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My sister is a nurse practitioner and lately has been seeing a lot of former military patients has been greatly surprised by the number and severity of their past injuries they still have to deal with, and most of all the high cases of PTSD. Our grandfather was a tank commander in WWII in Europe and told me some pretty terrible stories that he didn't talk about much, and carried a lot of sadness about those times. One thing I never really remember though is hearing anything related to PTSD (there wasn't really a name for it back then). I never heard any episodes besides nightmares that caused any issues with him being married until he passed away as well as raising 7 children. Listening to veterans of WWII talk, there is always a sadness regarding the events they have gone through (naturally), but I rarely see signs of the struggles I see that seem to be happening today. I have read up a lot on the Korean War and met several veterans of that war as well and feel much of the same thing. Veterans of both wars saw horrific things, and may have suffered life altering injuries, but generally seem to have been able to 'move on' so to speak.

I feel like things begin to change in Vietnam. The US military generally fought with one hand behind its back fighting an insurgency most of the time. It was hard to tell who the enemy was. I think this left a lot of lingering issues for veterans (aside from combat or injuries they suffered of course) that might have been different from previous conflicts. In WWII and Korea, you know who the German, Japanese, North Korean, and Chinese soldiers were. They were generally very identifiable. This changes for most of the fighting in South Vietnam against the Viet Cong. Desert Storm was a conventional war, but the wars in Afghanistan and Iraq were different. Both dealt (or are still dealing with) extensive guerilla style combat where an enemy can suddenly appear from a crowd of people, and not identified by standard military uniforms.

So not having been in this situation myself, I imagine this causes a soldier to be much more alert on a constant basis and more sensitive to sudden changes in their environment. The constant attention needed to be given to scanning crowds, buildings, room clearing, and worst the effects of sudden IDEs has to cause a lot of stress on the mind. And much like with Vietnam, some veterans have a hard time disconnecting that mindset than I am guessing it might be veterans of the earlier wars of the 20th century. I had a high school history teacher who fought in Vietnam and would tell us some crazy stories, and he continued to have knee-jerk reactions stemming from experiences in Vietnam (such as diving to the floor when a student threw a wadded up piece of paper into the garbage from a distance away). I know shell-shock was well documented after WWI, but I would consider that more to be an injury than a stress related event.

So I am wondering what some of your thoughts are. Could the nature of insurgency dominated wars cause a higher number of veterans suffering from PTSD than conventional wars? In the case of the WWII generation there wasn't much study at the time on this, let alone a name for it, so it could be this sort of thing was always around, but just now being more identified and more well known. . .

My gut says no. That's about as far as I want to go into it.

I have a little experience of PTSD on account of having a relative who suffers from it, not as a result of being in combat but due to being the victim of a violent crime. It's far more common than people realise and can manifest years after the event which triggered it.

I really don't think it's a case of it becoming more common. It's more that we're only just beginning to understand it and in the past, most cases went undiagnosed and untreated.

Shell shock in Ww1, battle fatigue in WW2 and Korea, ptsd in modern times. It's always been there just in the shadows of the past. Many vets suffered silently in the past with problems from war. Like I said always been there just not in the forefront because of how psychology and medicine has changed.

 Chute82 wrote:
Shell shock in Ww1, battle fatigue in WW2 and Korea, ptsd in modern times. It's always been there just in the shadows of the past. Many vets suffered silently in the past with problems from war. Like I said always been there just not in the forefront because of how psychology and medicine has changed.

My unit got a new building last year. I spent about 18 months doing research into naming it after a suitable candidate. We ended up selecting a man who spent 18 months in Greenland servicing remote equipment, before volunteering to jump into Normandy, despite having almost no combat training. On the night of the invasion, he ended up being shot 4 times and severely injured by a grenade blast. When he was eventually dragged to an aid station, German artillery shelled it, and he spent 4 days buried in the rubble before he was discovered and evaced to the beaches. He would then spend 2 years going through numerous surgeries and convalescence in recovery. He would then go on to be one of the very first weather men on the ground in Korea, and would spend significant amounts of time behind enemy lines in his 7 months there.

