TIME

‘Trauma Ruptures You in Two’

Rhiannon Cosslett is a writer, columnist and the co-editor of feminist blog The Vagenda.

Four years ago, a man tried to sexually assault and strangle me to death. Your brain does strange things when it thinks you’re about to die

Your brain does strange things when it thinks you’re about to die. It is difficult to articulate just how strange. We forget, most of the time, that we are animals. We are civilized, rational beings, secure in our autonomous personhood, safe in the unassailable certainty of self – “I begin and end here, at the tips of my fingers, at the surface of my skin.” But when another person tries to disrupt that personhood, tries to take from you that autonomy that you have been taught to hold sacred, the primitive takes over and you become unrecognizable. Your sense of self is upturned.

The only way that I can describe it is to say that trauma ruptures you in two. It happened to me when, four years ago, a man tried to sexually assault and strangle me to death as I walked home from a party. Suddenly, there was this new, unrecognizable me, existing in parallel to my normal, rational self. In contrast, she was completely irrational and unpredictable. She was a wounded animal in the corner, flinching at every perceived threat.

As if living your life in a fragile state of fear and hyper-awareness weren’t enough, additional problems come when outside observers try to impose their rational view of the world on trauma victims. Friends and family, police officers, prosecutors, college counselors and, perhaps most relevantly here, journalists, will view your trauma within their own, undisrupted, rational frameworks. They might question why you are recounting the incident with such a lack of emotion, or why you are laughing. They might say that your testimony is inconsistent, as Rolling Stone did when its editors backtracked on their report of the alleged gang rape of student Jackie at the hands of a group of University of Virginia fraternity brothers. There were, they said, “discrepancies” in her account. An original version of their note, which has since been revised, said their “trust in her was misplaced.”

As people clamored to accuse Jackie of lying about her assault, to make her a poster child for false rape accusations, all I could think was, “Discrepancies? That sounds about right.” As Lena Dunham, whose own rape testimony has been subject to the doubting scrutinity of reporters, said, “survivors are so often re-victimized by a system that demands they prove their purity and innocence. They are asked to provide an unassailable narrative when the event itself is hazy, fragmented, and unspeakable.” If anything, I would have been more surprised had a woman who has been held down in a dark room and raped by man after man for hours been able, after all that horror and trauma, to produce a lucid, cohesive, play-by-play account of events.

I don’t know whether Jackie was raped. Only she and the alleged men in the room that night know this. But I do know that discrepancies are a natural consequence of extreme trauma. Few people seem to realize that a muddled, incoherent account of a traumatic incident is almost humdrum in its predictability.

From a neurological perspective, a traumatic incident triggers a fight-or-flight response. The brain’s prefrontal cortex, which is responsible for decision-making, social behavior and personality expression, is temporarily impaired. The non-conscious parts of your brain take over and stress hormones are released. As a result, traumatic memories become stuck, and the rational parts of your brain are unable to access them.

Trauma can severely affect the hippocampus, which converts short-term memories to long-term memories. Memories of the incident become disordered, fragmented, and incoherent. The two sides of the brain stop working together. Trying to produce a coherent narrative from the event, as a police interviewer or a reporter will attempt to do, is an obvious challenge. The victim will struggle to give a linear account and inconsistencies will be pounced upon.

I became aware of the fallibility of memory after I entered therapy for Post Traumatic Stress Disorder. Part of the treatment revolved around reliving, in detail, the night I was attacked. This helps your brain store your chaotic, confused memories properly. Think of it as a filing cabinet, except all the papers are in a muddle on the floor. Your task is to file them. It was emotional, and often tedious work. As the months went on, the Word document that I kept on my computer became longer and longer as events and actions were suddenly recalled and filled in. In comparison to my initial police statement, it was rich with detail. It took nearly a year to get there.

Law enforcement officials will naturally expect a timeline peppered with facts, but for many victims of rape and assault, establishing that timeline is not just a struggle but a near-impossibility. Police and prosecutors need to be more aware of this. They are, essentially, dealing with someone whose brain has been damaged.

We inhabit a culture in which female victims are so often blamed for their own assaults. Yet so many of these victim-blaming statements can be attributed to the affects of trauma. Aside from patchy and disjointed memories, there are other classic behaviors that are relevant here. Observers may ask, “Why didn’t she fight back?” when to freeze and enter a dissociative state is a common response during a traumatic incident. A lack of emotion or numbness when describing events can be explained by the symptom of flat affect. A failure to cooperate with interviewers can be attributed to hyper-vigilance – a need to control the circumstances surrounding the assault after what has amounted to a complete lack of control. A reluctance to go to the police at the time could be explained by the classic evasiveness displayed by a PTSD sufferer. The victim may want to avoid reliving the incident for fear of flashbacks, which inevitably trigger a primitive, panicked response exactly like that which took place at the time. This evasiveness can be conscious or subconscious. I am usually not a forgetful person, but in the months after my attack I would repeatedly forget appointments with my Victim Support officer.

Then, on top of all this, you have the guilt and the shame. The belief that it was your fault. The fear that you will not be believed. A fear that Jackie may have hinted at when she said she tried to withdraw her testimony from Rolling Stone. A fear that was then confirmed. People do not believe her, yet according to a report by the National Center for the Prosecution of Violence Against Women, only 2% to 8% of rape accusations are false.

I have no doubt that our tendency as a society to victim-blame women has its roots in misogyny. But I also think it shows a fatal misunderstanding of the effects of trauma on the brain. Retraining those working in the field is expensive and laborious but of urgent necessity. Your brain does strange things when it thinks you’re about to die. We owe it to victims to try to understand this, to help them piece their ruptured selves back together.

