Psycho social and Moral Development of PTSD
Psycho social and Moral Development of PTSD
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Posttraumatic stress disorder (PTSD) is a malady that has been known by many names for centuries (Dean, 1997). For example, Homer noted behavioral changes in participants in the Trojan Wars that would likely meet the current definition of PTSD (Shay, 1994). However, causation has been poorly understood, and agreement about reasons for symptom onset has been at wide variance (Dean, 1997).
Currently, PTSD is listed as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000). The DSM-IV-TR also describes PTSD cases as being acute (symptom duration of less than 3 months), chronic (symptoms at least 3 months or longer), or with delayed onset (at least 6 months have passed between the traumatic event and the onset of symptoms).
Much of what is known about combat-induced PTSD is oriented to the American experience in Vietnam because con- siderable research has been conducted with veterans of that war (Kulka et al., 1990; Lifton, 1992; Wilson, 1980). Meichenbaum (1986, 1994) attempted to treat PTSD via cognitive-behavioral therapy, emphasizing that clients must recognize disordered behaviors or thoughts prior to having potential for change.
Another approach to treating PTSD is offered by Figley (1995), who included the veteran’s family members in the treatment process via grief and family therapy. The therapy is preceded by an accurate evaluation of the veteran and each fam- ily member accompanied by crisis intervention when needed. On the basis of interviews of veterans experiencing PTSD, Wilson (1980) concluded that the social-personality arena has the best potential for helping veterans experiencing PTSD.
According to Dean (1997), it is common if not normal for veterans to experience dread, guilt, or sadness when recollecting their combat experiences. Combat veterans from various wars report similar feelings, mood swings, temporary inability to relate to noncombatants, and cyni- cism at calls to arms from the “unblooded” (i.e., those who have not seen combat). Why then do some of these combat veterans become dysfunctional?
One pathway to resolving this dilemma may be enhanced understanding of the psychosocial and moral development stages of combat veterans when exposed to war trauma. Specifically, in Vietnam, the average age for combatants was approximately 19 years, a time when forming a coherent personality structure is the predominant developmental task (Erikson, 1963). Wilson (1980) pointed out that a complex mixture of social, political, and moral factors the young Viet- nam combatants faced may have undermined the period of psychosocial moratorium for some of them that society usually provides. Thus, their opportunity to unify critical elements of ego identity may have been interrupted, perhaps leading to arrested psychosocial and moral development.
Erikson (1963) conceived of human development as a psychosocial process consisting of conflicts and challenges occurring at each developmental stage. In his Eight Ages of Man model, Erikson viewed humans as proceeding through stages, each of which presents special crises or challenges related to basic elements of society. Successful mastery of the challenge for each stage enhances the transition to the next stage. Failure to meet the crisis successfully leads to continued ego challenges regarding that crisis even though one moves on chronologically to face the crises of the future stages. Erikson believed that individuals, although having passed through earlier stages unsuccessfully, can learn to meet the chal- lenges of earlier stages successfully later in life. On the other hand, some individuals do not meet the challenges of earlier stages successfully and continue to experience psychosocial problems associated with those crises. For example, they may experience role confusion because they did not successfully achieve psychosocial identity. In the present studies, we refer to that unresolved attempt to meet those challenges of a stage as arrested development.
Our focus in the present study is on three stages—Stage 5: Identity Versus Role Confusion (late adolescence), Stage 6: Intimacy Versus Isolation (early adulthood), and Stage 7: Generativity Versus Stagnation (adulthood). It appears that most combat veterans experience war in their late adolescence.
John G. Taylor, U.S. Department of Veterans Affairs; Stanley B. Baker, Counselor Education Program, North Carolina State Univer- sity at Raleigh. Correspondence concerning this article should be addressed to John G. Taylor, U.S. Department of Veterans Affairs, Vocational Rehabilitation and Employment, Box 4360 (MCAS), Jacksonville, NC 28540 (e-mail: ADJJTAYL2@vba.va.gov).
Psychosocial and Moral Development of PTSD-Diagnosed Combat Veterans John G. Taylor and Stanley B. Baker
Two related studies were conducted in order to investigate whether psychosocial and moral development appeared to have been disrupted and arrested in veterans diagnosed as having posttraumatic stress disorder (PTSD). Study 1 was devoted to developing a measure of late adolescence, early adulthood, and adulthood stages of psychosocial devel- opment. In Study 2, a sample of 32 PTSD-diagnosed and 32 PTSD-free veterans participated. The PTSD-diagnosed participants presented evidence of arrested psychosocial and moral development.
Journal of Counseling & Development ■ Summer 2007 ■ Volume 85 365
Development of PTSD-Diagnosed Combat Veterans
A concern in the present studies was whether veterans diag- nosed with PTSD may have experienced challenges to their psychosocial development at or before the late adolescence stage that may not have been resolved successfully. If so, failure to resolve the crises associated with early stages of psychosocial development may be related to the symptoms or PTSD, and Erikson’s (1963) paradigm may offer recom- mendations for treatment.
Erikson (1963) believed that the challenge for adolescents is to achieve true identity amid the confusion of playing many different roles for expanding audiences in an expanding social world. This is an ideological time. The ideological outlook of society that speaks most clearly to adolescents is rituals, creeds, and programs that define what is evil, uncanny, and inimical. Shay (1994) suggested that the dissonance between these developmental ideals and the brutality of war may lead to a sense of betrayal. Focusing specifically on Vietnam veterans, LeLieuvre (1998) supported the contention that those who experienced PTSD never successfully resolved the psychoso- cial tasks associated with Erikson’s late adolescence and early adulthood stages. Additional research with Vietnam veterans with PTSD indicates that they cannot share experiences, lead- ing to relationship difficulties (Kulka et al., 1990).
Building on the work of Piaget (1932/1965), Kohlberg (1976) posited that moral judgment is developmental in na- ture. He stated that humans proceed through the same stages of moral judgment/development in the same order. However, the rate of development varies, and all do not achieve the same developmental endpoints. The theory suggests six levels of moral development that are classified into three categories: pre-conventional, conventional, and post-conventional.
Although Kohlberg’s (1976) theory is not age specific, and keeping in mind that the average age of American combatants in Vietnam was 19 years, it seemed reasonable to speculate that most veterans were at the conventional stages when involved in combat. Also, research by Rest (1986) suggests that age may be related to levels of moral development. Characteristics of these stages are experiencing conventions, rules, obligations, and expectations as part of oneself and adherence to authority. One might speculate that Kohlberg’s conventional levels of moral development correspond to Erikson’s (1963) psychoso- cial development Stage 5 (late adolescence). Thus, information gleaned from the theories of Erikson and Kohlberg suggested that the average combat veteran, particularly in the Vietnam War, should have been engaged in addressing the challenges of late adolescence psychosocially while having achieved con- ventional levels of moral judgment/development.
In combat, one’s social and moral horizons have been known to shrink (Shay, 1994). Could the combat experience in late adolescence have caused the veterans, later diagnosed as having PTSD, to have experienced arrested psychosocial and moral de- velopment? Could treating PTSD-diagnosed veterans for arrested psychosocial and moral development by helping them to master the challenges associated with those psychosocial development
stages and achieve higher levels of moral judgment/development be a way to help them? Seeking answers to these questions led us to undertake the present studies. Specifically, the purpose of the present studies was to investigate whether psychosocial develop- ment, as described by Erikson (1963), and moral development, as defined by Kohlberg (1976), appeared to have been disrupted and arrested in veterans who were diagnosed as having PTSD.
