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Hello, this is Semen Bashkirov, I am Russian journalist.
Almost a month ago, while scrolling through Facebook, I came across a video. In it, writer and politician Zakhar Prilepin said: “I do not know a single mentally handicapped person from war. There are even people who have been in captivity, who have had the most severe injuries, who have seen things that, God forbid – and this are the most remarkable, clear, and healthy individuals.” Prilepin considers post-traumatic stress disorder in soldiers to be a fantasy. According to the writer, it was invented by the “Soldier’s Mothers Committee” to “destabilize society.”
These words cannot be called simplification, distortion of facts, or even simple ignorance. It’s a lie that doesn’t stand up to the collision with a multitude of authoritative scientific studies. In the West, not only is the problem widely discussed, but it is also meticulously researched. In 2019, Joe Biden (then a candidate for US President) acknowledged that “the number of suicides among veterans is exponentially higher than those killed in combat.” Two years later, a study by Boston University confirmed this: for every seven thousand American soldiers killed in combat, there are thirty thousand who have taken their own lives.
Perhaps Zahar Prilepin would object to me and say that the problem only exists in the USA. And he would be wrong again – in my letter today I will prove it. My text is about how people return from war. Why this is a problem for the whole society, not just specific military personnel. And what ways there are to cope with it.
In the autumn of 2021, former American military Brian Riley was walking around the city of Lakeland, Florida. Seeing a man mowing the lawn, Riley ran up to him and screamed, losing his voice.
Riley yelled that the daughter of a man named Ember wants to commit suicide – and supposedly, God himself told him, Riley, about it. The man on the lawn was very surprised: firstly, he was caught off guard, and secondly, he didn’t have a daughter named Ember.
The man told Riley about it and he left. But the next day he returned, invaded the man’s house and shot him. And along with him – his wife, their three-month-old child, grandmother and dog.
Riley was arrested. During interrogation, he stated that he was ordered to shoot the family by voices in his head, one of which belonged to “God” himself. The sheriff of Polk County, to which Lakeland belongs, emphasized at a press conference following the incident: “This is not a typical criminal. We are dealing with someone who obviously had mental health problems.”
In turn, the director of the local branch of the “National Alliance on Mental Illness”, Natasha Pier, stated that Riley suffers from post-traumatic stress disorder: from 2008-2010 he served as a marine in the US Navy contingent in Afghanistan and Iraq.
According to Pierre, the trigger for a man could have been the withdrawal of American troops from Afghanistan – this happened after 20 long years since the beginning of the campaign. Many veterans then asked themselves questions like “What was it all for?” and “Was it even worth it?”.
Part One, Theoretical: What is PTSD and how does this disorder manifest in those who have returned from war
Post-traumatic stress disorder, or PTSD, occurs in individuals who have experienced a deep psychological trauma. This can be, for example, the death of a loved one, a serious car accident, a natural disaster, sexual or physical violence. War is also a cause – and PTSD can occur in both civilians and military personnel (who have witnessed death or killed others themselves).
In post-traumatic stress disorder, a person repeatedly relives the traumatic event after it has ended. Strong emotions and physical reactions resemble those that occurred during the event.
If we specifically talk about military PTSD, then in scientific publications, four of its main manifestations are described:
- Obsessive thoughts. War seems to return in dreams and flashbacks. It may even seem that the battle is happening right now (as, for example, in this video), which often leads to panic attacks.
- Change in behavior. A person avoids places and things that remind them of the war. They try to protect themselves from stress as much as possible, gradually losing interest in work and usual hobbies.
- Negative emotions and beliefs. And not just negative, but exaggeratedly negative: fear, feelings of guilt and shame.
- Alertness. A person feels that they should always be on guard. Therefore, it is difficult for them to concentrate, sleep poorly and be constantly irritated.
Symptoms of PTSD can manifest both in waking life and in dreams. This condition has several serious consequences. For example, people with PTSD often become aggressive and display unjustified anger. In addition, they are more likely to commit suicide. Some studies explain this with physiological changes that occur in the hippocampus, prefrontal cortex, and other parts of the brain. However, these theories are still not fully understood.
Not all military personnel who have experienced combat develop PTSD. The proportion of those affected varies from conflict to conflict, and we will discuss this in more detail below. The likelihood of developing the disorder depends on several factors. Age plays a role (the older, the more likely), rank (the lower, the more likely), as well as whether the military personnel themselves became a victim of physical violence (if so, it is more likely).
Science cannot definitively answer whether post-traumatic stress disorder (PTSD) can be permanently cured and considers it a chronic condition. According to WHO, approximately 50% of people with PTSD recover within three months of their initial symptoms. However, there is evidence that only one-third of people recover within a year.
And a third of people still have symptoms of PTSD even 10 years later.
Part Two, Historical: How People Came to Understand That War Veterans Sometimes Become “Different”
The term “PTSD” appeared relatively recently, in the second half of the 1970s. However, humanity made the first attempts to describe this condition over five thousand years ago.
