Greetings, dear readers. The Witch has been busy, lately. I’m back in school (carrying an A average, thank you very much), and enjoying the hell out of my English Composition II class. Our final big paper is a researched proposal, and our Professor cautioned us to choose a topic we could write volumes about. So I did. 

I’ve told you about my mother, in an earlier post, and now, I’d like to tell you a little about my father. He was a man of very few words. A World-War II veteran, from him I learned two things: my love of history, and that war is a terrible thing. When he first said those words to me, I was young enough that I didn’t quite understand the true weight of what he had said. Time and acquaintance with the world in all of its glory (or lack thereof) have lent new meaning to his simple statement. I fully support the men and women who serve not only my country, but nations all over the world. They have an unimaginably difficult job to do, and I wish them blessings, each and all. This is my final proposal from that class. I hope you enjoy my work as much as I enjoyed researching it and writing about it. This is about combat-related Post Traumatic Stress Disorder, so be warned: it’s not my usual fluff…


Imagine, just for a moment, the most horrifying event of your life: a time when you genuinely felt your very existence was threatened. Remember how helpless you felt, knowing there was no escape, even as the adrenaline rush of terror urged you to “Run!” Now, imagine re-living that trauma over and over again, day and night, both in your dreams, and during your waking hours. While you’re at work, and when you’re spending a quiet afternoon with your family; perhaps while you’re fishing with your child, or out with friends in a crowded night club. Aside from the fact that you can’t escape from the horror you’re re-living, you have little or no warning before it hits, and when it does nobody can see or hear or taste the horror, except you. But they can see you, and how you react to what looks (to them) like thin air. Not understanding, they call you weird or crazy, and suddenly you’re more alone than you ever thought possible. You try to hide it, because you can’t explain it—to even try might make the horror even more real. And who would believe you anyway? This is reality, for many combat veterans who suffer from Posttraumatic Stress Disorder. We owe it to the men and women of our armed forces to educate ourselves about the worst wound of war, so that—as a society—we can help them enjoy the freedom they fought so hard to win. It’s time to repay the debt society owes those who gave so much for the cause of freedom.

According to an article in Developments in Mental Health Law by F. Don Nidiffer and Spencer Leach, as long as humans have hunted animals, and competed with other humans for food, there have likely been stress reactions to life-threatening traumatic events similar to PTSD. Combat-related hysteria has been recorded as far back as 1700 B.C.E, ancient Egyptian physicians observed anxiety reactions to combat. Shakespeare refers to combat anxiety in Henry IV, but it wasn’t until two hundred years later, in 1678, that the malady was given a name—“Nostalgia” (6). Most who recall the Vietnam War know of someone who suffered from “Post-Vietnam Syndrome”, however it has only formally existed as a disorder since its inclusion (in 1980) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (Nidiffer and Leach 3). The criteria that must be met for this diagnosis include “A traumatic event considered outside the range of usual human experience that would be distressing to almost anyone” (Adler 301). Those criteria continue to evolve.A subsequent edition of the Diagnostic and Statistical Manual—DSM-IV—includes the following “…exposure to a traumatic event in which an individual ‘experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or threat to the physical integrity of self or others…’ and their subjective reaction to this [A-1] event was one of ‘one of intense fear, helplessness, or horror.’” (qtd. by Adler 301)

Reactions to combat-related hysteria from military commanders have been varied and often brutal. During the American Revolution those suffering from PTSD were treated as deserters or malingerers, and punished accordingly—flogging and sometimes execution were common punishments (Nidiffer and Leach 6). During World War II, in a now-infamous incident, General George Patton encountered a young man suffering from shell-shock, and slapped the young man, telling him to get out of the hospital and back on the battlefield. More recently, in the wake of the Vietnam War, combat veterans returned to a country that had transferred its negative feelings about the war itself on to them, isolating them from the social and emotional support normally provided veterans. This fueled an already intensely negative self-image, making it even more difficult for them to return to a quasi-normal life. The emotional and psychological disturbances faced by Vietnam veterans were the basis for the formal establishment of PTSD as a mental disorder.

