Our Ambivalence

John and Ann's stories stirred intense feelings in me, as I imagine they do in you. Our reactions are the real topic of this article, because they determine how we think about people who've experienced horrific events, and how the mental health profession defines and treats their problems. Imagine now that these events happened to you or someone you care about deeply. Do you notice any attempt to avoid or move quickly away from the pain, fear, and horror these stories evoke in you? Do you want to distance yourself from the reality of what happened, to diminish or mute the feelings getting stirred? Are you aware of any conflicted feelings about how John and Ann have coped—do you feel sympathetic, yet a little bit critical or judgmental? Are you asking yourself how you might deal with such horrors?

Ambivalence is at the core of our response to such stories. When we hear of a horrific event, we may try to understand it by imagining what it would be like for us to have that experience. We'd like to think that we could surmount such catastrophes, but if we're at all aware of our own vulnerabilities and limitations, we probably doubt that we could, yet we're aware of our internal judgments and how we tend to hold others responsible for their ability to manage life's challenges.

To complicate our feelings even more, we may fear that our struggle to get over something might engender negative judgments from others. Just hearing such stories can raise conflicting feelings, causing us to bounce from sympathy to implicit antipathy. Added to that is the uneasy feeling that we might someday be on the receiving end of other people's impatient remarks like, "Bad stuff happens to everybody, but they get on with life—what's wrong with him that he can't get his act together after all this time?"

In subsequent work in the group and individual therapy, John focused on his anger at his chain of command. He felt deeply betrayed by his platoon sergeant's failure to come to his aid. "That son of a bitch! He let us all down. Because of him, Larry died. And I had to pick up another soldier's body and tuck his guts under my arm."

As a Vietnam combat veteran, I could easily understand his rage. I knew a thing or two about people's failures under fire. "If anything," I said, "you're letting him off easy. He didn't just 'let you down.' That's calling him on a misdemeanor, when you've got him on a capital offense. What he did was dereliction of duty under fire. Not too long ago, he could have been shot on the spot for that."

John listened to that and nodded.

"But how does that help you?" I asked. "It could be that if he'd done his duty, things might have been easier for you. Maybe that's true. But Larry probably would still have died, and you'd still have to deal with that. You haven't mourned his loss yet. Every time you get near to feeling your grief for him, you jump to your anger at the sergeant."

John didn't like that, and immediately changed the subject to his battalion's commanding officer. "That bastard would volunteer us for extra missions—unnecessary ones, dangerous ones! Everyone in the battalion knew why: so he could get promoted. That fobbit, who never once went outside the wire, sat on the base and sent us out to get killed so he could make colonel." (A fobbit is a pejorative term for a soldier who never leaves the safety of the Forward Operating Base.)

"They're all liars, all corrupt," he muttered. "That's why I don't trust anyone anymore. And to think I used to want to go into politics, be a leader!" He snorted derisively. "Now all I want to do is go back to my family farm in North Carolina and raise sweet corn." It's on that farm, however, that John's story really begins. His father was a Vietnam veteran, an alcoholic, and a recluse, who'd always belittled and verbally abused him, yet John idealizes him as a hardworking provider and practitioner of "tough love."

Ann's backstory, too, complicates the picture. As the therapy group continued, she revealed deep anger at her husband, who regularly attacked her verbally, calling her a "fruitcake" and much worse. Other group members were appalled by the cruelty he inflicted and she tolerated. She was openly contemptuous of him in group, but rebuffed any of the group's suggestions or attempts to help, appearing willing to remain locked in a bitter, antagonistic relationship. However, her endurance of her husband's abuse seemed more understandable when she revealed that her father had been a bigamist, who'd surrounded himself with several subservient wives and explicitly espoused the subjugation of women. Her history shed light on her experiences in the Army, which included sexual harassment and male superiors' blatant disregard for her safety.

We may feel tempted to believe John and Ann are at increased risk for PTSD because of their early family life. Since their current troubles have plausible roots in difficult childhoods, we may be inclined to regard them as more fragile than others, lacking "resilience," and less able to "take it" when the going gets rough. This commonly held opinion isn't so different—except for the modern psychologizing gloss—from the way societies throughout history have viewed soldiers who fail the test of battle. In every era, across virtually all cultures, people by and large believed that there could be only one reason that a person feared going to war, abandoned the fight, or had serious "adjustment" difficulties afterward: he was a coward, and his behavior reflected a failure of courage and character.

Consider the viewpoint of the Greeks of Homer's time, a warrior culture if ever there was one. In that heroic age, it was universally assumed that any war-related mental suffering of the kind currently labeled PTSD stemmed from an inherent moral deficit or weakness of character. According to some authorities, The Odyssey is a disguised account of Odysseus's struggle with PTSD. They see him as a psychological wreck, crippled by war-induced hallucinations, flashbacks, irrational fears, nightmares, depression, and explosive anger, all of which are recast as a series of adventures with externalized monsters. Using metaphor and exaggerated adventures, Homer succeeded in composing an epic poem about a crippled hero that's endured through the ages.

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clieb   |Registered |2011-03-27 08:58:52 "The knowledgeable reader will note that the therapy I describe above is hardly specific to treating PTSD. Indeed, it's nothing other than basic psychotherapy." I currently work on a PTSD team in a VA clinic where all traditional therapy as you describe in this excellent article has been replaced by so-called "evidenced-based", manualized treatments which are solely focused on diagnosis and symptom reduction. My impression is that the author would find very few "knowledgeable readers" left within the VA or DOD who have had any training or practice in the type of non-straight-line therapy you describe. Am I right about this? I hope not. docsoc70   |Registered |2010-12-26 13:36:48 I appreciated Roy Clymer's article. I worked, as a psychologist with Vietnam veterans for 20 years and then wrote my PhD thesis on 'The Discursive Construction of PTSD'. I looked at the way the veteran constellation, ie veterans, the variety of mental and physical health providers, and the practices of our Veterans Administration, actually thought and talked about the disorder. I concluded 'Perhaps the reason for the conformity of opinion of those who judge the disorder (PTSD) as an 'already there' reality is that the communities of mental and physical health providers, in our secure consulting rooms, are circumscribed by the monocularaties of our practice. It is perhaps that we, who treat this disorder are trained to see and interpret what we are looking for, to satisfy the requirements of a needy population; the realities of government policy, and the dictates of VA practices specifically designed around 'Care, Compensat... ruffing  - The Puzzle of PTSD byn Clymer   |Registered |2010-11-30 10:24:28 My hat is off to Dr. Roy Clymer. He is not only insightful, honest and professionally ethical, but also daring. His excellent article will surely draw fire from those deriving benefits from their involvement with indivduals diagnosed as such. Dr. Clymer can surely take a place beside other brave insightful professionals such as Dr. William Glasser and James S. Gorden who challanged the diagnoses of depression as being a medical disorder and provided working solutions in their books Choice Theory and Unstuck. I am fortunate to have spent time as a student of the Dutch priest, Dr. Father Adian VanKaam, he often stated, "if you do not have an established self, you will seek a pseudo self". One of my assignments in the fifty five years of involvement in this fiel was to examine individuals seeking employment in law enforcement. It became very clear that individuals with no concept of self were seeking a pseud...

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