Is PTSD an Excuse to Keep On Drinking?

Is PTSD an Excuse to Keep On Drinking?

By Bill Manville 08/09/16

Shell shock, combat fatigue, PTSD—the name changes, but the suffering is real.

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Is PTSD an Excuse to Keep On Drinking?
It's real.

“Bill, my husband came home addicted from service in Afghanistan. He says he is suffering PTSD. Is that really a medical condition or just an excuse to keep on drinking?”

I got the above email from one of my Fix readers. “Tony served in Afghanistan,” she went on, “and came home with a mild drug habit. When I told him I did not like it, he quit…or maybe merely turned to alcohol. Except for some violent flare-ups of bad temper, we had a good marriage for a long time. But in recent years, his drinking has steadily grown worse—his temper too.

“Last year, he checked himself into a rehab…stayed the 28 days…and began drinking again almost the day he got out.

“Bill, I Googled up Post Traumatic Stress Disorder, and found some Internet doctor who said yes, PTSD often does lead vets who’ve been in a war first into addiction and later into relapse. The talk frightened me. Does this mean there's no hope for my husband?”

And she signed herself, “Emily.”

**

When the U.S. Army put me through the usual entry battery of mechanical aptitude tests, I did not do well. On a scale of zip to one hundred, I scored maybe an eleven, which is the category that says, don't give this soldier so much as a pointed stick let alone a weapon with moving parts. So they lost me in what is laughingly called "military intelligence," and the only stress I suffered in my army career was the Abandoned Dance Hall Bar in Hopkinsville, Kentucky, on a Saturday night.

But if I don't know much about the stress of combat, I do know all I need about relapse—my own, which I have detailed in these pages—putting me through the worst two weeks of my life.

**

What's in a name? In World War I, they called it "shell shock." In World War II and Korea, "combat fatigue." After Vietnam and the Gulf War, it was Post Traumatic Stress Disorder. Now, with our engagement in Afghanistan plus our new War on Terror, will the malady be given still another title?

No matter. The name changes but the suffering is real—the topic of PTSD, combined with addiction and relapse, is increasingly important. So I turned to my friend, mentor and an eminent practicing psychotherapist, Larry Bouchard—once an Air Force combat photographer in Vietnam, later assigned to the Army for clandestine missions about which he remains "vague" to this day.

"Right off the top," said Larry, "let me give you a minority opinion. I think PTSD is maybe the most misdiagnosed or over-diagnosed disorder today. A guy comes in to see a psychiatrist or someone like me because he's addicted, and can't stop. Then, if he's a combat vet, it's easy to go right past his rocky marriage or oppressive childhood—both of which could be the unresolved issues that keep him drinking. He's a combat vet and therefore, BINGO! We pin this red-hot diagnostic label on him. PTSD, tada…"

"You're saying there's no such thing?"

"I'm saying it's misunderstood, and its symptoms falsely attributed. Whether it's getting your new bicycle stolen the day after Christmas, or having your closest comrade shot through the eye while reading a letter from home, the grieving process is the same.

"There are seven distinct and equally vital stages," said Larry, writing them down for me on a paper napkin.

"First, denial. It didn't happen. When I look in the backyard again, the bike will be there, probably behind a tree. Or, he isn't really dead, the medics will fix him.

“Second, anger. If I find the kid who stole it, I'll stab him with a rusty spear, I'll eat his liver. Or, I'll blow away every nasty gook I can find and all his friends too.

“Third, bargaining. Please God, when I wake up, let the bike be there, I won't ever tease my little sister again.

“Fourth, acceptance. No use moaning. It's gone. Reality is beginning to set in."

Larry continued: "In the fifth step, there's an experience of melancholy and loss. It was such a wonderful bike. I loved the way the sunlight glinted off the red fenders. Ah, well…

“Sixth stage is resolution. Well, it was a wonderful bike, but life goes on. Maybe I'd better get my homework done for tomorrow. And hope enters in the seventh: maybe I'll get a better bike for my next birthday."

"What if you don't finish the entire seven step process?"

"Sooner or later, bad things happen—mostly later. PTSD used to be diagnostically called 'Delayed Stress Syndrome.' It was abandoned because it implied the victim had a choice as to when to process stress. If you're already using alcohol and/or drugs to escape life's difficulties, delayed stress is a way of life."

"You saw people go through this process yourself?"

"When I was living with the Army, I saw guys coming back from the sharp end of the war every day. One grunt, tall and stringy—we called him Greenbean—he had a wonderful family back home. Never interested in dope or booze. But I saw Greenbean come walking out one day, carrying his best friend in his arms. Carrying him three hours. The medics had to tell him, put the guy down, Greenie, he's shot through the head, he's dead."

