For Soldiers With PTSD, nd Daily Struggle : NPR...never truly be able to be that person once again because of the things I saw and the things I did. I don't think it's possible for

2/27/13 For Soldiers With PTSD, A Profound Daily Struggle : NPR

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan, broadcasting todayfrom the studios of Texas Public Radio in San Antonio.

Shellshock, soldiers' heart, combat fatigue, combat neurosis -names used since the Civil War to describe the varied miseries thattoo many veterans bring home from war.

Today we use a more clinical term: post-traumatic stress disorder,PTSD for short. We know symptoms include sleeplessness, angerand anxiety, and those can lead to depression and even suicide;that the systems we've set up to treat both active and retired militaryare overwhelmed; and that stigma still prevents many from seekinghelp.

We're in San Antonio today, home to two Air Force bases, Fort SamHouston, the San Antonio Military Medical Center, and one of thelargest populations of veterans in the nation.

Mental health providers here are working to find ways to treat andeven prevent PTSD. If you have experience with PTSD as a patient,a family member, a caregiver, give us a call, 800-989-8255. Emailus, [email protected]. You can also join the conversation on our website.Go to npr.org. Click on TALK OF THE NATION.

Later in the program, the ethics of medical research on our closestrelatives, chimpanzees. But first, PTSD. Dexter Pitts was 19 yearsold when he deployed to Iraq in 2004 with the U.S. Army. Less than



a year later, he was seriously injured by a bomb while driving aHumvee in Baghdad. He was later diagnosed with PTSD.

Dexter Pitts is now a police officer with the Louisville MetropolitanPolice Department, and he joins from member station WFPL inLouisville, Kentucky, and thanks very much for being with us today.

Mr. DEXTER PITTS (Police Officer): Thank you for having me, sir.

CONAN: And I know you suffered some serious physical injuries inthat blast as well. How are you doing now?

Mr. PITTS: Well, I'm doing - actually, I'm doing rather well. It's been along, long journey, but you know, I've been coming along, and I'mvery, very happy with where I'm at now.

CONAN: I know you spent six months at Walter Reed recoveringfrom an injury that almost cost you your arm. But when did yourealize you needed help with something other than physicalinjuries?

Mr. PITTS: I believe it was soon after I got back. I remember I waslaying in my room, my mom had adopted my little cousin, I believehe was nine at the time. He kept coming to my room, and he keptbothering me, and I was like, Zach, leave me alone. Just leave mealone.

And he wouldn't leave me alone. I yelled him. The next thing youknow, he got mad at me, came in the room, and he hit my injuredarm. And at that point I just lost it. I blacked out. I chased him downthe hallway, grabbed him by his shirt, picked him up and punchedhim in his chest as hard as I could.

And my mom was like: What are you doing? And I just had thisblank stare on my face. And that's when my mother was like: Baby,you need some help. And at that point, that's when I realized that,you know what, maybe I really do need some help.

CONAN: And once you realized you needed help, did yourecognize some other symptoms?

Mr. PITTS: I had already recognized symptoms, you know, but it's -



nobody really wants to admit to it, especially being in the militaryand being in the infantry, all units.

I knew the symptoms - when I was in Walter Reed, they were kind ofgetting us, taking us through the PTSD courses and such, but Ireally avoided it. I didn't really want to accept it, that there wasnothing wrong with me, that nothing had changed.

CONAN: Nothing wrong with you that needed to change, yeah,especially when you're a strong young man.

Mr. PITTS: Oh, very much. That's what they - you know, the militaryboot camp and infantry, that's what they build you up to be, this biglarger-than-life - almost like a superhero. You feel like you'reSuperman.

You know, you walk around, you carry a gun, you give commands,and if you're anything other than that, you're weak-minded, andnobody wants to be looked as weak-minded.

CONAN: You're Superman, but all of a sudden you realize you'reafraid to drive.

Mr. PITTS: Yeah, afraid to drive, afraid to just go out and talk topeople, afraid to talk to people you've known your whole lifebecause you don't want people to look at you like: Hey, you'redifferent, and you've changed. You don't want to hear that becausein your mind you're still thinking, I'm still the same person, but you'rereally not.

