Monday, January 19, 2015

PTSD

Post-combat insight from Lt. Col. Dave Grossman


Chuck,
Just read your latest article. Well done. Your usual great work at presenting the information. To get people "re-blued" or "re-calibrated" after a combat deployment I recommend that agencies put the police officer thru a series of video simulator scenarios. This is a tremendous tool to help ID any problems, and to get the individual back on track.
However, I'd like to submit the "rest of the story." You ID'd three cases where there were problems, and no doubt there are others, BUT, a) we don't know if these would have happened anyway, b) we can both find a LOT of examples of officers who were NOT in the combat zone who made the same kind of mistakes, and (most importantly) c) in most cases the returning combat veteran is a superior asset for the agency.
Remember, in WWII we had 11 million men in uniform. Remember "Saving Private Ryan?” Most of the WWII vets saw things we can't imagine, many of them were there for 2, 3, and even 4 years on end, and they returned to the US as superior members of society. They were the "Greatest Generation" and a new greatest generation is now coming home.
These new combat veterans have all the advantages that we associate with the seasoned old WWII/Korea veteran cops that some of us 'old timers' remember. I remember how my dad, a beat cop in the 60's, looked up to the WWII/Korea vets. The WWII/Korea vets were his heroes, and the best thing he could say about them was that they were in combat in WWII or Korea. As far as he was concerned, that said it all. They are cool under fire, less likely to over-react, and most of them are better able to deal with stress. After combat, everything else in life can be a cake-walk.
Indeed, these new veterans may be better able to perform police duties than the veteran of Normandy, Anzio, or the Pusan Perimeter. The WWII and Korea vets were in constant high-intensity warfare. Our new vets were deeply involved in nation building, in an environment in which too much violence can be detrimental to the cause and is often severely judged and immediately punished.
Below is an extract from the 2d edition of On Combat that addresses the problem of finding “balance” in our care for the returning veteran.
With thanks for all that you do for the community.
Hooah!
Dave

