Opinion

Treating the trauma of war – fairly

In relabeling cases of PTSD as 'personality disorder,' the US military avoids paying for treatment.

Page 1 of 2

The high incidence of post-traumatic stress disorder (PTSD) among soldiers returning from Iraq is one of the many "inconvenient truths" of this war. Inconvenient largely because it is costly: The most effective and humane means of treating PTSD are time-intensive and long-term.

The military, however, has changed the terms and given many thousands of enlisted men and women a new diagnosis: "personality disorder." While the government would be obliged to care for veterans suffering from combat-related trauma, a personality disorder – defined as an ingrained, maladaptive way of orienting oneself to the world – predates a soldier's tour of duty (read: preexisting condition). This absolves Uncle Sam of any responsibility for the person's mental suffering.

The new diagnostic label sends the message: This suffering is your fault, not a result of the war. On one level, it's hard not to see this as another example of the government falling short on its care for Iraq war veterans. Yet there's another, more insidious, bit of sophistry at work. The implication is that a healthy person would be resistant to the psychological pressures of war. Someone who succumbs to the flashbacks, panic, and anger that haunt many former soldiers must have something inherently wrong with him. It's the psychological side of warrior macho: If you're tough, you can take it. Of course, we know this is not true. Wars forever change the lives of those who fight them and can leave deep scars.

Now is not the first time that psychiatric diagnoses of returning soldiers have been altered apparently for reasons of political expedience. During World War I, countries in Europe were overwhelmed with men coming home complaining of paralysis, confusion, insomnia, and other unexplained symptoms. The disorder came to be known as "shell shock" – a term the British War Office banned in 1917 because it asserted a direct connection between the war and the problem, which meant those suffering were eligible for treatment.

German psychiatrists debated whether such mental problems were the result of "trauma" (from the Greek for "wound") or "hysteria" (from the Greek for "womb," referring to a neurotic state associated with women). Over time the medical establishment favored "hysteria," which put the blame on the individual's failure to adapt rather than on the intolerable nature of modern warfare. In fact, it was thought that the camaraderie and rigor of battle would help strengthen those with "weak" mental constitutions and motivate potential malingerers. (A great scholarly book on the topic is "Hysterical Men: War, Psychiatry, and the Politics of Trauma in Germany, 1890-1930" by Paul Lerner.)

In Germany and Austria, the goal shifted from easing a man's pain to rendering him fit to go back to battle, often through the use of strong electric current. (Sigmund Freud was an expert witness at a trial for a prominent psychiatrist accused of overly cruel electric treatments.)

Page 1 | 2 | Next Page

Get Monitor stories by e-mail:
(Your e-mail address will be protected by csmonitor.com's tough privacy policy.)
(Lionel Cironneau/AP/File) When the Berlin Wall came down
Twenty years later, the rest of the world is a different place because of that event.

POLITICS Patchwork Nation
The American voter beyond red and blue


Daily podcast

Monitor Reports

Discussions with Monitor reporters from around the world


Today

Pat Murphy

Life and duty continues at Ft. Hood.




Making a difference
Making a Difference

What happens when ordinary people decide to pay it forward? Extraordinary change. See how individuals are making a difference, finding solutions, overcoming adversity, and giving back globally.

To address South Africa's huge education gap, José Bright helps students achieve, one by one.

Melanie Stetson Freeman/Staff

Educating South Africa's kids, one by one

José Bright flew in as a consultant, but decided to stay and become a real force for change.