PTSD: Surviving the unimaginable

Quite a lot is written about Post Traumatic Stress Disorder, or PTSD as it is more commonly known. Like many other words that have become familiarly codified in our modern lexicon, it has lost much of its meaning due to the casual nature with which the term is slung about by this journalist or that in contemporary literature.

The mere mention of this four-letter acronym instantly, for many, conjures up the hazily malevolent image of a maladjusted, anti-social, ambiguously threatening individual who seems (so we have been socialized to believe) to be responsible for a range of anti-social acts in our culture.

The term is most often used nowadays in connection with aging Vietnam-era veterans who for too many years after America’s sudden disengagement from that unwinnable war were simply shunted off to the fringes of society and either forgotten entirely or were left to their own anguished devices to fend for themselves in an ostensibly peaceful urban American setting.

Today, however, some 43 years after America pulled out of Vietnam, the ravages of PTSD continue to haunt our society as veterans of the Iraqi and Afghanistani wars return home burdened by experiences that no human being has ever been fully emotionally prepared or equipped to undergo.

The Vietnam war is generally reckoned to have lasted about 20 years (1955-1975), although most of the escalated core of America’s direct involvement occurred from about 1963 through 1975. 20 years is a long time to maintain a war by most anyone’s standards in America, but today we have exceeded even that prolonged period with our involvement in the (equally) unwinnable war that is the Southwest Asian (Middle Eastern) campaign.

Each modern war from about the mid-1800s onward has introduced both new weaponized horrors and vastly refined iterations of old ones. The parallel development of medical treatment capabilities has somewhat ameliorated the tragedy of bodies being blown apart and grievously injured, but only on a technical, physical basis; the psychological devastation of modern warfare itself continues largely unabated.

The acronym ‘PTSD’ was first formally recognised as a treatable syndrome in the mid-1980s but PTSD has existed for centuries (perhaps even as far back as pre-historic times) under various other names. Among these have been combat fatigue, war neurosis, ‘nostalgia’, shell shock, ‘soldier’s heart’ and up until recent decades PTSD has often been misdiagnosed on the battlefield as cowardice.

PTSD is most commonly manifested through experiencing (or witnessing) a severely traumatic event and it is not exclusive to war alone, being often seen in individuals who have undergone violent accidents, natural disasters, terrorism, rape and/or personal assaults.

The symptoms of PTSD are commonly fear, stress and marked anxiety and PTSD patients frequently have disturbing dreams, flashbacks, recollections, nightmares, disturbing feelings and/or thoughts relating to the causative event. These symptoms are invariably intense, dynamic and can be disabling to the point of gross physical and mental dysfunction.

Patients with PTSD may develop a broad range of subtle anxieties, general agitation, hyper-alertness, suppressed anger, reactivity, irritation and recklessness (among many possibilities). Self-destructive behavior often results from repressed feelings of trauma and suicide is not uncommon among extreme cases.

The functional causes of PTSD in human beings are still largely unknown in a strictly biophysical context, but its is suspected that stress hormones (adrenalin and norepinephrine) that are released when the body is subjected to acute levels of stress may figure significantly in the development of the disorder. Not unironically, these hormones are an inherited relic of our past evolution as carnivorous mammals.

Individuals who suffer from PTSD continue to produce high levels of these hormones well after the causative trauma they experienced has occured; in particular the brain’s amygdala, its center for handling fear and emotion, remains highly reactive. If uncontrolled or untreated, actual biophysical changes in the brain’s cellular structure may result and the hippocampus (responsible for processing memory) may also be dangerously altered or affected.

There are a good number of excellent clinical and non-clinical studies of PTSD available (both in the literature and on-line) for those who wish to know more about the syndromic nuances of PTSD and its numerous manifestations, but suffice it to say that it is estimated that there are just under 8 million diagnosed cases of PTSD in America today.

