Combat Ptsd Quotes

As a civilian, I know nothing about combat, the Marine Corps experience or modern man's struggle adjusting to peace after war. I only know what's been shared with me; confidences I would never betray, nor use as details in a novel.

The brave men and women, who serve their country and as a result, live constantly with the war inside them, exist in a world of chaos. But the turmoil they experience isn’t who they are; the PTSD invades their minds and bodies.

Who supports the troops? The troops support the troops.

Combat and rape, the public and private forms of organized social violence, are primarily experiences of adolescent and early adult life. The United States Army enlists young men at seventeen; the average age of the Vietnam combat soldier was nineteen. In many other countries boys are conscripted for military service while barely in their teens. Similarly, the period of highest risk for rape is in late adolescence. Half of all victims are aged twenty or younger at the time they are raped; three-quarters are between the ages of thirteen and twenty-six. The period of greatest psychological vulnerability is also in reality the period of greatest traumatic exposure, for both young men and young women. Rape and combat might thus be considered complementary social rites of initiation into the coercive violence at the foundation of adult society. They are the paradigmatic forms of trauma for women and men.

Trauma destroys the fabric of time. In normal time you move from one moment to the next, sunrise to sunset, birth to death. After trauma, you may move in circles, find yourself being sucked backwards into an eddy or bouncing like a rubber ball from now to then to back again. ... In the traumatic universe the basic laws of matter are suspended: ceiling fans can be helicopters, car exhaust can be mustard gas.

The victims of PTSD often feel morally tainted by their experiences, unable to recover confidence in their own goodness, trapped in a sort of spiritual solitary confinement, looking back at the rest of the world from beyond the barrier of what happened. They find themselves unable to communicate their condition to those who remained at home, resenting civilians for their blind innocence. The Moral Injury, New York Times. Feb 17, 2015

People generally don’t suffer high rates of PTSD after natural disasters. Instead, people suffer from PTSD after moral atrocities. Soldiers who’ve endured the depraved world of combat experience their own symptoms. Trauma is an expulsive cataclysm of the soul. The Moral Injury, New York Times. Feb 17, 2015

War becomes a part of you. It is a feeling just as much as an experience. If you can’t feel it, you weren’t paying attention. And if you weren’t paying attention, you are probably dead anyway.

Post-Traumatic Stress Injury isn't a disease. It's a wound to the soul that never heals.

I feel no emotional connection to these outwardly human gestures. I am not there, because I never left Afghanistan.

They Served ...reliving memories that will not die giving their all for you and I - friends taken lives shaken...

I left a piece of my soul that will always rightfully belong in the desert.

Combat stress, PTSD, is debilitating and can lie dormant, and then erupt again at the most unfavorable of moments for the sufferer.

It has become clear that, as Janet observed one hundred years ago, dissociation lies at the heart of the traumatic stress disorders. Studies of survivors of disasters, terrorist attacks, and combat have demonstrated that people who enter a dissociative state at the time of the traumatic event are among most likely to develop long-lasting PTSD.

The science on the subject is pretty clear: according to the New England Journal of Medicine, rape is about four times more likely to result in diagnosable PTSD than combat. Think about that for a moment—being raped is four times more psychologically disturbing than going off to a war and being shot at and blown up. And because there are currently no enduring cultural narratives that allow women to look upon their survival as somehow heroic or honorable, the potential for enduring damage is even greater.

One group of people that get a lot of PTSD are soldiers who have been in combat. You know who gets more PTSD, has higher rates of PTSD? Women who have escaped prostitution. That tells me that the war that men wage against women is actually worse than the wars they wage against each other.

We don’t really want to know what soldiers go through in combat. We do not really want to know how many children are being molested and abused in our own society or how many couples—almost a third, as it turns out—engage in violence at some point during their relationship. We want to think of families as safe havens in a heartless world and of our own country as populated by enlightened, civilized people. We prefer to believe that cruelty occurs only in faraway places like Darfur or the Congo. It is hard enough for observers to bear witness to pain. Is it any wonder, then, that the traumatized individuals themselves cannot tolerate remembering it and that they often resort to using drugs, alcohol, or self-mutilation to block out their unbearable knowledge?

When we deployed, in our heads, the towel we left hanging next to the shower to dry, would still be hanging there when we got back. Well, it won’t be. If it is, some important questions need to be asked.

There are people who come home from war and want to talk about the pain, but no one wants to listen; there are others who want to keep silent and repress the memories, and all their family and friends want is to talk about it. I call this the war veteran reintegration paradox.

I was not descending in a plane, coming Home. I was watching an alien world as it ascended towards me - and one that I could never begin the process of readjusting to, because I knew that I would just as soon be returning to another world, whose normality was as alien to this home as I now was.

