Qari Abdullah is roughly thirty years old and has lived in war his entire life. Never has he gazed upon land unscarred by bombs, and no mountain around his home is absent of a fighting position. His father is old but can remember beyond the 1979 Saur Revolution that brought communism to Afghanistan. His detail fuzzes at the edges like forgotten dreams. Qari cannot even imagine his country without war. Even the most peaceful moments of his life were surrounded by violence. Whether it was at madrassa in Pakistan’s northwest frontier province or trying to scrape together money for his wedding in Tehran where Afghans are second class citizens, violence persisted around him before he even began what he calls his jihad against America. His father laughs and says it is not a real jihad like the one he fought against the Russians, but it’s the only one Qari has. He likes the camaraderie, excitement, respect, and of course the glory. It’s a lifestyle and the only one that he understands. Sitting with him, an interviewer would never assume the young fighter’s past. His eyes are bright and kind, and his smile is quick to split his long beard. His mind is sharp and clever, and his words reveal the depth of his intellect. War has not torn at his psyche, though he has lived surrounded by violence for three decades as both a citizen and soldier.
Conversely, an American Soldier, Sergeant Harris, joins the army for the camaraderie, excitement, respect, and, of course, the promise of glory; however, all too frequently a twelve month deployment renders men like him unable to control the emotions that surface through outbursts. He fears his dreams and hates sleep. He becomes jumpy and suspicious. Anxiety builds an internal pressure that he struggles to understand as it makes him feel more alien in a society that cannot understand him.
Post Traumatic Stress Disorder (PTSD) is classified as an anxiety disorder in the Diagnostic and Statistics Manual of Mental Disorders: Fourth Edition (DSM IV) which is an internationally recognized diagnostic guide for mental health conditions. Essentially, this mental anguish develops when an individual is exposed directly, or even indirectly, to an extreme stressor such as a real or imagined threat to life, limbs, or personal integrity. A person can even develop the condition through the synthesis-powers of the neo-cortex by sympathetically imagining what it would be like to face adversity as long as the common response involves intense fear, helplessness, or horror. Though the newest revision should soon be released, the current DSM IV has not been updated since 2000. PTSD was only added as a diagnosis in 1980, but its universal diagnoses uniformly apply to all peoples, although uniform diagnostics do not take into account where a culture falls within the spectrum of human need. Maslow’s Hierarchy of Needs forms a pyramid consisting of five blocks of human need. These blocks are: physiological needs, safety, belongingness, esteem, and self actualization. In theory, a man cannot move onto the next block until the ones beneath are satiated. With respect to these human needs, the symptoms of PTSD and behavior caused by those symptoms more commonly manifest in an American society rather than in Afghanistan’s tribal communities.
In America most people are born into relative safety where their physiological needs are a given. Likewise, their identity, socioeconomic or ethnic group is provided, which leaves a modern man only the chore of figuring out the man he is and the man he wants to be. In tribal communities, these first two blocks are not necessarily met. Violence is used to secure physiological needs, such as water and food, as well as personal safety and the safety of the tribe. A permanent reaction to the observation of something horrific would therefore be detrimental to the survival of the individual and the tribe. The inverse relation to survival and violence is best illustrated in Roland Wierstall’s PTSD survey which found only two child soldiers of eighty-three Ugandan child soldiers from the Lord Resistance Army who exhibited symptoms classifiable as PTSD by the DSM IV. Incidentally, these two also show less appetite for aggression, meaning the more aggressive the perpetrators of violence, the less likely they were to exhibit signs of PTSD. Similar results were yielded in Wierestall’s survey of 269 Rwandan prisoners convicted or facing conviction for the 1994 genocide that violently eradicated between 800,000 and one million people. Evidently, when the first two blocks of the hierarchy of need were not secured, violence absolved the tribesman of symptoms, whereas the American Soldier is born with those two blocks taken for granted, thus only learns a classically conditioned response to fear that manifests itself in the form of PTSD symptoms. Consequently, eight percent of adult Americans suffer from PTSD, but it is so common in returning veterans, by 2010 in eighteen states, thirty-eight Veteran Treatment courts were established to address the rise of veteran-specific misdemeanors and foster rehabilitation over incarceration. While this may seem to be a valuable assistance to veterans, separating them from the rest of the population potentially serves to attack their senses of belonging which then must quake and skew the veterans’ senses of esteem and self actualization, rendering them more susceptible to adverse symptoms.