When you go overseas and you get hurt, or just going overseas andeven surviving the tour, you leave a piece of yourself over there. Youdon't come back the same person. It's just not possible.

CONAN: And do you ever get that piece back?

Mr. PITTS: You know, I think a piece of me will always be gone, butit's - I feel like I've pieced myself together slowly, slowly, you know,slowly, month by month, day by day and just by the years. It's beensome years since I've been back.

And I feel I'm closer to being who I once was, although I feel like I'll



never truly be able to be that person once again because of thethings I saw and the things I did. I don't think it's possible for me totruly be that person again.

CONAN: What about the men you served with, your mates in the10th Mountain?

Mr. PITTS: I haven't - thanks to things like Facebook and Twitter,you know, I still talk to many of them, a lot of them. Some of them Ilost contact with. One of my good friends, my roommate, my battlebuddy, Joshua Cox(ph), if he's out there listening, I haven't talked tohim in forever. Last I heard, he was not doing well. He was suicidal,and he lives in Texas.

And I have not heard from him in forever. I have been trying to get incontact with him, check on him, see how he's doing. And I heard hewasn't doing well at all.

Other than that, most of the guys I served with, they're actually stillin. Some of them, they're on their fourth or fifth combat tours.

CONAN: Some people might wonder about your choice of career.Police officer might be a little challenging for somebody who's gotPTSD.

(Soundbite of laughter)

Mr. PITTS: Yeah, that was a big thing for me. When I was goingthrough the process, the selection process, I kept thinking when I gotto the psychological part of the police department for the hiringprocess -there's no way they're going to hire me. I have PTSD.There's just no way I'm going to get this job.

And I told them everything I went through. I went to counseling andtook medications, and they actually took me. And my family, when Itold them I was going to be a police officer, they looked at me like:What is wrong with you, Dexter? You barely made it out of Iraq, andnow you want to go be a police officer and work the late shift in theworst part of town.




CONAN: And how's it going?

Mr. PITTS: I love my job. I love the department I work for. I love the

people I serve. And I love this city. There's - I have 24 years to retire,

and I'm not counting. I love what I do. I was born to serve.

CONAN: I understand you improve with PTSD. I don't think you

ever, from what I've read, I don't think you ever completely get over

it. Do you worry sometimes that that same anger that caused you to

hit your little cousin is going to strike you when you're on the job?

Mr. PITTS: No, actually, no, I don't, because I've gotten to the point

where I've dealt with it so much and I know myself, you know, and I

know when I'm getting to that point to where, hey: You know what,

Dexter? You need to walk away, and you need to calm down.

I've been in therapy - I have two therapists now, actually. I go to the

VA, and I actually have a professional civilian doctor I see here. So

I'm actually pretty good with keeping myself under control because I

know that it's not just me.

My actions will represent my police department, and I don't want to

disrespect or degrade my police department's name at all. So I think

about my actions before I do anything.

And plus, I know the last thing - a lot of police officers worry about

getting killed. A lot of people - me, that's not - I'm not worried about

that. I worry more so about my name and my reputation.

And my reputation is - when I'm done with the police department

here, I want to be known as one of the most friendliest cops

anybody's ever met.

CONAN: Dexter Pitts, please pull me over.


CONAN: Thank you very much for your time today, and continued

good luck to you.

Mr. PITTS: Thank you very much for having me, I appreciate it.



CONAN: Dexter Pitts, a former U.S. Army private, now a policeofficer with the Louisville Metropolitan Police Department inLouisville, Kentucky, joined us today from member station WFPLthere in Louisville, Kentucky.

And it's a great story. Dexter Pitts' story, though, mirrors theexperience of many other combat vets. Medical anthropologist ErinFinley interviewed more than 60 for her book "Fields of Combat:Understanding PTSD Among Veterans of Iraq and Afghanistan."She's now a health research scientist with the South TexasVeterans Health Care System, and she's with us here at TexasPublic Radio. And nice to have you on TALK OF THE NATIONtoday.

