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.
Military men and women spend their careers training and preparing for deployments - learning codes of conduct, military identity and values, and dependability. Alongside practical skills they also learn another essential skill; keeping their emotions in-check, especially the negative ones. Being a team-player means focusing on the positive and keeping negative comments to yourself. The realities of faraway places, however, can bring many things - they see first-hand the benefits and limits of their training, the values and costs of comradeship and an intensity of life that can not be repeated anywhere else. Some veterans describe it as becoming a supercharged version of themselves that they have to give up again to fit in back at home. For some people, it feels like spiraling down into emptiness and this is where problems begin; they face troubling questions about who they are, the value of what they did, and about the world in general. Memories of deployments begin to pop up to be reconciled but the need to keep emotions suppressed keeps these experiences locked in place with no outlets.
The promise of being larger than life is fleeting – ‘it’s like a drug’ - even though the physical and mental costs of adrenaline mode can continue for a long time afterwards. They miss the rush. Military veterans tell me many things: ‘It was nothing like I thought it would be but I still miss parts of it, it’s crazy - the excitement, the never knowing … I mean all the training and that was it … there is nothing more, just come back home and forget about it … it’s not finished … It’s not like what you see on TV, you’re just there, man. Who do you tell this stuff to? ’
There are two common ways to describe reactions to extreme events - as a form of brain dysfunction affecting memories and secondly as an inability to return to some former pre-event status. While the first explanation is the subject of ongoing research, the second one is usually the focus of nearly all forms of PTSD treatment. So, what keeps people from returning to their normal; preoccupied instead with past experiences? Some do not want the past to end because coming home brings a tremendous loss; they simply don’t want to came back down to what feels like emptiness. But, there is not much room for super-charged people in routine life. They are left to rely on strategies to avoid losing emotional control (remaining externally-focused and maintaining mental toughness) which paradoxically keeps the good and not so good parts of past experiences alive – they pile up and threaten to explode. The number one fear among those who may be traumatized is losing emotional control because it goes against everything they have been trained to do – they don’t know where it might lead. Some people carry secrets that can never be said out loud for fear of embarrassment or ridicule; they try to ignore reactions of emptiness or outrage linked with guilt or the failed promises of being larger than life. It takes incredible mental energy to keep these emotions in-check – it wears people down.
Getting back on track does not mean wallowing in uncontrolled emotions. Instead, the creation of safe environments where military people can speak candidly and honestly without fear of repercussions or being emasculated may be the real challenge in heading off OSIs. People get well all the time; first when they feel safe enough to be real, and secondly, when they have the courage to begin the business of facing themselves.
John J. Whelan
John J. Whelan, Ph.D., is the author of Going Crazy in the Green Machine, available now on FriesenPress.