C:\PETER\Website\THE SOLDIER & PTSD.htm

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PTSD "Post-Traumatic Stress Disorder"
- war trauma -

LIST OF SYMPTOMS
(text of a flyer composed by Peter Tucker for distribution among Bosnian
and other refugee ex-soldiers in Sweden)
TOP }{ SITE CONTENTS

•
Nightmares, flashbacks, hallucinations, and other forms of uncontrollable
invasion of the present by memories of the past
(intrusion)
•
Intense distress at exposure to events that symbolise or resemble an aspect
of the traumatic event, including anniversaries of the event
(intrusion)

•
Difficulty in recalling events from the war years, especially those
that were traumatic;
unwillingness to remember the war;
reluctance to meet people, read books, see films etc.
that remind one of the war
(constriction)

•
Episodes of severe rage
(hyperarousal)

•
Violent impulses towards what may be indiscriminate or innocent targets;
unnecessarily violent reaction on being taken by surprise
(hyperarousal)

•
Severe survival guilt; feelings of guilt at having survived the war
while others, perhaps more deserving, have died
(constriction)

•
Alienation from one's own feelings; reacting with emotions
that do not seem appropriate to the situation;
periods of acute depression, interrupted by periods of
sometimes manic behaviour
(constriction/hyperarousal)

•
Markedly diminished interest in significant activities; apathy
(constriction)

•
Sense of a foreshortened future - feeling of being older
than one’s true age
(constriction)

•
Doubt about whether one can ever love or trust someone else again;
pessimism about the very nature of love and life itself
(constriction)

Technically speaking, PTSD is not a mental sickness, but a "syndrome", ie. a collection of symptoms. The term describes the delayed and often chronic reaction experienced by people exposed to the particular kind of intense stress encountered in war zones, natural disasters and other catastrophic situations. The PTSD reaction must be regarded as a normal human response to the impact of abnormal stimuli - the activation of certain survival mechanisms which, although useful at the time of the event, become a source of constant pain and distress if prolonged over years. The reaction has been found to be more extreme when the stressor is of human origin, as in war, or in the case of violence on the streets or in the home (rape etc). The specific form of PTSD suffered by soldiers is known as combat-related PTSD. There should be no shame attached to PTSD; it is often the most courageous man in a unit who gets hit by the syndrome. A stress reaction may surface after months or even many years (known as delayed-action PTSD), including some or all of the symptoms below. Few suffer from every symptom listed here, but if you recognise several in your own, or some loved one’s behaviour, then the chances are that the person in question suffers from more or less severe post-traumatic stress.

(Note: The list above is based on the description of PTSD to be found in DSM III, the official diagnostic manual of the American Psychiatric Association. Intrusion refers to the unwanted invasion of one’s mind and body by memories of past traumatic events, Constriction refers to the strategies taken by the mind to stop this invasion, Hyperarousal refers to the state of constant alertness that is the legacy of having been involved in such events.)

WHAT TO DO ABOUT PTSD?

If you recognise several of the symptoms on the previous page in your own or some loved one’s behaviour, and are prepared to admit (or nearly admit) that you or they suffer from PTSD … what should you do?

There are difficulties here. Firstly, this is a problem that cannot be solved on one’s own. Very few PTSD sufferers have succeeded in pulling themselves up out of the shit with their own hair. At the very least one needs the support of a few close (and very tolerant and understanding) friends, the kind of friend who is prepared to listen when you ring him up at four in the morning to tell him that you feel like putting the muzzle of a gun in your mouth because it’s the anniversary of that battle in the hills outside Tuzla, or whatever. Such friends are invaluable, but scarce. Secondly, when it comes to asking for support and help, most PTSD sufferers feel that there is no point in even beginning to talk about these things to one who has not gone through the same experiences. In other words, the PTSD veteran can only open up to someone who has also been a soldier and experienced combat. That cuts out most psychologists.

