The Evil Hours, by David J. Morris

So...the big question is...having worked in VA hospitals...would I recommend that a combat veteran friend of mine go seek treatment there for PTSD? Well...no.

Pacific Standard

"Morris served in the Marine Corps in the halcyon 1990s, so he experienced most of his trauma not in uniform but as a reporter in Iraq. When he was embedded during the 2007 surge in Baghdad, an IED buried in a trashpile rocked Morris’ Humvee. For several harrowing minutes, a wheel of the burning vehicle was stuck in the blast crater, and Morris was trapped.

That terrifying ordeal, followed by the turmoil precipitated by his trip to the cinema, led him to the San Diego VA for treatment. There, the young clinicians were caring but didn’t much help. Morris underwent a VA-approved treatment called prolonged exposure, which entails exposing patients to their most feared experience repeatedly over several months, until the situation no longer invokes panic. Morris found PE too anxiety provoking, and quit. (In the largest study of PE in veterans, a modest 55 percent had good outcomes.)

He also underwent cognitive processing therapy, a form of group therapy aimed at clearing up distortions in thinking (i.e., the world is a dangerous place; the war made me unlovable; I need alcohol to cope). Morris found it somewhat helpful but still incomplete, and too focused on the symptoms. A fuller reckoning with trauma, he found, required treating it as more than just a series of near-death nightmares, and instead as the transformative experience it really is. “Never was I invited to think of how my experiences might be converted into a kind of wisdom or moral insight. When I did so, on my own initiative, I was admonished for ‘intellectualizing.’” Many soldiers find war, Morris writes, “to be sublime, and more than a few of them ... were suddenly consumed by a need for answers to life’s greatest questions.”

Fortunately, VA clinicians are increasingly attuned to the existential dimensions of veterans’ needs. However, there are too few seasoned clinicians to go around, and newer mental health professionals—like the ones Morris saw—are assigned to conduct one-size-fits-all, protocol-driven treatments. There is a place for these treatments, but not at the expense of encouraging suffering veterans to see returning from war as a major existential project, a struggle to “make meaning out of chaos.” By “making meaning,” Morris means telling stories, a process with “tremendous healing power” for both the teller and the listener."