PTSD and the rehabilitation of returned soldiers

As reports emerge that as many veterans have taken their lives this year as have been killed in the 13 years of the war in Afghanistan, a new narrative is emerging around post-traumatic stress disorder.

His reckoning came on the Kokoda Track, among the mud and mosquitoes, but it wasn’t the physical toil that awoke him. It was the stories. Adrian Talbot had taken this pilgrimage as part of Families of the Fallen, a group of veterans and families who had lost serving children. They bonded negotiating hellish inclines, but were more deeply joined by the stories they shared at day’s end. “There were guys talking about transitioning to civilian life,” Talbot tells me. “And families would tell us how their sons died. It resonated. I broke down on that mountain.” 

It was 2013 and Talbot was suffering. He was withdrawn, volatile, distressingly numbed. At the funeral of a friend’s daughter – she had died agonisingly young, taken by muscular dystrophy – he watched the father carry the tiny coffin. Then he scanned the room. Everyone was swollen with grief. “I knew I should be feeling sad,” Talbot says, “but I didn’t. I had suppressed so much.”

He had left the defence force after six operations on a shattered hip forced a medical discharge, and he drifted. Before the discharge he had been first on the scene when a colleague killed himself with a single shot to the head. He had watched as the body bag of a dead soldier was moved and recognised the attached service number as a friend’s. He had patrolled Afghanistan during a counterinsurgency where it was often impossible to immediately determine the enemy. Here, hyper-vigilance and paranoia were adaptive virtues. Now, though, they were expressions of an illness. In civilian life, he was working in security, like many vets. He was also abusing prescription pills and drinking heavily. 

Adrian Talbot had post-traumatic stress disorder, even if he didn’t realise it yet. He tells me he was fortunate enough to have a wife who “stayed with me when I was an awful individual. Something inside her told her I’d come back.”

On the Kokoda Track, years of suppressed emotion finally revealed itself. The stories he heard struck a chord. He realised he wasn’t alone. Realised he had been defying assistance. When he got home, he asked work for time off and barely left the couch for two weeks. He was exhausted. But he was going to get help. 

More than a decade earlier, in 2001, Talbot was in his early 20s and coaching young tennis players in New South Wales. One day, at home, he watched the twin towers collapse live on television. Something stirred. He tells me this inner agitation was partially naive, confused. But it was insistent. He wasn’t sure how he was meant to go back to work the next day; how he could pretend nothing had changed. His daily routine – his purpose – suddenly seemed less vital. “A seed was planted,” he told me. 

Four years later, while travelling in Europe, he joined Britain’s Royal Marines Commandos. He later deployed to Afghanistan. 

Controversial diagnosis

Post-traumatic stress disorder did not appear in the Diagnostic and Statistical Manual of Mental Disorders until 1980, when it was added largely as a result of the dismal flood of United States Vietnam vets who were experiencing the disorder. An estimated 700,000 veterans required some psychological help. But even then, PTSD remained controversial among clinicians – it required the pioneering work of psychiatrists such as Chaim Shatan to champion its inclusion in the DSM. 

The US military had launched Operation Salmon during the Vietnam War, embedding therapists in every battalion, and had seen reduced numbers of infantry demonstrating psychological distress compared with the Korean War. It was initially thought a success. But in the years following the war it became clear there was a generation who, in the words of famed war correspondent Michael Herr, “had their lives cracked open for them”.  

For centuries the symptoms of PTSD were recognised, but their cause was found in moral dissolution. In Shakespeare’s Henry IV, the titular king returns from war and his wife mournfully asks him: “What is’t that takes from thee thy stomach, pleasure and thy golden sleep?” Centuries later, 300 British soldiers were executed for “cowardice” during World War I.

What might be clinically recognised as PTSD today, was variously referred to as “shell shock”, “battle fatigue” or “war neurosis” throughout the 20th century’s major wars. These conditions were considered at the time to carry implications of individual fault or lack of moral fibre. 

What was crucial about the PTSD as it was described in 1980 was that it formally shifted the etiology – or causation – of battle-induced trauma. Where previously it was attributed to an individual’s weakness, it was now recognised as the result of an external, catastrophic event. Today, it is a household phrase. 

“Over 30 years ago,” Professor Mark Creamer tells me, “when I started, I had to try very hard to convince people that it was real – that it wasn’t the result of weakness or cowardice. Thirty years later and it’s almost the opposite – I’m trying to convince people that people are resilient and that the majority of veterans aren’t significantly affected.”

Creamer is a professorial fellow at Melbourne University’s psychiatric department, and an expert in PTSD. He tells me there are four core elements of PTSD. “One, that the person is haunted by this past horror. Two, the person avoids any reminders of it. Three, there’s a more general psychological distress that overlaps with depression or anxiety, say, and finally a hyper-arousal. You will see fluctuations between each of these.”

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