Rhiannon Cosslett is a writer, columnist and the co-editor of feminist blog The Vagenda.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Etiquette

I Have PTSD, and It’s Not a Joke

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I’ve been struggling with this illness for more than half my life now, and I can assure you: it’s not funny

xojane

This story originally appeared on xoJane.com.

Sometimes writers make questionable decisions for the sake of comedy. They might drop an f-bomb for comedic emphasis, or use shocking words for dramatic effect. Recently, I’ve noticed a disturbing new trend: using “PTSD” as a humorous term. In the same manner that we’ve begun to remove the words “gay” and “retard” from our “comedic” vocabulary, I believe the same consideration needs to be applied to the term PTSD.

Case in point:

On November 11, xoJane posted two otherwise harmless articles. One, about silly underwear, said: “…I have tween angst PTSD…” Another, an article about expensive beauty products, had a quote that read in part, “I still have ‘poor kid’ PTSD…”

These articles were both published on Veterans Day, a day meant to honor those who serve — many of whom suffer from PTSD themselves. I’m sure this wasn’t intentional, but it was the poorest possible timing.

In the context of these articles, Poor Kid PTSD and Tween Angst PTSD are supposed to be amusing. You’re supposed to imagine that being an angsty tween and a poor kid, respectively, was so traumatic that they now have horrific flashbacks about it. But being embarrassed about shopping at Hot Topic or being afraid that you might experience poverty again is not the same as actually having a PTSD flashback.

As a PTSD sufferer, I have trouble looking the other way when this term is misused, and it bothers me that we are perpetuating this improper use on xoJane. I’ve been struggling with this illness for more than half my life now, and I can assure you: It’s not funny.

The English language is very dynamic. Over the years, the meaning and usage of terms tend to shift. People become a little lax with the words they use, causing their misuse to become commonplace (“literally” now means “figuratively,” for example).

In the case of medical terminology, however, this can be extremely damaging. Using PTSD in a casual, joking manner contributes directly to the deterioration of the term as a whole. Misuse encourages misuse (“Selfie,” anyone? It’s short for self-portrait. There should only be one person in it) and before you know it, you’re dealing with a bunch of people who think they know the proper definition of PTSD, when they actually just know how it is used in comedy writing. It’s dismissive to those of us who actually have the disorder. Imagine the scene:

Me: I think you should know, I have PTSD.

Friend: I know exactly what you mean. I got a really bad haircut last year and I totally have PTSD about going to cheap salons now.

That is not PTSD.

PTSD is not a slight aversion. PTSD is not an embarrassing thought that still makes you cringe a little when someone reminds you of it. PTSD is not a fear of haunted houses or horror movies or clowns.

PTSD is a scratch across the record album that is your brain, forcing your memory to get stuck in a rut and skip. PTSD is a harsh interruption and a reminder of terrible incidents — truly terrible incidents. Incidents that were so disturbing, your brain didn’t know how to process them… so it continues to try.

When I hear people use PTSD in improper context, one thing becomes perfectly clear to me: these folks do not understand what I have gone through. The same way people use the term OCD when they mean “particular” or “well-organized,” using PTSD to mean, “I worry I’m going to get a bad haircut,” is alienating to those of us who suffer from the disorder.

PTSD can be a very solitary illness — one of the symptoms is self-isolation — and hearing someone misrepresent it only seems to further drive home the fact that when it comes to our illness, we are truly misunderstood and alone.

During a PTSD flashback, your brain rewinds to the worst moment of your entire life. Then that horrible moment is amplified and played over and over again. Every nasty sight, sound, smell, and physical sensation, replayed in your brain in an infinite loop. You hate it. You don’t want to see it, you don’t want to think about it, but you are powerless to stop it.

Eye Movement Desensitization and Reprocessing therapy (EMDR) has been shown to help, but there are two caveats: EMDR is expensive, and it also tends to make your flashbacks worse before it makes them better.

The truth of the matter is, my own PTSD — a result of childhood trauma that I’d rather not disclose — is very mild. I have persistent, recurring thoughts, and I am hyperaware of the danger lurking in any given situation. (I like to think of it as being prepared for all possible outcomes, but it means that I can come off as an extreme worrywart.)

The worst of all my symptoms, however, is that I startle easily. Inexplicably, I actually enjoy haunted houses, but in my normal waking life, I’m liable to scream (and sometimes, punch!) if someone approaches me too quickly, or shouts my name from another room. These symptoms have been very difficult to deal with, so I cannot imagine how hard it must be for people who are suffering from severe PTSD.

“How do you have PTSD? You haven’t been in a war.”

That’s what my mother said when I was first diagnosed. Yes, war veterans are extremely likely to suffer from PTSD (more than 30% of Vietnam veterans have had PTSD in their lifetime, and between 11-20% of veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom have had PTSD in a given year). But the fact is, PTSD can be caused by just about any traumatic experience: being in an automobile accident, being the victim of a violent crime, witnessing death or injury, being sexually abused, and of course, facing combat.

About 10% of all women (that’s 10 out of every 100) will experience PTSD at some point in their lives, so it’s likely you may already know someone who is suffering silently from the disorder. I urge you to exercise some sensitivity with your use of this term. It’s a real and painful illness, not something to weave into your comedy routine.

Alison Downs is a copy editor living in Connecticut.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Research

PTSD Raises Risk of Premature Birth, Study Says

The researchers hope that treating PTSD could reduce the risks of premature birth

An analysis of more than 16,000 births by female veterans found that women with posttraumatic stress disorder (PTSD) are significantly more likely to give birth prematurely.

