We're really at the beginning of understanding PTSD I think.

Some anecdotes:

I spent a few months in a war zone years ago, it was beyond stressful. I didn't participate in any combat, and other than a few close-ish calls, came away relatively unscathed. But I was very "wired" for months and months afterwards. The innocent sound of cars driving slowly on gravel, the popping sound of the rocks under the tires, made me hunt for cover from incoming gunfire for example. I was supremely agitated and on edge for maybe a good year after I got back. But after a while, most of it went away and other than the occasional night sweat but I don't have nightmares or anything else. I'm pretty sure I was just very stressed and my adrenaline reaction was primed for a while, but it's not anymore. I don't believe I have or had PTSD.

I once worked with a Vet, long after he had retired. He was textbook untreated PTSD. Decades after he saw conflict, a loud noise, like a piece of equipment falling on a concrete floor, would send him into immediate action mode, one time diving out of his car at a stoplight when another car backfired. He was highly stressed, argumentative over little things and had lots of trouble keeping a job. I met him when I was working a low waged computer service job in the mid 90s.

My father was in the Korean conflict, landed with MacArthur's forces at Inchon and saw quite a bit of action North of the 38th. He was shot in the leg, spent time in Japan recuperating, got hooked on morphine, beat it, went back in, got shot again and finally made his way home. Along the way, he was field promoted from Sergeant to LT simply because everybody above him kept getting killed. Other than 2 or 3 stories he told me once, he doesn't really talk about it. PTSD wasn't a word back then, so he went entirely untreated. Decades later when it was finally understood to be a thing the stigma meant he never sought treatment (in fact he avoids all things military, won't use VA benefits, or hang out at the VFA, that's how he's been treating his PTSD all these years, avoidance). My father doesn't display really any of the daytime symptoms, irritability, chest pain, hyper-vigilance, etc. But my mother tells me that he's always had night issues. Waking up screaming, reliving nightmares in his sleep, sleep walking. It settled down over the years till it was just a rare occasional thing. My mother tells me that when I announced my engagement to my South Korean wife, his PTSD came back in full force. But then as he got to accept her, it went away just as quickly. I found him one day looking at some old National Geographic Magazines one day, looking at pictures of Korea from around the time of the war, then looking at pictures of Korea from today -- this is the first time he's ever looked at anything Korean since the war. My mother says his night issues appear to have gone away completely.

When I was very young, I got to know Nguyễn Ngọc Loan [1][2] quite well. He was a local businessman near D.C. after the Vietnam war. And my family had gotten to know him and his family well and we frequented his restaurant at the local shopping mall. His kids worked summer jobs for my parent's business and watched me from time to time and I think my father and him even did some business together. Obviously he saw, experienced and participated in some pretty brutal stuff. Little known is that he also lost one of his legs in the war so he got as good as he gave. He complained every once in a while about phantom pain in his leg, but AFAIK didn't suffer from PTSD.

I worked another time with a recent Vet or the Iraq War, his unit was blown up in an IED explosion in Iraq, he was a few meters from the blast and was violently thrown to the side with just a few bruises. A couple soldiers in his unit were not so lucky. The VA classified him as partially disabled with Traumatic Brain Injury and PTSD. He said he had nightmares from the incident and trouble sleeping. To treat his PTSD they put him on some kind of medication, which caused him to balloon in weight, but didn't appear to have resolved his night issues. Which lingered on several years later. Other former soldiers who had seen it worse (some with and without PTSD diagnoses) gave him endless grief over his PTSD diagnosis and his weight gain. He felt like he didn't deserve it and it led to lots of depression and social issues. His symptoms sounded almost exactly like mine, only they hadn't gone away, and being a vet, he was part of a social circle that should have given him more sympathy or understanding, but didn't.

It seems that to me that PTSD shows up in many many forms, and it's very complicated. I think it's likely that we'll start to identify patterns in it and produce some finer grained group of related diagnoses: high stress short-term sensitivity, chronic long term hyper-vigilance, etc. And we'll get to know this family of recognized issues and "PTSD" will seem like a brutish and ignorant way of calling all these different and discrete issues.

1 - http://news.google.com/newspapers?nid=950&dat=19781102&id=MW...

2 - https://en.wikipedia.org/wiki/General_Loan