I start with a disclaimer that what follows is empirically based on thirty years as a practicing psychiatrist and psychotherapist. It has been verified by formerly enlisted and senior officers from the Armed Forces, but has not been validated by any research or double blinded studies.
How does PTSD happen?
Central to nearly all the people I have treated or spoken with who suffer from Post Traumatic Stress Disorder (in preparation of my book, “Post Traumatic Stress Disorder for Dummies”) is the “fear of re-traumatization” and their efforts at any and all costs to avoid it often results in the symptoms they develop.
Soldiers enter basic training as “loosey goosey” enlistees whose minds and personalities are broken down and built back up into fighting machines devoted to fulfilling a mission and the well-being of their fellow soldiers. Imagine those recruits as a “green” rattling Ford pickup truck that can’t take a corner safely, being torn down and rebuilt into a turbo-charged Porsche that can handle any curve thrown at it and you get an idea of what the process is like.
Even Hollywood has jumped on this metaphor with the popular Transformer movies where rattling cars and trucks are broken down and reconfigured and rebuilt into monsters of good and evil. Get the idea?
After they finish basic training, it’s pretty heady, adrenaline driven stuff that can make soldiers feel nearly superhuman. Add to that the notion that they are going to fight evil and they can feel like a band of superheroes out to rid the world of villains.
But then they hit the reality of war face on or rather it hits them in the face. In the process they see horrors and create collateral damage no training can fully prepare you for. Imagine being ordered to run over a young child who will not get out of the way and you can’t swerve to avoid them because of the mine-laden side of the road and hearing the thump of their body as they hit the bottom of your Humvee. Or imagine following orders to take out a sniper nest in a house in a village and then entering it, only to discover a dog, a grandpa, a mother, and two children “shredded” or incinerated by you.
What happens to you when all your training for war runs head on into the debasement of humanity that you perpetrate in waging it?
The trauma cuts you to your core. The horrors that you see and the horrors that you caused won’t leave you alone. You don’t tell anyone else, because you think they’re handling it better than you and that you are just weak and missing the “right stuff” that your fellow soldiers have.
Although you never fully get over that trauma that rips you to the center of your being, as in human being, your training is good enough to enable you to get past it through the days and weeks and possibly even the tour of duty you are on. However the damage is done and the crack in the porcelain of what was once your soul remains.
You don’t let the world know about it and you do everything you can to not feel that fragility. But even though you don’t think about it, you believe that if you were re-traumatized that crack would cause you to shatter from the inside out and like Humpty Dumpty, all the king’s horses and all the king’s medics would never be able to put you back together again.
So you live your life avoiding anything that might re-traumatize you. You numb yourself with alcohol or drugs; you withdraw from family matters especially the yelling of your spouse and young children. Every now and then a car backfires or something catches you by surprise and you jump out of your skin, because you had temporarily relaxed your guard and that temporarily removed the paper thin veneer protective graft above your crack. It’s like someone pouring acid in an open cut, except this cut is in your mind.
If you are put in a situation in which you feel you will be re-traumatized, you can go into a state of near panic, in which you resort to your most basic “fight or flight” instincts.
Why does PTSD happen?
Have you ever passed a cut tree and seen all the exposed rings? Each of those rings represents a year in the life of that tree. Some of those rings may look thick and healthy indicating and good year; some may look very thin indicating a drought; some may look darkened indicating a forest fire that the tree survived; some may look nearly rotted indicating some fungal or insect infestation. In your minds eye you can also imagine that those years will have a lot to do with the eventual health of that tree and its overall resilience.
Trees are not the only living creatures that develop from the inside out. Imagine your brain as actually having three brains. Like the rings of a tree layered one upon the other, imagine your human (neomammalian) upper brain is layered upon your paleomammalian middle brain is layered upon your most primitive reptilian lower brain.
Now imagine figuratively that a recruit’s brain and “loosey gooseyness” is due to their three brains being loosely wired together. Then imagine that during basic training, those loose wires are stretched and even broken. But then those three brain are built up in to a tightly wired machine specialized for waging war.
When a highly trained, tightly wired and molded for war brain suddenly runs face to face into horrors perpetrated upon you and that you perpetrate on others, soldiers show that they are not Transformers, but rather, that they are too human an animal.
When does PTSD happen?
In the face of trauma, your three brains lose the way they are wired and coupled to each other. That feeling of being lost (especially when they return home without a mission, a squadron or an activity that creates and lives off the adrenaline they have become accustomed to during war) causes them to feel at a lost. Being used to being tightly coupled their brains will spontaneously recouple around a new mission. But this time the new mission is to avoid re-traumatization at all costs and that is the world in which someone with PTSD now lives.
Addendum: I did not serve in Vietnam, but two of my high school classmates are on the Vietnam War Memorial wall; my children did not serve in the current conflicts, but my friend Jane Bright’s son, Sgt. Evan Ashcraft and she started the Evan Ashcraft Foundation after he was killed.
I believe sacrificing oneself to protect others you have never met is the highest virtue in human beings. Our young men and women returning from Iraq and Afghanistan — as well as all the other veterans who have served in past wars — deserve much better than to fall between the cracks of all the organizations that try as they might are not doing the job and are falling further behind the challenge. Helping our young men and women successfully return to civilian life is the war after the war and if we do not do that better, it will in the end claim more lives than the Iraq and Afghanistan Wars.
To address the challenge of transitioning the military to civilian life I along with Lt. General Marty Steele (USMC retired) am organizing a group of “can do, will do, failure is not an option” decision makers from the military and government to meet as part of Big Task Weekend in Los Angeles that will take place September 30 – October 2, 2010. Big Task Weekend brings together top decision makers from a variety of companies, organization and NGO’s to learn the process of “collaborative action” by actually taking on and solving “big tasks” that affect national and corporate well being. This year’s big tasks will include: The Future of Education, The Future of Corporate Learning, America’s Health and Wellness, Health Care Reform, Financial Literacy, Military Transition to Civilian Life.
The measure of a civilization is how it treats those who have hurt it, and those who are hurting in it.
Mark Goulston, M.D., is the author of the new bestselling book Just Listen: Discover the Secret to Getting Through to Absolutely Anyone.