By Lt. Col. Robert Bateman, USA
Best Defense department of strategical and historical affairs
Now, obviously (given my own book which dealt heavily with the topic of veterans who falsely claim PTSD), I agree that there is room in the system for correction. Sometimes it is too easy to fool the VA, for example.
But just as with the machining tolerances within the extremely reliable AK-47, you need some slack in the system to ensure that everyone who should be taken care of actually is taken care of. The AK never jams because it is machined to a looser standard than our own Western, weapons. A little extra gas escapes, and because of this the weapon does not have the amazing accuracy of our weapons. But also because of this slack built into the system, you know that when you pick up an AK out of the dirt, that it WILL fire every single bullet in the magazine. An American weapon, picked up out of the dirt or dust or swamp, not so much. The American weapon must be clean, and well cared for, because there is no tolerance built into the system, which means some rounds won't fire, and that can be a bad thing.
Much the same might apply to the definitions of PTSD and how they are applied. Do we want the "perfect" system, which sometimes causes catastrophic jams, or do we want a system that has some leaks and inefficiencies, but works for 100 percent of the rounds you put through it?
In partial answer to a colleague's query, let me offer a short annotated bibliography.
Eric Dean, Shook Over Hell, Post-Traumatic Stress, Vietnam, and the Civil War (Harvard University Press, 1997): This is a pretty decent book, although the author is not entirely conversant in the then-latest medical scholarship. Also, frankly, he could have done entirely without the opening and closing artificiality of examining PTSD from Vietnam. It was enough that he uncovered, and demonstrated the broad and then-well-known phenomena of "nostalgia." Essentially, from all contemporary descriptions, this was PTSD as it was diagnosed in the post-Civil War era in the United States. Given this evidence of widespread PTSD (including cases ending in suicide) in the Civil War generation, were they just softer than the Mexican-American War and War of 1812 generations?
Peter Barham, Forgotten Lunatics of the Great War (Yale University Press, 2004): The focus here is on those slackers and weak-willed types, the Edwardian Tommies who fought in the trenches of WWI for the British. Barham's work is dense, but readable, and discusses the evolution of attitudes towards these "slackers." (Or, as was the case with much of the military -- then and perhaps now -- who want to ignore the issue, the lack of evolution.) The work focuses upon asylums, mostly after the war.
Peter Leese, Shell Shock, Traumatic Neurosis and the British Soldiers of the First World War (Palgrave MacMillan, 2002): Covers much of the same ground, but more in depth on how the topic was dealt with during WWI, with only about 54 pages devoted to post-WWI period. Still, it's a shorter and somewhat more digestible book, so if you wanted just one book on the topic as it related to the British in WWI and after, I'd go with this one. Since Leese (writing from his faculty position in Krakow, Poland) and Barham (writing, then, in the UK) were writing at nearly the same time, their works overlap, but not excessively so, and they do not reference each other.
Now, on the changing of attitudes towards all veterans and their malaise, there has been some evolution. For a good multinational examination of the history, I recommend a fairly dense academic anthology: David Gerber, ed., Disabled Veterans in History (University of Michigan Press, 2000). Fascinating, if constrained by the nature of an anthology, I'll list just a few chapter titles and let you decide if you want the book. "Heroes and Misfits: The Troubled Social Reintegration of Disabled Veterans of World War II in The Best Years of Our Lives" by the editor, Gerber. Geoffrey Hudson, "Disabled Veterans and the State in Early Modern England." Isser Woloch, " 'A Sacred Debt': Veterans and the State in Revolutionary and Napoleonic France." etc.
Now, on the American side of the equation we have some pros and we have some cons. It is also an area where my personal interaction puts me in the middle, and so my analysis here must be balanced against my personal friendship with both, opposing, authors.