For example, symptoms similar to those of PTSD are recorded on Mesopotamian clay tablets. And one of the first mentions of psychological trauma caused by war belongs to the Greek historian Herodotus. Describing the Battle of Marathon in 490 BC, Herodotus told of an Athenian soldier who went blind upon seeing the death of the man standing next to him (although the blinded soldier himself was not even wounded).
In the 19th century, soldiers’ anxiety and constant stress were identified as a separate disease called “soldier’s heart”. The study of this condition was accelerated by World War I: a large number of veterans returning home “different” attracted the attention of psychiatrists.
Russian historian Alexander Astashov described the impact of the First World War on Russian army soldiers, many of whom were formerly peasants: “Even more significant for trench soldiers was the oppressive trauma of sitting in trenches in a state of perpetual ‘melancholy’ and ‘boredom’ rather than in battle, which at least offered some certainty… Compared to ‘combat psychoses’ in the trenches, the intensity of emotions was less, but the duration was longer. Hence, exhaustion of the nervous system, loss of strength, melancholy, a sense of anxious waiting, and an overall strongly expressed emotional sphere in illness.”
In the second year of the First World War, in 1915, military hospitals of the warring states were overcrowded with soldiers suffering from panic attacks, blurred vision, and convulsions. British military psychiatrist Charles Myers observed them and published the results of these observations in the scientific journal The Lancet. He introduced the term “shell shock”: according to Myers, changes in the psyche of soldiers were caused by the noise of artillery shelling.
What Myers called “shell shock” was a common phenomenon. However, it was believed that only people with moral deficiencies and weaknesses were susceptible to it. Some were even accused of cowardice – supposedly, a brave fighter would not have such reactions. The therapy was harsh: electroshock and regular physical exercises. Eighty percent of the military personnel who underwent such treatment were not able to serve again. Because of this, they tried to help themselves – mostly with drugs and alcohol (which, of course, only exacerbated their condition).
Some methods of treatment at that time were more humane. For example, British army doctor Arthur Hurst tried to help his patients through “conversational methods”. No electric shocks or exhausting training – instead, Hurst sent veterans on calming walks through the English countryside and gave them the opportunity to work on a farm. In addition, the doctor suggested that the soldiers reveal their creative potential by publishing a special magazine – it contained, for example, a gossip column called “What They Whisper in the Ward”. It was claimed that up to 90% of Hurst’s patients recovered quickly.
At the beginning of the Second World War, doctors increasingly recognized that military actions could have serious consequences not only for physical but also for psychological health. In an attempt to understand why this was happening, scientists concluded that supposedly too many men with tendencies towards anxiety or “neurotic tendencies” were selected to participate in the First World War.
Partly because of this conclusion, six times more Americans were not allowed into military service in the early 1940s than at the beginning of the 20th century. However, this did not help. In World War II, symptoms of PTSD were recorded about twice as often as in the First World War. They were called “psychic collapse”, “combat fatigue” or “war neurosis”. Almost 1.4 million out of 16.1 million American soldiers during World War II were treated for “combat fatigue”; it was also the cause of 40% of discharges from service.
A real breakthrough in the study of PTSD occurred after the Vietnam War. Society did not support it, and the goals set before the army were achieved at great cost. In the late 1960s, the American contingent began gradually withdrawing from the country. Soldiers who had suffered deep emotional trauma from the war returned home: many of them became much less psychologically stable; some were overwhelmed with rage; others, on the contrary, were in a state of numbness.
Canadian-American psychiatrist Haim Shatan called it the “post-Vietnam syndrome.” He began a campaign to officially recognize the “syndrome” as a diagnosis. And in 1980, “post-traumatic stress disorder” was included in the American Diagnostic and Statistical Manual of Mental Disorders, Third Edition. Twelve years later, it was included in the International Classification of Diseases.
The American edition of ABC told the story of Vietnam veteran Ed Smith, and there are thousands of such stories in the United States. In childhood, Smith studied at a Catholic school, served as an altar boy, and sang in the church choir. He enrolled in the University of Miami, then was drafted into the Vietnam War. Recalling his first days at war, Smith admitted that he sympathized with the enemy. However, he quickly realized that he needed to “fight for himself to get out of here as soon as possible.”
Smith quickly received the rank of captain. Artillery installations, helicopters, and military ships were put into action at his command. And Smith recalled that controlling them “was the ultimate high on the planet.”
After a year of service, the veteran returned home. His loved ones noticed that he had changed greatly, and Smith himself recounted this change as follows: “Before the war, I was a good and meek person, but afterwards all my attitude towards the world was expressed in words like ‘to hell with this, to hell with that’. I no longer had sympathy for others. The army broke me.”
The man was diagnosed with PTSD. He started drinking and his marriage fell apart. Even decades after returning from Vietnam, the veteran cannot fall asleep without circling his house perimeter – like a guard on duty.
But it doesn’t help him sleep well either: Smith often wakes up in the middle of the night to take another round.
Part three, medical: why do some military personnel experience PTSD while others do not (and how those who do experience it are treated)
In 1983, the US Congress initiated a comprehensive study of PTSD in soldiers who returned from Vietnam. It was found that the disorder occurred in 30% of men and 27% of women.
