A reading list: The best books on PTSD

By Lt. Col. Robert Bateman, USA

Best Defense department of strategical
and historical affairs

Now, obviously
(given my own book which dealt heavily with the topic of veterans who falsely
claim PTSD), I agree that there is room in the system for correction. Sometimes
it is too easy to fool the VA, for example.

But just as with
the machining tolerances within the extremely reliable AK-47, you need some
slack in the system to ensure that everyone who should be taken care of
actually is taken care of. The AK never jams because it is machined to a looser
standard than our own Western, weapons. A little extra gas escapes, and because
of this the weapon does not have the amazing accuracy of our weapons. But also
because of this slack built into the system, you know that when you pick up an
AK out of the dirt, that it WILL fire every single bullet in the magazine. An
American weapon, picked up out of the dirt or dust or swamp, not so much. The
American weapon must be clean, and well cared for, because there is no
tolerance built into the system, which means some rounds won't fire, and that
can be a bad thing.

Much the same
might apply to the definitions of PTSD and how they are applied. Do we want the
"perfect" system, which sometimes causes catastrophic jams, or do we want a
system that has some leaks and inefficiencies, but works for 100 percent of the rounds
you put through it?

In partial answer to a colleague's query, let me offer a short annotated
bibliography.

Eric Dean, Shook
Over Hell, Post-Traumatic Stress, Vietnam, and the Civil War (Harvard
University Press, 1997): This is a pretty decent book, although the author is
not entirely conversant in the then-latest medical scholarship. Also, frankly,
he could have done entirely without the opening and closing artificiality of
examining PTSD from Vietnam. It was enough that he uncovered, and demonstrated
the broad and then-well-known phenomena of "nostalgia." Essentially,
from all contemporary descriptions, this was PTSD as it was diagnosed in the
post-Civil War era in the United States. Given this evidence of widespread PTSD
(including cases ending in suicide) in the Civil War generation, were they just
softer than the Mexican-American War and War of 1812 generations?

Peter Barham, Forgotten Lunatics of the Great War (Yale
University Press, 2004): The focus here is on those slackers and weak-willed
types, the Edwardian Tommies who fought in the trenches of WWI for the
British. Barham's work is dense, but readable, and discusses the
evolution of attitudes towards these "slackers." (Or, as was the case
with much of the military -- then and perhaps now -- who want to ignore the
issue, the lack of evolution.) The work focuses upon asylums, mostly after the
war.

Peter Leese, Shell Shock, Traumatic Neurosis and the British Soldiers
of the First World War (Palgrave MacMillan, 2002): Covers much of the
same ground, but more in depth on how the topic was dealt with during WWI, with
only about 54 pages devoted to post-WWI period. Still, it's a shorter and
somewhat more digestible book, so if you wanted just one book on the topic as
it related to the British in WWI and after, I'd go with this one. Since Leese
(writing from his faculty position in Krakow, Poland) and Barham (writing,
then, in the UK) were writing at nearly the same time, their works overlap, but
not excessively so, and they do not reference each other.

Now, on the changing of attitudes towards all veterans and their malaise,
there has been some evolution. For a good multinational examination of the
history, I recommend a fairly dense academic anthology: David Gerber,
ed., Disabled Veterans in History (University of Michigan
Press, 2000). Fascinating, if constrained by the nature of an anthology, I'll
list just a few chapter titles and let you decide if you want the book.
"Heroes and Misfits: The Troubled Social Reintegration of Disabled
Veterans of World War II in The Best Years of Our Lives" by
the editor, Gerber. Geoffrey Hudson, "Disabled Veterans and the State in
Early Modern England." Isser Woloch, " 'A Sacred Debt': Veterans and
the State in Revolutionary and Napoleonic France." etc. 

Now, on the
American side of the equation we have some pros and we have some cons. It is
also an area where my personal interaction puts me in the middle, and so my
analysis here must be balanced against my personal friendship with both,
opposing, authors.