PTSD has long been suspected of increasing the risk of premature delivery, but the study, jointly conducted by Stanford University and the U.S. Department of Veterans’ Affairs, provides strong support for the need to treat mothers with PTSD.

“Stress is setting off biologic pathways that are inducing preterm labor,” Ciaran Phibbs, the study’s senior author and an associate professor of pediatrics at Stanford, said in a statement. The study, published online on Thursday in Obstetrics & Gynecology, offered hope that treatment could prove effective in reducing the risk. While women with PTSD in the year leading up to delivery faced a higher risk of premature delivery, women who had been diagnosed with PTSD but had not experienced symptoms of the disorder in the past year did not.

“This makes us hopeful that if you treat a mom who has active PTSD early in her pregnancy, her stress level could be reduced, and the risk of giving birth prematurely might go down,” Phibbs said.

The implications extend beyond women in combat, since PTSD is not unique to combat. In fact, half of the veterans in the study had never been deployed to combat.

TIME Combat

Exclusive: A SEAL Recounts a Kill Mission and the Emotional Aftermath

Mark Owen is the pen name of Matt Bissonnette, a veteran SEAL and the author of No Easy Day: The Firsthand Account of the Mission that Killed Osama bin Laden and the forthcoming No Hero: The Evolution of a Navy SEAL.

The only thing Mark Owen says his SEAL training didn't teach him: how to return to normal life after a brutal combat mission like one in Iraq, 2006 (WARNING: this article includes some graphic content)

I’ve been through shooting courses. I can go rock climbing, ride a dirt bike, drive a boat, and handle explosives. The government spent millions of dollars training me to fight in the jungle, arctic, and desert. I took language courses and I can parachute at night and land right on target. But I’ve never been trained to handle the stress of combat. We spent months learning how to be SEALs and hours of every day keeping those skills sharp, but we got no formal training dealing with any of the emotional stuff.

Before I joined the SEALs, I wondered if I would actually be able to pull the trigger. Could I defend myself? I only really thought about it before I became a SEAL because once I was on missions I didn’t have time to think about it. Everything I did overseas was done to protect the guys to my left and right, and my country. I obeyed the rules of engagement and never targeted innocents.

But that doesn’t mean it didn’t f-ck with me. To this day, if you ask [my SEAL teammate] Phil about “the cat,” he’ll tell this story of a 2006 mission in Iraq.

***

The unmanned drone flying over the target reported seeing a half dozen men sleeping outside. It was summer in Iraq, and even at night it was too hot to stay inside without air conditioners. The village was really just a cluster of about ten squat, adobe‑style houses. I didn’t see any power lines coming into the village as we patrolled, so we expected people to be sleeping outside.

We closed slowly on the village just before three in the morning. The desert was flat and wide open and it was hard to see the horizon, even with my night vision goggles down. The village could have been on the moon. Nothing surrounded it for miles except sand and rocks. Above me, the stars were thick and bright.

Now, close to the houses, the march was one slow step at a time.

The troop chief gave the word and we moved into a large “L”‑shaped formation and started to close on the village. The base, or bottom, of the “L” was going to set up just outside of the village and, if needed, provide a base of fire and cover our movement. The vertical part of the “L” was going to move through the village searching for fighters. I was in the second group.

On the radio net in my ear, I heard updates from the other assault teams. I knew that circling above us and just outside of audible range, we had drones to give us eyes in the sky and an AC‑130 to cover us in case we needed immediate close air support. I scanned over to where the drones reported seeing the sleepers. I could make out about ten bedrolls.

A pair of men stood, scanning the desert. They weren’t talking, or at least it didn’t appear so. It looked like they were straining to see into the blackness of the desert night.

Did they hear something?

I was sure they couldn’t see us. Maybe they heard the AC‑130 above. Finally, one man moved over to where the others were still sleeping and began waking them up. His partner never stopped scanning the open desert. I could see the others getting up, slowly, and start looking around.

While the others got moving, the pair of men walked toward the nearest house. The others eventually followed. None of the men had guns so we couldn’t open fire, but it was definitely suspicious to see a large group of men sleeping on the outskirts of the village. Where were all the women and kids?

The group was halfway to a house on the edge of the village when they stopped. The entire group turned and started to walk back to their bedrolls. We were about two hundred meters away and I could see every one of the men clear as day in my night vision.

When they got back to their bedrolls, I could see them grabbing AK‑47s, RPGs, and even a belt‑fed PKM machine gun. Multiple IR lasers popped on and zeroed in on the chests of the fighters as our snipers went to work. Seconds later, three of the enemy dropped.

The others panicked and started running back toward the village. Suppressed rounds continued to pour in on them.

I counted five dead fighters. By this point in the war, we were very conscious of not running to our death, so we paused for a moment. The base of the “L” stayed in place. We were hoping the enemy hadn’t noticed the rest of us off to their right flank. Our position hadn’t fired yet in an effort to stay undetected.

Within minutes I heard the troop chief ’s voice over the radio. “OK, guys, the base is going to hold position and the maneuver is commencing assault at this time.”

“OK,” I heard the troop chief say over the radio. “Take it.” Our entire element got up and began slowly bounding forward in pairs. Two or three SEALs would slowly make their way forward with guns at the ready, stopping a short distance ahead of the next group. They would then take a knee and hold security while the rest of the unit bounded past them. We were just about to enter the village when we saw four men in a dead sprint racing back to the bedrolls.

