Five years after the last American soldier left Vietnam,

the issue of wartime trauma was still not on anybody’s agenda. Finally, in the

Countway Library at Harvard Medical School, I discovered The Traumatic

Neuroses of War, which had been published in 1941 by a psychiatrist named

Abram Kardiner. It described Kardiner’s observations of World War I veterans

and had been released in anticipation of the flood of shell-shocked soldiers

expected to be casualties of World War II.1

Kardiner reported the same phenomena I was seeing: After the war his

patients were overtaken by a sense of futility; they became withdrawn and

detached, even if they had functioned well before. What Kardiner called

“traumatic neuroses,” today we call posttraumatic stress disorder—PTSD.

Kardiner noted that sufferers from traumatic neuroses develop a chronic

vigilance for and sensitivity to threat. His summation especially caught my eye:

“The nucleus of the neurosis is a physioneurosis.”2 In other words, posttraumatic

stress isn’t “all in one’s head,” as some people supposed, but has a physiological

basis. Kardiner understood even then that the symptoms have their origin in the

entire body’s response to the original trauma.

Kardiner’s description corroborated my own observations, which was

reassuring, but it provided me with little guidance on how to help the veterans.

The lack of literature on the topic was a handicap, but my great teacher, Elvin

Semrad, had taught us to be skeptical about textbooks. We had only one real

textbook, he said: our patients. We should trust only what we could learn from

them—and from our own experience. This sounds so simple, but even as Semrad

pushed us to rely upon self-knowledge, he also warned us how difficult that

process really is, since human beings are experts in wishful thinking and

obscuring the truth. I remember him saying: “The greatest sources of our

suffering are the lies we tell ourselves.” Working at the VA I soon discovered

how excruciating it can be to face reality. This was true both for my patients and

for myself.

We don’t really want to know what soldiers go through in combat. We do

not really want to know how many children are being molested and abused in our own society or how many couples—almost a third, as it turns out—engage in

violence at some point during their relationship. We want to think of families as

safe havens in a heartless world and of our own country as populated by

enlightened, civilized people. We prefer to believe that cruelty occurs only in

faraway places like Darfur or the Congo. It is hard enough for observers to bear

witness to pain. Is it any wonder, then, that the traumatized individuals

themselves cannot tolerate remembering it and that they often resort to using

drugs, alcohol, or self-mutilation to block out their unbearable knowledge?

The Body Keeps the Score by bessel Van Der Kolk

There are moments when, out of nowhere, my mother’s voice comes to me, “Just who do you think you are?” and I would remember I am nobody. I know nothing, can do nothing right, will never have anything to offer of value to anyone. For years, decades really, it was all I knew for certain about myself and I lived my life accordingly. When people treated me with disrespect or abused me saying words like “I’m doing this (or saying this) for your own good.” I knew they knew my horror and shame and only meant to help. But the abuse went on and I let it because I deserved no better.

It was a twisted way to live, think, feel but it was familiar.

As I write this page I feel remnants of that old tired thought and I say, “I am somebody. I can write this book.”

War is war and like millions of others who have not faced bombs, gunfire, or were forced to kill or be killed, I have battled endlessly onward merely to survive in the aftermath of my war. For victims of trauma there is only the reliving and the silence because nobody wants to hear.

I am grateful that PTSD is in the news, I am sorry so many soldiers had to suffer so much to bring it to light. They deserve better, and so do the rest of us with PTSD. When people say “Get over it,” the words are to soothe their own discomfort with the horror we have known, but it is an impossible task. It will never happen. What is happening is science, investigation, knowledge, and the application to my mind and body.

There is no difference where a person gets PTSD.