The Evil Hours (37 page)

After heading west in 2002, Elise ended up getting her bachelor's degree in psychology from UCLA and marrying an architectural engineer, who sits in on her morning yoga classes sometimes.

When I asked her why yoga was so powerful for her, she said, “Western therapy just didn't work for me. Sitting there, talking with a therapist who's like ‘Hey, let's sit down and relive the thing A to Z, and go over it again and again and again in your mind' didn't help me. I just became a sobbing hysterical mess. I couldn't get through it. I refused to take medications. I had a strong desire to be clean, even though I ended up drinking a lot. I was trying to feel my way out, and yoga made me feel better, so I went with it. It worked.”

 

Elise's story is not unusual. The fact is that for many people, Western talk therapies do not work for post-traumatic stress. Modern psychotherapy, partially inspired by the Freudian ideal of catharsis via verbiage, is in some ways the last thing some people need. As anyone who's experienced true terror will tell you, the essence of the experience defies words, a fact that only serves to irritate some therapists, many of whom cling to a sort of crackpot wisdom that says that disclosure is the only way out. Jonathan Shay, a VA psychiatrist, describes in
Achilles in Vietnam
a situation similar to what Elise saw. “During the early days of the current era of PTSD treatment, mental health professionals shared a folk belief that simply ‘getting it all out' would result in safety, sobriety, and self-care. The consequences of these well-intended ‘combat debriefings' were catastrophic, resulting in many suicides.”

As an alternative to mainstream talk therapy, yoga stands out as a uniquely effective treatment, precisely because it insists that people shut up and start listening to their bodies. Yoga works to correct the central lie of Western philosophy, which goes all the way back to Descartes, who said that the body and the mind are distinct entities that exist independent of each other.

It is almost as if researchers have been talking to Elise: a number of recently completed studies, including one conducted by David Emerson and Bessel van der Kolk at Harvard Medical School, have shown that yoga is very effective at reducing the hypervigilance and hyperarousal associated with PTSD.
If you're familiar at all with yoga practice, it's not hard to imagine why. Yoga teaches mindfulness of breath, calmness, and connection to the rhythms of your body, allowing you to feel “at home” in it. All of these core practices serve to repair the damage done by trauma. As van der Kolk points out, “Neither CBT protocols nor psychodynamic therapeutic techniques pay sufficient attention to the experience and interpretation of disturbed physical sensations and preprogrammed physical action patterns.”

One of the major long-term goals of any trauma therapy is to get survivors to change their perception of time, to focus less on the past and focus more on the present. Yoga seems to do this by encouraging you to focus on the “now” of your physical self, a form of nonthinking that might seem counterintuitive at first. Psychologist Mihaly Csikszentmihalyi describes this state as one of
flow
, arguing that “after an episode of flow is over, we generally emerge from it with a stronger self-concept . . . The musician feels at one with the harmony of the cosmos, the athlete moves at one with the team, the reader of the novel lives for a few hours in a different reality. Paradoxically, the self expands through acts of self-forgetfulness.”
(Several trauma survivors have told me that they found the focus on “being present,” as described in Eckhart Tolle's
The Power of Now
, to be strikingly powerful for them. As Tolle argues in his book, “To be identified with your mind is to be trapped in time: the compulsion to live almost exclusively through memory and anticipation. This creates an endless preoccupation with past and future and an unwillingness to honor and acknowledge the present moment and
allow it to be
.”)

Yoga is also, as Elise readily admits, ridiculous. There is nothing sillier than seeing a bunch of people standing around in a park twisted into enlightened pretzels, repeating words from a long-dead language. Yoga is moronic, which is part of what makes it so great. In the Marine Corps, we had a saying: “If it's stupid but it works, then it isn't stupid.”

Personally, I plan on doing stupid, functional things like yoga for the rest of my life.