Peace surfaced here. Hard to imagine a person finding peace through war, but no one finds peace in war—peace finds you. It crawls into your sleeping bag and helps you fall asleep, nudges your arm, tells you to turn over, think about home.

You are no longer human, with all those depths and highs and nuances of emotion that define you as a person. There is no feeling any more, because to feel any emotion would also be to beckon the overwhelming blackness from you. My mind has now locked all this down. And without any control of this self-defence mechanism my subconscious has operated. I do not feel any more.

There are two things a combat deployment offers which all of us strongly desire. The first, being purpose. Every morning we woke up and knew why we were there. It is immediate and unavoidable. Although, it is extreme and unpleasant, there is a comfort in that purpose. The second, is simplicity. We have one goal. There are relatively simple rules on how to accomplish it, and we understand that just about everything will go wrong. Pretty simple.

According to Hoge and colleagues (2007), the key to reducing stigma is to present mental health care as a routine aspect of health care, similar to getting a check up or an X-ray. Soldiers need to understand that stress reactions-difficulty sleeping, reliving incidents in your mind, and emotional detachment-are common and expected after combat... The soldier should be told that wherever they go, they should remember that what they're feeling is "normal and it's nothing to be ashamed of.

I guess I was always looking for something. What it was, I didn’t know. I wanted help from the VA, but didn’t want to go back, didn’t want to be subjected to that second-rate treatment any longer. I wanted to find peace within myself, but didn’t know how or where to locate it. I wanted to be a sergeant again, a writer, less angry, a better husband, and to ward off the constant bombardment of war-related thoughts. Most of all, I didn’t want any more Americans coming home from Iraq in boxes or with jingle-jangled minds.

HYPERAROUSAL After a traumatic experience, the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment. Physiological arousal continues unabated. In this state of hyerarousal, which is the first cardinal symptom of post-traumatic stress disorder, the traumatized person startles easily, reacts irritably to small provocations, and sleeps poorly. Kardiner propsed that "the nucleus of the [traumatic] neurosis is physioneurosis."8 He believed that many of the symptoms observed in combat veterans of the First World War-startle reactions, hyperalertness, vigilance for the return of danger, nightmares, and psychosomatic complaints-could be understood as resulting from chronic arousal of the autonomic nervous system. He also interpreted the irritability and explosively aggressive behavior of traumatized men as disorganized fragments of a shattered "fight or flight" response to overwhelming danger.

Recently, a young Iraq veteran took issue with calling his combat anguish PTSD and, instead, poignantly referred to his pain and suffering as PTSI—the “I” designating “injury.” What he wisely discerned is that trauma is an injury, not a disorder like diabetes, which can be managed but not healed. In contrast, posttraumatic stress injury is an emotional wound, amenable to healing attention and transformation.

Maybe PTSD really is triggered by a single incident, a stressor, as it's known in the psychiatric community, and maybe the attack at Al-Waleed was that stressor for me, but as I have learned in the intervening years, I was not damaged by that moment alone. In fact, while there are specific memories that resurface with some frequency, like the suicide bomber in Sinjar or the order riot at Al-Waleed, I find myself most traumatized by the overall experience of being in a combat zone like Iraq, where you are always surrounded by war but rarely aware of when or how violence will arrive. Like so many of my fellow veterans, I understand now how that it is the daily adrenaline rush of a war without front lines or uniforms, rather than the infrequent bursts of bloody violence, that ultimately damages the modern warrior's mind.

Everyone acted like they knew so much about the war. But none of them really knew anything besides what they had learned through Internet searches or shady half-truths political pundits spouted from the comfort of their news desks. Nothing could ever be flushed out because nobody bothered to ask the troops or look at both sides of the story.

A blur? Hardly. She'd give anything for a blur.

How strange, thought Blanca, that she should only realize how miserable she was when threatened with happiness.

Many veterans feel guilty because they lived while others died. Some feel ashamed because they didn’t bring all their men home and wonder what they could have done differently to save them. When they get home they wonder if there’s something wrong with them because they find war repugnant but also thrilling. They hate it and miss it.Many of their self-judgments go to extremes. A comrade died because he stepped on an improvised explosive device and his commander feels unrelenting guilt because he didn’t go down a different street. Insurgents used women and children as shields, and soldiers and Marines feel a totalistic black stain on themselves because of an innocent child’s face, killed in the firefight. The self-condemnation can be crippling. The Moral Injury, New York Times. Feb 17, 2015

Since it morphed from “battle fatigue” or “shell shock” into a formal psychiatric illness, combat PTSD has been framed as a result of the sheer terror of being under attack, of someone trying to kill you and those around you. As we’ve seen, it is an illness where fear conditioning is overgeneralized and pathological, an amygdala grown large, hyperreactive, and convinced that you are never safe. But consider drone pilots—soldiers who sit in control rooms in the United States, directing drones on the other side of the planet. They are not in danger. Yet their rates of PTSD are just as high as those of soldiers actually “in” war. Why? Drone pilots do something horrifying and fascinating, a type of close-range, intimate killing like nothing in history, using imaging technology of extraordinary quality. A target is identified, and a drone might be positioned invisibly high in the sky over the person’s house for weeks, the drone operators always watching, waiting, say, for a gathering of targets in the house. You watch the target coming and going, eating dinner, taking a nap on his deck, playing with his kids. And then comes the command to fire, to release your Hellfire missile at supersonic speed.

