Friday, February 26, 2016

PTSD: it's not all it's cracked up to be

I'm sure most of my readers are familiar with the acronym PTSD.  It stands for 'Post-Traumatic Stress Disorder', and is commonly bandied about concerning combat veterans, those in high-risk, high-stress jobs like law enforcement, emergency medical services and firefighting, and the like.

It's also perhaps one of the most misunderstood and fraudulently applied diagnoses in the USA.  Chris Hernandez has just written an excellent analysis of the situation.  Here's an excerpt.

It’s fair to say most of us combat veterans have suspicions about PTSD claims. We’ve been frustrated by stories of horrible, disabling PTSD from people we know were never in combat. We’ve heard of troops coming home from deployments to peaceful countries, never hearing a shot fired, but immediately claiming PTSD. We know that in the War on Terror only a small percentage of troops actually faced an enemy, and many of those relished the experience. We have the nagging feeling most PTSD claims are more about free money than healing and recovery. Some of us have become so skeptical, we automatically throw a mental BS flag when we hear someone talk about having PTSD.

. . .

If our suspicions were confirmed, that would be pretty depressing. Know what would be even more depressing? Being told by two VA psychologists that the system is even more corrupt and full of liars, scammers and thieves than we thought.

There's more at the link.  It's well worth reading.

I understand PTSD at first hand.  After eighteen years of military and civilian involvement in South Africa's internal struggle to get rid of apartheid, I was pretty much burned out.  I just wasn't coping.  However, I knew darned well what the problem was, and I knew that it could be dealt with.  I took the first step by getting away from the situation that had caused my burnout - I immigrated to the USA.  I'll always be grateful to this country for giving me a fresh beginning.  Next, I looked for a counselor who had himself been in combat - intensive combat - and who could thus be expected to understand what it involved, how it affected those involved, and how to overcome those stresses.  After a little searching, I found one.

In less than six months of regular sessions, we dealt with the major problems.  He was able to show me new perspectives, new ways to handle the bad memories, and how to look forward to my new life rather than look back upon the old one.  I continued to see him on a less regular basis for a couple more years, more for companionship than anything else.  We got to the point where each of us would freely discuss our memories.  I suspect it was more like joint therapy for both of us rather than a traditional therapist-patient relationship.  When he finally said that any more visits would be a waste of my money, we visited as friends, after hours.  He's no longer with us, but I remember him with respect and affection.

The point is, it didn't take all that long to deal with the nasty memories.  Once I had an opportunity to talk them out with someone who understood them - and understood them innately, from personal experience, not just out of a textbook - they largely went away.  Oh, sure, I still have the occasional nightmare about the past.  That's inevitable, and part of being human.  However, they no longer hang over me.  They don't control me.  I control them.  When I wake up from one, I'm able to remind myself immediately, "It's OK.  That's past and gone and done with.  It's not real.  It can't hurt me any longer."  Within a few moments, I've regained my balance.

I can't honestly believe that PTSD is something that can or should hang over one for years, even decades.  If it does, I suspect one or more of three things is involved.

  1. The victim hasn't been willing to look inside himself and deal with it.  Instead, he flinches away from it.  It's like he's pulling the scab off a wound, never giving it time to heal.  He's perpetuating the problem by not dealing with it.
  2. He's under treatment by counselors and therapists who don't understand the problem - or who do understand it, but prefer to keep him dependent on them, because his repeated visits mean that they have job security and a guaranteed income, all at his expense.
  3. He's a fraud, milking the problem for psychological and/or emotional and/or financial benefits, making it out to be much worse than it is.

I think that (1) above is relatively rare.  On the other hand, I suspect both (2) and (3) are far more common than most PTSD 'victims' and those treating them would care to admit.  Chris Hernandez, who also understands the situation from personal experience, appears to agree.

