A Quokka Dreeds its Weird

I will be doing a series of posts on Biggles/Worrals-related research I've done, in case it's of general interest and/or usefulness.

They will be linked at bigglesevents; if you have also done research to write Biggles or Worrals, or for your own work or just general interest but it's Biggles-relevant, please feel free to cross-post or link posts there. I'm hoping to get a convenient hub of useful and easily findable information there. They don't need to be essays like this! I will have more posts that are just collections of helpful links.

I completely failed to save my sources for this post, sorry; you should be able to find them by searching for key phrases.

Note: I am using the word PTSD for convenience; it's a much more modern word and was not used at the time periods I'm discussing. If you're interested in historical conceptions of PTSD, I have a lot of posts on it if you're willing to plow through my PTSD tag. Also, I'm using "pilots" as shorthand for any flying combatant.

The modern conception of PTSD and its treatment were founded by Dr. W. H. R. Rivers at the WWI hospital for shellshocked soldiers, Craiglockhart in Scotland. He pioneered talk therapy as a PTSD treatment. Dr. Rivers was considered an outlier at the time, including in Britain, where shellshocked soldiers were commonly seen as cowards and could be subjected to "treatments" that were essentially torture, such as electric shocks. Pat Barker's Regeneration trilogy is closely based on history and is excellent reading for more on Rivers and Craiglockhart.

Pilots were not treated at Craiglockhart so far as I'm aware. The article linked below has some information on how medical treatment for pilots was organized, and suggests that as airplanes were so new at the time, it was believed by medical personnel that flying itself posed special dangers (apart from the obvious) and so PTSD/combat stress suffered by pilots and other flyers may have been considered differently from that of infantrymen, as a medical condition rather than cowardice. It was not called shellshock, but rather nerves.

The Nervous Flyer: Nerves, Flying and the First World War

Note: I have yet to come across literally any source, nonfiction or semi-autobiographical fiction or heavily researched fiction, in which pilots' nerves are seen by pilots as medical rather than psychological.

The early Biggles books were directly based on Johns' own experience as a fighter pilot and on stories he heard from other WWI pilots. In them, nerves is treated as a normal and common occurrence. It's not seen as a form of cowardice or shirking, nor is it seen as a medical issue. It's consistently portrayed as a normal reaction to the extreme psychological stress of aerial combat and the extremely high casualty rates, which caused grief, the knowledge that you could die at any moment, and the belief you would die eventually.

Biggles suffers off and on from nerves throughout the WWI books. He's repeatedly sent away for leave to recover, though with the understanding that it's not a permanent cure, just a respite that will allow him to return and fight again until the next bout. By the time the war ends, he's drinking heavily and flying so recklessly that everyone around him recognizes it as a form of suicidality, and he's about to be posted home permanently to save his life when events intervene. Through all of this, he's shown (and shows to others in similar states) only understanding and sympathy.

The Worrals books I've read so far, which are set in WWII, don't feature anything we'd call PTSD, but they do show some brief combat stress reactions. Other pilots are sympathetic and explain that Worrals isn't showing any weakness, it's normal for anyone involved in combat, and it has nothing to do with her being a woman.

The general level of understanding and sympathy for pilots with nerves does seem to be higher than that for ground troops in nonfiction I've read about WWI. However, the general level of understanding and sympathy for ground troops with shellshock also seems much higher in the trenches than once they get sent away from them, unsurprisingly. So I think a big factor there is that pilots may have been more likely to be sent off for short breaks and less likely to be sent away for lengthy treatment where they risked falling into the hands of sadistic doctors. The extremely short lifespan of a pilot may have made it likely that they'd be killed before they had time to get sufficiently far gone that a short break wouldn't cut it.

Now let's go to Germany. There's some really interesting things going on there, primarily that Germany was conceptualizing civilian psychological trauma reactions as the same as ones caused by war. With a few exceptions that didn't catch on, this didn't happen in the US or England until much, much later. In pre-war Germany, PTSD was recognized as a phenomenon that could be caused by civilian trauma such as an industrial or train accident.

