PTSD and other psychological issues in Pakistan army

[Ahsan Butt]

Some peoples supports US and Pak army to join .. As they firmly believe Pakistan and US army are brothers in arm i completely disagree with them, are they blind ? they cant see what US done with Pakistan . Go and please read History

Hi All,
@extinct brought up a good topic in another thread. This is about the occurrence of PTSD (Post traumatic Stress Syndrome) in Pakistani army at a lower level compared to say US army soldiers. This is in no way an effort to put down all those millions of fine soldiers of US military, but a humble effort to perform some rational analysis.

Because in the end of the day, I firmly believe that US and Pakistan army soldiers are brothers in arms. Their destinies tied in everywhich way.





Extinct bhai,

I too have relatives in army in the past and in present.

PTSD is not absent in PA, it is of lower intensity than one would expect. So why it is lower in intensity compared to the expected situation? There are many many reasons both professional and social.

1. Average age of fresh recruit in PA is higher compared to Western armies. This allows a bit more mature men to participate in the war and then be able to deal with after effects.

2. Martial traditions - Pakistani army is recruited from a distinct group of regions / tribes. While Western armies have much bigger and wider recruitment base.

3. Retirement age is much much higher in PA compared to Western armies. For example in US army, you do certain numbers of tours of duty, and you are let go into civilian life. In PA (or Indian army), The concept is very very limited and few army men leave army after 3-4 years of service.

4. Family structure. this is linked to #2 above. As most of the soliders come from martial tribes, certain outcomes like death and injury is accepted as "natural outcome", and everyone around the injured /handicapped soldier is willing to lend a helping hand.

5. Lack of alcoholism. While Alcohol in small quantities is great for ones health, the same think can't be said about someone becoming alcohol say finishing 1 or 2 bottles of liquor a day. I suspect a lot of PTSD issues become much worse when you add drug/alcohol abuse.

6. Wars are typically close to home. Pakistani army soldiers can usually come home on a short notice. The last big wars for soldiers from our region, that were long way from home happened to be WWI and WWII. Back then, even US army soldiers suffered much less PTSD. These days US soldiers serve through out the world and thus in many cases loose direct and immediate contact to the families back home. Suppose if we deploy 100,000 troops in Iraq to face off IS, then perhaps PTSD incidents could go up.


Please make sure you look at all of these as a holistic picture and not as individual factors. Some people may try to drag "Islam" into this, but Islam is not a valid reason for lack of PTSD severity. Sikh and Hindu from martial tribes in our region do as well if not better than Muslims soldiers from martial tribes.

So there you have it.

Please feel free to add more if you like.


Thank you.

@Slav Defence, @Luftwaffe, @WebMaster, @Jungibaaz, @jaibi, @notsuperstitious, @Azlan Haider, @ajpirzada, @DESERT FIGHTER, @AgNoStiC MuSliM, @Jazzbot, @Jf Thunder, @Hyperion, @JonAsad, @Nihonjin1051, @cirr, @Cherokee @Donatello, @Genesis, @Bamxa, @SarthakGanguly, @Cat Shannon, @Butchcassidy, @Norwegian, @Mr.UTurn, @GreenFalcon, @Syed.Ali.Haider, @CENTCOM,@Joe Shearer, @scorpionx, @Irfan Baloch, @orangzaib, @jhungary,@Xeric @Icarus

Hi All,
@extinct brought up a good topic in another thread. This is about the occurrence of PTSD (Post traumatic Stress Syndrome) in Pakistani army at a lower level compared to say US army soldiers. This is in no way an effort to put down all those millions of fine soldiers of US military, but a humble effort to perform some rational analysis.

Because in the end of the day, I firmly believe that US and Pakistan army soldiers are brothers in arms. Their destinies tied in everywhich way.





Extinct bhai,

I too have relatives in army in the past and in present.

PTSD is not absent in PA, it is of lower intensity than one would expect. So why it is lower in intensity compared to the expected situation? There are many many reasons both professional and social.

