| For information on the book explaining PITS in more detail (Perpetration-Induced Traumatic Stress: The
Psychological Consequences of Killing), or for a DVD of a workshop presentation on Killing as Trauma, click here.
The best price on individual copies of the paperback version of the book can be found at Barnes & Noble.
There is also a page on PITS in world literature, a page on PITS in personal stories, notes on therapy, and a
What is it?
Many people have heard of Posttraumatic Stress Disorder (PTSD). This is the professional term for a pattern of
symptoms that used to be called combat fatigue, battle fatigue, or shell shock. In the Civil War of the United States it was
noticed, regarded as cowardice, and treated with contempt. In World War I, it was commonly thought to be due to the
sound of shells, and its origin was thought to be physical. German psychiatrists treated it as being caused by a desire
for compensation and treated it very cruelly, by putting men back in battle immediately.
By the time of World War II, its origin was finally recognized to be psychological , due to suffering a trauma, and
treated accordingly. With the American war in Vietnam, the number of cases grew, and so did the lobby for treating the
veterans more seriously. In 1980, the official psychiatric manual finally recognized it as a disorder and gave it its current
Even so, people were still thinking in terms of PTSD being caused entirely by being a victim of a trauma. The soldier
was scared of being shot, the soldier was grieved over buddies being shot. The idea that the act of shooting could be
traumatizing to the soldier rarely occurred to people. When it did, it was mainly the "atrocities" -- killing civilians or
prisoners in gory ways -- that got the attention, not the ordinary killing of traditional combat.
More recently, some research has been done on this. From U.S. government data on its Vietnam veterans, those who
say they killed have more severe PTSD than those who say they did not. It was not just that they were in more intense
battle, because those who killed in light combat had heavier PTSD scores than those who did not kill even though in
heavy combat. The form of PTSD shows those who say they killed had much more by way of intrusive imagery --
nightmares, flashbacks, unwanted thoughts that just will not go away -- and also much more by way of irritable outbursts.
They also tended to have higher scores on measures of alienation, hypervigilance, and feelings of disintegration. But
those who had not killed were more likely to have the pattern of concentration and memory problems. (This is detailed in
the full book).
The American war in Vietnam had a higher percentage of soldiers actually engaged in killing from previous wars.
Several studies of different wars show that throughout history, only 15-25% of soldiers have worked against the natural
inclination against killing. Vietnam was different because the U.S. military was aware of this problem and solved it by
better training. Bull's-eye targets don't commonly fly around battlefields, so they used more realistic human-shaped
targets that went down when they were hit. With this conditioning, the firing rate in soldiers went way up. If the act of
killing is not only traumatic, but more traumatic than just being a victim of trauma, then it would make sense that the
PTSD rate among American veterans of the war in Vietnam would be much higher than in previous wars.
I have called the form of PTSD which is caused by being active in causing the trauma Perpetration-Induced Traumatic
Stress (PITS). This is not yet recognized in the official psychiatric manual and has barely been studied. In fact, it's at the
stage of being a hypothesis rather than something which is known, because so little study of it has been done.
World literature shows evidence of the idea of PITS. This will be of interest to students of literature and to students of
history. It will be of interest to psychologists who want to see expressions of the experience, not just look at numbers of
how people answer scales or get classified by psychiatrists ("qualitative" as opposed to "quantitative" data). I'm hoping it
will also be of interest to member of the general public. There are many people who take an interest in the idea, but
don't want to wade through the complications and caveats and nuances that are necessary for technical research
writing. Understanding the idea through poems and stories that were originally written for the general public can be a
better way of understanding.
Of course, there is no diagnosis to be made of historical characters long dead, and even less to be made of fictional
characters. Psychiatrists and clinical psychologists pay close attention to the definition and decide whether a person in
their care does or doesn't fit it, so that if someone almost fits it but not quite, they may be counted as "sub-clinical" or
they may not be counted at all. But someone could easily suffer from just one symptom and nothing more, and not be at
the level of a disorder.
A lot of people will never go to seek treatment because their condition isn't bad enough to seek treatment. I have met
several veterans like this, and they were grateful for the information I had because it let them know that what was
happening to them was in fact normal. For every person with a severe case of PITS, after all, it would make sense that
there are several people with milder cases.
Symptoms of Posttraumatic Stress Disorder - American version
paraphrased from DSM-IV, the manual of the American Psychiatric Association
A new definition is coming out in DSM-5 on May 27, 2013. It's very similar, organized a little differently,
and the summary will be changed here once it's available.
