Psychiatric Casualties
EP:4 Evolution of Military Psychiatry
Join Dr. Mark Russell and Dr. Charles Figley as they navigate the complex history of military mental health, uncovering the silent suffering behind the heroism. Their conversation takes a critical look at the evolution of military psychiatry, from the days of the Civil War to our contemporary conflicts, and the often-overlooked psychological traumas that accompany them.
Mark and Charles will bring these crucial conversations to the forefront, honoring the full spectrum of sacrifice made by our military personnel.
Table of Contents for Discussion
For further insights and to join the conversation, reach out to Mark at mrussellphd@gmail.com. Your engagement can help pave the way for a future where military mental health is no longer a silent battlefield.
Tune into our CHW Streaming Radio and the full lineup at cominghomewell.com
Download on Apple Play and Google Play
Online-Therapy.com ~ Life Changing Therapy Click here for a 20% discount on your first month.
Thank you for listening! Be sure to SHARE, LIKE and leave us a REVIEW!
Join Dr. Mark Russell and Dr. Charles Figley as they navigate the complex history of military mental health, uncovering the silent suffering behind the heroism. Their conversation takes a critical look at the evolution of military psychiatry, from the days of the Civil War to our contemporary conflicts, and the often-overlooked psychological traumas that accompany them.
Mark and Charles will bring these crucial conversations to the forefront, honoring the full spectrum of sacrifice made by our military personnel.
Table of Contents for Discussion
For further insights and to join the conversation, reach out to Mark at mrussellphd@gmail.com. Your engagement can help pave the way for a future where military mental health is no longer a silent battlefield.
Tune into our CHW Streaming Radio and the full lineup at cominghomewell.com
Download on Apple Play and Google Play
Online-Therapy.com ~ Life Changing Therapy Click here for a 20% discount on your first month.
Thank you for listening! Be sure to SHARE, LIKE and leave us a REVIEW!
What we got here is failure to communicate, a chronic neglect of military mental health care. This is psychiatric casualties. How and why the military ignores the full cost of war.
Speaker 2:Hey everybody, welcome. I'm Charles Spigley. Mark Russell is with us and we're talking today, and I'm going to talk about what we normally do about military mental health and what a mess we have. But what we're doing is attempting to deconstruct this mess and to explain it in as logical and direct terms as possible. But it's something that both of us have cared about deeply, and Mark and I wrote a book. I'm not even going to talk about the title because I'm not promoting the book, right, Mark? What do you think?
Speaker 3:Yeah. So what do I think? I think it's. I find it very difficult, to say the least very challenging, to try to condense everything like in this one chapter. It really is a very concise chronological history of traumatic stress, war stress and the whole trauma, pension wars and everything else that leads up to today's current views about how we, what we perceive as legitimate or illegitimate, you know, consequences of warfare or exposure to trauma. So it's to me it's always very difficult to try to pick out one or two items that the focus on when I feel like there's such that history is so rich and so important to learn in heeding to George Santana's famous saying that those who don't know history are doomed to repeat it.
Speaker 3:And so I got. I probably go a little too far in the weeds when it comes to history, but it's always been interesting to know that what we're dealing with in today's society, today's military, is no really different than what they dealt with back in the American Civil War and earlier. So we'll have a lot to talk more about that in this episode.
Speaker 2:Okay, well, one first thing we're going to be talking about is the section in the book in which we address is 40 to 45 pages, so it's quite a bit. But one more to and relearning the realities of modern war. Yeah we were just in a point, you know, as a country, in which we thought we, we got it and so we understand this. We have experiences from another world war.
Speaker 2:And so we're going to develop all kinds of measures and all kinds of strategies for being able to eliminate, if not reduce, significant, and just the opposite happened, as we talked about last time. Which, yeah, and then the table 1.1. We had a mortality rates during World War One, 21%, but it jumped to 30% more or two, and stabilized kind of with the Korean War, 25% less. But it's, it's that kind of relearning. And so you pointed out, yes, yes, I co-authored the book, but you have pointed out on numbers of conversations, etc, etc. That it doesn't have to be that way, didn't need to be that way, and that's one of the reasons why we're probably doing this now, mark.
