Tuesday, February 17, 2015

Book review and PROGRAM!

The Evil Hours: A Biography of
Post-Traumatic Stress Disorder,
by David J. Morris

In The Evil Hours, former Marine infantry officer and war journalist (and PTSD survivor) David Morris traces the history of “a species of pain that went unnamed for most of human history.” It would be unfortunate to miss reading this book because you assumed it was merely a clinical overview of a disorder suffered mostly by those who have experienced psychic trauma in combat. This is a book much larger than that. It has both a personal and an expansive view. It looks at PTSD as a disorder symptomatic of our times, one that is intimately connected with our growing sense of vulnerability in the world and one that is related, as well, to how we have come to view the enterprise of war and our returning soldiers. How the disorder came to be defined and officially recognized, its causes and symptoms, the politics and social forces that have helped shape its clinical as well as its popular image, and the courses of treatment that have become semi-official, tell us important things about our contemporary society and culture. Morris writes that today PTSD has become “…not only a way of understanding the self but a way of interpreting culture and history.”

PTSD was a diagnosis first described in the DSM III (The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) in 1980, something that came about largely as the result of the lobbying of those psychiatrists who had worked with psychological trauma among Vietnam Veterans. The etiology of the diagnosis has done much to create a stereotype of the disorder as one particular to combat veterans, but combat veterans are only a portion of those in this country who are afflicted with PTSD. It is now the fourth most commonly diagnosed psychiatric disorder in the United States. It is estimated that there are 27 million PTSD survivors in this country. There is a higher incidence of PTSD that results from rape and violence against women than from combat, and other forms of trauma as well as natural disasters have been associated with the diagnosis.

While of interest to the general reader, this book will also be of practical value to those who may have PTSD. Morris creates a list of symptoms that define the disorder by referencing his own difficult experiences and using information from interviews with other PTSD sufferers. He cites examples from his extensive reading on the subject, and he has discussed PTSD with notable clinicians. PTSD is characterized by: nightmares, flashbacks, and triggers which prompt someone with PTSD to relive the experience. PTSD disrupts the “normal” narrative of time; a heightened sense of vulnerability and paranoia are common; and cognitive distortions cause those afflicted with PTSD to see dysfunctional patterns in events in their everyday lives. He summarizes current cognitive and pharmacological therapies: prolonged exposure therapy, or flooding, which reprises intense trauma; and cognitive-behavioral therapy. He looks at the moral and ethical implications of propranolol, a drug that if administered shortly after trauma can help reduce the memory of a traumatic experience. He evaluates the evidence for the effectiveness of selective serotonin reuptake inhibitors such as Prozac and Zoloft; eye-movement desensitization and reprocessing; martial arts, and even yoga. His evaluation of various treatment modalities is even-handed. About some of these treatments he raises moral questions, but on the issue of their practicality, while he finds the effectiveness of some overstated, his major concern is with the institutionalized insistence that any single method of treatment is the effective one for any given individual.

The expository achievements of this book are important, but in assessing the impact of The Evil Hours, both as exposition and argument, much of the success of this book is due to the skill with which David Morris has managed its form. This book is a blend of personal memoir and journalistic investigation. In the hands of a less skillful writer that could have made for an emotionally uneven, desultory and confusing book. But Morris has blended those different genres to create a form that perfectly mirrors the path by which he has approached his subject as well as his contextual point of view about PTSD. In comparing healing in “traditional” societies to Western medicine, Morris writes about how shamans and healers were often trauma survivors themselves. “In the West today, the opposite is true. It is the most protected, the most insulated, the most innocent who are presumed to be the most knowledgeable about loss, terror, and moral chaos.” In The Evil Hours, our guide, the investigator of the territory, is a survivor, not an academic or a clinician, but an Everyman who has an intellectual curiosity to find out about what it is he has experienced and continues to suffer from. He is not willing to leave the field to those holed up in particular fortresses of expertise and circumscription, but rather insists that this is a human, interdisciplinary, and existential inquiry, one that thinking men who have suffered it might address. Morris is an empathetic and companionable guide, one yearning for understanding and for hope, and that makes for a close connection with readers.

The theme that this book contributes most passionately to the public discussion we must have about PTSD is Morris’s insistence that we not lose sight of the moral questions at the heart of PTSD: His fear is that PTSD diagnosis will be “morally neutered by psychiatry,” that we would come to disassociate the disorder from the violence and war that are the causes of this kind of trauma. Morris describes how after becoming, according to his clinician, “non-compliant” with his Prolonged Exposure therapy, he asked for an alternative and was put in a cognitive therapy group where he at last met a group of fellow PTSD veterans. It is some of Morris’s finest writing. In a single paragraph it represents simply and forcefully the spirit that animates this important and moving book:

“Yes, at first glance, this was what should have been a depressing scene, and yet I was secretly elated. This was a room of suffering, a room filled with enough anxiety to power a small city, filled with guys who had paid a lot for daring to sign up, probably a lot more than they’d ever expected to pay, but to me it was a room filled with a strange kind of almost poetic beauty: something we are so rarely allowed to see in this world, trauma and loss and the work of history written on the human face. It might’ve just been the odd buzz I got sometimes after an evening formation in the Corps, a kind of churchy feeling, but there was, it seemed to me, something noble about the scene before me, heroic, in the ancient Greek sense. This room, I saw suddenly, was part of the journey, a way station on a great odyssey: some of us were going up, some of us going down, but all of us in the room, every one of us, whether we wanted to or not, were going somewhere.” 

Please join us on Wednesday night at 7:00 p.m. at the Buena Vista branch as author David J. Morris discusses his memoir. Copies of the book will be available for purchase and author signing, and refreshments will be served.

The Burbank Public Library has invited Mr. Morris to appear here to celebrate its creation of a special collection of books for veterans, which will be available in late February at the Central and Buena Vista branches. This collection was made possible by a generous donation from the Friends of the Burbank Public Library.

Reviewed by RTKO

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