PTSD and Traumatic Brain Injury: Trauma Inside Out

by Drew Matott and Drew Cameron

by Drew Matott and Drew Cameron

By Zoë H. Wool

Jake was fond of saying that even though he had become dumber, he wasn’t quite dumb enough. He knew that the improvised explosive device (IED) in Iraq had mangled his body, brain and self.

Jake (a pseudonym) lost 30 IQ points due to Traumatic Brain Injury (TBI) from that IED blast. According to the military, he was still smart enough to function and hold down a job, so they didn’t plan to include TBI in his disability rating.

He fought them on this, just as he fought them on the decision not to amputate his leg. After countless surgeries and rehabilitation techniques, his leg was almost useless, allowing him maybe 30 minutes of use before it started rebelling against its reconstructed form. The pain that caused was excruciating; he simply couldn’t use it more.

Eventually Jake won his battle to lose his leg. It was the best thing that happened to him during the year I got to know him while doing my dissertation fieldwork at Walter Reed Army Medical Center in Washington, D.C. (yes, that Walter Reed).

Dealing with, or writing about, TBI is rarely as clear as an amputation. The same is true of TBI’s nearly constant companion, Post Traumatic Stress Disorder (PTSD). TBI and PTSD are not injuries that you can see, unlike a lost leg. Despite the high numbers of TBI and PTSD cases from Iraq and Afghanistan, the relationship of these conditions to more obvious forms of combat trauma remains a fraught one: Witness the debate about PTSD and the Purple Heart.

Most people think that the Purple Heart, that most iconic of military honors, is awarded to American military members injured in combat. As with most issues military, it is not quite that simple.

In 2008, after months of consultation, the decision was made not to award the Purple Heart to those suffering from PTSD because, in part, the medal “recognizes those individuals wounded to a degree that requires treatment by a medical officer, in action with the enemy or as the result of enemy action where the intended effect of a specific enemy action is to kill or injure the service member.” PTSD doesn’t count.

Though the decision was officially framed in rather bureaucratic terms, the debate which surrounded it raises much deeper issues about the nature of trauma. Thinking through these issues has led me to think about the Cartesian split between the (internal) mind and the (external) body and the nature of trauma inside and out.

Continue reading

Forever at War: Veterans’ Everyday Battles with Post-traumatic Stress Disorder

ptsd-iwo-jima“To this day, every time I smell firecrackers or fire arms being shot, I feel like I am right back there. All I have to do is close my eyes and I see the whole scenario over and over again. I can’t erase it.”

Hundreds of thousands of US veterans are not able to leave the horrors of war on the battlefield. They bring the combat home and re-experience it in their minds each and every day, no matter how much time has passed.

“I don’t like people. I just live my life.”

Many PTSD veterans live a life riddled with divorce, unemployment, and loneliness because they are unable to form lasting social networks within civilian life. It is not uncommon for a war veteran plagued with PTSD to desire a solitary life in the mountains. One informant described Montana as the ideal locale – far away and quiet.

“I should have buried him.”

This veteran is still tormented by the fact he did not give an honorable burial to a fellow soldier. He knows he would have met a similar fate if he tried to leave his foxhole; yet his inability to act haunts his memory. He asks himself everyday why he didn’t even try to honor his fallen comrade. He also has never been able to justify why he wasn’t the soldier left unburied on that remote Pacific island.

“I didn’t even have the motivation to kill myself.”

Many of these men and women believe their situation will never improve. Some contemplate suicide as their only relief from the symptoms of PTSD. A number of the veterans we spoke with had thought about or even tried to end their own lives. They also participate in risky activities, threatening their life in a deliberate yet indirect way.

“I always feel like there is someone behind me – following me.”

Being on edge is the only way to survive in combat. Unfortunately, many PTSD veterans are unable to readjust within the civilian world. Everyday life becomes a battlefield.

Something as mundane as walking through a crowded grocery store aisle can be a source of intense anxiety for a veteran suffering from PTSD. Overwhelmed by a feeling that the shoppers behind them are enemies, PTSD veterans always feel as if they are under attack. A trigger as simple as the clashing of shopping carts can make them jump in fear of an imminent explosion. They are forever at war.

OUTREACH

Over the course of 4 months, South Bend veterans with Posttraumatic Stress Disorder (PTSD) have revealed their daily realities to us, five undergraduates at the University of Notre Dame. In conjunction with a course taught by Dr. Daniel Lende entitled Researching Disease: Methods in Medical Anthropology, we have engaged in community-based research with members and supporters of PTSD, Vets, Inc. Here, with the approval and encouragement of these vets, we seek to give their experiences a well-deserved voice.

Continue reading