Speaker 3:Yeah, yeah, thank you, joe. So that again, that chart, the mortality rate again highlights the importance of learning our hard fought battlefield lessons In this case it was the lessons of medicine and to improve survivability, and in the war zone. But when it comes to psychiatric lessons of war, I want to read you just a very brief excerpt, coming from 1914, again out of the First World War. This is from the famous German neurologist, herman Oppenheim, who coined the term traumatic neurosis that we talked about last episode and this is what he said is the psychiatric lesson of the First World War and the wars before that. The war has taught us, it will continue to teach us, that, just as before, they are traumatic neuroses, that they are not always covered by the concept of hysteria and that they really are the product of trauma and are not goal oriented, well cultivated, pseudo illness. Very profound statement and framing that part of the trauma pension debate. And that says that most people's responses after traumatic stress exposure, whether in the private sector or through war, are legitimate forms of suffering and that we've all involved changes to the how the brain is functioning, and that is the concept of traumatic neurosis. And then shell shock was adopted, and you know as a war manifestation of that and it's not covered as a hysteria. Which is the other side of that trauma pension debate is that it's all due to predisposition, predispose, weakness, personality and or greed Wanting a paycheck. And that open, open, I'm really does frame both sides of that trauma pension debate.
Speaker 3:That, as we go into this, the second world war, every warring power and we need concerted efforts to how did, like you said, how do we stamp out the psychiatric problem? How do we resolve the mental health dilemma in the military? So let's say that after the first world war concluded in 1918. There were a lot of large medical conferences and military conferences about the psychiatric problem and they had a these, all these experts testifying from throughout the world and talked about what led to this epidemic and psychiatric casualties that every warring power experience and what they concluded was that it was due to, again, the weakness of society, modern society. It had to do with offering people pensions, a compensation that led to the initial evacuation syndromes. It had to do to poor leadership or training and also the corrosive influence of psychiatry. That are medicine that they were giving people labels that made people think that they actually had an injury and that that led to their being removed from the front lines. Everything concluded was, except the fact that modern warfare had proven to be especially toxic and that the threats now came from the sea, came from under the sea, it came from the air, the air you breathe. It came from long range artillery, rapid machine gun fires, all the technology of warfare, including tanks and all the other high level explosives that didn't get factored at all as to explaining this epidemic and moisture casualty.
Speaker 3:So, as a consequence, you had states, countries like Germany, that outlawed the use of psychiatric terms and, leading up to the Second World War, all the military powers, including the United States, disbanded their psychiatric programs, again trying to remove that corrosive influence of mental health providers. They eliminated all that frontline psychiatry, but he took all the psychiatrists out of the military, kicked them out and they screened out in the most robust mass screening of any type of psychiatric predispositions ever undertaken, and we'll talk more about this in future episodes. But the bottom line is, for the US military, we screened out almost 2 million Americans from entering the military due to some predisposed risk factor, like if their parents had divorce, if they stammered or stuttered when they were kids, if their ears were asymmetrical, I mean any conceivable risk factor. They were removed from entering the military. So that was the posture of not just the American but again all the European powers as well, as they entered the Second World War.
Speaker 2:So all of this happened when we had full confidence we'll be able to control all the problems that we needed psychiatry for.
Speaker 3:Yeah. So basically what happened after the First World War and all these post-war analysis were done is they concluded that the problem was mass hysteria, that these were not real illnesses, and that we needed to get rid of the roots of that hysteria, which are get rid of the weak people from joining the military and the weak predisposed people, and then also get rid of the influence of medicine and psychiatry in particular, so that what we are left with is a very hearty, resilient fighting force that's immune from these environmental factors that they attributed their epidemics and psychiatric casualties to, as opposed to the military. So that was the plan. How did it go? Not well.
Speaker 3:Well, if for the Americans I'll stick to the American side the psychiatric casualties in the first year of war outnumbered the number of new attrition, new recruits that came in the war. So all those people who were screened out from being in the military and all you're left with is a bunch of cat in America, is really the most resilient, psychologically hearty fighting force ever put together. I mean, they were psychologically tested to the nth degree and these were all people who shown to have no predispositions of weakness or preexisting personality problems that were not morally corrupt. However, psychiatric casualties outstrip the number of recruits, leading to them the US military having a backtrack in 1942 and said we're going to get rid of this policy now, mass screening out and rejecting people. And they brought back American mental health providers, psychiatry psychologists, social workers and they reinstituted their frontline psychiatry policies that were adopted in the First World War.
Speaker 2:Now that war too. That was kind of in the middle of the war, right, it wasn't toward the end. It was what? 1942 or something.
Speaker 3:Yeah, so that was the second year of the American involvement in the war and of course they were in Europe, started in 1939 for the Second World War. But every warring power was faced the same problem in the Second World War, which was psychiatric casualties now were approximating or outnumbering the number of physically wounded or killed in action. And so that whole issue that they thought they settled out through the First World War, because they misread yeah, they misread history, they misread the legitimacy of traumatic stress, injuries and the fact of modern warfare has on the human mind and human body, that lesson was relearned a dozen fold in the Second World War.
Speaker 2:So in effect, Oppenheim was correct.
Speaker 3:Oppenheim was absolutely correct.
