PTSD By Any Other Name

This is a transcript of an earlier broadcast of this episode; there may be slight changes in wording in the rebroadcast.

BRIAN: So today’s show is our Veterans’ Day show. But before there was Veterans’ Day, there was Memorial Day. Here’s an excerpt from one of the more famous Memorial Day speeches delivered in the 1880s by a prominent Bostonian, a man who had fought for the Union in the Civil War.

MALE SPEAKER: We attribute no special merit to a man for having served when all were serving. We also know very well that we cannot live in associations with the past alone. And we admit that if we would be worthy of the past, we must find new fields for action or thought and make for ourselves new careers. But nevertheless, the generation that carried on the war has been set apart by its experience.

Through our great good fortune, in our youth, our hearts, we’re touched with fire. It was given us to learn at the outset that life is a profound and passionate thing. Oliver Wendell Holmes, May 30, 1884.

ED: In our youth, our hearts were touched with fire. That’s one the most famous lines in American Civil War memory. Now, Holmes spoke for a generation of men on both sides of the Mason-Dixon line. But his lofty language belied the war’s darker effects. Matter of fact, you might not know from that quote that he, himself, was desperately wounded in the war.

The years after the war ended, hundreds of thousands of men struggled to rebuild their lives. And they had no official government services to assist them, no language to describe the terror and isolation that they continued to feel. Psychotherapy hadn’t been invented yet. So a lot of soldiers just turned to alcohol or rootless wandering.

Recently, I had a chance to talk about some of this with Edward Tick, a psychotherapist who has spent almost three decades working with traumatized veterans of many American wars. He explained that, ironically, given Oliver Wendell Holmes’ quote about hearts being touched by fire, in the decades after the Civil War, another metaphor of heart was used to explain what we now call post-traumatic stress disorder. It was called soldier’s heart.

EDWARD TICK: The dominant medical model of the time put our afflictions in our heart rather than put it in the brain and central nervous system. So physicians of the 19th century believed that there were literal physical changes to the heart and how it functions as a result of exposure to war. They believe the heart enlarged. The heart beat harder.

They also had the poetic meaning that soldier’s heart was referring to the deep changes in how we feel, what we value, how we think, how we behave that result from experiencing war.

ED: So it’s very interesting soldier’s heart coming from the Civil War era. Then how did that concept evolve over the 20th century up to our time?

EDWARD TICK: There are some fairly famous terms that the public is aware of. In World War I, we know of shell shock, in World War II, battle fatigue. Post World War II, for a while, it was called combat neurosis. Though that term was thrown out in the 1950s. And then there was nothing for a while between the ’50s and 1980, when post-traumatic stress disorder was introduced. Vietnam veterans and other survivors of trauma had to lobby for years and years to even get the public and the health professions to admit there was a problem.

ED: So how did we come to PTSD? What is it that that conveys that the earlier names for this did not?

EDWARD TICK: Well, let me say that many veterans hate the diagnosis post-traumatic stress disorder, because to them it sounds too scientific and medicalized and pathologized. Veterans returning from combat do want public and professional help and understanding. But they don’t want to be treated as if they are individuals with an illness and then separated out from the culture.

On the other hand, as a diagnosis, many veterans also find it helpful to finally understand that there is a complex and holistic wound that they’re carrying. So PTSD is diagnosed as a stress and anxiety disorder that can and will be developed by anyone who goes through severe, sustained, life-threatening stress. Normalizing it helps veterans realize that what they’re carrying is an inevitable response to the horrors of warfare rather than any individual weakness.

ED: So is it your sense that this is getting worse?

EDWARD TICK: Yes. Post-traumatic stress disorder is getting worse with modern American war conditions. And there are a lot of reasons. One is that the technology of destruction has become so brutal, moving at such lightning speed that it has surpassed the human capacity to tolerate and endure without breakdown.

Then the nature of warfare itself changing from large, massive battles, where armies range against each other, struggle for a few hours or a few days, and then break off and have days, weeks, or even months to regroup, to talk about what happened, to try to heal some wounds, and to reposition themselves for their next battle. That used to characterize warfare up through World War II. But these kinds of wars like Vietnam and Iraq, Afghanistan are very different kinds of wars where guerrilla fighting, urban street war, not knowing who the enemy is, not being able to differentiate enemy combatants from civilians, and civilians and the infrastructure becoming recognized and acceptable targets all contribute to massive confusion, pain, dislocation on the part of anybody serving. And all of these factors contribute to post-traumatic stress disorder.

ED: Well, we have a few clips here that illustrate the feelings of dislocation that soldiers returning from Iraq and Afghanistan are facing. These were gathered by Youth Radio out in Oakland, California. Let’s listen to them.

JESUS BOCANEGRA: In the combat zone, you’re going 100 miles an hour. You’re like a little radar turning everywhere. Coming from a combat environment to a civilized environment, that’s really hard.

RICHARD DENNING: That transition from always knowing you’ll have three hots and a cot and there will always be someone right there to tell you what the hell to do if you’re not so sure yourself to being a functioning young adult, the pressure is huge.

CAPTAIN WALTER: If you’d give me the choice, I’d rather be deployed than not be deployed. In Iraq, I knew where I was. I knew what I was doing. In Afghanistan, I knew where I was. I knew what I was doing.

