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Literature & Medicine: From the Inside Out
by Suzanne Brown ::: bio

Echoes of War
 

The strong response to the Literature & Medicine program at the Veterans Administration Medical Centers (VAMCs) in Togus, ME and White River Junction, VT made it clear that other VAMCs might benefit from the program, particularly as their staffs face an increasing volume of younger, critically injured patients. Thanks to a major grant from the National Endowment for the Humanities, 13 other VAMCs across the country will join Togus and White River Junction in hosting Literature & Medicine.

The Maine Humanities Council asked Suzanne Brown, long time facilitator at White River Junction VAMC and many other L&M sites, to compile a collection of short readings that address issues particularly relevant to those caring for veterans. In the essay that follows (a version of her introduction to the anthology), Suzanne shares her thoughts on some of the readings she selected and how they relate to the issues that she believes are important to address.

The Thinking Behind Echoes of War: a Literature
and Medicine Anthology

The anthology, Echoes of War, is intended for health care professionals in Veterans Administration facilities, and therefore the selections focus on issues unique to, or more acute in, hospitals for soldiers. Nevertheless, any group of health care professionals could profit from the readings, both because all health care facilities will increasingly see veterans, and because “veterans’ issues” often illuminate general medical concerns. I hope, too, that the general public will appreciate these readings as a way to better understand the experience of the men and women who fight for us. The photographs by Platon offers a visual introduction to these Americans—training for, traveling to, engaging in and then returning from war.

Even in the face of public support for veterans, those away at war often feel that they cannot communicate their experience to anyone at home, and this creates pressure for returnees and their families. This worry can compound a more general medical problem: the severely ill often doubt that the healthy can fully comprehend their reality. While medicine overall is coming to see that treatment should take account of a patient’s home situation, VA hospital staff members have long known that understanding the potential disconnection between patients and their families is crucial. Thus, homecoming complicates the medical issues warriors face. Over a century before we saw soldiers repeating tours in Viet Nam and Iraq, Tennyson, in “Ulysses” and “The Lotos-Eaters,” both included in the anthology, understood homecoming as something fighters avoid even as they long for it. Like contemporary psychiatrist Jonathan Shay, Tennyson interprets Homer’s Odyssey as a tale of reluctant return.

...any group of health care professionals could profit from the readings, both because all health care facilities will increasingly see veterans, and because “veterans’ issues” often illuminate general medical concerns.

Homecoming can also be difficult for the families and society that soldiers left behind. Families need support because the anger veterans may feel is often visited on those closest to them. Anne Brashler’s short story “He Read to Her” illustrates this, reminding us that all patients can lash out when their bodies betray them. The fury of the middle-aged woman after her colostomy may seem remote from the anger of those returning from a war zone, but many health care providers will sympathize—both with her and with the husband on the receiving end of that fury when she yells, “I don’t want tea! Just leave me alone.” It also shows the potential for reading about a situation related to—but removed from—one’s own to help people deal with difficult situations and emotions. The husband in Brashler’s story seems to understand this when he chooses Moby Dick, the tale of Ahab’s furious pursuit of the white whale that has taken his leg, to read to his angry wife. For spouses, questions of fidelity and abandonment can also cast a shadow over homecoming. And George Garrett’s “Wounded Soldier (Cartoon Strip)” emphasizes the larger cultural tensions surrounding homecoming when the severely disfigured Veteran is asked to remain in the hospital because “his appearance in public, in the city or the country, would probably serve to arouse the anguish of the civilian population.”

Sometimes the best discussions about important issues occur when those central concerns are slightly displaced in literature—mirrored yet also distanced. I have therefore included in this reader pieces that address veterans’ issues obliquely as well as directly. Using both approaches simultaneously respects the uniqueness of those issues and connects them to other aspects of medical—and human—experience. The very title of “The Use of Force,” a short story about the emotions experienced by a doctor in a battle of wills with a child as he tries to make a diagnosis, compares the doctor in the story to a soldier. This work by William Carlos Williams probes the visceral anger aroused when anyone employs force even in “a good cause.”

...those away at war often feel that they cannot communicate their experience to anyone at home, and this creates pressure for returnees and their families. This worry can compound a more general medical problem: the severely ill often doubt that the healthy can fully comprehend their reality…Thus, homecoming complicates the medical issues warriors face…Tennyson, in “Ulysses” and “The Lotos-Eaters,” both included in the anthology, understood homecoming as something fighters avoid even as they long for it.

