Forever at War: Veterans’ Everyday Battles with Post-traumatic Stress Disorder

ptsd-iwo-jima“To this day, every time I smell firecrackers or fire arms being shot, I feel like I am right back there. All I have to do is close my eyes and I see the whole scenario over and over again. I can’t erase it.”

Hundreds of thousands of US veterans are not able to leave the horrors of war on the battlefield. They bring the combat home and re-experience it in their minds each and every day, no matter how much time has passed.

“I don’t like people. I just live my life.”

Many PTSD veterans live a life riddled with divorce, unemployment, and loneliness because they are unable to form lasting social networks within civilian life. It is not uncommon for a war veteran plagued with PTSD to desire a solitary life in the mountains. One informant described Montana as the ideal locale – far away and quiet.

“I should have buried him.”

This veteran is still tormented by the fact he did not give an honorable burial to a fellow soldier. He knows he would have met a similar fate if he tried to leave his foxhole; yet his inability to act haunts his memory. He asks himself everyday why he didn’t even try to honor his fallen comrade. He also has never been able to justify why he wasn’t the soldier left unburied on that remote Pacific island.

“I didn’t even have the motivation to kill myself.”

Many of these men and women believe their situation will never improve. Some contemplate suicide as their only relief from the symptoms of PTSD. A number of the veterans we spoke with had thought about or even tried to end their own lives. They also participate in risky activities, threatening their life in a deliberate yet indirect way.

“I always feel like there is someone behind me – following me.”

Being on edge is the only way to survive in combat. Unfortunately, many PTSD veterans are unable to readjust within the civilian world. Everyday life becomes a battlefield.

Something as mundane as walking through a crowded grocery store aisle can be a source of intense anxiety for a veteran suffering from PTSD. Overwhelmed by a feeling that the shoppers behind them are enemies, PTSD veterans always feel as if they are under attack. A trigger as simple as the clashing of shopping carts can make them jump in fear of an imminent explosion. They are forever at war.

OUTREACH

Over the course of 4 months, South Bend veterans with Posttraumatic Stress Disorder (PTSD) have revealed their daily realities to us, five undergraduates at the University of Notre Dame. In conjunction with a course taught by Dr. Daniel Lende entitled Researching Disease: Methods in Medical Anthropology, we have engaged in community-based research with members and supporters of PTSD, Vets, Inc. Here, with the approval and encouragement of these vets, we seek to give their experiences a well-deserved voice.

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Body Swapping

Do psychotherapists now have a new trick? Or is it all smoke and mirrors? The New York Times reports today on Standing in Someone Else’s Shoes, Almost for Real, where neuroscientists have shown that “the brain, when tricked by optical and sensory illusions, can quickly adopt any other human form, no matter how different, as its own.”

The article “If I Were You: Perceptual Illusion of Body Swapping” by the Swedish researchers Henrik Ehrsson and Valeria Petkova appears this week in PLoS ONE, and is ably summarized over at Neurophilosophy. You can also read Ehrsson’s previous article on the virtual arm illusion and his Science piece on the experimental induction of out-of-body experiences.
out-of-body-illusion
The approach in all of this research is rather simple. You can see the out-of-body experiment design pictured to the right. Body swapping adds another person with goggles.

A subject stands or sits opposite the scientist, as if engaged in an interview.. Both are wearing headsets, with special goggles, the scientist’s containing small film cameras. The goggles are rigged so the subject sees what the scientist sees: to the right and left are the scientist’s arms, and below is the scientist’s body. To add a physical element, the researchers have each person squeeze the other’s hand, as if in a handshake. Now the subject can see and “feel” the new body. In a matter of seconds, the illusion is complete.

body-swap-by-niklas-larsson
This “switching” happens because the brain is literally embodied – after growing up with this particular body, it’s a fair assumption to assume that one’s eyes and one’s hand are getting feedback about the same interactive phenomenon. For a first-person view of this, see Karl Ritter’s AP article today on the body-swap illusion, which includes this photo of the two-goggle set-up.

Ehrsson is excited about being able to trick the brain in this way: “You can see the possibilities, putting a male in a female body, young in old, white in black and vice versa.” The NY Times article pushes the uses body swapping can have in therapy.

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Demons on the Web

vaughan-bell-by-paul-smith
Vaughan Bell of Mind Hacks makes the New York Times today! So finally a picture of the man! He is seated in the garden outside the Department of Psychiatry at the Universidad de Antioquia, where he now works in Medellin, Colombia.

The NYT piece Sharing Their Demons on the Web begins:

For years they lived in solitary terror of the light beams that caused searing headaches, the technology that took control of their minds and bodies. They feared the stalkers, people whose voices shouted from the walls or screamed in their heads, “We found you” and “We want you dead.”

