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Treating American Empire

On providing therapy for agents of state violence

In one of the final scenes of the recent movie Bad Boys for Life, members of the elite AMMO squad sit on a seaside patio, toasting their victory over a Mexican drug cartel. In the previous scene, this group of Miami Police officers had engaged in a shootout far outside their jurisdiction, in a Mexico City mansion. One of the officers shot a helicopter pilot, causing the craft and its passengers to go up in flames. Another officer shot a woman several times in the chest, causing her to fall into a raging fire.

Now, as they banter over cake and cocktails, Officer Dorn interrupts with an announcement.

“Guys, I got some news for you,” he says. “I just started therapy, and my therapist thought it’d be super beneficial if we could all, you know, hit up a group sesh together.”

“For sure, definitely,” everyone agrees.

Committed to psychologically healing from two hours of cinematic killing, the squad returns to their celebration.

Post-Traumatic Stress Disorder (PTSD) was added to the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-III) in 1980. This newly codified diagnosis helped to explain the influx of military veterans who had recently returned from Vietnam experiencing flashbacks, nightmares, and anxiety. But the condition itself was not new. During World War II, it was known as “Combat Stress Reaction.” During World War I, it was called “Shell Shock.” The observation that soldiers are traumatized by battle predates even the invention of modern warfare, appearing in the Bible, the Epic of Gilgamesh, and Herodotus’s telling of the Battle of Marathon. PTSD was a new name for a set of symptoms that has existed for as long as humans have been making war.

However ancient its roots, it was until recently believed by many soldiers that PTSD was for pussies. My boyfriend, who served in the Marines in Afghanistan, tells me that for a long time, people would avoid seeking help at all costs. In the rare cases where they did, they’d often furtively attend their therapy sessions, maybe get medicated, and almost definitely never talk about it—especially not with their buddies. It was shameful to admit that you had regrets about killing or fears about being killed. As late as 2013, a study from the Psychiatric Rehabilitation Journal looking at PTSD stigma among veterans of Operation Enduring Freedom and Operation Iraqi Freedom found that “common perceived stereotypes of treatment-seeking veterans with PTSD included labels such as ‘dangerous/violent,’ or ‘crazy,’ and a belief that combat veterans are responsible for having PTSD.” It concluded that many veterans avoid treatment due to this stigma.

There is not much data on the actual usage of mental health services by soldiers and police officers over time, but anecdotally at least, things have changed, my boyfriend tells me. Now, many more soldiers (and police officers like those on the AMMO Squad) are seeking help, though plenty still aren’t. He says that it seems like for some, particularly those who don’t actually suffer from PTSD, therapy is understood as a kind of badge of honor: it means you were man enough to really see shit, that you sacrificed your mental health in the line of duty.

An article published by the Community Policing Dispatch, part of the Department of Justice’s COPS Office, estimates that 15 percent of police officers have symptoms of PTSD. A 2016 Pharmacy and Therapeutics article found that, depending on the study, between 13.5 percent and 30 percent of Iraq and Afghanistan veterans screen positive for PTSD, though a number of mitigating factors make it unclear whether PTSD is more common among veterans of these wars than previous conflicts. It is also unclear what percentage of veterans who screen positive actually seek out mental health services.

The role of the therapist under these conditions thus becomes helping law enforcement and military personnel metabolize violence that is accepted, prima facie, as justified.

What’s undeniable is that in recent years, there have been a number of attempts to encourage more veterans and police officers to seek out mental health treatment. The 2017 Law Enforcement Mental Health and Wellness Act, for example, directed the Department of Justice to report on mental health practices used by the VA that could be adapted for police officers, and allocated grant funds toward “establishing peer mentoring mental health and wellness pilot programs within state, local, and tribal law enforcement agencies.” In 2014, Congress designated the month of June “PTSD Awareness Month.” It is even possible that the throwaway line about therapy in Bad Boys for Life was intended to serve this purpose: the movie employed a police consultant named Dale Liner. The Iraq War-focused podcast Blowback recently observed that many of the films made about that conflict fall into the “shoot and cry” genre. This category of films—a term coined in Israel, where the genre is wildly popular—follows the psychological struggles of a soldier dealing with their trauma in the wake of war. As professor Gil Hochberg has written, these films have become just as much “about self-justification and the creating of a masculine, warrior subject.”

