that you have to make the population among whom extremists or terrorists are residing to make that less hospitable and less of a viable option. >> i unfortunately have to bring this to a close now but you can join us after for a conversation at a reception outside this room. the book is available for purchase and i suspect signing as well. i would invite you all to come back next week when heather cox richardson of boston college will be speaking on march 2 on her new book. my thanks to our audience and thanks to pay for for a very, very engaging talk. >> thank you. [applause] ..

next on booktv's "after words." war correspondent and former marine infantry officer david morris sits down with iraq war veteran and a rand corporation's kayla williams. the two talk about the history of post-traumatic stress disorder and the 27 million americans including david morris

himself who currently suffer from ptsd. ms. williams is also the author of plenty of time when we get home, love and recovery in the aftermath of war. >> host: i am kayla williams. i'm a combat veteran of the iraq war and the spouse of a wounded veteran. my second book chronicles my family's journey after my husband sustained a traumatic brain injury in iraq and develop post-traumatic stress disorder. so it is both with personal and professional interest that i'm tremendously pleased to sit down today with david morris and have a conversation about his new book "the evil hours" a biography of post-traumatic stress disorder. thanks so much for joining me today. >> guest: thanks for having me. >> host: i wonder if he could start about the telling me about yourself and why he wanted to write this book. >> guest: it's difficult to answer. in some ways i had always lived in the shadow of ptsd most of my

early adult life because my first adult years were in uniform. i spent 10 years in uniform including rotc so i was vaguely aware of the idea of ptsd that it was something soldiers were associated with and furthermore my dad was a vietnam veteran. i grew up in suburban san diego. i felt like i really grew up in the shadow of vietnam. it was part of the conversation and part of sort of this lingering shadow of my childhood. so i always have a general awareness of it and then they served in the military and was certainly familiar with the idea of ptsd. in 2004 i was out of the marine corps at this point and was an embedded reporter in iraq. i came back and noticed immediately getting off the plane in california and just feeling very different. going to a bar in looking over.

my best friend took me to this bar near the airport and we went to this club and an intimate scene. i remember looking at the people and i could tell everyone is drinking and talking and socializing and just as they had before as if nothing had changed and i remember there was no particular reason to feel angry or upset but it struck me that i had changed. i remember oddly not being suddenly very bored and uninterested with what was going on inside the barn i left. i stepped out and i think i went to the local liquor store. one interesting thing about san diego is all of the liquor stores are run by call the in iraqi's. the owner of the store was from baghdad so i ended up talking with him. i was just off the plane not really fitting in and what do i do? i walk out the door and there

were some iraqi and he's from baghdad. it was this very strange feeling that i felt from my earliest days. i was also angry about the war and how it had been prosecuted. i had been at the tail end of the first battle of fallujah and i had seen marines for my old regiment that were explaining to me what they saw as really gross mismanagement, poor leadership and completely irrational policymaking decision process that they had lost men as a result of this. a few weeks later abu ghraib happened and no wmd and then i was then iraq returned in july 2004 and a few months later in november george w. bush was reelected so for me that was a very difficult process to understand that americans would in light of everything that happened in all of the lies that

have been exposed in 2003 in 2004 it was difficult for me to accept that people would in the face of the knowledge of that information turn and reelect the person that had put us there in the first place. as i began researching and i begin to develop symptoms of my own. there was a movie theater in 2009, fast ford briefly hours in a movie theater that an action movie and there was an ied explosion that closely resembled one that i was and that was shot from the point of view of where i would be in a humvee. so bad in the cinematic experience was overwhelming for me. i actually sort of blacked out and when i regained full consciousness i was in the hallway of the cineplex. i stuck back in the theater. no one else was having this difficulty and i asked my girlfriend at the time what happened? there was an explosion in the movie and you are now. i began to sense on a personal

level but not all was right upstairs and i did not have full control of my memories. one irony from the book having ptsd was like having memories gone wild taking on their own life. so that was one of the impetus is for me to examine ptsd not just on a personal level but also as a historical entity. i was curious like a lot of people a lot of marines and veterans i thought of ptsd is a copout as a shortcut to having a more authentic honest emotional engagement with your service and your post-war service. i thought it was a way to dodge responsibility until i started looking into it until i started having the symptoms. what i discovered briefly is that the original people who

