To say that combat veterans have a resistance to treatment is a misconceived attribution attached to combat PTSD. A chronically mentally wounded combat veteran has many issues that must be continually and thoroughly assessed throughout the treatment process. Many treatments modalities stop at symptom reduction, while veterans have significant relief they still have symptomology that intrudes into daily life.
After I was in the treatment center for homeless veterans for 20 months I stopped all therapy as I felt I was in the best place in my life I had ever been. Gradually over the last two years the dissociative responses have become the major symptoms that I face. It interferes with my relationships, studying, and my sociability. My level of structural dissociation of the personality I would consider at the secondary level and complex PTSD as a diagnosis. I have tertiary dissociation features, with periods of psychosis and hallucinations during extremely high levels of stress.
The combat flavor of PTSD has serious implications with identity crisis and integration of the personality. To adjust to killing, a psychic shift must prevail and in doing so splinters the personality, shattering the attachments with significant others and reforming them into the troop-organism, an identification with the combat squad. Separate action systems whereby the individual reformulates their value system in congruence with the combat environment mediate the internal operating system. They have completely replaced their civilian self with a warrior self.
The warrior identity (WI) has a separate sense of self from the other aspects of the personality and will assert itself when faced with the possibility of its demise. The crux of this juxtaposition lies in the survivability of the person in relation to threats perceived or otherwise. To survive, evolution has provided us with a mechanism to do the deed. In doing so the Darwinian switch triggers the animalistic defensive operating system from the higher functioning administrative capacity to the lower level of reflexive WI.
To carry out its function of survival the WI has adapted a code of moral imperatives relative to the act of killing and survival. To understand this matrix as it relates to the spectrum of structural dissociation of the personality and the fracturing into differing selves relative to the combat soldier or veteran, one needs to ascertain the connections of attachment systems, identity, developmental cognitions, evolutionary defensive systems, the nature of memories, emotional blocks and how all of these form the schemas of the person. To do this one should educate themselves on the Theory of Structural Dissociation of the Personality.
The Theory of Structural Dissociation of the Personality has given me incredible insights into myself and a greater understanding of the dynamics of action systems and defensive systems that drive thinking, behavior, emotions and actions (Structural Dissociation of the Personality, Lee, 2009, Steele, van der Hart, and Nijenhuis, n.d., para. 8, Steele, van der Hart, and Nijenhuis, 2005).