'Is everyone fed? Has everyone been paid? Has everyone received their medals? Good, all conditions of service have now been met. Now go home and don’t be an asshole.' Commander’s address to a US Infantry Division on completion of the division’s tour of duty in Afghanistan¹

Introduction

It is widely accepted that post-traumatic stress and post-traumatic stress disorder (PTSD) result from exposure to trauma. The Australian National Health and Medical Research Council defines trauma as ‘involving actual or threatened death or serious injury (real or perceived) to self or others evoking feelings of fear, helplessness or horror’.[1] Unsurprisingly, warfare exposes many soldiers to very serious trauma.

Australia has been involved in more than a decade of continuous war, where tens of thousands of troops have served with distinction on recent operational deployments in Afghanistan, Iraq and throughout the Asia-Pacific region. Predictably, some of these troops either have developed or will develop PTSD. This article accordingly seeks to explore how the Australian Defence Force (ADF) as well as other militaries can better prepare individuals for operational deployments and how they can shape their culture in the aftermath of such deployments in order to achieve post-traumatic growth.

Many Australians have criticised the military and the Department of Veterans’ Affairs for the prevalence of PTSD among veterans and the perceived inadequate support they provide to serving and ex-serving personnel. The contemporary narrative around veterans, which is laced with sentimentalism and paints veterans rather simplistically as both heroes and victims, may be actually harmful because it:

  • Potentially hinders veterans from seeking the right treatment to address their illness;
  • Excludes those who may be able to help as a result of the ‘you cannot understand what I experienced’ myth;
  • Promotes a tendency to ‘dependence’ rather than ‘independence’;
  • Potentially sets soldiers in the wrong frame of mind going into operations, making them more vulnerable;
  • Encourages pity from others (whether sincere or not); and
  • Inhibits the application of post-traumatic growth, which is the idea that veterans can become better people as a result of their operational experience.

Context

The experiences of operational service can have a profound psychological and physiological effect on an individual. There is no simple way to measure the correlation between operational service and enhanced job performance but it is generally accepted that veterans are extremely valuable to any military organisation. A veteran’s experience and understanding of operational complexities, regardless of which operational theatre they have served in, provide context, perspective and character from which to draw from.

Conversely, the experience gained from operational service can sometimes skew the perceptions of service personnel and lead to an inflated sense of entitlement and privilege, leading to poor attitudes and performance on return from an operation. The influence of disenchanted veterans, particularly over more junior personnel, can therefore have a catastrophic impact on a unit’s morale. Their influence, be it passive or active, can be immense. From an organisational perspective it is therefore imperative that we seek to maximise the positive impact of operational service.

Psychological preparation and resilience

The prevalence of PTSD from those experiencing a traumatic event is higher among Australia’s veterans than it is among Australia’s general population. The 2010 ADF Mental Health Prevalence and Wellbeing Study estimated that 90 per cent of Australian military personnel have experienced at least one potentially traumatic event at some time in their life, compared to 73 per cent of an age and employment-matched sample of the Australian community.[2]

In the civilian population, an estimated 5.2 per cent of Australians who have experienced a potentially traumatic event develop PTSD compared with an estimated 8.3 per cent of those who have served.[3] But why would military personnel be more likely to develop PTSD after experiencing a traumatic event than the civilian population? Something not taken into account in these studies was the intensity, duration or type of exposure to trauma, which would likely have affected the onset and/or severity of PTSD.

Given that service personnel undergo psychological screening and rigorous training in anticipation of the demands of war, it seems counter-intuitive that the prevalence of PTSD for those exposed to trauma is greater among service personnel than it is among the general population. It seems reasonable that members of an organisation that promotes resilience and trains for war ought to be better prepared to deal with psychological trauma than people who do not.

For example, a school teacher on their way to work who comes across a horrific road accident could reasonably be expected to suffer from some form of post-traumatic stress, as would an office assistant who narrowly escapes from an unexpected building fire, or a university student unwillingly involved in a heinous act of terror. It is understandable that incidents that are totally unexpected and well outside the realm of someone’s daily expectations have the potential to cause psychological trauma.

Contrarily, a paediatric nurse who witnesses the death of a child and then comforts the grief-stricken parents or a police officer who confronts an armed suspect would perhaps not have the same likelihood of suffering severe post-traumatic stress because these incidents, although traumatic, were not entirely unexpected. Similarly, it could be argued that an infantry soldier, faced with sustained close combat, should be better prepared and therefore not as susceptible to PTSD as others who find themselves in similar situations. These examples are, of course, a simplification of a complex and delicate topic—and there is no question that different situations shape different people in different ways.

Nevertheless, it could be argued that service personnel should be psychologically better prepared for trauma than most others. However, in Australia, the statistics suggest they are not. Indeed, the high percentage of PTSD cases resulting from recent conflicts suggests that existing psychological preparedness measures and resilience training has not been as successful as expected in mitigating the prevalence and severity of PTSD in veterans.

Perhaps some service personnel simply do not expect that they will ever be involved in combat or otherwise called upon to bring about the defeat of an adversary through the use of violence. It could also be argued that the overly sentimental view of Australian military history has clouded the realities of contemporary service and that society has grown complacent—it has become comfortable with a Navy that conducts mid-intensity regional sea patrols, an Army that engages in anti-insurgent operations in far-away lands, and an Air Force that contributes to multi-national air campaigns in similarly distant lands where the details of operational missions are veiled in secrecy.

