Abstract
An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder (PTSD) grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members.
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References
Adler, Amy B., Paul D. Bliese, Dennis McGurk, Charles W. Hoge, and Carl A. Castro. 2009. “Battlemind Debriefing and Battlemind Training as Early Interventions with Soldiers Returning from Iraq: Randomization by Platoon.” Journal of Consulting and Clinical Psychology 77 (5): 928-940. https://doi.org/10.1037/a0016877.
Adler, Amy B., Paul D. Bliese, and Carl A. Castro, eds. 2011. Deployment Psychology: Evidence-Based Strategies to Promote Mental Health in the Military. Washington, DC: American Psychological Association. https://doi.org/10.1037/12300-005.
Adler, Amy B. and Carl A. Castro. 2013. “The Occupational Mental Health Model for the Military.” Military Behavioral Health 1:1–11. https://doi.org/10.1080/21635781.2012.721063.
Albright, David L. and Bruce Thyer. 2010. “Does EMDR Reduce Post-traumatic Stress Disorder Symptomatology in Combat Veterans?” Behavioral Intervention 25:1–19.
American Psychiatric Association. 1980 Diagnostic and Statistical Manual of Mental Disorders, 3 rd Edition (DSM-3). Washington, DC: American Psychiatric Association.
American Psychiatric Association. 2013 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington, DC: American Psychiatric Association. http://dsm.psychiatryonline.org/book.aspx?bookid=556.
Benner, Patricia. 1984. From Novice to Expert: Promoting Excellence and Career Development in Clinical Nursing Pactice. Menlo Park: Addison-Wesley.
----, ed. 1994. Interpretive Phenomenology: Embodiment, Caring and Ethics in Health and Illness. Thousand Oaks: Sage.
Benner, Patricia, Ethel Roskies, and Richard Lazarus. 1980. “Stress and Coping under Extreme Conditions.” In Survivors, Victims and Perpetrators. Essays on the Nazi Holocaust, edited by J.E. Dimsdale, 219-258. New York: Hemisphere Publishing Corporation.
Benner, Patricia and Judith Wrubel. 1989. The Primacy of Caring. Saddleback: Prentice Hall.
Bennett, Maxwell R., Sean N. Hatton, and Jim J. Lagopoulos. 2015. “Stress, Trauma and PTSD: Translational Insights into the Core Synaptic Circuitry and its Modulation.” Brain Structure & Function May 20:1007-1056. https://doi.org/10.1007/s00429-015-1056-1.
Bourdieu, Pierre. 1977. Outline of a Theory of Practice. Cambridge: Cambridge University Press.
----, 1990. The Logic of Practice. Translated by R. Nice. Stanford: Stanford University Press.
Carr, Russell. 2011. “Combat and Human Existence: Toward an Intersubjective Approach to Combat-related PTSD.” Psychoanalytic Psychology 28 (4): 471-496.
Castro, Carl A. 2014. “The US Framework for Understanding, Preventing, and Caring for the Mental Health Needs of Service Members who served in Combat in Afghanistan and Iraq: A Brief Review of the Issues and the Research.” European Journal of Psychotraumatology 5:24713. https://doi.org/10.3402/ejpt.v5.24713.
Castro, Carl A., Amy A. Adler, Dennis McGurk, and Paul D. Bliese. 2012. “Mental Health Training with Soldiers Four Months after Returning from Iraq: Randomization by Platoon.” Journal of Traumatic Stress 25:376–383. https://doi.org/10.1002/jts.21721.
Chan, Garrett, Karen A. Brykcynski, Ruth E. Malone, and Patricia Benner. 2010. Interpretive Phenomenology in Health Care Research. Indianapolis: Sigma Theta Tau Int.
Christova, Peka, Lisa M. James, Brian E. Engdahl, Scott M. Lewis, and Apostolos P. Georgopoulos. 2015. Diagnosis of Posttraumatic Stress Disorder (PTSD) based on Correlations of Prewhitened fMRI Data: Outcomes and Areas Involved.” Experimental Brain Research. https://doi.org/10.1007/s00221-015-4339-0.
Cloitre, M., C.A. Courtois, A. Charuvastra, R. Carapezza, B.C. Stolbach, and B.L. Green. 2011. “Treatment of Complex PTSD: Results of the ISTSS Expert Clinician Survey on best Practices.” Journal of Traumatic Stress 24:615-627.
