Hollywood Slimes – But I Repeat Myself

David Grossman is a professor of psychology, former Army Ranger, and the author of a number of books on the psychology and sociology of legitimate and illegitimate violence.

His publisher contacted Joe and asked if we’d review the new edition of his book ‘On Combat‘.

A longer review will follow, but I think I want to open with a quote that will perfectly explain my disgust with the Hollywood flood of ‘damaged soldier’ films, as well as the root of my disdain for the Scott Beauchamp / The Nation / Kos ‘Killitary’ meme that is echoing among our would-be intellectual betters this week.

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 essence of bad news. Create an expectation in veterans (and their families, neighbors and employers) 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 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 a 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 page of every newspaper in the nation. Sadly, this too inspires countless other 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?

pp298-299

If you wonder why I am filled with contempt for those who demean soldiers – as opposed to those who dispute policy – it is because in doing so, they actively harm the soldiers; it is one thing to damage the reputation or power of an actor in the political arena. It is another to damage the psyche of someone who was willing to take up arms in our name. I may strongly disagree with folks who dispute me on issues what the right thing to do may be – and some elbows may get thrown, although I hope they would be rare.

But I loathe people like the Hollywood elite mentioned in the New York Times this morning, folks like Scott Rudin, who see the souls of the U.S. military in the couple of kids who murder – while ignoring the reality that like murderous football players or music producers, soldiers who murder are rare indeed.

But let me get back to Grossman.

Grossman discusses three broad areas in this book; the psychology and physiology of human beings under incredible stress; the ways people train or condition themselves to cope with such stress; and the impact of that stress on them once it is over.

There are things Grossman suggests which I can’t quite bring myself to accept. But the problem is that everything in the book that I have actual experience of is 100% accurate.

And I’ve got to accept it when evidence pushes back against belief.

Grossman codifies academic research and anecdote into the foundations of a new discipline in understanding people under stress. I’m not aware of anyone working at his level in this area – I’d love to be pointed at others if they exist.

And in a world where good people will be required to do bad things – as we have been since time immemorial – and where the core values of society don’t readily accommodate them (I doubt that Spartans or Huns got PTSD), this discipline will be incredibly valuable at bringing those good people home.

As noted, I gave my copy to my son, who has read it and will take it with him when he reports for service. I can’t compliment the book any more than that.

45 thoughts on “Hollywood Slimes – But I Repeat Myself”

  1. I doubt that Spartans or Huns got PTSD

    What could bring you to make such an unfounded assertion?

    For someone who says they feel contempt for those who demean soldiers, this is an awfully strange thing to say.

  2. This guy might be a great expert, and yet what he’s doing with his four points is politics.

    Lots of people who went undetected in previous wars had very serious problems. I had an uncle who went through korea, who did eventually get detected. He woke up strangling his wife a few times, and after he threw her down a set of stairs while she was pregnant he finally got hospitalised and suffered the treatment of the time.

    When I was little I ran into PTSD victims occasionally. Like the man who came into another uncle’s country store and talked about his experience on guam, after WWII. They were sending planeloads of people home as fast as they could, and the planes were overloaded, and there was a hill past the end of the runway where a new plane crashed each day. He was on the team that tried to get people out of the wreckage. He told his sad story and left, and somebody else said the experience broke him and he’d never amounted to much since. Of course he went undetected.

    Nowadays I can find a big handful of homelss vietnam vets, in the homeless community. I don’t know whether they’re on record as suffering PTSD or not.

    If we have effective treatment we should be getting that treatment to everybody who can use it. Not everybody who desperately needs it, who can’t survive without it. Everybody who finds it useful. Don’t treat them as victims who deserve special privileges for being victims, but *get them treatment*.

    When a soldier loses a leg you don’t go on and on about how he’s a victim. You help him recover. And if he’s only lost half a foot you don’t go on about how it doesn’t count, you still help him recover. Same with PTSD.

    People who talk like our soldiers are all getting turned into monsters and there’s no PTSD treatment that does any good wind up turning that into a political stand. But when this guy tries the opposite political scheme he winds up less effective than he might be otherwise. If he has something that works effectively and at reasonable cost, he should be heading toward getting that treatment available to all combat troops. There shouldn’t be any stigma to getting that treatment. Just part of the process.

    I don’t know that much about the huns, but the spartans designed a society where things like PTSD wouldn’t much be noticed. They kept a lot of slaves who were always on the edge of a slave revolt, so spartan men had to be ready to fight all the time whether there was a war or not. Occasionally they’d need to kill slaves on general principle. They systematicly brutalised themselves.

    Romans were special for designing a culture that could win a giant empire with hand weapons. John Barnes had a quote about it I almost remember, I think he put it in Pompey’s mouth. “The particular genius of the roman man is he can look a man straight in the eye and ram a bar of metal in his gut and twist it, and smile. And sleep well.”

    Lots of germanic people had a religion for war. Bravery was the big virtue. If a unit wasn’t brave enough, they’d cast lots and pick somebody to be hanged. He’d kick and gurgle while everybody watched, and that was a message from god. It wasn’t a big deal if you had PTSD symptoms provided you fought well when it counted. People believed in ghosts and such which could make people unreasonably fearful or even take them over and make them turn violent. It wasn’t PTSD, it was ghosts. The saga of Gretter the Strong fits that. Grettir had PTSD symptoms until the end of his life but they thought it was from a glamour a barrow wight gave him.

    We could restructure the society so that PTSD was normal. I’d prefer not to.

  3. A.L., I would respectfully suggest you reserve your disdain and disgust until you have actually SEEN the films and then determine if you think the people who made them films a) actually demeaned soldiers; and/or b) intended to demean the soldiers. Also keep in mind that a film that depicts an heroic act by a soldier–or a group of soldiers–is not meant to be taken as a depitction of ALL soldiers, but rather, the telling of a dramatic story. It is usually the exceptional, rather than the ordinary, that have made up the stuff of tales.

