Jim Hayman: As I wrote in a recent blog, one of the major characters in my last thriller, The Chill of Night, was a young woman named Abby Quinn who was suffering from schizophrenia. I don’t know whether or not I’m particularly drawn to characters with mental health issues but, as it turns out, one of the key characters in my new novel (which I recently finished writing and is now with editors) is a young former marine, a scout-sniper who served in the battles of Fallujah and Ramadi in the Iraq war. His name is Harlan Savage and he is the younger brother of my ongoing heroine and McCabe’s partner, Portland Police Detective Maggie Savage. Maggie and Harlan’s father is Washington County Sheriff John Savage.
Like many other Iraq and Afghanistan veterans, Harlan suffers from Post Traumatic Stress Disorder (PTSD). In the book, the possibility that Harlan may have been involved in the murder of his ex-girlfriend and perhaps of another young woman draws Maggie back to her childhood home in Machias to help Maine State Police detectives investigate the case.
As with Abby, many of the chapters of the new book (tentatively titled Darkness First) are written from Harlan’s Point of View. This required me do to a little basic research into PTSD and it’s effect on the minds of returning veterans. Now that I’ve finished the book some frightening new information seems to be emerging.
As Nicolas Kristof wrote in a series of recent pieces in the New York Times, American Iraq and Afghanistan veterans “kill themselves at a rate of one every 80 minutes. More than 6,500 veteran suicides are logged every year — more than the total number of soldiers killed in Afghanistan and Iraq combined since those wars began.” And it’s not just the suicide rate among returning vets that is disturbing. Large numbers of them have been involved in murders, particularly of loved ones, and other crimes. Even larger numbers have been diagnosed as clinically depressed and frequently engage in excessive drinking and other drug abuse.
In writing the book, I treated Harlan’s PTSD, as most doctors do, as largely a psychological condition, a mental illness brought on by the trauma of war and exacerbated by coming home to a country reeling from high unemployment and severe recession.
However, in a follow-up piece published by the Times last Wednesday, April 25th, Kristof suggests something even more disturbing might be afoot. He cites research conducted by a team headed by neuropathologist Dr. Bennet Omalu at the Brain Injury Research Institute in Morgantown, West Virginia. Dr. Omalu hypothesized in a paper published in 2011 that what we call PTSD, at least among combat veterans, may be caused by traumatic brain injury, a condition called chronic traumatic encephalopathy or CTE.
Kristof writes “The finding of C.T.E. may help answer a puzzle. Returning Vietnam veterans did not have sharply elevated suicide rates as Iraq and Afghan veterans do today. One obvious difference is that Afghan and Iraq veterans are much more likely to have been exposed to blasts, whose shock waves send the brain crashing into the skull.
‘Imagine a squishy, gelatinous material, surrounded by fluid, and then surrounded by a hard skull,’ explained Robert A. Stern, a C.T.E. expert at Boston University School of Medicine. ‘The brain is going to move, jiggle around inside the skull. A helmet cannot do anything about that.’ ”
Dr. Omalu was the researcher who first found signs of CTE in professional football players and other athletes who had sustained repeated concussive blows to the head. In 2011, he conducted an autopsy on a twenty-seven year old ex-marine who had committed suicide and found signs of similar brain damage.
In athletes, CTE has been shown to lead to degenerative memory loss, diminished thinking ability and in many cases to dementia. If the hypothesis that explosive shock waves has had the same effect on the brains of returning combat veterans proves correct, the future challenges facing medical professionals at the VA and other mental health facilities will be daunting indeed. Here, as on other critical areas, I believe we as a country must resist the cost-cutting (and tax-cutting) frenzy going on in Washington and devote whatever resources are needed to finding whatever answers may exist.
Kait Carson
Charlene D’Avanzo 
100% with you, Jim. I note that last week, Maine public safety officials were doing a training for first responders in how to handle situations involving people with PTSD. We’ve got a serious crisis waiting in the wings, and the latest reports about the VA are that they cook the books so it looks like they’re treating our vets when they’re really just stamping time cards and moving on.
