The political messages in Michael Moore's film are framed like the game where one connects dots and pictures emerge. The pictures are ones that have, in part, been supported by the reports from the 9/11 Commission about ineptitude, at best, and incompetence all round in foreseeing and then dealing with the events prior to the World Trade Center destruction. The dots also connect the deceit, double speak, and disinformation that preceded and have continued right along in the US/British war in Iraq. And don't forget oil, the lubricant of world money and power, and of the Bush family's longtime financial relationship with the Saudi ruling family and the Bin Ladens, who, it seems, were whisked back home to Saudi Arabia on the only planes in the sky, other than US military planes, 2 days after 9/11.
But I can't let go of the reality that I see the world as a doctor, and the scene that was most important and moving for me was a brief one in the rehabilitation unit of a Veterans' Administration (VA) hospital. A US serviceman who had lost both arms below the elbow tells the camera of the phantom pains he was experiencing and how upsetting they were to him, but how the docs gave him enough morphine to help the pain and he was grateful for that.
For 3 months in the fall of 1969 I had one of the best posts any medical student from the Midwest could imagine — a well-paying job as a research assistant for a VA clinical study, based at the VA hospital in San Francisco. One day, in the cafeteria, I met a quadriplegic army veteran who was a patient in the rehabilitation unit of the hospital. He invited me over to see where he lived and to meet some of his friends. Larry introduced me to a generation of soldiers who felt forgotten and shelved, from their families and from society. Like so many people one meets in a lifetime, especially a clinical lifetime, I was changed forever, and they are gone and I am left telling stories 35 years later. That scene from Farenheit 9/11 took me back to that desperate ward of disabled, angry, struggling vets from another war, Vietnam, which would affect my generation forever in ways that are again being acted out on the international stage. I didn't know what to do or say 35 years ago and I still don't today.
After Vietnam, the term PTSD (post-traumatic stress disorder) became a more common part of the medical lexicon. I have taken to asking men of a certain age, as part of a routine medical history, whether they have served in the military and if they had been to Vietnam. If they have, I ask them whether they have ever needed or received help with dealing with their experiences. Men being men, most have not. The doctor part of me realises that these denying Vietnam veterans left with their nightmares and depression will soon be replaced by the strutting, confused, scared American troops who Moore interviews in Iraq and the US. So, my new question for my 20-something patients and their 40-something National Guard age colleagues will be, ‘were you in the service, and if so, have you been in the Middle East, and if so, have you gotten help dealing with it?’
Farenheit 9/11 also shows the family-doctor viewer the next generation of patients and their families who will be part of our practices. The family that Moore focuses on in the film is from his home town of Flint. One of the things I respect most about Moore is that, despite being lionised at Cannes, he remains a man of Flint, Michigan, the industrial town abandoned by industry, but more an ‘all-American city’ than all the glitzy book-and-latte, or well scrubbed suburban towns that carry that label. When Moore speaks on campuses, he talks about Flint more than he does about his films. He seems to have been radically changed, at some point along the road, by a seminal encounter with unfairness toward his friends and neighbours, which continues to motivate everything else he has done since.
The family whose mother loses a son, and who sits and reads his last letter from the field, is a family of working people, mixed race, and with true grit, who have been believers, despite evidence to the contrary all around them, in the resilience of American communities. The mother works in a job training programme, having risen from unemployment and welfare to being a supervisor. And she, like many parents around the world, encouraged her children to join the military as a way of paying for an education and gaining skills and experience while being of service. Neither she nor her family expected that service would include a downed helicopter in Baghdad.
The 20th century was full of novels and films of lives shattered by wars, since there were so many wars and so many individual and family lives that had been affected by them. Sadly, rather than making serious ongoing efforts to open communities to the physical and psychological needs of survivors, society seems to pay tribute to disabled veterans with a yearly parade, and, in the US at least, discount rates on automobile licence plates.
It is not because the VA health system doesn't try to address the needs of veterans, but because, like so much of public sector healthcare in the US, it is grossly underfunded and looked on by mainstream medicine as a venue for doctors who couldn't quite make it in the real world. The wealthy can get virtual colonoscopies and Botox on demand, but there are not enough rehab centres in the downsized VA system for the new ‘consumers’ coming back from the Middle East. Those with physical damage will undoubtedly get care, since the VA system has waiting lists and capacity issue. Those who come back ‘whole’ will return to their ‘usual source of care’ and that means us in the community. I will start seeing these guys at some point. I am glad to see them, frankly, since it is one way that I can help and apologise to myself for the insanity that we in the US have, once again, brought on ourselves. This time, I will be with the veterans for the long haul and maybe feel a bit less embarrassed about how relieved I felt, in 1969, to be leaving the San Francisco VA and shutting it out of my memory.
- © British Journal of General Practice, 2004.