Military looking for ways to predict PTSD

Two days before shipping off to war, Marine Pfc. Jesse Sheets sat inside a trailer in the Mojave Desert, his gaze fixed on a computer that flashed a rhythmic pulse of contrasting images.

Smiling kids embracing a soldier. A dog sniffing blood oozing from a corpse. Movie star Cameron Diaz posing sideways in a midriff top. Troops cowering for safety during an ambush.

A doctor tracked his stress levels and counted the number of times he blinked. Electrode wires dangled from his left eye and right pinky finger.

Sheets is part of a military experiment to try to predict who's most at risk for post-traumatic stress disorder. Understanding underlying triggers might help reduce the burden of those who return psychologically wounded — if they can get early help.

PTSD is a crippling condition that can emerge after a terrifying event — car accident, sexual assault, terrorist attack or combat. It's thought to affect as many as one in five veterans returning from Afghanistan and Iraq.

Military doctors have been mystified as to why certain warfighters exposed to bombings and bloodshed develop paralyzing stress symptoms while others who witness the same trauma shake it off.

Studies on veterans and civilians point to some clues. Childhood abuse, history of mental illness and severity of trauma seem to raise a person's risk. Having a social net and a coping strategy appear to offer some protection.

However, none of the factors explored so far are reliable predictors.

"Right now, we can't determine with certainty who will and who won't develop PTSD," said Paula Schnurr, deputy executive director of the Department of Veterans Affairs' National Center for Posttraumatic Stress Disorder. "Perhaps with better measures, we can get closer."

Earlier this year, a quarterly publication from the national PTSD center found that studies to date have looked at only "a narrow band of the potential risk and resilience predictors" and that more work beyond surveys was needed.

New PTSD studies are using technology to try to get at the answer. Select Marine and Army units are undergoing a battery of physical and mental tests before deployment including genetic testing, brain imaging and stress exams. They are followed in war zones and upon return.

There's an urgency to detect early signs. Since the 2001 terrorist attacks, more than 1.8 million U.S. troops have fought in Afghanistan or Iraq. The Obama administration is weighing whether to increase forces in Afghanistan where violence has escalated in recent months.

Previously called shell shock, combat fatigue and post-Vietnam syndrome, PTSD was officially recognized as a mental disorder in 1980. Sufferers experience flashbacks, nightmares, sudden outbursts and social withdrawal and are sometimes haunted years after the trauma.

The ongoing wars have given scientists fresh opportunities to follow service members.

One autumn morning, a throng of Marines squeezed into a trailer at the Marine Corps Air Ground Combat Center in Southern California before deploying to Afghanistan. They belonged to the 3rd Battalion, 4th Marine Regiment — nicknamed the "Thundering Third."

"We're doing this not to make you better prepared to go do what you have to do in Afghanistan. We're not doing this to make your health any better," said Dr. William Nash, a retired Navy psychiatrist and study co-investigator. "We're doing this so that we can learn more about how to protect Marines from stress injuries like PSTD."

Nash asked how many have heard of PTSD. A half dozen raised their hands.

Who wants PTSD? "Right, nobody," he answered rhetorically.

The trailer soon buzzed like a factory, with Marines rotating from one test station to another in an assembly line. They donated blood, urine and saliva samples so researchers can search for genetic biomarkers that might play a role.

Groundbreaking research published last year on adult survivors of child abuse suggests that specific variations of a gene increased their chances of developing PTSD. Scientists believe there may be many other gene variants that contribute to PTSD risk.

Marines also underwent a blink test to gauge their startle response and neuropsychological screening. They filled out questionnaires and were interviewed by psychiatrists with a checklist to diagnose PTSD.

The work is funded by the Marine Corps, Veterans Affairs and Navy Medicine. Last year, about 1,000 Marines were recruited before leaving for Iraq.

This latest batch of 673 Marines who were tested during a two-week period in the fall headed to Afghanistan where they're sure to see more intense fighting. They will be followed up in the field by Navy corpsmen with special "stress first-aid" training to read early signals.

Researchers recently did six-month follow-up testing on some Marines who returned from Iraq. It will take time to analyze the results, said the study's lead investigator, Dr. Dewleen Baker of the VA San Diego Healthcare System.

Cmdr. Bryan Schumacher, the 1st Marine Division's top doctor, said the purpose of studying PTSD triggers is not to bar someone from service. If it turns out that something can be done to prevent it, those vulnerable could get special training to reduce their risk, he said.

