Should war-caused emotional pain be called a mental illness?
Is human emotional misery always a mental illness?
In 2003, as the Iraq War was about to begin, in my mind's eye I saw what I feared would be the future: Waves of military servicemembers would come back from war, devastated, and not only psychotherapists but the nation as a whole would say, "We know what's happening to them. They've got Post-Traumatic Stress Disorder (PTSD), a mental illness. Send them to therapists for drugs and maybe therapy."
After all, the use of psychiatric diagnoses and psychiatric drugs had ballooned to an extent almost beyond belief since the Vietnam War, so that Americans are quicker than ever to interpret virtually anything other than happiness as evidence of mental illness.
But can't we stop and think before saying that being devastated by having been in combat and thus now being plagued by grief, fear, shame, rage, numbness, moral conflicts, existential crises, and/or other kinds of upset constitutes a mental illness? Consider: What would be a healthy response to being at war?
Should we let the fact that many therapists call war trauma PTSD, which is listed in the Diagnostic and Statistical Manual of Mental Disorders (note those last two words), persuade us that what used to be called soldier's heart, shell shock, and combat fatigue is actually a mental illness? Let us not lose sight of the fact that the authors of the diagnostic manual are the folks who call stuttering a mental illness, who do the same for having more trouble with mathematics than other kinds of cognitive functions, and who say that if a loved one dies, and you are "still" grieving two months later, you are mentally ill.
In fact, the VA's Iraq War Clinician's Guide includes the instruction to avoid calling the emotional pain caused by war a "disorder," an instruction that some military and VA therapists follow and some do not.
It should be possible to say to people who are suffering because they have been traumatized by life's worst horrors that their feelings are understandable and not sick, given what they have been through. Indeed, to tell them that can be a first and major step toward their feeling better and starting to reconnect with others, once they know there is nothing weird or weak about them for reacting as they did to having been at war. They need to know that if we were sent to war, we would probably react as they have.
This is not to say that no one who has been at war suffers from anything beyond the effects of war, for some people who go to war already have or would in any case have developed other kinds of problems. But it is to say that it is important for us to avoid leaping immediately to the conclusion that if someone has been at war and found the experience harrowing, therefore they are mentally ill.
It will take much to help ease the suffering of servicemembers and veterans. Still, as a beginning, you might consider finding an opportunity to talk to at least one person who has been at war (not just a current one), and looking for a way to let them know that you consider their intense emotions and painful struggles to be signs that they are human.