PTSD: Treating Trauma .. Treating the PTSD Vet with Virtual Iraq

Promoted -- GH

During my last physical, my doctor ordered up some tests for me this week... follow ups necessitated by events occurring years ago -- an ICU stay from October through December, a stay precipitated by perintonitus and included 8 emergency surgeries, several blood transfusions and countless procedures. Since these new tests would take place in settings similar to my "ordeal," my doctor warned me to be prepared for some PTSD episodes.

As most of us know, PTSD:

...is precipitated by a terrifying event or situation—war, a car accident, rape, planes crashing into the World Trade Center—and is characterized by nightmares, flashbacks, and intrusive and uncontrollable thoughts, as well as by emotional detachment, numbness, jumpiness, anger, and avoidance.1

My doctor didn't actually need to remind me. I have had extreme flashes before. The first time I went to visit a doctor (after a ten-year moratorium) whose offices were in a hospital medical center, the staff almost wheeled me into emergency because my blood pressure reading was off the charts and I exhibited all the symptoms of a stroke or heart attack. And when I had a minor surgery, performed in a hospital, to remove a melanoma in my scalp, conducted with only local anethesia, I became hysterical as soon as the blood started dripping down my forehead.

In both instances, my emotional reactions were ridiculous. I know this to be true because everyone there told me so, including that not-so-little voice in my head that screamed: "What the heck is wrong with you!"

Admittedly, it sounds disrespectful to talk about PTSD in a civilian, especially given the horrific conditions -- coupled with Traumatic Brain Injury (TBI) that many, oh so many, far too many, of our young service members are suffering while serving in Iraq and Afghanistan at the behest of our President and our Congress.

But because of my pathetic experiences, I could sense a kernel of hope for our troops while reading Sue Halpern's Virtual Iraq in this week's The New Yorker. Her article details a fledgling program that immerses the patient into the environment where the trauma occurred. The slow and controlled immersions attempt to de-couple the deep emotional responses from what, to the non-afflicted, are neutral components of our everyday civilian environment.

Halpern describes the Virtual Iraq project, started by Albert (Skip) Rizzo in 2004 and based on a similar test program called Virtual Vietnam which had shown early promising results but were stopped as soon as the funding dried up. By fall of 2005, after Falluja but as U.S. troops were being sent to police Haditha, "the first patients were recruited to try it [Virtual Iraq] out." In the program, Halpern writes:

Prolonged-exposure therapy, which falls under the rubric of C.B.T., is at once intuitively obvious and counterintuitive: it requires the patient to revisit and retell the story of the trauma over and over again and, through a psychological process called “habituation,” rid it of its overwhelming power. The idea is to disconnect the memory from the reactions to the memory, so that although the memory of the traumatic event remains, the everyday things that can trigger fear and panic, such as trash blowing across the interstate or a car backfiring—what psychologists refer to as cues—are restored to insignificance. The trauma thus becomes a discrete event, not a constant, self-replicating, encompassing condition.

Anecdotally, I sense that these programs might work. Previously, I have overcome intense "fear of flying" by continuing to fly frequently, eventually desensitizing myself to the cues. And more recently, while undergoing my tests this week, the nurses and technicians, alerted to my state, were prepared for possible panic attacks. Although my face was wet and my hospital johnny soaked with tears, I was completely emotionally detached... and didn't even realize that I was weeping... as many of the cues are being neutralized. As Halpern reports, therapist JoAnn Difede describes the process:

“If you suddenly become afraid of the staircase because you had to walk down twenty-five flights of stairs to get out of the World Trade Center, the stairs went from being neutral to being negative,” Difede explained. “What we should be doing is extinguishing the cues associated with the stimuli..."

Beyond the obvious moral and humanitarian need to provide for our veterans, there's also an urgent societal need to neutralize the stimuli... returning veterans suffering from PTSD can harm their families, their communities and then turn the violence on themselves in order to still the voices and sensory overloads.

It's important and critical to seek and fund therapies that can help.

And then there's news that the U.S. may send another 7,000 troops into Afghanistan.

Of course, that news has hardly broken the surface in the obsessive, "Oh, shiny, new" fixation the reading public seems to have on the breathless "he said; she said" coverage of the democratic presidential candidate race.

Let's hope that a few people manage to read Halpern's article and reach out to help our vets.

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Photo source: reprint rights secured. Photo (c)2007 Bryan Myhr. American troops silhouetted at sunset at the Ur ruins in Iraq.

1. Halpern, Sue. "Virtual Iraq." The New Yorker, May 19, 2008. pp. 33 -37. For a slideshow of the Virtual Iraq program, Not a Game