A clear disconnect exists between how we perceive physical and mental illnesses. This cognitive dissonance isn’t particularly logical (because no one would choose to live with anxiety, schizophrenia, depression or any of the other maladies laid out in the DSM-5 or ICD-10 diagnosis codes), but that doesn’t stop people from reflexively suggesting that a person who suffers from panic attacks, agoraphobia, or bipolar disorder is making their affliction up, doing it for attention, or otherwise weak in some way.
Post-Traumatic Stress Disorder (PTSD) is one of these misunderstood disorders (perhaps one of the most misunderstood). You can read the full criteria for diagnosis here, but the Cliff’s Notes are well known: PTSD occurs after someone has experienced a traumatic event (one which has endangered the life, sexual agency, or emotional integrity of the subject or someone they’re close to) and is diagnosed after the individual has experienced symptoms including intrusive thoughts, nightmares, emotional numbness, hyper-vigilance, an exaggerated startle response, and a marked need to avoid anything having to do with the traumatic incident (triggers) for over a month. What’s not as commonly understood is that PTSD doesn’t just go away, and is responsible for a variety of negative life outcomes, including suicide (although it’s important to mention that killing oneself as a result of PTSD isn’t as common as you might think).
Like any illness, mental or physical, PTSD doesn’t exist in a vacuum. A shaky understanding by the general public has the potential to compound the matter. The more we view PTSD as something shameful, or a sign of weakness, the more people are going to be afraid to talk about it, because they’ll see their experience as an embarrassment. Therein lies the rub (and one of the many reasons why mental illness is a public health crisis).
According to recent statistics, 70 percent of American adults (that’s over 200 million people) have experienced an event that could be classified as traumatic. These traumatic events may mean war, but they also include child abuse, domestic violence, natural disasters, sexual assault, and accidents. Of those 70 percent of American adults, up to 20 percent go on to develop PTSD. PTSD United reports that, at any given time, 8% of Americans are living with the disorder. It’s hard then, to think that something that affects so many people could possibly be explained away as some sort of character deficit.
Here’s a pertinent example: In 2012, San Diego residents were upset when the VA proposed building a residential treatment center for vets who suffered from PTSD or other traumatic brain injuries nearby a school. While numbers indicated that there was very little danger from vets, the community had an emotional reaction. As the VA’s official blog points out, these beliefs are possibly due to headlines that have referred to vets suffering from PTSD as “ticking time bombs,” or articles suggesting that returned vets turning violent is a “growing problem,” — despite numbers to the contrary.
The debate over where to build the center raises important questions: If our vet panic was warranted, wouldn’t it suggest a greater need for facilities? Doesn’t it beg for more support?
“I like to say that we are a warring but not a warrior culture,” says Thomas Barnhill, the founder of the Holos Project. Holos helps post-9/11 combat vets heal from their psychological wounds by reconnecting them with the outdoors — where they go hiking, backpacking, and rock climbing — though Barnhill also holds a master’s in counseling psychology and feels that traditional therapy is still an important component of healing.
“I’ve spent a lot of time with indigenous people,” Barnhill continues. “Traditional cultures had a process to return their warriors from battle to the community. Here, it’s ‘thank you for your service, sorry your foot was blown off, here’s $1,200 bucks a month and go sit in your apartment and get a job.'”
Barnhill knows this is a very bleak picture of how we treat veterans, and explains that there’s no way to transform how we treat PTSD unless we start talking about the brutal realities of being in combat. “We don’t want to think about it,” he says. “It’s a two-fold thing: There’s a culture that’s not prepared to have the appropriate dialogue and you have military trained and acculturated not to show weakness.”
“The sad reality for many veterans with PTSD,” Barnhill continues, “is that they self-treat or ‘self-medicate.’ They manage it with isolation, alcohol and drugs; they white-knuckle it through the day. They grin and bear it, really, so they’re actually tremendously strong.”
Connie, a non-combat veteran who spoke with us on the condition of anonymity, told us that her PTSD came from the fact that, while in the Navy, she was ostracized by her peers and superiors after she complained about harassment by her supervisor. “You can’t quit,” she says, “You’re stuck there. And you have to find some way of coping. PTSD isn’t a moral failing. It’s a response to extreme stress.”
Connie’s case shines a light on the fact that many mental health practitioners don’t understand how to handle vets with PTSD. When Connie began to seek treatment — outside the VA, at first — she found herself being misunderstood by civilian therapists.
“I went in and I was having issues at work due to my PTSD and I made a mention of it,” Connie says. “And this counselor sat up and said, ‘Tell me more about it.’ I said, ‘Well, what’s your training with this?’ and he said, ‘I want to learn more…’ I said, ‘No, I’m not your guinea pig.'”
PTSD isn’t limited to vets, either. There are countless millions of other people who suffer because of events that happened closer to home. According to the Adverse Childhood Experience (ACE) study — a joint venture between Kaiser Permanente and the Centers for Disease Control — a great number of adults suffer health problems due to the way they were treated during their childhoods. In some of these cases, Thomas Barnhill notes, people compound this trauma by viewing the military as a way of getting out of an abusive situation.
