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forgetfulness,” Homer suggests that if you forget your pain, you forget your homeland—you “lose your hope of home.” To really
be home
means to be emotionally present and engaged. Even without alcohol, stimulants, opiates, or sedatives, some entirely clean and sober combat veterans endure civilian life with all of their emotions shut down, except for anger, the one emotion that promoted survival in battle. Homer seems to be saying that if you are too successful in forgetting pain, forgetting grief, fear, and disgust, you may dry up the springs of sweetness, enjoyment, and pleasure in another person’s company. This fits our clinical experience.
    Veterans use many strategies to numb their pain, to silence the nightmares, to quell guilt. Chemicals are only one such strategy, danger seeking is another, workaholism is another, sexaholism another still 5 —and it is not an exaggeration to say that Homer has seen it all (see Chapters 5 , 6 , and 14 ). These have in common that they cut the
emotion
out of the veteran’s homecoming. Even when he’s physically with his wife, his children, his parents, he’s not
there.
Many men go through the motions, but emotionally speaking, they’re; like ice. The second chapter of Aphrodite Matsakis’s
Vietnam Wives
carries the grim title, “Living with the Ice Man.” 6
    Selective suppression of emotion is an essential adaptation to survive lethal settings such as battle, where numbing grief and suppressing fear and physical pain are lifesaving. Whatever the psychological and physiological machinery that produces this emotional shutdown, it appears to get jammed in the “on” position for some veterans. Do not imagine that this is a comfortable or pleasant state of being. Veterans in this state say they feel “dead” and that they watch life through a very dirty window. They are never
in
life. More than one has described it as like being wrapped in cotton wool. Such deadness prompts some who sufferer from this hateful numbness to self-medicate with “uppers.”
    In parallel, mobilization of the mind and body for danger, the vigilant sharpening of the senses, the tense readiness to kill an attacker, is also an obvious survival adaptation to combat. When this is stuck in the on position and persists into civilian life, the veteran may embark on a frenzied search for calm. Such a state directly interferes with sleep, often causing a vicious cycle, because of the physiological and psychological “jacking up” that comes from going completely without sleep. “I’ve got to get some sleep!” is a cry of many veterans. The easy, cheap, legal availability of the sedating drug alcohol has been irresistible to many veteran insomniacs. Most have learned, to their sorrow, that it is a poor choice, full of its own dangers and ambushes. The other downers have their own characteristic problems, some different from alcohol’s, but problems no less.
    I argued in
Achilles in Vietnam
that simple combat PTSD is best understood as the persistence into civilian life of valid survival adaptations to combat. Both hyperarousal and numbing may persist into civilian life, paradoxically coexisting as constantly inflamed anger, but numbing of everything else. Or they may alternate with one another, giving the veteran a history of “cycling” between overexcitement and numb withdrawal. No wonder many have been labeled “manic-depressive,” or the more recent term “bipolar affective disorder.” Combat veterans with PTSD sometimes come to our clinic dragging behind them a long history of alternately self-medicating
both
numbing and hyperarousal and carrying the dismal label of “polysubstance abuser.”
    Can drug and alcohol abuse among veterans be prevented? Clearly, when one in four
civilians
7 meets the criteria for alcohol abuse or dependence currently or some time in their life, we are talking