As we mark Memorial Day, I am joined by David Morris, a journalist who narrowly escaped death while embedded with troops in Iraq. His 2015 book, The Evil Hours: A Biography of Post-Traumatic Stress Disorder, stands as a testament to the unseen battles waged by those touched by war, long after they’ve left the battlefield.
Morris tells of his personal journey through the aftermath of an IED explosion in Iraq, and offers an insightful exploration of post-traumatic stress disorder (PTSD). As we honor those who have made the ultimate sacrifice, we must also acknowledge the lasting psychological wounds of the survivors of war’s horrors.
Our discussion traces the evolution of PTSD, from its early recognition in the shell-shocked soldiers of World War I to its current status as a recognized psychiatric disorder. The conversation takes a philosophical turn as we explore how religion and personal worldview can shape an individual’s response to trauma, and how different perspectives and beliefs can influence resilience in the face of adversity.
Morris scrutinizes the therapeutic approaches to PTSD, including prolonged-exposure therapy and cognitive-processing therapy. These treatments, he argues, shed light on the path to healing, offering hope to those grappling with the haunting memories of traumatic events.
Finally, he talks about the unique struggles faced by war correspondents dealing with PTSD. These individuals, much like our veterans, often bear the burden of their traumatizing experiences in silence.
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Jeff Schectman: Welcome to the WhoWhatWhy podcast. I’m your host, Jeff Schechtman. Each Memorial Day, we take a moment to honor the brave men and women who have made the ultimate sacrifice in serving their country. Today on this podcast, we’re not just honoring their sacrifice on the battlefield, but delving into the battles they continue to fight long after they’ve left the war zone, the inevitable battles within their minds. Our guest today is David Morris, a journalist who has walked the path himself.
While embedded with troops in Iraq, he almost died when a Humvee he was riding in was hit by an IED. He survived, but like many, he returned home with wounds that weren’t visible to the naked eye. His experience led him to his 2015 memoir, The Evil Hours: A Biography of Post-Traumatic Stress Disorder, a deep dive into the labyrinth of PTSD. We’re going to talk about that today with David Morris. He’s a former Marine Infantry officer, a journalist who has written for Slate, Salon, the Los Angeles Times, and The Nation.
And it is my pleasure to welcome David Morris here to the WhoWhatWhy podcast. David, thanks so much for joining us.
David Morris: Hi. Thanks for having me.
Jeff: It’s great to have you here. PTSD, as something that is defined in DMS and something that psychologists and psychiatrists have talked about, has been around for quite a while, and yet it really is only in the past 20 years that we’ve really begun to focus on it and even to understand it. Talk a little bit about that.
David: Well, it’s important to understand that PTSD is a product, as it’s understood today, is a product of the protest movement of the 1970s. It rose up against the Vietnam War, a group of protestors and anti-war advocates from the left, a group called Vietnam Veterans Against the War, and the most famous member of which is John Kerry. And it was a group of people that were protesting the Vietnam War, but they felt that there was no meaningful distinction to be made between the politics of the war and their own psychological difficulties in returning from Vietnam.
So, they fought for and agitated for about 10 years beginning in 1970 before PTSD was officially recognized by psychiatry in 1980, when it was officially entered into the Diagnostic and Statistical Manual of Mental Disorders or the DSM, which is kind of the Bible of psychiatry. And once you get into the DSM, then medicine will officially recognize and treat, and health insurance companies will recognize and treat that disorder. But it’s important to recognize as well that PTSD, just because we recognize it in 1980 didn’t mean that it didn’t exist before.
And in fact, if you look back at even prehistoric records or what we do know about prehistoric times, PTSD is, certain aspects of it are an essential element of human beings from what we can tell. And one of the ways we know this is researchers have gone back to New Guinea and interviewed tribal warriors there from the tribes and some of the remotest parts of New Guinea. And these people, the tribes of Papua New Guinea, are thought to be some of the most well-preserved examples of what mankind was like before agriculture, before industrialization, before modern technology happened.
