S6E6: The Impact of War on Medicine and Identity

Margaux: Harjit, can I share your exciting news? I'm so excited.

Harjit: Oh, yeah. I think you could share it. I feel like people know.

Margaux: People know, but not our listeners. I don't know. I'm just excited.

Harjit: Yeah, I don't think I told Hạ either.

Margaux: Well, everybody, Harjit was voted to be one of our psychiatry chiefs for next year. I'm so excited. And obviously, she's an amazing choice. And I'm very excited.

Harjit: Yeah, it was exciting news. It was funny running for an election. But I was also co-assistant chief, so it was helpful. I feel like I was building my platform for a whole year.

Hạ: I feel like a lot of the Bundles keep getting their glow-up, finally getting to live our cool high school dreams.

Margaux: Yes, and getting a little bit more of space and a power seat at the table to make some radical changes maybe.

Harjit: Yeah, hopefully, I'm really excited. I think in my speech, I said something about I hope to close the gap between the illusion of power and real power. Because I think it's always hard when you're in positions that give you a platform and a voice, and being able to utilize it properly is really difficult.

And so I'm excited about chief resident, but I'm also nervous because I always want to do a ton. And then I need to remember that I need to pace myself. I have a hard time pacing myself because I get too excited about stuff.

So if you've been listening to "Bundles," this is Harjit. If you haven't, my name is Harjit Kaur. And also on this episode, we have Margaux and Hạ. I'm so excited because today we're going to have a topic that actually has to do with power, something we just discussed, and it is actually about war.

I really was excited to do this episode topic because I think that war is a very important concept that shapes people's personal and collective identities because it's part of society from . . . I don't know when. But I feel like it's been going on forever. And I really wanted to talk about how it impacts people in medicine.

But before we can understand that, I thought maybe I could outline what war means and kind of a definition of war.

War is basically when two different entities generally fight over something, right? And in the end, ultimately, they're supposed to get something.

I also think about war a lot in the concept of white supremacy. I think three things uphold the concepts of white supremacy. This is something I talked about in our episode about anti-black racism. One is slavery and capitalism. The second is genocide and colonialism. And the third is war. And I think war is really about either protecting or taking away land, and then making it profitable.

That's something that got me really thinking about how I think about war. What do I think about it? Growing up, I remember in elementary and junior high and high school, I thought, "Oh, this is just a natural course of a society." But I've been really thinking recently about how people utilize it to further disenfranchise communities, especially those that are directly impacted by material conditions of war.

Margaux: Yes. Like you talked about, we have had initial discussions about anti-black racism. And like you mentioned, war is one of the pillars that holds up white supremacy, and fueling that is capitalism.

When you look at what capitalism actually is, it's this idea that we should be driven by private ownership of things, like you mentioned, land, and always seeking the profit for an individual benefit. And that is usually driven by the ideas of having private property, so land, and competitive markets, wage labor.

But as you also mentioned, slavery is another pillar that holds up white supremacy and stems from the idea of capitalism that you could, instead of paying people to work, get more profit for yourself, and benefit you as an individual, if you could use other people to do the labor for you without paying them.

And then in the theme of war, when I was reflecting on this episode, it came to me that there's a lot of rhetoric of what we call independence, right? And we celebrate Independence Day, when we, as the U.S., won the war, are now independent in this power position. I was thinking about all of that and then how it connects to me and my identity.

For those of you who are just joining "Bundles of Hers," my mother and my maternal side of the family and ancestors are from what is now known as the Czech Republic and initially from the indigenous peoples of that area, who are called the Slavic people. And the word slave actually stems from a Greek and Latin word that they used to call this group of indigenous people, the Slavic people, or slave.

Because they tended to be as non-religious and they didn't have a formal government, they were one of the first peoples that were enslaved in the Middle Ages. And so the word slave, it was derived from this group of people. And so that is an interesting connection that I was thinking about when talking about this episode.

