Back in November, I returned home from a six month deployment to Bagram Air Field, Afghanistan. I mercifully did not directly endure what several of my brothers and sisters in arms have experienced, most of which is now public knowledge. An IDF (indirect fire) killed a contractor on her way to breakfast, a negligent discharge killed a soldier, a C-130 crashed, and a helicopter crashed; not long after I left, several Air Force Office of Special Investigations agents and their Security Forces escorts died in a suicide bombing. I counseled several people who were directly involved in the events, whether they were first responders, team mates, or part of the recovery efforts. There were a number of unrelated suicide interventions. My scars are relatively minimal compared to theirs.
The first few weeks after I got home, grocery stores were a little overwhelming -- not because of crowds, but because of the sheer number of food options available to me after six months of the same handful of meals on rotation. It's almost three months later, and I still tense up a bit if I hear anything that sounds remotely like the klaxon warning us of an incoming IDF or the phalanx guns firing that intercept them -- the later sounds a bit like heavy wood furniture scraping across a carpet, followed by popping noises as the rounds explode. Every now and again, I'll have a Bagram dream. In sum, I don't feel like I need a pity party. I had a great time and grew a lot, and I would be happy to trade stories with other OEF / ORS vets. Because of my job, though, I'm somewhat knowledgeable about PTSD and troops who experience it.
The good folks at Mental Health could probably explain it better than I could, but here goes. A traumatic stress event is an event so traumatic that the human brain can't adequately process it. Triggers could be moral injury, violence, physical or sexual trauma, and so forth. While there are trends, a traumatic stress event is subjective and individual. I've resilient folks who have endured a shocking amount of stuff and are mostly fine. I counseled folks who completely ignored IDF klaxons and could care less, and I counseled folks who were scared to walk to the Dining Facility for fear of being hit.
So, the traumatic event happens, and the brain can't handle it right then and there. So, it files the event away in what seems to me to be the subconscious mind, which gets to work on processing the event. The subconscious mind is a powerful thing. It's what makes you remember song lyrics your conscious mind couldn't recall four hours ago, but all of a sudden, there they are. So, it goes to work processing the traumatic stress event.
The individual meanwhile experiences post traumatic stress. It's normal and manifests itself several ways: emotional distance, heavy emotion, changes in behavior, sleeping a lot, sleeping a little, bad dreams, and so on. It's normal to have post traumatic stress for a period of time -- say, a 30 to 90 days. I tell people that in briefings, mostly because people tend to think their symptoms are isolated and idiosyncratic, or that no one can help or relate to them because of their unique symptoms.
Now, if the post traumatic stress continues after, say 90 days, it can become post traumatic stress disorder. If the symptoms are particularly strong, it can be due to a disorder. See? Post traumatic stress is normal. When it continues beyond the normal time period or the symptoms are extreme, it becomes a disorder. The subconscious can't, for whatever reason, sort out the traumatic stress event, and complications happen.
Imagine a computer's operating system. There are active programs and background programs. Your browser is chiefly an active program, for example, but it can have background processes as well. The active programs are the conscious; the background programs are the subconscious. Now, sometimes, a software error can happen, and a little window pops up informing the user. Sometimes, a bad error happens, and a blue screen of death or worse happens.
Certain stimuli can trigger something in the subconscious that trigger a psychosomatic response. So, remember how I said the phalanx guns sound like heavy wooden furniture dragged across the carpet? I know that because I heard the sound recently, and my pulse sped up, adrenaline flowed, and I became a little hyper-alert. For someone suffering from PTSD, the stimuli can evoke psychosomatic responses from the trauma. So, for example, smells can especially cause the response. If troops were brewing a certain brand of coffee when a mortar round punched through the ceiling, exploded, and hurt several folks in the room, smelling that coffee can cause a psychosomatic response.
With PTSD, stresses, coupled with the subconscious' inability to process a traumatic stress event, can cause the person suffering to respond poorly to the stress. So, some have an issue with large crowds. Some react poorly to loud noises. Some struggle with anger or stress or displays of emotion. For sexual assault, some become extremely asexual, and some become promiscuous. The most effective way to treat PTSD is Radical Exposure Therapy, and from all I've read, it's no fun at all--it involves exposing someone to the stimuli that evokes the psychosomatic responses, effectively forcing the person's subconscious to deal with the traumatic stress event.
So, we come to Sarah Palin's son, Track, who was recently charged with assault in Alaska. I don't know most of the details, though I've read alcohol was involved. I've no idea what Track experienced while in the Army; it may well be that he saw some things, did some things that were traumatic stress events. It may be that he has post traumatic stress disorder. It may be that he deals with his PTSD with alcohol, which in turn causes him to behave under its influence in ways that he might not otherwise behave.
To blame his behavior on PTSD as his mother has done (and Pres Obama's administration, but that's another story), however, removes Track Palin's moral agency. It strips him of his responsibility for his actions and effectively reduces him to the status of a child who must be cared for -- not an adult in his mid-twenties who is responsible for his behavior -- particularly, the decision to indulge in alcohol, if he has done so, and all of the consequences that result from that decision.
To blame his behavior on PTSD also casts a shadow on people who have the diagnosis. The VA's tracking on violence and PTSD suggests that PTSD is comparable to other anxiety or depressive disorders and severely aggravated by alcohol or substance abuse. We do not need public figures attributing alleged criminal violence of their family members to PTSD, in no small part because it does a disservice to the vast majority of people suffering from PTSD who are non-violent and high functioning. It also makes the jobs of care-givers, whether they are mental health professionals or chaplains like me, that much harder because service-members fear the stigma associated with PTSD.
In short, I wish Sarah Palin had not described her son's behavior in that way because of the way it seeks to remove moral agency from our troops, inadvertently stigmatizes people diagnosed with PTSD, and increases the difficulty of actually treating people who have suffered from traumatic stress events. The comment reminds me of when people refer to our airmen (sorry, biased!), marines, sailors, and soldiers as "our kids" when they are legal adults making adult decisions. The comment is intended to help; it doesn't.