PTSD and the Hidden Wounds of War

Everyone has heard of PTSD, but veterans, clinicians and scientists say most people misunderstand not only the disorder, but the other ways that war affects individuals and families.

This video was produced by the Dart Center for Journalism and Trauma from interviews conducted at "When Veterans Come Home," a conference held in Atlanta in 2010, sponsored by Dart Center, the McCormick Foundation and the Carter Center’s Mental Health Program. For more interviews on this subject, see our Videos on Veterans.

Anyone who reads the news has heard of post-traumatic stress disorder among returning veterans. Those four letters — PTSD — have come to represent everything negative that war does to soldiers' minds and spirits. But scientists, clinicians and scientists all take issue with this use of the term.

In this video, Sonja Batten, deputy director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, explains exactly what post-traumatic stress disorder means as a psychiatric diagnosis. Matthew Friedman, executive director of the National Center for PTSD, talks about how the term has been stretched. Jonathan Shay, a clinical psychiatrist and author of two must-read books on the experience of veterans, points out that the affects of war are far more wide-reaching than any psychiatric diagnosis. Michael Jernigan, a retired Marine corporal who sustained physical and psychological wounds when his Humvee was hit by a roadside bomb in Iraq, explains how PTSD doesn't do justice to his own experience.


Michael Jernigan: Let's talk about PTSD. A very clinical term, very much medical. You know, you think of rubber rooms and straight jackets, you know, this is a "psychological disorder," a "mental illness," a "mental disease" are some of the terms that have been used to describe it. It's not.

Matthew Friedman: I think there's a difference between PTSD, the clinical disorder, and PTSD, the metaphor. You know, we use a lot of mental health diagnostic terms colloquially. People say, "I'm depressed" or "I'm feeling paranoid" when it's really a metaphor; when I'm feeling lousy or I'm feeling suspicious. I think the same thing is happening to PTSD now that it's become part of the culture at large.

MJ:  PTSD is an anxiety disorder that is basically a sheet of symptoms that if you can check enough of those symptoms off then you receive that classification.

Sonja Batten: The first set of symptoms are what we call the re-experiencing symptoms. The re-experiencing symptoms are things like intrusive memories, flashbacks, nightmares, things like that. The second set of symptoms are what we call the avoidance symptoms. Those are things like not wanting to go into situations that remind you of the event. Avoiding conversations that have to do with the traumatic event, emotional numbing, things like that. And then actually with the third set of symptoms in PTSD are what we call the arousal symptoms. And arousal symptoms are things like hypervigilance, being on guard all the time, always scanning for signs of danger, having an exaggerated startle response, something like that.

MJ:  It is a psychological injury. That is a key term that I've learned in this conference that I like, I think I'm going to use it, I'm going to stick to it. An injury denotes something that I can recover from. A disorder makes me think of something that is just daunting and that I'll never be able to get over it.

Jonathan Shay: The primary and irreducable psychological injury from war is the persistence in the civilian life of those valid adaptations that allow you to survive when other people are trying to kill you — and doing a damn good job of it. Those adaptations are in the mind, in the brain: in the mind, in the form of social connection that people form, and also in the culture that people come to inhabit in the armed forces. So it really encompasses the whole human critter.

MF: We shouldn't be surprised that bad stuff's going to happen, and we shouldn't be surprised that some people are not going to be able to cope with it and are going to have problems, and that those problems may be clinically significant, which is where diagnosis ... but for most of them, they're going to be — they can wreck a marriage, they can wreck a career, they can wreck a friendship, but it might not be PTSD,

MJ: We are people, you know. And we have feelings. And we don't feel like we're victims, we don't feel like we're suffering. We just feel frustrated with trying to come to grips with the things that have happened to us and trying to learn to live with them. How to live productively and happily with our experiences that we've had.

Additional video by Charles Mostoller and Daniel Johnson-Kim.