The Evil Hours (42 page)

America didn't look the same when I came back to it that first time. The houses were closed to me now, shuttered, the people foreign. I had only been gone three months, but it felt like years had passed. A silence came over my life, one I didn't know how to break.

Later, after I was back from the war for a few years, I read a poem Siegfried Sassoon wrote called “Fight to a Finish.” Toward the end of the poem, Sassoon imagines leading a bayonet charge into a crowd of smug, patriotic civilians after a victory parade in London. The poem ends with an assault on Parliament, payback for a stupid war. It is a fantastical poem, written in a tone that seems intended to shock, but I wasn't surprised when I read it. I didn't serve in a war like Sassoon, but I recognized the anger, the feelings beneath it, feelings so potent that you never spoke of them, even to friends. Even to lovers. Even to yourself most of the time.

Sometimes when I get depressed or worried that my memories of the war are slipping, I get into my truck and make the trek up to La Jolla, that beautiful place that hovers over the dark Pacific like a hallucination, that place with the hills covered in what looks like mohair. I drive up past the Mormon temple, past the organic market and the pharmacy school, and I park, and I walk through the sliding doors of the VA and take the elevator up to Same-Day Psychiatric on Two North.

When I get there, I just sit and listen for a while, taking in the waiting room while they call out the names of those who are next. I spent hours waiting here for my name to be called. I used to hate waiting here, but now I don't mind it so much, and I know my name won't be called, at least not today. To my right is a man pouring his life into a cell phone, telling a friend that he's so sorry, that he needs him to go into his bedroom and throw away all the coke in his backpack because he's so sorry, but he can't be trusted anymore. To my left is a man whose leg is going up and down like a jackhammer. Everywhere are the faces, each like a page from a book that never ends. Looking out over the room, which was full yesterday and will be full tomorrow, I sit thinking as the names of the chosen float through the air, and I wonder which one of them was in Danang, which one of them was in Fallujah, which one of them was in some godawful place in Afghanistan that I've never even heard of, which one has a heroin habit that will kill them, a wife who is going to leave them, which one has lost more than they ever knew they had, has paid more for their dreams than I ever paid for mine, and to all of them I say it's okay, it's okay, it's okay.

Thank you to Mike, Kay, and Bev. Thank you to Ryan and Lisa Sims, Joe Garza, Michelle Latiolais, Ron Carlson, Geoffrey Wolf, Elliott Woods, Ted Genoways, Ramona Ausubel, Ismet Prcic, Nathan Phelps, Mitchel Zafer, Steve House, Steve Schall, Alex Gilvarry, Joel Kiker, Elizabeth Wyatt, Christine Eubank, Beverly Prange, Jesse Weiner, Margaux Wexberg-Sanchez, Rey Leal, Annessa Stagner, Jo Dery, Matt Sumell, Ryan Ridge, Jon Wiener, Tom Ricks, Ghislaine Boulanger, Gerald Nicosia, Marc Walker, Mike Bryant, Maggie Shipstead, Jen Percy, Derek Keller, Dewleen Baker, Leila Mansouri, Dan Morris, and Angie Wolf.

Thank you to Seth Fishman and Andy Kifer at the The Gernert Company. Thank you to Eamon Dolan and Ben Hyman and everyone at Houghton Mifflin Harcourt. Thank you to Bryan Russell.

Thank you to Field Test Film Corps, Bob Sims, Edward Woods, Lisa Kenney, Bridgid MacSeoin, Leon Higley, Jacob Snyder, Jessica Halpin, Kees Marijs, Mary Jane Nealon, Patrick Austin, Matthew Philip Wee, Seth Tucker, Jill Britton, James Lemke, Evan McGee, Joshua Lewis, Matthew Desautel, Cheryl J. Taylor, Lorene Delany-Ullman, Patrick Coleman, Rob Kunzler, Brittni Waldow, Cindy Boyer, Mary Duran, Caroline Davies, Gunveen Kaur, Jane Satterfield, and Michael Pavlichek.

Thank you to the National Endowment for the Arts, to the MacDowell Colony, to the Norman Mailer Writers Colony, to the staff at the Dolph Briscoe Center for American History, to the staff of the Richard Nixon Presidential Library, and to the U.S. Navy Seabee Museum in Port Hueneme, California.

