David J. Morris' The Evil Hours: A Biography of Post-Traumatic Stress Disorder, is excellently written and a must read for anyone interested in understanding what many have referred to as the 'signature wound' of my generation of Iraq and Afghanistan veterans. Miller creates a plot line around PTSD, almost as the main character in an adventure novel. He moves with PTSD through history while also weaving in a fantastic amount of research covering combat and non-combat trauma, his own experience with trauma from time as a war correspondent, and his experience in the VA (he was a Marine officer) and with other therapies trying to heal.
Morris is very balanced in his writing, giving time, and explaining, why there are those who believe PTSD is mostly more of a cultural phenomenon than an actual psychological condition. The long course of human history shows that it was poetry, families, and clergy, not psychology where we have turned, "for solace post horror."
The author also works hard to ensure the focus of PTSD, its causes and its after effects are not only pointed towards combat and military service but also includes conversations of PTSD associated with rape, mountaineering accidents, other violent crimes, and natural disaster. Even for those who have experienced trauma that does not turn into diagnosable PTS, he claims "Virtually every survivor of trauma...returns to the regular world and quickly recognizes that things are not as they were." How one is able to manage this new viewpoint, and it isn't actually a question of having the strength or ability to manage it well or not, may be the ultimate determinant for why some get PTSD and others do not.
Miller catalogs a number of the various PTSD treatments along with their historical roots. He presents that there are no known pharmacological treatments for PTSD, only various therapies. This is different for other mental health issues like depression which has a host of pharmacological treatment options. While pharmaceutical companies may not see a profit motive in researching treatments for PTSD, there is, as is pointed out in the book, a huge amount of funding going to various different research projects for therapy creating a special interest group around PTSD research. Only three protocols are presented--prolonged exposure therapy (PET) , cognitive behavior therapy (CBT), and eye movement desensitization and reprocessing therapy (EMDR)--that have reached the threshold of evidence based research to be used by the VA to treat PTSD. They are not, however, used uniformly throughout the VA system and all have their detractors.
He categorizes a host of other alternative and folk therapies that are outside of the formal health care system that have been brought forward to deal with PTSD -- which, mostly lacking evidence based research are "more philosophy than science," and perhaps most tellingly are not easily placed on power point slides to be briefed.
Near the end of the book he embarks on a discussion of post-traumatic growth. This idea -- held since ancient times and still by many shamanic cultures -- is that trauma can in fact be positive, leads to emotional growth and leads to increased wisdom. Paradoxically, the limited research available indicates the longer, more enduring the trauma, the greater the 'growth'.
He presents one researcher, Dr. Richard Tedeschi, who believes post-traumatic growth is more prevalent than post-traumatic stress. Miller notes, however, that post-traumatic growth and post-traumatic stress are not opposite ends of the same spectrum. In doing so he references a study done of former Israeli prisoners of war (POW), 23% of whom decades after release, still had PTSD but also displayed other measures characterized as post-traumatic growth. The two are not mutually exclusive.
Read The Evil Hours. If you don't read it though, remember if nothing else, this passage:
No other people in history is as disconnected from the brutality of war as the United States today. Were the truth of war to become apparent to Americans, we wouldn't continue to train, equip, and deploy warriors the way we do. Nor would we ask them when they came home if they killed anyone.