Speaker 2:And it was at a time in which there was agreement, etc. Etc. But then something happened.
Speaker 3:Yeah, well then the Second World War happened. The First World War concluded right, and they did their post war analysis and they concluded, wrongly, that it had nothing to do with the effects of modern warfare. All it had to do with the individual weakness and, you know, in lack of unicef training and you know other variables. But so what happened with the paradigm? Again, the paradigm after 1916 was that it was pseudo illness, it was traumatic hysteria that these were no longer legitimate injuries of the brain or the body or the mind, that these were all pseudo, fake illnesses or hysteria.
Speaker 3:In the Second World War, when they changed their policies to let psychiatrists back in and they reinstituted the frontline policies etc. They adopted and modified paradigm which said this that acute stress injuries are authentic, real injuries, just as you know, equated with physical injury, and that every human being has a limit in terms of how long they can tolerate that exposure to extreme stress or traumatic stressors of war or in general. So to change the paradigm that there's universal acceptance that every human being can break down in the face of extreme stresses and that that's to be predicted, but that these breakdowns are short lived and they typically, you know, say that you know, within a few weeks or months that those problems should resolve and that anyone who had any longer lasting symptoms then that's a manifestation of hysteria, and those are the people who are looking to malinger, to get out of combat or to get a paycheck or something, a disability paycheck. So they did modify the paradigm that said okay, we accept the fact that any, it's universally why humans are vulnerable to being in those types of environments, but that it's limited to these very transient, short lived, acute stress reactions.
Speaker 3:Anything beyond that, lastly, more than you know, several months, up to six months, is then what? Now we're talking about personality disorder. We're talking about predisposed weakness, and that's where we're at today. That's that policy, that modified traumatic neurosis policy, where they kind of split it and says some parts of that are legitimate injuries. The initial injury, these acute injuries, are real, but anything longer than that are fake, essentially, or hysteria.
Speaker 3:That is that paradigm we we have today. It just worded differently that I said it, but it boils down to that same effect that that we still have a paradigm today of traumatic hysteria and there's still this ongoing debate and controversy about whether PTSD is legitimate and whether that is a manufactured, a socially manufactured condition from anti-war psychiatrists who push this onto the medical field. Is concept of PTSD?
Speaker 2:Mark, can I ask you about your experiences today, actually, with going through these medical records and making determinations?
Speaker 3:Yeah, so I do VA kind of disability exams and looking through the records and talking. I'm interviewing people who are still on activity as well as those who just got out and people all the way from the Korean War I still I'm seeing people from that other wars as well. But the modern day, in today's military, they're dealing with the same issues around mental health, stigma about the whole construct of weakness, predisposed weakness and not want to be labeled with a mental health condition like PTSD because it conveys weakness, and all that is unchanged. So the issues again, some of the vernacular, the wording has changed.
Speaker 3:There's a lot more lip service in the military today about acknowledging that psychological wounds of war are legitimate and people should seek mental health. But then there's the weaponization of stigma still exists today and we'll talk about that in later episodes. But yeah, folks, I feel a lot of more empathy, if anything, that things haven't changed in my day in the military. They haven't changed in your day in the military. We have perpetuated, as we have not learned, our psychiatric lessons of war and so the psychiatric mortality charts would be relatively flat. It'd be unchanged generally from the time of the, say, the First World War up until now. We still are repeating the same mistakes.
Speaker 2:You know, one of the things that occurs to me is that there's this constant rotation right within the military.
Speaker 3:Yeah.
Speaker 2:Right, I mean one way or the other eventually.
Speaker 3:Deployment rotations.
Speaker 2:Deployment, but I'm thinking more of how change of command does not carry on what was determined, and there is this rotation always.
Speaker 3:Yeah, I think that contributes a little to the diffusion of responsibility in the military that people do rotate out. You know the civilian leaders of you know the heads of military medicine are usually civilian, you know they're at the deputy assistant, whatever the department of defense, so they rotate out and so there's not that continuity. I'll tell you where we could have in the American Civil War, if I might. There was a certain general named William Hammond who adopted what he called a mind-body unitary theory. That he put into action In 1862, he developed a specialized hospital, the US Army Hospital for Nervous Diseases. It was called Turner Lane in Philadelphia and this was the first ever in the world hospital that was.
Speaker 3:Its mission was to research and treat war stress injuries back in the American Civil War. In fact, the very first clinical trials of what we would call PTSD was conducted by Jacob de Costa at Turner Lane and was published in, I think, 1863, during the American Civil War, where he treated, I think, 200 or so union soldiers who developed what they called Irreble Heart, which is the type of shell shock traumatic neurosis condition. But anyways, from that certain general and that everybody in the Union Army Medical and the Union Army in particular accepted this paradigm that these traumatic neurosis are legitimate injuries and should be equated to physical injuries, but that certain general had the right policies and he put that program. But as soon as the American Civil War ended, that research part, that innovative part of a dedicated treatment and research center for war stress injuries evaporated, that mission went away and it just became a hospital for the insane, so to speak.
