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Postcombat PTSD in the movies.

Clint Eastwood's new World War II docudrama, "Flags of Our Fathers," begins in the midst of battle. On a dark, denuded landscape, a solitary combatant stares blankly at us, his face transfixed with shock. We're on Iwo Jima and looking at John "Doc" Bradley, a Navy medic assigned to a Marine infantry company. Or is this Doc Bradley's combat flashback sometime in the future?

We move forward in time--which happens often in this film, as it interlaces combat scenes with fragments of subsequent events down to the present day--and meet Doc Bradley's son, James. He grew up knowing that his father, a prosperous mortician, had been a corpsman during WW II and was one of the six men who planted an American flag atop Iwo Jima's Mt. Suribachi on Feb. 23, 1945, an act immortalized in an almost accidental photo by Joe Rosenthal that became one of the most famous pictures in the history of photojournalism.

The elder Bradley was celebrated as a hero, awarded the Navy Cross, and repatriated to the United States, where he took part in a barnstorming tour of the country to promote war bond sales, along with the two other surviving flag raisers. Thereafter, Bradley never spoke of his combat experiences, except for a single conversation with his wife, on their first date, and one journalistic interview, in 1985, which he granted only upon his wife's incessant urging, for posterity's sake.

A Son's Quest

John Bradley died early in 1994, at the age of 70. Whereupon James, troubled by many questions and few answers, resolved to discover the full story of his father's war experiences. His 4-year effort, which involved tracking down and interviewing surviving witnesses and families of all the flag raisers (encounters that are dramatized in the movie), resulted in the book "Flags of Our Fathers" (New York: Bantam, 2000), coauthored with Ron Powers, a Pulitzer Prize winner for journalistic criticism.

Eastwood's film follows a screenplay by William Broyles Jr. (who wrote "Jar-head") and Paul Haggis ("Crash"), based on Bradley and Powers' account. Though flawed, "Flags" is a poignant and timely testament to the tragedy of war, a thoughtful reflection on heroism, and a valid representation of postcombat psychosocial problems.

War Writ Large and Small

Returning to the film, back in 1945, we get acquainted with young Doc Bradley and his Marine buddies as they kill time playing cards and joshing one another aboard a troop ship, part of a huge armada closing in on the tiny island fortress. The ensuing invasion is spectacular: hundreds of ships stretching to the horizon; the mass landing of troops and materiel. This montage is shorter but equally as graphic in carnage and confusion as was the Normandy invasion sequence in Steven Spielberg's "Saving Private Ryan."

Then we encounter small-scale combat as Marines edge up Mt. Suribachi, at immense cost (according to another surviving flag raiser, Ira Hayes, only 27 of 250 men in his company survived the month-long invasion). Next we witness the two flag raisings on the morning the Marines won control of the mountain: Yes, there were two, a couple hours apart, and it was the second raising that Rosenthal photographed.

The war bond tour that follows--featuring Bradley (played by Ryan Phillippe), Hayes (Adam Beach), and the third surviving flag raiser, Rene Gagnon (Jesse Bradford)--is in itself an ironic study of the public exploitation of war heroes. Ultimately we learn the separate fates of these three men: Only Bradley lived a relatively long and successful life. Hayes died of alcoholism at 32. Gagnon worked at menial jobs, also became alcoholic, and died at 54.

The conflation of truth, faulty recollections, bad intelligence, and purposeful disinformation that makes up the "fog" of every war is laid bare here, well wrought in the central parable of this film: competing versions of the Iwo Jima flag raising itself. What is the true story here?

Questions about heroism, sometimes addressed obliquely and never didactically, include: What makes a hero? What motivates combatants to fight with such seeming courage? What is the relationship of death and survival to heroism? Who is it that needs heroes? Or needs to pretend to be one? How fleeting is the fame of "yesterday's" heroes? What are the long-term costs of heroism, to the individual and to society?

Film Portrayals of PTSD

Twenty-six years after it was first codified in the DSM-III, posttraumatic stress disorder (PTSD) remains controversial. In some quarters "stress disorders" have gotten a bad name because of frequent requests for workplace leave and claims for disability compensation. Psychiatrists of good conscience disagree about whether stress disorders are overly diagnosed, and some even remain skeptical about the validity of the disorder, especially long-lasting, chronic PTSD.

