The first time I realized I had a problem, I was in a subway station in New York City. It was almost a year before the attacks of 9/11 and I’d just come back from two months in Afghanistan with Ahmed Shah Massoud, the leader of the Northern Alliance. I had no appreciation for how that experience would affect me psychologically, and so I was completely unprepared for the aftermath. Massoud was fighting a desperate action to open up supply lines across the Amu Darya River before winter set in, and he was blocked by Taliban positions on a prominent ridge overlooking the Tajik border. Hundreds of Taliban troops were dug in with tanks and artillery and protected by a few MiG jets that were based at Taloqan. Al Qaeda’s infamous 055 commando brigade was up there, as well as volunteers from Uzbekistan and Chechnya, and Pakistani commanders who shouted over the radio in Urdu and berated the locals for not fighting hard enough.
Massoud’s men were outnumbered three to one and in short supply of everything from tank rounds to food. At one point I and the men I was with made our way to a frontline position that had just been taken from the Taliban and arrived in time for the inevitable counterattack. We curled up in the slit trenches and listened to rockets come screaming in and detonate against the packed-clay earth. The Northern Alliance had no artillery to speak of, so all we could do was stay down and wait for the Taliban to run out of rockets. We eventually managed to get out of there, though we lost one of our packhorses in the barrage. I felt deranged for days afterward, as if I’d lived through the end of the world.
By the time I got home, though, I’d stopped thinking about that or any of the other horrific things we’d seen—casualties from an infantry assault through a minefield, starving civilians, MiG jets circling us, looking for a place to drop their bombs. I mentally buried all of it until one day a few months later when I went into the subway at rush hour to catch the C train downtown. Suddenly I found myself backed up against an iron support column, convinced I was going to die. For some reason everything seemed like a threat: there were too many people on the platform, the trains were moving too fast, the lights were too bright, the world was too loud. I couldn’t really explain what was wrong, but I was more scared than I’d ever been in Afghanistan.
I stood there with my back to the column until I couldn’t take it anymore, and then I sprinted for the exit and walked home. The nation wasn’t at war yet, and I had no idea that what I’d just experienced had anything to do with combat; I just thought I was going crazy. For the next several months I kept having panic attacks whenever I was in a small place with too many people—airplanes, ski gondolas, bars. The incidents eventually stopped happening, and I didn’t think about it again until two or three years later, when I found myself at a family picnic, talking to a woman who worked as a psychotherapist. The United States had just invaded Iraq, and that may have been what prompted her to ask whether I’d been traumatized by the wars I’d covered. I told her that I didn’t think so, but that for a while I’d had panic attacks in crowded places. She nodded.
New Perspectives on Chronic Trauma
What I had was classic short-term PTSD. From an evolutionary perspective, it’s exactly the response you want to have when your life is in danger: you want to be vigilant, you want to avoid situations where you’re not in control, you want to react to strange noises, you want to sleep lightly and wake easily, you want to have flashbacks and nightmares that remind you of specific threats to your life, and you want to be, by turns, angry and depressed. Anger keeps you ready to fight, and depression keeps you from being too active and putting yourself in more danger. Flashbacks also serve to remind you of the danger that’s out there—a “highly efficient single-event survival-learning mechanism,” as one researcher termed it.
Almost everyone exposed to trauma reacts by having some sort of short-term reaction to it—acute PTSD. That reaction clearly has evolved in mammals to keep them both reactive to danger and out of harm’s way until the threat has passed. Long-term PTSD, on the other hand—the kind that can last years or even a lifetime—is clearly maladaptive and relatively uncommon. Many studies have shown that in the general population, at most 20 percent of people who’ve been traumatized get long-term PTSD. Rather than being better prepared for extraordinary danger, these people become poorly adjusted to everyday life. Rape is one of the most psychologically devastating things that can happen to a person, for example—far more traumatizing than most military deployments—and according to a 1992 study, close to 100 percent of rape survivors exhibited extreme trauma immediately afterward. And yet almost half of rape survivors experienced a significant decline in their trauma symptoms within weeks or months of their assault.
