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The Vets Are Alright (The Rest of Us Are the Problem)

December 6, 2011

Ed: Today’s guest post is by blogfriend Petulant Skeptic, med student and US Army 2LT. When not tweeting or blogging, he’s visiting gun shows on my behalf. 

As I read through recent stories about military veterans one thing has crystallized for me: the relentless focus on injuries, PTSD, TBI, and the soldier’s and veteran’s general distress.

Based solely on the media’s portrayal of returning soldiers and veterans one would believe them all to be fragile individuals whose lives may shatter at the slightest additional trauma. However, the vast majority of soldiers return healthy and capable, even if they are forever changed by their experience serving. That is to say, we seem to live in a world where the afflictions of soldiers are covered in the media like airplane crashes, rather than car accidents:

Page-one coverage of airplane accidents was sixty times greater than reporting on HIV/AIDs; fifteen hundred times greater than auto hazards; and six thousand times greater than cancer, the second leading killer in America after heart disease.

The media remarks on the bad – and only on the bad. To be sure, PTSD, TBI, amputations, automobile accidents, plane crashes, and cancer deaths are all very real and very tragic, but it’s long past time we consider the consequences of our relentless focus on the those afflicted by war – because those consequences are real as well.

While the media’s predilection for rare and extraordinary stories has been well documented, what’s more important than the coverage itself is the nature of the coverage. For example: this October 2010 Washington Post article, Traumatic brain injury leaves an often-invisible, life-altering wound, is typical for its genre, coming in at nearly 3,000 words, yet devoting only a few sentences to any sort of wider context. We are told the raw number of diagnoses of TBI since 2000, then given another, larger, number from a RAND corporation study. Completely missing is any sense of scale. Do those 180,000 (or is it 300,000?) soldiers represent 1%, 10%, or 90% of individuals at-risk for TBI?

In a 1996 paper Shanto Iyengar, the Chandler professor of Communication at Stanford University, examined how television news influenced viewers’ attributions of responsibility for political issues and concluded:

By reducing complex issues to the level of anecdotal cases, episodic framing leads viewers to attributions that shield society and government from responsibility. Confronted with a parade of news stories describing particular instances of national issues, viewers come to focus on the particular individuals or groups depicted in the news rather than historical, social, political, or other such structural factors.

This relentless focus on anecdotal, emotional cases that have been stripped of their context is immensely damaging in two different, yet synergistic ways. The first has to do with people’s inability to accurately assess likelihood and frequency. As Jason Daly recently wrote in Discover:

Even if a risk has an objectively measurable probability—like the chances of dying in a fire, which are 1 in 1,177—people will assess the risk subjectively […]. If you have been watching news coverage of wildfires in Texas nonstop, chances are you will assess the risk of dying in a fire higher than will someone who has been floating in a pool all day.

The actual name for what Daly is writing about is the availability heuristic (though it is often referred to as the availability bias), which states simply that people tend to estimate prevalences and occurrences based on how easily they can bring an example to mind.

Which brings us to news stories like those I linked above: their focus on wounded and damaged veterans they make these depictions available. None of these pieces are a problem in and of themselves, but taken together they form our predominant characterization of returned veterans. Moreover, the particular way in which they disseminate this information tends towards the anecdotal and emotional. In a study of the same effect at work in the reporting of automobile accidents using newspaper reports from 1999-2002, Monica Rosales and Lorann Stallones found that:

Injury related events are more likely to be covered when they seem to be out of the ordinary, rare, or dramatic. This may lead to presenting such stories as isolated events (episodic), not as a public health concern. This type of reporting may provide the public with an inaccurate perception by overestimating infrequent causes of mortality and underestimating frequent causes.

The second effect of our national obsession with wounded veterans is more subtle. As Ethan Watters recently wrote in the New York Times, speaking of ADHD, rather than PTSD:

What the history of psychiatry tells us is this: Mental illnesses are not spread evenly among populations over time but come and go as unique and deeply complicated combinations of culture and biology. Which symptoms we collectively see as legitimate determines how we individually express internal feelings and unease. Psychiatric historians suggest that every generation has a “symptom pool,” behaviors by which individuals can communicate their distress.

While Watters was writing specifically about ADHD, his point applies equally well to PTSD. With so much of our culture shaped by a frenzied media, it’s imperative that we recognize feedback loops like this. As the anecdotes become ever more heart wrenching, we widen and deepen the pool of symptoms by which individuals may express their distress. Clinical psychologist Vaughan Bell recently found this interaction of cultural symptom pools and PTSD while writing about PTSD among demobilized guerrillas in Colombia:

While working on a project to rehabilitate ex-members of illegal armed groups, [Dr Ricardo de la Espriella] noticed a striking absence of post-traumatic stress disorder in his patients, despite them having experienced extreme violence both as combatants and civilians. Many had taken part in massacres and selective assassinations, and many had lost companions to equally brutal treatment. There were high levels of substance abuse, aggression and social problems, but virtually none showed signs of anxiety. Intrigued, de la Espriella decided to investigate more closely and carefully interviewed the ex-paramilitary patients again, using the Clinician Administered PTSD Scale, which asks specific and detailed questions about post-trauma symptoms. After this more detailed examination, more than half could be diagnosed with the disorder.