  4. One other and equally small point: Grossman’s seems to believe that sending a young adult off to war will make them better people (“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 [i.e., PTSD}.” ), but that these same young people, who will be enobled by combat are, at the very same time, such malleable, gulible little wimps that we can “screw them up” simply by “telling them….”that they are ticking time-bombs doomed to a lifetime of mental illness.” Doesn’t this view demean soldiers by condescending to them? We don’t need to protect them from the effects of combat but we sure do need to protect them from the opinions of those who have anti-war views that are in part based upon the effects of combat. This edges toward the view that our real enemies are those who dissent from the party line.

    “I prefer to emphasize the positive expectations. Positive self-fulfilling prophecies. Now there is a nice concept. ” Very nice, and one which the likes of Lenin and Mao would appreciate. Don’t tell it like it is, but like you would have it be… so that it will be.

  5. Nowadays I can find a big handful of homelss vietnam vets, in the homeless community.

    You mean you can find a big handful of homeless people who claim to be Vietnam vets.

  6. mark – if you get a chance to read the book, that’s not what Grossman says; he does say that people who have been ‘innoculated’ against stress have greater coping skills and are typically more resilient.

    He distinguishes the value judgment (sheepdogs/sheep) from the analytic one pretty clearly.

    A.L.

  7. Mark —

    Your analysis fails on several levels. One, you seem to imply that there is no need for young men to risk lives and limb to defend against the nation’s enemies who want to destroy America. This in turn would hold true ONLY if human nature has changed radically over the last 50 years (laughable) or if America has some super-weapons that can deter attacks. That latter possibility decisively disproven by 9/11.

    So we need soldiers, sailors, airmen and marines. And they will go into battle and kill and be killed, see and do and suffer terrible things, so that we may live in freedom (relative at least).

    Two you are being disingenuous. ALL Hollywood films that have come out except the Great Raid and Rescue Dawn have portrayed our soldiers as brutal, ignorant, and victimized louts and the enemies as noble warriors. Even Iwo Jima, the site of astounding bravery and courage and sacrifice by our Marines, was debased into garbage by Clint Eastwood.

    AL — I think you miss the point. Hollywood and Liberals are all about POWER. Which is a zero sum game. Hollywood and Liberals are scared to death about sharing power with people who would demand it: soldiers, sailors, and airmen who put their lives on the line for them.

    The only way to prevent the horror of horrors of sharing power with mostly working/middle class white men by Hollywood, Liberals, and “Peace Activists” who are almost all feminist middle aged women is by first demonizing the soldiers, then portraying them as mentally defective victims who cannot be trusted with power.

    Hollywood/Liberals/Feminists/Business elites/Activists have since 1976 or so had a total monopoly on power. Have never been required to share it with especially ordinary people. The war is a threat, a threat by ordinary people to wrest a share of power away from them and that CANNOT STAND by the elites.

    Hence Soldiers as monsters or victims, neither appropriate to have even a smidgen of shared power.

  8. Alan,

    Spartans and Huns didn’t get PTSD because their societies looked up to them and venerated their participation in combat. That’s why our society has an obligation to support our soldiers and honor their service.

  9. Oclarki, why would you think spartans and huns didn’t get PTSD?

    If you were in sparta, and a celebrated veteran turned his back on you and then whirled around and said “Never ever try to sneak up behind me!” and he knocked out a couple of your teeth and started killing you slowly and let up only when you promised him that you had no grudge against him whatsoever and you’d never ever again try to sneak up behind his back, they wouldn’t think there was anything wrong with him. He was a hero and he could treat you however he liked. It wasn’t PTSD, it was just him doing whatever he wanted.

  10. If you call it a spike, sure. Looks to me like they were returning to pre-war levels; it’s not unusual to think that drafting a significant proportion of the young males in the population into military service might have some effect on the murder rate.

    As far as WWI, you’d do well to examine the psychological effects of coming under a concentrated artillery barrage. We don’t fight that kind of war anymore – our aim is good enough that we don’t need that kind of saturation of firepower, and our enemies can’t concentrate the artillery without us destroying it anyway.

    Is it likely that a significant number of Spartans (or, heck, any pre-industrial warrior society) suffered from PTSD? Not so much. A big part of that would be a differing preparation for combat. We train our troops to be effective warriors, but the “good” in the act of killing the enemy is abstract – they fight to win, not because it lets them fight and kill. Why not compare that to the Iliad? There, combat is a good for its own sake – it lets the warrior win glory, and not just an abstract glory of having been part of the winning team, but a very specific glory where you take a sharp bit of metal and ram it into somebody, spill his blood into the dust, and take home some part of his anatomy or at least his armor and weapons as your booty. That was the point; there wasn’t a problem where people trained to an essentially peaceful society suddenly had to develop a killing reflex and then tame it once more once the war was over. Or at least, to the extent that he did, it wasn’t the peace that he held to be valuable!

  11. #8 from Jim Rockford: “AL — I think you miss the point. Hollywood and Liberals are all about POWER. Which is a zero sum game. Hollywood and Liberals are scared to death about sharing power with people who would demand it: soldiers, sailors, and airmen who put their lives on the line for them.”

    In my experience, what some theater folk with star potential are about is feeling like heroes, without actually being heroes because that is not their job. And though they may not lack potentially heroic qualities, we have made heroism far too much a trade, a profession.

    George W. Bush made an immense, terrible, historically irreparable mistake when he told these people in effect that they were not wanted (on our side), that they should go shopping.

    They still want to be heroes, they still want to win.

    And, dammit, he’s made a second mistake all along by refusing to identify the enemy and defend people against it! If you do something as mild as publish Muhammed cartoons, you are then exposed to the full spectrum of Islamic intimidation and thrown to the wolves. Whatever happens to you, including professional damage, you are alone. The State Department will imply you are at fault, the American President will never say a word for you. You will not be a hero, even a little bit, you will be defined as a bigot loser.

    People want to be heroes, they want to make a desirable difference, they want to win – and to win, they need to take on challenges they have a chance against, and they need to be recognized by others.

    This opportunity has been denied to idealistic people, some of whom might have acted differently if they had had it.

    That means, even some of those who are not hopelessly prejudiced (and there are of course a lot of those, I would say a thumping majority) … need another side.

    George W. Bush is not too scary an evil to take on.

    Neither is the American military.

    You have to accept some uh … dubious stories to make our armed forces the bad guys. But playing make-believe is not too hard.