PTSD after the Vietnam war

In the USA after the Vietnam war, the returning veterans were shocked and distressed to find that no one was interested in hearing about their problems. They were ostracised by society. Furthermore, no one knew about PTSD. It had been conveniently forgotten during the years since the second world war. Left to their own devices, some of them got together and with the help of a few enlightened psychologists formed their own "rap-groups". This proved to be the salvation of thousands upon thousands of men, who until then had been suffering alone, usually totally unaware that there were others who had exactly the same problem, and often driven to drugs and alcohol as the only means of deadening the pain. Not only these men, but also their wives, children and families were the victims of PTSD. It is not easy to live with someone who suffers from this syndrome. Today, the "rap-group", and group "self-therapy" in one form or another, is being used in the USA and all over the world as the best method of helping men and women who suffer from PTSD. You may not be able to pull yourself up out of the shit with your own hair, but several in the same position, working together, have a far better chance of getting the job done.

Forming a veteran's group

What is a ""rap-group"? It’s very simple. Several veterans get together and agree to meet at regular intervals, perhaps once a week or once a month, to talk about their experiences. Not the hero stories, the kind of stories they might tell in a bar, but the stories that they have probably never told to another human soul. The other side of the coin of war. Things that one cannot bear to think of, that one perhaps is ashamed of, that one often has difficulty in remembering (the brain is clever at repressing things which might cause too much pain). This story-telling should take place without beer or spirits on the table; the idea is to face one’s problems, not avoid them. One at a time each veteran tells his story to the others, perhaps several times, each time getting deeper, nearer to the core of the problem, to the traumatic heart of the pain. That kind of story-telling heals, not necessarily immediately, but with time. It works! Try it yourself.

How to form a group? Get in touch with other veterans. Talk to them. Show them the list of symptoms on the other side of this page. Ask them if they recognise themselves. Suggest that you meet regularly to talk about the war, and what happened. Decide to meet, either in each other’s homes, or, if this causes family problems etc, in some neutral location. Good luck!

COMBAT-RELATED PTSD IN SWEDEN

PTSD as a cause of war

War tends to repeat itself. The roots of present conflict can always be found in the past. Immediate economic, political and other reasons for war ride on a deeper swell of historical necessity, not so much rooted in the history books as in the minds of the people, in the memories of those who experienced and survived the previous war. To take one example: the current Yugoslavian conflict would probably never have been possible, at least in the vicious form it takes today, had the older generation been given a chance to properly process the horrors of 1940-’46. Ruthless political leaders have always understood that manipulation of this kind of earlier trauma in the national consciousness is the most potent means of mobilising a people for war. In the case of Yugoslavia, many of these leaders (eg. Mladic, Milosevic, Tuchman) are driven by their own particular traumas, caused by events experienced when they were children during the last war. In other words, the most effective conflict resolution takes place immediately upon the cessation of hostilities, not forty years later, when the next war is brewing. By then it will be too late.

The mind of the soldier

The psychic stress of war (PTSD: post-traumatic stress disorder) lives long after the fighting has ceased. In former Yugoslavia, attention has quite understandably been focussed on the plight of the millions of innocent, civilian victims, especially women and children. But what of the soldier? When peace comes, as it inevitably will in the end, thousands upon thousands of psychically disturbed men who have been fighting on each of the several sides in the Bosnian conflict will have to be re-absorbed into civilian life. The destructive potential of these men, both in regard to themselves, their families, and society at large, is out of all proportion to their numbers. Unless they receive help in dealing with their traumas they will become a highly inflammable element, undermining every attempt to rebuild the peace of mind of the community. In the long run, they will provide the seeds of new war in the Balkans.

Combat-related PTSD
- an underated threat to the stability of society -

So-called "combat-related PTSD" is a difficult subject to discuss. The military understandably avoid the issue if at all possible, since it is believed that recruiting figures might suffer. Even civilians working in peace and aid organisations do not find it easy to integrate their concern for the victims of war with caring for the soldier - the perpetrator. Yet if the problem of combat-related PTSD is not faced, it will cause great pain and distress, not only to the men themselves, but to their wives, families and friends - often for years on end. The greatest sufferers are the children of the PTSD-victim. Like the children of alcholics, they tend to bear the symptoms over into the next generation.

