On PTSD, or more properly, on Coming Home

Posted By Grim

Kat from Castle Donovan wanted us to talk seriously about the problem of what is fashionably called "PTSD."  No one here needs an introduction to the topic.  Kat's concern is that, in knocking down bad numbers on veterans' mental or spiritual health, we might ignore a real problem that needs to be dealt with.

She wants us to talk honestly about it, so I'm going to do that.  There's quite a bit about myself I'm not going to tell you, now or ever.  I will tell you some things you haven't heard before, to be sure, but I won't tell you why I know what I know.  Just see if it seems right to you.

Professor Andrew Lubin and I talked to COL Sackett, of TSGLI, about the need for legislation to help make sure combat veterans can receive whatever treatment they want without wrecking their career.  There is also the famous problem of the 'stigma' of asking for help, which is often seen as an admission that you're bent or broken or damaged.  Young men, as combat soldiers tend to be, often don't want to show weakness.  That is natural enough.

What you need to know, first and last, is that so-called PTSD is not an illness.  It is a normal condition for people who have been through what you have been through.  The instinct to kill and war is native to humanity.  It is very deeply rooted in me, as it is in you.  We have rules and customs to restrain it, so that sometimes we may have peace.  What you are experiencing is not an illness, but the awareness of what human nature is like deep down.  It is the awareness of what life is like without the walls that protect civilization. 

Those who have never been outside those walls don't know:  they can't see.  The walls form their horizon.  You know what lays beyond them, and can't forget it.  What we're going to talk about today is how to come home, back inside those walls:  how to learn to trust them again.

There is a sense that combat changes people, but it really doesn't.  It brings out parts of yourself that were always there, but that you hadn't encountered directly.  Those parts are in everyone else as well.  No one has clean hands.  No one is different from you.  That is important, so let me repeat it.  Everyone around you is just like you.  They don't know it, but they are.  You are not sick; you are not broken.  Everyone else is just the same.

One of my friends is a combat veteran of fourteen years and four wars:  Somalia, Haiti, Bosnia, and Iraq.  He fought into Baghdad in OIF 1, and is here again on his third tour.  He has a thing about indirect fire -- he walks to the DFAC from one bunker to another, along a route he has created specially so that he will never be more than a hundred feet from one.

Is that living your life in fear?  No:  it is experience.  He has been in the blast radius of a mortar before.  He carries the wounds.  We get indirect fire here fairly regularly.  He is the one who understands what it means.  Those who do not behave the same way are the ones who are fools, not him.  Here, that insinct is wise and will protect him.  When he goes home, he will need to start learning to trust that the skies will not drop explosives.  That will be hard, and I know he knows it.  He is afraid, and man enough to tell me so.

Or take this story, to show that this is not just about combat, but about reality.  That's important to know, because it reinforces the point that this isn't something in you that has broken.  It's just that you've learned something others haven't realized.  Those lessons come from the world we live in, and point to its real nature.  As such, the lessons can come from any place, anywhere the walls break down -- it's just that combat often brings that about.

When I first started to ride horses, I would get up on them without any sense that it was a dangerous thing to do.  We'd go running through the forest free and easy.  The first time I was thrown wasn't enough to lose that sense; it took nearly being killed, not once but three times, before the reality of what I was doing set in.  That shook me up, I am not afraid to tell you.  There was a time, months, when I could hardly sit a horse at all -- and no matter what I did, no matter which horse, it would spook or bolt when I got on it. 

I couldn't do the normal things that any little girl could do:  get up on a horse and ride it.  It wasn't that I was wrong:  I knew something that the little girl doesn't know, because she is too young to realize she can die.  I was right; I understood. 

But it made me helpless.  I had to learn, here as elsewhere, to ride in spite of the fear, in spite of that clear knowledge.  You have to learn to sit deep.

So, let's say you're in the saddle.  You're coming down a rocky trail -- steep, and maybe washed out.  How do you sit the horse?

You lean back, to take some of your weight off her front legs, and you relax.  You let your weight sit deep on her hips.  In two minutes you could be starting the rest of a long life in a wheelchair, but you relax.

And when she stumbles?  You relax, sit deep, calm her.  If she spooks?  Relax, sit deep, pull the reins.  If she falls, you do your best to leap free -- but until then, relax and sit the horse deep.

Relaxing isn't just about attitude.  If you stiffen up, your center of balance shifts.  It's easy to get thrown.  It's easy to fall yourself.  You can throw the horse's balance off, which will make it more likely she'll fall. 

Or she'll sense your fear, and spook.

The attitude this breeds with practice has a direct parallel with warfighting and diplomacy alike.  Both deal with genuinely dangerous situations.  Likewise, in both cases, there are many times when the worst thing you can do is show fear.  Sometimes, the best thing in the world is to show that -- no matter what -- you're feeling relaxed. 

So here you are, where we've all been.  You are suddenly aware of something your upbringing didn't prepare you for, and your society doesn't grasp.  You know it's real, because you've seen it; and the fear and anger echoes deep into your core, because you have the same instincts that propelled us successfully through ten thousand years of war. 

Yet now we have a society full of people who have never looked death in the eye, and never felt what it feels like to want to kill, or the guilt that comes from having wanted it.  You have to come home and live among them, but to them you seem strange.  You are afraid of what they will think of you, of how terrified they would be if they could see in your heart.  You have thought how you might kill them.  You don't intend to kill them; you just do that now.  It scares you that you do, but it just happens, like breathing.

I know what that's like, and there are plenty of us who do.  You can come home.  You can learn to sit deep. 

In fact, horseback riding may be one of the best things you can do.  If there is a place where you can take lessons, I would strongly suggest that you consider them.  It will focus your mind, and the discipline you will learn there is exactly the one you need elsewhere.  You have to learn to trust the horse, even though really horses can't be trusted; just like you have to learn to trust the walls that hold up society, even though you know what lies beyond them.

Another thing that you can do is find a martial arts group that is composed of combat veterans like yourself.  Here again, you will find a situation where you can train yourself in a discipline that will build just the qualities you need to deal with the world.  Look for a group that teaches real fighting techniques, not sport techniques; and one that is filled with fighting men, not sportsmen.  They will understand you.  Anyone can -- you are normal.  All of us are like this to a greater or lesser degree.  It's just a question of whether or not they've had the experiences that let them see beyond the walls.

These tools will help you learn to do what you have to do.  They will not be enough.  More than anything else, you need love.  Love cannot heal you:  it cannot make you trust the walls.  The training is what will do that.  Love is what will give you the reason to push through the hard times, until the training can take hold.  You must find someone who loves you, a mother or a wife or a friend, and trust them with your fear and your pain.  You must be honest with them, especially because you fear it will scare them and drive them away. 

Let them see.  If they love you, they will stay with you.  If they do, you will know you can rely on them.  That will give you time, and strength, to train.

A few last words on what are called 'the helping professions.'  There are three of these:  psychologists, psychiatrists, and chaplains. 

Psychology is a form of magic, not a science -- its fundamental models of the human mind are not falsifiable.  That's a technical matter -- if you're interested in the question, I've written about the dangers of taking psychology seriously on occasion -- but it is important.  We should never allow any of our veterans to be stigmatized, or have their careers in any way harmed, because of the opinion of a psychologist.  They mean well, but they aren't doing science -- their readings of your psyche should impact your career neither more nor less than the chaplain's, who also isn't doing science, but is at least honest enough to admit it.

That said, psychiatry is a medical science.  If you find that friends and chaplains aren't enough to drive off your demons, a psychaitrist can treat underlying chemical problems that may be adding to your difficulties.  This can buy you some time to sort things out within your soul. 

We tend to try to do this with alcohol.  I've done plenty of that myself, so don't think I'm preaching here -- there are just some problems that booze won't fix, and might make worse.  The right pill can turn off the parts of your brain that cause problems.  Sometimes the right medicine might make the difference between learning to love and trust again, or not making it home.  If you're thinking you may need that, and want to talk to someone you can trust, I'd suggest you try Doc Russia.  He is a medical doctor, not a psychiatrist, but he knows about this stuff.  More importantly, he's a Marine.  You can talk to him without worry.

As for Chaplains, I have a lot of respect for men of God.  That said, not all of them can be trusted, and not every religion is right for you -- and indeed, not everyone seems to be right for religion.  You've got to sort that one out for yourself.  A lot of men have found a fortress in God.  You might be one of them, and finds walls there that you need not fear to trust.  You might not.