Despite the image of rugged bravado, average American men must be trained to take another man’s life as well as withstand the psychological impacts of fear, helplessness, and horror that may arise within the situation. This is evident in the “non-firer phenomenon” that prevailed throughout America’s historical wars captured in Lieutenant Colonel Grossman’s treatise On Killing. Of the 27,574 rifles recovered from the battlefield at Gettysburg, ninety percent were still loaded. Twelve thousand rifles worth of that ninety percent were loaded multiple times – one even loaded twenty-three times. In a black-powdered battle where loading consumed the majority of those intense minutes, it’s suspected that the owners of these rifles simply went through the motions of firing to prevent being viewed as cowards - though they were in fact conscientiously objecting. Similarly, non-firers have persisted throughout World War I and World War II. To counter this reluctance to kill, the U.S. military overhauled the training regimen. Young privates are now praised for their violence of action as a testimony of their motivation; however, evidenced in the prevalence of PTSD, a couple of years of training and twelve months in combat are not enough to renovate the natural humanity of average young American men.
Around the same timeframe as Gettysburg, though miles away in the Kingdom of Afghanistan, a much more gruesome battle occurred with much less reluctance for violence. A classical Pashtun tribesman devotes himself to honor that is often rendered upon violence at an extremely early age. His arch rival is his own first cousin with whom he competes for the seat of the patriarch the tribesman’s entire life in a competition known as tarburwali, or cousin-play. Despite the innocence of the term, it often ends in death. Each scion bears the honor of his entire ancestral line, and the pressure to maintain that honor often manifests in violence. This is best illustrated in David B. Edward’s anthropological treatise, Age of Heroes: Moral Fault Lines on the Afghan Frontier. When Safi tribesman, Akhunzada Talabuddin, was slain by his cousin’s qawm (familial sub-tribe), his eldest son Sultan Mohammed Khan was obliged to avenge his father or lose his family’s honor. He was only thirteen years old at the time. Initially he balked at the opportunity and fled before the enemy qawm could kill him. In his absence, his mother took the vengeance, or badal, and killed her husband’s murderer, which left Sultan Khan in a state of honor bankruptcy or daus. To remove himself from under the paighur, or ridicule, and regain his place in the tribe, he first gouged out his mother’s eyes then systematically killed every fighting age male from his cousin’s qawm before taking his seat as the ruler of the tribe until he died an elderly man. While the blinding of his mother was an extreme example of badal, the eradication of a neighbor’s line is a typical response that still occurs in Afghanistan. Indoctrination in warrior culture begins at birth and is fostered throughout life whereas the American military tends to interject this indoctrination as a momentary pause in the length of a Soldier’s relatively humane life. Unfortunately, only one scenario seems to prepare warriors for instances of intense fear, helplessness, and horror.
American Soldiers are at a disadvantage within the fractured structure of American society, often finding that they no longer belong upon their return, while tribes rely on their warriors as mainstay of the community. Qari Abdullah prepares for battle. First, he asks his mother’s permission, then prays for God’s blessing. His little brother hands Qari his rifle as he heads out the door to meet the men he grew up with. His neighbors wave to him and wish him luck. The old timers see themselves in him and hope his fight will bring peace to the village. They know if he fails, Americans will never leave them alone, and their presence will draw outside jihadists who may damage their crops or, worse, harm their people. Everyone wishes Qari well.
