Post-Traumatic Stress Disorder
by Colonel (Retired) Wes Martin
(June 2012)

During and since Vietnam, American combat leaders developed a policy and personal commitment of never leaving a warrior on the battlefield. Living, wounded, or dead, every effort is made to physically bring our warriors home. Psychologically, we have not achieved that goal. Far from the bullets, explosions, and death, the victims of what is now being identified as Post-Traumatic Stress Disorder (PTSD) are still living the battles and suffering the results of their experiences. Rather than decreasing from Vietnam numbers, the PTSD casualties from America's Global War on Terrorism are escalating at an alarming rate. Also growing, is the concern that because PTSD is still not completely understood and not physically seen, its research and treatment may become a casualty of future budget cuts. The victims of PTSD are very real casualties of war and must never be left behind.

By one man's doing, today's American warriors have been engaged in combat operations longer than in any other period in history. From the very beginning, Secretary of Defense Donald Rumsfeld warned that the War on Terrorism would not be over quickly. No one suspected that his subsequent actions would make it a self-fulfilling prophecy. By his hand, the ten-year-in-the-making, classified Department of Defense plan for defeating and securing Iraq cut to two-fifths of the number of troops identified as needed. What should have been the primary, if not only, effort to go after Al Qaeda in Afghanistan received second billing. By spring of 2004, without enough troops on the ground to secure the country and its borders, Iraq spiraled out of control. Finally when Iraq began to settle down, Afghanistan flared. The expected single combat tour became multiple deployments. The mission for returning warriors was to reset themselves and their commands for another combat deployment.

Senior military leaders worked hard to provide as much time between deployments as possible, but as the war plodded on, the numbers just weren't there. The tension of the deployments, the hostile engagements, loss of teammates, physical and mental injuries, separations from families, memories of what was left behind, exhaustion from the never-ending hours, and adjustments of returning home have produced a significant number of long-term and permanent impacts on America's warriors.

Wounds resulting in loss of legs, arms, and other parts of the body are immediately identifiable. The unseen wounds are more difficult. It took a long time to realize the seriousness and extent of brain injuries resulting from explosions. Even more difficult to identify and address is traumatic stress. No physical exam or x-ray can detect it. It is not a simple problem with an easy one-cure-fits-all solution.

Coming out of combat, it is very common for a warrior to experience three phases: shear exhaustion, inability to focus and concentrate, can't remember "stuff" (CRS). Overlapping and mixed throughout are anxiety, frustration with oneself and others to the point of sudden or enduring anger, and a host of other reactions. To varying degrees, these reactions have the potential to affect all warriors, regardless of their rank. These feelings can further intensify when fellow warriors are killed or seriously wounded in combat. Within the survivors, the event itself can be over analyzed until it takes on a life of its own. Feelings of guilt or self-doubt can overcome the survivors and those unscathed. The guilt of surviving can consume the PTSD victim no matter how many successes were achieved. Simply put: "When you beat the enemy, you feel good about it. When he beats you, you live with it." Easing of this doesn't always pass quickly. Sometimes it takes years. Even today, as we look at some at our World War II, Korea, and Vietnam veterans, these feelings remain.

The military's difficulty in dealing with PTSD has not been through lack of trying, but rather a lack of understanding. In many cases, well-intentioned efforts have been counter-productive. Requiring all service members departing a combat zone to be cleared by a chaplain created its own problems. Most of these chaplains had never left the secure perimeter in anything but an armored vehicle. Warriors were not always interested in talking to chaplains and sometimes considered this requirement a violation of their freedom of religion rights. As the suicide rates climbed, commanders and leaders were required to provide anti-suicide briefings. Although well-intentioned, the leaders were not properly trained and tried to do the best they could with their existing knowledge and styles of leadership. Their all-too-frequent "tough love" presentations discouraged victims of PTSD from seeking professional help. With this came the sometimes all-too-real perception of what happens to a service-member identified as having psychological problems. Assignments, promotions, and careers can come to a sudden stop. Cast upon many PTSD victims for decades was the prescription of anti-psychotic and anti-depressant drugs. The drugs only masked problems suffered by PTSD victims and were successful only about five percent of the time. On the reverse side, these drugs sometimes caused veteran warriors to spiral further out of control.

Another lack of understanding resulted in commands automatically providing time off for warriors once they came home. This noble, but misguided, gesture had Active Component soldiers off duty for thirty days while Reserve and Guard warriors were not required to drill for three months. In combat, the strongest anchors for warriors are their chain of command and comrades. At the most critical time for decompression, these anchors were removed as the combat veterans were sent out to reintegrate with their families and a society. The families, who had not seen the warriors for months, and were going through stresses of their own, needed reintegration - not compression.

Adding to the pressure within the warriors is reintegration into civilian society. Reserve and Guard warriors experience it at the end of every tour. Active component members experience it upon discharge. Returning into a dysfunctional economy, the odds are very much against the combat veteran. Even for those returning to jobs, promotions and openings have been filled during the warrior's absence. While recognition for military experience and accomplishments may be expressed in appreciative comments, seldom does this recognition transfer into job competitiveness. Many government agencies responsible for handling veterans' issues move at the pace of a startled snail. In turn, savings are depleted while looking for jobs far below qualifications. Additional financial credit is often difficult at best. Loan companies do not consider what an applicant has done in the past, only the certainty of being able to repay the loan. The warrior is left wondering why the self-sacrifice for national security if this is the treatment upon return.

Since the beginning of the War on Terrorism, through the efforts of many, there is marked improvement. The value of professionally trained counseling teams to work with units and individuals when an attack resulted in a fallen comrade was identified. These teams are on the ground within twenty-four hours of the incident. As they should be, chaplains are an option, not a mandate. In the summer of 2011 the Veterans' Administration came to realize the negative impacts of anti-psychotic and anti-depressant drugs, and that procedure is being greatly curtailed. "Tough love" presentations are gone. Unit support is now better understood and being practiced. Training has become much more professional and involves families. Survey specialists now have discussions with the warriors over specified periods of time. Especially within the Army and the Marine Corps, analysis has been conducted to identify factors resulting in the high level of suicide, and work continues to catch the problems while still at the stage of depression. Yet, denial and concealment of a problem, lack of understanding PTSD, self-esteem, and the still-lingering concern of being identified as having psychological problems remain as major obstacles in warriors self-identifying themselves as needing help.

It has taken centuries to even identify what was causing after-effects on warriors. Diagnosis and treatment has advanced since Patton's personally administered prescription of just slapping it out of them. It is really difficult to believe his remedy had any long-term positive effects. Treatment elsewhere at the time wasn't much better. Impeded by an array of shortfalls, caring for the victims of PTSD still has a long way to go and the casualty count is still mounting. Caring for combat veterans suffering from Post-Traumatic Stress Disorder cannot be a casualty of upcoming budget reductions. Like physical wounds, psychological cuts don't heal unless properly attended. American warriors have earned the right to receive our nation's support in helping them overcome the negative impacts on their lives, especially when considering it is a result of their answering the call to duty.

©2021 Wes Martin