The Valor of Stress

James_DixonUnlike for physical injuries, no formal recognition is currently given by the US military for the biopsychosocial injuries sustained in combat, known as posttraumatic stress disorder or PTSD.  It is as if the many behavioral, emotional, and social consequences of traumatic stress are perceived to be of lesser impact, and thus less deserving of acknowledgement.  That they can be serious enough to warrant medical and psychological attention is now fairly well established.

The evidence is certainly not lacking, as serious outcomes of PTSD continue to occur. Most recently, the blog The Soldier’s Load reported  the story of  James “Rooster” Dixon III, an ex-Marine and long-time sufferer from PTSD who was killed by a State Police SWAT team in front of his house in Baxley, Georgia.

James sought treatment from the VA for his Post-Traumatic Stress Disorder (PTSD), but was unable to shake the constant anxiety and depression that are hallmarks of the disorder. On February 19, 2012 James decided to end his struggle by walking into the bullets of law enforcement: as much a casualty of the war as any service member who died in Iraq.

The blog’s editor, as someone with direct experience of war zone and combat stress and its psychological consequences, also offer insights into his own struggles with PTSD.

I became a functional recluse—avoiding social situations and new experiences that might trigger a panic attack. Friends and acquaintances got accustomed to me declining their invitations to socialize. Eventually they stopped asking. I drank heavily and destroyed romantic relationships in a depressing cycle of thrilling novelty, fear of entrapment and cold dismissal. After three years of struggling with the symptoms of my unknown malady, I chose to leave the Marine Corps. On my way out the door, the VA finally diagnosed me with combat-induced PTSD.

A Purple Hart for PTSD?

images Events such as the tragic end of James Dixon highlight the important questions that still surround how PTSD is perceived, labeled, acknowledged and treated—including the idea of awarding a Purple Hart in recognition of this very serious constellation of injuries that are sustained by so many service men and women. According to the Military Order of the Purple Heart, the Purple Heart medal “is awarded to members of the armed forces of the US who are wounded by an instrument of war in the hands of the enemy and posthumously to the next of kin in the name of those who are killed in action or die of wounds received in action. It is specifically a combat decoration.”  Should this wording be applicable to PTSD?

The Soldier’s Load asks,

Why do we fail to classify veterans with PTSD as combat wounded? I suggest that the reason has less to do with logic and more to do with the emotions surrounding a small bronze portrait suspended from a narrow purple ribbon. (…) Until we correctly label combat-induced PTSD as a “wound” suffered from contact with the enemy, we as a society will continue to view its sufferers as a shadow legion of men with strange habits and questionable character. We will not methodically identify the trauma, apply medical treatments, and provide appropriate rehabilitation and therapy during the recovery process. In short, we will draw distinctions between segments of combat veterans based on an arbitrary and antiquated determination that only the visible wounds of war are worth recognition, honor and treatment. Such a view will not be helpful to the thousands of combat veterans waging a daily war within, nor prevent some from ending that struggle before victory is won.

Read the full blog post. Do you support a Purple Hart for PTSD?

Election Stress: What’s Remarkable

Have you noticed how resilient, how unflappable, how remarkably at ease the Republican candidates seem to be with the ups and downs of the primaries? I see good public stress management in this.  There appears to be an ability to maintain one’s composure in the face of the many gyrations brought on by polls, speculations and actual results, which have made these primaries particularly stressful and also particularly interesting.

Unless one has direct experience of it, it is objectively hard to appreciate the rigors of a national political campaign.  The lack of sleep, poor nutrition, constant travel are hard on the body.  The need to be constantly on, to never let one’s guard down more than so much, to come across as competent and well prepared on anything the candidate may be asked to speak on are hard on the mind.  The relentless demands of the news cycle, the unflinching stare of the media and of the public in general, and the near-constant re-examination of one’s principles, conviction and history are hard on the soul.  There is probably no better image of what stressful circumstances really are about than a candidate for political office on a bus or airplane, exhausted, traveling toward yet another rally, another interview, another stump speech, another event.  And it goes on like this for months and months.

The aging that takes place in office is a well known phenomenon.  In our modern era, we have photographs of presidents taken at all points of their campaign, at inauguration, at midterm, and after they leave office.  It is plain to see the toll that the job takes on the individual’s physical appearance.  Less obvious is the toll that it takes on the mind and on the soul. The fact that we have presidents and ex-presidents who not only do what they are supposed to do, but do it well, and continue to be in good health and function well into their late adulthood is certainly a testament to their resilience and excellent stress management skills.

And so for the candidates, the test begins upon declaring their intention to run for the highest office.  The highly public management of their stress levels begins at that moment and never lets up. If their bid is unsuccessful and their campaign ends, they can return to normality and what they may have to work through is the fallout from having lost their campaign.  Not easy, to be sure, but at least it can be relatively private.  For those who succeed and win primary after primary, or win enough to be a player and stay in the race, the rigors of the campaign will either hone their skills or bring out the lack thereof.

When the last man is finally left standing and he’s elected president of the United States, another even more demanding phase of public stress management begins, never to let up again until the very end of life.  It is remarkable and an object lesson that it can even be done as well as it is by these truly exceptional individuals we call our presidents.