TIME photography

Bearing Witness to the Legacy of War

Photographer Giles Duley, who lost three limbs in Afghanistan, speaks about his new project

In 2011, photographer Giles Duley began a project that would document the lasting effects of war on people living in cities and towns across the globe where the fighting had ended many years, even decades ago.

That year, while patrolling in Afghanistan with American troops, Duley stepped on an Improvised Explosive Device. The blast nearly took his life; he lost both legs and an arm. After a year in the hospital and nearly 30 operations, Duley returned to photography with a new determination to finish his project, which he calls Legacy of War. The project encompasses 14 countries and comprises photographs, original poetry and music.

Last month, he launched a Kickstarter campaign to help fund the project, which you can contribute to here. Below, TIME Multimedia Editor Mia Tramz caught up with Duley as he continued his work on the project from Cambodia.

TIME LightBox: What’s the scope of the project and the idea behind it?

Giles Duley: The idea came to me I guess four or five years ago. A lot of my work has been documenting the effects of conflict over the years. One of the things I noticed was that there was a lot of commonality between the stories that I heard, and so I became interested in trying to bring all these different stories together. I was actually going to Afghanistan to start the project when I got injured, so I thought it would never actually happen. My plan was if I could get working again, I would return to doing this project.

The thing that really strikes me is that a war doesn’t end when a peace treaty is signed. In school, as you’re growing up, you’re always taught about the dates of a particular conflict. And I was interested [by] what happens after this final date; what happens when the conflict is supposedly finished. Because what I’ve experienced in my work was that the war is not over if people are still dying from it, if they’re still injured, if their lives are still impaired by it.

My idea was to try and bring together stories from approximately 14 countries, showing various themes that kind of crop up in post-conflict countries. That might be land contamination from land mines, from UXOs and it might be the effects of things like Agent Orange or depleted uranium. But it’s also looking at the physical effects on people who are living with injuries, and people living with the psychological trauma of conflict. I wanted to bring all these different stories together and just get people to reflect on the fact that conflict doesn’t end when a peace treaty is signed.

TIME LightBox: Which countries will you be covering and how did you choose them?

Giles Duley: One of the things I kind of want to do is to bring together stories that may be a little bit more familiar to us with stories that are less familiar. Hopefully, by bringing them together, you get to understand the similarities. In the United States, I wanted to look at the effects of trauma on former combatants, especially soldiers from [the] Vietnam War, how their lives have been affected. The same in the U.K. looking at injured servicemen and [those] with PTSD. Then it’s countries like Vietnam with Agent Orange and UXO; Cambodia, Colombia, Laos and other countries like it by land mines. I’ll be doing stories in Angola, which has a huge legacy of war; in Congo or the DRC, I’ll be looking at the effects of sexual abuse in both men and women. In Northern Ireland, I’m looking at the effects of the troubles, [which have] caused poverty and other social issues.

Other countries [will include] Gaza, [where] I’ll be looking at the long-term effects of conflict there. I’ve already done a story on the refugees in Lebanon, a country which really had two tiers of refugees from war. I’ll be looking at refugees in Sahel Sahara. It’s a vast cross-section of stories.

TIME LightBox: How did you arrive at the aesthetic for this project?

Giles Duley: I actually decided to use film for this project — a mixture of 35 mm and medium format. The main reason for film is that I wanted the images to both have a timeless feel and to serve as documents. Many of the photographs will reflect the period when the conflict happened and at the same time, a print made from a negative has a sense of true documentation. In a period when many question the role of Photoshop and other manipulation in documentary photography, I wanted to return to a simpler process.

TIME LightBox: Outside of the photography, what other components are you working into the project?

Giles Duley: I want this to be more than just a set of photographs. As a child, I was really influenced by the poets of the First World War and the black-and-white photographs covering the Vietnam War. They were the two things that really changed my opinion as a very young teenager about conflict. I grew up as a kid [thinking] that I wanted to join the army. I was fascinated by military history. But as I say, it was reading this poetry of people like Sassoon and Wilfred Owen and looking at the photographs of people like Don McCullin that really galvanized something in me, that made me realize the true consequences of war.