First, and foremost, are Jonathan Shay's books, Achilles in
Vietnam and his later Odysseus in America. (Personal
disclaimer: I know, and like, Jonathan. He has been to my house, broken bread
with me and drunk my scotch. He is a good, honest, and truly dedicated health
care provider who really cares about his patients, and the modern American
fighting man.) Shay wrote, movingly, about the plight of men who had
experienced serious combat in Vietnam and who, as a result, had "difficulties."
He linked these stories with the stories of the Iliad and
the Odyssey, arguing that there is evidence, from his perspective
as a psychiatrist, to argue that both tales contain evidence that PTSD is a
part of the human condition. In other words, that it is a normal and
predictable byproduct of what happens when large numbers of humans are exposed
to extremes of violence. In his second book Shay was arguing for better
psychological PRE-battle training, not just for compassionate reasons (his motivation),
but for combat effectiveness (which he knew would appeal to the military). Shay
is not a trained classical historian, or a historian at all. But his books
contribute greatly to the literature and in the latter case provide at least
one decent roadmap on how we might reduce PTSD before it occurs, instead of
trying to treat it afterwards. How can that be wrong? Unfortunately, and
perhaps sadly, it appears clear that in his first book he was taken for a ride
by at least a couple of his patients at the Veterans Administration clinic
where he worked who told him tales that he was not qualified to question or
disbelieve. At least that was the contention of the other author/friend of
mine, whom I also believe.

The other, critical work on the topic of modern, or at least post-Vietnam
PTSD, is also by a man I call friend. B.G. Burkett, a former stockbroker from
Texas, was an entirely normal Vietnam vet who, by his own admission, spent an
entirely uneventful year in Vietnam doing base work. He was annoyed, then moved
to anger, by the phenomena of fake veterans who were stealing the headlines in
the 80s and 90s for their misbehavior. So, unlike many others, B.G. started
doing the hard research work to expose these fakes, expose the problems of the
media (who are supposed to be skeptical from the outset) falling for obvious
fakes, and the VA and psychiatry's complicity in expanding and enabling fakes
to claim VA benefits for combat they never saw. The end result of his 80-90 percent
useful efforts (my highest rating) was the standout self-published book, Stolen
Valor. In which, for example, B.G. convincingly exposes the fakes that
Jonathan fell for, as well as a whole host of fakes who fooled journalists and
the VA system.

It was his work
that inspired my own research techniques and methods when uncovering the
personality at the core of the No Gun Ri story, Ed Daily. 

Finally, two great works which, together, give you the history of both the
psychology and the psychiatry, as well as the history, of the developing
treatments for combat veterans dealing with their memories of war.

Edgar Jones and Simon Wessely, Shell Shock to PTSD, Military Psychiatry
from 1900 to the Gulf War (Psychology Press, East Sussex, 2005)
actually dips back a little further, with accounts going back to the Crimean,
but mostly starting with the Boer War. It is a solid, if stolid, multi-national
examination, albeit with a 75 percent tilt towards diagnoses and treatment as it
related to British/Commonwealth forces. It can be a bit of heavy-going, and if
you've already read everything else on the list to this point, you could skip
this one. Alternately, just read this one and skip the others. But if you do
so, understanding will be a little thin. At least that would be the case
without the last, and best, of the lot.

Ben Shephard, A War of Nerves, Soldiers and Psychiatrists in the
Twentieth Century, (Harvard, 2001): Without a doubt one of the most
fascinating works I've read. Shephard writes in an easy, engaging, and yet
detailed "voice" on the topic of the changes, over time, to the
diagnoses applied to those "mentally softer" Tommies and Doughboys of
WWI, the weak-willed and selfish Tommies and GI's of WWII, and the Grunts of
Vietnam. (Again, to be absolutely clear, I am using these terms sarcastically,
and if you are historically astute, a tad ironically. Shephard never said such
things.) Fairly equally balanced between the U.S. and the U.K., what is really
interesting in this book is that Shephard delves into the history of the
psychiatrists themselves. How did the "DSM" (Diagnostic and
Statistical Manual of Mental Disorders), first published in 1952, updated as
"DSM II" in 1968, and so on, come to be? What were the "inside
baseball" things going on within the field of psychiatry, as well as the
political implications of the actions and motivations of the most prominent
psychiatrists in, say, 1967, and how did these affect the definitions and
descriptions of the "disorder" (originally known as
"Post-Vietnam Stress Disorder" but then later, for political and
other reasons, renamed PTSD and now, again, changed to PTS or PTSS)? All
fascinating stuff, and probably your one-stop shop to learn about the answers
to all of your questions.

Hope this is
useful.

LTC Robert Bateman, has written books and
articles on military history and military theory, as well
as immeasurable amounts of snarky commentary in every outlet from Armor magazine to Parameters, from the Marine Corps Gazette to USNI Proceedings. He was once an honest infantryman, but is
now a strategist, serving in England after a recent one-year vacation
in Afghanistan.