Very recently I picked up a paperback book (‘One More Wakeup Revisited’) by Charles J. Sharps, PhD, a resident of Coos Bay, Oregon, who survived a year (1968-69) of intensive, savage combat in Vietnam. Sharps was a college student, who like myself found himself academically just short of the requirements for a continued academic deferment at the time when the President (Lyndon Johnson) revoked draft exemption for all but the highest achievers in school. Sharps had been in the ROTC at his university (BYU in Utah), hoping to graduate and enter the service as a commissioned officer.

In Sharps’ case, despite spending almost 5 years working on his undergraduate degree, and being only a few hours short of completing the requirements, he was ultimately faced with the prospect of either evading the draft (i.e. seeking refuge in Canada) or enlisting (in hopes of being granted his choice of military specialty) in the US military services. In that perplexing situation, his eventual choice was similar to my own: he enlisted in the US Army Airborne (173rd Airborne) where, because of his advanced academic stature, he was put through a special Non-Commissioned Officer (NCO) training program and fast-tracked to the rank of Staff Sergeant (E-5). These special NCO ranks were disparagingly referred to as ‘Shake’n’bakers’ by regular NCOs, since they were preternaturally advanced to Staff Sergeant, a rank normally acquired only after years of service. Upon completing that program, he was assigned to the 173rd Airborne and flown off to Vietnam.

Sharps has written several books about his experiences in which he details the horrific nature of what it was like to be at the very heart of all the savagery that was the war on the ground in Vietnam. He spent a year’s combat tour there, at the end of which he was returned to the USA.

One year may not seem like very long to most of us, but 365 days of exposure to the sorts of horrors he so articulately and graphically recounts is a lifetime in the practical comparison.

Charles Sharps was at various times a squad and platoon leader, fighting some of the most dangerous skirmishes experienced in Vietnam…unlike people like me, who never got more than thirty thousand feet close to most of it (e.g. as a US Air Force medical person, based in the US ZI or Zone of the Interior, who only participated in two brief TDYs or Temporary Duty assignments with my North Dakota based bomb wing.

In his book, Sharps often refers to what the ground troops scathingly referred to as REMFs (Rear Echelon Mother Fuc*ers) and in a certain sense I was myself one of those despised support troops, even though I was in a different service entirely and assigned to medical duties in a non-combat area. Of course, at that time we were fighting two wars simultaneously: one in Vietnam and one that was world-wide (i.e. the ‘Cold War’). Ours, the latter one, was so much ‘safer’ in day-to-day, practical terms than Sharps’ was that it almost shrinks entirely in comparison, although I have to acknowledge that the stakes we played for were far higher in the end, since had we ever gone to war armed with our mega-kiloton nuclear weapons, the world-wide Armageddon that ensued would probably been as unsurvivable as it is unimaginable.

Different kinds of hazards and dangers posed by each, to be sure, but his personal war (the ground war in Vietnam) had more immediate risks to one’s life that could be and usually were grave, if not fatal. My own, while equally horrific in theoretical contemplation, were far less likely to occur.

In his book, Sharps gives the ordinary individual, enmired in the press of deadly dull, day-to-day concerns of civilian life, a small taste of what it was like to live every second of your life waiting for a fatal bullet, shell, bomb or booby-trap that would come without warning…and to struggle to exist in that sort of environment for more than a year. Of course, it is entirely lost on his civilian readers, most of whom have never shared any of those deadly proximities he cites to a ghastly, imminent death. At most, Sharps book probably leaves a fleeting impact on these innocent souls, until the next vapid moment of their pedestrian existence sweeps over them, burying their sensitivities in a banal sea of social effluvia.

It is a shame, since as any survivor of brutal, deadly combat knows full well that true empathy with something as terrible as modern war is only fully attainable by others who have coequally shared that danger, who participated to the same extent and underwent the same ordeal by fire.

This is one of the reasons why so few memoirs are written by those who suffered through the most unspeakable terrors of direct, in-your-face combat. It’s simply futile. At most it helps the writer (the survivor) to partly expiate some of those demons that bring on the daily flashbacks, nightmares and recollections of impending death at every turn, since writing out one’s fears and demons on paper often helps considerably.

