I was standing at the register of my part-time summer job after college graduation, helping check a man out, when one of my fellow employees (a former special ops serviceman) started talking about posttraumatic stress disorder.
“I’m so sick of seeing veterans get disability checks for PTSD.”
I turned to him, confused, having studied PTSD extensively in my undergraduate career and ignorantly believing he would be one of the few in favor of benefits for soldiers suffering from such an illness.
“I don’t understand,” I replied. “You don’t think combat veterans with PTSD should be compensated?”
I’ll never forget his response: “Nah, man, PTSD isn’t a thing.”
***
Unfortunately, it is a thing. It’s a thing that happens to people who experience near death situations. It’s a thing that leads to sleepless, terror-filled nights. It’s a thing that causes uncontrollable anxiety and persistent negative emotion. It’s a thing that motivates reckless and destructive behavior. It’s a thing that leads to avoidance and numbness. It’s a thing that alienates families and friends. It’s a thing that destroys people from the inside out.
It’s a thing that kills 20 veterans, on average, every single day (Department for Veterans Affairs, 2016).
It’s a mental disorder.
The problem is, I can’t fault anyone for failing to see this reality – not even someone who likely has friends battling the disorder. Because despite the social stigma that, arguably, all mental illnesses carry, PTSD is especially stigmatized in that it’s not only influenced by social acceptance, but the political agenda of any given generation.
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PTSD and Politics
"Posttraumatic Stress Disorder" was not formally recognized as a term in medical sciences until it appeared in the third edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1978). Prior to this, problems related to trauma and stress were labeled as "shell shock" or "soldier's heart"- diagnostic criteria that were meant to make the disorders appear physical in nature so as to avoid any speculation that soldiers might be capable of succumbing to mental impairment (as it was seen as indicative of their being "weak"). An early conceptualization of PTSD appeared in DSM-I under the name "gross stress disorder" but it was omitted in DSM-II after the United States experienced several years of peacetime. DSM-III brought mental health professionals back to the idea of an existing disease that occurred as a result of experienced trauma and labeled it PTSD, in large part because of the Vietnam War.
Because the condition was not officially coined until the DSM-III, PTSD is thought of as a relatively new disorder and has experienced rapid growth in research over the last several years leading to numerous evidence-based treatment techniques. However, in June 2014, a panel comprised of leading scientists (Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder) released findings that there has been a dramatic rise in soldiers suffering with the disorder, as it has increased tenfold between 2004 and 2012. Moreover, the research concluded that the percentage of the United States Department of Veterans Affairs’ (VA) research budget devoted to PTSD had declined over the last three years, from 32.4 percent in 2010 to 24.6 percent in 2013. This could lead to another period of time (such as when DSM-II was published or when the disorder was altered during DSM-IV) when peace causes a decrease in active research and treatment of PTSD in the United States.
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Why the Correlation?
Judith Lewis Herman (1992) coined the phrase “episodic amnesia” to address this continuous cycle whereby interest in a psychological trauma alternates between periods of active investigation, during which the concept of a trauma is thoroughly studied and reviewed, and periods of oblivion, during which examination of trauma-related problems appears to be abandoned. Herman concluded that this is because, to study psychological trauma, one must be willing to face both human vulnerability and the existence of evil in human nature, something that, at least periodically, becomes detested.
Shalev, Yehuda, and McFarlane (2000) believe that the current acceptance of PTSD, as well as the resistance that has followed it, reflect a paradigmatic shift – one that means we are admitting that survivors of traumatic events face calculated and painful effects and that we, as people, now believe these individuals have been ignored and deserve to be helped. Shalev and colleagues (2000) also state that paradigms continue in cycles, inferring that despite the advances our society has made in PTSD over the last two decades, there is an opportunity for us to backslide.
***
The number of PTSD diagnoses is expected to grow in the years to come. Lasting wars in Iraq and Afghanistan have ensured that the number of patients will increase continually as soldier's return from the Middle East (Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder, 2014). Moving forward we must be willing to challenge the idea of “episodic amnesia” in further research to address PTSD even in times of national peace so as to prevent any further periods of oblivion (Herman, 1992).
Historically, PTSD has not always been treated with the greatest care or respect; however, today, it is researched thoroughly by psychologist and psychiatrists alike (Andreasen, 2010). This research must continue into the next several decades to keep up with an influx of soldiers suffering from the disorder for reasons of national security as well as cultural, personal, and societal health.
