I strongly agree that the PTSD diagnosis has been overextended and that it carries with it - even where it genuinely occurs and is properly diagnosed. Further, the additional stigma placed on one is that one who suffers from it is that he or she is a highlyl dysfunctional individual, unable to adjust and move on. The truth is far different: the vast majority of veterans who experience the severe stresses of war put their memories in the background and go on to lead productive lives and build and sustain solid relationships, both personal and professional.

I don't think it is fruitful to get into a debate about whether Iraq or Vietnam produced more PTSD. There wasn't much of a rear in Vietnam either (particularly at night): incoming rockets, mortars and artillery rounds were common nighttime occurences at many forward combat bases, LZs, air bases and other areas in the rear of the grunts. My locales along the DMZ were within range of heavy, dug-in 152mm and 130mm NVA artillery - not pleasant.

Regardless, if we had properly understood and properly diagnosed PTSD in previous wars I suspect the number of cases from our more recent wars would pale against the numbers of those cases from WWII, WWI and the Civil War, where the slaughter was on a scale we contemporary Americans can barely comprehend, yet those men came back to settle the American west, build American industry, survive the Great Depression, and build America into the world's premier economic engine and military power. I doubt that very many saw themselves as victims.

The marks left by war more often inspire people to make the very best of the life that remains to them, and while those who struggle with it deserve all the help we can give they ought not be held up as exemplars of entire generations of warriors. A perfectly healthy and well-adjusted personality is no less so because the person also has nightmares from time to time, or is swept by emotion or difficult memories. It is in those memories that, among other things, we pay homage to those we left behind, and that is NOT dysfunctional.

Some of what is diagnosed as PTSD may be part of a physical ailment rather than just psychological. Acute respiratory distress precipitates mood disorder and cognitive impairment, typically peaking two years later. Incidence and severity depend on treatment at the time of exposure. This is part of what happened to Gulf War I vets because of the massive exposure to burning oil and to some of the people now tracked in the World Trade Center Health Registry.

I would also agree that some people adjust to trauma much better than others. The circumstances to which they return make a difference, too. Higher stress environments and more broken families make those adjustments more challenging now than they were after the Civil War or World War I. PTSD may be over-diagnosed now, but it is still poorly understood, and that's the more important problem.

I've heard some people refer to "combat stress" as if it's a milder form of PTSD - sort of like heat exhaustion vs. heat stroke. Is this a true condition? If so, maybe the error is in the nomenclature. Those who are able to function fine - but have occasional nightmares and such - have combat stress instead of true PTSD. Then again, this may just be part of the general muddying of the waters when it comes to discussing PTSD.

When I was a young officer someone explained to me that the Army personnel system works like a fire hose. When a post gets low on people they turn the fire hose on and it overflows...then another cup gets empty and they fire hose it. So you are either 25% understrength or 25% overstrength. I have since learned that we also conduct Public Affairs issues the same way. After the Walter Reed debacle we turned the fire hose on soldier care. Now we are still going like a fire hose on anything to do with health issues so every soldier is a potential "victim" of something. PTSD, MTBI, suicide, prescription drug abuse, sexual assault...we are all just ticking time bombs waiting to go off. The truth is that the overwhelming majority of us have seen horrors we would rather forget and often they show up at the wrong time. More often than not your wife rubs your shoulder and tells you that things are fine and you get on with life. Its not always PTSD or MTBI...sometimes its just the life of a soldier and we are getting carried away beating the victim drum to a ridiculous degree. There are many in our ranks who need real help and we have to take care of them but to assume everyone is a potential patient with no hope of recovery is a bit much. Just my opinion after four combat tours.