The Evil Hours (45 page)

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an incident of so-called friendly fire:
In an October 1998 article in the
Journal of the Royal Society of Medicine
, Martin Deahl cites an example from the Gulf War where a group of survivors of a friendly fire incident suffered a PTSD rate of 56 percent, the highest prevalence rate he cites. Researching my 2004 book
Storm on the Horizon
about the battle of Khafji, I found that the veterans most haunted by the war were those who'd had comrades killed by friendly fire.

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the “Hanoi Hilton” prisoner-of-war camp:
Interviews with Taylor Kiland, Francine Segovia, and Richard Tangeman, April 2013. See Kiland,
Lessons from the Hanoi Hilton
. See also Dennis Charney, “The Psychobiology of Resilience to Extreme Stress: Implications for the Treatment and Prevention of Anxiety Disorders,” keynote address at ADAA conference, March 23, 2006; Francine Segovia et al., “Optimism Predicts Resilience in Repatriated Prisoners of War: A 37-Year Longitudinal Study.”
Journal of Traumatic Stress
25 (2012), 1–7; William Sledge et al., “Self-concept Changes Related to War Captivity.”
Archives of General Psychiatry
37 (1980): 430–443.

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Describing what he called his “transforming”:
See McCain,
Faith of My Fathers
, 321.

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when the men of the Hanoi Hilton were finally released:
Interviews with Taylor Kiland, Francine Segovia, and Richard Tangeman. See also Peter Davis's excellent 1974 documentary on Vietnam,
Hearts and Minds
, which shows George Coker's lavish homecoming to Linden, New Jersey.

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As John McCain later wrote:
McCain,
Faith of My Fathers
, 323.

 

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One group of VA investigators:
Friedman,
Handbook of PTSD
, 8. On page 13 of
Post-Traumatic Stress Disorder
, Shiromani says, “Very few studies actually include the assessment of post-trauma factors in terms of their contribution to the development and maintenance of PTSD. Social support is the one exception. Across 11 studies, Ozer et al. found that perceived social support following the trauma event was associated with PTSD symptoms.”

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Therapists like to talk about “small-t” traumas and “Big-T” traumas:
I heard this expression used by three separate psychotherapists who treat people with PTSD. Two of them were with the VA in San Diego, while the other was in private practice in Denver.

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These little details, many of which go unnoticed:
LeDoux,
Emotional Brain
, 142–148. See also Kandel,
In Search of Memory
, 342–345; for a more accessible discussion of conditioning, fear, and emotion, see Gonzales,
Surviving Survival
, 20–36. His chapter “The Crocodile Within” is very helpful.

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During a small-t trigger, the amygdala:
See LeDoux,
Emotional Brain
, 256–258. See also Yehuda's 2002
New England Journal of Medicine
article, “Post-Traumatic Stress Disorder,” 110 –112.

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Outwardly, this process is often described:
LeDoux,
Emotional Brain
, 45. See also Laurence Gonzales,
Deep Survival
, 35–36.

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“At the sound of the first droning”:
Remarque,
All Quiet
, 56.

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Big-T traumas can destroy the soul:
In
Achilles in Vietnam
, Jonathan Shay argues that “severe trauma explodes the cohesion of consciousness” (188).

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People with chronic, long-term PTSD:
See Robert Scaer,
Trauma Spectrum
(New York: W. W. Norton, 2005). See also Herman,
Trauma and Recovery
, 118–122. For a brief discussion of the biological aspects of PTSD, see Yehuda's 2002
New England Journal of Medicine
article, “Post-Traumatic Stress Disorder,” 110–112.

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When resistance and escape from terror:
Herman,
Trauma and Recovery
, 34–35.

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During the 1973 Yom Kippur War:
Junger,
War
, 122.