Interviewing these warriors, anthropologists have discovered that they report having nightmares of post-battle, [and] in particular, nightmares of being abandoned by their buddies. So there is an aspect of PTSD that is immortal. And then there are other aspects of it that have been more influenced by religious beliefs, and by culture at the time. And here’s an example. There is, if you consider the flashback, which is considered today to be one of the cardinal symptoms of PTSD.
In fact, a group of British researchers from King’s College went and examined the memoirs and accounts and records of war veterans from conflicts predating the age of cinema. And they discovered that veterans who served in the 19th century did not report flashbacks. And in fact, a flashback is a term borrowed from cinema. And for example, Civil War veterans are far more likely to report being haunted by ghost spirits and demons and the ghost of fallen comrades.
So there is a part of PTSD that is immortal and unitary and universal. And then there’s other parts of it that seem to be very influenced by culture and by how human culture has evolved over time.
Jeff: One of the interesting questions in the way PTSD evolves is the degree to which it is about something that happens to us versus something that we see, something that we witness, and the impact of that. And there does seem to be a fundamental difference between those two things.
David: Well, yes, and they both play into each other. I mean, they’re both connected. And one of the interesting things when you spend time in a war zone, is how visually stimulating and visually interesting it is. And you see dead bodies, you see wounded people, you see life pushed to its extreme edge, and for the same reason that people slow down and rubberneck on the freeway, these are the same impulses that govern our behavior in warfare. The idea of seeing really awful things is at once really fascinating and repulsive, and it’s very hard to look away.
And for some reason, you end up with a lot of soldiers and natural disaster survivors who will come back haunted by visions of things that they saw and that they looked at. And so there is this visual sense that the mind almost seems to want to curate all of these awful and repulsive themes that are on view during war and in situations like tsunamis and Hurricane Katrina, for example. But there is, as you alluded to, this visual experience and these collecting of horrific and hallucinatory images that seem to haunt in the aftermath of traumatic events.
Jeff: Is there a difference with respect to a traumatic event that is expected versus unexpected, a natural disaster or rape, for example, versus the experience of combat where in some ways you are prepared for what’s about to happen?
David: Well, yes, in fact, that’s the feeling of being overwhelmed, surprised, or helpless. Those are the most trauma-producing type situations. And for example, you do find with the Hanoi Hilton cohort, which was a group of prisoners of war held in Hanoi, the most famous of whom was John McCain. That group of prisoners of war were generally older, better educated, and had spent a significant amount of time and years of time in training as pilots and aircrew. And because they had such great preparation, and many of them in fact had been to a mock prisoner of war camp before even deploying to Vietnam.
And so they had a better frame of reference, they had a better understanding of what could happen to them. And they had some training and some resilience, resiliency to fall back on because they had spent so much time preparing and thinking and maturing into their social role as leaders and as aircrew. So there is always that element of preparation and training and being. And there are a number of factors that researchers call either protective factors or risk factors that all play into whether or not a person is going to end up with PTSD in the long term.
So a person who came from an abusive family, who struggled [or] maybe came from a poor family and is deprived and overwhelmed, and in the case of a rape survivor is raped, then that person is far more vulnerable and far more likely to develop PTSD just in and out of those risk factors. In addition to that, rape is also considered to be the most common and toxic form of trauma. So it’s important to remember that not all traumas are equal. And there is sort of a spectrum of human responses that we think.
Jeff: Do we know if there’s a genetic component at all with regard to predisposition to PTSD?
David: Yes, there is some evidence and the epigenetics behind PTSD is a new area of inquiry. And so it’s difficult to say. We don’t know a whole lot about it yet, but there does appear to be physiological changes that occur in human beings, particularly with respect to the stress hormone cortisol which is a hormone that is released in times of stress, and the way the human body secretes cortisol is communicated genetically.
