Updated: Feb 11
It is positive that awareness, and to a large degree acceptance, of Post-Traumatic-Stress-Disorder (PTSD) has grown within the military community over the last two decades. There has been a lot of work by service people and veterans themselves to promote awareness and they deserve genuine credit for their work which will have saved lives as a result.
Unfortunately, along with greater awareness has come an unhelpful narrative of PTSD as a heroic injury. At first glance, it might seem helpful to frame PTSD in this way because it seems like it promotes a view that is both respectful of the sacrifices service people make in combat and of service people themselves. However, when framed in this way it brings unintended consequences that far outweigh any benefits, so it's worth looking at the reality of PTSD.
PTSD is not limited to combat experiences or military service. Anyone, military or civilian, has the potential to suffer trauma and to be diagnosed with PTSD and indeed most people with PTSD have not served in the military or experienced combat. PTSD can result from a range of threatening situations including car accidents, assaults, childbirth, or indeed any sufficiently threatening event. It can even be a response to a vicarious experience such as that of a parent whose child is taken suddenly ill. It does not need to be earned; it simply is, and any experience of PTSD is as valid as any other.
PTSD symptoms, and the impact on the ability of the sufferer to function, do not map simply onto an 'objective' assessment of how 'bad' the incident was. Every individual is affected differently because every individual's experience, both prior, during, and after the incident are different.
PTSD can be cumulative, sometimes referred to as Complex -PTSD, or CPTSD, due to experiencing multiple traumas, overtime. You are very unlikely to know the full extent of someone's experiences when judging the validity of their diagnosis.
PTSD will affect other areas of sufferers' lives. They may develop problems in their work and personal lives which increase their stress, or which lead to added difficulties like depression. The result is that PTSD may indeed be only part of the problem but that does not mean it is not either central or a valid part of those difficulties. Pointing to these other difficulties, or writing them off as life problems, misses the point of how PTSD is likely to impact sufferers lives in multiple ways.
Despite these realities, the desire to make PTSD a heroic injury, like a war wound, which is only experienced by those who have shown exceptional courage and valour, makes sense when we consider that mental health problems are very often still viewed as personal weakness within the military community. To many in the community, to see oneself as 'weak' is near the worst thing one can be. This is no accident; military culture is designed to produce service people who identify with a view of self that is based on a particular archetype of masculinity rooted in 'strength' and 'mental toughness'. Anything seen to depart from this identity is framed as weak (see here for more) and so, in that context, it is understandable that there is a desire to make PTSD different to other mental health problems in hope that it loses the connection to 'weakness' and is reframed as 'heroic'. The effect of this can be damaging for everyone, including those with PTSD...
It perpetuates the notion that mental health problems are the result of 'weakness' and the answer is to be stronger. But not only is this false, it's harmful, particularly as strength in the military is often synonymous with suppression of unwanted thoughts and feelings leading to people attempting to cope, or even deny the problem, in ways that make things much worse in the long run.
It creates a false hierarchy between PTSD and other mental health problems, where PTSD is seen as valid while other diagnosis continue to be stigmatised. This can, and does, prevent people seeking help for their mental health, prolonging suffering, and increasing risk of harm.
Internalising the belief that mental health problems are weakness means that even those with PTSD can come to view their own experience as being the result of weakness, regardless of the narrative of heroism attached to PTSD, because most people do not identify themselves as heroes. War is messy and complex, and PTSD impairs our ability to step back and put our experiences into context. The result is many sufferers feel they do not meet this 'ideal' and are shamed away from seeking the help they are entitled to.
Framing PTSD as the result of heroism, leads people to create a hierarchy of 'acceptable' causes of PTSD. Arguments are regularly made on online, and offline, about the validity of individual's PTSD diagnosis because people didn't see combat, enough combat, or their tour was not deemed hard enough. It causes well meaning people to police the label of PTSD and to decide who is deserving or not for fear that the 'undeserving' are gaining credit for heroism they believe some others do not deserve. But, as we know now, PTSD can impact anyone, it has nothing inherently to do with heroism, or weakness. The result is sufferers are expected to prove their experience was 'worthy' or else be framed as effectively liars or 'weak'. This is invalidating, creates needless suffering, and counterproductive. It leads sufferers to question if they are 'worthy' of help and the result is many fail to come forward due to the shame this produces. This can, and does, kill people.
So, there are three takeaways I would ask people to consider, and encourage others in the military community to consider. Firstly, to question whether continuing to frame PTSD as a 'heroic' injury is as helpful as we might intend it to be and to consider who might be harmed if we continue to push this narrow understanding of a complex condition?
Secondly, to ask ourselves if, as observers, we really have information we need to question other people's experiences? What do we think we are gaining when we do this, who are we helping, and who are we harming in the process?
Thirdly, how best we can get people who need help what they need, regardless of whether we personally think the PTSD label fits, or not? If people tell you they need help, is it not better to help them access it than dissuade them by argue the merits of their diagnosis?
Service people and veterans rightly take pride in supporting one another. If people say they need help, they need help. That's all we really need to know. So lets worry less about the labels they use and more about making sure they get the help they need.
Christian Hughes is a veteran and Psychotherapist, specialising in Acceptance and Commitment Therapy, Compassion Focused Therapy & CBT, with expertise in trauma & PTSD and a special interest in Moral Injury.