I was less than one hundred yards from them. I raised my gun and zeroed in on the first guy in the group. He looked anxious as they sprinted, his eyes wide. He practically slid to a stop, his chest heaving, and started to root through the folds of his bedroll. The first man got to his bedroll and knelt down. I could see him pull out an AK‑47.

I put my laser on his chest and fired. My teammates also opened fire. We all hit the same guy in rapid succession, spinning him down. One by one, I followed our lasers to the next target until all four were on the ground, unmoving.

Again, we paused to assess the situation.

I took a knee and began scanning the surrounding buildings, waiting for any more “heroes.” Phil, my team leader, took a knee next to me, and I could hear him whisper.

“That was interesting,” he said. “I guess they really want to fight. Let’s take it slow and careful tonight. These guys mean business.”

“Let’s keep moving,” the troop chief interrupted over the radio.

My team spent the next thirty minutes clearing house after house. I scanned every doorway and window, watching for a fighter to pop out.

Up ahead, I caught a glimpse of a guy peering out of a door. He was tucked back in the doorway, but not far enough. I could see the muzzle of his AK‑47 as he waited for us to come closer. Thankfully it was dark. At least it was dark to him. We had our night vision goggles.

I wasn’t sure Phil saw him at first. The man pulled his head back quickly and I saw Phil’s laser shine on where his head once was. The man slowly slid his head back into view as he attempted to get a look at our position. Phil’s laser was now
on the man’s forehead.

I heard several suppressed shots from Phil’s MP7, and the man’s head disappeared from view. Two fighters ran through the village, popped out the other end, and tried to hide by running out into the open desert. They stood out immediately on the infrared cameras carried by the ISR and AC‑130. A team of four SEALs and a combat dog raced out of the village after the fighters. The AC‑130 banked and headed toward the group. I was keeping track of their progress on the radio. Finally, I heard the thump of the AC‑130’s guns.

When my teammates got to the bodies, it was a shocking scene. It looked like one of the fighters was blown completely inside out. A round from the plane’s one‑hundred‑and‑five‑ millimeter howitzer must have hit him. The one‑hundred‑and‑five‑millimeter shell is twice the size of a bowling pin, and it can do some serious damage.

Back in the village, I was still holding security when Phil’s voice came over the net. “Alpha Two, Alpha One,” Phil said, using our call signs. “Need you in here.”

I stepped over the fighter’s body and saw Phil and two of my teammates searching the main room. The gun the fighter had been holding was leaning against the far wall of the foyer. Phil had taken the magazine out and cleared the chamber.

I looked back at the dead fighter. His head was lying away from the doorway leading to the main room. Had the fighter not exposed himself in the doorway, there was a good chance neither Phil nor I would have seen him. If he’d had a little patience, he would have had the jump on us.

Phil had clearly popped him with a great shot. The bullet hit him just above his nose, flush in the bottom of his forehead. Half of his face was torn off, leaving one good eye staring blankly at the ceiling. Blood was slowly pooling up around the back of the fighter’s head.

I started to look away when a flicker of movement caught my eye. A ratty‑ass‑looking calico kitten, its fur matted to its skinny rib cage, was at the edge of the blood pool. The kitten sniffed at the pool, and then I saw its pink tongue dart out and lick the blood. I expected to see dead bodies, and I had more or less gotten used to it by this point, but there was something about the ratty cat and the blood that didn’t seem right. I didn’t expect it. It was pretty f-cking gruesome.

I turned away and started to search the house. The area was secure, so I wasn’t quiet. I was digging through a cabinet near the door when I heard something behind me. It sounded like a sob or a whimper. I swung around, one hand on the grip of my rifle, and saw a small child huddled in the corner. He was balled up behind a pile of blankets, and my teammates must have missed him in the initial clearance. I squatted down to get a better look at him. I wasn’t sure if he was injured. His hair was matted. His tears washed away some of the dirt from his cheeks. He looked as ratty as the cat licking blood in the foyer.

I looked back over my shoulder and realized that from his vantage point, he would have seen the man in the foyer as he was shot. I had no idea if the man was his father or just a fighter hiding in the house. Either way, he’d watched us shoot the guy and probably saw the cat licking the puddle of blood. “Wow, I’ve seen some crazy shit, but this poor kid is going to be f-cked up by this the rest of his life,” I thought.

The kid was shaking he was so scared. He probably thought we were going to kill him too. Plus, I figured with all of my guns and gear strapped to me, I looked pretty menacing.

The kid continued to quietly sob. I slowly slid a chemlight out of my vest and popped it. The stick lit as I shook it, bathing the room in a green hue. I also slid out a Jolly Rancher and held it out to him. The kid wouldn’t look me in the eye at first.
I shook the chemlight.

“Hey, buddy,” I said. “I’m not going to hurt you.”

I knew he had no idea what I was saying. My only hope was he got my tone. Slowly, he looked up. He was sizing me up, trying to gauge if I was a threat. I tried to smile, but I knew in all my gear a smile wasn’t going to be enough.

He looked away and then quickly snatched the chem light and candy. He didn’t eat the candy; instead he just clutched it in his hand. I got on the radio to figure out where we were consolidating all the women and kids. They were in a house not far away, so I stood up and waved at him to follow me.

He didn’t understand me, so I took his hand and led him out of the house. I tried to block his view of the dead fighter and the cat, still licking at the pool of blood.

We walked through the village. I could hear a few of the women and kids sobbing when I got to the house. A teammate was at the door keeping watch. When the kid saw the other children and women, he let go of my hand and walked into the middle of the room. I didn’t linger. I had work to do and I knew the kid was safe now.