Nothing in his records would indicate he experienced PTSD. I've been through them all.

Talk to his family though, and it's an entirely different story.

I feel many of the "Greatest Generation" did suffer it. The atrocities they encountered in those two wars left scars that they silently bore throughout the rest of their lives. For many, it was years on end of it that they experienced. It wasn't 9 months on the ground and rotate home. There were guys who were a part of the first wave in, and they didn't get home until 1945 if not later.

Something about combat does things to people. It's horrible. One of my worst nights in Afghanistan was when a US SpecOps base was under a massive attack. Just watching it through the cameras that my unit had in the sky was horrible. Accounts I've heard from the guys actually on the ground, I can't imagine what it was like to experience it. Let alone experience it for years on end.

I was thinking maybe the PTSD wasn't just from combat itself, but from the nature of living in the environment day after day. I mean, if every time you leave the wire and you have a hard time determining friend from foe, over time that might cause added stress in addition to combat itself.

I could tell from the stores my Grandfather told me that he saw some horrific things and they probably effected his sleep at the very least, but it was far different behavior than what my history teacher showed just in class.

I don't think there's anything about nonconventional warfare itself that would cause more PTSD cases than other wars. There's been plenty of nonconventional wars in history and in the US. The Spanish American War was a nonconventional war.

I think the biggest contributor to PTSD rates is that for the last 16 years of war in Iraq and Afghanistan the govt (both the Bush and Obama administrations) decided that the best policy was to make sure the war effort affected the smallest number of people possible. During WWII the war effort was omnipresent in society. Kids collected scrap metal, women took up new jobs in the factories, gasoline and other commodities were rationed, civil defense forces were created, it was national effort. Shared experiences and a society that understands and values the efforts of the combatants are key factors in treating and eliminating PTSD and we don't see that in the US anymore. Returning veterans deal with a much more alienating experience than previous generations. There are a host of issues with current US society that creates a lot of alienation of people that greatly contributes to poor mental health for everyone but that's a little bit off topic.

Sebastian Junger's book Tribe is a really good read on the subject and includes a ton of references for more in depth source material.
https://www.amazon.com/Tribe-Homecoming-Belonging-Sebastian-Junger/dp/1455566381/ref=sr_1_1?ie=UTF8&qid=1502726591&sr=8-1&keywords=tribe+sebastian+junger

It's been in shadows probably since war began for centuries and centuries.

But only truly became as known in the ww1 period and understood far later on when we began to actually look and take note of the effects and veterans returning home.

 jhe90 wrote:
It's been in shadows probably since war began for centuries and centuries.

But only truly became as known in the ww1 period and understood far later on when we began to actually look and take note of the effects and veterans returning home.

Nah, there's plenty of examples of cultures that had very specific traditions and rituals to help combatants overcome the effects of war/PTSD. It's just that such traditions haven't been kept up or incorporated by modern western societies.

I'm gonna say no. The only thing that has changed is that we are now more aware of PTSD being a thing and what it's total effects are. PTSD, as we call it today, has always existed. It's just not been a focus of medicine, or indeed anything, till now.

Plus in the past, insurgencies were somewhat easier to deal with. If an occupying force thought there were rebels hiding in a particular village, they might start just killing people in the village till the locals either ratted out the dissenters or the whole village was wiped out. This would drive insurgents away from urban areas into rural areas. Meaning occupying soldiers didn't have to worry as much about getting attacked while on patrol in the cities and towns, and if they encountered some suspicious people out in the woods they were almost certainly rebels. And you could just offhandedly execute suspicious people and call them rebels.

So I think its just a combination of more awareness of PTSD and the modern rules of engagement and treatment of civilian populations which cause insurgencies to drag on. Plus insurgents now have access to bombs as weapons of choice instead of conventional weaponry.