fought for the ptsd diagnoses in the 70s felt similarly to how i felt. the founder of this group vietnam veterans against the war which is the group that advocated for the ptsd diagnosis in the 70s, they saw the founder saw in his view there was no distinction to be made between the politics of vietnam in their own personal psychological struggle. out of that conversation and that acknowledgment came to ptsd diagnosis that we have today. >> host: your book is a really ambitious synthesis of the personal historical literary and scientific aspects of ptsd. you just touched on the history of it being conceptualized in the modern era and given its current name but what do you think is the most interesting thing you have learned about the vast history of what we now call ptsd? >> guest: interestingly like a lot of people i assume ptsd has been around since 1980 so as long as cable television and i

assume like a lot of people it was recognized then but it was his mortal permanent thing that it was a central human condition and was always out there. when i began researching it i found that is not exactly the case. for instance jared diamond who is a geography -- geographer at ucla has spent a lot of time with the tribes of new guinea and the mckinney and tribes are thought to be some of the best preserved pre-scientific human societies. he discovered that post-battle travel warriors often have nightmares and the nightmare something you can find in the furthest reaches of human history. >> host: very common in current ptsd. >> guest: a write-down some people consider to be the signature symptom of seat -- ptsd the nightmare. there are parts of it that are theoretically immortal universal and central to her current

symptoms but there other aspects that have evolved and that's one of the arguments i make in the book. coulter is more important in biology in ptsd. >> host: how people experience it. >> guest: yeah how we are trained to experience the manifest symptoms and the flashback is considered to be one of the cardinal symptoms of ptsd but in the early 2000 a group of researchers from king's college went back and examine the memoirs and accounts of soldiers who had served before and discovered that the flashback was really not there in these accounts. and furthermore if you look at the accounts of civil war veterans they are far more likely to describe their intrusive symptoms as visitations by spirits, ghosts and demons. interestingly the american civil war period with a far more religious time than our own so there is the sense you get that the time period and the culture

at the time does influence how people manifest their symptoms. now in the flashback which i alluded to earlier was originally a term borrowed from day era of the world of film to describe a break in the chronological flow of a story. interestingly it appears as if cinema and film have become so central to how we conceive of human consciousness that is part of how ptsd works. so there are to answer the question historically there are aspects that appeared to be universal and their other aspects that appeared to be under the influence of society that they emerge from. it's an interesting mix of both immortality and long-standing history and then also in evolution. i was really surprising. this flashback is a permanent thing but in fact it has evolved. >> host: what do you think modern veterans and other

survivors can learn from reading literature? >> guest: in the book i argue for instance the iliad which is the foundation of literature you do see the evidence of ptsd. jonathan shea his work on vietnam were some of the things that change the conversation about ptsd and war trauma. and the survivor's guilt so there is this evidence you can find and i think that's a lot of veterans today, the idea of this achilles who was a super warrior this ultimate veteran in a lot of ways that someone like that could suffer psychological distress after war can be very comforting. it's this very old thing. people have suffered for as long as human beings have fought each other which is forever.

so i think and in the book i argue that literature is a very powerful medicine and something that psychiatrists in particular don't think much about and certainly don't dwell on the value of tim o'brien's works were phil claeys works that literature has an extraordinarily powerful impact in a measurable medical impact in terms of teaching you bringing you in closer touch with your on interstate your own sense of emotions and naming them for one thing. a lot of veterans are unable to because the military trains you to function and to focus on mission completion at the expense oftentimes of introspection and inner thought. novels in particular poetry and literature generally offer people the experience to number one understand that they are not alone and their struggles are the struggles of immortality and

secondarily to get a greater sense of the emotional life and the ways that a person can conceptualize their story and think about their own war experience. i personally learned a lot by reading tim o'brien's and getting a greater sense of how tim o'brien and his other books as well and if i die in a combat zone taught me a lot about what is coming home experience was like. so there is this, in many cases actual psychotherapy that you read about the most powerful impacting psychotherapy that the va uses to treat ptsd across-the-board often focuses on this idea of narrative of discovering your therapist helping you find your story and a way to conceptualize yourself as a person in the world. literature is basically a