Let me close by pointing out a very current example of how to deal with PTSD.  During the past couple of years the Yazidi people of Iraq have been savagely attacked by ISIL, which has kidnapped many of their women into sex slavery.  Thousands have been 'sold' to its fighters or others, raped repeatedly, even murdered.  If anyone in the world has the right to claim PTSD, they do . . . but the survivors, when they escape, aren't doing that.  Instead, they're getting over their PTSD in the best possible way, by arming and training themselves to deal with those who enslaved and raped and degraded them.  There's now an entire battalion of former Yazidi sex slaves in the Kurdish armed forces.  They'll take out their stresses by killing those who caused them.  Well done, those ladies!  I've already donated something to their support;  and frankly, if it were possible (and legal) to donate weapons and ammunition to them, I'd do that, too.



Anonymous said...

I agree with all three, and have lived both 1 and 2. (My family dynamics were of the "interesting" variety, so my issues don't stem from combat in war, but in being raised in a severely abusive and toxic household.)

It wasn't until I found a counselor that understood and had experience in treating PTSD that I've made any progress. And you're right--it doesn't take an age to start to get better. I was surprised how much just talking to someone who understood helped. I'm still at the beginning stage of dealing with the PTSD, but it is getting better--especially the nightmares. It gives me hope to know that this isn't something I'll have to carry around forever.

It's probably judgmental of me, but my rule of thumb for discerning whether someone is really dealing with PTSD or not is how they deal with it. I still have trouble saying it out loud, but no one I've had contact with that's dealt with it wears the PTSD like a badge of honor. They don't throw it around on social media, and they don't go around demanding everyone and everything conform to not talk about or discuss whatever triggers their anxiety. They also don't go around demanding everything have trigger warnings on them.

Because trigger warnings, to someone who actually has PTSD, don't help the problem. They make it worse. They reinforce to the brain that the thing it's afraid of truly is something to be afraid of. Avoiding the stimuli that causes the fear response makes it worse, not better. It's in standing up, refusing to be a victim, and facing (with help. I did as much as I could on my own, but there came a point where me helping myself just wasn't cutting it) those fears that one gets better. And I don't know how anyone who has ever had to live with real PTSD (as opposed to the badge of victimhood) would want to *not* get better, healthier, and happier.

Peter said...

@Anonymous at 7:52 PM: You're spot on with your last two paragraphs. Hear, hear!

Anonymous said...

Thank you, thank you, thank you. I have had this exact thought fermenting in my mind for some time now. I have a son that was deployed three times. He is battling with PTSD. Some days good; some days bad. Is on meds that rankle him due to the side effects.
The thing I see with him is his choice of "buddies" that he hangs with. They all have PTSD or so they say. Their get togethers look more like a high school drunken party in the back pasture.
So the question that has wiggled itself to the front of my mind is this: is/are his buddies self perpetuating their PTSD? Are these guys; by virtue of their loud obnoxious and alcohol induced behaviors helping themselves or helping to continue their problems?
THEY will tell you that they need the release that their group gives them. I think it's a mutual pity party that keeps them in a state of perpetual angst.
I know, I sound harsh and I don't see their anguish and I don't know what they went through......
I guess that could be true; but then I will begin to tell you some of the stories I have after 30+ years of pre hospital emergency services. Possibly a bit tit for tat; but hopefully you get my drift.

Jon said...

I remember when I was a kid. My mother was a well liked teacher at a VA sponsored education center. This was during Vietnam. My brother and I came over there after school (single mom) and sort of became a mascot to these guys. One guy (I still remember his name among all those guys I have forgotten) taught me how to paint model airplanes. He'd spent two tours in Vietnam and then went as a merceneary to africa for awhile. I digress.

There was one guy there who looked pretty messed up. Very softspoken hispanic guy, young very nice. Had to use a cane to walk. One day I was rushing down the hall and dropped one of my books. It landed flat and sounded like a gunshot or a firecracker. He freaked out and almost took my head off with the cane. The other guys calmed him down and Larry (the model painter) pulled me aside and said not to take it personally, the sound startled him. He'd been stitched from right shoulder to left hip with a VC machine gun. Guy had a purple heart and a bronze star.