For most of the twentieth century, it was the study of combat veterans that led to the development of a body of knowledge about traumatic disorders. Not until the women's liberation movement of the 1970s was it recognized that the most common post-traumatic disorders are not those of men in war but of women in civilian life. The real conditions of women's lives were hidden in the sphere of the personal, in private life. The cherished value of privacy created a powerful barrier to consciousness and rendered women's reality practically invisible. To speak about experiences in sexual or domestic life was to invite public humiliation, ridicule, and disbelief. Women were silenced by fear and shame, and the silence of women gave license to every form of sexual and domestic exploitation. Women did not have a name for the tyranny of private life. It was difficult to recognize that a well-established democracy in the public sphere could coexist with conditions of primitive autocracy or advanced dictatorship in the home.

In the aftermath of traumatic events, survivors doubt both others and themselves. Things are no longer what they seem. The combat veteran Tim O'Brien describes this pervasive sense of doubt: '... There is no clarity. Everything swirls. The old rules are no longer binding, the old truths no longer true. Right spills over into wrong. Order blends into chaos, love into hate, ugliness into beauty, law into anarchy, civility into savagery.' ...

We forget nothing really . . . the front-line days . . . are too grievous for us to be able to reflect on them at once. If we did, we should have been destroyed long ago . . . - terror . . . kills, if a man thinks about it.

There are two types of memory frequently experienced by individuals who have had overwhelming trauma that has been suppressed psychologically or chemically. The first is general memory, experienced as an adult, in which there is a natural recall of early events. The other is the memory that is often associated with post traumatic stress syndrome (PTSS). The person suddenly smells, sees and feels as though he or she is actually living the event that took place months or years earlier. Many soldiers who survived horrifying combat experiences have PTSS. This has frequently been discussed in terms of Vietnam veterans who suddenly mentally find themselves in the jungle, hiding from the enemy or assaulting people they see as a threat. The fact that they have not been in Vietnam for decades and that they are experiencing the flashbacks in shopping malls, at home or at work does not change what they are mentally reliving. But PTSS has existed for centuries and has affected men, women and children in the midst of all wars, horrifying natural disasters and other traumatic experiences. This includes physical and sexual abuse when growing up. the PTSS Cheryl was experiencing more and more frequently, in which she found herself seeing, feeling and re-experiencing events from her childhood and adolescence had become overwhelming. She knew she needed to get help.

Thoughts of suicide are common symptoms of combat PTSD. Paradoxically, they are also signs of life. If a person enters the zombielike state of indifference beyond despair, rage, suicidality, and fear, he or she simply dies. This is the testimony of concentration camp survivors and combat veterans. The ability to kill oneself is the bottom line of human freedom. Many combat veterans think daily of suicide. Knowledge that one has this freedom seems to be sustaining.

I am young, I am twenty years old; yet I know nothing of life but despair, death, fear, and fatuous superficiality cast over an abyss of sorrow. I see how peoples are set against one another, and in silence, unknowingly, foolishly, obediently, innocently slay one another. I see that the keenest brains of the world invent weapons and words to make it yet more refined and enduring. And all men of my age . . . throughout the whole world see these things; all my generation is experiencing these things with me. What would our fathers do if we suddenly stood up and came before them and proffered our account? What do they expect of us if a time ever comes when the war is over? Through the years our business has been killing; - it was our first calling in life. Our knowledge of life is limited to death. What will happen afterwards? And what shall come out of us?

Of course, the diagnosis of PTSD was only itself introduced into psychiatry in 1980. At first, it was seen as something rare, a condition that only affected a minority of soldiers who had been devastated by combat experiences. But soon the same kinds of symptoms—intrusive thoughts about the traumatic event, flashbacks, disrupted sleep, a sense of unreality, a heightened startle response, extreme anxiety—began to be described in rape survivors, victims of natural disaster and people who’d had or witnessed life-threatening accidents or injuries. Now the condition is believed to affect at least 7 percent of all Americans and most people are familiar with the idea that trauma can have profound and lasting effects. From the horrors of the 9/11 terrorist attacks to the aftermath of Hurricane Katrina, we recognize that catastrophic events can leave indelible marks on the mind.