Similar research is ongoing 1,300 miles away at the University of Texas at Austin where scientists have collected detailed health data from 178 soldiers from nearby Fort Hood who recently came back from Iraq. The base was the scene of a massacre on Nov. 5 when an Army psychiatrist opened fire, killing 13 people and wounding dozens more.

The shooting has not affected the research, which enrolled first-time deployed soldiers. Unlike the Marines, the soldiers filled out monthly questionnaires online while in combat that tracked their experiences such as whether they saw a roadside bomb go off or knew of a wounded buddy.

Before deployment, soldiers submitted a DNA sample, had an MRI scan of their brain and inhaled carbon dioxide as part of a stress reaction test.

Early results suggest soldiers who reacted more strongly to the CO2 test and who were exposed to more stress in the field showed greater PTSD symptoms, said chief researcher Michael Telch, of UT Austin's Laboratory for the Study of Anxiety Disorders.

The decision to volunteer in the Marine experiment was personal for Lance Cpl. Jaecob Kyllo. His grandfather fought in Korea and Vietnam and two uncles served in Operation Desert Storm. They spoke less afterward and would get irritated easily.

Kyllo said his uncles were diagnosed with PTSD and suspects his grandfather had it too.

"I've seen it before and it's not the most pleasant thing," said the 20-year-old from Seattle, who previously served in Iraq.

Melvin Carter, a 27-year-old Marine sergeant who had done three tours in Iraq, noticed buddies who were once laid-back turn angry after coming home. The Oakland, Calif., native copes with stress by laughing and cracking jokes.

Navy corpsman Benjamin Reinhardt was recently trained to look for signs of PTSD in 20 Marines attached to a mortar platoon. He likened his job to a school nurse. Marines confide in him about their innermost struggles. He thinks he can spot when someone is not himself.

"I tend to be reasonably observant with people's personalities. I can see changes," said the 21-year-old from upstate New York.

He added: "I hope none of us become PTSD casualties."

Sheets, a 22-year-old private first class from Newark, Del., has never seen combat before. Before joining the Marines, Sheets dabbled with college and was working a dead-end job hauling trash.

He enlisted after being inspired by a sermon from his pastor. While in infantry school, he met a sergeant who suffered from PTSD. He's not exactly sure what it is, but has heard horror stories.

"A guy comes home from war and he's freaking out. He's beating his wife. He's drinking. He's doing everything he can. He'll go off and he'll hate the Marine Corps," Sheets said. "And it's just like, OK, is that going to be me when I come home?"

Sandra Price on November 20, 2009 - 2:59pm

Why not bring all our soldiers home and stop sending them to a nonwinnable war in the first place? Bringing these torn men and women home without any help reminding them of the love they left and traded for action in a hell hole of misery. We cannot win in the Middle East and we should not try. Will we go through another 2000 years trying to kill for Jesus Christ? Remember, we send our brightest and best to these wars and they come home spent, bent and sick. Are we not lighting the fires of extinction of our species?

Will we stand by and watch our species dissolve into potential mental idiots. We started this action in Korea, Vietnam and now the Middle East. I want my kids home, safe, in one piece and loving. The strength of America is with these young soldiers. God Damn our government for destroying them in the name of America and Jesus Christ. It is nothing but a biblical religious sacrifice. Hell I lost half the men in the previous generations to wars that brought no peace to America. We will end up like every other losing nation who could not stop killing for liberty.

Our government is using and abusing all Americans for their greed and power. It is time to say NO MORE!!!

griff on November 20, 2009 - 3:11pm

How about you stop using experimental vaccines on them?

Sandra Price on November 20, 2009 - 4:47pm

The last time I looked we were discussing Uranium getting into our soldiers systems. Depleted they said it was but I'm not certain. Blackrain was a blogger here and I read some of his books. He knew about this. But that was years ago and we have no people with new fears. I have no idea who your words were directed to.

Sandy

woody188 on November 20, 2009 - 10:57pm

DU is used in most of our armor piercing rounds because it burns very hot and will go through armor like butter.

It does have some side effects, or collateral damage, whatever. (Not for weak stomach. Shocking images.)

Kent.Shaw on November 21, 2009 - 9:51pm

"Depleted Uranium". You just have to love military nomenclature. There is NOTHING "depleted" about "depleted uranium". Uranium, fully decayed, or depleted is LEAD, which is not radioactive. Depleted uranium is highly radioactive (I know, not when compared to weapons grade 95% pure uranium) and nothing you want to even be near, let alone when it hits armor plate and "spalls", as they say.

