Dr. Hurd Talks With a Veteran About PTSD, the VA and Much More

Daniel Duffy served in Iraq from November 2006 to April 2007. He was part of the “surge” strategy President George W. Bush ordered to quell the insurgency. His basic mission was to help keep insurgents from getting a stronghold in Haditha Triad and to maintain peace in the city. He volunteered to go to Afghanistan as a combat replacement to help another battalion that had suffered significant casualties.

He agreed to be interviewed by Dr. Hurd regarding his experiences with PTSD [post-traumatic stress syndrome] and that of his fellow soldiers.

 

Dr. Hurd: I understand that as a veteran, you were actually required to obtain mental health evaluations and/or attend talks on PTSD, and the like.

What were these like, and what did you learn or experience from them?

In your view, were they helpful, neutral or negative? For example, you said to me that, “In 2007, [the postwar talks/seminars] struck me as a much more deterministic message, as if we were fragile and damaged goods. While in 2009, the message resonated with me as much more rational.” How so? You went on to say, “The message was more or less, “It’s not a natural thing to be in combat. It’s normal to have reactions like dreams, etc. It doesn’t mean you have PTSD, it’s just your body’s way of reacting. Doctors, EMTs, etc. all have traumatic experiences and the majority don’t develop PTSD. PTSD does exist, and if you’re having problems, talk to someone, but make a distinction between natural reactions and larger problems.”

That’s interesting. So when PTSD is described as an automatic reaction of the body (combined with emotions) to an unnatural, abnormal and terrible situation, it leads you to feel less fragile and more like it’s a reasonable reaction. Is that it? Let me know your thoughts, and also your own personal ideas of what PTSD actually is, and how you personally view or define it.

 

Daniel Duffy: The post-deployment talks were pretty generic. They weren’t really mental health evaluations, just lectures on what to look out for, and where to seek help if you’re having trouble, basically.

Yes, I think when it’s described as an automatic reaction it seems more reasonable. If we know that emotions are automatic value judgments, of course you’re going to have a negative automatic response to something bad or unusual. But I think implicit in this message (the one I received after Afghanistan) is that we still have the ability to evaluate and respond to these negative responses. In short, we still have the ability to not let them overcome you and negatively impact areas of your life.

Missing in the 2007 message (the one after Iraq) was this element of choice. If I outlined it, it would be:

symptoms> disorder> treatment.

Negating the fact that we have the ability to choose not to be over determined by some negative experiences. I remember feeling a tinge of resentment with this deterministic message. Mostly, I tuned it out, however, because I didn’t anticipate myself having problems, but also probably because I resented the fatalistic approach.

Because of this streak of determinism, I think the 2007 talk was slightly negative. The 2008 one was a positive experience, I think. Because I thought it provided clarity to the issue.

If I were to define PTSD, it would probably be: difficulty coping with traumatic experiences that negatively impacts mental health and areas of life. (That’s a little bit of a primitive definition, but I think you get the point). It would be like if someone got sexually abused as a child, maybe that experience has become so embedded in him or her that it manifests itself in other areas of life, like forming romantic relationships as an adult.

For whatever reason (and I’m sure you could explain it better than I could) that person has difficulty coping with that experience. In that sense, I think it does exist, sure. I don’t think it’s wholly unreasonable to suggest that sometimes experiences of a traumatic nature become so embedded that it affects mental health. But that’s still different than saying we are determined by experiences. There still is an element of free will and choice.

 

Dr. Hurd: Some in the American Psychiatric Association have stated, “Certain military leaders, both active and retired, believe the word “disorder” makes many soldiers who are experiencing PTSD symptoms reluctant to ask for help. They have urged a change to rename the disorder post-traumatic stress injury, a description that they say is more in line with the language of troops and would reduce stigma.” Based on your own experience, as well as any you know with PTSD, what do you think about this?

 

Daniel Duffy: I think I would probably agree. I think the word “disorder” smuggles in a fatalistic connotation. Most rationally based people would resent this, and I think this discourages them from seeking help. Anyone with self-esteem takes pride, often subconsciously, in their free will and ability to rationally choose. When you attach the word “disorder” like it’s an innate medical condition, I think most people will become very suspicious at the least of that sort of “treatment.”

