The Evil Hours (51 page)

[>]
In 2008, the prestigious Institute of Medicine determined:
See Institute of Medicine,
Treatment of Posttraumatic Stress Disorder
, 95–99.

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In an August 2002 study in the:
Edna Foa et al., “Does Imaginal Exposure Exacerbate PTSD Symptoms?”
Journal of Consulting and Clinical Psychology
70 (2002): 1022–1028.

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“something intended to be effective works better”:
Greenberg,
Manufacturing Depression
, 306. See also D. Westen et al., “Empirically Supported Complexity: Re-thinking Evidence-Based Practice in Psychotherapy.”
Current Directions in Psychological Science
14 (2005): 266–271.

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Greenberg also rails against another statistical procedure:
Greenberg,
Manufacturing Depression
, 307. Phone interview with Greenberg, April 2013. Several critics of PE pointed out this experimental design flaw to me. The fact remains that PE has the highest recorded dropout rate of any PTSD therapy, which makes one wonder why the VA chose it as one of its frontline therapies, when there are other, safer, less controversial, and less expensive therapies available.

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The controversy surrounding PE also resembles:
See Jonah Lehrer, “The Forgetting Pill Erases Painful Memories Forever.”
Wired
, February 17, 2012
. While much of Lehrer's work has been retracted due to factual issues, this article was cleared by
Wired
's editors, according to a review later published at
Slate
magazine. Lehrer's article does a good job of succinctly reviewing the CISD controversy. Another researcher, at UC Irvine, whom I spoke to confirmed Lehrer's assessment of CISD's lack of empirical support.

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For his part, Roger Pitman remains skeptical of PE:
Phone interview with Pitman, January 2014.

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“It is important to emphasize that exposure may”:
See van der Kolk,
Traumatic Stress
, 435.

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Prior to undergoing PE, I had, in fact, read:
See Shephard,
War of Nerves
, 2001. See also Laurent Tatu, “The ‘Torpillage' Neurologists of World War I.”
Historical Neurology
75 (2010): 279–283 .

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There are no documented cases of veterans or other PTSD survivors:
Shay, on page 187 of
Achilles in Vietnam
, says, “During the early days of the current era of PTSD treatment, mental health professionals shared the folk belief that simply ‘getting it all out' would result in safety, sobriety, and self-care. The consequences of these well-intentioned ‘combat debriefings' were catastrophic, resulting in many suicides, according to veterans in our program who participated.” The “combat debriefings” Shay describes are not the same thing as PE therapy, but they seem to be motivated by the same purgative principle—that the contagion of trauma can be expelled, washed away, “cleaned out” like a festering wound, to use Scott's metaphor. For more on this, see Herman,
Trauma and Recovery
, 172.

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“dialectic of trauma”:
Herman,
Trauma and Recovery
, 47.

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There were the usual introductions:
I have changed the names and significant life details of these veterans in order to protect their privacy.

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Cognitive Processing Therapy is one of the most popular:
For an overview of CPT, see Victoria M. Follette and Josef Ruzek, eds.
Cognitive-Behavioral Therapies for Trauma
, 100–102. For more on Aaron Beck, see Greenberg,
Manufacturing Depression
, 288–290; Clark and Beck,
Cognitive Therapy of Anxiety Disorders
.

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“caught up in the contagion of the times”:
Quoted in Greenberg,
Manufacturing Depression
, 288.

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“therapist and patient work together to identify”:
Ibid., 289.

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“CBT teaches objectivity”:
Solomon,
Noonday Demon
, 107.

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CPT has been extensively studied:
See P. A. Resick et al., “Cognitive Processing Therapy for Sexual Assault Victims.”
Journal of Consulting and Clinical Psychology
60 (1992): 748–756. See also Candice M. Monson et al., “Cognitive Processing Therapy for Veterans with Military-Related Posttraumatic Stress Disorder.”
Journal of Consulting and Clinical Psychology
74 (2006): 898–907.

