Friday, April 29, 2011

Post-Traumatic Stress Disorder: Was It Made in America?

The news from the mental health front is not good. Recent studies have shown that mental illness and emotional problems are not universal medical conditions, but are caused, even produced by different cultural expectations.

Those who are trumpeting the advent of a new scientific age where mental illnesses will be more and more treatable should temper their enthusiasm.

So says Ethan Watters in several articles and a great and important book: Crazy Like Us.  Watters published a comprehensive essay on the topic here and a shorter column about post traumatic stress disorder here.

Writing in the Times about researchers who have done cross-cultural analysis of mental illness, Watters says: “Swimming against the biomedical currents of the time, they have argued that mental illnesses are not discrete entities like the polio virus with their own natural histories. These researchers have amassed an impressive body of evidence suggesting that mental illnesses have never been the same the world over (either in prevalence or in form) but are inevitably sparked and shaped by the ethos of particular times and places.”

This is not to say that people who suffer from what we call mental illnesses do not have problems. Most of the time they do. It is to say that the way they present those problems, the symptoms they unconsciously choose, and their path to recovery is strongly influenced by the ambient culture.

Watters explains: “In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.”

What are the underlying forms of emotional distress that manifest themselves differently in different cultures? In my view they involve anomie, loneliness, isolation, rejection, failure, and demoralization.

Many cultures see these as moral issues, to be solved or managed by family or community. Our culture has tended to medicalize and pathologize the problems and to pack sufferers off to mental health professionals.

In that way we absolve ourselves of responsibility for helping our friends and family. At the same time we feed the ever-growing and ever-hungry therapy industry.

Even where we are dealing with a brain disease like schizophrenia, the recovery rates have a great deal to do with the way a society sees the disease and the way the community relates to the person who has it.

Tuberculosis is tuberculosis is tuberculosis. No matter where you live, no matter your cultural background, the disease is caused by a bacterium and is treated with antibiotics.

Watters explains: “The course of a metastasizing cancer is unlikely to be changed by how we talk about it. With schizophrenia, however, symptoms are inevitably entangled in a person’s complex interactions with those around him or her. In fact, researchers have long documented how certain emotional reactions from family members correlate with higher relapse rates for people who have a diagnosis of schizophrenia.”

Among the worst things you can do for the schizophrenic, studies have found, is to surround him with people who express their emotions openly and freely. You might be surprised to hear this; I was not.

Evidence for the way a culture generates its own forms of mental illness has recently come to us from studies about post-traumatic stress disorder.

Comparisons between American and British soldiers returning from deployments in Iraq and Afghanistan have shown that Americans suffer a far greater incidence of PTSD than do their British counterparts.

Watters reports: “Neil Greenberg of the Academic Centre for Defence Mental Health at King's College London and colleagues reported that studies of American soldiers showed  PTSD  prevalence rates of in excess of 30 per cent while the rates among British troops was only four per cent. UK soldiers were more likely to abuse alcohol (13 per cent reported doing so) or experience more common mental disorders such as depression (20 per cent).”

And also: “’Despite some claims to the contrary,’ Greenberg et al write, ‘PTSD seems not to be a 'universal stress reaction', arising in all societies across all time. Evidence from both world wars suggests that the ways in which service personnel communicate distress is culturally determined and that the development of PTSD may be one more phase in the evolving picture of human reaction to adversity.”

Soldiers do not come home from war with PTSD. The condition develops over time. Watters explains: “This suggests that the psychological reaction to war does not happen in a flash like a shrapnel wound. Rather, it evolves as the soldiers integrate their experiences with the values and expectations of their culture.”

While British and American cultures have much in common, they do set “significantly different expectations for their psychological recovery…. In America, soldiers frequently return to a culture that fully expects them to be psychologically wounded by the experience.”

The evidence suggests that PTSD was induced or conjured into existence by psychiatrists who opposed the Vietnam War. If so, we are facing a situation where psychiatrists have used the pretense of science to impose their values on the nation.

How did it happen? According to Watters: “Diagnosis of PTSD began to take shape in the US after the Vietnam war and represents much more than a clinical set of symptoms. It has become a world view; a weapon in a battle between a militaristic view of the world – where going to war and using deadly force can be both morally justified and personally uplifting – and a therapy view of the world, where violence is an aberration that inevitably damages the human psyche and spirit.