The controversy is not about the symptoms (persistent, disabling reexperience of the traumatic events in dreams, waking reveries or dissociative fugues; avoidance of stimuli associated with the trauma; increased arousal) but about the characteristics of the trauma. Exceptional, horrific events like combat or assault are one thing, but when the stressor is commonplace, such as workplace strains, invoking PTSD stretches the concept beyond its intended limits.

Based on 30 years' experience--first with merchant seamen who had survived a maritime disaster, later for 18 years with war veterans in the Veterans Affairs Healthcare System--I am convinced that PTSD is a valid construct conceptually and clinically. (I have published articles on combat-related PTSD symptom patterns and was a consultant on PTSD for the 1987 revision of the DSM [DSM-III R]).

"Flags" delivers authentic dramatized depictions of combat-related PTSD. For Ira Hayes the most prominent features we see are extreme survivor guilt, depression, social dysfunction, and alcohol abuse to temporarily assuage his psychic pain. Doc Bradley suffers from lifelong combat reexperiencing symptoms, insomnia, and his own version of survivor guilt: He won't talk about his war experiences with loved ones, a common form of avoidance.

Some veterans, like Hayes, never surmount their symptoms, while even "well adjusted" former combatants, like Bradley, can experience more prominent symptoms in later life, triggered by failing health or other losses. Because Hayes is a Pima Indian, some viewers might mistakenly think that Native American combat survivors with PTSD are especially vulnerable to alcoholism. In fact, alcoholism and drug dependence are equal opportunity afflictions, common in the aftermath of combat-related PTSD irrespective of race or ethnicity.

Hollywood Wars

The flaws in this movie, all illustrative of commercialism, occur early. When we first meet the principals, their banter aboard ship--around the card table or listening to "Tokyo Rose" up on deck--seems stagy and contrived. A train station homecoming scene begins with the engine moving toward us, pulling up to the platform, where everyone in the orderly crowd is tricked out in immaculate costumes: a pristine scene straight out of some '50s mainstream movie. A European or indie treatment might have begun the homecoming sequence aboard the train, more intimately.

Do we really need the massive invasion sequence? In "The Thin Red Line," Terrence Malick does not invoke a spectacle to ratchet up our angst level as an infantry company engages the enemy on Guadalcanal. Malick's approach is unceasingly up close and personal. Precisely because of that, the supercharged tension of combat that we feel is all the more compelling.

One can argue that mainstream American filmgoers are conditioned to require spectacles, special effects, and stylized scenes. Such elements thus serve as necessary devices to lure people into theaters in the first place and then help assure that they stay tuned after the first 30 minutes for the some subtle messages that follow (heroism issues).

The casting of relatively unknown actors in most roles in "Flags" is both an asset (we are more inclined to see these men as soldiers, not actors) and a liability (so many anonymous faces makes for confusion about who's who--it took me more than half the film to get everyone's identities sorted out).

Best War Trauma Films

"Flags" evoked a melancholic mood in me that came to a head when Doc Bradley dies late in the film. At the end, to my surprise, I wept openly. I was crying for the loss of my father. For the loss of life and the crippling of survivors caused by wars. And for other losses of equal gravity: war's corruption of innocence and morality; waste of vast resources that might have been spent on projects of far more redeeming value.

When I think of other films that excel in depicting stress disorders and postwar adjustment problems, seven stand out: "All Quiet on the Western Front" and "Mrs. Dalloway" (the subplot involving the "shell-shocked" soldier, Septimus Smith) (both from WW I); "The Best Years of Our Lives" and "Thin Red Line" (WW II); "Coming Home" and "The Deer Hunter" (Vietnam); and the recent Danish film, "Brothers" (Brodre), about a NATO peacekeeper forced by captors to kill a comrade (post-Sept. 11 Afghan war). "Flags" merits inclusion in this group, particularly for its demonstration of the long-lasting sequelae of war trauma.

These days James Bradley is busy building a peace foundation. I imagine he is pleased with the work Eastwood and his team have done here.

DR. ATKINSON is a professor of psychiatry at Oregon Health and Science University, Portland. For more reviews, visit his Web sites at www.AtkinsonOnFilm.com and www.Psychflix.com. Share your thoughts with Dr. Atkinson by writing him at cpnews@elsevier.com.

BY ROLAND ATKINSON, M.D.
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Title Annotation:REEL LIFE; post-traumatic stress disorder
Author:Atkinson, Roland
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Dec 1, 2006
Words:1566
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