How a PTSD Diagnosis Can Help, and Harm

Psychological diagnoses can tell someone they are not alone. They can also be used to alienate even further.
How a PTSD Diagnosis Can Help, and Harm
Image: MivPiv/iStock

This June, CT drew attention to veterans’ experience in the cover story “Formed by War.” To continue the discourse sparked by that story, alongside the Centurions Guild, CT is hosting an online series called Ponder Christian Soldiers. (Read the Introduction to the series here.) The following essay is from Warren Kinghorn, associate professor of psychiatry and pastoral and moral theology at Duke Divinity School.

Ray sat in my examination room, tense and uncomfortable. A Vietnam combat veteran with a wiry build and a gray, frizzled beard, he was sitting in a Department of Veterans Affairs (VA) hospital for the first time in 38 years. He had visited once in the 1970s and had left angrily, vowing never to return. But his wife had recently told him that she was leaving for good if he didn't get help. So he was back, sitting in my office.

After hearing Ray’s story, I asked him a set of standard clinical questions:

Do you have trouble sleeping?

Yes—four or fewer hours per night, since Vietnam.

Frequent nightmares?

Yes—at least twice weekly, usually of experiences in Vietnam that he doesn’t want to talk about now.

Do you avoid situations that remind you of combat? Check.

Are you "triggered" by certain smells and sounds? Check.

Is being in crowds difficult? Do you startle easily at loud noises? Check. Check.

I asked if he had ever heard of post-traumatic stress disorder (PTSD). He hadn’t. I told him that PTSD names the experience of some veterans who witness hard things in war and then have difficulty moving past those memories. The memories return at unexpected times and places, sometimes as nightmares. People go to great lengths to avoid them, but still they come. People may feel tense all the time and have trouble sleeping. “Does any of that describe you?”

Ray looked at me as if I had read his soul. So we kept talking—about how he was not alone, how other veterans would want to support him, and how there were treatments that could help. He brightened, even smiled a little, and left with a plan.

3 Ways a Diagnosis Can Harm

Christians and non-Christians alike worry about ways that psychiatry uses diagnostic language to label people. They worry that diagnostic labels can stigmatize and disempower a person—or, rather, that other people use labels to stigmatize and disempower those who have them. More subtly, diagnostic language can teach that big parts of a person’s human experience—anxiety, reactions to memories, difficulty in relationships—are medical problems that medicine alone can address.

But Ray’s story shows how a psychiatric diagnosis can help. For a veteran struggling with confusing, uncontrollable thoughts and nagging shame, a PTSD diagnosis can be good news. A diagnosis says: You are not alone. Others have experienced this also. You have a community of support. There is help.

PTSD is without question a real set of experiences for hundreds of thousands of veterans. But that does not mean that the label “PTSD,” even when it fits, is always helpful. Rather, it must be made helpful.

There are at least three ways that a psychiatric diagnosis can be harmful. The first way is to treat a person as if their diagnosis is their identity—to speak of someone as a “raving schizophrenic,” a “hopeless alcoholic,” or, in the case of PTSD, a “crazy vet.” This brings shame to the person diagnosed, and aversion from everyone else.

The second way—common even among those who don't want to stigmatize—is to treat someone as the victim of a medical disease over which they have no control, and that mental health professionals alone can address. This brings anger, shame, and discouragement on the part of the person diagnosed, and pity on the part of everyone else. It leads to the conclusion that, because mental illnesses like PTSD are medical problems, the church has little to offer.

The third way (more specific to combat-related PTSD) is to put someone on a pedestal as a larger-than-life hero who, because of their heroism, is no longer an ordinary human being. This brings alienation and bewilderment on the part of the valorized person, and comfortable, reverent distance from everyone else.

None of these approaches sees the veteran as fully human; none is consistent with a Christian vision of human dignity. A PTSD diagnosis is not an inescapable identity, an uncontrollable disease, or a mark of superhuman valor. Rather, it describes an experience common to some of our fellow image-bearers. The key question for all of us along the way is, “What is needed, right now, for the journey?” A PTSD diagnosis is helpful only if it facilitates wise responses to that question.

Medical treatments, including talk therapies like Cognitive Processing Therapy, can be helpful. But if Christians are to walk wisely with veterans with PTSD, we must avoid a narrow understanding of PTSD as a medical condition that can only be treated by medical professionals. PTSD has a broader social and relational context. PTSD arises when one’s capacity for basic trust in others, in one’s environment, and in oneself is profoundly threatened—usually because of close experience with evil. (“Moral injury,” which can happen after someone witnesses or participates in the transgression of a deeply held moral code, is one version of this.)

Having lost this basic trust, people with PTSD often go to great lengths not to be vulnerable, even if that means withdrawing from community. The cruel paradox of PTSD is that it threatens the very friendships that would otherwise lead to its healing.

Don't Make Veterans Talk about War

Christians who know veterans with PTSD would do well to cultivate the friendships and communities that show the church at its best. Veterans with PTSD can be invited to exercise their gifts and held accountable within relationships just like any other person. Indeed, veterans with PTSD will often bring unique gifts that are borne in the context of struggle.

But the dynamics of PTSD should remind those who walk with veterans to be “quick to listen, slow to speak, and slow to become angry” (James 1:19), and to refuse to allow diagnostic labels to keep veterans at a distance. Don’t force veterans to talk about war—but be ready to hear about it when the time is right. Keep issuing gentle invitations to community, even when the initial answer is “no.” Care for veterans by caring for their families. Be cautious about forcing veterans into crowded, noisy spaces or into social “command performances.”

Above all, whatever veterans have witnessed and whatever veterans have done, veterans are like the rest of us in their need to belong and to be loved. Like the faithful veteran of the Gospels, they need to hear Jesus’ healing word (Matt. 8). And veterans need to know that there is no power in all creation, including war, that can separate them from the love of God in Jesus Christ.

We want to invite conversation about the experiences of veterans. If you have a story to share, or a question to ask, direct those to Centurions Guild founder Logan Isaac at logan[at]centurionsguild.org.

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How a PTSD Diagnosis Can Help, and Harm