When people who believe such things reported them to the police, doctors or family, they said they were often told they were crazy. Sometimes they were medicated or locked in hospital wards, or fired from jobs and isolated from the outside world.

But when they found one another on the Internet, everything changed. So many others were having the same experiences.

The article goes on to discuss this “extreme” online community that gives peer support a whole new meaning! Mind control, stalking and paranoia become the delusions of the net. “The views of these belief systems are like a shark that has to be constantly fed,” Dr. Hoffman said. “If you don’t feed the delusion, sooner or later it will die out or diminish on its own accord. The key thing is that it needs to be repetitively reinforced.”

On the other hand, Derrick Robinson, a janitor in Cincinnati, says “It was a big relief to find the community. I felt that maybe there were others, but I wasn’t real sure until I did find this community.” Mr Robinson has gone on to become the president of Freedom from Covert Harassment and Surveillance.

Vaughan estimates that there are a small number of these intense sites that are frequented around the Internet. I ran across a similar phenemenon exploring pro Ana websites that support anorexia a couple years back. But Vaughan has published everything! The article ‘Mind Control’ Experiences on the Internet: Implications for the Psychiatric Diagnosis of Delusions (pdf) appeared in Psychopathology (also available here through Scribd).

As expected, Vaughan documents the NY Times article over at Mind Hacks. He described the outcomes of this research in an earlier post on Internet mind control and the diagnosis of delusions. As Vaughan concludes about this research:

This is interesting because the diagnostic criteria for a delusion excludes any belief that is “not one ordinarily accepted by other members of the person’s culture or subculture”, whereas these individuals have formed an online community based around their delusional belief, creating a paradox.

Bad Boys or Bad Science

So here’s a recent New Scientist title: “Bad Boys Can Blame Their Behaviour on Hormones.”

All I can think is: New Scientist, Old School. Old, as in nature-nurture old and biological determinism old. Old as in moldy, rusted, failing ideas old.

But it’s not just New Scientist. Discover matches New Scientist with, “Teenage Hoodlums Can Blame Bad Behavior on Hormones.” And The Daily Mail delivers “Now Teenage Thugs Can Blame Their Hormones for Bad Behaviour.”

So what’s the problem? Well, it’s two-fold. First are journalists playing out a cultural script just like they subscribe to old-school cultural determinism. And second is some bad research that, not coincidentally, helps the journalists act like cultural automatons.

The cultural model goes like this: stereotypes, then blame, then biology. Take a stereotype we fear (“we” meaning journalists and readers alike). Bring in the politics and ideology of blame – hey, there’s a reason they are not like us, and why they threaten us. Invoke a cause, generally biological (though cultural causes come up too), outside of our particular realm of control. Hormones, nothing we can do about that, it means they were bad from the get-go. So we’re right to fear them and better make sure they don’t hurt us, whatever it takes.

Don’t believe me? Just look at the photos that accompany the articles. At the Daily Mail, a hooded guy point his hand like a gun at us the reader. Over at Discover, a crazed man with a clenched fist yells in our faces.

We all know journalists will play to stereotypes and will get research wrong and so forth. But in this case, like in most of the biologically-oriented research about complex human phenomena, the research only feeds into journalists typing out the normal crap.

The article in question is “Cortisol Diurnal Rhythm and Stress Reactivity in Male Adolescents with Early-Onset or Adolescence-Onset Conduct Disorder” (full access) by Graeme Fairchild, Stephanie van Goozen et al. and appears in the October 2008 issue of Biological Psychiatry. Neurocritic gives us the overview of the article if you don’t want to read the whole thing. (While I liked the Bad Boys music, I could have done with some more criticism in this particular Neurocritic post – but that’s okay, I’m going to play the bad boy this time.) Here’s the popular take from New Scientist on the article:

Out-of-control boys facing spells in detention or anti-social behaviour orders can now blame it all on their hormones. The “stress hormone” cortisol – or low levels of it – may be responsible for male aggressive antisocial behaviour, according to new research. The work suggests that the hormone may restrain aggression in stressful situations. Researchers found that levels of cortisol fell when delinquent boys played a stressful video game, the opposite of what was seen in control volunteers playing the same game.

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Ethos: Cultural Politics of Mental Health in Native North America

I thought this would interest some of you.  Here’s the link to the online version. And for more info on Ethos, including the links to an entire issue on Jerome Bruner, just click here. Or check out the editorial office.