1. Average age of fresh recruit in PA is higher compared to Western armies. This allows a bit more mature men to participate in the war and then be able to deal with after effects.

2. Martial traditions - Pakistani army is recruited from a distinct group of regions / tribes. While Western armies have much bigger and wider recruitment base.

3. Retirement age is much much higher in PA compared to Western armies. For example in US army, you do certain numbers of tours of duty, and you are let go into civilian life. In PA (or Indian army), The concept is very very limited and few army men leave army after 3-4 years of service.

4. Family structure. this is linked to #2 above. As most of the soliders come from martial tribes, certain outcomes like death and injury is accepted as "natural outcome", and everyone around the injured /handicapped soldier is willing to lend a helping hand.

5. Lack of alcoholism. While Alcohol in small quantities is great for ones health, the same think can't be said about someone becoming alcohol say finishing 1 or 2 bottles of liquor a day. I suspect a lot of PTSD issues become much worse when you add drug/alcohol abuse.

6. Wars are typically close to home. Pakistani army soldiers can usually come home on a short notice. The last big wars for soldiers from our region, that were long way from home happened to be WWI and WWII. Back then, even US army soldiers suffered much less PTSD. These days US soldiers serve through out the world and thus in many cases loose direct and immediate contact to the families back home. Suppose if we deploy 100,000 troops in Iraq to face off IS, then perhaps PTSD incidents could go up.


Please make sure you look at all of these as a holistic picture and not as individual factors. Some people may try to drag "Islam" into this, but Islam is not a valid reason for lack of PTSD severity. Sikh and Hindu from martial tribes in our region do as well if not better than Muslims soldiers from martial tribes.

So there you have it.

Please feel free to add more if you like.


Thank you.

@Slav Defence, @Luftwaffe, @WebMaster, @Jungibaaz, @jaibi, @notsuperstitious, @Azlan Haider, @ajpirzada, @DESERT FIGHTER, @AgNoStiC MuSliM, @Jazzbot, @Jf Thunder, @Hyperion, @JonAsad, @Nihonjin1051, @cirr, @Cherokee @Donatello, @Genesis, @Bamxa, @SarthakGanguly, @Cat Shannon, @Butchcassidy, @Norwegian, @Mr.UTurn, @GreenFalcon, @Syed.Ali.Haider, @CENTCOM,@Joe Shearer, @scorpionx, @Irfan Baloch, @orangzaib, @jhungary,@Xeric @Icarus

@ALi
I completely disagree with your opinion as US and Pakistan soldiers are brothers in arms. i shocked how can you say this ? raymon davis , memo gate are the worst example of it.,

 

[extinct]

At a very superficial level, the more the Indian Army expands beyond the so-called martial races, the more the cases recorded of stress in serving soldiers, expressed not in classic terms as described as the symptoms of PTSD, but clearly seen in instances of nervous breakdowns, of fragging and of suicide.
...
PS: Read posts 12 and 13 after writing this above.

Glad to read some rational attempt to make sense of it... I do not agree that it has anything to do with some groups having more stomach for "acceptance of violence in civilian life"... Sindhis, Punjabis, Pathans or Balochs are very hospitable people but that does not mean they are pushovers... They all have areas where you can "mine" for the "martial ore" and again that does not mean that they are violent by nature... They however do have a strong sense of culture, traditions and pride and that triggers reactions that the offenders might not appreciate to put it lightly... This unique quality makes them a martial race and does not mean being violent in civilian life... Its kinda like Texans who have a strong sense of belonging and pride and they mark their territory, where you are most welcome as a friend but a hell if you are a foe...

Curious to know why exactly did the "martial ore" dried up for IA and they had to go looking elsewhere? There is no such concern for PA... and any act like the APS Peshawar only reinvigorates it...

