My supervisor was invited to speak at a two-day training at Fort Lewis on treatments for posttraumatic stress disorder (PTSD). The army is preparing for the first waves of returning soldiers from the Gulf War.

I learned a lot about the unique problems treatment providers in the military face. For example, how do you treat someone with PTSD symptoms if they will be deployed again in four months? Can you treat them at all? Not really. That was the big issue that came up repeatedly.

I found it very interesting how the military tries to deal with the contradiction of preparing people for battle while also trying to preserve the well-being of the force. The stated goal is to ensure that our citizens are healthy, but the actual goal is to keep bodies available for deployment. They're on the payroll, after all. Many of the tactics used to prepare people mentally for battle are the same tactics identified as perpetuating the symptoms of PTSD. So, how do you prepare people to deal with combat and then teach them something entirely different in order to cope down the road? It's a problem.

And yet, that preparedness and community does protect people. Soldiers do have a context in which to put what happens to them more so than, say, people who have been sexually assaulted. And when they come home, they are objectively out of the traumatic environment, which is not the case if you have been attacked in your neighborhood or in your home. The social and economic structure is a support system that helps people cope. However, soldiers are discharged upon injury or mental decomposition, at which time the support structure (emotional and financial) that might help them cope has effectively rejected them.

It's also interesting to notice how difficult it is for military personnel to discuss rape. Torture, combat, as long as it's good ole war play, that's fine. But what about soldiers raping soldiers? The top two traumas that predict PTSD: torture and sexual assault. So, it was interesting that when one of the treatment providers brought up the issue of soldiers being raped by fellow soldiers in theater, the discussion drew awkward and the moderator changed the subject.

Well, it takes a long time to change, but it is obvious that the organization is trying—It is trying to do better by soldiers. But, it has a long way to go, and, at least from my perspective, there's no clear path—unless an end to combat could be guaranteed, which it can't. The psychologists and the psychiatrist in attendance are in a bind, bound by two, often contradictory, imperatives: To promote mental well-being and to ensure fitness for duty. Their job is not easy, and you could see their concern, the stress.

I learned that, as a whole, Vietnam veterans do not function well. Not just those with PTSD, but the whole cohort. We're talking dysfunctional and dissolved families, chronic mental and physical problems, and underemployment. The military has done a fair amount of research into the question of what might have caused this and it is applying strategies for improving the long-term functioning of Gulf War veterans. The key issue seems to be that Vietnam veterans were released home directly from theater, without debriefing. They were, in that process, separated from community and colleagues. They lost whatever outlets they had for talking about what they had experienced as they were dispersed to their home towns. Moreover, in contrast to WWII vets, they did not have the same degree of financial benefits and did not enjoy the mobility of an economy vigorous as it was after WWII. An interesting thing about mental health functioning is that you cannot discount the importance of access to financial resources to mental well-being. People with access to money fare better. It makes perfect sense, but you don't hear it mentioned among our folk ideas of what promotes mental health.

Of course, how much do we know about the WWII cohort? You know, I think about that generation, its silence and its sense of duty. Something of it was embodied in my grandma's perspective on life and on her government. What I saw in her was a tightlipped resignation to sacrifice, much of it her own, true, but some of that I've also seen in others of her generation. And I wonder about that silence. I think about a generation like that and its children, who it sent to college partially on VA-funded middle-classness. It was its children that became the college-educated war protesters. And it was the wives of WWII veterans who became the middle-aged instigators of the feminist movement. They were the ones in the backround that comprised the mass of the movement while the media diverted our attention to the young bud-breasted bra burners and Gloria Steinem. And so, I think about those rebellions and I can't believe that they weren't in part a reaction to the posttraumatic functioning of a generation of young men. Can you?