I love thinking about how our generational histories and traumas and experiences shape who we are today, even though I've grown up here in the U.S., which has a very different perspective on war, than maybe my ancestors had experienced.

Hạ: I feel that growing up in the U.S., a lot of the rhetoric that we're initially taught is, as you mentioned, independence. It's really associated with a lot of pride. And sometimes you go to war for something right or wrong, essentially. And there is a lot of ethical push into it and it seems very black-and-white.

But the truth about war is that when you really start breaking into things, and even the wars that we're taught to really look up to and to think as really wonderful . . . well, not wonderful, but very important and necessary to do for bigger patriotic ideals in a sense. If you really then study history and go deeper and deeper into it, you realize that, as we've mentioned, there's a lot of capitalistic, a lot of imperialistic reasons behind why war is waged.

But because of that divide where we're taught to have this really huge emotional weight on war, with often neglecting the fact that there are other more insidious, less idealistic forces behind it, it makes it a very difficult topic to discuss.

And people's lives are very much impacted and hurt because of war. And so I find that it's something that . . . For me, I try to navigate these conversations with a lot of care and I always have to switch. I feel like I'm switching between two hats when I talk about war, right? I'm switching between a much more emotional hat and a much more intellectual hat.

Harjit: Hạ and Margaux, I'm really appreciative of your perspectives because I think we hit on a lot of concepts that will really help us shape the understanding of how war is connected to identity.

I want to definitely bring up something that Hạ already mentioned. War has impacted a lot of people and there's a huge emotional component. So I know we're almost a little bit into the episode, but trigger warning for anybody who this is difficult to listen to. I understand if that's something you need space and time for.

So when I was thinking about people's identity, it becomes a very black-and-white thing, right? There is your perspective, and that perspective is shaped by this nationalistic rhetoric, right? And when you mentioned the concept, Margaux, of independence and freedom, but then also thinking about is that freedom then taken? Is it something that's traded?

Growing up as an American, initially I thought war was important. It was right. It was used for protection. It was used for pride, right? And I think when you're a younger child, it's easier to be like, "This is right, this is wrong, and this is why we're doing what we're doing." But as I have grown, I feel my perspectives on war have changed tremendously.

I also realized that I'm most connected to people who have been a part of war now than I ever have been, right? Either it's people who are refugees, like my patients, or people who have been impacted by war. And then there are also the people that I help that actually have been veterans, especially because we work at the VA. And seeing how they both, being those protectors, have been impacted by war.

But it's so interesting because I think all of us, in a sense, have been brainwashed to be thinking about war in a certain perspective. As we're younger, there's this, "This is what all Americans think about war, and this is what's important." And then when you're at the VA, you hear so many people that are so young that got into the military services.

And that also reminds me of how people get militarized, right? This is internationally. Usually, it's very young people, very strong people, people that are still forming their views on the world. And I always wonder if people really, really understood what they were getting into, if they would choose that choice anyway.

But there are a lot of incentives for going to war, right? You're a protector, you'll get free health insurance, you will get a job, a lot of things that people feel like they need. So that's kind of been my perspective growing up as an American about what war means.

Margaux: Harjit, on that note, I would agree with both of you that in school we're socialized that war protects us, that war is necessary. Being a prominent, what we call, world power as the U.S., we are taught that we need to be on the offense always to protect our power.

Especially growing up in the post-9/11 era, that whole rhetoric changed even more, that we have to be on the defense. And oftentimes, the people that are impacted by the wars that we go into were dehumanized and talked only about as casualties, and we never really highlighted as other people who were truly suffering from the consequences of what our country was doing in the benefit of the "protection" that we were benefiting from.

And in your vein of talking about sending these young people into war through military enrollment, it's very interesting to me that we choose to celebrate Independence Day or other celebrations of war and victory with fireworks and things that sort of mimic what happens in war. When the reality is so many people have been traumatized and suffer from PTSD, and the very sound of a firework going off can trigger them.