Far more war diaries and memoirs are written by more ordinary people like me, who never really got close to the most intense battles, hand-to-hand combat and actions. People who flew B-52 bombers over the Vietnamese jungles, separated by a distance of typically 30,000 feet or so from instant death and dismemberment. That isn’t to say that crews flying BUFFs (B-52s) over Vietnam were not in jeopardy of sudden death, since ground-to-air missiles (SA-2s, otherwise known as the S-75 Dvina in Russia) could rise from the jungle traveling at a speed of in excess of Mach-3 to take out an entire aircraft in an instantaneous fireball-tinged puff of black smoke: poof! But with appropriate electronic countermeasures and precautions, the chances were stacked in favor of the BUFFs.

At ground level, there was no such thing as the theoretical (whether purely psychological or not) margin of safety afforded by a 30,000 foot buffer zone of separation. Death could come from any direction at any second, usually with no warning at all. Sharps’ war was therefore several orders of magnitude more intense than anything we fly-guys ever faced.

On the ground, as Sharps documents in a number of gut-wrenching scenarios, seeing your buddy cut in half, his intestines blown out of his thorax, fatally dismembered, irreparably disfigured or being smacked in the face with his brains was a daily occurrence.

The impact of such experiences simply cannot be gauged by most of us, lacking as we do a meaningful context within which to visualize or comprehend such extreme violence as that is.

In Vietnam, as in all modern wars, the average foot soldier was a mere boy, taken from his farm or suburban environment where he had existed in the peaceful routines of civilian life until thrust into a crucible of death and dying that was totally beyond anything he could either anticipate or fathom.

That sort of dynamic is characteristic of the sort of experience that causes PTSD, whether in the violent combat of intense warfare or in the shock of a traumatic incident such as a domestic murder, natural disaster or equal measure of extreme social stress.

During warfare, contrary to what most non-combatants think (or imagine), soldiers do not fight for great causes, for national honor or for personal glory. That may well have been the case centuries ago, but since the advent of so-called ‘modern warfare’ (roughly reckoned to be from the late 1800s onwards), the true motivation for fighting has always been the intense bonds of loyalty and comaraderie developed between warriors who face combat together.

The close friendship that intense combat experience gives rise to has been described by psychologists and historians as some of the most intense human associations conceivable, closer even than in most marriages; for in combat you don’t survive unless each member of the team looks out for the others. Mutual survival is often predicated by utter mutual reliance in such settings. A combat squad or platoon is no place for individualists, accordingly, and once a soldier has proven himself to his mates he is uncritically accepted, warts, blemishes and faults, by the others with whom he fights. It is this sense of collective bonding…as the famous war story put it…being a ‘band of brothers’…that effective combat teams are formed from. And due to the trauma and highly emotional sense of loss (of comrades) resulting from the fighting one is engaged in, PTSD is often a common result.

During the First and Second World Wars, American military historians were drawn to the fact that German military units often fought with near-fanatical dedication, intensity and determination…far more so than equivalent American units. The question ‘why?’ prompted a study that revealed that whereas in the United States soldiers were drawn from the broadly scattered heterogeneous regions of the continental US, units in the German Army were drawn from small and highly regionalized, localised populations.

German soldiers often enlisted as a group of comrades from a particular village or town, hence there was more uniformity and commonality in their composition than in American units. In combat, they were already a team in both spirit and dedication. American units, comprised of (typically) soldiers from disparate parts of California, New York and Georgia (for example) that had no relationship with each other, took far longer to develop those same bonds of closeness and mutual regard that German units had from the onset. In this study, it was found that German soldiers fought not for their nation, but for their provincial unit comrades, since Germany has never had a strong sense of nationhood, given that the German states had remained independent of each other for centuries until relatively recently (Bismarck’s unification of the German states in 1871).

This sense of localised identity is still to be found in Germany today and occasionally puzzled onlookers will wonder why, whereas so many Americans are prone to grab and wave our flag at the least provocation, the Germans rarely celebrate their national unity in an equal manner or with equal enthusiasm. Instead, they rally around their regional loyalties (i.e. Hesse, Bavaria, Saxony, Saarland, etc.,) at sporting events such as the Olympics or the Soccer World Cup matches.

