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PTSD

Jerry Rutigliano and Dr. Gerald Levine

©2014, Aaron Elson

In 1994, with the 50th anniversary of D-Day approaching, I suggested to my editors at the Bergen Record that I look for an expert in post traumatic stress syndrome. My search led me to Dr. Gerald Levine of the VA Hospital in East Orange, New Jersey, and to one of his clients, Jerry Rutigliano of Hackettstown, New Jersey.

East Orange, N.J., May 1994

    Aaron Elson: I'm looking for information on post traumatic stress as it manifests itself in World War II veterans.

    Gerald Levine: PTSD became part of the diagnostic nomenclature around 1980. A lot of the World War II vets did experience symptoms. They tried to normalize their symptoms, they thought that everyone had those symptoms, and they didn't really know that there was help to be had or how to go about getting it. So I think the label PTSD legitimized it as an impairment.

    Many of them, early on, report a lot of anxiety related problems. Problems falling asleep, problems staying asleep, intrusive memories of their war experiences, nightmares, these are all reexperiencing phenomena. They would have intrusive thoughts, nightmares. To a lesser degree I hear about flashbacks, not real sustained flashbacks, but with a flashback what happens is that something can trigger it, a smell, a word, a sight, even something symbolic like an anniversary, and for the moment the person is transported back to the scene of the traumatic event, and they forget where they are. These flashbacks can last for a second, or they can go on for hours. But we see that a lot more in Vietnam vets than we do in World War II vets.

    Aaron Elson: Why do you think that is?

    Gerald Levine: I'm not sure. It may be that theyíre closer to the event even though this is 20 years later, but it may be something that recedes over time. That's one possibility, that some of the reexperiencing phenomena, they just somewhat decrease over time, that's probably the more likely thing.

With Vietnam vets weíve seen a greater degree of anger and mistrust than World War II vets. I think part of that is due to the fact that with World War II there was a clear moral right and wrong, and with Vietnam the country was very divided about our presence in Vietnam. And many of the people in the country didnít separate out the war from the warrior, and so treated the homecoming Vietnam vet in a rejecting way. So a lot of Vietnam vets came back feeling like they were betrayed after serving their country, and that sense of betrayal led to mistrust of authority, and a feeling of real hurt and rage and bitterness. We donít see that in the World War II vets, and it may be that they won a war, and they were received as heroes.

    Aaron Elson: One thing Iíve noticed in the interviews Iíve done is that these men cut off their feelings, and they almost were aware of it. They couldnít feel anything after a certain point. And yet they did have feelings. if a friend was killed, they would still be overwhelmed, but in order to go on, they would see things, and it would almost be like looking at a photograph. Itís hard for me to conceptualize because I never was in a situation like that. How does that affect someone?

    Gerald Levine: It's called emotional numbing, and it's a very common feature of PTSD. What happens often is that a person feels alienated. They have great problems with intimacy, great problems feeling softer, more tender emotions. Often the only feelings they can feel are more intense feelings of rage, and when they're very stimulated, like a lot of vets who are numb are drawn to more daredevil activities as a way of feeling something. And now actually there's some important research going on, we don't know whether that numbing is due to a natural occurring opiate which is released in the body, and some of the drugs that are being explored are opiate antagonists. One of our psychiatrists is involved in that research. It's in an experimental stage, but the fact is that this is a very common complaint, and it's a common complaint of the families, that these men are cut off from their feelings. They say that they just can't feel closeness for anyone, they can't really be touched, although when they talk about World War II vets and losses there, they get very flooded emotionally. Somehow that overwhelms them.

    War is one of those experiences that most people, unless you've been in war, you don't have a parallel experience to relate to, and a lot of combat vets, whether it's World War II or Korea or Vietnam, they feel that either there's not going to be an interest in what they have to say, or they'll be judged by their activities, or they're just simply not going to be understood, so there is a lot of withholding. I think as the World War II vets are aging and they're becoming more aware of their mortality as they see their numbers decrease, I see them reaching out more and feeling a need to talk more about their experiences with their families.

    I at one point was co-leader of an ex-POW group here. We thought, we didn't get it off the ground, of doing oral histories, videotaping some of that. But I think it's very important that that generation bear witness to their experiences and pass it along to the next generation.

    Often the stories are very painful. There's a lot of avoidance in recounting painful material, at least that's what we find here.

    Aaron Elson: Often when they have told the stories they seem relieved.