Some peoples supports US and Pak army to join .. As they firmly believe Pakistan and US army are brothers in arm i completely disagree with them, are they blind ? they cant see what US done with Pakistan . Go and please read History
@ALi
I completely disagree with your opinion as US and Pakistan soldiers are brothers in arms. i shocked how can you say this ? raymon davis , memo gate are the worst example of it.,

Calm down my friend @Ahsan Butt ... I would gladly answer your concerns if you please fix the English in your post or alternatively write it in Roman / Nustaliq Urdu...

As an example... "they cant see what US done with Pakistan" in your post above should state "they cant see what US has done to Pakistan"... but hey that sin falls in your English teacher's lap...

 

[Icarus]

I don't know of any instance of PTSD or any other psychological problems in the PA !

Unless I'm mistaken we don't even have the problem of soldiers committing suicide 'cause of psychological issues.

What say you @Xeric @Icarus ?

PTSD is part and parcel of high stress jobs where you have no routine, no semblance of a 'normal' life, where you see your best friends bleeding to death and you are powerless but to watch, where you are in a constant adrenalin rush waiting to kill or be killed. So yes, troops deployed to the front lines do suffer from PTSD.
That being said, we are a tough people and I have never seen or heard anyone committing suicide or harming others due to PTSD, in fact I fail to remember anyone who even took counseling for their PTSD.
In my own case, it was about two months of vivid nightmares and some trouble sleeping, that was all. At no point was I suicidal or taking any medication.
Its not the PTSD that drives people to social anxiety and suicidal tendencies in the west, it is their dependence on drugs to alleviate that suffering. Just allow your brain to readjust its hormonal balance in its own time and you should settle back just fine.

 

[Bouncer]

Interesting discussion!

I refuse to believe that PA soldiers are not prone to PTSN. I don't think the alleged absence of PTSD from PA has anything to do with this old and abandoned "martial race" theory. There could be three reasons;

1. Since we are primarily comparing US Army with PA, medical care in the US is obviously way more advanced than Pakistan. They have diagnoses and treatments for diseases which are not termed as diseases at all in Pakistan! So its quite possible that our soldiers do suffer from PTSD but the symptoms are brushed aside as fatigue etc. So these cases are not reported.
   
2. Family structure: we have a very strong family based culture. Our soldiers return to their wives, parents, siblings and children in their cities and villages. US soldiers (my knowledge is based on newpapers, movies, TV shows) return to their partners (wives/GFs). Family values are different. Pakistanis are not afraid of sharing their thoughts. I guess its a little different in the West. So this natural family based therapy is absent for average US soldier.
3. Finally, an average Pakistani has probably heard about or seen more violence than an American. This probably "dampens" the effects of atrocities you see / commit in a war?

Then again I am no psychologist and this is the first time I am participating in a discussion on the subject.

 

[Joe Shearer]

Glad to read some rational attempt to make sense of it... I do not agree that it has anything to do with some groups having more stomach for "acceptance of violence in civilian life"... Sindhis, Punjabis, Pathans or Balochs are very hospitable people but that does not mean they are pushovers... They all have areas where you can "mine" for the "martial ore" and again that does not mean that they are violent by nature... They however do have a strong sense of culture, traditions and pride and that triggers reactions that the offenders might not appreciate to put it lightly... This unique quality makes them a martial race and does not mean being violent in civilian life... Its kinda like Texans who have a strong sense of belonging and pride and they mark their territory, where you are most welcome as a friend but a hell if you are a foe...

Curious to know why exactly did the "martial ore" dried up for IA and they had to go looking elsewhere? There is no such concern for PA... and any act like the APS Peshawar only reinvigorates it...

These were tentative conclusions: I have little or no knowledge of these areas, and would rather watch the exchange of views between more knowledgeable people.