PTSD is a very real wound. Whether immediate or as a delayed reaction, an estimated 16-20% (Buchanan et al. 743) of combat veterans find that the training they’ve received—teaching them how to endure the rigors of life in a war-zone—aren’t something they can pack away with their uniform and try as they might, they find themselves unable to cope with day-to-day life on the home-front. The emotional detachment, hyper-vigilance, and obsession over combat-related experiences become a cross that proves difficult to bear, where once they were skills essential for survival. Combat-related PTSD affects sufferers every moment of every day. SSGT. Jeremiah Workman, a Marine Drill Sergeant and veteran of Operation Desert Storm who now suffers from combat-related PTSD, describes a typical morning for him:

“I slide out of my rack. When I hit the floor, I feel clammy and off. I haven’t felt right in months. Now that the booze remains in the bottle, the memories and nightmares plague me every night. What little rest I get is always interrupted.

Beside the bed, I stretch and yawn. A typical morning routine, but the engine’s not firing. Something’s missing.

Hope. Faith.

Oh, yeah. The realization wipes out the last of my sleepy grogginess.

I shamble over to the bathroom sink and find my razor. Water running, I start to lather up.

My eyes focus on the sink. I know I’ll have to look into the mirror, but I avoid it as long as I can. I dread this time. I cannot hide from myself. In my reflection, there is no escape.” (Workman 5)

Workman’s situation is far from uncommon. Approximately 10-20% of the men and women who have served in the Persian Gulf War (PGW) alone, are affected to some degree by PTSD—a daunting number, when you consider that nearly 1.9 million have served in-country during the PGW in some capacity. (Tanelian, 5) A personal friend—also a veteran of Operation Desert Storm—who wished to remain anonymous had this to say about his own experience with PTSD:

 “The bullet-wounds and knife-wounds heal, and the scars fade. Those are easy. But war? Fighting in a war, the things you do and see? That changes you. It makes you look at who you are and what you believe about yourself and the world. It scars your soul! And you can’t tell anyone the things you’ve done because they’ll think you’re a monster. It damages you. And if you believe in reincarnation? Your next self will still carry that scar, too. It just never goes away. I know I’m a monster. I hate what I became because of war” (Anonymous).

Yes, sometimes the personal demons win. While with continued treatment, a combat veteran may resume some close proximity to a normal life, for them the war never really ends. It changes them on such a visceral level, that a good night’s sleep, uninterrupted by dreams of the past is something a combat veteran with PTSD can no longer accomplish.

            Post-traumatic stress disorder is treatable, responding well to a combination of therapy, family education, and various anti-anxiety and anti-psychotic medications. These make the symptoms more bearable; however the already bad situation is aggravated by the stigma attached to admitting that there is a problem. Fear of being labeled a coward, losing a promising career in the military, or of being called a liar prevents many sufferers from seeking treatment. Lack of access to—or outright denial of—care and services (a problem that has existed since the Korean and Vietnam Wars, if not before) presents an additional barrier to healthcare utilization. (Buchanan, 744) Left untreated, many combat-related PTSD sufferers turn to alcohol or illicit drugs to ease the worst symptoms, or simply to get drunk or high enough to not dream—not to remember how damaged their psyche is. Their use and abuse of these drugs creates further problems with friends and family, causing them to further withdraw into their inner world.

The severest of symptomology of PTSD is difficult to wrap one’s brain around. How can the mind of one specially trained to have little or no emotional reaction to the horrors of war be so adversely affected by combat experiences, that the affected soldier re-lives it in the form of hallucination, dissociation, and/or vivid nightmares? Are they just making it up? There is an unscrupulous minority of malingerers who will try to benefit from the real suffering of others. Studies, such as those conducted by Porter, et al., Frueh and Kinder, and Morel, among others, have shown that, with the right information and a moderate amount of acting ability, it’s possible to successfully falsify answers on self-reporting questionnaires used to determine a diagnosis of PTSD, at least superficially. However, these same studies have shown that using several of these diagnostic tools in conjunction with each other, along with more traditional psychiatric tools, such as the Rorschach Ink-blot Test, decrease the possibility of successful malingering significantly (Freuh and Kinder 292).