Some very interesting research study was done by Rachel Yehuda here at the VA Bronx. And she discovered that the offspring of Holocaust survivors from the maternal side, so the grandmother in this case had survived the Holocaust, her offspring would have a different cortisol stress hormone response than a control subject, than another person, than the offspring of someone that had not come from a Holocaust survivor family.
So the way the human body is organized physiologically does, in fact, change after trauma. And if you think about that from just a basic evolutionary standpoint, that is an understandable and expectable outcome in the sense that an organism is going to respond to the stimuli in its environment, be they adverse stimuli or positive stimuli, and would transmit that to their offspring in order to maximize the survival and the thriving of their offspring.
So there is this genetic [factor]. And cortisol is a very important stress hormone that impacts the entire functioning of the human body. If you have too much cortisol, you tend to suffer other somatic difficulties, ulcers, and a lot of the normal somatic problems that we associate with people that have a lot of stress in their life. There are a bunch of possible genetic impacts to PTSD down the road that we are just now beginning to get a sense of.
Jeff: To what extent does philosophy, philosophical outlook, worldview, even religion play a role in how we view evil in the world, for example, and how that shapes how we respond to trauma?
David: Well, interestingly, and that’s a tricky question, but one that I’ve thought about a great deal. And one of the things that is of interest is actually when you look at who tends to develop PTSD down the line. And you find that people that have a more religious outlook, for lack of a better phrase, who have a sense of an omnipotent being who is looking out for them and for whom their destiny has been decided, and who has some sort of control over their life on Earth is less likely to develop PTSD because there is this sense of the universe is a meaningful, ordered place that is being governed by a beneficent being, by God.
And I am not able to control, it is beyond my control. And in fact, His design is being enacted in the world. And I saw this, interestingly, when I was in Iraq, [when] I was on patrol with a Marine unit and some Iraqi soldiers. And without my prompting, this Iraqi soldier told me that he didn’t worry about getting blown up or dying because he knew that Allah had already been decided and it was in His hands and that it was improper for him to consider, to worry about it himself since God had already decided what would happen.
In this sort of surprising way, and I’m not a particularly orthodox religious person, you do find that a person who takes a more existential perspective and says life is absurd, life is meaningless, life is without order, and it’s a morally chaotic situation, that sort of person is confronted with a heavier philosophical burden because it is incumbent upon them to discover their own meaning and their own order.
And after trauma, not everyone who has a particularly formally religious background is going to find trauma, be it rape or a tsunami, is not going to find that experience necessarily meaningful or under the providence of God. A lot of people, Phillip Caputo being a notable example, the author of A Rumor of War and a Vietnam veteran, he was raised Catholic, and did not find the war to be a faith-affirming experience.
So it informs a lot, as it informs every shape, every decision of a person’s life. Our feelings towards God, towards any omnipotent being plays a huge role in how trauma is interpreted and managed by a victim.
Jeff: The corollary of that, as you talk about, is this sense in PTSD of always trying to find deeper meaning in the events, particularly on the anniversary of events.
David: In the book, I dwell on this idea of apophenia which is this term that comes from psychiatry. And it is related to the idea, it’s similar to paranoia, of finding meaningful connections between unconnected events. For instance, in my book, I talk about how the day before I hit a very serious IED for my IED ambush in Baghdad, the day before someone had asked me if I had ever been in an IED ambush before, which I had not.
And everyone in the Humvee that day when I was asked that question got really upset with the soldier who asked it because that is considered to be extraordinary bad luck to ask that kind of question. And so when I was hit by an IED the next day, it was both surprising and unsurprising because it’s easy to feel as if… The behavior that governs victims, natural disaster victims, and soldiers in active war zones, and even when they come home, their behavior is very similar to a lot of the rituals and talismans that govern the behavior of gamblers.