The broadening of the window of recruitment in the Indian Army was deliberate policy. If you see the officer intake, which is based on two or three points of entry, the composition is still the same. Sikhs, including them, Punjabis in general, along with them, Haryanvis, closely followed by Rajputs, Garhwalis and Kumaonis, and Dogras, and the Kodava from the south, the mandatory number of Nairs - all are there, in their traditional numbers. However, recruitment into the regiments at enlisted man level is spread fairly widely across the nation. As a result, there are quotas for each recruiting centre, and there are riots and unhappiness once the quota is met and the doors closed.

Calm down my friend @Ahsan Butt ... I would gladly answer your concerns if you please fix the English in your post or alternatively write it in Roman / Nustaliq Urdu...

As an example... "they cant see what US done with Pakistan" in your post above should state "they cant see what US has done to Pakistan"... but hey that sin falls in your English teacher's lap...

PTSD is part and parcel of high stress jobs where you have no routine, no semblance of a 'normal' life, where you see your best friends bleeding to death and you are powerless but to watch, where you are in a constant adrenalin rush waiting to kill or be killed. So yes, troops deployed to the front lines do suffer from PTSD.
That being said, we are a tough people and I have never seen or heard anyone committing suicide or harming others due to PTSD, in fact I fail to remember anyone who even took counseling for their PTSD.
In my own case, it was about two months of vivid nightmares and some trouble sleeping, that was all. At no point was I suicidal or taking any medication.
Its not the PTSD that drives people to social anxiety and suicidal tendencies in the west, it is their dependence on drugs to alleviate that suffering. Just allow your brain to readjust its hormonal balance in its own time and you should settle back just fine.

I really appreciated that input, and my rating was by no means a tit-for-tat matter. Only those who have served can be trivial or airy about this problem. For those of us who are non-combatants, we can only contribute observations and vicarious experiences.

 

[SipahSalar]

This thread is very biased. I personally know of a Commanding Officer in PA who is suffering from PTSD. His battalion had suffered heavy casualties (40+) in WOT under his command. He has to see a psychiatrist from time to time and is on medication.

If such senior officers are not immune from it then I'm sure its much worse at lower ranks. And there is nothing to be ashamed of in this, it just shows what our soldiers have to face everyday and we must salute them and admire them even more.

 

[jhungary]

I suffered from PTSD after my second tour, I drank, I shoot up, and eventually I tried to kill myself by slitting my own wrist.

If you don't believe me, this is my left hand, I can't show you the photo of the day I do crack and drink, but the scar from cutting my own wrist is still there

I will have to say, if you are talking about PTSD, then no one, no organisation in this world is ready to deal with, and it don't just happened to lowly soldier, we officer saw the same crap as them and we do the same thing in war, what's more, it's an officer job to send someone to death, and this is your job to choose which one you want to expand.

People need to understand what we see in war is not normal, and PTSD associated a lot with shellshock too, where the French describe it as "One's soul is dead yet his body stay alive, and the brain justified on this facts." When you do enough crap,, you bound to have PTSD.

You can say the discover rate is low simply because of either, 1.) You want to put up a brave face, 2.) you don't realise when you have it. I still remember the first day I got back home you just can't help but look at the car parked in line on the street outside your local Walmart, you starting to go automatic mode by checking occupant, and check if the suspension is lowered. And then you have nightmare at night.

No one is immune to PTSD, and it never really goes away, I mean, how do you get away from the feeling of feeling guilty? Either you killed or something you do that someone else is hurt, but not you, that's call survival guilt. In the end, with or without medical intervention, you would realise this is what you going to live with until the day you die.

I know it's kind of grim, but that is the reality.

In war, people who feel nothing is either lying or a true psychopath........

 

[SQ8]

Before we talk about anything else, please present the basis for claiming that "PTSD is of a lower incidence and/or intensity in PA" other than anecdotal stories and impressions.

Data about the US forces looks at the issue in detail and is available openly:

How Common is PTSD? - PTSD: National Center for PTSD

It is incorrect to assume that PTSD is not of similar level as elsewhere, however the typical opiate for the masses that is religion boths masks and offsets the diagnosis of the condition.

