A Different Tack: Shipboard Mishaps and PTSD

Cover photo by Mass Communication Specialist 2nd Class Austin Haist (US Navy/Released)

The Smoking Elephant in the Room

The Navy has been in the news again lately. This time for a fire aboard the Wasp-class amphibious assault ship USS Bonhomme Richard (BHR). An aircraft carrier in all but name, its extended loss–whether it is ultimately restored to service or not–represents a major blow to the United States Navy and, by extension, the United States’ ability to project power overseas. And if you don’t care about that, well, it’s a lot of money that could have gone to other causes, too. Point being, it’s kind of a big deal. And as much as I would like to take this opportunity to comment on what this event says about the Navy in general and the surface Navy in particular, I won’t.

To be clear, there are many things wrong with the Navy in general right now and the surface Navy in particular, but the information just isn’t out there yet to determine how the fire aboard BHR fits into all that. The ongoing dialogue over longstanding issues should continue unabated, but no one should be pointing to this event and using it to support one vision of fleet readiness over another. So while I’m confident that something went wrong aboard BHR–I mean, outside major combat operations, a multi-billion dollar warship shouldn’t go up in flames and be written off as “business as usual”–I won’t speculate beyond that. Real harm can be done to real people–people who the coming investigation may well show did nothing wrong–if premature conclusions are drawn based off incomplete information.

What I do want to talk about is this: 40 sailors and 23 civilians were treated for heat exhaustion and/or smoke inhalation as a result of firefighting efforts aboard BHR. While all reported injuries have been described as minor and I have every confidence that’s true from a physical standpoint, the “different tack” I want to approach this from is the specter of PTSD. Why? Because, trauma can occur outside any combat zone. That’s not idle speculation, that’s established fact, and this is as good a case in point to advance that discussion as any.

For the Record

I’ve been planning to do a post or two on PTSD for a while now, but I had intended to lead off first with a discussion of two of the “less glamorous” conditions afflicting servicemembers: the twin specters of Depression and Adjustment Disorder. Too often, where veterans’ mental health is concerned, the discussion jumps straight to PTSD, with an emphasis on combat trauma, and skips right over these more prevalent conditions (about three to five times more prevalent for the Navy). With that said, we have a fairly well-publicized example of a potentially traumatic event occurring outside of a combat zone, and that at least is a part of the PTSD conversation that I think gets overlooked. So here it goes…

Words and Meanings

PTSD is a mental health condition. It does not just occur in combat zones and it does not just effect military veterans, but then neither does it effect all veterans, nor even all veterans who have deployed to a combat zone and been in combat. Each individual will respond to trauma in their own way. Each individual may deal with trauma(s) differently over time. PTSD is a diagnosis that should come after evaluation by responsible mental health professionals, not a term to be thrown about as a way to label or excuse bad behavior from veterans or other survivors of trauma. With that, there are diagnostic criteria that must be met. The following come from the National Institute of Mental Health, but it’s basically the same set of criteria as the Department of Veterans Affairs, and both are derived from criteria laid out in the DSM-5 and it predecessors, going back to 1980:

• Re-experiencing symptoms:
  • Flashbacks
  • Bad dreams
  • Frightening thoughts
• Avoidance symptoms:
  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event
• Arousal and reactivity symptoms:
  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts
• Cognition and mood symptoms:
  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

At least one or more of each of the four basic types of symptoms above (re-experiencing, avoidance, arousal/reactivity, and cognition/mood) must be present. Merely being unpleasant to be around is not, by itself, sufficient reason to call what someone is experiencing PTSD. But even if most or all of the above symptoms are present in scads, there is still one critical criteria that must be met in order for someone to have PTSD: they must have experienced a traumatic event.

Which brings us to…

What is a “traumatic event”?

If there is no traumatic event, there is no PTSD. Examples of traumatic events, as outlined by the Department of Veterans Affairs, are:

• *A serious accident or fire
• *A physical or sexual assault or abuse
• An earthquake or flood
• A war
• Seeing someone be killed or seriously injured
• Having a loved one die through homicide or suicide

*It is enough that death or serious injury is threatened, it does not actually have to occur.

Notably, only one of the above experiences must necessarily involve deployment to a combat zone. All those other things? They can occur anywhere, including, for our purposes here today, a “serious accident or fire.” Notably, someone need not have been seriously injured as a result of the event: the mere fact that they were directly exposed to it, even if they escaped without physical injury of any kind, is enough to satisfy the necessary first pass criteria for PTSD (they experienced a traumatic event). Beyond that, whether or not they have or will go on to develop PTSD, is down to the individual and their circumstances, some of which may be influenced by how those around them respond and the level of support made available in the aftermath.

In short, all the sailors involved in firefighting efforts aboard BHR lived through a traumatic event. Therefore, all of these sailors, many of whom came from ships across the San Diego waterfront, need to have access–and to know that they have access–to resources and treatment for possible PTSD-related symptoms.