The worst thing, though, is to trust someone who betrays you  -- whether a chaplain, a psychologist, or a wife.  Sadly, there are those who will.  I told you that you should show yourself to those who love you, so you would know whom you could trust to love you while you train.  It's different with 'helpers' -- they don't love you.  Trust them if they come well recommended.  Reach out to other fighting men to find the ones you can trust.  They are out there. 

At this time in my life, I feel very peaceful and easy.  I have a wife who loves me and whom I know completely I can trust.  I have a child who reminds me of the joy that is just as much a part of our nature as are wrath and murder.  I have friends and family, and things are all right.

You can have that too.  You can come home.  It may seem like you will never know joy again; you may feel like all positive emotions are washed out, empty, or shadows of what they used to be.

That will not always be so.  You can come home.

Comments

[Jeffrey Carr]

Excellent post, as usual, Grim. Blackfive is lucky to have you. I hope that the commenters, in particular, pay attention to your opening paragraph where you write: "Kat's concern is that, in knocking down bad numbers on veterans' mental or spiritual health, we might ignore a real problem that needs to be dealt with."

There's something seriously wrong with people who are so polarized that if a person they perceive as a hated "Liberal" says 'look at the problem with suicide rates or PTSD among Veterans', they can immediately dismiss it as a less of a problem than it is; not out of concern for the veterans but out of rage against Liberals. Talk about skewed priorities.

[douglas]

Jeffrey, the whole genesis of this post was that when people try to posit bogus trends or inflate the reality, we should be careful to not ignore the individuals who are in need of assistance. Why would you want to twist things back around immediately and divert the discussion when Grim is making such a good point? Talk about skewed priorities.

"What you are experiencing is not an illness, but the awareness of what human nature is like deep down. It is the awareness of what life is like without the walls that protect civilization.

Those who have never been outside those walls don't know: they can't see. The walls form their horizon."

I thought immediately of the animal rights types who have no idea what nature is really about- they anthropomorphize nature, while simultaneously not realizing that we ARE a part of nature too- we are not outside or above the system, we are a part of it. We just have the luxury of pretending that we are above it.

Thanks to rough men, we have the luxury of not having to look beyond the walls of civilization too often. I, for one, am grateful.

Grim, if asked, would you be willing to allow the armed services to reproduce this and distribute it to their personnel? It seems it would be excellent not only for those returning, but perhaps more importantly those deploying. Hopefully, if they are better prepared, they might be less negatively impacted by the view beyond the wall.

[Grim]

It's posted on an open source, douglas. Anyone can use it as they wish. I hope it may help someone, somewhere; but as I said, everyone needs just to read it and see if it seems right to them. Everyone is different, and some people may not find this helpful at all. That doesn't make anyone wrong; it's just how it is.

[Willy]

Wow Grim,
Well said brother.
This was not only a helpful, but insightful post.
You are a man both wise and intelligent, and these words should be read by many of our brothers, and anyone else who might need to hear them, be it policemen, firemen, paramedics, or anyone else who had to deal with PTSD.
Like you said, many things that can be labled as illnesses often aren't really illnesses at all. It's just easy for psycologists (and pharmicists) to label them as such.
And frankly, people who experience war, killing, death, or the fear, denial, guilt, shame, or any other emotions that come with what we experience, living outside those walls of civilization, truly 'get' reach a part of the human nature that most people can't and don't get to see and feel. And certainly don't understand.
But they are lucky, and we are to, in a macabre way. It is really in how each of chooses to recognise it, and deal with it.
Thanks for the great post and letting me pontificate on the subject for a bit.
Willy

[Laughing Wolf]

Well said, and Well Done!

As always.

LW

[jordan]

Beautifully explained, and sorely needed.

It's difficult to strike that balance between destigmatizing and understanding this problem, and remaining vigilant against attempts to exploit the PTSD issue to advance a political agenda.

I've already seen that done recently, quite artfully. NPR's "On Point" did a multiple show series last week that left you with the impression that PTSD lay simmering in every veteran, just waiting to be triggered, that no human could come back from war without it, and those who did were probably sociopaths.

DailyKos is doing a series of columns on it that wraps PTSD in a "Bush is evil" framework, full of heated emotion and high rhetoric. These ideas are out there, and have to be countered, period.

As you lay it out, you could argue that the impulse toward PTSD is the ultimate sanity, and those of us who haven't experienced it are the ones in denial, blissfully unaware of how "real" the human condition can get when civilization's walls are allowed to break unchecked.

A family member who just came out of "transition" last week recounted a screening that went: "Are you having trouble sleeping?" "Nope" "Any bad dreams?" "Nope". "Are you sure? Not one bad dream?" "Uh, no." "Any headaches?" "No. Sorry."

I'm aware that these answers can change over time. But we also need to be aware that there is an effort out there to use PTSD to stigmatize people who served in Iraq and Afghanistan in order to serve a political agenda, and are exploiting it and it's sufferers publically to justify sensationalist coverage and mindless hyperbole about war, all under the guise of "caring deeply" about the vets.

As in all things, it's a balance, I suppose.

[defendusa]

That was a great perspective piece. And helps to answer a question I had of my friend who was in Iraq last year. How come he seemed so "normal" after what he had experienced in comparison to another friend? Because one already had the tools do deal with the experiences and the other did not.

Excellent info here and I am dead sure it will help anybody who reads it. Thanks.

[Jeanet]

Here's some reaction about your post from across the ocean. (The Netherlands.)

I'm a PTSD-sufferer myself. And I've never come across a more human, honest, respectfull and loving way of describing what I personally call "it".

Since over 5 years I work at "a place" where I encounter numerous soldiers who, sometimes again (so, still), or for the first time are confronted with what PTSD is all about. Back-up and help is, unfortunatly, still under-developed. (Although it's not as bad anymore as it was only a few years ago.)

I kind of "stumbled" upon it, being only a volunteer at first. Untill I started to recognise the body-language, the behaviour and especially "the eyes" of some guys who I've known before and than came back after a mission. (Yes, the eyes are the mirrors of the soul!.)

Maybe it's because I don't weare a uniform, maybe it's because I'm a woman, maybe it's because I suffer of PTSD myself (not-military-connected, but still.....)but, mostly it's because I was kind of guided by Big Powers to start my volunteer-work exactly at this place at the right time.

Fact is that you explained in simple but respectfull words what it's all about. And that's exactly how I've dealt with it the past years. First, towards myself, then, passing it out to those who need it so badly.

Yes, you are not a bad person, no, there's nothing wrong about you. YES, look for HELP. NO, don't let yourself being labeled as "gaga". ( Although, the "gaga"-part has became kind of "part-off-the-deal". Without lots of humor I wouldn't have survived myself and it surely does help a lot when I have to crack some hard nuts ;) No pun intended.)

My personal experiences help me a lot to help those who are in need of help. All the words you have posted here help me again to go on with the path that I haven't chosen for AND the one that I chose to go.

With your approval I'll print your post and read it over and again every time I feel I'm out of solutions and out of resources to put a PTSD-sufferer back to one piece again as the result of a pledge I made myself one very dark night several years ago; never to let any one down the way I was let down when I hit rock bottom. To take the hand that reaches out for help. (Yes, it's a great deal about love and respect and avoid the mistakes that were made in the past with me as the victim.)

Thank you, Grim.

Let me bow my head for you in great respect.

J.

[defendusa]

Jordan--
You are right on the mark. The DK peeps are using PTSD as a way to justify the hatred they have of Bush and the war, but then project that into the "all soldiers" coming back will suffer PTSD from this unnecessary war.

The trouble with The DK, DU or any leftist "anti" organizations is that they cannot see how their own inadequacies stray so far from the issue that it makes them ineffective as mouthpieces. Hence, the sites like B5 whose writers focus on issues, reach farther to help than any of the horse shit published on the lefty sites. They only bitch, they seek not to solve. Never an ounce of sacrifice or doing. Just complaining and twisting to meet their agenda.

[65D]

Extremely well written. This will surely be able to help someone who might be in the roller-coaster of PTSD. Your explanations and analogies are right-on.

My only hesitation came with what I read as you guiding those with PTSD towards a medical provider that can give pills to ease the pain. I apologize if I am in error regarding that segment. Pills, when weak with this condition, might seem as the only way out; the only way to feel 'normal'. Chemical dependency is just as bad, if not worse, than the original presenting factor, PTSD.

