Mike Muller is on the Advisory Board for Thuy Smith International Outreach. He is a Vietnam Veteran and has been a Psychologist counseling veterans for many years.  He writes novels under the pen name of Michael FitzGordon.

It seems that people want simple, black and white categories.  Take alcoholism, for example.  People say that it is a disease, a mental illness.  I mean, it must be, right?  It’s listed in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (the DSM) as alcohol dependence and alcohol abuse with all sorts of descriptors and qualifications for each person’s individual situation.  Yet if you kill another person while driving drunk, you can’t tell the jury it wasn’t your fault, because it was your mental illness that made you do it.  No jury will buy that.  What they will believe is that you acted irresponsibly and it resulted in the death of another human being.  So, is alcoholism a disease, or isn’t it?  In some ways it is, and some ways it isn’t.  But you have to be careful when talking about this, because people tend to become quite irrational and even to rage about whatever their pet opinion is in this regard.  At times it is difficult to have a rational discussion on the topic.

Thuy asked me to blog about the stigma of having PTSD, and that’s why I’m discussing the tendency of people to put things into black-and-white categories.  Is alcoholism a mental illness, or isn’t it?  Is PTSD a mental illness?  I’m glad that there is a DSM, because it provides a place where certain common patterns of behavior can be described in detail and given a name.  Thus, we can say that someone has alcoholism or PTSD.  But once such a pattern is described and named as a mental illness, it also acquires a stigma, rightly or wrongly, in our society.

Over the years I worked with veterans who had PTSD, I don’t think that I personally viewed them negatively.  On the contrary, I respected them for what they had endured and saw them as strong.  I actually did not like the fact that PTSD was classified as a “mental illness.”  I was glad that it was described as a pattern of behavior so that it could be recognized, and so that veterans who were having a difficult time fitting into society could receive some financial support.  But clearly, just saying that mental illness consists in not fitting into society is an inadequate definition.  So just what is mental illness?  In truth it is not something that is easy to define.  No matter how many times one asserts that something is scientific, the fact is that the definition of mental illness is a social and moral judgment which is far from scientific.

In combat, soldiers tend to distance themselves psychologically from the enemy by dehumanizing them, and they often have a variety of insulting, dehumanizing names for the enemy.  Thus it is less distressing  to kill “those” people.  People tend to have this same distancing in regard to mental illness.  They think about “those” people who have mental illness.  It frightens them to think that their own thoughts and feelings might be questionable if exposed to a closer examination.  It’s a distancing defense, much like blaming the victims of rape as if they somehow caused the rape by wearing the wrong clothes or being with the wrong people.  Then you can rationalize that you don’t do those things, and therefore don’t have to worry about being raped.  You have distanced yourself from “those” people who get raped.  So-called “normal” people most often have a strong motivation of unrecognized fear that causes them to distance themselves from “those” people who have mental illness.

So, is PTSD a mental illness?  I don’t think so.  I think it’s a normal reaction to certain kinds of situations.  However, after having had this reaction, you are no longer like most of the people in society, and no longer “fit into” society comfortably.  You may not be able to fit in well enough to hold a job.  You’re too big, or too small, for the roller coaster that everyone else rides on.  So in the sense of “not fitting in,” I guess you could say it was a mental illness.  So having PTSD described and listed in the DSM is something that society needs, but at the same time it creates a stigma, and many people will want to distance themselves from people with PTSD.

My clients used to tell me about friends who were jealous of their disability benefits.  I would tell them to tell their friends that they were welcome to the benefits, but they would have to take the disability too!  I myself met a psychologist whose job it was to counsel veterans, and he was jealous of their disability benefits!  I was incredulous!  I wanted to tell him to wake up, but I didn’t.  I can say from much experience, both as a counselor to veterans with PTSD, and as a veteran with PTSD myself, that most veterans who receive disability benefits are grateful for them, yet they surely wish they could fit back into society the way they did before they were traumatized, and did not need the benefits!

From my point of view, I am compromised by the secondary effects of my PTSD.  That is, I am lonely and isolated because of my PTSD.  Yet I do not want to let go of the PTSD itself!  I don’t want to be less vigilant.  I don’t want to pretend that human beings are not capable of vicious acts.  I don’t want to pretend not to see the folly of our society and its incessant seeking after war and violence.  I don’t feel like I’m mentally ill.  I feel like society is.

Personally, I like people with PTSD.  I think they are awake.  Sure, there are some who, because of the secondary effects of isolation, “not fitting in,” and being misunderstood become depressed or angry or alcoholic, but that is not really the PTSD itself.  It is the reaction to being such a misfit in a society that does not see reality.  So, what is the answer to the question of whether there is a stigma to PTSD?  My answer is this:  there shouldn’t  be any stigma, because there is nothing wrong with people who have PTSD.  However, there is definitely a stigma attached.  People need to distance themselves from this, and need to believe that it could never happen to them.  They have stereotypes about veterans with PTSD being violent, wild, and unpredictable.

My ideal program of treatment for people with PTSD would consist in educating them about the ways in which they have become different from the society around them, and helping them to find ways to communicate with and cope with society in constructive and meaningful ways, all the while striving to be patient with a society that simply doesn’t get it.  For example, some programs seek to desensitize veterans to the sounds of gunfire.  That, not PTSD, is crazy.  I would hope that all those who wish to survive would be highly sensitized to the sounds of gunfire and armed conflict.  So many treatment programs seem to resolve into that attitude of trying to pretend that there is nothing bad to worry about.  That is crazy, not PTSD.

Intellectuals have been arguing for hundreds of years about what constitutes “mental illness.”  But in conventional society it is whatever syndromes are listed as such in the DSM.  Most people don’t think beyond that.  So, because of the stigma, one has to decide for oneself when one does and does not want to reveal that one has PTSD.

Mike’s Related Posts:

Mike Muller- MACV CORDS operations advisor, Binh Chanh District, 1970.  Briefing officer for DEPCORDS Ambassador Funkhouser to CG & staff, III Corps Vietnam, 1971.  In addition to briefing the staff I briefed visiting officials such as the Secretary of the Army.  I was in Vietnam for one tour.

Disclaimer: If you are needing more extensive assistance or counseling, we can supply you with a list of available agencies to assist you. No blogs are ever meant to substitute a person seeking help through professional counseling.

2 thoughts on “The Stigma of PTSD

  1. I like your article. It is true of so many labels. I know some “heavy drinkers”. Are they alcoholics? I guess the accepted rule is someone can be considered something in a category if it adversely affects the quality of their lives to a large degree. Personally I believe I had PTSD after being with my brother during his lfew months and last couple of days of life. It not only adversely affected my life for about 3 years, but continues to haunt me in so many ways. For a while, it drove some of my decisions (or inability to make decisions is probably more accurate). It definitely had a negative impact on my mental state of being and although I suppose death does that to people, I felt it went beyond that…maybe because he was so important to me and represented so much more than a brother.
    Who cares about labels? I agree that it’s great there is a manual (DSM – soon to be V) that helps sort some of this out so people can get help by others when they need it.

  2. I like your article too. There seems to be a need for a new vocabulary in identifying the effects of PTSD, yet this may also be a form of distancing from society. I really like what you said about people experiencing PTSD being awake although it frightens me that sometimes the hypervigilence is unwarranted. While not all Vets are wild and violent, sadly news is news and those stories travel fast. More education for everyone is key.

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