'The Evil Hours': Author's deep, personal take on post-traumatic stress

What are causes and effects of PTSD?
pkg ptsd health minute_00001624


    What are causes and effects of PTSD?


What are causes and effects of PTSD? 01:00

Story highlights

  • Journalist and former Marine David Morris almost died in a Humvee explosion in Iraq
  • He developed PTSD and has written a book exploring the history of the disorder
  • Morris also delves into his own treatment and examines PTSD in rape and natural disaster survivors

(CNN)During World War II, a soldier under U.S. Lt. Gen. George S. Patton's command in Sicily was hospitalized for psychiatric treatment. Doctors at the time commonly called this condition "battle fatigue."

Patton was so disgusted by what he perceived as cowardice that he berated and slapped the soldier. For that -- and an almost identical incident a few days later -- Patton received his own kind of professional slap from Congress and Gen. Dwight Eisenhower. But some in the U.S. supported Patton.
Now, post-traumatic stress is the fourth-most diagnosed psychiatric disorder in the United States, with 28 million expected to suffer from it in their lifetimes.
    Everyone knows -- or thinks they know -- what PTSD is. It's so often referred to that it's become a kind of shorthand in the United States for the wreckage of more than 13 years of nonstop war.
    As former Marine David Morris put it, "Even if you don't have it, people assume you do."
    Morris nearly died in a roadside bomb explosion in Iraq in 2007. At the time, he was no longer a Marine but an embedded journalist.
    Two years went by after that brush with death, and many other close calls, before he found himself sitting in a movie theater in 2009 watching a scene of a bomb blowing up a car. He blacked out and woke up in the lobby, frantically checking people's hands to see if they had weapons.
    Morris' new book, "The Evil Hours," isn't only about his experience with PTSD. He explores rarely discussed research about trauma resulting from sexual assault and natural disasters, and delves into sometimes controversial treatments of PTSD.
    He also examines the medical community's historically slow understanding of PTSD. Psychiatry didn't formally recognize the condition until 1980, even though emotional trauma was first documented in 1866 in London by a researcher collecting stories of people who witnessed railway accidents.
    Trauma happens when people "catch a surprise glimpse" of death, "the coming annihilation not only of the body but the mind but also, seemingly, of the world," Morris writes.
    Trauma kills a person's sense of time. There's life before and life after the traumatic event, and perceptions of reality are often constantly looped and tangled up in an injured memory.
    Though therapy and drugs can ease symptoms, there's no cure for post-traumatic stress.

    Out of step, out of mind

    As a Marine, Morris was deployed in 1996 in peacetime. He saw no combat, but he returned home with a sense that he was out of step with other Americans.
    "When you come back -- and it's the same for reporters -- you see that the world has moved on and it doesn't really need you, you're not essential, that time has continued without you," he told CNN. "A lot of people in the military think to themselves: When I get home, I'm going to drink all the alcohol I want, watch all the TV I want, have sex with my wife as much as I want. I'm going to have everything I've ever wanted when I get home."
    That desire for a pleasurefest is rooted, he said, in the feeling -- justified or not -- that "the world owes you because you're serving your country and you think, 'I'm doing this all for you,' why aren't these obstacles to readjustment taken out of my path?'"
    Morris notes in "The Evil Hours" that in North America, a service member might get a debriefing and a long plane ride before he or she is thrown back into civilian life. There is no ceremony or ritual.
    That's not the case elsewhere, such as in New Zealand. That country's infantry regiment practices an ancient Maori battle cry called a haka, which involves stomping feet, making faces and slapping thighs at the start and end of a deployment, a practice that Morris thought might be cathartic for Western troops.
    Diagnosing returning warriors might unintentionally be North America's ritual, Morris theorizes, because it's done with such regularity. An estimated 600,000 veterans have been diagnosed with PTSD but, according to many who work with traumatized veterans, the actual number is much higher because of those who don't seek treatment.
    While the military has made strides in destigmatizing PTSD and encouraging its members and their families to get therapy, Morris told CNN the armed forces are failing to do one critical thing.
    "The U.S. military is a fighting organization that trains, equips and deploys people," he said. "There's nothing in place that develops an emotional intelligence for service members. When you're young, wrestling with everything that goes with that -- the yearnings, the impulses -- repressing that isn't good, but speaking from my own experience, Marine training is built on learning to numb your emotions and put them in the back of your mind to execute the mission.
    "You put them on layaway, but there's compound emotional interest that accrues," he said.
    Eventually, some pay that interest by breaking mentally.
    Though Morris knew what could be at stake, he chose to return to Iraq in 2004 as a journalist. There was no question that Morris, the son of a Vietnam veteran and a fan of iconic war chroniclers Ernest Hemingway and Michael Herr, would wind up back on the battlefield. "I had spent most of my adult life training to go to war and thinking and writing about war. All of my friends were over there. Iraq was the very center of our world then."
    When he returned home every three months, he was angry a lot and on edge. He didn't know how to talk to his girlfriend. Friends told him they were nervous around him, though they asked for vignettes, they tried to understand. A writer who has always found words, in those instances he couldn't find any.
    "It feels like you have this secret that you can't communicate," he told CNN. "You don't know how to. And this is what takes you the rest of your life to figure out -- what is this secret and how do I translate it to the real world."
    Shame didn't make him silent, he said. Even the most cursory reading of history assuaged worry that he was unique or alone. Civil War soldiers suffered from "soldier's heart." Stories abound of warriors with "shell shock" in World War I. Only after Vietnam, when veterans began talking about their trouble sleeping, haunted dreams and flashbacks, did the psychiatric community inch toward giving post traumatic stress a name.
    It was first listed in the Diagnostic and Statistical Manual of Mental Disorders, psychiatry's bible, in 1980.

