It is quite surprising that after studying war and its effects for hundreds of years, we have nothing but rhetoric to spout about Post Traumatic Stress. There is so much wrong with how we talk about it as a society, by our own Veterans’ Administration, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and by Veterans ourselves, just so we pretend we are talking and doing something about it.
First, let’s discuss what Post Traumatic Stress Disorder is and why it is dangerous to the survival of our Veterans in ways most don’t understand. We know what the DSM-5 says; it is a psychiatric disorder, dysfunction. They are saying your mental faculties are not working properly, which is a complete farce. It is a natural response to an unnatural event. While the symptoms of PTSD are damaging enough and can be confused with moral injuries, Survivor Guilt, and Adjustment Disorder in many cases, in fact probably a lot of cases, the diagnosis by this definition is far more damaging. What? How can being diagnosed with something be more damaging than the injury, illness, or disease?
The first, and likely most damaging, is the societal- and Service-imposed stigma that is attached with having a disorder. Break a leg in combat and you are a tough Warrior; break your brain and you are weak, can’t hang, broken, damaged, unfixable. If it were a traditional injury, you wouldn’t have a problem seeking medical attention. But, alas matey, it’s a problem with you. So, you can seek help, but we may mock you, despite the courage it takes to seek help to make yourself better. Paraphrasing what SMA Grinston recently stated; we don’t pick on you for going to the gym to make yourself stronger, or a financial advisor to make you financially stronger, why would we chastise you for making yourself emotionally stronger? We shouldn’t. And to all my brethren still serving who would do this, shame on you for letting your troops do that or on you for questioning “what is wrong with you?” or “suck it up troop.” Is that how you want your leadership to treat you? If it were a leg injury, you would get a profile and given time to rehab. Nope, not here. “Go to your appointment and meet us out at the MOUT Site.”
So, what does the simple act of calling this a disorder do? It prevents the already confused or scared Warrior from seeking help because of the stigma. The next damming action is by the VA. The VA compensates you forever for PTSD. Aka, you are screwed forever, so here is some money because we don’t believe you can be fixed. PTSD and all its symptoms are treatable, even curable in some cases with certain treatments. But, if the Warrior never seeks help, treatment never comes. But, the DSM-5 and VA says you are stuck with this insideous malfunction. So, Warriors in Chapter 3 of their lives lose hope.
If the DSM-5 would change Post Traumatic Stress Disorder to Post Traumatic Stress Injury, recognizing that there is treatment and potentially the ability to cure it, it would be a major shift in Warrior and societal attitude. It would also morally demand treatment by the VA. I have seen many cases where Warriors are told that they are untreatable, and, like some secluded Warrior tribes in Africa, are sent off to die alone, basically. What other illness, injury, or disease do they simply stop treatment unless it is physiologically hopeless? None. So, what you are telling the Warrior, in the prime of his life, is that their existence is hopeless. And along with this hopelessness comes a giant financial cost to our VA Healthcare system that could be spent finding a more overarching cure. Some numbers say that up to 30% of Warriors returning from The Forever Wars have filed claims for PTSD. Do the permanent financial math for that.
If Warriors who have true signs and symptoms were given a chance at treatment, with a chance of at least reducing all symptoms, they would have more hope. If the VA could make a larger investment in finding that one test that could verify PTS vs Survivor Guilt or a Moral Injury, they could better treat the Warriors. Currently, PTSD is self-diagnosing, basically. During the initial session, a series of questions are asked and if you answer a certain number positively in a few different categories, you have PTSD. So, it is diagnosed through self-reported symptoms only, no signs that a doctor can truly measure. This also leads to some who might take advantage of this flawed system of compensation.
I have mentioned Survivor Guilt and Moral Injury a few times now. Survivor Guilt, which I am all too familiar with, can manifest itself very similar to PTS. Nightmares, dangerous behavior, heavy drinking, hypervigilance, etc. The symptoms can be, as the lawyer in My Cousin Vinny said, “iiidentical” to PTS. A group of doctors at an esteemed facility for brain injuries and PTS diagnosed me with PTS. Yet, two other doctors, given the same information said they thought it was Survivor Guilt. Again, no measurable test, no way to tell, unless you go through counseling, which the VA doesn’t mandate if they feel you won’t get better. So, no counseling, no real prognosis or treatment, no resolution, no hope GI. Oh, wait, take all these pills to mask the symptoms. Back to the broken leg situation. If I broke my leg, would the doctor just give me motrin and send me home? Well, an Army medic would (love you guys, except the dick who lost my shot records, twice. You know who you are.)