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A 2002 study by Resick, using a large sample of sexual assault:
P. A. Resick et al., “Comparison of Cognitive-Processing Therapy with Prolonged Exposure and a Waiting Condition for the Treatment of Chronic Posttraumatic Stress Disorder in Female Rape Victims.”
Journal of Consulting and Clinical Psychology
70 (2002): 867–879.

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Another study, published in
Behavior Therapy
in 2004:
Nicholas Tarrier et al., “Treatment of Chronic PTSD by Cognitive Therapy and Exposure: 5-Year Follow-Up.”
Behavior Therapy
35 (2004): 231–246.

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A number of critics, including Gary Greenberg and B
. 
E. Wampold:
See Greenberg,
Manufacturing Depression
, 302–314; Wampold,
Great Psychotherapy Debate
, 2001.

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One stunningly illuminating study conducted by Hans Strupp:
Hans Strupp et al., “Specific vs Nonspecific Factors in Psychotherapy: A Controlled Study of Outcome.”
Archives of General Psychiatry
36 (1979): 1125–1136.

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About these sorts of elemental questions:
For more on the idea of moral injury and violation of
themis
(Greek for “justice”), see Shay,
Achilles in Vietnam
, 3-21.

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“For most of the 20th century, psychoanalytic theory”:
Ghislaine Boulanger, “Witnesses to Reality: Working Psychodynamically with Survivors of Terror.”
Psychoanalytic Dialogues
18 (2008): 640.

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The VA, which sets the tone for PTSD treatment worldwide:
For the VA's PTSD treatment guidelines, go to:
http://www.ptsd.va.gov/professional/treatment/over view/index.asp
.; see also Carr, “Combat and Human Existence,” 494.

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“Biological research is where the money is”:
Interview with senior VA psychiatrist, April 2013.

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“Sixty years after its introduction”:
Kandel,
In Search of Memory
, 365.

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Russell Carr, a navy psychiatrist at Bethesda–Walter Reed:
Carr, “Combat and Human Existence,” 471–496; “The Problem of Therapeutic Alliance When Treating Combat-Related PTSD.” Presentation by Commander Russell Carr, MC, USN, Navy and Marine Corps Combat and Operational Stress Control Conference, San Diego, California, May 23, 2012.

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Intersubjectivity theory, the school of thought that Carr:
See Stolorow,
Trauma and Human Existence
. Carr, in “Combat and Human Existence,” said, “As I left for a deployment to Iraq in the summer of 2008, I was wrestling with how to reach soldiers with traumatized experiences that left them with profound shame and difficulties with their relationships with others . . . A few months into the deployment, I developed an even stronger sense of urgency as one of my patients killed himself. I felt the effects of his suicide on his unit, the medical staff who tried to resuscitate him, and the other mental health team on base . . . As I thought of him and continued to meet with my other patients there in Iraq, I felt a strong urgency to find a better way to understand the effects of trauma. I then stumbled upon the writings of Robert Stolorow. I obtained a copy of his recent book,
Trauma and Human Existence
. It fundamentally changed how I work with traumatized military personnel” (473–474).

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As Stolorow sees it, everyone wants to be understood:
See Carr, “Combat and Human Existence,” 475–476.

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In his military practice, Carr treats some of the most chronic and complex:
Interview with Russell Carr, April 2013.

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“Doc, you get this more than anyone I've talked to about it”:
Carr, “Combat and Human Existence,” 474.

 

7. Drugs

 

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In the world of memory science, McGaugh:
This chapter is based on my interviews with McGaugh, emails exchanged from 2007 to 2013, the UC Irvine website, and interviews with his colleagues. In his book
Memory and Emotion: The Making of Lasting Memories
(New York: Columbia University Press, 2003), McGaugh describes the thought process behind some of his discoveries and some of the aspects of his academic training. After interviewing McGaugh, I stumbled across a fascinating article published in the
New England Journal of Medicine
by Troy Lisa Holbrook (“Morphine Use after Combat Injury in Iraq and Post-Traumatic Stress Disorder,” January 14, 2010), which seemed to confirm much of McGaugh's work and was derived from data collected in Iraq. Holbrook and her colleagues found that giving wounded soldiers and Marines morphine “during early resuscitation and trauma care” cut their risk of getting PTSD by 50 percent. Without realizing it, medics and physicians in Iraq had disrupted traumatic memory overconsolidation in a manner similar to what McGaugh had done in the lab.

