PTSD in War Veterans: An Existential Psychology Approach

Introduction

The reality of trauma and shock resulting from exposure to violence and warfare is not new. As Foa and Meadows (1997) observe, "the concept of trauma-related emotional disturbance has existed for over a century, having names such as shell shock, war neurosis, and rape trauma syndrome" (p. 449). However, the recognition of this condition as a formal medical and psychological disorder is relatively recent. Post-traumatic stress disorder (PTSD) was only formally introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of the American Psychiatric Association in 1980 (Foa & Meadows, 1997, p. 449). This means that treatment protocols and methods of addressing PTSD among veterans are still at a comparatively early stage of development.

One of the more recent methods of understanding and treating this condition is through existential psychology and analysis. This paper explores existential views on PTSD and its treatment. The importance of this form of analysis and treatment will become clear from the discussion that follows. Existentialism is a perspective that views PTSD in terms of a more holistic understanding of lived experience and the ways in which extreme trauma can affect the individual.

PTSD and Existential Analysis

Radical experiences — such as prolonged exposure to extreme violence and life-threatening situations — can lead to the symptoms of post-traumatic stress disorder, including depression and suicidal tendencies. Existential analysis is particularly relevant here because it is grounded in an interrogation of the meaning of existence and reality. As a philosophy it has many diverse sources, from the work of Nietzsche and Martin Heidegger to the school of thought popularized by Jean-Paul Sartre.

One of the central concepts in this worldview is authenticity, or "authentic existence." This refers to an existence that is felt to be truthful and harmonious, as opposed to non-authentic existence, which is perceived as false and disharmonious. Gabriel Marcel, for example, comments that existence is that "state in which man… achieves… full realization of himself" (Allers, 1961, p. 33). More broadly, "all existentialists… affirm the ontological priority of the human being" (Allers, 1961, p. 34).

In essence, the existential perspective on treating this disorder takes account of several fundamental factors. The first is that the psychosocial effects of post-traumatic syndromes can be triggered by a dislocation — or even destruction — of the individual's previous worldview. This refers to the individual's framework of psychosocial stability and reality that provides a sense of identity and security. As one study notes: "Traumatic stressors challenge one's paradigm of the self and/or world. Maimed or shattered paradigms create a state of psychological crisis until new paradigms can be adopted, for these paradigms are the basis of our psychological stability" (Vandervoort & Rokach, 2003, p. 675). This view establishes an essential starting point for understanding PTSD from an existential perspective.

The Destruction of Core Assumptions and Authenticity

Extreme trauma, such as exposure to warfare, can disrupt or destroy "our functional illusions of individual invulnerability" (Vandervoort & Rokach, 2003, p. 675). This disruption extends to four core assumptions that constitute psychological stability: "the world is benevolent or at least benign; life is meaningful; we have control over our lives; and positive self-worth" (Vandervoort & Rokach, 2003, p. 675). When individuals experience extreme trauma, these basic assumptions are called into question, producing a state of existential anxiety. As Vandervoort and Rokach (2003) explain:

The experience of trauma makes one acutely aware that these assumptions are not true and thus one's ability to act… as if these basic assumptions about the world are valid is lost. One can no longer believe that people are basically good and that good things happen to good people or that by engaging in the "right" behaviors… (p. 675)

Many veterans exposed to existential trauma therefore tend to question the meaning of life and their own personal self-worth, which can lead to the various symptoms of PTSD. Traumatic experience can also produce a sense of dislocation from reality and give rise to specific psychological problems.

Another dimension to consider is the existential dichotomy between good and evil. Veterans may come "face-to-face with the existence of evil and the breakdown of a moral universe" (Vandervoort & Rokach, 2003, p. 676). This confrontation can in turn lead to a questioning of self-authenticity. The concept of authenticity plays an important role in existential analysis, referring to one's sense of worth and personal reality — both of which may be shattered by traumatic experience. "Authenticity refers to autonomous self-creation of who and what individuals are to become" (Vandervoort & Rokach, 2003, p. 676). The individual who suffers from post-traumatic illness experiences a "psychological world… filled with terror which results in psychobiological changes" (Vandervoort & Rokach, 2003, p. 675). The intense anxiety they experience stems from the loss of security and meaning previously found in the world, and from the destruction of their framework of self and the collapse of a once-stable belief system.

The following extract from an actual case study typifies the traumatic experience that many veterans continue to relive:

When Mike went on a drinking binge during his short hospital furlough, he was reliving his war trauma and other PTSD symptoms, on the anniversary of one of the most terrifying days in his life.… Two days later, he attempted suicide with a .45 caliber pistol which he had brought home from Vietnam and kept in a cedar chest, along with his high school yearbook, his medals from Vietnam, including three Purple Heart awards and photos of his buddies killed in action. (Wilson & Thomas, 2004, p. 112)

Conclusion

The treatment of PTSD among war veterans is a complex and often very difficult process. The embedded traumatic experiences are usually deeply disturbing to the individual and can lead to characteristic symptoms of PTSD, such as depression, suicidal tendencies, and loss of personal motivation.

From the standpoint of existential analysis, these traumatic experiences can be understood and examined from the subjective and experiential viewpoint of the individual. The advantage of this form of analysis and treatment is that it is grounded in the recognition that the psychological worldview of the individual is dysregulated — and even destroyed — by the traumatic events he or she has experienced. Starting from this point, treatment is better positioned to address the underlying factors and the broader issues that impact the patient's existential world.

In conclusion, the use of existential psychology to treat PTSD is extremely valuable and appropriate, because this approach does not merely treat symptoms but attempts to repair and address the underlying causes of traumatic anxiety from a holistic perspective.

References

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