It would be like an alcoholic checking into AA, and the first thing they tell him is that he has a disorder and doesn’t have any control over his alcoholism. That person is probably thinking in the back of his or her mind:

“Well, no, not really … I just need help making the right choices.” But perhaps they silence this voice and defer to the authority of the “experts.” I think some alcoholics refuse help because of this, and I don’t think it’s unreasonable to say some veterans refuse help because of this, as well.

 

Dr. Hurd: According to a RAND study, 50% of those with PTSD do not seek treatment; and out of the half that seek treatment, only half of them get “minimally adequate” treatment.

Why do you think this is? And from the point-of-view of an emotionally struggling ex-soldier, what do you think treatment should consist of, or accomplish?

 

Daniel Duffy: I think there’s a couple points to take away. First, I think it speaks back to how it is defined.

I think some resent the no control/disorder mentality. Secondly, I think it reflects a distrust of the VA (or more broadly the bureaucratic nature of government). Even in researching for this article, it inspired me to renew my vow to never do business with the VA.

Let me put it this way: if you had a serious problem would you go to the DMV for help? You would have to be crazy to say yes. There’s some very bright, talented people in the VA (mostly young doctors and dentists; some of whom are in my family).

But unfortunately the bureaucracy is too thick to make it an effective organization.

The government has a large control of the market to help veterans. Because it can offer these services for “free,” it severely limits the competition of private firms. Like anything the government touches, the lack of incentives, lack of accountability, and superfluous levels of bureaucracy make the treatment incompetent. So of course most veterans that seek help would rate it as “minimally adequate.”

 

Dr. Hurd: The Institute of Medicine writes: “PTSD is characterized by a combination of mental health symptoms — such as reliving a traumatic event, avoiding trauma associated stimuli, and experiencing the mood swings and hyperarousal that persist for at least 1 month and impair normal functioning. Symptoms may occur soon after exposure to a traumatic event or may be delayed, sometimes for years. Increased exposure to combat-related trauma is associated with increased risk for developing PTSD.” In your experience, why do some people suffer with PTSD while others do not, following exposure to the wars in Afghanistan and Iraq?

 

Daniel Duffy: For some, it’s simply because they experienced more, I think. Others may have more of a vulnerable self. To be perfectly honest, with some it’s the “cool” thing to do. It always seemed like to me that the ones that cite PTSD most often are the ones that don’t do much in country. Almost like they’re compensating for their lack of combat experience, because there is that adventurous side of the military that always wants to “see what it’s like” to be in combat. Some of the rear troops may become disappointed when all they do is sit at the base. They don’t want to leave empty handed without any adventurous stories, so perhaps they adopt the PTSD narrative.

 

Dr. Hurd: You spoke favorably of one article on PTSD because it “makes an important distinction between all service members and the ones that are actually in combat. Something I’ve always thought was missing from most discussions about this issue. There is a huge difference between the life of a front-line, infantry solider or Marine, and the personnel in the rear that spend most or all of their time on the large bases that are basically glorified camping trips, complete with Taco Bell, Pizza Hut, etc. As you can see in the article, the suicides among these, latter, military members is still quite high. I’ve always suspected the high suicide rates weren’t so much as a direct result of combat (although some are) as the sometimes dehumanizing bureaucracy that you often have to deal with in the military, as well as long periods of separation, etc.”

That’s fascinating. Not only the distinction you made between different types of service members, but the reasons for suicide in those who experience combat. I think most people, even most mental health professionals, assume that suicide would come from a sense of malevolence or despair over having experienced the war itself. But from what you say, that’s not quite it. It’s more what happens after they come home from the war. You mention the sometimes dehumanizing bureaucracy of the military. Can you give some examples of this bureaucracy, and how it might lead someone to a state of despair which might escalate to suicide? For those who cope better with this bureaucracy, what’s their secret? How do they mentally or behaviorally handle it better?

 

Daniel Duffy: I’m not saying there are no cases of suicides as a result of despair or malevolence over having experienced the war itself. One of the worst stories I’ve heard of the war was in Afghanistan. A Humvee hit an IED (improvised explosive device) and was flipped over, burning. A Marine was trapped inside as his buddies tried to rescue him, but the heat made an AT4 rocket cook off (go off) and it killed him. Something like that I could see where one would suffer despair or malevolence that could lead to depression, and possibly suicide. I’m sure there are many cases like that.