"You're saying he didn't drink or dope over that?"

"And I don't think he ever will," said Larry, a staff sergeant in Vietnam who ended his career 18 years later a captain. "People like Greenie, who come from families who loved and supported each other, learn to process these events and come out healed and even stronger. What Greenie did was make a song about his friend dying, played it at the barbecue that night, cried a lot and went back out to the war again the next day."

"He processed the whole thing in 24 hours, all seven steps?"

"You know how people will not take a ten- or twelve-year-old kid to a funeral home to see their dead grandparents? They think they’re 'protecting' their kids. What they are really doing is aborting and perverting the learning process. Healthy families grieve well, and teach it to their kids," said Larry (who incidentally is the father of three fine, wonderfully well-adjusted young men.)

"How," I said, "how does any of this apply to Mr. and Mrs. Tony & Emily?"

"Listen to her words," said Larry. "Tony had a 'mild' drug habit. He 'merely' turned to alcohol. 'We had a good marriage,' she says. I believe they had a good-looking marriage. She's in denial, which deepens his isolation and demands he continue drinking to numb the pain and inevitable loneliness that brings. Maybe he experienced terrible trauma in Afghanistan. Maybe not. The question for therapy remains: Did he go 'though' the trauma? Or did he just encounter trauma, put the mandatory grieving process on hold, get back to the States and then repress it completely—attempting to escape the suffering that genuine grieving would entail?”

“Booze and dope being the prime agencies in that attempt to deny his feelings?”

"But he can't," said Larry. "They’re too painful, too real, too raw and unprocessed. That's where PTSD enters, but when I met guys like Tony in my job, many were predisposed to use maladjusted ways of handling stressors, starting long before they went to war. I bet Tony came from a troubled family, one as deeply into denial as Mrs. Tony. That's why he married her: he felt at home with her."

"If Tony were your client, what would you advise him to do?"

"It sounds like he's still stuck somewhere in unresolved grief—probably anger and/or bargaining—and no one has detected that. Probably, as his wife says, he's still burning with unresolved anger. I call that resentment, which is the Number Two cause of relapse, right after overconfidence that you have addiction beat.”

And Larry went on: "If you didn't learn how to process grief and loss as a kid, one of the best ways I know is to get a good AA program, and do the 12 Steps over and over until they are integrated into your daily life. All lives have loss, and all people experience trauma. The ones who have the mental tools to get through life's sufferings—e.g., lean on friends, share feelings, cry, laugh, go bang garbage can lids, curse God till it hurts (in other words, go crazy for a while)—these people go on to the next phase and live life as it comes.”

“And the ones who deny, delay it or try to escape it?”

“They suffer ten-fold the original trauma in countless other, seemingly non-related areas of their lives, including the compulsive insanities of addiction."

"Larry, did any of this happen to you, in your own life?"

"When the movie Platoon came out, vets were advised not to see it alone. 'Take another vet with you,' we were told, 'because it's all there except the smell.' Tough guy that I thought I was, bulletproof, I went alone. After 20 minutes, the smell was there! I knew I had work to do 'someday,' but Bill, I put it off. 'Someday,' I thought, 'but I'm busy right now,' ordered a beer and let it go. I even volunteered to work on a committee verifying spellings, ranks, hometowns, dates of birth and death, for names going up on the Vietnam memorial wall—one of about 120 from all five uniformed services doing the work."

"You paid a visit to the wall yourself?"

"And when I finally did, something changed—my anger dissipated into the ether. I just never believed I was actually carrying all that shit. Isn't denial a bitch when you don't know you're doing it? I hadn't finished my own grief work until that visit—a visit to the memory and pain of the loss of 13 cherished comrades, a reconciliation to the idea of their death, and when it comes, to my own. Suddenly their lives had meaning, not their dying but their living…and so did mine. And there, on a hot, muggy, sweat-filled D.C. evening in front of total strangers—just suddenly—there was hope. Resolution and then hope. Real, undeniable, breathtaking hope."

"You saying all those years, you were going through a kind of repressed PTSD yourself? When did you leave Vietnam?"

"January, 1972."

"When did you visit the wall?"

"June 30th, 1999," said Larry.

"27 years?"

“27 years,” he said, smiling at himself in wonder and shaking his head.

“Okay, let’s close,” I said, “with a final word for Emily. If she were sitting with us here right now, what would you tell her?”

“That the VA has superb psychiatrists who use both PTSD recovery groups and psychotropic drugs for treating people like your husband. Such VA treatment is typically a year with good aftercare available. Both are best done as outpatient treatment WITH whole family participation.”

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