bellied sapsuckers, slaps them, and sends them back to battle. They're taking these people off the battlefield.
But you really have to wait to see what's going to happen because as my father said, less talk and more ado. They're saying the right things. But this is something that's very difficult to deal with in a martial atmosphere, in which you're supposed to be tough, you're supposed to be resilient, things aren't supposed to affect you like this. And now all of a sudden, they're saying: It's sort of okay to be wounded. It's okay to be - to be psychologically damaged. We're going to try and treat you, and send you back.
But we'll see. It is significant that they're admitting this, and they're committing the resources.
GROSS: Some of the interviews in your movie are done by James Gandolfini, who is famous, of course, for "The Sopranos." How did you end up working with him on documentaries? I think this is the second one you've done with him?
Mr. ALPERT: Yes, that's correct. Both HBO, Sheila Nevins, the director of documentaries, and James Gandolfini have a strong commitment to try and help Americans understand what happens when we send our people into war.
And Jim Gandolfini, before he ever made a documentary, was going over to Iraq and talking to the soldiers, trying to help them feel better, using his celebrity to entertain them but also trying to understand what happens when people go to war.
And it was interesting working with him because on his TV show, he plays a big, tough guy who has psychological problems because of what he has to do in his line of work. And the soldiers don't necessarily see him as Jim Gandolfini. They see him as Tony Soprano, and they relate to him in a very direct and honest way.
He would sit down and two seconds later, they would be telling him of their deepest, darkest problems, like he was their brother or their father-confessor.
And to some degree, it's the same thing with the generals. I don't know why, but they were talking to him in a very relaxed and candid fashion that, as a reporter, I would find difficult to try and get them to speak the same way to me.
GROSS: Jon, you mentioned your father was a World War II veteran, and had told you stories about the war and why he fought. So what kind of stories did he tell you, and what impact did those stories have on you?
Mr. ALPERT: My father was a pilot in the Pacific, and he flew patrol routes, squares up in the air, looking down at the ocean, hunting down Japanese submarines. And that was about all he ever told us. He wouldn't tell us anything else because they had sworn him to secrecy. And like a good soldier, he didn't talk about this.
But he finally began to talk about it, and one of the reasons why he said he didn't want to talk about it is that he wanted to put all that behind him and get on with his life. This was the thing that a lot of the World War II guys wanted to do.
And he said his hero was Cincinnatus, who was a soldier in Rome - a very accomplished general - who then put down his sword and went back and became a farmer. And he believed that this was the ideal of American patriotism, in which common citizens go serve their country, and then get back to their normal civilian life.
And the problem with post-traumatic stress is when you come back, you can't do it. You want to do it so badly. You want to be able to go to school. But when the kids in there are talking about the football game and you have battles going on in your head, and you're just unable to sleep at night because you're having nightmares because of all the things that you've seen, there are people who can't do what my father was able to do, what Cincinnatus did, because they have post-traumatic stress. And it's a lot of them - it's thousands and thousands and thousands of soldiers.
GROSS: I want to thank you both very much for talking with us. Ellen Goosenberg, Jon Alpert, thank you so much.
Mr. ALPERT: Thank you, Terry, really appreciate it.
Ms. GOOSENBERG: Thank you.
GROSS: Ellen Goosenberg and John Alpert directed the new documentary "Wartorn: 1861-2010." It will be shown on HBO this Thursday, Veterans Day. We'll talk with a psychologist who treats PTSD in the second half of the show. I'm Terry Gross, and this is FRESH AIR. Transcript provided by NPR, Copyright NPR.