The Puzzle of PTSD


November/December 2010


At eight o'clock on Tuesday morning, I walk into a nondescript room at Walter Reed Army Medical Center to greet seven soldiers and marines who've been back from Iraq or Afghanistan for a year. Sprawled around a large, coffee-stained table, looking wary, the vets are here because they, or someone else, said they have post-traumatic stress disorder (PTSD).

This is the first meeting of an exposure therapy group I'll be facilitating, and I'm anxious because if the treatment goes well, it'll be painful for them, and everyone prefers to avoid pain. These men and women have been treated with medications or intermittent counseling to help them deal with the emotions and conflicts they fear, but they remain symptomatic. Now they've landed at Walter Reed's Deployment Health Clinical Center to participate in a three-week, multidisciplinary program that helps vets adjust to life after combat. They're guarded, skeptical, but not without hope.

I meet their hope with my faith that I know how to help them. My approach is different from most because it's premised on the belief that the way the field currently understands the effects of war and communicates that to veterans can, however unintentionally, undermine their recovery. I believe the diagnosis of PTSD actually hampers our ability to help these vets do the hard work of facing their demons, coming to terms with their experience, and ultimately healing.

I start the group by explaining how exposure therapy…

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