To Heal PTSD in US Soldiers, First We Have to Heal America, Says Sebastian Junger

Sebastian Junger investigates PTSD in US troops and finds war may not be the root cause, but rather the painful transition from platoon communalism to the fractured individualism and social divides of modern society.

Sebastian Junger:  PTSD is a confusing phrase I think for a lot of people. I mean first of all it’s not just something that soldiers get. It’s not just something that happens at war. Life is traumatic. There are car accidents, children die of cancer. I mean all kinds of horrible things happen to civilians and they wind up with a long term traumatic reaction which is just as crippling as what could happen to soldiers in combat. So it’s important to remember this is just the human condition that we’re talking about. When I was covering war in the nineties I had never heard of the term PTSD. I didn’t know that there were long term psychological consequences to trauma. And so when I came back from Afghanistan in 2000, I was there a year before 9/11 with the Northern Alliance under Ahmad Shah Massoud. I spent two months in the north and back then the Taliban were a real military force. I mean they had fighter planes. They had an air force. They had tanks. They had everything. And so fighting the Taliban was a really daunting proposition and we got hammered a few times.

And I came back to New York pretty altered actually but I didn’t know it. I was a young man, I didn’t think anything really affected me. And I was fine until one day I went down into the subway and unexpectedly I had the first panic attack of my life. Everything was going to kill me. The trains were going too fast and were going to jump the rails and somehow plow into me. There were too many people on the platform and they were going to somehow turn on me and attack me. The lights were too bright. Everything was too loud. I knew I wasn’t in danger but it felt like I was in enormous danger and I was absolutely terrified. And I finally ran out of there and walked to wherever I was going. And I kept having panic attacks in small places where I was confined and couldn’t leave. For months later I had no idea it was connected to combat. I mean I wasn’t in a situation like that in combat so I didn’t know that they were connected. But in fact it was. And I was having what’s called short term acute post-traumatic stress disorder. It’s a survival adaptation.

I was having all the reactions that you want to have if your life’s been in danger. You want to react to sudden noises. You don’t want to be in situations where you don’t have control. Small confined spaces with too many people, too much going on. That’s a dangerous situation. You want to be a little bit depressed. It keeps you quiet and out of harm’s way. You want to be quick to anger, it makes you prepared to fight. All the things we associated with PTSD have real survival value in a situation of great danger. The problem happens when that acute PTSD turns into a long term disorder that can last even someone’s lifetime. And at that point it doesn’t have survival value. It actually has negative value. I mean it gets in the way of leading a healthy life. And that’s chronic long term PTSD. It’s not adaptive. It’s not healthy. It’s the opposite. And that is the problem that America is trying to solve with some of its soldiers.

Most of the U.S. military is not face to face with their enemy. Even at OP Restrepo, a combat outpost that I was at off and on for a year those guys were in an enormous amount of combat. We never once saw the enemy. There were muzzle flashes. They got shot at, whatever. A lot of stuff was going on and there were casualties but they actually never were – they never saw the enemy. And most of the U.S. military is not in combat. Only ten percent of the U.S. military is actually in combat. But the curious thing is that when you bring these soldiers back to this country a much larger percentage than ten percent experience pretty intense psychological distress. It can’t be trauma because they weren’t in combat. So what is it exactly? If you look at Peace Corps volunteers who obviously aren’t in war zones but they’re living in small tightly bonded communities in the developing world. And when they come back something like 25 percent of Peace Corps volunteers go into a serious depression. Soldiers even if they weren’t in combat and most weren’t, soldiers experience a very similar communal life within their platoon.
Each person is essential to the group. The group is essential to each person. It reproduces our evolutionary past very, very closely. They do everything together. They eat meals together. They sleep in the same area. They live a communal in the sense primitive existence. That feels really good. And when people come back from circumstances like that be it the Peace Corps or the military or what have you, when they return from a situation like that to modern society it’s psychologically very, very hard and the depression rate is very high. Soldiers call it PTSD because that’s the term that is current in society right now. But actually and I’m not a psychologist my guess is that a fair amount of those people actually weren’t traumatized and what they’re actually experiencing is a painful radical transition from communalism to the sort of individualism of modern society and it doesn’t feel good.

Drone warfare is an interesting example of how you don’t have to be in danger to be traumatized. And in fact what researchers have found is that the most traumatizing thing to human beings is witnessing harm to others, witnessing dismemberment, witnessing people being killed, particularly women and children. But even enemy combatants. Seeing harm and dismemberment to other human beings is extremely disturbing. And I know from my own experience the times that my life has been in danger those incidents have changed me but I wouldn’t say that they’re traumatizing me. The things that have really remained in my mind and can pretty quickly bring tears to my eyes are the times that I’ve seen other people suffering or other people dead, people who should not be dead. And civilians, children, that kind of thing. And so now think about drone operators, you know. They’re in an air conditioned room somewhere in Nevada or at least that’s where I picture them but wherever they are. They’re in an air conditioned room with a joystick flying drones around halfway around the world and deciding when to annihilate a group of people on the ground. They’re playing God.

