This response was waiting for me to moderate. Well, I liked it, so thank you Chief Vollink, I’m making it a post by itself, not a comment.
Post Traumatic Stress Disorder Diagnosis Vs. Combat Stress Disorder Diagnosis
By James T. Vollink, Chief of Police (Ret.)
As a combat veteran having had the job of treating the wounded, I believe I can speak clearly about the fact that I believe with every ounce of my being that Combat Stress Disorder should be adopted and replace PTSD for combat veterans. I believe that if the diagnosis of CSD were added to the DSM, it could not only more specifically define the problem for the veteran but it could bring the veteran a certain amount of dignity from friends and family that his or her problem were a result of combat. Consequently and hopefully, it could increase the veterans chances of healing (even though there will never be complete healing.) Also I am hoping it will help them to be able to live with things that no human being should ever have to live with.
Why Is It Important To Distinguish Between The Two? PTSD and CSD are, without a doubt, first cousins and will always share a lot of the same problems. Right now, the APA does not carry a diagnosis of CSD and I believe that they should. Every combat veteran who carries the diagnosis of PTSD has to share the same stage with civilians who never knew what it would be like to take a willing part in the thing that caused their diagnosis of PTSD. I would like to make it clear though that I would also never try and diminish anyone’s pain or suffering that has been diagnosed with PTSD. PTSD victims usually have one bad day that results as their stressor, such as being the victim of a rape, an armed robbery, a horrendous vehicular accident, an assault and battery, a house fire, and the list goes on. With CSD though, the veteran faces hundreds of bad days where he or she is in the kill zone where any one of those days could be classified as the stressor that pushed them over the edge
into CSD hell. The main thing that separates the two can be summed up in two words and those are, “righteous indignation”. By that I mean because PTSD victims were, for the most part, not willing participants in the thing that gave them PTSD, they can therefore lay claim to the use of the words, “righteous indignation”. Being able to use those two words can contribute enormously to the possibility of making a rapid recovery (never total though), and, more importantly, a reduction in the guilt that they have to deal with. CSD victims cannot and will never have, that same advantage because they were willing participants in the thing that gave them their diagnosis of CSD. For a CSD victim, they leave a part of themselves on the battlefield that they will never be able to get back. The part that remains on the battlefield, unfortunately, is also the part that a person needs to form and keep meaningful relationships in their life. Words like “trust” and “faith”,
and “hope” and, “love” become almost obsolete. One word though, becomes greater than any other word when it comes to trying to heal from CSD. That word is guilt and especially survivors’ guilt. I believe with all my heart that guilt and more specifically, survivors guilt can be the biggest stumbling block standing in the way of any type of healing or recovery. What really compounded matters for Vietnam combat veterans, is the fact that we not only felt the guilt, but if we were fortunate enough to return, their country was telling them that they should feel guilty. A recipe for a disastrous life, if there ever was one. I believe that returning combat veterans are a National Treasure and deserve to be treated accordingly. Guilt can be the biggest door to open for healing if the victim can get a strangle hold on it to keep it under control as much as possible. There is a lot of stigma attached to a diagnosis of PTSD because no soldier wants any one to know that they
it, and as far as getting help, it is next to impossible because they do not want anyone calling them a slacker. It also has a lot to do with all that “macho warrior” stuff and peer pressure to be able to stand up under incredible pressure.
Finding someone a CSD victim can trust, when it involves going back to the same government that was responsible for the problem in the first place, is a pretty huge pill for them to swallow.
Warning the veterans when they are discharged, what the signs are for CSD can easily give them a head start when it comes to getting treated. This is where the government can do a lot to prepare them ahead of time if their life starts going downhill. Their ability to relate to their family and friends like they did before could possibly be gone forever. Having CSD hands them the blueprints for how to build walls and never bridges.
What Is The Solution?
For a total recovery to take place, I do not believe that is possible. However, If the APA and VA would accept these facts and further refine the DSM to include CSD, I personally believe that the healing process for the men and women on the front lines who are diagnosed with CSD could begin sooner. And, hopefully lessen the severity and improve dramatically the ability of the veteran to live a more productive life. If the victim of CSD can take away any of the negativity that is connected with PTSD, they can stand a much better chance of some real damage control.
Family’s should be sent a letter before their veteran comes home telling them about CSD and what symptoms to watch for so if they think their vet is in need of
help, they can do so lovingly and proudly because a psychological injury can be
just as devastating as a physical injury and should be put in the same category.
When they take the oath and put on the uniform, they need to know that there is a good possibility that they could do unthinkable things. When it comes to any pain they may suffer from as a result of being in combat they should deal with it as soon as possible.
PTSD victim’s can take great comfort in the fact that no matter what, they didn’t have it coming. Being able to claim a “victim’s” status can and does put their experience into a much more manageable disorder. Not so with the veterans who were there because they volunteered to be there.
The part that remains on the battle field also causes a person to bleed internally and causes him or her to become what is classified as “the walking wounded” for the remainder of their lives because all they can ever do is to try and control the bleeding. For the veterans who try to control their bleeding with alcohol or any other drug, if they are fortunate, they soon find out that all they accomplished was to further complicate their lives. I would be extremely happy if every returning combat veteran was put through a two or three week debriefing where they learn why they received the kind training they did and let them know if they ever start developing any of the CSD symptom’s, they should seek help immediately. If this country just discharges them without any debriefing, they could be putting them out on a limb with a saw in their hand. Like anything else, the more a person knows about a problem, the easier it is going to be to try and fix. Making a diagnosis of CSD
and then telling the veteran that they have nothing to be ashamed of would probably be honey to their ears. Changing the diagnosis of PTSD to CSD can elevate and dignify the disorder if it is handled properly.
Having someone telling them that they should feel the same way about a CSD diagnosis as they would about being wounded from an IED, could bring a certain amount of honor and dignity to an otherwise dismal and depressing future. Before they can start opening some doors for healing it is critical for them to know that it was their job to follow orders and there are consequences that happen when those orders are carried out. Tell them that one of the consequences could involve CSD so they should be taught to look for any of the symptoms early on.
Before they are discharged, let them know if they ever get the urge to go out in the woods with their camouflage on and shoot off a few rounds, that is a byproduct of their training. They should be told to not think that they are dangerous to others if they want to do so. Powerful things can and do happen if their return to civilian life is handled properly and they are given the necessary tools for developing the coping skills necessary to deal with their disorder.
I would also tell them that in each and every one of us, there are actually four people who need to be nurtured and cared for. By that I mean that each person is who he or she is physically, emotionally, intellectually, and spiritually. Then I would tell them that usually the one person that gets ignored the most is the spiritual person and that person just happens to be the one that could offer the most comfort and healing. This country owes it to them to do everything in its power to help them through their nightmares. If you asked me how long it has been since I have been in Vietnam, I will tell you I was there last night.
A little about the author. I was born in Michigan in 1945. My family moved to a suburb of Chicago and I grew up there and enlisted in the Navy in 1963. Once I was transferred to the Marine Corps, I was with the 2nd Batt., 3rd Mar. Div., Hotel Co. Vietnam ’65 – ’66 as a Hospital Corpsman. After I was discharged, I took a job as a police officer and I am now a retired Chief of Police. I live in Traverse City, Michigan and would welcome any calls in regards to this plea for CSD vs. PTSD.
You can reach me at 231 946 6279 or Jimconserv@aol.com.