The Evil Hours

by David J. Morris

  Of course, there are as many different responses to suffering as there are people in the world, but as the PTSD diagnosis has continued to grow in popularity, researchers have started searching for new ways to look at trauma apart from the simplistic “you have been scarred for life” mindset that seemed to be the prevailing sentiment of the Vietnam era. Indeed, some Vietnam vets have complained to me about this phenomenon, saying that they resent the presumption of psychological damage being connected with their military service. Elliott Woods, an Iraq veteran turned reporter, echoed this sentiment, saying, “It feels to me as if the U.S. civilian population has pathologized the veteran experience.” In a 2014 speech, James Mattis, an outspoken retired four-star general who is something of a cult figure among Marines, went so far as to say that “there is a misperception of our veterans out there, that they are somehow damaged goods.” Mattis said, “I don’t buy it.”

  Perhaps the most radical of these reformulators is Richard Tedeschi, a psychologist at the University of North Carolina, Charlotte. In the early nineties, Tedeschi was looking for a new line of research. “I thought, who do I want to know the most about, distressed or violent or crazy people?” he explained. “Instead, I think I want to know the most about wise people. Perhaps I’ll learn something myself.” Along with his research partner at UNC Charlotte, Lawrence Calhoun, he began interviewing people who had suffered from severe physical injuries, including a number of people who had been paralyzed in car accidents. After that, the two interviewed senior citizens who had lost their spouses. In case after case, they found that while the person regretted the loss of their mobility or their spouse, the experience had altered them for the better and given them a fresh perspective on life.

  After a follow-up study of hundreds of trauma survivors, Tedeschi was able to boil these positive developments down to three general “domains”: a changed perception of the self, a changed sense of one’s social relations, and a changed philosophy of life. As Tedeschi wrote, “It is in the realm of existential, and for some persons, of spiritual or religious matters that the most significant post-traumatic growth may be experienced.” In 1995, Tedeschi and Calhoun published their first book on the subject, titled Trauma and Transformation, coining the term for which they are now synonymous: post-traumatic growth. The following year, they published what amounts to a sunnier, more upbeat twin of the CAPS, the post-traumatic growth inventory. Tedeschi’s research has led him to a stunning conclusion: post-traumatic growth is far more common than post-traumatic stress.

  Perhaps unsurprisingly, Tedeschi’s research has not been embraced by the PTSD community. One senior VA psychiatrist I spoke to scoffed at the idea of post-traumatic growth, calling it an insult to people who have suffered. Some researchers question whether post-traumatic growth is a real, observable phenomenon. “I have no doubt that there are people, perhaps many people, who do change in positive ways, but we are not able to measure it,” said Howard Tennen, a professor of community medicine and health care at the University of Connecticut.

  The fact that some of the most experienced trauma workers are skeptical of post-traumatic growth as a clinical concept isn’t terribly shocking. Part of the undisguised disgust I encountered was no doubt due to the fact that the idea of telling someone that trauma might actually be good for them seems morally outrageous. The term itself, post-traumatic growth, is problematic; replacing “stress disorder” with “growth” makes it almost seem that it is being offered as a kind of alternative to PTSD, as if there were some sort of choice to be made. These questions of framing all highlight the degree to which psychiatry and the Western scientific mindset are limited by their own preconceptions. Science and psychiatry like to market themselves as being open to any proposition, but ultimately, the ideas that are the most likely to gain currency are those that can be easily isolated and measured. In that environment, the idea of testing for something as nebulous as personal “growth” would seem to be a fool’s errand.

  The other reality that virtually no one within the VA likes to talk about is that the PTSD community today is essentially a special interest group within medicine and the federal government. Every year, billions of dollars are earmarked for PTSD research, treatment, and disability payments, and the idea that people stand to benefit from being blown up, shot at, or raped threatens to undermine the entire moral argument—and financial support—for PTSD. For its part, the VA and the military seem to have adopted a wait-and-see approach to the idea of post-traumatic growth. Tedeschi is one of a handful of researchers looking into post-traumatic growth, and the body of research relating to it is puny compared to PTSD. But the VA isn’t exactly closed off to the concept, either. As Matthew Friedman, the recently retired executive director of the National Center for PTSD, told me, “PTSD and post-traumatic growth aren’t mutually exclusive. They can both happen at the same time.”

  Recent research confirms Friedman’s contention. In 2007, Zahava Solomon, an Israeli psychiatrist, surveyed 103 former POWs from the Yom Kippur War and found that while 23 percent of them still met the criteria for PTSD thirty-four years later, virtually all of them reported significant growth using Tedeschi’s scale. According to Solomon, “Posttraumatic stress disorder is not necessarily indicative of an absence of psychological growth and maturation. These two different types of outcome cannot, therefore, be conceptualized as two ends of the same continuum; they are not necessarily characteristic of two different types of individuals.”