JESUS BOCANEGRA: I wish I would have stayed in the military, because when I was with my unit, it was sort of a bubble. The outside world does not get in. The hard part is when you go home and there’s no 10, 20 guys you talk to in the morning in PT formation. And that’s the difficult part when you wake up in your own bed and you don’t have that guy or those people you talk to every day.

CAPTAIN WALTER: I know when I go back home on leave and I’m with people that I knew before who don’t really know me now, I tell them a story that’s amusing, because it’s not that they don’t really want to know the rest of it. They care. It’s just that I don’t know how to tell them. There’s a huge portion of your life that they’re never going to understand.

ED: That was Jesus Bocanegra, Richard Denning, and Captain Walter. The interviews were conducted by Youth Radio. And we’ll link to the full version on our website. So Ed, if the incidence and severity of PTSD is increasing, would you say our means of dealing with it are increasing too?

EDWARD TICK: I would say that’s partly true. There’s more attention to it. There’s more publicity. On the other hand, the way we’re practicing war, our power politics, and many of our methodologies ignore some of the root causes of PTSD. One of the most troubling dimensions of post traumatic stress disorder is what I call moral trauma.

That is that people who have served in the military, people who have fought and, perhaps, killed in combat are very troubled by what they did and why they did it and whether it was necessary. One World War II Bombardier he was in the Flying Fortresses over Europe during World War II as a 19-year-old. And he came in for therapy and his late ’70s, because he said, I have felt like a mass murderer my entire life.

I know World War II is called a good war. But I dropped bombs on civilian targets all over Europe. And I know I helped burn European cities and kill thousands and thousands of civilians. So I don’t want to die torn to shreds by this legacy. I want to be able to go to the other side, face God, whatever happens next with a clean conscience. And I don’t know if I can do that. So please, help me find some peace before I die.

That’s emblematic of what many vets feel. And so we always have to help our veterans ask the moral questions too. Why did I serve? What was I serving for? What were my original values in serving? And how was I used in the political climate of the times? And how do I feel about that now afterwards? And how can I give meaning to my experience and turn it from a moral wound into something that teaches me about human nature and guides me to live a good life afterwards?

ED: All that’s wonderfully eloquent. I guess I would just end our interview by pointing out that all those are historical questions as well. If you don’t understand where we were in that moment, and why these things happened, and why the leaders said the things that they did, and how what you did fit into a larger pattern, it seems to be impossible for people to answer those larger moral questions.

EDWARD TICK: Yes, the historical questions are very important. However, some veterans achieve healing by identifying with the worldwide warrior tradition rather than with a particular service they had. So I’ve had veterans declaring as they’re going through their healing process, I am no longer a Vietnam veteran or a Somali veteran or a Korean veteran. Rather I declare myself to be a warrior whose historical service was in Vietnam or Somalia or in Korea.

ED: Kind of de-historicizing it in a way, right? Taking solace in the universality rather than the particularity of their experience.

EDWARD TICK: Exactly.

ED: Ed, thank you very much.

EDWARD TICK: You’re very welcome. And thank you, again, for giving airtime to this very important topic.

ED: Edward Tick is a psychotherapist specializing in veterans’ issues. He’s the founder of Soldier’s Heart, a veterans’ healing center based in Troy, New York.

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BRIAN: Well, Ed, to re-historicize things, I just want to put three interesting issues of historical context on the table. One is literally how veterans are reintegrated into society. Does it really make a difference that folks returning from World War II come back on ships? They’ve got weeks, sometimes even months, before they get back to their home communities, as opposed to getting on a plane. And a day later, they’re home– boom.

The second is the shift from a draft and a war effort, where there’s a sense of everybody being involved to an all volunteer army, which, in many ways, further isolates our fighting men and women, maybe makes reintegration more tough. The third cuts the other way. We now have folks before they engage in combat, they’re text messaging and they’re on the worldwide web, sitting over there in Afghanistan and Iraq. And these are all issues of historical context that dictate how veterans are going to feel when they return, how they feel when they’re away and serving away from society.

PETER: I thought it was really interesting this notion of a worldwide universal warrior cult, because, of course, that is defining yourself apart from a larger population. It’s really part of the mythos and ethos of the modern military.

ED: I think that these are all great questions, of course. It strikes me intrinsic to the military experience, the fighting experience, is that you are simultaneously embodying what your society is all about and forever alienating yourself from most of the experience of other people in that society.

BRIAN: And what strikes me about all of these questions and issues is how little control the veteran himself or herself actually have over any of these.

ED: And that’s the spirit, I think, of the Sons of Confederate Veterans, as we heard at the very beginning of today’s show. They’re saying, look, cut the individual foot soldier some slack. Whatever you think they were doing, they were just doing what seemed right at the time. So if we took it from the experiential frame of reference rather than the political frame of reference, you can see the logic that they try to follow on that.

BRIAN: Well, guys, I think that’s a good note to end the show on. Listeners, the conversation continues online. Visit us at backstoryradio.org to see what people are saying. We’d love to hear your thoughts on today’s show.

ED: And while you’re there, sign up for our free podcast and our weekly newsletter. That’s at backstoryradio.org. Thanks for listening.