A lot of faith is put in luck- good luck charms, good luck T-shirts, and doing things the same way because performing certain rituals will provide a person with good luck. So there is this different kind of relationship, it’s almost magical thinking that can evolve in wartime situations, and plays out in the form of elaborate superstitions. For instance, in the Marine Corps, it has long been considered bad luck to eat apricots, if you’re ever in a Humvee or an armored vehicle, to the point that the MREs, the field rations that marines and soldiers are issued, they stopped including apricots in the ration because people were convinced that if you ate apricots, you were going to have a technical malfunction either in your vehicle, in your armored personnel carrier, or in your Humvee. So those are the sorts of things.
Because war is so chaotic, so morally chaotic, confusing, and anarchic, you do find people looking for these relatively morally neutral events and items, and imbuing them with a special, sacred, magical power. And the idea of good luck charms in the form of soldiers, particular soldiers, or particular Iraqi interpreters or Afghan interpreters, is very common.
Jeff: One of the things you talked about in The Evil Hours are the treatments for PTSD, things like prolonged exposure and cognitive therapy. Talk a little bit about those. But in a broader sense, what do the treatments tell us about PTSD itself?
David: Well, [regarding] the treatments, there are a rainbow. There are a wide variety of treatments for PTSD out there. And I’ll briefly just discuss the top two or three that the VA, the US Department of Veteran Affairs, prefers. And the first one of those is prolonged exposure [which is] the number one VA individual psychotherapy that is approved for use by the VA. And prolonged exposure is generally derived from the ideas of Ivan Pavlov; the conditioning and classical learning theory.
And the thought behind prolonged exposure is that if you tell the story of your worst trauma over and over again, what they could call your index trauma, if you tell that story of it over and over again, eventually that memory will lose its heavy traumatic charge and become just like any other normal memory. So for me, I underwent prolonged exposure and so I was asked to tell the story of my IED ambush, [on] October 10, 2007, in Southern Baghdad. Prolonged exposure has a really good track record, a lot of great science behind it, and it works.
It shows improvement in 60 percent of people who undergo it. But for me, I experienced significant side effects and prolonged exposure therapy, which is the number one psychotherapy offered by the VA, it actually made my symptoms worse. It made it really hard to sleep, read, or even write. So I discontinued that therapy rather quickly. The second, VA’s number two psychotherapy, cognitive processing therapy is quite different. And in its own way, resembles more traditional psychotherapies, although it’s usually done in a group setting.
In cognitive processing therapy a survivor or veteran is asked to examine their thoughts or feelings about their war and about the events that they went through that are troubling them, and examine if their thoughts and feelings about it have led to other problems in their life. For instance, it’s very common for rape survivors to think that they in some way brought it on themselves, that they are at fault, and that either they asked to be raped in some manner, or they failed to fight off their assailant enough.
And so there’s this very pernicious, very painful and destructive process of self-blame that occurs in many, many rape victims that really just makes the damage a lot worse. And so CPT or cognitive processing therapy, one of the questions it will ask is, are those feelings of you being a bad person or being marked by a scarlet letter of a kind, of a sort, is that really a legitimate empirically supportable reality-tested thought?
Can you really say that that was something that you did not fight off your assailant enough? Is that a valid conclusion to come to, and so that if you start with those sorts of questions and examine how those thoughts end up impacting your feelings about yourself and your feelings about the world generally? And so what this says to me, look at these various different therapies that treat PTSD, and they all approach it, they all tackle a different side of it.
And there’s no one overarching therapy that everyone responds to, in the same way that there’s no one overarching miracle drug or golden bullet therapy that really cures people. So there is this problem with PTSD, because it doesn’t appear to be, as to contrast it against depression, which is far more responsive to SSRIs and other drugs like Zoloft and Prozac and what have you. There is really no one golden bullet drug for PTSD, which should point to how complex and how very individual the responses are to PTSD.