While much of this book is based on my own life experience and firsthand reporting, I also relied on the hard work of a number of other researchers and writers. In these notes, I have tried not only to identify my sources but also to briefly explain how I arrived at certain conclusions. Research is a detective story. What follows is the trail of clues, some found in the library and in archives, some found on the internet, and others at conferences and lectures I attended. The story of PTSD is one with a poor signal-to-noise ratio—there are a lot of people saying a lot of things about it, many of them contradictory. Writing this book has taught me to be a better critical listener as well as a better critical thinker. I have also learned the value of peer-reviewed science, as well as the value of reaching out to thinkers who have been banished to the intellectual wilderness by the popular trends of the day. I have also come to appreciate anew the empirical value of poetry and fiction, the forms of inquiry that originally informed and inspired this book.

I also wish to honor the writers upon whose shoulders I stand. Judith Herman's
Trauma and Recovery
(New York: Basic Books, 1992) remains a foundational text and provides a superlative overview of the field of trauma studies from a psychiatric standpoint. Alice Sebold's
Lucky
is a one-of-a-kind book: powerful and well written. It helped me immeasurably. Gerald Nicosia's
Home to War: A History of the Vietnam Veterans' Movement
(New York: Three Rivers, 2001) is an excellent history of the movement to have PTSD recognized in the 1970s. Jonathan Shay's
Achilles in Vietnam
(New York: Scribner, 1994) and
Odysseus in America
(New York: Scribner, 2002) both give a sense of how trauma was conceptualized in the ancient world and how Greek mythology can illuminate our understanding of trauma today. Ben Shephard's
A War of Nerves:
Soldiers and Psychiatrists in the Twentieth Century
(Cambridge, MA: Harvard University Press, 2001) is an excellent survey, though it occasionally suffers from a curious ethnocentrism. Shephard's treatment of the world wars is superb. His treatment of the American experience in Vietnam is less than superb. Paul Fussell's
The Great War and Modern Memory
(New York: Oxford University Press, 1975) is an enduring masterpiece and captures the cataclysm of World War I and how that conflict continues to influence our world today. An overlooked work of scholarship is Eric Leed's
No Man's Land: Combat and Identity in World War I
(Cambridge: Cambridge University Press, 1979). Leed's discussion of liminality and war neuroses is illuminating and informed much of my thinking. Laurence Gonzales's
Surviving Survival: The Art and Science of Resilience
(New York: W. W. Norton, 2013) thoughtfully examines the science behind trauma and resilience. From an organizational standpoint, I gleaned much from Siddhartha Mukherjee's
The Emperor of All Maladies: A Biography of Cancer
(to which I owe the literary conceit of a clinical “biography”) and Andrew Solomon's
The Noonday Demon: An Atlas of Depression
. Finally, I am indebted to William Gibson for teaching me about the concept of apophenia, which I first discovered in his novel
Pattern Recognition
.

 

Prologue: The Warning

 

[>]
Apophenia: finding patterns:
Sophie Fyfe of University College London, in her article “Apophenia, Theory of Mind and Schizotypy: Perceiving Meaning and Intentionality in Randomness” (
Cortex
44
, Nov-Dec 2008: 1316–1325), defines apophenia as “the perception of connections or meaning in unrelated events.” As William Gibson explained in a 2003 article in
The Telegraph
, “It's probably projection, but I'm inclined to think that everyone experiences it, to some extent . . . It seems to me that it is the thing we do which distinguishes us from other species. We seem to be so evolved to do it that we're prone to seeing faces in clouds. I bet birds don't see birds in clouds, right?”

[>]
a prominent psychoanalyst:
The psychoanalyst I spoke to was Robert Stolorow of the Institute of Contemporary Psychoanalysis, Los Angeles.

 

Introduction

 

[>]
a handful of disgruntled Vietnam veterans:
The best resource for those interested in the Vietnam Veterans Against the War “rap” groups is
Home to War: A History of the Vietnam Veterans' Movement
by Gerald Nicosia. Nicosia collected six hundred oral histories from VVAW members, the transcripts of which are stored at the Dolphe Briscoe Center for American History in Austin, Texas. The importance of Nicosia's contribution to the history of PTSD is hard to overestimate.

