Hour. I wondered if you could start out by telling me a little bit about yourself and why you wanted to write this book. Guest into some ways i had always lived in the shadow of ptsd roast of my adult life. My adult years were in uniform including the rotc. So i was vaguely aware of the idea of ptsd and that it was something soldiers were associated with and furthermore my dad was a vietnam veteran and i grew up in suburban san diego so all of my neighbors were either top gun instructors or marines and so i felt like i really grew up in the shadow of the vietnam. I was always part of the conversation and this lingering shadow. So i always have a general awareness of it and then i served in the military and was familiar with the idea in a general sense and then in 2004 i was out of the marine corps at this point and i did my first two are as a reporter in iraq and came back and noticed immediately getting off the plane in california feeling different, going to a bar and my best friend took me to this bar right near the airport we went to this club and i remember looking out over the people and there was i could tell everyone was drinking and talking and socializing and just as they had before as if nothing had changed and i remember there was no particular reason to feel angry or upset it really struck me that i had changed. And i remember oddly not being suddenly very bored and uninterested with what was going on and i left, stepped out and i think i went to use the atm at a local birth birth story at the interesting store at the interesting thing about san diego is all of them are run by iraqis and if so i went in and the owner of the store was from baghdad and so i ended up talking with him. So i was just off the plane not really fitting in and what do i do my walk i walk right next door and theres in iraq he we Start Talking about baghdad. It was a very strange feeling of apartness but i felt from my early days in 2004 and i was also angry about the war and how it had been prosecuted and i had been in the tail end of the battle in falluja and i have seen marines from my own regimen that were explained to me what they saw was gross mismanagement, poor leadership and completely irrational policymaking. They lost men as a result of this and then a few weeks later no wmd and then i was in iraq returning in july of 2004 and just a few months later in November George w. Bush was reelected so for me that was a very difficult process to understand that americans let in light of everything that happened all of the lies have been exposed so it was very difficult for me to accept that people voted in the face of knowledge of that information turn and reelect the person that had us there in the first place. And as i began researching and i began to develop symptoms of my own. There was a Movie Theater in 2009 fast forwarding briefly i was in a Movie Theater in an action film and there was an explosion that closely resembled one that i was in and it was shot from the point of view from where i would be in the humvee. So thats end of the cinematic experience was very overwhelming for me and i actually sort of blackout and when i regained full consciousness i was in the hallway. Snuck back into the theater, no one else was having this difficulty and i asked my girlfriend at the time what happened and she said there was an explosion in the movie and you ran out so i begin to sense began to sense on the personal level but not all was right upstairs and i didnt have full control of my memories. One marine i introduced in the book told me having ptsd was like having memories gone wild. So that was one of the incidents for me to begin examining ptsd not just in any personal level but also historical entity because i was curious like a lot of people. A lot of marines in veterans we thought of it as a copout as a shortcut not to having a authentic and honest emotional engagement with your service and postwar service. I thought that it was a way to dodge responsibility until i started looking into it and having these symptoms and what i discovered briefly is that the original people who thought for the diagnosis in the 1970s felt similar to how i felt and the founder of the group of Vietnam Veterans against the war which is the group that advocated for the diagnosis in the 70s, they saw the founder saw in his view there was no distinction to be made between the politics in vietnam and their own personal psychological struggle and out of that conversation and acknowledgment came to diagnosis that we have today. Host so you get a very ambitious synthesis of the personal historical, literary and scientific aspect. You touched on the history of its being kind of conceptualized in the modern era and given its current name. But what do you think is the most interesting thing that youve learned about what we now call the ptsd . Ptsd has been around since 1980 so about as long as Cable Television and it seems like a lot of people that if they were just recognized that it was a permanent thing that was always central to human condition it was always out there and what i found when i began researching is that is not exactly the case. And for instance Jared Diamond is a jogger for delete the geographer spent times in new guinea for the best preserved societies and he discovered talking to travelers that the postbattle with warriors often have nightmares and its something that you can find in the furthest reaches of Human History you find evidence of that. Host aerie common in the current suffering. Guest people consider it to be the symptom of ptsd the nightmare so there are parts of it that are theoretically a mortal comedian ever so and