Society and the Soldier: Post-Traumatic Stress Disorder, Part II, 2007

   Traumatic neurasthenia. Railway spine. War syndrome. Gross stress reaction. Old sergeant syndrome. Neurocirculatory asthenia. Vietnam disease. Cerebro-medullary shock. Simple continued fever. Disordered action of the heart. Buck fever. Swiss disease...

   When we speak of post-traumatic stress syndrome, or PTSD, most of us are familiar with a handful of the labels given the after-effects of war. We've probably heard that it used to be called 'nostalgia' or 'irritable heart' during the Civil War. During World War I it became 'shell shock' in reaction to the arrival of powerful industrial weapons of war like the quick firing artillery piece, the machine gun and the magazine rifle. By World War II it became 'combat fatigue' or 'battle fatigue.' The second-to-last stop before arriving at the definition we use today was 'post-Vietnam syndrome.'

   While these are the more well-known of labels given to modern post-traumatic stress disorder, by merely repeating these more familiar terms, we lose sight of an important aspect of the history of PTSD: the human resistance to acceptance of the condition -- no matter what it's called. The fact that one generation after another has to 'rediscover' PTSD and give it its own name offers a glimpse into society's desire not to have to own up to it, not to have to dig too deeply into the dark recesses of it, not to expand on our understanding of it, perhaps not even to believe it exists.

   Indeed, even today there is a rejection bubbling under the surface surrounding the use of post-traumatic stress disorder. Many doctors and counselors and soldiers believe the term falls short of the mark, saying that 'psychological injury' or 'deployment-related stress' or 'combat-related stressors' more accurately describe what's going on here; others don't like the term because it's become 'too political.' Of course, whatever you call the aftereffects of war, it's always been political.

   The story of combat-related PTSD is a saga steeped in both sociopolitical intrigue and medical maneuvering. Conflict, inspiration, frustration, and relentless determination to find understanding and healing have been the markers of the experience.

   The reality is that combat PTSD -- or whatever we once called it, or whatever we're going to call it next -- calls into question the human reliance on war to solve our problems.

   While we may wish that our smart bombs and our superior military power will so overwhelm our enemies that our wars can be clean, quick and painless -- and without any blowback on us or those we've sent to fight in them -- there's no debating that war trauma has always existed, and it will exist as long as we wage war. In many aspects, the war trauma of today can be more debilitating than that of previous eras for a wide variety of reasons, which we'll look at in Part 3 of the Series. But a lingering shock to the system following combat has been a common thread that ties each generation to the next.

   In February 2006, the Archives of General Psychiatry reported the findings of a University of California-Irvine study of US Civil War medical records, appearing to validate the lingering and sometimes permanent effects of wartime trauma. After reviewing the pension and health records of 15,027 Union soldiers, they found that 44% reported mental or "nervous" problems following the war. In addition, researchers found that soldiers attached to companies suffering the greatest casualties were at greater risk for cardiac, gastrointestinal, or nervous disease down the line. These researchers established the same link between 'irritable heart' and long-term physical health we find in a growing body of PTSD data today.

   Indeed, the National Center for Post-Traumatic Stress Disorder estimates 1-in-20 combat veterans coped with nightmares, irritability, and flashbacks in the wake of WWII, while the Department of Veterans Affairs still had 25,000 veterans of this war cashing PTSD-related disability checks in 2004.

   Unfortunately, although combat trauma observations were made and treatments applied with each successive American war, there wasn't a strong movement in the military (much less civilian) community to build and expand on the knowledge gleaned from one war to the next. What a waste. Denial and expectations and perceptions and prejudices towards mental health issues would stand in the way of progress and improved care that could have been provided each successive generation of veterans.

   In the years following the Vietnam War, veterans began streaming into the Veterans Administration seeking help. Others who couldn't get beyond their distrust of the government -- or 'get past the bricks' as VA psychiatrists used to say back then -- formed their own support groups (called 'rap groups') to find an outlet for some of the symptoms they soon found out they shared with other veterans. These veterans complained of nightmares and cold sweats; flashbacks; anguish and shame over atrocities they witnessed or committed; anger at the society's hostility towards them; and alienation from that same society that didn't seem to care about what hell they'd just been through in their name.

   What they were suffering from, called post-Vietnam syndrome, or PVS, would eventually transform itself into what we now call post-traumatic stress disorder, or PTSD. The label, though many appear to dislike it, seems to have finally stuck since its inclusion in the DSM-III (the bible of psychology) in 1980. But what exactly is PTSD as we know it today? After our short history lesson, it's time to get into the heart of the matter and find out what exactly this disorder is all about.

