Six Thoughts on Posttraumatic Stress Disorder

Retired Tech. Sgt. Chris Ferrell, a former Explosive Ordnance Disposal technician who suffers from Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury after combat tours in Afghanistan and Iraq, displays a mask he painted in Hanover, Pa., April 5, 2017.  (U.S. Air Force photo by J.M. Eddins Jr.)

Posttraumatic Stress Disorder. Shell Shock. Battle Fatigue. Call it what you want, it’s that combination of psychoglogical and behaivoral reactions to exposure to traumatic events that people see in combat veterans. There is a lot of discussion, whether at the water cooler, kitchen table, social media, wherever, about what it is. Who has it. What can it mean for those who do have it, those who live with them, and those who work around them.

There are a lot of misconceptions around PTSD, a lot of unknowns that cause people to jump to conclusions. While I’ve written about PTSD before, and often try to make a point that challenges that veterans experience in regard to their mental health goes far beyond PTSD, I thought that I would lay out some of my thoughts about the condition. Here are six quick thoughts that might help you understand what PTSD is, and how it impacts veterans.

Just Because a Veteran Has Been to Combat Doesn’t Mean They Have PTSD

One of the stereotypes that many in society have is that exposure to combat, or even just combat deployments, must mean that a veteran has PTSD. Witness the high-profile events over the last eighteen months in which military service members committed egregious criminal acts: the sniper-style shooting event in Dallas, the multiple homicides in Baton Rouge a week after that, or the Airport Shooting in Florida. In each of these cases, the veteran’s military experience, including deployment experience, was examined to determine if PTSD was the “cause” of their actions. Correlation is not causation, as any scientist will tell you, and the fact that a veteran deployed to a combat zone does not mean that they will automatically develop PTSD.

The fact is, there are a large number of individuals who deployed to a combat zone who never actually saw combat action. They were never shot at, they were threatened with rocket or mortar attacks, their lives were never really in danger from enemy activity. That does not mean that nothing bad ever happened when not in active combat; certainly accidents happen. I recall, as a young Soldier in Bosnia, walking from our living area to the motor pool. Everyone walked the same path; we had arrived in the winter, so the snow was trampled and worn. Guess what happened when the snow melted, however? All of the unexploded ordnance started to appear on the ground. I don’t want to make it sound dramatic and say that we had been walking through a minefield, but if the path had been ten feet to the right or left, someone would have gotten hurt or killed. The military is an inherently dangerous profession, so certainly mishaps and accidents can occur…but the individual who deployed to Kuwait in 2012 was not faced with the same danger as the group of men and women hanging off the side of a mountain in 2009. So, just because someone’s a “combat vet” doesn’t automatically mean they “have PTSD.”

PTSD Is Both a Natural AND Negative Reaction

PTSD is as much a neurological condition as it is a psycholgoical one. Studies have shown that repeated exposure to trauma results in physical areas of the brain, specifically the amygdala and the hippocampus, actually undergoing structural change. Activation of the amygdala and hippocampus combined with reduced activation and volume in the frontal lobe of the brain are indicative of veterans who display symptoms of PTSD. Therefore, the brain is adapting the way the brain should adapt to repeated traumatic exposure.  It is doing exactly what it should do when exposed to high levels of cortisol and adreneline and constant activation of these regions. Many who rail against the “D” in PTSD say, “why pathologize a natural reaction to combat?” That’s absolutely right…PTSD is precisely a natural reaction.

That doesn’t mean that it’s beneficial. There are hundreds of things that are natural reactions to our environment, and they’re still not beneficial. Allergic much? Anaphalactic shock occurs after a bee sting, it’s a reaction of one organism to a substance from another. Am I comparing PTSD to allergies? Of course not, but just because a reaction is typical for a small group of people doesn’t make it beneficial. This very natural reaction can be a debilitating condition…it’s both.

A Veteran Can Experience Challenges Even If They Don’t Have PTSD

To be clincially diagnosed with PTSD means that the individual must meet a certain set of critira. I have written about these criteria before, so you can check that out here. But not all veterans meet all the diagnostic criteria at the same time. Some veterans don’t experience nightmares or intrusive thoughts, but behaviorally isolate themselves. Or are extremely hypervigilant. At one point in their lives, or in one particular location, they can experience the mood symptoms but nothing else. Not only that, PTSD may not be the issue, but guilt or shame may be the issue. Or a lack of purpose and meaning in their lives, a substance abuse problem, relational difficulties, or any other of a number of challenges that many veterans…and many non-veterans…face.

A Veteran Can Develop PTSD from a Single Event or Multiple Events

Complex trauma as a result of exposure over an extended period of time can result in PTSD that is much different than that of a single event. Any one of us can experience PTSD after a vehicle accident or a natural disaster. As a matter of fact, these are two of the most common conditions that non-veterans would experience when it comes to developing PTSD. Complex trauma, however, occurs when multiple traumatic events happen over a period of time, or even a lifetime. As I’ve mentioned before, the military is almost a refuge for many who had a traumatic childhood, when is then compounded after exposure to trauma as an adult.

PTSD can also occur after single instances of sexual assault, which is much different than that which results from accidents or natural disasters. This form of PTSD is much more personally and physically intrusive, and layers of guilt and shame. An aspect of Military Sexual Trauma (rape or assault while in the military) was made clear to me as I attended a conference in San Francisco: MST can almost be seen as incestuous. We talk about the “Band of Brothers” and the military family, how we become closer to those we serve with than we sometimes are with our own family. Often, the perpetrators of the assault in the military are those in a position of trust, either professionally or personally. So an MST survivor has not only the trauma of the assault, but also the betrayal of trust.

A Veteran can Develop PTSD Even If They’ve Never Been to Combat

I’ve worked with veterans who have developed PTSD, but have never deployed. The 82nd Airborne Division responded to Hurricane Katrina, and had to recover the remains of their countrymen. Just that level of devastation can have a traumatizing effect. I have known, of course, service members who have been raped, as discussed above. Any event that causes threat or actual death, dismemberment, or sexual violence is described as “traumatizing” when it comes to PTSD. Having a bad experience with a supervisor while you were in the miltiary? Not PTSD. It could certainly lead to helplessness, frustration, angry outbursts, depression, and a whole host of other mental health concerns, but not PTSD.

But, as I mentioned above, the military is a dangerous profession. Parachute accidents, howitzer misfires, training accidents, each of these are potentially traumatic and could cause someone who has served to develop PTSD, even if they haven’t deployed.

A Veteran can “Have” PTSD and Still be Functional and Productive

So perhaps a veteran has been exposed to multiple traumatic events and meets the clinical definition of PTSD. Does that mean that we should write them off entirely? Of course not. The condition can be managed to the point where the veteran may not feel the challenges for months, if not years. With treatment, the veteran can absolutely manage their PTSD symptoms to the point that they can be a functional and productive member of their community, their workplace, their family.

Understanding this condition is a key factor in reducing the gap in understanding between those who have served in the military, or love those who have, and those who have not served. What questions do you have about PTSD? What do you know about it, and how can we have a conversation that can help you understand more? Reach out, comment below, and join the conversation.

The Head Space and Timing Blog is supported by the Colorado Veterans Health and Wellness Agency, a 501(c)3 Nonprofit in Colorado Springs, Colorado. The goal of the CVHWA is to provide military culturally competent mental health counseling to veterans and their spouses, regardless of characterization of discharge, time of service, or era of service. Our vision is to assist veterans to identify and remove barriers to their mental, physical, emotional, and behavioral wellness. For questions or inquiries, contact us!