Shaili Jain - The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science

This book is dedicated to

My mother, that rarest of souls who gives of herself to others with pure joy.

&

My father, who insisted on preserving a precious inheritance. In a larger sense, you are the author of this book.

The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable.

Judith Herman, Trauma and Recovery: The Aftermath of ViolenceFrom Domestic Abuse to Political Terror

No story lives unless someone wants to listen.

J. K. Rowling

The interview room at Milwaukees veterans medical center is small, so before our patient Josh enters, we rearrange the seating so as not to overwhelm him and settle on a circle formation. Our team consists of a serious, bespectacled medical student; the psychiatry intern dressed in her standard VA-issued royal blue scrubs; me, the chief resident, on the cusp of graduating from residency; and our attending physician, a seasoned senior psychiatrist. Josh has our undivided attention; none of us is preoccupied with our to-do lists or glances at the clock to check if it is time to move on to the next patient. We are, in a way, entranced, unified in knowing that we are witnessing something significant.

Joshs appearance sets him apart. Self-assured with a muscular build, Josh has a slight tan, his brown hair is cut short, and he has piercing blue eyes. All of twenty-one, he tells us how, along with so many of his friends, he was moved to action by the events of 9/11. He joined the marines not long after graduating from high school, because that was what was expected in his family. Both his grandfathers, a couple of uncles, and a handful of cousins had joined the service, and so had he. Josh was born and raised in a rural town a couple hundred miles north of Milwaukee. He was sent to the hospital in the city because his local VA did not have an inpatient psychiatric hospital.

He tells us how happy he was to come home after his military discharge and how good it felt to see family and friends. But those feelings were brief and quickly gave way to strange thoughts and emotions. Josh articulates his story with disarming poise. As he talks, I begin a mental diagnostic checklist.

Not long after coming home I started having nightmares. I would say they are worse than nightmares because they are a replay of stuff that really happened in Afghanistan, stuff I want to forget. I feel everything I felt when I was in Afghanistan: fear, panic, my heart thumping in my throat. I wake up screaming, and my sheets are drenched. This happens almost every night, and I dread going to sleep.

Nightmares. Check.

Weird stuff is happening when Im awake, too. I cant trust my eyes and ears anymore. I look at everything again and again to be sure that Im safe. I always feel something bad is going to happen. I cant just relax.

Hypervigilance.

I went to the store with my kid brother once, and we were loading up the truck with groceries when a car backfired. I just hit the ground. My body just reacted. I wasnt in control. When I realized it was a car, I calmed myself down... there were a bunch of people staring at me, and some were laughing. I dont care about them; it was the look on my kid brothers face that just killed me. He was scared and looked shocked, like he didnt recognize me. I just felt so ashamed.

Exaggerated startle response.

After that I just started to hang out more at home; I didnt want to do any of the things I used to love doing. Before Afghanistan, my mom always complained how I could never sit still and that I was always out with my buddies, at the movies, bowling, fishing, playing ball, and now I didnt want to do any of that. I just sat at home for weeks at a time, drinking beer and staring at the TV watching dumb reality shows, sort of zoned out and feeling numb.

Markedly diminished interest or participation in significant activities.

Then I started getting a lot of thoughts about Afghanistan during the day. The slightest thing took me right back. If I happen to flick to news covering the war, then bam! Im suddenly lost in this other world. Sometimes, family or friends would come over to visit, and some even asked, Did you kill anyone? or Did you see anyone get killed? Their questions made me want to puke. I felt so sick I would just get up and leave. I started to feel pissed all the time, like I was looking for an excuse to knock someone out! Whisky calms me down, and it helps me sleep, too. I dont have the nightmares when I drink, or if I do I dont remember them as much, so I started drinking more.

Avoidance of external reminders that arouse distressing memories, thoughts, or feelings about the traumatic event.

Persistent negative emotional state such as anger, guilt, shame. Check.

I was doing that for months, and then my mom was having a birthday party for my grandpa. The whole family was coming over. I love my grandpa, but the thought of all those people, the noise, it was too much. I started drinking the morning of the party. By the afternoon I was drunk. It was a barbecue, and this is where it gets vague, because Im telling you I cant remember. I remember the decorations, the cake, and then the smoke from the meat on the grill, it just hit me, and I was back in Afghanistan again, like really there, fighting for my life. I swear I could not help it. If I could have, I would have. I have no idea what is happening to me.

The team knows what happened at the birthday party; we read the eyewitness accounts, police report, and emergency room evaluation before we met Josh. He had a flashback, a quintessential symptom of post-traumatic stress disorder (PTSD), where he felt a combat experience was happening again in real time. Once the flashback was under way, he lacked the ability to stop it, and he relived all the original emotions of rage and terror. During the flashback, he assaulted family members. He kicked and punched and grabbed one by the neck so hard that it took three grown men to pull him off. The police were called, ambulances arrived, and that was what led to his hospital admission.

If this had been the 1970s, after the Vietnam War and before such flashbacks came to be viewed as a hallmark feature of PTSD, Josh probably would have been misdiagnosed with schizophrenia. But this was 2004, and our understanding was much deeper.

The VA patients I had met before Josh were typically middle-aged Vietnam Warera veterans whose PTSD looked different. For some, it had been treated and tamed over the decades and was not a major issue. For others, it was entrenched and layered with decades of severe alcohol and drug addiction, homelessness, and suicide attempts. For those patients, their PTSD was buried under all the other problems and was not the main focus. Joshs PTSD was fresh, florid, and untreated.

Josh stares at his hands with disbelief after revealing this altered version of himself. His earlier poise caves in to reality, and his face falls to anguish. To my left, the medical student has teared up, and even our attending physician, with all her years of experience, seems struck by his story.

I abandon my mental checklist.

We are on the verge of becoming a trauma-conscious society.

Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Imagine, if you will, a circle. Entering this circle is every American who has survived a trauma. By trauma I dont mean a messy breakup, losing a job, or having a home repossessed, even though these are all thoroughly stressful. Traumatic events go beyond that to a moment when your life is threatened, you are rendered helpless, and your sense of normalcy is shattered. Perhaps the most obvious image that comes to mind is the soldier back from war, but that is only part of the story. Being raped, being robbed at gunpoint, surviving a fatal car accident, escaping a deadly fire, or witnessing a spouse, child, or parent be brutally assaulted can also be a trauma.