PTSD has had a lot of names and a lot of causes. It is troublesome and painful enough that people over the centuries -- CENTURIES -- have tried to figure it out enough to get a “cure” or at least some kind of survivability out of the aftermath of war. Some have succeeded. It appears that what has worked the best, in spite of all our sophisticated meds and strategies, is to simply get used to it, wear it out, repeat the stories -- with other people who have had the same experience, with trained therapists, or with the self through the use of tape recordings listened to repeatedly. It's a little risky. The other stuff helps some people. It would help to disentangle the issue from alcoholism/drugs/self-medication and from homelessness/joblessness/“familylessness.”
What we are learning through fMRI research, war stories, cultural histories, is beginning to cross disciplines now. Some of the concepts that felt like realities -- courage, obsession, vulnerability, and whatever PTSD is being called this time around -- turn out to be multiple, layered, and interactive. They come apart more easily (at least for me) when seen through this five-aspect list I’ve been using.
1. The actual “machinery” of the body when it was assembled molecule by molecule during gestation and the first few years afterwards, which are really the last part of gestation outside the womb. This forms a unique shape for each person: what limits there are, what special gifts, what will be taken in through the senses, what will be imperceptible. The first “world-frame” that the awakening brain uses to sort itself out physically snuffs neurons that aren’t used, allotting more neurons to needed categories.
2. The beginnings of experience after the person begins to be self-motivating are crucial. Very bad things like a flood, a war, a disintegrating family, physical attack, might make a young person shut down or split or internalize warnings. Various forms of dissociation can form, instead of the dynamic but coherent process of being human. As the body's muscles and bones are shaped against the world, so are the parts of the brain. It helps to have a significant person to use as a model and protection.
3. One figures out what to do by referring to the cohort: one looks to the people around nearby for clues and relationship. Kids at this stage can belong to what amounts to a pack, so that in indigenous/homogeneous/isolated societies, there is a shift from the family to the group of same-age same-gender youngsters. Often physical separation, at least part of the time. Seventeen-year-old guys gravitate to this in a way that makes them easy to form into an army, a team.
4. Later there are two forces: one is the cultural overview of the Big Picture -- what life is about, a kind of religio-political metaphor that guides and unifies pluralities and contradictions. The other is sexually driven pair-bonding that can produce babies. Or same-sex bonds that can raise babies. This is as far as mammals can go, except for humans. Our television stories and novels operate at this level. So do organized religions. They are vulnerable to challenges by experience. They can be inspired, building cathedrals.
5. In the mid-twenties the brain has reached a stage where it can operate on the virtual level, actively conceiving of things not seen, not heard of, outside any box. Abstract, analytical. Scientific, if you like. Cosmic. Understanding that a human being is a tiny particle in a vast and gorgeous drama. Most people never get to this.
I’ve just finished reading “Field of Combat: Understanding PTSD among Veterans of Iraq and Afghanistan” by Erin P. Finley, who is a cultural anthropologist, meaning that she studies the patterns of a culture and their effect on individuals taken as a group. This is neither therapy nor history nor sociology, but an account of a specific group surviving a particular time, place, and situation: in this case, veterans at a Texas hospital trying to overcome damage -- physical and psychological -- imposed by service in Afghanistan and Iraq. The rising numbers of strugglers (both the veterans and their families) and the lagging understanding of what to do meant that Finley could get funding. She had done similar studies with former combatants in Northern Ireland, heroin and cocaine users in Boston, and Sudanese refugees resettled in Atlanta.
For a psychological point of view, consult the Diagnostic and Statistical Manual of Mental Disorders produced by the APA. As a reminder, there are three symptom “clusters” each with 5 or 6 sub-items. All three clusters are both physical and “mental” so dividing the symptoms on those terms is useless. They also vary between cultures, but these particular veterans were a coherent group. They are:
Reexperiencing (dreams, flashbacks, waking reenactment, intense reaction to reminder cues.)
Avoidance/numbing (being solitary, blocking memories, not being able to feel emotion)
Hyperarousal (sleep problems, irritability and anger, trouble concentrating, hypervigilance)
The individuals Finley interviewed at length -- sometimes with their wives -- were members of a volunteer army with inefficient and underfunded management in a blundering political climate. Because they were in Texas, most were low-income whites, blacks and Latinos. The most assorted cultural styles were the Latinos whose families came from the vast Spanish-speaking territory of Central and South America. There turned out to be negligible differences between the categories. What all these men shared was intense bonding, especially those who saw combat, combined with ghastly deaths and grievous harms. There turned out to be negligible differences between the ethnic categories.
Since the culture around the military is invested in a notion of what a man is or ought to be (TOUGH! SUPERIOR! ) those ideas interfered with each soldier’s attempt to be the best he could be, since everyone has limits. It opened the door to very high expectations and a good deal of self-blame for not meeting them. They were not used to the idea of a person as a shifting, reorganizing, response to situations, so put a lot of energy into trying to stay the same, both during enlistment and afterwards.
Since these veterans were in the hospital setting, their shattered identities often had to accommodate missing parts, esp. feet and legs because of land mines. In previous wars, casualties were as high as a third of the soldiers. Now they are about 10%, but only because there is a new category of alive-with-deficits, a category that gobbles money for medical care, bionic compensation, and steep assisted-learning curves. The hardest deficit is brain damage, characteristic of terrorist-bomb sudden explosions while in transit. Concussions don't necessarily show as wounds. Maybe one of the hardest things to witness for these men who took pride in fathering was the callous collateral damage to women and children.
This book is easy to read, full of stories and examples of resilience. But it is not just about soldiers and their families. It is about being human in a world that can be turbulent and horrifying. In modern America where the predominant religion is arguably no-limits prosperity and even traditional or “spiritual” contexts are often expressed with money, then a war that makes questionable allocations of basic resources and doesn’t pay soldiers enough to keep their families off welfare is demonic. But Finley doesn’t take this on -- she is not a comparative religion anthropologist.
For men in Texas, as in Montana, “cowboy up” (walk it off) meets “be a soldier” (ignore pain) with the difference possibly being that a cowboy is an independent survivor but a soldier is part of a group that depends on him. The public sees PTSD in terms of Vietnam so that it associated with national guilt over the treatment of those soldiers. In today's wars, the dimension of “saving the world” that was a big part of the WWII is missing.
The WWII men are just going over the horizon. When my brother-in-law (b. 1912) spent his first Thanksgiving at home, my husband took a group pic as the turkey was carved. The flash sent his brother under the table and then outside, vomiting. Lifelong he was a functioning alcoholic, quietly secretive but potentially combative -- doing the best he could to meet conventional standards and mostly succeeding. His business was successful, his marriage stayed intact, and he was well-respected. He just hated Germans. Not every warrior develops PTSD and even those who do sometimes just accept the burden and go on. But they are not the same.
Some people try to argue that PTSD is just an idea anchored in one cultural moment, but it’s easy enough to find in EVERY culture the childhood fault-lines, physiology tuned to intense response, high expectations and blame at failure. That’s why we need cultural anthropologists.
Robin Asti was a male pilot in WWII. In the Seventies she switched to being a female. Now 92, she has been happily married ever since. To her, it was NOT traumatic. Until she was denied widow's benefits. Story at: http://www.buzzfeed.com/skarlan/this-92-year-old-trans-wwii-veteran-is-fighting-to-be-treate#.ejO4jZl3b Money and trauma are intertwined.