The end result is a sanitised view of war. Very few people understand that Australia’s combat soldiers are trained to conduct the most brutal and ruthless of tasks—to kill another human being and, more accurately, large numbers of them. An unpleasant reality remains clouded in carefully managed footage of recruiting advertisements, and society loses sight of the fundamental reason the military exists. The inconvenient truth is that there is little social appetite to accept that the military exists as a legitimate fighting force, trained to use controlled violence and aggression to impose its will on an adversary in the furtherance of the nation’s interests.

Instead, Australian society might see its military as a business savvy, modern employer. Smartly dressed men and women march in public parades and television commercials showcase its world-class leadership training, yet the realities of war and operational service (save for the edited, filtered, and vetted footage from commercial media) are omitted. When it comes to explaining the reason for the military’s existence, there is little serious discussion. In addition, a portion of our junior soldiers and officers struggle to grasp the concept of ‘service before self’ and seem to come from a generation of entitlement and privilege. But what do we expect to recruit from a society which has been sheltered from war and close combat for so long?

Regardless, it a leader’s responsibility to best prepare these people to physically and psychologically perform under extreme conditions. The importance of veteran junior commanders as positive role models and coaches cannot be understated. Driving resilience through realistic training and expectation management from the grass-roots level is key to success. Servicemen and women should not only recognise the possibility of dealing with psychological trauma, they must actively look to grow from their experiences.

Whilst psychological preparation for war is, largely, an individual responsibility[4] commanders must provide realism in training (and the recently introduced Army Combatatives Program is a positive step in this direction) but, more importantly, foster an environment that encourages individuals to prepare themselves. Wide and critical reading, professional education, honest performance reporting and the maintenance of morale are essential for setting soldiers up for success.[5] Preparing for the realities of war will encourage veterans to grow from their experience and invest in the next generation of soldiers.

The hero/victim narrative

In the words of Thucydides: 'The bravest are surely those who have the clearest vision of what is before them, glory and danger alike, and yet notwithstanding, go out to meet it.'[6]

The contemporary hero/victim narrative is both counterproductive and confusing for those trying to promote post-traumatic growth. Veterans returning from a period of high-tempo operational service are faced with transitioning back into a society that has no real understanding of their profession. Sadly, PTSD is now synonymous with ‘veteran’, as if it defines someone’s operational experience.

Unfortunately, there is anecdotal evidence that some veterans are ‘playing the PTSD card’.[7] There are several reasons that personnel not affected by PTSD may decide to falsely claim (or are misdiagnosed) after returning from operational service. Some are motivated by personal reasons, while some see opportunity for fraud through systemic loopholes. Due to the lack of physical signs and symptoms, it is far easier for a veteran to claim a mental health problem than any other physical injury. The psychological screening and assessment processes undertaken after veterans return from operational service are comprehensive. However, medical professionals openly admit that fraud is difficult to detect—and that a claim of PTSD is difficult to disprove. Regardless of the motivation, some veterans are knowingly taking advantage of the support networks available for genuine sufferers of PTSD.

At the same time, comment and opinion regarding PTSD in the military is widely considered taboo for all but psychological and medical experts, particularly if it is not supportive of veterans. Public comments regarding the legitimacy of PTSD cases are also met with fierce opposition from veterans who are quick to defend their peers, and patriotic citizens who are quick to defend their heroes. For example, in 2015, Rear Admiral Robyn Walker, then Commander Joint Health and Surgeon General of the ADF, indicated that some cases of PTSD in the Australian military may have been due to previous experiences other than operational service.[8] Although her comments were based on reputable studies, she faced widespread public criticism and condemnation.

Popular methods of pseudo-scientific ‘feel-good’ therapies do little to repair the real damage faced by sufferers. Bush walks, guide dogs, and fun-runs unfortunately saturate the veteran community with false hope and dependence. Feel-good therapies give temporary relief to veterans suffering from PTSD, but the underlying issues remain. Rather than transitioning to independence and recovery, PTSD sufferers eventually return for another hit of relief. This approach is fundamentally flawed and disrupts the road to recovery.

Unfortunately, veterans who are stuck in the feel-good therapy loop soon form unrealistic expectations and (some unknowingly or unwillingly) contribute to the hero/victim myth. With the developments in social media and peer to peer networking, it has become fashionable to simply ‘raise awareness’ of PTSD rather than practically address the root causes of the problem and provide realistic, appropriate treatment.

Treatment and support for those suffering from genuine PTSD is available, but recovery is not always guaranteed. Scientifically-based methods of psychological intervention such as Cognitive Behaviour Therapy help individuals to identify unhelpful thoughts and behaviours and learn healthier skills and habits to overcome their issues. It is widely accepted that these treatments are difficult to undergo and require full investment from individuals to re-visit their traumatic past.

Conclusion

PTSD is a serious issue affecting service personnel in Australia and across the world, and genuine sufferers absolutely deserve our full support and attention. However, PTSD should not be considered the expected outcome of combat service.

It is the responsibility of a nation’s military to establish realistic expectations for its veteran community, which sets the tone and increases understanding in the wider civilian population. When deciding to go to war, governments clearly have a responsibility to consider the lasting impacts on service personnel, which includes ongoing support to the wounded and ill. But of equal importance, individuals who volunteer to serve must be provided with a clear understanding of the requirements of service, which include the potential to be exposed to war and close combat. Leaders at all levels must accept the challenge of fostering an environment that ensures that individuals are psychologically prepared for the rigours of combat—and can personally grow to benefit their militaries with the gift of experience.

 

Note: ¹Author was an embed with this US Infantry Division.