    Though it’s useless to wish, I wish that the first four public words out of President George W. Bush’s mouth after the 11 September, 2001 attacks had been We are at war! and that he had gone on to talk about how your country needs you, and not just if you are in the military or good army fodder.

    Lots of bloggers started blogging then because they wanted to help, though they did not seem to be wanted, and that was what they could do.

    A more significant minority of the performing arts crowd than we have seen might have gone the same way, and in doing so might have chosen the same side.

  12. It has apparently escaped Hollywood–or they do not care–that, among others, Tom Clancy got to be immensely wealthy portraying America and American soldiers as the good guys.
    Michael Medved made a similar point about family-safe films and edgy, R-rated films. The former make money, the latter get awards from….Hollywood.
    So the picture of Hollywood as putting money first, last, and always is false.

  13. _I would respectfully suggest you reserve your disdain and disgust until you have actually SEEN the films and then determine if you think the people who made them films a) actually demeaned soldiers; and/or b) intended to demean the soldiers._

    Why would anyone expect anything else from the current group of film makers and actors?

  14. The person who alluded to all the homeless Vietnam vets might try checking their service records before he gets too excited about all this terrible effect on soldiers. He might even read “Stolen Valor” and see how many were fakers. It was most of them. I’ve seen “Vietnam vets” in the County Hospital who were 9 years old when US troops left Vietnam. Of course, if you want it to be true, it makes it much easier to believe.

  15. Has Mr Medved managed to explain the popularity and profitability of that portion of the film industry located not in Hollywood, but in the San Fernando Valley? Beats the hell out of R-rated New Wave art films. Conservatives are always interested in the morality of the free market—until it’s time for porn and rap music. Work that out, and then get back to us about Hollywood somehow not making profitable patriotic movies.

  16. _Can someone explain to me why so many WWI Tommies had PTSD given the jingoistic climate of the times?_

    I think the numbers suggest more Krauts suffered from shellshock than Tommies, but to the extent recorded, shellshock corresponded to periods of non-movement in the conflict in which the soldiers were at close quarters, perhaps under bombardment, perhaps stuck in a hole with a decomposing comrade. It was recorded less during periods of movement where greater casualties were taken.

  17. You mean you can find a big handful of homeless people who claim to be Vietnam vets.

    Yep.

    American troops were withdrawn from Viet Nam in 1973, 34 years ago. The age of enlistment in the US military is 18. Basic math tells you that anyone who is younger than 51 and claims to have served in Viet Nam is a liar.

  18. It is not a new phenomena that Hollywood portrays more internal foes than external. This has been going on for decades. it can be seen as a product of many things, but largely the period in the sixties when pop psychology, self help, self medication, self-contemplation and self destruction began to become the normal. The internal was the enemy in an over developed freudian/jungian cascade of crock.

    Naturally, movies began to move in that direction as well. There were no more grand movies reflecting the great expansion and achievements of mankind. Those movies were far and few between. Everything has been about the internal struggle of man which translates to movies reflecting the same.

    since government must be a reflection of the great “us” and America is a person, it is America’s internal struggles which defines it, not the external. Anything external that occurs is not good or noble because there is always the internal struggle, our internal conscience and our internal dialog or self examination that continually has us struggling with right and wrong. Since we cannot know it for ourselves, certainly our nation cannot and must be reflected as such. It is the “truth” after all. But, somewhere in seeking the truth, they have abandoned hope.

  19. Regarding the apocryphal tale of daily transport aircraft crashes on Guam post-WWII…

    My dad was an Air Force pilot. He served on Guam post WWII. He never mentioned anything to me about daily plane crashes. As a matter of fact, the advantage that the Air Force had in designing and building airstrips on Pacific islands was that they could be oriented as to face the prevailing winds. This allowed for lower speed necessary for both landings and takeoffs. Sorta like heading an aircraft carrier into the wind for a catapult launch – only without the aircraft carrier. Or the catapult. Okay, bad example. My point is that I don’t believe any hooey about daily plane crashes on Guam. Sorry.

  20. There’s a tendency to ignore, as much as we can, that we’re a product of thousands of years of evolution. Behaviors and our reactions to them were naturally modified through often very nasty selection processes. However, being so modern and so enlightened, we like to think we can ignore them because we’re so smart.

    When the hunting group returned from their trip, wounded, maimed, and missing, the survivors were celebrated. It meant that the clan would survive another year, because the stuff that kept them feed between the collection of seasonal vegetation. The triumph of surviving an attack upon the community or the reduction of threats to early city and city-states, were celebrated, because it meant that the survivors would live another generation to continue their way of life. Each group had evolved ritualistic processes to ’cleanse’ their warriors. Groups that failed to address the need and all the attendant consequences, were groups that would eventually fail in the friction that constitutes the record of history. Does the phrase “when Johnny comes marching home again” strike a tune. Where’s the celebration? Where’s the cleansing?

    We’ve dropped the ritualistic stuff. Today in our smug intellectualism, we engage in identifying, categorizing, and labeling ’conditions’. It’s treated so antiseptically. In the process, we ’dehumanize’ the subject. It’s permitted the culture to strip the warrior of the ‘cleansing’ celebration necessary, in the end, for the culture to survive. We substitute ‘modern medicine’ for something societies in the past did ‘naturally’, at least those that survived. Instead, modern rituals as view in ‘popular’ culture are the exact opposite by degrading the subject. How much medicine is there when the ‘culture’ hammers away in the opposite direction?

  21. The other day the History Channel was running a documentary on the Jeep. One clip showed Hollywood stars publicly riding a caravan of Jeeps to raise support for the war (it may have been war bonds). There are celebrities today who have supported the troops (e.g. Toby Keith, Denzel Washington, Drew Carey, Kathy Grifin) but their efforts get almost no recognition. Let some 23 year old song writer named Norah pen an anitwar song and it’s suddenly important news. As if 23 year old song writers are the people we should look to for sober decisions about how best to keep America safe.

    For example, right now we have the American military engaging Al Qaida on foreign soil. Given that Al Qaida isn’t going to go away, this is about the best we can hope for. Our military is the best at fighting Al Qaida – certainly preferable to having our police and civilians deal with them. Having the battles on foreign soil means the innocents killed and the collateral damage are not American. It’s bad for the people of Iraq but certainly better for us.

