PTSD in history, other cultures

[Steve Blair]

, though I think I recall LTC(R) Grossman saying something about SOF guys being sociopaths....but sociopaths in a good, sheepdog-like way.

I think that's because to a great extent SOF has taken the place of warrior societies in what could be considered the military tribal culture.

Grossman has some interesting points, but he gets too wrapped up in himself at times (and some of his social guilt ideas) and misses some important considerations. If you look at many of the Plains Indian cultures, most of them had a warrior society (or two...or three) that served to 'select' the more combat-prone (and capable) members of the tribe to serve as what might be considered full-time combatants. They were often the first (and last) line of defense for the community. But within that framework there were cleansing rituals and ways of dealing with the effects of combat that we really no longer have (at least in what could be considered a formal, ritualized sense). In a related note, I've also seen commentary that direct flights from the combat zone to "home" with no decompression period have greatly accelerated the impact of PTSD-type issues. Sometimes it's worth remembering that WW2 guys had to (for the most part) take ships home...and had time with their buddies to talk about what they'd seen and done (if they so chose).

Most elite units develop similar rituals over time. One thing I'd be interested in seeing is a comparison of PTSD rates between members of SOG and (say) a line battalion in the 9th ID during 1969. On a side note, I seem to recall reading in a couple of places that the PTSD/combat fatigue rate skyrocketed in Vietnam during the drawdown...as combat became rarer (it might have been in Shay's first book, although I know Kieth Nolan has addressed this in a couple of his books in a slight way).

I don't think PTSD is related to industrialized warfare...at least not directly. I might be more inclined to suspect that its recognition and possible increase is due more to industrialized societies losing touch with their earlier coping mechanisms...but that's just a suspicion.

[Sergeant T]

The saying I recall hearing is toughness in another term for training and training is another term for reducing the unknowns. The unknowns become the psychological outliers that generate trauma. There does seem to be a correlation between level of training and incidence of PTSD.

I'm particularly interested in at what point does "PTSD" change from being a normal reaction to sustained stress, and start being a genuine disease.

The DSM IV distinguishes between Acute Stress Disorder and Post Traumatic Stress Disorder, with the main difference being duration of symptoms. I think the thing to remember is that trauma is relative. For lack of a better analogy, stress is an emotional gas that will expand to fill the volume of its container. Training, experience, toughness, or whatever you want to call it will give you a larger “container”. Also, I can’t find the citation, but recall reading the estimate that 30 to 35% of soldiers experience acute or chronic PTSD. The rate among cops is somewhere north of 40%.

[Ken White]

In my observation, the quantity and quality of training do favorably affect the number of PTSD cases by driving that number down.

However, I've noticed that it is impossible to predict what event will send even the strongest will around the bend. I've seen people blow off mind numbing events and seen a crying child send an old experienced soldier into la-la land. No way to tell what will be the proverbial straw...

That 30-40% figure also tracks with my observation over the years. I believe that figure is telling. If about that percentage have Sociopathic tendencies (and I suggest they do), they're unlikely to get combat related PTSD; stands to reason that an approximately equal percentage have the reverse of Sociopathy and are therefor going to be highly prone to develop PTSD.

Psychological selection for combat suitability should be viable -- if not right now, then soon...

[Adam L]

The first thing I have to point out is that PTSD is what a lot of doctors would call a “trash can diagnosis.” It's a diagnosis that fits such a wide array of symptoms it is not particularly useful diagnostically. I've met several psychiatrists who see it as their professions “chronic prostatitis.” PTSD in and of itself is more of a grouping of symptoms and syndromes which are similar in root and form. It is an attempt to put a name on something that is so complicated and convoluted that it is all but impossible to identify and classify. (I'll be explaining this in a minute. ) Although I do believe it is a useful term, I believe that it is doing harm with so many not acknowledging the terms lack of utility. PTSD has always been around in one form or another. Although, I bet it was less common in certain culture due to culture, upbringing (different societies perceive different things as traumatic) and to an extent genetics. PTSD is very misunderstood.


Starting off, we have to remember that it is caused by a variety of different factors. These can best be broken down into the following groups: psychological and neurological (which for our discussion will include both physiological and chemical issues.) What makes understanding this so difficult, is that both of these react to each other. The neurochemistry greatly effects your psychological make up, while your psychological makeup can effect your neurochemistry.


When you begin to explore the psychological components, I really think the best way to begin to understand the behavior, is to analyze an animal rather than a human. Let's say you adopt a 3 year old dog from the pound. From the first day you bring him home you start to notice certain behaviors. When you take out the ironing board, the dog runs for a corner. The dog never wants to sit with you or for that matter anyone. Rather he prefers to be off to the side in a position where he can view all present parties. As stand-offish as this dog is, when ever you leave the dog becomes very agitated. I believe the causes of the dogs behavior are very obvious. Although it may seem odd to compare the recovery of a dog from years of abuse, I believe it is a very good parallel. The dog has learned certain responses to situations. These responses were often proper in a hostile environment, but now, in the safe environment, they are not appropriate. The rehabilitative treatment of the dog in many ways is not that different from the way we would treat humans. It all centers around breaking and/or changing learned responses. (marct – this is sort of what you are getting at.) (part of the reason we don't want to get into to much neurology, is that we don't know what in the ----- is going on. We have a few good ideas, but we really know so very little.)


Learned responses are both psychological and chemical in nature (I won't go into this, it will turn into a ten page paper on neuroanatomy and neurochemistry.) This makes them very difficult to change, if this can be done. High levels of training in many ways can be viewed as somewhat of an inoculation. We are controlling the creation of certain learned responses which are necessary for survival in a hostile environment. Hopefully these learned responses will be adequate and prevent inappropriate responses from being learned in combat. Also, it gives a soldier experience so when they encounter the real thing, they are not quite so out of their depth (Sorry for restating the obvious which has already been stated by other posters.) As Sergeant T pointed out, “The saying I remember hearing is toughness is another term for training and training is another term for reducing the unknowns. The unknowns become the psychological outliers that generate trauma. There does seem to be a correlation between level of training and incidence of PTSD.”


This deals with the more obvious PTSD symptoms. After this we start getting into the more complicated psychological (Ken's "la la land") and neurological roots (shell shock), which I'll try to post on later.



Adam L


Note: My knowledge and opinions do not come from any professional knowledge or experience. I have just spent a lot of time reading about this stuff. I know I am not using the proper terms at times, but this is for the sake of clarity and readability.

[AmericanPride]

The Army says suicides are highest in 20 years.
http://www.cnn.com/2008/US/05/29/army.suicides/

How does this compare to comparable conflicts?

[Ken White]

numbers can lead you astray. How many were in Theater; how many elsewhere in the world. How many in CONUS. Any combat tours? If so, how many? Where? What was the catalyst? Spousal problems? Money problems? Stress? Combat stress or other stress? How many male? How many Female?

IIRC, the current rate is still lower than the 19-25 non-military demographic in the US for males but higher for females. I also seem to recall reading somewhere that the in theater rate was lower than anyone expected and the majority were not in the two theaters.

Without detailed info, the raw number is borderline meaningless. The fact that it's the highest in 20 years is at least partly due to the fact that as a result of the surge the active duty end strength is higher than it has been in 20 years...

* That similarity is from memory (and I'm old, so it may be flaky). Not an issue to me but Google may be able to provide definitive numbers of a sort.