   The American Heritage Dictionary says:

posttraumatic stress disorder, n. (Abbr. PTSD): A psychological disorder affecting individuals who have experienced or witnessed profoundly traumatic events, such as torture, murder, rape, or wartime combat, characterized by recurrent flashbacks of the traumatic event, nightmares, irritability, anxiety, fatigue, forgetfulness, and social withdrawal.

   The National Center for PTSD, an organization established by the Veterans Administration in 1989, adds:

Posttraumatic Stress Disorder, or PTSD, is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting. [underlining added]

   What this definition tells us is that if you're looking at PTSD strictly through a mental lens, then you're missing its other two components. Society, biology and psychology all come together to create the conditions that bring about post-traumatic stress disorder. This is one of the things that makes PTSD unique -- the physical body, the internal emotions, and our external relationships all have a bearing on its incidence, its experience and its tackling. To hammer this important point home, let's take a look at one more definition.

From the Textbook of Military Medicine:

The three groups of factors -- biological (inherent propensities and physical attributes), interpersonal (cultural, social), and intrapsychic (individual psychological) -- can affect positively or negatively the soldier's ability to withstand the stresses of combat. [underlining added]

   In the latter part of the 20th century, most people across the board believed that those who broke down on (or later off) the battlefield were somehow to blame. It wasn't the carnage of combat that caused their mental injury; it was personal weakness that led to any breakdown that might occur. Not only did average citizens believe this to be true, most professionals did, too. As NPR reporter Alix Spiegel explained on the radio program All Things Considered,

"Mental health at the time was really dominated by psychoanalysis, which believed that childhood trauma alone caused emotional problems in adult life. According to this logic, if a soldier emerged from war with psychological disabilities, it was because he was a bad apple, and poor parenting was to blame."

As long as we lay the blame solely on the individual, then we can wash our hands of any responsibility -- and we can demand that they take their problems elsewhere out of our view. So, a paradigm shift was needed if we as a society were to move from thinking that negative traumatic stress reactions couldn't possibly be related to outside events -- but instead were just another sign of inside neuroses.

   Support at a personal (through friends and family), local (through community), and national (through the larger society) level are all key contributing factors that have a bearing on a recently returned combat veteran's ability to cope with PTSD. While we as humans have a great knack for throwing out what we've learned (no matter how costly in blood, time or treasure those lessons may have been to come by) one moral of the post-Vietnam War era seems to have stuck to the American ribs. Most of us today do believe that you can support the troops without having to agree with the handling or policy of the war. Most do believe that you can separate some of the doings of a few from the many serving admirably. Most do want to -- and will -- welcome home our soldiers, sailors, airmen and Marines, honoring the sacrifices they've made in time, energy and personal safety to serve our country. No matter what the final outcome of the century's ongoing wars may be, most today realize that the troops who've been sent to carry out our nation's orders are simply doing just that -- their job.

   The growth, the failings, the limitations and the strengths of our nation are revealed through our handling of the concerns of our returning troops and their families. While we've seen incredible reporting uncovering the horrible conditions at outpatient wings of Walter Reed Army Medical Center, and we've begun talking about the need to fix a VA system that is clearly failing many of our troops who are forced to wait their turn for treatment -- at times with deadly consequences -- why is the issue of mental health (especially as it relates to returning veterans suffering with PTSD or other psychosocial problems brought on by combat service) still so contentious?

   Can it be because our collective choices and our moral character as a group are called into question when we discuss issues of psychological wounds inflicted on those we send to battle in our name? Perhaps there's some guilt associated with it. It may be easier to blame psychological breakdown on the individual vs. blaming ourselves for our role in unleashing such deep and permanent, if invisible, wounds on another generation. But looking beyond ourselves, our own possible remorse or guilt, society's attitudes shape the way our returning veterans process their combat stresses and experiences. It's a feedback loop. Our way of thinking about the invisible scars carried home from war positively -- or negatively -- impacts the way our returning veterans process their pain and internal injuries. While we've come a long way in our new century, the PTSD battle still rages on as people from opposing camps continue their work to bolster or undermine its definition, its acceptance, its very existence.

   So it's important that we as a society talk opening and honestly about these issues. For, if we don't wish to bother with them or hear about them or accept them, how might the individual coping with them find his or her way through to the other side? Should they be expected to do it all on their own and not bother the rest of us?