Excerpts from PoliceOne National Advisory Board Member Lt. Col. Dave Grossman, from the second edition of his bestselling book On Combat
[In] this age of sensational tabloid journalism, the media can encourage our returning warriors to wallow in the pity party by presenting endless reports and exaggerated "news" pieces implying that virtually every veteran of the war in the Middle East is suffering from full-blown PTSD. This can create dire consequences, as we shall see in a moment.
Here is a letter that I often send the press in response to their queries about the military and PTSD. It’s taken in part from an article of mine that appeared in Greater Good magazine:
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Today I am on the road almost 300 days a year speaking to police agencies and numerous military organizations deploying and returning from combat. I teach them that there are two dangers they must guard against. One is that of the “Macho man” mentality that can cause a soldier to refuse to accept vital mental health services. The other danger is what I call the “Pity party.”
Interestingly, the very awareness of the possibility of PTSD can increase the probability that it will occur. There is a tendency for human beings to respond to stress in the way that they think they should. When soldiers, their spouses, parents and others are convinced that the returning veteran will suffer from PTSD, it can create a powerful self-fulfilling prophecy.
I decline most requests for media interviews because of my time-intensive traveling and teaching schedule. I also decline them because I refuse to be part of that "drumbeat of voices" that tells veterans that they are doomed to a lifetime of psychological trauma. I tell the media the truth but then they edit out anything that does not support their belief that “the war will destroy all the soldiers and we'll pay a price for generations to come.” This sensationalist “if-it-bleeds-it-leads” journalism is irresponsible because it can cause more harm to our warriors.
Sadly, it is not difficult to find people in the mental health community to support the thesis that anyone who kills, experiences combat, or witnesses violence (or any other fill-in-the-blank 'victim du jour') is doomed to lifelong PTSD and, consequently, needs lifelong mental health care. Too few mental health professionals communicate to their patients that 1) they can recover quickly from PTSD and that 2) they will become stronger from the experience. Yet that expectation must be there if there is to be hope of anything other than a lifetime of expensive counseling.
Here is what I tell all my military and law enforcement audiences:
PTSD is not like pregnancy. You cannot be “a little bit pregnant;” either you are, or you are not. PTSD is not like that.
PTSD is like being overweight. Many people carry around 10, 20, or 30 pounds of excess weight. Although it influences the individual every minute of every day, it might not be a big deal health wise. But for those people who are 500 pounds overweight, it will likely kill them any day now. There was a time when we could only identify people who had "500 pounds" of PTSD. Today we are better at spotting folks who carry lesser loads, 30, 40 or 50 pounds of PTSD.
I have read statistics that say 15 percent of our military is coming home with “some manifestation of psychological problems.” Others claim it is 20 percent and still others report 30 percent. Well, depending on how you want to measure it, 30 percent of all college freshmen have some manifestation of psychological problems. Mostly what is being reported on today are people with low levels of PTSD (30, 40 or 50 pounds of PTSD) who in previous wars would not have been detected. We are getting damned good at identifying and treating PTSD and, when the treatment is done, most people are better for the experience.
PTSD is not like frostbite. Frostbite causes permanent damage to your body. If you get frostbite, for the rest of your life you will be more vulnerable to it. PTSD is not like that.
PTSD can be more like the flu. The flu can seriously kick your tail for a while. But once you shake it off, you probably are not going to get it again for the rest of the year. You have been inoculated. PTSD can kick your tail for a while (months and even years). But once you have dealt with it, next time it will take a lot more to knock you off your feet because you have been stress inoculated.
When I was a kid, World War II veterans were everywhere. They were our police sergeants, captains and chiefs. They were our battalion commanders and our senior NCOs. They were our business leaders and our political leaders. The idea that a World War II veteran was a shallow, fragile creature who would break under pressure was ridiculous. (There were some people like that; everyone knew of a few, but they were rare.)
Nietzsche said, "That which does not kill me makes me stronger." The Bible says something similar many times. For example, Romans, chapter five says: "...we glory in tribulations...knowing that tribulation worketh patience; And patience, experience; and experience, hope: And hope maketh not ashamed." Throughout history, we have understood that bad things can make us stronger.
The World War II generation was the "Greatest Generation" and today a new Greatest Generation is coming home. That is, if we do not screw them all up by telling them (and their families, their neighbors and their employers) that they are ticking-time-bombs doomed to a lifetime of mental illness.
Here is what I believe is the heart of the matter. To harm and destroy people you have to lie:
Lie Number 1: Ignore the vast majority who are just fine and report only on the minority with problems.
Lie Number 2: Fail to report that most PTSD cases are people with only 30, 40, or 50 pounds of PTSD, people who in previous wars would have gone undetected.
Lie Number 3: Fail to report that we are damned good at treating PTSD and that we are getting better at it every day.
Lie Number 4: Fail to report that PTSD can be a step on the path to stress inoculation and that one can be stronger when they come out the other end.
Lie four times over. Lie the worst kind of lie: the lie of omission that gives only the distilled essence of the bad news. Create an expectation in veterans (and their families, employers and neighbors) that they are all fragile creatures who could snap at any time and are doomed to a life of suffering. Get veterans invested in their grievance and in their role as victim. Get them to draw disability from PTSD and convince them that they will never recover.
I want the media to care, but I am convinced that most of them are part of a mob-mentality, a pile-on, if-it-bleeds-it-leads profession that does not care about the harm they do. Remember, this is the same profession that put the Columbine killers on the cover of Time magazine twice – yes, twice - thus giving those brutal mass-murderers the very fame and immortality they wanted. This in turn inspired the Virginia Tech killer who also appeared on every news show and on the front pager of every newspaper in the nation. Sadly, this too inspires countless others as the media continues to be their happy co-conspirators in a murder-for-fame-and-immortality contract.
Please forgive me if I have been harsh but the situation calls for us to be passionate. Yes, some of our veterans will suffer from PTSD and we have an obligation to give them the best possible support. But we also need a balanced, tough love that creates an expectation that they will get over it, get on with it, and be better for the experience. That they will be the new Greatest Generation
I prefer to emphasize the positive expectations. Positive self-fulfilling prophecies. Now there is a nice concept. But will we ever see it in the news?

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