central, but there are other aspects of it but have evolved and thats one of the arguments i make in the book is that culture is more important in biology than ptsd. Host and how people experience it. Guest how we are to explain and benefits benefits sometimes. And its also considered to be one of the cardinal symptoms of ptsd. But in early 2008 group of british researchers at Kings College went back and examined the memoirs and accounts of the soldiers who have served before the age of cinema and discovered that the flashback wasnt really there and if you look at the account of the civil war veterans, they are far more likely to describe their symptoms, the visitations as spirits, ghosts and demons. And interestingly the civil war. Over the far more religious time than our own so there is a sense that you get that the time. Co. And the culture at the time influences how people manifest their symptoms and now in the flashback i looked at early here it was a term borrowed from the film to describe a break in the chronological blow in the story. So interestingly it appears as if the cinema and film have become so central to how we can conceive of human consciousness but its part of how ptsd works. So to answer your question there are historically aspects that appear to be universal and a mortal and other aspects that appear to be under the influence of the society they emerge from so its interesting mix of both immortality and a longstanding history and also in evolution and that was surprising to me. Did you think of it as a permanent thing that gets evolved. Host what you think modern veterans and other survivors can learn from reading literature lacks guest in the book i argue for instance that the elliott which is the foundation of western literature and you do see evidence johnson, his work a key reason the non and america kind of changed the conversation about ptsd. In the elliott eusebius keeley is feeling the survivor skills and crying over the death of his aid. Several of the veterans today the idea is that this super warrior, this alternative veteran and when a lot of ways with someone like that could suffer enduring psychological distress after war could become burning because its a very old thing. People have suffered for as long as human beings fought each other which is forever and so i think in the book i argue that literature is a very powerful medicine and something that the physicians and psychiatrists in particular dont think much about and certainly dont do well on the value of the work or you know literature has an extraordinarily powerful impact any measurable medical impact in terms of teaching you bringing you in closer touch with your own interstate and sense of emotions and naming them. A lot of veterans are unable to because the military sort of trains you to function and focus on the Mission Completion at the expense often times of the inner thoughts. The novels in particular and poetry offer people the experience number one as i alluded to to understand that they are not alone and their struggles are the struggles of immortality. And to secondarily get a greater sense of the emotional life and the way that a person can conceptualize their story and think about their own experience. And i personally learned a lot by reading the things they carry and getting a greater sense of how tim obrien in his other books as well, the memoir if i die in combat zones a combat zone me a lot about how what his homecoming experience was like. So there is this in many cases actual psychotherapy that you read about is the most impacting therapy used to treat across the board often focus on this idea of the narrative of discovering helping with your therapist helping you find your story and a way to conceptualize yourself as a person in the world and literature is basically a Training Session and public hopes us to understand how stories can be told. A lot of people if you grew up in television and film which is less emotionally rich in a lot of cases you dont get that emotional, you dont develop that and get a sense of how a story can be told. And for example, i think that its very useful to look at because after the trojan war he wonders for ten years and is literally homeless which in some ways is a metaphor for the homecoming experience in america and the idea of travel as a medicine and as this way of changing. So to understand and see how that works and how people can find themselves through wandering and how that plays out can be extraordinarily powerful and its measurable. This is a very High School English teacher thing to say but read a book. Psychologists have measured the impact and in particular they found that reading a book, reading a novel was one of the most effective ways to care for a job interview. So, you know for a variety of reasons there actually is a scientifically measurable impact models have on people. Host i would love if you would read a small excerpt from it if you dont mind. I pointed out earlier one that i would love for you to share with us. Guest this is from the Second Chapter and what i was trying to do here is after some brief memoir material sort of step back and examine the larger role and part of my idea for the book was to get as close to the idea of ptsd and the symptoms and the research and then at the same time step back and try to conceptualize it in the larger philosophical framework that ptsd exists. In the terrorist shadow. We are born into toeing the world. This is the shadow that darkens every cradle. Trauma is what happens when you catch a surprise glimpse of that darkness, becoming an violation not only of the body and the mind but also seemingly of the