Davidson, Paul R. and Kevin C. Parker. 2001. “Eye Movement Desensitization and Peprocessing (EMDR): A Meta-analysis.” Journal of Consulting and Clinical Psychology 69 (2): 305–316.
Dreyfus, Hubert L. 1991. Being in the World: A Commentary on Heidegger’s “Being in Time, Div. I. Cambridge: M.I.T. University Press.
----, 1992. What Computers Still Can’t Do. A Critique of Artificial Reason. Cambridge: M.I.T. University Press.
Dreyfus, Hubert L. and Wakefield, Jerry. 1988. “From Depth Psychology to Breadth Psychology: A Phenomenological Approach.” In Hermeneutics and Psychological Theory edited by Stanley B. Messer, Louis a. Sass, and Robert L. Woolfolk, 272-288. New Brunswick: Rutgers Univsity Press.
Dreyfus, Hubert L., and Charles Taylor. 2015. Retrieving Realism. Cambridge: Harvard University Press.
Epstein, Mark. 2014. The Trauma of Everyday Life. New York: Penguin Press.
Finkler, David. 2013. Thank You for Your Service. New York: Sarah Crichton Books, Farrar, Straus & Giroux.
Finley, Erin P. 2011. Fields of Combat: Understanding PTSD among Veterans of Iraq and Afghanistan. New York: Cornell University Press.
Foa, Edna B., Terrance M. Keane, Matthew J. Friedman, Judith A. Cohen, eds. 2009. Effective Treatments of PTSD. Practice Guidelines from the International Society for Traumatic Stress Studies. 2nd edition. New York: Guilford Press.
Geertz, Clifford. 1977. Interpretation of Cultures. New York: Basic Books.
Gordon, Deborah R.1988. “Tenacious Assumptions in Western Medicine.” In Biomedicine Examined edited by Margaret Lock and Deborah Gordon, 19-56. Boston: Kluwer Academic Publishers.
Hoge, Charles W., Carl A. Castro, Stephen C. Messer, Dennis McGurk, Dave I. Cotting, and Robert L. Koffman. 2004. “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care.” New England Journal of Medicine 351 (13): 13-22.
Institute of Medicine. 2014. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. Washington, DC: The National Academies Press.
Karlin, Bradley E., Josef I. Ruzek, Kathleen M. Chard, Afsoon Eftekhari, Candice M. Monson, Elizabeth A. Hembree, Patricia A. Resick, and Edna B. Foa. 2010. “Dissemination of Evidence-based Psychological Treatments for Posttraumatic Stress Disorder in the Veterans Health Administration.” Journal of Trauma Stress 23:663–673.
Kelley, Patricia, Deborah Kenny, Deborah R Gordon, and Patricia Benner. 2015. "The Evolution of Case Management for Service Members injured in Iraq and Afghanistan." Qualitative Health Research 25 (3):426-439.
Klay, Phil. 2014. Redeployment. New York: Penguin Press.
MacLeish, Kenneth. 2013. Making War at Fort Hood: Life and Uncertainty in a Military Community. Princeton: Princeton University Press.
Marlantes, Karl. 2011. What it Means to Go to War. New York: Grove Press.
McIlvaine, Rod. 2012. “Army Research looks at new PTSD Treatment. http://www.army.mil/article/81916/Army_research_looks_at_new_PTSD_treatment/.
Merleau-Ponty, Maurice. [1962] 2012. The Phenomenology of Perception. Translated by D. A. Landes. New York: Routledge.
Monson C.M, Candice, M., Paula P. Schnurr, Paula A. Resick, Matthew J. Friedman, Yinong Young-Xu, and Susan P. Stevens. 2006. “Cognitive Processing Therapy for Veterans with Military-related Posttraumatic Stress Disorder.” Journal of Consulting and Clinical Psychology 74:898–907.
Noe, Alva. 2010. Out of Our Heads: Why You Are Not Your Brain, and Other Lessons from the Biology of Consciousness. New York: Hill and Wang.
Polanyi, Michael. 1974. Personal Knowledge: Towards a Post-critical Philosophy. Chicago: Chicago University Press.
