David Mattingly
December 29, 2014 · in Charlie Mike

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.”