The Evil Hours (8 page)

This quagmire of questions would seem to overwhelm the scientific mind and to a certain extent it does. Fundamentally, we do not know why some people are damaged by terror and some are not. Part of trauma's power lies in its mystery, in the fact that it remains outside the range of normal human perception, like a distant galaxy beyond the reach of even the most powerful telescope. It remains an enigma because human beings are an enigma. Nevertheless, scientists have in recent years developed what amounts to a recipe for post-traumatic stress, for lack of a better word. If you surprise someone, trap them, physically violate them in some way (as with rape), and expose them to the elements for some period of time, you will soon see the hallmarks of what we call PTSD. According to the
Comprehensive Textbook of Psychiatry
, the common thread in psychological trauma is a feeling of “intense fear, helplessness, loss of control, and threat of annihilation.”

Chief among the crimes that trauma commits against the mind is the distortions of memory it introduces. In the face of terror, the mind skips straight over some things and perversely overrecords others; one pattern that researchers see is that during terror the mind's normal capacity to record novel visual stimuli tends to go into overdrive, creating what early psychologists called the
idée fixe
.
One of the most unsettling features of trauma is the odd sense—which one gets when visiting war zones and automobile accidents—that the mind functions as a sort of mad curator of the grotesque and the bizarre, documenting in painstaking detail the most repulsive scenes of violence and human violation. The mind, which recoils at the thought of its own extinction, adheres to visions of the extinction of others, as if to collect clues to its own demise. Here one is reminded of the tragic cry of the overexperienced—“If I could just get that sight out of my head!” I cannot, for instance, get out of my head the sight of the soldier in Dora who'd been wounded in the groin. Nor can I unsee the red Igloo Beverage Container floating in a filthy canal next to an overturned Humvee north of Fallujah that contained the bodies of two dead Pennsylvania National Guardsmen. The sight of the bodies being loaded onto a medevac chopper is paradoxically less vivid, less real, than that of the red Igloo, an American symbol of portable leisure, floating in an eddy next to the Humvee, occasionally brushing against some bracken on the shore.

It is almost as if certain types of events—the bloody, the melodramatic, the spectacular, the incongruous—are somehow biologically protected from the normal degradations of time, permanently seared into the gray matter.
This, in fact, is one of the more disconcerting things one learns in the first month of war: the same obscene impulse that compels civilians to rubberneck at a highway accident exists in a war zone in even greater force. You don't want to look, and yet you have to. And so you do, and you're stuck with what one Marine buddy of mine calls “a mind tattoo.” In the end, such things turn out to be one of the strange tricks of human perception, another object lesson in the idea that “PTSD is a disease of time”—the worst things in the world enter your brain in an instant, though it may take you the rest of your life to understand what you saw.

From a certain vantage point, it is tempting to say that trauma is trauma is trauma, when in fact something like the opposite is true. Trauma is much like cancer in that each individual subspecies has a different impact on the individual. Some of the most intriguing insights into the human experience of trauma come from looking at how people react to natural disasters. For reasons that defy explanation, so-called acts of God like tsunamis and hurricanes are somehow less aggravating to the psyche than acts of man, such as rape and combat, and result in substantially lower PTSD rates for survivors.
It is as if, somewhere deep within, there remains an animal part of us that accepts the omnipotent caprice of the physical universe without question. Though they retain the ability to drive people mad, natural disasters are interpreted by the mind as less of a betrayal than manmade disasters or interpersonal violence, a relationship that speaks to the idea that it is not merely the blunt force of trauma that matters so much as how it impacts one's social environment and one's
interpretation
of the social environment. On some lower substrate, the body understands that nature is always a killer. With people, one can never tell.