    Gerald Levine: Sometimes they've never really told it. Part of the therapeutic task, the kind of therapy you do with people who have been through these kind of traumas is, you're not a removed kind of therapist, you have to be active and engaged and very real. And you simply follow their lead. Some people would call it a kind of dosing model, or they gradually tell more and more as they're comfortable. You certainly don't push it with someone in over his head, but the aim is that the emotion that surrounds the event gradually gets neutralized as it is retold. That seems to happen. It doesn't always happen, but some of the charge is taken out. Especially when there are some feelings of guilt associated with the event.

    We see two types of guilt. We see survivor guilt, which is usually associated with the loss of a buddy. During war people develop close attachments and then when someone close to you dies, it's more than a feeling of sadness over the loss, it's a feeling that perhaps you could have done something to prevent it. There's an almost mystical sense that if someone had to die, why was it that person and not me, if that person had lived they would have done something more worthwhile with their life than I'm doing with my life, so it just shifts their sense of the world, so there's that kind of guilt. With survivor guilt you get a depression and a sadness, and part of the task is to help the person separate that you can be sad for someone else and at the same time be happy for yourself, you don't have to hold yourself hostage from experiencing joy in order to keep the memory of that person alive. So there are those issues. And then there's the kind of guilt that you might call moral guilt, that people violate values that they've grown up with, and they're involved in killing. That's very different from hurting someone's feelings, or the kind of neurotic guilt that therapists usually see. So that's always a struggle.

    Aaron Elson: Some of the World War II veterans seem to compartmentalize their life. There was the period before the war, there was the war, and there was after the war. Many have had marriages that lasted 50 years and been exemplary family men, whereas the next generation has been full of divorce. Does this tie in to their experience during the war? Did that make them value family more than the next generation?

    Gerald Levine: I don't know that the war relates to that. I will tell you that a lot of them came back feeling that now they were back home and they had to get on with life, and they really did throw themselves into work and raising a family, and that distraction really, in many ways, made them not address the kinds of symptoms they were experiencing. Now we're finding that as men retire and they don't have the same activity level, some of them are having a recurrence of the PTSD symptoms. And we think that some of it is that their daily structure is not competing with those thoughts, they have more unstructured time, and so there's more reverie about the past. As far as the divorce rate and all that, I think it's probably more a comment on shifts in cultural values. I mean, certainly people who served in the war, many of them take fewer things for granted. That is one of the lessons or gifts they take from the suffering that they went through, so there often is a greater appreciation.

    Aaron Elson: Can you give me a couple of examples of people youíve treated who have developed symptoms after retirement?

    Gerald Levine: Last week I saw a World War II veteran who was a pilot whose brother died, his kid brother died in World War II, and he still carries that grief with him, and it's very raw. With the approach of D-day and the approach of the anniversary of a lot of events, itís triggering much more intensely a lot of memories. I think last year the guys who served in the Pacific theater were experiencing some symptoms with the anniversary of Pearl Harbor, so some of it is an anniversary reaction. Some of it is that the whole issue of mortality stirs up a lot of feelings. Wanting some sense of closure, everyone has that, it may be, I have found with some World War II vets, they are sharing experiences that they have never shared before, because I think that they are aware that their time is more limited now, and there is a greater need to share.

    Aaron Elson: What makes someone in that position seek treatment?

    Gerald Levine: First of all they're informed that treatment is available. I think we need to get the word out, especially to the Persian Gulf vets, but usually itís an exacerbation of symptoms. Usually with World War II vets itís anxiety related symptoms or depression, itís often depression. Medication is really an important component of our treatment.

    Aaron Elson: When you say anxiety related symptoms, here you have a guy who was in World War II, basically went his whole life without recognizing symptoms...

    Gerald Levine: They often recognized them.

    Aaron Elson: Or concealing them, because they didn't feel it was manly, or right.

    Gerald Levine: That's a good point, that while they were proud of their record in the service, they didnít feel that it was manly to seek treatment. I mean, there is a whole thing about self-reliance and dealing with things on your own, and I think that some of them, as we've begun to understand more about PTSD, the people providing treatment are more responsive. Some of them felt unresponded to when they did seek treatment in the past. So there's a greater awareness of people providing treatment as well. At this point, many of them are having a great degree of anxiety and pressure, sometimes nightmares.

    Aaron Elson: Sometimes during an interview the person will say, "I had a nightmare once, but only once," or once or twice. I get the feeling that they had them more, but they were minimizing it.