But at the same time, I don’t think that’s the full story as well. If I remember correctly, that article found that 80% of veteran suicides were from veterans who had no direct combat experience. This alone should make us pause and question the assumption that it is just combat experience that leads to depression/suicides.

Don’t get me wrong, I love the Marines, and I’m proud of what the military stands for (or should stand for…), but the fact is that it can be very bureaucratic sometimes. By that I mean, it can be hard to act on your own judgment. If happiness is the end of the game, a precondition is having the freedom to choose and act on your own judgment (the freedom of what career to pursue, whom to marry, etc.). Because the military can be so regulated and micromanaged, it stifles this freedom of choice, and I can see where it would lead to despair.

I’d imagine depression in statist countries like North Korea would be staggering. Most fundamentally, it comes from the inability to act on your own judgment.

One of the reasons Atlas Shrugged resonated with me so much was that it put a voice to the undefined, wordless, anxiety and even terror heavy bureaucracy places on individuals.

One such scene happens in the opening pages, where Eddie Willers remarks that the public clock always bothered him, but he could never really explain why. I’ve always thought that same emotion portrayed in AS is analogous to the emotion one can feel in a heavily controlled industry or area like the military. Different concretes, but same essential concept.

I think that explains Eddie’s demise, as well. I think he never got over that stage and wasn’t able to conceptualize why the world was crumbling. I don’t think it’s farfetched to say something similar happens with some people in the military. I could definitely see how constantly being micromanaged from the top down can be demoralizing, and perhaps some, like Eddie, can’t really identify the source of the anxiety and this leads to despair.

It’s a little bit like when you go to the DMV. Most people know the place is inherently dysfunctional. But more than that; there’s something unsettling about it. Perhaps it’s the fact that no matter how rude the people are, or how poor the service is, you’re still compelled to do business with them; or that there seems to be no real human control or leadership, but rather, people mindlessly subscribe to the motions dictated to them. Maybe it’s both, but most people sense that there’s something unsettling about the place. It only makes sense that that feeling is more pronounced in the military because you’re exposed to more bureaucracy than an average civilian. Furthermore, unless you’re willing to spend significant amounts of time and energy dissecting that emotion, it’s likely to go unidentified.

I think that lack of core understanding compounds the problem. Good leadership in the military knows that units are most effective when they have the most autonomy, and it is also much more empowering.

In my humble, yet right, opinion, that’s what makes the Marine Corps better than all the other branches, because it emphasizes small unit leadership.

Constantly being micromanaged can be downright depressing. There are lots of examples. I remember in Afghanistan, when we were transitioning out of the country, there’s a couple weeks that we spend on the larger “POG” bases (Personnel Other than Grunt) before our flight out. The company’s first sergeant would make the whole company (120 Marines or so) march in-step to the “chow hall” (lunch). Here we have grown men who just returned from the responsibilities of a combat zone being told that we can’t go to lunch unless we march in unison with the entire company. It’s not hard to see where that would be demoralizing and lead to resentment.

Unit cohesion and team building certainly has its place. But again, good leadership is judicious in implementing it, and makes a distinction between something that’s going to build pride of being part of the fighting force, and something that makes you feel like a number.

As to the issue of how do some cope better, again, I think there’s a distinction between the front-line, combat troops and the rear, support elements. Particularly in Iraq and Afghanistan. The front line troops are often separated from the larger force in country. Naturally, this allows for more autonomy and less bureaucracy.

Perhaps this helps explain why most of the suicides in the military happen from personnel that have never even seen combat. I can say with certainty that the overwhelming majority of Marines I know would rather face the enemy than suffer long periods of having to endure heavy bureaucracy or “the bullshit” as Marines often refer to it as.

 

Dr. Hurd: From my knowledge and experience with suicide, it often has a lot to do not just with depression, but with a sense of anger resulting from frustration and futility with life itself, or some important aspect of life. Often people struggle with disappointed expectations, perhaps unrealistic ones fostered by the military/government or others, that they will be taken care of, or have things handled for them when no such thing ever happens. It can be a traumatic or disillusioning letdown in itself. I would think especially so when you just finished quite literally putting your life on the line, only to be given standard fare (or I suspect subpar) government treatment. That’s usually how government is, but some have criticized our government for not making veterans the same level of priority they make senior citizens receiving Medicare, or those eligible for food stamps, and so forth. Any thoughts or comments on any of this?

