veterans


This seems like the appropriate day to tell you that we have a problem with military veterans in the US. We all do. It doesn’t matter where you land on the ideological spectrum or what you thought about some US foreign policy decision. If you live in the US, you are benefitting from the sacrifice of our veterans, and it’s not enough to pay your taxes and put a “support our troops” magnet on your car.

The problem has two aspects. The first is more or less logistical–a resource problem. There are veterans today who, after risking life and limb for you, are homeless, who are taking out second mortgages on their homes to pay their bills, who are undergoing long, intense bureaucratic nightmares for disability benefits, and many other forms of economic suffering. Not all of them, of course, but it happens, and this should never happen. Unfortunately, aside from voting or working in social services, I’m not sure what you can do about it. If you hire people, though, consider hiring veterans.

The second aspect is more spiritual. In this country, we are bad at integrating our warriors into civilian society. We get tired of our wars and stop paying attention to them. We don’t know where our returning warriors have been or what they have done. We’re not interested. We benefit but we don’t care. Or we’re scared to find out. Our warriors end up holding their stories on their own, or inside their brotherhood, not fully part of the wider culture. Not all of them, of course, but many, and this should never happen. Luckily, there is something you can do about this. Stay interested in the details of our conflicts. Be around veterans and be interested. Don’t pry, but listen.

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PTSD was recognized in the early 1970s and formalized in 1980, largely the result of work by and with US veterans of the war in Vietnam. Many people who think about these things consider this recognition to be a turning point in psychological diagnosis. In fact, one way of thinking about psychological diagnosis is that most of what we now call Mental Disorders are basically variants of PTSD–the ways that different people respond to different traumas. If the committee working on version V of the DSM were to humor us, they might rename the tome The North American and European Catalog of Post-Traumatic Stress Behavior Patterns Plus a Few Other Human Difficulties.

Here’s a fuzzy map from the wikipedia article, showing PTSD rates. The darker the red, the more PTSD, and the lighter the yellow, the less:

Here are the criteria, word for word, from the Diagnostic and Statistical Manual of Mental Disorders IV-TR, pages 467 and 468:

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

(2) the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or More ) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep

(2) irritability or outbursts of anger

(3) difficulty concentrating

(4) hypervigilance

(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The distrubance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

Acute: if duration of symptoms is less than 3 months

Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor