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Friday, May 4, 2007

Is PTSD normal after War?

Yes, it is. Right after a single trauma, according to one study, everyone gets all the symptoms of PTSD. Some of them seem to heal, so it is a disorder of healing. Our society seems to be set up especially to prevent healing from trauma. Everyone wants you to be over it in a week. I remember hearing a woman who barely got out of the Trade towers on 9/11 saying a week later that her friends were asking her why she was still upset. After all, she lived.
It is illegal in this country to feel pain. We are all supposed to be fine. FINE is an acronym to some of us: F**cked up, Insecure, Neurotic, and Egotistical, which fits those people who think "It wouldn't have affected me/didn't affect me/shouldn't have affected you."
All the symptoms of PTSD start out as survival skills which are built into the brains of all of us. No one is exempt. Those who seem to have been exempt, like John Wayne or Rambo, actually sat out their wars and were never exposed to combat.
The first survival skill set is called "symptoms of increased arousal not present before the trauma" by the diagnostic criteria. One problem with this is that if they were present before the trauma, it probably means you were traumatized earlier. Beatings, emotional abuse, neglect, sexual abuse, when these happen to a kid, they are more traumatic, not less, and kids react by becoming very wary and very fast. This makes them better soldiers. It is what basic training is designed to reinforce because these behaviors will keep you alive. The first PTSD symptom/survival skill is an effective (not "exaggerated," EFFECTIVE) startle response. Others include irritability and outbursts of anger, inability to fall or stay asleep, hypervigilance, and "inability to concentrate" which is actually the inability to concentrate on anything that is not survival information. These keep you alive. This is the fight/flight/freeze capacity, built into all of us that enables us to react before thought. Our brains are designed to scan for danger and react instantaneously. Since this capacity is based in what they used to call "the reptile brain" in High School science, it doesn't speak English (that's in the frontal lobes, the last part of the brain to develop) and can't tell time, so you can tell yourself you are home and it is over, but the message does not get through to this part of the brain for a long, long time, sometimes never.
The second survival skill set is called numbing and avoidance. Our brains are designed to pay attention to threats, which means extraneous stuff like emotions go into a box. The brain is also designed to rapidly adapt to whatever is going on, which means the first dead person is very upsetting, the second, not so much, and by the third, you may be numb as a stump. This keeps you able to keep fighting and doing your job, saving yourself and others. (In medicine, this is called professionalism). Trauma/combat happens so fast that you can't take it all in, so you may forget all or part of some particualrly horrific incident, which is your brain's way of protecting you. Unfortunately those details remain in the emotional/non verbal parts of the brain and may cause you a bunch of trouble later. Once you have been in combat, you may not be expecting to live long. You know, on the most basic level that life can end in an instant. You've seen it. You will also probably feel like other people can not understand, that you are different, so you get detached and estranged from people. Part of this is because after your buddies are killed, you protect yourself by not attaching to new guys, but it is also a reality you are going to face for the rest of your life. Your brain has been changed by combat. And OTHER PEOPLE CAN NOT UNDERSTAND WHAT YOU HAVE BEEN THROUGH. I learned this when I came out of the movie Platoon and said to my husband, "That was so awful!" He looked at me, almost puzzled, and finally said, "It's worse when it's real." That statement hit me hard and I realized I will never know. I may want to understand, but if I am honest, I know I can't. On top of this people say such shitty things to combat vets, "Did you kill anyone?" "Why aren't you over it yet?" etc. that you know they don't understand. Then you start to avoid things that remind you of the trauma. You avoid thoughts and feelings that remind you of the war, so if you were happy and your squad got hit, you may decide you will never be happy again. If you feel it was your fault, you may decide you will never be wrong or feel guilty again, which will make you self-righteous and argumentative and critical of others. If you love your buddies who died (and soldiers in combat are closer to their buddies than anyone) you may decide never to love anyone again. Next you avoid activities and situations that remind you of the trauma: driving, cookouts (burning flesh), crowds (bigger target), sports involving blood (hunting, football), movies, reunions, etc. Avoidance behaviors are survival skills in that they help you avoid triggers which can cause strange embarrassing behavior. And triggers can have children and grandchildren, so that if a car backfired while you were watching kids play, and you hit the dirt, the sound of kids playing can become a trigger too... The progression of triggers can get you to a point where you can't leave the house. Avoidance is also a survival skill because it keep you from feeling a depth of pain that most people cannot imagine, a depth of pain that is quite illegal in America, the land of the fine. Once you are numb, it is much easier to stay numb. The commonest way to do this is alcohol, although almost any substance (drugs, food, booze, etc) or behavior (sex, gambling, internet, religion, shopping, TV, workaholism) will do.
Unfortunately your brain also wants to figure out what happened, so you will also start re-experiencing the trauma. This is what brought PTSD to the attention of shrinks who were determined not to see it back in the 60's and 70's (the American Psychiatric Association's denial and delusion period) so they think it is a wierd reexperiecing disorder with associated wierd behaviors. I'm lucky in that I knew my husband before he went, and after I found out there was such a thing as PTSD, I began to look at why these symptoms developed and how it would happen under the hammer of war. That is why I see PTSD as normal, meeting the need to survive built into all of us. BTW, others who think like me include John Briere, PhD and Sandra Bloom, MD, and some of the ideas I have mentioned here came from their work.
I have not been able to blog for a couple of months because of my rage at the REMF's who started this war, please note, WITHOUT LISTENING TO THE GENERALS!!!, and are now presiding over the mistreatment of PTSD, sending people back into the war on medications, and the mistreatment of our returning veterans, and giving bonuses to VA managers...
However, I think the most helpful thing I can do for our returning vets and our vets who are being re-triggered by this miserable cluster-f**k is to blog about my take on PTSD as a normal response to war. If you take nothing else away form my blog, remeber it is NORMAL TO BE AFFECTED BY WAR. NORMAL. NORMAL. NORMAL.
More tomorrow.


  1. Thank you for the nice post.

  2. Patience, it is normal and I totally agree that all of us should stand on top of rooftops and scream it out to the world.
    So many people ask me why my husband isn't over it..or give me that silly assed sympathetic look of -- 'oh'.
    You know the look, you know how it feels.

  3. thank you very much for this whole blog; i'm actually using what you say in this post as the main argument in a research assignment for my english class.

    i thought you might be flattered to know that you're now a credible source (at least to my professor)