The reason for why none of these symptoms presented in day-to-day life seemed to lie in paramilitary subculture. While aggression and drug abuse are tolerated, anxiety is taboo to the point where members showing signs of anxiety can be killed by their compatriots for being ‘weak’. This brutal emotional environment shapes the men to neither show nor spontaneously report any form of fear or nervousness.

The crucial point here is the feedback between wider cultural views and the individuals who suffer from psychiatric disorders. To be clear, this feedback is not an issue of accepting or denying whether these disorders exist. As pointed out by both Dr. Richard McNally:

PTSD is a real thing, without a doubt. But as a diagnosis, PTSD has become so flabby and overstretched, so much a part of the culture, that we are almost certainly mistaking other problems for PTSD and thus mistreating them.

and Ethan Watters:

The really mind-bending fact — the one that Americans can rarely seem to grasp — is that just because these disorders are culturally shaped does not make them necessarily less real.

Greg Jaffe recently penned a piece in the Washington Post with the headline, “Troops feel more pity than respect.” In the NYT retired Army linguist Kristina Shevory wrote of her peacetime service:

[T]here’s a growing sense that I’m not a full veteran. I didn’t suffer hundreds of mortar attacks. I didn’t roll over an I.E.D. on patrol in a Humvee. I didn’t watch a buddy step on a land mine and turn into “pink mist.”

We have already reached a point in our cultural characterization of soldiers that they are beginning to profess their own discomfort and insecurity with it. Unfortunately, these views aren’t the canary in the coal mine giving warning; they are the collapsed mine shaft.

With our relentless focus on emotionally titillating stories of soldiers and veterans who suffer tragedy, whether they are redeemed by the end or not, we perpetuate a binary view of soldiers: They are either the epitome of professionalism and sacrifice, or they are tragic and broken. Moreover, each story serves to deepen the symptom pool, dragging distressed soldiers closer to calamity by forcing them deeper — towards more extreme behaviors — in order to communicate their anguish as the shallower depths become more anodyne.

These effects don’t influence any individual’s conscious views or judgements. There is no tipping point to this. It is the gradual accretion of dozens upon dozens of newspaper stories and nightly news segments that ever-so-gradually steer us towards an ever more dangerous simplification of the men and women who have, and continue to, wear our country’s uniform.

  1. James Rosse permalink
    December 7, 2011 10:38 am

    The problem is that our media has created a situation where people think that everyone who comes back from warfare has been irretrievably, and incurably traumatized. Therefore, if you come back and you’re not a mess, then you weren’t really there. The only way to demonstrate that you’re a mess is by acting out.

    This is not the truth. There are thousands of troops who were not traumatized by combat. There are many who were. Do not mix the groups, but get the ones who were traumatized the help they need, and the ones who weren’t traumatized the respect and admiration, so they don’t feel like they weren’t part of the team who went and did the job, excellently

  2. December 8, 2011 10:11 pm

    Here’s a number you missed Diana. The remains of 274 military were dumped in a landfill by the USAF. The rest of you are the problem.

  3. gman permalink
    December 9, 2011 11:37 am

    PTSD it’s real, However it’s also hid by many of us based on the stigama as a mental case.
    Or is it the TBI? Both are serirus however one must look at all of the facts. either way. Seem like we are test cases. I’m gain but let us know.

  4. gman permalink
    December 9, 2011 12:43 pm

    after one is stripped and placed in military solitary, amoung others and then set free to deal with the real world on their own with no help or guidence that in itself is untreated PTSD as I see it. That in itself create a whole new military battle that must be won. head injuries and ptsd are real. But it is good to feel free now . execpting to deal with wife ,grands and aged parent.

  5. Grumpy permalink
    December 10, 2011 10:12 pm

    If it happens to you, it is not an issue. *But, when it happens to them, now, we have a real issue!*

    “gman”, we live in a society that looks at the terms “neurological” and “mental” and consider them interchangeable, they are not. Most of society fears those things, they do not understand.

    Did you ever notice, people talk about the things, *they know about and not about things they know.* There is only one way to get over that threshold, go through it!

  6. Claudio Alpaca permalink
    December 11, 2011 11:34 am

    PTSD is not a fragility, but the consequence of years of chronic stress due to war’s theatre scenes, cruent death of buddies and other people, menace of live on any moment and there is not resilience that may win thougths, as thoughts are repentine and must not be arrested. Wound is not only psycological but physyological, as those scenes, blasts an any war manifestation cause disruption of brain wawes. PTSD is as component of human people on such situation and for such a time. To be afraid is not a fragility. Thinks that also Jesus Christ, who was God and man, was afraid on the Getsemani. He abandoned itself to The Father. He made evident that to be afraid is a natural situation on several times of our live. Thus wounded warriors are not fragil men, but men whose skill and resilience has been proved by years and that for they have served us. Now we must serve them, not considering them as little men. They are big men and merit our plause, honor, thanks.We have a duty that is aid those have served us.
    Claudio Alpaca

  7. OSWALDO SANVITI permalink
    December 11, 2011 11:45 am

    Y nadie ha pensado por que algunos sufren de PTSD sin haber motivo aparente alguno? a menos que la persona recuerde que ha tenido un shampoo especial que retrasa la memoria por algunas decadas.bueno a veces usan mas de un shampoo.


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