And not only are they playing God, they’re playing God in a situation where they themselves are not in danger. And I think on some level as tactically sensible as drone warfare is, on some level I think to the actual pilots it might feel a little bit dishonorable. Like you’re killing people without being in any danger yourself and that sense of, you know, is this honorable or not actually can be – that question can actually be kind of traumatic. I know from talking to psychologists who studied Vietnam one of the most disturbing ideas was that we might not be fighting an honorable war over there. That was really disturbing to people in ways that having a bullet go by your head isn’t that disturbing. You can recover from that pretty quickly. And so for drone operators the fact that they have an elevated rate of PTSD, they have the same rate of PTSD as people who fly combat missions in the arena of combat in actual airplanes. So that’s something very profound about humans and in some ways it says a good thing about humans. That we’re that deeply disturbed by doing harm to others I think sort of allows us to see a glimmer of hope for the human race.

I often look at this country through the eyes of soldiers who have fought for us all. And I know that out there, I know this because I’ve see it. Out there there are literally no distinctions of race or politics or religion or anything. People in a platoon in combat are valued for how they act not for their race, their beliefs, whatever it may be. It’s a weird egalitarian utopia in that sense. And they come back to a country which is really at war with itself. Soldiers fight for this country and come back to a country that’s fighting itself. And I imagine – I’m not a vet so I don’t know firsthand but I imagine that is incredibly demoralizing. You have political parties, political leaders who are literally accusing each other of being an enemy of the state, of actively trying to harm this country. You have people mocking their own president. You have political leaders who are actually suggesting that certain segments of the American population of U.S. citizens aren’t as sort of legitimate and deserving as other segments. Whatever your political beliefs surely that is an insult to our shared idea of democracy and equality. And when soldiers go overseas to fight for those ideals and come home to watch a country that can’t agree on them and, in fact, is endangering itself through this behavior it must be incredibly demoralizing. And again I’m not a psychologist but I know a lot of soldiers who have gone through a lot of stuff and I’ve gone through a lot of stuff with them and I imagine that along with the other psychological stresses that come with combat there’s this other horrible psychological stress that happens when they return home and they see what we’re doing to each other. And if only for their sake I wish we’d stop it.

Posttraumatic stress disorder (PTSD) can strike almost anyone. It is the unwanted souvenir of experiences like car accidents, violence, witnessing death, tragic destruction, and all the things in between that most don’t want to think about. But perhaps its most common association is with war, where the condition is seen over and over again in soldiers to the point of cliche, although many of them don’t know what’s happening to them. The stigma of mental illness in America coupled with the thick-skin culture of the military means that many soldiers don’t talk about these things, and don’t share the pain of what they went through with family and friends.

PTSD wasn’t officially recognized until 1980, and even when Sebastian Junger – journalist and author of several books including his latest, Tribe: On Homecoming and Belonging – was reporting on war in the 1990s, he had never even heard of it. Even after he spent two months in a combat zone in Afghanistan in 2000, he didn’t understand the nature of his panic attacks on the subway when he returned home. It wasn’t until he suffered these feelings for some time that he realized trauma could have long-lasting effects.

The fight or flight panic of a PTSD episode evolved as a survival aid, sparking within someone all the instincts they need to survive, but there comes a point when it only serves as a negative impact and an impediment to a normal life.

Junger returned to Afghanistan again in 2007, spending a year with a platoon in the Korengal Valley, turning his experience into the award-winning documentary Restrepo. Sparked by his own experience and the experiences of the many soldiers he knew, Junger book Tribe examines the PTSD phenomenon and debates whether it is expressly experiencing trauma that causes the disorder, or whether the root cause is something else. After all, approximately 20 per cent of the US military suffers from PTSD even though only 10 per cent of soldiers ever experience combat. Drone pilots, who operate from a safe distance with the push of a button, experience the same rate of PTSD as soldiers in direct combat. Junger believes the disorder might not be related purely to the experience of war, but the homecoming after the war.

In experiencing the close-knit tribal relationships between soldiers, Junger discovered that all the usual prejudices of race, class and sex are nullified within a military platoon. The day-to-day life soldiers share – eating, showering, sleeping, working, and surviving side by side – is so unifying that these typical social divides are bridged by brotherhood. But when it’s time for soldiers to come home, they return to an America that is torn apart by racial violence, mass shootings, political voices that actively seek to wall out certain groups, hateful rhetoric, and such grave social division that their homeland somehow has become more alien to them than the foreign land they fought in. Is this what they were fighting for? A country at war with itself? Junger argues that this widespread social conflict, in direct opposition to the camaraderie they experienced during their service, is perhaps what shocks veterans most deeply.

Sebastian Junger's book is Tribe.

Photos: Courtesy of Let Grow
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The surprise reason sleep-deprivation kills lies in the gut

New research establishes an unexpected connection.

