November 11 Reflections on Combat Neurosis


Post Traumatic Stress Disorder (PTSD) is often in the news and the plight of veterans much discussed-depression, suicide and substance abuse are not infrequent sequelae to combat exposure. The syndrome has been recognized since the US civil war with various monikers: shell shock, battle fatigue, and combat neurosis or stress reaction.

In neuropsychological terms a battle situation primes the limbic system fight or flight protective response to a high pitch. The anxiety thermostat is necessarily set on overdrive as a survival tool.

At the time someone is being exposed to an intensely fearful situation, their mind ‘suspends’ normal operations and it copes as well as it can in order to survive. This might involve reactions such as ‘freezing on the spot’ or the opposite ‘flight away’ from the danger. By virtue of combat training the individual copes in an automated manner. Many veterans will say later that their ‘training took over’ and they survived.
The mind does not record a memory for the frightening event or events in a normal way because it has delayed this until the danger passes. Once the danger has passed, the mind will try to store away the memory. This means it tries to file the facts of what happened, the emotions associated with the trauma and the sensations (eg: touch, taste, sound, vision, movement, and smell).

Except, for many the memories are not easily filed away and the end result is a re-experiencing of the traumatic experience in the form of flashbacks, hyperarousal to loud noises and emotional numbing.

Depressive reactions are also common, with changes in thoughts and mood, such as exaggerated negative beliefs about the self or the world and persistent feelings of fear, guilt, or shame. This is accompanied by diminished ability to experience positive emotions and a feeling of detachment from others.

Combat PTSD sufferers are on guard all the time, and emotionally reactive, as evidenced by irritability, angry outbursts, reckless behavior, difficulty sleeping, trouble concentrating, hypervigilance, and an exaggerated startle  response. In other words the limbic thermostat is primed for war. This is analogous to “bear readiness” with no bears in sight.

Occasionally some veterans will talk about their military background and experiences but many do not and would prefer not to share their recollections.

My first clinical exposure to combat stress PTSD was with a former RAF WWII Spitfire pilot whose therapy involved cognitive restructuring which involved the reframing of his guilt associated with killing an enemy pilot who had parachuted over the English channel.

When he heard loud noises or a siren however, he would still “run for cover”. This continued despite having his issues addressed as a programmed CNS survival response. One effective reconditioning technique I used for this was to repeat to himself that the reality you feel as if the trauma is currently happening, must be countered by looking around and recognizing that you’re safe. eg “I am feeling panicked or overwhelmed, because I am remembering a traumatic event but as I look around I can see that the event isn’t happening right now and I’m not actually in danger.”

Relaxation therapy such as yin yoga meditation can augment this positive reframing.

Another gentleman I encountered was a 96-year-old WWI vet  whose complaints of depression were associated with vivid recollections of trench warfare. He had one lung resected from  a chlorine gas attack. He told me how breathing through urinated socks would be an antidote assuming you could pee under duress. He seemed to benefit from discussing his survival guilt while so many others didn’t.

Instead of punishing yourself, I told him you can redirect your energy into honoring those you lost and finding ways to keep their memory alive. This proved to be an effective strategy.

Some adjust better due to favourable psychological pre war adjustment or social circumstances. Back in the day my office was barely 20 miles from a former POW camp for German navy personnel, mostly U-boat survivors. Very few returned to the fatherland after the end of hostilities, instead marrying Canadian women, raising families and establishing roots. One fellow I saw did not feel the need to discuss his combat experiences but did want help for his nightmares and sexual dysfunction due to anxiety.

My involvement with Vietnam veterans was more complex due to the moral ambiguity of their experiences. There was a tendency in these men towards substance abuse coping and a higher risk of suicide or other violence.
One veteran I knew, had violent flashbacks whenever he met a person of Asian descent or smelled certain cooking aromas.

I found that for these vets, group therapy was far more effective than individual therapy due to their shared support and the feeling that “unless you were there you could never empathize”.

I have recently heard some ask, how long we had to keep up this Remembrance Day stuff. The short answer is as long as those guys in the war graves stay dead and we are free because of it.

For many of survivors however the feeling is one of “too trapped in a war to be at peace, too damaged to be at war”.

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One Response to “November 11 Reflections on Combat Neurosis”

  1. Kristina H Nadreau says:

    thank you. I now have greater understanding of PTSD. I wonder what is happening with the survivors of the middle eastern wars? I sense it may be particularly ugly.

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