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Wednesday, April 9, 2008

Is it ethical to send people with PTSD back to war?

The answer is NO. PERIOD.
I am writing about this because I got a call from a BBC reporter who wanted to talk to a veteran with PTSD who was being sent back to Iraq or Afghanistan.
When my husband Bob was diagnosed with "combat fatigue" about a year after he got back from Vietnam, (1966) the Army sent him the diagnosis and the information that as a result he could NEVER BE SENT TO A COMBAT ZONE AGAIN.
So what has changed?
They changed the name of the condition, but it is still the same condition.
They have new medication, but there is no medication for combat PTSD, as Jonathan Shay, MD says in his article at
There is no draft, but they need more soldiers than they have.
The job of psychiatrists today is to give pills, not find out what is torturing their patients.
The job of military patients, who are in because they want a military career, is to shut up and take the pills so they don't lose their careers.
It is the political situation that has changed.
Politics, as usual, sends people back into hell.
What is the evidence for it being safe? As far as I know there is none. Israeli studies of their multi-war vets showed that those who had PTSD got it faster and worse in the next war.
This is one of those cases where what should be (It ought to work, sending them back on meds) trumps actual experience. We see WWII, Korean, and Vietnam vets with long term effects from war, but this time it's different. We have medications! Well most of those veterans were SELF-MEDICATING all along, and it didn't work. But we have better meds. Oh, yeah? Where are the randomized double-blind trials to prove it. There are none.
It is like the earlier denial and delusion period of American psychiatry-1968 to 1980-when on no scientific evidence, any diagnosis which derived from traumatic events was dropped because people, normal people, "shouldn't" be affected by horrific experiences. Guys with couches decided that. Guys with pill bottles are deciding this.
Recovering from traumatic events takes time, just like recovering from a physical wound. This is a stress injury, not a chemical problem. Even if the chemistry is changed by the experience that should be a hint to everyone that war is not good for people. Our bodies are designed to react to stress and to AVOID it. Most PTSD symptoms start out as brain-and-body based, built-in survival mechanisms, which keep you alive and get you out of there! Modern warfare is designed to provide stress after stress after stress. Pills will numb your edge and, in my humble opinion, get you in worse shape. They may help when you get back as you work on recovery, but they are not recovery.
What works for emotional numbing and avoidance? Feeling the pain of your dead buddies, working through the stages of grief. There is no pill for that. It takes time.
What works for hyper-arousal? Somatic therapies, meditation, learning people-skills like "We can agree to disagree," etc. Learning to avoid triggers. Learning to identify triggers. Learning how to bring yourself back to the present when you are triggered.
What works for re-experiencing? Going through the story of what happened and turning it from fragments of smell, sound, vision, emotion, into a coherent narrative which moves it from your reptile brain up into your narrative memory in your fore-brain.
There are many methods which work to do these things. Probably the fastest is TIR (Traumatic Incident Reduction, Most of them take TIME and time is what the current situation does not allow for, nor military culture, nor the culture of current psychiatric practice which is heavily influenced by the major drug companies.
It is not ethical. First do no harm. Sending them back with PTSD harms our soldiers.


  1. Amen. Forget the meds, let's work this through!

  2. Patience, I first want to say thank you for the wonderful information you are putting out there. In my search to find help for my husband, I have come across your blog and I'm now reading your book, "Recovering From The War". I have recently started my own blog, in hopes that I can help someone going through the same thing.

    I have 4 children with my husband and after his second deployment to Iraq his PTSD symptoms became apparent. We are going through a very hard time. In not knowing what he was really going through, (and him having an emotional affair with someone), I asked him to move out of our home. We have since started to see a counselor together. He comes around and things seem to be getting better between us. The problem now is that he tells me that he feels like damaged goods and that he wants me to move on and find someone who can make me happy.
    How do I get him to understand that I want to stay and support him through this, without making him feel bad and how do I continue to fight for our marriage when he keeps telling me to move on. He says he wants to deploy again and I feel that it will only make him worse. That's another reason why he tells me to find someone else because he will feel guilty if he comes back worse.
    Should I just completely back off and let him go overseas again. I don't really know where I stand with him, he wont tell me he loves me anymore, but I know deep down inside he does. He says he is just so overwhelmed by everything that he doesn't want to hurt me more than he already has.
    What advice can you give me?

  3. Do you want to move on? If you don't then keep working at your marriage.
    To do that you will have to let him feel bad when he does. He's allowed to feel bad. He probably has a lot to mourn. Trying to make him be happy is a common mistake. He has to work through the pain in some way that works for him which means you will have to work on yourself to keep from trying to make it all okay. I didn't know how to let Bob feel bad, because I was raised to fix things. Maybe you were too. The good little woman role.
    In the past, once a soldier had PTSD, he was NEVER returned to the combat zone for any reason. They want to go back because it is comfortable and often because they want to help the guys that are there now because they have valuable experience. I consider the current military practice of sending people back on drugs as unfounded on any studies and therefore unethical.
    I don't know if you can keep him from deploying again. Perhaps he would let you come and talk to his psych about it and see what the professional opinion is about it.
    I also think that it would hurt you more for him to end it, and you should tell him that. That doesn't mean he will do as you want, but you will have been honest.
    Sometimes when Bob would say I should divorce him, I would say, "You are worth the pain."

  4. Thank you Patience for your message. I have decided to stay and fight and I do believe he is worth the fight. I will be telling him this tomorrow when we meet with our counselor. He is still determined to return overseas but he seems at times to question that decision. I don't think there is any way I can keep him from going back. I know that I don't want to tell him that if he leaves I will leave him because he will still go.
    I was afraid that if I continued to show my determination in regards to me staying when he wants me to leave, that perhaps it was making things worse. I'm relief to hear that its ok for me to be honest in my support for him.
    Again, I thank you for your wonderful advice, I have learned so much from you!