Scientists have been observing Vietnam War veterans for decades and have discovered that many of those who experienced the war continue to suffer from PTSD even years later. Because of this, veterans have faced a range of problems including frequent conflicts within their families and divorces, difficulties in raising children and sexual dissatisfaction, low levels of happiness and physical health. This was confirmed in 2015 when researchers found that there are still around 271,000 people in the US living with PTSD acquired in Vietnam.
Every time the US Army has entered into another armed conflict over the past 30 years, the consequences have been studied by psychiatric scientists. And every time, a portion of veterans have returned home with PTSD. This applied to both the successful campaign in the Persian Gulf and the unpopular invasion of Iraq in society.
Some researchers noted that the frequency of PTSD among soldiers was influenced by the intensity of the conflict. Thus, only 11% of American soldiers who served in Afghanistan were found to have the disorder, while 20% of those who were in Iraq had it. According to experts’ estimates, these military campaigns differed in the frequency of stress factors. For example, 39% of “Afghans” saw killed people compared to 95% of “Iraqis”. Distribution by other indicators was also not in favor of Iraq: soldiers were shot at (66% vs 93%), attacked (58% vs 89%), personally knew someone killed or seriously injured (43% vs 86%).
Western media often writes about incidents involving veterans of Afghanistan and Iraq. For example, in 2014, the British newspaper The Guardian told the story of Englishman Danny Fitzsimons. As part of the allied contingent in Yugoslavia, Afghanistan, and Iraq, he was a sniper and earned many military awards.
After eight years of service in 2004, the man’s contract was not renewed due to the discovery of an “anxiety disorder”, but no psychological assistance was offered. In Britain, Fitzsimons was charged with attacks on people and for firing a signal pistol at teenagers who climbed onto his roof.
In 2008, a court-appointed psychiatrist diagnosed PTSD in Fitzsimmons, and a year later another specialist confirmed the diagnosis. In his report, the doctor wrote: “He [Fitzsimmons] vividly describes nightmares, vivid dreams, and visual flashbacks. He often feels the stench of burning flesh and smells of death… His whole body tenses up when he sees emergency signals of vehicles, as in Iraq they were only turned on in those cars that transported explosive devices”.
In August 2009, Fitzsimons secretly started working for a British private military company without the knowledge of his family and doctors. He was sent to Iraq without any background check, and there he immediately shot two of his fellow soldiers. The 20-year-old man was put in a local prison. In 2019, he was transferred to the United Kingdom, where the former soldier is still serving his sentence.
Including because of such incidents, PTSD is recognized as a serious problem among military personnel in the West. In the USA, the medical care program for active-duty service members and veterans covers the expenses for the treatment of this disorder.
The special American agency, the Department of Veterans Affairs, deals with not only physical but also psychological health issues of military personnel. To diagnose PTSD in military personnel, they undergo interviews where standard questions are asked. This conversation can take anywhere from five minutes to an hour. For example, the patient needs to evaluate on a five-point scale how well statements like “Before I joined the army, I had more close friends than I do now” describe their condition.
If a veteran is diagnosed with PTSD, they are offered treatment. It includes both psychotherapy (individual, group, or family) and taking antidepressants.
Most often, when working with patients suffering from PTSD, psychotherapists use cognitive-behavioral therapy. This is one of the most researched psychotherapeutic methods, which has been proven effective in many disorders. It was invented by American psychiatrist and psychotherapist Aaron Beck (the same one who created the well-known Beck Depression Inventory). The therapy takes about three months and allows about 60% of patients to be cured.
Another popular practice was once considered doubtful by many experts, but its effectiveness has since been experimentally proven. It’s called Eye Movement Desensitization and Reprocessing (EMDR). Here’s how it works: the patient imagines the moment of trauma while the specialist moves their fingers in front of the patient’s eyes and asks them to follow the movements. This continues until the patient’s anxiety decreases. Then they must focus on positive images and thoughts, such as moving from “I will die” to “I have overcome this, it’s in the past.”
There are also attempts to use experimental methods for treating PTSD – with narcotics. In April 2016, the drug enforcement agency allowed the testing of cannabis for treating post-traumatic stress disorder in veterans for the first time. Within a month, the US Congress allowed veterans to buy medical marijuana for PTSD therapy – in states where it is permitted in principle. However, soon the Republican majority blocked the amendment on this.
Another narcotic substance that some researchers consider promising for PTSD therapy is MDMA. Several scientific studies prove that taking MDMA (but not just any, but controlled – under the supervision of a doctor) helps PTSD patients to open up better during psychotherapeutic sessions, tell more about their traumatic experience, and work through it.
Researchers came to these conclusions after the results of experimental eight-hour sessions with several volunteers who suffer from PTSD. They took MDMA and discussed their experiences with specialists, while also attending regular therapy sessions with their psychotherapists every week. The MDMA experience was repeated twice more – once a month. After this, PTSD symptoms disappeared in 66% of patients. However, this study was conducted on a small sample (90 people participated in the experiment), so final conclusions cannot be drawn from its results.