world. Trauma is the savagery of the universe made manifest within us and it destroys not only the integrity of consciousness but the myth of selfmastery and experience over time but also our ability to live peacefully with others almost as if it were a virus coming passage and content to do nothing besides replicate itself in the world over and over until only they remained. , is a glimpse of truth that tells us a lie that love is impossible and peace is an illusion. Therapy and medication can ease the pain but neither from the blood makes the survivor him see the darkness and unknow the secrets that lie beneath the surface of life. Host think you. One of the things that struck me in that passage was referring to trauma trying to replicate itself and i know in other spaces in the book you almost give agency to things. Talk about the universe scheming to wipe us out and the world is designed to hurt us and i wonder if you think that is an example of seeking patterns in things and if you belief and faith. Guest patterns that are not there. Yes i think with respect to the first question i think one of the reasons i wanted to that the book is a biography of the posttraumatic stress disorder and one of the problems when i originally began researching the topic as i found most of the journalism was related to ptsd and much of the science to simply recapitulate the symptoms and it gives us sort of general ideas about how it exists in the world by how it manifests to the emotional numbing. But i began the book with an excerpt from norman mailers book a time of our time where we talk about how the disease has a life of its own. And this applies to all. Cancer has a life and an intention. All the cds we look at the symptoms and the exterior parts of it and the resume of how it exists in the world in terms of how it manifests itself in the interior parts of the human being that has its own intentions and has its own way of being in the world. So i was interested to know if it is this being in the world that enters the body and expects its agenda and in particular i compare it to a virus and i want to be careful because i think that the over medical eyes. I dont look at it in terms of its treatment or its conceptualization. Host contagious . Guest in some ways depending on how you treat the metaphor it does have its contagious aspects to it and thats what is interesting when you talk about the cycle of violence and what they called the repetition. You find the war veterans are often even frequently waged to fix or to adjust or improve upon the legacy of what was thought. We invaded iraq because we didnt finish the gulf war in some peoples mind and there peoples mind and there is that relationship of one trauma exacting its toll and then on another level repeating itself and trying to recreate itself in another way and then people come from abusive families that were sexually traumatized by older leptons find themselves in situations where they receive the trauma and inadvertently unconsciously so there is a viable aspect that is fascinating and unnerving when you think about it because it continues to repeat itself and viruses, which i am not a cancer or aids researcher but speaking to some recently, there is this idea out there that viruses exist only to replicate. That is their major function in one of their main main main purposes in life and so the idea of wanting to replicate itself i think is something that is interesting because that is sort of situated in the medical literature. Additionally, one of the ideas one of the reasons i wanted to write the book was to make sense of my experience. I worked merely as a journalist overseas and one of the reasons i kept going back to iraq and served in the infantry in the mid1990s and had left before 9 11 we invaded iraq and everyone went to college with was there. Virtually as far as i was concerned michael universe had deployed to iraq. So i went for those reasons that additionally i went to iraq because i felt i had always been drawn to extreme experiences. I spend a lot of time in extreme environments and ive learned a lot about myself and i think living as a warrior in a war correspondent is a great way of being in the world because you see see the society pushed to its extreme and get insight into the nature of existence. So i kept going back to iraq because i thought there was some way i had a sort of mystical idea that the longer i stayed there and the closer i got to defend the longer i stayed in the mahdi the more spiritual insights i would get into the closer i get. One of the things i discovered was the longer you stay and more tired you get the more fatigue takes its way into your body and you notice connections that were invisible to you before. And i delved into this in a number of ways in the book that one of the most striking is the day before my worst ambush i was in a humvee with a bunch of soldiers who are all from latin america in the u. S. Army and born in guatemala and el salvador and one of them asked me have you ever been blown up before sir which as been talking about almost dying you dont do that from my perspective it was old and most like dont talk about them and how lucky youve been this week because you are tempting fate. So all of us when he asked that question we got angry because you cant ask that. Thats the last question you ask someone in a combat zone is have you ever been shot at, have you ever been wounded by because you are inviting you on your self and so in a way it didnt surprise me when i hit an ied the next day because the soldier had spoken in my way of thinking had spoken my faith so there is a sort of mystical connection this finding of