In lieu of an editorial for this issue, I wish to share my opening remarks from the 3rd Annual Symposium on PTSD hosted by Maine VFP Chapter 1 in Portland, Maine on June 7th. The preceding introductory comments are by VFP co-founder, Doug Rawlings:

Maine Chapter 001’s third annual symposium on PTSD this past June 7th featured four speakers: Michael Uhl, Penny Coleman, Tod Ensign, and Rosemary Masters. Our audience of 85 included health professionals, veterans and their families. The focus this year was on the family: how do those who support PTSD sufferers cope? What can we do to support them? Coleman provided the perspective of a Vietnam veteran widow who has done extensive research on PTSD and veterans’ suicides; Ensign gave us a legal perspective on how the current VA system is disserving today’s active duty soldiers and veterans; and Masters provided us with her experience as a neurobiologist and a psychotherapist who has worked with families trying to cope with PTSD. Michael Uhl set the tone for the conference with his opening remarks – “PTSD from the Inside-Out” –which wove together the politically charged atmosphere of PTSD issues in this country with the impact of PTSD on the personal lives of veterans and active duty soldiers. His own narrative brought the audience into the full meaning of the symposium: we in VFP have empathy and sympathy for those afflicted by PTSD. We have walked the walk, and now we are committed to using our own experiences to help others gain perspective on PTSD.

     I've done a fair amount of reading on PTSD, interviewed some of the major researchers and clinicians in the field, read stacks of their journal articles. It was in the mid-1990s while interviewing Dr. Daniel King of the VA's Boston-based National Center for PTSD that I first learned about late-onset PTSD. In those years, there was a sudden spike in the numbers of Vietnam veterans in their 50s seeking treatment in the VA system for war-related emotional issues, many of whom - like me - would subsequently be diagnosed with PTSD. Being something of a classifier by nature, I was happy to discover the late on-set niche as one fragile perch of certainty in my quest for some sign of external validation that this mentally disordering thing weighing me down since my return from Vietnam indeed had a life of its own. It wasn't just a mood swing or a bad day; it had threatened to become a state of being which seemed to literally drive my will toward choices that were irrational and self-defeating. Beyond that my explorations in the clinical, analytical and statistical literature did little to clarify or explain how I experienced PTSD from the inside out, in particular the sense of personal violation that seemed to fuel this raging loss of control. Reading the literature left me with a feeling I can best express, exaggeration intended, through the line of a favorite poem. “AT&T lied. It didn't bring my mother any closer.” The literature was missing what for me was a key component.

     Let me try to explain. What really struck me most deeply from my encounter with Dr. Dan King, for example, was his own story as a veteran. He was totally blinded from a wound suffered in a conventional fire fight with uniformed combatants while in Vietnam. Returning home, he completed his doctorate in psychology and began working for the VA. Dan told me that he himself does not suffer from PTSD, a fact I found extraordinary given the severity of his physical loss, and the traumatic circumstances under which it occurred. Another Vietnam veteran I know never actually set foot ‘in-country’, as we used to say. He was stationed aboard an aircraft carrier where he loaded bombs on airplanes. His PTSD is rated at 100%. What got to him was a persistent preoccupation with images in his head of those bombs he loaded exploding on the peasant villages where the carrier's jet fighters dropped much of their ordinance.

     An ex-Marine I know participated in a village massacre in Vietnam. He's as solid a citizen as you will find on this planet, but he's rated 100% for PTSD as well. I could cite many other cases of a similar nature, including my own as a combat intelligence officer routinely exposed to the abuse and torture of Vietnamese civilians. But in every case the common thread would be that our PTSD seems related, not necessarily to what happened to us - even in the instance of a most horrific wound like that of Dr. King's - but to what we did to others, especially to the unarmed and the innocent.

     We say that PTSD is really as old as war itself. But I submit to you that the historical birth of PTSD, its official insertion, bounded by specific criteria, into the DSM - the diagnostic manual - of the American Psychiatric Association circa 1980, also had to do with the way in which this age-old war and traumarelated psychic wound had itself evolved in the context of postmodern, non-conventional, counter-insurgency warfare. This is the piece, I believe, that is missing from the scientific studies, the world historical context in which this disorder, within its own military universe, has some of the characteristics of an epidemic.

     While my inferences here are admittedly anecdotal, they are not frivolously based. I've had contact with a wide and representative cross section of Vietnam veterans over the past forty years. And most of those I know who operated in the infantry in thickly populated rural zones of Vietnam, or who served as interrogators or bomb loaders, and who suffer from PTDS, are possessed of an empathy that found soldiering in those ambiguous circumstances in direct conflict with the person they believed themselves to be back in their own country, where they were regular Joes, possessed of a sense of fair play, and not inclined to bully anyone. Whereas, in Vietnam, this initial wounding - long before most of us came to define our experiences politically - only deepen depending on the script we would eventually play our day-to-day in encounters with our adversaries who appeared to us most frequently as non-combatant civilians, and we to them as the agents of the horrors of war.

     Now it's déjà vu all over again in Iraq and Afghanistan, military occupations where our soldiers once again confront a largely invisible enemy embedded in a very visible civilian population. As a predictable consequence of soldiering under those conditions, we will likely be adding over a hundred thousand new disabled veterans to the VA's PTSD roster in the years ahead - a roster, keep in mind, only begun after 1980, and till now virtually limited to veteran trauma cases of the Vietnam generation. Billions of tax dollars have already been spent, billions more will be needed to treat and stabilize the lives of these PTSD veterans, subsidies which, in many cases, will stretch over the course of a lifetime. What we call PTSD may date from antiquity, but PTSD as an acknowledged cost of war is a modern event. And, it need hardly be said, that every citizen today has the moral and civic responsibility to ask if, and under what circumstances, a given war is worth this particular cost.

     In the meantime, leaving aside the thorny larger questions I've touched on only loosely here, and the fact that the essence of PTSD remains mysterious, what we do know about this disorder is very real. We know that those who suffer it are stalked by a particular shadow which darkens their lives, and it is therefore reasonable, as well as compassionate and just, that a good deal of intellectual and professional energies among those acting in good faith around this issue must go into finding from among a wide range of techniques and therapies the means to lighten that shadow, still that hyper-vigilance, quiet the monkey talk, challenge and redirect the anti-social behaviors, ameliorate the pain.

     These efforts to heal and manage symptoms, I believe along with Dr. Robert Jay Lifton, a pioneer in this field, benefit from a reserve of resiliency in the human spirit. It is this resiliency that we must emancipate and nurture in our treatment of those with PTSD. Whereas the struggle each individual PTSD sufferer must inevitably - and perhaps perpetually - confront is, who's in control here, me or the demon?

     The other obligation assumed by the mental health community, as well as by those of us for whom the PTSD narrative is a matter of humanitarian concern and national policy, is to continue to educate ourselves, and continue to bring what we know and what we don't know to forums such as this to help inform and shape the conversation about PTSD that is taking place all over this country, as the intense, almost daily, media coverage on tragic individual cases can testify. Each of our presenters today is playing a dynamic role in that national conversation. Let us now listen to what they have to share with us.

(Opening comments at the Maine Veterans For Peace 3rd Annual Symposium on PTSD, Portland, Maine, June 7, 2008, featuring Penny Coleman, Tod Ensign and Rosemary Masters). A DVD of their presentations will be available soon from Maine chapter 1.