Speaker 3:But if we had continued that policy, or if the First World War in 1916, if we had maintained traumatic neurosis as the dominant paradigm, that psychological injuries are the same as physical injuries, essentially it's legitimate. We ought to treat it seriously, we ought to prepare for it. We're obligated to treat and to intervene where we can. Where would we be today in the field of mental health care and society If that had been the adopted paradigm that continued? Where would we have with mental health stigma today? It would be almost non-existent or it would be an outlier if people thought differently. Right? So the lack of continuity, like you're saying, due to military leadership. It does add to the problem when people who do believe in the value of the holistic paradigm of treating mental health on par with physical health, when they're no longer in office, somebody else comes in and upends the apple cart.
Speaker 2:One of the things that I was also going to talk about I mentioned briefly last time was US Army Captain Frederick Hansen. Do you want to talk about that experience that he had?
Speaker 3:Yeah, so what Hansen was doing this was in North Africa. When the American military first got into the Second World War, we took on North Africa as our first venture. It was the largest at that time, the largest amphibious landing ever conducted. And in Tunisia Hansen and his group were part of that new cadre of psychiatrists that the Army brought in once it reversed its faulty mass screening policies and in rooting out psychiatry. So they brought back in the psychiatrists and it was Hansen who was a neurologist. Actually he did that initial study, basically adopting the First World War's frontline policies and implementing it there. And that's where he talked about his study. I think it was 30% return to duty or 40% or something like that. So that led to the American military establishment to say, okay, let's start doing this widespread again and we'll start implementing this frontline policy.
Speaker 2:Yeah, apparently he was able to return to duty all of these folks in 30 hours and it's not like it's after a couple of weeks.
Speaker 3:Yeah, and then other people started reporting on their particular experiences with frontline psychiatry and it was return to duty rates of 70%, 80%, even 90%. And the people at the headquarters in the Pentagon started questioning some of these statistics because they were still seeing more psychiatric casualties coming out of the war zones, coming back home. And if we were returning to duty all these people, why are we still having this large attrition rate? So they did some classified investigations into the frontline psychiatry programs and one of the secret this was secret until they removed the secret finding by, got my hands on it and what.
Speaker 3:These two colonels I think it was Greenker and Siegel were the two Army colonels that did this study for the Pentagon. Yeah, and what they found was that actually, I think they said less than one to 2% of these soldiers, marines, whatnot, who were repeatedly returned to the front lines after breaking down, less than one to 2% were actually fit for full duty and this was in a secret classification report. But that was because they did that again, because there was skepticism about people overreporting the efficacy of this policy of repeatedly returning nervous soldiers, individuals who had broken down in combat, and returning them back to the front lines that they had real questions about that, the efficacy of that.
Speaker 2:Yeah, you were talking earlier on about how various programs that seemed to work were stated away after wars.
Speaker 3:Always.
Speaker 2:Start over again and everyone that worked.
Speaker 3:That's right so that's from our research right that there's a generational pattern that after the war is in all these new programs and all the lessons learned for psychiatric, for managing psychiatric problems or the managing the mental dilemma, all fade away very quickly and that's what we're seeing today too. I'm sorry, I cut you off.
Speaker 2:And it's already starting.
Speaker 3:It already has yeah.
Speaker 3:Oh yeah, we see it in spades. Once the bullets stop flying, those programs dry up very quick. Why? Because the military doesn't really fully believe that that one they're responsible for treating more stress injuries and that by offering these programs there is a large suspicion or skepticism that what we're doing is reinforcing weakness in the ranks. And so they kind of go into this half-hearted that it will appease the politicians. Maybe some leaders believe it's the right thing to do. But there is a large bureaucratic organization there that looks at the primary mission of military to fight and win wars. Military medicine and psychiatry is to force, protect and maintain that fighting force. And they believe that that second mission sometime interferes with the first mission and that we coddle people too much, we're giving people too many ways off the front line and psychiatry is the primary culprit in that.
Speaker 2:And at the same time we haven't really come to terms with how horrible and terrible combat is and how natural and normal it is to be afraid and to grip your teeth. At the very least.
Speaker 3:I mean, my God.
Speaker 3:I mean I've actually read the studies that were done in the UK after the First World War and this, the investigations into shell shock, like I alluded to that earlier, and it is appalling the extent that these experts in the military medical experts, psychiatric experts, the extent that most of them went to blame everyone and anything other than the war itself, that modern warfare is at a level of technology where the technology is not designed as much to kill, it's designed to frighten, it's designed to demoralize the other force and it's highly effective, and more so now in today's modern warfare and technology than ever before, with all the use of drones and other other tactics and techniques and so on.
