War Requiem

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War — the cost of war — seems worth consideration on the occasion of Memorial Day 2010. Perhaps you have seen the movie Brothers. It will be in the same spirit, I hope, that I reflect a bit on the cost that any war brings, however necessary it might be. I will do this by quoting two poems and directing you to some wonderful music using poetry as text.

World War I,  “a war to end all wars” according to President Woodrow Wilson, generated lots of verse. British poets, in particular, found the pity in wartime, and as Wilfred Owen wrote, “the poetry is in the pity.” Owen fought and wrote about fighting, as in a letter to his mother just after his arrival in France:

“I can see no excuse for deceiving you about these 4 days. I have suffered seventh hell.

I have not been at the front.

I have been in front of it.”

The 25 year-old Owen was to die in battle just one week before the armistice on November 11, 1918.

When Benjamin Britten, the pacifist English composer, was commissioned to write music in honor of the reconsecration of Coventry Cathedral in 1962 (which had been destroyed in World War II), it was Owen’s World War I poetry and the Latin Mass for the Dead to which he turned. The piece, for large orchestra (with the addition of a chamber orchestra), three vocal soloists, and chorus, alternately rages against and laments the ravages of wartime.

The War Requiem ends with the Owen poem Strange Meeting, sung at the première by an English tenor and a German baritone, no coincidence as England and Germany fought against each other in both World Wars.

In this poem (excerpted below), the narrator finds himself in the bomb shelter and sleeping quarters below the trenches of the enemy, “down some profound dull tunnel,” as part of a night raid where he encounters dead and dying soldiers. There, he and his enemy recognize their shared human bond:

…Then, as I probed them, one sprang up, and stared
With piteous recognition in fixed eyes,
Lifting distressful hands as if to bless.
And by his smile, I knew that sullen hall
By his dead smile I knew we stood in Hell

“Strange friend, ” I said, “here is no cause to mourn.”
“None,” said the other, “save the undone years, the hopelessness.
Whatever hope is yours, was my life also…
For by my glee might many men have laughed,
And of my weeping something had been left,
Which must die now. I mean the truth untold,
The pity of war, the pity war distilled.
Now men will go content with what we spoiled,
Or, discontent, boil bloody, and be spilled…

I am the enemy you killed, my friend.
I knew you in this dark: for so you frowned
Yesterday through me as you jabbed and killed.
I parried; but my hands were loath and cold.
Let us sleep now…”

The English language changed because of World War I. Phrases and references to the word “trench” became part of common parlance, as in the phrase “in the trenches” which still refers to working at a hard, grinding task; and even the phrase “trench foot,” which led back to a type of frost bite common in the muddy, cold, wet, and verminous condition of those dark places inhabited by the warriors.

Or, how about “trench fever,” a bacterial infection associated with the lice that bred there. The expression “No Man’s Land,” plays back to the space between the trenches — between you and the enemy trench — which could be a few hundred yards. It was the place belonging to “no man” or side in the conflict, and it was the place where no man could easily survive. So too, when one army decided to launch an attack on the other, they had to go “over the top” of the trench and into hostile fire.

But it was to a much earlier use of the trench in warfare that the poet Patrick Shaw-Stewart would refer.

Patrick Shaw-Stewart was born on 17 August 1888 in Wales, and fought as part of the British Expeditionary Force at Gallipoli on the Chersonese peninsula during World War I, not far from the site of the Trojan War.

Gallipoli was a disaster for the British. Shaw-Stewart was on three days leave from the front on the island of Imbros when he wrote the untitled poem that follows. It refers to the Trojan War as represented in The Iliad, so a little background is required to better understand it.

The war began soon after the Trojan prince Paris abducted Helen, the most beautiful woman in the world, but the wife of one of the Greek kings (Menelaus). The Greeks organized their own expeditionary force and followed Helen to Troy so they might retrieve her.

Many years into the conflict, Achilles, the greatest of the Greek warriors, stopped fighting because the leader of the Greeks (Agamemnon) had taken away Achilles’ concubine. Achilles’ rage and his decision not to fight is called “The Wrath of Achilles.” In addition, Achilles knew if he returned to battle he would not survive the war. Despite this, he resumed the fight and turned its tide, with the goddess Athena beside him, both shouting in a trumpet-like, horror-inducing scream to make the Trojans flee.

Achilles and Athena stood at the ditch in front of the wall built by the Greeks to protect their ships. Achilles’ head was surrounded by an aura of flame created by the goddess (to which the poet refers in the heart breaking last stanza), so better to terrify the Trojans, who panicked and ran away.

Shaw-Stewart tells his own Illiad-like war story from the standpoint of his temporary leave from fighting:

I saw a man this morning
Who did not wish to die
I ask, and cannot answer,
If otherwise wish I.

Fair broke the day this morning
Against the Dardanelles ;
The breeze blew soft, the morn’s cheeks
Were cold as cold sea-shells

But other shells are waiting
Across the Aegean sea,
Shrapnel and high explosive,
Shells and hells for me.

