January 15, 2014

My Case for the Syndrome of Survival

A popular argument to fight the stigma of PTSD is to abandon it as a disorder. There have also been cases for calling PTSD an injury because of damage to the hippocampus, but this is perhaps the worst piece of evidence because this scarring occurs in bi polar disorder and the entire spectrum of anxiety disorders: some caused by trauma, some not. The injury moniker's most problematic issue is that it seems to create an acceptable male, or females living up to male ideals, non mental illness. Even rape survivors are said to "have MST" instead of PTSD caused by rape in the military (why there is any effort to sterilize rape in the military continually blows my mind). However, the worst thing about injury or trauma titles is their omission of how paradoxical and complicated PTSD, Shell Shock, and Civil War Nostalgia have always been. Injuries are often a lot more simple: rest, ice elevate does very little to your identity. War alters our identity and what we have is a persistent illness, disorder or syndrome. Yet, anyone who truly understands PTSD grasps how it is the persistence of survival skills into non survival situations. Those survival skills ultimately saved our lives, but makes the mundane and routine parts of life harder to manage.

Syndromes are often permanent and the damage to our brain was not instant, it takes years of overuse of the limbic system to damage the brain's declarative memory and create the scaring identified by injury advocates. Moreover, calling it a syndrome of survival also will explain the deep longing and even nostalgic memory of war. We are damaged, but most of us possess some longing to return, and even miss combat or trauma. When we act like PTSD is solely an injury, we confuse injuries and disorders, all because of stigma. Assholes will be assholes whatever title is used, but calling PTSD what it is with respect to trauma's paradoxical complexity will help us accept what war, and survival have done to us. It will also, help war survivors recognize what they have in common with rape survivors, and that their persistent problems are extremely difficult and life altering, but they ultimately come from a place of strength, not weakness. We are all survivors and we should have a better title.

I know that this is a controversial topic that many well informed and capable people will disagree about, but as both a historian and combat veteran I have never been able to feel comfortable with any of the other popular titles. The syndrome of survival seems to captures all the complexity of survival as well as addressing lasting syndrome. Survival is a universally respected, even celebrated, aspect of the human experience and connecting our troubled lives to this ultimately positive fact will also encourage growth in all of those affect by trauma. We also need a title that people who suffer are more willing to bear publicly so that the conversation shifts, becomes broader and more substantive. A title that should come with a stronger sense of corporate pride and empathy from non survivors. A title that expresses a collective appreciation for what people have survived and the baggage that comes from it. No other title does that in the way that one crafted around survival. Survivor is a moniker  that captures the fact that we are not leaves blow about by circumstances. We survived through merit and resilience, and we can also survive the way that those original experiences have changed us, maybe even let our survival motivate us to be something better than we would have been without our horrible experiences.


  1. Six years learning to be a caregiver to a former combat medic who still feels shame in having PTSD and this is the first time I've come across an explanation of his illness that I think he'll accept.


  2. Thanks Chris I was reluctant to post this because I knew people had such strong opinions about it.

  3. Joe, Thank you for posting this ♥

    -a civilian woman wanting to understand

  4. "If only I could tell someone
    The humiliation I go through
    when I think of my past
    can only be describe as grace.
    We are created by being destroyed."
    --Franz Wright

  5. Joe,
    in my year long search for treatment for my own combat veteran I have had little or no success finding people who actually understand this. My observation may be informative. I witness the struggle he goes through. It is hard for him to focus. It is hard for him to explain his situation to medical. It is near impossible for him to handle stress.
    I have read several professional articles that not only detail this hippocampus injury- but also the micro fracturing on a synaptic level those who also suffer from tbi- and in my veteran multiple tbi.
    Among the problems with finding appropriate treatment for this very debating condition is getting so many issues treated, many also have survivor's guilt, and on some level embarrassment over having to admit they are suffering. We call it stigma
    I agree that there is a great difference between civilian equivalent's. However, I think getting the civilian support at least we can agree that given any situation where there is repeated real near death experiences to include graphic trauma is more complicated than a one time traumatic event.
    I hope this is not inappropriate- I am still trying to get him into an appropriate treatment.
    mil mom

