The Evil Hours (10 page)

In my new post-Iraq life, I saw myself doing a kind of survivor shuffle, alternating between hating the past and missing it with an intensity that warped the present into a kind of extended flashforward. The past was always present, just like with Reaper,
EVERYDAY IS DAY ONE
, forever, or even worse, Tomorrow Is Day One. 2014 is 2004. Bodily, what I thought were two separate conditions I now know are one: withdrawing from the world and feeling like part of you is always on patrol in a sort of adrenalized present. Though I didn't notice it until years later, I became irritable whenever someone walked behind me on the street, feeling their presence like heat on my back. On the street, I watched rooftops without even meaning to and searched the roadway for IEDs, taking note of potholes and irregularities in the asphalt. At times like this, I never felt like I was literally back in Iraq, but for a very long time I felt on edge, and I was not pleasant to be around. Average Americans, undisciplined and shambling through life without a care in the world, never failed to get on my nerves. My survival brain, trained and retrained by my years in the Marine Corps and Iraq, had wired a protective carapace of memories, many of which had outlived their usefulness.

The war is over, but it will live forever in the cipher of my brain. It is a part of me. To wage war against a memory is to fight against an old dream and, for me, an old way of looking at the world, the idea that “what does not kill me only makes me stronger.” Some ideas die the hard way: I can see now how foolish that notion is. Like many of my friends, I used to cherish my near-death experiences, collecting them like Boy Scout badges. A close call wasn't simply a brush with mortality, it was an experience, a story, an episode from a novel in which I was featured as the hero. Now, when I think about getting shot or being vaporized by an IED or burned to death in the fiery crash of a helicopter, all the various ways of shuffling off this mortal coil, a certain melancholy settles in. The first time you see someone shot, it's the most amazing day of your life; by the third time it begins to seem sad, sad and oddly boring, because you realize that there is nothing inherently meaningful or of metaphysical import in random enemy contact. As modern, technologically enhanced humans, we may live like gods, but we die like animals.

It is easy when you are young to believe that you have a date with destiny and to assume that the universe is waiting to reveal its deepest secrets to you if you choose to put yourself in harm's way. When I decided to go to Iraq, like many Americans, I was young and had mistaken my lust for danger as real insight into the nature of existence. I never supported the war, but I did believe that it would grant me a clarity and fix what was wrong with my life. In the end, Iraq did give me a certain clarity, it did force me to come to grips with my own human frailty and the frailty of others, but this insight, which has guided the writing of this book, didn't happen simply because I went to Iraq. It happened because of what transpired afterward, in the years after I came home. Whatever knowledge or wisdom I might have achieved came in the aftermath as I began to read, to introspect, and to consider the choices I made in my life and how I fit into the larger world.

There are so many ways to think about PTSD. As a construct, it touches on so many things, but the most important of these might reside in the simple meaning of the first letter of its formal name, the
P
. The loss, the insight, the fragmentation, the moral vertigo, all of these things only happen
post-
, after The Event has come and gone and we discover to our shock and surprise that we are not who we used to be. It is perhaps a facile thing to say, but it seems to me that the first duty of every survivor is to simply acknowledge the existence of trauma, to accept that there are things in this world that can break us. Only then can we begin to make meaning out of everything that comes after.

3

M
OST PEOPLE
, when they first learn about PTSD, assume that the hypervigilance, social isolation, flashbacks, and nightmares of the condition are universal complaints, as old as the hills.
In fact, the opposite is closer to the truth, in that the collection of symptoms and concepts that we call PTSD is a relatively new historical entity that emerged from a very particular point in time and space—1970s America, a period lived in the long shadow of the Vietnam War, a period notable for its social upheavals, its crises of faith, its questioning of gender roles and modes of thought, what Joan Didion called its “febrile rhythms.”
The seventies were, after all, the years that brought us Watergate, Patricia Hearst, Kent State, Jim Jones, the Weather Underground, and, perhaps most importantly, the end of the Vietnam War, a conflict that radically altered not only the way Americans looked at trauma and the role of the veteran in society but also the way America looked at the world.