connections where there shouldnt be connections and noticing patterns that were invisible to you before. These sort of things were a huge part of my war experience and why i kept going back because i thought i was learning. There was in a satiric knowledge, the spiritual insight about the nature of existence that was becoming available to me the longer i stayed there. So i reflect on that in the book it is an altered state of consciousness that be leaving those sort of things and that magical way of thinking is part of the dramatic universe and the idea of the supernatural trauma in the supernatural experience and visitations from the other side and for me even while i was there i felt there was this other side of the paranormal or the other world that was present in my experience. Host so when i talk about my war experience and homecoming i sometimes joke going on my first book tour was my own special version of prolonged social therapy because i got to talk about some of the most awful things i experienced with journalists asking me things like what is it like to watch someones death so i was really interested to read your discussion of your experience with formal prolonged exposure therapy at the va something that you called a sadistic virtually indistinguishable from torture, and punitive reconditioning. I was curious if you are at all concerned about using that type of language and might deter some people from thinking [inaudible] possibly. To go back prolonged exposure is the vas number one individual psychotherapy and its loosely based on the idea of pavlov and the idea of reconditioning a person. And the ideas of pavlov and others, classical psychological theory were updated by the university of pennsylvania researcher and its a therapist that asks you to recount. Very common in the world today. However i found it to the research does show that it works in the case is most veterans to get the benefits from it. But i found as i recounted the story of my ambush in baghdad on october 10 2007 i was asked to recount the story of dozen of times and for me i dont know really in that and what i found was the same then am i felt in my blood in the same talk since i felt just the activation and the feeling of being on point on the knifes edge here. A lot of the feelings that had been tormented then stirred up like a fish tank. All of the upset here that had been asleep for a weekend and i found when i went into the research i didnt do anything about prolonged exposure. I did with the da asked me to and they put me in this bigger therapy. But as i dug up some research, i discovered that my experience and my anniversary action was not only not uncommon that was very common and they have been documented by a number of researchers. Specifically if the Harvard Medical School they had very they discovered they had gotten various reactions from those that they have tried exposure therapy ons of the question for me became why did this happen why he is prolonged exposure not working and why did the va why have they spent so much money on this particular research on this particular therapeutic malady . And what i discovered is a member of things but the idea behind prolonged exposure was originally in adopting a rape teen psd therapy and it tends to be in most cases a onetime event and not an extended 15 month you know cumulative small trauma is adding up kind of situation which is more descriptive of the combat veteran. And so i think i want to be clear the va are the good guys. They are about clearing the clearinghouse for the research in the world. They spend more time and money and extend more resources on the problem than anyone else. They have no peers in this realm. And they had come up with some extraordinarily efficient therapies that are getting release i think as we speak. With respect to prolonged exposure but therapy fits very neatly in the history of psychology and into the classical learning theory and if so it appeals to the researchers because it has a very clear lineage back to the don of psychology and the russian physiologist. And it does work in many cases one of my good friends the battle of falluja veteran who saw worse things than i did as they worked wonders. However i dont think i think that there are a lot of side effects that are not being addressed by the va and specifically i think it is interesting because and this speaks to the medicalization which is the major problem today. We treat it like we treat strep throat. We treat it based on the perceptions and research and knowledge and wisdom gained from people in the lab coats who taken us very far in terms of public health. However, it is very rare to need to psychiatrist or psychologist who has been in a combat zone and i can think of that, too and they tend to be rather disinterested and not proponents of the prolonged exposure and theres a fundamental misunderstanding in a part of the va about the nature of combat trauma. And if you talk to the iraq veterans someone who spent seven months and did the second deployment in the middle east to the province of which i know several marines you look at the issues they are struggling with and in most cases it isnt a single ied ambush that can be excised or treated with prolonged exposure. Its often a host of dozens of events and living in the shadow for literally four months, for months and months. I think there needs to be a reassessment of that modality and a consideration of how to better conceptualize the idea of the combat as an ex essential events that impacts the entire individual and not simply a onetime event that can be treated with the antibiotic of prolonged exposure. Host the next treatment