Kent Shaw

Carl Nemo on November 21, 2009 - 4:33pm

A good idea would be to give mandatory polygraph tests to subjects that have been identified as risks to security and their fellow servicemen.

So when Major Hasan began to show instabilities he should have been rousted and administered a polygraph test as to his allegiance and sentiments concerning jihad etc. There are also drugs that can be administered along with this test to insure that there's minimal chance of beating it with tacks in the shoe and other such ploys; ie., drugs that will lower one's resistance to sensitive questioning.

The CIA along with other high level agencies administer such tests to applicants and also to employees that have shown up on their radar screen concerning possible security issues post employment.

If the serviceperson refuses the test then they get a summary General Discharge. Simple as that. Get'em out of the service. Our military doesn't have time to coddle and screw around with nutjobs that represent a threat to their fellow servicemen and women. By my standards Major Hasan should have been given the boot long before this tragedy, but the bleeding hearts continue to screw around until a disaster such as this occurs.

The Virginia Tech massacre could have been averted by a proactive administration. Cho Seung-Hui, the shooter's writings and bizarre classroom mannerisms and behavior over a period of time should have caused a high yellow alert to professors with the necessary referral to staff for resolution. Of course this didn't happen and the rest is tragic history.

I'm providing a link concerning Cho's classroom behavior etc. and the concern on the part of at least one professor and surely others that didn't come forward.

http://www.cnn.com/2007/US/04/17/vtech.shooting/in...

Carl Nemo **==

Kent.Shaw on November 21, 2009 - 9:54pm

Surely, you are not suggesting general discharges for soldiers suffering from PTSD?

Kent Shaw

Carl Nemo on November 22, 2009 - 5:58am

Hi Kent Shaw et al.,

No, not for soldiers genuinely suffering from such trauma. I'm suggesting a General discharge for a soldier that should fail a security screening associated with an investigation based on threatening behavior and also linked with terrorists, jihad and other such dangerous activities.

Major Hasan was never in a combat zone. This was to be his first tour, but had acted quite erratically over many years.

He wanted out of the service and was willing to reimburse the Army for his medical training, but they said no way.

If the Army had used due diligence using polygraphs, interviews etc. determining that Major Hasan was a danger to himself and his fellow soldiers then he only deserves a General Discharge because he did not fulfill the requirement of his contract, not because he's mentally unbalanced, but the fact it's determined that he has an agenda based on his religious beliefs and allegiance to Islam. Why should he get an honorable discharge? He would not fulfill the terms of his contract ripping off the U.S. taxpayer for his medical education which would allow him to live quite well in years to come.

Of course other situations would require possibly a different, more benign dispensation towards the serviceperson. Genuine PTSD as a function of those that have been in combat is not the issue, but simply lone, possibly deadly assailants imbedded within our U.S. forces that may have plans to do harm to others.

Carl Nemo **==

almandine on November 21, 2009 - 11:33pm

A little over the top on this one, eh?

Carl Nemo on November 22, 2009 - 6:00am

How so Almandine?

Carl Nemo **==

almandine on November 22, 2009 - 9:12am

Well, I agree with Kent on the discharge idea, and I'm wondering how much you know about PTSD. Nutjobs is the farthest thing from what they are. Post-Traumatic to a fault... having lived individual nightmares from which there is no escape. Watching their comrades-in-arms explode before their very eyes, only to have it happen again tomorrow. Blood and gore - scared shitless - no where to turn - again and again.

This Hasan character had not even experienced trauma from which to be Post-Traumatic. It's all a ruse... or monumental ignorance.

My experience with PTSD includes 3 or 4 close friends from the Vietnam days... a Navy medic attached to the Marines, an Air Force guy turned ground-pounder for lack of better timing, and an Army forward observer, as well as my Dad, who laid wire for communications ahead of the front lines advancing across Germany in WWII. Each and every one scarred with the FEAR and personal sacrifice that the ravages of death and its smell can bring at any moment.

No Carl, these guys aren't nutjobs. In fact they must be very, very sane. What else would such experience in hell leave behind?

Kent.Shaw on November 21, 2009 - 9:47pm

How to predict PTSD? Hmmmmm. I wonder what would happen if we sent a guy on 3 or 4 or 5 battle tours into the Middle East and/or South Asia. I have a great idea! Let's do it and see what happens.

Kent Shaw

Carl Nemo on November 22, 2009 - 6:32am

Hi Kent,

The rise in PTSD is a function of having a professional military. With no draft in place to build our forces to a size necessary so successive rotations aren't necessary isn't a popular idea. I believe we should have a draft in order to bring the violence of war home to Mayberry, USA a "bigtime". Such an action would cause the necessary public outrage to possibly end these adventuristic "police actions" that are destroying both lives along with the huge wastage of national treasure.

