A very interesting article about PTSD appeared in a recent edition of the American magazine Vanity Fair (http://www.vanityfair.com/news/2015/05/ptsd-war-home-sebastian-junger). The author, Sebastian Junger, is a journalist who spent time in Afghanistan writing an article about the leader of a militia fighting the Taliban. He obviously witnessed some gruesome scenes and was in a trench during an hour-long rocket attack. While he felt “deranged” for days after this, it was only after returning to the USA that things dramatically changed for him.

Here is how he describes it:

a few months later…I went into the subway at rush hour to catch the C train downtown. Suddenly I found myself backed up against a metal support column, absolutely convinced I was going to die. There were too many people on the platform, the trains were coming into the station too fast, the lights were too bright, the world was too loud. I couldn’t quite explain what was wrong, but I was far more scared than I’d ever been in Afghanistan.

I stood there with my back to the column until I couldn’t take it anymore, and then I sprinted for the exit and walked home. I had no idea that what I’d just experienced had anything to do with combat; I just thought I was going crazy. For the next several months I kept having panic attacks whenever I was in a small place with too many people…

Before going on there is are some important corrections and clarification that need to be made about Junger’s article. Firstly, the criteria for PTSD have changed and the term “Acute PTSD” is no longer valid. Secondly, Junger says that PTSD shouldn’t be called a disorder because it is a normal reaction to trauma. This is incorrect as the majority of people return to normal functioning within 30 days, whereas PTSD can only be diagnosed after 30 days. So in effect PTSD is identifying those who, for whatever reason (and there are many), have not been able to return to normal functioning after 30 days. So PTSD itself is not a natural response to danger, though the symptoms are. I would agree with Junger if he had said that Acute Stress Disorder should not be called a disorder, as this is the term for PTSD-type symptoms that occur 3 days to 30 days after a trauma. This then is the “normal” period of the typical symptoms and in the past the term Acute Stress Reaction has been used to identify this time period. I think this term is more appropriate and accurate.

Having (hopefully) clarified that, the article makes many vitally important and thought-provoking points:

  • Killing an enemy soldier, or witnessing a killing, is more distressing than being wounded oneself
  • Seeing a friend killed in action is the most distressing event
  • Rape victims experience far higher rates of PTSD, but a greater percentage recover quicker than soldiers with PTSD

[Comment: While not disagreeing, I’d like to see the evidence for this]

  • Frontline troops experience less PTSD than those in more rearward positions
  • Drone pilots have the same levels of PTSD as pilots who fly conventional combat missions

Now for the really interesting statement that I will return to in part 2 of this blog:

[Troops] return from wars that are safer than those their fathers and grandfathers fought, and yet far greater numbers of them wind up alienated and depressed. This is true even for people who didn’t experience combat. In other words, the problem doesn’t seem to be trauma on the battlefield so much as re-entry into society [emphasis added].

In order to be more accurate, I would definitely rephrase that last sentence to read: “In other words, the problem doesn’t seem to be only trauma on the battlefield, but also re-entry into society.”

See you next time.