I’m very interested in the educational component. I realized that schools are still studying poetry from the First World War. So what I want to do is update that and get poets and musicians writing about current conflicts and their long-term consequences. For me as a photographer, I hope that the poetry and the music will add a different dimension to the work, so that it’s more accessible to people.

TIME LightBox: What’s your process working with these musicians and poets? Are they seeing the photographs you’re making from those particular parts of the world, or are they just writing or creating from their own experiences, or a mix of both?

Giles Duley: Anybody that’s working with me on this project will either be traveling with me at a later stage in the project, or it will be a process of me meeting them, showing them the photographs, and probably most importantly sharing the testimonies of the people who are photographed.

TIME LightBox: What has surprised you most since you started working on this project about what you’re finding?

Giles Duley: I don’t know if it surprised me, but what I’m becoming very aware of is just the enormity of how conflict affects life. [For example], in Vietnam, Laos and Lebanon and Cambodia — you start to look at one story, and immediately that opens up 10 other stories. It’s often in less expected ways or [something] you just don’t think about. Some of the stories are more obvious, like land mines, etc. But when you look at the long-term impact of a child that was born to a woman who was raped, that is a real legacy of war. And they live with that legacy for all of their lives — the psychological trauma of people affected by war is something that is not often talked about or documented, but whole generations of civilians have been traumatized by conflict.

TIME LightBox: Can you talk about where you see the project living when it’s finished and in what form?

Giles Duley: This is a project that has four phases. The first phase is the photographic phase, which is to go out there and document the initial stories. The second phase is to work with poets and musicians to give more depth to the stories. The third phase is then looking at how that body of work comes together through exhibitions and a book. For me that stage is very important because the exhibitions have to be in public spaces. They have to be in places where people interact with these stories who wouldn’t normally go to a photographic gallery.

And I’m also very interested in taking the project back to the countries that I’ve photographed. One of the things that most surprised me is how interested people are in the other countries I’m photographing. People in Northern Ireland are asking me about the people in Rwanda. The people in Vietnam are very interested in stories that I’m going to be doing in Angola, for example.

One of the key elements is, as well as having the photographs exhibited in the public spaces in Western countries, it’s for the exhibitions to return to the countries where these stories first came from, so the stories are shared. Because that’s what it’s all about. It’s about sharing stories. I have no judgments, I have no opinions. I’m merely going out there to try and gather the stories of people affected by conflict and to share those stories.

And then the final stage, the fourth stage, will be educational. And that’s about taking it to schools. It’s about getting it on the curriculum, [so that when] people are taught the historical facts of a conflict, they’re also taught about how a conflict continues to affect people [long after it’s over]. That’s how I see it developing. And hopefully, in the end, it will be something that will kind of take on a life of its own and I can step back and people can continue to share these stories.

TIME LightBox: Your story is also woven into this. How has your experience informed your approach to this project and how it has been integrated into it?

Giles Duley: No matter what I choose to do for the rest of my life, I will live with the scars, both physically and mentally of what happened. So it’s given me a great understanding. But I think more than that it’s kind of focused my ambition and determination to carry this project through because, as I say, every day now I live with a reminder of what conflict does.

It has opened up communication with a lot of people that may have been more suspicious of why I was doing this story; people who see my personal experience and can relate to it. I guess weirdly, although I may be a lot slower as a photographer now and it may be a bit harder for me to work, there’s probably not a photographer in a better position to actually tell these specific stories about the legacy of war.

TIME LightBox: What do you see as the biggest challenges in getting this project done?

