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A War Doctor Turned Poet Treats PTSD with Literature

We spoke with war poet Frederick Foote, a neurologist who's making poetry a required course of treatment in military hospitals.

Rory Tolan

Photo of Fredrick Foote by Greg Dohler via Gazette.net

Gunners in Sevastopol, Ukraine, had unhinged the gates of hell on a battalion of British troops. On October 25, 1854, cannonballs flattened dozens of men a pop, and warhorses sank to their hocks in the splatter. When the smoke cleared 110 were dead, making the Battle of Balaclava one of the most notorious suicide missions of the Crimean War.

Six weeks after the massacre Alfred, Lord Tennyson, Britain's poet laureate, hailed the soldiers' valor in 55 lines of verse and enshrined them in legend. A tragic ballad with a biting sense of futility ("Theirs not to reason why, / Theirs but to do and die"), "The Charge of the Light Brigade" became the ambivalent banner cry of this and so many subsequent wars of questionable cause. But Rudyard Kipling's postscript to the poem, "The Last of the Light Brigade," written years later, went nearly unnoticed. His largely forgotten effort considered the battle's forgotten survivors, who, "limping and lean and forlorn," had inherited from their country nothing but shell shock, pained deformity, and crippling unemployment. Though Kipling wrote the essential poem about Crimea, Tennyson wrote the crowd favorite, as the public wants the battle but not the aftermath, like a child loath to clean up its mess.

If the war poet Frederick Foote has a mission, it would be to unite Tennyson's gift for elegy with Kipling's sense of debt. His debut collection, Medic Against Bomb, has enjoyed considerable acclaim since its quiet release last fall, receiving the Grayson Books Poetry Prize, earning applause from the National Endowment for the Arts and the Library of Congress, and being named by the Progressive as a best book of the year. An account of Foote's time as a US Navy doctor in Iraq and Afghanistan, the book is a tonic for the genre. A relic of the sickbay rather than the battlefield, it prefers the guts of war to the glory, lamenting the wounded on both sides with Hippocratic impartiality.

Like Kipling, Foote knows he is here not to eulogize but to heal. And his interest in the intersection of art and war doesn't end with his poetry collection. After studying humanities at the University of Chicago, Foote trained in neurology at Georgetown and Yale. When he returned from Iraq and Afghanistan he dedicated himself to finding new ways of treating veterans beset with brain injury and post-traumatic stress disorder. His approach has been auspiciously atypical. With military funding, Foote founded the Epidaurus Project, which researches and advocates the use of holistic medicine throughout the armed forces, and his writing group, the Warrior Poets Project, puts verse at the center of this practice. In other words, his writerly endeavors are inseparable from his pastoral care, devoted as it is to the therapeutic power of art. If his work as a poet focuses on the literature of medicine, his work as a doctor focuses on the medicine of literature.

I recently spoke with Foote to learn more about his efforts. What follows is a conversation on the value of war poetry, the healing power of literature, and his scientific research into art's effects on the brain and its place in the hospitals of the future.

VICE: Have you always written poetry, or did you find your voice on the front lines?
Captain Frederick Foote: I always wrote it, but more urgently after treating the wounded—both American and Iraqi—on the hospital ship Comfort during the 2003 invasion of Iraq. That was the origin of many of the poems in the book, which focuses on the wounded of the conflicts in Iraq and Afghanistan.

In a poem about the Comfort, you tell the detached, emotionally AWOL generals to "come live two weeks on our ward, with the harm we have here— / You'll be mutinous then—and as pacifist as we." Have you always been a pacifist? How has this complicated your identity as a member of the armed forces?
This is the place to note I'm retired Navy—after 29 years of service—and not a federal employee, so nothing I say represents the views of the US government.

In any case, my breed of pacifism is "Hate the war but love and honor the warrior." For now, unfortunately, we may need to accept the existence of conflict as necessary if we are to reach justice.

As Robert Gates has said, some of the biggest pacifists in Washington wear uniforms. I'm one of those odd, seldom-promoted intellectuals whom the military keeps on the shelf in case of need. When they needed new approaches for treating brain injury and PTSD—the main health problems afflicting veterans of the current wars—they dusted me off and put me to work at Walter Reed, our flagship military hospital near the capital.

The poems are consistently harrowing and pay particular attention to the anguish medics experience. Were these poems a way of coping with the trauma of war? As a doctor, did you intend them as a palliative for your brothers in arms?
Writing them was automatic after I got to back to the States. I needed to witness and interpret what I'd seen. I think it's really the truth that heals—for both reader and writer.

