The Battle Over PTSD
By John Grant
--Kali Tal, Worlds Of Hurt: Reading the Literature of Trauma
There's a major struggle for meaning going on in America now that centers on war trauma among returning soldiers and veterans of our wars in Iraq, Afghanistan and, now, Libya.
Post Traumatic Stress Disorder (PTSD) is the current official term for what has plagued soldiers throughout history as they returned from wars to civilian society. PTSD became an official term in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association in 1980, following a period of struggle among psychiatric authorities and activists that focused on the experiences of Vietnam veterans. The DSM is regularly revised and updated.
What sort of meaning one ascribes to war trauma depends on who one consults and how connected they may be, directly or ideologically, to the Department of Defense, which has a major stake in establishing certain parameters of meaning in how PTSD is perceived in the culture.
The key terms for the military are about establishing resiliency to facilitate the reintegration of soldiers into their units for future deployment and the idea of a warrior class with a warrior ethos. In the case of resiliency and reintegration, those concepts are also key in civilian-based trauma recovery. It just depends on what one is building resiliency for and what one intends to reintegrate a soldier into, civilian life or future re-deployment.
The era of the citizen soldier has faded into the past when there was a draft and when wars like World War Two were “popular” and widely understood to be defensive and to make sense to most people. Now, we have a completely volunteer military, an institution that is becoming more and more separated, even aloof, from civilian life, as it deploys its soldiers to fight foreign wars that, for many, make less and less sense and use up more and more national resources.
No one is a “soldier” anymore; whether you're in special ops doing lethal night raids into Pakistan or repairing computers on a FOB, you're now a “warrior” — as if you wore studded breast-plates and carried swords and lived by the rule come home with your shield or on it.
The major psychiatric literature on PTSD emphasizes that the linchpin in recovery from PTSD is in the narrative-formulating functions of the brain that tend to get short-circuited with traumatic experience. Creating narratives is how we make sense of our lives on many levels. Extending outward from the mind, narrative is involved in establishing meaning in the culture itself, and the Pentagon has entered this arena with new agencies that focus on the personal suffering and struggles associated with PTSD as they carefully manipulate a soldier's reintegration back into the Pentagon war mission.
This became clear to me when I recently attended an interesting two-day workshop put on by the Dart Center For Journalism & Trauma of the Columbia School of Journalism. It was called “When Veterans Come Home” and was attended by newspaper and radio journalists, photographers, documentary filmmakers, clinicians and others interested in PTSD and issues concerning soldiers returning from our war zones. It was sponsored by the Thomas Scattergood Foundation for Behavioral Health and was held at the studios of WHYY, the National Public Radio affiliate in Philadelphia.
The issue of PTSD is on a lot of people's minds. Currently, I'm involved in an apolitical veterans counseling group called Healing Ajax, named after the mythic Greek warrior who committed suicide upon return from the Trojan Wars. In the past month, I've attended three separate workshops that dealt with trauma and PTSD from a clinical, counseling posture. One of these workshops dealt with trauma as very much a civilian, human phenomenon, which is one of the current directions trauma studies are headed. Trauma can and does happen to anybody; a lot of it happens to kids, especially poor kids. Studies show that early childhood trauma is too often linked to later adult substance abuse problems, violence and incarceration. More attention and funding needs to be focused on this kind of trauma.
I'm a Vietnam veteran journalist who has traveled twice briefly to Iraq in 2003 and 2004, where I spoke with soldiers in that war zone. I have written a lot of critical things about our wars; I think they can be, and they should be, ended. So covering veterans' issues may be less alien turf for me than it was for some of the reporters and journalists at the Dart workshop. That seems to have been the motivation behind the workshop: to help reporters maneuver the shoals of today's military reality so they can better report on returning soldiers. I certainly gleaned a lot of valuable information, such as learning about Veterans For Common Sense in Washington DC, an incredible data and contact resource for journalists.
There were panels of experts on PTSD, on re-integration and re-adjustment issues, on the dos and don'ts of reporting veteran and military stories, on how to navigate the Veterans Administration; a Philadelphia judge told about the city's jail-diversion Veterans Court; several reporters told how they pulled together military related stories they'd done; and, maybe most important, there was a panel called “Listening to veterans: What every interviewer should know.”
The segment that most interested me, though, was one called “Military Cultural Competence 101.” It was an hour, and it was given by Dr David Riggs, the executive director of something called the Center for Deployment Psychology, a part of the Uniformed Services University of the Health Sciences – all funded by and part of the Department of Defense.
