Stigmatizing PTSD

Perpetuating shame over PTSD is a serious business.

To his credit, throughout much of the presidential campaign, Donald Trump has expressed concern about the treatment of returning U.S. combat veterans, their high suicide rate and the need to improve the performance of the U.S. Department of Veterans Affairs. But a remark the Republican nominee made early this week — whether intentional or simply inartful — was entirely counter-productive to that stated goal, perhaps disastrously so.

Speaking Monday to the Retired American Warriors political action committee in Virginia, Mr. Trump raised the issue of mental health problems among service members by describing how the horrors of combat affect people differently. "When people come back from war and combat and they see things that maybe a lot of folks in this room have seen many times over and you're strong and you can handle it, but a lot of people can't handle it," he said.

People attuned to mental health and particularly to Post Traumatic Stress Disorder, or PTSD, will instantly recognize the problem. While it's certainly true that people react to stressful situations in different ways, it is fundamentally wrong to regard people who do not develop PTSD as "strong" and thereby imply that those who do manifest symptoms are weak. That's not only misleading and false, but it's the kind of mindset that stigmatizes mental illness and leads sufferers not to seek help that is critical to their recovery.

Vice President Joe Biden may have summed up the situation best when he was told about the candidate's remarks on Monday. "I don't think he was trying to be mean. He is just so thoroughly, completely uninformed," Mr. Biden said.

Mr. Trump is obviously not a psychiatrist, and he's been the target of his share of armchair mental health diagnosticians (narcissistic personality disorder being the consensus pick), but the words of a presidential candidate matter — almost as much as those of a sitting president. People who have PTSD can find themselves constantly reliving bad memories or nightmares, avoiding situations that remind them of these events and feeling constantly keyed up or jittery. Their personalities may fundamentally change as they are wracked by feelings of guilt or shame.

People with PTSD may suffer depression or anxiety. They may develop drinking or drug addictions, suffer chronic pain, and have trouble holding a job or staying in a relationship. Studies suggest it's a malady shared by roughly 8 million American adults, and it puts them in a much higher risk for suicide, according to the VA. There are treatments, of course, including cognitive therapy and medications (antidepressants such as Prozac and Zoloft are commonly prescribed), but such approaches are wholly ineffective if the sufferer feels too ashamed to seek assistance in the first place.

Why do some veterans suffer PTSD after witnessing traumatic events and some do not? Researchers don't know. It could be a matter of brain chemistry. But it is dangerous to state, or even imply, that victims are inherently weak or somehow inferior. There are other myths about PTSD — that it happens immediately after a traumatic event, that people who have it are dangerous and can't function in society, that they are not truly "wounded" and that they should just naturally get over it. All are absolutely false.

By Tuesday, Mr. Trump's defenders complained that his words were taken out of context — they were part of a speech in which the candidate was actually expressing concern about the high suicide rate among veterans — and we can sympathize to an extent. But that doesn't excuse such a fundamentally misguided description of a mental health disorder. To imply that someone with PTSD is less "strong" than his or her peers is like describing veterans who lost limbs to explosions as less "careful" than veterans who survived combat with arms and legs intact.

Such comments should be regarded as unacceptable from any candidate, but it's particularly regrettable from one who avoided military service and once took an especially distasteful shot at Sen. John McCain for his time as a prisoner of war in Vietnam. Instead of suggesting the media is covering these ill-chosen words as part of some liberal conspiracy, he ought to simply step up, apologize and put the matter behind him. Such a move would demonstrate how easy, if regrettable, it is to perpetuate a mental health stigma. Alas, Mr. Trump appears incapable of admitting fault on this or most any other occasion.

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