On PTSD: Post Traumatic Stress
Brian (Chick) Hennessy. Vietnam vet. Ex 6RAR first tour.
This is the last chapter in Brian’s book on Vietnam titled, The Sharp End: my war in Vietnam. See eBooks in the toolbar above for information.
On PTSD: Post Traumatic Stress.
My opinion only.
These days we know a lot more about how a soldier’s psychological health can be affected by his military service. Combat stress reactions have been described as long ago as the conflict between Athens and Sparta in the 5th century BC, and more recently in World War I where it was known as shell shock. In World War II it was described as battle fatigue. Today, it is known as post traumatic stress disorder or PTSD.
And there it is in a nutshell: post traumatic stress; i.e., after the trauma stress. Generally speaking this classification describes delayed symptoms which are involuntary and recurring. For example: re-experiencing phenomena which include flashbacks and intrusive thoughts and feelings; avoidance behaviours such as a refusal to have anything to do with distressing reminders of combat-related traumas; and arousal symptoms such as hypervigilance, difficulty sleeping, outbursts of anger and so on. And as if these symptoms are not enough for an ex-serviceman to cope with, PTSD is often accompanied by what Winston Churchill described as ‘the black dog of depression.’
After the initial joy of the homecoming has dissipated, family and friends notice changes. Although the returned soldier may look the same outside, it becomes apparent that internally he has changed. As well as the above symptoms he may have difficulty feeling emotionally close to his loved ones. He may feel as though he has no future. This is emotional or psychic numbing.
What is going on here? During his active service, a soldier is exposed to traumatic events which are outside the normal range of human experience. However, the mind is not wired to cope with these situations. They are psychological outliers or ‘one-offs’. Further, when they occur he cannot afford to feel the emotions that one might expect because he is part of a team which depends on him to function effectively in the midst of chaos. He has a role to play and a job to do. Thus, emotions are sidestepped and buried. The problem however, is that they are buried alive not dead.
Also, settling back into civilian life can be surprisingly difficult. Every returned serviceman knows that like it or not, his wartime experiences separate him from his civilian peers. For example; Oliver Wendell Homes was a young captain who fought for the Union Army in the American Civil War and he observed that having served in combat distanced him forever from men who had not. Thus many ex-soldiers live a life tangential to society. Some men adapt and play the game very well, no matter how estranged they may feel inside. Others are unable to do so. They watch from the sidelines. Both groups know however, that life is transient and that at any moment it can be tipped upside down forever. So they are always mentally prepared for this possibility.
In contrast, some American Indian tribes have a tradition of reintegrating warriors (ancient and modern) back into civilian life. They honour them for protecting their community and offer them non-combat leadership roles whereby they can continue to guide and protect society members. Surely a win-win situation for everyone.
Unfortunately, modern Western industrialised societies and their exact sciences have not been as successful at reintegrating ex-soldiers into their home communities. Perhaps there is no close community for them to be reintegrated into. This can make it more difficult to treat the consequences of combat.
The worry is that PTSD may be regarded by some mental health professionals as an illness or disorder rather than as the natural consequence of an extraordinary event outside the normal range of human experience. The holistic experience of the sufferer becomes compartmentalised and medicalised, with the result that symptoms may be treated in isolation. For example: cognitive behavioural therapy for negative thoughts; desensitisation for re-experiencing phenomena; and medication for depression. All well and good as far as they go. But when therapy relieves suffering yet fails to cure, symptoms can then be labelled as chronic. That’s when the wiser veterans lose hope.
PTSD is more than a collection of symptoms. It’s deeper than this. Consider the civilian victims of natural disasters, terror, and war as another example. Their safe, predictable environment sundered in a second. The foundations of society as they know it, gone in an instant. Physical culture, a home, belief systems – life’s sustaining structures – blown away in a moment. A sense of control over one’s life and future shattered forever. I was involved in helping communities recover from the Sichuan earthquake in China in 2008, so I know about communal trauma first hand.
It’s the same with soldiers. Whether it is the infantryman who must kill or be killed, the medic who must stop soldiers from bleeding to death on the battlefield, or the doctors in field hospitals who are overwhelmed with casualties which just keep on coming, the result is the same. They will be changed forever by their traumatic experiences, and they will live in a world which is potentially threatening rather than benign and predictable. Unexpected reminders will always have the power to trigger repressed memories and emotions. High anxiety and deep depression may degrade a satisfactory life. The suburban rituals and familiar routines of civilian life can become intolerable for men conditioned to living life on the edge. Some will adapt successfully to this bi-polar existence, others will not.
For therapy to be successful it must be provided by a trusted mature individual who is prepared to work within the veteran’s unique appraisal of his own situation. The providers should be specialists in trauma, have plenty of life experience outside a hospital or counselling service, and know how much they don’t know. The sharper minds among them will always be looking outside the box for insight into this chronic affliction. I’ve worked with two of these gems, so they are out there. You need wisdom to treat PTSD.
A reminder: the veteran does not have a mental illness. He is suffering from a real-life specific event which would traumatise any other person on the planet. It’s a reaction not a condition. Remember this.
