Everywhere you look these days, you see PTSD. The best estimates tell us that only around fifteen percent of Iraq and Afghanistan veterans have Post-traumatic Stress Disorder, a mental health condition characterized by hyperarousal and nightmares, but the feeling one gets is that there’s an epidemic gripping the nation and that every veteran has it or soon will. Recently, however, some prominent veterans have begun pushing back against this narrative. One such veteran, retired four-star general James Mattis, speaking at the Marine Memorial Foundation, said, “You’ve been told that you are broken, that you’re damaged goods...I don’t buy it.”
A condition that went unacknowledged for millennia and only began its public life thirty-four years ago when it first entered the DSM, PTSD has spread to every corner of our culture, becoming in the words of one medical anthropologist, a kind of “psychiatric Esperanto.” Movie critics wonder if Batman has it. In April, Sean Guillory, a writer at The New Republic even suggested that all of Russia might be suffering from it. There are even commemorative PTSD patches that consumers can purchase online for $5.99 that read, “P.T.S.D.: Some Wounds Aren’t Visible.”
Some of this makes sense, traumatized people—and veterans especially—have always been granted special status, though often this specialness was negative, a stigma that had to be purged through ritual cleansing.
In the Middle Ages, for instance, the Catholic Church required returning warriors to do various penances when they came home. Even the Bible recounts the forcible ostracism of veterans. In the book of Numbers the Israelites are instructed: “anyone who has killed someone or touched someone who was killed must stay outside of the camp for seven days” (31:19).
Today, instead of the Church or a priestly class governing the conduct of returning warriors, we have modern consumer-driven psychiatry, a medical field that saw a 250% increase in the number of disorders it diagnosed between 1987 and 2007. As one Iraq veteran told me not long ago, sometimes it feels like America today has turned the entire veteran experience into a kind of pathology.
In his April 23rd speech, General Mattis challenged this mindset, saying, “while victimhood in America is exalted I don't think our veterans should join those ranks.” He added, “I would just say that there is a misperception of veterans…that they are somehow damaged goods. I don’t buy it.” Mattis’ speech didn’t exactly blow up in the internet but a lot of veterans, especially Marine vets who look at Mattis as a kind of modern-day Patton, took notice.
Mattis can come across as a bit of a blowhard at times but he is perhaps the most articulate spokesman of the modern warrior class. The general said what a lot of veterans and military leaders are thinking: Americans today are too quick to paint vets with the victim brush and that by assuming that all of them have PTSD, and are “damaged goods” in Mattis’ words, they are totally missing the point.
I am not trying to make the outlandish case that PTSD doesn’t exist or shouldn’t exist, although interestingly, others have. (Two leading historians of psychiatry, Edward Shorter at the University of Toronto and Ben Shephard at the University of Bristol, have both argued in print that the PTSD diagnosis is dubious.)
When you ship off millions of young people to kill and die in a war, there is always going to be a sense of guilt and incomprehension among the stay-at-homes. PTSD is a valid and incredibly important psychiatric concept but lately, given its overwhelming popularity as both a diagnosis and a cultural force, I find myself wondering if it hasn’t become a bit of a dodge, a way for Americans to assuage their guilt about the stupid wars they asked their sons and daughters to fight in, a junk drawer into which they can throw all their unresolved feelings about 9/11, the Bush era and the War on Terror.
At this point in the discussion of PTSD, a lot of therapists and veteran advocates will tell you that it is simply a medical condition, a result of brain damage caused by an IED or a chemical imbalance caused by trauma. But research shows that post-traumatic stress has a large social component to it. As Otto Fenichel, a contemporary of Freud wrote in 1945, “neuroses are social diseases…corresponding to a given and historically developed social milieu.”
To give just one example of the way that culture has influenced how we think about trauma, consider the “flashback.” Commonly thought of as a signature symptom of PTSD, the “flashback” is, in fact, a term psychiatrists originally borrowed from the world of film. In 2002, researchers at King’s College in London, digging through war records dating back to the Victorian era found that flashbacks were virtually nonexistent among veterans who fought before the age of film. Put another way, PTSD is not a fixed clinical state but a malleable conceptual framework that can absorb elements from the broader culture.
And more to Mattis’ point, surviving a war or a major trauma has some strange, positive side effects, as ridiculous as that may sound at first. When you come back from a war, lots of domestic moments take on an almost sacred quality. It is one of the few times in adult life where you are allowed to openly question the meaning of existence and to reinvent yourself. Coming back from Iraq my second time reminded me of being in college, when you walk down the street experiencing every known emotion, both good and bad, more powerfully than you do in other phases of life.
Returning from war can make sunsets are more beautiful. The sight of a woman on the street in heels is a minor miracle. A bar open at three in the afternoon makes you want to organize a parade for the Twenty-first Amendment. Time itself seems to have changed. (As Allen Young, a medical anthropologist wrote, “PTSD is a disease of time.”) It’s impossible to reconcile these strange feelings with how civilians look at war. I mean, how many times have you heard a television reporter talk about the joy of being alive with an Iraq veteran? Instead, they (and we) all slip back into a cultural habit that has its origins in the Vietnam War: we turn to pity and pathos. The veteran is a broken person, exploited by the state. A creature deserving of pity and a medical diagnosis that will grant them a special status in society.
