A study of Norwegian veterans who served in Afghanistan finds that being exposed to the death and suffering of others tends to result in worse symptoms of post-traumatic stress disorder (PTSD) than being put in life-threatening situations.
The study, published in the European Journal of Psychotraumatology, is part of a comprehensive survey of how veterans are faring after the war in Afghanistan. Just over 7,000 Norwegian soldiers participated in the war in Afghanistan between 2001 and 2011, and 4,053 of them participated in this research.
Trauma is roughly divided into danger-based and non-danger-based stressors. Both types of stressors lead to an increase in PTSD, an anxiety disorder which can involve being hyper-alert, jumpy, sleeping poorly and reliving events after they’ve happened.
Danger-based trauma occurs when soldiers are exposed to trauma in classic military settings, such as being shot or ambushed. It is an active threat that is linked to anxiety.
Non-danger-based trauma is divided into two subgroups: Witnessing (seeing the suffering or death of others, without being in danger oneself) and moral challenges (seeing or performing an act that violates a person’s own moral beliefs).
“An example of witnessing might be that a suicide bomber triggers a bomb that hurts or kills children and civilians. Then our soldiers come in to clean up or secure the area after the bomb has gone off and experience the devastation,” said study author Andreas Espetvedt Nordstrand from the Norwegian University of Science and Technology’s (NTNU) Department of Psychology.
Performing actions that violate moral principles can involve killing an innocent person. “For example, an officer may order a person shot because it looks as if he is wearing a suicide vest. But then it turns out that he wasn’t, and a civilian ends up being killed,” he says.
“Another example could be when an officer supervises and instructs an Afghan unit, and then learns that someone in that unit is abusing small children. It can be difficult to intervene in that kind of situation, but easy for a Norwegian officer to think afterwards that he should have done something,” Nordstrand said.
There is a marked difference between how danger-based and non-danger-based stressors affect the symptoms of psychological distress. Non-danger-based stressors are likely to trigger far more symptoms of psychological distress.
In fact, the findings show that exposure to personal life threats often leads to positive personal development. This type of trauma can contribute to the individual appreciating life more, getting closer to relatives and experiencing greater faith in their ability to handle situations.
Non-danger-based stressors, on the other hand, usually lead to negative personal development, where the person values life less, feels more distant from others and has less faith in himself.
Nordstrand’s idea for the study came to him through his job as a psychologist in the Norwegian Armed Forces stress management service, where he noticed that often other issues than having been shot at were plaguing the soldiers.
“A lot of soldiers told stories of how witnessing someone else’s suffering, especially of children who became victims of the war, were tough to work through,” said Nordstrand.
One of the soldiers he’s followed up with had participated in lots of battles without dwelling on them.
“The experience that stayed with him and burdened him afterwards was when he went out onto the battlefield after a bomb had gone off and found a child’s sparkly shoe spattered with blood,” said Nordstrand.
He added that a lot of people hide their non-danger-based trauma and don’t talk about it to their family, friends or colleagues. He thinks this relates to the fact that non-danger-based trauma is often linked to shame and guilt, and that it can be more difficult to talk about than that they were scared in an exchange of fire.
“A lot of soldiers are probably afraid of feeling alienated if they would tell their family and civilian friends of all the horrors they saw and experienced. Such experiences often don’t fit very well with the world view we protected Norwegians have,” Nordstrand said.