of allergy if that that is cognitive processing therapy. And you referred to that as yankee optimism that solves nothing but acknowledged the schools and tools help you get out of bed in the morning. And as you just mentioned you have concerns that over medical icing ptsd and focusing on treating the symptoms might actually go so far to encourage the government to wage a war and silence survivors. I want to dig into that a little more deeply because i can definitely understand where you are coming from but at the same time i cant imagine interpretations of giving people the tools to manage their symptoms actually enables them to speak so i think for example about a friend of mine who was sexually assaulted in the military and because of the success of the therapy is able to get out of bed in the morning and leave the house and cope with traffic and take the match row and sit on capitol hill and testify before the house and Senate Committees about the experience of military sexual assault. I wonder if you would kind of dig into that a little bit more. Guest you make a good point. And i think with respect to your colleague i think that is an excellent outcome and something you want to encourage. I think one of the most important things to recognize is that it is a moral argument. It has a moral component and that argument is war and rape which are socially generated as the human beings and ask them on other human beings, ptsd as the argument has the argument that says there are longterm psychological enduring costs during both of those events and as a result we should be more careful in how we wage the war and we need to think more exhaustively and more clearly about how women are treated in the society and we need to do a better job than we are in the military and civilian way to protect women and ensure their safety. So there is a moral component thats important to recognize. Before it was recognized people thought you were either killed and wounded and after the war he went home and put your uniform in the closet and went on with your life so there is an aspect of ptsd that should echo and shouldnt be minimized in any way and that was one of the arguments that robert was one of the initial architects from yale who began arguing for what began ptsd was concerned that he himself was a psycho analytic trained to fight the tradition of the psychologist but his concern because he was working in the 70s he was a very politically active person and he was very concerned that this moral argument that ptsd as an entity as an objection to the american warmaking machinery if that were treated strictly as a technical matter in which it is treated today, one of the first concerns as they were advocating to get this recognized is that it would be essentially morally neutered by a medicine medicine which is largely happening in my opinion. There is which i think has been for the better. Robert was very much a man of the left, an iconic man of the left but i think that it would be inaccurate and a distortion to say you have to be a lefty to get ptsd and if you are a republican its not for you. And as a result of this since it has been medicalized and Mainstream Insight psychiatry and its become treated as a biological disorder which is the tenor of research now thats more biological in its emphasis that it is more apolitical and its made it less than arguments against the war and more of a condition that arises like war and rape and can be treated. So in all of the original architects of ptsd who all grew out of the protest in the 1970s mind you, they were all very concerned in one of their motivations for advocating for the ptsd recognition was to increase the likelihood of the war and to think about and step back and ask more questions of the american way of the war and this i think its important to recognize that without the protest movement or Antiwar Movement of the 1970s, without the political context of vietnam created, we wouldnt have ptsd. Thereve been a number of occasions after world war i for after the holocaust when the nations and cultures like the british and the israelis had opportunities to institutionalize Something Like ptsd and did not so its interesting that the in america ended up inventing this disorder for lack of a better word that it came out of the protest movement in the 1970s. So i think its interesting. I think there is a large the moral argument is one of the most powerfully impacting ideas for me to think about the idea that veterans can be damaged by the war and its something that is a cost all of society must bear because we live in a world you and i both know better than most that only 1 of americans served in the military so there is this to treat soldiers as ammunition and veterans has been expended so i wanted to ptsd to be taken seriously and im glad the media covers it with such seriousness because it is important to think about, and the va should be the nursery of all americanborn foreign policy. We need to think about the cost of the war before we wage them. Host tell us a level thats more of ptsd. You mentioned how the preference after the Natural Disaster is a little lower than maybe the personal violence and within the war you mentioned friendly fire leading to hire rape. Is that related to that feeling of betrayal and his death linked to moral injury x. Guest iindia it is and that is one of the arguments i make in the book and why i argue that the culture is more important in biology and social realm is more important than the biological realm with respect to ptsd. If you look at who is more likely to get ptsd, the most toxic for much is rape. Around 50 of rape victims develop ptsd in the long term. Longterm. 