    So, even though it’s an awful situation, it’s the best we can attain right now (OK, maybe fighting them in Cuba would be more convenient but Al Qaida’s logistics train can’t sustain a battle half a world away from SaudiArabia so that isn’t going to happen). Most every proposal we hear will make things worse. For example, giving them Iraq will strengthen them and let them choose the time and place for the next battle. Yet that’s what so many want to do under the guise of “ending the war”. It would do nothing of the sort.

  22. I think that previous posters may have brought up an important point: the type of warfare probably has a large effect on how the soldiers are affected in the long-term. Personally, when it comes to things that might make life difficult for soldiers when they re-enter civilian society, I can’t imagine that there could be anything worse than service in a guerrilla war, where you can’t tell friend from foe.

    Also, due to our enormous wealth, there’s never been a greater gulf between middle class society and a warrior’s society. Mr. Rockford may decry our “feminized” society, but I don’t think it’s coincidence that a ‘feminized’ society is exactly what we’ve built as soon as we had the money and means to do so. However, this does make it far more difficult for returning soldiers to reintegrate. Most middle class people have almost no exposure to violence and no desire to be exposed to even second-hand violence (unless it’s long enough ago to be no longer personally relevant). Soldier’s that don’t hide actual combat service (as opposed to simply service in the armed forces which proves civic responsibility) may face discrimination by those who are uncomfortable around someone who has proven their ability to kill another human being.

    Unlike many people here, I don’t think this trend away from warrior society is due to conspiracy. In evolutionary terms, the whole point of wealth is to protect oneself and one’s children. If that can be accomplished with wealth rather than personal risk, then that’s exactly what will happen. I think the changes we have seen in society in the last 50 years are an almost inevitable result of the unimaginable wealth we find in contemporary society.

  23. I’ve met a number of vets coming back from Iraq and I wouldn’t classify many as victims. The majority share one thing in common, they want to go back to their units. One of my friends has what could be described as PTSD, but truly is an exacerbation of a previously existing illness.

    Part of the problem is that there is no such thing as PTSD (in the postmodern sense). We use the term to signify all sorts of things, but the media tends treat it as monolithic.

    Between the victim-fetishism of the media and the macho status quo of the military there is a pretty reasonable middle. Grossman hits on it in his points, namely that PTSD can be normal, is not always distastrous or crippling, and even can be seen as a stage within a military career or even tour, not the end of a career or even life.

    The Israelis have a very proactive PTSD program that is based on a similar philosophy to Grossman’s. Worth checking out.

  24. Anyone who thinks this quote is representative of Dave Grossman, or that it implies that he thinks the psychological cost of war is minimal, might want to read this article by him on the “Psychological Effects of Combat.” This is just from the introduction:

    One obvious and tragic price of war is the toll of death and destruction. But there is an additional cost, a psychological cost borne by the survivors of combat, and a full understanding of this cost has been too long repressed by a legacy of self-deception and intentional misrepresentation. After peeling away this “legacy of lies” that has perpetuated and glorified warfare there is no escaping the conclusion that combat, and the killing that lies at the heart of combat, is an extraordinarily traumatic and psychologically costly endeavor that profoundly impacts all who participate in it.

    By the way, if Spartan combatants did not experience PTSD, it’s because, as Grossman himself says:

    It must be understood that the kind of continuous, protracted combat that produces such high psychiatric casualty rates is largely a product of 20th-century warfare. The Battle of Waterloo lasted only a day. Gettysburg lasted only three days–and they took the nights off. It was only in World War I that armies began to experience months of 24-hour combat and vast numbers of psychiatric casualties were first observed.

  25. Spartan women would tell their husbands and sons to either come back with their shield like a hero, or carried on it dead. If you read any of the ancient historians, you would see all the classic signs of PTSD even back then. Noted psychologist Jonathan Shay did extensive research when he wrote two of his books exploring the human connection between combat trauma and ancient warriors. Shay works for the VA in Boston and has done so for many years.
    What keeps getting missed are the other causes of PTSD. Combat just happens to be the number one cause because exposure to trauma is guaranteed. Trauma is Greek for wound. Any life threatening situation can cause PTSD and that is why it is called, Post Traumatic Stress Disorder. It is not an American illness only and all nations have to deal with it because it is a human illness. It does not come from within but is an emotional assault setting off chemical changes in the brain. It has nothing to do with bravery, patriotism or any characteristic we associate with the men and women in the military. It has to do with being human. These men and women are only humans, no matter how courageous they are. Many will operate on adrenaline until they are out of danger. This is why being back home, out of danger, is the most dangerous time for them. It is also the most important, critical time for them to begin treatment so that they can heal and lead “normal” lives. Some heroes get PTSD. Some do commit crimes but again, we are talking about humans capable of all kinds of things. Most however, become withdrawn, suffer in silence and watch their lives dissolve before their eyes. They need support and above all right now they need the stigma of PTSD removed from the dialog.
    If some in this country had their way they would still be shot for being cowards like they did in the Civil War when ignorance refused to recognize these brave humans had just been wounded.
    The averages are one out of three exposed to trauma will develop PTSD, but in different degrees of it. Redeployments raise the risk by 50% each time they go back. This is why we are seeing such high rates. Some are back on their fifth tour. Stress does a lot of damage to the body as well. One of the other things we have to recognize is that if they really were cowards, then why do so many commit suicide well after they have done their duty and served their country, after their risk was over?

  26. This article by AL can only be understood an apologia for current policies which send soldiers into Iraq or Afghanistan for fifteen months of continuous combat, with perhaps a two week break, followed by another fifteen months one year later. Marines have shorter, but more frequent tours.

    Barring a drastic change in policy, every enlistee in the Army now will probably serve two tours in war zones, and possibly three.

    So who is worried about Hollywood: those who “damage the psyche of someone who was willing to take up arms in our name” are those who callously treat those people in this way. A movie is just two hours: thirty months in Iraq within 40 months is something else.

    PTSD, as a spectrum of anxiety disorders affecting performance, is real and is cumulative to exposure to danger.