Pre-war, Hermann Oppenheim, a German Jewish neurologist, coined the term "traumatic neurosis." This was basically the idea that traumatic events caused physical effects; witness a horrific industrial accident, and you might have tremors, headaches, insomnia, etc afterward. He believed that it was essentially neurological (not psychological) in nature, and had a whole theory on it that is too complicated to summarize here but is NOT the current theory on the neurological aspects of PTSD.

If you were injured in an accident and had a medical diagnosis, you were eligible for a pension. Traumatic neurosis, as it was literally a neurological injury equivalent to a spinal injury, would have been a medical diagnosis. So the entire concept was fiercely opposed by the government as it would have triggered pension payoffs. The government was joined in its opposition by heads of industry, the German medical establishment, and anti-Semites.

So they needed a different term and theory to cover all the people who had PTSD from industrial accidents, one which would not be pension-worthy and would discredit and discourage anyone trying to get a pension. They came up with "hysteria virilis" (male hysteria), aka "pension neurosis." This was defined as post-traumatic symptoms caused by being a hysterical, unpatriotic, effeminate wimp greedily gunning for a pension.

Note that they did not have any alternative to this idea - if you had post-traumatic symptoms, the only possible explanation was pension malingering.

When WWI started, soldiers were eligible for medical pensions. So the cheap assholes in the government and medical establishment again trotted out hysteria virilis/pension neurosis as their equivalent of shellshock. They conceptualized male hysteria due to war as similar to industrial accident hysteria, and decided the best cure was...

... more work! Very convenient for the war effort, too. They funneled shellshocked soldiers into other kinds of work, which... was better than electrocuting them, at least.

If you tried to get a pension for your shellshock, you had "pension neurosis" and were by definition greedy, selfish, lazy, and unpatriotic. Also, "Male hysteria" was conceived of as being proof that there was already something wrong with you, and that whatever happened in the war triggered but didn't cause it. It was literally considered proof that you had a pre-existing mental condition, and therefore you didn't warrant a pension. The more things change, the more they stay the same.

So if you were a German soldier and had PTSD, you would want to hide it if you wanted to stay in service, because revealing it would get you sent home in disgrace and very possibly also financial difficulties due to the lack of pension. After the war, it would still not be something you'd want to talk about because you'd be labeled a lazy coward gunning for an undeserved pension.

(Note: I don't want to make it sound like Germany and Britain were uniquely horrible to veterans with PTSD. France was, if anything, even worse.)

And now, back to Biggles. Erich von Stalhein was a spy in WWI, which at the time was not only a very secret profession but often considered a disgraceful one that a gentleman wouldn't engage in. It's a very lonely life where you can't talk to anyone about anything, and if you reveal the truth about yourself, people will dislike and despise you.

So when Biggles had issues with combat stress/PTSD, everyone around him was very supportive, made sure he was getting rest and leave without him even having to ask for it, and treated it as a completely normal reaction to unbearable stress. He clearly internalized that as how you deal with severe emotional stress in general - be supportive and matter-of-fact, don't treat it as anything weird, and reassure the person that it's normal and they'll be OK. This comes up again and again in the series - one example is in The Black Peril, when Ginger is upset over maybe killing someone and not even knowing if he had or not. Biggles is brisk but kind, and in a manner that suggests that he's had this conversation a lot before.

If von Stalhein had any issues with combat/espionage stress, he would have had to hide it, and probably would have internalized the general attitude about it to some degree as an example of how he's deeply flawed and doesn't deserve nice things. Which was literally the official position of his country's government and medical establishment: PTSD is proof that you don't deserve a pension and are also a bad person.

