A MIND AT WAR
IN THE DAYS after my initial diagnosis, I learned more than I wanted to know about PTSD and how it affects the brain. Of course, it all starts with trauma and the interaction the traumatic incident has with the human brain. Everyone has psychological barriers, protective walls that are supposed to defend us from harm should we see or experience something truly horrible like a car wreck; the loss of a mother, or father, husband or wife—or worst of all, of a child.
Everyone’s walls are different. Some of us have low ones, frail and patched together after a childhood of too much pain. Others have walls so thick it seems like nothing will ever get through to harm the fragile psyche bunkered down behind them.
In the end, though, our walls are never thick enough. Profound trauma can always penetrate them; it is the terrible silver bullet too many have been felled by once home from combat. Violence, death, imminent harm—these are the stressors that can trigger a total collapse of our psychological walls with devastating results.
Once a brain receives an overdose of trauma, it sustains physical damage. Its neurochemistry actually changes. New neural pathways are forged, and old ones wither from disuse. These changes alter the landscape of the victim’s character and personality, often with tragic and deadly painful results.
Worst of all, the trauma doesn’t go away. The brain absorbs it, but can’t process it. Once it pierces the defensive walls, it rattles around inside, ricocheting from corner to corner, inflicting even more damage.
Think of the human mind as a record. Put the needle down, and the record plays its tune. But what happens when something gouges that record? The scratch becomes the needle’s nemesis. The tune cannot continue, the scratch makes the needle repeat over and over, and it will never escape the damaged part of the record on its own.
That’s exactly what happens with PTSD. The brain gets stuck in mid-process. It can’t continue the process of healing as the silver bullet scythes back and forth through the victim’s psyche. And so, the trauma becomes the damaged brain’s obsessive fixture. The needle skips and skips and can never move past the scratch. The brain replays the traumatic event in the same way. Over and over, conscious or not, the victim never stops experiencing the worst moments of his or her life. It becomes a permanent part of every waking moment, and every dream that invades the victim’s restless sleep.
Exactly how PTSD affects a person varies widely depending on the victim’s psychological makeup and the level of the trauma, but there are some common elements among victims. First, the trauma never lessens, never ebbs away. Time heals all wounds, right? Not with PTSD. The trauma remains as painful, as powerful, and as horrifying as the first time its victim experienced it. If anything, it gets worse. The pain sends the victim into a spiral of depression. Self-medication with alcohol or drugs often follows. Nightmares, flashbacks, sudden bouts of terror, and rage develop. There is no way to purge these emotions; the damaged brain has no positive outlet. The result is poison to the soul.
Victims of PTSD sometimes turn violent. Others overreact to ordinary life stresses. The rage and despair form a self-destructive cocktail that sometimes leads to suicide, other times to murder. Those are the extremes, of course, but on the path downward, the middle ground is filled with anger that only those suffering from PTSD truly understand. A misplaced toy, a casual remark, a wayward glance, or a traffic jam is all it takes to trigger the overreaction. It can easily spiral out of control.
Pride and prejudice come into play about this time, and both these things wage a war without any hope of recovery. In the military, weakness is not allowed. A Marine does not flinch at physical wounds. Nor does he admit to frailties of the mind. The proud soldier, the stellar Marine, hides his agony and pretends that nothing is wrong for fear of destroying his military career. Worse, he holds it inside for as long as he can, and conceals it from his platoonmates and peers for fear of losing their respect and trust.
This wall traps PTSD inside the victim’s mind. The damage worsens; the spiral deepens. Yet too many never reach out for help.
All of this takes a toll on the victim’s family. Divorce rates skyrocket. Relationships break down under the weight of all the negative emotions, self-medication, and despair. As PTSD drives the victim’s closest loved ones away, the pain and trauma of these failed relationships feed right back into the original traumatic event. Each replay becomes even more vivid and emotional. The reactions become hyperfueled, the outbursts increasingly worse. It is a vicious cycle, and once in the spiral the victim may never get out.
It isn’t an isolated problem either, nor is it one that started with our war. In 1914–1918, it was called “Shell Shock”; in World War II, it was called “Battle Fatigue,” and in the British Royal Air Force, “LMF—Lack of Moral Fibre.” Only during the Vietnam War’s final stages was there a major effort undertaken to understand the effect of combat on the human mind. Ironically, it originally came out of the antiwar movement.
In 1980, the American Psychiatric Association officially acknowledged the symptoms of PTSD, and the condition was integrated into the Diagnostic and Statistical Manual of Mental Disorders. At the time, the feminist movement played a significant role in getting official recognition for PTSD, as the same symptoms are often prevalent in rape victims. Since then, considerable research has been devoted to understanding and trying to mitigate the effects of PTSD.
