EVERY BIG WAR has its signature wounds. If the Civil War didn’t kill
you, you were likely to end up with amputations. Surgeons in World
War I advanced the art of facial plastic surgery (mustard gas liquified
facial tissue). Gulf War veterans barely saw combat, but many suffer
from mysterious symptoms believed to be linked to nerve agents.
PTSD was common after most of these wars—even Homer wrote
about it—but it went by different names: shell shock, soldier’s heart,
combat fatigue. Frederick Law Olmsted, from whom I have a quote in
just about every chapter (because, as well as being a badass nature
guru, he was, like Zelig, witness to just about every significant beat of
the nineteenth century, from plantation slavery to the gold rush to the
invention of suburbia), described the Union soldiers after the Battle of
Manassas as a “disintegrated herd. . . . They start and turn pale at the
breaking of a stick or the crack of a percussion cap— . . . It is a
terrific disease.” PTSD wasn’t officially named and recognized by the
Veterans Administration until 1980.
In the general population, about 8 percent of us will experience
PTSD. Among veterans, that figure is about 18 percent, but a recent
examination of the data for over a million veterans of the wars in
Afghanistan and Iraq found a 27 percent rate (with over 70 percent of
that coexisting with depression). The fingerprints of the recent wars
are so far clear: PTSD, traumatic brain injury (TBI) from explosives,
and sexual assault.
Some studies suggest that women experience PTSD at slightly
higher rates than men, or they may just more readily admit to having
it. According to the latest iteration of the Diagnostic and Statistical
Manual of Mental Disorders, symptoms of PTSD cluster around four
subgroups: reexperiencing (flashbacks, nightmares), avoidance and
withdrawal, bad moods and depression, and hyperarousal, such as
jumpiness, vigilance, aggression and sleep problems. Women, who
now make up about 15 percent of the military, express some
symptoms differently, experiencing higher rates of anxiety and eating