And as you listen to Dexter's story, there was a lot that you werenodding your head at, and at one point when he said, you know, Ilove my job, you gave a cheer.

CONAN: Oh, I'm sorry, we're having a little difficulty with yourmicrophone. So we'll get you on in just a moment. Yeah, it's not you,it's a small technical problem. We'll get it worked out in just amoment.

We're talking with Erin Finley, who's a medical anthropologist, and,well, she's talking about the general problem of PTSD and talkingabout PTSD as, well, not - as a problem of growth and seeing it assomething that can be improved. And we're just talking to someengineers and maybe see if we can move her over to anothermicrophone here and see if we can get her on mic.

Bear with us. We're at a studio here, and they're of course doingvery well there, but let's see if we can hear from Erin Finley. Erin,can you say something?

Ms. ERIN FINLEY (South Texas Veterans Health Care System):How's this?

CONAN: How's that? No? Well, we're still having technicaldifficulties. Okay. Erin, why don't you come over here, and you sit inmy chair. Live radio, folks. So as - just getting back to the question,we wanted to find out more about Dexter and what it was you were



cheering about when you were hearing Dexter Pitts talk.

Ms. FINLEY: One of the things that has so struck me in working withthe veterans that I have worked with has been how many of the folkswho are really most successful in reintegrating and going on to livea really wonderful, satisfying life, is that they have been focused onserving others, whether that's serving their community as a policeofficer or serving their family by having a career and taking care ofthem.

And that's such a common theme among the veterans that I haveworked with. It's just a delight to hear from Mr. Pitts that he has madethis his calling and is doing what sounds like such a wonderful jobwith is.

CONAN: Serving others in the same way sort of reinforces the ethosthat they grew up with in the military culture, where you work soclosely with every - with your buddies.

Ms. FINLEY: Absolutely, and I think that can be a real strength,particularly when it comes to identifying a problem such as PTSDand seeking out care.

Many of the veterans I know who ended up in care and had a verypositive experience with treatment were those who sought carebecause they saw the impact PTSD was having on others aroundthem, for example like Mr. Pitts and his nephew. And it reallybecame a catalyst for very positive change in their own lives.

CONAN: Obviously Dexter Pitts got the help he needed and is doingwell. That is not always the case, however. Recently the NinthCircuit Court of Appeals issued a scathing ruling against theDepartment of Veterans Affairs for how it has handled mental healthcare for veterans.

The ruling cited what it called unchecked incompetence,unchallengeable and interminable delays. And when we come backafter a short break, we're going to be talking about how we turn thataround and get the new system up and running and working forpeople in addition to people like Dexter Pitts. So stay with us. I'mNeal Conan. You're listening to TALK OF THE NATION from Texas



Public Radio, from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conanbroadcasting today from the studios of Texas Public Radio in SanAntonio.

About a 20-minute drive from here, you'll find Fort Sam Houston andthe Brooke Army Medical Center. One of the things researchers anddoctors there continue to work on is PTSD, its treatment diagnosisand prevention.

The U.S. military has been criticized over the years for notrecognizing and treating the disorder. Military medicine has madeprogress in recent years as more veterans return from the tours inIraq and Afghanistan with tell-tale signs of post-traumatic stress. It'sbeen described as an epidemic.

If you have experience with PTSD as a patient, a family member orcaregiver, give us a call, 800-989-8255. Email us, [email protected]. Youcan also join the conversation on our website. Go to npr.org. Clickon TALK OF THE NATION.

Our guest is Erin Finley. He works as a health research scientistwith the South Texas Veterans Health Care System and wrote abook on the subject, "Fields of Combat: Understanding PTSDAmong Veterans of Iraq and Afghanistan."

And Erin, we hope your mic is working now.

Ms. FINLEY: How are we doing?

CONAN: I think we're doing a little bit better. And I wanted to askyou about those scathing words from the Ninth Circuit Court ofAppeals. How are we going to turn this around? Is this simply afactor of the system being overwhelmed?