What has Kantorek [their teacher] written to you?' Muller asks him [Kropp]. He laughs. 'We are the Iron Youth.' We all three smile bitterly . . . Yes, that's what they think, these hundred thousand Kantoreks! Iron Youth! Youth! We are none of us more than twenty years old. But young? Youth? That is long ago. We are old folk.

PTSD is curable when one realises how the unconscious mind works and that the symptoms of PTSD are actually the unconscious mind attempting to protect the person experiencing them. With the right therapies it is possible to take a person with extreme PTSD and help them to neutralise all their painful memories and emotions permanently.

And even if these scenes of our youth were given back to us we would hardly know what to do . . . it would be like gazing at the photograph of a dead comrade; those are his features, it is his face, and the days we spent together take on a mournful life in the memory; but the man itself it is not. We could never regain the old intimacy with those scenes.

Given the profound alienation of modern society, when combat vets say that they miss the war, they might be having an entirely healthy response to life back home. Iroquois warriors did not have to struggle with that sort of alienation because warfare and society existed in such close proximity that there was effectively no transition from one to the other.

A woman in combat? Yes. Since when? Since Native American warrior Buffalo Calf Road Woman knocked that prick General George Custer off of his horse. Since Pantea Arteshbod propelled herself to become one of the greatest Persian commanders during the reign of Cyrus the Great. Since Hua Mulan disguised herself as a male to engage in combat and became one of China’s most respected heroines.

We have become wild beasts. We do not fight, we defend ourselves against annihilation. It is not against men that we fling our bombs, what do we know of men in this moment when Death is hunting us down - now for the first time in three days we can see his face, now for the first time in three days we can oppose him . . . No longer do we lie helpless . . . we can destroy and kill, to save ourselves, to save ourselves and to be revenged.

There is clear evidence from internal investigations in the past that some raters actually see themselves as adversaries to veterans. If a claim can be minimized, then the government has saved money, regardless of the need of the veteran. Just recently, the press exposed an official e-mail from a high-level staff person who stated in essence that PTSD diagnosis was becoming too prevalent and offered ways to delay and deflect ratings in order to save the government money.

Our faces are neither paler nor more flushed than usual; they are not more tense nor more flabby - and yet they are changed. We feel that in our blood a contact has shot home. That is no figure of speech; it is fact. It is the front, the consciousness of the front, that makes this contact. The moment that the first shells whistle over and the air is rent with the explosions there is suddenly in our veins, in our hands, in our eyes a tense waiting, a watching, a heightening alertness, a strange sharpening of the senses. the body with one bound is in full readiness.

Much, much later. when I am back home and being treated for Post Traumatic Stress Disorder (PTSD). I will be enabled to see what was going on in my mind immediately after 11 August. I am still capable of operating mechanically as a soldier in these following days. But operating mechanically as a soldier is now all I am capable of. Martin says he is worried about me. He says I have the thousand-yard stare'. Of course, I cannot see this stare. But by now we both have more than an idea what it means. So, among all the soldiers here, this is nothing to be ashamed of. But as it really does just go with the territory we find ourselves in. it is just as equally not a badge of honour. Martin is seasoned enough to never even think this. but I know of young men back home, sitting in front of war films and war games, who idolise this condition as some kind of mark of a true warrior. But from where I sit, if indeed I do have this stare, this pathetically naive thinking is a crock of shit. Because only some pathetically naive soul who had never felt this nothingness would say something so fucking dumb. You are no longer human, with all those depths and highs and nuances of emotion that define you as a person. There is no feeling any more, because to feel any emotion would also be to beckon the overwhelming blackness from you. My mind has now locked all this down. And without any control of this self-defence mechanism my subconscious has operated. I do not feel any more. But when I close my eyes. I see the dead Taliban looking into this blackness. And I see the Afghan soldier's face staring into it, singing gently as he slips into another world. And I see Dave Hicks's face. shaking gently as he tries to stay awake in this one. With this, I lift myself up, sitting foetal and hugging my knees on my sleeping mat.

And that is why they let us down so badly. For us lads of eighteen they ought to have been mediators and guides to the world of maturity, the world of work, of duty, of culture, of progress - to the future. We often made fun of them and played jokes on them, but in our hearts we trusted them. The idea of authority, which they represented, was associated in our minds with a greater insight and a more humane wisdom. But the first death we saw shattered this belief. We had to recognize that our generation was more to be trusted than theirs. They surpassed us only in phrases and in cleverness. The first bombardment showed us our mistake, and under it the world as they had taught it to us broke in pieces.

