The Puzzle of PTSD. June 27th is PTSD Awareness Day.

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.

The Puzzle of PTSD

Jonathan Shay, a VA psychiatrist, wrote Achilles in Vietnam and Odysseus in America, two books showing that PTSD existed long before we had a name for it.  In the past the condition has been referred to as nostalgia, shell shock, and combat neurosis.  I find “nostalgia” interesting, because it suggests a longing for the innocence of one’s past before experiencing traumatic horrors.  The paintings of Nguyen Thanh Chuong, a former North Vietnamese soldier, suggest a longing for the pastoral peace of his childhood.  Nor is “shell shock” such a bad designation.  The theory was that multiple concussions created many tiny bleeds in the brain, resulting in a diffuse brain damage.  Anyone who has been in heavy shelling knows this is all too likely.  When I was counseling WWII veterans I would sometimes read their medical records from the past, long before there was any such diagnosis as PTSD.  It was interesting to see the clinicians from the past describing what was instantly recognizable to me as PTSD, and then giving it some other name, such as combat neurosis or even schizophrenia.

Recently I was reading The Book of Psalms in the Old Testament.  Psalms is believed to have been written by King David.  I found the psalms very meaningful, and I felt that David was a kindred spirit with whom I would have liked to have a conversation.  Later a friend of mind suggested that David had PTSD.  Of course!  As a kid he fought the giant, Goliath.  He did his best to serve King Saul, but Saul was jealous of David and tried for a long time to hunt him down and kill him.  And David of course wrote the favorite verse of so many combat veterans, “Yea, though I walk through the valley of the shadow of death, I will fear no evil” (Psalm 23).  It does seem to me that David might have had PTSD.  Yet he was a very competent warrior and king.

Recently I was viewing and enjoying Michael Wood’s very interesting four-hour documentary for PBS, “In Search of Shakespeare.”  It is a biography of Shakespeare and a description of the society in which he lived.  England in Shakespeare’s time was a very oppressive society in which there were many paid informants, and in which being a Catholic could result in execution.  Shakespeare’s family had been Catholic before the government outlawed Catholicism.  There is evidence that Shakespeare’s family remained secret Catholics.  You might notice that none of Shakespeare’s plays were about contemporary events!  That could get one beheaded.  His plays were set in the distant past, in distant countries, or in fantasy worlds.  Any allegories or references to present events were very subtle, indirect, discreet, and cautious!  When Shakespeare was a teenager, one of his uncles was suspected of being a clandestine Catholic, and was executed in the usual style, which was to be taken to the meat market for public viewing of his execution.  He was disemboweled, and his intestines were set on fire so that he could see them burning before he died.  Then he was beheaded.  Perhaps his head was placed on London Bridge for additional public viewing.  Whether the young Shakespeare saw this, we do not know.  But he certainly knew of it.  When I read Shakespeare’s early plays, it seems to me that there is a clear horror for the folly of the human conflicts that raged all around him in society.  I believe it is likely that Shakespeare could have been diagnosed with PTSD.

General William Tecumseh Sherman is notorious for his decisive action and scorched-earth policy in his march to the sea.  Before the Civil War he fought in The Second Seminole War.  Before the Civil War he also warned the secessionists about the course of this war they were seeking.  His statement about the course of the war was, in retrospect, uncannily accurate, and very nearly psychic.  He knew what he was talking about.  In the early part of the Civil War, however, Sherman was relieved of command as unfit for duty and crazy.  Apparently he was considered to be hypervigilant, and to be having a nervous breakdown.  He did eventually return to duty, and was caught by surprise in one engagement because, although he had wanted to be hypervigilant and take precautions and prepare defenses, he feared that he would once again be considered crazy and hypervigilant.  His unit was in fact attacked and forced into retreat.  His competent leadership later contributed greatly to the victory of the Union.  I believe that Sherman could have been diagnosed with PTSD.  But like Shakespeare, of whom he was fond, Sherman was also exceptionally intelligent and competent.

In future blogs I want to continue to address this puzzle about the ways in which PTSD is disabling, and the ways in which it is not.  Perhaps I will develop a theory.  I also want to discuss some well-known authors who probably had PTSD, and the different ways they coped.  Each person who has PTSD is unique.

Other Related Posts by Mike:

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.

The Stigma of PTSD

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.

Intergenerational PTSD—Another Perspective (Part TWO)

Mike Muller is on the Thuy Smith International Outreach Advisory Board, Psychologist (Ph.D.), and Vietnam Veteran who has counseled Veterans and their families for many years

