Damned if they do, damned if they don't
Experts divided on validity of Post-Traumatic Stress Disorder
There was a little girl on the ground in purple rubber boots, not breathing. A crowd formed around her, which was what drew Darryl King's attention in the first place. The corporal was on routine duty, closing up his peacekeeping tour in Kosovo with Canadian Forces 15 Combat Engineers, when he saw civilians running towards a stopped car on a road near his position in Pristina. It was early December 1999.

What happened over the next few minutes eventually strained his family relationships, hindered his military career and to this day haunts his thoughts. The little girl, who had been struck by a speeding car, was actually known to King. She used to tease him when he did his daily exercise run in Pristina.

But that day, he scooped her up and ran for her life, towards a nearby medical unit. Later, with her blood still on his hands, King found out the little girl had died. He worried then - and he still worries now - that his spur-of-the moment rescue run might somehow have contributed to her death. "She was about seven or eight years old," he says quietly. "Her name was Hannah. She was born in war and survived it - for what? To get run over by a car?"

The incident was central to King's mental anguish upon returning to Edmonton Garrison - and to him being eventually diagnosed with Post Traumatic Stress Disorder, the bane of the modern peacekeeping soldier. Those succumbing to PTSD face a classic military Catch 22. Seek help, and perhaps the nightmares, the chronic anxiety and the unchecked anger will be treated. But asking for help raises questions from fellow soldiers, suspicion of dereliction of duty.

King's experiences also serve to enlighten a growing debate, inside and outside the military, about PTSD. While the diagnosis is widely accepted among mental health professionals, some critics say PTSD is a fiction - a creation of a society obsessed with psychology and psychological labels. This cult of victimhood, they say, allows malingerers to always blame something or someone for their suffering, instead of taking responsibility for their own behaviour and happiness.

In the ever-litigious U.S., claims of PTSD have reached the civil courts and resulted in successful multi-million-dollar lawsuits. What then followed was a landslide of claims, some of which were trumped up, according to Dr. Mark Levy, an American forensic psychiatrist who often testifies in such lawsuits.

The problem, says Levy, is that the symptoms of PTSD are so subjective. They can be faked and there are always people who will attempt to scam the system. But while that happens - and helps foster the cynicism about PTSD - it doesn't mean the illness itself is false, he says.

"Is PTSD real?" says Levy. "Yes, it's real."

Just ask Darryl King. The career soldier was constantly jacked-up with anxiety when he returned from Kosovo in December 1999. Over the following weeks he slept no more than a couple hours a night, then paced the floors. Flashbacks weren't unusual and he snapped at his family over small incidents.

The low point came when his daughter came to the dinner table one night with lips stained blue from a candy.

"Go - get away from the table," King yelled at his nine-year-old. "I don't want to see your face."

Later, in therapy at the Operational Trauma and Stress Support Centre at Edmonton Garrison, King told psychologist Rhonda Gibson about yelling at his daughter. The blue lips, it turns out, had flashed him back to the little girl in Kosovo.

"The guilt? It was brutal," says King.

PTSD first entered the medical vernacular in 1980, with the release of that year's edition of the American Psychiatric Association's manual of diagnosis. The diagnosis was developed by the manual's authors, for the most part, to describe and deal with the prolonged mental suffering of Vietnam war veterans.

Levy even traces PTSD back to the 19th Century and survivors of railway accidents, who were said to be experiencing "Railway Spine." In the First World War soldiers were said to suffer from "shell shock," while in the Second World War the terms "war neurosis" and "combat fatigue" entered the lexicon.

Romeo Dallaire, who commanded peacekeeping forces during the mass genocide in Rwanda, really brought PTSD to Canada's attention when his continuing troubles, including a drunken incident in a park, became public. More recently, Cpl. Christian McEachern, charged after a reckless driving incident at Edmonton Garrison, complained he could not get proper care for his PTSD, caused by stressful peacekeeping missions. Another 200 Armed Forces personnel in Edmonton have been diagnosed with the disorder and Dallaire estimates as many as 3,000 Canadian soldiers suffer from PTSD, many of them silently.

But it is just those kinds of suggestions, made about soldiers during peacetime, that creates the cynicism. According to licensed Canadian psychologist Tana Dineen, much of it justified.