Ms. FINLEY: You know, I think we're really at a point - what Iunderstand from the Ninth Circuit Court of Appeals Ruling was thatwas really focused on disability claims related to PTSD, rather thanproviding treatment itself.



Now obviously, making sure that every veteran has the resourcesthat he or she needs to get through life in terms of whether thosemight be disability payments, et cetera, are very important.

However, my work has really been much more on the treatment sideof things, and there we're really seeing a very exciting revolution inPTSD care.

And the VA is really, at this point, making some great strides in whatis available and what we can offer in terms of effective treatments forveterans.

CONAN: One of the things the Ninth Circuit Court of Appealsdecision did talk about was unconscionable delays in gettingtreatment, that it is only 40 to 50 percent of the time that somebodywill be seen on the same day as entering a complaint, seen by atherapist, and that an appointment can take weeks. And we've heardthese conversations from our callers.

Ms. FINLEY: You know, that's certainly a concern always, and thereis great variability around the country. Some VAs are very goodabout getting folks in quickly. Other VAs have struggled with this.But it has been something that leadership has paid a lot of attentionto, and certainly we have made enormous gains over the last fewyears.

Nonetheless, it is always important to continually push to get itbetter.

CONAN: One part of the solution may be to prevent PTSD in the firstplace and find ways to better integrate the clinical world of mentalhealth with the warrior culture of the patients.

Clinical psychologist Craig Bryan served as director of theTraumatic Brain Injury Clinic at the Air Force Theater Hospital inIraq. He now researches suicide prevention and psychologicalresiliency, and he's also with us here at the studios at Texas PublicRadio. Nice to have you with us today.

Dr. CRAIG BRYAN (Clinical Psychologist): Thank you for havingme.



CONAN: And is it really possible to prevent PTSD?

Dr. BRYAN: We certainly think so. And there is some good

evidence, particularly when you look at the research on one

particular type of preventive approach, which is called stress

inoculation training.

And what stress inoculation training is, if you kind of think of the

notion of inoculation against illness or disease in general, it's sort of

the theory that underlies vaccination, as well. Is - you introduce the

service member to increasingly stressful situations that mirror the

traumatic event as much as possible, and over time, they learn to

habituate, and they become more immune to the effects of the

stressful situation.

CONAN: More immune to the effects. You can't eliminate it

completely, I assume.

Dr. BRYAN: I don't think we'll ever get to the point where we will be

able to completely eliminate traumatic responses. There's too much

individual variability amongst, you know, unique service members.

CONAN: Well, let's see if we can get a caller in on the conversation.

Again, our number is 800-989-8255. Email [email protected]. And

Mark(ph) is on the line, Mark with us from Boynton Beach in Florida.

You're on the air. Go ahead, please.

MARK (Caller): Yeah, I recently spoke to a friend of mine that has

served a couple of tours in Iraq, and he's actually now in Africa. And

we were talking, and he was telling me how hard it is for him to - and

his buddies - when they come over to the actual civilian world, to

adjust, and then take everything as natural as we see it every day.

Obviously, because of the environment where they've been for the

last years, it's very hard for them to relate and take a normal...

One thing that I've seen, and everyone should take an hour and take

a look at it, is a documentary called "Beyond Treason." And you

look at that, and the reason why I'm telling you, because before we

totally send people to war, we should take it to the last possible

option before we go into war.



These people that experience these traumatic things, it's very hard

to ask them to erase these experiences or take medications to erase

the experiences. You know, it's not that easy. So...

CONAN: Erin Finley, it's not really a question of asking them to

erase it. It's a question of teaching them how to cope with it.

Dr. FINLEY: I think that's exactly--

MARK: Yeah, it's just that the things that you see and experience

are things that are out of the ordinary. I don't think a human being

can prepare... and I don't think any type of medication can help,

really. It may help you to get over it, momentarily, but I think - I mean,

people that went to Vietnam are still having nightmares after 30

years of...