Another thing about von Stalhein vs Biggles is that Biggles' symptoms were very recognizably nerves/PTSD as it was conceptualized at the time: nervous tics, suicidal recklessness, impulsivity, obsession, rage, alcohol abuse, the belief that he will die. (Regarding the last: yes, reasonable to believe that he probably or likely wouldn't survive under the circumstances, but he was 100% sure of it.) So other people could very clearly see what was up with him and were sympathetic.

I'm not saying all of von Stalhein's issues are PTSD because he has a lot going on, but I do want to mention some lesser-known symptoms: depression, hopelessness, self-hatred, lack of trust, relationship difficulties/isolation, putting yourself in situations that you know are bad for you because you think you deserve it/think you don't have better options/are used to it. Even today, if you have that set of issues, people tend not to recognize it as PTSD and just think you're a fucked-up person. Which just perpetuates the problem.

What I'm saying is that this needs some fanfic.

Johns was one of those British men of a certain era with a biography that sounds that it can’t possibly be true, featuring more heroics, odd incidents, narrow escapes, and prolific writing than one would expect from any twelve reasonably adventurous people. He was a fighter pilot in WWI, where he had a number of exciting incidents, including accidentally shooting off his own propeller, culminating in being shot down and taken prisoner. He then became an RAF recruiting officer, and rejected T. E. Lawrence for giving a false name. Mostly after this, he wrote 160 books, including 100 about ace pilot Biggles. (I cribbed this from his Wiki article, which is well worth reading.)

These books were hugely popular in the UK for while, and are probably still easier to find there. They were also reasonably popular in India when I was there. I virtually never see them in the US, and had I known this I would have obtained some before leaving India. They weren’t huge favorites of mine, but I did enjoy them and they are excellent for researching early aviation and fighting tactics, such as they were; Johns notes that WWI pilots were not formally taught to fight, but had to learn on the job. Casualty rates were high.

Biggles Learns to Fly is a solid, if episodic, adventure story; the interest is in the very realistic details. It takes new pilots time to learn to spot enemy aircraft while flying, even when a more experienced gunner is screaming that they’re on top of him, because they’re not used to scanning in three dimensions. It fascinated me to read the details of such early, primitive aircraft and aerial warfare. Pilots communicated with hand-signals, and Biggles was sent on his first combat mission after something like ten hours of solo flying.

Here’s an excerpt from the very last page, after yet another heroic action. Major Mullen shot a glance at Biggles, noting his white face and trembling hands. He had seen the signs. He had seen them too often not to recognize them. The pitcher can go too often to the well, and, as he knew from grim experience, the best of nerves cannot indefinitely stand the strain of air combat. The Major sends him off for a week’s rest.

This is what we would now call combat stress (acute stress in civilians), which may or may not be a precursor to PTSD. (It becomes PTSD if it doesn't go away.) I found it interesting because of how matter-of-fact and sympathetic Johns is, depicting it as something that happens to everyone and doesn’t reflect badly on Biggles. Some other writing from WWI sees it as a sign of cowardice or mental/moral deficiency. Possibly he would not have been so sympathetic if Biggles wasn’t back in reasonably good shape after his rest. Or possibly the RAF had a different attitude. Then again, the book was written in 1935. Benefit of hindsight?

That's also a good example of the tone in general; emotions are noted but not dwelled upon. We only get enough of anyone's interior life to make their actions make sense.

Reading for one of my trauma classes. I’m not summarizing the whole thing, just bits I found especially interesting.

Chapter One: Clinical Features of PTSD. Nothing new here.

Chapter Two: Cognitive and Behavioral Features of PTSD.

Amnesia. People rarely have global amnesia for traumatic events (not even knowing it happened or having no memories of any of it), unless they also had a head injury or other physical damage (ETA: or are children, or there were a whole series of similar events, of which only some are remembered. What doesn't happen often: a sober adult has something horrible happen to them, and later does not even recall that it ever happened.) But partial amnesia is extremely common. A typical example is “weapon focus,” in which a person might recall every detail of the gun but nothing about the attacker’s face.

