The United States of America has been in an uninterrupted state of war for almost 250 years (Marsella, 2011). 250 years of violence and loss… In these brutal battles, the soul of the soldier also becomes a casualty. The veterans who return home are haunted by memories of terror and bloodshed. For them a new fight begins on this groundˆ’a fight for dignity, honor, and healthˆ’as they face the cold-blooded diagnosis and rhetoric of psychopathology.
The fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (2000) strives for “brevity of criteria sets, clarity of language, and explicit statements of the constructs embodied in the diagnostic criteria” (p. xxiii). Yet in the name of brevity, clarity, and explicitness, this thick book betrays the depths of archetypal experiences. It avoids all possible contradiction, necessary tension, and expressive complexities that belong to psyche’s ways of being and its pathologies. With its codes and bullet points, the DSM-IV classifies and categorizes a compendium of conditions. It dissects and distorts, injuring soul with deadening diagnostic criteria and descriptions of disorders. In its compulsive attempt to simplify, the manual of the medical model becomes an abbreviation itself: DSM.
While the DSM-IV and other handbooks on psychopathology offer the clinicians important scientific knowledge for the standardization of concepts and language, they cannot effectively care for the war-torn psyche of veterans. In the healing and helping communities, if we identify solely with the medical approach, we become numb to the intricacy of psychological realities. When we witness suffering, we rely on numbers. We report, rather than remember. We infer, rather than imagine.
Once home from war, the soldiers are given a new rank, an abbreviation—PTSD—a code for the insurance company, a clue for treatment plans. As a consequence, the soldiers’ valor and anguish are reduced to a sterile set of symptoms signified by these four letters. The late James Hillman, a Jungian analyst and a founder of archetypal psychology, believed that words had psychic components; that a word was a messenger, a person, an angel. Following Hillman, an abbreviation is never just an abbreviation. If we imagine into the capital letters, within the given diagnosis we can begin to discern the armies of gods and goddesses—a pantheon of archetypal forces:
P.: Pain. Pride. Pandora. Psyche.
T.: Terror. Torture. Trust. Tragedy.
S.: Sacrifice. Self. Shadow. Suicide.
D.: Denial. Dionysus. Depth. Death.
By inventing diagnostic terms and reducing language to fit the medical model, we believe we can shrink-wrap the mythical beings and archetypal truths words hold, concealing them in a prison of psychological jargon. This economics of rhetoric is a misleading fantasy. It is an illusion, dangerous and deadly, for it not only threatens the archetypes living in the words, but also the psyche which is in need of archetypal meaning and beauty.
Imagine: A six-day old beard, a half-burnt cigarette. The soldier sits on an old couch slowly inhaling the dust collecting in the corners of the room. His chest barely moves when he breathes. His eyes are glassy. He stares soft-focus at the wall. His shoulders slope. The expression on his still face is vacant, almost like a trick of camouflage. He blends into the stale air surrounding him. He was a warrior; now he is a sick man impossible to understand. He is a veteran, but the diagnoses, the meds, the stigma make him a living dead.
He, and the men and women like him, are part of the incalculable cost of war as the unfathomable depth of trauma to psyche is beyond all financial estimates. Every year United States Department of Defense spends hundreds of billions of dollars to amass the required technical and material measures to fight all enemies, domestic and foreign. Yet, these plans ignore the psychological dimension of the archetypal experience. By now we should know, as Hillman (1975) did, that the real cost of war is not monetary: “Human existence is psychological before it is anything else ¾economic, social, religious, physical” (p. 173). Our Western cultural fantasies about war deny this truth.
Department of Defense objectives begin as conceptual agreements on a piece of paper. When soldiers are deployed things change. They are ordered to cross invisible desert borders; commanded to bring about the demolition of nuclear powers. Crossing back into civilian life, the soldiers face a Department of Defense that is blind to the essential needs of the human soul.