Dineen, while careful not to criticize soldiers, says the psychology industry has led them down the garden path. How? By convincing people they are mentally ill and require professional help.

PTSD, for example, "is a creation of the American Psychiatric Association," says Dineen, who wrote a scathing critique of the so-called psychology industry in her book Manufacturing Victims.

Dineen argues that the establishment of an illness called PTSD not only allowed doctors to bill patients and insurance companies for treatment, but it served other agendas, as well.

"Some people say that rather than look at the social and political issues from Vietnam, what we did was pathologize - create an illness." The same thing could be happening with Canada's peacekeepers, says Dineen. Instead of debating whether or not we should be taking on some of these peacekeeping roles, we end up debating whether the military has sufficient psychiatric resources to treat the soldiers so they can re-deploy.

Dineen is troubled by the ethics of pathologizing what she believes is normal human suffering. Labelling normal human reactions as an illness might actually create one, she says. People who might normally cope with haunting memories in all sorts of routine ways, are now being told they are mentally ill and need treatment.

"We all now know the term PTSD and casualties are sort of falling all over in our society," says Dineen. "And that's happening, partly, because we're training people to think that way - to think that if you feel badly, instead of getting over it, you have an illness and need help." It's a classic self-fulfilling prophecy, she says.

While Dineen is the rare example of someone who speaks publicly about her PTSD cynicism, she's not alone.

Darryl King found out that members of his squadron were talking uncharitably about him, behind his back. A superior tried to get a doctor's note quashed, so King could be used on a peacekeeping mission, instead of going to therapy.

Dr. Wendy White, clinical director of the Operational Trauma and Stress Support Centre at Edmonton Garrison, says she's heard plenty of cynicism about PTSD, inside and outside the military. The military psychiatrist is undaunted and says PTSD is as real as shrapnel.

So too, are the claims by peacekeepers. White says she's heard story after story from soldiers who witnessed horrific incidents of rape and murder during deployment in places like Bosnia and were forbidden from taking any significant action because of their neutral, peacekeeping role. "Some of them have had to stand back and watch the killing," said Dr. White. "They would be disobeying orders to do anything. And they feel a complete sense of impotence and loss of control."

Levy says forced passivity and loss of autonomy is a huge contributor to stress. It's why assembly line workers are so much more vulnerable to burnout than corporate executives who often face incredible pressures, but have the power to take action.

Many peacekeepers also went over with a optimistic fantasy, of helping to rebuild schools and help children, but ran face-first into the aftermath of genocide.

Darryl King actually helped to rebuild one school and paved the way for a Fort Saskatchewan school to send letters to kids in Kosovo. On of those better days, King was driving back along a road and noticed a group of about 15 kids, aged 7-12, surrounding an elderly woman. He asked the driver to stop.

"I couldn't believe what I was seeing," says King. "They were trying to kill her."

Turns out the woman was suspected of cooperating with enemy forces. The kids were stoning her and King says if he hadn't intervened, they wouldn't have stopped.

King says that when he first arrived in Kosovo, he had a soldier's philosophy about being in a potential hot zone.

"I thought to myself, 'I could die here.' But I was OK with that. I was trained for a gun fight. What I wasn't ready for was the civilian end of things."

The civilian "end of things," as he calls it, involved little kids with murderous intent, and little kids dying in his arms. King has now left his squadron and moved to the air force, where he is being trained in air-traffic control. He's being transferred out of Edmonton, to North Bay, Ontario.

As much as he's haunted by the memories from his one peacekeeping tour, he's also stung by the fact some of his military colleagues - and civilians who have never met him - think he's faking this thing called post traumatic stress disorder.

"Strap on a pair of soldier's boots and walk a couple of miles," says King, smiling grimly. "If you still feel the same way at the end of it, well I guess I am just weak."

"I'm a professional soldier, and if I have to take my lumps, I will." He's happier now. More relaxed, content. He feels deep gratitude to psychologist Rhonda Gibson, who treated him.

And he hopes other soldiers read his story and realize they too can get help. "My life has definitely changed for the better. My family? We've gone through a lot. But we're good, you know?"

Scott McKeen
Journal Insight Writer

Edmonton Journal
April 14, 2001