Taylor suggests that this is caused by “attentional narrowing,” which is a common result of extreme arousal. The apparent amnesia is caused by hyperfocus on certain details and total ignoring of others, so the ignored details were never encoded into memory at all. (As opposed to being forgotten or being present but inaccessible.)

My note: be upfront with people about this – they may never be able to recall everything, and that’s okay. Total recall is not necessary to healing.

Guilt. Trauma survivors tend to have a number of incorrect beliefs about the trauma which cause them a lot of pain and suffering. Helping them identify and argue with these beliefs can be very helpful. Great breakdown of common false beliefs on p. 34-35. I’ll just list a few.

- Hindsight bias. “I should have (magically) known the drink was roofied.”

- Justification distortion. “What I did/did not do during the trauma was unjustified.”

- Responsibility distortion. “It was entirely my fault.”

- Wrongdoing distortion. “What I did during the trauma went against my morals and ethics.”

These come about for the following reasons (I only excerpt a few); unraveling them and making them explicit may be very helpful.

- Judging your actions not based on the reality of the situation, but against an ideal or fantasy that didn’t actually exist. “I should have disarmed and kicked the asses of the men who were holding me at gunpoint.”

- Blaming yourself for not acting on ideas you didn’t get until after the fact. “I should have memorized the license plate.”

- Overlooking actual benefits of actual actions. (ie, you got out alive, possibly because of what you actually did.)

- Focusing only on imaginary good outcomes of actions you didn’t take. “If I’d tried to disarm him, I definitely would have succeeded.”

- Not taking into account that when all options are bad, selecting the least bad is a highly moral choice.

- Not taking time and emotional factors into consideration – what you’d do if you had an hour to contemplate it in the peace of your own living room is different from what you do when you have seconds and a gun to your head.

Beliefs about Symptoms

- People with PTSD often think their symptoms mean they’re “going crazy.”

- They tend to interpret emotions or physiological responses as objective truth. “My heart is pounding and I’m frightened, therefore the situation is dangerous.”

- Physical/emotional arousal has become so entwined with negative feelings that they may avoid all arousal, including that caused by exercise or positive feelings. (Anxiety sensitivity.) Interoceptive exposure (inducing arousal in a safe, controlled manner) is good for this.

Clinician's Guide to PTSD: A Cognitive-Behavioral Approach

The great epic Mahabharata describes vivid combat stress reactions exhibited by the ancient worriers.

http://www.lankaweb.com/news/items/2011/01/07/the-history-of-ptsd/

http://io9.com/5898560/from-irritable-heart-to-shellshock-how-post+traumatic-stress-became-a-disease

http://www.tandfonline.com/doi/pdf/10.1080/13674670903101218 (Check this out: PTSD in the Book of Job. Not a bad case, but they are clearly reaching in some parts. The "feelings of detachment or estrangement from others" is more about the person's own feelings than, as in the verse they site, others literally ditching the person.)

Some nice sources here to look into, but one thing I'm noticing is that a lot of people are citing the same 20 or so primary sources, often without quotes. I'm sure there's much more out there that could be turned up with original research.

Two years ago I wrote a set of posts called “A User’s Guide to PTSD.” They attracted a lot of attention, and several people friended this LJ in the hope that I would write more in the same vein. I pointed out that I write about mental illness approximately once every two years, so it could be a long wait. If any of them are still reading, I hope they enjoy this follow-up. If you missed the first set, I've linked them below.

Part I: What I Did In The War. (Introduction; background; what happens during trauma; what happened to me.)

Part II: What Does A Flashback Feel Like? (My history with PTSD, what it felt like to me, and dealing with other people who have it.)

Part III: I Don't Have To Do That Any More. (On recovery; lingering effects; book, film, and TV recommendations.)