I'm personally against a fulltime professional military during wartime that depends too heavily on reservists who leave their civilian sector jobs regularly to wage war. This sends people time and again to zones of conflict, then reinserting them into society.

Recently I talked with a woman who's husband, a reservist has voluntarily done multiple tours in Iraq. She is awakened in the night with him beating the crap out of her, acting as if his position is being overrun etc. She's terrified of him. I met the guy. He's surly, distant and has averted eye contact. I can tell he's got loose boiler plate and I'm not doing the necessary analysis he seems to need desperately. Why does he do multiple tours? Simple, he likes the bucks and the adventure of being away from his wife and kids no doubt. He's become a "combat zone junkie" no different than many other addictions. Money and 'action' is what he craves. Meanwhile he's damaged himself and has become dysfunctional relative to his wife and kids.

His story is one of thousands of returning "pro" vets returning from Iraq. The Bushistas engineered this war along with both poor "Rumsfeld" grade planning and undermanning the conflict, now we're stuck the resultant damage to our soldiers and families.

Carl Nemo **==

almandine on November 22, 2009 - 9:17am

"The rise in PTSD is a function of having a professional military. "

I must disagree again... but multiple tours couldn't help but make matters worse.

PTSD is a function of combat... period.

Carl Nemo on November 22, 2009 - 12:44pm

Hi Almandine,

True, actual the cause of PTSD is combat, but it's the relentless reassignment to these zones of conflict due to the limited pool of combat ready GI's that's pushing more and more men over the top. More battle ready men, the less rotations which would preclude too many months in a combat zone turning G.I. Joe's into rabid squirrels.

My Dad who passed away Veterans day several years ago age 87 was in Normandy +8, "the Buldge", the Ardennes etc. He was shot up, sent to England then sent back to the zone his last command running a POW camp. He was later called up again for Korea, but luckily it was winding down so he didn't see any serious combat.

I come from a family of five, four boys, one girl. He ran our household like a POW camp with us having to stand inspections in our bedrooms. If we didn't get it right he dumped everything on the floor making us do it over and over until we got it right. He inspected our homework, our fingernails, our general cleanlisness and deportment. You only reached once at the dinner table past anyone without getting your first and only fork stabbed into the back of your hand...OUCH! You learned quickly to obey and to better each and every day. He didn't drink and oddly, smoked one cigarette per day on the back veranda at 7:30pm each night?! He abused my mother and us 24/7/365. The doctor's called if "psychoneurosis" in those days and he needed serious meds, but failed to medicate. Us kids all grew up straight, all of us going on to make a career of the military as officers representing all branches of the service except the U.S. Coast Guard. My sister is married to a physician in Atlanta.

I alway remember his admonition to "us kids" mind you, that "inattention to detail will get one killed in combat" among many others. He whipped our butts from pillar to post and it only took "his look" to give us his thoughts on what he expected. On occasion we'd get whipped for no reason or by mistake. When we complained or whined, he's simply say it was for "general principles"! Yep I know about living and growing up around victims of PTSD; it ain't "Ozzie and Harriet"... :D

"Attention to detail...attention to detail"... : |

Carl Nemo **==

almandine on November 22, 2009 - 6:41pm

I only had one brother and I was the oldest... living up to the standard must have been the watchword of those days. How many ass bustings??? Tell me about it.

Yeah, you've seen it, it was called neurosis in those days, but nobody knew why. God and country, duty, responsibility... suck it up and get on down the road.

Really, that's all there is now, but that stern discipline and fastidious behavior have been replaced by victimhood, denial, and deflecting blame. There really is a reason, even PTSD, but so what?

Suck it up and get on down the road.

Carl Nemo on November 22, 2009 - 8:06pm

Thanks Almandine for your understanding reply.

I'm ashamed that I misspelled "Bulge" wrong this AM along with my opening use of "actual" instead of "actually", lastly "he's" instead of "he'd".

If my dad were still alive he'd be giving me a piece of his mind even at 87 for spelling "Bulge" wrong along with the other mistakes. Three mistakes and I'm "dead" no doubt. / : |

I was rushed this AM and had to go to Portland. This is a case of me not paying attention to detail and I would surely have had to pay with my life or my mens' too by his standards; ie., in a combat situation, no excuses allowed!... ; )

Carl Nemo **==