training session and good books explain and help us understand how stories can be told. a lot of people if you grew up on television and film which is less emotionally rich in a lot of cases you don't get that emotional, you don't develop that emotional iq and get a sense of how a story can be told and how it veterans story can be told. for example it's useful to look at, after the trojan war he wanders for years. he's literally homeless which in some ways this is a metaphor for the homecoming experience and the idea of travel as a medicine. to understand and to see how that works and how people can find themselves through wandering and how that played out can be extraordinarily powerful. it's measurable and this is something a high school english

teacher will say read books novels will save your life. but scientists and psychologists have measured the impact in particular they found reading the book, reading a novel was one of the most effective ways to prepare. for a4a give reasons there is a scientifically measurable impact that novels have on people. >> host: your book is not a novel but i want to read a small excerpt from it if you don't mind. i would love for you to share with us. >> guest: this is from the second chapter and what i was trying to do here was after some brief memoir of materials was to step back and examine the larger world. part of my idea of the book was to get as close to the idea of ptsd in the symptoms and the research and the same time step back and try to conceptualize it

within the larger philosophical framework. in terror shadow. we are born in debt owing the world a death. this is the shadow that darkens the cradle. trauma is what happens when you catch a surprise glimpse of that darkness the coming annihilation not only the body and mind but also seemingly of the world. trauma is the savagery of the universe made manifest within us and it destroys not only the integrity of consciousness the myth of self-mastery and experience of time but also our ability to live peacefully with others. almost as if there were a virus pathogen content to do nothing besides replicate itself in and the world. over and over until only the remains. drama is the glimpse of truth that tells us a lie, the lie that love is impossible that peace is an illusion. there've been medication can ease the pain but neither can

the venom from the blood and makes the in m.'s -- the survivor on c. the surface. >> host: thank you. one of the things that struck me in that passage was you are referring to trauma trying to replicate itself and that i noticed in several other places in the book you almost give agency to things talking about the universe scheming to wipe us out in the world is designed to herd us. i wondered if you think that is an example of apathy may i you talk about, seeing patterns in things and if you believe in fate? >> guest: patterns that aren't there. i think with respect to the first question i think one of the reasons i wanted to write the book was the biography of post-traumatic stress disorder and one of the problems i had when researching the topic was i found most of the journalism

relating to ptsd and indeed much of the science simply recounts in recapitulates the symptoms and gives us general ideas about how it exists in the world how it manifests in the symptoms of hypervigilance and emotional numbing and does some accounting on that. but i wanted to -- that began the book with an excerpt from norman mailer's book where he talks about how disease has a life of its own. this applies to all pathology. cancer has a life and an intention and a mind all its own. all we see when we look the symptoms and exterior parts of it and we look at his resume and how to exist in the world and what it does in terms of how it manifests itself in the skin and the interior parts of a human being but it has its own intentions. it has its own way of being in the world. i was interested to note come to think about and anthropomorphize ptsd and drama as this idea is

this being in the world that enters the body and its agenda on us. in particular i compare it to a virus and i want to be careful because i think we have over medicalized ptsd. i don't look at as strep throat. >> host: is contagious. >> guest: it is in some ways. depending on how you treat the metaphor does have is contained just a aspect and when you talk about the cycle of violence and what freud called the repetition compulsion you find war veterans, wars are often infrequently waged to fix or to adjust or improve upon the legacy of the last war that was fought. we invaded iraq because we didn't finish the gulf war in some peoples people's minds. there is that relationship of one trauma exact exacting itself, exacting a toll and on another level repeating itself

in trying to re-create itself another way. people that come from abusive families or they were traumatized by over loved ones find themselves in situations where they repeat the trauma inadvertently, unconsciously. there is the spiral aspect of trauma that's fascinating and really unnerving when you think about it. he continues to repeat itself in viruses and i'm not a cancer researcher but speaking to some researchers recently there is this idea out there that viruses exist only to replicate. that is their major function. that is one of their main purposes in life to the idea of trauma wanting to replicate itself is something that is interesting. that is situated within the medical literature interestingly. additionally one of the ideas one of the reasons i wanted to write this book was to make sense of my war experience. i worked primarily as a journalist overseas and one of

