We’re nearly done with our discussion of mental health because I’m nearly at the limits of what I can talk about with any kind of confidence. But before that concludes, there’s one specific condition I’d like to look at more closely . . . because arguably, it’s one more of our characters should be suffering from.
That “arguably” isn’t just me hedging: the uncertainty is real. Our understanding of what’s currently called post-traumatic stress disorder (PTSD) is constantly evolving; five or ten years from now, it’s entirely possible a reader will be rolling their eyes at the things I say here. (It’s entirely possible now, since I am not a specialist on this topic.) What causes it, who’s more likely to develop it, how it can be treated — all of these things are moving targets.
Especially since this is one of the places where we can potentially see the effect of culture on mental illness. Before PTSD, it was battle fatigue; before that, shell shock; before that, soldier’s heart . . . did PTSD exist in the more distant past?
There are certainly claims that it did, with scholars trawling the historical record for traces and finding them in everything from Shakespeare to Viking berserkers. As I mentioned before, though, the evidence for mental health in the literary record is often slim enough and malleable enough that you’ll tend to find the diagnosis you’re looking for. That some people sometimes had psychological conditions akin to what we now call PTSD is extremely likely. But was it common and widespread among soldiers and warriors?
I tend to side with those who argue that no, it probably wasn’t, for several overlapping reasons. We rarely know what the common people thought, but the elites of the past wrote a lot about war, and while they sometimes mention e.g. being haunted by the ghosts of dead comrades (which some count as evidence of PTSD), the overall message tends to be that war is awesome. It is the thing that makes a man truly a man, the crucible from which he emerges stronger and more capable. This message is pervasive enough that it’s hard for me to buy that they were all putting a brave face on what was actually a traumatizing experience, one that left many of them psychologically scarred; I think it’s more likely that they were not in fact scarred in the ways we see today.
Contrast that attitude with the war experiences recorded in the last century or so, which are more likely to tell you that war is hell. Some people still react to it well, feeling that it transforms them into stronger versions of themselves, but that’s not the dominant cultural narrative anymore. On top of that, while members of the warrior aristocracies of yore could feel they were being initiated into a realm shared by their fathers and grandfathers and peers, soldiers returning home now are more likely to be surrounded by civilians with no direct experience of combat. It’s more isolating — at least in places like the U.S.; I have no idea what it’s like in countries where military service is mandatory — and potentially more traumatizing as a result.
Why did the narrative change? A lot of reasons, I suspect, including things like the expansion of our “sphere of empathy,” making it less broadly acceptable to dehumanize enemy combatants and civilians — the extent to which we do that today is nothing on past centuries — but a whole chunk of it may come down to technology. And for that, let’s look at the factors that seem to increase the likelihood of PTSD.
After all, not everybody comes out of these experiences with long-term trauma — not even people who underwent the same experience. There are personal factors that can influence this, but in terms of the event itself, two things are noteworthy. Last I heard, current research suggests you’re more likely to develop PTSD if:
1) the traumatizing event took you by surprise, and/or
2) you were helpless to do anything in response to the trauma.
Now let’s look at the history of war. (PTSD can develop in lots of contexts other than war, and the above factors go some way toward indicating why, but war is the easy one to look at.)
Even in historical accounts of ancient or medieval armies accidentally running into each other on the march, relatively few of those battles were going to go from zero to widespread violence in a matter of seconds. “Running into each other” would more commonly have taken the form of scouts returning at a dead sprint to report that the enemy force was nearby, and everyone scrambling to get ready for the battle that could not be avoided. Ambushes could certainly hit faster and harder if properly staged, but the majority of clashes would be preceded by the combatants drawing up into battle array. You had some amount of time to prepare, some ability to see your enemy coming.
For a completely different scenario, consider both Iraq and Vietnam, two theatres of conflict legendary for the frequency with which attacks hit out of nowhere. An IED blows up a truck; riflemen pop out of the underbrush and start picking soldiers off. Both of those wars have produced a lot of PTSD, and both of them feature an environment in which it feels like danger could strike from anywhere, at any time. Is it any wonder that hypervigilance, a characteristic symptom of PTSD, is common among those who have spent time in that environment?
As for the helplessness, think of World War I. Soldiers on the front lines had to hunker down while artillery barrages hammered the area for hours or even days, unable to do a single thing other than wait for it to be over. Artillery in general has greatly increased the likelihood that you might be killed by something far outside your own range of response — meaning that instead of facing someone at the length of a spear or a sword, where your own strength and skill can make a difference, your survival depends more on factors like luck and the tactical decisions someone else has made.
My (admittedly non-specialist) suspicion is that modern warfare has made war more traumatizing in the ways most likely to produce PTSD. The process has been going on for a while, as gunpowder made it easier for us to kill each other en masse and at great range, but it’s really picked up steam in the recent past. Combined with those other cultural factors — greater empathy for other people, civilians as a higher proportion within the peer group — it makes for a very different experience.
So bringing that back around to the starting question . . . should more of our characters have PTSD as a consequence of the plot?
The answer in any given case is going to depend on the circumstances. A character trained for combat who sees the enemy coming will probably be less vulnerable than the civilian attacked out of nowhere. The nature of the combat can make a difference, melees of the sort we love to write into our novels being a different beast from long-range weapons. Personal factors play in, too, as some people are more psychologically resilient than others, while cultural factors will affect what narrative the character builds around the events. And remember, this isn’t just about combat: torture, abuse, vehicular accidents, disasters, and more can all produce short-term or long-term psychological trauma.
Probably the broad answer to that question above is “yes.” Many authors put their characters through absolute hell, and relatively few truly explore the effects that hell might leave behind. Which is understandable; sometimes we just want the adventure and don’t want to grapple with the reality that such an adventure would be goddamned scary. But when we’re looking to up the drama and increase the stakes, sometimes it’s worth bearing in mind that we don’t have to crank the event dial to 11. A lower setting can still leave a mark . . . and paying attention to the after-effects can make the trauma hit so much harder.