Thank you again, Grim, for an outstanding post.

[Theresa, MSgt (ret)]

Damn Grim, that was awesome. I'm going to copy this and send it to my nephew, whom I've mentioned more than once on this site. He is heading home as we speak after doing 13 months in country. During his two week break, he went home to Vermont. I was told by family that he is no longer the easy going young man who joined the Army two years ago this past September. I hope your words along with the love of his family will help him "come home". Thank you sir, not just for your words, but for your service.

Theresa, MSgt (ret), USAF

[JihadGene]

Much needed words, Grim. Wise and helpful...and so very true. Thank you for your honesty and sincere advice.
Kat, thank you for having this brought up on B5.

[Brian H]

Superb, a unique and very useful POV. BTW, I've never ridden a horse, but motorcycles, now ... :D

[Deltabravo]

Grimmy, you are a jewel. This is one of the best pieces I've read here yet. (Suggestion to B5... Please put a direct link to this post in your margin somewhere under a title like "In case of fire, break glass..." so it's easily accessible from now on to those who need it.)

Grim, you have given a language and a way of talking about PTSD that is very helpful. To those who have had to see beyond the wall in their lives... and it isn't just those who have been in armed combat... some have had to see beyond the walls in their own family situations or in their own traumatic experiences... you have given a way of looking at that experience which doesn't put labels on people. It shifts the burden of understanding to the clueless noobs who have never had to look over that damned wall they hide behind.

Thanks for that. I believe long ago a British commander described the view beyond the walls as "Beyond the Pale."

It's not nice out there.

I agree with Douglas. This post should be printed on pamphlets and left in every VA waiting room, every chaplain's office, and every barracks in the U.S. armed forces.

(And thanks also for making me understand why I've NEVER liked to be around horses.)

[MICHAEL in MI]

GRIM - Thank you for this post. I can only echo the compliments in the previous comments.

This helps me as a civilian with very limited contact with the military and military members throughout my life. I struggle to interact with military members in general, just because while I respect and honor them for their service and completely support them in their mission and make the efforts to talk with them about military matters and their experiences and such, I know that I will never have any sort of bond or understanding of their experiences and what they go through, since I have never been in the military. And I always get the feeling that while the military members I've talked with appreciate my interest and my respect of them and my eagerness to learn more about the military so as to have a better understanding, they also hold back, because they know there is just no possible way to explain some things to a civilian.

It's a very humbling, frustrating and helpless feeling. But, at the same time, I don't blame them. I'm more frustrated with myself for not having joined the military when I was younger, so I would have that bond and shared understanding. Then again, I wasn't the person when I was young that I am now. But I digress...

As I said, reading this is a great help to a civilian such as myself as well. I am very grateful for men such as yourself and the efforts you make to share these things with others on Blackfive. I know your main purpose is to help those in need in the military community, but just know that it also helps civilians such as myself as well.

Keep up the good work, sir.

[Kat-Missouri/USA]

Thank you very much Grim and Blackfive for taking a moment to address this issue. As a respected milblog with many military readers, a discussion from this site will indeed make it more "normal".

In regards to some of the comments, first I'd like to address the "normal" aspect of these conditions. I say "these" because it is broken down into two aspects: Acute, short term Post Traumatic Stress and the more long term, chronic Post Traumatic Stress Disorder. In fact, many soldiers will experience the short term version of this condition. It IS normal, as Grim notes, to take certain experiences with us back to our "other" life. A little heart pumping moment when a car drives too close, a dream that incorporates aspects of our experiences that wakes us up, a little extra sweat when we're in crowded places that we don't know everyone...all of that is pretty "normal". Usually, this condition can and does recede within 30 - 90 days, though some "light" or inconsistent moments can occur later on.

If people recognize that and, as Grim notes, take some basic steps to deal with it, it does not have to become career ending or the more long term Chronic disorder. I would also like to point out that PTS and PTSD are pretty normal among civilians, not just police officers and firemen. Anyone who has been in a terrible car accident, been assaulted with a weapon or some other violent crime, or been the victim of a natural catastrophe (such as the total destruction of Greensburgh, Kansas, earthquakes, devastating floods or hurricanes like Katrina), any time an event occurs that reduces our sense of safety, can lead to this condition. It IS normal.

I myself was in a car accident where a car changed lanes and side swiped my car, pushing me in to several other cars and causing a very nasty accident. I was uninjured, but for months afterwards, if I saw a car in the lane next to me out of the corner of my eye, I would get very nervous and drive closer to the other side of the lane. That is PTS and it IS normal. While it is not "combat", it is the normal response, as Grim notes, of all humans who have experienced those moments when their "security" is compromised.

PTSD, the chronic form, is a concern when either the symptoms are so intense that they begin to effect daily life and our relationships or if the symptoms go on for six months or more. If dreams are consistently the same, wake the sleeper up, interfere with normal sleep patterns on a regular basis, this can be signs of a more intense condition of PTSD. Lack of sleep adds to this situation because sleep helps us recalibrate. People without sleep for long periods of time can experience increased sensitivity to certain situations, become angry more often and are likely to "self-medicate" with alcohol or drugs in order to combat it. That's when we need to recognize that it requires something more.

It's important to recognize that this condition does not mean "forever", though for an increasingly small number it can. That is why the discussions need to be more often and the military, as well as many civilian organizations, are pushing forward with important "first steps" recognition and treatment. Doing so has come a long way in reducing the impact on the individuals and the advancement of such conditions.

PTS, the non-chronic version, is not career ending, even in the military. In fact, they have taken steps to address it within the confines of the person's military career by keeping them in the service and with those that they have served with. Many complain about the "transition" phase of returning home from the front, but it has a good reason. even those who might think they are not benefiting from it, are in some ways. Professionals and the military have recognized that shared experiences can assist in the "transition" and that separation from people we've experienced these events with can be equally traumatizing.

It's not science, as Grim notes. It is "an art", so everything that is done doesn't necessarily translate for all people into "the right way". The "right way" takes a lot of give and take with the patients and the professionals. It's a good reason to share with someone close who would become a bulwark and an advocate while this transition or treatment occurs.

This is not an additional guilt, but a reminder that PTS and PTSD are not conditions that are suffered "alone". It impacts friends and family. Most of whom only want to help and don't know how, particularly when it seems its rejected. They don't need to know everything that you know, but they do need to understand. And, almost all of the time, they will be supportive, but it is difficult if that support is rejected. They are confused, too.

In rounding out what Grim said, PTS and PTSD are two different things. Many who are experiencing symptoms of PTS are afraid to say anything because they don't know that. They think it will be "career ending" and "life changing". It isn't and doesn't have to be.

Finally, I would like to note that this is not about being "weak" or "strong". In fact, it is often the people that consider themselves "strong" or are viewed by others as such, who may experience this more often. It's not a "weakness" or a "chink in the armor". People who are strong are used to being in control of their lives and others. Traumatic events are out of our control and we don't adapt well to that. That's not a weakness, that's a strength.
It is that strength that can help reduce these factors and, to quote Grim:

You can come home.

[MICHAEL in MI]

Jeffrey Carr - I believe jordan and defendusa answered your query better than I could. The basic reason that most of us disregard this issue when it is brought up by leftists is because most (not all) leftists bring the issue up as a political point, not as a sincere attempt to help military members. They use it as a weapon with which to attack the Bush Administration or "neocons" or the war effort. This issue is completely separate from the politics of the war effort and should be treated that way. GRIM does that. Most of the Left does not.

[Kat-Missouri/USA]

During his two week break, he went home to Vermont. I was told by family that he is no longer the easy going young man who joined the Army two years ago this past September.

One thing people need is "acceptance". I think one soldiers' mom put it succinctly that we need to recognize these changes are "normal" and not try to force that person back into some pre-existing idea of their personality. They are not going to be the same, ever. If we accept them as they are, they will, too and that will go a long way towards mitigating the conditions.

It doesn't mean not to look out for the things that might be clues to a more serious problem, it just means we have to do our own sorting out as well.

[MissBirdlegs in AL]

Thanks so much for this post, Grim. As some of your other commenters, I found that your wise words most certainly apply to some civilian situations and not just to the military. It's the most sensitive and compelling explanation I've seen for other things some of us have experienced. Again, my sincere thanks.

