In the New Yorker, David J. Morris looks at the psychological chameleon we call PTSD:
As it is understood today, post-traumatic stress disorder is a grab bag of symptoms that emerges after experiencing trauma, like nearly dying or having one’s bodily integrity violated. It includes a persistent sense of hypervigilance and recurrent, intrusive memories of past traumatic events. In the worst cases, veterans with P.T.S.D. may hallucinate the voices of dead comrades, enemy combatants, or their commanding officers. A 1995 study of combat veterans with P.T.S.D. published in Traumatology found that sixty-five per cent of subjects reported hearing voices, including command hallucinations that they felt compelled to obey. As the psychiatrist Jonathan Shay, the author of Achilles in Vietnam: Combat Trauma and the Undoing of Character, put it, “P.T.S.D. can unfortunately mimic virtually any condition in psychiatry.”
But there are a growing number of psychiatrists and researchers who are challenging our understanding of P.T.S.D. — even its very nature as an ailment. Modern psychiatry, they argue, is locked into a mindset that systematically overdiagnoses P.T.S.D. without nurturing veterans’ ability to heal themselves. American culture, meanwhile, vacillates between elevated ideas of hero worship and victimhood in its conception of veterans, which can be destructive to the veterans themselves. One of the chief proponents of this school of thought is Ben Shephard, a leading British historian of military psychiatry. In his provocative book, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century, he describes a historical cycle that governs the treatment of war stress: “the problem is at first denied, then exaggerated, then understood, and finally, forgotten.” Shephard claims that the West, and America in particular, are deeply mired in the exaggeration phase of that cycle. These skeptics of the prevailing model of P.T.S.D. were described in Scientific American as a “broad array of experts indeed, giants of psychology, psychiatry and epidemiology.” One of the major tenets of this argument is a fact that, on its face, suggests that P.T.S.D. is a culturally determined phenomenon as well as a medical one: American veterans are 2.5 to four times more likely to be diagnosed with P.T.S.D. than British veterans.
As Jonathan Shay, the author of Achilles in Vietnam, shows in his follow-up, Odysseus in America: Combat Trauma and the Trials of Homecoming, while the problem of returning from war is one of humanity’s oldest struggles, the use of P.T.S.D. to frame a wide variety of traumatic experiences is a relatively recent development. The growing criticism of our current understanding of P.T.S.D. suggests that what was once ignored or treated as a failure of character — the soldier’s weakness — has now been medicalized to the exclusion of discussing its moral and spiritual dimensions. “It feels to me as if the U.S. civilian population has pathologized the veteran experience,” Elliott Woods, an Iraq veteran-turned-reporter, told me not long ago. “One well-intentioned person said to me the other day, ‘I can’t see how anyone could go to Iraq and not come back with P.T.S.D.’
H/T to Tim Harford for the link.