So it’s important to recognize that it is in the catalog of malady. It’s in the book of woe, the DSM. But it’s really in its own category and it’s very difficult to compare to any other mental health disorder. And it’s very difficult to treat because any number of things, millions of different kinds of events can cause PTSD. Anything, so many things that happened in war, so many things that happened in [the] streets and in crime situations. So it’s really the human response to trauma is as diverse, there are millions of responses to that in the world.
Jeff: With respect to your own personal experience, did you think about your experience differently from somebody that was engaged in combat as opposed to someone embedded and there to bear witness? Was there something in that that you thought about and that impacted you in your recovery?
David: Being a reporter in a war zone and being a soldier in a war zone is more similar than you might think. I’ve had a number of people say to me, it wasn’t the same for you which I would argue is false, because most reporters I knew that spent time in Iraq, spent most of their time outside the wire going out on patrols and actually seeing combat operations on a daily basis. It’s very clear when you work as a war reporter that the story, the real story, is really happening where the bullets are flying. So you got to get out there and see it and be a part of it.
And so there is an element of a very strong resemblance in terms of the type of trauma that a war journalist will see, be exposed to in a war. And there are two other major differences that I’ll also highlight between the soldier experience and the war correspondent experience. And that’s this: the war correspondent – typically it’s against the Geneva Convention to carry a weapon in a war zone for a journalist – so reporters are slightly more defenseless than soldiers, so they have a reduced ability to control their environment and to defend themselves in combat. A fact which we know is more likely to cause PTSD down the road.
So there is that. And the other thing that puts war correspondents at risk is the tendency to jump from hotspot to hotspot and to travel from, say, Libya or Syria on a moment’s notice to a different part of the Middle East or to return back to their news bureau, be it London, Paris, or New York or wherever their news outlet is headquartered.
And to go from the war zone alone and to return to a news environment or a corporate environment where no one has been in a war zone. There exists, for war correspondents, because of their comparative rarity, less opportunity to be understood upon returning home. No one thanks NPR war correspondents or New York Times war correspondents for their service. Even though I would argue that a reporter from a major news organization, or any new organization, is contributing to the cause of democracy, because it’s an important, although it’s not as overtly patriotic, it is an essential part of our democracy to have an informed electorate and to have a transparent and understandable and discernible military force, and reporters play a large role in that.
Jeff: It is also particularly interesting to think about the effects of PTSD on a reporter that comes back from a war zone or continues reporting after, because one of the symptoms that you talk about that is so prevalent is this failure to live fully in the present.
David: Yes. And I think that’s an issue because, and it can exacerbate things in the sense that, for instance, when I returned from Iraq, I was a writer and was publishing on it the entire time. And continuing to write and continuing to introspect and to meditate and think on my war experience, which I think have both had a mixed effect. And it had a good effect in the sense that writing about your wartime experience or your traumatic experience of any kind can help you process and locate patterns, and create your own story that makes sense of the trauma.
So it’s really good in that regard but there’s also the sense of trying to, if you spend time willingly thinking and meditating on really tragic events, it has a tendency to make you ruminate in a negative way, and that’s about the negative experiences. So you have to, as a writer and for any artist, you have to strike a balance of finding some meaning, finding some coherence in the chaos of your past, but then also exerting a certain amount of self-care, and not dwelling on it too much, and focus on things that bring you greater peace and greater insight that have nothing to do with war or crime or rape, natural disaster or what have you.
Jeff: David Morris, I thank you so much for spending time with us today here on the WhoWhatWhy podcast.
David: Thank you for having me. Good to talk to you.
Jeff: Thank you. And thank you for listening and joining us here on the WhoWhatWhy podcast. I hope you join us next week for another radio WhoWhatWhy podcast. I’m Jeff Schectman. If you like this podcast, please feel free to share and help others find it by rating and reviewing it on iTunes. You can also support this podcast and all the work we do by going to WhoWhatWhy.org/donate.