  6. I couldn't agree more mil mom, and my last VA appointment my counselor blamed my retention of high standards for myself for my depression. I don't have a care team that I am pleased with either. I also could not agree more with substance of what you are saying about multiple exposures to traumatic experiences as well as scale that is usually greater for military PTSD. I, and probably your son, was exposed to hundreds, maybe even close to thousands of traumatic events. However, I also feel like people in less developed countries and children or adults who experience continuous domestic violence or sexual assault have the same problems. Yet we tend to blame the victims of domestic violence in ways that we would never blame veterans, except a few on the extreme soldier hating peace advocacy side (I see this from time to time on campus but it is rare). What I and some others would say s that the ideology shaping indoctrination of the military tends to connect the warrior identity to a love of violence and almost celebration. The cadence of "napalm sticks to kids" and "what makes the grass grow blood, blood, blood" is very contradictory to the how we actually experience violence. So PTSD supposedly disconnects us to this critical identity of survival that we were classically conditioned to believe in training and that is what I truly think separates the military form civilians. Or the betrayal of rape from a battle buddy that "always has your back" is similar in rape or sexual assault. Like you said this breaks down to anatomy and endocrine chemistry so that wouldn't favor the military except the ways that the military has purposefully used behavioral psychology to shape soldiers in a manner contradictory to the actual experience of violence.
    I think we need to start reading David Grossman more cynically and recognize how aware the military was of what it was doing with reflexive fire tables and bayonet drills, especially because he was on the reading list when they expanded their systematic use of classic conditioning in marksmanship through reflexive fire tables. He already linked the previous qualification standards to Viet Nam PTSD and they expanded it exponentially in the wake of his research.
    In terms of your sons treatment I would you and him what he enjoyed the most before war, and then fight to reintegrate that into his life again. For me shame kept me from those old hobbies because I subconsciously believed the training that taught me I was weak because I didn't love killing terrorist. I hated myself before war, until I connected to that previous self. Now I realize how important my pre war self was to my survival. You can't get that self back but the act of trying has been so vital to my self esteem and well being. I am clinically and brain chemically depressed, but I non material soul feels wonderful and that keeps me going.

    Sorry for the long answer but I think it gets at what you are saying about the differences between military PTSD and civilian PTSD from a different perspective.

  7. Thank you for this article Joe. I was in Afghanistan in 2007 and I am just now seeking treatment, realizing I will never "snap out of it" on my own. Your words really touched home with me. I relate very much to "Survivor's guilt" which is why I have not tried to receive help until now. Very informative perspective. Even as a psychology major who should probably know better, I have a huge fear of the stigma related to being diagnosed and treated for PTSD. Keep up the informative articles please.

  8. it seems to me that the military just doesn't "get it" when it comes to treating PTSD. Would you take an alcoholic to a bar every day and then be surprised when he or she gets drunk? Why would you keep a soldier at Ft. Hood or anywhere else that they are surrounded by and immersed in everything that makes them angry and dysfunctional? It's time for the military to step aside and let someone else help these soldiers transition to a productive life while they get the help they need to PTSD.

  9. I am not sure moving him would have helped considering that the soldier had some limited, ie not as severe a case as most of our contributors, issues with mental illness, even more limited combat experience. There were little warning signs in this case. Also I kind take offense to the implication PTSD at all justifies what he did. At the implication that it was anyone's fault but his own. I hope that this blog is about finding a way to transcend trauma, and a dialogue blaming a heinous crime done by an individual on the Army is not something I am willing to back. I certainly think the Army messed up on my case over and over again, but I would sooner turn my self into a 1950s, or 19th century asylum and receive a frontal lobotomy or sterilization before I ever used PTSD as an excuse or explanation for what happened at Forth Hood. I agree that the Army is 100% messed up on PTSD, but would never make the leap in logic to blaming that ineptitude on this tragedy.

    for March 26th comment

    First of all I apologize for the delay I posted a comment and it didn't go through. I thank for you for your feedback. I think my biggest problems with stigma is how I feel weak sub consciously and I have to continually remind myself that I have PTSD because I was strong int he face of an unrelentingly horrible situation.

    I don't want to ruffle any feathers today but I really take a lot of offense and think veterans are taking a step backwards on stigma when it is even implied that PTSD or our poor treatment by the Army and VA would ever justify hurting other people. This forum is about accepting PTSD and growing despite it and we can control the rage our experiences have given us. We are agents capable of acting and self discipline even when our situation might make us long to lash out. You might have overstated the connection to Fort Hood, but it is important that we never validate these sort of actions or allow PTSD to justify them. I Happen to have been in a well done forum on this today and I think we all dealt withe the situation very well.


  10. Well done. I am a vet with PTSD and a counselor for the VA. You touched on something I have been talking about for a while, the persistance of survival skills into the "mundane" civilian world. Thank you for validating my "personal theory" on the issues of PTSD. Keep up the good work.

  11. Anonymous,

    I couldn't possibly disagree with you more. While the military/VA is not perfect - or indeed, even close to perfect - on PTSD, they have a 75% solution. The civilian sector: a 5% solution. The VA and military health care has a large number of people who specialize in PTSD treatment - and another large number who can empathize, even if not specialized. Many combat vets, myself included, have difficulty realting and explaining to their own families, who (hopefully) know them best. Imagaine trying to relate to a new therapist. However when I talked to my military psychologist about my experiences in Iraq, and he starts talking to me about his experiences in Vietnam - we now have a connection, a shared language, and a shared way of identifying and dealing with issues. I do a lot of "I don't know if I explained that well enough," and he does a lot of "I know exactly what you are talking about." Moving this away from the VA and military health care system would completely ruin that.


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