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.

TIME Military

The PTSD Epidemic: Many Suffering, Few Solutions

Soldiers with the U.S. Army's  Bravo Company, 1st Battalion, 36th Infantry Regiment rest in an Afgan National Police compound before going on patrol near Command Outpost AJK (short for Azim-Jan-Kariz - a near-by village) in Maiwand District
Soldiers with the U.S. Army's Bravo Company, 1st Battalion, 36th Infantry Regiment rest in an Afghan National Police compound before going on patrol near Command Outpost AJK in Maiwand District, Kandahar Province, Afghanistan on Jan. 24, 2013. Andrew Burton—Reuters

The scourge of wars in Afghanistan and Iraq is worse than we thought

Now that Iraq is falling apart, it seems only fitting that the U.S. government issues a fresh accounting revealing that neither the Pentagon nor the Department of Veterans Affairs has any idea if the billions they’re spending on PTSD treatments are doing any good.

A congressionally mandated Institute of Medicine panel reported Friday that neither agency assesses the success of their PTSD care. “Without tracking outcomes, neither DOD nor VA knows whether it is providing effective or adequate PTSD care, for which they spent $294 million and more than $3 billion, respectively, in 2012,” the 300-page study concludes.

Roughly 5% of all troops have been diagnosed with PTSD, the report says, but it’s nearly double—8%—for the 2.5 million who served in Afghanistan and Iraq. Post traumatic stress disorder is also increasing among older veterans. In 2013, the VA diagnosed 62,536 new cases in veterans who did not serve in the Iraq and Afghanistan wars. One out of every three new patients in 2012 in the VA’s specialized PTSD programs was a Vietnam-era veteran. All told, the number of veterans seeking PTSD care jumped from 190,000 in 2003 to more than 500,000 in 2012.

“Although these numbers are likely to underestimate the incidence and prevalence of PTSD, they demonstrate that action is needed to respond to this growing problem,” the study says. “Demands for post traumatic stress disorder services among service members and veterans are at unprecedented levels and are climbing.”

The IOM report is crammed with data about the extent of the problem, and figures to back them up (you can see more of them here):

  • Total Pentagon spending on PTSD treatment jumped from $29.6 million in 2004 to $294.1 million in 2012.
  • Outside PTSD care funded under the Pentagon’s TRICARE program climbed from $22.4 million in 2007 to $131 million in 2012.
  • Between 2006 and 2012, the number of hospitalizations of service members for PTSD increased by 192%.
  • The total annual cost for health care for a veteran who had PTSD was estimated to be $11,342, which was more than double the annual VA health care cost of a veteran without PTSD.

Even those who have dealt with the issue for years are surprised. “The acceleration of PTSD among service members and veterans is staggering,” says Elspeth Ritchie, a retired Army colonel and the service’s one-time top psychiatrist.

The Pentagon’s PTSD treatments “appear to be local, ad hoc, incremental, and crisis-driven, with little planning devoted to the development of a long-range approach to obtaining desired outcomes,” the IOM report says. While the VA’s programs are “more unified,” they both lack records of what treatments work, meaning they “have no way of knowing whether the care they are providing is effective.”

The Pentagon PTSD bill grew 10-fold between 2004 and 2012. IOM

“Given that the DOD and VA are responsible for serving millions of service members, families, and veterans, we found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not,” says committee chair Sandro Galea of Columbia University’s Mailman School of Public Health. The report is a follow-up to an initial IOM assessment of PTSD treatment released in 2012 that only surveyed what was available; Friday’s study was to find out if they work.

The number of veterans of all eras who sought care for PTSD from the VA more than doubled from 2003 to 2012—from approximately 190,000 veterans (4.3% of all VA users) in 2003 to more than a half million veterans (9.2% of all VA users) in 2012. For those treated for PTSD in the VA system in 2012, 23.6 percent (119,500) were veterans of the Iraq and Afghanistan wars.

PTSD can happen when someone experiences a traumatic event, on the battlefield or elsewhere. It can lead to anxiety, depression, sleeplessness and other symptoms that can interfere with life, sometimes contributing to domestic violence, divorce and suicide. The multiple deployments required by a force too small to support the wars fought has played a major role in the PTSD increase among recent vets.

Unfortunately, even if the government begins tracking outcomes, the results may be what the IOM calls “modest,” at best. The only program that routinely conducts such assessments is the VA’s small specialized intensive PTSD program (SIPP). “In 2012, the 39 SIPPs had 3,792 entrants for a total cost of $88,572,953, or $23,578 per patient,” the study found. “The average PTSD Checklist (PCL) scores for veterans at admission to the programs and 4 months after discharge were 65.9 and 60.2, respectively. That indicates that most program graduates met the criteria for clinically significant PTSD after discharge on the basis of a PCL cutoff score of 50.”