It's probably around, undiagnosed. I'm sure it's there, just not recognized for what it is and called PTSD.

A soldier or officer being more vociferous in their family life, in their religious practice or in their attitude may not be recognized as effects of PTSD. @jhungary

 

[jhungary]

It is incorrect to assume that PTSD is not of similar level as elsewhere, however the typical opiate for the masses that is religion boths masks and offsets the diagnosis of the condition.

A soldier or officer being more vociferous in their family life, in their religious practice or in their attitude may not be recognized as effects of PTSD. @jhungary

That's actually the problem, I don't even know I have them until I was in a downward spiral. Nobody tells me what is PTSD, before and after the war, and you just think it's some crap you are going to think, it's like your mind is playing trick with you.

You started to move back in the alert status you had in a war zone, even tho you are in a Kmart Parking lot. You started to check out people, and all in while you don't even realise you are doing that.

If the government would just explain it a little instead of let soldier going in blind, I guess that would save a lot of live, I was nearly dead myself from it............And you are talking about the US Army....

Interesting discussion!

I refuse to believe that PA soldiers are not prone to PTSN. I don't think the alleged absence of PTSD from PA has anything to do with this old and abandoned "martial race" theory. There could be three reasons;

1. Since we are primarily comparing US Army with PA, medical care in the US is obviously way more advanced than Pakistan. They have diagnoses and treatments for diseases which are not termed as diseases at all in Pakistan! So its quite possible that our soldiers do suffer from PTSD but the symptoms are brushed aside as fatigue etc. So these cases are not reported.
   
2. Family structure: we have a very strong family based culture. Our soldiers return to their wives, parents, siblings and children in their cities and villages. US soldiers (my knowledge is based on newpapers, movies, TV shows) return to their partners (wives/GFs). Family values are different. Pakistanis are not afraid of sharing their thoughts. I guess its a little different in the West. So this natural family based therapy is absent for average US soldier.
3. Finally, an average Pakistani has probably heard about or seen more violence than an American. This probably "dampens" the effects of atrocities you see / commit in a war?

Then again I am no psychologist and this is the first time I am participating in a discussion on the subject.

Better medical care in the US is one thing, but the knowledge and realisation is another. And if you have PTSD, you would probably push your family and GF/Wife away.

 

[Koovie]

Unfortunately many still regard PTSD not as a real issue or as something that does not comply with martial values or the notion of manhood in most non western nations despite the clinically proven fact that its a very very serious issue!

Many western nations already have specialized hospitals with the soul purpose of treating these conditions.

 

[VCheng]

It's probably around, undiagnosed. I'm sure it's there, just not recognized for what it is and called PTSD.

Of course it is there, it is the incidence that we are trying to estimate, given the lack of formal data.

Then, of course, is this immortal line:

"We don't have any gays in Iran." - Mahmoud Ahmedinijad.

It is incorrect to assume that PTSD is not of similar level as elsewhere, however the typical opiate for the masses that is religion boths masks and offsets the diagnosis of the condition.
...............

"Opiates" are potent in many ways indeed.

 

[VCheng]

Before we talk about this further, let us review what is PTSD:

DSM-5 Criteria for PTSD - PTSD: National Center for PTSD

DSM-5 Criteria for PTSD

In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (1).

The diagnostic criteria are specified below.

Note that DSM-5 introduced a preschool subtype of PTSD for children ages six years and younger. The criteria below are specific to adults, adolescents, and children older than six years.

Diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition.

Two specifications are noted including delayed expression and a dissociative subtype of PTSD, the latter of which is new to DSM-5. In both specifications, the full diagnostic criteria for PTSD must be met for application to be warranted.