   During the Vietnam War era, dramatic battlefield reporting found its way into America's kitchens and dens via our television screens. War coverage was up close and personal at that time. War reporting was a serious thing and certainly wasn't trivialized; news, it seemed, was a sincere and acclaimed enterprise in those days.

   Today, other than the momentary spurt of coverage during 'Shock and Awe' campaigns or the taking down of statues, we have seen very little on our television screens that capture the war's daily rhythms and beats.

   We may hear how many have died today; but we don't see or hear much else about these events, or the people they've undoubtedly touched. Casualty figures are merely sterile numbers repeated over the airwaves, empty of any meaningful reality for most typical non-military American families. Perhaps if our news anchors would also begin reporting on how many troops were injured in any given day it might perk up some ears (since the figure is much higher than the KIA count); but, we hear nothing of those casualties. And we certainly see nothing of them, either. Perhaps we like it that way. Our compartmentalized lives allow us to look at death and destruction from afar -- if we even choose to look at all -- safely secure in the knowledge that war is a good thing and we're right to wage it.

   In World War II, too, things were not like they are nowadays. The war coverage was entirely unlike that of the Vietnam era; yet, it didn't spirit away the troops as our government and media prefer to do today. Troops returned home and were enthusiastically brought into the public eye as heroes featured in war bond drives and recruitment campaigns. Even wounded soldiers and Marines returned home to star in movies (The Best Years of Our Lives, for example) and appear on television variety programs.

   Today we -- and our attention -- are pulled in so many directions. We're working one, two, even three jobs to put food on the table, fighting to maintain our standard of living and afford health insurance, etc. We're struggling to pay for the fuel that drives our lives, and we're struggling to cover spiraling tuition and housing costs, too. Or we're taking care of aging parents. As a mature industrial society, our communities are fractured and sheltered, and our lives are compartmentalized and much more stressed than perhaps in previous eras. And so, we can easily turn off the news of the war if we don't want to know anything about it; what's more, we can also choose what type of coverage we like, and tune out the kind we don't like. If you like your news with a conservative bent, you can tune into FOX News and your sensibilities won't be challenged. On the other hand, if you're someone who favors alternative or progressive news, you can tune into Free Speech TV exclusively and never have to hear news with a slant that might upset you. This isn't the way it used to be. News and our experience of the world were much less disjointed in the not so distant past.

   When the Beatles invaded America they only had one show to hit it big on (Ed Sullivan) to ensure complete and full pop culture victory over us. Today, though, with hundreds of television channels, and thousands of video games, and billions of websites, our experience of what is cool or real or fact is seemingly indefinable and very individualized. We no longer have a shared and common experience of the world. This scattered view of what's going on around us is a great challenge for our time and our society. Suffice it to say, it's one of the reasons it's difficult to raise awareness across the board on a challenging issue like combat PTSD (much less any other serious topic); those who don't want to think about war and its consequences simply don't have to.

   Back during WWII, however, you couldn't get away from your responsibly as a citizen. Even going to the movies usually meant you -- along with everyone else in the theater"”would sit through a newsreel update on the war's progress. As you made your way to the cinema, you might pass one or more posters along your way reminding you that When You Ride Alone, You Ride With Hitler. If you flipped through a magazine while waiting for the film to begin, you might see an advertisement stating Waste Helps the Enemy. You couldn't get away from the war -- and your responsibility in helping out -- if you tried. Today, you don't even have to try. We haven't been asked by our leaders to save or sacrifice a thing; and, these days, most of us know very few -- if any -- Americans personally serving overseas. Our wars in Afghanistan and Iraq aren't personal to the better part of us. The vast majority of us are simply not involved in any physical or emotional way. Circumstance is one part of the problem; but lack of solid and inspiring leadership is clearly another.

   In the crosshairs, war serves up heavy doses of reality. There's little room for manipulation. And every warrior is exposed to an equal opportunity foe: combat trauma. While war trauma is as old as war itself and has gone by many a name, it's always been there.

   And it's about as vivid and real and in full color as anything out there.

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Bio: Ilona Meagher is a member of the CCN Troops and Vets team and editor of the online journal PTSD Combat: Winning the War Within. She is also the author of Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops and a writer for ePluribus Media. Her collaboration with ePMedia has resulted in the PTSD Timeline -- a database of reported OEF/OIF PTSD-related incidents -- as well as the 3-part series Blaming the Veteran: The Politics of Post Traumatic Stress Disorder. She resides in Illinois with her husband and is completing a degree in journalism at Northern Illinois University.