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Major traumas are both a death and a rebirth:
In her memoir
Lucky
, Alice Sebold writes, shortly after her rape, that “my life was over; my life had just begun” (33). On page 53, she writes that “it was an early nuance of a realization that would take years to face. I share my life not with the girls and boys I grew up with, or the students I went to Syracuse with, or even the friends and people I've known since. I share my life with my rapist. He is the husband to my fate.” On page 204, Sebold says, “I remember agreeing with my mother that I had gone through a death-and-rebirth phenomenon in the span of one year.” In
We Came Home
(Toluca Lake, CA: P.O.W. Publications, 1977), Richard Tangeman, a former Hanoi Hilton POW, says, “I was deeply moved by the warmth and sincerity of all the wonderful people who welcomed us home and witnessed our ‘rebirth.'”

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“men spared their lives in great disasters”:
McCarthy,
Crossing
, 146–147.

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World War I veteran:
Fussell,
Great War and Modern Memory
, 139.

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Reunited with his family:
Tangeman,
We Came Home
.

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“My life was over”:
Sebold,
Lucky
, 33.

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One Hindu survivor of the 2004 tsunami in Sri Lanka:
Interview with Gaithri Fernando, 2013. In a 2012 article in
Transcultural Psychiatry
, Fernando writes, “Early in my Fulbright visit to Sri Lanka, I met Radha, a 34-year-old Tamil woman who had been severely tortured by the Sri Lankan military. During my assessment of her I was struck by her lack of distress when describing her current condition . . . I asked her what her torture experience meant to her. ‘Well,' she said, ‘I am
really
looking forward to my next life. I must have done some terrible things to have deserved this horrible suffering. I know that in my next birth, I will have the most wonderful life. This knowledge makes me very happy'” (396–397).

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In the increasingly interconnected PTSD community:
See, for instance, the 2007 HBO documentary
Alive Day Memories: Home from Iraq
, produced by James Gandolfini.

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On March 25, 2010, professional mountaineer Steve House:
Interview with Steve House, 2013.

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One friend of mine, who was raped:
Interview with Elise Colton, 2013.

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Stolorow describes how for a survivor:
Interview with Robert Stolorow, 2013.

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As psychiatrist Judith Herman explains:
Herman,
Trauma and Recovery
, 36.

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Poet Robert Graves recounts how:
This quotation can be found on page 288 of Graves's 1929 memoir
Goodbye to All That
, a book he described as his “bitter leave-taking of England.” Here is the full quote, which describes his experience, one reminiscent of many Iraq veterans I have known: “Not only did I have no experience of independent civilian life, having gone straight from school into the army: I was still mentally and nervously organized for war. Shells used to come bursting on my bed at midnight, even though Nancy shared it with me; strangers in daytime would assume the faces of friends who had been killed. When strong enough to climb the hill behind Harlech and revisit my favourite country, I could not help seeing it as a prospective battlefield.
“I knew it would be years before I could face anything but a quiet country life. My disabilities were many: I could not use a telephone, I felt sick every time I travelled by train, and to see more than two new people in a single day prevented me from sleeping. I felt ashamed of myself as a drag on Nancy, but had sworn on the very day of my demobilisation never to be under anyone's orders for the rest of my life.”

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Researchers at the University of California at Irvine:
Interview with Alison Holman. See Alison Holman et al., “Getting ‘Stuck' in the Past: Temporal Orientation and Coping With Trauma.”
Journal of Personality and Social Psychology
74, no. 5 (1998): 1146–1163. See also Schacter,
Seven Sins of Memory
, 175.

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“zombie subroutines of the brain”:
Eagleman,
Incognito
, 131–132. Other neuroscientists have referred to this aspect of brain function as “alien subroutines,” “zombie agents,” “zombie systems,” and “System 1,” all of which emphasize our lack of conscious access to them.