Or so the thinking goes.
There is something that happens when you go to a war and come back, which is the release of a pent-up energy, a kind of existential fury. To be a survivor is to be reborn. There is a raw, jangly feeling that seizes you, the force of life making itself known. It is always there deep inside of us, but war and other forms of near-death compress it and when it is finally released at home, can be difficult to understand. Mostly you just try to hang on. I have never, for example, focused more on my writing or thought more clearly than I did after I got back from Ramadi in the summer of 2006. It was as if part of me couldn’t believe I was still alive. There was a long stretch where I lived on just a few hours of sleep at night. I was jittery, jumpy, doubly alive. It got to the point where one of my friends asked me if I was doing cocaine.
The problem is that this survivor’s high doesn’t last forever. Usually a couple months after you get back from a major event like a war or a natural disaster, the adrenaline starts to wear off and you’re forced to confront the normal world again. It is often in the middle of this confusing adrenaline crash that you start to hear the murmurs about PTSD, often from well-meaning professionals who have been trained to believe that everyone coming back from is a sufferer.
For many survivors of war or other traumas, of course, there is no post-trauma adrenaline high. They are reborn, but into a body they no longer recognize, a body that responds to neutral stimuli in the world and reads them as threats. Potholes in the road become IEDs. Police helicopters overhead become CASEVAC birds, coming for them. These people, in many cases, have PTSD. But a substantial number of people, probably more than have PTSD, are reborn and find that they cherish life in a way that would have been inconceivable to them before. Toward the end of his talk in San Francisco, Mattis referred to this alternative view of trauma saying, “There is also something called post traumatic growth where you come out of a situation like [Iraq or Afghanistan] and you actually feel kinder toward your fellow man and fellow woman.”
The idea for post-traumatic growth as a formal concept stems from the work of Richard Tedeschi, a psychologist at the University of North Carolina-Charlotte. In the early nineties, Tedeschi was looking for a new line of research. “I thought, who do I want to know the most about, distressed or violent or crazy people?” he explained. “Instead, I think I want to know the most about wise people. Perhaps I’ll learn something myself.” Along with his research partner at UNC-Charlotte, Lawrence Calhoun, he began interviewing people who had suffered from severe physical injuries, including a number of people who had been paralyzed in car accidents. After that, the two interviewed senior citizens who had lost their spouses. In case after case they found that while the person regretted the loss of their mobility or their spouse, the experience had altered them for the better and given them a fresh perspective on life.
While I was doing research for my book on PTSD, I interviewed Steve House, an elite climber who in 2005 won the Piolet d’Or, mountaineering’s highest honor for his ascent of Nanga Parbat, a 26,660-foot peak in Pakistan. (Full disclosure: House is my first cousin.) While House considers the ascent of Nanga Parbat to be his greatest accomplishment, it was an incident that occurred on a far lesser peak in the Canadian Rockies that proved to be his life’s turning point.
In 2010, House was halfway up Mount Temple, an 11,627-foot peak, when he took an eighty-foot fall, breaking several ribs, his pelvis and puncturing a lung. In the aftermath of the accident, House began to rethink his life. “The accident basically recalibrated everything about my life,” he explained. “It recalibrated my value system. I felt like, ‘Okay, this huge thing happened and rather than fight it, I’m gonna let it change my life, in fact, I’m gonna help it change my life. I’m gonna use the momentum of this event to fix things that I think are wrong and try to create things that will take me in a better direction.”
After his fall, House essentially reinvented himself. After a long painful process, he ended a relationship with his longtime girlfriend and relocated from Oregon to Colorado. Shortly after arriving in Colorado, he fell in love and got married.
Trauma and loss are highly individual affairs and most of us aren’t elite mountain climbers, but neither are we only hapless victims of our grief and earlier losses. At this point in history, with PTSD’s wide acceptance across our culture, it’s time to broaden the conversation about trauma. We need to re-examine what it means to be a survivor and consider it in something other than the strictly medical context of disease, damage and cure.
War, rape, and natural disasters—the traditional events that can lead to PTSD—all change people in different ways. The last thing anyone wants to do is to trivialize another person’s nightmarish ordeal or disrespect their war service by telling them to buck up and “grow” from it, but lately it’s become harder for me to distinguish all the talk about PTSD from garden variety pity.
It has become important for Americans to look upon their veterans as victims, to believe once a person has seen the world at its worst and been changed by the experience, that they have fallen into a kind of abyss, an underworld of the diseased defined solely by loss and pain. But what if they were to, say, decline to fall?
David J. Morris is a former Marine infantry officer and war correspondent. He is the author of The Evil Hours: A Biography of Post-traumatic Stress Disorder (Houghton Mifflin Harcourt).