Entitlement, Expectations, Disappointment & Post Traumatic Embitterment Disorder

“Embitterment is a persistent negative feeling in reaction to common negative life events, and is a reactive emotion towards injustice, insult or breach of trust. Embitterment is a gnawing feeling and has the tendency not to stop.”

I first encountered the term Post Traumatic Embitterment Disorder (PTED), during a Winston Churchill Memorial Trust funded research trip to the USA in 2011, it stuck a chord as it accurately described the symptoms displayed by hundreds of the veterans we have worked with over the last 10 years. On return to the UK I bought a copy of the book Posttraumatic Embitterment Disorder: Definition, Evidence, Diagnosis, Treatment (2006) Linden, Rotter, Baumann & Lieberei.

It has turned out to be one of the most influential book I have ever read. Yet, PTED is neither recognised or discussed and has fallen out of favour, probably because it didn’t get a classification as a disorder in its own right in the Diagnostic and Statistical Manuel of Mental Disorders. Which is a shame as it accurately describes many of the people referred to our service.

In a recent edition of Professional Social Work one article was entitled;

‘Great ideas never die but they can be buried alive’

Personally, I believe Post Traumatic Embitterment Disorder is a perfect case in point.

Over a lifetime’s work in Social Work, Criminal Justice and social welfare settings I have met hundreds of people who are unable to move on from traumatic life events, injustice or violation of their basic beliefs. These days, we might call it Post Traumatic Stress, Moral Injury, Adjustment Disorder or a host of other terms. Shame, guilt, disappointment and a sense of failure can all lead to self harming behaviours and a belief nothing will ever change for the better…at that point some people may start to think they have become a burden and loved ones might be better off without them. Dangerous territory.

After a year of repeated lockdowns, the terms normally associated with veterans mental health such as PTSD or Moral Injury are now used on a daily basis to describe the millions of individuals who have struggled to cope with the fear of catching, a potentially life ending virus. A virus that has, the potential, to ‘take you out’ in little more than 28 days. For frontline health workers the fear of catching the C-19 virus is ever present, and the daily dread of inadvertently passing it on to loved ones never goes away. Others are struggling to cope with loss and bereavement at a time when its essential we all isolate ourselves from each other. Social isolation and a real sense of disconnection from ‘normal life’, has created an upsurge in depression, anxiety, poor sleep, self harming behaviours, debt, alcohol misuse, loneliness, fear, domestic violence and relationship breakdown. Experts in the field talk of an anticipated tsunami of mental health disorders, with requests for mental health support estimated to be in the region of 15 million people. If this is the case , the reality is, this will overwhelm mainstream services and people will be added to waiting lists that could go on for years.

Veterans are currently being promised fast track mental health services and support, and if not handled sensitively, this prioritisation has the potential to be divisive and cause conflict between those viewed as deserving or undeserving.

These day’s, many people have a sense of entitlement. Entitlement is described as a pervasive sense of deservingness. People with a sense of entitlement believe that they should get what they want because of who they are! The Government has promised veterans entitlement to fast track medical services because of their unique experiences in the military.

Rightly or wrongly, the problem is, once promised, people will have high expectations. However it might not be possible to deliver on those promises. It could be something as simple as supply and demand and this will inevitably, lead to disappointment, psychological distress, anger and resentment. Yet, millions of others will probably feel the same way, and if Local Authorities and mental health services are , as the Armed Forces Bill implies only required to pay ‘due regard’ to the Armed Forces Covenant, the needs of the majority will prevail, and veterans may go to the bottom of the list when it comes to mental health treatment, housing or practical support.

As ever, the role of the much maligned small military charities will be crucial in helping support those feeling betrayed by a system, that promised so much.

Whatever happens… its going to be interesting.

Tony Wright

Forward Assist