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If McGaugh's work has a governing principle:
McGaugh,
Memory and Emotion
, 83.

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“In medieval times, before writing was used to keep”:
McGaugh,
Memory and Emotion
, ix.

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Scientists have known for a long time that certain:
K. S. Lashley, “The Effects of Strychnine and Caffeine upon the Rate of Learning.”
Psychobiology
1 (1917): 141–170.

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McGaugh stumbled across Lashley's research in the fifties:
McGaugh,
Memory and Emotion
, 60–61.

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Soon after getting his PhD, McGaugh began experimenting:
McGaugh,
Memory and Emotion
, 63–70.

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They soon discovered that adrenaline, the chemical released:
Ibid., 73, 97–108.

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This drug—propranolol, a beta-blocker developed:
Ibid., 100–106. See also L. Cahill and J. L. McGaugh, “Modulation of Memory Storage.”
Current Opinion in Neurobiology
6 (1996): 237–242; Roger K. Pitman, “Pilot Study of Secondary Prevention of Posttraumatic Stress Disorder with Propranolol.”
Biological Psychiatry
51 (2002), 189–192; Friedman,
Handbook of PTSD
, 392.

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As I would learn later, the other not-small problem:
Phone interview with Roger Pitman, April 2014.

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Could trauma—the nightmares, the daemons, the vanished hopes:
McGaugh,
Memory and Emotion
, 122–125.

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“will clip an Angel's wings/Conquer all mysteries by rule and line”:
Quoted in Redfield Jamison,
Touched with Fire
, 259.

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While the number of research subjects involved:
Brunet et al., “Effect of Post-Retrieval Propranolol,” 503–506.

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In January 2014, Pitman told me:
Interview with Pitman.

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Society, it seems, is not ready for wholesale memory erasure:
See Luckhurst,
Trauma Question
, 204–205.

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In October 2003, before the most promising experiments:
President's Council on Bioethics,
Beyond Therapy: Biotechnology and the Pursuit of Happiness
. Washington, D.C.: Government Printing Office, 2003.

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“Propranolol might be the most philosophically vexing”:
Chuck Klosterman, “Amnesia Is the New Bliss: A Breakthrough Drug Can Erase Your Worst Memories—But Not Everyone Thinks You Have the Right to Take It.”
Esquire
, April 10, 2007.

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“To be denied a ‘normal psychopathology'”:
Outka, “History, the Posthuman, and the End of Trauma,” 76–81.

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Trauma, when heard by society, is a form of testimony:
See Herman,
Trauma and Recovery
, 1. See also Caruth,
Trauma
.

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Nevertheless, not everyone is convinced that propranolol:
Adam Kolber, “Therapeutic Forgetting: The Legal and Ethical Implications of Memory Dampening.”
Vanderbilt Law Review
59 (2006): 1561–1626.

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“The original memory is indeed still there, deep inside the brain”:
See Robin Marantz Henig, “The Quest to Forget.”
New York Times Magazine
, April 18, 2004.

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Prazosin, a drug first used to reduce high blood:
M. A. Raskind et al., “Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study.”
American Journal of Psychiatry
160 (2003): 371–373. See also Shiromani,
Post-Traumatic Stress Disorder
, 341–343; Friedman,
Handbook of PTSD
, 392.

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Some of the most experienced psychiatrists who treat PTSD:
Comments made by Jonathan Shay during a presentation given at San Diego State University: “PTSD and Moral Injury: What's the Difference and Does it Matter?” October 4, 2012.

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The most popular class of drugs prescribed for PTSD:
See Friedman,
Handbook of PTSD
, 387. See also Shiromani,
Post-Traumatic Stress Disorder
, 348–352. Friedman asserts, “SSRIs are the treatment of choice for patients with PTSD, as attested by four independent clinical practice guidelines” (387).