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Writing About Anguish Beyond Words

Question: How do you resolve the tension \r\nbetween the\r\nimpossibility of conveying war’s horrors and the need to try?


Tim O’Brien: Well, through story, \r\nessentially.  The hope is that, when you do what I\r\ndo, and you write novels, you are hoping for a sense of feeling to come \r\nthrough\r\nin the end.  That through\r\nnon-fiction, the brain is engaged and the head is engaged primarily.  Not always just that, but\r\nprimarily.  And with fiction,\r\ntelling invented stories, the hope is that through the story, the reader\r\n lying\r\nin bed at night, or reading the book on the subway, or the bus, will \r\nsort of\r\nleave the bus or leave the bed and be transported to Madame Bovary’s\r\nbedroom.  And you’re kind of there,\r\nhalf a witness and half a participant in a story.  And\r\n my hope is that those who read "The Things They\r\nCarried," to my other books too. \r\nYou hope that they’re feel a certain identification thing that \r\nhappens\r\nin a story, where you’re rooting for people, you know, or hoping the \r\nvillain is\r\ncaught, or your emotional take on—you’re in it, not just observing it \r\nthe way\r\nyou observe CNN, or observe the Fox Channel with disgust.


Question: How do you resolve that same \r\ntension in your own\r\nlife?


Tim O’Brien: I don’t think I’ve ever tried \r\nto\r\nresolve it.  It’s just one of those\r\nthings that just kind of resolves itself. \r\nWhen I speak about Vietnam, or when I write about it, I’m not—my \r\nown\r\nselfhood kind of evaporates.  I’m\r\ninterested in what’s occurring on the page and I’m interested in what’s \r\ngoing\r\nto become to these characters and I’m interested in the moral struggles \r\nthey’re\r\ngoing through.  And I don’t—My\r\nattention is on the making of an object, in a way.  In\r\n an artifact, the way a sculpture may look at a piece of\r\nstone.  And you may have a vision\r\nfor what you want that stone to become, but part of what you do is just,\r\n the\r\nstone kind of leaves you to what it’s going to become.  A\r\n vein of minerals may run through it,\r\nand ah, that’s there, that could become this.  And\r\n that’s a bit like writing fiction.  A bit of \r\ndialogue may pop out of a\r\ncharacter’s mouth that’s unplanned, and unintentional on my part.  I have no volition over it, it seems to\r\nappear.  I know that it’s coming\r\nfrom somewhere inside my head and my history and my imagination, but it \r\ndoesn’t\r\nfeel as if I’m willing it and making it happen by volition; it’s\r\nappearing. 


Stories have a way of pulling you along, kind of \r\nchasing the\r\nstory as you are writing it, and it doesn’t feel as if I’m playing that \r\nold\r\nchildhood game of connecting dots, that they’ve all been planned and I’m\r\n just\r\ngoing to write sentences to connect it all.  It \r\nfeels more as if I’m on a riverboat and watching people\r\nand scenery go by, and the novel, or story, as that feel of a voyage in \r\nwhich\r\nI’m partly a participant and partly a witness.


Question: Do you feel fresh anguish when \r\nwriting about\r\nanguishing experiences?


Tim O’Brien: I wish I could say yes, because\r\n it would sound\r\nso much "Big Think-y," but the act of writing for me is largely the act \r\nof\r\nfollowing sentences and making sentences. \r\nAnd for most people that probably is the time to click off and \r\nlook at\r\nsomething else, but unfortunately for me, stories grow out of a \r\nsentence.  For example, the sentence, "This is\r\ntrue," began one of my stories.  I\r\nwrote the sentence and had no idea what was true, true in what sense I had no idea.  Then I wrote \r\nanother sentence to follow\r\nthat: "A buddy in Vietnam named Bob Kiley."  Well,\r\n I’m partly discovering and I’m partly just curious\r\nabout or fascinated about issues of what could be true and what is the\r\ncharacter going to say is true, and does this character really mean it?  Does he really mean it’s true?  And\r\n to what degree does this character\r\nthink it’s true?  And how can\r\nanybody say "this is true" without a little tongue-in-cheek action going\r\non?  So, it’s a discovery, and what\r\nI think is one of my better stories grew wholly out of the unplanned, \r\nout of a\r\nscrap of language.  It’s forgotten\r\nby readers, I think, or largely forgotten, that there are 26 letters in \r\nthe\r\nalphabet and some punctuation marks and that’s all we’ve got.  And that is what I work with sitting in\r\nmy underwear, day after day, year after year.  I \r\nuse 26 letters and these punctuation marks.  And \r\nout of that, characters come and\r\nmoral quandaries are explored.  But\r\nin the end, the work of writing unfortunately is really the battling \r\nwith A, B,\r\nC, D, and that comma which is so incalcitrant.

Recorded March 22, 2010
Interviewed by Austin Allen

How to convey the horror of war to someone who’s never witnessed it? It’s language, not the pain of remembering, that makes the task so hard.

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Predicting PTSD symptoms becomes possible with a new test

An algorithm may allow doctors to assess PTSD candidates for early intervention after traumatic ER visits.

Image source: camillo jimenez/Unsplash
Technology & Innovation
  • 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.