Speaker 3:So but no, the studies do very rarely point the finger at the war itself and that in the toxic levels of stress exposures on modern battlefields and it's it's all about the individual weakness and the lack of that stiff upper lip and the cuddling, corrosive influence of psychiatry and weakening of society. That's what a lot of these experts point to. Quite it's demoralizing to hear that these are the leaders. They can't even acknowledge that the war itself has some major part to do with why people who are otherwise very resilient and hardy and strong succumb to these war, stress, injury.
Speaker 2:Yeah, very much. So Let me go to the next one, and this is, yeah, the Vietnam war. And it just says that. You know, we start up here. Among eight, the 8.5 million who served in Vietnam 1964 to 1973, is the the color right. I was there at 65. So there wasn't very many people there.
Speaker 3:No right.
Speaker 2:And we landed in Fubai well, not landed, a ship came into Fubai and we disembarked there and we, you know, they drove us out to well, as it turned out, where we went at least the Marines went was an army installation about 20 clicks away from way, but we only say they're briefly, just mentioning this briefly. And then I was assigned, I was to take five men back, not back, but to a new place that our company was moving toward, moving from Da Nang to July, which is south of Da Nang. But it was surreal because you had really no enemy that I could see or we could sense, and that everyone seemed very happy, the locals, et cetera. I mean the VC hadn't really penetrated into the south.
Speaker 3:Before before 10, right so.
Speaker 2:Oh yeah, 68. That's when everything started crashing through. Yeah. But the leaders credit front lines of country for low rate, low rates and war stress casualties. Yet the congressional committee that was formed I can't remember exactly the year, maybe 83 or something like that yeah, I think that's about right. Is that right?
Speaker 3:Okay, I think so.
Speaker 2:Yeah, so the PTSD among 30% of the combat death at the time. So mark remark marked about no military research has been conducted that compared outcomes of frontline psychiatry, rtd, with psychiatric evacuation and treatments.
Speaker 3:Yeah, well, that's you know. That's been the repeated thing throughout. You know, since the frontline policies, psychiatry policies, were adopted, there's been really no interest to actually research it, because when the military has researched it, in that secret report I said, it concludes it's not very favorable for it and they weren't prepared to get rid of it all together because that's what they did after the 1st World War and they found that the lack of psychiatry and those programs were devastating. You know, to probably, to probably get the war in the 2nd World War. So you go to Vietnam and they seem to have learned that lesson. They kept forward psychiatry policies intact and they deployed army psychiatrists and psychologists et cetera to the front lines and they were reporting, you know very, extremely low rates like 1%, 2% of psychiatric casualties during the Vietnam War and they declared basically it was a New York Times article that came out around that same time period where they quoted army psychiatrists and army leaders and saying that they have stamped out, using my words, but they literally had stamped out the issue of psychiatric casualties in war and they stamped out that problem. They ended the epidemic right. They solved the mental health dilemma by putting all these resources in there and that prevented people from being evacuated from the front lines after an emotional breakdown and sending them back and back and back again, and that was the lore for a good amount of time.
Speaker 3:But then there was a lot of skepticism, as you know, when people got back, like yourself, from Vietnam and and this is way before we had PTSD but the suicide rates were extraordinarily high and people were going to psychiatric hospitals at high rates and what was called then Vietnam War syndrome, as you wrote about. And they did that study and I think it was like in the mid 1980s or something like that congressionally mandated task force looked at what's going on and they found that a large percentage of these people met criteria for what is then, now and now is known as PTSD and that was adopted in 1980. Yeah, and that these previous reports of no psychiatric casualties in Vietnam that were published were all misleading. Right, it was. It was fanciful, fanciful thinking like you could actually get rid of the predictable outcome of war, which is not only people wounded by shrapnel and you know gunshots, but that you're going to have psychiatric casualties Just by the fact that human beings are in a toxic environment like a battlefield.
Speaker 2:Well, I think among those the conference was Peter Bourne, oh yeah, do you know? Peter Bourne? I don't, but I have communicated with him and I know his face, etc. And what did he write?
Speaker 3:about, though. Do you remember? Do you remember anything that should out?
Speaker 2:I can't recall, but he cited the low percentage of those who have problems. Pretty much consistent with what you're saying.
Speaker 3:Oh, actually, yeah, but he was the special assistant to the president.