If not decisively dealt with at an early stage, combat-related PTSD can undermine society from within. As in the former Soviet Union, where psychically disturbed veterans from the war in Afghanistan do not only over-load an already highly strained medical and social system; they are also a major disruptive factor in the breakdown of law and order, feeding the crime syndicates with ruthless and experienced gunmen. Many are fighting in the minor wars that have sprung up on the periphery of the erstwhile Soviet empire during the last few years, some as mercenaries on the Serbian side in the Bosnian conflict. This wave of lawlessness has recently gone global. The Russian syndicates are now seriously challenging the power of the Maffia in the USA. Their unscrupulous and cold-blooded modus operandi has shocked experienced law officers. Ironically, the USA once more faces the consequences of combat-related PTSD, this time in organised form, and with its roots in Afghanistan rather than Vietnam. The same pattern can be noted in South Africa, where PTSD is rife, and where crime figures now exceed those in the USA. In peacetime, the ex-soldier with PTSD who does not receive help in dealing with his trauma will often continue to do what he is trained to do – kill.

Combat-related PTSD in Sweden

a) UN troops returning from Bosnia
Sweden has not been directly involved in war for over 170 years. Combat-related PTSD has therefore not been a relevant issue here until recently. However, every battalion returning from Bosnia brings many actual, and even more potential PTSD cases into the country (every sixth man is reported to have more or less severe psychic problems - Eriksson, 1995). This applies as much to non-combatant units, eg field hospital staff serving in places like Somalia. Although Swedint has tried to learn from the experience of other countries (USA after the Vietnam war, Britain after the Falklands), and has instituted a two day psychic de-briefing period on the return of units, there remains widespread ignorance, both in the military and among civilian doctors, regarding the long-term effects of the syndrome (delayed-action PTSD), and how these might best be treated. This general ignorance is particularly worrying since by the time symptoms become apparent, the men will have passed out of the jurisdiction of the military system and become the concern of the civilian, social and medical services, organisations with no experience of combat-related PTSD whatsoever.

b) Ex-soldiers among refugees from war-torn countries
A further source of combat-related PTSD in Sweden are the many refugees who have served in the armed forces of their respective countries, or in guerrilla armies fighting against repressive regimes. This applies to Kurds, Turks, Somalians, Eritreians etc. Many refugees from Bosnia have been front-line troops, experiencing almost continuous action for months on end in the mud and mountains of that messy war. Many have more or less severe symptoms of PTSD. They are served by the often under-staffed and insufficiently financed so-called "torture centres" for refugees in Sweden. These centres are not adequately named. Certainly, many of the patients that are dealt with are the victims of torture, but others are ex-soldiers suffering from PTSD, some of whom may themselves have administered the torture. The name "torture centre" is thus misleading. In a well-meaning attempt to avoid public protest (it is obviously politically easier to commit resources to projects involving civilian victims), the true nature of the problem has been swept under the mat. Furthermore, probably only relatively few of those refugee ex-soldiers with an actual or potential PTSD problem reach the little help that is available. Many more may develop symptoms later (delayed-action PTSD), after they have married and settled down, either in Sweden or in their home countries. They can pose a considerable social problem in the years to come. Whether these men decide to stay here or return home, their psychic needs must be met – now, rather than later, when they will be much harder to treat.

Combat-related PTSD
- a critical factor in securing peace -

Combat-related PTSD is a vital issue in every post-war society. This applies as much to the Libanon, Northern Ireland, and South Africa today, as it eventually will in Bosnia and Chechnya. The experience of South Africa, for example, now facing the task of balancing the demands of reconciliation with those of justice in the aftermath of 20 years of civil war, will be an invaluable guide for other, currently war-torn countries, when they find themselves in a similar position in the future. In South Africa, the underlying problem of PTSD contributes more than is generally realised to the difficulties faced by the present government.

In other words, the re-establishment of functioning, economic, political, and social systems in a post-war society may hang on the issue of PTSD. Bombed out cities, power-plants, roads, airports, telecommunications etc can be rebuilt in a matter of years. So also can economic and political structures. Rebuilding the psychic health of the nation is a far more challenging task, but without this base, the new structures cannot be made to work.

When the war in Bosnia draws to an end, it should be borne in mind that unless the problem of PTSD is courageously tackled from the outset, no amount of aid will lift the country from its present morass of criminality, political unrest, and social despair.

Peter Tucker 22/08/95