The soldiers who are sent back home no longer belong to their military divisions, but to Veteran Affairs. They are offered veteran pensions, disability compensations, vocational rehabilitation, insurance, and prescriptions; and provided with pamphlets that explain their anguish and anxiety. In response the soldiers’ need for healing, the DSM-IV inflicts the differential diagnosis: Posttraumatic Stress Disorder—PTSD. Found under Axis I, code 309.81, this diagnosis describes the symptoms to assess in a mechanical language of pathology which lacks psychological depth. In this lack the soul of the soldier suffocates and suffers.
A veteran is assumed to have returned from the front, but this is not the case. The soul of the soldier is still at war. Caught in a “frozen war consciousness,” the fighting goes on (Tick, 2005, p. 99). Instead of Afghanistan, the soldier now moves in the “lacunae” of the psyche, traveling through its “gaps” and “wasteland” (Hillman, 1975, p. 89) ¾ï€ claimed by a ground that perhaps was as foreign as the battlefields in the Middle East. This time around, the soldier pledges allegiance to the pathology as it is both a matter of survival and honor.
The civilians and even the clinicians may fear the moist darkness of veterans’ eyes, but the veterans need this sickness. Their suffering is more significant than those small pills they are supposed swallow in order to suppress the symptoms. As Hillman (1975) would argue, soldiers’ pathology is “valid, authentic, and necessary” (p. 58). The affliction provides a certain vision to the soul of the soldier.
What the DSM-IV defines as the “recurrent and intrusive distressing recollections” (2000, p. 468) is in fact the invincible force of imagination. For the veterans the presence of war is everywhere; the psyche holds onto the gruesome images of war to be able to make sense of life. Thus, the veterans’ symptom is a sign of the soul striving for reflection. The veterans break down, in order to crack open the meanings and metabolize the archetypal experience of war. The pathology becomes an opportunity, a path to soul-making for soldiers who are deemed helpless. Not recognizing the process of pathologizing as this ability and need, and undermining this archetypal journey in the name of clinical diagnosis are not only wrong, but treacherous.
Imagine: When the house is most quiet, the veteran gets off the couch, drops his cigarette on the rug, and shuffles his feet. He enters his bedroom, opens the closet, and takes out a shoebox. The brand name on the cardboard reads: Nike. The Goddess of Victory. He reaches in and takes out his handgun. He presses the cold muzzle against his head. His finger on the trigger trembles ever so slightly.
The tip of the gun points at the temple. The bullet aims at the brain.
Psychology has become a mind-game. By mistaking the concrete for the archetypal and reducing soul to biology, psychopathology has defined the disorder living in the brain. There is only one way: Ego’s scientific rationality, coded into diagnostic language, has to prevail. Such acts of reason bring us to Apollo’s altar.
But we cannot understand the madness of Ares with distant and calculated thoughts. We need courage and passion. We need turmoil.
The trigger moves. Bang!
The temple is instantly blown apart. Apollo sighs. The Goddess of Victory extends her lovely hand to Ares. The ego does not leave a trace. We stand appalled.
This is the most intimate and delicate dance of psyche with Hades. As the veteran sits in his armchair seemingly immobile, his soul tiptoes in circular motions: a dancer, all white and weightless, ready to descend into the realm of Death. Slowly, she spirals down. Innocence surrenders to the near visions of war; the soul submits herself to the invisible hungry mouth of Hades, begging to be devoured.
The language of the DSM-IV cannot depict this journey. Instead, it desperately longs to control both the subtle and immense movements of the psyche, killing the archetypal specters with its bullet pointed list of symptoms, and condensing soul into categories with its rushed rhetoric. The stubborn labels and stereotypes leave no space for metaphorical possibilities. Nothing divine or profane remains for the imagination to embrace.
War is mythic. An experience that, as Hillman (2004) wrote, “begs for meaning, and amazingly also gives meaning” (p. 10). In their silence the veterans step into the vast realm of visions and memories, carrying for all the rest of us war’s horrific numinosity. Therefore, the veterans’ silence is not necessarily “an impairment in social and occupational areas of functioning” like the DSM-IV claimed (2000, p. 468). The internalization of images provides the means for the psyche to both speak and listen to itself.