I recently underwent training to join a team which counsels people in crisis situations. A crisis situation could be finding the body of a loved one who died of natural causes. It could be witnessing a car crash. It could be surviving a brutal mass murder. (All calls are absolutely confidential, so while I discuss the training a bit below, you will never hear any counseling anecdotes on this blog.) Since the team is run by psychiatrists, they’re very concerned with the psychological effects on the volunteers. During the training, I and the other prospective team members were repeatedly asked to consider what triggers we might have and what situations we might find especially disturbing, so we’d either be able to prepare ourselves or bow out of situations involving those triggers.

Since I was abused as a child, had a family member murdered in a domestic violence situation, had other family members die slowly and painfully of natural causes, was in a serious car accident, and have done several suicide interventions not to mention attempting suicide myself, I was confounded by the idea of avoiding crisis situations with possible triggers. What crisis situation wouldn’t have one?

“I think I’d be upset by dead children,” I hazarded. “That’s one I haven’t encountered yet.”

Statistically speaking, a prior history of PTSD puts you at risk of recurrence should you again be exposed to trauma. We are not strong at the broken places. The broken places remain fragile. We build up our strength around them to compensate. If we’re lucky, that’s sufficient.

I do not expect to have any kind of catastrophic meltdown. If I did, I wouldn’t have volunteered. I do expect that, if I come across a particularly disturbing situation, it will exact some sort of price – some sleepless nights, some nightmares, some hyper-vigilance – the sort of thing I’m subject to anyway if there’s a lot of stress in my life. Basically, the same sort of thing the counselors are subject to regardless of personal history, should they encounter something sufficiently unsettling.

One can’t avoid all stress, but it’s easy to avoid work which puts you into direct contact with other people’s traumas. But avoiding it also exacts a price. I sometimes get a feeling as if a fire alarm went off in my head, a sudden sense of urgency and the conviction that something terrible is happening somewhere and I ought to be doing something about it. This sense can keep going at a low level for weeks on end, periodically startling me with an especially intrusive feeling that I should go! Go now! Run!

I used to identify this as a peculiarly specific anxiety attack, though what it really feels like is the world's most useless psychic power. I cope mostly by consciously acknowledging it for what it is - a habitual firing of neurons that were overused for too many years, and never got used to peace. It's not meaningful. It's annoying background noise. It doesn't mean I have to actually do anything, though if it gets especially "loud" stocking up on earthquake supplies or activities of that nature sometimes helps.

But in fact, terrible things really are happening somewhere at any given time, and I really ought to be doing something about them. I don’t expect that being a volunteer crisis counselor will make the alarm turn itself off permanently. But at least I will be doing something.

(I could elaborate, but I had to write three separate essays over the course of ten weeks on “Why I Want to Join the Crisis Response Team (please detail your strengths and weaknesses,)” and I’m a bit sick of the subject. No, I didn’t say anything about fire alarms in my head. I figure that sort of thing can wait till they know I’m not a raving axe maniac me a bit better. Though I think that if most and maybe all people were to disclose absolutely everything that goes on in their heads, they'd all sound at least as strange as I do.)

A year ago I was involved in several (unrelated) extremely stressful situations. I would lie awake at night thinking, “What if right now [something terrible] is happening?” I should note that this wasn’t my internal fire alarm. There really was a reasonable chance that [terrible thing] might, in fact, be happening at any given moment. That being said, my insomniac obsessing was helping neither the situation nor me. I wanted to see a therapist, but my insurance only covers therapy in cases of “major mental illness” as defined by the insurance company.

I went to a psychiatrist and asked for a diagnosis, only to be informed that in her opinion, I was under a lot of stress and would benefit from therapy, but did not have a mental illness, major or otherwise. “Actually, especially given your history with mental illness and what’s going on in your life right now, I think you’re pretty emotionally healthy.”