 

Anton Chekhov, who was a doctor as well as a writer, once observed that “if many remedies are prescribed for an illness you may be certain that the illness has no cure.”
There are many remedies recommended for post-traumatic stress, a truly bewildering variety of choices that can seem at times like a psychological supermarket. Some of these alternatives seem at first like applied common sense, while others seem more like applied hobbies, ideas that took root after someone found comfort in them and began recommending them to friends. Some of them sound suspiciously like religious cults. Many of these therapies exist on the margins of modern science and are only now being explored by researchers. One review of alternative therapies published in the VA's
PTSD Research Quarterly
in 2012 concluded that “the most striking finding overall is the relative lack of empirical evidence for CAM [Complementary and Alternative Medicines] for PTSD.”
Very few of these alternatives seem genuinely harmful or dangerous, except possibly to your bank account. The sheer number of them speaks to the magnitude of the problem, the inherent complexity of PTSD, and the extremes to which people will go to seek relief from their symptoms. With the growth in popularity of the PTSD diagnosis and mounting concern about the welfare of Iraq and Afghanistan veterans, alternative therapies are showing up everywhere these days.

One crowdsourced website I consulted, which maintains a regularly updated database of therapies for PTSD, lists seventy-nine such remedies, including acupuncture, art therapy, biofeedback, fish oil, gardening, hiking, hot tea, journaling, marijuana, MDMA, meditation, moving to a new city, Reiki, “using a clear shower curtain,” vitamin C, vitamin D, walking, white noise, yoga, and zinc.
Mingled with these curatives are a host of general lifestyle choices, such as getting exercise, eating well, enjoying nature, playing sports, going to church, and spending time with friends. In the course of researching this book, I crossed paths with advocates for boxing, cycling, horseback riding, in-line skating, mountaineering, Native American sweat lodges, rifle marksmanship, tai chi, and warm water therapy as post-trauma treatments. In 2011, a journalist friend of mine spent several weeks in Georgia interviewing members of a Christian group that performs exorcisms on traumatized people.

In Southern California, where the military and the West Coast self-improvement culture often overlap, a cottage industry of PTSD curatives has cropped up, with yoga practitioners, tai chi devotees, fitness professionals, and virtual reality researchers all advertising help for the traumatized. One mixed martial arts gym a few blocks from my house has a vets-only team whose organizers promoted its benefits for veterans with PTSD. At the beginning of my research, I ran into a retired couple in the mountains north of San Diego who were putting together a horse ranch for traumatized veterans. Perhaps the most entertaining remedy came from a man from Texas who touted the benefits of
Tetris
, claiming the classic video game helped him with his PTSD. In short, there is no shortage of ideas for PTSD therapies, nor is there a shortage of concerned citizens with advice for those who struggle with the condition.

In
Once a Warrior, Always a Warrior
, Charles Hoge, a retired army psychiatrist and the author of an influential PTSD study in the
New England Journal of Medicine
, writes, “There are numerous new modalities of treatment being promoted for PTSD, and treatments
du jour
seem to be constantly springing up as the latest ‘answer' to the PTSD problem.
A lot of interest has been generated by increased government funding for research for both these conditions since the start of the wars in Iraq and Afghanistan . . . Some of these have been promoted in news stories, and many veterans have questioned why the DoD and VA have not adopted them for regular use. The reason is that these modalities have not been proven to be effective in rigorous research studies.” He concludes by saying, “The bottom line is that there is no ‘magic bullet' for PTSD, and claims to the contrary should be taken with more than a grain of salt.”

While I agree with Hoge about the absence of a magic bullet, my experience suggests that many nonstandard therapies have value, in part because they create what researchers call an expectancy effect, where the simple expectation of improvement communicated through the practitioner brings about healing. A guiding principle when shopping for therapies is that PTSD is an incredibly complex condition, and it manifests itself in people in a dizzying variety of ways. As the philosopher Roland Barthes wrote, “Each of us has his own rhythm of suffering.”
In addressing one's particular rhythm of suffering, one often must undergo a process similar to the one that Elise underwent, experimenting with different therapies, while paying close attention to your individual symptoms, eventually settling on the therapy (or therapies) that feels right for you.