O hell of ships and cities,
Hell of men like me,
Fatal second Helen,
Why must I follow thee?

Achilles came to Troyland
And I to Chersonese :
He turned from wrath to battle,
And I from three days’ peace.

Was it so hard, Achilles,
So very hard to die?
Thou knewest and I know not-
So much the happier I.

I will go back this morning
From Imbros over the sea;
Stand in the trench, Achilles,
Flame-capped, and shout for me.

Much like Achilles, Patrick Shaw-Stewart survived the Gallipoli campaign, but not the war.

He was 29 at the time of his death.

Can You Sleep At Night? Being Ashamed and Feeling Guilty

There is an important distinction between being ashamed and feeling guilty. Both are connected to wrong doing, errors, mistakes, or failures. Both involve emotions. Feeling guilty, however, unlike being ashamed, doesn’t require an audience.

A person typically feels guilty almost automatically when he believes that he has done wrong. It matters not whether anyone else knows or finds out. Often, it doesn’t even matter that others might forgive the transgression. Thus, a sense of guilt is an internal state connected directly to an act thought to be wrong.

Shame, on the other hand, requires an audience, or at least, others’ knowledge of the inappropriate behavior or failure, even if they did not directly witness it.

By these definitions it is possible to feel guilty without being ashamed. One need only believe that one has done wrong. But someone who has been shamed (in other words, found out and condemned) might only come to feel bad if his behavior is widely known.

You might think that this always happens, but it doesn’t. Take the recently removed Governor of Illinois, Rod Blogojevich, who has yet to admit any guilt and who certainly doesn’t act ashamed; indeed, who appears quite shameless. Shamelessness is never a compliment, but rather a statement about someone who has no “shadow,” no sense of ever doing anything inappropriate.

To cite a couple of other examples, one a therapist and one a minister, neither felt guilty even after having their iniquity publicly exposed. In both cases the misbehavior was of a sexual nature that involved infidelity, as well as a violation of the code of ethics of their professions.

In the former case, the therapist had sex with ex-patients; in the latter example, the clergyman had sex with parishioners. Both were married (not to each other) at the time of these acts. The public exposure of their actions and ensuing humiliation mortified each of them and, indeed, each one contemplated suicide. But neither really believed what had happened was terribly wrong, and rationalized the transgressions in defense of his own self-image. In both cases the rationale involved holding the sexual partners largely responsible for the romantic encounters.

The connection between shame and suicidal depression is interesting and can be found even in the epics of Greek mythology. When Achilles died in battle, the Greeks held a vote to decide who among them should be awarded the splendid armor of Achilles, which had been fashioned by the god Hephaistos. Ajax (Aias) the Greater, the best warrior after Achilles, lost this competition to the cleverest of the Greeks, Odysseus, who had designed the Trojan Horse strategy that won the war. In his humiliation, Ajax went mad and eventually killed himself. Such is the devastating effect of a “loss of face.”

It should be said that the therapist and the minister I have referred to were quite narcissistic people who saw themselves through a very forgiving lens. Both terminated contact with old friends following their public embarrassment, in order to avoid facing them. In a sense, the self-love and lack of a well-developed conscience of the two people in question set the stage for their wrong doing — they believed that they were without moral flaws and therefore that anything they thought to do would automatically be a morally acceptable behavior.

Beware of those who say that they can sleep easily at night and use this standard as their primary method of judging or evaluating their own behavior. I doubt that the worst of the totalitarian rulers and despots of history would have failed this test of moral correctness, despite the murder, unhappiness, and genocide they created.

In the USA, on the political front, we have seen lots of people who don’t admit wrong, who rationalize what they do, and who serve themselves while claiming to be acting “on behalf of the American People.” I’m sure some of them come to believe their own story, their own rationale — shameless, as I said before; indeed, almost a kind of self-delusion.

In my experience, people who come to psychotherapy because they feel ashamed (but not particularly guilty) don’t usually take responsibility for their actions in the course of treatment. Rather, if the process follows the typical course, they will recover from the injury to their ego and be able to go on with life, still guarded against significant self-awareness. Moral self-reflection doesn’t seem to come easily or naturally to them.

By contrast, individuals who experience guilt that causes them to enter counseling often can learn to forgive themselves and recover from the depression that usually accompanies their guilt. For them, however, the risk is in taking too much responsibility and being too severe in their self-judgment, exactly the opposite of the person who is only ashamed.

It is useful to be capable of feeling guilt, to admit wrong doing, and to feel ashamed; that is, if one is to lead a moral life. On the other hand, it might be argued that those who are shameless and who rarely feel guilt probably have more fun in life and are less troubled — the mirror reflects their image back to them in the way that they want to see it, and not in the way it actually looks. They live in a state of ethical blindness. Whether that permits a satisfying life is another story.

You be the judge.

The above image is Shame by Libertinus Yomango, sourced from Wikimedia Commons.

What Do Antidepressants Really Do?