What's the role of the arts, and truth telling, in your clinical practice? How is your work as a poet related to your work as a neurologist?
I've been developing holistic, integrative medicine programs for the military since 2001. That year, I started the Epidaurus Project, which engages civilian experts to lend advanced health ideas to the military. It's paid off. My other big projects include the Walter Reed Arts Program, which we're now spreading into the veterans' community, and the $4 million Green Road Project, the nation's largest healing garden. Baltimore's Institute for Integrative Health, where I am a scholar, is involved in these efforts.

The Warrior Poetry Project is my small current piece of the Walter Reed Arts Program, which I co-founded in 2011. With the help of an extensive staff—including three paid coordinators, more than a dozen paid artists in residence, and many therapists and volunteers—nearly all our wounded warriors make art or music during their stay at Walter Reed. It has huge healing effects, especially in brain injury and PTSD.

So all inpatients at Walter Reed, which is the primary veterans' hospital in the United States, are expected to write poetry or produce other forms of art? And you see improvement in their conditions?
Absolutely. Making music seems to be especially powerful, but all the arts work. We are in the process of proving this by "hard-science" research. In brain injury and PTSD, patients routinely tell us that the arts program was the most helpful part of their entire therapy.

Why do you think the arts have been so effective in the veterans' hospitals? From Tolstoy to David Foster Wallace, countless writers have remarked on the therapeutic power of literature. Does having an audience—as veterans do in the journal you help edit, O-Dark Thirty—lessen their sense of isolation and make them feel that their suffering is shared? Does the focus of poetry, the act of distilling their anxieties into a concrete, innocuous form, offer a kind of exorcism?
We're doing research on that, but some clues emerge from what vets in writing workshops tell us. One said that writing about his experiences lets him control his memories, instead of their controlling him. Another told us that writing allowed her to put the painful experience away in a mental drawer, and only take it out when she wanted to.

You've written that Western medicine has been plagued by reductionism since the Enlightenment. At the same time that Descartes and Leibniz insisted on breaking the world into its constituent parts in philosophy, physicians began addressing the body in terms of its individual organs. Why is the opposite view, a whole-person approach, essential to treating conditions like brain injury and PTSD?
Conventional medicine treats a single-organ system with pills or surgery—the Cartesian approach. Holistic care refers to "whole-body" therapies, such as healing buildings, family engagement, integration of care, basic wellness (nutrition, exercise, and alternative medicine), and advanced wellness (use of nature, art, and spirituality in health care). I've done projects on all the above during my years at Walter Reed.

Brain injury and PTSD are whole-person disorders because they affect every aspect of a person's life and ability to function. In addition, medications and surgery—the main tools of conventional care—don't work well alone in brain injury and PTSD. The best care combines both approaches.

The arts have been especially useful—and will be pivotal in the hospital of the future.

You've done a great deal of evidence-based research into the neurological effects that literature and the arts have on suffering. What have you found?Holistic care has been neglected because it's hard to measure whole-body transitions from illness to wellness. In the Epidaurus 2 Project, conducted from 2009 to 2011, my colleagues and I identified several advanced metrics that seem to register those changes. These include studying patients through advanced genomics, integrated biomarkers of the stress response, language analysis, and several artificial intelligence paradigms.

Our scientists at the Uniformed Services University are applying these to assess the arts program, the Green Road healing garden, and other holistic projects on the Walter Reed campus. It's still early, but we expect to prove the healing effects of the arts and nature on the body—by direct measurement, not self-report—within five years. That will be a game changer—not just for medicine but for the environmental movement. Our culture's "war against nature," declared by Machiavelli 500 years ago, seems to be coming to an end in our time.

Is there any plan to implement this nationwide?
Many of these innovations—healing buildings and gardens, family-centered care, and arts and literature programs—are already spreading widely within the Military Health System and the VA. Many earlier advances in medicine—anesthesia, complex surgery, infectious-disease control—were pioneered in the military. I'm writing a book to explain what we've done at Walter Reed to a general audience. The next step is to go directly to towns and communities and show them how to heal their own veterans via locally managed arts and garden projects. I have funding to start this "Johnny Appleseed"–type work across Maryland in 2015–16. By doing a multimedia show of my poetry, I can educate and motivate audiences very quickly, bridging the military/civilian divide. Programs for healing are the result. Who can say where art stops and "real life" begins?