Anthropologists like Kohrt, Hoffman, and Abramowitz have identified three factors that seem to crucially affect a combatant's transition back into civilian life. The United States seems to rank low on all three. First, cohesive and egalitarian tribal societies do a very good job at mitigating effects of trauma, but by their very nature, many modern societies are exactly the opposite: hierarchical and alienating. America's great wealth, although a blessing in many ways, has allowed for the growth of an individualistic society that suffers high rates of depression and anxiety. Both are correlated with chronic PTSD. Secondly, ex-combatants shouldn't be seen -or be encouraged to see themselves - as victims... Lifelong disability payments for a disorder like PTSD, which is both treatable and usually not chronic, risks turning veterans into a victim class that is entirely dependent on the government for their livelihood... Perhaps most important, veterans need to feel that they're just as necessary and productive back in society as they were on the battlefield... Recent studies of something called 'social resilience' have identified resource sharing and egalitarian wealth distribution as major components of a society's ability to recover from hardship. And societies that rank high on social resilience...provide soldiers with a significantly stronger buffer against PTSD than low-resilience societies. In fact, social resilience is an even better predictor of trauma recovery than the level of resilience of the person himself.

At the sound of the first droning of the shells we rush back, in one part of our being, a thousand years. By the animal instinct that is awakened in us we are led and protected. It is not conscious; it is far quicker, much more sure, less fallible, than consciousness. One cannot explain it. A man is walking along without thought or heed; - suddenly he throws himself down on the ground and a storm of fragments fly harmlessly over him; - yet he cannot remember either to have heard the shell coming or to have thought of flinging himself down. But had he not abandoned himself to the impulse he would now be a heap of mangled flesh. It is this other, this second sight in us, that has thrown us to the ground and saved us, without our knowledge how. If it were not so, there would not be one man alive . . .

From the moment when Pierre saw this horrible murder performed by people who did not want to do it, it was as if the spring that upheld everything and made it seem alive had been pulled from his soul, and it had all collapsed into a heap of meaningless trash. Though he did not account for it to himself, his faith in the world's good order, in humanity's and his own soul, and in God, was destroyed. Pierre had experienced this state before, but never with such force as now. Before, when doubts of this sort had come over Pierre, those doubts had had their source in his own guilt. And deep in his soul, Pierre had felt then that salvation from that despair and those doubts lay in himself. But now he felt that it was not his guilt that caused the world to collapse in front of his eyes and leave only meaningless ruins. He felt that to return to faith in life was not in his power. p. 968-969

Democratic process embodies the apparent contradiction of safe struggle. Combat veterans with unhealed PTSD have the greatest difficulty conceiving of any struggle apart from killing and dying. Passionate struggle conducted within rules of safety and fairness simply doesn't make sense to them or seems a hollow charade. For them it is psychologically impossible to win a struggle without killing or to lose without dying, and they do not want to do either. Many veterans' response is to withdraw and not participate. Democracy embodies safe struggle over the shape and implementation of a future. An unhealed combat veteran cannot think in terms of a future. Democratic political activity presupposes that the future exists and that it is meaningful. Combat taught the survivor of prolonged combat not to imagine a future or to want anything. Prior to seeing the point of one's voluntary participation in a social process, one must feel that it is safe to want something.

Of course, the diagnosis of PTSD was only itself introduced into psychiatry in 1980. At first, it was seen as something rare, a condition that only affected a minority of soldiers who had been devastated by combat experiences. But soon the same kinds of symptoms—intrusive thoughts about the traumatic event, flashbacks, disrupted sleep, a sense of unreality, a heightened startle response, extreme anxiety—began to be described in rape survivors, victims of natural disaster, and people who’d had or witnessed life-threatening accidents or injuries. Now the condition is believed to affect at least 7 percent of all Americans and most people are familiar with the idea that trauma can have profound and lasting effects. From the horrors of the 9/11 terrorist attacks to the aftermath of Hurricane Katrina, we recognize that catastrophic events can leave indelible marks on the mind. We know now—as my research and that of so many others has ultimately shown—that the impact is actually far greater on children than it is on adults.

And that is why they let us down so badly. For us lads of eighteen they ought to have been mediators and guides to the world of maturity, the world of work, of duty, of culture, of progress - to the future. We often made fun of them and played jokes on them, but in our hearts we trusted them. The idea of authority, which they represented, was associated in our minds with a greater insight and a more humane wisdom. But the first death we saw shattered this belief. We had to recognize that our generation was more to be trusted than theirs. They surpassed us only in phrases and in cleverness. The first bombardment showed us our mistake, and under it the world as they had taught it to us broke in pieces. While they continued to write and talk, we saw the wounded and dying. While they taught that duty to one's country is the greatest thing, we already knew that death-throes are stronger . . . We loved our country as much as they; we went courageously into every action; but also we distinguished the false from true, we had suddenly learned to see. And we saw that there was nothing of their world left. We were all at once terribly alone; and alone we must see it through.