Speaker 2:If you recall, you remember that. Oh, I don't remember that yeah he was the special assistant of the president when my book, my first book, stress Disorders among Vietnam veterans, was published. So Peter Bourne and arrange for a White House reception helping to uplift everyone knowing about stress disorders among Vietnam veterans and be able to do something and change the course and all that sort of thing. But I didn't really know he had that kind of background in terms of publishing. Well, that's his way to go. That's how we go.
Speaker 2:However, I think it was on my way to, on our way to driving from Ohio to Washington DC to attend this, and nothing ever happened to me like that I would have. My first book would have that much attention. However, he was I don't know if fire, but he was relieved of his position because he had given a script to a staff member who then utilized it for emotion, pain pills, whatever. It is something relatively minor that everyone gets these days. So he was out of a job in effect. So when we came into town but I had learned before we came into town, but they had quickly hustled up and had a special ceremony at the VA that get his name, the VA director I knew him. He was lost both legs. Why am I not remembering his name there? About 70,000 people now that I know. I think I know you're talking about?
Speaker 3:I can't remember.
Speaker 2:He was former, he was in.
Speaker 3:Congress right.
Speaker 2:Yeah, he was. I think he was governor of, not he was attorney general, I think in Georgia. But in any case that was a bit of a mess but it turned out fine. I mean, he was a Vietnam combat veteran and certainly the president wasn't, so that worked out fine for all of us. I don't think anyone noticed the difference or really cared that much. I was glad it was over, obviously, but it was extraordinary that something that major would take place and it was in somewhat at least associated with his status. You know, as a Vietnam vet. I would say it was certainly embarrassing for him, but I do remember the National Vietnam Veterans Readjustment Study that you were talking about that Congress mandated and that we all had to follow.
Speaker 2:I was I'm pretty sure I was part of the VA's you know review committee. I wasn't. I didn't participate in the study.
Speaker 3:Yeah.
Speaker 2:And there was, I think, an extraordinary time and I think we did a pretty good job. We reported and I think it wasn't stress disorders, no, no, it was in another book, strangers at Home about the challenges that Vietnam vets faced at that point in time. But they definitely found that the PTSD rates, for example, men were 15.2. But the women's PTSD rate was 8.5. Now that was modified up for both men and women thanks to Dorin once the search. But I was surprised to read that we were putting pulling the book together, because these days, when men and women complete, these women are always higher in PTSD rather than lower.
Speaker 3:Yeah, I think I've seen some studies to that effect. I've seen studies Mark.
Speaker 2:All of the studies say yeah, I mean the most recent in the last five years, for example, but it's it's, it's makes sense and that's consistent. My question is why don't they then separate male version, female version, when there's such a significant difference just based on gender? I didn't understand that.
Speaker 3:I didn't understand that either, but you're. But that's been called for. I know for decades that you know women veterans have been clamoring for. You know, having PTSD programs that are specialized for women, right, because it's been, you know, male dominated from the inception of the VA.
Speaker 2:that it's outdated and how we approach that, yeah, and things that improve significantly in many ways, I would say, but yeah, it was always that way and the the assertion was well, it's because of the sexual assault etc. And you know I can't disagree with that at all, but yeah, they're different than then they respond differently. They're just very different beyond just the gender differences. But in the recent kinds of combat related PTSD for example, I published a couple of papers focusing on combat medics and that's men and women and that kind of context.
Speaker 2:Weren't that different really In the studies that we did in interviewing female medics we found out that that's a way of getting along with the rest of them. Women have found that that's the way of being able to not only tolerate men but being able to be accepted by them by by their changing and by the female changing and adapting to various kinds of maybe even sexist kind of behavior. I think that's waning, hopefully, but definitely been based fast.
Speaker 3:I mean your race is really fascinating points and it's just a whole. I think the area of research that has really been lagging is trying to explain some of the like, in this case maybe a gender effect and the differential rates or what there's. Probably I'm pretty sure there's been some studies done but just as wide spread knowledge and there's not as much attention at all really given to female. Veterans always been given a short stick and the military now is becoming more and more. I don't know what the breakout is as far as gender goes, but it was still predominantly male, but I think it's like 30, 40% maybe female and male and females are in combat positions as they often have been exposed to combat stress before but other ones.
Speaker 3:Yeah. So it'd be interesting to see where that goes. But certainly we're lagging for any type of being proactive and addressing what the needs are for female veterans, both on active duty, when they get out. That's something that neglected, like a lot of mental health, unfortunately. Yeah, one thing I wanted to ask you to is that we talked about this paradigm shifts, the trauma pension debates and so on.
