Combat-Activated Thymic Disorientation DW Alexander A thesis submitted for the degree of Doctor ...

294 Pages·2016·1.18 MB·English

Combat-Activated Thymic Disorientation

D. W. Alexander

A thesis submitted for the degree of Doctor of Philosophy

Centre for Psychoanalytic Studies

University of Essex

July 2016
ii
ABSTRACT

This thesis addresses the complexity of the experiences of severely
distressed contemporary combat veterans in the Western world. It examines the specific
features of their affliction that is not accounted adequately for either by the
existing psychiatric approach to mental health disorders or by the complementary
psycho-philosophical “moral injury” paradigm. Following a systematic review of the
relevant literature, a new approach is proposed to address these distressing phenomena
of combat-related disorientation based on thymos, an ancient Greek anthropological
concept. The “moral injury” paradigm has previously examined the relevance
of thymos in contemporary veteran care, but has limited its consideration to Homeric
material, and has also cross-interpreted the concept through modern psychological and
physiological lenses in order to develop clinical applications. The original contribution
of this thesis is the provision of a diachronic lens for investigating thymos in its organic
philosophical context from Homer through the Golden Age of Greek philosophy,
the teachings of early Christianity, and its current use in Eastern Orthodox
Christian monastic tradition.

This diachronic perspective provides an existential understanding of certain features of
such combat-related disorientation that were previously unidentified. More specifically,
it discerns a systemic dysregulation of three essential capacities for human flourishing
that can occur, often sequentially, after exposure to intensely adverse events in combat:
primary emotion, instinctive motivation to action, and moral intuition. Moreover, it
develops a comprehensive account of two distinct features that are previously not
addressed sufficiently: (1) the enduring sense of self-horror after a perceived
“absorption of evil” in battle, and (2) radical loss of the ability to attribute meaning to
events or to maintain narrative coherence of life’s experiences.
iii
CONTENTS
ACKNOWLEDGEMENTS AND PREFACE .................................................................. vii
LIST OF ABBREVIATIONS .......................................................................................... viii
Chapter
1. INTRODUCTION: A PHENOMENON SEEKING UNDERSTANDING ............... 1
Epistemological Complications in Crisis Care

The CTAR Corrective
2. EXAMINING THE PHENOMENON IN DETAIL ................................................. 12
First-Hand Accounts

Complementary Accounts

Accounts of Self-Horror at the Perceived Absorption of Evil

Accounts of a Conscious Disconnect from Emotion and Bodily Sensation

Accounts of Persistent, Socially Debilitating Mistrust

Accounts of a Radical Dissolution of Moral Intuition & Narrative
Coherence

Accounts of an Uncontrollable, Lustful Rage

A Summary of Five Related Elements

A Working Label for the Phenomenon
3. PSYCHIATRY & CCAD ......................................................................................... 59
A Variety of Approaches to PTSD and Complex PTSD

A Unifying Factor

"Dissociative Depersonalization"

"Negative Alteration in Cognition"

"Alteration in Arousal and Reactivity"
iv

Seeking Explanation for the Dissolution of Moral intuition & Narrative
Coherence

"Delusional Disorder"

Is the Psychiatric Paradigm Sufficient?
4. MORAL INJURY & CCAD .................................................................................... 90
Moral Injury in Context

Moral Injury after Leadership Betrayal
Accounting for Debilitating Mistrust & Dissolution of Meaning Making

Moral Injury in the Berserk State
Accounting for a Lustful, Uncontrollable Rage
The Post-Berserk State & Disconnect from Emotion and Bodily Sensation
Moral Injury through Witnessing Inhumane Violence

An Adequate Account of the Phenomenon Under Consideration?

Shay and Homer: a Tale of Two Thymi

Epistemological Considerations

In Summary
5. A CONTEXTUAL VIEW OF HOMERIC THYMOS ......................................... 121

Homeric Thymos: Essential Function

Thymos and Emotion

Thymos and Instinctive Motivation to Action

Thymos and Moral Intuition

A Summary of Essential Human Function

The Impact of Lost Function in Homeric Usage
v
Emotional Disorientation

Instinctual Disorientation

Moral Disorientation

A Summary of Thymic Disorientation in Homer's Work

Methodological Issues in Moving Forward
6. A DIACHRONIC VIEW OF THYMIC DISORIENTATION ............................... 154

Thymic Disorientation in the Golden Age of Greek Thought

Thymic emotion in Plato and Aristotle

Thymic aggression in Plato and Aristotle

Thymic morality in Plato and Aristotle

A summary of the contribution of the "Golden Era" Philosophers

Thymic Disorientation in the Moral & Spiritual Philosophers of Late Antiquity

Thymic disorientation in the Cappadocians

Thymic disorientation in Evagrius of Pontus

Thymic disorientation in the Evagrian contemporaries

Thymic disorientation in Maximos of Constantinople

A summary of the contribution of these moral & spiritual philosophers

Thymic Disorientation in the "Modern Desert" Teaching

Thymic disorientation in current Syro-Lebanese & Coptic traditions

Thymic disorientation in the contemporary Athonite tradition

Thymic disorientation in contemporary Valaamite and Optina traditions

A summary of the contribution of the "Modern Desert" Teaching

An Ancient Philosophical Concept Applied to Contemporary Social Care?
vi
7. CCAD & COMBAT ACTIVATED THYMIC DISORIENTATION .................... 203
A Summary of CATD from Homer to Today