[Theresa, MSgt (ret)]

I agreed Kat. Thankfully, my nephew's immediate family (Mom/Dad, 2 sisters) are very close. My nephew is extremely close to his father. I don't think he'll encounter any problems with not being accepted by them or even my side of the family. His father's family on the other hand are jackasses. I've already sent the post to my sister and brother-in-law. I hope, if nothing else, it gives them an understanding of what he could possibly be dealing with. I guess we'll have to wait and see. He gets home right before Christmas. Thanks for pushing for the discussion. I have PTSD. Nothing related to combat of course and not debilitating, but its there none the less.

[Deltabravo]

Let's call it what it is, Kat, because you are right. Those who return will never be the same again. That isn't a condemnation. It's an observation. In many cases they have looked into the face of Evil. A level of Evil many never see. And that changes one profoundly. I wouldn't want to know the person who could look on that kind of evil and NOT be changed.

Sometimes that Evil is a little hard for the brain to process. The brain doesn't WANT to process the fact that people can be that evil.

And in this respect, our vets share a lot in common with the people of Iraq and Afghanistan. How do you rehabilitate whole populations who have been forced to live outside "the walls?" How do you "fix" children who have known nothing else? How do you help societies like that readjust to "normal?"

Our hair-brained left-tards who have only seen the face of evil staring them back in the mirror are demanding that nations suffering from collective PTSD "snap to it" and behave "normally" within a year of being liberated.

Our soldiers and Marines who have been there know differently.

[DarthMalum]

GRIM: as a non-combat veteran of the U.S. Army and a Combat veteran of the UCK, which most people who served in the U.S. Forces know as the KLA (Kosovo Liberation Army)I can only say that what you need to ensure widest distrabution of this brilliant written work. You can be assured it will make its way around III Corps if you so wish it.

"What you need to know, first and last, is that so-called PTSD is not an illness. It is a normal condition for people who have been through what you have been through. The instinct to kill and war is native to humanity. It is very deeply rooted in me, as it is in you. We have rules and customs to restrain it, so that sometimes we may have peace. What you are experiencing is not an illness, but the awareness of what human nature is like deep down. It is the awareness of what life is like without the walls that protect civilization."

I have commited this to memory now and will be ramming it down the throat of the next person at Darnell AMC who tells me, or my wife that we have an illness.

[JustTruth101]

Question: My fiend is serving right now in Iraq, should I send him this post, or wait until he comes home in a few months to talk to him about this? I don't want to give him any more to think about than he already has on his mind. I had to go through some counseling a few years ago re childhood trauma, and when I was going through it, it screwed my mind up for a short time while I worked through the issues...and I do not want to do that to him. He's coming home in March, and when he was on a visit a few months ago, he did tell me some stuff that made me worry he might be feeling guilty about doing his job, which we talked about a little, but he didn't want to get too close to it. Anyway, opinions from those who have served would be appreciated...I have not so I just can't fully appreciate what it's like. Thanks.

[The WatchCat]

As a civilian who came home from overseas with PTSD, I have only two words: Thank You.

[David]

Nice post Grim. The horse story hit me personally odd. When I was a kid my parents sent me to a working dude ranch. I had never ridden a horse before. I was taught to ride deep and loose in the seat from the get go. I have never been thrown by a horse, though truth be told, I have been kicked real hard by a horse. She put two large perfect horseshoe bruises on my butt.

[MICHAEL in MI]

Anthony and Terri have a pretty good archive of PTSD and Military Medical Issues posts over at A Soldier's Mind, which is a nice complement to this post.

[Kat-Missouri/USA]

I should have posted a link to this earlier. The best thing to do is be informed so we don't get surprised or think something is more wrong than it should be.

National Center for Post Traumatic Stress Disorder

[MICHAEL in MI]

Kat - I tried that link and it did not work. But I went to the home page and then searched around and found this related to military issues.

This section contains links to a wide variety of military related resources, such as links to military family programs, all of the US military branches, and veterans service organizations (VSOs).

[Kat-Missouri/USA]

Thank you. Must have copied bad.

It is better to be armed with information. I can tell you that because I know I had to research a lot of information myself. My father has PTSD and I can tell you that, when he was diagnosed twelve years ago, we didn't know anything and these resources weren't available or proliferated. I'd hate to have people in the same boat as I was; confused, unsure how to support him, unsure what it meant and unsure what could be done about it.

One think I wanted to share was the idea of "trusting professionals". My dad went through several until he found someone he could work with. Even then it took some time for him to talk and address things. Mainly because it was a professional who diagnosed him and it ended his career as a police officer. He blamed that person and the profession for a long time. The truth, though, was that, by the time he was diagnosed, he was hitting all the "extremes" and simply wasn't able to continue in his job. That was hard after 21 years in.

But, the other truth was, if we had known earlier what it was (since we saw symptoms and he noticed it too), if it had not been a "stigma", if this information had been available, he might have received treatment sooner and this issue would have been moot. It's hard to tell. One of the problems was that my dad was always very strong mentally and physically. He had a hard time accepting that he couldn't control this or that it was a problem at all.

I'd hate to see other folks land in the same boat for the same reason.

[Kat-Missouri/USA]

This is the main website for the National Centers for PTSD

This website will give you the basics of what "PTSD" is: Information on PTSD

There's a video, a basic FAQ and a really good section on working with therapists. I think that would help people be prepared, ask the right questions and know that they have input in their health care.

[Sig]

There's another angle about getting help that I don't think is as well recognized. In addition to not wanting to appear weak, some of us have security clearances which are required for both our military and civilian careers--often simultaneously for people in my Guard unit. Getting help for combat stress-related issues is often viewed as a double-edged sword; I've heard several people say that they won't go to the VA (or anyone else) for fear of risking their clearance or their chance to go back in theater when we deploy again.

Army-wide, we are required now to have training on recognizing causes and symptoms of mild traumatic brain injuries and PTSD.

Sig

[AGruntsWife]

Grim,

It doesn't seem like nearly enough, but here it is anyway. Thank You.

Tink

[Swede]

Ok. I've done 2 tours in Iraq. The first was a combat tour (by anybody's standard), the second was a staff tour. I was a medic in an airborne infantry company the first tour. I've been in two IED attacks, both had casualties, one had 2 fatalities. We did about a million mounted and dismounted patrols. We made contact, we captured and killed bad guys. I've treated wounded Soldiers, hajis and civilians. I've dealt with dead Soldiers, hajis and civilians. I've spoken with fellow Soldiers about the things we've seen and done. I've spoken to the Chaplain about many of the same things. Not because I felt the need to, but because our Company policy was to see him after every contact. I have always felt very strange about this because it seems that everybody almost EXPECTS you to have some kind of problem dealing with these things. I don't. Or, at least, I haven't yet. I'm not a tough guy. I cry at weddings. Me and about 4 or 5 women are guaranteed to cry at a wedding. That doens't mean that I don't think PTSD is real. I've seen some of it's effects on some pretty strong characters. I guess my point is that some people experience traumas, deal with it, and move on. Some need more time. The problem I've always had with any public discussion about vets and PTSD is that I think most people think that everybody who has experienced combat has it. In particular, I am always suspicious of liberals who talk about it like they have any genuine concern for Soldiers at all, you know, "I support the troops", but nobody really believes them, particularly not Soldiers. So who are they trying to convince? Themselves? Because they sure don't convince me. I really believe they are only concerned about PTSD and Soldiers when it is convenient for them to do so because it supports some political point they want to make. So imagine, if you can, that almost everybody supposes, because of your combat experience, that you have some degree of PTSD. I would argue that most combat vets don't. I have nothing but my own experiences and the conversations I've had with fellow Soldiers to base that on.

[Bookworm]

Absolutely excellent post. Thank you. My Dad was a veteran of WWII (five years in North Africa and Southern Europe) and the Israeli War of Independence. My mother was a concentration camp survivor (Japanese, not German) and resident in Israel during the War of Independence. Both went on to live productive, normal lives. They worked, they raised children, they had friends. They were not untouched by what they experienced. Nevertheless, it did not define them nor did it constrain them. Yes, my Dad worried about long drives (very risky) and my Mom, to this day, hoards sugar, but they never saw themselves as victims, only as victors and survivors. Certainly I think both would have been happier people over the long run if they'd had counseling after the war, but even that's not clear. Both came into the war already scarred, having experienced broken homes, poverty and escape from the Nazis. With those types of histories, it's impossible to point the finger at their wartime experiences as the sole source for any subsequent neuroses they might have displayed.