Giles Duley: The biggest challenges on a personal level are the travel, the work. I have no legs and I’ve got one hand, and I travel on my own to do this work. It’s not easy. I must admit last year when I found myself in paddy fields in the rainy season in Laos, trying to carry all my cameras and a backpack and my legs getting stuck in the mud, I was thinking, “O.K., who came up with this idea?” [Laughs.] So the obvious challenges like that are there, that in a weird way as I say, also drive me on to complete the story.

Aside from that, obviously this is a project that I’m self-funding. It’s something that I think is important. A lot of NGOs and nonprofits and charities are helping me with the stories. I have years and years of working with NGOs and they’ve been fantastic in supporting this project. So the likes of MAG, which is a de-mining charity; Handicap International; UNHCR; Emergency, which is an Italian NGO; and Find a Better Way, which is another land-mine charity, have all been supporting it. But at the end of the day, I have to find a way to finance these stories, or at least finance the physical costs of the photographic side of it.

The project really I think for me is the defining project of my life. It will probably be the last major overseas project I do because it’s simply so physically draining and difficult for me. But I am determined to carry this out to the utmost of my ability.

This interview has been edited for length and clarity

Giles Duley is a freelance photographer and an Honorary Fellow of the Royal Photographic Society. Follow him on Twitter @gilesduley.

Mia Tramz is a Multimedia Editor for TIME.com. Follow her on Twitter @miatramz.

TIME Innovation

Five Best Ideas of the Day: February 24

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. For some returning from war, a ‘G.I. bill for farming’ eases the transition home.

By Abby Wendle at Harvest Public Media

2. In Egypt, a class project to fight sexual harassment has grown into a campus-wide movement encouraging women to “Speak Up.”

By Ahmed Fouad in Al-Monitor

3. Your kid’s school is missing the tech revolution, and it’s all your fault.

By Jason Tanz in Wired

4. Community courts focus on rehabilitation and compassion for non-violent offenders.

By Henry Gass in the Christian Science Monitor

5. A new ‘Uber for packages’ service is partnering with Waffle House to build a network of delivery points around the south.

By Amar Toor in the Verge

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Crime

Vietnam Vet Loses Bid to Stop Execution on PTSD Claim

Andrew Brennan was convicted of shooting and murdering a 22-year-old cop

A decorated Vietnam veteran who argued he was suffering from post-traumatic stress when he killed a sheriff’s deputy in 1998 lost a bid for clemency on the eve of his scheduled execution. The Georgia Board of Pardons and Parole declined to commute the death sentence of Andrew Brannan to life in prison after hearing from prosecutors and defense lawyers at a Monday hearing.

Brannan was convicted of murdering Laurens County deputy Kyle Dinkheller, who had stopped him for driving 98 mph. Dash-cam video showed Brannan dancing in the street and saying “shoot me” before he pulled a rifle from his car and…

Read the rest of the story from our partners at NBC News

TIME Veterans

Killed in Action, Far From the Battlefield

Iraq Archive 2007
Benjamin Lowy / Getty Images Iraq, 2007: Both a VA psychologist and the veteran who allegedly killed him served in Iraq that year.

VA psychologist gunned down by Iraq war vet

If you check the latest toll at icasualties.org, 4,489 Americans died in the Iraq war. But a killing Tuesday at a Department of Veterans Affairs clinic in El Paso, Texas, should have pushed that figure to 4,490—one of many additional KIAs in the Iraq war that will never be added to its final tally.

KIA means “killed in action,” and might not seem to apply to the death of Timothy Fjordbak, 63, allegedly at the hand of Jerry Serrato, 48, on the fourth floor of the El Paso clinic at Fort Bliss.

But, unfortunately, it does.

Serrato, 48, had served in Iraq for several months in 2007. He was discharged from the Army in 2009 for undisclosed physical reasons. He worked for a short time at the clinic in 2013, where Fjordbak, 63, was the chief psychologist.

A former employee at the clinic has told the Washington Post that Serrato was upset that the clinic had found his claim of post-traumatic stress disorder unwarranted.

