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.