One study published in the
New England Journal of Medicine
found, for example, that the PTSD rate for female victims of natural disasters was 5.4 percent, whereas 45.9 percent of female rape victims suffered from persistent PTSD. Sonali Deraniyagala, writing about the 2004 tsunami in her memoir
Wave
, never curses God or the sea, reserving her anger for the Dutch family who moved into her old house, cruelly sold by an uncle while she grieved for her lost family.
The idea never seems to occur to Deraniyagala to blame the universe or look for evidence of God's hand in the holocaust of her life. In the face of nature, there is a curious moral suspension: she simply pines for her lost sons, crying when she sees their empty juice boxes in the back of her sedan. Similarly, if we think back to Linda, our notional thirty-one-year-old woman pinned beneath her bookcase, and compare her with another thirty-one-year-old woman who was “pinned down” for hours by continuous mortar fire in Iraq, the woman who was pinned down by mortar fire is roughly three to four times more likely to develop post-traumatic stress symptoms.

There is, it seems, almost a comfort to be found in the majesty of savage nature. One never discusses the “crime” of a tornado or the “violation” of a storm at sea, and in fact the impulse to savor the sublime power of nature, even at its most dangerous, seems almost restorative, as if the sight of it reminds us of our place in the universe. Every year, parents pay millions of dollars for tickets to zoos in order to point out tigers, bears, and sharks to their children. Returning home from Iraq in October 2007, my brother and I visited our old neighborhood in San Diego, which had just been decimated by a wildfire.
Touring the devastation, hours after President Bush had declared it a national disaster area, I was overcome by an awful sense of nostalgia for my lost childhood, a feeling that persisted for several days. The surreal image of our house, the lone surviving structure on our street, still resonates. Nevertheless, I understood somehow that such a disaster was to be expected. My brother and I had grown up watching giant plumes of smoke rising from the hills surrounding our suburb, and the fact that this particular fire had simply gotten out of hand seemed perfectly reasonable to me.

Not so with manmade trauma, especially if the perpetrators are well known to you, in which case the likelihood of lasting harm is even greater. In fact, the governing principle with social traumas seems to be that the greater the intimacy, the greater the “dose.” If, in our example, Linda is being mortared by friendly troops by mistake, an incident of so-called friendly fire, then the traumatic dose is generally regarded as being even greater than if the barrage were being inflicted by the enemy.
Together, all of these various factors reveal a rarely acknowledged tension within the field of trauma studies: the tension between the logic of nature and the logic of culture. These crimes, which are in essence interpersonal crimes, reflect the degree to which post-traumatic stress, a disorder that is so often viewed as a problem of neuroscience, is perhaps better thought of as a social wound, a damaging of the intricate web of relations that keeps a person sane and tethered to the world.

Perhaps the easiest way to understand how all these epidemiological factors play out in the lives of real people is to look at one of the most famous and thoroughly documented episodes in the field of trauma studies: the “Hanoi Hilton” prisoner-of-war camp in North Vietnam, which held a group of 591 American servicemen, including the future senator and presidential candidate John McCain.
This group of men, most of whom were pilots, was the longest-detained group of POWs in American history, with some men being interned for the better part of a decade. (McCain was held for five and a half years.) To say that the prisoners held at the Hanoi Hilton endured horrific conditions would be a vast understatement. Prisoners were routinely tortured and survived extended periods of solitary confinement, an unusually potent form of abuse. One of the methods favored by the North Vietnamese was a local variant of the
strappado
, a technique dating back to the Spanish Inquisition, which involved being hung from the ceiling by one's arms for hours. Repeated application of the
strappado
is the reason why Senator McCain to this day cannot raise his arms above his shoulders.

Unbelievably, the survivors of the Hanoi Hilton have one of the lowest lifetime PTSD rates ever recorded, a mere 4 percent. (By comparison, one study on the Americans held by the Japanese during World War II found that more than 85 percent developed PTSD.) More surprising is that a substantial number of these men consistently report that they actually benefited from the experience. Describing what he called his “transforming” time in the Hanoi Hilton, McCain wrote, “Surviving my imprisonment strengthened my self-confidence, and my refusal of early release taught me to trust my own judgment. I am
grateful
to Vietnam for those discoveries, as they have made a great difference in my life. I gained a seriousness of purpose that observers of my early life had found difficult to detect.”

How do we explain such a response to barbarity? Were McCain and his comrades superheroes, blessed with a supernatural ability to transcend brutality? How, when confronted with circumstances that would have destroyed most men, did they not only endure, but also, in many cases, actually seem to grow as human beings?