You can probably imagine my mixed feelings about that statement. (When I explained the situation with my insurance, she kindly wrote down for their behalf that I met the DSM-IV criteria for an adjustment disorder. “Technically speaking,” she added to me. An adjustment disorder is psychiatrist-speak for “temporarily unhinged by the sort of stressors that occur under normal life circumstances (death of a loved one, job loss, divorce, etc), as opposed to the extraordinary stressors that can cause PTSD (rape, combat, natural disaster, etc).” And yes, the therapy was very helpful. I'm now much better at walking away, letting go, and otherwise not pouring all of myself into a futile attempt to fix someone else's life.)

It wasn’t only that, after so many years of trying to fix my mental illness, the fact that I had largely succeeded was now preventing me from getting needed mental health care. It was also that PTSD, even before I knew what it was, had shaped so much of my identity that I felt strange without it, or even contemplating the idea of being without it. And yet she was only telling me what I already knew. It was as if, after many years of debating with myself over whether I was willing to lay down my armor and weapons in order to get out of the war zone, I found that I had already dropped them. And that I’d known I had, but rather than either pick them up or kick some more mud over them, I’d taken mental note of where they lay, just in case, and tried not to think too much about the lack of weight at my belt and back.

I thought of finding a different metaphor, because PTSD is not actually helpful protective armor but rather a set of massively counterproductive and painful reflexes that can feel like they’re all that stands between you and your own destruction. I also realize that my choice of imagery does not exactly shout out “emotional health.” But the metaphor I used is the one which feels true.

I can sleep through the night. I can eat without having to consciously make myself swallow each bite. I can let people touch me. I can walk down a busy street without flinching. I can sit with my back to a window or door. I can sleep while people walk into my room, if I know in advance that they might. I can let people walk up behind me and not turn around. I do notice when people walk up behind me. I guess I kept a pocket knife.

This is not PTSD as defined by psychiatrists and as recorded by history. I no longer meet a single one of the criteria. By that standard, I don’t have that illness any more. What I have now, technically speaking, is a sub-clinical set of reflexes, attitudes, and sensitive areas that were shaped by the experience of having PTSD.

(By the way, it’s still totally fine to say, “Rachel has PTSD.” I’m not particularly attached to the DSM-IV criteria, nor to the concept of having it now vs. having had it in the past.)

To return to the crisis counseling, I’ve considered the possibility that I’m attracted to it because it offers me the chance or excuse to pick my weapons back up, so to speak. But I don’t want to automatically assume that my subconscious is trying to kill me. Sometimes it’s best to operate under the assumption that your instincts are sound. That nothing bad is happening right now. That you’re not in denial. That, however unlikely it may seem, you really are all right.

Any sort of crisis-related field draws people who have been shaped by trauma. Those fields also draw people who haven’t, but are there for other reasons. I know why I’m there – and that it’s fine that that’s why, but it doesn’t make me a better counselor, let alone a better or cooler or stronger or more compassionate person, than those other guys. It’s just the road I happened to drive in on.

Like my first set of posts, this one is intended solely to reflect my own experience, not anyone else’s. That being said, having gone through all of this, I’ve learned some things:

That trauma is influential, but doesn’t define us or our lives or our choices.

That trauma isn’t what makes us special or interesting or ourselves, though how we choose to deal with it may be one of the things that does.

That we all live with our own private battles and own private pain, even those of us who don't have horrific stories to tell.

That ongoing pain and struggle doesn't mean we're not leading quite happy lives anyway.

That we can get much, much better.

That it isn’t our fault if we haven’t yet.

That change is possible, always, at any time, regardless of what we’ve done or haven’t done or for how long.

That it isn’t hopeless unless we’re already dead.

And that, courtesy of one of our more entertaining training sessions, you’re not dead till the coroner says you’re dead.

We got word that General Westmoreland wanted us to "maximize" destruction of the enemy.

"What the fuck does that mean?" Peewee asked. "We get a Cong, we supposed to kill his ass twice?"

This is one of the best Vietnam War novels I've ever read, and I've read quite a few of them.