Due to the relatively large physical size of the United States and the strong overall sense of Federalism that prevails in our national sentiments here, modern Americans tend to identify less as being from a particular region as from simply being ‘an American’. The two national entities (Germany and the USA) are therefore quite different in terms of one’s understanding the dynamics of what makes them fight.

In modern America, we are dedicated to a greater set of so-called ‘American ideals’, rather than to any particular subset of regional sentiments and unfortunately, this superficial ‘Americanism’ often results in a lot of reactive flag waving that frequently gets us all in trouble (such as Vietnam and the Afghanistani actions). But that is all mere backstory here.

Although extreme violence is and has always been an inextricable part of the human psyche from the dawn of recorded history. In our cossetted modern world, we (Americans) have turned into a nation of civilians obsessively dedicated to material and financial ends, leaving the actual warfighting our leaders elect to regularly plunge us into to a distinctly separate and elite body of warriors. Due to our often misplaced and ill-understood sense of egalitarianism, we believe that the burden of fighting should (in theory, at least) be borne on a shared basis, that is by all citizens. Hence when we levy wars, we draft everyone on an equal (or so it is commonly, if inaccurately supposed) footing. ‘Soldier-citizens’ is the popular euphemism.

This is in marked contrast to many other notable armies throughout history, which consisted of professional warriors (mercenaries, or as they are known in the popular HBO series ‘Game of Thrones’, 'sell-swords').

Mercenaries, or professional warriors, solely exist to fight, whereas civilians, who have suddenly been given a rifle, have not been sufficiently prepared to absorb the extreme violence that warfare invariably imposes upon us. While both groups are susceptible to PTSD, the latter population are far more likely to suffer from it, as most American wars have proven over the past 100 years or so.

Consider further, if you will, that not everyone has the same capacity to absorb extreme shocks to their sensibilities. Every individual is different. While some may have grown up in rough, tough and violent areas (such as in active drug-gang neighborhoods), others may have led highly insular, considerably sheltered lives. Taking someone from the latter category and throw them into a rice paddy infested with an enemy fighting for their homeland and you are certain to end up with a disproportionate percentage of the whole fighting force who later develop severe psychological disturbances (e.g. PTSD).

I myself was one of those ‘sheltered’ individuals, more prone as a child to indulging in tranquil, highly creative pastimes and a total stranger to any form of violent interpersonal interactions; I didn’t even know how to defend myself in a fistfight. I well recall being sold the hopeful lie (by my mother) that if I treated the world with respect, politeness and gentility, the world would respond accordingly. Yeah…right!

When my own student deferment was yanked in mid-1966 (during my 3rd semester in college), I soon had a disturbing vision one night of myself lying face-up in a rice-paddy with a big fat bloody hole in my forehead. I knew that, as the popular joke has it, that mother had not raised her gentle, courteous and polite little boy to kill others in deadly combat. I also knew that were I ever to be drafted and put in an infantry rifle squad in Vietnam, I would suffer the same fate (rather quickly) as one of my childhood buddies, a Japanese-American boy named Terry Ogami (who died the first week he was in the fighting there). After considering a flight to sanctuary in Canada as a draft-evader (and carefully considering all of the possible adverse, long-term consequences), I took the lesser of two evils and enlisted in the US Air Force. Even after all these years, I still think I should have headed for Canada, a decision further reinforced by a number of friendships I have with Canadians today.

In contemporary America, we as a nation have become conditioned to allowing ourselves to be manipulated by that very materialistic capitalism that we fervently worship. That ‘materialistic capitalism’ now takes the form of immensely wealthy partisan commercial and corporate interests, which in turn enables and supports the highest levels of upper-class society that elect and control our choices for government office, since in today’s America one does not successfully attain public office without first expending millions of dollars.

Those financiers and wealthy enablers of our American system count on us ordinary citizens being rather unreflective, unperceptive and highly emotional (rather than highly rational) individuals who can generally be played like a musical instrument for the right set of promises and small rewards.