  Steve House is a good example of Solomon’s point. When I asked him what he thought about PTSD, he admitted that he had no idea what it was exactly. But he also told me that he continued to have distressing dreams about waiting on the ledge for the rescue helicopter to arrive, so it’s possible that by the standard definition, he might have been diagnosable, but overall, he seemed far more interested in learning and physically recovering from his accident than dwelling on the symptoms of PTSD. In that way, House seems to serve as an exemplar of recovery. What saved him was his willingness to engage his inner resources, to stop and consider the fundamentals of his life, and then, perhaps most importantly, to take action. As Ben Shep­hard, a British historian of psychiatry and sometime critic of PTSD, wrote, “A job and a relationship can work wonders.”

  Paradoxically, Solomon and other researchers have also discovered that the more severe the trauma, the more likely the survivor is to report that they have benefited from the experience. In study after study, former long-term political prisoners and prisoners of war, when compared against regular combat veterans or single-event trauma survivors, reported more positive outcomes from their experience. In one study of U.S. Air Force POWs from the Vietnam War conducted by researchers at Yale, fully 61 percent of those surveyed felt the experience had been in some way beneficial. The Yale researchers were “impressed by the number of prisoners of war of the Vietnam war who explicitly claimed that although their captivity was extraordinarily stressful—filled with torture, disease, malnutrition, and solitary confinement—they nevertheless . . . benefitted from the captivity experience, seeing it as a growth experience.”

  Dennis Charney, a professor of psychiatry and neuroscience at Mount Sinai, studied American prisoners of war who did not, despite the traumas they endured, develop PTSD, and he identified a number of critical psychological elements that led to their resilience: altruism, having a solid moral compass, spiritual faith, having a role model, social support, confronting one’s fears, and seeing oneself as having a mission in life. The key predictor of who would bounce back from the ordeal and who would not was a sense of optimism. One study of Vietnam War ex-POWs even found that optimism or the lack thereof was more important than the nature of the trauma itself. Holocaust survivor Viktor Frankl, in his classic book Man’s Search for Meaning, argues for something similar, for what he calls a kind of “tragic optimism” based on a determination to “say yes to life in spite of everything,” arguing that “life is potentially meaningful under any circumstances, even tho
se which are the most miserable.”*

  The problem with all of these examples is that they are extreme cases: House is an elite mountaineer and arguably one of the more resilient people on the planet, while most of the Vietnam War POWs were highly trained, college-educated aviators. Likewise, Viktor Frankl was a highly unusual man who, after the Nazis occupied Austria, refused an American visa in order to remain with his parents in Vienna. (As one psychiatrist I spoke to pointed out, Frankl also took his doctoral dissertation with him to Auschwitz in order to work on it during his imprisonment, an unusual choice by any standard.) In fact, a substantial portion of the post-traumatic growth literature is derived from studies of exceptional populations, like the American POWs from Vietnam and other POW cohorts.

  And, in truth, the literature on post-traumatic growth seems to suffer from a kind of inspirational “magic bullet” fallacy, a selection bias in choosing the most transcendent anecdotes from the hundreds of interviews conducted. Tedeschi, for instance, was quoted in a New York Times Magazine article describing a patient whose helicopter was shot down in Vietnam. “As he fell from the sky in the midst of gunfire and explosions, a peace came over him. He saw the jungle around him, and it was beautiful. He felt connected to everyone, even enemy soldiers.”

  What is this other than a kind of religious experience, an epiphany?

  Later in the article, Tedeschi seems to concede this. “Maybe that was all an illusion,” he said. “But that became a guideline for his life, so I don’t think you can dismiss it.”

  Like a lot of old-school PTSD types, I was deeply skeptical when I first heard the term “post-traumatic growth.” It seemed like a classic example of what Europeans often say about American culture—that over and over again, we are commanded to smile, to be happy and optimistic, no matter the circumstances. As a rule, I am suspicious of people who think a positive mental attitude is the cure for all ills. It was a similar unrealistic optimism that led many to think Jeffersonian democracy would flourish in Iraq after the American “liberation.” But thinking about House’s response to his accident, I wonder if we often fail to consider the opportunities for positive change and wisdom-making that trauma grants us. I wonder if, on a certain level, post-traumatic stress suffers from a kind of storytelling problem within the culture. If society expects veterans, rape victims, and other survivors to be broken, doesn’t PTSD become a kind of self-fulfilling prophecy? Is it possible that the mythology of the condition is still too heavily influenced by the memory of the Vietnam War, a war whose veterans were often looked upon as being somehow morally compromised?

  Looking back on my experiences in the VA, there were only a very few occasions where any sort of growth-oriented thinking was encouraged. Never was I invited to think of how my experiences might be converted into a kind of wisdom or moral insight. When I did so on my own initiative, I was admonished for “intellectualizing” and for straying from the strictures of the therapeutic regime. Instead, I was encouraged to focus on my symptoms, to think about how to correct my various misperceptions so as to become more normal.

