Evidence Shows Trump's Comments on Veterans Could Perpetuate PTSD Stigma

During a campaign event on Monday, Donald Trump said that veterans with posttraumatic stress disorder (PTSD) “can’t handle” what they’ve seen in combat. Criticism of his comments indicated that his choice of words could perpetuate harmful stigmas about mental health, especially in the military.

A veteran participating in the Retired American Warriors town hall event asked how Trump would solve the problem of veteran PTSD and suicide. In his response, Trump addressed “the folks in this room” by saying “you’re strong and you can handle it,” but then drew a contrast between them and people who saw the same things but “can’t handle it.”

Some worried that these comments reinforce perceptions of people with PTSD as weak and could ostracize those who are struggling. Despite Trump’s apparent assumption that none of the veterans in the room were experiencing the disorder, the Veterans Affairs (VA) National Center for PTSD estimates that between 11% and 20% of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom have PTSD in a given year, while Vietnam veterans have a 30% lifetime PTSD prevalence rate.

Critics of the comments, including Vice President Joe Biden, conceded that while Trump’s words were likely not meant maliciously, they still could set back efforts to treat mental illness and prevent suicide among veterans. "I don't think he was trying to be mean. He is just so thoroughly, completely uninformed," Biden said while campaigning for Hillary Clinton.

Mental health experts and veterans’ advocates say that stigma, defined as a negative and erroneous attitude about a person, often surrounds PTSD in the military. The Veterans United Network listed the idea that “PTSD only happens to those who can’t handle tough situations” as the number 1 misconception regarding PTSD. “People often think that having post-traumatic stress disorder is a sign of mental weakness. In reality, even the mentally toughest human can be emotionally affected by something if they aren’t mentally prepared for an event, especially when it comes to combat,” it explained.

Veterans’ own attitudes about PTSD often revolve around a perception of weakness. A meta-analysis of 20 studies on stigmas and help-seeking in the military found that the 2 most endorsed stigma concerns were “My unit might treat me differently” and “I would be seen as weak” with weighted prevalence estimates of 44.2% and 42.9% respectively.¹

Studies suggest that the internalization of negative beliefs about PTSD can result in self-stigma, which then reduces motivation to seek help.² Supporting this idea of self-stigmatization, veterans who screened positive for a psychiatric disorder were more likely to agree with stigmas about perceived weakness.³ Furthermore, because an individual’s feeling of personal responsibility for a mental disorder is associated with lesser likelihood of seeking help, “soldiers may further avoid seeking mental health care if they believe that they should have control over their condition or feel responsible for experiencing symptoms of PTSD.”²

Many initiatives have endeavored to reduce these stigmas, in part by recommending changes from the top. Suggested interventions include teaching unit leaders how to create a climate that encourages soldiers to seek help for mental health issues, and implementing policies of support instead of punishment for soldiers receiving treatment.² Other efforts include websites like VA’s Make the Connection, which features videos from veterans candidly discussing their experiences with PTSD. These emphasize the fact that PTSD can happen to anyone, no matter how strong, tough, or experienced they may be.

References

1. Sharp ML, Fear NT, Rona RJ, Wessely S, Greenberg N, Jones N, Goodwin L. Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiol Rev. 2015;37:144-162.

2. Greene-Shortridge TM, Britt TW, Castro CA. The stigma of mental health problems in the military. Mil Med. 2007;2(157):172.

3. Pietrzak RH, Johnson DC, Goldstein MB, Malley JC, Southwick SM. Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatr Serv. 2009;6(2):108-116.