Dr. Riggs started out by asking us to shout out adjectives that we felt fit the military. There were shouts of “brave” and “young” and “loyal” and that kind of thing. I chimed in with “working class.” But when Riggs read them all back to us to show us who we thought the people in the military were, he left “working class” off the list. This did not surprise me, given the notion of “class” is a dirty word in today's America with a shrinking middle class and a growing gulf between the rich and poor. He next asked why we thought young men and women joined the military, and, following things like “patriotism” and “to protect America,” I said “because there are limited career options.” Dr. Riggs snickered and suggested that was a common delusion that was not true. A little provoked, I interrupted him and told him I had in fact spoken to, and read about, quite a few young men and women who joined for this very reason. At this point, he seemed to concede the situation was complex. As did I and, I think, everyone else.
I only bring this exchange up to show the direction Dr. Riggs, an experienced clinical psychologist, was clearly leading the discussion for the reporters and others in the room. He emphasized that being in the military was about barriers, “us versus them.” For soldiers there was always an “in-group and an out-group,” whether it involved inter-service rivalry or a declared enemy. And when it came to sitting down and talking with soldiers in today's military, we civilians were an “out-group.”
The military was about bonding and identity. He would say things like this, look around and softly say, “Right?” Then he'd go on: “Barriers are put up to keep you out.” Some of the reporters he was speaking to seemed unclear as to basic military rank, the difference between a battalion and a division or even what an MOS was.
As he built up this very controlled image of the all-volunteer military, he began to sketch out the idea of a warrior class steeped in a “warrior ethos.” On the other side, he emphasized the fact most American civilians don't pay much attention to the military and our current wars – unless, of course, they have a relative or friend in them, and, then, they're tangentially part of the elite warrior class system. The way he presented it, it was two distinct worlds that rarely overlapped.
He mentioned a term I had never heard of: “Post traumatic growth.” A Google search later revealed a paper from the VA's PTSD Research Quarterly that starts out quoting Friedrich Nietzsche's famous statement: “What doesn't kill me makes me stronger.” It ticks off a couple dozen studies that focus one way or another on the positive side of trauma. And it is certainly true, everyone reacts differently to the same kinds of experiences; some may even thrive in a very violent environment.
Dr. Riggs mentioned the term moral injury, something that had come up a number of times in the course of the workshop as maybe the most difficult type of stress our young soldiers had to deal with. Earlier, Dr. Paula Dominici, Rigg's colleague at the CDP, on a panel about “The Trials of Homecoming,” had said of returning soldiers, “The moral injury is what eats their soul.”
Dr. Riggs broke Moral Injury down into two components: one, the betrayal felt by a young soldier by his or her commander who the soldier feels violated some understood moral contract, and two, a soldier who for one reason or another personally perpetrates what he then, or later, believes is a violation of moral law.
He didn't minimize this kind of stress. What he did was suggest, in the former situation, the soldier may not have fully understand his superior's position and the tactical need to do what he was asked to do. As for the latter, he seemed to be saying, under the warrior ethos one can be asked to do bad things, and a warrior learns to deal with it. And the CDP was there to facilitate the understanding of that.
On its website, the Center for Deployment Psychology says it “trains military and civilian behavioral health professionals to provide high-quality deployment-related behavioral health services to military personnel and their families.” Based in Bethesda, Maryland, it has outreach centers at five Army, three Navy and three Air Force bases in the nation. It also has internet and other types of mobile outreach capacities.
There is also a major program called The Real Warriors Campaign, a program of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) that provides similar help and direction to soldiers. The CDP was founded in 2006 and the DCoE in 2007.
In an article on the CDP website called “Meaning-making, PTSD, and Combat Experiences,” Priscilla Schulz, a senior PTSD treatment trainer, says the DOD prefers the term “Combat stress injury” to PTSD, since that preferred term “sets an expectation that the disturbance is transitory.”
She mentions speaking with a Marine who fought in the WWII Battle of Okinawa. “After a while he asked, almost incredulous, ‘What kind of person kills another human being?!' … A few moments later he shrugged and said, ‘but, what are you going to do? If you don't kill them, they're going to kill you!'”
Then she closes the article this way: “Memories of traumatic events are enduring. Meaning matters. Let's help troops, who need help, grapple with their experiences by looking at the whole story, including the patriotism that brought them to a war zone, and the heroism they practice every day in the performance of their duties.”