Personal Experience

I have PTSD. Not only do I have PTSD, I was medically retired from the Navy based on the severity of my PTSD. My own, personal experience with PTSD is outlined below for illustrative purposes. If you could not care less about my experiences, but are duly concerned for others and so still open to some recommendations, scroll past to the next section:

1. The particular traumatic event that led to my PTSD occurred in 2006. It occurred during shipboard operations outside of a combat zone. It involved minor injuries to a few people, but nothing requiring more than a few days of “light duty.” Even so, any one of us (or all of us) could have died, and people have died in similar events.
2. I was not evaluated for PTSD in the aftermath of the 2006 event. Not even through one of those Post-Deployment Health Assessments.
3. Although I would eventually complete several Post-Deployment and Periodic Health Assessments over the years, I never considered them to be asking about events outside their own particular “reporting period” (that is, the year or the deployment in question). So, for instance, when I completed my first PDHA following the fire aboard USS George Washington in 2008 (I reported just after the fire), I assumed they were only interested in what traumatic events I may have been exposed to during that 2008 deployment, not whatever may have happened years prior that I was still grappling with.
4. I can’t recall getting any sort of Operational Stress Control training until I deployed to Iraq in 2010. At which point I realized I was only just starting to trend to the lighter side of “orange” from the 2006 incident.
5. I came back from Iraq in 2011 firmly in the dark orange-to-red category, and not just due to one thing, but to a collection of events and stressors, including the 2006 incident. But I had just signed SWOCP, and I wasn’t ready for my career to be over yet (which is how I saw things at the time, particularly as a nuke: diagnosis=career killer). I also had shore duty coming up, and who wants to ruin shore duty by having to answer a bunch of questions to a psychiatrist and maybe ending up on suicide watch?
6. The second department head tour broke me. Which is to say that the first one went well enough. Much of the difference had to do with the level of “back-up” I received from the chain of command (see also my earlier post, Tell Me I Suck).
7. I started getting treatment for mental health-related issues in mid-2017 (toward the end of my second department head tour), but it can take a surprisingly long time for the Navy to settle on a diagnosis and stick with it. I was not finally diagnosed with PTSD connected to the 2006 event until early-2018.
8. Had I been properly evaluated for possible PTSD sooner–and received care sooner–it is entirely possible that I would have either (a) been able to continue serving even with the diagnosis, as many people do where symptoms are mild and can be managed consistent with the demands of military service (b) not developed PTSD at all.

Thoughts and Recommendations

Given how my symptoms progressed over time, sometimes being aggravated by outside stressors, consider the following:

1. Whether fighting a shipboard fire (with explosions) seems like a traumatic event to you or not, know that it is, and that this is true whether physical injuries resulted or not. If sailors come away feeling “not quite right” after having participated in firefighting efforts aboard BHR, know that this is both natural and expected. The Navy has mental health professionals to evaluate and treat people who may be experiencing symptoms of PTSD: ensure that sailors have access to them without stigma.
2. Sailors may, rightly or wrongly, fear that their careers are in jeopardy if they seek treatment for or are diagnosed with a mental health condition.
3. Sailors may have some or all of the underlying symptoms of PTSD, but they may not realize it. Even if they realize that something is “not quite right,” they may attribute their symptoms to other stressors or see them as being due to personal failings. Be attentive, and consider: if they say they’re fine, but they don’t act fine… maybe they’re not fine?
4. While the fire aboard BHR provided the impetus for this commentary, traumatic events are liable to happen anywhere and at any time. Go back to that list of possible traumatic events, and consider whether anyone you know has been through one or more of them, whether they were injured or not. Were they ever screened for possible PTSD?
5. For that matter, have you ever been through one of those traumatic events, and if so, have you ever considered how it affected you and your outlook on things?
6. The PDHA and PHA process are among the means by which sailors may seek help for mental health-related issues (but going to medical is faster).
7. A diagnosis of PTSD can be used as grounds for a Physical Evaluation Board (same process as for physical disability) and a finding of unfit leading to medical separation or retirement, as it was in my case, but it need not necessarily. The less severe the symptoms, the more likely to come away with a finding of “fit” or to never end up before a PEB to begin with. You can be diagnosed with PTSD and get treatment for PTSD, and yet never go on LIMDU, never go before a PEB, and never risk your clearance (even I kept my clearance).
8. It’s also possible to frankly and openly discuss suicidal ideation with a Navy mental health professional (I often did) and not end up on suicide watch (I never was).

Conclusion

Many ships sent sailors to help combat the blaze aboard BHR. I cannot imagine how the experience may have affected those sailors on an individual level, and neither can you, even if you were one of them. For some, perhaps even most, this event will have had little to no effect on them, and that’s perfectly natural. For others, this event may have been traumatic, and that also is perfectly natural. Leaders must be attentive, engaging, and have an appreciation for the “known unknowns”–the things we may not even know about ourselves–and must ensure that those around them have access, without stigma, to necessary care. Leaders may even have to help nudge someone towards getting help because, again, sometimes we don’t even really know ourselves, particularly when grappling with the lingering effects of trauma.

Finally, if you haven’t read them already, here’s a couple articles from ProPublica that I think are worth reading, and very much on topic:

Warship Accidents Left Sailors Traumatized. The Navy Struggled to Treat Them.

The Navy Installed Touch-screen Steering Systems To Save Money. Ten sailors paid with their lives.

In that last article, take particular note of how things turned out for the helmsman aboard USS John S. McCain following its collision.

That’s all for now. Please consider sharing.

…trauma can occur outside any combat zone.

Tweet