Concurrently, today, more than ever before, our military has turned into a processing vacuum that for a large part sweeps up the poor and uneducated, turning them into the cannon fodder we send overseas to fight our economically motivated wars. While providing them with promised jobs skills and even education (if they survive the combat meatgrinder), the enticement works more often than not, since the extreme emotionalism that underpins ignorance of higher awarenesses and understandings seems to work perpetually and without fail.

Thus, young men (and now women) are tragically sent overseas (again), brimming over with inflated (if misplaced) idealisms, aspirations and hormones, where they are repeatedly exposed to excesses that most human beings are neither biologically nor psychologically prepared to absorb and survive. PTSD is therefore almost a universal affliction, merely differing on a case-to-case basis by the degree of effect and the extent of the disabling consequences.

When they return home, they are again subject to being conveniently shunted out into the margins of civilian society, despite all the rah-rah rhetoric aimed at them by well-meaning church ladies (‘Thank you for your service’) and the half-hearted medical efforts made by the Veterans Administration (and others) to treat their more unignorable needs. It is a cyclical, cynical process and it never, ever changes (much).

The whole sad business is most effectively viewed from the stature of a much older (and hopefully wiser) person who has the experience of several wars and an education sufficient to understand what is being perpetrated here. Younger individuals might as well be blind and dumb to the process they have been sucked into of enabling (war), since only with age and experience does true wisdom and understanding have much of a chance to thrive.

I have many times in my life wondered at the utterly implacable irony of how it takes a lifetime to learn life’s hardest lessons, only to have that painfully-acquired learning and understanding be totally extinguished when we die (as we all must). Further proof, I suppose, that (as I have often joked) God is a woman with an extremely cruel sense of humor.

When I read through Sharps’ book ‘One More Wakeup Revisited’, I was struck by the impossibility of having lived through all that personal tragedy only to be expected to smoothly and effortlessly transition from violently killing an enemy (who should never have been such to begin with) to resuming the placid, bucolic life of a civilian (Sharps went on to acquire a PhD and become a professor, despite having to live with the ravages of PTSD to this day). Not many could do what he has done, to be sure. Most have ended up strung out by serial substance addictions and other personal tragedies that not infrequently end in death by suicide or anti-social acts of violence.

Sharps remarks, and it is certainly true, that being shot at and surviving is living life on its sharpest edge, such an intense and exhilarating experience that one feels more ‘alive’ than one could in any, ordinary manner. It is almost an addictive state in itself and one that with speed-of-light suddenness comes to an abrupt end when that survivor returns to an erstwhile ‘civilised’ social setting in which restraint, moderation and consideration are ascendant social expectations. Making that transition is sometimes impossible and not unusually some of those who fail to forsake that vivid state of feeling alive, commit acts of social violence (such as mass shootings, etc.), being emotionally and/or psychologically incapable of readjusting.

[This same difficulty of readjusting from a constant, savagely violent war-like state to a bucolic civilian one actually resulted, back in the immediate post-WW2 era, in the phenomenon of 'outlaw biker' motorcycle gangs, wherein former soldiers so missed the intense thrill of danger and death that they created their own substitute of civilian mayhem.]

The thrills of risk-taking have been studied to a fair extent by modern neuroscientists and it has been found that the heightened euphoria that brain chemicals such as adrenaline, endorphins, serotonin, oxytocin and dopamine stimulate not only enhance risk-taking tendencies but may wreak permanent changes in the brain’s chemistry. PTSD is often the long-term result of those changes.

The ‘thrill’ of surviving unspeakably horrible violence, the sort of imminent death and mayhem that modern combat commonly offers, affects some more than others, of course, and again individuals vary from one to another in their capacity to deal with it. Not all are capable of rising to that challenge. Sharps is one who has, but he still pays the price every single day of his life. For him (as for so many others) every time a helicopter flies overhead, every time a car backfires or a fireworks display erupts, there is a very real risk of insuppressible memories being released once again in a tsunami-like flood of devastating impact on his personal life.

Speaking for myself, I can only wonder about such a condition, since the closest I have ever come to a similar state of psychological disturbance is the occasional random anxiety I find myself having, as I second-guess my life and dredge up all the personal failings I suppose myself to have.

