The measure of a civilization is how it treats those who have hurt it,

and those who are hurting in it.

How civilized are we?

Hardly
a day goes by where you don't read or hear of some story about Post
Traumatic Stress Disorder in soldiers and veterans. If you live or work
near any urban setting hardly a day goes by when you don't drive by a
homeless veteran who is possibly suffering from PTSD. Every week we
hear warnings about the expected "tsunami" of returning soldiers and
the toll that PTSD will take on them, their families and –if our
country has a conscience—the anticipated cost of treating them.

One
of the reasons PTSD is so overwhelming is that it can seem like a waste
bucket term that may include depression, anxiety, panic, psychosis,
alcohol, substance and tobacco abuse, domestic violence, work
impairment, medical illnesses, etc. As such we are often left acting
like a dog chasing its own tail taking a spackled approach to it, but
that ends up feeling as if we are falling further behind in dealing
with it.

Most
treatments that focus on alleviating symptoms from the outside in are
destined to fail or be incomplete until we truly understand PTSD from
the inside out. The following is a work in progress to do so. It is
based on my research and work with veterans and soldiers with PTSD. I
invite any and all people whom PTSD affects to offer input to make this
analysis more accurate.

1. Pre-trauma state of mind – actions, feelings and thinking aligned with a common purpose towards
   a command goal (i.e. post "boot camp," intra-deployment, pre-traumatic
   event mindset). This occurs when you have been broken down and rebuilt
   to serve the mission and look out for your buddies in war. You have
   been built into a fighting machine that feels like it can accomplish
   anything.
2. Horror – "I can't believe what I
   am seeing or what I have just done. None of my training prepared me for
   this." This occurs after you have been injured, seen a buddy or buddies
   killed or maimed, or have seen civilians you have killed or maimed. You
   feel like a deer in the headlights of a car emotionally, even as you
   proceed doing what you were trained to do.
3. Vulnerability – "I could kill or maim someone or I could get killed or maimed." You
   feel a crack in the porcelain of your courage (that you keep to
   yourself and causes you to feel weak, ashamed, and less worthy than
   others).
4. Terror – "I will be in another
   situation and then another and then another that will break me wide
   open." Fear of a re-traumatization that will rip the crack wide open
   (that you keep to yourself and feel weak and less than others) and make
   you shatter.
5. Panic - The terror is
   intolerable and you want to run, and if you can't, you start to implode
   inside. You smile as if to tell the world you're okay, but if anyone
   looks into your eyes they can see the fear.
6. Self-preservation - You do whatever you can to survive psychologically. You secretly don't
   tell anyone that the mission and even your fellow soldiers are less
   important than doing whatever you need to do to make it through another
   day. To help with this you begin to isolate from others, use alcohol,
   pot or whatever can help you numb yourself.
7. Shame - You feel weaker and less of a man than the soldiers around you. And
   when you are separated from the service, the shame keeps haunting you.
8. Avoidance - You avoid people because you feel so ashamed and don't want people to
   know and turn to drugs and alcohol or anything that will help you numb
   yourself.
9. Fight or Flight – after separation
   from the service, you pull away from your family and other people, who
   will never understand. A part of you is tempted to stay in contact with
   other separated soldiers, but a part of you wants to avoid that because
   it threatens to bring back too many bad memories. If you are cornered
   as in traffic by a motorist who cuts you off, or someone in public who
   ticks you off, or a spouse who won't stop badgering or nagging you, and
   if you can't avoid the confrontation, the "fight" part of your brain is
   triggered and without thinking, you may resort to what you've been
   trained to do and get violent.
10. Withdrawal into your mind –
    the more you run into incidents such as the one described in 9 above,
    the more you withdraw from others into your mind. But there is no peace
    there, so you again reach for things to numb you and this creates a
    vicious cycle.

(c) 2008 Mark Goulston