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Iraq Is Such a House of Trauma, It Doesn't Take Much to Get PTSD

Our idea of what used to be called "shell shock" tends to be limited to terrible battles, not just the daily stress of living in a war zone or surviving a couple of close calls.

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To avoid being rude, I had a pat response memorized: “I learned three things in Iraq. Military toys really are cool. Our troops are even more impressive than I had thought they were.  And war is much, much worse than I had ever imagined.”

For months, that’s all I was willing to say.

And here’s another thing from that manual I recognized: Persistent symptoms of increased arousal (not present before the trauma)... [such as an] exaggerated startle response.

Oh yeah. Definitely.

On my very first day out of Iraq, weirdly laced with survivor’s guilt, I checked into a hotel in Amman, Jordan, and fell onto the bed, beyond exhausted. Down the hall a door slammed shut and I panicked. I thought it was gunfire.

On my way home, I stopped in London. With a friend, I visited the Imperial War Museum to catch an exhibit on war propaganda. Half an hour of looking at posters demonizing enemy peoples turned out to be enough for me, and so I wandered into a World War I exhibit, a diorama of one of that war’s many murderous charges. To make the viewing experience more interesting, the designers had darkened the room and added an occasional flash of light and a soundtrack of kerblammy explosions.

I was unimpressed. It was just noise. Real explosions rattle your chest.

But when my buddy found me, he was horrified.  I had gone pale. He should have known better, he insisted, than to let me come here so soon.

***

“Duration of the disturbance,” says the manual, “is more than 1 month.”

I look at my colleague's wall calendar. It’s 29 days since I left Iraq and the nightmares have stopped, so I don't have PTSD. Or at least I'm not diagnosable. I feel a wash of relief.

Later, when the study he’s working on is released, I learn that, as of 2007, some  300,000 veterans are already diagnosable with PTSD, and it’s obvious that the wars in Iraq and Afghanistan aren’t about to end any time soon. How many more, I wonder, will be suffering from PTSD before it’s all over? How many will have some of the symptoms, but not enough to qualify for care? And what about civilians and contractors? What about Iraqis? Was anyone counting their incidence of sub-diagnosable symptoms?

Back in my office, I find the checklist online and stare at it. I berate myself. I should've sought care. No, I think, go easy. After all, I hadn't recognized the symptoms. And even if I had, in Iraq I had no unit for support, no routine, no institutional refuge. Military culture is clear: suck it up, get tough, be a man. And I had kept it all from my family. I wanted them to sleep at night.

Worst of all, I hadn't really seen anything of war. In that morning's attack, no one got hurt, at least not physically. None of us had been out shooting people or dodging bullets. Still, how could it not be a big deal? Just because so many things were far bigger deals didn't turn that morning into nothing.

People said they got used to it. I didn't believe them.

***

I thought I was done with the symptoms, but I was wrong. Some lingered for months, even years. The startle response, for instance. Doors, horns, any sudden noise and adrenaline would fire off, unwanted.

By the end of the following year, I was convinced it was finally over -- until, on the Fourth of July 2009, my girlfriend (now wife) and I went to a party and stood on a balcony to watch the usual fireworks. At the first explosion, I felt the panic return, and I had to retreat inside.

 
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