Nov 11, 2018
This content contains explicit and sensitive information that may not be suitable for all ages.
Rwanda will never end and I will never be free. I know there is no remedy for what I saw, what I did and did not do, during those three months of hell. There are no painkillers for the angst, the guilt, and the excruciating vividness of that time and place. The annual ritual of Rwanda in its foulest of times is the curse of the survivor. Each night I take my pills, and try to sleep with the hope that I will not awaken again amidst the roaming souls who still wander the hills of Rwanda asking me to join them.
Roméo Dallaire, Waiting for First Light: My Ongoing Battle with PTSD
Prior to 1980 when the American Psychiatric Association (APA) added Post Traumatic Stress Disorder to its third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‑III) the military disorder had been described using 14 different terms dating back to 1678. Swiss military doctors used the term nostalgia, German doctors used the term homesickness, while Spanish doctors considered the condition to be a state of brokenness. During the American civil war a cardiologist later discovered that afflicted soldiers consistently had higher than normal blood pressure and heart rates, thereby coining the term soldier’s heart. Russian doctors were the first to classify battle shock as a medical condition in 1905. But it wasn’t until the First World War that military physicians began to treat wounded warriors suffering from shell shock. Shell shock, the first medical term widely accepted in the medical community, was believed to be caused by a concussion as a result of the shell bombings. During WWI military soldiers diagnosed with shell shock were hospitalized for a mere few days, then sadly sent back to fight in the battlefields untreated. Post-WWI doctors realized the condition couldn’t be treated in a few days, leading physicians to rethink the condition is an emotional response to warfare rather than the result of traumatic brain injury. This medical military discovery led the path from shell shock to a psychiatric disorder which first appeared in the DSM in 1952 as gross stress reaction, but was later removed in the next DMS published in 1968. Some of the other terms used were combat neurosis, battle fatigue, Vietnam combat reaction, post-Vietnam combat syndrome and catastrophic stress disorder –that is, until 1980. After decades of military combat and peacekeeping missions, the medical community finally settled on the term we continue to use today: post-traumatic stress disorder (PTSD).
This year marks a century since that discovery.
This year marks a century since that discovery. To date, there is no cure for this debilitating illness that continues to cause of immeasurable angst and suffering, tragically resulting in the loss of military lives long after the war. This article proves a brief history of PTSD since WWI and WWII, explores what it means to live with PTSD after war through the life and memoir of retired Lieutenant-General Roméo Dallaire, and looks at the role we civilians play in helping our wounded warriors in their journey towards recovery. As we honour the centenary of Remembrance Day, so too should we remember the role that military veterans and military physicians have played throughout the past one hundred years in identifying, diagnosing and treating PTSD. This is one of the many contributions to the betterment of humanity that our military has honourably given us. As we reflect on the extraordinary sacrifices our military heroes have made on this Remembrance Day (Veteran’s Day in the U.S.), let us also take a moment to remember those veterans who have brought the war home and continue to sustain invisible injuries.
What is PTSD? Post-traumatic stress disorder is a serious neurobiological medical condition. While many people think it only applies to military veterans and active military personnel, we now know that anyone exposed to acute trauma may be susceptible to the disorder. We also know that there is a much higher risk of developing PTSD for military, first responders and survivors of acute childhood trauma, like myself. PTSD is a very serious disease. Left untreated, it can it can be fatal. As the Canadian government’s latest report on suicide rates of our military shows, the rates of death for military veterans is significantly higher than civilians. Exactly how much higher? A recent watershed study confirms “1,486 former military members ended their lives from 1976 to 2012, with one-third of the suicides occurring after 2002, when Canadian troops were entrenched in the Afghanistan war,” as reported in the Globe and Mail last year. This is largely attributable to higher incidents of PTSD caused by acute trauma in the context of war.
Identifying the symptoms of PTSD is important for caregivers and civilians alike.
While the Canadian Armed Forces have deemed mental health and suicide prevention a “top priority,” it’s also vital to raise awareness amongst civilians to overcome the stigma that keeps military and civilians alike from seeking life-saving medical care. This is why it is important to raise awareness and improve education about PTSD and raise the profiles of those military veterans who suffer disproportionally higher rates as a result of their sacrifices for our nation, for our freedom. An important part of understanding PTSD is knowing what some of the most prevalent symptoms are. Symptoms of PTSD may include the following: high blood pressure, tachycardia (higher than normal heart rate), endocrinology disorders, insomnia, sleep disturbances caused by nightmares, flashback memories, depression, emotional sensitivity, irritability, anger, impulse control, hyper-vigilance, and intense psychological and physiological reactions to triggers that are reminders of the traumatic event(s) as well as avoidance of triggers that may induce “fight or flight” responses. Identifying the symptoms of PTSD is important for caregivers and civilians alike, but so too is empathizing with the nature of their struggles.
