Please update your flash player...

Filmmakers Interview

"If there's one searing lesson in making this film, it's that PTSD is definitively connected to waging war."

HBO

What sparked your interest in the project?

Ellen Goosenberg Kent

When we variously were working on 'Alive Day Memories' we began to see that there were not only very severe physical injuries but also psychic wounds that some of these men wanted to talk about. For them, it was really hard to talk about and, in fact, they were embarrassed to talk about it. We all had it in the back of our minds that this was an important problem and then when we all began to read about the increasing and alarming suicide rate among veterans from Iraq and Afghanistan, we realized this was a pressing issue we should look into it.

HBO

At what point did you decide to focus solely on American soldiers, and why the period 1861-2010?

Jon Alpert

It could have been any war. I was listening to the BBC two nights ago and they were talking about the famous Charge of the Light Brigade. It was an account of an observer and the survivors and they were talking about the post-traumatic stress -- although they didn't know it at the time. We could have covered any war, but these were where we had the best documentation.

HBO

Between this, 'Alive Day' and 'Section 60,' what is it about the plight of the soldier that continues to interest you?

Matthew ONeill

The Iraq and Afghan wars are not just the longest wars in American history, they are being fought disproportionately by a very small number of people. The burden is being borne by that small number and their families and most Americans ignore it because it's not touching them directly.

Jon Alpert

But we can't afford to ignore it any longer and we're going to have trouble affording treating this. The government has made a commitment to recognizing and treating PTSD and has also recognized the numbers of people suffering from it; it's in the many thousands. It's not an easy illness to treat, it's not easy to treat quickly and the American citizen will be paying for the cost of this treatment and should be paying for it.

Matthew ONeill

It's important to acknowledge that the cost is bigger than just psychiatric care borne by the Department of Defense and Veterans Affairs. We're talking about a burden on the criminal justice system -- the number of veterans getting involved in crime because of PTSD or combat stress. We're talking about the cumulative effect on the children and wives.

HBO

So just why has it taken so long for PTSD to be taken seriously?

Jon Alpert

The easiest answer is that there is a stigma for all mental illness that runs through society. It's especially acute when you're dealing with macho culture that had treated mental illness as a form of illness.

Ellen Goosenberg Kent

Vets themselves have not wanted there to be a big focus on PTSD and crime, because they're concerned it makes them unemployable. It's a genuine concern, but it's a double-edged sword. If we dont recognize it for what it is, then the people who have sacrificed for us never receive treatment they deserve.

HBO

Did you have any trouble getting access to any of the doctors or General Chiarelli?

Matthew ONeill

We had immediate cooperation. The only thing you don't really see is people receiving psychological care because we focused on personal narratives of post-traumatic stress and combat stress.

Jon Alpert

There's also a great respect for Jim Gandolfini and when he comes knocking, they're more than happy to open the door. In terms of making the documentary, his participation was very important for shortening the amount of time it takes to get people to really reveal some of the things that under normal circumstances it will take filmmakers some time to get to start talking about.

James Gandolfini interviews Gen Chiarelli

HBO

The documentary spends a lot of on Angelo Crapsey  how did you come to know about him?

Ellen Goosenberg Kent

That was Caroline Waterlow, our co-producer for archival research. We wanted to look at the Civil War and it was important to find a first person account. There was a treasure trove of pension reports, which was a way that families of veterans could apply to the government for money but these reports are legal documents, and are not terrifically compelling. Angelo was someone who not only wrote to friends and family throughout his war experience, but maintained a diary and his family kept all of those things and an archive of all his writings, photographs. It was one of the best documented stories that we could find.

HBO

How about the other vets?

Matthew ONeill

We all worked on different aspects of bringing these stories out, some came from cold calls, news articles, others came from friends of a friend of a friend. For example, Nate Damigo was not a story we had researched on our own, but in speaking to parents of another incarcerated vet who for various reasons couldn't be filmed. They suggested we talk to Sharilyn and Mike [Damigo] because they knew them through this support network of incarcerated veterans. That there's a whole network dedicated to helping family members of veterans in the criminal justice system, it shows you the scope of the problem.

HBO

How unique are these experiences? Are career soldiers affected differently than draftees or reservists?

