Who will get PTSD?
Paul Kix, DMN, 13 Jul 2012
Part 2 of 2
Dewleen Baker, a professor at the University of California-San Diego and psychiatrist at the VA San Diego Healthcare System, is overseeing a longitudinal study with over 2,000 Marines, studying them from prior to their deployment until well after it, and looking among other things to identify the specific kinds of experiences that might cause PTSD.
Telch, among researchers who focus on the military, has pushed furthest toward the possibility of predicting whom PTSD might strike. With Brian Baldwin’s assistance and Fort Hood’s blessing, Telch had roughly 160 soldiers submit to a battery of tests at the University of Texas before the soldiers headed to Iraq. “We made sure that … they’d never been deployed to a war zone before,” Telch says, the better to establish a baseline of experience. Once they were in country, the soldiers filled out an online log every month of the stressors they’d faced and any psychological reactions they’d had to them. Once the soldiers had returned to the States, Telch and his staff monitored them for a year.
Perhaps the biggest insight came from the eye-tracking test. Before deployment, Telch asked soldiers to look at a panel of four faces while a computer monitored the soldiers’ eye movements. In the panel the soldiers saw a happy face, a sad face, a fearful face and a neutral face. The soldiers who quickly averted their gaze from the fearful face — looked away within 100 milliseconds of seeing the photo — were far more likely to develop PTSD after deployment, the study found. These soldiers needed only half as many war-zone stressors as other soldiers to develop symptoms associated with PTSD, the study found. The research was published last year in the American Journal of Psychiatry.
In total, Telch and his colleagues have published five studies on the Fort Hood soldiers and PTSD, with a sixth forthcoming. They measured the soldiers “in all sorts of things that haven’t really been looked at in a prospective study,” he says. The researchers have looked at what happens to cortisol levels when soldiers with high testosterone feel threatened. (The levels shoot up, indicating stress.) They’ve tested soldiers’ panic response, by having them inhale oxygen laced with 35 percent carbon dioxide; those who lose their nerve appear to be more likely to develop PTSD.
Dr. Jennifer Vasterling, the chief of psychology at the VA Boston Healthcare System and a researcher at the National Center for PTSD, says Telch’s work has “a unique place” in the study of the disorder. A few researchers have conducted a handful of before-and-after studies on PTSD in the military, she says, but never one with numerous real-time readings of a soldier’s psychological state.
Telch says his preliminary results are just that. He would like to know what other physical or mental characteristics might lead to an increased risk of PTSD — as well as conduct further tests on the characteristics he’s already singled out. Predicting PTSD is a new idea, he says, and it will take time to say conclusively which soldiers under what circumstances are likely to develop the disorder. “Do our studies have any implications for prevention?” Telch asks. “Definitely.”
As many as 20 percent of Iraq and Afghanistan veterans have PTSD or will develop it, the VA estimates. So what will the military do with Telch’s studies? Officials at the Department of Defense did not return requests for comment for this story, and Fort Hood officials declined to comment. Telch says he is not trying to develop a formal screening test himself; he says that would fall to the military.
It’s already clear what issues might arise as doctors get better at predicting who is more susceptible to psychological trauma. One is simple fairness. Is it fair to keep soldiers off the front based on a test that assigns them a higher percentage chance of developing PTSD?
Gen. Barry McCaffrey is a retired four-star general and an advocate for veterans battling drug and alcohol addictions. When asked if the military should filter out soldiers likely to develop PTSD, McCaffrey says without hesitation, “I think the answer is yes.” Some of these wounds can last a lifetime — or end a life.
McCaffrey also acknowledges that the military would quickly run into practical limitations: It is a force composed of volunteers, and the military has had to lower its recruiting standards simply to find enough men and women to fight in Iraq and Afghanistan. Many soldiers have endured multiple tours. Rigorous screening may not be practical; the military needs the recruits it gets.
It may also be harder to apply than it might first seem. To assume that some soldiers should go to the front while others drink tea with the locals misconstrues modern warfare, McCaffrey and other military experts say. There isn’t necessarily a front that you can keep soldiers away from: There are only urban streets, desolate villages, some familiar faces and a lot of uncertainty. The threat of a battle is everywhere and nowhere.
This underlies another problem that some experts have with screening soldiers for PTSD: the notion that traumatic events can somehow be contained. Tick worries that any successful predictive test could lull the military into seeing PTSD as a solvable problem, more like a preventable disease than an inevitable, if random, consequence of seeing combat. “That’s dangerous,” he says.
The best approach, he argues, is for the military to assume that some people will always be haunted by the experiences they endure, and that it is in fact normal for this to happen. The psychic impact of war isn’t so much a disorder, or a sign of some pre-existing weakness, as a battle injury — one that underscores the valor, and hardship, of what we ask of people when we send them to war.
“Combat hurts,” Tick says. “And it should hurt. [The military] can’t go looking for a silver bullet.”
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