Prestor Jon wrote:

 jhe90 wrote:
It's been in shadows probably since war began for centuries and centuries.

But only truly became as known in the ww1 period and understood far later on when we began to actually look and take note of the effects and veterans returning home.

Nah, there's plenty of examples of cultures that had very specific traditions and rituals to help combatants overcome the effects of war/PTSD. It's just that such traditions haven't been kept up or incorporated by modern western societies.

Maybe some of the nature of the battles and wars?

The world wars, and others where fought to defend the nation, there was more reason to fight than the likes of Iraq.

The enemy was known, and it was for., no good reason for war but a more required one. We did not need to invade Iraq. We did need to beat Hitler.

Be interesting to compare the war on terror with Vietnam too in that regard as they bear similarity so may help to identify the factors more likely to cause PTSD.

If you know the causes more. Such can help treat and prevent future cases, and help prevent less lives bring scarred by it.

 jhe90 wrote:

Prestor Jon wrote:

 jhe90 wrote:
It's been in shadows probably since war began for centuries and centuries.

But only truly became as known in the ww1 period and understood far later on when we began to actually look and take note of the effects and veterans returning home.

Nah, there's plenty of examples of cultures that had very specific traditions and rituals to help combatants overcome the effects of war/PTSD. It's just that such traditions haven't been kept up or incorporated by modern western societies.

Maybe some of the nature of the battles and wars?

The world wars, and others where fought to defend the nation, there was more reason to fight than the likes of Iraq.

The enemy was known, and it was for., no good reason for war but a more required one. We did not need to invade Iraq. We did need to beat Hitler.

Be interesting to compare the war on terror with Vietnam too in that regard as they bear similarity so may help to identify the factors more likely to cause PTSD.

If you know the causes more. Such can help treat and prevent future cases.

Pretty sure the purpose of a war has zero bearing on the rate of PTSD.

I'm sure French and German soldiers had identical rates of Shell Shock in WW1 and WW2. Even though the former were fighting to defend their country and others were fighting a war of glorious conquest.

PTSD is caused by a great number of things, not just by combat and not just by certain types of combat. It took me a long time to realize that I have it even though I was never a soldier.

Insurgency might end up with PTSD that manifests differently, but I don't suspect it has a marked influence on the rates of PTSD as a whole.

Prestor Jon wrote:I don't think there's anything about nonconventional warfare itself that would cause more PTSD cases than other wars. There's been plenty of nonconventional wars in history and in the US. The Spanish American War was a nonconventional war.

It's been 10 years since my deployment to Baghdad started. 10 years. To this day, I STILL get uneasy in crowds. Spend a year in an area where you have NO idea if the person you are about to pass or their vehicle is going to detonate and take you and several of your friends out. Close calls in that respect also add up and chisel away at your psyche. One of the nifty things I found out about suicide bombers is that most of them will clean themselves and shave before carrying out an attack. The purpose? I can't remember. I remember that fact, and the fact that black flags and black outfits were tied to martyrdom. So combine my combat experiences with that knowledge and a level of alertness that STILL hasn't gone away, and add that to this scenario: I was on a plane about to leave Houston to fly back to Indiana when a man comes in of Middle Eastern origin wearing a predominantly black outfit, his face still slick and wet with a couple spots of shaving cream on one jawline. I'm pretty sure my heart came close to stopping, and it took hours after landing to dial back the anxiety.


I'd say there's DEFINITELY something about the style of insurgent tactics over there that fostered to more PTSD than regular combat.

Maybe, but I'm not sure. I think it's just a different manifestation of PTSD. WW1-2 veterans would get jumpy at loud noises. A slamming car door, construction equipment, etc...

Only difference might be that the triggers are more common for people to run into.

Course this is all very subjective, and again it might just be that we are much more sensitive to it as an issue than we were in the past making it seem like it's a more prevalent issue.

I know it's only Wikipedia, but https://en.wikipedia.org/wiki/Combat_stress_reaction touches on a lot of issues that are mentioned in this thread.