Matthew ONeill

If there's one searing lesson in making this film, it's that PTSD is definitively connected to waging war. You're a six-time deployed Marine, youre a volunteer, or a draftee, whatever the reason -- waging war leaves psychological scars. Some people suffer after 20 years, and for some it's the first time they enter a combat situation. It's hard to say. One thing I took away was that there is no magic formula for PTSD. The only way to end it is to end war.

HBO

Does PTSD affect women in the same way?

Ellen Goosenberg Kent

You dont have to be an infantry soldier to experience or see horrific things in war. You see people in counter-intelligence, translators, medics, people who normally don't have these close encounters having experiences. They're men and they're women.

Matthew ONeill

There's a myth that you had to be sitting next to your buddy when he got blown up and died. It could also be the stress of being on a forward-operating base under the constant threat of attack. To be in the vicinity but not facing it yourself. You could be suffering even if there was no one traumatic event that pushed you over the edge. That's one important thing that the VA started recognizing: They used to require a precipitating event, and now you could have just served in a situation where it's reasonable to assume there was an event.

HBO

You talk to General Peter Chiarelli and discuss his mandate to address these invisible wounds. Do soldiers believe it's too little, too late?

Matthew ONeill

He has a difficult job because he's basically trying to turn around a battleship. Changing the culture of the armed forces is not something that happens overnight.

HBO

Are there any statistics on how effective this new philosophy is proving?

Ellen Goosenberg Kent

It's a little too soon to tell. There are probably some who maybe feel more encouraged. I think there have been a lot of disincentives to coming forward.

Matthew ONeill

When Jim talks to the two soldiers in Baghdad in a war zone, they feel comfortable talking frankly about the psychological stress they have been under. I think that's something new. The first time I was in Iraq five years ago and embedded there, I don't remember men having those conversations. In that way, the fact that they were willing to discuss this with Jim and each other shows that it has trickled down to where it's okay to discuss these issues.

"One thing that comes out repeatedly is a call for decompression help when service members come home, that they not be thrown back without a time to process what happened and/or some training or therapy to make that transition back to civilian life."

HBO

Are mental health professionals available overseas?

Jon Alpert

Jim saw them in action in Afghanistan and Iraq. The Army is working on this and I imagine other branches of armed service as well.

HBO

Is the burden on soldiers to ask for help or for commanding officers to recognize they need help?

Ellen Goosenberg Kent

One thing that comes out repeatedly is a call for decompression help when service members come home, that they not be thrown back without a time to process what happened and/or some training or therapy to make that transition back to civilian life. That to me is the biggest unaddressed issue. It seems to be called for repeatedly by the soldiers and the parents in the film.

HBO

You focused mostly on the Army experience. Do these stories apply to other branches?

Matthew ONeill

That's because the Army absorbed the brunt of the combat across these two current conflicts and they're the biggest. But across all the armed forces, they're wrestling with this.

HBO

The movie was recently screened at the Pentagon.

Jon Alpert

None of the families featured in the film thought that their stories and their concerns would be heard from the top military brass. I have heard from every single one of them how much that it meant to them that they were able to talk about what they were suffering and try to change the policy with the decision makers in the room.

Matthew ONeill

Medal of Honor recipient Paul "Buddy" Bucha spoke on the panel after, and emphasized that the psychological well-being was as important as physical. That was totally unexpected -- Medal of Honor winners are the toughest of the tough and to hear him talking about his own experience with PTSD and emphasizing everyone needs to seek help really struck me.

HBO

Are you familiar with the New York Times' series linking veterans to violent crimes after returning home?

Matthew ONeill

Violent crimes falls into "it bleeds, it leads." Other numbers that are important to look at are motorcycle deaths or car accidents for veterans. One mother pointed out that her son had $12,000 of speeding tickets, and when she talked to other parents of veterans, it was the same thing. These risky behaviors -- binge drinking, high impact physical activities -- there's something about the heat of combat that doesn't leave you.

HBO

Nathan Damigo is a tattoo artist, Noah Pierce wrote poetry, Akinsaya Kambon draws and paints, is it just coincidental that they all have creative outlets?

Matthew ONeill

Many of the vets wrestling with PTSD that I interviewed have some sort of creative outlet to manage their PTSD. In part because of certain trends in therapy for PTSD, but also, you need something to distract you from these haunting memories. Picking up a tattoo machine is better than a bottle of Jack Daniels.

Wartorn 1861-2010