Speaker 3:And in the Second World War they had to relearn the lesson that psychiatric casualties are a reality of modern warfare In, irregardless the predisposition, weakness and all that other stuff that they threw out there. So they adopted that paradigm as a modified paradigm. They said acute stress reactions are normal and are due to the excessive stress on the brain et cetera, and that anything longer than that is hysteria predisposed. And that's when they adopted these phrases combat exhaustion and combat fatigue or battle fatigue is to kind of talk about that's universally accepted breakdown that's transient, you're tired, you're fatigued, you just need some rest and some recuperation and you get your strength up and you go back to the fight. So that's all part of that frontline policy.
Speaker 3:But where PTSD comes into the trauma pension debates that was adopted in the second 1980 after the Vietnam War, is that now there's a whole PTSD controversy and that is PTSD, a socially fictional disorder that was created mostly by anti-war psychiatrists that were trying to end the Vietnam War but also end all wars by developing this contract called PTSD. What's the critics and there's many of them, and they're well-published and exist in our discipline of mental health that they view PTSD as a pseudo factor that didn't exist before 1980. And it's all it's done is it has a corrosive influence and let us down a bad path. But as somebody who's written about that and you were written about Vietnam War syndrome and what do you remember about how PTSD that came about and the reasoning for why the American Psychiatric Association adopted that do you have anything to add on that?
Speaker 2:I can tell you some of my experiences, especially with regard to the emergence of the nomenclature. I was invited because I had done some research. I was invited to St Louis to attend and I couldn't stay the entire time, but I stayed for a while and it wasn't very interesting what was being discussed A lot of technical terms, and but the thing that I sensed was that it's just a matter of time that the evidence will be sufficient for them to say, oh, okay, well, yeah, you're right, this is it. It never happened. And my assumption would be that if we're able to show that combat veterans have these kinds of emotions and there's a variation among them, that there would be more acceptance. And that's before I met you and learned all I have about the broader context that I was not at all looking at. I was looking at my people and, frankly, initially only at Marines. But yeah, that was always the mentality that I had and the people that I worked with said they'll figure it out, they'll come along, they will endorse, and I have to admit that's what mostly happened.
Speaker 2:I mean, there were very few meetings at any conference that I was aware of in which there was this skepticism that I guess in the earlier days when society for traumatic stress studies started, which was a long time ago. I can't remember exactly the years 70s. Oh yeah, laura was quite young this was born 1985, when it started. But it seemed like it was a growing, rather than the growing against PTSD or against trauma as a concept. It was growing the number of people that are interested, it appeared to me. But of course I can go to the skeptics conference, those that we thought knew best. But yeah, it was surprising to find that there was this robust group of people who didn't agree.
Speaker 3:Who didn't agree? Do you recall what were some of the arguments that were made? That who did not wanna see PTSD be adopted?
Speaker 2:No, I've never heard of many of them actually.
Speaker 3:Yeah.
Speaker 2:But I think what you've done, though, is you've gotten beyond what I'm aware of and what most people are aware of, and into the nitty gritty, and you could see how the strategy is for minimizing for well, don't talk about the symptoms of PTSD. Blah, blah, blah.
Speaker 3:Right.
Speaker 3:Yeah it's interesting because with PTSD being adopted and again that came in 1980 at the DSM-3, that it seemed like to have gone full circle. So before we talked about 1864, and that was kind of the first medical legal paradigm in Europe and North America that traumatic stress injuries, or at that time traumatic neuroses, were legitimate injuries, right, so that became the accepted paradigm until the First World War. And that was the day of infamy in September of 1916, where they put that, flipped that completely over and said no, it's all hysteria, but yeah. But I'm just really curious to how even today, there are still staunch critics of PTSD saying that there was nothing like that before 1980. So it's a completely revolutionized, invented construct. When you had and that's the arguments that I read from Ivy League people publishing books on trauma and PTSD, and yet you have folks like Oppenheim and there's public record of these, it wasn't that hard to find it.
Speaker 2:Yes.
Speaker 3:But there were precursors of PTSD, with different labels, obviously, but the symptoms were pretty much identical and there might be, if anything, or there were more broad symptoms earlier than PTSD. But how do other, these well-read, well-published authorities, conclude that it's all a social fiction? I can understand that, as there's always the minority.
Speaker 2:You have to let that go, Mark. There's always a minority of people who don't? Get who refuse have their arms sold and say la, la, la, la, la la la, maybe so. And that may be probably what accounts for why I don't know what they're saying, or-.
Speaker 3:Yeah, you just tune it out.
Speaker 2:Yeah, I think there's. So I mean, I look at the literature every single day and I don't see any evidence of their stature or their success.
Speaker 3:Well, except in the military, my friend, because when I've confronted people in the military and read things that people have published and these are the leadership many of them have, cite these authors that like Alan Young, and they cite them as evidence why PTSD is not real and uh good, and why it should be fought against, push back against, because it really just erodes and corrodes people's will and people's ability to be resilient. That type of thing. The whole Ben Shepherd. I don't know if you've read Ben Shepherd's War of Nerves.
