Menus Subscribe Search
bootsontheground

(PHOTO: SHUTTERSTOCK)

Coming Home Shell-Shocked

• December 10, 2012 • 4:00 AM

(PHOTO: SHUTTERSTOCK)

How do we treat post-traumatic stress disorder if we don’t first understand it?

Franklin D. Roosevelt, the president who led the United States into the depths of total war and back out again, has a little-visited memorial on the far side of the Tidal Basin in Washington, D.C. It’s private and reflective, like the man himself, and chiseled into the rough stone are these words, from a Chautauqua speech made three years before the German invasion of Poland: “I have seen war. I have seen war on land and sea. I have seen blood running from the wounded… I have seen the dead in the mud. I have seen cities destroyed… I have seen children starving. I have seen the agony of mothers and wives. I hate war.”

The awful cost and calculus of war never changes, of course, but in the 60 years between Operation Overlord and Operation Iraqi Freedom, our understanding of the human brain, on and off the battlefield, has marched far ahead. Post-traumatic stress disorder—what Roosevelt would have known as “shell shock”—is now both a clinical term and a household one. A traumatic brain injury is understood to be as dangerous a wound as the kind that bleeds. Psychologists like Brett Litz of Boston University even speak of “moral injury”—an act of transgression that violates a soldier’s ethical or religious code, and leaves its scar chiefly on the soul, rather than the body or the brain.

PTSD affects some 27 percent of soldiers returning home from Iraq and Afghanistan, according to the Congressional Research Service, while the suicide rate among male veterans is quadruple that of civilians. Those figures only include soldiers who sought help through VA hospitals, suggesting the actual numbers are higher.

For all the hand-wringing now going on at the top levels of the Pentagon, we understand relatively little of the neuroscience behind PTSD. Is it “combat exposure”—suffering and perpetrating the quotidian atrocities of war—that leads veterans to unravel once they’re back home? Or might some soldiers simply be predisposed to emotional distress?

That’s the question Dorthe Bertnsen, a Danish psychologist, and her colleagues raise in a novel study to be published in Psychological Science. Despite three decades of research, the authors note, there’s almost no baseline data on soldiers with PTSD, yet only by evaluating servicemen before they go into battle can we make sense of how they fare later.

The authors interviewed 366 Danish soldiers, male and female, at five points throughout their deployments to Afghanistan: before, during, and three times in the year after they came home. They then mapped the soldiers’ emotional trajectories, to see who came home damaged—and why.

Some interesting lessons emerged. Bertnsen identified three common paths: resilient soldiers, who showed low levels of PTSD symptoms throughout their deployments; afflicted soldiers, who showed low levels during deployment but increasingly began to suffer in the months after returning home; and, paradoxically, soldiers who appeared to actually benefit from being in combat, with high levels of PTSD symptoms before and after service, but not during.

Afflicted soldiers—those who enlisted healthy but came home distressed—were more likely to have had trauma in their personal lives, and to have received help for emotional problems, than their resilient peers. Many had witnessed family violence, been physically abused as children (burned, cut, bruised), or been assaulted by a partner. “Traumas involving interpersonal violence in childhood appeared especially central,” the authors report. “This finding adds to previous work showing the importance of childhood traumas as a risk factor for PTSD later in life.”

More surprising were the soldiers who “benefitted” from combat—those whose PTSD symptoms were temporarily abated while overseas but returned upon homecoming. This cohort, which accounted for 13 percent of the Danish soldiers, tended to be less well educated, with a high incidence of “pronounced emotional problems.” The servicemen apparently found the army’s camaraderie and esprit de corps a happy escape, however temporary, from the stressors of home life.

All of which muddies our understanding of PTSD—and refines it.

There is no single PTSD experience, the authors conclude, and any number of factors, not just combat exposure but childhood trauma and education level, influence how a veteran deals with the emotional aftershocks of war. “This does not defy a dose-response view of PTSD—that is, the view that the magnitude of the trauma predicts the severity of the symptoms—but suggests that such a view be considered in a more complex…perspective.”

With our troops home from Iraq and soon to leave Afghanistan, the “war on terror” is long over. The war on PTSD, however, has only just begun. It won’t be easily won.

Kevin Charles Redmon
Kevin Charles Redmon is a journalist and critic. He lives in Washington, D.C.

More From Kevin Charles Redmon

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

July 31 • 4:00 PM

Thank You for Your Service: How One Company Sues Soldiers Worldwide

With stores near military bases across the country, the retailer USA Discounters offers easy credit to service members. But when those loans go bad, the company uses the local courts near its Virginia headquarters to file suits by the thousands.


