about face

About Face: War, Unsung Heroes, A Sense of Self

It is hard to believe it has been a year since the horrifying Taliban takeover of Afghanistan. Admittedly, I was barely aware of the US’ 20-year “involvement” there until the messy and controversial evacuation. My limited knowledge of the place was only from the novels of Khaled Hosseini, some of which were so sad as to be almost unbearable to get through. I would ask myself: how did it happen that I was born here and those women were born there, and how do they endure such lives? 

With interest, I heard a young American war veteran talking about his experience in Afghanistan, which sounded much like how I remember young soldiers in my youth describing their experience of the Vietnam war. They had no idea what they were doing there or why. I was also surprised and gratified to hear the Public Radio commentator explaining the recently identified category of trauma referred to as “moral injury.” This is the trauma of being forced to witness or commit acts that painfully conflict with one’s own values, morals and beliefs. Often moral injury occurs in the line of duty: military, medical, where the survivor is faced with impossible choices or no choice at all. Of course, we know it also occurs plenty in families. This young veteran, only 20 years old, was talking about that. What a terrible burden to live out one’s days under such a yoke of grief, regret, remorse, guilt, anger and helplessness.

I remember when I was barely old enough to talk, my mother shaking her head and exclaiming, “I hate war!” in the same fierce tone as she sometimes said, “I hate alcohol!” She described herself as a pacifist, so I learned that word early. She loved Gandhi and Martin Luther King, and I remember her having a bumper sticker or a sign (I am not sure) that said “No War Toys.” Even though we were a family of all girls so it was not an issue for us, she was among a group of women opposed to little boys playing with guns, which it seemed like they all did. From an early age, I remember finding war horrifying, incomprehensible and frightening. I rarely watched a movie or read a book about it. In the Vietnam era, I was staunchly antiwar and active, but never quite knew or understood what was going on. Just that I hated it.

From an early age, I remember finding war horrifying, incomprehensible and frightening. I rarely watched a movie or read a book about it.

Unsung Heroes

I have always been amazed that Madonna and Jane Fonda looked so good, close to my age or older. Until I realized, well, parts of them are close to my age or older. They, and others like them, had had a lot of “work” done. Of course. I never knew the history of the science and art of plastic surgery until I recently read The Facemaker, a biography of the surgeon Harold Gillies. Gillies, born in New Zealand, was just completing his medical training when World War 1 broke out. Again, I was quite ignorant about this chunk of world history, and how that war was of a magnitude and scope of agony that seemed new even to the larger world. It also brought a new generation of weaponry that wrought new iterations of destruction: tanks, chemical warfare, bombs, rapid-fire guns. 

Besides the sheer numbers of dead and seriously injured, what compelled young Gillies was a massive increase in the appearance of young men whose faces had been blown apart. The damage was often so extreme that existing medical procedures and technology were completely unequipped to address it, let alone keep up with it. And where veterans who lost limbs and returned home in wheelchairs were often viewed as heroes, those with destroyed and disfigured faces looked so grotesque and frightening as to be repulsive to people, even their own children, fiancées and spouses. Even some medical personnel found them unbearable to look at while facing the new challenge, without protocols or textbooks, to develop techniques to try and put them even minimally back together. And, of course, the challenge was not only to “form” but also “function.” Not only was there a mandate to enable them to look such as to continue some semblance of “normal” daily life, but their faces, and the structures below, needed to be able to breathe, eat, and speak. 

Gillies made that his life’s work and became one of the founders of the art and science of plastic surgery in the process. In the beginning, plastic simply meant capable of being molded or receiving form, rather than a universe of ocean-strangling junk that we use to make virtually everything. Gillies and his comrades were truly creating an art form. In fact, alongside his unimaginable medical schedule, he added art classes so he could begin to draw and thus teach some of the techniques and procedures he was inventing. A massively energetic and generous human being who transformed many lives.

It was startling to me, as it often is when I discover a whole new category of knowledge or history that confronts me with a whole world of trauma and pain I had perhaps not thought about before. And unsung heroes that most of us never hear about. My own “petty” complaints about the appearance changes that come with natural aging; and narcissistic even identity related losses, paled into shame as I read these tragic accounts of young people in their twenties, trying to serve, or at the very least do what they were told, and being met with catastrophic losses of their sense of self. Often, they were greeted by a revolted and rejecting world, even their families. The horror was simply too much. This extreme of trauma shattered the interface of mind, brain, body, psyche, relationship, and most decidedly, sense of self. 

Sense of Self

The sense of self, as we know, begins at the very beginning, long before the face has developed much in the way of its unique characteristics. It develops in the most primitive part of the infant brain, as it resonates in a rhythmic dance with the attentive caregiver’s brain. That is sadly where the injury of neglect begins. The attentive caregiver is not there, or not nearly enough, or is out of rhythm due to their own trauma, depression, narcissism, addiction- whatever the harbinger of neglect. So the child is adrift, alone without a rudder or a boundary, long before there is a face. 

I have known and read about many a child of neglect who grew up and early on joined the military. It provided some sense of identity and affiliation, an orientation to how the world works, or simply instruction to the young adult who had never had anyone to help them know what to do or how to navigate the big world. The military tells one everything about what to do and when, even what to believe. It breaks my heart to think of the young men, 20 years old or even younger, who never had a sense of self to begin with, and then no longer had a familiar face in the mirror. Gillies cautiously permitted no mirrors in his hospital wards, to protect the patients from the anguish of their mangled reflections. Many of them had numerous surgeries and hospitalizations of many months and even years. 

Our mom was herself motherless and a survivor of war. Of course, her brain was sadly out of rhythm, and thus mine. It has taken years to slowly find the beat.

When I see younger people with beautiful skin, I tell them, “if I had known what I do now, when I was your age, I would not have this ragged old face. Take care of your skin!” I never thought about how lucky I am, however, to have an intact face! Perhaps my rhythm was long out of whack, and still sometimes is; with all the challenges of repairing a sense of self, I did not have that! It is a happy memory to think of my mother’s antiwar passion. I identify with that, even in relation to the parallel power struggles between intimate partners. I guess I inherited the passion for peace. 

Our mom sang this when we were kids – well, not with the rhythm you will hear in today’s song, but nonetheless. Thanks Mom!

Today’s Song:

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” was published on August 31st. It provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.

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