My last book, Redemption, is about the effect of all these returning vets, and these senseless wars (no one has ever won in Afghanistan. What’s that line about those who don’t remember history are doomed to repeat it?), and the effect on our Vietnam vets. But as citizens who’ve asked these young men and women to step up for their country, we absolutely owe it to them now to ensure that they have jobs, and places to live, and high quality medical care. And we are failing, because there’s a price tag. And no one wants to pay for anything anymore.
Thanks for writing this.
Kate
Amen. And, of course, Julia has also written about PTSD. (Julia? Comments?) But I suspect it’s a subject we’re going to continue hearing about, and learning about, for many years to come.
War trauma in any form is pretty scary. I remember talking to a retired NY Times photographer about his WW2 experiences and he spoke about things that just listening to would make you have nightmares. During the Vietnam war, I remember listening to returning soldiers who only could speak about things when they were very high or very drunk and even then, they often choked at certain details. I now have a nephew-in-law with one of these closed head traumas after three tours and it isn’t pretty.
It is a disgrace what we are doing to these , mostly kids. Of course at my age they are all kids.
I have two thoughts about this:
1. PTSD and CTE are just two of the many reasons that we should be doing a whole lot more than we are currently managing to do to address the needs of our servicemen and women who are returning home from conflicts such as those mentioned here. If we are going to send our people into these horrific situations, then we need to step up [no matter what the price tag may be] and do everything necessary to help them when they return home.
2. Although I certainly recognize the necessity of a strong military, I shudder over the sending those who defend our freedom into conflicts such as the ones mentioned here. I say this with a certain amount of dread as my youngest daughter is about to be deployed with the Navy and will [no doubt] end up in the midst of all that in some fashion. My oldest daughter is a graduate of the Air Force Academy and my husband is retired from the Navy after almost thirty years of service, so our family has a long tradition of honorable military service. As one who has always stood in support of our military folks, I believe we need to demand something better for those who serve . . . one would think that, as an enlightened citizenry, we could find a better way than armed conflict to assist the citizens of the world who are in need. After all, as the good Captain Kirk once remarked in one of those wonderful message-filled “Star Trek” episodes, “Well, no one wants war.”
Another thought to add to the mix: Many returning military people will go into law enforcement (bonus points are awarded to candidates with military experience). Place one of these individuals, who have been cleared by military medical personnel, into a high impact response situation and what will we have? As long as the federal budget continues to underfund the VA and long-term care for our returning wounded, the country will be weakened on several levels.
You might be interested in a Maine-based nonprofit called Fearless Nation PTSD Support that helps people with PTSD. I’m proud to be on their board. http://www.fearless-nation.org/FearlessNationHome.html
The suicide crisis among vets and others with PTSD is terrible, and it is destroying not only the vets themselves but the families they leave behind. It should be talked about more, and I’m glad you brought it up here.
I do need to comment on some of what you said. While people with PTSD have committed crimes or violence, it is usually the result of a co-morbid condition (another mental illness, essentially), not a direct result of the PTSD itself. People with PTSD are much more likely to harm themselves than anyone else. Your saying “large numbers of them have been involved in murders, particularly of loved ones” is absolutely not true. It has happened, yes, but only in isolated incidents. Even then, it is hard to blame PTSD — the people committing violence most likely had emotional problems or other psychological conditions before they were ever traumatized.
As for traumatic brain injury, TBI and PTSD are two separate conditions, but often hard to separate. PTSD is, indeed, a very real injury — it can cause drastic changes to brain structure — and individuals often have both TBI and PTSD, but Kristoff’s second article, which you cite, is based on a study of just one individual. That’s not good science, it’s just speculation. This blog post I happened to read just before I read your own goes into great detail: http://neurocritic.blogspot.com/2012/04/little-evidence-for-direct-link-between.html
Thanks John for your insights o this very sensitive issue.
Jim Hayman
John Platt makes the point that Kristof’s article is about one individual; Kristof himself stressed this in his piece. Still, it is noteworthy that a peer-reviewed neurological journal [http://www.ncbi.nlm.nih.gov/pubmed/22044102] published a sentinel article about the condition known as CTE (chronic traumatic encephalopathy) discussing just this one individual. As Kristoff mentions, “experts have since autopsied a dozen or more other veterans’ brains and have repeatedly found C.T.E. ” It may be too soon to draw any conclusions about behavior from these findings but it is not too soon to be gravely concerned for our combat soldiers and support troops.