As I walked back to the house to continue my search, I could still picture the cat licking the blood, and the kid watching from across the room as the man’s head was blown off. I quickly pushed the image out of my mind and resumed my search.

***

I didn’t have time to dwell on it. After missions, I blocked it out. I know some guys who make a big deal about killing. I’d shot people from long distances and shot people at point‑blank range. But I always rationalized it this way: If I hadn’t shot the enemy, he would have killed one of my swim buddies or me. I didn’t need another explanation.

That didn’t make it easier when I got back home to the real world. At home, we’re expected to forget everything we did to survive overseas. How did I leave it all over there? I don’t know. All I know was I got better and better at compartmentalizing things. I simply blocked out a lot of the emotional stuff. I pushed myself through the confusion of living one life overseas and another at home.

It was a struggle, one I overcame by redirecting many of the lessons I learned from SEAL training. I simply didn’t let the effects of combat control me. When I came home I never talked about work to people outside of my teammates.

But after the [REDACTED] mission, I couldn’t shake the stress. The mission was spilling out of my mental compartments. As I left the cage after talking to my buddy, I felt better. I felt reassured knowing that others were going through the same mental gymnastics as I was. I wasn’t the only one having trouble trying to comprehend all the shit that had gone on since the raid.

A few years earlier the Navy started trying to address combat stress. Their first idea was requiring us to spend a few extra days in Germany on the way home from every deployment. They wanted us to decompress.

Before Germany, we’d be home sometimes twenty‑four hours after an operation. I’d go from a gunfight overseas and within a day be back in the States at Taco Bell for my routine, two tacos and a bean burrito. It sounds pretty strange, but that stop at Taco Bell was probably me putting up a wall on another compartment in my brain; it allowed me to keep everything separate.

After the policy change, we stopped in Germany and the command’s psychologist flew over to meet us and give us classes on coping with combat stress and reintegration into the civilian world. For the guys with families, the training was focused on going back to the family routine. The funny part was we’d be home for a few weeks, only to head out on our next training rotation, which would keep us on the road for weeks.

The command eventually replaced the Germany stop with a new policy. We all had to meet with a command psychologist. We were required to sit down for a single thirty‑minute meeting after each deployment. The thirty minutes were used to talk about any issues we might be having. Once I went down with another buddy, Gerry, to knock it out. We weren’t buying into this, and it had become just another line item on my to‑do list after returning from a deployment. Each person’s thirty‑minute session had to be complete before they would allow us to take any leave or vacation time. It was something the senior guys blew off, but we were required to go. We knew it was a box that needed to be checked so the Navy could say we were being counseled and trained to deal with the stresses of combat.

It was toward the end of the day when Gerry and I got to the psych office. I don’t remember if it was my appointment or Gerry’s, but when the two of us walked into the office, the psychologist was taken aback. She was pregnant, about three weeks away from popping. She looked as tired as we did.

“Listen, you don’t have much time,” Gerry said, pointing at her stomach. “We’re going to save you an extra thirty minutes by doing our sessions at the same time.”

After thinking about it a minute, she waved us both into her office. Gerry folded his more‑than‑six‑foot‑five‑inch body into the couch. I took a seat across from the psychologist. She sat in an office chair with a notepad.

“We’re going to talk about some stuff, some sensitive things. Are you guys OK with doing this together?” she said. “Gerry knows everything about me,” I said. “And I know everything about him. We’re good.”

For most of the thirty minutes she asked us questions about how we were handling stress and if we had any PTSD symptoms. I can remember her handing us a sheet of paper with a list of symptoms on it. I took a second and quickly read down the list. The symptoms included trouble sleeping, avoiding crowds, and keeping your back to the wall in a restaurant.

“Holy shit, I think I have every single one of these,” I thought.

“Why are we not more f-cked up?” I asked. “Why are we not more messed up from the shit that we’ve seen? You talk about PTSD. Gerry and I have been trained to deal with just about every combat or tactical situation that can be thrown at us, but we’ve never had one second of training to deal with the emotional side of things.”

She nodded.

“The best way I can describe it is BUD/S,” she said, [referring to Basic Underwater Demolition, SEALS, the six-month SEAL training program].

“So are you saying BUD/S made me stronger? Or BUD/S just weeded out the weak?” I asked.

I stumped her with that one. Before she could answer, Gerry jumped in.

“I think we’re just mentally stronger than everyone else on the planet,” he said with a smile.

He was obviously f-cking around. There was no way that we could comprehend all that we’d seen and done. It was easier to just make a joke and ignore it.

We left the doctor’s office after our thirty minutes and never said another word about it. Over time, I started to sleep better, and there was some comfort knowing I was strong enough to compartmentalize the traumatic experiences I’d had overseas. I still have the list that the doctor gave me. From time to time, I read over it, and I still have every single symptom on the list.

From the helicopter crash on the [REDACTED] raid to that small malnourished Iraqi cat licking the pool of blood from the fighter’s head, each experience had its own compartment. The symptoms didn’t go away even after I got out of the Navy. I just choose to block them out.

We all deal with the stress of combat in different ways. The way that I’ve dealt with it isn’t perfect and certainly isn’t for everyone. Being a SEAL is a tough life and career. The sacrifices go far beyond what I’d ever imagined, but if asked whether I would do it all over again, my answer, without hesitation, would be simple.

Yes.

 

NO HERO

From NO HERO: THE EVOLUTION OF A NAVY SEAL by Mark Owen with Kevin Maurer. Published by arrangement with Dutton, a member of Penguin Group (USA), Inc. Copyright © 2014 by Mark Owen.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Five Best Ideas of the Day: November 5

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Beyond PTSD: Returning soldiers struggle to recover from the ‘moral injury’ of war.