To view an online version of this email, click here.
Journal of the Society for Psychological Anthropology

Ethos presents a special collection:

Cultural Politics of Mental Health in
Native North America

Guest Editor: Joseph P. Gone

The September issue of Ethos includes a remarkable collection of articles on the contradictions and conflicts that arise in mental health counseling involving majority culture counselors and Native Americans. Articles featured in this collection include:

Introduction: Mental Health Discourse as Western Cultural Proselytization
Joseph P. Gone

Discourses of Stress, Social Inequities, and the Everyday Worlds of First Nations Women in a Remote Northern Canadian Community
Naomi Adelson

Clinical Paradigm Clashes: Ethnocentric and Political Barriers to Native American Efforts at Self-Healing
Joseph D. Calabrese

Sobriety and Its Cultural Politics: An Ethnographer’s Perspective on Culturally Appropriate Addiction Services in Native North America
Erica Prussing

Commentary: The Problem of Mental Health in Native North America: Liberalism, Multiculturalism, and the (Non)Efficacy of Tears
Audra Simpson

Commentary: No Itinerant Researchers Tolerated: Principled and Ethical Perspectives and Research with North American Indian Communities
Joseph E. Trimble  



About Ethos

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Ethos is an interdisciplinary and international journal devoted to publishing scholarly articles exploring interrelationships between the individual and the sociocultural milieu, between the psychological disciplines and the social disciplines.

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Psychiatry affects human psychology: e.g., ‘bipolar’ children

Prof. Joseph Biederman, MD

Prof. Joseph Biederman, MD

Although I really enjoy psychology, like many anthropologists, I feel a deep ambivalence about some contemporary psychological theory and research.

Some of these problems are trivial and tendentious, to be honest, more the effects of pushing our own disciplinary preferences in the way research is presented or semiotic hair-splitting in theoretical terms than substantive concerns. But there are some more profound issues, touched on in recent posts like Daniel’s Neurotosh, Neurodosh and Neurodash and my post, Bench and couch: genetics and psychiatry. Ironically, I was reminded of one of the more serious issues while reading a piece a few weeks ago by psychologist and psychologist-sceptic Bruce Levine on Alternet, The Science of Happiness: Is It All Bullshit?

In a meandering way, this post is a reflection on one of anthropology’s consistent criticisms of psychology; the often unacknowledged role of psychiatry in shaping psyches. That is, the difficulty of studying a phenomenon when one is helping to create it and one’s theories influence your subjects’ accounts. When psychology is successful in breaking through into popular awareness, it becomes entangled with its subject, a kind of folk theory operating in the same space that psychologists seek to study. So this post is a kind of neuroanthropological reflection on clinical psychology as both research enterprise and world-making project, and the way the two come into conflict.

Specifically, Daniel’s post on Neurotosh and Levine’s story of John Stewart confronting Harvard happiness researcher, Prof. Tal Ben-Shahar, reminded me of the recent scandal surrounding psychiatrist Prof. Joseph Biederman. Biederman took large unreported consulting fees from pharmaceutical companies who manufactured anti-psychotic medicines while he was simultaneously encouraging psychiatrists to diagnose children with bipolar disorder, and then to prescribe their young patients anti-psychotic medicines. Senator Charles E. Grassley (R-Iowa) held hearings on the financial conflicts of interest as reported in The New York Times in Researchers Fail to Reveal Full Drug Pay, by Gardiner Harris and Benedict Carey. (For an earlier critical article, see the Boston Globe piece, Backlash on bipolar diagnoses in children.)

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Neurotosh, Neurodosh and Neurodash

Neurotosh. The best word from the entire Montreal Critical Neurosciences conference! There was Cordelia Fine, capturing perfectly her frustration at the manipulation of data and science in the service of stereotypes. Just pure neuro-nonsense.

The neurotosh in question was Louann Brizendine’s The Female Brain, an excellent representative of the neurosexism sold in recent popular books. It is popular, a bestseller translated into many languages, and it is simply bad science. In Nature Rebecca Young and Evan Balaban describe the book as “dressing the [gender] myth up in new clothes” and selling a “melodrama,” noting that “The Female Brain disappointingly fails to meet even the most basic standards of scientific accuracy and balance.”

Cordelia Fine took us step-by-step through several passages, examining the supposed citations and supporting evidence. Gender differences were confirmed by (a) studies with only women, (b) studies on a different topic entirely, and (c) personal communication. Ouch.

Plenty of other people have gotten on the bash-Brizendine-bandwagon, helping to undermine the moral authority that Dr. Brizendine wields through her academic credentials and “scientific” claims. Language Log has several critical analyses of the gender difference claims about language (see here, here and here). Mother Jones takes Brizendine to task on her approach to medicine. The most popular Amazon reviews of the book lead with titles calling The Female Brain disappointing” and “nonsensical.” Vaughan Bell at Mind Hacks gets in on the pile-on-party as well.

Still Simon Cohn, a British anthropologist at the meeting, was rather nonplussed at Cordelia’s agonizing over the data and methods and claims made by Brizendine. As Simon said to me, “It’s called ‘The Female Brain.’ Doesn’t that tell you everything right from the start?” His point was that knowledge gets turned in the service of ideology and profit and power all the time.

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