By William C. Shelton

(The opinions and views expressed in the commentaries of The Somerville News belong solely to the authors of those commentaries and do not reflect the views or opinions of The Somerville News, its staff or publishers.)

I fear [the American people] do not comprehend the full weight of the burden we carry or the price we pay when we return from battle. This is important, because a people uninformed about what they are asking the military to endure is a people inevitably unable to fully grasp the scope of the responsibilities our Constitution levies upon them.

– Mike Mullen, Chairman, Joint Chiefs of Staff

In a speech last month, our nation’s top military officer observed the growing disconnect between U.S. citizens and those whom they send to fight and die.  He said that Americans could be “forgiven” for not”possessing an intimate knowledge of our needs or of our deeds.” I believe that he was being charitable.

Time after time politicians with scant understanding of complex political, cultural, geographical, and yes, military situations in distant lands declare what is best for us.

They belittle the patriotism of anyone who questions their certainty. They manufacture evidence or do not question it. They wrap themselves in the flag. They visit dismembered combatants at Walter Reed Hospital and murmur thanks for sacrifices made.

Time passes. Civilians become weary of the war, and politicians pander to them. They demonize others about the yawning budget deficit. They don’t acknowledge that a major portion of it comes from their refusal to ask constituents to make the modest sacrifice of paying a war tax.

Few politicians comprehend the far greater sacrifices made by the combatants and their families. And those families are often at a loss regarding how to best care for those who return broken in mind as well as body.

The average Iraq or Afghanistan vet has had less “down time” than veterans of any previous U.S. war.  93% report being shot at; 89%, being attacked or ambushed; 95%, seeing dead bodies.

We as family, friends, and neighbors can help to heal the anguish and trauma of those who come back alive. So I would like to reiterate some things that I wrote in this space four years ago.

An essential part of healing is discharging the horror at the center of the trauma.  Continually pushing these experiences away from conscious memory and from the attention of loved ones is exhausting and makes the trauma unavailable to be worked through.

The traumatic evens are extremely difficult to share with others.  Doing so requires re-experiencing ugly and paralyzing feelings.  Those who have experienced intense trauma also feel shame, guilt, and the irrational conviction that this happened because there is something deeply wrong with them.  A common reaction is “survivor’s guilt,” which is exactly what it sounds like.

When encouraging a friend, family member, or coworker to talk about his experiences, one must be thoughtful.  It is critical to have such conversations in an environment in an environment that feels as safe, comfortable, and trusting as possible, an environment that is in every way a contradiction to that of the trauma.  It is also important that the vet not feel forced to speak of these thing.  He or she may initially need to talk about with comrades or a counselor.

Friends and families’ normal impulse is to throw a welcome-home party. But returning vets may most need rest and respite, so they should be asked if a party and the attention that come with it would be welcome.  Being explicit in all matters is helpful, including stating what one wants from him or her.  Blame of demands deepen the injuries.

Veterans’ families and workplaces will have changed in their absence.  Explicitly discussing these changes and how the vet can reintegrate reduces stressors, while simultaneously building trust and communications skills that can help him or her to discharge traumatic distress.

When the time is right to discuss traumatic experiences, expressions of pity, or even sympathy, will kill the conversation.  The most important attitudes to communicate are interest and basic respect.  Strong reactions to the horror that the vet describes may unconsciously reinforce feelings that he or she is apart from and less worthy than “normal” human beings.  Listening without interruption or judgment is essential.

Certain behaviors are common among those who suffer acute stress reactions.  Recognize them as normal don’t overreact or take them personally.  They include:

• Being edgy, easily startled, or constantly on guard;

• Feeling sad, guilty, or abandoned;

• Feeling withdrawn and detached while having difficulty trusting others and sharing control;

• Having trouble concentrating or sleeping;

• Experiencing bad dreams, flashbacks, shock, or numbness;

• Feeling incapable of happiness;

• Driving aggressively;

• Avoiding anything that reminds one of the trauma; and

• Using alcohol or substances to “self medicate” these conditions.

A majority of survivors recover in weeks or months.  But for 20% to 30%, these persist and may worsen, producing diagnoses of Post Traumatic Stress Disorder (PTSD).  We don’t yet know why some recover and others struggle, but we know that it’s not because of any weakness.  Nor does PTSD discriminate among cultures, races, ages, or sexes.

In these cases, caring family and friends should encourage the vet to get expert help.  They must insist, if he or she poses a danger to themselves or others.

Department of Defense and VA policy makers discourage PTSD diagnoses.  But my experience of front-line caregivers is that they are responsive and caring.

Iraq and Afghanistan vets can get immediate help with combat stress at the Vet Center, 665 Beacon St., Boston, without any potentially damaging information reaching their service unit.  Calling 617 424-0665 beforehand will eliminate waiting.

The VA outpatient facility, 51 Causeway St., 617 671-9000, will require vets to register as a VA patient.  Applications are available at www1.va.gov/health_benefits.  Vets with PTSD symptoms too severe to wait for the outpatient facility’s daily 1:00 PM intake sessions should go directly to the VA emergency room in Jamaica Plain.

The Trauma Center is a great organization where I was first diagnosed and treated for PTSD many years ago.  They may be reached at 617 232-1303 or traumacenter.org.

Finally, Somerville Veteran’s Services Director Frank Senesi, a former marine and a PTSD survivor, is warmly responsive to any vet.  Frank is both a great listener and provides effective referral to needed services. He may be reached at 625-6600 ext. 4700.