TIME Veterans

Veterans Offer Each Other Help as Iraq Falls Apart

A US marine from the 3/5 Lima company po
A U.S. Marine in Fallujah in November 2004. PATRICK BAZ / AFP / Getty Images

One group warns of “frustration” that could lead to suicide

More than 1.5 million Americans served in Iraq between 2003 and 2011. More than a few of them are upset with what’s happened to that country, where they fought and their friends died, over the past week.

That’s why the Wounded Warrior Project sent an email Tuesday to its 50,000 members acknowledging their sacrifices and offering mental-health services if they find the latest happenings from Iraq depressing.

“Your feelings are justified,” Ryan Kules, 
the project’s national alumni director and a double amputee, said. “If you feel frustration watching the news, remember that we did our duty and served admirably, coming home with the visible and invisible scars of that service.”

The reaction of those who fought, and whose friends died, in Iraq has been somber. There wasn’t so much bitter anger as a palpable sadness. Those who thought the invasion was a mistake consoled themselves by blaming President George W. Bush; others blamed President Obama for not fighting harder to keep some U.S. forces in the country after 2011 to try to ensure the lives of the 4,486 Americans who died there didn’t end in vain.

“So many of my friends died in a war that didn’t need to be fought, but that did ultimately provide a reasonable chance for a democratic Iraq in the center of the Middle East,” retired Army officer John Nagl says. “It now appears that all those lives have been squandered because of an unwillingness to pay an insurance premium of a few thousand advisers and some airpower.”

Such grim tidings can lead to despair, which is why Kules of the Wounded Warrior Project reached out. He urged troubled vets to seek help “if you are dealing with PTSD triggers because of current media coverage,” and gave a phone number—1-800-273-8255—for any veterans “struggling with thoughts of suicide.”

Michelle Roberts, the communications chief at the project, says the group reaches out when an event—like last year’s Boston Marathon bombing—might trigger adverse reactions among those who served. “We’re very aware of the conversations our alumni are having with each other, and our staff, about the recent developments and how they affect them,” she says. “We just felt it was a really appropriate time to communicate with them.”

Interviews with veterans echo that view. “I’m just heartbroken, tired and nearing mute,” says Alex Lemons, an Iraq vet and former Marine sergeant. “I never saw a concrete objective and, in consequence, a willingness to win on our part.”

Lemons pulled three tours in Iraq, and says the goal shifted with each:

I was told this at the beginning: `And our mission is to clear, to disarm Iraq of weapons of mass destruction, to end Saddam Hussein’s support for terrorism, and to free the Iraqi people.’ WMD? Nothing. Fiction. Al Qaeda and indigenous terrorism? Terrorists entered the country after we invaded and then recruited heavily amongst those Iraqis we alienated with de-Baathification and firings throughout the army. Even during the surge, we could not crush every insurgent group. Regime change? We mishandled the trial and subsequent execution of President Hussein. In some ways, the Maliki government is another Baath party in Shiite garb.

“All Americans who fought there want Iraq to succeed so that we can have personal closure and know our sacrifices were worth it even as the rest of America, like the Vietnam experience, wants to forget,” Lemons says. “But Iraq will never give us that.”

Even Army Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, feels the sting. “Many of you have served in Iraq or know friends and family who made great sacrifices there,” he said in a message sent to troops Thursday. “Like many of you, I was disappointed at how quickly the situation in Iraq deteriorated as well as the rapid collapse of many Iraqi units.”

“It was somewhat expected, yet still disappointing, says Rob Kumpf, who served in Iraq as an Army non-commissioned officer. “Fighting an asymmetric war with one hand tied behind your back, with poor planning and unengaged leadership, led to the current situation Iraq’s security forces face. We screwed up the end game when we withdrew, and will soon do the same in Afghanistan.”

But other veterans have shrugged off what is happening. “Iraq’s political situation is not the concern of individual veterans of the war,” says William Treseder, who deployed to Iraq and Afghanistan as a Marine sergeant. “Combat veterans should value their service based on what they did, not on what happened after the fact or in some larger international context.”

Those who haven’t fought don’t know how combat can change one’s perspective. “Love, loyalty, sweat, and blood are the currency of service—its beating heart. Politics is a dry husk that tries to cover and limit that vitality,” Treseder says. “I wish Iraq and Afghanistan the best as countries, but I do not give them the power to determine how I feel about my service to the United States of America. Nor do I think it’s wise for any other combat veteran to do so.”

But some plainly do. “Your examples of valor and strength educate and inspire those around us,” Kules of the Wounded Warrior Project told them in his email. “Remember, you are not alone. Many of your fellow warriors make themselves available to help others…and WWP remains by your side to provide whatever support and assistance you need.
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