PTSD and the Flawed Biology Narrative

A 'narrative' can be described as the main story or public discourse to describe the ways in which we understand and talk about social issues. The prevailing PTSD story – a medical story - grew out of the USA in response to distress among a disavowed and rejected generation of military men and women. It has been around so long that we do not even think about it. Increasingly, other stories from veterans challenge this prevailing narrative but these stories do not gain traction, they don’t seem to stick, because they are often at odds with or introduce information which negates the power of the science narrative. For example, the ‘moral injury’ narrative, the ‘sanctuary trauma’ narrative or the ‘betrayal trauma’ narrative accounting for veteran distress seem to float independent of the science narrative. These other accounts do not fit with the science story so they are conveniently forgotten because they place the spotlight on the social environment and away from individual sufferers. I am not saying, necessarily, that these other narratives are at odds with the flawed biology narrative (And, by the way the evidence only suggests affected biology but not the origins), just that these other perspectives are not taken seriously by those who benefit from the science narrative.
 
The main accounting of PTSD as injured brains carries considerable weight; it is consumed readily by average citizens. The power of science also convinces those who are affected directly. It is important that people experiencing any form of mental distress benefit from having their legitimate concerns and problems taken seriously.  And biological science does answer some of the questions about what is occurring in the brains of people who are chronically distressed. But this science - medical narrative also excludes other information from consideration. Almost every military person and first responder tells me that institutional values and codes around performance, relationships and actions of their leadership, and the day-to-day organization of their workplaces are what wears them down. Yes, first responders see and participate in awful things; that is part of the work they sign up for and conduct on behalf of the rest of us. But, they also tell me that it is not the awful things but the lack of respectable outlets in recognizing and managing the after-effects of adrenaline mode that wears them out. To allow themselves to have human responses just does not cut it …. It goes against everything they have been taught, trained, and been required to do.

The flawed biology narrative would lead us to believe that the lingering effects of wars can be reduced to brain anomalies among some people – Susceptible heroes. Witnessing the effects of war, death, and killing become sterile conversations about medical symptoms. When it comes to military veterans, a second narrative in Canada, at least, seems to come down to the management of compensation for legitimate injuries. In this case, the after-effects of military training and deployments are reduced to squabbling over financial compensation and governmental liabilities. Distress is reduced to a central question - Are they real hero victims?

There is another narrative, the social-relational story (that accounts for moral, sanctuary, and betrayal trauma), if you will, that accounts for much of the lingering distress among first responders. Typically, nobody entertains this view because of concerns it could erode the seriousness to which other people take veteran concerns. In my experience, mental health issues do not emerge from a vacuum; things like depression, anxiety, and chronic PTSD occur as responses to the environment, including the relational environment. Everything matters - the immediate threat environments, the values and beliefs of responders, and the seriousness to which everyone takes the issue of decompressing and acknowledging the personal costs of life in uniform – any uniform.
 
Again, I am not discounting the medical narrative. But I am saying that a mental disease tag comes with a very high price – Broken hero. It is too steep a price for many people to consider paying. We would be better off considering PTSD as the mental-emotional price that is paid by people attempting to uphold and work within a set of beliefs and values that simply do not apply in the face of their direct experiences. In other words, the injury is also about an erosion of an identity under repeated assault. It is vital that veterans and other first responders continue to tell their own stories. We need to agree on a narrative that reflects their actual experiences and the things that institutions and communities need to consider to help prevent these issues in the first place and respond more effectively when mental declines do occur.       

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