The Evil Hours (33 page)

Intersubjectivity theory, the school of thought that Carr employs, is derived from the work of Robert Stolorow, a Santa Monica–based psychoanalyst and philosopher.
According to Stolorow, a person who survives a traumatic event often perceives life in a fundamentally different way than the rest of the world—a world populated by people Stolorow calls the “normals.” A traumatized person, in his view, no longer believes, or has an intellectual understanding, that the world is a dangerous place, but instead feels its danger and menace in a profound way. Over time, such people find themselves deeply at odds with the rest of the world. The survivor may feel trapped inside the moment of maximum danger, unable to escape its force. The present has ceased to exist. The “normals,” who are still living in a coherent world of past, present, and future, can never understand the dissociated moment that the survivor still lives within. As Stolorow sees it, everyone wants to be understood, so much so that traumatized people are inexorably drawn toward others who had similar experiences, what he refers to as “siblings of the same darkness.”

In his military practice, Carr treats some of the most chronic and complex PTSD cases in the country, including snipers, forward air controllers, and special operations personnel who have killed Iraqis and Afghans in the line of duty and struggle with the guilt and shame associated with killing another human being.
Carr argues that intersubjectivity, with its focus on empathy, the unique emotional life of the patient, and helping the patient find a “relational home,” is an extraordinarily powerful therapy. Having spoken to both Carr and Stolorow at length, I can attest to the fact that while intersubjectivity lacks an extensive empirical grounding, the basic ideas behind it offer a refreshing contrast to the robotic, one-size-fits-all protocols of PE and CBT.

The problem is, of course, that intersubjectivity, like classical psychoanalysis, is more philosophically dense than PE and CPT, a fact that presents some challenges for its widespread use. Nevertheless, Carr, who was forced to truncate and condense many of Stolorow's ideas while in Iraq, has found tremendous success with it. Like all psychodynamic therapies, intersubjectivity relies more on the art of therapy than the science, which forces the therapist to focus more energy on developing a connection with the patient. All of which seems to have worked for Carr, who, while in Iraq, had several soldiers tell him, “Doc, you get this more than anyone I've talked to about it.”

I can see the point of people, like Eric Kandel, who argue that psychoanalysis isn't based on science. The thought of putting a young Marine lance corporal on the couch is ridiculous. Still, talking for a few hours to practitioners like Carr, Stolorow, and Boulanger while researching this book helped me about as much as twelve weeks of CBT. The main thing I got from the psychodynamic psychotherapists I talked with was a deeper sense of the psychic cost of trauma, a humanist sensibility, as well as a refreshing willingness to think through issues relating to trauma in more than the rote terms of the manualized therapies. Carr, Stolorow, and Boulanger all got excited and emoted while in conversation, whereas the CPT and PE advocates I interviewed seemed to talk about trauma from a cool remove, as if by not engaging their own emotions they could somehow remain above the fray. Now, I'm a writer, and I experienced the war through the lens of an infantry officer turned journalist, so I'm hardly your average survivor, but I really benefited from talking about how trauma has altered my sense of time and hearing what Martin Heidegger thought about it.

And while almost no one within the VA will admit it, these sorts of “nonspecific” effects of therapy, all the benefits a patient gets from connecting and developing a rapport with a therapist—even if they're just English professors who've been briefed on a few therapeutic techniques—has a lot of empirical support. But from what I can tell, the VA and the Department of Defense, the eight-hundred-pound gorillas of PTSD treatment, aren't terribly interested in that sort of thing. What they seem to want instead is mass-produced, scalable, scripted therapies that make for compelling PowerPoint slides. In a way, it's a lot like what you see in the national debates over education. Every parent knows that it's the passionate, sometimes eccentric teacher-artists who really make the difference in their children's lives, but it's incredibly difficult to institutionalize that kind of quality teaching, and educational administrators in the United States frequently view those brilliant
Dead Poets Society
–style teachers with suspicion because they fear the unknown.