I particularly found interesting the piece at the end of the WWII section on 'Peacekeeping Stress', which like this thread mentions problems caused by the rules of engagement and the constant threat of conflict.

https://en.wikipedia.org/wiki/Combat_stress_reaction#Peacekeeping_stresses

There is very little data on suicide rates of WWII vets after the war. And absolutely no data on PTSD after the war, obviously Things like that were not tracked backed then due to social stigmas. If anything we are just more keenly aware of what happens to people during traumatic events.

Grey Templar wrote:Maybe, but I'm not sure. I think it's just a different manifestation of PTSD. WW1-2 veterans would get jumpy at loud noises. A slamming car door, construction equipment, etc...

Only difference might be that the triggers are more common for people to run into.

Course this is all very subjective, and again it might just be that we are much more sensitive to it as an issue than we were in the past making it seem like it's a more prevalent issue.

I guess I should have mentioned that sort of thing as well. Nail gun goes off in an office that has construction going on, I immediately take cover at the corner by the desk, desperately patting down my side looking for an M4 that is not there. That sort of stuff is universal. What makes it different is that it either wasn't tracked like some have said, was less intensive since the friendly/enemy line was more clear, or a combination of both. In Nam, there was a high level of insurgency fighters as well, and much more documented PTSD cases as well as suicides.

 djones520 wrote:

I feel many of the "Greatest Generation" did suffer it. The atrocities they encountered in those two wars left scars that they silently bore throughout the rest of their lives. For many, it was years on end of it that they experienced. It wasn't 9 months on the ground and rotate home. There were guys who were a part of the first wave in, and they didn't get home until 1945 if not later.

I think the biggest difference between then and now, is that, now, men are "allowed" to feel. They suffered back then, but they had to suffer in silence, or they would somehow be seen as less of a man. We still see a lot of this today, sadly.

Didn't one of our big generals in WW2 get into trouble for trying to practically beat a shellshocked soldier back to the front lines?

 Tannhauser42 wrote:
They suffered back then, but they had to suffer in silence, or they would somehow be seen as less of a man. We still see a lot of this today, sadly.

It's a national tragedy that it's still that way. More troops have died of suicide than combat for years now and as a country we need to find a way to stem this. You can't ask people to do and see horrific things and then not take care of them afterward.

I think I come across as being anti-military sometimes because I often espouse greatly reducing the size of the military, which I definitely do support, but it's because I think having an economy so geared to military spending (among other problems) lends itself to needless adventurism - if your only tool is a hammer, every problem starts to look like a nail. I'd like to see a lot less bs wars, less garbage like buying super expensive weapon systems that no one asked for and which are really corporate/political welfare, and substantially better care taken of the people involved instead.

 d-usa wrote:
Didn't one of our big generals in WW2 get into trouble for trying to practically beat a shellshocked soldier back to the front lines?

General patten.
1944 ish maybe.

He was a a somewhat lose cannon but also a very skilled armoured officer and very aggressive in taking fight to Germans.

 jhe90 wrote:

 d-usa wrote:
Didn't one of our big generals in WW2 get into trouble for trying to practically beat a shellshocked soldier back to the front lines?

General patten.
1944 ish maybe.

He was a a somewhat lose cannon but also a very skilled armoured officer and very aggressive in taking fight to Germans.

General George S. Patton. His viewpoint was that shellshock or battle fatigue was a myth, just a free ride back home. He himself fought through tank battles of WW1 before he gained command of the units he commanded in WW2. I think that because he didn't experience battle fatigue that he didn't believe it existed.

 Grey Templar wrote:


I'm sure French and German soldiers had identical rates of Shell Shock in WW1 and WW2. Even though the former were fighting to defend their country and others were fighting a war of glorious conquest.