My mother describes me as 'a real hero . . . just like your grandfather'. But I do not know what to do with this accolade for her son, other than let her have moment, or it helps her back here.

My family says they are proud of me. Of course, I would rather hear this than the contrary, but I cannot say that I am proud of myself, so I find that I cannot 'talk about it'.

Aside from clinically-diagnosed psychopaths, I have not met one person in war who thoroughly enjoyed killing. If someone ended up bragging over a kill, it was safe to assume that their story was mere fabrication or that they were one bad day away from an inpatient psychiatric ward. No matter how much someone may appear to deserve to be killed, something dies within us when we kill. It's contradictory, the antithesis of our species survival instinct.

Prozac had no effect at all on the combat veterans at the VA—their PTSD symptoms were unchanged.

When I began writing, I did not realize that the Holocaust would become a critical part of the story. During and after WWII, neither the survivors of the Holocaust nor the combat solders were diagnosed or treated for what is now known as PTSD (Post-traumatic Stress Disorder). Many of the characters in this book were victims of this now well-known disorder.

A man being shot is war, but a man being shot by a pardoned combatant is traumatic.

Restoring honor to the enemy is an essential step in recovery from combat PTSD. While other things are obviously needed as well, the veteran’s self-respect never fully recovers so long as he is unable to see the enemy as worthy. In the words of one of our patients, a war against subhuman vermin “has no honor.” This is true even in victory; in defeat, the dishonoring absence of human themis [shared values, a common sense of “what’s right”] linking enemy to enemy makes life unendurable.

Not surprisingly, people with PTSD commonly feel detached or estranged from others. People who have endured combat, rape, disaster work, and other forms of trauma often assume that they are now different and that no one could possibly relate to their experiences. They might feel that they can’t tell others about what happened or what they did for fear of judgment, and the secrets and fear of being shunned lead to their feeling disconnected from others. Because they no longer feel comfortable in social situations, they might avoid gatherings—or they might go but find no pleasure in them. Of course, to connect with others, people need to be emotionally open. This is difficult when one is still struggling to contain memories of the past.

In his recent guest editorial, Richard McNally voices skepticism about the National Vietnam Veteran’s Readjustment Study (NVVRS) data reporting that over one-half of those who served in the Vietnam War have posttraumatic stress disorder (PTSD) or subclinical PTSD. Dr McNally is particularly skeptical because only 15% of soldiers served in combat units (1). He writes, “the mystery behind the discrepancy in numbers of those with the disease and of those in combat remains unsolved today” (4, p 815). He talks about bizarre facts and implies many, if not most, cases of PTSD are malingered or iatrogenic. Dr McNally ignores the obvious reality that when people are deployed to a war zone, exposure to trauma is not limited to members of combat units (2,3). At the Operational Trauma and Stress Support Centre of the Canadian Forces in Ottawa, we have assessed over 100 Canadian soldiers, many of whom have never been in combat units, who have experienced a range of horrific traumas and threats in places like Rwanda, Somalia, Bosnia, and Afghanistan. We must inform Dr McNally that, in real world practice, even cooks and clerks are affected when faced with death, genocide, ethnic cleansing, bombs, landmines, snipers, and suicide bombers ... One theory suggests that there is a conscious decision on the part of some individuals to deny trauma and its impact. Another suggests that some individuals may use dissociation or repression to block from consciousness what is quite obvious to those who listen to real-life patients." Cameron, C., & Heber, A. (2006). Re: Troubles in Traumatology, and Debunking Myths about Trauma and Memory/Reply: Troubles in Traumatology and Debunking Myths about Trauma and Memory. Canadian journal of psychiatry, 51(6), 402.

Basically, PTSD is when you experience or witness some really fucked up stuff and it messes up your head. The traumatic event isn’t limited to combat, but it can also include things like natural disasters, physical abuse, or sexual trauma. The group of symptoms that come along with PTSD is pretty distinct. If you know someone who has PTSD, you will know exactly what I’m talking about. The person with PTSD is likely going to have some sort of re-experiencing of the traumatic event either in the form of flashbacks or dreams. They deserve to forget, but their douchebrain keeps going, “Nope! Time to live it all over again.” They are also likely to be on edge and hypervigilant. This means that they are always looking for signs of danger and startle a lot more easily than other people. Emotional symptoms are also common with PTSD. These are a little different from person to person. Some become very withdrawn and anti-social, while others explode outward in anger and rage. I fucking hate PTSD. If you did your time and had to live through something so terrible, your brain really should do you a solid and just let you move on. Sigh…