“Although we do not know all the details, what we know of the case suggests anger at the VA for denial of benefits,” says Elspeth Ritchie, who served as the Army’s top psychiatrist before retiring in 2010. “Unfortunately, the scenario of angry patients killing their doctors is way too common, both in and out of the military.”

In October, 2013, Serrato allegedly threatened Fjordbak at a grocery store after Fjordbak didn’t recognize him, the FBI said following the murder. “It was a verbal threat —real or not—his (Serrato’s) perception was some wrong had been committed against him,” bureau agent Douglas Lindquist said.

“I know what you did,” Lindquist quoted Serrato telling Fjordbak, “and I will take care of it.” Fjordbak reported what he perceived to be a threat to local police.

Mid-afternoon Tuesday, Serrato went to the top floor of the four-story clinic and killed Fjordbak with a .380-caliber handgun.

VADr. Timothy Fjordbak

Fjordbak left a private practice after 9/11 because he wanted to help veterans, officials said. He had served in Iraq for several months in 2007, just as Serrato did. There was no known doctor-patient or workplace relationship between the two men.

Fjordbak was lauded by troops he had treated, as well as colleagues and friends. “His main thing was that he could differentiate between symptoms of PTSD and traumatic brain injury,” Michael Rushton, a U.S. Air Force veteran treated by Fjordbak in November, told the El Paso Times. “It was a five-hour appointment and it was a very comprehensive series of tests. He was amazing and an excellent guy.”

The tragic case highlights the fog that is PTSD. Few PTSD sufferers are violent, and it’s challenging to attribute specific acts to the malady. “Although PTSD is associated with an increased risk of violence, the majority of veterans and non-veterans with PTSD have never engaged in violence,” according to the National Center for PTSD.

Was Serrato mentally ill? Angry over how the VA handled his case? Suffering from PTSD? Or some combination of those factors?

Victoria County, Tex., Sheriff's Office
Victoria County, Tex., Sheriff’s OfficeJerry Serotta, following a 1997 drunk-driving arrest

We’ll probably never know. After killing the psychologist, Serrato went into a restroom on the clinic’s third floor and killed himself.

Better up that toll to 4,491.

TIME mental health

The Link Between Mental Trauma and Diabetes

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Women with more PTSD symptoms appear to be at a higher risk for Type 2 diabetes, a new study says

Women with symptoms of post-traumatic stress disorder (PTSD) have a two-fold increased risk for type 2 diabetes, according to a new study.

“When we are under stress we are more likely to get sick, but women with PTSD are in this extreme stress response a lot of the time,” says study author Karestan Koenen, an epidemiology professor at Columbia University’s Mailman School of Public Health. The new study, published in the journal JAMA Psychiatry, looked at 49,739 women participating in the Nurses’ Health Study II to assess the link between PTSD symptoms and type 2 diabetes over 22 years. They found that women with the most symptoms had double the risk of developing type 2 diabetes, and that the association increased based on the number of symptoms women experienced.

“It’s so important that people understand PTSD isn’t just in veterans. Most PTSD is just in regular people in the community,” says Koenen. One of the most surprising findings in the study was that using antidepressants and having a higher body mass index (BMI) accounted for about half of the increased risk for type 2 diabetes in women with PTSD. Past research has linked PTSD to having a higher BMI, with some research suggesting that elevated stress response could result in cravings for highly caloric food and lead to weight gain.

The antidepressant link is the most unexpected. An obvious explanation for the link is that some antidepressants cause weight gain, but the researchers argue weight gain isn’t caused by all antidepressants and therefore cannot account for all of the effect. “It’s probably one of the most interesting findings and I don’t have a good explanation for it,” says Koenen.

The researchers say it’s possible that extreme stress can cause changes in the regulation of the body’s immune system, inflammation markers and hormones, which could contribute to the onset of type 2 diabetes.