Completely and totally false. Faced with invasion from two sides Germany had no option but to hope for a quick knockout blow to one flank before turning to face the other. Soldiers on all sides went to war in August 1914 in the belief that they were simply defending their nation and their people. The same thing US troops are told today when they are ordered into yet another sovereign nation.

It is very easy for PTSD to slip past a society that isn't looking for it. In past wars we didn't look and didn't want to see the toll it had on soldiers. But then you look at how much higher rates of alcoholism & suicide were compared to today it's pretty clear it was there.

Another sign of how easily we miss PTSD is to see how this thread has focused purely on soldiers. But rates of PTSD among police, health workers (especially paramedics), firemen etc can be as high, and even higher than soldiers. But the public is still only just starting to become aware of how PTSD and how far through the community it reaches.

 sebster wrote:
It is very easy for PTSD to slip past a society that isn't looking for it. In past wars we didn't look and didn't want to see the toll it had on soldiers. But then you look at how much higher rates of alcoholism & suicide were compared to today it's pretty clear it was there.

Another sign of how easily we miss PTSD is to see how this thread has focused purely on soldiers. But rates of PTSD among police, health workers (especially paramedics), firemen etc can be as high, and even higher than soldiers. But the public is still only just starting to become aware of how PTSD and how far through the community it reaches.

Very good point, PTSD can affect anyone that experiences traumatic stress, which covers a variety of jobs besides the military as well as any random person that experiences a traumatic event. The foundation of society is community, people having shared experiences, working together to overcome adversity and being valued for their contributions to the whole. When people have uncommon experiences, especially traumatic ones, it often leads to feelings of alienation and a struggle to fit back into society. That's why it's important as a society to not ignore or be ambivalent towards people that experience trauma, whether that trauma is getting shelled with mortar fire in the Green Zone in Iraq or being called into chaotic life and death emergencies as an EMT or going through a life threatening car accident. We need to accept that mental and emotional trauma needs to be treated in a similar fashion to physical trauma. If you're in a group of people and somebody in your group suffers a physical trauma like a broken leg you don't just ignore it, tell the person with the broken leg to sort it out themselves and move on. The group helps the person with the broken leg, puts a cast on it, help the person maintain a place in the group while they heal and then that person can go back to being a useful valued contributor once he/she is healthy again. Same thing with mental trauma. PTSD is a temporary condition, its a natural reaction to undergoing trauma, and we can help people get through it easier and faster instead of leaving people to deal with it as individuals.

Strongly agree with the broken leg analogy. Would even go further, and say that though healing from a broken leg can leave your bones stronger, it can also paradoxically leave you with chronic aches or susceptibility to further breaks. It's the same with mental illnesses - recovery can grant wisdom and self knowledge, but the scars of mental issues equally can leave weaknesses and flaws that can cause issues to bubble up under pressure.

Taking good care of yourself, keeping an eye on what's bubbling away in your subconscious and generally being careful with your mental state is important even for those who recover from mental illness.

I don't think it ever fully goes away, but it becomes manageable.

As to PTSD, I wonder what it is that makes some vulnerable to it and others not? Or is everyone equally vulnerable, but just requiring different contexts? My brother fought on the ground in Afghanistan, but as far as I can tell he has no issues with PTSD or other issues relating to the war.

For me (medical field) I think it's a combination of how much I am exposed to and how helpless I felt about it. For many the symptoms are also not obvious, and may be completely absent most of the time. Mine only acts up one or two days out of the year, around the anniversary of day, and even on those days I'm just acting a little down. There are only a handful of people who know I have PTSD, and I don't think most people would suspect it.

 Da Boss wrote:
As to PTSD, I wonder what it is that makes some vulnerable to it and others not? Or is everyone equally vulnerable, but just requiring different contexts?