The story of John McCain's survival has been told and retold so many times that it has become something of a secular American sermon, and it is tempting, on a certain level, to simply chalk up the entire Hanoi Hilton episode to the mysteries of heroism. The truth of the matter, however, is more complicated and fascinating. In fact, McCain and his comrades enjoyed a number of measurable psychosocial advantages that enabled them to survive and stay sane in the face of unspeakable horror. If scientists had set out to engineer a group of men designed to withstand the pain and furies of trauma, they might have created the men of the Hanoi Hilton. As a group, they were older, higher-ranking, and more mature than the average draftee. (The typical prisoner was fifteen years older than the average American servicemember.) Virtually all of them had been to college, and as pilots and flight crew, they were the products of one of the most rigorous military training systems in existence at the time, a training regimen that typically included over a year of flight school and a comprehensive medical screening. A substantial number of them had even attended a mock prisoner-of-war school designed to help captured personnel survive enemy captivity. The U.S. government had literally spent millions training each of these men.

Second, the Hanoi Hilton is unique in the annals of military prisoner-of-war camps for its relative geographic stability and for the emotionally supportive prisoner culture that developed there. Admiral James Stockdale, one of the highest-ranking prisoners, who was later awarded the Medal of Honor, described his role in the prison as one “presiding over a unique society.” This society was built upon mutual care, unity, and optimism in the face of adversity. Newly captured prisoners would later speak of being “mentored” by the more experienced prisoners.

Importantly, when the men of the Hanoi Hilton were finally released at the end of the war, they were given a lavish hero's welcome.
In a time when many Vietnam veterans were met with suspicion and hostility when they came home, these men were treated like returning astronauts. President Nixon, who had campaigned extensively on the issue of their repatriation, hosted a special dinner at the White House in their honor, which included performances by Bob Hope, John Wayne, and Sammy Davis Jr. Most of them returned to find their marriages, families, and finances intact. Each man was given a complete medical exam, free access to medical care, and even lifetime passes to Major League Baseball. Many of the former POWs, like George Coker, a navy pilot captured in 1966, were given their own welcome-home parades and the “keys to the city” of their hometowns. Most of the Hanoi Hilton “alumni” chose to remain on active duty and were generally regarded as something like celebrities by their comrades. They were frequently called upon to deliver motivational speeches, imparting the life lessons they had learned while in captivity. In short, while their traumatic “dosage” was exceedingly high, this group of survivors was not simply told they were heroes upon return and sent packing; their suffering was acknowledged, processed, meditated upon, and even celebrated by their culture. Trauma workers often talk about the post-trauma reintegration process being dictated by the “opportunities to be understood.” From this standpoint, the POWs from the Vietnam War were uniquely blessed.

As John McCain later wrote,

 

In the many years since I came home, I have managed to prevent the bad memories from intruding on my present happiness. I was thirty-six years old when I regained my freedom. When I was shot down, I had been prepared by training, as much as anyone can be prepared, for the experiences that lay ahead. I wasn't a nineteen- or twenty-year-old kid who had been drafted into a strange and terrible experience and then returned unceremoniously to an unappreciative country.

 

The Hanoi Hilton experience is a unicorn in the literature of trauma, a case in which a perfect storm of circumstances converged to produce a group of people who defied the odds and, as such, would be exceedingly hard to duplicate. The episode does, however, highlight the myriad factors, both personal and cultural, that dictate who suffers post-traumatic stress and who does not, as well as the special role that reacculturation plays in the process. In most post-traumatic situations, survivors are viewed by “normals” with confusion, suspicion, and in some cases outright hostility. For a psychologically wounded person returning to the regular world, it is only natural to return this suspicion and hostility, virtually guaranteeing their own social isolation. One group of VA investigators, summarizing twenty-five years of research, wrote that “the major posttraumatic factor is whether the traumatized person received social support. Indeed, receipt of social support, which appears to be the most important factor of all, can protect trauma-exposed individuals from developing PTSD.”