Some Thoughts on PTSD

I read a post at Vox Veterana the other day about Post Traumatic Stress Disorder.

Would I agree that PTSD is probably overdiagnosed? Yes, definitely: We, as a society, have an obsession with being happy and successful, and anytime we’re not, we assume there must be an underlying problem.

Can’t run a mile? It’s not because you’re an overweight couch potato, it’s probably just asthma.

You can’t sit through two hours of class without fidgeting? It’s not because you’re a seven year old boy, it’s ADD. Have some medicine.

You’re not happy 24 hours a day? Must be depression. Have some medicine.

That said, PTSD is a serious problem and we need to strike a balance between letting people know that it’s ok if they are difficulty adjusting to life post combat and forcing a diagnosis on someone because they’ve experienced something that might lead to PTSD. You don’t want someone to feel stigmatized by having PTSD, but at the same time you don’t want someone to feel like there’s something wrong with them if they don’t have PTSD.

One of my dad’s friends was killed in the line of duty in the 1980′s and when he told his supervisor that he was having trouble dealing with it and wanted to talk to someone, his supervisor told him that police officers didn’t talk to people about emotions – essentially, be a man, suck it up and move on. Did that help him cope? No – instead he bottled everything up for twenty years, never dealing with anything, and letting all the problems compound upon each other until he couldn’t work as a police officer anymore. A lot of departments have since implemented programs that require debriefings after traumatic incidents and I think that’s a good thing – as long as it’s a one time requirement and not a series of required meetings, and as long as people know that they can talk more if they need to and not be judged and that they don’t have to keep talking to people if they don’t need to, and that’s fine too.

It’s true that the rates of PTSD between WW2 and Vietnam, and even Iraq, are very different, but I don’t think that is necessarily the result of a societal obsession with negative consequences of war.

Vietnam was a very very different war from WW2, and one that removed quite a few justification mechanisms from soldiers. In WW2 the enemy was clear: he was wearing a uniform and he was on the battlefield. In Vietnam, the enemy was everywhere. You couldn’t tell who was a friend or who was an enemy. VC didn’t wear uniforms and they lived among the village people, who helped you out sometimes.You weren’t safe anywhere: paranoia developed. Same with Iraq (from what I’ve heard). Bombs could be anywhere, and you can’t even trust kids. That messes with your mind, and it’s definitely not something soldiers in WW2 or WW1 had to deal with.

Along that same line, when the soldiers came home from Vietnam, they weren’t always greeted as heroes, like the soldiers in WW2. Some were accused of being baby killers and murdering innocents – in that sense, one of their major psychological defenses was removed. It’s never going to be easy to deal with knowing that you killed someone, but if you have people telling you that it was necessary to protect you and your country and your friends, it’s a lot easier to justify, morally and psychologically, than it is when you start to have doubts about what you did. When you have doubts and you start to question whether you were right or wrong, that’s when you end up at a higher risk for PTSD.

So I guess to wrap this up, I would just say that while it is possible – even likely – that we are overdiagnosing PTSD now, because we became so familiar with it after Vietnam that we look for it and shape people’s experiences to fit the mold, I wouldn’t agree that downplaying the possibility of PTSD is a good thing. When things come out of the blue, they have a larger and possibly more damaging effect. Allowing for the possibility of something allows people to prepare for it mentally – to build up defenses and be prepared when (if) something happens. And I think that it might better to be overly cautious when it comes to mental health than to let some people who do have problems slip through the cracks because they don’t know what’s wrong, or where they can go for help, or that if they tried harder the problems would go away.

Some reading recommendations (in this order):
On Killing by Dave Grossman
On Combat by Dave Grossman
Force Under Pressure by Lawrence Blum (About Policemen and PTSD)
Achilles in Vietnam by Jonathan Shay (With the warning that he gets pretty philosophical and theoretical from time to time, and it’s a denser read)