That’s a far faster recovery rate than soldiers have exhibited in the recent wars America has fought. One of the reasons, paradoxically, is because the trauma of combat is interwoven with other, positive experiences that become difficult to separate from the harm. “Treating combat veterans is different from treating rape victims, because rape victims don’t have this idea that some aspects of their experience are worth retaining,” I was told by Dr. Rachel Yehuda, the director of traumatic stress studies at Mount Sinai Hospital in New York. “For most people in combat, their experiences range from the best of times to the worst of times. It’s the most important thing someone has ever done—especially since these people are so young when they go in—and it’s probably the first time they’ve ever been free, completely, of societal constraints. They’re going to miss being entrenched in this defining world.”
Also, adversity often leads people to depend more on one another, and that closeness can produce a kind of nostalgia for the hard times that even civilians are susceptible to. After World War II, many Londoners claimed to miss the exciting and perilous days of the Blitz, for example; and the war that’s missed doesn’t even have to be a shooting war. “I am a survivor of the AIDS epidemic,” an American man wrote in 2014 on the comment board of an online lecture about war. “Now that AIDS is no longer a death sentence, I must admit that I miss those days of extreme brotherhood . . . which led to deep emotions and understandings that are above anything I have felt since the plague years.”
What people miss presumably isn’t danger or loss but the unity that these things often engender. There are obvious stresses on a person in a group, but there may be even greater stresses on a person in isolation. Most primates, including humans, are intensely social. A modern soldier returning from combat—or a survivor of Sarajevo—goes from the kind of close-knit group that humans evolved for, back into a society where most people work outside the home, children are educated by strangers, families are isolated from wider communities, and personal gain almost completely eclipses collective good. Even if he or she is part of a family, that’s not the same as belonging to a group that shares resources and experiences almost everything collectively. Whatever the technological advances of modern society—and they’re nearly miraculous—the individualized lifestyles that those technologies spawn seem to be deeply brutalizing to the human spirit.
One of the most noticeable things about life in the military, even in support units, is that you’re almost never alone. Day after day, month after month, you’re close enough to speak to, if not touch, a dozen or more people. When I was with American soldiers at a remote outpost in Afghanistan, we slept 10 to a hut in bunks that were only a few feet apart. I could touch three other men with my outstretched hand from where I lay. They snored, they talked, they got up in the middle of the night to use the piss tubes, but we always felt safe because we were in a group. The outpost was attacked dozens of times, yet I slept better surrounded by those noisy, snoring men than I ever did camping alone in the woods of New England.
That kind of group sleeping has been the norm throughout human history and is still commonplace in most of the world. Northern European societies are among the few where people sleep alone or with a partner in a private room, and that may have significant implications for mental health in general and for PTSD in particular. Virtually all mammals seem to benefit from companionship; even lab rats recover more quickly from trauma if they’re caged with other rats rather than alone. In humans, lack of social support has been found to be twice as reliable at predicting PTSD as the severity of the trauma itself. In other words, you could be mildly traumatized—on a par with, say, an ordinary rear-base deployment to Afghanistan—and experience long-term PTSD simply because of a lack of social support back home.
Anthropologist Brandon Kohrt found a similar phenomenon in the villages of southern Nepal, where a civil war has been rumbling for years. There are two kinds of villages in that area: exclusively Hindu ones that have sharp class distinctions, and mixed Hindu and Buddhist ones that are far more open and cohesive. Child soldiers of either sex who went back to stratified villages could remain traumatized almost indefinitely, while those who returned to more communal villages tended to recover fairly quickly. “Some had trauma rates that were no different from children that had not gone to war at all,” Kohrt told me about those ex‑combatants. “PTSD is a disorder of recovery, and if treatment only focuses on identifying symptoms, it pathologizes and alienates vets. But if the focus is on family and community, it puts them in a situation of collective healing.”
The Healing Power of Community
Israel is arguably the only modern country that retains a sufficient sense of community to mitigate the effects of combat on a mass scale. Despite decades of intermittent war, the Israel Defense Forces have by some measures a PTSD rate as low as one percent. Two of the foremost reasons may have to do with the proximity of the combat—the war is virtually on their doorstep—and national military service. “Being in the military is something that most people have done,” I was told by Dr. Arieh Shalev, who’s devoted the last 20 years to studying PTSD. “Those who come back from combat are reintegrated into a society where those experiences are very well understood.”