CONAN: No, I think World War II, people are still having nightmares,

so...

MARK: Oh, yeah, that's why before we go to war, you know, we

should really - I don't think it's ever an option. It's that simple. It's like

asking what's the solution to the problems that we're having in the

Gulf with drilling. Well, don't look for the solution after you've done

the drilling. You look for the solution of not drilling. You don't drill,

and then you don't have those problems. It's kind of like that.

CONAN: Thanks very much for the call, we appreciate that. And that

goes, Craig Bryan, a little bit more to your work and interestingly that

Erin Finley was talking about looking at an opportunity to grow with

this disorder, understanding you've got it, understanding its effects.

It was interesting, you were involved in a project called the

Defender's Edge Program, and I found that really interesting to read

about, in part because you accepted: Yes, combat can lead to PTSD

and a lot of debilitating things, but part of the problem for a mental

health provider is to understand it can lead to some positive things,

too.

Dr. BRYAN: Right, yeah. It's - you know, one of the most interesting

things about working with service members is that, you know,

situations like combat, a lot of us have started to look at them more



as akin to athletic events.

And when you think about what service members do when they

deploy, you know, these men and women, they're the best of the

best. They're very elite. They're in shape. They have very high

physical conditioning and mental conditioning.

They're asked to carry over 100 pounds of gear every single day in

100-plus-degree weather while they're dehydrated and sleep-

deprived and to continue to do those for months on end. They are

athletes.

And so what we've started to do with these service members is get

them to start looking at these experiences not as necessarily

something that's going to bring them down and cause problems in

life but how to look at it as a way to grow and to become a better

person.

And the reality is that all of us become better people through

hardship and through adversity and through rising up and

overcoming. And without hardship and challenge, we never learn

anything in life.

CONAN: We never learn anything. Interesting, too, that the

Defender's Edge Program involved putting mental health experts in

the field with the troops and then trying to use their terminology - the

soldiers' terminology - and not the clinicians' terminology.

Dr. BRYAN: Right, yeah. So, you know, we all talk extensively

about, you know, mental health stigma and how service members

aren't going to come into mental health because they're afraid of

coming in and talking to doctors.

And what we did within this program is we say: Well, instead of

trying to convince the warrior to change their mind about who they

are and to violate their rules about talking to a mental health

provider, what if we change the mental health provider, and we alter

the way that they provide services.

And instead of talking like doctors, why don't we talk like warriors

and get us to help them to understand basic psychological



principles as job skills and as occupational performanceenhancement.

CONAN: So this is a way to do your job better, as opposed to a wayto be forced to leave your unit in the field to go make an appointmentat the base, and everybody knows what you're doing.

Dr. BRYAN: Yeah, exactly. And, you know, most warriors, they aretrained how to manage stress. I mean, they have a stressful job, andthat's all basic training and, you know, specialty career field trainingdoes is teach them how to handle stress.

And so what we started doing was saying: Look, this is what you'velearned in your work as a service member and as a warrior. Nowhere's how you can apply those same skills to help improve yoursleep, to help, you know, calm yourself down after having anargument with a spouse, to keep yourself focused and on track andrespond to stressful situations.

CONAN: Erin Finley, let me turn back to you. Then we'll get back tothe phones. And so many of the men you interviewed said it was, ina way, a lot easier to be in the field under all that stress than to comeback home. Had they - had this had this kind of help then, do youthink it might have been easier?

Dr. FINLEY: I think it may well have been easier if they had had thiskind of skills training. I think some of the work that Dr. Bryan and hiscolleagues have been doing is really tremendously exciting in termsof helping our service members make the transition home in asmoother way. But, certainly, if you live in that environment and thatis the environment that you are trained for, for a long period of time, itcan begin to feel more comfortable than what we think of as normalcivilian life after a time.

CONAN: Let's get Roy(ph) on the line. Roy with us from Wilmingtonin North Carolina.

