You can get decent introductions to the current understanding of PTSD in a hundred places. This one looked good enough when I read it. I started out as a psychblogger, which I had actually forgotten until I did my 100(+) most-visited posts to close out 2019. The first few years I connected often to Dr. Sanity (Pat Santy), Gagdad Bob, and other names long gone from this site. Neoneocon was trained in some sort of counseling, I recall, and Gringo, who still shows up as a commenter on a few sites I frequent, was in mental health as well, though I think he is coming up to retirement in more generic Human Services at this point. At the time, I thought there were a number of myths about psychology and psychiatry that were still prevalent in conservative and Christian circles, ans i wanted to bring some clarity. I discovered by trial-and-error that the number of conservatives willing to give up their myths was small, and most of those were Christians, usually of unusual sort.
Liberals, even Christians, who could give up their myths approached zero. I had a cheerful cynicism when I started, thinking that a generous amount of bonhommy (scroll down a bit) and solid information would bring many around. Hah, I say now. Hah.
When I come back and do this at all, it is with that mythbusters attitude, though I hope to also bring some value-added. So here. I attended a recent Grand Rounds given by one of the top few experts in the field, now nearly retired and thus fearless. A good sign. I am usually prepared to mutter in irritation at the cliched or revanchist attitudes or such, or even worse, a seemingly complete capitulation to political correctness and faddism. I learned a few things from his presentation, but mostly, I recalled that I have known some things for years that I should have shared here. The speaker's examples were good ones, and I shall borrow from them.
In the popular mind the trauma of PTSD must be severe, or it doesn't count. One should only use the word trauma for something very, very bad. This thought is clung to because the idea is that if we allow smaller things to be called trauma, then everyone is going to be claiming trauma about everything, when they should be just putting on their big girl panties (as our nurses say) and getting on with life. I think this comes from thee derivative word traumatic, which we reserve for serious events. It is not quite that the opposite of this idea is true, but it is something very near. Trauma in a physical, medical sense, has long been regarded as a category, not an amount. One can have mild trauma. such as hitting your thumb with a hammer. It does hurt. It does have observable consequences. It may limit your activities for a time or cause you to adjust your actions. It doesn't mean you are permanently disabled or deserving of more than a bit of sympathy, but it is not imaginary.
Let me give away a bit of where I am going by noting that if you already have a thumb injury, or a medical condition that causes such a mild injury to be worse for you than for others, or you hit your thumb many times (even if it is your own damn fault), then this trauma may turn out to be more significant.
A comparison with pain is useful, as it brings in the idea of variability. We note first that some people have a high pain threshold and others not, but even this is not so clear. Some people do very well with acute pain but not chronic. Some can endure great amounts of headache but not frostbite or other pain in the extremities. Still others adjust to the loss of a leg but are undone by back pain. Finally, other symptoms like loss of sleep, compromised breathing, or sensory impairments such as reduced vision or hearing may be harder to bear than pain, for some. It is all highly variable. Trauma of any sort is a real thing.
Recognising that actually frees up comparisons with other difficulties. Watching a loved one die of a lingering illness may be horribly sad and painful. There is no need to make it borrow the name of "trauma" to validate it. Trauma is not the only bad thing. There are mild traumas, and terrible things which are not traumas.
We usually think of PTSD in terms of two very different types of events. Military service - or less often, domestic emergency services - and sexual abuse, especially of children. Both of these have mild but real examples. When minor sexual assaults are described, women will sometimes scoff and say "that was just called 'dating' at my high school." Perhaps so, but return to the example of hitting the thumb with the hammer. It matters whether the female has been sexually violated before. It matters if it is repeated and escape does not look easy. It matters if there are power issues involved. It matters how much support one has. If you have sisters or friends who discuss these things, even humorously, you receive warnings which are preparations. You are given examples of responses that might work. You receive validation for your courage or sympathy for your fear. These add to resilience. There were girls who were shy or friendless or sheltered who had none of this. It matters.
The presenter gave an example of servicemen stuck in traffic in Basra when a local comes up and starts beating on their hood, laughing. He does not leave when ordered off. They eventually draw their weapons, then soon drive free, and when they get back to temporary base find there were no explosives attached. No one was hurt. Was this trauma? The audience was about 50-50. This is expected in a war zone. No one was hurt. The presenter declared "Of course this was trauma. People had recently been killed in these situations. If it was a daily occurrence it could take you apart. If you had had a friend die this way it would be worse. The fact that there are worse traumas doesn't matter." Yes, being prepared for what might happen in a war zone helps. That's why the services have training. Yes, having friends and coworkers to validate this danger helps.
Once this concept of phenomenon vs intensity is understood, a lot of other things open out. You can see that a real trauma might have only temporary effects, but reactivate (we use the word "triggered," which has been stolen for political purposes for other things that are not trauma) in the presence or retrauma. A good analogy is frostbite. Once a finger, toe, or nosetip has been frostbitten, it is forever more susceptible to pain. It just is. You can take actions to avoid it or protect from it, but that greater susceptibility is just always going to be there.
Additional piece to contemplate: people enter the armed services when they are young, and are not always all that aware of their own personalities. Many join in order to "fight back" against a hard life, or think they are building on their previous survivorship status. They have a dream of being a soldier or marine as a statement of having conquered previous demons. This does happen. In fact, it is what usually happens. But it is also a situation in which traumatised kids are putting themselves in retraumatising situations, with terrible consequences. A lot of this would be preventable if enlistees were honest going in, but they aren't. And to be fair, a lot of them who slide by the requirements of disclosing how many drugs they've used, or how much police contact they've had, or what their mental health history is, succeed in the end. The solutions aren't that simple.
There are other types of trauma, less recognised. Maybe I'll get back to that.