1) PTSD is not only caused by traumatic experiences. It has more to do with the person than the experience. Two soldiers can experience something horrible, but only comes away with PTSD. Often times, someone who struggles with PTSD has become locked into crisis mode, where they treat normal life as if it is filled with the same level of trauma, regardless of environment. This crisis mode is not only caused by moments of crisis, but persistent vigilance in response to perceived threats. I'll demonstrate that latter fact in a second.
2) PTSD is not only reflected in dramatic outbursts and explosions. It is often reflected, especially in its milder forms, in distorted emotions and reactions, paranoia, and fear. Again, PTSD is dependent upon the person, not the experience. The way in which one responds to crisis often determines the makeup of their particular struggle with PTSD.
These corrections were brought home to me again today. I was meeting with one of my good buddies here, and he spoke to me of unusual emotional patterns. For example, he has only cried twice around his wife since they got married. Now, he finds himself crying virtually every week. He also mentioned to me that he got incredibly angry yesterday when his armored vehicle drove through town and he noticed Afghans staring at his vehicle and talking on their cell phones.
Both his weekly bouts with crying and this irrational anger are totally out of place with his normal character. But this soldier, like many others, is unlikely to notice such changes. They often happen gradually, and deployment doesn't afford many opportunities for introspection. In fact, changes like these are often ignored as a survival mechanism in an environment that requires soldiers to "drive on," regardless of their experiences.
Now this soldier has not experienced anything directly traumatic. Indirectly, he had to deal with the fact that several Afghan contractors who worked under him in a different part of the country were killed by an IED. But the thing that really wore on him is what I believe the most common cause of PTSD in a theater of war--not combat, but a hyper-vigilant lifestyle.
Every time I go outside the wire, I subconsciously gird myself. We all do this. My stomach instinctively clinches, anticipating a hypothetical IED. I notice every person talking on a cell phone, knowing they might be triggering an IED. Every time we get stuck in traffic, I work harder to scan my surroundings, believing that a VBIED (vehicle-based) could be nearing at any moment. Even inside the wire, I wonder if the Afghan I pass in the night has an undetected weapon and scroll through strategies of fight or flight. Every soldier thinks these things, but most every soldier is also no longer aware that he thinks these things. He just does them. They become his lifestyle.
But then he goes home. He will drive through a suburb, noting pedestrians who talk on their cell phones. He scans the overpass for snipers. He wonders whether a pile of trash or pothole contains an IED. He fears large crowds because of the unpredictability. He gets irrationally angry when circumstances seem outside of his control. His crisis mode has become his permanent mode. He has PTSD.
The soldier I met with is spiritually strong, by God's grace, and more emotionally health than most any soldier out here. But I encouraged him to get counseling upon his return. What most soldiers (and people) don't realize is that this is more than a psychological problem. The constant rush of adrenaline reconfigures the brain to maintain such levels. It is a physiological problem.
Before I left, I told the wifey that I would probably have PTSD upon my return and than I anticipated needing counseling. No shame in that sentiment, just an anticipated reality. She asked me recently whether I still wanted to get counseling. Forgetting what I have learned about PTSD, I told her that I probably wouldn't because I haven't experienced anything particularly traumatic. While I might not seek counseling immediately, if, after a couple of weeks, the wifey detects that something is off, she has full permission to demand that I get treated.
As I have told soldiers for years, not only is there no shame in getting psychological help, but it should be expected for those who have willingly engaged the world in its brokenness for the sake of others' security. Our soldiers not only need counseling, they deserve it.
And just as we fight for our families, we desire to return right for our families. And if we love them (and we all do), we will engage the latter battle as eagerly as we engage the former.
