Institutional PTSD

Institutional PTSD


Leonard Zwelling

         This article is critical for all Americans to read. Its thesis
is simple. PTSD, post-traumatic stress disorder, has nothing to do with what
happens on the battlefield and everything to do with what happens once a
soldier returns home. The author, Sebastian Junger, is a famous war
correspondent who knows battle.

         In this lengthy essay in Vanity Fair, Junger strives
to reconcile the fact that only about 10% of American military personnel
actually experience combat, but almost a third eventually are diagnosed with
PTSD. He is very persuasive that something other than battlefield action is
causing the mental distress.

         What could that be?

         Junger then elaborates on the human condition in 2015
America and how different from a healthy society (one that nurtures our true
nature) we live in now. Humans are tribal and social, yet more and more live in
single family dwellings, in socially isolated situations, where both parents of
most children work, and sleeping is a solo activity or, at most, done with one
other human. This is not the situation in which humanity found itself for most
of its existence and certainly not the one to which we as a species adapted. It
is also not the one experienced by most soldiers.

is a manifestation of the normal human reaction to danger. PTSD victims are
hypervigilant, sleep lightly, have flashbacks and are both anxious and
depressed. There is a feeling of helplessness that can only be “counteracted”
by “high levels of training” to prepare for both the battle and peace. Our
military appears to be superb at the former and only partly so at the latter.

is also not the welcome when soldiers come home that is the problem for PTSD is
far more common among today’s very welcomed returning veterans than among those
vets from the Vietnam Era when soldiers were met with scorn and derision upon
their return from the horrors of the dense jungles and rice paddies.  In fact, Junger notes that returning vets go
to the VA until they get full disability then they never return for additional
medical care. Thus, “the most traumatized should be seeking more help, not
less.” But that is not the case. They are estranged from their families, their
buddies, now also alone at home and the system that promised to care for them.

problem is in the society to which these veterans return. It is a society of
isolation, without the shared sacrifice of military service (e.g., as in Israel
where virtually all citizens serve), and without the natural human surrounding
conditions of group effort, close proximity and total commitment to a common
goal. One percent of America is fighting 100% of the wars.

is no accident that the conditions favored by humans and those sought by
returning troops are the precise characteristics that Coach Mike Krzyzewski
seeks in his players on the Duke basketball team—communication, trust,
collective responsibility, caring and pride. Coach K is a product of West Point
so no surprise there. Junger calls these “loyalty, inter-reliance, and
cooperation.” In a place I used to know, it was called integrity, caring and
discovery. All three systems of catchwords have in common the idea of
self-sacrifice of the individual for the group if the group is to prosper.
There is one other characteristic that these systems share and that is clarity.
These words guide clear minds and are understood at the gut level as the
bedrock of the civilization. What’s the bedrock of the American civilization
now? Hope and change? LOL? 15 minutes of fame? Or is it the extreme me-ism of
Wall Street and the self-centered egocentrism and narcissism of so many American

are not confused about what they are in battle to do and this clarity is
nurturing in and of itself.

is also true of companies and other large institutions. When there is a clarity
of group action and participation, there is success. When individual activity
is that which is most rewarded, even when there is some success, it is not a
shared success and it is not an institutional success. It is not a collective
success and in great organizations, the lack of collective success is no
success at all. Those who work where there is no institutional success
perceived to be operating have institutional PTSD.

to MD Anderson.

was nothing more marvelous when we arrived at Anderson in 1984 than the total
commitment of the entire faculty and staff to the institution and the clarity
of the goal of fighting cancer. For the past 15 years, this has been lost to a
tide of striving for individual greatness, money over substance, edifices of tribute to past Presidents and Sheikhs, and the need
for the outside world’s stamp of approval (#1 ranking from USN&WR,
more grants and contracts, etc.). Rather then make our own way guided by our
own principles, MD Anderson under John Mendelsohn got off track by Dr.
Mendelsohn’s trying to “raise the bar” because that was interpreted as taking
individual, not group, effort. Salaries on grants became an issue and life
became worse. Financial competition among departments was the new normal
developed by Messrs.’ Leach and Fontaine. (How the hell do they know whether
the most critical clinical activity MD Anderson does is see new patients and consults?
Shouldn’t every patient encounter be of equal value?)

DePinho has taken this to a greater level with animus toward many and
favoritism toward a few and no sense of the collective whatsoever.

cannot win a basketball game with 5 great centers and you cannot be the best
cancer center with only bench investigators and drug developers.

in my life I have been in combat-like situations without the guns. The first
was as a Duke intern where I was on-call 5 nights out of 7, perpetually
sleep-deprived, fat from not exercising, and overwhelmed with patients. Only my
bonding with my fellow interns and residents got me through. They are my
brothers to this day. This was reproduced on a smaller scale during my first
year at the NCI Medicine Branch when Gershon Locker, Jim Doroshow and I were
the only things that gave each other any time off at all. There were no interns
or residents there. The call schedule was 24/7. There was no ICU then and no
orthopedic or ENT surgeons should a breast cancer patient break her leg or a
leukemic sustain an unstoppable nose bleed. It was just us, 9 fellows in groups
of three, keeping each other sane and fighting the senior staff whose only
concern was getting more patients on protocols so they could do research and
publish. (They didn’t have to write grant applications, after all.)

don’t long for those days, but they warm me all the time for the bond formed
with those men and women have lasted a lifetime.

used to be MD Anderson and it can be again, but this will require
acknowledgement of the poor leadership that has caused the institutional PTSD
and a reversal of the trend toward individualization and back to one of
communitarian values and effort.

would be great to Make Cancer History.
But first, it’s the last 20 years we need to make history.

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