    Gerald Levine: Well, it's on a continuum. We get people with nightmares several times a week, we get people with nightmares once or twice a year, thereís a difference between nightmares and night terror. Some people have night terrors which occur at different stage of sleep, and the person might not have a recollection, but often itís their spouse or their bed partner who will say that the person was shouting or flailing around and was very agitated. And the individual himself, striking out, defending himself. So itís often at another stage of sleep.

    Aaron Elson: What are some of the nightmares like? Are they related to specific incidents?

    Gerald Levine: Some of them are actual replays, reliving of events. Sometimes theyíre not. Theyíre often about vulnerability, being under attack, either feeling helpless to defend oneself or trying very hard to defend oneself. The man whoís here today, I think heís had some interesting dreams which he could tell you. He was a pilot, and he had recurring dreams about one more mission, being called for one more mission, so I would suggest that you speak to him.

    I also wanted to say something about some of the issues with the Gulf War. Weíre finding that thereís a great concern about health. There are a number of differences with the Persian Gulf War vets. It was the largest callup of reservists, I think 18 percent of the people called up were reservists, 50 percent were reservists and National Guard. And often these people had civilian lives, and their lives were disrupted, so we're finding greater family problems with that disruption. There was a concern that Iraq would use biological or chemical warfare, so a lot of the vets were inoculated, and also took pills. Now it turns out that some of those inoculations had not been FDA approved yet, they were still in an experimental stage, and they produced their own effects. So the veterans are concerned about the effects of the medications. There is some question about whether in fact biological warfare was used and whether they were exposed. The oil refineries were burning, and they certainly were exposed to burning fuel. So thereís an uncertainty about their health, and they also have the usual PTSD symptoms of some nightmares and vulnerability and anxiety, and vigilance. Weíre first beginning to see this emerge, although certainly apparently something like 34 percent of Persian Gulf veterans have some distressing symptoms, and 9 percent are diagnosed with PTSD.

    Aaron Elson: One other thing, have you seen people who cracked under pressure, like combat fatigue, and later lived normal lives?

    Gerald Levine: I think you can make a distinction between acute trauma and post traumatic stress. Many of the vets who had what they called shellshock, which really was acute trauma, did not go on to develop PTSD.

 (Jerry Rutigliano enters)

    Jerry Rutigliano: You're with the Bergen Record? I miss that paper. I lived in Bergen County for 25 years. I moved to Morris County, in Hackettstown. You canít seem to get the paper out there. We get the Star-Ledger.

    Aaron Elson: You were a pilot?

    Jerry Rutigliano: I was an aerial gunner, on a B-17.

    Aaron Elson: Is that your unit, the 381st?

    Jerry Rutigliano: Right. This was written by the chaplain, Dr. Brown. Actually itís a diary of every mission they went on, shot down, captured, killed, POWs like I was. Iíve got a page, where was the invasion...

    Aaron Elson: You were in the invasion of Normandy?

    Jerry Rutigliano: No. This is a listing of every mission that the group went on, and the dates, and the city. The yellow is the missions I went on. And these two are D-Day. I missed D-Day. I was on my 27th mission when we got shot down. See, what happened, when I first got there you had to do 25 missions, and Jimmy Doolittle took over in January or February of í44, and my first mission was in February of í44. We got halfway through, and he raised it to 30 missions, and we got shot down on our 27th. I was a POW for eleven and a half months.

    Aaron Elson: Twenty-seven missions was a lot more than the average, wasn't it?

    Jerry Rutigliano: The life expectancy was less than half of that. But the odds against making 25 missions are right in the front of the book, about five to one.

    Aaron Elson: You were a tail gunner?

    Jerry Rutigliano: I was a waist gunner. We were in the middle of the aircraft. We used to have 10-man crews, two waist gunners, then they cut it down to one waist gunner, when the fighters werenít as thick as they used to be. On our 27th mission we were leading the squadron over Berlin.

    Aaron Elson: Over Berlin?

    Jerry Rutigliano: Yeah, I had six trips over Berlin. The first Berlin raid was March 6, 1944, we lost 68 bombers. That's 680 men. We made it through that mission. We stayed down on the 7th, and went again on the 8th of March. We lost 37 more bombers. And then on the 9th of March...

    Aaron Elson: This is like history. I've seen this on documentaries.