Ultimately, Koenen believes the study is important because it provides further evidence that medicine can benefit from a more holistic look at patients that includes not just disease but also mental health and psychology. “Our health care system acts like the brain and the body are two separate things. This is just one of hundreds of studies that have now shown that mental health affects physical health and mental health,” she says. “We need a more integrated medical system where the mind and body are worked on together.”

Koenen, who used to work in veterans affairs, says veterans have been asking for such care for a long time, with studies and surveys showing patients often ask for alternative services like yoga. “Patients understand this but the medical system hasn’t caught up,” she says.

TIME Diet/Nutrition

The Spice Ingredient That Can Block Bad Memories

curcumin turmeric
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A study in rats points to the anti-inflammatory power of curcumin

Curcumin, a compound found in turmeric that may have protective effects against neurodegenerative diseases, might one day help those with PTSD let go of bad memories, suggests a new rat study published in the journal Neuropsychopharmacology.

Researchers at Hunter College and the Graduate Center at the City University of New York wondered if the compound could help post-traumatic stress disorder. To test the idea, the researchers fed rats either regular chow or pellets enriched with curcumin. They then conditioned the rats to fear a certain sound by playing a tone, then shocking their foot. After the conditioning, the researchers removed the rat brains and analyzed them. In other sets of experiments, they tried to get the rats to recall the fear memory by performing memory retrieval tests on them.

They found that rats who ate curcumin-spiked food had a much harder time retrieving the fear memory, suggesting that the compound played a role in keeping bad memories at bay.

“The curcumin effectively prevented the reconsolidation of the fear memory, and the effect was very long-lasting,” says Glenn Schafe, PhD, study coauthor and professor in the department of psychology at Hunter College. “It looked to us like very convincing data that the fear memories lost were lost in an enduring manner.”

You can’t draw human conclusions from rat studies, of course, but the results were so promising that the researchers plan to devise a way to test human subjects next.

They don’t yet know the mechanism behind curcumin’s memory magic trick, but Schafe suspects its anti-inflammatory property plays a role. Curcumin can affect cellular processes in the brain, and it’s especially good at targeting inflammation: a response implicated in a wide range of diseases from cardiovascular diseases to Alzheimer’s and even PTSD, he says. “The brain has its own kind of immune system,” he says. “The idea that curcumin, which is a natural anti-inflammatory compound, when introduced in the diet can affect these processes—which have also been implicated in memory formation—is pretty well grounded.”

Memory reconsolidation is a hot area of psycholofgy and psychiatry right now, Schafe says: A therapist will sometimes ask a person with a traumatic memory to recall it, a process that weakens and destabilizes the memory before it’s put back more permanently. Targeting that window with a dietary intervention like curcumin could be useful. “The idea is that the curcumin [interferes with] cellular processes in the brain that are critical for putting a memory into long-term storage,” he says.

Schafe’s rat study used 1 gram of curcumin per kilogram of body weight, which would translate into about 68 grams of curcumin per day for a human—out of reach for even the most avid curry lover. They used such a high dose because the compound is very poorly absorbed by the body, Schafe says, which is one of the major drawbacks right now for this promising natural remedy. And while cooking with turmeric is a good idea, the spice contains only about 3% curcumin. “The question is, how do we get this compound that does so many great things medicinally to get into the human in a concentration large enough to actually make a difference?” he says. “That is the future of this area.”

He hopes that one day, scientists will make a modification of the curcumin molecule to make it far more absorbable with effects at much lower doses. “The fact that we can feed rats curcumin at these very, very high doses that would be untenable in humans and show these effects certainly suggests that it’s worth pursuing,” he says.


‘Trauma Ruptures You in Two’

Rhiannon Cosslett is a writer, columnist and the co-editor of feminist blog The Vagenda.

Four years ago, a man tried to sexually assault and strangle me to death. Your brain does strange things when it thinks you’re about to die

Your brain does strange things when it thinks you’re about to die. It is difficult to articulate just how strange. We forget, most of the time, that we are animals. We are civilized, rational beings, secure in our autonomous personhood, safe in the unassailable certainty of self – “I begin and end here, at the tips of my fingers, at the surface of my skin.” But when another person tries to disrupt that personhood, tries to take from you that autonomy that you have been taught to hold sacred, the primitive takes over and you become unrecognizable. Your sense of self is upturned.