  Whatever the shortcomings of his research, Tedeschi makes a good point. If we, as people, can’t find something redeeming in war and other disasters, where can we find it? The problem might, in fact, relate to how the academic disciplines are organized today. Psychiatry and clinical psychology are simply not equipped to explore the kinds of questions Tedeschi raises. Psychiatry, clinical psychology, and the neurosciences focus on disease, not personal growth. It was this limitation that drove psychologists like Martin Seligman and Mihaly Csikszentmihalyi to begin exploring the more positive aspects of human psychology, like the psychology of creativity and what Csikszentmihalyi called “flow,” or the autotelic state, which it turns out fits quite nicely into a number of alternative trauma therapies. As it stands now, however, far more resources are directed at addressing the negative aspects of trauma than exploring the possible opportunities for insight. As Tedeschi himself admits, most post-traumatic growth seems to be spiritual and philosophical in nature.

  Despite all this, I think survivors like House and the Hanoi Hilton POWs can offer practical, secular lessons on managing post-traumatic stress. Talking to Steve, I was struck by his impulse to embrace the accident as an opportunity to change his life. As he put it, he didn’t just let it change his life, he helped it change his life. He took advantage of its momentum to take him to a different place, as Epictetus might have suggested. There was also an element of being prepared to see the need for change as well. Like a lot of mountaineers, House is an unusually thoughtful and circumspect person who has been forced by the exigencies of long expeditions to pay close attention to his emotions. In other words, he knew himself, even before the accident happened. He always took a stack of books and a journal with him on expeditions for the inevitable tentbound days at base camp, which helped expand his store of self-knowledge. After his fall, he took an active role in his own recovery, deciding to go off painkillers to assess the extent of his injuries and then, when he was ready, to begin climbing again. He sought—and found—patterns in his life.

  Similarly, the POWs that Zahava Solomon and others studied showed a capacity to adjust their internal emotional state and coping skills to different situations. They learned to look for things they could control within their environment. When they found those things, they exploited them. James Stockdale, one of the ranking POWs at the Hanoi Hilton, recalled the wisdom of Epictetus while he was in captivity, writing that “I remembered the basic truth of subjective consciousness as the ability to distinguish what is in my power from that which is not.”

  Did I grow because of Iraq? I grew and I shrank. Parts of my mind that I didn’t know existed before appeared. It was like waking up and noticing that someone has built a new addition onto your house during the night. I stepped into it and enjoyed the new space. But the other, older parts of the house looked different than they had before. Changed. With a darker coat of paint. I had to learn the new layout.

  The war was awful, but it was like a refuge from real life in a lot of ways. Certain things were harder over there, but certain things were easier. In death’s lengthening shadow, your life shrinks down to a few, very important concerns. Like a leaf held up to the light, you see life as a series of branching veins. A lot of ridiculous demands and expectations that drive people crazy stateside don’t exist in a war. You don’t have to worry about how you look, for instance. Fretting over the kind of car you drive seems like the height of folly. In a strange way, you are free. The only thing you can lose is your life.

  Living out of a backpack for months, I learned that I didn’t need very much to be happy. I learned that most people waste their lives obsessing over consumer items that serve no real purpose. Once I was back in the world, this focus, this streamlining of life’s priorities, gave me a new confidence. I carried myself differently, more assertively. There was a new faith, derived from a simple declarative statement that echoed in moments of pain and crisis: Well, this sucks, but it’s better than Ramadi. I also learned how to ignore things that were beyond my control, like death.

  But the war also gave me knowledge that I don’t know how to live with. It taught me that the world is a dangerous place. That death is random. That governments lie as a matter of course. That time is elastic. That terror is relative. That truth is local, tribal even. That what is true in Baghdad isn’t necessarily true in Ramadi. That what is true in Basra is almost never true in Ramadi. That things only seem absolutely true in Washington. That the closer you get to death, the harder it is to know anything for sure. The war was another world. A lot of things that happened there only made sense there. A lot of things that happened there made no sense at all, but they happened anyway.

  Was this growth or just too much information?

  The war gave me a kind of maturity, but it made me a child again. When I got back, there were simple human moments that I realized the war had taught me how to see again. Basic sights overl
ooked by people who had never almost died or walked through a destroyed city. My eyes seemed to work differently. They were hungrier, more sensitive to beauty. Flying over Greenland on my way back in 2004, I saw the glaciers, melting and wondrous and reflecting seven kinds of white, and cried. Before the war, I would have told myself it was only scenery. I became a watcher of night skies, of cloud formations, of shooting stars. The world had a music I’d forgotten how to hear. Whatever secret harbor of wonder, of childlike yearning for the sights of the world, that drains away as we grow up, had been filled again.

  Then, just like that, the whole thing would flip, somebody would say something callous or ignorant, and I’d be angry again. Angry at the direction the world had taken. Angry at how stupid people were. How everyone seemed to have accepted the war, the wasteful, mammoth injustice of it, with a shrug.

  Did being made crazy by this fact mean that I was actually going crazy?

  I stewed on this for months. Was I mad or wise? Was this loss or insight? Stress or growth? In 2004, these were difficult questions to answer. Ten years later, I still don’t have the answers.