I do have nightmares occasionally about some of those uncomfortable moments, although calling them nightmares is probably exaggerating things considerably. It is more of a generalized anxiety that comes through in many of my own dream states and I rarely, if ever, have what I would call a pleasant or ‘happy’ dream. Certainly nothing at all on the order of those experienced by Charles Sharps.

To give you an example of my own ‘bad dreams’, I sometimes dream about an experience I had in Saudi Arabia when I was arbitrarily thrust into occupancy of a flat with two other ‘first-timer’ expats in Riyadh. My two flatmates, two medical technologists named Drex Agner and Rand Rounds (curious name), were from the LA area, while I was from San Francisco’s East Bay. There is a regional mutual dislike by residents of each for the other to begin with.

Rounds was a rather bulked-up young fellow, obviously someone who had frequented the gym, possessed of an equally bluff personality. Agner, in contrast, was an older and somewhat more reflective individual who affected a beard and had a slightly scholarly demeanor.

The first day we arrived in the Kingdom, we were taken in by a cohort of fellow expats to someone’s flat and offered home-brewed wine. My two flatmates gladly accepted this without any qualms at all, but I was considerably hesitant, given my knowledge of how forbidden alcohol supposedly was to the Islamic Saudis.

Not knowing the Saudi temperament as well then as I do now, I was afraid to accept this technically illegal brew and that quickly earned me a status in the eyes of the others (especially my new flatmates) as a somewhat woosy ‘timid soul’. It was only later, after I fully understood the hypocrisy that riddles Saudi Arabian society that I got over that hesitation and merrily fermented my own wine. I am, I have found, far more cautious and safety obsessed than most others I know.

Rounds in particular regarded me as somewhat less manly than he was due to this and went out of his way to make life as a flatmate difficult for me…a status that was only changed when I found a group of Australians that I moved in with shortly thereafter, who were as fine a set of mates as anyone could possibly hope for in a foreign land.

Still, to his day, I occasionally have unpleasant dreams full of anxieties over this period of my life that are now over three decades old. Other anxious dreams, dredging up other unpleasant experiences, also haunt me from time to time. As I said, I never have pleasant dreams. But real PTSD? Never!

That said, however, that’s as close to anything following the PTSD model that I’ve ever experienced and this despite having been on aircraft accident teams charged with responsibility for recovering the mangled, broken, burnt and unrecognizable remains of crash victims. I could bore you with stories about what it’s like dealing with those horrifically abused cadavers after an aircraft full of people (100s) violently impacts the earth at 600 miles an hour, but I’ll spare you the sordid details. Suffice it to say that while scenes of mangled human bodies and bloody carnage never seems to have phased me, being socially rejected and unfairly regarded as somehow less worthy as a peer by my fellows still grossly upsets me to this day. Go figure, eh?

I suppose if I were to be asked to mercifully summarise all the foregoing words, thereby sparing you all more needless cogitation, I’d have to say that PTSD is but a tiny fragment of the experiences that human beings have visited upon themselves by participation in events that exceed our personal physical and mental comfort zones. It could happen to you as easily as the next person and I hope that all of us realise that Post Traumatic Stress Disorder is increasingly a major and serious element of the often-bizarre circumstances life tosses at us.

This brief glimpse of mine into PTSD covers only the tiniest fraction of all those afflictions now listed in the DMS-5 (the current standard reference of psychiatric diseases and disturbances used by physicians to diagnose and treat mental disorders), but next time when you run into an account by a military veteran like Charles Sharps of the traumas of modern warfare, I hope you will consider that such expositions are extremely rare…and value them highly, accordingly.

Be well. As bad as modern warfare is, with all its ingenious methods of inflicting high-tech violence, death and misery upon humanity, you may as well get used to it. The Earth will only experience true peace when the very last human being is extinct!

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“The cruelest enemy of man is man himself!” -Johann Gottlieb Fichte (1762–1814)

“We have met the enemy and he is us!” –Pogo Possom (1955