[Jeffrey Carr]

Swede wrote: "In particular, I am always suspicious of liberals who talk about it like they have any genuine concern for Soldiers at all, you know, "I support the troops", but nobody really believes them, particularly not Soldiers. So who are they trying to convince? Themselves? Because they sure don't convince me. I really believe they are only concerned about PTSD and Soldiers when it is convenient for them to do so because it supports some political point they want to make."

Let's start from the top. I'm a Liberal. My wife suffers from PTSD, not because she's a combat veteran but because she was raised by a physically abusive father for 18 years. Now, 20 years later, she still suffers from it. My brother-in-law suffers from PTSD. He's a cop, but took 2 years off to fight in Iraq with his Army National Guard unit. When he returned from the war, it quickly became apparent to both his family and his fellow cops that he wasn't the same person and the department encouraged him to seek counseling. He's diagnosed with PTSD, stemming from his service in Iraq.

Finally, no one scores political points except politicians, certainly not some commenter on a blog. Bottom line, your bias only makes you look ignorant. When it comes to real people suffering real problems, Liberals and Conservatives ought to be able to find common ground.

[Swede]

That sounds so sweet, Jeffrey.

But if you want to see ignorance about vets and PTSD in action, take yourself back to your regular stomping grounds at Daily Kos and DU. You can read, all day long, about how McHaliChimpBurton has broken our military, as evidenced by all the broken Soldiers (who they support, by the way).

The fact that you claim "no one scores political points except politicians" only shows you to be the dumb ass that everybody here already has you figured for.

[Cincinnati_Bob]

Grim, Required reading, and as you allude, I would guess we got the tip of the iceberg here.

I haven't been there. So all I care to say is that I hope you and yours continue to do well.

Though I believe I'd be eyes open and able to deal with it like Swede. Who knows, and I'm also not I'm my early 20's or less, so who knows. (I knew a 'Swede' when I was a lot younger.. very impressive guy but it can't be you Swede because that was 30 years ago, and he wouldn't be getting back from Iraq. fwiw)

PS - Jeff, how are you sweet thang? Wait don't tell me.

[Cincinnati_Bob]

Geez. Ok, I'm not in my early 20's or less so who knows, and the Swede I knew wouldn't be getting back form Iraq because he never would have been assigned there...

Off to have another Heineken..

[elly]

Thank you, Grimmy.
Another great perspective on this subject from a Vietnam veteran; long but well worth the read.

[elly]

Oops. Ignore previous post. Link was all wrong.
here is the correct link.

[Kat]

Grim... This is an area where I have no knowledge, yet you gave me a small glimpse into what it might be. FWIW, this was a clear, simple (NOT "simplistic") post which appears to me to have great sense and practicality. I do hope and pray that God puts it in the hands of those who need to read your words.

I appreciate your openness and your perseverance, and I am so glad that you are blessed with such a worthy Lady for your wife. I pray that you two have many, many more years together as true partners.

Thanks again: your words have given me a lot to think about.

-- Kat
www.CatHouseChat.com

[Steve J.]

Psychology is a form of magic, not a science -- its fundamental models of the human mind are not falsifiable.

If you are referring to Freudian theories, you are basically correct but clinical psychology has made a LOT of progress since those days.

[Synova]

The reason I avoid talking about PTSD is because I'm sure it's going to come out wrong. Those who need help certainly need it, and without prejudice, and those who need medication need that, too. But I just figure it would come out wrong to try to argue that it would be entirely *abnormal* for someone not to react to long term stress and a war zone. (Swede, I've got my theory on you, being Scandinavian myself. When I've had the stress reactive "get under a desk" twitches I've thought, "wow, that's interesting" rather than "Ohmygod, what's wrong with me!" Sound familiar? Or do you really not look for cover at loud noises?)

Obviously, things become a problem when they become a *problem*, but I didn't figure it would be useful to share my thought that battle reflexes were normal. I figured it would always come out as "everyone is sick, war breaks everyone."

I'd never considered what Grim said, that the person arriving home, nervous in crowds and involuntarily reactive to loud noises, always a bit on edge, was the person who saw the world as it is... a dangerous place. That their reactions are the correct ones.

Certainly there are degrees of adjustment and degrees of needing help but I think for a lot of people just knowing that keeping an eye out for danger or planning how to kill random people if they turn out to be a threat (curiously, this is a little bit what we do in the martial arts that I take... what would I do now if I had to... situational awareness) doesn't warrant a "what's wrong with me?!" response, will probably help more than therapy.

I'm glad you wrote this Grim. Even though I'm certain that someone will pick it up and twist it, the people who need to read it need that worse than we need to avoid the risk of "having it come out wrong."

[Jeffrey Carr]

Swede wrote:

"That sounds so sweet, Jeffrey."

Really? Did it make you cry, like you do at weddings?

"if you want to see ignorance about vets and PTSD in action, take yourself back to your regular stomping grounds at Daily Kos and DU."

For Daily Kos and DU to be my "regular stomping grounds", I'd have to post there regularly. Since I don't post there AT ALL, that would be a neat trick.

"The fact that you claim "no one scores political points except politicians" only shows you to be the dumb ass that everybody here already has you figured for."

I see that I'm arguing with a child, so I'll re-visit what I said in an even simpler way in the hopes that you'll grasp 50% of it.
Scoring political points is only important to someone who is in a contest, where "points" amounts to more votes, or more donations, or something worth winning once all the "points scored" are tallied. If there's no reason to keep score, i.e., no contest, then only idiots keep score.

Now that I've cleared that up for you, I'd like to suggest that if you still think that someone is keeping score of "political points", that you're probably suffering from some kind of Dementia, which would also explain why you don't believe that you have PTSD.

[Jan Bussey]

Excellently said. As someone above said, it isn't enough, but thank you.

[Papa Ray]

Great post Grim.

Yea, I identified with it, way too much. I could write a book about this condition. Not sickness, nor illness, but a condition of the mind and the soul.

In fact I did, it was part of my therapy years ago.

I have helped several "civilians" get through hard times after having terrible things happen to them or their loved ones. Let us not forget them. Us Vets are one thing, but the innocents that have seen the "other side" should not be forgotten nor neglected.

It seems that many that are, turn to terrible things themselves and then other innocents suffer because of it.

It took me a long time to find my way back home.

But then I always knew I would.

Papa Ray
West Texas
USA

[Freedom Now]

Jeffrey,

Your insinuation that Swede has PTSD is completely based on an unwarranted personal attack because you have no evidence to base that on or to even question the point.

It shows that you are indeed willing to use PTSD for political benefit.

Thank you for proving the point.

[Swede]

"Scoring political points is only important to someone who is in a contest, where "points" amounts to more votes, or more donations, or something worth winning once all the "points scored" are tallied. If there's no reason to keep score, i.e., no contest, then only idiots keep score"

Dude, do you even know who Markos whateverthehellhislastnameis is? Do you know what he does for a living? He's a liberal who takes money from other liberals and gives it to liberal candidates. You see, Jeffrey, he does this by scoring political points on his blog, which nobody here doubts you are very familiar with, by feeding the moonbats that post there with the opportunity to say wonderful things about this president and our military. You see, Jeffrey, according to Kos, our military is broken. And Bush broke it. Just look at all of the troops suffering from PTSD. Almost every single one of them. AND IT'S ALL BUSH'S FAULT (hooray)!! He then encourages these same moonbats to give up some of their money to the candidates who will end this war, if only for the sake of the Soldiers (who they support, by the way).

Oh, and Freedom Now seems to have your number, too.

[Swede]

By the way, thanks for making it "even simpler" for everybody to see your third rate intellect in action.

It almost makes me cry, like at a wedding.

[Peg C.]

Outstanding post, Grim. A keeper forever.

There are civilian or non-war types of PTSD. My husband, who made it through a year in Vietnam unscathed (Air Force plane mechanic), lost a child to a terrible, violent crime 2 years ago. We, especially he, saw the evil in the heart of man -- of all humanity. The stress on the family has been horrific but I also know he's been suffering from PTSD. It has gotten better with time, and he understood exactly what was wrong with him, but the pain never goes away, it just dulls a bit. He cannot experience the unfettered joy of life as he once could but slowly the colors and feelings came back. PTSD is a very lonely, cold and dark place where you are numb. I agree that people need help, even medicinal help, to come back from it to the world of the living.

