PTSD vs Normal Emotional Reactions

PTSD is often considered an abnormal emotional reaction to war. War causes an emotional reaction, of that there can be no doubt. But emotional reactions are not necessarily PTSD. Emotional reactions are most definitely not a sign of mental illness. In fact, they are a sign of sanity.

To understand the difference between normal and abnormal emotional reactions and responses, we as civilians must first understand these terms, as they are understood by our warriors.

One of the most shocking things a soldier can say to a civilian is, “I want to go back”.

To many, and sadly even some in the mental health community, this is a sign of something wrong. The assumption is that either the solider grew to like killing too much or has a death wish. (As a side note, if you know or worse, are a mental health provider who thinks this way, do the world a favor and stay as far away from our military and veterans as possible. This thinking shows a complete lack of understanding of the realities of the experience of war.)

When a soldier comes home, they are grateful a walk outside or a ride in a vehicle carries little relative risk of being shot or blown up.  When they say they miss war, it is not the fear they miss though the adrenaline rush of risk can be attractive, particularly in hindsight. What they look back at most fondly is a place and time when everything was simple, everything was more intense, everything made sense. Surprisingly, many felt safer, an admittedly oxymoronic thought.

Volumes have been written about the immediacy of life that is experienced when continued life is uncertain. Friendships are formed faster and more intensely, often with people one would not otherwise associate. The most basic things in life, like a hot shower, a cold drink and a soft bed when they can be had are appreciated out of proportion to their relative merits. Even a crappy mess hall meal, if hot and on demand after days or weeks of MRE’s is a sumptuous feast. These are the ingredients of war stories since men went off to fight. Yet, these are not the things soldiers pine for most when they say “I want to go back”.

There is a simplicity to life that has nothing to do with the next day even the next moment not being promised when in a war zone. It is about knowing what you need to do, moment to moment and knowing the guys next to you are doing the same. There are very few decisions that need to be made; maybe, if you’re lucky, you can decide which pair of socks to put on, though generally that decision is made for you based on which pair is least crusty.

Just as many volumes have been written about how our world has become so chaotic, so fast paced and frenzied, so filled with unending choices. This is the boon of living in modern civilization, but it is also the downfall for many of our veterans. Time and distance do funny things to our memories, causing terror to fade while romanticizing the moments of relative peace. In truth, those moments of downtime while in a combat zone were mind-numbingly boring, but they were among the most peaceful and beautiful ever experienced. You were back at your base, having survived another trip outside the wire. The adrenaline rush is over, the heart rate slows and the relaxation that follows is more complete than any you can remember.

Now home, in your old familiar bed, surrounded by family and loved ones you’re surprised you can’t relax. Sleep is as elusive as a puff of smoke. There is no threat, but your mind keeps racing with your heart galloping to keep up. You have your guard up, you’re hyper-aware and vigilant though you know the probability an RPG will come crashing through the ceiling is pretty low. Even in this day and age of rampant crime, there is little chance armed men are going to come bursting through your door, yet you can’t keep from checking and rechecking that everything is locked and secured. At every sound, or absence of sound, you bolt upright and wide awake.

Not only is this not a sign of mental illness, it is a perfectly normal reaction.

An inability to sleep is one of the most commonly reported complaints of our returned soldiers. Again, this is not necessarily a sign of a mental problem or coping issue. When at war, even bedding down in a field with nothing more than the clothes on your back separating you from the hard ground, restful sleep was had. It goes back to the idea that everyone had a job, did it and knew others were doing theirs as well. When it was time to sleep, you put your trust in the guy on sentry or guard duty, knowing when it was your turn, he put his faith in you. Sleep was more than just rest, it was being cradled in the knowledge that those whom you have come to call brother were actively protecting you.

When you come home, you are the one who is trained to protect and watch over others. If you’re asleep, who is watching? Who is guarding your family, your kids? Granted, most of this is not an intentional thought but once it is, you can actively work on reordering your thoughts making restful sleep possible once again. Of course, allowing time for your autonomic system to reset is a prerequisite as well. When your system is fried from overload, that reprogramming is going to take longer. Still, this is normal and natural, not a problem.

Most people experience this disruption in sleep when they move into a new house or apartment, or from the city to the suburbs. We say we have to get used to the normal sounds of our new environment and once we do, we sleep better. If your previous home was in the heart of a city, the relative absence of sound can both wake you and make it difficult to fall asleep. Even if you are used to a level of ambient night noise, a change in those sounds can disrupt sleep. Think of how many people who live in the heart of a city still ask for a room in a hotel away from the elevator or ice machines, as those sounds, even though not particularly loud are out of the ordinary and therefore prevent a restful night.

Realistically, it is nearly beyond the limits of the human psyche to flip that switch off and then back on again. For many,  if the decision is even consciously made, it feels safer just leaving it the on position for many in our current generation of warriors. They know there is not only the possibility but a strong probability that those reactions, that situational awareness will once again be a matter of life and death. And we, as civilians, view that as a problem. We react negatively when our soldiers, out of hard learned habit, won’t sit with their back to a door. We think there is something wrong with the instantaneous defensive reaction to sudden loud noises. We call them paranoid when they scan large crowds for potential threats. And as soon as they say they can’t sleep, we give them drugs rather than help them understand why their inability to sleep is a normal, natural reaction.

One of the very worst things a civilian can do to our warriors is assume these reactions are a problem. Even friends and families of our soldiers think that because a person is having an emotional response to their experiences, difficulty sleeping or instantaneous defensive reactions,  there is something mentally wrong. These misunderstandings are most acute in the first days, weeks and months of a soldier’s return home. Some units have begun to address this with classes and orientations  for the soldier’s family prior to a unit’s return, but this is not yet universal within all units or branches. Perhaps once it is, there will be fewer separations and divorces among our newly returned warriors. Assuming of course, the simple understanding that these reactions are not just normal but a mark of sanity and not a sign of a problem in our soldier.

That lack of understanding is not only a significant barrier to knowing our returning warriors, it also places unrealistic and some say, unrealizable expectations on those who have stood in the blood and guts of their brothers in arms. Those experiences change a person. And it is good and right to be changed by first hand encounters with horror. But taking, and needing time to adjust to life in a non-war zone is normal, natural and healthy.

With these attitudes home is sadly another form of a hostile environment, one that is in some ways harder to survive. These warriors have displayed intelligence, mental toughness and situational awareness beyond what most civilians can imagine, enabling them to return to what has sadly become the dubious comforts of home.

Next – The Chemical Causes of Post Traumatic Stress

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