A. TRAUMATIC EVENT
B. RE-EXPERIENCING THE TRAUMA
1. RECURRENT, INTRUSIVE RECOLLECTIONS
3. SUDDEN ACTING OR FEELING THE EVENT IS RECURRING
4. INTENSE DISTRESS AT CUES THAT RESEMBLE THE TRAUMA
5. PHYSICAL STRESS REACTIONS TO CUES OF THE TRAUMA
1. AVOIDING ANYTHING ASSOCIATED WITH THE TRAUMA
2. AVOIDING THINGS THAT REMIND ABOUT THE TRAUMA
3. INABILITY TO RECALL SOMETHING IMPORTANT ABOUT THE TRAUMA
4. MARKEDLY DIMINISHED INTEREST IN SIGNIFICANT ACTIVITIES
5. FEELING DETACHED OR ESTRANGED FROM OTHERS
6. BLOCKING OFF EMOTIONS (CONSTRICTED AFFECT)
7. SENSE OF FORESHORTENED FUTURE
D. INCREASED AROUSAL
1. SLEEP PROBLEMS
2. IRRITIBILITY, OUTBURSTS OF ANGER
3. TROUBLE CONCENTRATING
5. EXAGGERATED STARTLE RESPONSE
Symptoms of Posttraumatic Stress Disorder - International version
from the ICD-10 of the World Health Organization: 
"Arises as a delayed or protracted response to a stressful event or situation (of either brief or long duration) of an
exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.
Predisposing factors, such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness, may
lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor
sufficient to explain its occurrence. Typical features include episodes of repeated reliving of the trauma in intrusive
memories ("flashbacks"), dreams or nightmares, occurring against the persisting background of a sense of "numbness"
and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance
of activities and situations reminiscent of the trauma. There is usually a state of autonomic hyperarousal with
hypervigilance, and enhanced startle reaction, and insomnia. Anxiety and depression are commonly associated with the
above symptoms and signs, and suicidal ideation is not infrequent. The onset follows the trauma with a latency period
that may range from a few weeks to months. The course is fluctuating but recovery can be expected in the majority of
cases. In a small proportion of cases the condition may follow a chronic course over many years, with eventual transition
to an enduring personality change."
This is what PTSD is not:
* It's not the same as an acute reaction to trauma -- the negative feelings a person can have right away. Over the
course of time, these can subside. It's when they don't subside, when time and loving care has not been enough, that
PTSD might be a possibility.
* It's not grief. Again, grief lasts a while but subsides over time.
* It's not panic attacks, though such attacks can be associated with it.
* It's not guilt. Though obviously guilt can be associated with post-traumatic stress if it was caused by killing, these are
* It's not just acting crazy. Though irritable outbursts and flashbacks are among the symptoms, paranoia is something
different and delusions are something different.
* It's not the distortion of time or sense of unreality at the time of the trauma. This psychologists call dissociation.
There's reason to believe that it makes PTSD symptoms more likely, but it is not one of the symptoms itself.
* It doesn't come from an imaginary trauma. Though symptoms could be similar, if the event never actually happened,
this is a different problem.
* It doesn't come from things that most people would not regard as traumatic. Over-reacting to things most people would
regard as mild irritants at most is a different psychological problem from PTSD.
Hollywood movies have treated PTSD in various ways. The term is used in the movie Antz, but was used incorrectly --
the veteran was acting crazy, but not with this disorder, according to the definition. This was just a folk mis-diagnosis. On
the other hand, PTSD was never mentioned but clearly portrayed in The Legend of Bagger Vance, complete with one
flashback where the young captain could hear the guns of the war.
There was a remark in "Almost Famous" which indicated a minor symptom of PTSD, which could be regarded as PITS
since it involved a man being involved in a hit-and run accident. In the scene, everyone is making confessions as an
airplane is going down and apparently about to crash. This fellow mentions running away from the accident when the
other was injured and says "I see his face every day." That sounds like an expression of the intrusive imagery.
Similarly, an episode of Star Trek Voyager (broadcast the week of January 29, 2001) had a line from a man who had
committed a murder. He expressed distress and still being able to see the sight and hear the sound of his victim.
As some of the symptoms, if not the full disorder, show up on rare occasions in Hollywood fiction, they have also
shown up in the world's literature and many biographies and autobiographies. There are differences across cultures in
how these things are perceived and expressed, but the same underlying set of symptoms can be seen. PTSD, and
therefore PITS, to be well-founded as psychological categories, must be found in different times and places. There is
quite a bit of variety in expressions.
* * *
For information on the book explaining PITS in more detail (Perpetration-Induced Traumatic Stress: The Psychological
Consequences of Killing), or for a DVD of a workshop presentation on Killing as Trauma, click here.
The best price on individual copies of the paperback version of the book can be found at Barnes & Noble.
There is also a page on PITS in world literature and a page on PITS in personal stories.
The author is available for teaching and speaking.
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