The military estate is the most honored. But what is war, what is needed for success in military affairs, what are the morals of military society? The aim of war is killing, the instruments of war are espionage, treason and the encouragement of it, the ruin of the inhabitants, robbing them or stealing to supply the army; deception and lying are called military stratagems; the morals of the military estate are absence of freedom, that is, discipline, idleness, ignorance, cruelty, depravity, and drunkenness. And in spite of that, it is the highest estate, respected by all . . . the one who has killed the most people gets the greatest reward . . . They come together . . . to kill each other, they slaughter and maim tens of thousands of men, and then they say prayers of thanksgiving for having slaughtered so many people . . . and proclaim victory, supposing that the more people slaughtered, the greater the merit. How does God look down and listen to them! . . . Ah, dear heart, lately it has become hard for me to live. I see that I've begun to understand too much. And it's not good for man to taste of the tree of the knowledge of good and evil . . . Well, it won't be for long!

Were Beecher’s observations relevant to people with PTSD? Mark Greenberg, Roger Pitman, Scott Orr, and I decided to ask eight Vietnam combat veterans if they would be willing to take a standard pain test while they watched scenes from a number of movies. The first clip we showed was from Oliver Stone’s graphically violent Platoon (1986), and while it ran we measured how long the veterans could keep their right hands in a bucket of ice water. We then repeated this process with a peaceful (and long-forgotten) movie clip. Seven of the eight veterans kept their hands in the painfully cold water 30 percent longer during Platoon. We then calculated that the amount of analgesia produced by watching fifteen minutes of a combat movie was equivalent to that produced by being injected with eight milligrams of morphine, about the same dose a person would receive in an emergency room for crushing chest pain. We concluded that Beecher’s speculation that “strong emotions can block pain” was the result of the release of morphinelike substances manufactured in the brain. This suggested that for many traumatized people, reexposure to stress might provide a similar relief from anxiety.17 It was an interesting experiment, but it did not fully explain why Julia kept going back to her violent pimp.

When a study published by the New England Journal of Medicine revealed that wounded Vietnam combat veterans suffered more from PTSD than victims of rape and muggings,69 it received little publicity.

Shame is an emotion that many rape survivors struggle with for reasons that can be more complicated than we might think. It is a distinctly insidious form of humiliation, the result of a serious injury to our self-esteem, which can be exacerbated by the feeling that we’ve done something wrong. Humiliation is par for the course when your body is used sexually against your will—that part of the aftermath of sexual violence is pretty well understood. Less well appreciated is why rape survivors may end up feeling responsible for what has happened to them. A common assumption is that women blame themselves because of low self-esteem: if only I had dressed differently, if only I had not looked at him that way, if only I had made better decisions for myself. While a woman’s self-image may play a role in how she comes to understand what has happened to her, the sense of responsibility held by many rape survivors is at least partly driven by a dominant worldview regarding personal safety and harm. Although this picture is slowly changing, historically, at least in the West, girls have been taught from a young age that the world is basically a safe place and that so long as you are sufficiently careful and intelligent, you can protect yourself from any serious harm. Underscoring this narrative is the fact that in our entertainment-saturated media culture, the everydayness of sexual violence against women is overlooked in favour of sensationalized stories of extreme violence. And because rape is typically experienced in private, unlike other traumatic experiences, like combat fighting in war, for instance, the clear evidence of its pervasiveness is obscured from our collective vision. This further reinforces the mistaken notion that the world is a benign place for women—and worse, it makes incidents of sexual violence against women look like a series of unrelated, isolated events when in fact they are the systematic consequence of patriarchal social structures. So how does the rape survivor reconcile this dominant worldview with what has happened to her? After all, it cannot be true both that the world is a safe place and that you were raped, unless, of course, the rape was your fault. The other alternative is to reject the dominant worldview, but this means accepting the fact that we live in a world where women, by virtue of being women, are at risk. For a variety of reasons, it can be easier and less painful to believe instead that being raped was a result of your own poor choices.

What happens when the sacrifice, or the sincere willingness to sacrifice does not "work"? This is a situation experienced by many combat veterans with PTSD. In an ethical universe run by a just, loving, and all-powerful God, the "person I was willing to die for" is not supposed to die. Incomprehensibly, he does die. Mortal soldiers discover that they differ from the immortals in this heartbreaking way: They cannot save, cannot protect, cannot resurrect the comrades they have come to value ore than themselves.

Interestingly, in the first solid scientific study using EMDR in combat veterans with PTSD, EMDR was expected to do so poorly that it was included as the control condition for comparison with biofeedback-assisted relaxation therapy. To the researchers’ surprise, twelve sessions of EMDR turned out to be the more effective treatment.

Killing seems to traumatize people regardless of the danger they’re in or the perceived righteousness of their cause. Pilots of unmanned drones, who watch their missiles kill human beings by remote camera, have been calculated to have the same PTSD rates as pilots who fly actual combat missions in war zones.