I saw all these guys dealing with real shit in their heads with dignity and damn little help from anyone but their brothers under arms. Ever since then I understood that these guys were heroes, battered, but they didn't carry their victimhood around with them. They just dealt.

So yeah, you start whining about your victimhood around me you are likely to get a few choice words.

I've told that story to my kids over the years to remind them not to whine about unfair or tough. Worlds unfair. Those of us who deal with reality aren't going to whine about the unfairness, we are just going to try and change the world a little bit.

Anonymous said...

The Time Cure is a great book for dealing with PTSD. The coauthor is the guy who did the Stanford prisoner experience.

Timehut, the company for the other author has a great video on YouTube called the river of time that is very soothing. That author is a practicing psych in Hawaii. There is also a treatment guide around that is a good read.

Mindfulness is a good tool for learning to live in the present. It helps to get out of automatic decisions - habits. Search inside yourself is a great book in mindfulness out of Google. And has an institute with classes and videos at I think.

Psycho cybernetics is a good book for helping you reprogram yourself through visualization. A newer book is guided imagery for self healing.

I watched a webinar by Daryl hill from Annapolis, ex marine, who helps vets. He uses nlp and his technique was impressive. You can find him on Facebook.

Most therapists are clueless in general, and especially for ptsd. Think the 80/20 rule. More like 5/95%. Most programs for ptsd don't work.

It's more than memories. It's habits you have developed due to those memories. And how do you change those automatic actions. And habits are very hard to change.

I'll add links in another post when I get to my desktop.

I need to set up an account for commenting. Due to my awareness of Google, I don't want this associated with my name.

Another anon

shugyosha said...

Regarding your "1", I think you're being optimistic. There's a certain safety in a _known_ pain that can keep people locked in.

Has anyone read Jonathan Shay's books? 'Achilles in Vietnam' and 'Odysseus in America'. The second one called me harder, but that might be personal. One of the many points it tried to touch is WHY some people do get PTSD and some, with equivalent or worse experiences, don't. I think Tom Kratman sort of touches this, too. Recalling from memory, Col. Kratman points that part of the non-PTSD-gone-through-Hell people manage that by NOT having the "all men are equal" meme; the guys one the other side of the range are NOT as human as "us". Not battle conditioning, but societal facts. Dr. Shay says (also recalling, sorry) there's a huge impact on PTSD from your relationship with society, how it reacts to your experiences; that a big part is not being able to publicly cleanse oneself, become accepted, and another is, more generally, a treason from society or command.

I can't say about the first, but the second part explains some cases I've known.

Take care.

Timbo said...

Excellent post and comments. This raised a question in my mind as to the treatment of shell shocked troops in WW1 and those called LMF or lacking moral fiber in the second one.

BigHeadRob said...

I retired as a firefighter/emt after 25 years averaging 11 calls a day for 100-24 hr shifts a year. Eighty five percent were ems calls. At middle age, I am back to school working to become a clinical social worker. My goal is to as a therapist. Police and firefighters are one of the demographics that I hope to serve. In our field, we refer to PTSD as critical incident stress. Conventional means of handling particularly bad calls is a seven step, peer run, debriefing process within a pretty rigid framework. Much of the reading that I have done questions the effacacy of the traditional seven step process. Most nay-sayers state that the critical incident stress felt by first responders is a natural human reaction to extraordinary circumstances. For years, mental health professionals have ignored what I suspect to be what may be the real issue. Is cumulative incident stress, rather than critical incident stress, the elephant in the room? Cumulative Incident Stress can be looked at as a mental death of a thousand cuts. Perhaps Critical incident stress can be augmented by addressing the cumulative issues as well. Maybe, the critical incident is the rather large straw that broke the camel's back. Thoughts?

shugyosha said...


I'm only thinking aloud, since my experience in these jobs is nil, but your idea would seem a "Duh!". EMS don't have decent R&R, as far as I know. No "some weeks off the clock" beyond holidays.

Take care.

Gail said...

Dad dealt with World War II his entire adult life. It didn't change his productiveness, his humor, his life. I think he thought it a sign of weakness and over came by himself and on his own. It was never an excuse but it was always in his dreams.