 

Daniel Duffy: I think the overwhelming majority of military members learn not to trust the bureaucracy of the government pretty quick, and they expect to be let down.

I can see how one could become disillusioned after four or eight or twenty years in the military, and then being exposed to the incompetence of the VA. It’s not surprising that that would eventually take its toll. But I don’t think that’s because of unrealistic expectations, so much as just being demoralized.

If someone grew up in the heart of the welfare state and all they knew was a cradle to grave mentality of: “someone will take care of you” then perhaps I could see how those unrealistic expectations could lead to frustration and resentment. But I still think the majority of service members hold very low expectations of the government delivering their promises.

I remember in Afghanistan, we were promised absentee ballots to vote in the presidential election. Not surprisingly, they were never delivered. I think most soldiers and Marines learn that the same government that can’t deliver a ballot certainly won’t provide you with the promises they speak.

 

Dr. Hurd: And along with that, what about the VA scandals? Do you think they’re representative of what goes on, or perhaps marginal although still horrifying and inexcusable?

 

Daniel Duffy: Honestly, I wasn’t surprised in the least. I’m not religious, but the honest to God truth is that long before any debate on healthcare, I remember thinking to myself that I wouldn’t wish government healthcare on my worst enemy, and that there’s no other word for it other than: Evil. I do my best to stay as far away from the VA as possible. So I guess I couldn’t say firsthand whether the care there is still incompetent; but that’s a little bit like saying I couldn’t say firsthand whether the Pacific Ocean is blue ‘cause I’m in Minnesota. To be certain, there are talented, young doctors and dentists in the VA. Some of whom are in my family, but their abilities are stifled by the bureaucratic side of the VA.

 

Dr. Hurd: You said to me, “I know you’re well familiar with the sacrificial foreign policy our country practices. But a concrete example of this manifests itself in our ROEs (Rules of Engagement). Offhand, I don’t remember the exact words of the ROEs. But I do remember late in deployment in Afghanistan (2009) a new set of ROEs came out, and I remember my reaction was more or less flabbergasted that they would expect to us to serve in a combat zone with our hands tied behind our backs. I’ve always thought that perhaps some military personnel fail to really understand why our foreign policy and ROEs throw them under the bus, and that creates anxiety. If I may be so bold to play amateur psychologist….”

This strikes me as very important. Can you provide an example or two of the Rules of Engagement utilized in Iraq and/or Afghanistan? I have read about them, and it appears to me they were violations of common sense, as well as historical military practices, for the sake of trying to make it look like we were not really at war with Islamic nations — even though by being there, we obviously are, and these Islamic nations obviously were (and remain) at war with us.

 

Daniel Duffy: Perhaps the most popular example is depicted in the movie “Lone Survivor.” The military decision is clear, but the SEALS choose to put themselves in extreme harm, which eventually leads to their deaths, because the rules of engagement do not justify the action.

(If you haven’t seen the film it might be helpful). Marcus Luttrell goes more into depth about the decision in the book. He makes it clear what the moral and military decision would be, but the fear of the media and being prosecuted as a war criminal override this and it costs them their lives. Luttrell’s justifiable anger at the media is prominent throughout the book.

This happens every day, however. At the most extreme it means: break the rules of engagement and legally be a war criminal, but uphold the safety and well-being of yourself and your fellow soldiers/Marines; or; adhere to the muzzling rules of engagement and put yourself and fellow troops in grave danger. (Notice I didn’t even mention winning the war. Pretty impossible when you have these rules of engagement combined with the altruistic strategy). There are a couple of analogies that I think might help:

First, I think it’s a little bit like antitrust laws. The laws are so all-encompassing that a businessman is left with the ultimatum: break the law or go out of business. It’s a little bit like; break the rules of engagement or end up dead.

Second, it’s almost like a religious person that’s been told it’s evil to be selfish, but lives most of their life pursuing their own interests. This creates guilt and inner conflict. While I don’t think guilt is the primary emotion at play after a combat zone, you can see where one would be faced with conflicting emotions if by definition they’re considered a war criminal, but in the heat of battle, it’s either choosing that or putting yourself and fellow soldiers or Marines in grave danger.

