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What are You Responsible For? Navy SEAL Eric Greitens on Resilience

When he watched his close friend, one of the toughest of the tough in his Navy SEAL basic training class, fall to pieces after deployment to Afghanistan, Eric Greitens knew he had to write a book on resilience.

Eric Greitens: Everybody has to deal with hardship. Everybody has to deal with struggle. And there’s this great quotation from Hemingway, “The world is a hard place and the world breaks everyone,” he said. “And many are strong at the broken places.” Now people often remember this phrase strong at the broken places, but it’s also important to remember his qualifier — many. Not all are strong at the broken places. And some people when they confront hardship actually end up in a place where they’re helpless. Some people are broken by suffering. Some people are actually really hurt by pain in such a way that they can’t move forward. But it’s also the case that some people deal with hardship and become heroic. And one of the things that I’ve tried to do in these letters to my friend is actually show him what you have to do in a really practical way to actually build resilience and be heroic. Now one of those things is that you have to learn how to take responsibility.

If there was a single question that you can ask someone to measure how resilient they’re going to be, you ask them what are you responsible for? And what you find is that even in the most difficult situations when you look at stories of people who have been prisoners of war, for example, people who survived said I’m going to take control of my thoughts or I’m going to take control of the way that I breathe. There are certain things even though my freedom has been taken away from me, that my ability to eat, where I live, all of these things have been taken away from me, I’m still going to control something. And when you focus on actually taking control of something and what happens is your circle of control begins to widen and people begin to see that even in the face of hardship and difficulty there’s a way for them to build power and live a purposeful life.

So this book came when I was driving down Highway 70 in the middle of Missouri and my buddy Zach Walker called me. Now Zach is a tough kid from a northern California logging family. He was in my BUD/S class, my Basic Underwater Demolition SEAL training class. And even in a SEAL training class he was one of the toughest of the tough guys in this class. And we stayed friends after we left the training. He went to the East Coast; I stayed on the West Coast. And he came back from a deployment in Afghanistan and when he came back things were going all right at first. He was a good father to his two young kids. He bought a concrete pumper. He started a small business. And then his life was just hammered by hardship. What happened was his brother died; he lost his business. Then one day he drove his truck into his driveway. He got out of the truck and fell to the ground because he believed that there was a sniper watching him. And he lay there for hours until the sun went down and then he got up and he ran into his house and he realized he had post-traumatic stress disorder. And then he started drinking and on the weekend it was not a six-pack, but a cooler full of beer that he was working on.

And he called me after he’d been arrested. So we had this guy who was a Navy SEAL war hero coming home from Afghanistan who now is the unemployed alcoholic on disability who’s looking at having his kids come to visit him in jail. And we talked a lot that night. When I got home I started writing him a letter. He wrote back to me and we did this for months with letters back and forth. And the book now is a series of edited letters to my friend Zach Walker about how you can take a lot of this wisdom that’s in our philosophical and religious traditions, how you can take a lot of wisdom from your own experience and use it to build a resilient life.

Navy SEAL Eric Greitens, author of the new book Resilience: Hard-Won Wisdom for Living a Better Life explains the series of events that led him to write the book. He recalls how a close friend, also a SEAL, fell to pieces after deployment to Afghanistan. Resilience takes shape as a series of letters Eric wrote to and received from this friend. Their correspondence shines a light on how academic knowledge based in philosophy can be merged with life experience to overcome strife and build up defenses against trauma. Greitens discusses the process of becoming broken and how even the ostensibly strong still need strategies for dealing with hardship.

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  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
  • Early treatment is available but there's been no way to tell who needs it.
  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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