ROY (Caller): Yes. I'm a Vietnam veteran, and I suffer from PTSD.And I agree with, well, a lot of what those folks are saying, and it'ssomething you don't talk about, but it's also something you neverforget - those experiences and those trials and tribulations that you



went through once you came back home, especially the way a lot ofus came back home to demonstrations and people yelling babykiller and slogans such as that.

And I've been into treatment with the VA for a number of years, andthe treatment and the medications don't seem to help. It's just a - it'san ongoing thing, and it's very frustrating. And you just don't knowwhat to do. So now, I'm pretty isolated. I'm in a tent off the coast ofNorth Carolina, and I don't deal with - I don't see many people at all,and it - I don't know. It's just - it's not a good life.

CONAN: I'm so sorry for your experiences, Roy. It's got to be difficultto do that. When did you come to realize that you needed to - it mightbe better for you to live by yourself in a tent?

ROY: Well, I've been doing it on and off for a period of time, probably1987, '88, somewhere in there, and, you know, on and off. I might gobe as a roommate and get tired of that, mainly because of all thedrama that goes along with that with a lot of people. And it'ssomething I can't handle, and I can't handle large crowds.

I have an inability to look at people in authority and see how thingscan be done so much easier, and they don't want to listen to you orthey don't want to maybe change some of the processes they gothrough to do what they do. And it becomes - it comes to a pointwhere you just say: Forget it. I'm just not going to deal with any of itanymore and...

CONAN: Roy, we wish you the best of luck. Thank you very muchfor sharing your story.

ROY: You're welcome. Thank you. Bye now.

CONAN: We're talking about PTSD with Erin Finley and with CraigBryan. You're listening to TALK OF THE NATION from NPR News.

And, Erin Finley, I know you wanted to respond to what Roy wasjust telling us.

Dr. FINLEY: Well, I wanted to thank Roy for calling in. Sir, you'vedone something very wonderful by reminding us of just how high the



stakes are in terms of getting treatment out to folks.

One thing that has been very exciting in the last few years is that theVA has been able to make what we call evidence-based treatmentsavailable to our veterans, and not just to our veterans of Iraq andAfghanistan. We are seeing veterans - Vietnam veterans nowcoming in.

And within a period of months, maybe they have been in treatmentfor decades without much success, but now, with the new treatment,within a period of months, they can see their whole lives absolutelyturned around.

I heard a story from a clinician recently who had a Vietnam veteranpatient who had not really been able to have a relationship with hischildren when they were young because his need for isolation wasso great. At the close of treatment, which was very successful forhim, he brought a picture of himself with his grandson in to theclinician and said I can have a relationship now with mygrandchildren that I couldn't have with my children and thank you forthat.

So I would really encourage you to go back and try again, if at allpossible, because we have so much more to offer now.

CONAN: Craig Bryan?

Dr. BRYAN: I agree with that a hundred percent. I think one of themost important advances within the mental health field over the pastseveral decades, since the time of Vietnam, is in our treatment ofPTSD. And now, we have treatments, you know, in particularprolonged exposure and cognitive processing therapy. These arethe gold standards, and I don't think these were really available, youknow, 30, 40 years ago. And they absolutely work.

I've used the treatments myself with service members. Interestinglyenough, I actually treated a Vietnam vet while I was deployed inIraq. He was there as a civilian contractor and had been living withPTSD very similar to Roy for many, many years and underwentcognitive processing therapy with me in a combat zone in Iraq. Andwe saw some very significant gains after, you know, decades of



living this way.

CONAN: I wanted to ask you - the Defender's Edge programrequires change, yeah, from the troops but also primarily frommental health providers to change their culture to adapt to thepeople they're going to serve. Are you going to get many cliniciansto sign up for the Special Forces, do you think?


Dr. BRYAN: No, I don't anticipate there to be a significant increasein recruitment for military psychologist or psychiatrist positions. So,and interestingly enough, that's been my experience. You know,there's a core of us who've been kind of doing this type of work andprogramming, and we've found that one of the biggest challenges istrying to convince the mental health system itself to take this newapproach.