The only way that I can describe it is to say that trauma ruptures you in two. It happened to me when, four years ago, a man tried to sexually assault and strangle me to death as I walked home from a party. Suddenly, there was this new, unrecognizable me, existing in parallel to my normal, rational self. In contrast, she was completely irrational and unpredictable. She was a wounded animal in the corner, flinching at every perceived threat.

As if living your life in a fragile state of fear and hyper-awareness weren’t enough, additional problems come when outside observers try to impose their rational view of the world on trauma victims. Friends and family, police officers, prosecutors, college counselors and, perhaps most relevantly here, journalists, will view your trauma within their own, undisrupted, rational frameworks. They might question why you are recounting the incident with such a lack of emotion, or why you are laughing. They might say that your testimony is inconsistent, as Rolling Stone did when its editors backtracked on their report of the alleged gang rape of student Jackie at the hands of a group of University of Virginia fraternity brothers. There were, they said, “discrepancies” in her account. An original version of their note, which has since been revised, said their “trust in her was misplaced.”

As people clamored to accuse Jackie of lying about her assault, to make her a poster child for false rape accusations, all I could think was, “Discrepancies? That sounds about right.” As Lena Dunham, whose own rape testimony has been subject to the doubting scrutinity of reporters, said, “survivors are so often re-victimized by a system that demands they prove their purity and innocence. They are asked to provide an unassailable narrative when the event itself is hazy, fragmented, and unspeakable.” If anything, I would have been more surprised had a woman who has been held down in a dark room and raped by man after man for hours been able, after all that horror and trauma, to produce a lucid, cohesive, play-by-play account of events.

I don’t know whether Jackie was raped. Only she and the alleged men in the room that night know this. But I do know that discrepancies are a natural consequence of extreme trauma. Few people seem to realize that a muddled, incoherent account of a traumatic incident is almost humdrum in its predictability.

From a neurological perspective, a traumatic incident triggers a fight-or-flight response. The brain’s prefrontal cortex, which is responsible for decision-making, social behavior and personality expression, is temporarily impaired. The non-conscious parts of your brain take over and stress hormones are released. As a result, traumatic memories become stuck, and the rational parts of your brain are unable to access them.

Trauma can severely affect the hippocampus, which converts short-term memories to long-term memories. Memories of the incident become disordered, fragmented, and incoherent. The two sides of the brain stop working together. Trying to produce a coherent narrative from the event, as a police interviewer or a reporter will attempt to do, is an obvious challenge. The victim will struggle to give a linear account and inconsistencies will be pounced upon.

I became aware of the fallibility of memory after I entered therapy for Post Traumatic Stress Disorder. Part of the treatment revolved around reliving, in detail, the night I was attacked. This helps your brain store your chaotic, confused memories properly. Think of it as a filing cabinet, except all the papers are in a muddle on the floor. Your task is to file them. It was emotional, and often tedious work. As the months went on, the Word document that I kept on my computer became longer and longer as events and actions were suddenly recalled and filled in. In comparison to my initial police statement, it was rich with detail. It took nearly a year to get there.

Law enforcement officials will naturally expect a timeline peppered with facts, but for many victims of rape and assault, establishing that timeline is not just a struggle but a near-impossibility. Police and prosecutors need to be more aware of this. They are, essentially, dealing with someone whose brain has been damaged.