According to Nidiffer and Leach, military training is a double-edged sword. In essence, soldiers are taught the behaviors that become Combat-Stress Reaction (CSR)—often a precursor to PTSD. In their words, “The irony of military training is that soldiers are trained to be hyper-vigilant…to remain unemotional about what they might have to do in injuring or killing others or tending to their own wounded comrades, and to obsess about previous combat related experiences, thereby enhancing their chances of success and survival” (Nidiffer and Leach 12). An un-named Virginia National Guardsman with the Explosive Ordinance Disposal Unit put it neatly: “The military teaches you how to have PTSD” (Nidiffer and Leach 12).

But while they teach these behaviors as a matter of survival in battle, there is a marked lack of reintegration training for soldiers and their spouses or family members. Scott A. Lee, a combat veteran and PTSD survivor, has the following to say, in his blog: “Without… reintegration of the self, a combat veteran can and will run afoul of friends, family, and society. The returning combat veteran faces hurdles that they have not been trained to handle.” He states that compared to the hell a soldier has been through in battle, a returning combat veteran is misled by his training into believing that he will be able to easily re-enter civilian life. “…they are still operating from the combat value system and attachments, where in American society they individual is the central concern” (Lee). Lee describes untreated PTSD as a “permanent and debilitating mental wound”.  

Aside from the psychological damage to the individual there is a marked effect on those closest to the combat veteran, as lack of education regarding PTSD leads to a breakdown in interpersonal relationships. According to the study conducted by Buchanan et al. regarding partner education, less than half of the participants (spouses/intimate partners of returning combat veterans) had  received any formal training regarding the potential for and symptoms of Posttraumatic Stress Disorder (746). This lack of training, coupled with the substantial barriers, both psychological and physical, to treatment-seeking that returning combat veterans face, serves only to exacerbate an already difficult situation. Partner education gives friends, family members, spouses, and intimate partners the tools needed to encourage their loved one to seek the treatment they need, and to support them throughout that treatment and recovery. Breakdowns in romantic relationships have been linked with poorer prognosis, lower treatment engagement, and increased risk of suicide for combat veterans (Renshaw and Campbell 953). Considering the case of Soldier X, whom we will assume is male, the chain of events leading to the breakdown in family relationships is fairly simple. It starts when Soldier X is deployed for active combat. We all know that war is a terrible thing, but nothing can truly prepare a soldier for what he (or, in some cases she) is about to face on the battlefield. Soldier X experiences numerous episodes of intense, stress-inducing trauma (e.g. being shot at, seeing others die, being physically abused or seeing others being physically abused, etc.) during combat, and the anxiety and fear related to these events. Assuming that he doesn’t lose his life in battle, Soldier X returns home after deployment, ready to return to his life pre-deployment (Buchanan, et al. 744). He attempts to re-integrate into ‘normal’ life, and finds that his/her world-view is altered to the point that he is unable to trust even those he’s closest to. The predominant feeling reported by combat veterans is a deep feeling that they are all alone both in combat and after it, that they felt deserted in combat, that all of their past and present relations had been severed in combat, and that everything had become meaningless (Dekel, et al. 416). Soldier X finds himself plagued by horrific, incredibly vivid nightmares, flashbacks, and/or other dissociative episodes, auditory or olfactory hallucinations, etc. Reacting to these episodes in a manner consistent with his military training, the soldier’s emotional detachment/numbing, hyper-vigilance, adrenaline rush, paranoia, and obsessive behaviors become more pronounced. These ingrained reactions make Soldier X seem withdrawn, distant, edgy, and irritable to their romantic partner and/or other family members. Lacking an understanding of the symptoms of PTSD, as roughly 2/3 of spouses or intimate partners do (Buchanan, et al. 746), the partner mistakes this withdrawal and irritability as being directed toward them (Renshaw and Campbell 957) Confused, the partner attempts to discern what they’ve done to prompt this behavior, or set of behaviors. Soldier X closes himself off emotionally. Fear of being labeled ‘crazy’, ‘cowardly’, ‘weak’ or losing their military career (Buchanan, et al. 743) prevents Soldier X from discussing his problems or seeking treatment for them, and he withdraws further into his shell. Soldier X may begin engaging in self-destructive behavior, such as alcoholism. According to a 2004 Study by Isobel Jacobson, et al., approximately 30% of participating veterans who were diagnosed with PTSD suffered from some sort of alcohol-related problem (667-668). As his family relationships deteriorate, Soldier X’s symptoms increase in severity—as well as his reaction to them. He becomes moody or angry much of the time, and aggressive toward his partner and other family members, largely due to the excessively high levels of adrenaline flooding his body, keeping him in a constant state of ‘fight or flight’. There is an increased risk—up to three times greater—of domestic violence. (Buchanan, et al. 744) Statistics show 42% of veterans with PTSD committed at least one act of physical violence against their partner. 92% reported a minimum of one instance of verbal aggression ( The likelihood of divorce increases—according to statistics reported by the U.S. Department of Veterans’ Affairs National Center for PTSD, in a study of 50 Vietnam veterans diagnosed with PTSD 38% of marriages failed within six months of return from deployment. Furthermore, veterans with PTSD are three times as likely to divorce two or more times. (