I have long believed that civilization is merely a thin veneer separating us from our violent, animalistic selves. I believe that even more after having run into claims that the human race has progressed past wars, tribalism and general horror. The human race hasn't been in existence long enough to progress past anything! Our genes don't evolve that fast. A lot of our problems are due to technology, culture and civilization progressing much more rapidly than the laws of human nature can keep up with. I am particularly taken with your comparison (in the linked WoC post I read a year ago) of the concept of "clean hands" and "dirty hands." I have never shot a gun or killed anything bigger than a spider (I don't think having racoons or deer run into your car counts, though it's a bit traumatizing) but I know, in my heart, I am capable of killing, even of murder, even of mayhem. Every one of us is and we are fooling ourselves if we think otherwise. The reality of human nature and the human condition is the reality of the world. It is folly to pretend otherwise.

[Grim]

Cut it out, you two.

[CactusJack]

..He has a thing about indirect fire -- he walks to the DFAC from one bunker to another, along a route he has created specially so that he will never be more than a hundred feet from one...

Thank you, Grim, for a well-thought essay about PTSD.

I also have this "thing" about incoming. During my time over there early last year, I followed a similar routine as described above. Not only were bunkers along my route scoped out in advance, but also ditches or anything else that could potentially provide cover from incoming.

It's normally difficult for me to discuss such matters. I sometimes wondered if my pre-planned response to IDF was excessive, although perhaps not.

[Grim]

It was not excessive. We had incoming very recently. I was sitting right outside a bunker when it came in, so when it hit I was laying down inside the bunker.

If I'd picked a different place to smoke my cigar, instead of picking a spot that was by the bunker "just in case," things might have been different. Shrapnel travels. It's good to take care. No reason to make it easy on the bastards.

[Cincinnati_Bob]

Jeffery Carr.

Why do you feel the need to insult in each and every post ?

I mean I know, but do you?

It is your conditioned response targeted at giving you the false illusion of superiority. It only lasts a couple seconds and then you have to do it again, and again, and again, over and over and over.

Do you often do
The Superior Dance?

[douglas]

"Jordan--
You are right on the mark. The DK peeps are using PTSD as a way to justify the hatred they have of Bush and the war, but then project that into the "all soldiers" coming back will suffer PTSD from this unnecessary war." -defendusa

Yes indeed, but there's a greater problem with that, and Grim sort of touched it tangentially- When they use the inflated spectre of 'every troop will suffer PTSD', they actually create a series of larger problems:

First, they actually fertilize the stigma on PTSD, though it should not exist. Why? Because they present it as a sign of guilt for wrongful actions, rather than a normal possible response to highly stressful situations.

Second, as they use it as a political weapon, many military members might want to hide it because, among the multitude of reasons already discussed, they wouldn't want to harm the war effort by giving the anti-war types more ammunition.

Third, troops suffering short term effects, because of the 'conventional wisdom' of 'all troops get PTSD(acute)' might see it as a prelude rather than the short term re-acclimitization to civilization that it may be. If so, they may react in ways that exacerbate the problem and possibly make a self-fulfilling prophecy, when there may have been minimal effect if dealt with properly.

Using the issue improperly as a political football has consequences. Those who do so are not without blame.

[Kat-Missouri/USA]

I really believe they are only concerned about PTSD and Soldiers when it is convenient for them to do so because it supports some political point they want to make. So imagine, if you can, that almost everybody supposes, because of your combat experience, that you have some degree of PTSD. I would argue that most combat vets don't. I have nothing but my own experiences and the conversations I've had with fellow Soldiers to base that on.

Swede,

First, I'd like to assure you that you are correct. According to studies, over 80% of all soldiers do not experience either the short term PTS or the long term PTSD. Many develop coping skills or had them all along. There is nothing wrong with that, nor does it imply any hidden number. In fact, current programs have come a long way in addressing these issues and helping to reduce them. Current studies from the NCPTSD show that 30 out of 100 Viet Nam Veterans experienced some form of the condition while it is down to 18 of 100 in Iraq and 11 of 100 in Afghanistan (Iraq having a previously greater instance of persistent combat). So, we're making progress.

Even some soldiers with these coping skills may experience some of the "symptoms" of PTS or PTSD and never develop the actual condition. As Grim points out, certain responses are natural. As I note above, many who experience some aspects of the condition, actually have those "symptoms" recede within a few weeks or months of redeployment. No one here is saying that everyone has PTS or PTSD. In fact, it is unhelpful to state such a thing and no one should "self-diagnose". Sometimes, over worrying about that alone can be a stressor that leads to other issues.

However, if there are multiple symptoms and they are persisting, whether pre or post redeployment, it is better to address them, ask questions and get a professional opinion before rejecting it or embracing it as a definite. One should simply be cognizant of the potential, the symptoms and the causes. It is better to be forearmed with the knowledge than to be left wondering. As I noted to a friend, when you go into combat, you prepare for the mission by checking the intelligence, reviewing the map, checking all your men are fit for the mission and checking all your equipment. You know the potential risks ahead of time. On mission, you maneuver and react to insure your team remains secure and completes the mission together. This is simply an extension of that. Your mission is now returning home.

As for making you speak with the Chaplain and whether it is a waste of time, the issue here is the military trying to be pro-active based on available information regarding the potential on-set of either PTS or PTSD. Most studies show that if people who have been involved in such events have the ability to address their thoughts on the event and any negative feelings immediately afterwards, the potential for the on-set of such symptoms or conditions is greatly reduced.

Since attitudes towards these discussions have not changed (ie, no one wants to due to the "stigma" issue) and previously offering voluntary sessions resulted in most rejecting it, the military handles it by ordering it for everyone. That, as you know, is the military way. I might add, while it may not seem beneficial to some, in fact it has a hidden benefit of being at least a safe place for a release valve. Many might even not realize that it is happening or helping.

And, it is not about one single event. For combat veterans, it is often about multiple events that add up over time. That is why each event is addressed in order lessen the "build up" factor.

Finally, in regards to the fear that some have in reporting these possible symptoms and ending either their own or someone else's career: If one of your soldiers was physically injured, would you take him on mission if you felt his condition would harm the mission or create a risk for the other men? This is no different. A physical wound and a psychic wound can create the same risks to the soldier and to those around him. Of course, there is some decision making in this process as to what condition someone is really in. We can always look at a physical wound and decide, based on some quantitative factors, that it is not enough to hinder the mission. The psychic wound is much more difficult because people can and do go out of their way to hide it. Thus, the chaplain and a lot of additional training for officers and NCOs on what to look for and a much more difficult decision on how to handle it.

I want to address the differences in PTS and PTSD. PTS is a short term condition. It rarely lasts more than a few weeks or months. Many people do have that condition and often do not require any treatment before it recedes. It is nothing to fear and is quite normal. The issue for developing the chronic condition is how extreme and how long these symptoms last. Here's the real kicker. If someone is experiencing the short term version and some of the symptoms, they may inadvertently create worse conditions by over worrying about it. It creates a whole other stresser on the situation.

But, the best way to handle that is not by ignoring it. Instead, those who are concerned should read the information available regarding the condition and talk to a professional. That is the only way to get a diagnosis or to have it "ruled out" and relieve the stress.

I want to thank you and everyone here for their time in commenting on the subject. It has allowed a great many questions or thoughts to be addressed that may assist someone in addressing their situation.

[Kat-Missouri/USA]

Getting help for combat stress-related issues is often viewed as a double-edged sword; I've heard several people say that they won't go to the VA (or anyone else) for fear of risking their clearance or their chance to go back in theater when we deploy again.

Army-wide, we are required now to have training on recognizing causes and symptoms of mild traumatic brain injuries and PTSD.

Sig,

There are many programs and places to go that are not related to the military and are perfectly confidential without damaging any security clearances. Civilian chaplains, the VVA (viet nam veterans of America offer programs) and others who are willing and able to discuss these issues without fear of repercussions. I might add that, if you talk with your unit chaplain, it doesn't necessarily end up as a bad rap on your record. General discussions on some anxiety or experiences are not looked at as "bad". What people generally fear is that they do have something worse and that it will effect their careers.