Next, let’s talk about Adjustment Disorder and how it mirrors PTS. During Chapter 2 of our lives, our military service, we were taught to be vigilant, cautious, independent, logical not emotional, rehearsed, prepared to train hard every day, always conducting an After Action Review of our actions. I spent 23 years in our great Army. Do you think I could turn those things off the day I walked the stage? Those things still rage in my mind. I am going to list the symptoms of PTSD. Let’s see who can draw an arrow from the behaviors in Chapter 2 to symptoms in Chapter 3. Reliving, hypervigilience, flat affect, negative thoughts, hyperarousal, withdrawal. Maybe many of us who have been labeled with PTSD are actually just well trained and haven’t been able to find the switch they installed to turn this shit off. So, now, with no reason to have most of those behaviors but also no way to turn them off, they rise to the forefront of our mind and behavior and manifest as PTSD. But, again, if the VA deems you hopeless, stuck with this truly unknown malfunction of the brain, you won’t go to counseling and find out whether it is PTSI or just an Adjustment Disorder.
So, SGM, where do we go from here? Here are some thoughts. Holistically, we have to bring back hope. That is the best way to potentially solve the issue of long term suffering and ultimately prevent the almost 17 Warriors a day who have given up all hope and have chosen to take their own lives. (yes, it is not “22 a day” like all the slogans say. Google the 2019 VA report on Veteran suicide and correct your rhetoric, my brethren). How do we bring back hope and find a cure? Change the term to PTSI in the DSM-6 when it comes out. Research has shown a physical rewiring of the brain in patients with PTS. Stop giving permanent compensation without mandatory treatment. Make treatments like Stellate Ganglion Block (SGB) and Eye Movement Desensitization Reprocessing (EMDR) more available for Warriors. Senior Leadership in our military, likely many suffering from PTSD, need to come forward and have honest discussions about having it. There is no way that 30% of your troops have it and some of you don’t. If you say it’s ok for them to come forward and it won’t affect their career, prove it. SMA, Chairman of the Joint Chiefs of Staff, Joint Chiefs, Division Commanders and CSMs, I am calling you out to call yourself out. Then Brigade and Battalion leadership, then your troops will seek treatment without fear. Show us why you are a senior Leader. Stop condemning it while in Chapter 2 and then joking about it in Chapter 3.
And to my brothers and sisters, it’s time to work on your injury and stop just living with it. Whether I have PTSD, Survivor Guilt or have Adjustment Disorder, I am openly telling you I have something and receive treatment for the sometime overwhelming symptoms. I tell you this so you know there is no shame, no reason to not seek help, no reason to judge those who suffer, sometimes in silence, sometimes in a bottle. The more of us who do this, the more of us who will seek help. And when we destigmatize this phantom, like we have destigmatized over drinking in the ranks, we will be able to move forward.
—SGM DTB—
Outstanding article! I will make sure to share this with as many Veterans as I know. I will continue to talk about these subjects as a leader in the Army and someone who suffers from conditions described in your article.
Thanks brother. Lead from the front! I still have that award y’all gave me on my wall. My most important of all. My undying thanks for what you have done to “bring em all home”.
Excellent writing. The “D” has officially been dropped from PTS, which is good. I think the problem is that the medical/psych community is trying to fix the symptoms of PTS, i.e., survivor guilt, anxiety, depression, instead of looing at them as symptoms of a greater injury, the actual PTS. It is discouraging when you find out you have conquered one part, say some of the anxiety, only to find out you haven’t even scratched the surface of the equivalent of Mount Everest. Sometimes you know you will never be the old “normal” you just want to be able to navigate what is the new normal and be able to function without too many interferences and distractions. It like having cancer. Instead of working on curing the cancer, they are just focused on the side effects. I believe the greatest barrier is that most psychologists, psychiatrists, and therapists don’t listen to what their clients/patients are trying to tell them, rather, they are so focused on whichever therapy they were taught or school of thought they belong to, that if we, the damaged, would only listed to them and do what they tell us, we would become whole again and they can then return to their self-hero worship. I had two counselors out of many at the VA that were excellent. One told me, Sam, whatever you decide (I was contemplating divorce) I will support you; the other, my last before I went overseas for an assignment, gave me actual hope that I can get better, that I would not remain this empty, fragile shell and she was right, step by step, inch by long and hard fought inch, I see changes and improvement. I startled my self the first time I had a real laugh and the first time I cried for a reason, not just because I was slipping back into the black hole – I used to live down there permanently, now I just visit ever so often. They need to understand it is not just us, the damaged ones that need to listen, they, above all, must listen and hear what we have to say without their own biases interfering.
Thanks for that feedback and sharing your story. Where have you seen that the “D” has been dropped. If you have a reference, I would love seeing it!