TRC Final Report

Volume 4

Chapter 8

Subsection 9

■ THE REALITY AND CHALLENGE OF POST-TRAUMATIC STRESS DISORDER

47 In an oral submission by a psychologist, Mr Gary Koen, and in the written submission by Ms Trudy de Ridder, a number of the common symptoms of post-traumatic stress disorder were highlighted. These include recurrent nightmares, anxiety about and feeling tainted by death, insomnia, heightened aggression, social withdrawal, substance abuse, difficulties in interpersonal relationships and generalised distrust of others.¹³ Mr Koen emphasised that these symptoms can result from a range of events, such as a single episode of life-threatening harm and violence (for example rape and assault). In his submission he focused on war-related incidents, in particular those linked to guerrilla warfare:

Guerrilla warfare, the type of war fought on the South African borders for the past twenty years, contains many unique features not seen in conventional warfare. These include hit and run tactics, surprise ambushes, extensive use of landmines and booby traps, as well as the stress experienced by people who are primarily town dwellers fighting a bush war. Unpredictability characterises this type of environment and the uncertainty of either attack or safety leads to a high level of anxiety and hyper-arousal in anticipation of the next attack.

Whilst the majority of the South African troops were not involved in actual fire fighting, a significant number were exposed to the conditions exposed above. It is these soldiers who have been most likely to suffer the effects of such stress.

48 As an illustration of what it means to suffer from post-traumatic stress disorder, he described the therapy he conducted with a member of the medical corps in the operational area:

S. would often chastise himself for having let others die or even accuse himself of having killed them. His guilt seemed not only irrational but also completely unfair.

Certainly the most painful moment in the whole treatment occurred when he lamented the death of the child, the child who died in his arms, and perhaps the most brutal moment occurred when he smashed his fist into his own face, blaming himself for having caused the child’s death. The contrast between the two experiences was marked.

The first experience evoked an entirely human reaction, the pain of all those who died becoming sensed around this experience of a solitary child’s death. There is nothing more vulnerable and in need of protection than a child, and there is little else that shows up the barbaric nature and violence of war than when a child is killed. S. accessed this awareness in the most painful way; his grief was shy of the most profound despair.

Simultaneously, this experience gave rise to the most abusive and seemingly inexplicable guilt and self-condemnation. In this instance, what required recognition, understanding and containment was [the fact] that there really was nothing that S. could do. His feelings resulted from the tragic consequence of being placed in a situation where he was impotent and helpless. His immense guilt was a reaction against this experience of helplessness. The child in his arms was helpless, and the child died.

Helplessness is equivalent to death, so rather than acknowledge his helplessness, he would condemn himself for living and blame himself for the child’s death. S’s fantasy was that if he [had been] a doctor with somehow the skill to save the child it would have been different. This is known as failed enactment whereby the veteran, by simultaneously experiencing the horror of the incident, also has an anticipatory plan of action to remedy the situation and in failing to do so suffers the consequences for that failure indefinitely.

This profound experience of guilt is not something essentially resolvable. Guilt is integral to the human experience, because it is from the experience of guilt that one draws the necessary insights into the morality of our actions - how they affect ourselves and others. As such, guilt is necessarily ambiguous and it is this aspect that facilitates a movement beyond this stuckness (sic) that characterises traumatic guilt. It provides the possibility of finding some alternate enactment for the image that haunts one, of undergoing personal transformation around that image.

S. had to recognise not only how much he had suffered but also how glad he was that he was alive. Perhaps the most uplifting moment in the whole treatment was when S. welcomed himself back. He allowed himself the pleasure of living again, bringing both relief and joy.

49 A summary and extracts from a mother’s letter, written in Afrikaans, to Archbishop Tutu is further illustration of the various symptoms of post-traumatic stress disorder:

My son was normal and had a happy childhood and successful career until his compulsory enlistment in the army for border duty. Here his problems started, i.e. serious drinking, trying like so many others to forget. He could not come to terms with the horrors of war ... His wife divorced him, leaving a seven-year-old son without a father.

50 His parents, who were pensioners, were devastated. They lost their house (literally) and their son (figuratively). He became an alcoholic. Ministers and family and friends shunned him. Eventually, the son became aggressive and assaulted his mother.

51 The mother wrote that she had no option but to “throw him out of the house”. She says, “if the army could forget” then she “will have to as well”. The letter continued:

One morning a ‘bum’ will be found dead - a child of God whose only mistake was to fight for his country... When you see the mothers sobbing for their children on TV you can understand how I feel. I hate the government for turning my son into a zombie. Somewhere, someone should start a place for such boys, because when he marches his troops through the night there must be many others doing similar things.