Two thoughts: 1) the fear of such can be equally as debilitating and dangerous to mission. It's better to talk and get a "yes" or "no" than to bottle it up and end with a definite "yes". You can always talk to your friends or others who have experienced the same that may not be in your chain of command and may not have an onus to report anything. Further, I recommend reading the information at the links above. Stressing about it because you don't know can be the added weight that sets you back.

2) If it is a concern enough to have that person leave the mission or not continue then we should stop looking at it as a "bad" and start looking at it from the perspective of what would be more helpful? Someone that is having a problem and may be a risk on the mission or having that someone stay behind until they've cleared or go on to get additional assistance.

As I noted above, this is really about making good decisions, even if they are difficult to make. When we're thinking about this subject, if we think we may have an issue, it is difficult not to become introspective and not lose site of the bigger picture. I want to re-iterate what I said before: it's about being mission ready. If one of your guys had sprained his ankle and it was swelled up to the size of a cantaloupe, would you take him on mission? If he had suffered a severe concussion from a blast and the doctor recommended a 48-72 hour rest before returning to action, would you take him on mission? And, even if he insisted that he was fine and capable of going, wouldn't you still weigh the situation and make the best decision for both that soldier, your other soldiers and your mission?

Like I said, physical wounds are much more quantitative and simpler to make decisions on. You can see them. You can assess them with your eyes. You can even physically assess it like make the guy jump up and down on his foot three or four times to verify it. It is much more difficult to do that with a psychic wound. Most of what you have to go on is what you know about that soldier, what their previous behavior or attitude was like, what they say and your own intuition. There's no physical test you can apply. Though, there is a great self assessment tool on the NCPTSD website.

Then there is the issue of future mission readiness. If we make a decision now to ignore it when it could be addressed and mitigated, what will their mission readiness be in two or three missions? Will they become totally unable to function? That sometimes is something that you really can't tell unless there is some professional intervention and diagnosis. which sometimes turns out to be no diagnosis.

Then again, we should be aware that combat and long deployments do have an effect on everyone and can change attitudes and behavior without being any part of the potential for PTS or PTSD. Many are going without sleep or regular food or clean clothes or showers or any of the other things that we might deem as "normal" in regular situations. So, it is much more complex. I'll say again, educate yourself so that you aren't ignoring it nor thinking it is something that it isn't.

[admiraljim]

This would be so much more accepted by medical professionals I want to send it to if the term "psychiatry" and related references weren't MISSPELLED! PLEASE FIX.

[jordan]

Jeffrey, your comment to Swede was way out of line.

I don't want the "thesis" of the post to get lost, i.e., how do you fight against the use of PTSD as a political wedge or smear tactic for partisan, anti-military or political purposes.

There continue to be attempts to paint all Iraq vets with a broad brush and infer that all are potential misfits due to their service in Iraq, and even misrepresent a recent uptick in PTSD claims as proof, while others say the recent uptick is due to older vets making claims from Vietnam service, not younger Iraq vets.

If PTSD is clinically studied and it's sufferers treated respectfully and written about with medical precision, rather than infused with the politics of the day, fine. But these days we have emotionalized hyperbole blaring from, for example, a Newsweek article, 8/9/05, by Mark Benjamin, trumpeting:

"'I'm on so many drugs for nightmares sometimes days go by and I don't know what day it is,' says La Branche. La Branche lives in the woods, with lots of guns..."

The irresponsible exploitation of it's sufferers extends to blanket characterizations of today's returning vets. WaPo 6/18/07, by Doug Feaver, says PTSD has become "a massive problem". Another on 7/1/04 illicited a comment that "a huge percentage of troops are returning with major psychological problems, and we haven't even won the peace!"

Stories like this are what get a stereotype going. They sensationalize and victimize someone -- a volunteer warrior no less -- to accuse an entire group, just as they did to Vietnam vets. Left unfettered, look at the results: a generation of shamed vets who actually WON the war militarily, and then took the fall of defeat at the behest of vain anti-war stars and civilian cowardice.

When I think "Never Again" that's what I mean. There are too many of these PTSD victim horror stories to enumerate, far more than stories about the heroics or unbelievable strength and courage of soldiers in battle. And all tied up with a nice little bow of War is bad, Bush is evil.

Yet, in countering that, you don't want to take away from treating it as a legitimate issue, or influence people who need help to refrain from asking for it.

But covering something like PTSD that way, with journalistic integrity and social responsibility, as well as love for country and love for it's vets, is probably something that's beyond today's media. They aren't too big on context and perspective these days.

[Kat-Missouri/USA]

Jordan,

The political aspect of it and the reporting is a two edged sword (I think someone said that already). While I cringe at some of the reporting, I try to take into account that the way most voters vote or press on issues is by the emotional button. While realizing that some of the emotional "button pushing" is largely geared towards the over all war, I try to remember that it may indeed push people's other emotional buttons concerning veterans benefits and care for our active, guard and reserve soldiers. That way, when a new program comes out, we can push forward with bi-partisan action to make it happen.

Obviously, we can counter some of the negativity by addressing it as we do here as normal, respectful and honest as we can. As I noted at my post at the Castle, this blog and many others get thousands of visitors a day. Some of them are likely active duty or veterans who can benefit from the discussion and will pass it on. Just based on the links below, this conversation may have reached over 20,000 viewers already and may reach many more who read the archives or do searches on the subject. Every time we hit this post, it increases its chances of moving up in that search.

Some have already indicated that this post has helped them understand. If we reach only one and make a difference, it is well worth every moment. I try to think the same of these other reports. That, some soldier or veteran may read about these other young men, identify with them and reach out for assistance. I realize that is an unsatisfactory "glass half full" answer, but that is where we are.

I try to look at programs regarding returning soldiers and their adjustment to home life as the same. Not just "human interest" stories, but the possibility of letting others know they are in the same place. Like the great website spousebuzz.com. You can't really get a better place than that to find out that you're sharing the ride with others.

The other way is to work with contacts within the greater media to distribute accurate information and have the same honest conversations. Which is why I originally reached out to Blackfive and some others (though not everyone took me up on it) to go beyond the debunking of numbers and the politicization to talk about it. I am greatly appreciative of those who did. Veterans who are interested could write to their local papers, contact other media people that they know, give interviews and a whole host of other things.

It means, of course, that we have to be willing to expose ourselves a little more and go out on a limb. But, who are we doing it for anyway? Are you doing it for republicans? Are you doing it to discredit Democrats? Or, are we doing it for our veterans?

It would be nice to get someone from one of these programs to talk in an interview and discuss the reality. I may have contacts that are willing to do that. Let's see if anyone will take me up on the offer. maybe another milblogger would share their experiences, good and bad. Even anonymously.

In which case, I offer my contact information: kehenry1@hotmail.com

If anyone would like to take part in further discussions and assist with providing good, accurate information for others, please contact me directly or the writers of this blog. Thank you.

[htom]

Most very well done, Grim. Wise and well-said. I'm sure that this post will save lives in the future.

Sadly, the way our society is structured, for a person to be treated by a medical professional, there must be an illness. Hence the labeling of any condition that a person can be aided through by a psychologist or psychotherapist is called an illness, even if it's really an extremely close encounter with the real real world.

In some cases, drugs can "cure" a mental condition, like insulin "cures" diabetes. It's not a real cure, which would mean you would do without the drug. What they are better used as, and can do extremely well as, is a splint or crutch, allowing you to get on with getting better through other forms of therapy.

Finding the right medical professionals, drugs, and treatments for mental problems can be a trial in and of itself. Too many don't survive the process.

[jordan]

Thanks, this has been helpful. FYI, and in this vein, CNN is doing a special tonight at 8pm on how these issues are being handled titled (surprise, surprise):

"War on the VA".

It will be balanced and fair, I'm sure. Also, Cavalry OnPoint excerpts James Brady's book, which seeks to explain why Marines fight, why men are drawn to the guns, and how the primal environment of combat affects them. It tracks with Grim's theme above about how bad reality can get when civilization's walls crumble, and how society just doesn't want to hear about it.

Cue Jack Nicholson's Guantanamo Colonel about standing on the wall, and how we can't handle the truth.

[The Wolf]

Damn. One.Fine.Post, Brother Grim. Took me over an hour of reading, and carefully going thru these comments. Enlightening would not cover it (Except 'those two').

