After PTSD, More Trauma

After PTSD, More Trauma

After PTSD, More Trauma

Going in for therapy at a Veterans Affairs hospital is a lot like arriving at a large airport in a foreign country. You pass through a maze of confusing signage. Your documents are scrutinized. There are long lines you must stand in and a series of bureaucratic rituals that must be endured before anything resembling a human encounter occurs.

In April 2013, after doing a series of intake interviews and sitting on a waiting list for three months, I had my first human encounter with my assigned therapist at the big V.A. hospital in San Diego. Little did I know that the delay in treatment would be less agonizing than the treatment itself.

My first session began with my therapist, a graduate student finishing up his doctorate in clinical psychology, offering a kind of apology. “Now, I’m probably going to make some mistakes and say some stupid things,” he said. “Are you going to be O.K. with that?”

I understood. Two decades before, as a newly minted infantry lieutenant in the Marine Corps, I’d been charged with the welfare of a platoon of 30 young Marines. Too often my best wasn’t good enough, and I made a number of errors in judgment while in command, errors that bother me to this day. Offering my therapist some grace seemed like my only option.

I’d come to the V.A. for a number of reasons. After being discharged in 1998 from the Marine Corps, I worked as a reporter in Iraq from 2004 until one day in 2007, when I was nearly killed by an improvised explosive device, or I.E.D., in southern Baghdad. Occasionally I had weird dreams about the war that mixed people and places from my time in the Marines with my time in Iraq. But what really concerned me was something that happened a few years later. I was sitting in a movie theater with my girlfriend when the world suddenly went black. When I regained consciousness, I was pacing the lobby of the theater, looking at people’s hands to make sure they weren’t carrying weapons.

Afterward, I asked my girlfriend what happened. “There was an explosion in the movie,” she said. “You got up and ran out.”

Post-traumatic stress disorder has stalked me for most of my adult life. I don’t mean to say that I’ve suffered from it all that time. But the idea of it, the specter of it, has haunted me, as it haunts virtually everyone who has served in the military. You may not have PTSD, but most of your fellow citizens assume you do, and this fact alone has a powerful effect.

A year or so after the episode at the movie theater, with my symptoms not improving, I went to the V.A. for help.

There are two widely used treatments for PTSD at the V.A. One is called cognitive processing therapy. The other is prolonged exposure therapy, the effectiveness of which the V.A. heavily promotes. After explaining my symptoms to the intake coordinator, I was told that prolonged exposure was the best therapy for me. He said that the treatment worked for about 85 percent of people (“some pretty darn high odds if you ask me”).

My therapist, with whom I would meet twice a week, started with a short overview. Prolonged exposure therapy was developed in the 1980s by Edna Foa, a professor of clinical psychology, and colleagues of hers at the University of Pennsylvania. It is built on the idea that after traumatic experiences like I.E.D. ambushes, plane crashes and sexual assaults, survivors can “overlearn” from the event, allowing fears arising from their trauma to dictate their behavior in everyday life. Some survivors find that the only way to feel safe is to restrict their daily routine to a small range of activities. One Iraq veteran I knew, who had lost several buddies in an I.E.D. blast near Falluja, stopped leaving his apartment.


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