According to Shalev, the closer the public is to the actual combat, the better the war will be understood and the less difficulty soldiers will have when they come home. During the Yom Kippur War of 1973, many Israeli soldiers were fighting on the Golan Heights with their homes at their backs. Of the 1,323 soldiers who were wounded in that war and referred for psychiatric evaluation, only around 20 percent were diagnosed with PTSD, and less than two percent retained that diagnosis three decades later. The Israelis are benefiting from what the author and ethicist Austin Dacey describes as a “shared public meaning” of the war. Shared public meaning gives soldiers a context for their losses and their sacrifice that’s acknowledged by most of the society. That helps keep at bay the sense of futility and rage that can develop among soldiers during a war that doesn’t seem to end.
Such public meaning is probably not generated by the kinds of formulaic phrases, such as “Thank you for your service,” that many Americans now feel compelled to offer soldiers and vets. Neither is it generated by honoring vets at sporting events, allowing them to board planes first, or giving them minor discounts at stores. If anything, these token acts only deepen the chasm between the military and civilian populations by highlighting the fact that some people serve their country but the vast majority don’t.
As anthropologist Sharon Abramowitz told me, “We valorize our vets with words and posters and signs, but we don’t give them what’s really important to Americans, what really sets you apart as someone who’s valuable to society—we don’t give them jobs. All the praise in the world doesn’t mean anything if you’re not recognized by society as someone who can contribute valuable labor.”
Anthropologists like Abramowitz and Kohrt have identified three factors that seem to crucially affect a combatant’s transition back into civilian life. The United States seems to rank low on all three. First, cohesive and egalitarian tribal societies do a very good job at mitigating the effects of trauma, but by their very nature, many modern societies are exactly the opposite: hierarchical and alienating. America’s great wealth, although a blessing in many ways, has allowed for the growth of an individualistic society that suffers high rates of depression and anxiety. Both are correlated with chronic PTSD.
Secondly, ex‑combatants shouldn’t be seen—or be encouraged to see themselves—as victims. One can be deeply traumatized, as firemen are by the deaths of both colleagues and civilians, without being viewed through the lens of victimhood. Lifelong disability payments for a disorder like PTSD, which is both treatable and usually not chronic, risks turning veterans into a victim class that’s entirely dependent on the government for their livelihood. The United States is a wealthy country that may be able to afford this, but in human terms, the veterans can’t. The one way that soldiers are never allowed to see themselves during deployment is as victims, because the passivity of victimhood can get them killed. It’s yelled, beaten, and drilled out of them long before they get close to the battlefield. But when they come home they find themselves being viewed so sympathetically that they’re often excused from having to fully function in society. Some of them truly can’t function, and those people should be taken care of immediately; but imagine how confusing it must be to the rest of them.
Perhaps most important, veterans need to feel that they’re just as necessary and productive back in society as they were on the battlefield. Iroquois warriors who dominated just about every tribe within 500 miles of their home territory would return to a community that still needed them to hunt and fish and participate in the fabric of everyday life. There was no transition when they came home because—much like in Israel—the battlefield was an extension of society, and vice versa. Recent studies of something called “social resilience” have identified resource sharing and egalitarian wealth distribution as major components of a society’s ability to recover from hardship. And societies that rank high on social resilience—such as kibbutz settlements in Israel—provide soldiers with a significantly stronger buffer against PTSD than low-resilience societies. In fact, social resilience is an even better predictor of trauma recovery than the level of resilience of the person himself.
Unfortunately, for the past decade American soldiers have returned to a country that displays many indicators of low social resilience. Resources aren’t shared equally, a quarter of children live in poverty, jobs are hard to get, and minimum wage is almost impossible to live on. Instead of being able to work and contribute to society—a highly therapeutic thing to do—a large percentage of veterans are just offered lifelong disability payments. And they accept, of course—why shouldn’t they? A society that doesn’t distinguish between degrees of trauma can’t expect its warriors to, either.
Adapted from the book Tribe: On Homecoming and Belonging by Sebastian Junger. Copyright (c) 2016 by Sebastian Junger. Published by Twelve, an imprint of Grand Central Publishing, a division of Hachette Book Group, Inc. All rights reserved.
Photo © Getty Images/Raphye Alexius
CategoriesThe Larger Conversation Clinical Practice & Guidance Issues & Developments The Field Trauma
Earn CE Credits
Just for reading the Networker!