Raising awareness requires that we first take the time to learn and listen to their stories. Military veterans have become fearless in sharing their post-traumatic stress disorder in memoirs, speaking engagements and media interviews. In a society that continues to stigmatize mental illness and a professional climate where soldiering means showing toughness, bravado and strength, even the slightest hint of vulnerability or difficulty coping be deemed weakness or lack of character. Nevertheless, courageous military heroes have begun coming out from behind the shadows of intense suffering to narrate their harrowing journeys from sickness to recovery. On this special day I want shine a spotlight on one of our greatest Canadian leaders, The Honourable Lieutenant-Governor Roméo Dallaire, who has been sharing his acute trauma openly and honestly for more than two decades now.
Lieutenant-Governor Roméo Dallaire is a Canadian humanitarian, former Senator and retired General who was tasked with the most notable United Nations peacekeeping mission in the past century in 1993-1994. He first began sharing his story and the acute trauma he endured as the Force Commander of UNAMIR, the failed United Nations peacekeeping in Rwanda between 1993 and 1994 that would later lead to his diagnosis of PTSD. His mission was to support the peace agreement signed by the Hutu and Tutsi peoples. However, although the peace agreement was signed, immediately the day after the plane carrying the Presidents of Rwanda and Burundi was shot down by a missile just as landing had commenced in Kigali, three months of genocidal slaughter began. As his award-winning non-fiction book Shake Hands With the Devil recounts, between 500,000 and 800,000 Tutsis were slaughtered by the hands of machete-wielding Hutus. Witnessing the atrocities of genocide in Rwanda and the lack of international intervention from NATO caused Lieutenant-Governor Dallaire such severe and long-lasting trauma that his battle for recovery from PTSD is one he continues to fight today.
He describes his existence as “living-in-death.”
Dallaire’s Canadian military legacy has gained widespread global attention. As early as 1994 while still on the ground in Rwanda, he began to share his personal distress over the apocalyptic horrors he was witnessing through the media. His intention was to publicly expose the lack of UN support; the unexpected consequence was also that he showed the world how a Lieutenant-Governor can both be a soldier and also emotional. His book, Shake Hands With the Devil, took him three years to write for which he received Canada’s highest literary honour, the Governor-Generals Award for the best work of non-fiction. It was a #1 best-seller. Dallaire was also later featured in the movie Hotel Rwanda, based on a true story. The film garnered $33.9M at the box-office and the People’s Choice award at Toronto’s International Film Festival. The documentary Shake Hands With the Devil: The Journey of Roméo Dallaire based on his book was also a tremendous success, earning awards from the Sundance Film Festival, Gemini Awards, and Directors Guild of Canada, to name a few.
In 2005 Dallaire was discharged by the military on the discriminatory grounds of mental illness in 2000, he was appointed to Canada’s Senate by Prime Minister Paul Martin and established, Child Soldiers Initiative, in partnership with Dalhousie University. The initiative was the first of its kind in Canada, bringing together thought leaders, politicians and charitable organizations to combine world-class research and political advocacy on behalf of child soldiers. During his time on the ground in Rwanda he witnessed the horrors endured by child soldiers. Upon returning home, he began his fight for children’s rights against becoming child soldiers with passion and vigor. He wrote a book on the subject titled, They Fight Like Soldiers, They Die as Children, which painfully depicts the excruciating trauma child soldiers are subjected to. Dallaire quickly became a leading voice for child soldiers, outspokenly challenging both public opinion and policy alike, as evidenced by Dallaire’s petition to “authorize the repatriation of Omar Khadr without delay,” that he launched the year after this interview with George Stroumboulopoulos aired by CBC in 2011.
Dallaire shares his story in his own words in his recently published memoir Waiting for First Light: My Ongoing Battle With PTSD. In it he offers a poignant and heart-wrenching description of what means to live with post-traumatic stress disorder that will resonate with many PTSD survivors. He describes his existence as “living-in-death.” In the book he accounts pivotal moments that have marked his life from Rwanda to sleeplessness, nightmares and tortuous nights in fits of terror at home. Here is an excerpt from his book released in 2016.