And so just how disconnected we are from what happens to the people who are on the frontlines of war, who are directly involved in war, is so huge and evident when I sit down to think about it.

And especially having interacted with patients at the VA, it just makes me think about how it has to be that we're socialized to have such a glorified view of war, or else I think we probably all wouldn't buy into it as much as we do.

Hạ: Yeah, Margaux, you bring up a really interesting point with the fireworks and just about generally how we celebrate these things. And it makes me think a lot about how a lot of our lives and how we view war is really based off of narratives that are fed to us.

And we aren't really taught to be very critical about the narratives, both in thinking about it in a social and finding a bit more evidence and understanding things from a social and historical perspective, but also in a human perspective.

We often, I feel, conflate people who are involved with war, as has been alluded to with ideals, whether it is a hero or, as you mentioned, Margaux, a more de-humanistic sort of perspective of people. And we neglect the fact that war impacts anyone involved, whether they are on the frontlines or in the land of fire, quite deeply, and that those impacts that war has are very opposite the ideals that we are fed.

And it's something that I think a lot about, because growing up, I always had this cognitive dissonance. In school, I always felt like the narratives toward war was very celebratory thinking about the American Revolution, thinking about the Civil War, thinking about World War Two, a lot of it was placed in this framework of justice. But then when I would go home and talk with my mom about war and about what our family, my family went through because of war, it felt very different.

For newer listeners, for context, my grandparents lived through World War Two, and my mom lived through the Vietnam War. And my mom's perspective about war growing up, to me, was always that it's always these people up top fighting for things that really don't matter to the people at the bottom. And it ends up being that the soldiers and the civilians are the people who end up suffering the most.

And so growing up and having that dissonance was something that I couldn't quite grapple. I learned to just when I'm around all the other Americans at school to be very "rah, rah" fine about it, but when I'm at home, to be very reflective, and to be very sad about all of that has been missed because of war.

Harjit: Hạ, I'm really grateful that you kind of started telling us a little bit about your experience, because it's in the home and outside the home. There's Side 1, there's Side 2. There are people who are waging the war, there are people who are suffering from the war. And then honestly, it's the people at the top who are the least directly impacted that make these decisions and choices.

I think of war a lot in forming collective identities and communities that are impacted by war.

As I've mentioned before, I'm Punjabi. I'm also Indian, and the British Empire used to own India. And I think that's my context of understanding war a lot growing up.

At that point, the British Empire was in power, and a lot of Sikh or Sikh-identifying folks were usually at the frontlines or the soldiers fighting against the British Empire.

So my views on war are very deeply tied to this rebellious spirit, this need for justice, this need for independence and freedom from an empire that had by war taken over India.

So my views on war growing up have been of resistance, from my understanding. So when I was growing up and I was like, "Oh, yeah, Americans waging war, this is exactly what they're doing. They're fighting for the independence. And they also were trying to get away from the British." So I remember growing up, I used to be like, "Oh, I understand why people are doing this."

But as I grew, and in 2001, 9/11, the Twin Towers fell, and then there was also the war in Afghanistan. I remember a lot of people from my community, as mentioned, got killed because they were seen as terrorists.

And then I was like, "This is such a confusing concept." And that's when I really took a deep dive into what is war, and what does it really mean, and how does it really impact people?

And I want to boldly say that I am anti-war because I have seen the way my patients have suffered psychologically. I've seen the way my friends have suffered psychologically and emotionally and mentally, and then physically as it comes out in every way from the impacts of what war can do to a community.

Margaux: I think, like you mentioned and alluded to earlier, Harjit, war shapes all of us whether we have been directly impacted or affected, or indirectly.

Something I think a lot about is . . . So my mom and her family were displaced from what was the former Czechoslovakia in 1968 when Warsaw Pact invasion of that country due to the need and want to shut down the reform against the Marxist-Leninist state there. And so they then had to flee their country.