Image source: Vaccaro et al, 2020/Harvard Medical School
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  • A study provides further confirmation that a prolonged lack of sleep can result in early mortality.
  • Surprisingly, the direct cause seems to be a buildup of Reactive Oxygen Species in the gut produced by sleeplessness.
  • When the buildup is neutralized, a normal lifespan is restored.

We don't have to tell you what it feels like when you don't get enough sleep. A night or two of that can be miserable; long-term sleeplessness is out-and-out debilitating. Though we know from personal experience that we need sleep — our cognitive, metabolic, cardiovascular, and immune functioning depend on it — a lack of it does more than just make you feel like you want to die. It can actually kill you, according to study of rats published in 1989. But why?

A new study answers that question, and in an unexpected way. It appears that the sleeplessness/death connection has nothing to do with the brain or nervous system as many have assumed — it happens in your gut. Equally amazing, the study's authors were able to reverse the ill effects with antioxidants.

The study, from researchers at Harvard Medical School (HMS), is published in the journal Cell.

An unexpected culprit

The new research examines the mechanisms at play in sleep-deprived fruit flies and in mice — long-term sleep-deprivation experiments with humans are considered ethically iffy.

What the scientists found is that death from sleep deprivation is always preceded by a buildup of Reactive Oxygen Species (ROS) in the gut. These are not, as their name implies, living organisms. ROS are reactive molecules that are part of the immune system's response to invading microbes, and recent research suggests they're paradoxically key players in normal cell signal transduction and cell cycling as well. However, having an excess of ROS leads to oxidative stress, which is linked to "macromolecular damage and is implicated in various disease states such as atherosclerosis, diabetes, cancer, neurodegeneration, and aging." To prevent this, cellular defenses typically maintain a balance between ROS production and removal.

"We took an unbiased approach and searched throughout the body for indicators of damage from sleep deprivation," says senior study author Dragana Rogulja, admitting, "We were surprised to find it was the gut that plays a key role in causing death." The accumulation occurred in both sleep-deprived fruit flies and mice.

"Even more surprising," Rogulja recalls, "we found that premature death could be prevented. Each morning, we would all gather around to look at the flies, with disbelief to be honest. What we saw is that every time we could neutralize ROS in the gut, we could rescue the flies." Fruit flies given any of 11 antioxidant compounds — including melatonin, lipoic acid and NAD — that neutralize ROS buildups remained active and lived a normal length of time in spite of sleep deprivation. (The researchers note that these antioxidants did not extend the lifespans of non-sleep deprived control subjects.)

fly with thought bubble that says "What? I'm awake!"

Image source: Tomasz Klejdysz/Shutterstock/Big Think

The experiments

The study's tests were managed by co-first authors Alexandra Vaccaro and Yosef Kaplan Dor, both research fellows at HMS.

You may wonder how you compel a fruit fly to sleep, or for that matter, how you keep one awake. The researchers ascertained that fruit flies doze off in response to being shaken, and thus were the control subjects induced to snooze in their individual, warmed tubes. Each subject occupied its own 29 °C (84F) tube.

For their sleepless cohort, fruit flies were genetically manipulated to express a heat-sensitive protein in specific neurons. These neurons are known to suppress sleep, and did so — the fruit flies' activity levels, or lack thereof, were tracked using infrared beams.

Starting at Day 10 of sleep deprivation, fruit flies began dying, with all of them dead by Day 20. Control flies lived up to 40 days.

The scientists sought out markers that would indicate cell damage in their sleepless subjects. They saw no difference in brain tissue and elsewhere between the well-rested and sleep-deprived fruit flies, with the exception of one fruit fly.

However, in the guts of sleep-deprived fruit flies was a massive accumulation of ROS, which peaked around Day 10. Says Vaccaro, "We found that sleep-deprived flies were dying at the same pace, every time, and when we looked at markers of cell damage and death, the one tissue that really stood out was the gut." She adds, "I remember when we did the first experiment, you could immediately tell under the microscope that there was a striking difference. That almost never happens in lab research."

The experiments were repeated with mice who were gently kept awake for five days. Again, ROS built up over time in their small and large intestines but nowhere else.

As noted above, the administering of antioxidants alleviated the effect of the ROS buildup. In addition, flies that were modified to overproduce gut antioxidant enzymes were found to be immune to the damaging effects of sleep deprivation.

The research leaves some important questions unanswered. Says Kaplan Dor, "We still don't know why sleep loss causes ROS accumulation in the gut, and why this is lethal." He hypothesizes, "Sleep deprivation could directly affect the gut, but the trigger may also originate in the brain. Similarly, death could be due to damage in the gut or because high levels of ROS have systemic effects, or some combination of these."

The HMS researchers are now investigating the chemical pathways by which sleep-deprivation triggers the ROS buildup, and the means by which the ROS wreak cell havoc.

"We need to understand the biology of how sleep deprivation damages the body so that we can find ways to prevent this harm," says Rogulja.

Referring to the value of this study to humans, she notes,"So many of us are chronically sleep deprived. Even if we know staying up late every night is bad, we still do it. We believe we've identified a central issue that, when eliminated, allows for survival without sleep, at least in fruit flies."

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