Hillbilly said...

From my experience in Afghanistan (1 tour) and Iraq (2 tours) and seeing how some people reacted to it. It seems like the less down time between traumatic experiences the greater the effect.
I worked in logging for several years while taking a break in service from the Army. If you do the research logging is one of the more dangerous ways to make a living. While I've never had nightmares or anything from my time in the Army I've had flashbacks plenty of times about close calls while logging where close calls or actual injuries happened almost daily.

HeroHog said...

I got out in 80 and was later granted a 10% service connected disability that was increased to 20%, NOT combat connected. I came in RIGHT as Nam ended and left before anything new got cranked up. FF to the 20teens when I am now 100% disabled,can't work and now am back to having to depend on the VA for my medical care. For SOME strange reason I have depression. OK, I've probably had some slight issues for years but my health issues and financial issues kinda kicked it into high gear, ok? I'm getting good care form psych and my depression is well controlled yet at this one evaluation they are worried that I may have PTSD! They are pushing this hard. "Are you SURE this that and the other?" Finally I say, "look, I have a chemical imbalance that causes me to have depression. Prozac takes care of that. My health and financial issues made it worse, were working on that and my meds were adjusted to compensate and I'm fine. I don't want to hurt me, you or anyone else and I have no reason to suffer from PTSD!" That ended that line of inquiry. PS: My VA Psychiatrist signed off on my CHP medical release form so I guess I'm OK. PPS: I have been completely released from all Psych care.

Anonymous said...

As a young Marine my Dad served in the Pacific, and was wounded on the island of Guam. While growing up I was very interested in military topics, but he never spoke of his combat experiences.

Except one night.
On the 50th anniversary of VJ Day we were watching a documentary on the Pacific Campaign. During the program I glanced over and saw tears streaming down his face.
When the program ended he poured us a couple fingers of bourbon, and described the action in which he received his wound, as well as some details about the voyage to the theater, and the long trip back to the States.
This evidently had been living inside him for five decades, and when the dam burst that evening he was finally able to let some of it go.
An unforgettable evening for me- it was an unexpected and very powerful story. He was very proud of his service, and I am very proud of him. He was a remarkable Man.
He passed away in 2003 and was interred at Arlington near his brothers, who are also combat veterans.

RIP, Dad.
And, thank you...

Diamond Mair said...

Peter, I agree that “PTSD” is over-diagnosed; right after I got myself enrolled in the VA system, I was referred to a psychiatrist, to deal with the emotional aftermath of the FodGuy’s suicide. The shrink’s initial, all-encompassing diagnosis was PTSD – nevermind that the only ‘trauma’ was coming home from work and finding he’d shot himself – we hadn’t had an argument earlier, I wasn’t there to hear the shot, etc. Also, the emotional “goo” proffered by the shrink was irritating – I was, and still am, VERY angry at the FodGuy for giving up due to his health issues. The shrink prescribed some ‘anti-depressant’ which only confirmed my earlier experiences with such meds, ie, they do NOT work for me {chemically-induced rage, anyone?}. As far as prescribing a medication which I have used intermittently, with great success for years, ummmm, NO. {WHY Valium is such an “absolutely NO” drug for me is one of life’s mysteries for me.} One of the problems, as I see it, is the damnable insistence on linking anxiety and depression – personally, the depression isn’t crippling, the anxiety is.

With the current thyroid problems, my eyes are betraying me; the ophthalmologist on Friday was asking about me quitting smoking – as I told her, I have MAYBE one or two adult beverages a year, I do NOT use street drugs, and physicians will NOT prescribe Valium for me – smoking and my Joie de Vivre {Common Marmoset} are my only sources of pleasure / relaxation – and Joie can be problematic for relaxation ;-) .

*IF* I return to therapy, I will be pushing for a term other than ‘PTSD’ for what I’m going through – in the world of the English language, there MUST be words which would convey what people go through, short of painting with such a broad brush.

Semper Fi’