    For example, the continuous exposure to the reality and possibly of “indirect fire” (rockets and mortars) produces certain changes in a person: you avoid open spaces (stay close to walls and other barriers) and have a startle reflex to loud noises. The repeated release of adrenaline has an effect.

    I loathe the apologists for current policies and minimizers of PTSD like the contempible Dr. Sally Satel from the warmongering AEI, and AL, whose writing will be quoted in future proposals to cut the VA budget.

    And AL, how’s that trip to Iraq coming, and how’s your boy doing in the Air Force?

  27. No, motley, I’m not apologizing for anything. I’m damn unhappy with many of the choices the current Administration has made, and my only solace is that the Kerry administration would have made far worse ones.

    That’s the frustrating nature of reality; I don’t get to design perfect outcomes, I have to choose between available ones.

    I’m bummed I didn’t make it to Iraq this year to have dinner with my Iraqi friends; I hope to do it next year.

    As to my son, you’ve gotta keep up. Sorry it’s difficult; there’s a lot going on.

    A.L.

  28. And the band plays on, with Spike TV’s 8 hr! hostage drama feauturing a bank robbing Iraq war veteran; whose robbing for body armor and for senator’s sons to be sent to Iraq (Sen. Bunting,
    Bond, Webb, Johnson, et al should take note). Next
    ABC’s “Masters of Science Fiction” seconf offering,
    adapted from a Howard Fast (are you kidding me?)
    tale “The General Shot an Angel” set in Iraq called
    the “Awakening”. Beats Beauchamp by a mile.

  29. I’ve spent a long time trying to make sense of how I feel about what Dr. Grossman says, so here it goes. I think I can sort of see where Grossman is coming from, but he’s making some major assumptions, and some of his commentary is contradicted by other parts of it.

    Research in the past 15 years has proven that for a substantial percentage of patients, mild mental health conditions can be treated successfully, either through the use of medications, talk therapy, or both. Actually, Department of Defense was one of the earliest institutional proponents of treating mild clinical depression with cognitive behavioral therapy and SSRIs. The DoD’s patient population has, in part, provided the statistical basis for declaring depression a “treatable” illness. (Fun fact: Early identification and treatment of people with depression significantly increases the chances of successful outcome.)

    The work done on talk and medication therapies for treating depression is the baseline for many of the therapies that Grossman references when he says that “we are damned good at treating PTSD and… we are getting better at it every day.” Heck, diabetes is a treatable illness, we’re getting better at treating it every day, and it too garners media attention, often dealing with the possibility that the rate of diabetes will increase as obesity increases. Following Grossman’s logic, diabetes receives media attention because the media is involved in a mob-mentality “pile-on” on fat people. (Well, at least it will be cushion-y.) (Fun fact: Diabetics do better when they’re in a positive, optimistic environment where making healthy lifestyle choices is rewarded.)

    I have no doubt that for some soldiers, what Grossman proposes would help them; it’s actually very close to what mental health professionals have been telling the DoD to do since Gulf War I.^ And there are any number of other protocols developed by the VA, the DoD components, and independent researchers that would help the PTSD-diagnosed.

    That’s the rub, isn’t it? In order for any positive outcome to exist, the soldier has to be brought into the mental health care process and *given treatment*. Appropriate treatment, at that. I appreciate Grossman’s warning about treating all returning soldiers as having pre-PTSD, but the reports I’ve seen about Ft Carson, Walter Reed, and Ft Sam Houston typically deal with soldiers with problems who haven’t even met with a mental health professional after discovery of their problems. How can the community of _positive re-enforcers_ described by Grossman help soldiers if they’re denied access to it? Fundamentally, those that Grossman rails against are rallying for what Grossman wants: soldiers’ access to competent mental health services and a military that supports them.

    —-
    ^ Grossman veers dangerously close to promoting PTSD as beneficial in-and-of-itself. Take another look at what he says: “[PTSD] can be a step on the path to stress inoculation and… one can be stronger when they come out the other end.” I’m not aware of any study that says that patients successfully treated for depression regard themselves as “emotionally inoculated” and stronger for the experience. “Better able to cope” with certain situations, yes, but that’s quite different from “be[ing] stronger.” Is Grossman saying that PTSD-diagnosed soldiers are our natural overlords? I’m all in favor of empowering those in treatment (it’s a prerequisite for the cognitive therapies that Grossman advocates), but really.

  30. Trot out the familiar right-wing propaganda theme of Hollywood subversion. A few movies made will be the cause of veterans’ problems, not their long repeated tours in

    Trying out another theme of the coming dolchstosslegende “stab-in-the-back” legend:
    1. MSM, not Bush administration screwups, caused war to be lost;
    2. Hollywood, not Bush administration screwups, cause veterans’ problems now.

    Grossman is a self-promoting academic, not a combat veteran. Whoopie, he’s got an M.Ed.

    With hundreds of thousands of combat veterans walking around, he has some nerve characterizing their experiences.

    With him, it’s all theory, his service was all peacetime.

    I am suspicious of someone who describes themselves as an “Army Ranger” without having served in a Ranger battalion.

    Ranger school is tough, but it’s just, like a school. It’s not like being one of “the boys of Point-du-Hoc,” or Pat Tillman.

  31. Of course, he is a “Ranger” having earned a Ranger tab, but tab-wearers I know are modest, do not go around saying “I’m a Ranger,” just as five-jump badge-wearers best not describe themselves as “Paratroopers.”

    Technically accurate, but just not done as a matter of etiquette.

  32. So motley, if Hollywood films matter so little in setting cultural norms and taste, why do brands pay so much money to be featured in them?

    Why did the men’s underwear industry hate Clark Gable?

    Why is it so hard to find a showing of ‘Birth of a Nation’?

    Culture matters – a lot. It has mattered in every civilization through recorded history. It’s one thing where Plato agrees with Habermas. People who claim that it doesn’t are lying or ignorant.

    And nice try on the ad-hominems re: Grossman. Weak sauce, though.

    A.L.

  33. Ad hominems? It’s perfectly legitimate to question someone’s qualifications to make statements about other people’s state of mind.