    America's war culture

    How we understand PTSD feeds off and is reflected in popular culture, Morris says. The term "flashback" isn't from psychiatry. It comes from cinema.
    Though only 2.5 million Americans fought in Iraq and Afghanistan, there's a war culture in the United States, he writes.
    We live "after 9/11," he posits, meaning that much of our culture is shaped by the constant fear of being attacked, a kind of hypervigilance similar to what PTSD sufferers exhibit.
    Do we go a day without hearing the word extremism, threat or terrorism in the news? September 11 is referred to -- directly and indirectly -- in movies and television. We're kind of obsessed with surveillance and homeland security, he argues. We love shooter video games. People compete in Tough Mudders and do SEAL workouts.
    Researchers have drawn connections between helicopter parenting and a societal paranoia that we're going to be attacked, Morris writes.
    Even all those zombies in TV shows and movies, he proposes, could be seen as symbols of death lumbering after us while we crazily and fruitlessly try to battle them or run away.
    There's no group that has a monopoly on PTSD, but Morris found that sexual assault survivors experience the disorder at a higher rate than combat and natural disaster survivors, Morris said. Rape victims develop PTSD 55% of the time, according to a review in the New England Journal of Medicine.
    PTSD is what happens, he says, when a person realizes that another person can exact a horrific act on them. It jumbles that "person's sense of the social order," Morris told CNN. Natural disasters happen; people choose to go to war and people argue that wars are justified. Rape survivors are victimized for no justifiable reason whatsoever, and usually by someone they believed they could trust.
    "Rape survivors ... find themselves in a very lonely spot," said Morris, who interviewed several for his book.
    "Veterans come back and are called heroes and people want to know their stories and movies are made about them. War stories are a cornerstone of Western literature," he told CNN. "No one asks rape survivors, 'Tell me your story.' Their stories aren't celebrated or acknowledged, mostly."

    Morphine, virtual reality and the broken-record approach

    Morris couldn't bring himself to acknowledge, at least to another person, that he was deeply worried about that blacking-out episode at the movie theater in 2009. After he had come to his senses in the lobby, he'd returned to his seat next to his girlfriend and offered no explanation. What did it mean?
    He went on with his life. Years went by. It's not as though he'd locked himself in a closet with a gun, he rationalized. He was fine.
    When he and his girlfriend broke up in 2011, his already cracked foundation became a crater. He stopped sleeping. Sometimes when he left the house, he could swear he was being followed. PTSD's classic symptoms -- hypervigilance, paranoia, inability to sleep -- gripped him.
    To Morris it was almost insulting, the thought of having PTSD, a simplistic string of letters inadequate to the complexity of his experiences in Iraq. So, he thought, forget that.
    But he couldn't ignore the symptoms anymore. He went to a VA hospital for help.
    There, he was paired with an inexperienced counselor who told him they were going to "clean" out his mental wounds. Morris started prolonged exposure treatment, which the VA has been using for nearly a decade and considers a first-line treatment because it helps most patients.
    Prolonged exposure asks that a person retell their traumatic experience hundreds of times -- even thousands. With each telling, so the theory goes, the memories will lose their painful charge.
    "The Evil Hours" takes a closer look at other treatments -- some controversial, some natural, such as yoga.
    Virtual reality is used to recreate a traumatic event, with the patient watching it. There's research that suggests that injecting morphine right after a battlefield injury can offset the chances of developing PTSD. Eye-movement desensitization and reprocessing, or EMDR, involves stimulating both sides of the brain while activating traumatic memories -- a treatment that can involve flashing lights and noises.
    Though Morris had a half-dozen close calls in Iraq, he chose for his prolonged exposure subject the time he was nearly killed in the roadside bomb explosion. After weeks of constantly recounting what happened, he stopped being able to sleep. He couldn't concentrate to read or write. He had, he writes, "body nausea."
    Then one day when his cell phone wouldn't dial out, he grabbed a knife and stabbed it until the blade bent 90 degrees.

    A more effective treatment

    Morris interviewed other researchers examining prolonged exposure and found that in some cases it exacerbates PTSD symptoms. But he also notes that prolonged exposure is one of the most researched treatments for PTSD and has helped many. It just didn't work for him.
    Morris made progress with cognitive processing therapy, which allows a patient to talk about feelings they have about an experience without having to recount the actual incident.
    That kind of therapy allows, for example, a woman who feels like she caused her own rape to ask aloud if that is really true. It blasts the "just-world" fallacy -- "Good things happen to good people, and a bad thing happened to me, therefore I must be bad."
    It worked as a kind of first aid, Morris said. It helped him confront pain without re-experiencing it too vividly.
    In "The Evil Hours," Morris writes that his mind can imagine just about any scenario. He can rewind events in his life, in history. He can imagine the Iraq war never happening, wars before Iraq never taking place, he and his girlfriend never splitting.
    But he can't imagine never being in that exploding Humvee in Iraq.
    He doesn't really want to.
    It's not just something that happened, or an event he lives with. Like hundreds of thousands of others who have PTSD, it's made him who he is.