Hillman (1975) explained that “the ideation process in psychology is far behind its methodology, instruments, and applications ¾and far, far behind the psyche’s indigenous richness” (p. 115). We witness this constant struggle in the rhetoric of the DSM-IV and its diagnosis for PTSD. The DSM-IV groups together the experience of military combat, personal assault, torture, natural disasters, accidents, and life-threatening illnesses in one neat box. It does not differentiate between war, cancer, and rape. While these are all archetypal journeys of encounter with Hades, each of them is fundamentally unique. Their images and gods are distinct. It is a naÃ¯ve illusion to think that we can justify them all through one diagnosis, enclose them in one code and shrink them into one abbreviation.
Once there were names addressing the particular pathos of the veteran, like “soldier’s heart” and “shell shock.” The images of war were alive in these expressions. When we read the clinical diagnosis for PTSD we cannot see or feel the changed heart and meaning-searching soul of a soldier. We cannot touch the gods that, in possession of peoples and nations, send the soldier into battle, nor the anguishing burden the soldier then bears. The language of modern clinical psychology fails to reflect the tragedy at the heart of the pathology. As it focuses on behavioral data, it discounts the utter terror and tremendous grief that the veteran feels. It dismisses, and therefore, it “insults the soul” (Hillman, 1972, p. 121).
According to the DSM-IV one of the characteristic symptoms for PTSD is “persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness” (2000, p. 468). However, with its carefully drawn categories and conclusions, and precautious terms, the DSM-IV persistently avoids stimuli of imagination and attempts numbing. We are in the grip of a major phobia. We are very afraid to enter into the disease and face the gods and their fury.
Driven by Ares’ irrefutable force Hillman (2004) declared that the “syndrome is not in the veteran but in the dictionary, in the amnesiac’s idea of peace that colludes with an unlivable life” (p. 32). Here, Hillman was speaking to our “endemic national disease,” in other words, our addiction to security and innocence, “to not knowing life’s darkness and not wanting to know, either” (p. 133). The very presence of the veteran is a threat to this resolute ignorance. The veteran has been initiated into war; he can no longer be numb to the possibility of pain and death. He no longer believes in innocence. We try to convince him otherwise. We give him a handful of pills and try to convert him back. We are that deep in our denial.
The label PTSD and the rhetoric of psychopathology shield us from the intrusive truth of tragedy, separate our imagination from the dark shadows of Hades. Nonetheless, they cannot protect us from Ares’ rage and unavoidable revenge.
He puts his gun against his head, presses it deep and hard into his temple. The bullet screams. The soul escapes deep down. Hades embraces it at once. A carpet with a small cigarette burn remains behind. A wall with blood stains. A deafening silence. An incomplete return from an unimagined war.
We continue to lose this battle, one veteran at a time.
Hillman (1975) put much emphasis on the insights that derive from “souls in extremis, the sick, suffering, abnormal, and fantastic conditions of the psyche” (p. 55). The veterans are a prime example of this. The experience of war and its demanding affair with the soul may be our opportunity to recognize the confining fantasy of innocence in which we find ourselves again and again. It demands that we re-visit our dread of Hades and Ares, see through our ego-defenses thriving at the heart of psychology and psychopathology, and re-vision our intentions in these fields. Stepping out of our abbreviated form of consciousness and taking a new look at rhetoric may be one of the first modest steps in this long and hard journey that awaits us.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental health disorders (Revised 4th ed.). Washington, DC: Author.
Hillman, J. (1975). Revisioning psychology. San Francisco, CA: Harper Perennial.
Hillman, J. (1972). The myth of analysis. Evanston, IL: Northwestern University Press.
Hillman, J. (2004). The terrible love of war. New York: Penguin Press.
Marsella, A. J. (2011, Summer). The United States of America: “A culture of war”. In International Journal of Intercultural Relations.
Tick, E. (2005). War and the soul: Healing our nation’s veterans from post-traumatic stress disorder. Wheaton, IL: Quest Books.