I remember one time in Afghanistan; a couple of civilians ran over an improvised explosive device and died. We could hear over the radio that the Taliban were attending the funeral as a way to plead forgiveness with the locals. Here’s an instance when we know where and when the Taliban will be, be we can’t do anything about it cause technically they’re not engaged in hostilities at the moment.

Another time in Iraq, we set up a checkpoint to make sure no insurgents were smuggling anything into the city. A suicide bomber killed two Marines and an interpreter at that checkpoint. We wouldn’t have been in that position in the first place if our strategy had been to be on the offense and not a defensive, nation-building posture.

It’s easy to see where these ROEs and strategy creates resentment. First, it creates more moments of horrible war. Second, I think it creates an indefinable anxiety because it’s all preventable, but soldiers and Marines lack the intellectual leadership to understand why they’re put in that position.

 

Dr. Hurd: Some former or active members of the armed forces have indicated to me that the ideology actively encouraged in training and particularly combat is one of selflessness and self-sacrifice. This contradicts the spirit and letter of the American Constitution these soldiers are defending, which is the only such document in history to uphold man’s individual life—the pursuit of life, liberty and happiness—as an end in itself. What have your experiences been in this regard? Did you find the military to convey more of a mixed or unclear message, or a very altruistic one based on the importance of self-sacrifice?

And how do you personally view military service? Did you view your service in dangerous areas as personal self-sacrifice, or did you view it as something different, and why?

 

Daniel Duffy: I don’t think I agree with the part of the ideology actively prominent in training and combat. At least not in the sense of what people actually believe. I guess it’d be a little bit like a corporation that preaches self-sacrifice in their mission statement, but every employee knows intuitively that that message is contrary to the nature of business, so blanks it out.

There is sometimes even an insulation from philosophical ideas. Put simply, you are just too focused on doing your job to worry about politics. I remember Obama was elected while I was in Afghanistan.

I didn’t like it, of course. But just the fact of being far removed from television, and American culture, it probably didn’t affect me as much as other reason-based people that were in the U.S.

However, I don’t think that element of insulation is mutually exclusive from what I wrote about earlier about policy, ROEs, altruism, etc.

I certainly don’t view military service as self-sacrificial. I think some may adopt that language, just because it’s the only sentiments that are considered virtuous and noble in our society. However, when we think past the range of the moment, it’s not self-sacrificial. People join the military because they love freedom, America and want to defend it. That’s not a sacrifice.

 

Dr. Hurd: Lastly, what is your view on the idea of “readjusting to civilian society” after experience in the military, especially in a particularly dangerous combat zone? What does the process of readjustment consist of, and how can members of the military best prepare themselves for it?

 

Daniel Duffy: There are some practical considerations, for one. For example, most haven’t touched a beer for several months or drove a car.

When you return from deployment, quite understandably, you want to celebrate. The low tolerance of alcohol coupled with a big celebration, can get out of hand. Leadership tries to guard against this some by giving a couple of weeks of being back in the states, on base, before soldiers and Marines go back home for leave.

I think the “readjusting to civilian life” is a little overblown, to be honest. I remember instinctively feeling for my weapon when I got home, just out of force of habit. But that’s not really a long-lasting psychological change.

 

Dr. Hurd: Please describe anything else you want to about PTSD or your experiences in the military here.

Anything important my questions left out, or anything that answering my questions led you to think about or wish to express, would be welcome.

 

Daniel Duffy: I think individual experiences vary. For some suffering from PTSD, or who have lost their battle with it, maybe it is the actual combat experience itself. Perhaps for some it is the long separation from family and/or dealing with the bureaucracy.

I do think some have an agenda to make soldiers and Marines into victims. In a lot of ways, the military represents the last bastion of self-reliant, reason-based, and freedom-loving culture in America. If the individuals dedicated to control and collectivism can make the troops victims, then they can make anyone into victims. It also serves as an “I told you so” opportunity for them.

 

After getting out of the Marine Corps in 2009, Daniel completed his pre-law degree and plans to attend graduate school. He now resides in Minnesota.