Archive for October 25, 2016

What’s Your Tribe?

Since July 1, 1970—just one of many lucky days in my life—when I learned that the draft lottery for military service in the Vietnam war had assigned boys born on my birthday a safe 163rd out of 365, I have wondered how I would have handled the traumas of combat.  Now that I treat my age mates at the VA who were less lucky than I, I can’t forget about the question.  Would I have been among the one in six exposed to combat trauma who would later develop post-traumatic stress disorder (PTSD)?

Sebastian Junger, in his recent book Tribe: On Homecoming and Belonging (2016) raises some perplexing questions about our current epidemic of PTSD.  You don’t have to be a soldier with PTSD to find this book relevant to your struggle.  If you’ve ever felt you’re a man or woman without a tribe, this extended but short essay (136 pages) may speak to you.

Why has the rate of PTSD among US soldiers risen over the past century, even though the rates of combat exposure and combat deaths have dropped?  Why are our PTSD rates among US war veterans so much higher than the PTSD rates among war veterans in Israel, Britain, and Sri Lanka?  Why do our drone pilots in a Kansas bunker suffer the same rate of PTSD as our pilots exposed to combat in Iraq (see “Eye in the Sky,” 2015)?

The question that interests all of us is, How resilient will we be when we face our next traumatic threat?  Junger argues that one factor that protects soldiers from PTSD is “unit cohesion,” or the close-knit group within which they cope with life-threatening dangers in battle and after they come home.  In the tribal era the wounded warrior came home to the intimate circle of those who knew and cared for him.  He recovered, lived, worked, and slept in close quarters with fellow warriors and their families, all intimately related.  In the modern era, the soldier comes home often to a family and culture that knows nothing about battle culture and offers too little “unit cohesion.”

We all wonder whom we will come home to after the battle, the car crash, the rape, the earthquake, or the mugging that nearly kills us.  Will our Tribe help us heal?

Though the concept of tight social networks as protection against PTSD and other severe psychiatric illnesses is not new, Junger’s early chapters in Tribe remind us that for most of our civilized history we humans have lived under the protection of our tribe.  Only in the last two hundred years has travel, industrialization, and urbanization weakened, and in some places abolished, tribal rule.  Yet today in rural Kenya and much of the undeveloped world your tribe still dictates your language fluencies, location, marriage options, religion, healthcare practices, education, diet, and your chances for certain jobs.

It’s tempting to think we were more resilient in those tribal conditions, but how many of us would trade our modern autonomy for the protections of tribal life?   A few make that trade; we call it joining a cult.  And in countries like Kenya that are moving from third to second world status, tribalism is widely viewed as a regressive tradition to be overcome in the politics of development.  We have other options now.

Junger’s book made me ask myself what “tribes” I belong to.  Our modern substitute for the one tribe that dictates everything may be the various networks we join.  They don’t exert the influence that tribes can, but they feel like lifesavers for me, and in some sense they own a part of me: my ever-growing extended Wulsin and Wells families, my psychiatry groups within my work (two academic departments, psychosomatic medicine subspecialty meetings, work teams at the VA hospital and the family medicine psychiatry residency, my research project groups), my Antioch writers group, our St Andrews church congregation, my Terrace Park soccer team, my tennis partner group, our Clifton neighborhood.

Like most of you, I get by without one Tribe.  I may need to belong to more groups or networks than the average person, so I devote a lot of time and energy to them. They keep me going; I try to keep them going. And I’m counting on some of my networks to catch me when I fall next or take a hit.   They’re my social insurance plan.  What’s yours?