It follows the usual structure of a novel from the point of view of an American soldier: the arrival of a naive kid who has no idea what he's in for, his brutal baptism of fire, his bonding with his fellow soldiers, his realization of the absurdity of military rules in a situation where logic doesn't seem to apply; disillusionment, misery, PTSD, questioning of what the war is about and whether killing other scared kids is right; black humor, grief, violence, terror; concluding in either death or a homecoming that, whether it's actually depicted in the novel or not, the reader knows is just the beginning of yet another long and harrowing journey.

Myers' novel fits that structure to a T. What makes it special is that it's just so well done: the black humor is actually funny, the characters are vivid, the atmosphere makes you feel like you're there, the philosophical and moral dilemmas are real and complex. Myers particularly excels at making combat suspenseful without making it seem glamorous. He captures the boredom of the troops without boring the readers by depicting them doing all sorts of ridiculous things, like watching a movie with the reels mixed up, in a desperate effort to kill time.

The dialogue is especially great. I kept marking pages with bits I wanted to quote, then moving the marker to the next page, and the next. Highly recommended.

The book's dedication: To my brother, Thomas Wayne "Sonny" Myers, whose dream of adding beauty to this world through his humanity and his art ended in Vietnam on May 7, 1968.

Click here to buy the paperback from Amazon: Fallen Angels

This is Part II of a three-part essay on Post-Traumatic Stress Disorder: understanding it, having it, writing it.

Part I: What I Did In The War. (Introduction; background; what happens during trauma; what happened to me.)

Part II: What Does A Flashback Feel Like? (My history with PTSD, what it felt like to me, and dealing with other people who have it.)

I Don't Have To Do This Any More. (On recovery; lingering effects; book, film, TV, and music recommendations.)

ETA: Several years later, I added Part IV: Postscript.

( It is generally a bad sign when you lose six months of your life. )

( You don't have to eat the eggplant. )

( If you have PTSD, odds are good that it is not your only problem. )

( Attempting suicide via sleep-deprivation will make you even crazier than you were when you got the crazy idea to try it. )

( What does a flashback feel like? )

( Don't go to sleep with a gun in your hand. )

( NEVER EVER hug a stranger from behind. )

( Or shake a sleeping soldier. )

At this point, you may be wondering how in the world I was managing to lead anything remotely resembling a normal life. Writing this essay, I wonder the same thing. And yet I did get an undergraduate degree, then a graduate degree, have friends, and hold various jobs, all of which I managed to perform with at least some degree of competency.

But, remember that I didn't have all the symptoms all at once. They come and go. I wasn't diving under desks 24-7, just if my level of overall stress, my level of symptomaticness (is that a word?), and outside triggers combined to produce a visible reaction. And even then, a lot of what was going on was not visible to others, because I was highly invested in and skilled at putting up a front of normalcy.

It’s absolutely possible to be completely disabled by PTSD, but it’s also possible to have fairly severe symptoms and still hold down a job and seem more-or-less normal to a cursory inspection. This will be affected by a lot of factors, such as how much money you have and so how much it will affect your life overall if you forget to pay a bill or miss a few days of work, whether you hold a job which requires a lot of concentration and skill to achieve even minimal competency (like brain surgery) or one with more room for error, how invested you are in keeping up appearances, whether and so forth. This is similar to depression, anorexia, or alcoholism: some people hit bottom fairly quickly, and some people never really do.

In literary terms, I’d be surprised if a person’s work life is entirely unaffected, but I’d buy that they could continue working with reasonable or even excellent competence. However, some area of their life is bound to be falling apart, because that’s the nature of the beast. Typically even if your work isn’t much affected, your social, love, or creative life is. Or any variant on that.

Feel free to link, ask questions, comment, share your own experiences, correct my science and statistics, or recommend media on the subject. Also, anyone is always welcome to friend this LJ.

ETA: I do still read and am grateful to receive comments on these posts, even many years later. I can't guarantee to respond to every one because it can be a bit overwhelming, but I do read them.