I recall the aftermath of a battle. Standing in the killing ground and looking down on the carnage. Friends and enemies sprawled across a small clearing in a scrubby coastal forest beside the South China Sea. Burying the memories so deep that it would take years before they resurfaced. Reminding me of unfinished business. Threatening to unravel everything.
Suffering feelings of shame for being unable to control these intrusive memories and the powerful feelings they provoke. I was an infantryman for God’s sake. Trained to keep putting one foot in front of the other while willingly walking into danger. How come I couldn’t manage a few distressing memories?
I felt worthless and alone. My previous life as a soldier intruding into real-time. A sadness so heavy that it pressed down on my shoulders. And no sleep.
Wondering how come I survived when Brasso and Pongo and Len and Ray didn’t? How come I wasn’t mutilated by mines like Bluey and Frank; and how come I didn’t go crazy like Gary?
Survivor guilt. Rational questions but no answers. The only possible response: ‘It is what it is, mate.’
My first therapists weren’t on top of their game. They were generalists. The second crew were much better, as they should have been, because they were veterans. They knew things. What a pity they eventually succumbed to the effects of their service in Vietnam, as I did also when years later I retrained myself as a psych who specialised in combat-related PTSD. I lasted three years.
Then I did some thinking. Recall the Athens-Sparta conflagration mentioned above. This war destroyed cities and killed and terrorised whole populations. Imagine the suffering. Relate it perhaps to the ethnic cleansing atrocities which occurred in parts of Bosnia-Herzogovina. Guestimate the incidence of PTSD. A trauma so profound that one gropes in the dark for inspiration on how to help a people recover from such a catastrophe. This is cultural implosion. The psychic damage is too deep. And it’s communal. The violence of one faction of a community toward another more traumatising than any natural disaster. It’s personal, folks.
I look back to ancient Greece for ideas and find something worthwhile that has been hidden for millennia. Just as the Middle Ages forgot about the philosophies of Socrates, Plato, and Aristotle, modern therapy has forgotten a treatment offered to survivors of the Peloponnesian wars.
Greek wisdom: severe trauma is a wounding of the soul. Therapy should be holistic.
It was offered in a place of safety and beauty where a small seed of hope was planted in a nihilistic desert of despair. A therapeutic island where people could indulge the senses via, for example; the visual arts, drama, massage, and music. Re-parenting the battered inner child. Reconnecting mind and body. Nurturing the shrunken surviving personality; fanning a small spark of spirituality; and restoring a sense of self and society. And for the educated, intellectual stimulation via philosophy. Healing the wounded soul, then returning a whole person to family responsibilities and communal rebuilding.
It’s an idea worth considering today. Expensive? In the short-term, yes. In the long-term however, it might lower the bill for hospitals, counselling services, and pensions. I’ll leave it up to the bean-counters to do the maths.
Finally, let me say a few words about the way I have personally coped with PTSD and its associated depression:
My Way
I realised that I would have to take responsibility for my own healing. PTSD is a chronic illness, so it was important to learn how to manage its symptoms. It was the same for depression. So I gradually developed my own way of coping with these unwelcome visitors.
In my opinion, a PTSD affected brain needs an adrenaline hit every now and then to kick-start it. So does a depressed brain.
With this in mind, I moved past what psychology had taught me and trusted my own intuitions. What the textbooks regarded as a symptom of combat-related PTSD (e.g., an inability to remain settled in one place) I accepted as my brain trying to tell me something useful: i.e., I should be intellectually and physically active. The brain needs stimulation. Change can be good for you.
I also knew that inactivity was a recipe for continuing depression. That was my personal experience. Blood flow to a depressed brain is constricted, and as a result, brain activity is diminished. This, coupled with lowered neurotransmitter activity (which may need medication), results in the typically slow-functioning brain of chronically mentally and physically exhausted depressed persons.
My plan was not to be a stationary target. My plan was to keep moving: intellectually and physically, in a proactive effort to try to stay one step ahead of the black dog. I moved when I heard it bark. I didn’t wait for it to bite.
Challenging the brain with new experiences is one way to do this: e.g., by deliberately putting myself in situations which demand adaptive responses to new stimuli rather than automatic reactions to familiar routines. In this way old neural pathways are revitalised and new ones created.
I tested this theory by relocating to China – another ancient civilisation – and started life again in the inland city of Chongqing, a huge metropolis on the Yangtze River, 1600 kilometres west of Shanghai.
Certainly, this was a challenge. But living and working as a foreigner in the middle of the Middle Kingdom proved to be a good idea. Learning the language and culture, and mixing it with the local people kept me on my toes. China is a complex society.
Travelling also. Radiating out from Chongqing and experiencing life in China from the ground up as I wandered around the countryside like an old Taoist monk. Sometimes travelling in comfort, at other times not knowing where I might sleep tonight or what tomorrow might bring.
Photographing everything and writing articles and books about my experiences. Keeping symptoms of PTSD and the black dog of depression at arm’s length for ten years. Without medication.
It was a good idea and a smart move.
These days my mind is active, my body is healthy, and my soul is at peace.
Well, most of the time anyway.
“Rest easy”, soldier.
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