Criterion A: stressor

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required)

Direct exposure.
Witnessing, in person.
Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Criterion B: intrusion symptoms

The traumatic event is persistently re-experienced in the following way(s): (one required)

Recurrent, involuntary, and intrusive memories. Note: Children older than six may express this symptom in repetitive play.
Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).
Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
Intense or prolonged distress after exposure to traumatic reminders.
Marked physiologic reactivity after exposure to trauma-related stimuli.

Criterion C: avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event: (one required)

Trauma-related thoughts or feelings.
Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

Criterion D: negative alterations in cognitions and mood

Negative alterations in cognitions and mood that began or worsened after the traumatic event: (two required)

Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs).
Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous").
Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).
Markedly diminished interest in (pre-traumatic) significant activities.
Feeling alienated from others (e.g., detachment or estrangement).
Constricted affect: persistent inability to experience positive emotions.

Criterion E: alterations in arousal and reactivity

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (two required)

Irritable or aggressive behavior
Self-destructive or reckless behavior
Hypervigilance
Exaggerated startle response
Problems in concentration
Sleep disturbance

Criterion F: duration

Persistence of symptoms (in Criteria B, C, D, and E) for more than one month.

Criterion G: functional significance

Significant symptom-related distress or functional impairment (e.g., social, occupational).

Criterion H: exclusion

Disturbance is not due to medication, substance use, or other illness.

Specify if: With dissociative symptoms.

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
Derealization: experience of unreality, distance, or distortion (e.g., "things are not real").

Specify if: With delayed expression.

Full diagnosis is not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

References

American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.

 

[SipahSalar]

If you don't believe me, this is my left hand, I can't show you the photo of the day I do crack and drink, but the scar from cutting my own wrist is still there

I spy a battlefield game.

 

[Icarus]

This thread is very biased. I personally know of a Commanding Officer in PA who is suffering from PTSD. His battalion had suffered heavy casualties (40+) in WOT under his command. He has to see a psychiatrist from time to time and is on medication.

If such senior officers are not immune from it then I'm sure its much worse at lower ranks. And there is nothing to be ashamed of in this, it just shows what our soldiers have to face everyday and we must salute them and admire them even more.

Like I said, everyone has PTSD but at no point are they a threat to themselves or others. My formation (not unit) took 176 fatalities alone, so I am no stranger to the toll that the stress of having to always be prepared to hoist a coffin into the heli entails. That being said, everyone deals with PTSD differently, I have seen a young officer of the medical corp going AWOL after he almost cracked treating battlefield wounded all the time, needless to say he was court martialed and received a dishonourable discharge.

So I would once again reiterate:
*Everyone suffers from PTSD
*But its not as big a problem as with our friends in ISAF

This probably has to do a bit with our personal capacity to bear violence which is cultivated since a young age as pointed out by Sir @Joe Shearer, in a western society, the instances of violence such as a burglary, murder, theft, family feud are minimal compared to our society and thus they arrive in the combat zone as virgins whereas we are already accustomed to a degree of violence.

You can say the discover rate is low simply because of either, 1.) You want to put up a brave face, 2.) you don't realise when you have it. I still remember the first day I got back home you just can't help but look at the car parked in line on the street outside your local Walmart, you starting to go automatic mode by checking occupant, and check if the suspension is lowered. And then you have nightmare at night.

I can totally associate with that, after coming back from active Ops are I used to drive like a maniac, I was constantly scanning the roadside for IEDs and watching out for cars moving too close to mine. I would survey people and pick off people I don't like and then I'd be thinking about how I should probably report them to the Police before they blow themselves up.

I spy a battlefield game.

Looks like BF4, you're a sneaky one....

 

[Providence]

I feel obliged to respond since I see some fallacious argument being peddled here like PA has less PTSD than US Army ? And why is that ?

Our soldiers are not stretched by any means and with the emergence of drones, are not exposed much to explosions and similar situations on a daily basis. Which is in total contrast to PA.

In fact PA now functions as a police in some cities with high no of such incidents. PA simply doesn't have enough resources to follow up and research the matter can be the probable reason for such PTSD cases going unreported !