PTSD: Is It Real?

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PTSD.

Almost 200 years ago, post-traumatic stress disorder was recognized as the "soldier's disease." That was during the American Civil War, which, although ultimately successful, destroyed a lot of lives.

By World War I (1914-1918), the soldier’s disease had become shell shock; essentially, the idea was that if there was anything psychologically wrong with you, your head must have been smacked by an artillery shell or something similar.

But by World War II, it was recognized that you didn’t have to have a physical impact to cause the syndrome. The syndrome became combat fatigue; something weird and violent had happened to you, but we didn’t know what. There was a chance, in some people’s minds, that you were just a coward, as suggested very strongly by General George S. Patton when he slapped the hell out of two combat fatigue victims in military hospitals in Sicily.

After World War II, a series of acronyms were used to describe the syndrome, but the latest is PTSD. And as psychologists, we should probably try to see how this syndrome fits into the rest of human psychology.

In previous posts in The Forensic View, we have seen how high states of arousal and the basic dynamics of the human nervous system can lead to irrational behavior under stress; this is perhaps most important in cases of PTSD.

PTSD is a huge and very expensive problem. Many veterans and law-enforcement people of the author’s acquaintance are deeply dissatisfied with officialdom’s attempts to deal with their very real post-traumatic stress disorder.

PTSD can involve enormous failures of concentration; “daytime intrusions,” in which something like a car backfire can lead to an effectively hallucinatory “trip” back into a combat zone; nightmares which massively disturb sleep, and therefore contribute to errors of memory and judgment.

But what exactly is PTSD? Well, it’s hard to say. The official DSM-5 criteria leave a lot of wiggle room, and we’re seeing far more PTSD than we would have expected in our West Asian war veterans.

But generally, in PTSD, we see tunnel vision so profound that it can reduce all peripheral stimuli to nonsignificance—a firecracker can become a mortar burst for PTSD victims, to the point that they don’t even notice that they’re in Denver rather than Fallujah. This tunnel vision can become so profound that veterans can engage in flashbacks, as they focus on their internal thoughts and memories to the virtual exclusion of external reality. (I recall a case in which a veteran was found scouring his backyard for Viet Cong booby traps, 40 years and 10,000 miles after the war was over.)

Highly impulsive behaviors may be seen, many of a type crucial in combat but lethal to a career or a marriage. Rational decision-making may suffer, increasing the potential for substance abuse. And the list goes on.

But, say some of the critics and the inevitable medical accountants, is PTSD truly real? In other words, are people, including military and law-enforcement veterans, faking it, perhaps to get money out of the rest of us?

No, the vets aren’t faking it. And yes, the syndrome is real.

How would we know? The symptoms of PTSD are now well known, so some people might be faking it. So, the best way to find out if PTSD is real today might be to examine it in the past, before anybody knew what it was, and see if the syndrome occurred in the same way back then. And that’s exactly what we did.

My wife, counseling psychologist Professor Jana Price-Sharps, and I drove over 5,000 miles in the American West on fieldwork for this project, visiting the site of virtually every pre-20th century Western disaster you’ve ever heard of. Custer’s Last Stand. The murder of Wild Bill Hickok (the intended subject of a future Forensic View). Spanish incursions, frontier battles, etc. And we ticked off the DSM-5 symptoms of PTSD, from both clinical and cognitive psychological perspectives.

And we found the symptoms of PTSD and relevant histories of trauma in the principal actors in every single case.

Little Bighorn, Deadwood, Bent’s Fort, everywhere—the individuals involved displayed the impulse control problems, the tunnel vision, the entire symptom picture of PTSD—except, at first, in one case.

Post-Traumatic Stress Disorder Essential Reads

Taming the Amygdala in PTSD

What Happens In the Brain During PTSD?

Our one failure, initially, appeared to be the Fetterman Massacre in Wyoming.

The story has always been that Lakota warriors, in that battle of 1866, lured U.S. Army Captain Fetterman and his infantry command beyond the boundaries ordered by his superior, in pursuit of those warriors. He was killed, and his command destroyed.

Now, Captain Fetterman was not a pleasant person by 21st-century standards, but there was nothing of PTSD about him. At all.

And then we walked the battlefield and talked to local historians and found something very interesting.

Modern research (e.g., Monnett, 2008), although still disputed, strongly indicates that Fetterman was not responsible for the Fetterman massacre. A fellow officer named Grummond was.

It was evidently Grummond, a Cavalry officer (horses are a lot faster than infantrymen), who impulsively and against orders attacked the Lakota beyond the boundaries. Fetterman’s slower infantry, coming from behind, were probably trying to save Grummond’s command when they were annihilated.

Grummond had suffered major traumas. Grummond was an alcoholic, a substance abuser. Grummond frequently and impulsively got into fights with fellow soldiers. And when Grummond died, only two of his wives showed up to collect his Army benefits.

It was Grummond who displayed the symptoms of PTSD, and it appears that it was Grummond in the grip of tunnel vision as he impulsively led his men into the killing zone.

Our 5,000-mile field trip yielded much evidence of historical disaster, but in every single instance, we saw the symptoms of PTSD operating. Over a hundred years before anybody knew what those symptoms were.

PTSD is absolutely real.

We need to treat it.