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Purple Heart or Scarlett Letter: PTSD-Stigmatization of War Veterans

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Rachel Robinson
August 1, 2017

Veterans deserve to enjoy the freedoms they fought for. Unfortunately, due to the stereotype that they all suffer from Post-Traumatic Stress Disorder (“PTSD”) and that PTSD makes them inherently dangerous (at worst) or unreliable (at best), veterans are sometimes unable to fully reintegrate into the society they served. Not all veterans suffer long-term PTSD effects, but for those that do, this social stigma imposes personal shame and can prevent them from obtaining the care they need. When veterans cannot find employment, they may not have the financial resources to cover the costs of their medical care. The VA reports that there are currently 20 million veterans in the United States spanning four wars: WWII, Korea, Vietnam and the Gulf Wars. The Department of Defense calculates over two million current active duty and reserve service members. This segment of the population cannot be ignored, not only because of their number but also because of their military contribution and potential to contribute in civilian life.

From Homer’s Iliad to Hollywood, society has glamourized war and acknowledged the mental effects it can have on its heroes. In real life, when these heroes return to civilian life, they may be forced to contend with an even more difficult and insidious enemy than the one they were trained to face on the battle field: the stigmatization associated with PTSD.

To properly train and prepare soldiers for battle, the military accentuates and rewards strength and stoicism while eschewing any perceived physical, mental or moral weakness. This focus on personal strength fuels the concept that mental disorders are a result of personal weakness rather than symptoms of personal trauma. Interestingly, in its attempt to treat veterans’ mental disorders and ameliorate the social stigma, the medical community has inadvertently contributed to it. William P. Nash, et al., chronicled the medicalization of PTSD in The Historic Origins of Military and Veteran Mental Health Stigma and the Stress Injury Model as a Means to Reduce it, Psychiatric Annals, August 2009.

Nash writes that Hippocrates, known as the Father of Modern Medicine, may have been the first to propose that mental disorders could be caused by a diseased mind rather than by direct intervention by the gods. Hippocrates’ theory was mostly ignored, however, until the Age of Enlightenment, when the scientific method was used to assess the behavior of humans under stress. During this era, military surgeons documented the disabling mood and anxiety symptoms of soldiers at war and named it “nostalgia.” This led to soldiers obtaining treatment rather than being shamed, exiled or even executed for cowardice. Since then, PTSD has been known by many names.

Wax - blogimage_VeteransInitiativeNash continues that during the bloody American Civil War, PTSD was diagnosed as “soldier’s heart,” “irritable heart” and “sunstroke.” In World War I, doctors believed physical brain trauma from nearby artillery blasts caused PTSD and, accordingly, renamed the disorder “shell shock” or “nervenshock” among the Germans. In 1916, the German Association for Psychiatry proclaimed that PTSD only occurred in individuals with “hysteria.” Although blatantly stigmatizing, the term persisted until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (“DSM”) removed it in 1980 and replaced it with PTSD. Since then, PTSD has been defined as the result of a stressor “that would evoke significant symptoms of distress in almost everyone.” Plainly stated, “a normal reaction to an abnormal event.”

While this definition seeks to normalize PTSD and thus reduce the accompanying social and personal stigma, only a minority of veterans suffer from long-term PTSD even when exposed to the same stressor events as their comrades. Thus, personal weakness has persisted as the default explanation. In response, the fourth edition of the DSM added a person’s preexisting vulnerabilities contribute to the effect of a stressor event. This can be construed, however, as simply a more neutral way of attributing long-term PTSD to a personal weakness.

Nash’s proposed “Stress Injury Model” attributes stressor events to physical changes in the brain that result in PTSD symptoms. This model seeks to neutralize the negative effects of PTSD stigmatization by proving that PTSD is not the result of personal weakness. However, while this model will likely lead to better medical care, it does not account for the societal and personal shame that prevents veterans from seeking that care in the first place. It will not assuage employers’ concerns or encourage them to hire veterans. The issue is not why some veterans suffer from PTSD but rather why society is so afraid of those who do.

The National Institute of Mental Health estimates about 18 percent of the U.S. population suffers a mental disorder. Yet, most people live fulfilling lives whether they seek treatment or not because they are not presumed to be mentally ill in the same way veterans are presumed to have PTSD. The irony is reintegration and access to proper medical care will ameliorate symptoms of PTSD and allow our soldiers to regain their rightful place in society so they can again enjoy the freedoms they fought for.

Author: Rachel W. Robinson holds a Master’s Degree in Public Administration with a focus in Leadership and Management from Bowling Green State University and a Juris Doctoris from Washington University in St. Louis School of Law. She recently completed the Bar exam (July 25-26, 2017) and will begin her legal career as an Assistant Circuit Attorney in St. Louis, Missouri in October. Congratulate her here: https://www.linkedin.com/in/rachel-w-robinson-j-d-a69922a

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