Clinical Anecdotes: A Painful Lack of Wounds

Colin came to me complaining of depression, which started after he got back from Iraq in 2005. Although he had served in the National Guard, he volunteered absolutely nothing about his time in Iraq as we spoke, instead focusing on other factors, like problems at his job and a family history of depression.

Colin's depression seemed serious but not severe. He had been functioning fairly well at work and was not suicidal, although his home life had begun to suffer. As the interview proceeded, I myself fell into Colin's blind spot, all but forgetting his tour of duty as I forged ahead with my list of questions. My avoidance was conscious at first, a deliberate reluctance to come across as one more morbidly curious onlooker recklessly inflaming the wounds of war.

When Colin complained of irritability, however, and being kept awake by sinister, shadowy “flashes” at night, I knew I had to ask about Iraq. He was probably suffering from post-traumatic stress disorder, I decided, and was thus trying to avoid the very memories that were haunting and hunting him. And for fear of retraumatizing him (if not suffering second-hand trauma myself), I had colluded in his denial.

So when I finally got around to asking about Iraq, I fully expected to hear horror stories, half-articulated perhaps, but all the more grisly for the graininess of their images. Instead, Colin surprised me. He had not experienced anything he considered traumatic. No bombs, bloodshed, or shattered bodies. And in fact, he felt like a “wimp” for having been assigned to a noncombat detail where he missed what might have been his last, best chance “to be a hero.”

Most of us would consider this a good thing, but in Colin's case, it had left him feeling somehow uninitiated, like he had not done his part or proven his manhood. Contrary to my assumption, it was the lack of trauma that seemed to trigger his depression upon returning from Iraq. In a relatively safe homeland, rife with middle-class comforts and lacking all but metaphorical rites of passage, perhaps we all feel this way at some level.

I pointed out to Colin that people have been dying everywhere in Iraq and under all different circumstances, not just combat. From my stateside perspective, just being there is brave. Although I meant to honor him, he seemed to take my offering as more evidence of his failure, reassuring me that nothing he did could ever compare with the unspeakable horrors endured by veterans of Viet Nam and World War II.

Now, as a civilian, he questions whether or not he would respond with sufficient ferocity if, say, he had to defend his family against an attacker. Although powerfully built, Colin (to his credit) has never been a brawler or a bully. Nonetheless, I have no doubt he could do whatever it took to protect his family. What concerns me more is the opposite: That in trying to prove himself, he might unwittingly put himself and his family in harm's way, if not hurt someone who was never really a threat to begin with.

With a new family member, I too feel the burden of hypervigilance. But although terrorists, serial killers, and gangs grab headlines, activating our visceral alarm systems, data from the Centers for Disease Control and Prevention suggest that a sedentary lifestyle still exacts a higher death toll among white American men, like Colin and myself. Although the effect of inertia on the body has been discussed extensively, its impact on mental health has received relatively little attention. Maybe for a creature who evolved on the African savannah, competing over territory and trying not to get eaten, the absence of a visceral challenge can be as debilitating as too much of one.

Colin seemed receptive to my concerns, which I took to be a good sign. Although insecure men are quick to fear emasculation, Colin did not seem to be the least bit threatened when I suggested a course...