Still, there are signs of hope. The VA has begun training some veterans as patient advocates who sit in on group therapy sessions. In 2010, the Marine Corps began fielding a peer counseling–type program that trained noncommissioned officers in basic techniques of combating operational stress. There are also the roughly two hundred “retail”-style Vet Centers run by the VA, located in strip malls across the country, which offer what is sometimes dismissively referred to by VA researchers as “supportive” counseling. Several veterans I interviewed found the Vet Centers to be the better option because they are smaller and the waiting list is far shorter than at your average VA hospital.

 

Most people cannot emerge from post-traumatic stress by simply gutting it out. Chronic PTSD is a life-threatening event and has to be treated or intensively managed by loved ones. During treatment, you must continue to fight, continue to seek insights into your experience, continue to read and to introspect, continue to seek out the company and advice of others. The community of survivors is a real thing. Researching this book has brought me closer to friends who have survived rape, just as it has brought me closer to other veterans and family members who have survived accidents in the wilderness. As I have attempted to demonstrate in these pages, going to therapy is not a sign of weakness, any more than going to a battalion aid station or an emergency room to have a broken bone set is a sign of weakness. Many of my heroes have struggled with post-traumatic stress: grizzled master sergeants, Medal of Honor winners, acclaimed mountaineers, poets, novelists, and artists of every stripe. Therapy saves lives, and the simple fact is, if you're embarrassed about it, you don't even have to tell anyone: just go. Just seeking out therapy has a proven salutary effect: researchers refer to this as the “expectancy” phenomenon. It's a surprising thing to say, but even sitting in a waiting room can make you feel better because you've already taken one step away from the pain.

One of the odd paradoxes of trauma is that it happens in a moment, but it can consume a lifetime. The choice as to how much time it is permitted to consume is usually in the hands of the survivor. I have interviewed a number of trauma survivors who speak of the time after being raped, or their time addicted to crystal meth after the war, as their “lost years,” as time that they pine for, time that they want back. I consider myself something of an enlightened stoic, someone who has found deep meaning in struggle, pain, and exertion. Some of my happiest moments in life have come after almost dying. Winston Churchill said, “Nothing is so exciting as being shot at without result.” Life is meaningless without suffering, but there comes a time when you have to accept the fact that not all pain is purifying or ennobling and that numbing out and isolating yourself from the world is counterproductive and destructive to yourself and your loved ones.

As a former Marine and someone who has reported on war for years, I see that we have come to the end of over a decade of seemingly never-ending bloodshed. With the end of horror comes the hope for insight. Ernest Hemingway, writing in 1946, the year after World War II ended, said, “We have come out of the time when obedience, intelligent courage, resolution and the acceptance of discipline were most important, into that more difficult time when it is a man's duty to understand his world rather than to simply fight for it.”

7

J
IM MCGAUGH IS
used to seeing his name on the sides of buildings, being feted, and seeing his portrait hanging in long hallways. But Jim McGaugh is no titan of industry, nor is he a star athlete or a financial wizard with a taste for philanthropy. Jim McGaugh is a neuroscientist. Into his eighties now, when he leaves his office at the University of California, Irvine's Center for the Neurobiology of Learning and Memory (which he founded in 1981) on his way to the science library, he walks by James L. McGaugh Hall, a four-story lecture building completed in 2002. One of the first professors hired at UC Irvine when the campus opened in 1964 and a perennial Nobel favorite, McGaugh has devoted his entire sixty-year career to understanding the biological nuts and bolts of human memory.