What evidences a healthy thymos

What evidences a disoriented thymos

Transitioning to a comparison of CATD and CCAD

Approaching CCAD from a perspective of CATD

CATD and Self-Horror at the Perceived Absorption of Evil

CATD and Conscious Disconnect from Emotion and Bodily Sensation

CATD and Persistent, Socially Debilitating Mistrust

CATD and Dissolution of Moral Intuition & Narrative Coherence

CATD and Uncontrollable, Lustful Rage

A Summary of CATD on CCAD

CATD Rather than Complex PTSD or Moral injury

The Usefulness of the CATD Paradigm, and Transition to Care
8. CATD AND THE CTAR FRAMEWORK.......................................................... 236

Avoiding Polarization in Care for CATD Veterans

Concepts Protecting Against Polarization in the CTAR Model
Avoiding Pathologization While Caring for CATD Veterans

Concepts Protecting Against Pathologization in the CTAR Model
9. CONCLUSIONS ................................................................................................. 264

Further Frontiers of Research

BIBLIOGRAPHY ........................................................................................................... 270
vii

ACKNOWLEDGEMENTS AND PREFACE

This research into philosophical, psychological, and theological aspects of care
to combat veterans represents a response to issues that have arisen in my own work as a
caregiver and clinical supervisor. The vignettes contained in this thesis arose from my
personal work in both psychotherapy and supervision, and names and specific locations
have often been changed either to protect the identity of vulnerable people under my
care and supervision or to protect the anonymity of monastic leaders who have left the
world in response to a personal sense of calling. I owe many thanks to my supervisor
and mentor, Dr. Renos Papadopoulos, who has affected almost every area of my
vocational and personal life over the last few years with his wisdom, perspective, and
tireless investment in my development. I also owe thanks to my wife and children for
their sacrifices and support at every stage of the development of this thesis.
viii
ABBREVIATIONS

ADM Admiral

ANS Autonomic Nervous System

CATD Combat Activated Thymic Disorientation

CCAD Complex Combat Activated Disorientation

CO Commanding Officer

CPT Cognitive Processing Therapy

CTAR Centre for Trauma, Asylum, and Refugees (University of Essex)

DSM Diagnostic and Statistical Manual of Mental Disorders

EFTT Emotion-Focused Therapy for Trauma

EMDR Eye Movement Desensitization and Reprocessing

FOB Forward Operating Base

HADR Humanitarian Assistance and Disaster Relief

HPA Hypothalamic-Pituitary-Adrenal (Axis)

ICD International Statistical Classification of Diseases and Related Health
Problems

NGO Non-Governmental Organization

PE Prolonged Exposure (Therapy)

PNS Parasympathetic Nervous System

PTSD Post-Traumatic Stress Disorder

UK United Kingdom

US United States of America

USNA United States Naval Academy

VA Department of Veterans Affairs, United States of America
CHAPTER 1

INTRODUCTION: A PHENOMENON SEEKING UNDERSTANDING

Human responses after exposure to extreme forms of adversity vary according to
a number of factors, including the type of adversity experienced, its severity, a
survivor’s prior exposure to similar and dissimilar forms of adversity, the human and
material resources a survivor has at his or her disposal before and after exposure, a
survivor’s physiological, psychological, and systemic behavioral predispositions to
certain responses to adversity, the philosophy or approach of community and caregiver
responses during and after a devastating event, the extent that a survivor is affected by
environmental and ecological changes during and after the event, and social, cultural,
and spiritual presuppositions or post-event formulations present among survivors and
their neighbors and caregivers which affect meaning attribution. Due to such varied
factors, which represent all of the dimensions of human experience, survivor responses
are not easy to predict or categorize, and as a result caregiver efforts require a great deal
of epistemological complexity and a vigilance to protect against sweeping responses
that seek to quickly respond to survivors in a unified manner, regardless of the wide
variance in survivor responses, and in survivor needs. Research suggests that, of all
adversity survivors, those surviving “[chaotic] interpersonal violence” such as killing,
sexual assault, mutilation of bodies, desecration of corpses, and brutality that seems to
have no objective” are the most likely to develop serious and long-lasting impediments
to health and well-being when their initial caregivers do not adequately understand their
needs (Friedman, 1999, p. 5).
2
In the modern Western world, the dangers of epistemological over-simplicity
when responding to adversity survivors is not always apparent, and therefore not
protected against in crisis response either at home or abroad. As a result, care agencies
and professionals often lean heavily on reductive assumptions about survivor needs that
can both blind them from the complexities of those needs and leave them with a lack of
commitment to eliciting reliable feedback from survivors on their own sense of what is
most needed in the aftermath of their exposure to adversity (Papadopoulos, 2002). One
common extension of this epistemological failure in approaching survivor care is the
further lack of commitment by agencies and professionals to eventually elicit feedback
on what care was provided, in order to offer opportunities to adjust the provision of
future care. This tendency applies equally in the global West to (1) private and
governmental international relief and aid agencies focused on emergent work in the
developing world, (2) domestic relief and aid agencies focused on emergent work
among internal populations, and (3) circles of professional caregivers providing long-
term psycho-social care for adversity survivors in internal populations. This
phenomenon of connecting epistemological failure in caregiving to a lack of concern for
feedback from survivors – both on and in their own terms – should briefly be expanded
for consideration here, in each of these three milieus mentioned in the previous
sentence.
A March 2007 recording from the Committee on Foreign Affairs of the Unites
States House of Representatives preserves an enlightening discussion on Iraqi internal
refugee care offered by American agencies during the height of Operation Iraqi
Freedom, and in this discussion two prominent statesmen remarked on the dearth of any