Meanwhile, beyond the miles across the ocean, Sergeant Harris prepares for battle. He heads to the bar for one last night with his team. His wife does not understand why he doesn’t want to spend this time with her, and he hardly talks to the rest of his family. The Army has kept him moving around for the last five years, so it’s just easier to call on birthdays and holidays. Strangers at the bar tell him "thank you for your service," but Harris knows that they have no idea what his service entails. It’s just an obligatory phrase they picked up from a bumper sticker, but he takes the free drink. In the morning he boards a bus, which goes to a plane that leads to a helicopter that drops him off at his new home for the next year in the middle of Afghanistan. Throughout that year, the fight is hard, and both men fight well. Harris loses a couple of friends, and Qari sends a man he’s known his whole life to martyrdom. When the year is done, Harris is relieved by an incoming unit while Qari continues to push. Harris watches on the news as the new unit loses the area that his friends died to gain. Every bit of good he thought he did is gradually undone. People at the bar thank him for his service, but what do they know? It’s impossible for them to understand. His wife doesn’t understand. No one does. He leaves the Army, and his friends move to their next assignment. Tears come for no reason, and he finds it increasingly difficult to control himself but has no idea why. He drinks a little more. He is more alone than ever before.
Qari’s village is grateful he has kept the foreign invaders out for another year, and thinks that might be why they had such a rich apricot and apple yield that year. Other villages hear of their tribe and know their fighting prowess so surrounding tribes divert more water to Qari’s crops. Qari’s victory is their victory, just as his failure would have been theirs. Together they bear the burden of failure and share in the spoils of victory. Qari is never alone.
Perhaps modern societies have outgrown their need for warriors, and PTSD is simply a reflection of this. In the higher order of esteem and self actualization, the pliable psyche of the modern American can no longer contain the ugliness that is a necessity for the foundation of human need, and coming to terms with this ugliness generates the anxiety which propels these unsettling behaviors. While Americans toil with those behaviors stunted somewhere in belongingness stage of the hierarchy, tribal cultures that depend upon violence for perpetuation of their existence immediately receive the benefit of their warriors’ victory or immediately suffer their losses. Together the tribe bears the burdens of war, while the American Soldier reflects in solitude, wondering who he truly is and how he can ever belong.
 American Psychiatric Association. Diagnosticand Statistical Manual of Mental Disorders Fourth Edition, Text Revision (Washington D.C.: American Psychiatric Association, 2000). 463.
 Lester, David. “Maslow’s Hierarchy of Needs and Psychological Health.” Journal of General Psychology (1983): 83-85. Academic Search Complete.
 Weierstall, Roland, et al. “When Combat Prevents PTSD Symptoms: Results from a Survey with Fomer Child Soldiers in Northern Uganda.” BMC Psychiatry (2012.) 6. Academic Search Complete.
 Weierstall, Roland, et al. “The Thrill of Being Violent as an Antidote to Post Traumatic Stress Disorder in Rwandese Genocide Perpetrators.” European Journal of Psychotraumology. Coaction Publishing (25 Nov. 2011). Doi: 10.3402/ejpt.v2i0.6345.
 Cartwright, Tiffany. “To Care for Him Who Shall Have Borne the Battle: The Recent Developments of Veteran Treatment Courts in America.” Stanford Law and Policy Review (2011): 305. Academic Search Complete.
 Grossman, Dave. On Killing. (New York: Little, Brown, 1996.) 21.
 Edwards, David. Heroes of the Age: Moral Fault Lines on the Afghan Frontier (Los Angeles: University of California Press, 1996), Kindle edition, Ch. 2.
About the Author(s)
This is a fascinating article and the comments are astutue. I had the privilege of serving as a law of war/humanitarian law instructor at the Ugandan equivalent of AIT and was struck by the matter of fact manner in which many of the students related their own childhood experiences with extreme violence. I often wondered about how they were able to do this and this article provides an interesting theory as to why.
I am writing this from the perspective of a National Guard officer who, after returning from deployment, had a difficult time adjusting to the pace and perspective of things here at home. The constant contact with the civilian world often creates tension within the returning veteran however much we personally or as a society try to mitigate this. I state this not as a criticism of our culture, indeed, I feel the growing civil-military divide in this country is a dangerous thing. Nor do I think that the civilian world has failed in its duty to support the returning veteran, as the efforts that appear in the media and that I’ve experienced personally have been extraordinary. Instead, it’s simply the fact that modern American culture, for better or for worse, is not a warrior culture. When this is combined with the fact that that passion of the people for the conflict as cooled, it is not hard to understand the negative second and third order effects this may have on some returning veterans’ mindset.
