I woke up this mornin' with the sundown shinin' in/I found my mind in a brown paper bag within/I tripped on a cloud and fell-a eight miles high/I tore my mind on a jagged sky/I just dropped in to see what condition my condition was in
-- LYRICS FROM "JUST DROPPED IN"
I have written early, often and with passion about the epidemic of post-traumatic stress disorder suffered by soldiers and veterans while being aware of an aspect that until now has been barely addressed: Whether there is a danger that as PTSD is finally if grudgingly being recognized as a legitimate condition by the medical establishment it could become an over diagnosed catch-all.
I posed this and other questions regarding PTSD to Dr. Clarissa Pinkola Estés, a friend and psychoanalyst who has been in clinical practice for 38 years and specializes in post-trauma recovery, often involving veterans, as well as being a poet and author whose books have been published in 32 languages.
Q: Post-traumatic stress disorder has had many names over the 150 years since Civil War soldiers were diagnosed with something called Shell Shock. They include Old Sergeant Syndrome, Railway Spine, Buck Fever, Swiss Disease and War Syndrome, to name but a few. Just as there is a rich lexicon of names, each new generation with each new war has to rediscover the horrors of PTSD and each new generation doesn't want to deal with it. Why is this so?
A: It's not that each generation doesn't want to deal with it. It seems more that it's that the minds at the top of any war bureaucracy rarely are trained to be attentive to anguish and suffering. It's rather quite the opposite with the focus on function and efficiency. There are many people in each generation who have to push against hierarchies whose job it is to produce able bodies for a war despite the condition of the minds, souls and animating spirits inside those bodies.
Q: Having noted the rediscovery-denial aspect of PTSD, it finally seems like it has gained a level of acceptance in the medical establishment as a result of the wars in Iraq and Afghanistan. Is this so? If so, why so?
A: I agree with your premise. There's been advancement because we are no longer a nation unexposed to medical realities as we were before television became a family member. So many people are educated by not only compelling television documentaries that provide cutting-edge medical information, but now WebMD and other sources of information are available to anyone who has access even to a computer at their local library. This availability of solid science-based information for anyone regardless of their background or credentials was unimaginable 20 years ago.
Some of the people who are more aware, and not just within the helping professions, tend to be the very people who also press for humane treatment for veterans. Less than 50 years ago, the local sage or politically-appointed brass educated in these issues (or most often not) called the shots, and if they hadn't experienced something themselves then it didn't exist. Today we have science-based outcome studies. It's not left to the whim of an untrained person who is trying to save money or redeploy the largest number of boots by saying PTSD is really only a complaint of the weakling. Combat troops are, in fact, the bravest of the brave. And because they're also human they can be badly hurt even in the midst of great courage.
Q: The concept of "cowardice" is never far away when discussing PTSD. The notion that "you have to be a man" and not admit to pain or emotional distress runs deep in the military psyche. Does this explain why there seem to be so many cases of soldiers in Iraq and Afghanistan being punished for saying that they had emotional problems?
A: I'd venture that it does. PTSD does not come about because of "problems" per se. It comes about, and predictably so, when humane people are put into situations where they are expected to exceed the human limitations of spirit, soul and psyche, often subverting conscience in order to carry the operation through. We all have these limitations because we are made fully human. We are made so that our instincts for living are far more turned toward life and construction than toward death and destruction. It is in our bones.
However, the ideal machine in war is a human mind that is sharply focused on capturing and killing strategies, or minds that will follow orders to capture, kill and risk life and limb without question. Though revenge and rage can override anyone's wiser counsel, they run out and without massive adrenalin charges . . . a person often cannot reconcile with their core humane self what they saw and did and what they saw others do.
Injury to a soldier's heart of humanity is the basis for PTSD. Anyone who has that fully intact cannot come home from bloodshed and worse -- and there is worse -- unscathed. When kings have spoken about the wages of war, they meant the gold it cost from their treasuries. But what is a human soul intact valued at? If kings know before they send souls into battle -- not psychotic men or women who love to murder -- but just regular heartfelt Joes and Janes from the tribe, then the wages of war also have to be the huge cost of tending to the soldiers afterward, sometimes for life.
Q: Is there any correlation between PTSD and the military suicide epidemic and the perception that the Iraq war is improper at best and immoral at worst? In other words, a Marine charging up a Japanese-held beach in the South Pacific during World War II knew that his was a war against global fascism, while a Marine charging into an insurgent hotbed in Diyala knows that his is a war for what? Oil?
A: From my work with veterans, I see that there are many ways each man and woman comes to terms with what they did during war. It depends very much on how mature they were beforehand and are now. How at ease with themselves they are. What pressures come from home. What respect or lack of respect they received before they enlisted or re-upped.
Because a soldier is a soldier -- remember that I'm a military wife (21 years Air Force) -- I've heard of many ways a soldier comes to terms with deployments and missions. A good soldier takes an oath and it is essential that he and she will do whatever is asked. In many situations their souls, spirits and minds might agree with their commander's ideals but not necessarily his or her ideas. But it's where the greater self does not agree with tactics that the soldier is often most vulnerable.
Donald Rumsfeld in his snark-aleck ejaculation about the soldiers in these current wars not being the inferior types that were sent to Vietnam ("You go to war with the army you have, not the army you might want") so grievously disrespected the legions of soldiers who gave their lives there and those who came back walking wounded. Rumsfeld actually make an irreversible revelation: If the soldiers today are better educated and more aware of the world than our brothers who went to Nam and never came back or came back but never really came back, then our soldiers today are even more able to ascertain words and causes they may find be hollow.
Q: There seems to be a danger that as PTSD is finally and grudgingly being recognized as a legitimate condition it becomes a catch-all and may be over-diagnosed. Has PTSD become too vaguely defined for its own good and is there the risk of creating a generation of patients who are trapped in a self-fulfilling vision in which, as science writer/blogger Johan Lehrer writes, "the diagnosis actually makes it harder for them to get over the trauma"?
A: Again, what is contained in the golden core of the human psyche is the desire to live, to truly live life. To be happy, to be content, to have joy, to enjoy the world, one's body and mind, spirit and soul. There is little need for concern about a person with PTSD wanting to forever ride in circles in the same old rowboat when they can speed along in a boat that is far more sleek and is actually going somewhere.
However, there are people who for a variety of reasons may try to stay in the rowboat long past it being the only boat available.Yet it is true and must be respected that a person with severe war-induced PTSD will row in circles for a bit as they get their bearings. This ought never to be confused with malingering. The time needed to process war experiences is why the depression aspect of PTSD, the shock induced injury to brain chemical and hormonal production needed for mental strength, mood balance, and so on, must be taken into account and watched over closely medically, most often for a long time. Psychotherapy also has to be present. One cannot simply give a pill to a person with PTSD and send them back into battle.
This is the rub and it always has been the rub: At what point does government stop treating soldiers as commodities, merely pairs of boots, and begin allowing and helping them fully rejoin the human race to which they were born and are inestimably valued as hearts, souls, minds, spirits and bodies in a way that no longer serves war but rather community, family and self? That's the question we are making progress in answering, but too often the helpers in this transition are still in the rowboat themselves going in circles while they wait for the "top brass" to catch onto what they already have known for decades. War can kill without you dying.
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Previous collaborations with and guest posts by Dr. Estés include The Anatomy of PTSD, A Warrior Loves Peace More Than Anything, and Why Were Psychologists Behind The Curve On The Bush Torture Regime?