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SUNDAY BOOK REVIEW
The field of psychiatric studies exploded during World War II because of an influx of traumatized soldiers. War is a kind of grand opening for studies of the mind. Historically, interest in trauma studies rises sharply during wartime, then wanes in its aftermath. But this time, even as the wars in Iraq and Afghanistan recede from public attention, rates of post-traumatic stress disorder have continued to increase. PTSD is currently the fourth-most-common psychiatric disorder in America.
“And yet,” David J. Morris, a journalist and former Marine infantry officer who suffered from PTSD, writes in his stunning new book “The Evil Hours: A Biography of Post-Traumatic Stress Disorder,” “like many mental health disorders, there is a broad disagreement about what exactly PTSD is, who gets it and how best to treat it.” “The Evil Hours” is a provocative, exhaustively researched and deeply moving analysis of traumatic memory and how we make sense of it. This book will teach you that a failure to understand this disorder is a failure “to acknowledge that trauma is part of the human condition,” and that to turn away from its history is to make yourself complicit in a plague of American disengagement. “No other people in history is as disconnected from the brutality of war,” Morris writes, “as the United States today.”
When Morris returned home for treatment, he discovered that most Veterans Health Administration workers were unfamiliar with the literature from which an awareness of PTSD emerged, “nor did they possess an even rudimentary understanding of the global war on terror.” At one point, Morris gave a copy of Thomas E. Ricks’s “Fiasco” to his therapist to make sure he understood the war in Iraq.
Without a decade-long campaign led by a group of anguished Vietnam vets, “PTSD as we know it,” Morris writes, “would not exist.” PTSD was not recognized as an official disorder until 1980. And when it did not exist — when it did not have a name — the sufferers were thrown into erroneous categories. During World War I, traumatized soldiers were viewed as cowards, and 306 hysterical soldiers were shot; hundreds more were subjected to electric treatment. During the Vietnam War, such individuals were considered schizophrenics. In the 1970s one V.A. psychiatrist called the idea of PTSD an “insult to brave men.”
Now is an important time to reflect not only on America’s folly in Iraq and Afghanistan but also on the way the wars have influenced us at home. Just how individuals respond to terror and are cared for by their country is largely a product of culture; the wake of grief is always wider than the individual, and as a nation we ought to engage communally in looking after our own. And, Morris says, when the grief of trauma is experienced by persons with “a lack of ritual and authentic public engagement in the war-making process,” the likelihood of PTSD increases. How can people bear such weight without social support? In the end this is a book not just about the health of the survivor, but also about the health of the entire culture.
“In retrospect, it seems that PTSD spoke to something in us at the end of the 20th century, as if the diagnostic concept held up a fractured mirror to ourselves, revealed how fragmented human consciousness had become. In time, PTSD would break out of the V.A. clinics and begin to insinuate itself into the dream life of the culture in a distinctly civilian fashion.”
Though it has taken decades for PTSD to be recognized as an official psychiatric condition, the sharp rise in cases may suggest that “it’s a medical concept that serves (however crudely) a deeper mythic need.” Perhaps these are wounds we fail to heal because PTSD actively destroys a self-preserving narrative. “Soldiers,” Morris writes, “are ultimately vessels and vassals of the state, and they do not go to war of their own accord, so why shouldn’t the state or the community help relieve them of their guilt when they return home?” Morris’s use of the word “guilt” draws on the work of Jonathan Shay, a prominent trauma scholar, who coined the term “moral injury,” expanding on the idea of PTSD to include injuries of the moral conscience. Shay believes PTSD is not an illness but a normal reaction to an abnormal event — and he defines moral injury as a result of the “betrayal of ‘what’s right’ in a high-stakes situation by someone who holds power.” PTSD, Morris comes to believe, “is, in a manner of speaking, a way of institutionalizing moral outrage.”
Morris takes the reader through several survivor stories: from the mountain climber Joe Simpson to a friend who was raped at 19. He introduces us to modern and archaic theories of trauma and to the “psychological supermarket” of alternative treatments. (One of the most controversial but promising of these is a common heart drug called propranolol, which can reconsolidate and dampen intense emotional memories.) Morris also turns to literature to understand PTSD, going to works as far back as “The Epic of Gilgamesh” and as recent as Alice Sebold’s “The Lovely Bones.” One senior V.A. psychiatrist told Morris that the “central image” of PTSD takes place at the end of “Moby-Dick,” when Ishmael is floating atop Queequeg’s coffin, staring off at the vastness of the ocean. “In a sense,” Morris writes, “nothing has changed, and today’s trauma survivors can take great comfort in knowing that they are confronting the same horrors that Achilles faced 4,000 years ago.”
But it’s Morris’s personal experience of Iraq and its aftermath that lends “The Evil Hours” its impressive essayistic quality — setting it apart from other clinical literature on the topic and making the book compulsively readable. The narrative is driven by a constant authorial intelligence and a genuine curiosity. We can see Morris’s mind working through questions on the page — and this is a great pleasure because it invites the reader to do the same.
In 2004, Morris was present as a reporter for bloody battles in Fallujah and Ramadi. “Spooky,” he writes, “is just a word in your mouth until you have heard the sunset call to prayer in a half-rubbled city surrounded by Al Qaeda fighters.” He was shot at, blown up and lost many friends. Back home, the love of his life told him, “You go off into this other place, and it’s like I can’t reach you.”
In the succeeding years, Morris has continued to feel as if it’s 2004. The past infiltrates the present. And because there is no cure for traumatic memory, Iraq will continue to make itself known. He describes it this way: “Once it enters the body it stays there forever, initiating a complex chemical chain of events that not only changes the physiology of the victims but also the physiology of their offspring.” Morris enters what he calls a “liminal” state, a kind of “underworld” where time warps and dreams are intel briefs from the unconscious. He thinks about apophenia, a coined Greek term for finding patterns where there are none. He becomes “a watcher of night skies, of cloud formations, of shooting stars.”
“The war had hurt me,” he writes. “I wanted the country to feel some of that hurt.” Yet, at home, he could barely begin to describe what he had seen because no one in America was listening. “I realized that the problem wasn’t just that they didn’t understand the war but that they didn’t want to understand it. What I had to say was not only inconvenient to their peace of mind but a tangible threat to it.”
“The Evil Hours” is an essential book not just for those who have experienced trauma, but for anyone who wants to understand post-9/11 America. Reading it will make you a better and more humane citizen.
THE EVIL HOURS
A Biography of Post-Traumatic Stress Disorder
By David J. Morris
358 pp. An Eamon Dolan Book/Houghton Mifflin Harcourt. $27.