An archetypal Man of Science, McGaugh looks a bit like a retired news anchor, a man who has lived inside the fort of his own gravitas for so long that it is hard to imagine that he was ever a gawky teenager, a boy with only a bike and a baseball glove to his name. Speaking in a kind of restrained stentorian tone that is reminiscent of the Midwest but is, in fact, native to the lost continent of pre-1970s California, McGaugh is strictly business. A mop of gray hair rises over the metal-framed glasses on his nose. Educated at Berkeley at the height of the Cold War, he works in a corner office overlooking the road that rings the campus. It's an open space, the white walls continually washed in California sunlight; two broad desks are stationed in the corners. Access to the sanctuary is granted by a secretary whose mastery of his schedule and daily routine makes her seem less like an assistant than a third arm.

In the world of memory science, McGaugh is a living legend, having seemingly from day one dispensed with the timeworn idea that human memory is a static, frozen entity, a tape recorder forever running, seeing it instead as a living, inherently irrational, moody thing, a thing deeply prone to revision and manipulation.

If McGaugh's work has a governing principle, it is this: unlike men, memories are not created equal.
Early in his career, he saw that emotion, as much as any other factor, influences the way memories are formed in mammals. While this fact was not acknowledged by science until relatively recently, humans have intuited this for centuries. As McGaugh wrote in the preface to his book
Memory and Emotion
, “In medieval times, before writing was used to keep historical records, other means had to be found to maintain records of important events, such as the granting of land to a township, an important wedding or negotiations between powerful families. To accomplish this, a young child about seven years old was selected, instructed to observe the proceedings carefully, and then thrown into a river. In this way, it was said, the memory of the event would be impressed on the child and the record of the event maintained for the child's lifetime.”
This odd story of how fear can influence memory has come to dominate McGaugh's work and will, in all likelihood, define his legacy.

Scientists have known for a long time that certain drugs enhance memory.
One study published in 1917 by psychologist Karl Lashley showed that rats given very low doses of strychnine were able to memorize mazes much faster than rats given a dose of a saline solution. (In small amounts, strychnine, often used as a rat poison, acts as a stimulant.) McGaugh stumbled across Lashley's research in the fifties when he was a graduate student at Berkeley and began thinking about what this might mean for the long-term storage of memory.
He knew, for instance, that you could disrupt the learning process in rats by delivering an electrical shock about an hour after they had been trained in a laboratory task, a fact that suggested that something continued to happen inside a rat's brain after a learning event occurred. Put another way, long-term memories are not made in an instant. It takes time for the “concrete” of memory to set. Neuroscientists refer to this process as “memory consolidation.” Keeping this in mind, McGaugh speculated that he might be able to enhance memory in rats by injecting them with a stimulant soon
after
learning a task, in essence throwing the rat into a river, as in his example from early Medieval history.

His graduate advisor thought it was a terrible idea when he brought it up to him. “It was a short discussion,” McGaugh wrote mordantly forty years later.

Frustrated by his advisor's reaction, McGaugh waited for him to go on sabbatical in Europe and then began his experiment, injecting rats with strychnine shortly after training them. To his delight and astonishment, he discovered that his intuition had been right. Given a strategically timed dose of strychnine, rats made fewer errors and were able to navigate the mazes in the lab more efficiently. This idea that drugs administered after an event would enhance the memory of it has since been replicated in dozens of experiments throughout the world.

Soon after getting his PhD, McGaugh began experimenting using a number of other drugs to enhance memory, including amphetamines, picrotoxin, and morphine.
After a series of dead ends in their work, McGaugh and Larry Cahill, one of his Irvine colleagues, began studying the effects of naturally occurring stimulants on memory. They soon discovered that adrenaline, the chemical released when a mammal is excited, enhanced the memory of a given event in a way similar to strychnine, and they could radically improve the ability of rats to remember experiences by injecting them with adrenaline.

But what if, McGaugh wondered, the reverse was true? What if you could inject rats (or people) with a substance that undermined the influence of adrenaline on the process of memory? What if you could make someone forget or at least dampen the power of a particular memory?

 

When I met McGaugh in his office on campus, he began by explaining the underlying neuroscience behind his work, concluding his minilecture with a blockbuster: there was a drug that could, from a neurological standpoint, prevent PTSD.