The author’s thesis is unusual and not a bit controversial, but certainly has merit. This is something to keep in mind for both leaders in the civilian world and the military, as well as in the mental health profession.
Looking at this:
<i>American Soldiers are at a disadvantage within the fractured structure of American society, often finding that they no longer belong upon their return, while tribes rely on their warriors as mainstay of the community.</i>
I have to wonder if the difference is between "American society" and "tribes" or between the nature of the conflicts. Both societies and the individuals involved perceive conflict differently when they see the conflict as necessary to defend them against a direct threat. When we send men far overseas to fight in wars with nebulous and uncertain purposes and questionable needs, we create a degree of confusion. That's not at all fair to those who fight - they don't choose the conflict - but it's still a real factor in the perception of the conflict and those who fought in it.
It's a very important article that deserves very high attention from the high brass. First I have to say that it's true that diagnosing PTSD in the DSM IV (RT)is an Westernized point of view, inapplicable to an Afghan tribesman. I have to add that the distinction between the Afghan boy and the American soldier behaviors didn't surprised me because we have different cultures (in the good sense), which wasn't taken into account at the moment. Maybe it was part of the error sending our troops without a complete (I repeat complete) understanding of the ground and population (behavior) where they were going to fight. Later appeared the COIN doctrine, which I don't know (it's my fault) at what extent it helped the new breed of combatants. What I can say is that USMC right now is using its best effort to transmit to the troops the best information they have about the Afghan people's customs. Good move!...but is it too late as to gain the trust of the people we're going to keep safe from the insurgents? Did the high brass read the many books by Galula and Kilcullen (to cite just a couple of authors)? Are we falling in another Vietnam, where we won battles but lost the war? I'd like to have some answers that tranquilize me.
Thank you for writing this. Our understanding of PTSD and mental health as it relates to service members is absolutely Western-centric. I never thought about it strictly in terms of Maslow's needs, but that makes a lot of sense.
I conducted research on Iraqi veterans of the Iran-Iraq War looking for underlying bonds between "veterans" and found notions of "military service" were not universal. This is something worth more exploration.
I've heard a lot about Heinlein's book but never read it. I'll have to add it to my already too long list of books to read. Thanks.
(I think it was a fantasy series. The cover had a drawing that looked like something out of the show Vikings on the History Channel.)
A few months ago, I witnessed a scene which has become familiar to me, a kind of closed circle of affection that is almost mysterious.
In line for coffee. Morning. No one talking much. Doctors (lots of residents always on the move between institutions), nurses, patients, veterans, all waiting in line. One young person in a motorized scooter, baseball cap on identifying as a Marine. Young. A book in the basket of the scooter, can't remember the name, it's science or fantasy fiction of some kind. I ask out of curiosity, "what are you reading?" Turns slowly to look at me but one eye doesn't quite look, can't look, because its completely opaque. "It's about warriors." The scooter is because the walking gait is messed up it seems, a gait like a wind up toy that can't wind up or down properly.
I'm a pretty talkative person in hospital environments and can have a conversation with pretty much anyone, but for once, I don't quite know what to say. Luckily, an older man behind me says, "Marine, I got your coffee" and gestures to pay the bill. He's wearing the same kind of cap, both veterans, generations apart.
There is a lot of talking that goes on, but it seems to take place in cafeterias, waiting rooms, hospital coffee shops, hallways. Always in hallways, out of the way. But this happens in a lot of hospitals, veterans or no. If you work odd hours, you will see the most heart tugging scenes in empty hallways, long after most workers have gone home. To be frank, the hospitals with children were worse. I could never handle any of that and admire those that work with ill children tremendously.
Anyway, it's everyday business here which makes it seem very different than much of what I see or read about in the papers or online. I'm so new to all of it and such an independent operator in a way, practicing a subspecialty of a subspecialty that leaves me on my own, that I'm still learning. Everyday is a different kind of place.
I see good and happy scenes too, which always surprises people. Really happy family scenes which must add to the sense of confusion and affect attempts at belongingness.