Another reason to consider one of the many alternative therapies out there is that they often offer a host of positive, difficult-to-­quantify social effects that are hard to find with traditional manualized therapies. For example, the idea of training people with PTSD to be cage fighters, as Iraq veteran Todd Vance is doing at the Undisputed gym in San Diego, seems ludicrous at first and potentially even damaging.
What exactly, one might reasonably ask, is the point of exposing traumatized people to even more violence? For my part, I hated the hand-to-hand combat training I did in the Marine Corps and have long found the mixed martial arts subculture to be a parody of American hyperaggressive masculinity. But when I sat in on one of Vance's classes upstairs at Undisputed, I found my mind changing.

Watching a group of sweaty young vets working on various holds and groundfighting techniques, I saw that MMA does provide a structured social environment for young men (and women) and a way to achieve a state of flow where they can get out of their heads and focus on mastering a regimen of techniques, not entirely unlike yoga. Like yoga, MMA seems to offer a wealth of hard-to-quantify nonspecific therapeutic benefits of the sort that frequently drives researchers crazy when they compare PTSD treatment protocols. More to the point, yoga and MMA, as disparate as they might seem at first, both offer an opportunity to escape “the PTSD bubble,” a chance to get out of the house and interact with people, while doing something that helps them create a greater knowledge about their bodies, a process that psychologists refer to as interoceptive learning.

In 2012, after finishing CPT, I took part in a VA study that examined mantram repetition as a PTSD therapy. The experiment, led by a nursing researcher, applied the teachings of Eknath Easwaran to the problems of post-traumatic stress. Easwaran, who was an English professor in India before he came to the United States in 1959 on a Fulbright scholarship, teaches that we all have inner resources for dealing with crises, and that by developing skills to cultivate an inner calm, we can transcend “the storms of life.” The study used group therapy to introduce Easwaran's principles and took place in one of the outbuildings at VA La Jolla. For the first session, the six of us were given workbooks and copies of Easwaran's book
Strength in the Storm
and told to read a few chapters for the following week. Much like CPT (and Buddhist teachings), Easwaran's philosophy revolves around the idea that the world is a largely neutral place, and it is the human reaction to events that determines the outcome. As Easwaran wrote, “We can't control life, but we can control how we respond to life's challenges. The answer lies in stabilizing the mind.”

For our next session, our leader, a kindly retired psychiatric nurse named Kathy, had us select a mantram from a list of ecumenical phrases (“mantram” is the correct conjugation of the Sanskrit, meaning “an instrument of thought”). I chose “Om Shanti,” a Sanskrit invocation for peace. The idea, Kathy explained, was to repeat our mantram as many times as possible each day, especially during relaxing times at first. As time went by, the mantram would become a personal codeword for inner calm and could be used in times of stress or fear to disrupt the fight-or-flight response.

One of our group was a Marine I recognized from Iraq named Andy. Andy had, like Fernando, done seven overseas deployments since 9/11. “Forty-nine months I've been away from my family,” he explained. As the group progressed, I found out that Andy and I had another thing in common: we were both members of an elite, little-known fraternity within U.S. military circles. We were both former Marines who surfed. Andy, however, was no chilled-out surf bro who'd worn a uniform between paddle outs (which was how an old company commander once described me). One look at him and you could tell he'd been down some bad roads. I had run into Andy at a small base west of Fallujah six years before, and I remembered him even then as unusually angry and short-fused. Toward the end of the eight-week study, he was surfing again and thinking about quitting his job, a job he didn't entirely need, and moving to a smaller house to shrink his mortgage.

The group ended a couple weeks later. The consensus was that while it was not a miracle, mantram repetition was helpful. For a variety of reasons, mantram repetition didn't really do it for me. I've always been restless and distractible by nature, and the idea of sitting in place and repeating the same three syllables over and over again for hours was, well, boring as shit. Reading for me is practically a biological function, and after about ninety seconds of saying “Om Shanti, Om Shanti, Om Shanti” in my apartment during my designated mantram times, my eyes would wander like heartsick lovers over to the nearest bookshelf, and before I knew it, my mind would be consumed by the plot of the latest Thomas Pynchon novel, not my mantram. Nevertheless, I was the only one in the group who didn't find mantram repetition helpful. Andy, in particular, said that it had helped him a lot. I'm inclined to believe his testimonial, since it's supported by the evidence of my observation. I'd seen him in Iraq, and he did seem slightly more at peace by the end of the eight-week study.