Abstract

      Since the attacks against our country on September 11, this nation has been at a state of war against terrorism.  Whether you agree or disagree with the reasons for war, there is one thing that is a truth that cannot be denied, and that is the debt this country owes to those who fight for it.  This review examines the writings of Dr. David Grossman and Dr. Jonathan Shay, two of the nation’s leading experts on combat stress, in dealing with the hidden wound which is often suffered in combat: Post-Traumatic Stress Disorder.

Post-Traumatic Stress Disorder

An Explanation of Combat Stress

      Post-Traumatic Stress Disorder (PTSD) is a normal reaction to abnormal conditions.  However, the term “disorder” implies something is wrong or broken, or that the veteran is mentally handicapped.  This causes many sufferers to avoid treatment, thus avoiding the stigma of a mental disorder.  This is a totally false perception, as 98% of all humans involved in sustained combat will suffer some level of combat stress (Grossman pg 44).  Dr. Jonathan Shay detailed four clusters of combat stress experiences to identify their “separate contributions to PTSD” (Shay pg 123).  They are exposure to combat, exposure to abusive violence, deprivation, and loss of meaning and control.  These are all contributors which can lead to PTSD, but there are many other factors to consider.

      One leading cause of PTSD in combat veterans is man’s unwillingness to kill another man.  Any animal is resistant to killing a member of its own species, and man is no different.  This is not a new phenomenon.  During the musket era of warfare, the common tactic of the day was for armies to march in tight formations within close proximity to the enemy, and begin firing volleys.  Hundreds of men would fire their weapons, with only 15-20 of the enemy falling over.  Battles would go on for hours, until nightfall ended the fighting for that day (Grossman pg 9).  Men do not like to aim at another man, and kill him.  When they do, the onset of PTSD can begin.

      PTSD can be called nervous system memory.  When a person has experienced traumatic events, the nervous system becomes conditioned and survival instincts become very strong.  This will result in hyper-alertness, emotional distance, emotional numbing, and sleep disorders, just to name a few symptoms (Cantrell pg 37).  A person suffering from PTSD is constantly mobilized for a threat, even though no threat is present.  Many combat veterans cannot tolerate crowded locations or sit in a restaurant with their back to the open room, even though their combat experience was years or even decades in the past.  Sleep disorders are another common trait, which can be displayed in disruptive nightmares of the traumatic event, or the inability to sleep at all.  In a support group meeting, one Iraqi war veteran expressed that he cannot fall asleep until sunrise.  While deployed, he had guard duty just prior to sunrise, and even though he has been home for three years, he still cannot break that pattern.   Many other veterans report the need for the adrenaline rush they experienced in combat.  Motorcycles, fast cars, and behavior which can easily result in violence are common in that adrenaline search.  It must be noted that these are not criminals, or “bad” people; they are people who have endured tremendous stress and are now in need of treatment.  For many, the realization of the need for treatment comes after incarceration or hospitalization due to their behavior.

 Factors That Contribute to the Onset of Combat Stress

      As already mentioned, one of the leading causes of PTSD is the killing of another human being.  Dr. David Grossman explained the process in his book entitled On Killing.  When a man kills another in combat, his first emotional response is elation.  He is elated that he won the fight and is still alive.  He may even do some grandstanding for his friends. When the elation fades away, he begins to feel shame and guilt.  These emotions are caused by the fact that he killed, and was happy about it.  This is when the rationalization process begins.  The veteran will tell himself that it was his job, he was following orders, it was him or me, or a multitude of reason such as that.  They are all valid reasons, and if they work, the veteran will most likely be fine.  If the guilt and shame persist, PTSD will very often begin to present (Grossman pg 115).

     Another common cause of PTSD in combat veterans is witnessing fellow troops or close friends being killed in action.  The bond of friendship which is forged in combat is closer than family or even marriage ties.  When a close friend is killed, the effect on those still alive is dramatic.  A compounding factor is in this culture, veterans are not allowed to fully experience the grieving process.  American troops are told to “shake it off” or “don’t get mad, get even”, yet if they cry over the loss of a friend, they are ridiculed by others.  In his book entitled Achilles in Vietnam, Shay drew stark comparisons between the experiences of Vietnam veterans and the characters in Homer’s epic Iliad.  The similarities are startling, but one important difference lies in the fact that the Greek and Trojan soldiers were allowed to grieve for their dead, as well as conduct funeral rites for their fallen comrades.  This process helped ancient warriors fully accept the death and bid farewell, thus allowing closure.  Modern day warriors do not get that closure, and they are left feeling empty, as though something is missing.  Allowing them to give a proper farewell can help mitigate the feeling associated with the death of a close friend.

