war on the rocks

The Unknowns in the Invisible War

December 29, 2014

David J. Morris, The Evil Hours: A Biography of Post-Traumatic Stress Disorder (Houghton Mifflin Harcourt 2014)

 

The unknown. In combat, the unknown represents one of the greatest sources of danger. But the unknown can be similarly dangerous after combat has been left behind. It applies uniquely to what has emerged as one of the greatest public health issues facing America today — post-traumatic stress disorder (PTSD). Discussions within the mental health community recognize PTSD as a “clinically diagnosed condition” caused by a person’s experiences with traumatic events or circumstances. Combat-related PTSD was first diagnosed as such among veterans of the Vietnam War (symptoms displayed by previous generations of vets were often not understood and were attributed to nebulously defined conditions such as “shell shock”). But in reality, PTSD can be traced to the earliest recordings of battle, including those featured in Homer’s The Iliad and The Odyssey. In The Evil Hours: A Biography of Post-Traumatic Stress Disorder, David Morris, a Marine infantry officer turned journalist, writes about his experiences as an embedded journalist in Iraq and his return to the states. This return, he soon realized, was to a world completely detached from the war he had just left, a fact he struggled to come to grips with. “The war hurt me,” he wrote. “I wanted the country to feel some of that hurt…Could a war really be called a war if nobody back home gave a shit about it?” To understand his own condition, Morris writes that he “went to the library.” He researched PTSD, interviewed leading researchers, clinicians, and other vets, and wrote about what he learned in parallel with his treatment at the Veterans Administration Medical Center San Diego.

Morris examines PTSD principally through the lens of war and combat. However, he also explores its presence in civilian society: among rape victims, survivors of natural disasters, and others who have experienced traumatic events. He cites Harvard’s National Comorbidity Survey — or as he describes it, a “census of misery” — which found that 55% of Americans will be exposed to at least one traumatic event in their lifetime. VA research shows the number of Americans that will experience a traumatic event is 60% of women and 50% of men and that 7 to 8% of Americans will experience PTSD during their lifetime. The question that remains unanswered is why one person emerges from an event with PTSD while another appears to move on without suffering significant lasting impact to live a normal life. An equally important question is why an event may set off PTSD years after its occurrence. The unknown may be found in a person’s mental health prior to joining the military, the event itself, and even what the person may have done immediately after the trauma.

The U.S. government, through the Veteran’s Administration and Department of Defense, has provided a large amount of funding for PTSD research. Therefore, the majority of studies relate to the effect of war and combat experience. Morris describes PTSD as a “junk drawer of symptoms,” some of which will appear in one person and not another. Along with the “junk drawer of symptoms” there is an equal “junk drawer” of treatments. And just as each case manifests itself uniquely, each also requires a tailored set of treatments.

In addition to the stories of mismanagement by the VA, the unknown or unknowable aspects of PTSD have made the VA and DoD a target for critics that fail to recognize the sheer variety of symptoms and treatment options and wish to quantify a return on investment for the money spent on PTSD research. While doing so is exceedingly difficult in the case of PTSD, there have been a number of obstacles to research. Morris describes the long, difficult process for progress made in PTSD research to find its way to clinics and treatment centers. He relates a story in which a graduate student had to wait for his advisor to go on sabbatical before proceeding with research that appeared to be producing promising treatment results. “Funding constraints, politics, institutional inertia, careerism, along with simple intellectual trendiness intrude upon the scientific process…” one senior VA official admitted. “Often what passes for science is just simple popularity.”

As with other writers on the subject of PTSD, Morris uses the metaphor of “no man’s land” to describe the separation of time and space between war and home. “This war is over when I get home!” is a phrase that is heard every day while on deployment. Nevertheless, often a new type of battle is just beginning for many vets when they get home and attempt to maneuver the bureaucracy of getting treatment. A lack of understanding of each veteran’s challenges and bureaucratic hurdles — “stacks of paperwork” — often act as triggers causing PTSD episodes. Sadly, these episodes themselves can lead to vets being dropped from treatment or research programs for failing to comply with treatment. Other vets drop out because of personality differences, distance from treatment centers, or a myriad of other reasons.

As researchers attempt to explain the unknown, the success of various treatment methods will be based not only on the personality of the patient, but on that of the clinician, as well. Morris quotes a rape victim: “Good therapists were those who really validated my experience and helped me control my behavior rather than trying to control me.” He goes on to describe how the personalities of individuals he worked with at the VA increased his trust in the world. Treatment at one facility may be different from another, especially as the vet moves from DoD’s care to that of the VA.

Is there a magic drug waiting to be discovered? Drugs have been successful in helping the patient cope with the symptoms of depression and anxiety but do not the address the root causes of PTSD. One Air Force vet faced with the possibility of losing custody of her daughter began taking medication, but in doing so lost her flight status. Such career repercussions have discouraged too many vets from seeking help. The VA and other researchers are also studying other types of drugs that seek to erase or mask a traumatic event, but these are not practical to use on the battlefield. A recent report in the journal of Neuropsychopharmacology advances the idea that medical marijuana may “provide relief and better care than current drugs.” Another study conducted between 2009 and 2011 in New Mexico — the only state which allows the use of cannabis to treat PTSD — indicates that patients who smoked cannabis saw a 75% drop in PTSD symptoms. Could this be the magic bullet? Other treatments like service dogs, yoga, horseback riding, and adventure outings have opened a “cottage industry” of treatments, especially in areas with veterans or military members.

America has faced tragedy and war for over a decade and will continue to face the effects of PTSD for years to come. How we as a society decide to deal with PTSD will be a reflection on our humanity as a nation. Those that suffer from PTSD due to natural disasters or from crime will benefit from the research conducted by the VA and DoD. In the end, we as a nation will have to ask the question of whether going to war is worth the cost to its citizens?

Coming back home is a goal for every service member; it just shouldn’t be so painful.

 

David A. Mattingly is retired from the U.S. Navy as a Master Chief Petty Officer and is now a consultant on National Security issues. He is a volunteer ambassador for the Iraq and Afghanistan Veterans Association.

 

Photo credit: The U.S. Army