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pexels-photo-54377-largeI was reading an article by Atwater (2009) which describes the hoops, obstacles and turbulence which many non-combat soldiers have to endure just to be recognized as PTSD sufferers. Soldiers such as medics, radiomen, technicians, intelligence officers, truck- drivers etc. who were stationed in the warzone and exposed to life threatening situations and could have easily been injured or killed just like their combat colleagues, have to produce further evidence , convince and justify their psychological symptoms more than combat soldiers. Non-combat PTSD is not easily recognized nor accepted by the government and others because the soldiers are not perceived as combat soldiers.  I have read and heard many stories from veterans about this issue. I find it outrageous that people who risk and sacrificed their lives for their country and for the sake of other’s peace and safety have to stand and justify why they now need their country to recognize their trauma and help them recover. It is disgraceful and shameful that their contributions and their suffering are not self-explanatory. In a sense the procedure is a sort of re- traumatisation of the soldiers which for the most part originates from ignorance. Scientific research has gathered vast evidence that PTSD can develop under many conditions. The following is my small contribution to support combat, non-combat and peacekeepers alike, who will return home shortly from the front after fulfilling their mission and who face similar doubt, criticism and even in some cases rejection from their environment and official organisations. I think that is crucial, especially now to enhance sensitivity, recognition and support to all those who need it.

According to the DSM-IV, PTSD symptoms are divided into four clusters. The first cluster (A) requires witnessing or experiencing traumatic and life threatening events, which stimulate in the individual anxiety, terror and helplessness. The remaining clusters are intrusion, avoidance and hyper-arousal. This implies that a direct or even vicarious exposure to life threatening stressors is sufficient enough for PTSD to emerge. PTSD symptoms are directly linked with perceived threat, the witnessing of atrocities, war zone hassles, irritations and deprivations (King et al., 1999).

Non-combat soldiers who were exposed to combat sights and feared being killed during their deployment are just as prone to develop PTSD and other psychological disorders as combat soldiers (Gibbons et al., 2011). The witnessing of other soldiers being injured, having friends being killed in combat and the exposure to friendly fire is strongly correlated to PTSD (Pietrzak et al., 2011). Both combat and non-combat veterans are exposed to warzone conditions, life threatening situations, witness traumatic monstrosities and have to be in a dangerous and malevolent environment. These conditions can potentially function as yeast to the development of PTSD.

UN soldiers, who report PTSD symptoms are also exposed to similar prejudices from others as non-combat soldiers. UN forces goals usually involve enforcement of peace and protection of humanitarian operations. A few examples of the tasks involved are patrol, providing buffer zones, observation and report. Most of the time they are supposed to act as observant and are not allowed to retaliate or to respond to the provocations. Peacekeepers are expected to maintain patience, impartiality, restraint and neutrality in the face of danger which comes unnaturally and is extremely difficult.  The soldiers are exposed to long lasting uncertainty and posses low levels of control. Sometimes they are confronted with humiliation and lack of gratitude. Unable to attack back they report frustration, helplessness and anxiety. Peacekeepers who feel that they had no control over situations, powerlessness and that the mission was meaningless report more PTSD symptoms (Dirkzwager et al., 2005). A personal negative appraisal of own emotional, physical and behavioural reactions to the traumatic experiences reduces their ability to cope with trauma.

People in the environment of the soldiers be it peacekeepers or non-combat often only consider the stereotypes of the roles in the army. The living conditions and the experiences that all soldiers experienced in the war zone is often ignored and underestimated.  The  underestimation of the severity of the life events and its implications on the life of the soldiers, can lead to criticism, denial of need in support, rejection and even in worse cases condemnations (Thorenson & Mehlum, 1998). As a result, soldiers often feel even more hopeless, helpless, lonely, isolated and abandoned.  Lack of support and the increasingly presence of negative schemata in the soldiers’ life will lead to the maintenance of the psychological symptoms and to the development of depression and PTSD.  It is also not unheard of these soldiers will try to cope by turning to self-destructive behaviours such as drugs, alcohol, unsafe sexual encounters and aggressive behaviours.

The homecoming period might begin in a honeymoon phase but will soon continue into a daily struggle to survive. Beside the psychological, emotional, physical,behavioral and cognitive implications of exposure to war traumata, each soldier will also have to confront daily stressful obstacles such as reconnecting with children and partner again, financial obligations, finding a job, readjusting to civilian life, becoming a parent again and etc. The path to ’normal life’ after the war front is stressful and filled with anxiety  for every soldier but especially for soldiers who  already experience the psychological aftermath. Each returning soldier, regardless of their role in the war zone, deserves nothing less than recognition, understanding, support, patience, respect, empathy and should be treated as such.

Atwater, A. (2009). When is a combat veteran a combat veteran? The evidentiary stumbling block for veterans seeking PTSD disability benefits. Arizona State Law Journal, 41, 243-272.

Dirkzwager, A. J. E., Bramsen, I., &  van der Ploeg, H. M. (2005). Factors associated with PTSD among peacekeeping soldiers. Anxiety, Stress and Coping, 18, 1, 37-51.

Gibbons, S.W., Hickling, E. J., & Watts, D. D. (2011). Combat stressors and PTSD in deployed military health care professionals: an integrative review. Journal of Advanced Nursing, doi: 10.1111/j.1365-2648.2011.05708.

King, D. W., King, L. A., Foy, D. W., Keanne, T. M., & Fairbank, J. A. (1999). Posttraumatic stress disorder in national sample of female and male Vietnam veterans:  risk factors, war zone stressors, and resilience-recovery variables. Journal of Abnormal Psychology, 108, 1, 164-170.

Pietrzak, R. H.,Whealin, J. M., Stotzer, R. L., Goldstein, M. B.,&  Southwick, S.M. (2011). An examination of the relation between combat experiences and combat related posttraumatic stress disorder in a sample of Connecticut OEF-OIE veterans. Journal of Psychiatric Research, 1879-1379.

Thoresen, S., & Mehlum, L. (1998). Suicide prevention in veterans of peace keeping. Norwegian journal suicidologi, 3.

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