“We return. We return from fighting. We return fighting.” So intoned W.E.B. Du Bois at the close of World War I, capturing the struggle of soldiers who had fought “for America and her highest ideals,” only to return to “lynching, disfranchisement, caste, brutality and devilish insult.” Du Bois’s enduring lines testified to the profound racial violence met by African-American veterans in the age of Jim Crow. But his words resonate with a more universal aspect of the veteran experience: the war does not end when a tour of duty or the conflict itself ends. It lives on in the minds and bodies of veterans whose fight to overcome war’s trauma can last for years, decades, a lifetime.
More than 2.3 million members of the US Armed Forces have served in the Afghanistan and Iraq wars. About one-fifth of these “war on terror” veterans have reported symptoms of post-traumatic stress disorder or serious depression. The actual incidence of PTSD among Afghanistan and Iraq veterans is almost certainly far greater. Wary of being branded as mentally damaged—a stigma that can lead to discrimination in the workplace and beyond—many returning soldiers are reluctant to seek diagnosis for psychological injury. The fear of social ostracism is especially pronounced in veterans suffering from military sexual trauma: an estimated 30 percent of women and 4 percent of men are raped or sexually assaulted by a fellow soldier while on active duty, but less than half of them pursue treatment. And despite recent attempts by the underfunded Department of Veterans Affairs (VA) to remove existing barriers to the diagnosis of PTSD—until 2010, patients were required to document the specific events, or “stressors,” that provoked their symptoms—veteran psychiatric care remains beset by neglect. Studies have shown that the military has saved $12.5 billion since 2001 by discharging soldiers diagnosed with personality disorder (PD), a “pre-existing condition” (one that all recruits are screened for, it bears noting) that is ineligible for disability benefits. These statistics don’t tell the full story, but they do highlight the multitude of cases that are being denied a hearing.
Post-traumatic stress has likely always accompanied the human experience of violence; in different historical periods, “soldier’s heart,” “railway spine,” “shell shock,” “war neurosis” and “combat fatigue” have named cognate symptoms. It was during the Vietnam War, though, that the now-familiar acronym “PTSD” first appeared. In the early 1970s, psychologists working with veterans’ advocacy groups created the antecedent term “post-Vietnam syndrome,” and in 1980 “posttraumatic stress disorder” was added to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). In the latter half of the ’70s, films such as The Deer Hunter and Apocalypse Now, and novels such as Philip Caputo’s A Rumor of War, gave cultural expression to the emerging popular awareness of PTSD. In the decades since, the corpus of cinematic and literary representations has evolved alongside “trauma studies,” an amorphous academic field that integrates the disciplines of psychoanalysis, philosophy, literature and history. By the 2001 advent of the “war on terror,” the terms “trauma” in general and “PTSD” in particular were well established as keywords of contemporary culture.