Some of it may be an issue with morality. Guys who kill without any questions are usually called psychopaths. It's not normal for a human to kill another without a reason. Saving a team mate by killing an active attacker is a lot easier on your mind than shooting an enemy who hasn't seen you yet. You did kill a man, but it was to save someone you know. And the propaganda, ofc. If you really believe the fate of your country hangs on you being able to kill a few of the enemy and staying alive it's a lot easier than killing people who did nothing to you just because your superior told you they need to be dead. A reason to fight makes it easier. Your brother may have rationalized it as helping his team stay alive and thus it is more acceptable than gunning down guys who haven't even seen him.

Though even that doesn't always help. An old friend's grandfather was a SMG gunner in our WW2. The guys who fought that war pretty much saved us from becoming a Soviet state but many paid a heavy price in mental health, seeing how the Soviets sent the same sort of poor farmers and workers against us as our own guys were. Up unto his death he still saw the poor Russians he killed in his dreams, and used to have a couple large glasses of brandy every evening just so he could go to sleep.

As someone who did suffer silently due to old rules that caused security clearances to be revoked for seeking psychiatric care I have a few insights.
1. PTSD is often used in lieu of other terms which apply better. The most common one being general anxiety disorder or a plain inability to adjust back to civilian life for those who get out soon after a harsh deployment.
2. PTSD being in the spotlight has a tendency to be overused. It is 100% treatable when recognized and properly diagnosed early. Thats not to say you still do not experience things differently however you can function.
3. Many of us were met coming off the plane with lines of people saying welcome home. At the Dallas airport when I went on leave I was made to parade through a crowd of people who all wanted to shake my hand. I wanted to just walk on through silently. I had no desire to look even into their eyes. I was alone and none of them could understand that I was just firing High Explosive(HE) artillery into human beings not 4 days earlier.
4. Civilians are the enemy mindset. (This does not mean I think its true) We are alone. We can not talk to you about it because you will judge us. We can not just melt back into society because the moment they hear you are a veteran the image of the crazy unstable veteran pops into their minds. Whether this is true or not its a perception. Look how we are portrayed on TV. EDIT: to cement this a bit more, on this very page Kris Kyle was called some pretty disingenuous names and if I remember it was a mod who did it. That man started giving back to the community but all a civilian sees is a sniper who killed people. Who made hard calls and had to live with those hard calls. And we all pretty much imagine that to be the truth. Look at many of the threads here and you will find a representation of public opinion on the matter.
5. Self Medication. Not all Soldiers leave after a deployment. Many stay in for a large number of reasons. The brotherhood we felt there, the sheer exhilaration and sadness all blended into one is something that is hard to forget. I for one started riding my dirt bike again, faster, harder anything I could to get that same feeling again. It could never be replicated. Others dive into the bottom of a bottle which masks real symptoms.
6. The Veterans Administration and active duty medical facilities were not equipped, ready, and in some cases willing to handle the number of problems.
7. Lastly: The cause of such anxieties and integration issues stems from many issues. Many noncombat personnel come back just a bit broken because even though they never fired a shot there is something that happens to your brain when you know at any moment a rocket or mortar could land on you and there isn't a damn thing you can do about it. You just get used to that feeling of helplessness. On patrols in Iraq I knew that was a high probability if we hit an IED I would have no warning, and you just accept that and keep on doing your job. It is not normal to operate that way. You know the dire risks and you move forward anyway. I worked as a Fire Direction Officer in Afghanistan, a Vehicle Commander in Iraq, and trained ANA on the last one back in Afghanistan. Any moment it would be all over, ANA would shoot you when you weren't looking, or you would step on a mine. You really do accept that you are already dead just like the famous line in Band of Brothers. Now you live through this, and you come back to the "real world" which is not fake to us and the sense of guilt for wanting to go back eats at you. You can't tell your wife you want nothing more than to leave again and go back.You can't go back because now its time to retire. You watch the brave uniformed personnel leave in your stead and you would do anything to join them. You look for a job with triple canopy and your wife sees the job application and thinks you are running from her. But in reality you are running towards that feeling you had where you never felt more alive and close to another human being like the man at your side.

That is a glimpse into why PTSD happens from my point of view.

Edit on Pt. 4