On Dec. 1, the NY Times published a tale rather disturbing to those of us who count dogs not only among "man's" best friends, but our very own. The Times reported on the fairly high, and rising, incidence of post-traumatic stress disorder in service dogs deployed with the military around the world. Such dogs are used to track enemy fighters, help secure buildings in urban combat, and sniff out mines -- among other perilous duties. In the process, they are exposed to the same gunfire and explosions as their human counterparts, and vulnerable to injury in all the same ways.
Including, it seems, mental injury. According to the Times, the diagnosis of PTSD in canines is no older than a year and a half, and still controversial. But whatever the condition is called, the toll of combat exposure among dogs is increasingly clear to the soldiers who rely on them, and the veterinarians who care for them. As many as one dog in 20 succumbs, perhaps more depending on the exposures involved, and winds up with fairly dramatic behavioral disturbances. Some dogs become "wired," demonstrating restlessness, abnormal excitability, and hyper-vigilance. Others cower under tables.
Equally apparent to those caring for these animals is that their expressions of mental anguish can be triggered by environmental stimuli. A dog traumatized in combat may, it seems, decompensate at the sound of even distant gunfire, posing no real threat. While we are limited in our ability to get inside a dog's head, this certainly bears a striking resemblance to the flashbacks associated with PTSD, in which some innocuous exposure recalls the traumatic one -- and results in decompensation.
Also of note is that PTSD in dogs -- by that name, or any other -- is not restricted to the battlefield. Similar reactions have been documented in dogs subject to motor vehicle crashes and other traumas. Most of us have seen, if not first hand, at least in commercials for the ASPCA, what trauma can do to the demeanor of an animal.
My fellow dog lovers and I will readily acknowledge the significance of this sad tale were it to go no further. While trauma to dogs cannot rival trauma to humans as the tragic costs of combat are tallied, at least the human combatants know what is going on. Dogs just trustingly follow where we lead them.
But the tale does not end with the dogs. If psychological trauma can be the tail that wags the demeanor of a dog, it has important implications for how humans treat humans.
Historically, mental health disorders have been denigrated in comparison to more demonstrably "physical" maladies. A person crying out in pain, with a compound fracture of the femur or metastatic cancer, receives a standard of care involving both compassion and appropriate medication. A person crying out from mental anguish with no visible explanation for it may -- even in this modern and ostensibly enlightened age -- be the recipient of insult to compound their invisible injury. There are few disparagements more bluntly dismissive than: "It's all in your head."
That dismissive attitude is quite pervasive. I know this from the privileged vantage point of clinical care. For the past 20 years, I have entered exam rooms with perfect strangers who have proceeded to tell me their most intimate details. What should be the sacred trust of the doctor-patient relationship requires nothing less.
Those details have included an incredible array of mental health disturbances and disorders, even in people who conceal such pain with remarkable effectiveness. Even after 20 years, I am still at times surprised by patients who look for all the world successful, content, and composed -- and then share the secrets of their well-guarded stress, depression, or anxiety.
In others, the manifestations of psychological trauma are less well concealed, although often veiled. The common veil is psychosomatism, with physical symptoms such as headache, chronic pain, chronic fatigue or gastrointestinal upset predominating over any direct evidence of the origins, wholly or partly, in psychological duress.
All too often, such individuals wind up encumbered with a "syndrome" -- the ignominious rubric applied when the full legitimacy of a "diagnosis" cannot be achieved. Often the distinction between syndrome and diagnosis resides in the application of diagnostic testing. If technology can show it's there, you can have a diagnosis. If we have to take your word for it, you are stuck with a syndrome -- which all too often means less respect, for you and your condition alike.
But of course, today's syndrome may well be tomorrow's diagnosis as the power and reach of diagnostic technology advance. It is no fault of a patient that he or she is burdened with a condition for which a diagnostic assay won't be available for another three years. But all too often, we act as if it were.
We medical practitioners can act that way. This is what innumerable patients have told me over the years. A dismissive attitude toward what is just "in their heads" has made such patients angry, discouraged and distrustful of doctors.
But this attitude is not limited to clinicians. As a society, we understand the need for a splint when a bone is broken. When "all" that is broken is one's composure or spirit, we often expect you to just get over yourself.
Which brings us back to the dogs. Dogs, it seems, can be undone by trauma -- and not just battlefield trauma. They can apparently have flashbacks, or a close canine analogue. And psychological trauma can become the tail that wags the disposition of the dog, changing his or her personality very fundamentally.
I suspect few would be inclined to suggest that such dogs are wallowing in discretionary self-pity. Few would argue, and none could argue convincingly, that such dogs should just shrug it off and get over themselves. The simple, uncluttered mind of a dog conveys a fairly straight-forward scene of traumatic cause, and pathological effect. We cannot blame the dog!
Yet we do tend to blame the person in a similar plight. The rationale is that the complex mind and rich psychological resources of our own species should be sufficient to do what the dog cannot. But such thinking is entirely misguided. Rather, if trauma can unhinge the naturally unencumbered mind of a dog, how much more so the natively complex, subtle and highly vulnerable mind of ourselves?
Like their human counterparts, military dogs lose their lives in the line of duty as a matter of routine. We now know they can lose their mental health and equanimity as well. If that loss can help us better appreciate the legitimacy of such conditions in ourselves -- whether due to battle or the lesser slings and arrows of outrageous fortune -- there is potential gain in it as well.
Which leaves us further in debt to our trusting, loyal, four-legged friends.
Follow David Katz, M.D. on Twitter: www.twitter.com/DrDavidKatz