And I feel a great amount of resentment and betrayal, from my mom and my grandma especially, of their country and their government and their safety and their identities. And when they came here, they formed new identities and really felt safe and secure in this rhetoric, I believe, of being on the offense and in a place that can offer that security, or at least the illusion of it.

And even though I was never affected or had to move or anything like that, I still feel and see that, and I know that it is part of what has shaped me.

And so I think that is important when we're interacting with patients to think about. Beyond their healthcare needs that are in front of us, what influences have impacted these patients and us, and how we interact with each other?

Hạ: Yeah, Margaux, you bring up a really great point also about thinking about it in a very generational perspective, too. I also didn't grow up in war. I was always in the U.S., so war was not fought in any terrain that I've been on, yet I still feel the impacts of war all around me. And it comes really from the generational impact that it's had on the people who have dealt with it, who have either fought in wars or who have lived through wars on their land.

And it is kind of funny thinking about how when my family immigrated here, it was a thought of, similarly as you mentioned, this facade of being able to escape from these things.

But then I also think about how every Fourth of July when there's a firework, it retriggers my mom. Because my mom was there in the Tet Offensive when they were bombing Ho Chi Minh City, and she freaks out every time she hears fireworks and that trauma just keeps living.

And while talking about fireworks and how people respond to it is a very tangible way to see the impact of war that permeates across time and space, the truth is there are also a lot of intangible ways. It impacts how people view the world. It impacts what makes them anxious. And those lessons, what's built in their bodies, they pass on to the next generation. And so then we also feel that impact too.

And on the flip side, thinking about, again, just narratives and everything, we are taught by the narratives that we live either by people who are very taught to view war with pride, or those who are taught to view it with a lot of bitterness. That also breeds into how we view the world and how we act upon things.

And I think on a very different level, if I had a different upbringing and if I hadn't become so disillusioned realizing that in our history books, we loved talking about the American Revolution, we loved talking about World War Two and everything, but the Vietnam War was always kind of pushed aside.

And teachers liked to explain, "Oh, it's because it's recent," but it was because it was a war that could not fit our ideals. It was a war that we couldn't justify and make ourselves seem as heroes that we don't want to talk about.

Realizing that something that caused so much suffering for so many people could just be forgotten or disregarded . . . And people who fought it, a lot of the Vietnam War veterans are often very much ignored, and just seen, not really celebrated in similar ways. And then all the Vietnamese refugees and the people who were there are still dealing with the trauma.

I think all of it, for me, thinking about it, it just makes me realize how much it just keeps permeating and it keeps impacting all of us. War just doesn't really bring a lot of joy because the impact keeps moving forward, and it comes from generation to generation. And the only way to break it is to be really critical about it. But the narratives that we're given, or that they choose to give us, don't allow us to be critical about war.

Harjit: Hạ, I think what you said is really important, because war does impact every facet of life, from personal, to professional, to governmental, to healthcare, everything. And I think that that's why this is such a difficult topic to talk about, but it is integral to identity and tied closely to identity.

And when I was thinking about how war is connected to medicine, I'm often reminded again about all the veterans I take care of at the VA hospital, and how they are daily impacted by war.

But it's also interesting then to come home and see how my parents have been impacted and my friends have been impacted. It's something that comes up in conversation every single day.

Some of us "Bundle of Hers" members are also from communities that are still going through war to this day. And I feel like we're Americans, but there are a lot of people outside internationally that have gone to protect whatever our interests are.

Another interesting concept I've been thinking about with war is a lot of people will say, "We're going to war to help somebody," but I also think that's a part of that not being critical.

Generally, war is to uphold people's interests and they're usually material. It's some type of money, it's some type of power, but it's disguised in, "We're helping blank-blank population," which I think is something that we always have to be critical of as well.