      Distance to target is another strong factor in the onset of PTSD.  A casual observer may point out that if killing people leads to PTSD, then bomber pilots and artillerymen would be the most affected population, but the truth is quite the opposite.  Pilots and cannoneers rarely see the death and destruction they cause, since they are miles from the carnage.  For them, it is simply another day at the office.  Snipers are also some of the least affected, since the distance to the target is so great (Grossman pg 98).

     Those who kill at close range are the most affected.  A highly decorated Marine officer recounted an experience he endured in Vietnam, when an enemy machine gunner had his Marines pinned down.  The captain was able to move, and approached the enemy gunner from the rear, getting within a few feet before being detected.  When the enemy tried to turn and fire, the captain shot him through the face with his pistol.  Until that point, he viewed the enemy as Godless, less than human, cold and unfeeling.  Now, in his nightmares, he sees him as he truly was; a scared teen-age boy.  He remembers the look of stark terror on the boy’s face right before he was shot, and the officer is riddled with guilt over that act, 40 years after the event took place.  This killing was almost at arm’s length, up close and very personal, causing a much stronger reaction.  This captain was also somewhat of a victim, in that he believed a common training tactic, which is dehumanizing the enemy. (Anonymous, personal communication, n.d.) 

     Shay covered this topic in detail, where the Viet Cong were viewed as “not real soldiers.  Stateside instructors portrayed them as ill-equipped and not to be feared…by the superior American war machine” (Shay pg 104).  Training tactics were altered after World War II, when a study conducted by General Marshall, USA, determined that of all front line troops involved in direct contact with the enemy, only 20% actually fired their weapons, even though their life was in direct danger (Grossman pg 15).  The military learned that if men do not like killing men, the enemy must be portrayed as less than human.  In Vietnam, the firing rate was 95% (Grossman pg 181).  This was viewed as a success, but in reality it exposed even more soldiers to the guilt of killing.  At the time of the killing, the enemy was less than human, but as the captain soon learned in his nightmares, they were very human after all.

 What Can Be Done?

     Many experts agree that one idea which can assist in warding off the effects of combat lies in realistic training.  Vietnam veterans complained that their training was in no way reflective of their combat experiences.  The military adjusted the approach to training after Gen Marshall’s discovery of such low firing rates.  Instead of the standard targets used on the firing ranges, bobbing targets shaped like men were used which would fall when hit.  Noise, smoke, and confusion were added to training evolutions, thus simulating the reality of combat to as close a degree as possible.  This helped prepare combatants for the reality of war, and shield them from the shock experienced by WW II, Korean and Vietnam war veterans.

     In the entire first chapter of Achilles in Vietnam, Shay makes the point that “bad leadership is a cause of PTSD” (Shay pg 196).  Trustworthy leadership gives combat troops confidence, but those combat leaders must adhere to strong moral convictions and forbid atrocities.  Many veterans related that when the leader violated a sense of “what’s right”, the onset of PTSD began (Shay pg 3).  Cantrell and Dean collaborated on a book entitled Down Range: To Iraq and Back, which strongly supports the views of Grossman and Shay, and expands on the prevention and treatment of PTSD.  They suggested that veterans can take personal measure to alleviate or mitigate the effects of combat stress.  The first step is to talk it out, in a safe environment, with people who can be trusted.  The next recommendation is to write it out.  Putting words on paper can help vent out the frustration and guilt felt by many veterans.  They highly recommend that veterans avoid self-medicating, but do develop a regular exercise routine to help release the tension of stress (Cantrell pg 52-53).
 

     In a telephone conversation with Dr. Shay, he relayed the importance of group therapy, and agreed that combat veterans helping other combat veterans is one of the strongest tools available in the recovery process.  Sadly, PTSD caused by combat stress will never completely go away.  A combat veteran has been permanently changed by the experiences of violence and death, but coping skills can be learned to help the veteran learn to enjoy living again, and live a full productive life. (J. Shay, personal communication, 23 Feb, 2008)

     The only guaranteed method to avoid combat stress is to avoid warfare altogether.  Until mankind reaches that level, the social impact of PTSD must be dealt with.  Men and women in uniform today are this nation’s best and brightest, and they deserve our full attention when asking for help.  Grossman, Shay and Cantrell covered the subject in detail, from cause to recovery.  Now, it is up to us to listen to their expert teachings, and take action.

Tim Jordan
Orientation to Graduate Learning in Psychology
Dr. Bob Jacobs
February 24, 2008

 References:

Cantrell, B. & Dean, C. (2005) Down Range: To Iraq and Back, Seattle: Wordsmith Books, LLC

Grossman, D. (1995) On Killing, New York, NY, Bay Back Books

Shay, J. (1994) Achilles in Vietnam New York, NY, Scribner