We must find a way to erase the stigma surrounding PTSD, both in the civilian world and within the military itself. Following the episode described earlier by SSgt. Jeremiah Workman, he was ridiculed by his commanding officer, who called him weak and a coward, and accused him of malingering to receive a medical discharge (the superior officer had never seen a single day of active combat). He was then relieved of duty and sent to a PTSD support group by the base commander (Workman and Bruning 7-15), who was far more sympathetic to his problem. Fear of being labeled a coward, of losing a promising career in the military, or of being called a liar prevents many sufferers from seeking treatment. Lack of access to—or outright denial of—Veterans Administration benefits and services (a problem that has existed since the Korean and Vietnam Wars, if not before) presents a further barrier (Buchanan et al. 744). We must do what we can to support those who gave their all for us, ensuring that they get the help they need to become functioning members of society once more. Education regarding this disorder is a great place to start. We owe them that much, and more. It’s time to repay our debt.


Works Cited

Adler, Amy, et al. “A-2 Diagnostic Criterion for Combat-Related Posttraumatic Stress Disorder.”

            Journal of Traumatic Stress 21.3 (2008): 301-308. Web.

Anonymous. Veteran of Operation Desert Shield/Operation Desert Storm. Personal Interview.

            31 March 2012.

Buchanan, Cassandra, BS, RN, et al. “Awareness of Posttraumatic Stress Disorder in Veterans: A

Female Spouse/Intimate Partner Perspective.” Military Medicine 176.7 (2011): 743-51.


Dekel, Rachel, et al. “World Assumptions and Posttraumatic Stress Disorder.”The Journal of

            Social Psychology 144.4 (2004): 404-420. Web.

Freuh, B. Christopher, and Bill Kinder. “The Susceptibility of the Rorschach Inkblot Test to Malingering of Combat-Related PTSD.” Journal of Personality Assessment 62.2 (1994): 280-298. Web.

Jacobsen, Isobel et al. “Alcohol Use and Alcohol-Related Problems Before and After Military Deployment.” Journal of the American Medical Association 300.6 (2008): 663-675. Web.

Lee, Scott A. “The Combat Veteran and the Birth of Dissociation.” PTSD: A Soldier’s Perspective. Blogspot, 21 Nov 2008. Web. 23 Feb 2012.

Meis, Laura A. et al. “Intimate Relationships Among Returning Soldiers: The Mediating and Moderating Roles of Negative Emotionality, PTSD Symptoms, and Alcohol Problems.” Journal of Traumatic Stress 23.5 (2010): 564-572. Web.

Nidiffer, F. Don and Spencer Leach. “To Hell and Back: Evolution of Combat-Related Post Traumatic Stress Disorder.” Developments in Mental Health Law 29.1 (2010): 1-22. Web.

Renshaw, Keith D. and Sarah B. Campbell. “Combat Veterans’ Symptoms of PTSD and Partners’ Distress: The Role of Partners’ Perceptions of Veterans’ Deployment Experiences.” Journal of Family Psychology 25.6 (2011): 953-962. Web.

Tanelian, Terri and Lisa H. Jaycox, eds. “Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery.” RAND Center for Military Health Policy. California: RAND Corporation, 2008. Web.

United States Department of Veterans’ Affairs National Center for PTSD. “Partners of Veterans with PTSD: Research Findings.” (12 December 2011). Web. 10 March 2012.

Workman, Jeremiah and John R. Bruning. Shadow of the Sword: A Marine’s Journey of War, Heroism, and Redemption. New York: Random House, 2009. Print.