By Jeff Severns Guntzel in On Being

2. On climate and so many other scientific issues, the way we communicate polarizes audiences. We can do better.

By Paul Voosen in the Chronicle of Higher Education

3. Entrepreneurs and educators need to observe students in school if they want to make real change.

By Alex Hernandez in EdSurge

4. Lifesaving ultrasound technology may soon come to a device the size of an iPhone. The applications for medicine in the developing world are massive.

By Antonio Regalado in MIT Technology Review

5. Many Arab governments are fueling the very extremism they purport to fight and are looking for U.S. cover. Washington should play the long game.

By Michele Dunne and Frederic Wehrey at the Carnegie Endowment for International Peace

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Mental Health/Psychology

PTSD Is Linked to Food Addiction in Women, New Study Finds

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"Weight status is not just a symptom of willpower and education," a researcher says. "There may be psychological factors in play too"

A new study published in JAMA Psychiatry has found that women who suffer from the worst symptoms of posttraumatic stress disorder (PTSD) are twice as likely to be addicted to food than those who do not, Reuters reports.

Researchers link symptoms of PTSD in women to a psychological dependence on food, or food addiction. But the study doesn’t mean that there is a direct connection between PTSD and overeating.

“We don’t know if it’s causal. It’s an interesting relationship and probably worth following up,” Susan Mason, from the University of Minnesota in Minneapolis, told Reuters.

To find out whether women were more likely to have a food addiction, in 2008 researchers asked 49,408 female nurses about PTSD symptoms. A year later they then asked the same group about food addiction.

They found the more symptoms of PTSD a woman had, the more likely it was for her to be addicted to food.

The findings could help doctors treat women with eating disorders, reports Reuters.

“Clinicians may be able to look for that information to deliver better care,” Mason said.

Researchers still don’t know what occurs first — food addiction or PTSD — but they hope the study will help them connect the dots.

“I just want this to add to a lot of research that people’s weight status is not just a symptom of willpower and education,” Mason said. “There may be psychological factors in play too.”

[Reuters]

TIME Innovation

Five Best Ideas of the Day: September 11

1. National service is a critical American value that has the power to unite us.

By Condoleezza Rice and Robert Gates in Time

2. The challenge for America’s strategy against ISIS isn’t our military might. It’s the will of our partners in Iraq and Syria.

By Jeff Shesol in the New Yorker

3. After a decade of urban violence, blacks in America report PTSD symptoms at the same rate as veterans of our last three wars.

By Lois Beckett in Essence

4. Municipal buses move more than 5 billion people annually. Converting them to electric power would slash carbon emissions dramatically.

By Daniel Gross in Slate

5. To gather valuable health data from the poor, texting survey questions yields impressive results.

By the University of Michigan Health System

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Brain

Erasing Bad Memories May Soon Be Possible

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Getty Images (1); Illustration by Mia Tramz for TIME

Using state of the art laser and gas techniques, scientists working with mice make stunning breakthroughs in turning bad memories into better ones

Memories are a complex combination of objective information—the color of a car, the size of a building—and less tangible emotional feelings, like fear, anxiety, joy, or satisfaction. But to scientists, memories are nothing more than a series of chemical and physical changes, the firing of a nerve here, which sends electrochemical impulses to another nerve there, which together encode everything that we associate with a memory.

But exactly what do those changes look like? And is it possible to override them? In a milestone paper published in the journal Nature, scientists may have provided some answers, explaining how emotional baggage gets attached to memories, and how that can be manipulated to quite literally turn bad memories good. In separate work appearing in the journal PLOS ONE, researchers say that a commonly used anesthetic gas, xenon, if administered at exactly the right moment, can also strip the painful and negative feelings associated with a traumatic memory, essentially neutralizing it.

The findings from both groups come from mouse studies, but the two teams are confident that the results will further efforts to understand and find new ways to treat depression and post traumatic stress disorder in people.

In the Nature study, Susumu Tonegawa and his team showed for the first time exactly where in the brain both positive and negative memories are created, and how these emotional layers can be switched around. They exploited a cutting-edge technique they developed called optogenetics to track an emotional memory as it’s made and also manipulated in the brains of mice. They studied both positive experiences—male mice were allowed to spend about an hour with female mice—and negative experiences—the mice were given mild foot shocks.

MORE: 5 Secrets to Improve Learning and Memory

First, the researchers administered a protein, called channelrhodopsin, into mice nerve cells that were activated during and immediately after those experiences (the positive and the negative). The protein reacts to a specific blue wavelength of laser light—and the scientists discovered that when that light was administered to the the part of the mouse’s nerve cells that fired up after those good or bad experiences, the emotion associated with the memory was relived as though it were happening all over again, even absent the stimulus that created it in the first place.

“Optogenetics for the first time allowed us to pin down the cells in the brain that literally carry the information for a specific memory,” says Tonegawa.

The real revelation came when the scientists tested how malleable the connection between the shock and the memory was. They allowed the shocked mice to spend time with females while their brains were hit with the blue light—which triggered their fear of the shock even though they didn’t get one. After 12 minutes of the laser exposure, the mice relaxed. But it wasn’t that they had replaced their fear with more pleasant feelings. Images of their brains showed that new circuits, presumably the ones associated with more positive feelings of being with females, had sprouted between the emotional regions of the brain and the memory center. Likewise, the mice that had had the pleasurable experience with their female counterparts were given the shock while exposed to the blue light, and now showed more fear and anxiety. The original emotional associations were not eliminated and replaced. Instead, says Tonegawa, the positive and negative circuits compete with each other, and whichever is dominant becomes the prevailing emotion linked to a memory.

