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September 15, 2009

Moral Courage

There are many kinds of strength. Many kinds of courage. The physical kind is just one, and not the greatest kind:

Post Traumatic Stress Disorder (PTSD) is the normal reaction to the most abnormal situation that is combat. When Jeremiah came upon his dead comrades in Fallujah, he describes a switch flipping on and then just taking care of business. Going back into that house time and time again because his fellow Marines were in trouble and the bastards who hurt them needed to pay. But when he got back home he couldn't just flip a switch and become normal again. He couldn't make his head shut up, or get to sleep, or stop thinking about the buddies he lost.He couldn't act like everything was normal, because it sure wasn't. So he did what many do, he drank too much, he self-medicated and he took it out on everyone around him. He went on an epic bender that all too often ends at the morgue.

But it didn't and so we get to redemption. The single most difficult thing for a warrior to do is admit weakness. But the only way to get any help is to accept the truth and ask for it. When Jeremiah looked around at the wreckage he had made of his life, he did just that. His will to live was stronger than his pride and he started talking to a therapist and letting the professionals help. Even more difficult was facing his friends and fellow warriors and telling them that he had PTSD. I met him not long after he had begun doing just that and was speaking in public about both Fallujah and what happened after he came back. It has been cathartic for him to do that, but he also knows that there are plenty of others out there fighting their wars over and over in their heads and that his example may spur them to seek help.

Brave man.

Posted by Cassandra at September 15, 2009 03:00 PM

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If it's "the normal reaction to the most abnormal situation that is combat", why do we call it Post Traumatic Stress Disorder?

Can't wait to read the book.

Posted by: Sly's Wardrobe Mistress at September 15, 2009 03:16 PM

In psychobabble, everything is a disorder.

That's part of the stigma...

Posted by: BillT at September 15, 2009 03:53 PM

BillT: Probably also because it is a 'disorder' compared to the 'standard' mindset, whatever the standard mindset happens to mean. Personally, I prefer the older term 'shell shock', but it does not describe PTSD in a non-battlefield situation. Although I guess arguably a massive shootout between the SWAT and some drugrunners might qualify as a 'battlefield', it does have uneasy connotations for me.

Posted by: Gregory at September 15, 2009 11:03 PM

Conventional wisdom has it that acknowledging that a problem exists is the first step towards conquering it. Makes sense to me; I only wish that more folks had the courage required to acknowledge that a problem does indeed exist...

Posted by: camojack at September 16, 2009 01:14 AM

I killed quite a few towelheads and I sleep fine!

Posted by: adolph at September 16, 2009 08:42 AM

I think Greg nailed it. The adaptations that allow soldiers and Marines to withstand the rigors of combat make sense in that environment and are desireable.

It's when they return to an environment where their lives are not constantly threatened that this heightened vigilance is maladaptive. The body and mind are always on alert but there's a mismatch between the mental/physical state and their current environment. It's a 'disorder' only in the sense that back here, that heightened awareness can actually get in the way.

I always think of it as analogous to building up thick callouses that you don't need if you're not currently working with your hands. If people could see PTSD as a normal and desirable survival response that helps them survive in wartime but is less suited for peacetime, there wouldn't be as much stigma attached to it. But what do I know? :)

Posted by: Cassandra at September 16, 2009 09:13 AM

Just ordered the book on my Kindle.

Posted by: Carrie at September 16, 2009 10:05 AM

This topic came up during one of the panels at the MilBlogging Conference. I agree with the guy (was it Kevin...?) that said it's not really a 'disorder'. I don't think that the stigma can be completely erased but if we start looking at it from a different perspective, maybe that will help. I don't see it as a disorder - more like a natural reaction to an unnatural situation.

Posted by: Sly's Wardrobe Mistress at September 16, 2009 01:15 PM

No disrespect, Sly's WM, but how about we think of it as a natural reaction to a natural situation? I'd like to believe that we, in this country, have forgotten what has been a given for most of human history: that political correctness, politeness and nannification have prevented us from recognizing the thin veneer of civilization we've accepted as our natural state. If you'd set me down in NOLA, right after Katrina, I'd hope that my training from years ago would've come back quickly and I'd've been able to defend my family to whatever extent was necessary, rules of polite society be damned.
My father was born in 1900, and at age 17 joined the Army, served 5 years there, and spent another 7 years in the Corps. He tried to join again in '42 but was considered too old. I'm sure he believed at that time that his WWI-era training would've stood him in good stead, and I guess that as a Jarhead he'd've still fit in, even today.
Not to say that it isn't hard to get back to the world and deal with a different set of realities in one's everyday life, and maybe some, such as Rick Rescola, are able to maintain that balance between getting along in New York City business life and remaining sharp enough to deal with the WTC disaster.
I got out in '69 and finally went to the VA in '70. BTW, anybody who complains about today's VA hasn't had the joy of dealing with the SanFran VA Hospital circa 1970. It may not be perfect now, but the strides made have been tremendous. Anyway, I went and talked to a VA shrink for about 10 minutes. He ended up awarding me a 10% rating to go with the 10% they seemed to be handing out with every Purple Heart, but to this day I have no idea if I was/am/will forever be suffering from PTSD.
Whatever the case, with our guys now, I hope that they find a way to make peace with themselves, their comrades and families.
My thanks to all who're now serving or have served, including their families.

Rob J 11B AlphaCo,4th/47th,9thInfDiv. USArmy Mobile Riverine Force RVN '68

Posted by: Inbred Redneck at September 16, 2009 10:12 PM

This may or may not be related, but I am reminded of optical illusions, which is the basically the mind making shit up when presented with contradictory inputs. Or like afterimages, or tinnitus, where the mind is really just screwing with you.

I am also reminded of total sensory deprivation experiments, when the mind starts to just generate spontaneous hallucinations because it was expecting inputs but none were coming in.

Maybe PTSD is similar - when you hear a loud bang, your mind is conditioned to think 'Explosion' rather than 'truck backfire'. Very handy in Baghdad, not so nice in Juneau. And in the utter lack of any such stimuli, your mind starts making it up.

Maybe a potential step that could be taken would be to gradually ramp the mind's expectations down, like they did with divers in the past. Go back up too fast, you get the bends and die. Spread it out over a few hours, you'll be fine.

Posted by: Gregory at September 16, 2009 11:47 PM

- when you hear a loud bang, your mind is conditioned to think 'Explosion' rather than 'truck backfire'.

It's a tad more like "dangerous *now*" vs. "*not* dangerous now" -- these days, the explosions don't make me cringe unless they're right on the other side of one of the blast walls...

Posted by: BillT at September 17, 2009 01:03 AM