50 to take that figure on then you look at the warfare for example in iraq and afghanistan that in the rape and ptsd diagnosis hovered the best ss rates around 1215 , so its roughly one third or one quarter of what rape victims suffer so take the total of 15 and compare that against people who survived tsunamis or earthquakes or poking those, normal Natural Disasters and that diagnosis writer tends to hover around four to 5 . So you think about that from the 50 figure with rape victims and then the 5 figure with Natural Disasters and compare and say what is the significant difference between the two phenomenon and the rape victims it is a social idea of betrayal by the human race, by your social by people being a century predators on other humans and that is all through the component of the war. But its not a naturally occurring phenomenon. Its something human beings do to other human beings. Speaking for myself and this is why the rank on the justice of the iraq war and politics for which no cost has ever been assessed in the Political Class in the United States that was one reason for me that was a serious blow to my belief in the United States. It felt to me in a and a lot of marines that i interviewed from the regimen felt that from the first battle of falluja was at the trail that they had victory stolen from them and that they had been asked to go and conquer the city and halfway through the would know, cut it off not a good idea and they felt betrayed by their leadership. So for me and a lot of veterans who are friends of mine come in a sense, in the sense of the betrayal by the National Leadership for which there was accountability after vietnam theres never been an accountability for the runup to the iraq war. I know im speaking in some sense out of terms because a lot of people a lot of republican members of my family get upset when i make this argument with them but for me this was one of the very strong convictions and one of the reasons i wanted to write this book is to understand how one conceptualizes politics in the postwar realm and how does the idea of a breakin of social trust and feel you have been betrayed either as a rape victim or you have been betrayed by the society that wouldnt protect you and failed to protect you and the men in your life that failed to protect you depending on circumstances these issues and these questions are what harm to the survivors. Host you write about other veterans expressing concerns about letting go of memories. I wonder if you think that its possible to look through and released dutch, and the negative reactions associated with the memories. Guest the short answer is yes. As we talked about having retold the story its become less toxic so thats a good thing. And it is easier to talk about a lot of the stuff and having written the book one of the reasons i wrote the book as i had questions i wanted to answer and i wanted to do it in a thorough way that would be satisfying and that speaks to the shape of the book and why it turned out the way that it did. But there is an aspect of the addiction of which and the addiction to the extremity and a adrenaline and the experiences and you see this with what the marines often called repeat offenders that dont know how to live with civilians and i knew a number of marines even when i was in the marine corps that a deployment would end and they would cross the connection coming on board because they didnt really want to go home and there is this feeling even among the veterans who get out and leave the service and live in the states in america of not being able to let go and being so addicted to their memories and not wanting to let them go for a variety of reasons number one because they loved it so much and why would they never want to think about it and then second come you hear a lot of veterans say my nightmares are an honor to my buddy. Host thats more of the type of memory guest id than you think through, thats really heavy to think about the person that a veteran is so impacted and this speaks to the gravity as it expresses itself in a lot of cases that ive heard other people say this, this veteran is saying my selfconscious is damaged as my way of honoring my buddy. But i would argue for myself personally i tried to yoga is hopeful helpful and the therapy was useful and i spoke to a lot of really smart people and ross is a psychologist at walter reed, very insightful and wise people that have spent time on this issue and really read the philosophy and read the literature and thought through this on a very deep level. And i discovered they all influenced the writing of the book that i discovered for me personally meditating on these issues was very powerful but then i also decided that as a matter of posttraumatic growth of wanting to make something positive of it i needed to leave some things behind and what i left behind was the idea of in some ways this book was my saying goodbye to my 30yearold self, my former marine and entry officer self my former war correspondent south, International Man of mystery this person that i wanted to be. And letting those go and saying i can continue this, i could go to afghanistan and spend years of my life working as a reporter and it will be an extension of what ive already done but something in me knew that i wanted to be a one war guy. I didnt want to go to afghanistan because i knew the longer i stayed there it was like last time. You cant get that kind back and when you are in a war it makes it every day you spend deployed overseas overseas that makes it that much harder to come back and with a whole life. So i wanted to leave that part of