    Jerry Rutigliano: I had six trips over Berlin. The sixth trip was May 19, which was a couple of days ago, 50 years ago a couple of days ago. May 19, 1944, we were leading the squadron. We turned on our IP, our initial point. When you turn on the IP, you have to stay straight. The bombardier takes over, and there's no way you can go but straight ahead. No evading flak or anything. You had the bomb bay doors open. We got two direct hits in the bomb bay. And I was in the waist. The plane caught fire.

    Aaron Elson: Where is the waist in relation to the bomb bay?

    Jerry Rutigliano: Midship, not far from the bomb bay. The bomb bay was between the pilot and the radio room, and we were behind the radio room.

    We peeled out of formation, but we couldn't get out, we were on fire. Our intercom was shorted out. And our alarm bell was out. Later on I found out that everybody went out the front, the pilot, co-pilot, navigator, bombardier, and engineer. And the radio operator turned to me and said, "Help!" I could see the blaze from the bomb bay. So just before I went out, I couldnít get the tail gunner, so I kicked the door off, and it went flying back, he saw the door, and he started crawling into the waist. The ball gunner, the guy in the lower ball, he came up, he was in a bit of a panic seeing the planeís on fire, and through lack of oxygen he collapsed.

    I had my chute on ready to go out, and I saw him laying there. So I went back, and me and the tail gunner revived him, and put oxygen on him. We smacked him, revived him, and we went out, one-two-three. The plane exploded. And a fellow who used to be in my crew was flying in another plane, he told me many years later that he told the tail gunner to keep an eye on our plane, and the tail gunner told him that it exploded and nobody got out. That's the way it appeared to him.

    So the pilot ó I didn't see him until 35 years later ó told me the navigator's parachute didnít open, and he was killed.

    I was captured by civilians. They beat me up.

    Aaron Elson: Really?

    Jerry Rutigliano: Well, some other fellows were shot, by civilians, and hung.

    Aaron Elson: By civilians?

    Jerry Rutigliano: They didn't like us. And when they got us, they said, "Youíre bombing the women and children." Thatís what they said we were doing. Then I went to a local prison, the soldiers took me down there. Itís a long story, I don't want to go too long.

    Aaron Elson: Where did you land?

    Jerry Rutigliano: Right in a farm. The civilians beat the hell out of me. First of all, I was running. I hit the ground hard and I had hurt my ankle. I was running away. It was a bright day like today, it was May 19th. I hit this plowed-up field, and I started running away from the farmers who were chasing me with a dog, when up out of the wheatfield pops this German with a big rifle, and a big mustache. He was gonna shoot. I had my hands up. And he told me to walk towards him. So I walked towards him. He searched me. He asked if I had a pistol. I said no. We werenít allowed to carry pistols anymore because the civilians were shooting the guys with their own pistols. We used to carry .45s. So by the time I'm talking to him, the civilians catch up and they start beating me. Then the soldiers came, and they took me to a prison.

    Aaron Elson: When they started beating you, where did they hit you, in the face?

    Jerry Rutigliano: In the face, the hands, they were swearing at me. I was a rough kid from New York, in fact I was just 20 years old the week before, I went on my 25th mission on my 20th birthday, it would have been a big surprise for me to go home.

    So I got down in this prison, and they came to take us out, and we saw a couple of other crew members. My co-pilot had a hole in his leg. He was bleeding. So they told me to pick him up, and I picked him up and carried him up this narrow stairway, one time I hit the wall with his leg and he started screaming, so they put him in the back of a truck and I told them to get him to a hospital. That's the last I saw of him. I went to Tempelhof Airfield, on the ground, there were about 50 other GIs there who were shot down. To make a long story short they took us by train to Frankfurt, interrogation, solitary, threatening, we got on a train and went to Grosteitschau, which is near Danzig, up in Poland. On the way up there we stopped, the air raid alarm sounded, we were locked in the train, the air raid alarm sounded, and we were out there. The guards took off and went to the air raid shelter, and we were in a marshaling yard in broad daylight, and they started bombing. Our own planes. Fortunately we were not hit.

    Aaron Elson: What went through your mind, being on the receiving end of a bombing like that?

    Jerry Rutigliano: There's nothing you can do. You can't scream or holler, "Let me out of here!" You just have to sit there, and you hear the flak going, bouncing off the roof of the train. So that was one crisis. Then after the all-clear sounded we went up to Poland, to Grosteitschau, Stalag Luft 4. They must have had over 50,000 Air Force POWs. They shot down like 4,000 airplanes.

