By Taylor Poor, NAMI Education Program Coordinator
Dr. Robert N. McLay’s recent book, At War with PTSD: Battling Post Traumatic Stress Disorder with Virtual Reality (Johns Hopkins University Press, 2012), offers a valuable lesson about treating people rather than diseases. After all, as the author says, “doing mental health is not just about biology.”
Posttraumatic stress disorder (PTSD) is a type of anxiety disorder associated with the direct or indirect experience of a traumatic event, and often involves memory disturbances, emotional detachment, hypervigilance (abnormally increased arousal) or insomnia. Though soldiers have endured the psychological consequences of armed combat for millennia, PTSD has gained credence only recently as a biological disease with a potentially measurable impact on the brain, a disease that can occur at any age, following any type of traumatic experience, from assault or rape to war or a natural disaster. But the increase of PTSD’s validity as a clinical diagnosis does not protect service members and veterans from the shame of the stigma they face from comrades-in-arms—and from the civilian population once they return home.
By Robert N. McLay
Dr. McLay emphasizes the importance of looking at where patients are coming from before starting treatment, whether that’s the battlefield, a prison, or a home with domestic abuse. He draws from countless individual testimonies (“psychiatric fables”) to illustrate the diversity of patients who are looking for different solutions and who require different approaches. Maybe the same basic treatment techniques will find success with both service members and non-service members experiencing PTSD, but for those service members, the idea that “somebody else gets it” is important; it’s helpful to talk to a military psychiatrist rather than a civilian doctor.
However, the distinction between combat PTSD and other types of PTSD isn’t necessarily clinical. Dr. McLay explains that combat PTSD is typically a version of “complex PTSD,” involving multiple, compounded traumatic incidents; unlike “simple PTSD,” which involves a single incident. However, the unique components of combat trauma, combined with the military atmosphere (“no problem marines can’t solve by more yelling”), demand a fine-tuned and circumspect treatment approach.
Dr. McLay always intended to join the military as a scientist, but “put it on the back burner” while at work on his B.A., M.A., Ph.D. and M.D. When the Navy offered him a job, he found the perfect arena for his psychiatric expertise: directing development programs for new technology to assist service members experiencing the stress of deployment. In 2008, he took a virtual reality machine with him on deployment to Camp Fallujah, Iraq, where he tested the effectiveness of virtual reality therapy on soldiers living with PTSD in the field. From the service members he treated, he learned about the values of confronting traumatic experiences head-on, through reconstructed combat landscapes, as well as the limitations of any form of treatment in the face of stigma and skepticism.
At the end of his book, Dr. McLay talks about the future of PTSD treatment for service members. He asks about two components of this future: reduction in stigma and scientific improvements in treatment.
Regarding stigma, the current landscape remains bleak: the world of psychiatric treatment for military veterans is a murky swamp of “perverse incentives”, Dr. McLay explained on the phone at the end of October. On the one hand, he believes initiatives to officially grant service members with PTSD eligibility for prestigious honors such as the Purple Heart (an unsuccessful political cause since World War I, and one NAMI supports) are well-intentioned efforts to reward bravery and to recognize that PTSD represents a real war wound, thereby reducing stigma.
However, Dr. McLay also believes that the difficulties of separating valid PTSD cases from “malingering”—faking illness to avoid duty—mean awarding the Purple Heart for PTSD could in fact worsen stigma as an unintended consequence. Meanwhile, service members who face discrimination when they apply for disability benefits without a visible wound are unlikely to then seek treatment, and thus possibly lose those hard-won benefits.
On the other hand, continuing advances in research and technology paint a brighter picture. Dr. McLay has cautiously gained confidence in virtual reality treatments since his return to the U.S., but is “convinced VR is not going to solve all our problems.” Other promising possibilities include: stellate ganglion block, or an anesthetic injection to a spinal nerve cluster that alleviates pain and some other PTSD symptoms; transcranial magnetic stimulation (TMS), which involves producing weak electric currents in the brain; and “third location”, or staged, decompression, where instead of being transported straight back into civilian society, service members returning from duty can spend a period of time in a non-combat zone outside of their home country. All of these techniques serve to widen the array of treatment options that can be personalized to reflect an individual patient’s hopes and priorities.
The reason Dr. McLay’s book doesn’t feel like the typical treatise on a controversial mental health diagnosis is his unassuming tone. There is no pedagogy about symptomatology or the complexities of PTSD: he seems to be simply taking the reader along for the ride as he figures out the answers—or some possible answers, at least—to the very questions he’s just asked in the text. His final message, which he reiterates on the phone, is similarly simple: the only way to reduce stigma is “to get the word out” about mental illness, and particularly PTSD. With the help of accessible, informative and compelling books like At War With PTSD, that goal seems more reachable than ever.
Copyright Date: 11/16/2012
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