War's Ripple Effects: Research Priorities
Understanding of the traumatic effects of war has progressed significantly. In this selection from Dart's Videos on Veterans series, leading researchers and clinicians shed light on what needs further investigation.
This video was produced by the Dart Center for Journalism and Trauma from interviews conducted at "When Veterans Come Home," a conference held in Atlanta in 2010, sponsored by Dart Center, the McCormick Foundation and the Carter Center’s Mental Health Program. For more interviews on this subject, see our Videos on Veterans.
We know more than we ever did about combat, traumatic brain injury, depression, post-traumatic stress disorder and all the other diagnosable psychological effects of war. But leading researchers say that there are still vast areas that need research.
Jonathan Shay, a clinical psychiatrist and author of two must-read books on the experience of veterans, wants research that moves from the brain and the mind to society. Thomas Horvath, the former director of the Michael E. Debakey V.A. Medical Center, wants better work on "so-called 'mild' traumatic brain injury." Matthew Friedman, executive director of the National Center for PTSD, outlines several avenues for research on how we deal with post-traumatic stress disorder.
Jonathan Shay: I think that we desprately need good, disciplined research, and with resources, to look at the social factors that contribute to or destroy peoples ability to return to civilian life. This is largely a kind of blank in the current research agenda, which seems to be tremendously focused on the brain — the biological psychiatrists — and the mind — the clinical psychologists, especially the cognitive behavioral folks.
Thomas Horvath: One area that's beginning to be done is the work on so-called minimal traumatic brain injury. And I abbreviate it to MBTI because there's nothing "minimal" about it. It can be quite disabling in a subtle and complicated way, and the concussion injuries that the troops are getting with the IEDs have really made our life difficult. If I could think of one area that still needs a lot more research with imaging with very sophisticated neuro-psychological testing with a kind of daily life testing, rather than just paper/pencil IQ. Because you might find that, for instance, behind a lot of homelessness, there are people with head injuries and that's being dismissed and you then blame the patient for not keeping appointments, for not sticking to a program, for not having motivation, when in point of fact, they're about as incapable of doing it, for the time being, as a stroke person is moving his right arm.
Matthew Friedman: Can we prevent PTSD? Can we innoculate people? One of the things I've been saying for years, probably one of my rants, is we should do stress education in the schools, because everyone's going to be exposed to stress, and half of those are going to be traumatic stress. I don't know about you but I've been exposed to traumatic stress, you know. Can we prepare ourselves, our population, better? Obviously, can we prepare our patients better? This, on the one hand, overlaps with resilience. Can we understand what's the difference between people who are really vulnerable when these things happen and they really fall part, and those people who are resilient and they may take a hit or two and bounce back. And in many ways, I don't want to say they're better for the experience, but they're different in good ways that they would acknowledge as post-traumatic growth or other kinds of things.
Also, we need to have better prophylactic approaches. I talk about a morning-after pill when I talk about my pharmacology bit, and if I've been in a terrorist attack or if I've been mugged or raped or something really bad has happened in a war zone, is there something we can give right away? It doesn't have to be a medication. It could be a psychological intervention that's going to prevent the later development of PTSD.
And I guess the final thing is that we need better treatments. We have some wonderful treatments. They're not for everybody. I think the people who benefited in the research are self-selected people that are willing to go back to the ninth circle of hell and confront their demons and are often much better for it. Not everyone can or wants to. Do we have something we can offer them? Maybe not, but these are important questions.