In December 2010 I wrote a blog on intergenerational PTSD and promised to write another.    After many years of counseling veterans with PTSD, and finally having to admit that I had PTSD myself, it seems to me that most of the people I have counseled were protectors.  They tend to be hypervigilant for all sorts of danger, whether physical or emotional.  They’ve seen terrible things, and they’ve seen people do terrible things.  They often know from personal experience what people are capable of.  I used to wonder about the symptom of avoiding crowds.  I thought that perhaps that came from the military rule of telling people to spread out and not bunch up, or “one round will get us all.”  It is often said of soldiers fighting urban wars that they avoid crowds because of a fear of a terrorist bombing.  Well, that’s true enough, I suppose, but I think the symptom of hypervigilance runs a bit deeper than that.  I think it has to do with a basic sense of trust.  Can human beings really be trusted?  Some people with PTSD have been blessed to see people who laid down their lives for others, and so they know that some people can be really, really brave, good, and trustworthy.  However, this is so rare that we tend to weep when we see it, because we realize just how wonderful the world could be if everyone were so brave and good.  On the other hand, most people with PTSD have also seen the completely depraved and ruthless acts of others, and they know that civilization is just a thin veneer over the vicious beast that is man.  So they don’t avoid crowds because they are afraid of an explosion or a bullet so much as that they simply don’t trust people.  People make them nervous.  People are wild and unpredictable.  Will there be a robbery or mugging?  An attack of some kind?  Of course this is all mostly unconscious.  All they know is that they just get nervous, jumpy, or uncomfortable.

While I’m on the topic of hypervigilance, I want to distinguish it from paranoia.  I hear people confusing these two phenomena all the time as if they were very similar.  Even mental health professionals confuse the two.  But I believe that they are almost complete opposites.  Paranoia stems from an exaggerated sense of importance which is created to compensate for a very deep and underlying sense of worthlessness and emptiness.  So in paranoia the person tells himself that people are out to get him because he is special in some way.  Thus, for example, one might have delusions of grandeur.  But hypervigilance is completely the opposite.  One does not think one is special at all.  Quite the contrary.  If normal people seem to fool themselves that bad things cannot happen to them, and then be ridiculously shocked when something bad does happen to them, hypervigilant people know that they are not special, and that bad things can just as easily happen to them as to anyone else.  They don’t have that “normal” sense of somehow being invulnerable and immortal.  So hypervigilance and paranoia may be similar in their sense of wariness, but they are completely opposite in terms of their psychological origins.

I put “normal” in quotations, because those with PTSD have a new “normal” that is not shared by conventional society.  They don’t fit in anymore.  J. Krishnamurti wrote “It is no measure of health to be well adjusted to a profoundly sick society.”  For example, would you want to be well adjusted in Nazi Germany?  And this is a matter of degree.  America, for example, has much to recommend it, and many people seek to be here.  Yet there is also much that is sick about America.  So which “normal” is best?  Society’s norm, or the PTSD norm?  Everyone seems to assume that we have to fix those people with PTSD and make them more like the people in society so that they will fit in better.  Many counselors, psychotherapists, and psychologists seem to be working very hard to make the people with PTSD “readjust” or fit in with society.  But I think that the goal of therapy should be to help the person realize the ways in which they are different from society, and the ways they will never be the same again.  Then they need to cope with that difference, accepting that they are different, and do their best to stay in communication with society.  In the end I think it is much more true that society is the one that needs to change; society is the one who needs to learn from the people with PTSD, e.g., to avoid another Holocaust.  So those with PTSD should speak their truths even when “normal” people don’t want to hear them.  It’s a dance.

And so we come again to the topic of intergenerational PTSD.  Intergenerational PTSD seems to be based on the idea that PTSD is in a sense contagious, and that kids will “catch it” from their parent, which they surely will.  But there is another way to think about this.  I believe it is very much like the situation in which people move to a new country with a new culture, and then experience agony when they see their children abandoning the culture and values of their parents and adopting the culture and value of their new society.  The parents and the society almost seem to be competing with each other to win the hearts and minds of their children.  This most often frightens the parents.  If the parents are enlightened and wise, then they will rejoice that their children are adopting the good things of the new culture, and caution them about adopting the bad things.

I lived with my mother for a few years when she developed macular degeneration.  She said she never felt safer than when I was there.  I was like a bodyguard or a security consultant.  I was a protector.  On the other hand there were times when she did not like becoming alarmed when I became aware of a danger to which she had been oblivious, or blissfully ignorant.  Years before when her car caught on fire at a resort, everyone was standing around looking at the fire and wondering what to do, when “all of a sudden Michael appeared with a fire extinguisher and put out the fire.”  I knew exactly where the fire extinguishers were.  I had checked that out when we first arrived.  At the time I did not realize that I met all the criteria for PTSD.