    We stayed there for nine months. And the Russians were coming from the East. So they told us they were going to evacuate the camp, and we were going to march for four days, to another camp. It was Feb. 5, 1945. So we took everything we owned, which wasn't much. We took what food we had, and started marching. We marched 86 days. Five hundred miles, in the snow, rain, sleet. Crap. We lived in barns. We slept on the ground. We lived like animals. Eighty-six days we never had our clothes off. We wore the same clothes, were lousy from head to foot, full of lice. We went through bombings, strafings. Part of that time we went on a train, there were 57 of us in this train, freight trains, we all had dysentery or diarrhea. There were no toilet facilities, of course. Half of us had to stand up and half of us had to lay down, we couldn't all lay down. And we did what we had to do to relieve ourselves. As I said, we had dysentery and diarrhea. They wouldn't let us out.

    We got out of that, and we marched, from February 5th to April 25. They never marched us at night, for obvious reasons, because there were about 4,000 of us in this march, all Americans. We marched to this roadblock, with SS troops, we marched through the roadblock. They put us in this field. We saw German soldiers on patrol. They had switched guards on us. They gave us the old Wehrmacht guards, old men, home guards, in their sixties. They told us, you're gonna sleep here tonight on the ground, you're gonna get up tomorrow, you're gonna march eight kilomters, that's around five miles, to the American lines. They didn't want to have anything to do with the Russians. We thought they were full of baloney because we couldn't believe anything they said, we didn't believe anything by this time. You can imagine what we looked like, all of us 20, 21 years old. I lost 80 pounds. We ate out of the ground, raw potatoes, raw kohlrabes. Turnips. It got us sick but it kept us alive. Dehydrated sugar beets, anything we could get our hands on.

    We were bedded down, and they said you're gonna march to the American lines tomorrow morning. To make a long story short we got up, we started marching, and sure enough, we saw an American jeep, a GI, and a rifle, First Army, 104th Infantry, the Timberwolves. We naturally went nuts. There was a major there who shook hands with everybody. So we marched across the Elbe River, and we were liberated. We had K rations. Which to us was like a steak dinner. We went back for seconds on K rations. The rest was all history, we finally got a shower, a bath, clothes.

    Aaron Elson: What happened to your guards?

    Jerry Rutigliano: They became POWs. They werenít the bad ones, the old men, like I am now, 70 years old. We had some bastards in there, but that's something else.

    Aaron Elson: Dr. Levine said I should ask you about the dreams youíve had. He said you described one nightmare in particular about going back, being assigned one more mission.

    Jerry Rutigliano: Oh yes, for a long time I was in a barrack and they awaken us, at one or two o'clock in the morning. They say you're going on another mission, last mission, and we get in the plane, and we always crash. We never make that mission. I used to dream about this all the time. In the beginning, I dreamt of it constantly. In fact I used to wake up screaming sometimes. My wife says last night I kicked her, screaming.

    Here's a crucifix my mother gave me. I carried it on every mission. I never left the ground without it. And this part that's holding it together is from an old Klim can, that's milk backwards. When the Germans caught me, they examined this, they thought it was something to do with spying.

    Aaron Elson: You were a sergeant?

    Jerry Rutigliano: A staff sergeant. Hereís a picture of the first day we were liberated, in Bittesfeld, Germany. I weighed about 115 pounds, from 185. Here's a couple of days later, after we got a change of clothes. Thatís at Hermann Goeringís airfield. And thereís Jimmy Doolittle. That's me and General Doolittle in Washington, D.C.

    Aaron Elson: Did you ever forgive him for increasing the number of missions?

    Jerry Rutigliano: That's exactly why he sat me down. This was in 1976 at an 8th Air Force reunion in Washington, D.C., and I went to see him, there were a whole bunch of people to see him. I said, "General, do you remember when you raised the missions from 25 to 30?"

    He says "Yes." He was a little bit of a man.

    I said, "Well, I got shot down on my 27th. And I was a POW because of you." I was joking, really.

    So he said, "Sit down." And he put his hand on my shoulder. He sat me down, there's hundreds of people waiting to see him, and he's explaining to me why he had to raise the missions. He's a general. I became a little bit embarrassed. Here I am asking him, hereís a guy that took off from an aircraft carrier with no hopes of getting back for that Tokyo mission, he was a great, great, great general, a great soldier, I admired him, and I told him that. I didnít want him to have a guilty conscience.

    He said we needed experienced crews. He was apologizing. And he wouldnít let me go, I wanted to leave because it was getting embarrassing, people wanted to see him, and he kept talking to me. He just died recently.

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