This gets at the crux of the problem. World War Two is a war few Americans have any interest in questioning, and, of course, in war, you have to kill people before they kill you. No argument. That's basic Patton: “Make the other poor slob die for his country.” But, then, Ms Schulz jumps ahead in history 65 years to 2011, as if the current array of wars were remotely like WWII with a similar civilian consensus behind them. She pleads with us to look “at the whole story,” but everything she says makes it clear she does not really want that.
For one, “the whole story” about Iraq, Afghanistan and now Libya is rife with delusion, dishonesty and military face-saving. And two, it's impossible for an American to look at “the whole story” because most of it is kept secret from him or her. Ironically, to really get “the whole story” about our current foreign wars, journalists would have to assume a posture akin to WikiLeaks and depend on sources like Bradley Manning, who is now being held in a solitary confinement cell in Quantico Marine Brig. A week does not go by that at least two references to WikiLeaks material appear buried in a New York Times story on US policy abroad. For an American citizen to really seek “the whole story” under the current in-group, out-group professional military as described by Dr. Riggs, one faces the danger of being branded a subversive.
The point is, the current professional, warrior-class military that Dr Riggs proselytizes about is to many Americans a frightening reality that is getting worse. As he was leaving the presidency in 1961, General Dwight Eisenhower warned the nation to “beware the military-industrial complex.” He was talking about the condition we find ourselves in right now.
On the other side of the struggle for meaning in the realm of war trauma are those who see a soldier's war trauma as a psychological and existential issue of his or her relationship with life in general. From this vantage point focused on recovery and reintegration into civilian life, there may be a very good reason for a Moral Injury from one's deployment to Iraq or Afghanistan. And that reason may be the immoral nature of the tasks we are asking our young men and women to undertake while there.
Again, Iraq and Afghanistan are not World War Two; they are asymmetrical foreign wars of choice now running significantly on their own insidious momentum. There's a perfectly logical reason why the United States has refused to join the International Criminal Court. While the American government assumes a holier-than-thou posture and suggests we will not be part of the ICC to avoid the danger that some party might use the court against us, the fact is the US government feels US soldiers in some cases could be internationally prosecuted under the ICC. There is a very real moral issue at play in deploying soldiers to these war zones. In the case of Moral Injury and other types of war trauma, the wars themselves and their advocates are the facilitators; and, if nothing else, the policy of re-deploying soldiers with PTSD issues needs to be reconsidered.
If like WWII a war makes sense, that's one thing; a soldier can use that making sense to somewhat alleviate his or her suffering by saying my evil act was for an overall good cause. But if a war does not make sense to someone — especially an inexperienced young person caught up in its maelstrom — personal violations of fundamental moral precepts can be extremely troubling and confusing. Currently, the DOD is trying to make sense out of the disturbing number of suicides of its soldiers. Personal psychological considerations that the Center for Deployment Psychology finds inconvenient to its mission may have a lot to do with these suicides.
When we recruit our youth at the beginning of their service, recruiters are notorious for not giving them a full, accurate picture of the unpleasant and even morally repugnant things they may be asked to do. The military, of course, has a massive budget for recruitment and publicity. In Philadelphia, the Army established a $14 million “Experience Center” in a mall to entice kids as young as thirteen. They could play violent videos and get on real-size, mock-up humvees to shoot “bad guys” on a village patrol. A friend of mine and his son did the mock humvee patrol and had a 25% civilian kill rate; they were disturbed by this, but the recruiter told them that was actually a pretty good score.
Now, the well-funded military seems to have an equally massive propaganda budget to sway public opinion on how to understand war trauma so it doesn't threaten future deployments.
All of this works to increase the elite and aloof quality of our incredibly lethal professional military, an institution that now uses over 50% of our national budget at a time of economic stress and need, as jobs disappear, education is being cut, retirement security is slipping away and our infrastructure crumbles from neglect.
The Dart Center for Reporting and Trauma and the Scattergood Foundation put on a fantastic two-day primer on covering soldiers and veterans “when they come home.” It raised a lot of important things for journalists to think about. For me, it raised the idea how important it is to care for our soldiers as people and not just cogs in future military deployments.
It would be great if, in the future, the Dart-Scattergood team could address the serious issue of Militarism in America. For many of us veteran and citizen journalists, that's a vital topic that rarely gets covered in the major media. We cover other nations and cultures when they have this kind of problem. But we don't encourage such coverage here.
And if the Center For Deployment Psychology has its way, we never will.
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