This article was originally published by The Mennonite

Helping those in the hell of PTSD

Eileen Ahearn attends Madison (Wis.) Mennonite Church. She notes that the opinions in the article are those of the author and do not represent the views of the Veterans Administration

Mennonites should become involved with and assist veterans.

War is hell. The statement has become a cliché, a commonplace almost devoid of import. But if you were to treat the young men and women returning from war, as I do, you would understand that many have experienced a ghastly evil and suffered psychic wounds from which they are profoundly scarred and may not recover.

I am a psychiatrist working in a VA (Veterans Administration) hospital. I am also a Mennonite committed to nonviolence. I see no contradiction in this and find the convergence of these two identities satisfying, even necessary. Christ is always on the side of the victims of war, and these veterans are as much victims as anyone else.

The rates of mental health issues in our returning veterans as well as the need for ongoing care are staggering. More than 1.6 million U.S. troops have been deployed to either Iraq or Afghanistan since 2001. Approximately 25 percent of returning veterans meet criteria for a mental health disorder. The RAND Study (see box, page 30, #1) found that 14 percent of returning veterans screen positive for posttraumatic stress disorder (PTSD), and 14 percent screen positive for major depression. Due to its high rate of occurrence, PTSD has been named a “signature injury” of the war in Iraq.

The violence of war can cripple the human psyche. PTSD, first used as a term to describe the psychological difficulties of returning Vietnam soldiers, often has disabling and enduring symptoms. People with PTSD must have had exposure to a life-threatening event and re-experience that event through distressing daytime memories, flashbacks and haunting nightmares. They are agitated and extremely watchful in public. High irritability and outbursts of anger are common, particularly in combat-induced PTSD. Avoidance of thoughts and feelings associated with the trauma is significant. These individuals feel emotionally disconnected from loved ones and often have a pervasive mistrust of people in general. If this is not bad enough, nearly three-quarters of people with PTSD have at least one other psychiatric diagnosis, and a significant number have at least three other co-morbid diagnoses (see box, #2). The personal costs of war-related injury to veterans and their families can be lifelong. Divorce, joblessness, economic hardship, substance abuse and increased suicide risk are all troubling byproducts of PTSD. The cost of providing medical care and long-term disability benefits to returning veterans is equally shocking, with recent total health-care estimates of $424 billion (see box, #3).

Why should Mennonites involve themselves in the effort to help returning veterans? After all, the United States has an all-volunteer military. People enlist knowing they may be in risky or dangerous situations. They also know they may be called upon to injure or perhaps kill another human being. Have these people not embraced violence and brought all this upon themselves?

Consider why young people enlist. Studies have shown that the propensity to serve has been declining among youth in the United States over the last two decades. In one study, only 30 percent of first-term soldiers knew during their high school years that they wanted to join the military. This group is identified in the literature as having a “high propensity” for military service and tends to join the military out of a sense of patriotism, a desire to serve and a desire for adventure and challenge. The majority of current first-term soldiers seem to fall into the “low propensity” group and cite occupational and monetary reasons for joining. In one study (see box, #4), the majority of soldiers endorsed reasons such as “best option available,” “repay college loans” or “lack of better options” as their explanation for joining. Therefore, the majority of today’s volunteer military enlists for financial and occupational reasons, not a predilection toward violence.

But how, a Mennonite may ask, can soldiers bring themselves to kill another human being, even an enemy? S.L.A. Marshall, in his book Men Against Fire (see box, #5), wrote: “It is … reasonable to believe that the average and healthy individual—the man who can endure the mental and physical stresses of combat—still has such an inner and usually unrealized resistance toward killing a fellow man that he will not of his own volition take life if it is possible to turn away from that responsibility. … At the vital point he becomes a conscientious objector.”

People have a high resistance to killing. It is not a natural response to threat and is anathema to most people. Historically, soldiers in battle have not fired their weapons. In World War II, for example, Marshall’s study showed a firing rate of only 25 percent. This “lack of enthusiasm” for killing the enemy is a well-known phenomenon and represents a powerful force, perhaps with moral, psychological and even spiritual roots. Unfortunately, the military eagerly adopted Marshall’s suggestions for changing infantry training to remedy the low firing rate, resulting in increased firing rates in the Korean War (55 percent) and in the Vietnam War (up to 90 percent). At their core, most soldiers do not want to kill anyone. It is their military training or indoctrination that modulates their natural inclinations and lowers this resistance.

Although the military may be more effective at training soldiers to fire at the enemy, they have been unable to eliminate the moral and psychologic consequences of killing. In my practice, I have treated hundreds of veterans with PTSD caused by killing another human being or witnessing the death of a fellow soldier, “enemy combatant” or civilian. I am still treating World War II and Vietnam veterans who weep uncontrollably when they recount taking a life. We are creating a new generation of young men and women who have killed people and can barely live with themselves as a result.
In her recent essay, Nancy Sherman (see box, #6) interviewed dozens of soldiers who talked about wanting to process the loss of what they had done or experienced in war. She writes, “They wanted to register the complex inner moral landscape of war by finding some measure of empathy with their own emotions.”

These soldiers are deeply troubled by what they have seen and done in combat.

Civilian deaths are particularly haunting. One soldier recounted firing shots at a car that accelerated toward a security checkpoint in Iraq. Soldiers at these checkpoints must make instantaneous decisions as to whether to fire on vehicles that fail to yield, because of the constant threat of suicide bombers who will blow themselves up as they drive through a checkpoint. One can only imagine that soldier’s horror when he opened the car door to discover the torn bodies of a young child and his father.

Witnessing the death of another soldier is also harrowing. I have heard countless stories of soldiers watching while fellow soldiers get killed or maimed in an IED explosion. In another grisly episode, a veteran noted his anguish to me after having to clean up the body parts of a soldier that had committed suicide by shooting himself while on guard duty.

While therapy and medication can help, there often is a larger struggle with the moral and spiritual dimensions of killing. The amount of suffering and anguish that occur as a result of PTSD is more significant than I have witnessed with any other psychiatric disorder. I believe that this has everything to do with the atrocity that one has witnessed or participated in. And I have yet to meet one soldier with PTSD who enlisted in the military because he or she felt compelled go to Iraq or Afghanistan to kill people.

So what does this have to do with us? Menno­nites are a people of service who rise to help those in need after disasters. What disaster is more

Eileen Ahearn attends Madison (Wis.) Mennonite Church. She notes that the opinions in the article are those of the author and do not represent the views of the Veterans Administration
Eileen Ahearn attends Madison (Wis.) Mennonite Church. She notes that the opinions in the article are those of the author and do not represent the views of the Veterans Administration

cruel or devastating than war?
It is fitting that Mennonites should become involved with and assist veterans. As witnesses for peace, we must recognize the devastating effects of war and reach out to those who suffer during war, including veterans. This is not the time to be afraid or conflicted in our efforts; our brothers and sisters are suffering. In Jesus’ parable, the Samaritan did not judge the injured man before he moved to rescue him. Neither should we.

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