I believe that the oldest reference to an antidepressant medicine comes in Homer’s Odyssey, which “could not have been completed much before the end of the eighth century B.C” according to Richmond Lattimore. The reference occurs when Menelaos (brother of Agamemnon),  Telemachos (son of Odysseus), and others are grieving the loss of friends and relatives in the Trojan War. Helen, the wife of Menelaos, is also present. It was her departure to the walled city of Troy with Paris that triggered the assault on that fortress to retrieve her. Having since returned to her husband, she wishes to salve the emotional pain of the men who are gathered at her home. The passage reads as follows in Lattimore’s translation:

“Into the wine of which they were drinking she cast a medicine of heartease, free of gall, to make one forget all sorrows, and whoever had drunk it down once it had been mixed in the wine bowl, for the day that he drank it would have no tear role down his face, not if his mother died and his father died, not if men murdered a brother or a beloved son in his presence, with the bronze, and he with his own eyes saw it.”

That would be a potent brew indeed. But the idea of it prompts me to say a few words about what an antidepressant can and cannot do, for there is much misunderstanding on this point. And, by the way, the first real antidepressants only became available in the 1950s.

An antidepressant does not make you giddy about your life or impervious to emotional pain; it doesn’t make you forget bad things. In other words, it is not what Helen of Troy administered. If an antidepressant is working well, it helps put a floor under you. That is to say, many people with depression feel as though there is nothing holding them up (metaphorically speaking), no bottom to their suffering.

An effective medication creates that bottom, relieving them of the sense that they are without any support underneath them. It reduces their suffering too, makes them less prone to crying, less exhausted, and less subject either to over-eating or having no appetite, and usually able to sleep better. In other words, the medicine helps you tolerate life and helps normalize that life.

Some people, including quite a number who shy away from psychiatric medications or medication or any kind, actually are attempting to “doctor” themselves with drugs or alcohol.

There is danger here, naturally.

You probably know some of the dangers, but one I want to mention in particular is the depressant-effect of alcohol. It might make you feel better in the short-run, but in the long-run it is likely to fuel your depression, not to mention create a dependency.

As the old Chinese expression goes, “First the man takes the drink, then the drink takes the man.”

I suspect that you know someone who believes that psychotropic medication (and perhaps psychotherapy too) is a crutch. There is no denying that being treated for emotional problems can produce negative judgments and a stigma. Moreover, historically speaking, insurance companies have paid less well for therapy and psychotropic medication than for “physical” illnesses. That has just changed in 2010, but the stigma won’t be legislatively erased by the US congress, as was achieved by “parity” legislation that now requires equal insurance coverage of both physical and “mental or nervous” conditions.

Yet some categories of depression are certainly just as “physical” as an imperfect gall bladder is, for instance. Specifically, Bipolar Disorder, also called Manic-Depressive Disorder, is one such biologically-based psychiatric category where medical intervention is often enormously helpful, if not essential.

Would you want your severely diabetic loved-one to avoid the “crutch” of necessary medication? If your answer is “no,” then you shouldn’t be put-off by treating a biologically-based depression with a proper medication to stabilize his mood.

Nonetheless, it is true that many depressed individuals do not have any biological flaw or chemical imbalance, but rather are reacting emotionally to difficult life circumstances such as repeated losses (e.g. divorce, job loss), unfinished grief, or abuse of one kind or another. Very often psychotherapy is able  to successfully treat these people without the benefit of medication. Indeed, sometimes patients are too quick to obtain antidepressant prescriptions which take the edge off their feelings enough to reduce their motivation to address difficult life circumstances, including repetitive patterns of behavior that lead to unhappiness.  In that event, they will risk having to stay on antidepressants lest they fall back into depression.

For those patients, on the other hand, who successfully address their issues in psychotherapy, antidepressants may never be needed or, if they are used, might be required only temporarily.

If you are seeing a therapist for depression, talk with him about medicine for your condition, especially if you feel that you need immediate relief or are having suicidal thoughts. Beware equally of therapists who never want their patients to go on medication, as well as those who always do.

I should mention that while many depressed people obtain medication from their family or primary-care physician or general practitioner (GP), this isn’t always the best source of psychotropic mood-altering substances. While some GPs are both comfortable with and experienced in prescribing such medication, some are hesitant or unsure. The latter group may be less adept at identifying the precise antidepressant which is best for you given your particular symptoms; moreover, their hesitation can cause them to give you too low a dose to obtain a therapeutic benefit.

A good psychiatrist, by contrast, is absolutely up-to-date on everything about the medications available to treat you, adept at identifying which of the available antidepressants is the best fit for your particular situation, and knows how to get you to a therapeutic level of the medicine as quickly as possible. Since those in pain so often feel as if there will be no end to their suffering, and since antidepressants often take a several weeks to produce relief, getting the medicine right as quickly as possible is very important.

If you do choose to obtain medication, be sure to educate yourself about your condition and the possible side-effects of the medication being suggested. Not all physicians are good about describing those side-effects before-hand, even including the sexual side-effects produced by some antidepressants. Be your own advocate. Don’t be passive in treatment. It is your body, it is your life.

Last I heard, you only get one of each.