Soldiers and Veterans Coping with Combat Stress and PTSD
As a civilian, I’ve been trying to understand combat trauma and the problems veterans face in returning to life at home after deployment in a war zone. Depression is a big part of their experience, but it’s combined with multiple problems. A couple of thoughts from a powerfully honest veteran blogger explain a lot about combat trauma and the behavior that’s come to be known as Post-Traumatic Stress Disorder - PTSD.
“... now that I am back I am not really back. I am still there fighting for my life... PTSD is a defense mechanism not an illness. Its a way to survive.” - The Mind of a Retired Shooter
As so many veterans have described their experience, Retired Shooter recounts in his blog the difficult story of bringing home the combat hypervigilance that got him through the war in Iraq. Driving fast and aggressively to avoid roadside bombs, sitting in a restaurant where he can see the door and everyone in the room, drowning out the voices in his head with alcohol, raging about minor disturbances. The impact of all this on his family and friends was to drive them away completely, leaving him alone and having to put together a completely new life.
Fortunately, he seems well on the way to doing that. A turning point came for him when he got help from the Veterans Administration and realized that he was not alone in this experience. And that is the message he frequently repeats to other veterans going through this crisis of adapting to civilian life. You are not alone.
PTSD has become a diagnostic label linked to trauma of many types. The terrible experiences of child abuse, sexual assault and rape, in which the victim is overpowered and helpless, can inflict psychic damage for a lifetime. Witnessing violence and disaster can do the same thing, and surviving a disaster that has claimed the lives of loved ones can add to the shock of the event itself the deep sense of guilt about still being alive when the others are gone.
But in addition to the impact of the violence soldiers witness and the violence done to them is the impact of the violence they do to others. Soldiers may become trapped by enemy fire and watch helplessly as their buddies are blown to bits - and so many of the stories veterans tell are about those constantly repeated memories and dreams of their worst moments. They are also trained to kill, and to do that their moral universe has to be turned upside down.
Violence and killing become right instead of wrong. The society that punishes these acts at home demands that you do them in the special setting of war. They are not to be considered ends in themselves but a means to the all-important goal of completing each mission. The enemy is dehumanized, an obstacle to getting the job done that has to be taken out. To do what you’ve been taught is wrong all your life, you are also trained to strip away all emotion and keep your mind solely on the mission and on protecting your comrades for a safe return.
Many soldiers, though, may suddenly lose that flipped sense of right and wrong and see themselves killing real people, quite likely some who are civilians. They feel they’ve lost an essential quality of being human and take the blame and guilt on themselves. That, combined with surviving through hypervigilance under extreme stress for long periods and the shock of losing fellow soldiers, create deep wounds that make re-entry to ordinary life so hard.
The psychiatrist Jonathan Shay (in his book, Odysseus in America) and the clinical psychologist Edward Tick (in War and the Soul) have written extensively about this and have criticized conventional treatment for not recognizing the full scope of PTSD. As a result, many veterans find the prevailing forms of therapy meaningless. They believe therapists are unable to help because they have no understanding of combat conditions.
Often, soldiers with PTSD are told to put the past behind them, shoebox their haunting memories and focus on re-establishing the normal routines of civilian life. The emphasis is on changing the habits of thinking that obsess on combat. That approach works for some soldiers, but there are thousands who find it irrelevant to their experience.
Tick links PTSD to the spiritual traditions of other cultures that emphasize the effect of war on the soul. He tells the story of one Vietnam vet who came to see him full of intense anxiety about safety. He scouted the office and took a seat in one corner of the room, satisfied that the place was now secure. The main point he wanted to make was that he had lost his soul. He had felt the thread holding it to him getting thinner and thinner until it finally broke during a terrifying retreat under a massive infantry assault.
When Tick told him that he believed this and probed further, the veteran explained something he had never told anyone. His soul was still out and went everywhere with him. It was right next to him at that moment, trying to figure out if he could trust this therapist. Was there anyway he could get his soul back inside his body? The soldier was amazed that Tick not only believed him but also offered a path to healing.
Based on patterns found in non-western cultures the world over, the path that Tick suggests has four phases: a cleansing experience of some sort, such as revisiting old battle sites or participating in ceremonies honoring dead fellow soldiers; storytelling to create inner distance from the events and connection with an audience willing to listen; recognition by community and nation - this has happened in a general way, but the PTSD sufferers are often denied care and treated as marginal people; finding a new purpose and committing to carry it out from that point forward.
That’s a hard path to follow and one that requires the recognition and assistance of the rest of us. PTSD brings out more dramatically than other conditions the role of society in shaping experience. I believe that’s true of other mental health problems as well, and I’ll look at that side of things in future posts.