Margaux: I think in one way or another, we've all expressed that having grown up here in the United States, war has not directly impacted us in our childhoods in the way we've grown up, but also the larger sentiment that war is something to be celebrated and something that does not happen here.

But as a parent and then having reflected on preparing for this episode, one thing I've been thinking about is the future and our impending climate crisis. And how with this capitalistic individualistic view, if water or basic human needs become scarce resources, what is that going to mean and look like on our own communities here in the U.S. in the way that we've grown up?

And so I think, for me, taking the next steps is really unlearning those capitalistic/individualistic ideas and sort of pushing in and leaning into community, understanding who's around me. If there is a total crumble of our society as we know it, who can you lean on? How are you going to come out of that?

It doesn't have to be this apocalyptic end-all, be-all. There can be, and we have seen throughout history of indigenous peoples and cultures, that you can survive with a very strong community model. But we need to move away and break down the larger individualistic and capitalistic societal norms. And I think that's a huge feat, but that's something that I've been trying to take the next steps and move towards.

Hạ: And I think, Margaux, with what you were saying, it actually made me think a bit about how a lot of times this whole discussion, and even when we were saying that we haven't lived through a war on our terrain, I think it's because war is framed to be very outside of the U.S. and it's framed to be a more imperialistic endeavor, right?

But as you were talking about community and the impending climate crisis, I was then thinking about it, and I thought, "But there have been wars fought on our terrain." If you think about it, for instance, they talk about "the war on drugs."

You think about all of the treatment of the indigenous community, and even when you think about racist actions, that is in itself a war. But we don't frame it that way because we are taught to think about war in a very imperialistic way and to think about it in, as you both mentioned, a very "othering" way.

Going to a place that needs help and not really reflecting and looking back and realizing that a lot of the principles . . . And this has been alluded to quite a bit throughout, and even Harjit had set it up at the beginning of this episode. All the principles that underline war and make war happen are very much in existence within our communities.

And in that sense, our communities and the things that we are facing within the U.S., thinking about the shootings that have been happening, thinking about all of that anti-black hate that has been happening, when we think all about that, they are, in a sense, a war at the core.

And so when I think about it in that way, I realized that really reflecting and seeing that interconnectedness, and being, again, very thoughtful about narratives, and really going back into the core and seeing that, "Yeah, as mentioned, war and everything that's similar to war is based off of self-interest," it means that the antithesis to it means that to move against it is, in a radical way, to be the opposite of it and be very much centered in love, in community, in healing, in opening away from black versus white, right versus wrong, idealistic, accepting that we are all very messy creatures and need to be held accountable.

But we're working towards a lot of growth and towards a lot of healing and understanding of each other and their perspectives.

Harjit: Hạ, I really appreciated what you said, because I think love/community is really a central model to kind of being anti-imperialistic, anti-war. Something that, Margaux, you mentioned as well.

I've been thinking a lot about when we interact with people with war, they have trauma. And looking at the world through a trauma-informed lens can be really helpful as well when it comes to our patients. And the core tenets of trauma-informed care are about being open about listening, about being kind and loving and compassionate.

If there was one thing I could change at the end of this episode, it'd be no more fireworks, because that's not very trauma-informed. It triggers people who were "protecting us," and it also triggers people who have actually been in those lines of fire when war was being waged.

And so that is an example. I know that's not very American of me. But I think it's important to understand that we can't fight against something if we continue to see an us-versus-them. It has to be us together as an entity, as a community, and that's where healing really stems from.

So I want to close out the episode. Thank you so much for listening to us. As you know, we have an Instagram @bundleofhers. If you have any reflections on this episode, please send us a submission.

We're really excited. We're bringing back some new pins, Power From Identity, for our season, and we're excited to give them to our listeners. Again, you can send that reflection in as a direct message at our Instagram @bundleofhers.

You can also listen to us on any streaming platforms.

Thank you for always being a part of this journey with us. Until next time, I guess.

Margaux: Bye-bye.

Harjit: Bye.