    Grossman’s really not that qualified to make many judgments about combat PTSD. It’s kind of like a virgin writing about sex: prose may be elegant, description of mechanics may be true, but no way does that person “get it,” and any accurate judgments about the matter are only lucky guesses. With the issue of combat PTSD, you don’t really “get it” until you’ve been shot at and had people dying around you.

    But if you want ad hominems, I’d call him a quack, but he’s not a doctor. Charlatan is more fitting. It’s that whole self-aggrandizing “Ranger” thing. All Army infantry officers go though Ranger school, they don’t go around calling themselves “Rangers,” unless they’re in a Ranger battalion or wear a 75th Infantry combat patch.

    Yeah, culture matters, but not like concrete personal experience. And attacking Hollywood is an old right-wing pastime.

  34. _My dad was an Air Force pilot. He served on Guam post WWII. He never mentioned anything to me about daily plane crashes._

    Sheesh. My father was shipped to guam after VJ day, and he mentioned it. Also I read it in Erny Pyle. That’s 3 sources. Your dad didn’t mention it. That’s one negative source.

    It went on for something like 10 days or 3 weeks and then the brass shut down the flights until they got it straightened out.

    Sheesh.

    The way my dad explained it, the war was over and everybody wanted to come home with their stuff. The planes were getting overloaded way past their official capacity, and guam was the place where a hill caused them trouble on takeoff when they were way overloaded. When it turned into a problem the brass stepped in and enforced the weight limits.

    This started from one example of WWII untreated PTSD. And then you wanted to say it never happened because your dad didn’t tell you about it. Sheesh.

    Maybe I got it wrong and it was when they were landing. If you want to research it and tell me about the details I got wrong, feel free.

  35. _Grossman’s really not that qualified to make many judgments about combat PTSD. It’s kind of like a virgin writing about sex: prose may be elegant, description of mechanics may be true, but no way does that person “get it,” and any accurate judgments about the matter are only lucky guesses. With the issue of combat PTSD, you don’t really “get it” until you’ve been shot at and had people dying around you._

    Motley, while I don’t much want to defend Grossman, who seems to be combining standard modern treatment with a political ploy, still your argument here is weak.

    While the best marriage counselor might be somebody who had 50 divorces before finding her true-love stable marriage, that isn’t going to happen.

    And it isn’t necessary for doctors to get rabies before they can treat rabies.

    And this is even more true of veterinarians. You don’t have to be a dog before you can treat or train dogs, and you don’t have to be a soldier to treat or train soldiers. (Hmm. That looks like it could be taken wrong. No slur on soldiers intended.)

    Anyway, while Grossman may look like a media whore with a political agenda, still it’s possible he might get some good results beyond telling people that PTSD isn’t so bad, and it will go away if we ignore it and treat the troops like heroes.

    He might have some value even if he hasn’t recovered from PTSD himself and even if he doesn’t have official qualifications to treat it.

  36. Grossman, who seems to be combining standard modern treatment with a political ploy

    You got it. The idea that “PTSD is exaggerated and should be mostly ignored” has already been pioneered by Dr. Sally Satel of the abominable American Enterprise Institute.

    It did not fly too well then, so now the Beta version has been rolled out by “Army Ranger” Lieutenant Colonel (retired) Dave Grossman.

    Something has gotta stop the torrent of stories about bad health care for veterans and the mental effects of repeated lengthy deployments.

    Grossman may look like a media whore with a political agenda,

    He knows where the money for his “Killology” consultancy is. It’s not at counseling returned Iraq veterans at the VA – it’s with studies justifying less care for those veterans, and greater individual exposure of war. That’s what the government, think tanks, and tax-cut PACs will be funding.

    still it’s possible he might get some good results beyond telling people that PTSD isn’t so bad, and it will go away if we ignore it and treat the troops like heros

    How? “Hey, we gave them a parade, what more do they expect? Treatment costs real money.”

    Mealy-mouthed AL adds his own spin: “Hollywood” is to blame by making a few movies about the effects of war, as if it hadn’t made thousands of movies glorifying war.

    It’s Hollywood’s fault. Damn.

  37. Grossman goes about making his arguments in the most ham-fisted, tone-deaf way that I have trouble believing he is a previously published author.

    All four of his lies are real issues, to certain extents. Lie #1: The current pre-screening process for returning troops is a continuing joke. Army Pentagon is in its third or fourth revision of its questionnaire, the questionnaires aren’t always distributed to troops, they aren’t always returned, the actions taken based on the questionnaires vary wildly from unit to unit and time to time. The net effect is that there is no pre-screening process and the military mental health care system loses credibility with everyone involved: potential client population, healthy soldiers, and the chain of command. The lack of a screening program and the lack of credibility creates a situation where “a seemingly healthy individual” “suddenly” starts exhibiting symptoms consistent with PTSD, which easily leads into a belief that anyone can suddenly develop PTSD, and if anyone can suddenly develop PTSD, then all returning troops just could be ticking time bombs.

    Reformatted screening and treatment programs that actually work and have buy-in from the chain of command could easily counter this belief, which, incidentally, Grossman doesn’t document. Or, we could just blame the media. Whichever.

    Lies 2, 3, and 4 are indicative of a much wider and more nuanced problem than Grossman lets on to. Let us, like Grossman, ignore severe PTSD and focus on milder presentations of the illness for the moment.

    Military mental health professionals continue to face a daunting task in getting the rest of the military to understand that milder forms of mental illnesses are worth recognizing as mental illnesses precisely because they are so treatable and those sufferers who are treated have much better outcomes than those who are left undiagnosed.

    Consider that for the past 10-15 years this has been, on paper at least, the way that the DoD treats mild clinical depression. Yet, there are still many in the military who feel that any mental health issue that stops short of requiring immediate hospitalization can be ignored. And if the problem is ignored once, it can continue to be ignored without consequence.

    The mental health care advocate is placed in the difficult situation of diminishing the stigma of mental illness, convincing someone that a problem exists, and persuading that person that the problem is solvable. Only at that point can we even consider what it takes to form that community of positive re-enforcers that Grossman advocates. The command master sergeant/squad leader/squadmate previously didn’t have to expend any effort on the “mentally ill” (they’re either batsh*t insane and are shipped off to a hospital or they’re simply making stuff up and aren’t deserving of any consideration). Now, they’re being told that they need to exercise judgment, demonstrate leadership, and actively take part in someone else’s treatment. The whole thing smacks of effort!