The agony and the angst are palpable.
Recounting the past 22 years since returning to Canada, he speaks with unfettered bluntness about everything in vivid detail including his unjust discharge from the military on the grounds of mental illness to the toil his suicide attempts have taken on his loving caregivers. Waiting for First Light is a sobering read that will leave you reeling, but it is also vital reading if we are to ever truly understand the invisible wounds that many of our soldiers come with. Reading this memoir shows us how these wounds never completely scar over. Night after night, one feels as if Dallaire’s invisible wounds are repeatedly ripped open again and again without end. The agony and the angst are palpable. In Waiting for First Light Dallaire exudes heroism simply by virtue of sharing his story with such truth and vulnerability. In doing so, the former Deputy Commander of the Canadian Armed Forces shows by example how a veteran battling PTSD remains a strong and courageous warrior not by concealing the fragility of ones wounds, but by bravely sharing them. His memoir teaches us that vulnerability is an act of bravery and strength, never weakness.
Dallaire has since retired from the Senate to pursue his Child Soldiers Initiative and to advocate for military mental health. The launch of his memoir and willingness to share his long-term battle against PTSD as he did in this is CBC As It Happens interview in 2016 testifies to his determination to fight for the rights and needs of his fellow military officers. By bearing traumatic witness to the genocide in Rwanda Dallaire changed the way that international leaders think about the right to sovereignty and military intervention. This culminated in The Responsibility to Protect (R2P), a doctrine that Canada served a prominent role in establishing and still represents as a peacekeeping nation. Similarly, there is little doubt that the former Canadian senator who is now a global voice for the rights of child soldiers, will be leaving a lasting legacy in the fight for children’s rights to be free from fighting in war. But perhaps it will be his first-hand account of the war he continues to wage against PTSD at home that will ultimately leave his most significant and indelible impact. One hopes so.
Stigma, on the other hand, demands a much greater call to action.
Roméo Dallaire is leading the way forward for military mental health and suicide prevention. But he isn’t the only one. New voices from military veterans are emerging and also shining a light on this darkness to bring awareness to the invisible injuries sustained in the wake of war. There are many more military veterans diagnosed with PTSD stationed at the battlefront now fighting against the two greatest enemies against PTSD: discrimination and stigma. More are needed. While there are increasingly more military writers and public speakers coming forward to share their stories, and more journalists reporting on military mental health, this has only started to weaken imposing discrimination. The Canadian Armed Forces has made critical strides forward but much more needs to be done both to provide better treatments, post-war decompression strategies, reduce military PTSD caused by sexual abuse within CAF, and reduce discriminatory practises against those suffering from mental illness. Stigma, on the other hand, demands a much greater call to action.
The sacrifices our military has made, and continues to make, in defense of our nation as a sovereign state and our freedom are lifelong ones. This should neither be taken for granted nor merely be reduced to one moment of silence each year. As citizens we have a civic duty to remember and support those who have honourably served our nation, and those who proudly serve Canada and Canadians now. A moment of silence is necessary, but insufficient. We should consider new ways to extend our respect and indebtedness throughout the year. This is a list of actionable steps to consider. Remembering our veterans and honouring our military each Remembrance Day is one significant way to pay tribute. But we can and should do more. The intention of this article is to raise awareness and encourage my fellow Canadians to keep remembering our military, especially our wounded warriors, by taking action. For just as these brave men and women have chosen to take action for us, so too should we choose to take action for them. It can be life-saving.
Among the Walking Wounded: Soldiers, Survival and PTSD by Colonel John Conrad
After the War: Surviving PTSD and Changing Mental Health Culture by Stéphane Grenier, Adam Montgomery
Matters of Life and Death: Public Health Issues in Canada by André Picard
Royal Military College had no suicide-prevention plan when three cadets took their own lives in 2016, inquiry finds by Globe and Mail journalist Gloria Galloway
Military sexual assault victims with PTSD will be competing for Canada in Sydney. ‘It gives people a direction, a purpose’: Veteran survivors of sexual assault to compete at Invictus Games by CBC journalist Carolyn Dunn
Military’s top commander applauds Legion’s Silver Cross Mother appointment by Globe and Mail journalist Renata D’Aliesio
The Wounds of the Drone Warrior by New York Times Magazine journalist Eyal Press
Healing a Wounded Sense of Morality by The Atlantic journalist Maggie Puniewska