Schwartz, Jeffrey, and Sharon Begley. 2002. The Mind and the Brain: Neuroplasticity and the Power of Mental Force. New York: Harper Collins.
Sherman, Nancy. 2005. Stoic Warriors. The Ancient Philosophy behind the Military Mind. New York: Oxford University Press.
----, 2010. The Untold War. Inside the Hearts, Minds and Souls of Our Soldiers. New York: W.W. Norton and company.
Stolorow, Robert D. 2007. Trauma and Human Existence. New York: Analytic Press, Taylor and Francis Group.
Taylor, Charles. 1985a. “Theories of meaning.” In Human Agency and. Language: Philosophical Papers, Vol. I, 248-292. Cambridge: Cambridge University Press.
----, 1985b. “The Concept of a Person.” In In Human Agency and. Language: Philosophical Papers, Vol. I, 97-114. Cambridge: Cambridge University Press.
Tick, Edward. 2005. War and the Soul, Healing our Nation’s Veterans from Post-traumatic Stress Disorder. Wheaton: Theosophical Publishing House.
Todes, Samuel. 2001. Body and world . Cambridge: M.I.T. University Press
Winnecott, Donald W. [1971] 2005. Playing and Reality. New York: Routledge Classics.
Wisco, Blair E., Brian P. Marx, and Terence M. Keane. 2012. “Screening, Diagnosis, and Treatment of Post- Traumatic Stress Disorder” Military Medicine 177 (8): 7.
Wool, Zoe H. 2012. “On Movement: The Matter of Soldiers being after Combat.” Ethnos. https://doi.org/10.1080/00141844.2012.658428.
Yoder, Matthew, Peter W. Tuerk, Matthew Price, Anouk L Grubaugh, Martha Strachan, Hugh Myrick, H., and Ron Acierno. 2012. “Prolonged Exposure Therapy for Combat-related Posttraumatic Stress Disorder: Comparing Outcomes for Veterans of Different Wars.” Psychological Services 9 (1): 16–25.
Young, Allan. 1997. The Harmony of Illusions. Princeton: Princeton University Press.
Acknowledgements
Acknowledgement to M. Epstein, The Trauma of Everyday Life. New York: The Penguin Press. 2013. Special Thanks and Tribute to all Service Members Who Participated in the Study.
Funding
This study was funded by the TriService Nursing Research Program (TSNRP # N08-P11) Uniformed Services University of the Health Sciences; however, the information or content and conclusions do not necessarily represent the official position or policy of, nor should any official endorsement be inferred by, the TriService Nursing Research Program, Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government.
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Author A, Patricia Benner has no conflict of interest; Author B, Jodi Halpern has no conflict of interest; Author C. Deborah R. Gordon has no conflict of interest; Author D., Catherine Long Popell has no conflict of interest; Author E, Patricia Kelley has received research grants from TriService Nursing Research Program and has no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Human Subjects Research Approval was received by all participating institutions.
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Informed consent was obtained from all individual participants included in the study
Endnotes
1 We will use the words “lifeworld” and “world” interchangeably to indicate the person’s experience of engaging in his or her everyday life, as constituted by identity, character, concerns, relationships, life history and more. It is the common human experience of dwelling in temporality, where past, present and future are inter-related, whether or not they are explicitly experienced by the person on not. For example the person may experience great continuity in their current lifeworld with their past, or they may seek to cut off, or numb themselves from an unwanted, traumatic, or difficult-to-integrate past.
2 A similar embodied view is captured by Merleau-Ponty’s “styles of comportment,” with sedimented meanings embodied in our comportment (1962). Temporality and sense of place are both embodied and intertwined with the person’s immersion in the world (Todes 2001; Merleau-Ponty 2012).
3 For a fuller description of methods and sample see Kelley et al. (2015).
4 Jodi Halpern conducted interviews with Broder and other Soldiers Project Therapists 2011-2013. See also: www.npr.org/templates/story/story.php?storyId=120278574.
5 Broder, interview with Halpern, 2012.
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Benner, P., Halpern, J., Gordon, D.R. et al. Beyond Pathologizing Harm: Understanding PTSD in the Context of War Experience. J Med Humanit 39, 45–72 (2018). https://doi.org/10.1007/s10912-017-9484-y
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DOI: https://doi.org/10.1007/s10912-017-9484-y