    How are soldiers who are currently diagnosed with PTSD treated, both by their healthcare providers and their units? Are they able to attend therapy sessions? Are they getting the meds they need (if they need meds)? Are they training with their fellow soldiers? Do their superiors and their fellow soldiers feel that they are worth expending their effort on? Does Grossman feel that these questions can be answered affirmatively? And if not, where does the blame lie? With the media or with the military?

    He is, at the end of the day, a fabulist. I’d really like to believe the things he’s saying, but he ignores a large chunk of those with PTSD and ignores current military and larger societal attitudes towards mental illness. It would be great if the world worked the way that Grossman wants it to, with mild cases of PTSD treated by a not overburdened mental health system with the complete support of the military from the Chairman, JCS down to the lowliest private on the frontiest of lines. I think such a world is far off, and if we’re interested in pursuing it, there are better uses of our time than sitting around feeling suspicious of the media.

  38. motley, that’s possibly the silliest serious thing I’ve had anyone say on this blog.

    When you say that “Grossman’s really not that qualified to make many judgments about combat PTSD. It’s kind of like a virgin writing about sex: prose may be elegant, description of mechanics may be true, but no way does that person “get it,” and any accurate judgments about the matter are only lucky guesses. With the issue of combat PTSD, you don’t really “get it” until you’ve been shot at and had people dying around you.” do you also mean that no one who hasn’t had cancer can be an oncologist or no one who hasn’t been shot can be a trauma surgeon? The subjective experience of both might add something to the practitioner’s understanding – but it might just take it away as well.

    And it’s obvious from your posts that you don’t have one clue to rub together about Grossman or his stances. Can I suggest a trip to the library before you start tossing slurs?

    A.L.

  39. AL, It’s possible that you have mischaracterized Grossman’s views for your own political agenda: that is what #26 by R. Portofatto implied.

    If this is true, then I suppose J Thomas, Darkwater and I should take back what we said about Grossman being wrong, politically motivated, and a charlatan.

    You pulled a quote, and we said what Grossman said was bullshit. To me, the quote looked like a brief rehash of op-eds by Dr. Sally Satel of the warmongering AEI which had been touted in the right-wing blogs.

    If you pulled a quote of Grossman’s out of context to help construct your own improvisation on the right-wing theme that Hollywood is evil, and is to be blamed for combat PTSD in any equivalence to the lengthy repeated tours in Iraq and Afghanistan, shame on you.

    do you also mean that no one who hasn’t had cancer can be an oncologist or no one who hasn’t been shot can be a trauma surgeon?

    You said that and accuse me of silliness? Do I have to spell it out for you? Cancer and gunshot wounds are objective physical things: surgeons and oncologists aren’t much different from mechanics and chemists. What they treat is all physical.

    Combat PTSD is all subjective. Speaking as a virgin yourself, there is an aspect to it you can’t understand. Of course, it does not mean that people who have not experienced trauma cannot help veterans, e.g. psychiatrists who have studied the incompletely understood biochemical aspects of PTSD, but those who haven’t been there have no business minimizing PTSD.

    Experience matters. That is why the VA hires combat. veterans to be PTSD counselors: they “get it.” You don’t. Really, quit postponing that trip to Iraq; you might learn something.

  40. Motley, I made the same criticism of that particular claim of yours.

    PTSD isn’t all subjective. It’s something that people really can study from the outside and get some results.

    Talk therapy is likely to go better with a counselor who’s been through it himself, sure. However, talk therapy is not very effective. Not like auto mechanics or chemistry.

    I’ll try out some theory. My theory isn’t particularly unorthodox but I’ll point out ahead of time it could be all wroing.

    Our soldiers have a strong sense of duty. They want to carry their share of the load or more, to do whatever is needed from them. Get PTSD and your effectiveness goes down. You can’t do your full share, and yet there’s nothing obviously wrong with you except inside your head. And some of the other soldiers and particularly higher officers don’t understand, and think you’re shamming because you don’t want to do your part. Other people soldier on, you wimp out.

    So there are these issues on top of the original problem. And having somebody who _understands_ can help get past the shame. Somebody who’s been through it himself can understand better. Just being understood helps some. You don’t feel as alone, or as ashamed, and getting past that stuff lets you face the rest of it that we don’t have a good therapy for. So it still takes an indeterminate time until you figure out how to help yourself by trial and error.

    If we re-created military culture from scratch, we could maybe get people to work as hard as they could toward their duty, and still not get upset when they just can’t do it. That might leave them open to laziness or malingering etc. Or maybe it would all work better. You can’t be sure what you’ll get when you redesign things from scratch. Pretty often it takes repeated tries before you get it right.

    It would be really great if we could just fix the parts of the PTSD thing that we don’t know how to deal with now. That would help not just soldiers and policemen and EMTs but also a whole lot of civilians. But we don’t know how yet, and I haven’t seen any reason to think Grossman knows how either.

    So why is Grossman writing for the public about his Four Lies? It sure looks like political hackery to me. He wants to tell people that

    1. The vast majority of soldiers have no PTSD and no bad effects at all from extended warfare.

    2. Most of the soldiers who do get PTSD only get it a little bit, and aren’t seriously harmed by it. We used to ignore all the mild cases and we were better off ignoring them.

    3. We’re damned good at treating PTSD and getting better every day.

    4. And anyway, soldiers who do get PTSD and get over it are better off than they would be if they hadn’t gotten it in the first place.

    So don’t you little civilians fret your little heads about it. There isn’t really any PTSD problem, and if you think there is you’re hurting the war effort and being unpatriotic and you’re hurting the troops. Just pretend it isn’t there and it will go away.

    Maybe there’s an antiwar theme that says all the soldiers get PTSD and turn into ticking timebombs that can’t ever integrate back into civilian life, so we need to end the war. Maybe Grossman thinks we need to counter that with the opposite lie. But still, he’s lying to the media. With the implication that PTSD is really no problem at all, that our brave soldiers can take five deployments, or ten, or twenty, and they’ll still be as good as new, and if they don’t let’s do some tough love and make sure they understand we expect them to get well fast. That will make them get well fast and back to their full duty-cycle.