When I first returned, the hardest adjustment for me was driving, by far. The time I was over there, driving was far more hazardous, as all WE had were civie/light skinned vehicles- no armored hummer's. That meant you drove like a maniac most of the time (glad I had a huge V-8 Dodge truck). You knew you did it right, for when you got to the FOB and found holes you never 'felt'. Far worse than the incoming for me. Adjusting to driving 'normally' here in the US was EXTREMELY difficult- I wanted to haul ass even driving to the store. Couldn't carry the kids for weeks- it would scare the bejeezus out of them. It was a conscious effort to keep it under 70 mph. I hated people driving next to me. Forget what it was like with trucks!

I adjusted to the incoming there by taking the 'golden BB' attitude- they couldn't aim them, you never knew when/where, so why bother? Wear your gear, be prudent, and unless you were at an IP station, you were not likely to be directly targeted in any way. Rounds would go far overhead, and people were diving all over- in my mind, they were acting 'silly' since they weren't even close. This piece accounts for that now, for me. Even after a BRUTAL night where my house took 5 direct rounds, didn't change this attitude. Far too cavalier, I know now...

I have found peace in Buddhism. Tranquil reflection and rhythm have helped immensely. I do find myself short-tempered in some ways (I can't STAND laziness and incompetence anymore) so I still have demons to expel...

-Wolf

[Jeffrey Carr]

As I said in my opening comment, the serious nature of this topic should transcend the usual Liberal-Conservative flame fest, and yet I disregarded my own advice and indulged in some flames of my own. Looking back, that was a poor choice on my part and I regret having done it. Normally, I follow the policy of flames beget flames, but I should have held myself to a higher standard for this particular thread. My apologies for contributing to a distraction from a worthy issue.

[Grimmy]

DeltaBravo and others:

I'm not Grim. Grim's not me. I'll probably get off my lazy arse soon and find another screeny to register here with so as to avoid spreading slime on Grim's good name.

A huge difference between the two of us, besides the obvious educational levels, is in how we approached this particular issue.

He got all wise and insightful. I went with the gravity assisted free-fall path of least resistance and landed square in the "industry" where a proclivity toward violent expression is considered a good thing.

Luckily for me, I did start pulling my head out from its lodgment right about the time that "career violent criminal" was getting officially recognized by the "three strikes" laws.

That is not a path I would suggest to anyone. It is much difficult to keep the guardian part of the Sheepdog alive when living and working among pure predators.

[Freedom Now]

Jeffrey,

Thank you for your appropriate response.

[Grim]

Admiraljim:

Hey, when you start the name of your profession with a silent "p," it takes guts to complain that people spell it wrong. :)

Fixed.

[Knee Deep]

Awesome post! I am humbled to admit that you have reminded me of some very important lessons I learned while I worked in mental health many years ago. I worked with "emotionally disturbed" kids as a therapeutic case manager. One thing I learned (and essentially the reason I left the field) was that normal human behaviors were constantly being turned into a pathology.

For example, I had a young client who watched his father beat his mother to death. He witnessed a brutal and horrific crime in his home, committed against his mother and committed by his father. I had only been working with him for a short time when I was called to a meeting with his school. They wanted to push for a diagnosis of ADHD and felt he had "autistic behaviors" that needed to be evaluated. Little Johnny wasn't interested in his school work and he did not play well with others. HELLO!! The kid just freaking witnessed his mother's brutal murder not even a year ago! He doesn't have ADHS or Autism... he's freaking grieving and he's scared crapless -- and rightfully so! He needs stability, security, an adult who is willing to protect him and time. Even then he will still always carry something with him due to what he saw -- does that make him sick? No, it makes him human. All I could do was help him to find adaptive ways (socially acceptable ways) to express his distrust of the adults around him.

I know that there is a time and place to call a behavior "pathological" but in today's society we simply don't want to let people have their time of grief and adjustment. Instead of normalizing the human response to stress and trauma we isolate those who have suffered by "diagnosing" every move they make. We want to medicate, sedate and use drugs to induce behaviors that we feel more comfortable with. Not to mention that if there is not a diagnosis, then there is not a patient/client. If there is no patient/client then there are no jobs for the mental health workers... etc. See, I have become very cynical over the years after working in that field. It did seem on some levels and in some programs that the client existed to serve the needs of the program instead of it being vice versa.

My son came home for leave today. I have been worried about how he would be when he came off the plane. I know he has been through a lot of combat and he has seen friends die. I started worrying more about whether or not he has PTSD than I did just thinking about how he needs to have a space here where he can be himself -- and you know what? That's exactly what I am noticing. He came into our house (it's new and he has never been here). He did a full sweep of the house, noticed all of the pertinent things, and then he was fine with it. When we talk his eyes are moving a million miles a minute as he sweeps his surroundings visually. Is he tense? Is he unable to relax? Is he suffering from PTSD? No. I think he has formed a skill for observation that I will never understand. Thank you for helping me see it that way. It was a nice reminder and refresher course on my own life lessons with this topic.

[Subsunk]

Grim,

Still the smartest gent in the room. You are one heck of an intellect, sir.

Well done and well said, as LW mentioned. Press on, sir.

Subsunk

[Teresa]

I'm very late to this comment party. But I thought I would add - there is at least one yoga studio here in Massachusetts that has a special program for veterans. It's been going for several years now and is helping some of the veterans in the area.

Ever since I found out about the program, I've been trying to let people know about it. And this seems to be a good post to let more vets know. It would also be a perfect compliment to a martial arts program. Something to think about.

[M. Simon]

PTSD is not only situational it is genetic. Which is why some get over it and some don't.

PTSD and the Endocannabinoid System

[WildThing]

Thank you so much for this! This is so important for everyone of us to read and pass on to others.

[R. Stanton Scott]

What evidence do you have--philosophical or otherwise--that "The instinct to kill and war is native to humanity" or that humans constructed "rules and customs" to constrain these instincts?

What is it that makes you believe that exposure to combat, killing, and dying does not cause negative reaction in some soldiers because it is in fact so deeply counter to the actual nature of humans as created by God?

Just asking.

[Freedom Now]

Do you believe that there was a time in human history that we didnt have bloodshed and violence?

Even ants and bees go to war.

Death is natural, but it sure doesnt do the body any good.

[Mike H.]

R. Stanton Scott, God commanded man to go to war a number of times. Why would he require something that he hadn't designed into man. Part of the duty of man is to overcome the natural inclination to combat and find ways to coexist. We have a sexual drive that causes friction. We're instructed by God to keep it in check under normal circumstances and use it for the most good. Attention to duty shows fealty,

[Grim]

'What evidence do you have--philosophical or otherwise--that "The instinct to kill and war is native to humanity" or that humans constructed "rules and customs" to constrain these instincts?'

I find that I am tempted to cite 'all of recorded history' as evidence; as well as the chief part of literature; and, likewise, the fact that a very great part of our anthropology from before recorded history comes from the recovery of skeletons that were plainly ritual killings.

As such, I am afraid I'll have to ask you to provide any evidence that may exist to support the contrary proposition. One might reasonably hold that the instinct to kill and war is embedded in man as part of Original Sin; I don't think you can reasonably hold, on a scientific or on a religious basis, that it doesn't exist.

Since yours is apparently a religious view, I'll end with a refutation by G. K. Chesterton. "Certain new theologians dispute original sin, which is the only part of Christian theology which can really be proved. Some followers of the Reverend R.J. Campbell, in their almost too fastidious spirituality, admit divine sinlessness, which they cannot see even in their dreams. But they essentially deny human sin, which they can see in the street."

Please pardon my poor phrasing of the question--I do not approach the examination of the nature of man from a religious perspective. To do so moves the question up a level to examination of the nature of God--at least to the extent we believe that God created man in His image. Mike H. apparently buys this view: God is a warlike Creator who designed man with a violent nature, sent him to war, but later determined that man should be socialized to stop fighting so much. Forgive me if I am putting words in your mouth, but if God Himself was for war before He was against it, perhaps we should look at John Kerry in a new light.

No, I think an examination of the nature of man should leave aside the question of how he got that way, unless we think that man's nature might depend in some way on the method of his creation.

That question aside, then, what evidence exists about the nature of man? Your "all of recorded history" argument leaves me unsatisfied. The recorded history of man says a lot about man's *response* to his nature and his experience, but very little about his nature itself. Without a logical