No Expiration Date on PTSD

Even though I live near Washington, DC, I'm not a politics maven. I remember when Sen. Max Cleland lost his seat in 2002, but I hadn't heard anything about him since, so I figured he had happily retired from the often-dirty fray. I could not have been more wrong.

I saw him again last month when he spoke to the researchers, biotech workers, and advocates at the "Next Frontier of the Brain" forum in Boston. Instead of relaxing after his decades of public service, Cleland had spiraled down into the abyss of PTSD—more than 40 years after he was grievously wounded in Vietnam.

"People who overcome, especially, physical injuries…usually do it by means of having some kind of purpose in their life. I had a strong meaning and purpose; it was called politics, government service."

"But then I lost [the election]. I lost my sense of meaning and purpose and destiny, vision. And at that point, then the reality of the wounding came into play. Then I realized, only recently, I was dealing with something that was much bigger than I was. And that was the basic, fundamental aspect of your brain.

"I went down into a massive, deep, dark depression sparked by massive anxiety and what we now know flooding of adrenaline and cortisol into the system—and all of that stuff came flooding back from forty-some-odd years ago, just like I was on the battlefield again, dying, overwhelmed, overcome." At one point, he said, he was so disabled, emotionally and cognitively, that he lost the ability to read.

Cleland went back to Walter Reed hospital, where he had first recovered from the loss of parts of three limbs in 1968. This time, the doctors helped him start to heal his inner wounds. "Thank God, patient help, trauma counseling at Walter Reed…anti-depressant for a while, I began to recover. And I'm beginning to restore my sense of self and all these other things, and then, you know, magically the emotions come back, and the cerebral capability comes back, and then you begin to start thinking again about meaning and purpose."

Cleland also tells his story in the documentary film Halfway Home, which follows several veterans through their first years home from war. The film had its Boston premiere as part of the forum; its director, Paul Freedman, and narrator, Martin Sheen, joined Cleland to talk about the film after the showing.

In the film, Cleland describes one of his low moments at Walter Reed, sitting and sobbing uncontrollably and then hearing, through the wall, his own voice, cheerful. It was from a video he had recorded long ago to inspire newly wounded patients to not give up.

"I had no idea for years, for decades, that I might have some kind of something called post-traumatic stress disorder," he said at the forum. "For those who have been wounded, whether they have been physically wounded or not, when they have been traumatized, that old horse, that thousand-pound steed in your mind, has been spooked. It has been spooked. And if it has been spooked numerous times, it ain't ever forgetting."

"And so anything that comes along and spooks that horse—we call it triggers, nowadays—then you're off and running. You're liable to be thrown off the horse and dragged along the ground."

Now Cleland is secretary of the American Battle Monuments Commission and, as always, a strong advocate for veterans. And he wrote a book about his journey, Heart of a Patriot: How I Found the Courage to Survive Vietnam, Walter Reed and Karl Rove. He ended his remarks with a plea to the audience: "Those of us that have made that journey and hundreds of thousands, really, millions of young Americans who have put their lives on the line for the rest of us, need you. We need you."

His remarks start just after the first minute of this video; researchers on pain, PTSD, and concussion follow (here you can find a description of those presentations). Video and mp3 audio also available on The Science Network site.

The forum was held in Boston May 23–25 by the One Mind for Research campaign, whose goal is "to significantly reduce the U.S. burden of disability due to brain disorders." The campaigners released a blueprint of research goals at the event: "A Ten-Year Plan for Neuroscience: From Molecules to Brain Health" (PDF). Videos of all the sessions and interviews are collected on the Science Network site.

Just before I left to travel to the conference, I read in my local paper of a hit-and-run driver who had killed a pedestrian in the dark of night. The top of the story described the accident and suggested alcohol was involved. In the middle of the story, I read that the driver, who was found disoriented in a nearby field, was a friend of the person he had allegedly hit; they were both headed home in the same neighborhood. At the end of the story, I learned that the driver was recently returned from a war zone. Now when I hear these stories, I wonder: Was he showing symptoms of PTSD? Was he getting the re-entry care he needed? Are there others like him we must help?

–Nicky Penttila

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