And really, it's just a cultural competency approach, and all of ushave, you know, ethical mandates to appreciate and understand thecultural background of the patients that we work with. And we reallyneed to recognize the military as a distinct subculture within theUnited States.

CONAN: And, Erin Finley, you obviously work with people here inSan Antonio. It's a different environment. But adapting to theirculture, this is something we all need to learn from, isn't it?

Dr. FINLEY: I think absolutely so, and I think clinicians will do whatthey see working. So that's something that will take us a long way.

CONAN: We're going to talk more with Erin Finley and Craig Bryanin a moment. If you have experience with PTSD as a patient, afamily member or caregiver, give us a call. 800-989-8255. Email,[email protected]. Stay with us. I'm Neal Conan. It's the TALK OF THENATION from NPR News.

(Soundbite of music)

CONAN: Right now, we're talking about PTSD and what we'velearned about the experience, treatment and prevention of a



disorder that the military says affects some 10 to 18 percent ofveterans returning from Iraq and Afghanistan.

Our guests here in the studios at Texas Public Radio in SanAntonio, Erin Finley, a medical anthropologist and a health researchscientist with the South Texas Veterans Health Care System in SanAntonio, and Craig Bryan, clinical psychologist who directed thetraumatic brain injury clinic at the Air Force theater hospital in Iraq in2009, now consults with the Air Force and Marine Corps on issuesrelated to psychological health and suicide prevention in themilitary.

Let's see if we can get another caller on the line. And let's go toJack(ph), and Jack is with us from Bellevue.

JACK (Caller): Yeah. I should mention I'm a veteran, and my fatherwas a World War II combat veteran with PTSD, which is how Ibecame interested in this subject. And the Veterans Administrationactually invented a treatment in the late '80s, early '90s based onbrainwave biofeedback. It's called the Peniston Protocol. And afriend of mine who runs a Wounded Warrior clinic at Fort Hood isone of only two locations, to the best of my knowledge, in the U.S.currently using this protocol. When it was...

CONAN: And...

JACK: ...published, it showed an 85 percent success rate withcuring PTSD, and I use the word curing specifically because thesoldiers and sailors that went through this treatment essentially wereable to return to a normal life after this treatment. So I would just liketo commend to your other participants that they might want to lookinto this particular treatment because it's been largely ignored in thecurrent VA.

CONAN: Craig Bryan, are you familiar with this?

Dr. BRYAN: I've not heard of that treatment specifically, but I'vecertainly heard of many different proposed treatments for PTSD.This particular treatment certainly is not vetted and well-knownwithin the scientific community, so it's hard to say that it's effective. Imean, sometimes, you get a lot of promising results from early, you



know, pilot trials, but until we do more rigorous evaluations, it's notreally safe to say that a treatment is fully effective.

CONAN: So it's - Erin, I wonder - I don't mean to - I know nothingabout this particular procedure, and it may work. But panaceatreatments that seem to be - promise great cures - maybe thereporter in me, I'm just skeptical.

Dr. FINLEY: You know, I think one of the things that's really excitingabout what our caller said was we really can talk about curing PTSDnow in a way we certainly never have been able to do so before.

One of the other things, though, is the treatments that we have been-that both DOD and VA have been recommending are treatmentsthat we have decades of multiple studies conducted with thousandsof individuals to show that they work. So I expect we will see agrowing number of treatments that serve maybe differentsubpopulations of our veterans and service members better thanothers, but we must take the time to accumulate the evidence tomake sure that they work.

CONAN: And as you look towards the future, I know you're seeing alot of promise in the treatments that are being offered now and evensystems that are overwhelmed as these systems are, have been bythe sheer volume of people who need the help. Do you look forwardto - with optimism to the - we're seeing, you know, so many peoplesuffering from this, 18 percent, as much as that, so many suicides. Itseems that we're just struggling to begin to catch up.

Dr. FINLEY: I think the difference is really being able to say for thefirst time we have so much to offer in a way that we simply haven'thad as much to offer in the past. So does that mean the work isdone? No. This means the work starts now. We have to make surethat every individual service member and veteran is getting his orher needs met. However, now we can say we have a solid grasp ofthe knowledge we need to make that possible.