Even with these data points to anchor us, trying to understand how PTSD fits into the larger sweep of history is a surprisingly difficult task because the human response to war and disaster changes in the way that Texas weather changes: constantly, capriciously, rapidly. To give just one example of the way that culture has influenced how we think about trauma, consider the flashback. Commonly thought of as a signature symptom of PTSD, the flashback is, in fact, a term borrowed from the world of film.
Originally coined by early twentieth-century filmmakers to describe a jump between different points of time within a narrative, the flashback is so deeply embedded in the public imagination that it is difficult to imagine a world without it, and yet in 2002, researchers at King's College in London, digging through war records dating back to the Victorian era, found that flashbacks were virtually nonexistent among veterans who fought before the age of film. (Civil War veterans who suffered from involuntary intrusive images didn't refer to them as flashbacks, and they were more likely to describe being visited by a host of spirits, phantoms, demons, and the ghosts of fallen comrades.)
Adding to the confusion, a variant of the term was also in wide use in the LSD culture of the sixties and seventies.
In all likelihood, the reason that the flashback is an essential part of today's understanding of trauma is that an influential San Francisco psychiatrist with an interest in stress syndromes and psychedelia, Mardi Horowitz, served on the working groups that oversaw PTSD's eventual introduction into the
Diagnostic and Statistical Manual of Mental Disorders
(DSM) in 1980.

Some scholars, such as Roger Luckhurst of the University of London, have even gone so far as to say that cinema's claim on the imagination is so strong that it serves to “shape the psychological and general cultural discourse of trauma into the present.” Looking back on my experiences in Iraq, it isn't hard to see where Luckhurst might derive such ideas. There were, wherever you went in Anbar province, continual references by Marines to
300
, a film about ancient Sparta, and then there were the soldiers in Dora who insistently referred back to their “
Black Hawk Down
day” when describing a series of ambushes they'd survived, as if the casualty count wasn't enough to lend it gravity. Thinking back on the soldiers' stories from that day, it is tempting to wonder if film, television, and, increasingly, video games don't provide the lion's share of our modern traumatic vocabulary, teaching us how to see our memories in the way that photography taught us how to see (and not see) sunsets, in the way that the minds of British soldiers from World War I were dominated by the poetic images of Kipling and Hardy, and in the way that Protestant Christianity guided the attitudes toward death and dying in the Civil War.

In fact, the more you dig, the less secure PTSD's place in history becomes and the more it seems to be a product of culture as much as a hardwired biological fact. Indeed, it is this historical slipperiness that led Allan Young, a medical anthropologist at McGill University, to declare that PTSD is an “invention,” arguing that “the dis­order is not timeless, nor does it possess an intrinsic unity. Rather, it is glued together by the practices, technologies, and narratives with which it is diagnosed, studied, treated, and represented and by the various interests, institutions, and moral arguments that mobilized these efforts and resources.”

The earliest appearance of the word “traumatic,” according to the
Oxford English Dictionary
, dates to 1656, and was used to indicate something “belonging to wounds or the cure of wounds.”
(The modern, multimillion-dollar trauma centers we hear about at large hospitals today refer to this early definition.) Indeed, for the greater portion of its life in the English language, “trauma” adhered to this earlier meaning, and it took more than two centuries before the word was first used in any way resembling its current usage as something “emotionally disturbing or distressing.” Tellingly, the catalyst for this shift in meaning was technology, in this case the railroad. In 1866, a London surgeon named John Erichsen published a book titled
On Railway Spine and Other Injuries of the Nervous System
, in which he described, in a way characteristic of the Victorian period, how the shock of railway accidents “depleted the nervous energies of victims,” comparing the damaged spine to a magnetized horseshoe that has had its attractive force “jarred, shaken, or concussed” out of it.

In other words, our current, deeply felt ideas about post-traumatic stress, what it means to be a survivor, and the basic vocabulary we use to communicate the aftermath of violence—ideas that are staples of the modern American media and seem so fundamental to the human condition as to be beyond question—are in fact not even as old as the United States of America, not even as old as the railroad.