myself behind. Host was creating this narrative a form of treatment for you . Guest totally. And i should say that it was very helpful because it was a therapeutic experience. I am not against writing the therapy that im against the publication of therapy. There are a lot of good books and is an excellent memoir that shes spoken about and i tend to agree with her that you cant use age or older can be an extraordinarily powerful medicine working for keeping the journal and recording your feelings and processing your feelings can be extraordinarily healing. But in the books that i am familiar with the tax wouldve used the publication process as a way of just merely sorting through their own form of therapy i am opposed to because i simply feel like im kind of a small but i guess. I like books where the writer knows what they are doing and is not using the book as simply a way of unloading their personal issues on me. I like to have some sort of echo and a writer that has a sense of the beauty where host so what do you think is more important therapists were the therapy of the particular modality that was chosen . Guest there is a lot of research that factors into my answer to that question but interestingly, a researcher in the 70s looked at this question and assigned a number of therapists using different modalities to treat patients and as a control this researcher took professors at the university, trained them in a couple of therapy techniques and compared research into the result across the board and found that english professors performed as well as the Clinical Psychology grad students. Host when you told that anecdote i couldnt help but wonder if your bad experience would have been different with a different therapist or if its the modality itself that was problematic or if it is how they intersect. Guest i think it is a combination of things but interestingly, anyone who has looked at the randomized trial that has been done on therapies come and its incredibly hard to do the research on because it is a constellation of factors and science designed to zero in and isolate the factors that the Researchers Show that the Therapeutic Alliance that occurs between the therapist and patient is the most important factor and interestingly, the va has sort of minimize that and theyve ruled out the state appears that are designed to be onesizefitsall and politically minimize the therapy on it so toomey its hard to see an upside to that. But i do think i talked to Gary Greenberg is whose a new york blogger and very smart therapist and hes a good idea for officials. You cant really train for that. But if you look at the programs around the United States you can institutionalize our and in tangible artistic and notionally smart therapist. Its not impossible. And any art form can be institutionalized in a way so there is a way out. There is a way to do that. But americans as a whole we tend to prefer the scientific fixes to things to their great credit its rolled out these evidence supportive treatments of minimize the artistic side of therapy. But the rationale which is a good one is they are trying to get as many means and treatments to as many as possible and they are doing that but i think that there needs to be some accounts made for the artistic softer, less tangible, less scientifically provable ideas of the art of therapy. Host you talked about the shaman is some in your book and in the conversations of the posttraumatic growth and i was wondering if you could maybe delve into those concepts a little bit more and see if you think any of those could be linked to the use of the counselors. Guest i think what is interesting one of my goals in the book was to delve deeply into the Research Literature and discover what i could about the epidemiology and the origins of the disease. And then which largely comes from psychiatry and psychological research. So that is sort of the weeds but i wanted to step back as far as i coded and still be on the planet earth and think about it from a very its rare to ask the question of all of the discipline and range of Human Experience is where does this fit in and if theres a sort of legal structure of Human Experiences and what i discovered come and it fits into the mythology and the prescientific thoughts rather neatly there is trauma has always been with us and we know how it impacts the brain from science that human beings have known about it and had opinions for very long a very long time they just use different names for it. And one of the things i discovered if you ask the question how our homecomings treated and diseases, the aftermath of disease treated and cured with journeys treated in the mythology of the larger culture and the prescientific culture what you discover is that there is a traumatic journey is often the heroic journey as it is described by Joseph Campbell and the idea we discussed the journey of what some people describe as a faith healer or secret politician someone who goes and is often called to the role by a true medic experience, by a neardeath experience or a close call so they were often people that have survived in the wilderness and had been out and come back to the mainstream to the tribe, the village with a secret knowledge that they have had achieved in the altered state and so interestingly when used against look at the larger history thats one thing that we have reversed in the va today and in the medical establishment today we look towards people that are the most sheltered in many cases and spend their lives in academia and have what i would argue are some of the far lesser knowledge of the dramatic universe and personal experience so they tended