“Originally called post-Vietnam syndrome, modern PTSD began in hothouse rap sessions held by Vietnam Veterans Against the War and supervised by antiwar psychoanalysts. The motivations behind the creation of the diagnosis are clear in early descriptions of post-Vietnam syndrome such as this one written by a young psychoanalyst named Chaim Shatan and published in the New York Times in the spring of 1972: These veterans were suffering because they had been, ‘deceived, used and betrayed‘ by both the military and society at large. That the creation of this syndrome would help the anti-war effort was clear. …

“The diagnosis of post-Vietnam syndrome was intended to highlight the psychological cost of participating in what many mental-health providers perceived to be an unjust war.”

This is not about science, or even brain chemistry. It’s an attempt by one group of people, the licensed professionals who purvey the therapy culture, to impose their values on those who fought honorably in a war. At the same time this group undermined the war effort and punished those who fought in it.

How does it work? Watters explains: “By isolating trauma as a malfunction of the mind that can be connected to discrete symptoms and targeted with specialised treatments, the disorder removes trauma from other cultural narratives and beliefs that might give deeper meaning to suffering. It claims to be value-neutral to cultural beliefs but this is problematic, given that those beliefs – be it God's plan for someone who's lost a child or patriotism for the soldier crippled in battle – are the very places where we once found solace and strength.

“In contrast to those angry but socially engaged Vietnam War veterans, the personal accounts of current-day US soldiers returning from Afghanistan and Iraq often seem pigeonholed into a PTSD diagnosis that is tied to a particularly modern style of lonely hyperintrospection.

“Because the disorder focuses largely on internal states and chemical imbalances within the individual brain, this explanation for psychological problems often leaves the soldier – to borrow a recent US military marketing slogan – feeling like ‘an army of one‘.”

To clarify my own position, and I think, Watters’, I do not think it’s about cultural narratives. It’s about belonging to, being accepted by,  and even honored by your community and the society at large.

The first step toward inducing PTSD was to denounce returning veterans. During the Vietnam era soldiers were spat on and called baby killers; they were considered to be war criminals and were often treated as social pariahs.

If they took pride in their service, they were considered to be suffering from a form of psychopathy. If they re-adapted to American culture when they returned from the war they were considered to be in denial.

The therapy culture communicates values. It values you for feeling vulnerable, but not for being resilient. It values you for being emotionally expressive, but not for being discreet. It values you for being introspective, but not for being gregarious.

It values those qualities that isolate you from you community and make the psychiatrist’s office your last and only refuge.

If you want to be accepted by a psychiatrist you need to present with symptoms that make sense to his value system. Thus, you develop PTSD. It is amazing that psychiatrists, who are credentialed medical professionals, allowed their profession to be hijacked by political activists who wanted nothing more than to label America and those who defended it as deviants and war criminals.


JacksonvillePat said...

"Stolen Valor" by B.G. Burkett; discusses the origin of PTSD as well as many other misconceptions about the Vietnam War.
There also seems to be a higher incident of PTSD in those with a history of excessive alcohol or drug use, disciplinary problems and personality disorders. Often many diagnosed with PTSD have marital conflicts as well.
There also may be some secondary gain by having a disorder that rates disability compensation based upon subjective symptoms.

Anonymous said...

This link is for a study which seems to break the PTSD numbers down more realistically.

PTSD is real. The way it is perceived from culture to culture may vary - I would not be surprised, but service in combat does change your mind and body. I have friends who have PTSD, and I myself like many Iraq Veterans have one or two persistent symptoms - an occasionally extreme temper and a physical reaction to fireworks and loud blasts. I was not a combat soldier, these reactions came about simply from the large number of mortar and rocket attacks on our camp. PTSD is not the way Hollywood portrays it - your average PTSDer is not a broken human being, unable to do anything or have any relationships, suffering from hallucinations, a heartbeat away from snapping and killing someone. They are just normal people who have some problems with hypervigilance and anger, but most adjust or compensate for those issues and do okay in life.

I think it is important to cut the wheat from the chaff. I just read Stolen Valor and I'm not surprised that many people walking around claiming to be Veterans are not. I AM surprised that for so many years the VA did not corroborate these people's stories, and that a fair number never left the U.S. or if they did, served in secured areas. The fact that the VA would believe 30% to be a believable rate of PTSD doesn't pass the common sense test.

Iraq and Afghanistan will present its own problems. It is normal for Veterans to have served two tours there (sometimes more) and there aren't nearly as many "secure" areas so more troops were probably exposed to combat situations, but at the same time, the enemy preferred to do its work from a distance via IEDs or mortar attacks. The long term rate of PTSD will probably be similar to the rate discovered in the study I linked to, with maybe a slightly higher number of us NOT fond of fireworks (please keep us in mind when you are considering firing them off in your yard for the heck of it.)

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