CONAN: Let's get another caller on the line. And I'm sorry. This isline two. We're having a little difficulty with our phoner system, too. Iapologize for that. Hi, you're on the air. Can you tell us who you are,please?



JOHN (Caller): Hello?

CONAN: Hi, you're on the air. Can you tell us who you are, please?

JOHN: My name is John. Can you hear me?

CONAN: Yes. You're on the air. Go ahead, please.

JOHN: Yes. About 11 days ago - well, exactly 11 days ago, mynephew who was diagnosed with PTSD took his life. One of manyreactions that I had was that he seemed so high-functioning. He hadgotten out of the service and finished his college degree and took ona very challenging job and seemed to - where some people seemedto have a difficult time, perhaps, getting up off the sofa. I mean, Idon't mean that to judge them, but it's - he seemed to be in someways very driven to and looking forward to life.

CONAN: And what job was he doing?

JOHN: Well, he went on to train Green Berets as a civilian, and sohe would take these guys out to the field for two or three weeks at atime. And we think that maybe that, perhaps, gave it a great deal ofstress to his life and that, you know, they do survival training andsort of things like this. And coming back, he'd have these longperiods of inactivity because they're not out in the field all the time.And so could that have contributed to his, you know, maybe lack ofsleep or poor diet or what-have-you that can add layers to stress toyour lives? But...

CONAN: Did he leave a note?

JOHN: No, he did not. No.

CONAN: I'm so sorry for your loss.

JOHN: Yes.

CONAN: I know it's going to be difficult to deal with and it's not goingto get easier, I don't think.

JOHN: Yes. It's - well, thank you very much. Like I said, that somepeople seemed to be sort of moving forward better than others and



yet, this happened to him. And like I said, that's one of my - one ofmany reactions to the...

CONAN: Yeah. Thank you very much for the call and for sharingyour story.

JOHN: Yes. Thank you. Bye-bye.

CONAN: Craig Bryan?

Dr. BRYAN: Yeah. I think this is, this is the tragedy of psychiatricillness in general. And I think what most people in our society don'treally understand is that suicide is a fatal outcome of psychiatricillness. And, unfortunately, when it comes to something like suicide,you know, sometimes we don't necessarily see it coming inadvance, even though there are plenty of warning signs and riskfactors.

And usually, it's after the fact that we kind of Monday morningquarterback and say, oh, now, I can see the indicators and it's just atragedy. And this is something that we're working on. We're actively-we have several research studies under way right now trying toidentify, how do you know when someone is at increased risk forsuicide in the short term, and how do you prevent that fromhappening?

CONAN: Yet, the number of suicides we're seeing every day; this isa terrible, terrible problem. This is an epidemic.

Dr. BRYAN: Yeah. The suicide rates have definitely increasedsteadily since about 2004, 2005. And we've been very aggressive intrying to address the problem. Interestingly enough, I think, youknow, the Department of Defense and the VA have spent moremoney researching and preventing suicide in the past several yearsthan probably the entire world, has spent up, you know, in history,up until this point. And unfortunately, as fast as many of us areworking, we can never get the answers fast enough to, you know,save as many lives as we would like to. But we're doing everythingwe can to bring out this knowledge as quickly as possible.

CONAN: Craig Bryan, thank you very much for your time today.



©2013 NPR

Craig Bryan is a clinical psychologist and assistant professor at theDepartment of Psychiatry at the University of Texas Health ScienceCenter and served as director of the Traumatic Brain Injury Clinic atthe Air Force Theater Hospital in Iraq back in 2009. He joined ushere at the studios of Texas Public Radio.

Our thanks as well to Erin Finley, a medical anthropologist, a healthresearch scientist with the South Texas Veterans Health CareSystem here in San Antonio, and the author of "Fields of Combat:Understanding PTSD among Veterans of Iraq and Afghanistan."

When we come back in just a few seconds, we'll be talking abouttesting on animals, indeed, testing on chimpanzees.

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