    Grossman may have noble intentions for his lies. Like he might believe he’s helping the war effort. But still, he’s lying.

  41. J Thomas –

    What’s your support for Grossman’s having a political view of the war (other than pro-troop)? What’s your support for the claim that he’s lying?

    Make an argument, and this could get interesting.

    A.L.

  42. Forget Spartans and Huns and let’s look a little closer to home.

    Native American Vietnam Vets are statistically diferent from their non-Indian peers in two ways: the suffered higher casualty rates in the field and had a lower mental illness rate on return. The former has been attributed to both a self-expectation (traditional warrior culture) and a higher rate of being given more dangerous jobs (“he’s an Indian, so he must be a good tracker – put him on point”). The latter has been attributed to a culture and society that respected the warrior and welcomed them home with honor. Go at a powwow today and there will likely be a ceremony in which they recognize the veterans and those who have enlisted.

  43. AL, I’ll make a start at it, though I thought it was obvious. But first a disclaimer, I haven’t read the book. I’m guessing from the scrap you quoted.

    So, first of all, he’s writing a mass-market book. He isn’t trying to influence specialists who actually work with PTSD. He’s selling books to the public.

    I looked over one of his other books. He repeated the research fairly accurately and made it interesting. He seemed like a good popularizer. So I’d hope that this might do the same, that it might tell the public about what’s going on with PTSD, particularly the new research, and make it interesting.

    But what you quoted didn’t do that at all. It created pro-war talking points.

    One of the things that caused trouble in past wars was that there was a big stigma to having symptoms. So soldiers would pretend nothing was wrong until they just couldn’t fake it any more. Better to deal with problems while they’re small. So we don’t want soldiers to be worried that everybody will think they’ve gone crazy if they get help.

    _Lie Number 1: Ignore the vast majority who are just fine and report only on the minority with problems._

    He’s saying it’s only a tiny minority that has problems, and the vast majority has no problem. He isn’t interested in catching problems when they’re small, he’s interested in denial.

    _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._

    He’s trying to persuade the public that the media is reporting wrong, he wants the public to believe the media ought to report different things. But when the media focuses on PTSD they tend to get it right. We *are* catching cases early, a lot of the people who get treatment now would not have gotten any treatment before. We’ve gotten good enough at getting soldiers to report their symptoms that we don’t have enough resources for them and a lot of them have to wait. So what’s his point? He’s telling the public that first the vast majority of soldiers get no PTSD at all, and second most of the ones that do only have a little bit of PTSD, no problem. It looks to me like he’s badly distorting the facts to counter somebody else’s political spin. They try to make people think that soldiers are getting a lot of PTSD as an argument to end the occupation. He’s saying it’s no problem. What other reason is there to say that, except to create political spin?

    Ideally the public would be sympathetic. See somebody displaying symptoms, you give them a kind word or at least a kind glance. They mostly aren’t dangerous. They’re only re-adjusting. When one of our brave soldiers comes home with PTSD, what civilians can do is _welcome him home_. But I don’t get that from Grossman. What I hear him saying is that it hardly ever happens, and the media shouldn’t report it happening.

    _Lie Number 3: Fail to report that we are damned good at treating PTSD and that we are getting better at it every day._

    Again, he’s denying. We aren’t that good at it yet. We’re getting better. His entire purpose is to tell civilians the problem is minimal.

    _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._

    More denial. “Never mind if they do get PTSD, they’ll be better for it when they come out the other end.”

    _Get veterans invested in their grievance and their role as victim. Get them to draw disability from PTSD and convince them that they will never recover._

    Here he brings up a valid point. Get people to see the advantages in a victim role and they may never leave it. But how likely is that? Our military is _very good_ at persuading soldiers not to act like helpless victims. Recruits who’re predisposed to that aren’t likely to get through their first training. Why would soldiers fall into that role from media prompting — unless the military had already abandoned them?

    _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._

    This is a complex topic. We don’t know how predict how long people will actually take to get over it. Do we want to put them on a schedule and stop helping them if they’re too slow? That’s a good thing for the slackers. “Hmm. All I have to do is say I have PTSD and go BS with somebody twice a week, and they give me money for six months. OK, sign me up.” It isn’t very good for the people who have real disabilities we aren’t yet good at treating, though.

    How come he’s talking tough love to the public? He doesn’t say, beyond his theory that it works. Self-fulfilling prophecy. Tell the men their PTSD will go away quickly and it will. More denial. It’s true we have an unsolved problem here. It’s a good thing to treat PTSD early, before it gets too bad. It’s a good thing for soldiers to understand it’s OK to report it early and get assistance early. But current treatment is kind of expensive, and it has unreliable results. We haven’t budgeted enough for it and we don’t have enough trained people yet. Should we spend more money, or are we better off to deny the problem? Denial is cheaper in the short run. And if the soldiers last until the military doesn’t need them, and if there’s a labor surplus in the civilian job market, then it makes a certain brutal sense to just let them rot. Why spend the money for expensive treatment for them? Somebody’s got to be unemployed, why not give the job to somebody healthy and let the old soldiers be the ones who sit around unable to work? I don’t like that reasoning.

    I’d like it better if we found reliable ways to beat PTSD. The drugs are a sort of crutch, and they don’t work reliably. Like, some of them cause memory loss. They keep you from thinking bad thoughts but they also keep you from having a life — you can’t really pay attention to much else either. Some of them keep you from getting excited, which can interfere with sex. A big variety of drugs that have different effects on different people. Crutches. And there’s talk therapy which may have results but is quite unreliable. I think if you take the drugs you ought to get talk therapy too, because that gives a much better chance they’ll notice bad drug effects than if you just go in every month or so and get your prescription renewed. Without the talk therapy they might just ask if you’re satisfied, and if you aren’t they up the dosage.

    So the concept that you can recover from PTSD, that it isn’t irreversible, is important. And of course we want to cut costs. But without a workable new therapy it seems to me irresponsible to just minimise costs. Tell the public it’s no big deal, just tell the afflicted to get over it, give them a good big dose of tough love. No problem.

    It sounds like spin to me.

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