 

3. Toward a Genealogy of Trauma

 

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Most people, when they first learn about PTSD:
For an in-depth discussion of PTSD's cultural construction, see Young,
Harmony of Illusions;
Shephard,
War of Nerves
, 385–399; Rosen,
Posttraumatic Stress Disorder;
and McNally,
What Is Mental Illness?
, 146–156. The idea that PTSD is not timeless and that the diagnosis has to a certain extent evolved in response to cultural conditions is controversial and upsetting to many veterans. One Afghanistan veteran reading about PTSD's slippery conceptual basis on the
National Geographic
blog “The Frontal Cortex” wrote in the comments section, “Denying that 20–30% of all U.S. forces who have served in Iraq and Afghanistan are afflicted with PTSD is outlandish! This is like denying that the Holocaust ever occurred in Nazi Germany during WWII.” As McNally put it in an article in the 2003
Annual Review of Psychology
, “Progress and Controversy in the Study of Posttraumatic Stress Disorder,” “There is never a dull moment in the field of traumatic stress studies. Discoveries are continually intermixed with explosive social controversies.”

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what Joan Didion called its “febrile rhythms”:
Didion,
We Tell Ourselves Stories
, 589. See also Wheen,
Strange Days Indeed
.

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Commonly thought of as a signature symptom:
Edward Jones et al., “Flashbacks and Post-traumatic Stress Disorder: The Genesis of a 20th-Century Disorder.”
British Journal of Psychiatry
182 (2003): 158–163. Bartley Frueh of the University of Hawaii at Hilo made a similar point in a June 2012 article, “Suicide, Alcoholism, and Psychiatric Illness among Union Forces,” in the
Journal of Anxiety Disorders
which looked for psychiatric symptoms among American Civil War veterans: “It is interesting that descriptions of classic PTSD symptoms of reexperiencing, such as nightmares or ‘flashbacks' were not found in that data reviewed.” Frueh's findings with respect to nightmares are hard to understand, as the literature of the Civil War is rife with veterans who claimed to suffer from nightmares and supernatural visitations. See also Luckhurst,
Trauma Qu
e
stion
, 179–185. Luckhurst is very good in examining the role that cinema (and seventies cinema in particular) has played in the development of PTSD as a diagnostic concept. On page 177, Luckhurst argues that “cinema in fact helped constitute the PTSD subject in 1980, and . . . has continued to interact with and shape the psychological and general cultural discourse of trauma into the present day.”

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(Civil War veterans who suffered):
See Dean,
Shook over Hell
, 101–114. See also Gilpin Faust,
This Republic of Suffering
, 161, 196.

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Adding to the confusion:
See Luckhurst,
Trauma Question
, 61, 148, 183.

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Indeed, it is this historical slipperiness:
Young,
Harmony of Illusions
, 5.

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The earliest appearance of the word:
Ibid., 13.

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In 1866, a London surgeon:
Ibid., 14. See also Shephard,
War of Nerves
, 16; Figley,
Trauma and Its Wake
, 5–14.

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Compared to depression, for instance:
Solomon,
Noonday Demon
, 285–286.

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The never-ending ebb and flow of war:
Shepard,
War of Nerves
, xxii. Interview with Bill Nash.

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With a mere three pages:
American Psychiatric Association,
Diagnostic and Statistical Manual, III
, 219–221.

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As sociologist Georges Vigarello argued:
Vigarello,
History of Rape
, 1. Joan Didion, writing about a rape case in New York in
We Tell Ourselves Stories
, in which the victim's name was persistently left out of newspaper accounts, writes that “the convention [of leaving victims anonymous] assumes that this violation is of a nature best kept secret, that the rape victim feels, and would feel still more strongly were she identified, a shame and self-loathing unique to this form of assault, that a special contract exists between this one kind of victim and her assailant . . . that the act of male penetration involves such potent mysteries that the woman is permanently marked, ‘different' . . . as in nineteenth-century stories featuring white women taken by Indians—‘ruined'” (690).

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Moreover, as Susan Brownmiller indicates:
Brownmiller,
Against Our Will
, 11.

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The other reason for this dearth:
Yehuda, “Post-Traumatic Stress Disorder,” 109–110.

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Despite the fact that rape is the most common:
Ibid.

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Most of what we know about PTSD comes from studying men:
See Finley's excellent
Fields of Combat
, 73–89.