Joe Tarantolo, M.D., Psychiatrist
The diagnosis of PTSD was created in response to pressure from Vietnam veterans who wanted to be sure of their right to receive medical and financial benefits as befitting any man (the military was minimally integrated at that time) who fought in an unpopular and hateful war. We must be clear about this to be able to take PTSD out of the sphere of medical diagnoses and place it where it belongs: a social, political, and moral position in a country ambivalent about its warriors.
If PTSD is not an illness, a medical condition, if we are clear about that, we can then be able to ask pertinent questions about the function and purpose of this pseudo-illness. What purpose does this diagnosis serve? Whereas initially, post-Vietnam, the diagnosis allowed an outlet for the country’s guilt for over 50,000 American deaths and a million Vietnamese deaths for an ill-begotten war which ultimately detracted from our world status and security, we are once again faced with harrowing questions about our national character:
(1) Are we a peace-loving or warmongering nation?
(2) Are we freedom-loving? Do we love freedom more than security?
(3) Are we committed to a noble view of the “warrior class” or is our deeper value more darkly cynical?
In answering these questions certain truths should be addressed:
(1) A large chunk of our volunteer military, perhaps a majority, seek out the military for a secure job, not out of patriotic love of country or the honor and courage associated with military service. This is particularly true in difficult economic times. We now have a type of military socialism – not quite what Eisenhower warned about a “military-industrial complex” but close – where very large numbers of the populace directly rely on the war machine to earn a living.
(2) Our freedom has been lessened, not enhanced, by the misnomer “war on terror:” restrictions on movement, unauthorized government intervention wiretaps, restrictions on habeas corpus and more. This is important given that the rationale for the war machine is to “protect our freedom,” literally die for our freedom. To understand pseudo-diagnoses one has to address Orwellian misspeak.
(3) With the perfecting of drone attacks, killing increasingly comes from afar. Killing from afar runs contrary to every cultural notion of a noble warrior class. This idea got significant play under the Clinton administration with the sending of bombers but no foot soldiers to make war on Serbia. There were actually some national/international voices calling us cowards. “Why don’t you fight like a man?!”
My thesis is that the function of the PTSD pseudo-diagnosis is that it gives voice as scapegoat to disowned parts of our national laments. We might think of PTSD as scapegoat – those with the diagnosis hold the revulsion that we can’t express more directly because of political and cultural constraint.
The PTSDer gets an enormous amount of pseudo-sympathy directed at him. The complexity is that he is also held in contempt, drugged as if he is unable to bear his memories, pathetic, requiring medical attention in lieu of compassionate understanding.
He, the PTSDer, must hold both our shame and our guilt, our guilt in that we have become the primary international killers and our shame in that we kill out of fear rather than noble cause.
A true “treatment” of PTSD needs a national voice that will not be spoken. We are not allowed to “apologize for American values” nor criticize our rationale for war. Recall, a decorated veteran (J. Kerry) of the Vietnam War, running for President, was called a liar and coward because he headed a band of vets who condemned the war. On the other side of that coin we were not allowed to criticize another nominee (J. McCain) for his bombing of innocent Viet Nam civilians.
We are now faced with an overwhelming number of veterans demanding disability benefits. I suspect much of this “disability” is the inability to speak out against the “war on terror.” Rage has become pathos, spousal abuse, suicide, homicide, drunkenness, and wounded brains. As Stan White (father of 2 vets lost because of the war on terror and who has championed better treatment of veterans) says, “Anger doesn’t accomplish anything.” Indeed.
Treatment Principles: ( The term “treatment “ is problematic but for now we are stuck with it.)
(1) Best in a group where multiple points of view are aired.
(2) Group leader quickly establishes that he does not think they have a disease.
(3) Minimal emphasis on symptoms such as insomnia, anxiety, depression, etc.
(4) The object of the intervention is clarity of thought, not in “ feeling better”.
(5) Therapist must be able to hold a whole spectrum of points of view, “ God bless America” “ God damn America”.
(6) The position of the therapist/facilitator is we are dealing with a moral, political, spiritual, existential problem, not a brain disease.
(7) Encouragement to “Speak-Up” about what you think about country, war, the “enemy”, government, leaders, particularly the negative views. In the negative views one will find the anger and ultimately the deeper sadness about themselves as “failed” warriors and failed peacemakers.
(8) The object, ultimately is to transform the military scapegoat (alias PTSD) into a role model for honest debate about who & what we are as a nation & a people.
(9) The group, as they reflect & debate will discover they are a microcosm of their country/culture debate, a debate poorly articulated. As they experience the conflict within the group, they will begin to see the conflict within each individual.
(10) Bad dreams & flashbacks are respected as the mechanism whereby we dare not forget. We must all hold the various horrors together.