MORE: This Is the Brain Circuit That Makes You Shy

That could explain how some psychotherapy currently works. To help depressed patients address their feelings, some therapists will revisit negative or emotionally painful experiences. Because memories are not recalled and returned in exactly the same way like a recording, any new information attached to that memory—such as more neutral or positive perspectives about the episode—can help to diffuse its negative impact. Tonegawa’s work in animals suggests that it’s possible to make that psychotherapy technique even more effective if therapists can help patients to focus on more positive feelings while reconsolidating painful memories.

That’s what another group, at McLean Hospital, is hoping to do with a much more simplistic strategy. Edward Meloni, an assistant professor of psychiatry at Harvard Medical School and Marc Kaufman, director of the McLean Hospital Translational Imaging Laboratory, found that the gas xenon, which is used in anesthesia (primarily in Europe), can neutralize the fear associated with a traumatic memory. Exposing mice that had experienced foot shocks to the gas dramatically reduced their fear behaviors – such as freezing up and avoiding areas associated with the painful shock – for up to two weeks. That’s because xenon preferentially targets certain receptors, called NMDA, on brain nerves that are concentrated in learning and memory regions. So when a traumatic memory is activated, those neurons involved in recalling that memory are prime targets for xenon, which blocks the cells from making their usual connections to the emotional hub in the brain known as the amygdala. “My speculation is that xenon lessens the impact of the emotional component, the real emotional pain associated with a traumatic experience,” says Meloni.

MORE: Memories Can Now Be Created — And Erased — in a Lab

It’s not clear yet whether the gas will have similar effects on long-standing traumatic memories such as those involved in PTSD, but Kaufman and Meloni plan to set up a human trial as soon as possible. Ideally, says Meloni, if xenon proves to be effective and safe for reshaping memories, patients who experience debilitating nightmares would be able to give themselves a squirt of xenon just as they would use an asthma inhaler. Since the gas dissipates quickly, so far there doesn’t seem to be a reason to worry about other potentially harmful effects on the brain.

And what about situations that don’t quite reach the level of PTSD, but are traumatic nonetheless, such as the death of a loved one or a bad breakup? “In general I think those painful experiences are probably not going to be impacted by xenon because there really isn’t a specific memory that is reactivated, like a flashbulb moment of trauma,” he says. “It’s more a global heartbreak.”

Because xenon isn’t specific to blocking the negative connections to the brain’s emotional nexus, Kaufman says it’s possible the gas could also be helpful in reducing the highs and the reward sensation associated with addiction. More studies will need to show that xenon could play a role in those situations as well, but both he and Meloni are optimistic. “We’ve got a good start in animals, and as we work through the ladder in getting it to people, I’m hopeful,” says Meloni.

TIME politics

Montana Senator’s Plagiarism Scandal Has a Silver Lining

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Sen. John Walsh, D-Mont., speaks during an event in the Capitol Visitor Center on the importance of the Land and Water Conservation Fund, July 23, 2014. Tom Williams—CQ-Roll Call,Inc.

Sen. Walsh's mental health may have nothing to do with lifting from other scholars, but the acknowledgement of PTSD and depression reveals a changing moment in politics.

Sen. John Walsh (D – Montana) is being accused of plagiarism for failing to properly cite the work of others in the master’s thesis he wrote while at the Army War College in 2007. Indeed, it has been widely reported that as much as a quarter of what the senator wrote—and presented as his own work—may have been the ideas and/or words of other prominent experts on Middle East policy.

When asked about this apparent transgression, Sen. Walsh stated that he believed he had done nothing wrong. He didn’t recall using sources improperly, but he is considering apologizing to scholars he failed to cite. A campaign aide for the senator acknowledged the plagiarism, but indicated that Sen. Walsh did not intend to deceive anyone and that his actions should be viewed in the context of a successful military career during which he was a highly decorated officer who served with distinction in the Montana National Guard. The aide noted that Sen. Walsh was going through a difficult period in 2007. One of the soldiers from his unit in Iraq had committed suicide during this time. The senator has acknowledged that he is being treated for post-traumatic stress disorder. He is currently taking antidepressant medication as part of this treatment.

We can’t know what Sen. Walsh intended when he failed to include citations for ideas that were not his when he wrote his thesis seven years ago. One indication of whether this act represents a flaw in the senator’s character, a lapse in judgment, or a failure to understand academic standards and practices is to look for a similar pattern of behavior—or lack thereof—across his life and career. Those on both sides of the political spectrum will be doing just that as this story unfolds.

Some are asking if there is a relationship between PTSD and plagiarism. There is none—at least not a direct one. There is, however, a clear relationship between the experience of trauma and possible impairment across a number of areas, including cognitive and emotional functioning. The relationship is even stronger if you experience repeated trauma. Imagine driving to work and having a head-on collision on the highway. Miraculously you walk away with no physical injuries, but others around you die. Imagine that this happens to you not once but several times over the course of several months or a year. You begin to have difficulty sleeping, concentrating and focusing. You might feel depressed, you might have flashbacks, and you most certainly will have guilt and possibly shame. Could this experience of repeated trauma affect your judgment or your ability to process information critical to your success in your relationships, at school, or in your career? Absolutely.