“If your dad is an abusive alcoholic, you may just be counting the days until you’re 17 and can cruise over to the Marines recruiter and get the fuck out of there,” he says. “You meet people who are highly functional, who won’t be drunk or hit you in the face. You go through boot camp and think, ‘Wow I actually am very capable.’ You get a brotherhood. Then you go to Iraq and two-thirds of your new brothers get killed. Now your family has collapsed, you’ve had no family structure to begin with, and then you have a statistical tendency to psychological impairment.”
But what about the people who never go into the military? What message do our collective PTSD stigmas send to them?
Ella, a 32-year-old woman who developed PTSD after a car accident a decade ago, says that the hardest part of living with the disorder is the triggers — she experiences panic attacks — and not being able to explain them without people thinking her crazy.
“The accident happened on Thanksgiving weekend,” she says, “and for years I wasn’t able to celebrate. I just couldn’t do it. A few years ago I was sent to a work event across the street from where the accident happened and I had a panic attack the whole time, but how was I supposed to explain to my boss why I didn’t want to go, even though I was accepting an award on behalf of my company? I’m young and still establishing myself. It would be so bad for my career to have a reputation as a panicky weirdo.”
Jae, another woman who lives with the disorder, says she wishes that people would understand that the disorder is in no way a weakness. In fact the people that live with PTSD, she asserts, are strong for continuing to survive in the face of their own minds becoming a hostile environment. “These are people, who like me, have encountered serious trauma either through domestic violence, violence and death from war, or through abuse. This is not a pussification of the new generation. It is realizing that some people are dealing with a severe mental illness that impacts their daily lives. We are surviving and carrying on despite the horrors we’ve seen.”
Jae also believes that the conversation needs to shift away from only talking about vets and encompass those who have experienced trauma outside of combat.
“The public perception of PTSD is only soldiers who have seen violence can have it,” she says. “In truth it can be anyone who deals with trauma on a regular basis. Most people know what they see in the movies. They ask ‘Oh wait, when did you see combat?’ My response is usually, ‘everyday of my childhood when I was fighting to stay alive.’ Men are especially higher risk because discussing how something makes you feel seems to make it ‘less manly.'”
Jae points to a popular Facebook meme — which reads “in 1944, 18-year-olds were storming Normandy; In 2016, 18-year-olds need a safe space” — as especially damaging: “To me this is a complete slap in the face because things and times have changed for mental illness,” she says. “The message is that noncombat victims are being told to suck it up, because it couldn’t have been that bad.”
So how do we navigate a path forward? How do we reconcile the fact that PTSD is real, that it affects millions of people and that it’s not a sign of weakness? Jae says that education is a necessity.
“I think the more people who come out and speak about it, the more it will be normalized,” she explains. “PTSD is a physical illness as well as a mental illness. There are changes to the brain, and just because it’s unseen doesn’t mean it’s not there.”
That education could transform the way that people who live with the disorder are understood and how they’re able to cope and talk about living with it. For Ella, it would mean being able to not be seen as a “weirdo.” For Connie, who doesn’t talk about her PTSD at work because of associated stigmas, it could mean being able to be more open with her co-workers.
The most dangerous thing of all, according to Elise Marie Franklin, a marriage and family therapist based in Los Angeles, is that due to the perception of PTSD as a character failing, people don’t consider treatment, which has been shown to be highly effective. “The stakes are so high,” she says. “By not seeking treatment, people are putting themselves at risk for substance abuse, suicide, anxiety, and a host of other disorders. I’ve worked with children who’ve seen their parents killed. If we’re expecting 4-year-olds to ‘just be strong,’ that’s insanity.”
“If we send the message that not being able to control your thoughts after a traumatic event is a sign of weakness, it becomes a vicious set-up for failure,” Franklin says. “It’s as absurd as saying that if someone raises a fist at you, that you shouldn’t flinch. And if you do flinch, that’s a sign of weakness.”
The danger here is that stigmas prevent proper treatment from occurring. “In the case of PTSD, suicide and other negative outcomes are often avoidable,” Franklin continues. “but people aren’t being treated and don’t know there are options. And the reason they don’t know there are options is because someone has told them that seeking help would help makes them weak. A lot of the time my work is undoing that belief, because you can see how thinking that way is a real barrier to recovery.”
In the case of veterans, Thomas Barnhill says that education and respect are paramount to transforming the idea that suffering from a traumatic experience somehow makes a person less-than: “You can’t just ‘choose’ to not get PTSD or just ‘choose’ to drop it anymore than one could just ‘choose’ to not have a broken arm.”
When asked about how non-sufferers can begin to understand post-traumatic stress, he says, “Use readily available popular media to get a greater sense of what the veteran experience entails. Recognize that veterans or people with trauma are people first. Approach them or think of them as normal people.”
Finally, Barnhill says that you need to “get active politically and know the stance your various representatives have on both engaging in conflicts and their stance/support for dealing with the human aftermath of sending people to war.”
Contact Mark on Twitter at @MShrayber