Since only 10 percent of our armed forces experience actual combat, the majority of vets claiming to suffer from PTSD seem to have been affected by something other than direct exposure to danger.

Secondly, ex-combatants shouldn’t be seen—or be encouraged to see themselves—as victims. One can be deeply traumatized, as firemen are by the deaths of both colleagues and civilians, without being viewed through the lens of victimhood. Lifelong disability payments for a disorder like PTSD, which is both treatable and usually not chronic, risks turning veterans into a victim class that is entirely dependent on the government for their livelihood. The United States is a wealthy country that may be able to afford this, but in human terms, the veterans can’t.

The biological aftereffects of sexual abuse that Putnam and Trickett have uncovered are even more startling, indicating that prolonged sexual abuse may lead to the same kind of disturbances in the physiological response to stress that have been found in combat veterans with posttraumatic stress disorder. The abused girls were found to chronically excrete higher levels of catecholamines—the chemicals epinephrine, norepinephrine, and dopamine released by the brain and adrenal gland in response to stress—than the nonabused girls. An excess of these chemicals in the body causes hyperarousal and has been found in Vietnam War veterans suffering from PTSD.

Could a child in the comfort of her own home experience anything as overwhelming as the terror and stress of a soldier in combat? In fact, children who are chronically physically or sexually abused must endure precisely the kind of protracted and inescapable fear, unpredictability, and helplessness that results in posttraumatic stress disorder. What makes an experience traumatic, says van der Kolk, is not its objective reality but the subjective meaning the victim attaches to it. In general, the more terrified a victim feels and the more powerless she is over her fate, the more likely she is to develop PTSD. Factors that may compound the sense of trauma include the relationship between victim and perpetrator, feelings of shame or guilt over actions the victim did or did not take, lack of support after the trauma or blaming or rejecting the victim, and any symbolic or psychosexual interpretation overlaid onto the experience. All of these are factors that come into play in childhood abuse. In some ways, an abused child faces terror and uncertainty far worse than anything a soldier experiences on the field of battle. She lives in a world of continual and unpredictable danger and may, with good reason, fear for her life. Yet she has no gun to protect her, no squad to back her up, no training for her combat role. She is completely alone, completely powerless, completely at the mercy of her parents' will. She cannot fight back, cannot escape. She is trapped. Like Pavlov's dogs, she endures a punishment inescapable. Her experience may actually be more akin to that of a prisoner of war, but it is even more psychologically pernicious than that. Her captors are her own parents, the people who are supposed to love and nurture her, teach her right from wrong, and protect her from harm.

What a returning soldier needs most when leaving war is not a mental health professional but a living community to whom his experience matters. There is usually such a community close at hand: his or her surviving comrades. Men and women returning from combat should "debrief" as units, not as isolated individuals. Unit rotation [in my understanding, the lack of it] is the most important measure for secondary prevention of combat PTSD.

They were said to be suffering from battle or combat fatigue, or being “flak happy,” a condition we now call Post Traumatic Stress Disorder. Most recovered from the stress when removed from combat. Some, however, carried it with them the rest of their lives.

Like the soldier overlong in combat, ptsd sets in because you feel as if you are constantly under attack. Unfortunately, internal attack is now added to external attack, and you become locked into hypervigilance and sympathetic nervous system arousal.

Culture often reserves the label “trauma” for events like combat because of the meanings we attach to those experiences. But the brain doesn’t distinguish between an explosion on the battlefield and rape and getting T-boned on your way to work and an avalanche. Culture validates trauma based on its source and we pass judgment on what matters and what doesn’t. But PTSD is an unconscious response and the brain is indiscriminate. It doesn’t care about the story of how it happened. No one’s PTSD is more valid than another’s. Trauma wears many masks, but to the brain and body it’s faceless.

The wives of men who suffer from PTSD tend to become depressed, and the children of depressed mothers are at risk of growing up insecure and anxious. Having been exposed to family violence as a child often makes it difficult to establish stable, trusting relationships as an adult. Trauma, by definition, is unbearable and intolerable. Most rape victims, combat soldiers, and children who have been molested become so upset when they think about what they experienced that they try to push it out of their minds, trying to act as if nothing happened, and move on. It takes tremendous energy to keep functioning while carrying the memory of terror, and the shame of utter weakness and vulnerability.

Someone just broke into your house and they are looking for you…you don’t have a phone to call the police. Do you A. Go toward them w/a weapon of sorts to combat or B. Hide w/weapon of sorts until they find you? I’m going straight toward them because the way my anxiety is set up, nobody puts baby in a corner! Sitting in a closet wouldn’t work for me. I’m shooting everything that moves.

He wrote me, “The science on the subject is pretty clear: according to the New England Journal of Medicine, rape is about four times more likely to result in diagnosable PTSD than combat.