We're Only Human

Embattled Childhood: The Real Trauma in PTSD

guard.hussarIn 2009, a regiment of Danish soldiers, the Guard Hussars, was deployed for a six-month tour in Afghanistan’s arid Helmand Province, a Taliban stronghold. They were stationed along with British soldiers—270 in all—at a forward operating base called Armadillo. Although none of the Guard Hussars was killed during the tour of duty, they nevertheless experienced many horrors of battle. A commander was seriously injured by a roadside bomb, and a night patrol ended in a firefight that killed and dismembered several Taliban combatants.

The Guard Hussars’ war experience is graphically depicted in the award-winning documentary film Armadillo, which follows the young soldiers from their emotional farewells in Denmark through their six months in combat and, finally, back to joyous homecomings and family reunions. The film is a study of the inner lives of young men as they experience the excitement and camaraderie, the tedium and—mostly—the terror and trauma of war.

Coincidentally, these same soldiers were also the subject of another, very different kind of study. At the same time that the film was being shot, the soldiers were part of a larger group of Danish soldiers who were being scientifically observed and tested for emerging symptoms of Post Traumatic Stress Disorder, or PTSD. A large team of Danish and American psychological scientists, headed up by Dorthe Berntsen of Aarhus University, wanted to do what had never been done before in the field of PTSD research: Instead of studying soldiers who were already suffering from PTSD, they decided to assess young recruits before they were sent off to war, while they were still relatively unscathed; then to follow them during the war experience; and finally to follow them back home and through several months of readjustment. In this way, the scientists hoped to see why some soldiers develop PTSD, and others do not, and how the symptoms of the disorder progress.

So, as in the film, the scientists first encountered the soldiers at home in Denmark, where they were readying for deployment to Afghanistan. Psychologists met with the soldiers five or six weeks before they were scheduled to leave, and administered a battery of psychological tests. These included a PTSD inventory, a test for depression, and a questionnaire about traumatic life events, including childhood experiences of family violence, physical punishment, and spousal abuse. Additional tests were administered during the soldiers’ service in Helmand Province, related to the direct experience of war: perceptions of war zone stress, actual life-threatening war experiences, battlefield wounds, and the experience of actually killing an enemy. The scientists continued to assess the soldiers when they were sent home—a couple weeks after their return, at three months, and finally at least seven months following their return from war.

The study revealed some surprising findings. The current and widely held view of PTSD is that exposure to combat and other war atrocities is the main cause of the disorder—and that more exposure to trauma boosts the likelihood of experiencing the disorder. Moreover, it’s believed that for those who develop PTSD, the typical pattern is for symptoms to emerge soon after a particularly traumatic experience and to persist over time. For unknown reasons, some soldiers appear resilient in the face of war trauma, never developing symptoms or rapidly recovering.

This is not what these scientists found. Indeed, the consensus view of the disorder may be fundamentally wrong in at least two ways. As reported in a forthcoming issue of the journal Psychological Science, PTSD does not appear to be triggered by a traumatic battle experience, nor does there appear to be any typical trajectory for PTSD symptoms.

What Berntsen and colleagues found instead is wide variation in both causes and development of PTSD. The vast majority of Danish soldiers were resilient—recovering quickly from mild symptoms—or altogether impervious to psychological harm. The rest fell into distinct and unexpected patterns of PTSD: Some showed no symptoms before deployment or even during their tour of duty, but symptoms spiked after they returned home. Symptoms did not appear to follow any specific traumatic event, but by seven months after returning from war, stress symptoms had worsened to the point where the soldiers were diagnosed with PTSD.

Even more interesting were the remaining soldiers, about 13 percent of the soldiers in the study, who actually showed temporary improvement in symptoms during deployment. That is, they had significant stress symptoms after signing up for service, but before deploying—symptoms that eased in the first months or war, only to spike again later, when they were safely at home. This pattern of symptoms has never been observed before, and it’s puzzling: Why would shipping off to a dangerous and unfamiliar war zone ameliorate stress symptoms?

The scientists have a theory, and it has to do with the root causes of PTSD, previously undocumented. All the Danish soldiers who developed PTSD were much more likely (compared to resilient soldiers) to have suffered emotional problems and traumatic events prior to deployment. In fact, it wasn’t traumatic war experiences that predicted the onset of PTSD, but rather childhood experiences of violence, especially punishment severe enough to cause bruises, cuts, burns, and broken bones. PTSD sufferers were also more likely to have witnessed family violence, and to have experienced physical attacks, stalking or death threats by a spouse. They were also more likely to have past experiences that they could not, or would not, talk about.

These previously overlooked PTSD sufferers were also much less educated than the resilient soldiers. This disadvantage, combined with their pronounced mental health problems before going to war, suggests that they may in reality have been escaping a different war zone: the family. In other words, they only showed improvement as soldiers because they were in such poor psychological condition in civilian life. Army life—even combat—offered them more in the way of social support and life satisfaction than they had ever had at home. These soldiers were probably benefiting emotionally from being valued as individuals for the first time ever, and from their first authentic camaraderie—mental health benefits that diminished when they once again returned to civilian life.

Wray Herbert’s book, On Second Thought, is available in paperback. Excerpts from his two blogs—“We’re Only Human” and “Full Frontal Psychology”—appear regularly in The Huffington Post and in Scientific American Mind.

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Can we generalise these findings to the local Afghan population. They would defenitely have both the risk factors mentioned in this study of early trauma exposure and poor educational acheivements. Does this mean that they have an high instance of PTSD, or are they protected(!)by continuing to live in a traumatic war zone.

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