July 31 • 2:00 PM

A New York State of Fracking

Court cases. A governor’s moratorium. Pending health study. A quick guide to the state of fracking in New York.


July 31 • 11:17 AM

How California Could Power Itself Using Nothing but Renewables

We don’t need fossil fuels.


July 31 • 8:00 AM

Should Athletes Train Their Memories?

Sure, but it probably won’t help.


July 31 • 6:00 AM

Universal Basic Income: Something We Can All Agree on?

According to Almaz Zelleke, it’s not a crazy thought.


July 31 • 4:00 AM

Medical Dramas Produce Misinformed, Fatalistic Viewers

New research suggests TV doctor dramas leave viewers with skewed impressions of important health-related topics.


July 30 • 4:00 PM

Still the World’s Top Military Spender

Although declining in real terms, the United States’ military budget remains substantial and a huge drain on our public resources.



July 30 • 2:04 PM

The Rise of the Nuisance Flood

Minor floods are afflicting parts of Maryland nearly 10 times more often than was the case in the 1960s.


July 30 • 2:00 PM

The (Mostly Awful) Things You Learn After Investigating Unpaid Internships for a Year

Though the intern economy remains opaque, dialogue about the role of interns in the labor force—and protections they deserve—is beginning to take shape.


July 30 • 12:00 PM

Why Coffee Shortages Won’t Change the Price of Your Frappuccino

You’re so loyal to Starbucks—and the company knows it—that your daily serving of caffeine is already marked up beyond the reach of any fluctuations in supply.



July 30 • 10:00 AM

Having Difficult Conversations With Your Children

Why it’s necessary, and how to do it.


July 30 • 8:00 AM

How to Make a Convincing Sci-Fi Movie on a Tight Budget

Coherence is a good movie, and its initial shoot cost about the same amount of money as a used Prius.


July 30 • 6:00 AM

Are You Really as Happy as You Say You Are?

Researchers find a universal positivity bias in the way we talk, tweet, and write.


July 30 • 4:00 AM

The Declining Wage Gap for Gay Men

New research finds gay men in America are rapidly catching up with straight married men in terms of wages.


July 30 • 2:00 AM

LeBron James Migration: Big Chef Seeking Small Pond

The King’s return to Cleveland is a symbol for the dramatic shift in domestic as well as international migration.


July 29 • 4:00 PM

Are Children Seeking Refuge Turning More Americans Against Undocumented Immigrants?

A look at Pew Research Center survey data collected in February and July of this year.


July 29 • 2:00 PM

Under Water: The EPA’s Ongoing Struggle to Combat Pollution

Frustration and inaction color efforts to enforce the Clean Water Act.


July 29 • 12:40 PM

America’s Streams Are Awash With Pesticides Banned in Europe

You may have never heard of clothianidin, but it’s probably in your local river.


July 29 • 12:00 PM

Mining Your Genetic Data for Profit: The Dark Side of Biobanking

One woman’s personal story raises deep questions about the stark limits of current controls in a nascent industry at the very edge of the frontier of humans and technology.


July 29 • 11:23 AM

Where Should You Go to College?


July 29 • 10:29 AM

How Textbooks Have Changed the Face of War

War is more personal, less glorious, and more hellish in modern textbooks than in the past. But there’s still room for improvement.


July 29 • 10:00 AM

The Monolingual American: Why Are Those Outside of the U.S. Encouraging It?

If you are an American trying to learn German in a large German town or city, you will mostly hear English in return, even when you give sprechen your best shot.


July 29 • 8:00 AM

The Elusive Link Between Casinos and Crime

With a study of the impact of Philadelphia’s SugarHouse Casino, a heated debate gets fresh ammunition.


Follow us


Subscribe Now

The Rise of the Nuisance Flood

Minor floods are afflicting parts of Maryland nearly 10 times more often than was the case in the 1960s.

America’s Streams Are Awash With Pesticides Banned in Europe

You may have never heard of clothianidin, but it's probably in your local river.

How Textbooks Have Changed the Face of War

War is more personal, less glorious, and more hellish in modern textbooks than in the past. But there’s still room for improvement.

NASA Could Build Entire Spacecrafts in Space Using 3-D Printers

This year NASA will experiment with 3-D printing small objects in space. That could mark the beginning of a gravity-free manufacturing revolution.

The Big One

One in two full-time American fast-food workers' families are enrolled in public assistance programs, at a cost of $7 billion per year. July/August 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.