Insights – 7 min read

No winners in war just Post Traumatic Stress Disorder for all

February 8, 2024
By Dr. Mark Whittington and Gaby Bush

The wages of war are paid by innocents in installments that span a lifetime.



If your parents were anything like mine, you’ll no doubt remember them saying “beware of talking about politics or religion”. People invest a lot of emotion in holding on to their beliefs. And they have a tendency to defend those beliefs very fiercely indeed. Sadly, the first casualties in a confrontation are all too often facts and logic.  In fact, they frequently become quite irrelevant. When someone wishes to impress upon you the righteousness of their opinion; passion and volume are often their first weapons of choice.


Those of you who have been following my commentaries may recall that when Covid came along I co-opted the old “don’t talk about politics or religion” trope and added “or Covid”. My reasons were exactly the same as they are now. The incendiary climate of fear, uncertainty, and a proliferation of conspiracy theories sparked disagreements that threatened many long-standing friendships and family relationships. Thanks to the current instability in the Middle East, we now find ourselves back in the same, if not worse situation.


I intend to talk obliquely “at a safe distance” through the metaphor of the headquake of PTSD to touch upon the “politics, religion, and the war in Gaza.” Although I fear that in the context of the current divisive conflict, it may be that no distance will be far enough to be safe. I will try my level best to avoid giving offense but despite my best efforts, I fear some will take offence even if only at my refusal to take sides. This discussion is not about my or anyone else’s views on the wrongs and rights of the combatants. It is about one calamitous wrong that effects both sides equally. The terrible mental wounding being sustained by innocents.


Prisoners and hostages are likely to suffer PTSD for a lifetime. Families will suffer from vicarious trauma for their entire lives as they are inseparably emotionally welded to the victims. Imagine millions of men, women, and children condemned to lifetimes of PTSD because of relentless rocket attacks and retaliatory airstrikes. Given the self-perpetuating nature of inter-generational trauma, the terrible things happening now will echo through time and have repercussions for both sides that will reverberate for many generations to come. In war, everybody loses. Even babies not yet born. For a baby in utero, the limbic or emotional part of the brain responsible for the flight or fight response (the amlydala) becomes active at approximately 5 months gestation. In a war zone, all those unborn babies are subjected to a heightened state of fear, just like that being experienced by their mothers. This profoundly adversely affects the developing brain. According to Dr Bessel Van Der Kolk this produces a triumvirate of problems PTSD, ADHD and Borderline (or unstable) Personality Disorder. He believes that this constitutes a psychiatric problem in its own right namely, Developmental Trauma Disorder. This disorder causes a lifetime of distress, disturbance and interpersonal problems. It affects everyone who cares about all the vulnerable and innocent victims who are wounded in this insidious way. It is sobering indeed to think that acts of war mentally wound and scar babies not yet born. There are no winners in war. Yes, you may argue that the winner loses a little less. Not always. Victory might be pyrrhic. It may inflict such a devastating loss on the victor that it is tantamount to defeat. You can win a war and still be left with nothing but a hand full of ashes. Whichever side of the fence you sit on, be mindful of just how high the cost can be.


The metaphor of an earthquake is a particularly apt way to describe PTSD because, like an earthquake, it devastates the metaphorical landscape of a person’s mind and of their everyday life, leaving everything in ruins. The terrible seismic psychological trauma of war changes and damages everything. That’s why I call it the headquake of PTSD. The metaphor (and portmanteau) highlights the massive and permanent upheaval and damage caused to the brain by severe mental wounding and deep emotional trauma.


During the headquake the metaphorical tectonic plates move in one’s mind. As one’s life is turned up, down and sideways structures that once appeared rock-solid crumble and fall. For the PTSD sufferer, experiencing abject fear and terror and feeling overwhelmed can feel like understatements. Imagine: In an instant you could be swallowed, smashed, squashed, ground or blown into a million pieces. Terrible scenarios race through your mind. You can’t escape. There is nowhere to run to. You are frozen. Paralyzed by fear. When confronted by the near, clear and present threat of death, each of us reacts differently. Imagine how insignificant and small you would feel in the face of an earthquake. Imagine mighty bridges and buildings tumbling down around you and the earth convulsing beneath your feet – and then imagine being powerless to escape or do anything about it.  Sometimes there really is absolutely nothing you can do. Your best efforts are useless. Your best judgment is irrelevant. What happens to you and your loved ones is in the hands of fate. There are situations in which permanent damage to your body and mind – or even your life or death – is the result of unpredictable unstoppable forces – like that of an earthquake in nature. Trauma can leave you unable to trust the very earth beneath your feet. The very ground underfoot is no-longer safe, solid or secure. Nothing is to be trusted.


The sudden silence that ensues in the wake of the thunderous roar of the earthquake is even more deafening. Every detail of the aftermath is burnt into your brain. It leaves a permanent scar. Every sight, sound, and scent of the headquake, is forever remembered exactly, precisely, and worst of all, it is recalled as if it is happening right now. The sudden deafening silence of a sudden ceasefire is very much like the tense interlude between earthquakes and aftershocks. When they will start again and how long they will last is unknown. You are left in limbo. And you can stay there all your life.


In the now, you may leap into action to help the wounded or clear the rubble. However, in the midst of all that is damaged and broken you remain acutely aware that another quake can strike at any moment. This sense of insecurity and exhausting hyper-vigilance will last a lifetime. Survivors of the headquake are never quite free from those awful feelings of panic and terror. Some part of you now believes that your survival depends on being ready for it to happen all over again. Nothing is ever safe, permanent or secure again. The normal structures of your life are left shattered like a pane of glass blown out by a bomb.


At best, time passes and you slowly start to mop up your life and throw out what has been destroyed. Material things that you valued might now seem worthless and irrelevant. Relationships may seem forever altered. The headquake of trauma changes everything. And then, as if it all wasn’t quite bad enough, you still have to face the matter of grief.


PTSD carries with it an enormous heartbreaking component of grief. In the wake of trauma you might be left mourning the passing of the old you, the person you thought was tough enough to take it, in addition to grieving the loss of life as you knew it. Like the ruins of the beautiful churches reduced to rubble in the Christchurch earthquake of 2011, the once dependable structures of your life might lie in ruins. Like the earthquake permanently scars the landscape, the headquake permanently scars the mind. The wages of war are paid by innocents and the installments go on being paid in suffering decade after decade. Plato said, “Only the dead have seen the last of war.” Let’s all hope and pray that on one bright future morning, the family of humankind awakens to prove him wrong.

About the author

Dr. Mark Whittington and Gaby Bush

Dr. Mark Whittington is a graduate of the distinguished Otago Medical School, and has more than 30 years’ experience working at the clinical coalface as a Consultant Psychiatrist.

Gaby Bush is a creative director, writer ,ex-patient, corporate refugee, and survivor of severe PTSD. Gaby is living proof of how well the Metaphorical Therapy System works in the real world.

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