We inhabit a culture in which female victims are so often blamed for their own assaults. Yet so many of these victim-blaming statements can be attributed to the affects of trauma. Aside from patchy and disjointed memories, there are other classic behaviors that are relevant here. Observers may ask, “Why didn’t she fight back?” when to freeze and enter a dissociative state is a common response during a traumatic incident. A lack of emotion or numbness when describing events can be explained by the symptom of flat affect. A failure to cooperate with interviewers can be attributed to hyper-vigilance – a need to control the circumstances surrounding the assault after what has amounted to a complete lack of control. A reluctance to go to the police at the time could be explained by the classic evasiveness displayed by a PTSD sufferer. The victim may want to avoid reliving the incident for fear of flashbacks, which inevitably trigger a primitive, panicked response exactly like that which took place at the time. This evasiveness can be conscious or subconscious. I am usually not a forgetful person, but in the months after my attack I would repeatedly forget appointments with my Victim Support officer.

Then, on top of all this, you have the guilt and the shame. The belief that it was your fault. The fear that you will not be believed. A fear that Jackie may have hinted at when she said she tried to withdraw her testimony from Rolling Stone. A fear that was then confirmed. People do not believe her, yet according to a report by the National Center for the Prosecution of Violence Against Women, only 2% to 8% of rape accusations are false.

I have no doubt that our tendency as a society to victim-blame women has its roots in misogyny. But I also think it shows a fatal misunderstanding of the effects of trauma on the brain. Retraining those working in the field is expensive and laborious but of urgent necessity. Your brain does strange things when it thinks you’re about to die. We owe it to victims to try to understand this, to help them piece their ruptured selves back together.

Rhiannon Cosslett is a writer, columnist and the co-editor of feminist blog The Vagenda.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Etiquette

I Have PTSD, and It’s Not a Joke

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I’ve been struggling with this illness for more than half my life now, and I can assure you: it’s not funny


This story originally appeared on xoJane.com.

Sometimes writers make questionable decisions for the sake of comedy. They might drop an f-bomb for comedic emphasis, or use shocking words for dramatic effect. Recently, I’ve noticed a disturbing new trend: using “PTSD” as a humorous term. In the same manner that we’ve begun to remove the words “gay” and “retard” from our “comedic” vocabulary, I believe the same consideration needs to be applied to the term PTSD.

Case in point:

On November 11, xoJane posted two otherwise harmless articles. One, about silly underwear, said: “…I have tween angst PTSD…” Another, an article about expensive beauty products, had a quote that read in part, “I still have ‘poor kid’ PTSD…”

These articles were both published on Veterans Day, a day meant to honor those who serve — many of whom suffer from PTSD themselves. I’m sure this wasn’t intentional, but it was the poorest possible timing.

In the context of these articles, Poor Kid PTSD and Tween Angst PTSD are supposed to be amusing. You’re supposed to imagine that being an angsty tween and a poor kid, respectively, was so traumatic that they now have horrific flashbacks about it. But being embarrassed about shopping at Hot Topic or being afraid that you might experience poverty again is not the same as actually having a PTSD flashback.

As a PTSD sufferer, I have trouble looking the other way when this term is misused, and it bothers me that we are perpetuating this improper use on xoJane. I’ve been struggling with this illness for more than half my life now, and I can assure you: It’s not funny.

The English language is very dynamic. Over the years, the meaning and usage of terms tend to shift. People become a little lax with the words they use, causing their misuse to become commonplace (“literally” now means “figuratively,” for example).

In the case of medical terminology, however, this can be extremely damaging. Using PTSD in a casual, joking manner contributes directly to the deterioration of the term as a whole. Misuse encourages misuse (“Selfie,” anyone? It’s short for self-portrait. There should only be one person in it) and before you know it, you’re dealing with a bunch of people who think they know the proper definition of PTSD, when they actually just know how it is used in comedy writing. It’s dismissive to those of us who actually have the disorder. Imagine the scene:

Me: I think you should know, I have PTSD.

Friend: I know exactly what you mean. I got a really bad haircut last year and I totally have PTSD about going to cheap salons now.

That is not PTSD.

PTSD is not a slight aversion. PTSD is not an embarrassing thought that still makes you cringe a little when someone reminds you of it. PTSD is not a fear of haunted houses or horror movies or clowns.

