You Don’t Have to See Combat to Get PTSD From War

There are many de­tails re­main­ing about the gun­man who opened fire at Fort Hood, Texas, killing four, in­clud­ing him­self, and in­jur­ing 16 more. But here are some key facts about Spc. Ivan Lopez: He served four months in Ir­aq, he was be­ing treated for un­dia­gnosed posttrau­mat­ic-stress dis­order, and he was not in com­bat dur­ing his de­ploy­ment.

In this type of situ­ation, it might be easy to over­look someone who suffered men­tal an­guish without ac­tu­ally see­ing com­bat. But there are ele­ments of war that are dis­turb­ing bey­ond shoot­ing a weapon and be­ing shot at.

So can a sol­dier get PTSD without ac­tu­ally see­ing com­bat?

“Yes, you can,” says Craig Bry­an, the ex­ec­ut­ive dir­ect­or of the Na­tion­al Cen­ter for Vet­er­ans Stud­ies. “It’s ac­tu­ally an is­sue the sci­ence in the last sev­er­al years has been catch­ing up with.”

In the past year, the Dia­gnost­ic and Stat­ist­ic­al Manu­al of Men­tal Dis­orders, which clas­si­fies men­tal dis­orders for the Amer­ic­an Psy­chi­at­ric As­so­ci­ation, changed its cri­ter­ia for PTSD to no longer re­quire that a per­son must have been in a life-threat­en­ing situ­ation.

The APA found that many mem­bers of the mil­it­ary and vet­er­ans of the wars in Ir­aq and Afgh­anistan, even though they didn’t think they were go­ing to die, mani­fes­ted the prob­lems as­so­ci­ated with PTSD.

“They have been ex­posed to at­ro­cit­ies or oth­er events that have a sig­ni­fic­ant ef­fect on their world view, sense of self, etc.,” said Bry­an, an as­so­ci­ate pro­fess­or at the Uni­versity of Utah. “People can struggle with men­tal-health prob­lems even if they haven’t been in com­bat.”

Ex­amples of those kinds of events range from see­ing dead bod­ies to see­ing oth­er people kill each oth­er to smelling rot­ting flesh.

In this case, the gun­man may have wit­nessed dis­turb­ing im­ages that would even­tu­ally re­quire treat­ment for de­pres­sion, anxi­ety, and be­ha­vi­or­al is­sues. Those de­tails are sure to come up.

One of the ma­jor struggles for psy­chi­at­ric pro­fes­sion­als, however, is that they don’t have the cap­ab­il­it­ies of de­term­in­ing who is go­ing to be­come vi­ol­ent and who’s not, Bry­an said.

But in the last dec­ade, through a large num­ber of clin­ic­al tri­als that the mil­it­ary has helped fund, they’re get­ting closer to resolv­ing this is­sue.

And the situ­ation is ur­gent. Ac­cord­ing to a re­cent Wash­ing­ton Post-Kais­er Fam­ily Found­a­tion poll, 31 per­cent of Ir­aq and Afgh­anistan vet­er­ans say their men­tal and emo­tion­al health is worse than be­fore the wars. If it re­mains a prob­lem, mil­it­ary sui­cides and mass shoot­ings are likely to con­tin­ue.