Prologue: The Warning
Have you ever been blown up before, sir?
Everything was fine until it wasn’t.
Apophenia: finding patterns where there shouldn’t be patterns
These were the words I wrote in my journal on October 9, 2007, the day before I was almost killed by a roadside bomb in Baghdad. The last line I wrote in the days afterward. Later, I went back and underlined it in a different colored ink, as if to emphasize that I had come back to it in a different state of mind. As if I were leaving a clue for some future version of myself.
I was in Iraq for my third reporting trip and had gone out on a patrol with some soldiers from the First Infantry Division into Saydia, a neighborhood that seemed, at least on the surface, to be relatively peaceful. On our way back inside the wire, one of the soldiers asked nonchalantly if I’d ever been blown up before. I considered the question for a moment, and then, as the silence deepened, I sensed that something was amiss. The words came awkwardly as I explained that while I had spent the summer before in Ramadi, at that point the deadliest city in Iraq, I was still a virgin in that particular area.
It was like my fate had been spoken: I had never been blown up before, but everyone in the Humvee knew that was about to change.
According to the laws of grunt superstition, I was the injured party, but somehow I managed to feel bad for the kid who’d asked the question. As it happened, the soldiers in the Humvee were from all over Latin America — Peru, Mexico, Guatemala — and they began pummeling him in a variety of languages and accents for what he’d done.
At the time, I felt embarrassed more than anything else and just wanted the moment to end. I didn’t like being the topic of conversation, and it took everything I had to avoid thinking about being blown into tiny red pieces. This, in fact, was one of the first head tricks I’d learned in Iraq, to systematically ignore the obvious: you were always just about to die — get over it. I was wasted, too, and my mind wasn’t right. I had been in Iraq for a total of nine months by this point, and even though I had seen people killed by roadside bombs, I’d never been hit myself, and somehow I’d come to feel that I had my luck under control. But in posing the question, it was as if the soldier had stolen that control, thrown me over to the forces of chance that I had worked so hard to insulate myself from.
Later, I interviewed a prominent psychoanalyst, who told me that trauma destroys the fabric of time. In normal time, you move from one moment to the next, sunrise to sunset, birth to death. After trauma, you may move in circles, find yourself being sucked backwards into an eddy, or bouncing about like a rubber ball from now to then and back again. August is June, June is December. What time is it? Guess again. In the traumatic universe, the basic laws of matter are suspended: ceiling fans can be helicopters, car exhaust can be mustard gas.
Another odd feature of traumatic time is that it doesn’t just destroy the flow of the present into the future, it corrodes everything that came before, eating at moments and people from your previous life, until you can’t remember why any of them mattered.
What I previously found inconceivable is now inescapable: I have been blown up so many times in my mind that it is impossible to imagine a version of myself that has not been blown up. The man on the other side of the soldier’s question is not me. In fact, he never existed.
The war is gone now, but the event remains, the happening that nearly erased the life to come and thus erased the life that came before. The soldier’s question hangs in the air the way it always has. The way it always will.
Have you ever been blown up before, sir?
Over the past four decades, post-traumatic stress disorder has permeated every corner of our culture. A condition that went unacknowledged for millennia, and began its public life with a handful of disgruntled Vietnam veterans “rapping” in the offices of an antiwar group in midtown Manhattan in December 1970, has spread to every nation on the globe, becoming in the words of one medical anthropologist a kind of “psychiatric Esperanto.” A species of pain that went unnamed for most of human history, PTSD is now the fourth most common psychiatric disorder in the United States. According to the latest estimates, nearly 8 percent of all Americans — twenty-eight million people — will suffer from post-traumatic stress at some point in their lives. According to the Veterans Administration, which spends more annually on PTSD research and treatment than any organization in the world, PTSD is the number one health concern of American military veterans, regardless of when they served. In 2012, the federal government spent three billion dollars on PTSD treatment for veterans, a figure that doesn’t include the billions in PTSD disability payments made every year to former servicemembers.
Since the attacks of 9/11, when public awareness of the disorder gained momentum, PTSD (a condition characterized by hyperarousal, emotional numbness, and recurring flashbacks) has, to the dismay of some international aid experts, supplanted hunger as the primary Western public health concern when a war or other humanitarian crisis hits the news. PTSD is one of the newest major psychiatric disorders to be recognized, and yet today it has entered the public lexicon to the degree that it is not uncommon to hear journalists describing entire countries as being stricken with it and writing lengthy articles debating whether or not Batman might be suffering from it. Consumers who are so inclined can now go online and purchase a commemorative patch for $5.99 that reads P.T.S.D.: NOT ALL WOUNDS ARE VISIBLE. As any trauma researcher will tell you, PTSD is everywhere today.
And yet, like many mental health disorders, there is broad disagreement about what exactly PTSD is, who gets it, and how best to treat it. There remains a small but vocal cadre of researchers who argue that PTSD is a social fiction, a relic of the Vietnam War era foisted upon the global community by well-meaning but misguided clinicians, and that by, in essence, encouraging people to be traumatized, we undermine their recovery. A condition born of strife, PTSD is dominated by conflict in its scientific life as well. There is, however, little disagreement that survivors of rape, war, natural disasters, and torture — the events that are generally recognized to lead to PTSD — experience profound, even existential, pain in the aftermath of such events. This brand of suffering has become so widely recognized that it has in fact permanently altered the moral compass of the Western world and changed our understanding of what it means to be human, what it means to feel pain.
Pierre Janet, a French neurologist writing in 1925, observed that emotional reactions to traumatic events can be so intense as to “have a disintegrating effect on the entire psychological system.” This book is about that effect and what it looks and feels like from the inside. Over time, PTSD has changed not only the way humans understand loss but also how humans understand themselves generally; I am interested in