This article in Scientific American by David Dobbs reports on the growing concern that “the concept of post-traumatic stress disorder is itself disordered”. The writer is critical of a culture which “seemed reflexively to view bad memories, nightmares and any other sign of distress as an indicator of PTSD.” To critics like this, the overwhelming incidence of PTSD diagnoses in returning Iraqi veterans is not a reflection of the brutal meaningless horror to which many of the combatants were exposed but of a sissy culture that can no longer suck it up. As usual, the veil of ‘objective’ ‘scientific’ evidence is used to cloak ideological biases.
FmH readers know that I too am critical of the frequency of PTSD diagnosis in modern mental health practice, but I think that is not a problem with the theoretical construct of PTSD but its slapdash application. With respect to domestic PTSD, the problem is one of overzealous and naive clinicians ignoring the diagnostic criteria and, more important, misunderstanding the clinical significance and intent of the diagnosis, labelling with PTSD far too many people who have ever had anything more than a little upsetting or distressing happen to them. Essentially, PTSD is meant to refer to the longterm consequences of either an experience or experiences that are outside the bounds of what the human psyche can endure. Both emotionally and neurobiologically, the capacity of the organism is overwhelmed and the fact of the trauma assumes an overarching and inescapable central role in future information processing, functioning and sense of self. Experience that occurs when the body is flooded with unimaginably high levels of stress hormones, when the nervous system is in the throes of the fight-or-flight response, and when the normal processes for making sense of what we are going through utterly break down are encoded differently in the body and mind, with immeasurable effects. Only someone who did not grasp this at all could misrecognize simple anxiety, depression or adjustment difficulties as PTSD. But it happens all the time, especially in the treatment of depressed women, largely because of do-gooder clinicians’ desires to be politically correct and not be seen as insensitive to their clients’ suffering. Unfortunately, what it mostly does is train these clients to remain lifelong inhabitants of a self-fulfilling inescapable victim role.
The concern, on the other hand, with soldiers returning from the wars in central Asia, is the opposite. All evidence is that PTSD is being underdiagnosed, because of systematic biases within the government and the military to deny the scope of the problem. Articles such as this, and the research that it depicts, should be seen as nothing but a conservative backlash, an effort to blame the victims. If coping with the scope of PTSD is a problem, deny the reality of PTSD. Certainly considerable research suggests that a proportion of soldiers returning from the battle front in bad shape will have shown their resilience, will no longer show a high magnitude of emotional disturbance, and will not warrant a diagnosis of PTSD if reassessed months or years later. Research also suggests that early intervention using a trauma paradigm may do more harm than good, perpetuating the vulnerability of the patient. And most Defense Dept. research on the effects of combat trauma is intended to figure out how to block the stress reaction so that a soldier can remain functional and return to a combat role as soon as possible. But it remains the case that the human nervous system did not evolve to endure the horrors of modern war, and that the indefensibility and anomie of this war in particular, based as it has been entirely on lies, amplifies the intolerability and makes it far less likely that a veteran can find sustaining meaning in the suffering they endured. This will inevitably turn into higher rates of PTSD than among veterans of other wars.
To deny the scale of PTSD in our returning veterans is to be an unquestioning apologist for the untrammelled American imperialist projection of power in lawless aggression. As Dobbs describes it, the PTSD deniers construe us as having a cultural obsession with PTSD which embodies “a prolonged failure to contextualize and accept our own collective aggression.” What horse manure. Our cultural neurosis, rather, lies in the unquestioning acceptance of suggestions like Dobbs’ that we should mindlessly embrace such aggression as natural. This was the neurosis that made it possible to elect Bush and his handlers to enact an administration that set about violating every supposed principle of our democracy and our humanity. I know we are not supposed to draw this particular analogy, but this brand of PTSD denial strikes me as akin to nothing as much as Holocaust denial. Via Scientific American.