On the one hand, this change in attitude is inarguably a positive development. Everyone deserves mental health care, and considering how militarized and policed American society is, the need is probably greater than ever among victims of state violence and those charged with meting it out. At the very least, increased usage of mental health care by people in law enforcement and the military has probably reduced rates of domestic violence and suicide: both professions have high rates of both problems.

But the destigmatization of mental health among veterans and law enforcement belies a deeper issue permeating the entire structure of the American project. The United States, as it is currently constituted, requires huge amounts of violence domestically (on the part of police) and internationally (on the part of the military) in order to function. The role of the therapist under these conditions thus becomes helping law enforcement and military personnel metabolize violence that is accepted, prima facie, as justified. Of course police will have to occasionally discharge their weapons or perform chokeholds, resulting in the injury or death of others. Of course the military must go into Iraq to do foot patrols, and in some cases must kill people there. After police officers and soldiers become traumatized, they can seek out therapy to help them get over their trauma in order to continue their work with minimal psychological damage. In the therapeutic context, it is rarely questioned why such traumatizing work exists in the first place.

Therapists, myself among them, work with all kinds of people, from all lines of work, participating in or caught up in all sorts of systems. I’m not saying that we should refuse to work with clients in the military or in law enforcement. But we should recognize that the work of therapy under American empire is full of paradoxes.

In most states, therapists are mandated reporters, meaning that we have to tell authorities if we find out that a client plans to harm themselves or others. What should I do if a police officer client is taking a course in Killology, named for the “philosophy” of Lieutenant Colonel David Grossman that promises to turn law enforcement and military personnel into more effective killers? Should I report the client to the authorities? What about a soldier who is reading Grossman’s book On Killing before deploying to Afghanistan?

And what about the trauma experienced by the victims of this violence or their families? Victims of police violence—never mind military violence abroad—are often poor, and the cost of mental health care can be prohibitively expensive without some kind of settlement. Hypothetically, laws could be passed giving victims of these incidents access to mental health services to work through their trauma. But while this might help assuage individual suffering in the rare cases where police misconduct is formally recognized and punished, it would also give an artifice of fairness and health to a fundamentally violent and unhealthy endeavor. Imagine if American therapists were deployed to the Yemeni wedding targeted by an airstrike in 2018 to help surviving guests “process” the drone bombing.

What does it mean to help people healthfully assimilate into a sick society, whether they are armed agents of the state or otherwise?

And what about the secondary trauma created by living in a society permeated by violence? Watching videos of police shootings at home and bombs dropped abroad is a public health issue. If you’re Black and you watch a video of a police shooting, you’re likely to be filled with anxiety about your own safety, or even symptoms similar to those of PTSD. If you’re white, I suspect you might feel guilt that these acts are being committed for your supposed benefit (especially given what researchers know about moral injury). And all of us, to a certain extent, are complicit in this violence, in that it is paid for with our tax dollars. I know I feel complicit, and I barely believe in the politics of guilt.

The endeavor of providing therapy to the custodians and victims of American empire raises questions about the purpose of therapy itself. What does it mean to help people healthfully assimilate into a sick society, whether they are armed agents of the state or otherwise? How can trauma acquired from the way our society is structured possibly be resolved in the therapist’s office if the material conditions outside of it remain unchanged?

In his book Achilles in Vietnam, Dr. Jonathan Shay, a psychiatrist working with Vietnam veterans at a VA clinic in Boston, writes that PTSD has a significant moral component. In order to adequately treat PTSD, he argues, it is important for therapists to help their clients work through moral questions about their experiences. Shay’s insight is a start, but therapists and anyone concerned about mental health should also join with social movements trying to end American imperialism. In order to create a less traumatized society, we’ll have to create a less violent one. But that work will need to be done off the couch.