Speaker 2:No.
Speaker 3:So his book and Jones and Wesley also have shell-shocked a PTSD. These are some of the most cited authors as experts and authority figures on the whole history of traumatic stress and war stress in particular, and their views are very much along those lines that PTSD was a again cultural fiction that was pushed by these anti-war psychiatrists and et cetera and that there's no evidence really that supports that human beings have been afflicted by exposure to traumatic stress that warrants a diagnosis like PTSD. And I mean and these are reviewed as some of the top the best known authors on that subject. So some people are reading that stuff and it's kind of compelling when you read it, except until you peel back the emperor's clothes. You find out, oh my God, they're really being deceptive about the history and there's a lot.
Speaker 2:I like the old stuff.
Speaker 3:Sorry, Mudsell.
Speaker 2:Yeah.
Speaker 3:Anyways, but you lived that part. I mean, I went to graduate school and DSM was introduced, so it was at that time. It was in the DSM, so it became something that they would teach on and so on. But you were living in that era where a lot of that controversy and debate about Vietnam war and about Vietnam syndrome and was that authentic or not, and then what led to PTSD?
Speaker 2:So I was worried about far more important things than that. Bruhaha. No, I mean other vets killing themselves. I mean that's an example. And yeah, I mean you started this conversation or a discussion about how did we get started, why are we so interested and et cetera. And yeah, my feeling when I was in Vietnam and when I was still in the, I had one year left at Troy Point, north Carolina. The air stick came there one the last year before I got out and you already know this. It does something to being in combat but, more importantly, being around those who were in combat a lot and looked burned out, who looked traumatized, et cetera. And that sticks with me. At least I've written about this in terms of autobiographically and it just it frustrates me that we have gone so far and then we go back.
Speaker 3:Yes.
Speaker 2:At the country, right, Go. And then we can go back and we're exposed to this horrific experience and we get it and we do something about it, but then we're not exposed to it. Then we forget about those people who are traumatized by that that we don't have to look at anymore.
Speaker 3:That's right.
Speaker 2:It's been frustrating for me when one day more ends there is a retreat. You know this as well. I mentioned it Well when yes. Yeah, keep going.
Speaker 3:Well, we coined the term national reset to describe that pattern is that after the war stopped and all the congressional and media attention comes off of the veterans and their families and the epidemics of suicide and all that stuff, right that, everything goes back to its baseline. It resets and it's like hitting a reset on your computer. It washes out everything, all the memories gone, all the lessons learned from the previous war, as far as psychiatric lessons are gone. And then you get into that where that admiral told me at that field hospital I was at, you know, and said, well, it all had to be reinvented again, had to be rediscovered. You know why the hell are we doing that? But that's national reset.
Speaker 3:It worries the hell on me because you know it's already started with this generation as the leaders who believe in the value of mental health and the reality of war and the effects that has on the brain and our mind and spirit. They have retreated, you know. They've gotten out, they've retired, they left the military, and so all that new wave of people and leadership are gonna reinvent these policies that this next major war that we'll be going into, and it'll just be like a replay of what happened after the First World War after the Second World War, Korea, Vietnam, Persian Gulf War and these two wars, and there'll be two other guys doing this kind of podcast.
Speaker 2:30 years this amounts that one, unfortunately.
Speaker 3:Right, they'll be citing us like, okay, these people talking about it and not much has changed. And that's really what. It's very demoralizing to kind of bear witness to that Once you're aware of the historical generational cycles that we go through. And then this whole idea about the national reset is that it's very foreboding about what will come, because there's absolutely nothing in the political winds or in society that tells us that people are really going to really fight back and really take on stigma and everything else to put mental health on par with physical health. There's no political will, there's no economic will to do anything of that nature. So, yeah, we'll see what happens, but I wouldn't be surprised.
Speaker 2:I will say, though, meeting you and beginning to start working with you, whether it's a book or all of the dozens of articles that we've written, or doesn't it's been great. I mean, I have it's. My interest in war and in military was reawakened Thanks to you, or we can cause a few. This is extraordinarily important stuff.
Speaker 3:Yeah, well, listen. So we're kind of at the end of our show today and I wanted to give my contact information. If he wanted to provide us feedback, ask any questions, want to refute anything we said or to correct anything, or just any feedback whatsoever will be welcome, and that you can reach me at mrussell2s2lsphd at gmailcom, and that will be for Charles and I. So if you have something specific you want to give to Charles, you can send that through me and I'll certainly pass that along. And until then, on an optimistic note, I hope everyone has a good week and then we'll look forward to talking to you again in the next episode.