During World War II, the National Center for Post-Traumatic Stress Disorder estimates that one in twenty American veterans suffered PTSD symptoms in their lifetimes. That doesn’t sound like much until one realizes that there were about eight million Americans in uniform during the war years. That five percent figure totals several hundred thousand veterans.
During the Second World War, for every man in combat, there were between ten and two hundred men and women providing logistical support who saw no danger outside of operational accidents.
When that is factored into the NCPTSD estimate, a frightening percentage of combat veterans came home and suffered from PTSD—and received little to no treatment for decades.
In 2004, the VA reported that 25,000 World War II veterans still received treatment for PTSD in its clinics and hospitals. Sixty years after D-day, minds traumatized by battling the Third Reich and Japan were still struggling to process the experience.
The Vietnam-era veterans suffered worse than their WWII counterparts. Between 1986 and 1988, the National Vietnam Veterans Readjustment Survey concluded that 479,000 men and 610 women who served in Vietnam continued to suffer from PTSD. That represented a 15.2 percent rate among the 3,140,000 men and 8,100 women who served in Vietnam.
But, recent surveys paint an even grimmer picture. Of the Vietnam vets who served in combat, 30 percent were afflicted with PTSD. More than thirty years after the last helicopter launched from the embassy roof in Saigon, over 160,000 Vietnam veterans still receive disability payments for PTSD. Since the War on Terror began, however, there has been a resurgence of Vietnam veterans seeking treatment for combat trauma. The images on television, combined with the fact that in many cases these vets have sons or daughters in harm’s way, reopened old wounds and caused major problems within their lives again. Since 2003, the number of Vietnam vets seeking help for trauma has increased 36 percent.
Time does not heal all wounds.
In fact, with PTSD, time can make it worse. With Gulf War veterans, the number of reported PTSD cases doubled between the end of the war and two years after it.
Korean vets seem to have had it the worst—up until now. Thirty percent of those who remain from that war continue to suffer from PTSD.
For a shocking number of our veterans, the wars they fought never ended. Never.
When preparing for the invasion of Iraq, the VA and the Pentagon estimated that there would be 8,000 cases of PTSD stemming from combat in the Middle East. In December 2007, the RAND Corporation issued a report that stated that about 300,000 veterans of Iraq and Afghanistan either suffer from major depression or PTSD. Another 320,000 have received traumatic brain injuries, mainly from roadside bombs, that frequently cause PTSD-like symptoms.
A 2007 editorial in the Journal of General Internal Medicine remarked, “Iraq has become a more effective incubator for PTSD … than any mad scientist could conceivably design.”
Exactly what percentage of Iraq and Afghanistan veterans have PTSD is unclear. It also varies from service to service. Some early-war estimates put the figure at 12 percent. More recently, further studies revealed that almost half the National Guardsmen who’ve been deployed suffer from PTSD, while 38 percent of Marines have some form of it. In some studies, the figure of 20 percent has been used. If that is the case, when the last soldier, airman, and Marine returns home at the end of the War on Terror, there will be at least another 360,000 cases of PTSD or PTSD-like conditions for the VA system to handle.
They planned for 8,000. Instead, there will be almost 700,000 of us by war’s end. By 2004, the VA and the military’s ability to handle the influx of PTSD cases was simply overwhelmed. In some cases, soldiers and Marines slipped through bureaucratic cracks, and at one point, the overburdened VA system had some 600,000 claims back-logged and waiting to be processed. For some, the wait proved to be too much.
We combat veterans tend to make this situation worse, since we see PTSD as stigmatizing. Between 23 and 40 percent of us have sought treatment. The vast majority of us continue to suffer in silence. According to internal VA memos and emails, eighteen veterans of Iraq or Afghanistan kill themselves every day. Of those, only four to five are actively seeking help from the VA.
As a result, the PTSD rates in my generation are almost certainly significantly higher than any other war. Part of the explanation for this lies with the nature of the fighting—frequently up close in urban settings against enemies who wear no uniforms. Part of it also rests with the fact that there are no safe rear areas as there were in most of America’s other wars. One study discovered that 86 percent of all Iraq veterans had experienced a firefight or a roadside bomb incident. When the front lines become blurred, and there are no safe havens, the chance for trauma increases.
The statistics don’t offer much hope for us—not if the Greatest Generation or the Baby Boomers are any indication. Chances are, those of us who suffer from chronic PTSD will still be suffering from it when we’re eligible for Social Security.
Right there is the key. After learning about what had happened to me, I needed a healthy path to take to avoid that fate. But how do you pull out of the spiral? Who is there to help along the way?
Unfortunately, understanding PTSD and overcoming it are two very different things.