In VA and non-VA hospitals alike, patients whose multiple physical ailments are entwined with their social circumstances are also difficult to treat and may frustrate caregivers. The nurse in “Bev Brown” at first avoids talking to the suicidal “frequent flyer” whose problems are overwhelming: poverty, Parkinson’s disease, stress incontinence, childhood trauma and sexual abuse, obesity. When she does enter the patient’s room, she feels she can only offer “a fountain of platitudes, which I hovered on the verge of believing,” not sure herself that Bev has a reason to live: “And though one voice inside me said: your words are crumbs, crusts, parings, another voice said: people can live on them. And do.”

The term “veterans’ issue” implies an experience common to all military, but the diversity of the individuals in the armed forces assures that these issues will play out differently in different cases. Over a third of recruits belong to a racial or ethnic minority. The narrator of Louise Erdrich’s “The Red Convertible” articulates the sorrow any family member might feel at failing to reach a veteran suffering from depression and PTSD, but Erdrich also suggests that the problems of Stephan, a Chippewa Indian, have an added cultural dimension. Wanda Coleman’s story “Slave Driver” examines racism in a clinical setting, making us ponder the best response when we see a co-worker subjected to a patient’s mistreatment.

Because VA hospitals continue to care for soldiers throughout their lives, they confront all the problems of aging as they also receive the young veterans returning injured from Iraq and Afghanistan. I have included two works by surgeon Atul Gawande that cover both ends of the spectrum. His “The Way We Age Now” reports sometimes-surprising facts about geriatric medicine, while his “Casualties of War” educates us about the current state of military medicine. We learn that blindness and traumatic brain injury are signature casualties in Iraq, and Gawande outlines the ways our entire health care system can profit from innovations in military medicine. Paradoxically, our ability to save lives that would have been lost in earlier wars brings the greater challenge to rehabilitate more severely disabled veterans. As Gawande puts it, “We have never faced having to rehabilitate people with such extensive wounds. We are only beginning to learn what to do to make a life worth living possible for them.” Thus, both aging soldiers and young returnees who must reinvent themselves after being wounded face the difficulties of living with a chronic condition.

The essays, poems, and stories were chosen for the very reason that they touch on so many vital concerns simultaneously. For example, Arthur Kleinman’s essay “Winthrop Cohen,” a case study of a Marine’s depression following his service in World War II, poses questions: Why does his guilt surface only four decades after the original trauma? Does racism affect Cohen’s guilt as he seeks to come to terms with killing? Clearly this essay might also be grouped with the Williams story discussed above as a study of the anger unleashed when someone uses force even in a “good” cause. The piece also raises troubling questions for mental health therapists, who, like Kleinman, must consider Cohen’s assertion “that I was part of the societal collusion to cover up the threatening implications of war experiences such as his.” Nor do the topics above exhaust the range of issues the essay raise. These are a few examples of the rich connections that may arise when the pieces in the anthology are combined in ways that readers themselves will discover and create.

Indeed, the Maine Humanities Council and I hope that the very variety of offerings will spur such unexpected and fruitful combinings. Selections deal with Viet Nam, World War II, the current war in Iraq, the Civil War, World War I and the mythical Trojan War. This range allows readers to consider both the universal in war, and the way each war generates its own unique circumstances and vocabulary. We have included works by novelists, psychiatrists, soldiers, surgeons, and nurses so that many disciplines can contribute to our understanding; we have chosen short stories, essays, photographs, and poems to reflect the Echoes of War in more than one genre. Despite such variety, this short reader is not, and is not intended to be, exhaustive. Hospitals for veterans are, first of all, hospitals. Staff there share the same concerns as other health care providers, and most VA reading and discussion groups would want to intersperse these readings with ones from other, more general literature and medicine anthologies. Some groups may want to include longer works, and we provide an annotated list of suggestions in the back of the reader.

Finally, this anthology and the programs it supports rest on our belief in the power of story to foster empathy and imagination. However, success in bridging the gap between the sick and the well, between veterans and those who haven’t “been there,” may also depend on acknowledging limits; literature may be our best means to get outside our own skins, but it simultaneously makes us understand and respect the power of experiences we cannot fully know.

See the table of contents [pdf].

Is there a Literature & Medicine author whom you would like us to feature? Please let us know! Email Lizz Sinclair.

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Literature & Medicine has received major support from the National Endowment for the Humanities.

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