[>]
psychiatric Esperanto: Ethan Watters, “Suffering Differently.”
New York Times Magazine
, August 12, 2007. This quote comes from Allan Young, a historian of PTSD and medical anthropologist at McGill University. On page 29 of
Crazy Like Us
, Watters writes: “In the spring of 1881 one popular French journalist wrote, ‘The illness of our age is hysteria. One encounters it everywhere. Everywhere one rubs elbows with it . . . Studying hysteria, Monsieur Lasegue, the illustrious master, and Monsieur Charcot have put their finger on the wound of the day . . . This singular neurosis with its astonishing effects . . . travels the streets and the world.'
Ethan Watters, “Suffering Differently.” New York Times Magazine, August 12, 2007. This quote comes from Allan Young, a historian of PTSD and medical anthropologist at McGill University. On page 29 of Crazy Like Us, Watters writes: “In the spring of 1881 one popular French journalist wrote, ‘The illness of our age is hysteria. One encounters it everywhere. Everywhere one rubs elbows with it . . . Studying hysteria, Monsieur Lasegue, the illustrious master, and Monsieur Charcot have put their finger on the wound of the day . . . This singular neurosis with its astonishing effects . . . travels the streets and the world.'”

[>]
the fourth most common psychiatric disorder:
Rachel Yehuda, “Post-Traumatic Stress Disorder.”
New England Journal of Medicine
346 (2002): 108–114, p. 108.

[>]
In 2012, the federal government spent:
IOM (Institute of Medicine).
Treatment of Posttraumatic Stress Disorder
. See also Finley,
Fields of Combat
, 128. Finley provides an excellent insider account of the workings of VA San Antonio, which paralleled my experiences at VA San Diego. It is important to emphasize when discussing the VA what a vast system it is and how each site varies in the quality of care provided. The VA centers at San Diego and San Antonio are unusual and instructive because of the large military/veteran populations in both cities. In 2004, the VA reported that it spent 4.3 billion dollars on PTSD disability payments to veterans. This earlier figure is cited in Finley.

[>]
Since the attacks of 9/11:
Watters, on page 71 of his book
Crazy Like Us
, describes the international response to the tsunami in Sri Lanka, saying, “By 2004 PTSD was on the cusp of becoming the international lingua franca of human suffering.”

[>]
Consumers who are so inclined:
www.patchstop.com
, SKU: P3216.

[>]
There remains a small but vocal cadre of researchers:
Allan Young, in
Harmony of Illusions
, argues that the condition we know as PTSD was not discovered but was “glued together” by “the practices, technology and narratives with which it is diagnosed, studied, treated and represented.” Two leading historians of psychiatry, Edward Shorter at the University of Toronto and Ben Shephard, the author of
War of Nerves
, have both argued that the PTSD diagnosis and the science behind it are dubious. An illuminating collection of dissenting voices can be found in
Posttraumatic Stress Disorder: Issues and Controversies
, edited by Gerald Rosen.

[>]
Pierre Janet, a French neurologist writing in 1925:
Herman,
Trauma and Recovery
, 35.

[>]
Over time, PTSD has changed not only:
See Don DeLillo's post-9/11 novel
Falling Man
(New York: Scribner, 2008), where a character says, “These are the days after. Everything now is measured by after.” Roger Luckhurst of the University of London makes a similar argument in his excellent scholarly work
The Trauma Question
.

[>]
both as a mental condition and as a metaphor:
For a fascinating discussion of this, see Seeley,
Therapy after Terror
, 147–167. See also Susan Sontag's classic
Illness as Metaphor
(New York: Vintage, 1979). In the chapter titled “Trauma as Metaphor,” Seeley argues, “Cultural conceptions of insanity, normality, morality, and reality are constantly in flux. Indeed Sontag's claim that physical illnesses are metaphors, in that they stand for, call up, and play out dominant social themes, anxieties, and inequalities applies to mental disorders as well. Like labels for physical diseases, labels for mental disorders designate the ills and ill fortunes of others” (150).

[>]
The ancient Greeks staged plays:
Jonathan Shay, in his pioneering
Achilles in Vietnam
, says, “The ancient Greeks had a distinctive therapy of purification, healing and reintegration that was undertaken as a community. We know it as Athenian theater . . . the distinctive character of Athenian theater came from the requirements of a democratic polity made up entirely of present or former soldiers to provide communalization for combat veterans . . . The Athenians communally reintegrated their returning warriors in recurring participation in rituals of the theater” (230).