I know there were many times when my daughter must have been frustrated with my hypervigilance and caution.  Of course, children are often frustrated by their parents’ cautions.  But I am more cautious than most!  I am like the parents who have moved to a new country and a new culture.  I have moved to the land of PTSD.  My daughter was trying to figure out whose attitudes and perceptions to adopt.  Mine, or those of “normal” society?  Do I want to make her into a scaredy-cat, or someone who is cautious and alert enough to be a survivor?  Or do I want her to be one of those “normal” persons who act as if nothing bad could ever happen to them?  When I was a boy I remember going far out into the surf with my father.  The waves were over my head, and I was having a lot of fun jumping off the bottom to ride on top of the big waves.  Years later my feelings about being in the surf were much more mixed, combining both fear and fun.  I knew there were things in there that could eat me if they wanted to, in the same way that there were people in the thickets in Vietnam who could have killed me.  I would go into the surf from time to time, but never again with the same joy and lack of concern that I had as a child.  Then I took my daughter to the ocean.  It was her first time to see the ocean.  She wanted to go way out into the waves.  What was I to do?  I went with her, acting as if everything were just fine, but staying very close to her and ready to grab her instantly and head for the beach, or fight off a shark.  She was having fun; I wasn’t.  I was afraid.  Did I successfully hide it from her?  Should I?  Should she be afraid also?  Did she “catch” my PTSD?  I have little doubt that she did.  But on the other hand, I really don’t want her to “catch” what seems to be “normal” in our society.  Like the parents who move to a new country and a new culture, I want her to adopt the good things and avoid the bad things.  I want her to be loving, wise, strong, protective, and vigilant, but I don’t want her to be afraid.  These are the same things I want for myself, but it is not so easy.  I am often anxious, and I am certainly a misfit in society.  I don’t particularly want to fit in, but that can be lonely.  According to my beliefs, the only antidote to fear is trust in God.  If you don’t believe in God, then I hope you believe in goodness, honor, love, and the Golden Rule, and believe that there is nothing to fear if you are acting in accord with these virtues.  We all die, but the more important question is whether we lived in accord with the higher values that humanity aspires to, or whether we lived like greedy, angry beasts.

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.

Intergenerational PTSD–What is it really? (Part One)

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.   

I remember when I was in graduate school in the 1970s after I had returned from the war in Vietnam. I knew almost nothing about PTSD—it hadn’t been formally recognized yet! Nor did I know that I had some symptoms of PTSD. In retrospect I can see them. I remember reading an article about the children of survivors of the Holocaust, and how the children were damaged and depressed because their parents, the Holocaust survivors, were damaged and depressed. Despite having no knowledge of PTSD as a formal entity (neither did the authors of the article), I remember feeling somewhat incensed at the attitude that these survivors, both generations, were somehow damaged because they did not fit into society. Yet even at that time the research was also clearly showing that “depressed” people often had a much more accurate perception of themselves than did other people. “Normal” people (normal meaning that they fit into society) consistently had self-perceptions that were distorted in a positive direction. It seemed to me then, and still does, that the Holocaust survivors were the ones who had the more accurate perception of humanity, society, and human nature. They knew what people were like. It was the “normal” people who were fighting to deny or dissociate from the truth. So it is that the survivors of the Holocaust know that they need to keep fighting for people to remember what happened, and for people to know what people are capable of doing so that history does not repeat itself.

It seems to me that the children of the survivors were caught in the middle between these two warring perceptions of reality. On the one hand their parents probably feared their children were being drawn into the same “normal” mindlessness that leads to so much misery in the world, while on the other hand the children’s “normal” friends thought they needed to have a more cheerful, positive attitude, and join them in the happy land of denial and illusions. I would hope that all of us would work out our own view of the world, and not uncritically (and most often unconsciously) adopt the world views of others. Having an independent world view can get you in trouble with your friends, who become uncomfortable when your views seem to contradict or challenge theirs. This dynamic does seem to be prominent in the history of humanity, in which groups of people feel they must compel others by force, war, torture, and imprisonment to think the way they do. Historically it seems that human migration is often caused by the need to escape from those who would kill us or otherwise compel us to think the way they do. People seem to feel very threatened when others do not think the way they do. We can only wish that each of us would treat with respect those who disagree with us, and that others would treat us with respect also.

So when we speak of “intergenerational” PTSD, I think we are speaking of children who are caught in the middle of these warring perceptions. On the one hand their parents’ “normal” assumptions and illusions have been shattered and replaced with more accurate perceptions of reality that are not shared by society. On the other hand they hear the siren call of society drawing them into their happy illusions.

Viktor Frankl, in Man’s Search for Meaning, did not write that the ones who survived in the concentration camps were those who maintained a cheerful, optimistic outlook. That would be absurd. He wrote that those who survived were those who had a reason and meaning to survive. The ones who had something they wanted to accomplish, or someone they were yearning to be with again, survived. Given this reason or meaning to live, they could endure all the pain and suffering that was heaped on them. I do not believe that people should whine, complain, moan, and cry out about how terrible life and human nature are. But I do think that people should probably weep, moan, and cry out in pain much more than they do. Then they should listen to their own cries and pay attention to what is wrong and what needs to be changed. They should also be able to be pleasant, joyful, and thankful when life presents its kind beauties and tender mercies.

Often the children of those with PTSD will criticize their parents for not being more like “normal” people. I wish that these children could gain some perspective, and see both of sides of these warring perceptions. They do not need to say that their parents are wrong and society is right, nor the reverse. And sometimes the intensity is heightened still more when children are also caught between the perceptions of warring parents, each of which is putting terrible pressure on the child to think the way they do, and to choose sides! Of course, by being independent thinkers they will nonetheless always be to a degree outsiders. Sometimes independent thinking will be rewarded and honored by others, but most often, almost by definition, it will not be honored and rewarded.

Related Posts by Mike:

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.