Though the consequences – if any – of Sen. Walsh’s actions in 2007 are yet to be determined, it is important that we continue to have conversations and discussions about the very real impact that trauma can have on someone’s long-term functioning. We need these discussions not because we should excuse behavior that is inappropriate, unethical or criminal, but because one in four Americans suffer from diagnosable mental health conditions, along with the trauma that often creates those conditions. Sometimes war causes these injuries, sometimes a natural disaster, or a rape, or an assault. Sometimes it is a bad role of the genetic dice that leads to significant impairment. Isn’t it better to discuss these issues openly and, by doing so, encourage appropriate care and relieve unnecessary suffering?

Perhaps one silver lining resulting from the last 13 years of war—and many tragic stories of those who have struggled upon their return from battle—is that we as a nation are becoming a bit more comfortable with the topic of mental health. Until now, few if any politicians or other public or military officials have been willing to admit they have a mental health issue, let alone suggest it may have clouded their judgment. Perhaps we are more willing to entertain the possibility that the cause of someone’s behavior just might be a bit more complicated than we think. After all, mental health is a part of the human condition. We all experience it, and sometimes the difference between being mentally sharp and healthy or not depends on whether we swerve the wrong way, are born with the wrong DNA or watch a buddy die in combat.

Barbara Van Dahlen, named to the TIME 100 in 2012, is a licensed clinical psychologist and the founder and president of Give an Hour. A notable expert on the psychological impact of war on troops and families, Dr. Van Dahlen has become a thought leader in mobilizing civilian constituencies in support of active duty service members, veterans and their families.

TIME politics

Veterans Affairs Needs to Get a Clue About PTSD Treatment

Veterans
Iraq war veteran Zach Choate, 26, leads a group of veterans to a rally on the steps of Russell Building to call for a end to the redeployment of troops who have diagnosed with Post Traumatic Stress Disorder (PTSD). Choate was redeployed while still recovering from wounds inflicted by an IED. Tom Williams—CQ-Roll Call,Inc.

Some medical centers may have a goldmine of PTSD data, which could help improve treatment. If only the department could get its act together.

Both the Departments of Defense and Veterans Affairs spend huge sums every year to treat post-traumatic stress disorder: $294 million and more than $3 billion, respectively, in 2012. But does the treatment help? According to a new congressionally mandated, 300-page report from the Institute of Medicine, neither the Pentagon nor the VA—the two agencies responsible for providing PTSD treatment to soldiers and veterans—have a clue.

The investigating committee found “spikes of excellence in both departments,” said its chairman, Sandro Galea of Columbia University’s Mailman School of Public Health. It also identified “tremendous variability in how care is implemented and an absence of data that tell us if programs are working or not.” Overall, the modest data that do appear in the IOM report are not particularly encouraging.

Members of the expert panel visited some of the VA’s Specialized Intensive PTSD Programs, or SIPPs, which are inpatient or residential programs of up to four months. They reviewed the results of all 39 such programs during 2012 and found that, after four months of treatment, the average patient still qualified for a diagnosis of PTSD.

This isn’t entirely surprising. The VA learned in the 1990s that their 16-week specialty inpatient programs were ineffective, and closed them down. Under political pressure in the 2000s, they started them up again.

But there might be good news—if only we could demonstrate it. After all, the majority of PTSD patients in the VA are not treated in inpatient or residential settings, but as outpatients. Presumably, these patients are better off than those referred to intensive programs.

So how do they fare? Are they better able to benefit from state of the art cognitive-behavioral therapies, such as prolonged exposure and cognitive processing? Clinicians routinely use these interventions to good effect in treating PTSD among civilians. We have every reason to expect that, in most cases, these therapies–in conjunction with psychotherapy and couples or family therapy or medication—have indeed helped veterans.

In any case, the IOM says there are no data. Well, not quite. While not reliably collected across the entire VA health system, there is some tracking information on treatment outcomes. For several years, the VA has required clinicians in every VA medical center to complete a PTSD Checklist (PCL) for each patient every 90 days. The PCL provides a total symptom severity score.

This enables clinicians to track changes in symptoms and establish the optimal frequency of therapy sessions, according to Ron Acierno, former director of the PTSD Clinical Team at the Ralph H. Johnson VA Medical Center in Charleston, S.C. Acierno and his team conducted routine PCLs, though how consistently and completely the surveys were administered at other VA medical centers is unknown.

In medical centers that do comply with the VA mandate to collect PCLs, there may well be a small goldmine of data to be excavated. With this information, we could answer immediate questions about the improvement of veterans’ symptoms and functioning. We could begin to learn what kinds of outcomes we see for younger veterans of the post-9/11 era and Vietnam veterans whose wartime experience is now several decades ago. Yes, Vietnam veterans are very much in the picture as new PTSD patients. One out of every three new patients in 2012 in the VA’s specialized PTSD programs was a Vietnam-era veteran, according to the IOM–even though they last saw military service decades ago.

We could also examine differences in response to treatment between active duty personnel and veterans. Our colleagues tell us, impressionistically, that men and women still in the service are, in general, more motivated than the patients they have treated in the VA. That’s because the culture of the military mental health system aims to help soldiers resume participation, while the VA’s current disability policies often reinforce illness roles and inadvertently pose disincentives to work and recovery because compensation is contingent upon the severity of PTSD.

In establishing PTSD Awareness Day, the Senate resolved to “help ensure that those suffering from the invisible wounds of war receive proper treatment.”

In some, though not all VAs, they do. Now the mission is to ensure quality care is widespread, and to learn whether treatment is helping, who benefits most (and least) and why. Veterans with PTSD deserve the best care possible; accountability is critical to seeing that they get it.

C. Bartley Frueh is chair of the social sciences division at the University of Hawai‘i at Hilo. Sally Satel is a resident scholar at the American Enterprise Institute. Both are former VA clinicians.

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