Nevertheless, some of the concepts that make up PTSD do have historical antecedents, and these traumatic responses have in some cases persisted in a manner not unlike traumatic memory itself—through long periods of ignorance and willful amnesia—and this reality makes the job of tracking down PTSD's past that much more challenging. In the great class photo of mental health disorders, post-traumatic stress is like the odd kid at the edge of the frame who always moves just as the shutter trips, leaving him permanently out of focus, forever fuzzing into his neighbors: depression, grief, and generalized anxiety. And a late bloomer, too! His pre-1980 existence is seemingly dominated by a confusing series of name changes, misbegotten identity crises, denial, and flat-out ignorance before passing through the crucible of Nixon's America, finally coming of age in 1980 with his induction into the DSM.

Compared to depression, for instance, which enjoys a clear and almost aristocratic lineage within psychiatry, traceable directly to Hippocrates and the dawn of Western medicine, post-traumatic stress is a dim figure shuffling before the lens of history, often existing as little more than an intriguing irregularity in the negative or a fascinating anecdote that refuses to be linked to any larger phenomenon, such as the Athenian soldier, reported by Herodotus, who went permanently blind from fear during the battle of Marathon in 490 BC, a case that for millennia was consistently described as being so unique, so extraordinary, so far outside the vein of practical experience as to be unfit for deeper examination.

And yet, amazingly, in spite of the shape-shifting ideas of post-traumatic stress, the changing attitudes and cultural schemes and the general fickleness of the language used to describe it, a few unifying themes do hold across the centuries, as we shall see.

Most of what we know about trauma's past comes from military history. The never-ending ebb and flow of war has produced a corresponding cycle of traumatic history, a cycle of societal ignorance followed by denial, a brief period of understanding, and then another interval of ignorance.
The bullets fly, the bombs explode, the body of knowledge about the effects of terror on the mind expands generously for a period of time. Previously uninterested doctors and other learned folk are drawn into the war effort. New treatments and technologies emerge. Then the guns fall silent, and the body of knowledge relating to trauma contracts with surprising violence as society moves on, leaving the survivors to more or less fend for themselves.

The change that broke this cycle, or at the very least seriously altered its periodicity, was PTSD's introduction into the DSM in 1980. With a mere three pages, some fifteen hundred words in a telephone book–sized manual published by the American Psychiatric Association, the West embarked on a new relationship with trauma, medicalizing what in previous eras had been a spiritual, moral, or artistic concern, inviting survivors to enter into the modern transactional relationship that exists between patients and doctors, expecting them to do what all good patients do: go to their health care provider, undertake a course of treatment, take their medications, and get well.

Frustratingly, there is no equivalent cycle for survivors of sexual trauma, whose existence, if it can be historically detected at all, is largely defined by society's insistence that they remain invisible, an insistence that no doubt worsens the harm immeasurably. As sociologist Georges Vigarello argued as recently as 2001, “The history of rape has never been written.”
Moreover, as Susan Brownmiller indicates in her study of sexual assault
Against Our Will
, the systematic erasure of rape can be seen throughout human history. “Thou shalt not rape” is not one of the Ten Commandments, whereas adultery and coveting thy neighbor's wife are both forbidden.
As she points out, this blind spot continued through the modern era: Freud, Jung, Adler, Marx, and even Karen Horney discuss rape only glancingly in their work.

The other reason for this dearth of knowledge is the simple fact that women are far more likely to be the victims of rape than men (91 percent of all rape victims are female), and the struggles of women have long been considered less worthy of the historian's attention than the struggles of (generally male) soldiers.
Unsurprisingly, one of the primary goals of seventies feminism was to force society to recognize the fact that rape is more common than our history textbooks would lead us to believe. By and large, this gendering of trauma continues today. Despite the fact that rape is the most common and most injurious form of trauma, the bulk of PTSD research is directed toward war trauma and veterans.
Most of what we know about PTSD comes from studying men: the eight-hundred-pound gorilla in PTSD research is the U.S. Department of Veterans Affairs, a governmental body designed to serve an overwhelmingly male population.
Even the beginning student of trauma will find this bias evident in this book: to explain various aspects of post-traumatic stress, I have been forced to rely on a deeply biased body of literature. I have attempted, whenever possible, to ungender these forms of trauma, to include stories from female veterans and rape victims, but for the sake of clarity I have been forced into many of the same regrettable habits that have gendered the history of trauma for so long. For this, I beg the reader's forgiveness.