First, and foremost, are Jonathan Shay's books, Achilles in Vietnam and his later Odysseus in America. (Personal disclaimer: I know, and like, Jonathan. He has been to my house, broken bread with me and drunk my scotch. He is a good, honest, and truly dedicated health care provider who really cares about his patients, and the modern American fighting man.) Shay wrote, movingly, about the plight of men who had experienced serious combat in Vietnam and who, as a result, had "difficulties." He linked these stories with the stories of the Iliad and the Odyssey, arguing that there is evidence, from his perspective as a psychiatrist, to argue that both tales contain evidence that PTSD is a part of the human condition. In other words, that it is a normal and predictable byproduct of what happens when large numbers of humans are exposed to extremes of violence. In his second book Shay was arguing for better psychological PRE-battle training, not just for compassionate reasons (his motivation), but for combat effectiveness (which he knew would appeal to the military). Shay is not a trained classical historian, or a historian at all. But his books contribute greatly to the literature and in the latter case provide at least one decent roadmap on how we might reduce PTSD before it occurs, instead of trying to treat it afterwards. How can that be wrong? Unfortunately, and perhaps sadly, it appears clear that in his first book he was taken for a ride by at least a couple of his patients at the Veterans Administration clinic where he worked who told him tales that he was not qualified to question or disbelieve. At least that was the contention of the other author/friend of mine, whom I also believe.
The other, critical work on the topic of modern, or at least post-Vietnam PTSD, is also by a man I call friend. B.G. Burkett, a former stockbroker from Texas, was an entirely normal Vietnam vet who, by his own admission, spent an entirely uneventful year in Vietnam doing base work. He was annoyed, then moved to anger, by the phenomena of fake veterans who were stealing the headlines in the 80s and 90s for their misbehavior. So, unlike many others, B.G. started doing the hard research work to expose these fakes, expose the problems of the media (who are supposed to be skeptical from the outset) falling for obvious fakes, and the VA and psychiatry's complicity in expanding and enabling fakes to claim VA benefits for combat they never saw. The end result of his 80-90 percent useful efforts (my highest rating) was the standout self-published book, Stolen Valor. In which, for example, B.G. convincingly exposes the fakes that Jonathan fell for, as well as a whole host of fakes who fooled journalists and the VA system.
It was his work that inspired my own research techniques and methods when uncovering the personality at the core of the No Gun Ri story, Ed Daily.
Finally, two great works which, together, give you the history of both the psychology and the psychiatry, as well as the history, of the developing treatments for combat veterans dealing with their memories of war.
Edgar Jones and Simon Wessely, Shell Shock to PTSD, Military Psychiatry from 1900 to the Gulf War (Psychology Press, East Sussex, 2005) actually dips back a little further, with accounts going back to the Crimean, but mostly starting with the Boer War. It is a solid, if stolid, multi-national examination, albeit with a 75 percent tilt towards diagnoses and treatment as it related to British/Commonwealth forces. It can be a bit of heavy-going, and if you've already read everything else on the list to this point, you could skip this one. Alternately, just read this one and skip the others. But if you do so, understanding will be a little thin. At least that would be the case without the last, and best, of the lot.
Ben Shephard, A War of Nerves, Soldiers and Psychiatrists in the Twentieth Century, (Harvard, 2001): Without a doubt one of the most fascinating works I've read. Shephard writes in an easy, engaging, and yet detailed "voice" on the topic of the changes, over time, to the diagnoses applied to those "mentally softer" Tommies and Doughboys of WWI, the weak-willed and selfish Tommies and GI's of WWII, and the Grunts of Vietnam. (Again, to be absolutely clear, I am using these terms sarcastically, and if you are historically astute, a tad ironically. Shephard never said such things.) Fairly equally balanced between the U.S. and the U.K., what is really interesting in this book is that Shephard delves into the history of the psychiatrists themselves. How did the "DSM" (Diagnostic and Statistical Manual of Mental Disorders), first published in 1952, updated as "DSM II" in 1968, and so on, come to be? What were the "inside baseball" things going on within the field of psychiatry, as well as the political implications of the actions and motivations of the most prominent psychiatrists in, say, 1967, and how did these affect the definitions and descriptions of the "disorder" (originally known as "Post-Vietnam Stress Disorder" but then later, for political and other reasons, renamed PTSD and now, again, changed to PTS or PTSS)? All fascinating stuff, and probably your one-stop shop to learn about the answers to all of your questions.
Hope this is useful.
LTC Robert Bateman, has written books and articles on military history and military theory, as well as immeasurable amounts of snarky commentary in every outlet from Armor magazine to Parameters, from the Marine Corps Gazette to USNI Proceedings. He was once an honest infantryman, but is now a strategist, serving in England after a recent one-year vacation in Afghanistan.
Thomas E. Ricks covered the U.S. military for the Washington Post from 2000 through 2008.