PTSD is a scratch across the record album that is your brain, forcing your memory to get stuck in a rut and skip. PTSD is a harsh interruption and a reminder of terrible incidents — truly terrible incidents. Incidents that were so disturbing, your brain didn’t know how to process them… so it continues to try.

When I hear people use PTSD in improper context, one thing becomes perfectly clear to me: these folks do not understand what I have gone through. The same way people use the term OCD when they mean “particular” or “well-organized,” using PTSD to mean, “I worry I’m going to get a bad haircut,” is alienating to those of us who suffer from the disorder.

PTSD can be a very solitary illness — one of the symptoms is self-isolation — and hearing someone misrepresent it only seems to further drive home the fact that when it comes to our illness, we are truly misunderstood and alone.

During a PTSD flashback, your brain rewinds to the worst moment of your entire life. Then that horrible moment is amplified and played over and over again. Every nasty sight, sound, smell, and physical sensation, replayed in your brain in an infinite loop. You hate it. You don’t want to see it, you don’t want to think about it, but you are powerless to stop it.

Eye Movement Desensitization and Reprocessing therapy (EMDR) has been shown to help, but there are two caveats: EMDR is expensive, and it also tends to make your flashbacks worse before it makes them better.

The truth of the matter is, my own PTSD — a result of childhood trauma that I’d rather not disclose — is very mild. I have persistent, recurring thoughts, and I am hyperaware of the danger lurking in any given situation. (I like to think of it as being prepared for all possible outcomes, but it means that I can come off as an extreme worrywart.)

The worst of all my symptoms, however, is that I startle easily. Inexplicably, I actually enjoy haunted houses, but in my normal waking life, I’m liable to scream (and sometimes, punch!) if someone approaches me too quickly, or shouts my name from another room. These symptoms have been very difficult to deal with, so I cannot imagine how hard it must be for people who are suffering from severe PTSD.

“How do you have PTSD? You haven’t been in a war.”

That’s what my mother said when I was first diagnosed. Yes, war veterans are extremely likely to suffer from PTSD (more than 30% of Vietnam veterans have had PTSD in their lifetime, and between 11-20% of veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom have had PTSD in a given year). But the fact is, PTSD can be caused by just about any traumatic experience: being in an automobile accident, being the victim of a violent crime, witnessing death or injury, being sexually abused, and of course, facing combat.

About 10% of all women (that’s 10 out of every 100) will experience PTSD at some point in their lives, so it’s likely you may already know someone who is suffering silently from the disorder. I urge you to exercise some sensitivity with your use of this term. It’s a real and painful illness, not something to weave into your comedy routine.

Alison Downs is a copy editor living in Connecticut.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Research

PTSD Raises Risk of Premature Birth, Study Says

The researchers hope that treating PTSD could reduce the risks of premature birth

An analysis of more than 16,000 births by female veterans found that women with posttraumatic stress disorder (PTSD) are significantly more likely to give birth prematurely.

PTSD has long been suspected of increasing the risk of premature delivery, but the study, jointly conducted by Stanford University and the U.S. Department of Veterans’ Affairs, provides strong support for the need to treat mothers with PTSD.

“Stress is setting off biologic pathways that are inducing preterm labor,” Ciaran Phibbs, the study’s senior author and an associate professor of pediatrics at Stanford, said in a statement. The study, published online on Thursday in Obstetrics & Gynecology, offered hope that treatment could prove effective in reducing the risk. While women with PTSD in the year leading up to delivery faced a higher risk of premature delivery, women who had been diagnosed with PTSD but had not experienced symptoms of the disorder in the past year did not.

“This makes us hopeful that if you treat a mom who has active PTSD early in her pregnancy, her stress level could be reduced, and the risk of giving birth prematurely might go down,” Phibbs said.

The implications extend beyond women in combat, since PTSD is not unique to combat. In fact, half of the veterans in the study had never been deployed to combat.

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