to look at things from a very particular point of view where originally trauma and neardeath experiences were looked upon as a source of wisdom and insight and mystical perception and growth and there was the idea in this one thought there is this idea of being traumatized as being the mark of the healer which completely inverts the modern idea as a war veteran is being damaged goods and so the idea of posttraumatic growth as i began kind of looking into the research and experience of ptsd i discovered and kind of came to the conclusion myself personally that we tend to overemphasize the pathology of the war experience and one very good friend of mine and iraq veteran told me that he feels the United States has apologized to the entire experience and overemphasize the negative parts of it and we tend to address them as damaged goods too much. And what i discovered is that there are a number of people, and i include myself in this subset of people that founded the war to be eight growth experience. There were certainly negative impacts on my experience that i but i discovered coming and i attribute my cousin whos and acclaimed who took an 80foot fall in the Canadian Rockies in 2010 and nearly died, and he took that moment of his neardeath as an attempt. He took that as an opportunity to recalibrate his life and in his words to fix something in his life that he wanted to change and so for him and he didnt really dwell he had nightmares but he didnt really dwell on the diagnosis of the idea. He focused on okay i almost died, when i was on this ledge in the rockies i i had peace talks and i was sort of reflecting on my experience and i have a better perspective on how i want to live my life now and i want to achieve some of the things off the mountain that i hadnt havent paid enough attention to and so as a result she moved to colorado, started this organization and kind of changed the trajectory. And they learned a lot from that. I think a lot of them can learn from that experience. You survived the war. Thats the craziest, wildest most extreme out their experience that humans have. You have seen first hand experience what can you drive from your survival and perseverance in not really insanely long odds and a lot of the prisoners of war came away with 60 of the u. S. Air force prisoner of war veterans described it as a positive spiritual experience for them so that is a possibility possibility that spin and determined that universe. Host i agree with that. One of the things when you talked about the survivors and the social bonds that they had had into the societal recognition of the experience when they got home, i was wondering what else do you think can be important for facilitating the civilians from recovery tax guest well, the whole ten killing is the sort of unicorn in the Research Literature because they had a strikingly low ptsd rate one of the lowest recorded around 4 which is a fraction of [inaudible] guest very low. And john mccain was in prison for five and a half years and endured torture at the extreme end of that has it has ever been measured and get a lot of people had very have very positive experiences. And what you discover a new look at the cohort is that those people were older, theyve been trained and prepared and many of them had been to a course before hand so there was preparation that had occurred and if you think about it in terms of a marine officer of the Toughest School tends to produce the best soldiers. So if you and bark on training that is really arduous and not abusive but very arduous and pushes people to their limits within reason, you tend to have a person who is more prepared for the extreme adversity deployment stressors and of the various kinds and they do find that to be the case. And this is somewhat deviated they have a low rate and people think the reason for that is the training is tougher. So i am a charge if i was in the marine corps and i have a particular view of what i think helps people. But working up and taking a stair step approach for people can build resilience because a lot of what when researchers actually examine what causes ptsd is a concept of surprise and the unknown or seeing something you were not prepared for and you feel helpless and that feeling of helplessness of being completely overwhelmed and being completely crushed like a glacier by your environment those are the sort of things that tend to produce trauma. So come if you can counteract that feeling and to give a person a sense of agency and a sense of optimism and control of their environment you reduce the likelihood of ptsd and researchers that interviewed veterans at the hanoi hilton coworker of the prisoners of war found that optimism the idea of being optimistic and positive and looking for the upside in your experience is often times what helps build resilience in the long run, just a feeling of we are going to make it out of this. We are good. My family loves me. All of those factors help to mitigate. Guest host im very pleased that weve managed to end the discussion about a very difficult topic on somewhat of an up note. Thank you so much for joining me today, david. Guest thank you for having me. That was after words come booktv Signature Program and which authors of the latest nonfiction books are interviewed by journalists, public policymakers and others familiar with their material. After words airs every weekend on booktv at 10 p. M. On saturday, 12 and 9 p. M. On sunday and 12 a. M. On monday. And you can also watch a after words online. Go to booktv. Org and click on after words in the book tv series and topics list on the upper right side of the page. [inaudible conversations]