What is PTSD?
Arizona Congressman Ruben Gallego is a rarity in American politics. The two-term Democrat has spoken openly about his struggles with post-traumatic stress disorder (PTSD), the result of his service as a Marine in the Iraq War.
Even then, he only revealed his symptoms — heightened anxiety and difficulty sleeping — after he was first elected in 2014.
“There is such a stigma that has been created by society,” said Gallego, 38. “Somehow if you have PTSD you can’t be trusted to hold your emotions together.”
Jason Kander, Gallego’s friend and brother veteran, joined that group this week when he dropped out of Kansas City’s 2019 mayoral race.
The former Missouri Secretary of State, widely considered an overwhelming favorite to win, stunned the city with the announcement that he was suffering from untreated PTSD and depression, a result of his 2006 deployment to Afghanistan as an Army intelligence officer.
In his Facebook post, Kander, 37, said that a week earlier, instead of celebrating a record fundraising haul, “I found myself on the phone with the VA’s Veteran’s Crisis Line, tearfully conceding that, yes, I have had suicidal thoughts. And it wasn’t the first time.”
His decision to stand down and seek help drew praise from tens of thousands on social media, including former Vice President Joe Biden.
“Jason — public service takes many forms, and bravely stepping forward today is exactly that,” Biden tweeted Tuesday. “By sharing your story, you are saving lives. Others will get the help they need because of you.”
The disclosure also raised a question: Why haven’t there been more Jason Kanders and Ruben Gallegos?
The numbers suggest that they exist.
Politics at every level is filling with veterans of the first Gulf War, Iraq and Afghanistan. Twenty-seven serve in the House and Senate. More than 200 have entered Congressional races in the 2018 cycle, according to With Honor, a bipartisan group that runs two political action committees to support “principled next-generation veterans.”
The Department of Veterans Affairs estimates that as many as 12 of every 100 Gulf War veterans and 20 of every 100 who served in Iraq or Afghanistan experience PTSD in a given year.
The politics of medical disclosure have slowly evolved in the 46 years since Missouri’s Senator Thomas Eagleton was dropped from the vice-presidential spot on the 1972 Democratic ticket after reports surfaced that he had been hospitalized for depression and received electroshock therapy.
Candidates over the last quarter century have been elected — and re-elected — after revealing illnesses like alcoholism, depression or bipolar disorder.
But PTSD remains almost entirely in the political shadows, misunderstood and feared by voters.
And while many ex-service members in office are outspoken proponents of increased spending to treat veterans with PTSD, discussion on a personal level is virtually non-existent.
Advocates and experts said the public’s perception of the disorder still remains largely fueled by popular stereotypes: Veterans consumed by homicidal rage or crippled by terrifying flashbacks.
Gallego said it means that ordinary expressions of emotion can be treated with suspicion.
“I’ve had people say things to me like, ‘Hey, you seem angry about something. Is that your PTSD coming out?’” he said. “It’s like we’re a hair trigger away from blowing up.”
PTSD and politics rarely mix.
Delaware Democrat Sean Barney, a Purple Heart Army veteran of Iraq shot in the neck by a sniper in Fallujah in 2006, is one of the outliers. Against the advice of consultants, he spoke openly about his sleep disorders and social triggers — both treated with medication and therapy — during his 2016 campaign for Congress.
Barney, who finished third in a six-candidate primary field, did not respond to an interview request.
“You don’t get kudos for acknowledging a mental disorder, particularly if it’s a psychological injury incurred during military service,” said Dr. Jeffrey Lieberman, chairman of the department of psychiatry at Columbia University College of Physicians and Surgeons.
“PTSD is a very real, common and shamefully neglected area of psychiatric medicine.”
PTSD can be caused by witnessing or surviving any kind of life-threatening event. It could be combat, sexual assault, a flood or an earthquake.
According to the National Center for PTSD at Veterans Affairs, it can present with a range of symptoms: reliving the trauma through nightmares, flashbacks or social triggers; becoming quick to anger or unaccountably negative to loved ones; experiencing troubles with sleep or concentration, or being startled by loud noises or surprises.
Police, firefighters and other first responders are vulnerable, as are children who experience violence at home, in their neighborhood or at school.
About 8 percent of the U.S. population will experience it at some point in their lives. Women are more susceptible than men.
Kander, who volunteered for the Army National Guard after 9/11, never saw action during his three months at Camp Eggers from 2006-07. But the fear he experienced was nevertheless life-changing.
In his new book, “Outside the Wire,” Kander described the moments before taking his first Humvee trip outside Eggers, over roads riddled with improvised explosive devices (IEDs).
“I felt fearful, beyond anything I’d ever felt before,” he wrote. “This was, for the first time in my life, the raw physical fear of being killed.”
His meetings with Afghan intelligence contacts kindled anxiety about being kidnapped.
He exhibited classic symptoms soon after returning home to Kansas City, including uncharacteristic anger and intense, paralyzing nightmares. They were marked by an “intense sensation of whatever was threatening me being in the room and moving toward me, so I’d panic and become desperate to sit up and defend myself.”
Although he was back in his own bed, “it seemed that the Taliban captured me every night.”
But Kander wrote that he did not have PTSD and said his symptoms had dissipated. Last week, he acknowledged that he had been in denial.
“I was just trying to convince myself. And I wasn’t sharing the full picture,” he said in his Facebook post. “I still have nightmares. I am depressed.”
That admission came after 11 years of untreated PTSD, during which he established himself as one of the brightest young stars in the Democratic party, serving as state legislator, secretary of state and coming close to unseating Republican incumbent Sen. Roy Blunt in 2016.
Lieberman said Kander’s story “is very plausible,” likening it to an untreated sports injury. While one can remain competitive through grit and determination, he said, the aging process and a declining threshold for pain eventually make it impossible to continue.
Kander’s denial started to waver shortly before he sprang his surprise decision to run for mayor. According to his Facebook message, about a month before he announced his candidacy in June, he contacted the VA for help, but was still unable to disclose his symptoms.
A deep sense of unworthiness fueled some of his hesitancy. Friends like Gallego — whose company lost 46 Marines and two Navy corpsmen between January 2005 and 2006 — had “earned” their PTSD.
“So many men and women who served our country did so much more than me and were in some much more danger than I was,” Kander said.
It seems in retrospect that Kander’s decision to enter the mayor’s race — an abrupt reversal of course after devoting all of his energy to becoming a player in national politics — was a kind of self-medication. He said as much on Facebook.
“I thought that if I could come home and work for the city I love so much as its mayor, I could finally solve my problems ... that I could fill the hole inside of me. But it’s just getting worse.”
For the time being, Kander said he will undergo treatment, which will likely be one of several forms of psychotherapy, medication or a combination of both. Success rates vary with the kind of treatment. There is no “cure,” just effective control of the symptoms. New approaches are emerging, including equine therapy. The healing power of interacting with horses has shown promising results in some studies.
For Gallego, it means dealing with a sense of danger: always sitting with his back to the wall in a public place, or making sure doors are locked in certain situations. He said he has a strong support system, and that his life is good, but “there are moments that pop up and I’m reminded of things.”
Is there a path back to politics for Kander, it that’s what he wants? There are no guarantees. But Gallego likes his chances.
“Absolutely. He’s one of the smartest, most talented politicians I’ve met,” he said of Kander. “He’s doing this to make himself whole again, to be the person he wants to be and not be owned by this. He’ll definitely be back.”
To get help
Veterans Administration crisis line, 800-273-8255.