What was left out of the presidential candidate’s comments to a group of veterans on Monday, and what has been left out of many of the discussions since then, is how little we understand PTSD. Thirty-six years after the disorder became an official listing in the Diagnostic and Statistical Manual of Mental Disorders, not a single medication has been developed specifically for its treatment. Rather, doctors rely on a host of antidepressant, anti-anxiety and other drugs to try to relieve PTSD’s symptoms.
“ ‘Why do we know so little today?’ is the question we should be asking,” said retired Army Gen. Peter Chiarelli, the chief executive of One Mind, an independent nonprofit dedicated to brain injury and illness. “We’ve been fighting this war [in Afghanistan and Iraq] for 15 years, and we had similar problems coming out of Vietnam and World War II. ... We don’t even know how many [veterans] have PTSD.”
Part of the problem, Chiarelli noted Tuesday, is that mental-health specialists don’t have a good definition of the disorder. “People look at this as a diagnosable disease, like cancer,” he said. “We can biologically diagnose a tumor. But we can’t see anything with PTSD.”
And while doctors and researchers aren’t too far away from developing “good, biologically based diagnostics,” Chiarelli says he thinks they are still way behind the understanding and treatment of traumatic brain injury.
“When you start venturing into the brain,” he said, “it’s like going back into what we knew about the heart in the 1930s,” when treatment for a heart attack was three weeks of bed rest.
Anyone who believes that those suffering from PTSD are somehow weaker-minded are simply misunderstanding how the brain can be affected by emotional trauma, Chiarelli said.
The same point was made by Vice President Biden Tuesday morning in an interview with CNN, when he chastised Trump for his ignorance and for not grasping what it means to have PTSD. “Look at what these kids are going through,” Biden said. “Look at the sacrifices they’re making and look what they go to sleep dreading.”
In fact, Chiarelli said, high rates of suicide and PTSD among the military’s most elite Special Operations troops are evidence enough that “weak” and “strong” are not the adjectives that should be used when referring to anyone with PTSD who serves or has served.
Special Operations forces “are the folks who have the highest selection standards and are careful who they bring in,” Chiarelli said. “They go through a very, very selective process that tests them both physically and mentally for the work they have to do. They go through a comprehensive psychology battery. To see the [PTSD] numbers increase in that community — the idea that these are all weak people is just not the case. ... We would never say someone has cancer because they’re weak.”
Although Chiarelli said it was unfair to point to Trump’s characterization of veterans with PTSD as reflecting a lack of empathy, he emphasized that “language really matters.” The American Psychiatric Association’s decision to continue calling PTSD a disorder triggered vehement debate several years ago, with many in the military arguing against that. They wanted it labeled a syndrome.
“I think ‘D’ should be dropped,” Chiarelli still maintains. “It’s an injury, not a disorder. When we tell a woman who has been violently assaulted she has a disorder, is that really the word we want to use?”
Because of the discovery of brain plasticity, scientists now know that every experience changes the brain, so the effects of psychologically traumatic experiences on it would appear indisputable.
“It’s not that people with PTSD are weak,” Chiarelli said. “It’s that humans can’t not have a reaction when [horrific] experiences happen time after time after time.”