the reasons i kept going back to iraq and i had served in the infantry in the mid-1990s, had left before 9/11 began writing and 9/11 happened. we invaded iraq. all of my marine buddies were prepared all of the people that i went to texas a&m with were there. my whole universe is deployed to as far as i was concerned. i additionally went to iraq because i felt i had always been drawn to extreme experiences. i'm a mountain air and a server and i spend time in extreme environments. i've learned a lot about myself and living as a warrior and a war correspondent is a great way of being in the world because you see society pushed to its extreme and you get insights into the nature of existence. so i kept going back to iraq because i thought there was some way i had this mystical idea that the longer he stayed there

in the closer i got to death and the longer i stayed in ramadi the more spiritual and sites i would get in the closer i would get to the rock rub of life. what are the things i discovered is the longer you stay there the more the fatigue makes its way into your body. he began to notice connections that weren't visible to you before. i delve into this somewhat in the book in a number of different ways. one of the most striking was the day before my worst ied ambush i was in a humvee with a bunch of soldiers who were all from latin america. they were in the u.s. army that they were born in guatemala and el salvador in one of the soldiers asked me have you ever been blown up before sir which as you know talking about ieds were talking about almost dying don't do that from my perspective. do not talk about ieds and how

lucky you have been this week because you are tempting fate. all of us when he asked that question got angry with him because you can't ask that. in my view that the last question you asked someone in a combat zone, have you ever been shot at because you are inviting it on yourself yourself. and away didn't didn't surprise me that i hit an ied the next day. and my way of thinking the soldier has spoken of faith so there's this mystic of connections where there shouldn't be connections and noticing patterns that weren't visible to you before. these sorts of things were a huge part of my war experience and why kept going back. i felt there was his esoteric knowledge, the spiritual insight about the nature of existence that was becoming available to me the longer i stayed there. so i reflect on that in the book book. it's clearly an altered state of

consciousness that believing those sorts of things, those dark sorts of -- that sort of magical thinking is part of the dramatic universe, the idea of this supernatural trauma throughout history is conceptualized as a supernatural experience. visitations from the other side in for me while i was there a felt there was this other side of the paranormal or the other world i was present at my work experience. >> host: thank you. so when i talk about my work's brands and my homecoming i sometimes joke going on my first book tour with my own special version of going to psychotherapy because i got to talk about the most awful things i experienced on live tv. i was at things like what's it like so i was interested to read your discussion of your

experience with former all prolonged experience at the va something you called virtually indistinguishable from torture in punitive reconditioning. i was curious if you are at all concerned that using that type of language might deter some people from seeking therapy. >> guest: possibly into backup for a second, prolonged exposure is that the a's number one individual psychotherapy. it's loosely based on the ideas of reconditioning a person. though the ideas of pavlov and other classical psychological learning theory were updated by the university of pennsylvania research, the idea of it is that they're possessed you to recount the story of your worst trauma. it's one of the most common ptsd their piece peace in the world today however research shows it

does work in 60% of the cases and most veterans to get benefits from it. i've personally had a very adverse reaction to it. what i found as i recounted the story that might ied ambush in baghdad on october 10 2007 i was asked to recount the story dozens and dozens of times into me i found no relief in that an impact what iowa i found was the same and toxins i felt in my bloodstream when i was in baghdad and ramadi, just the activation and the feeling of being on point on the knife's edge of fear. a lot of those feelings were stirred up like a fish tank. all those feelings, all the stress hormones and all of the upset in fear that had been asleep were awakened. as i did the research and before

i went to therapy at the va i didn't know anything about prolonged exposure. the va put me in this particular therapy. what i did this research i discovered that my experience, my adverse reaction was not only not uncommon but have been documented by researchers specifically harvard medical school have discovered that they had gotten very adverse reactions from vietnam veterans. the question for me became why did this happen and why is prolonged exposure is not working and why is the va spending so much money on this particular research and therapeutic -- and what i discovered were a number of things but the idea behind prolonged exposure was

originally a rape ptsd therapy and typically speaking in most cases rape is a one-time event and not an extended 15 month cumulative small traumas adding up types of traumas which is more descriptive of a combat veteran. so i think and i want to be clear the va are the good guys. they are the global clearinghouse for ptsd research in the world. they spend more time, more money and expend more resources on the problem that anyone else. they have no peers in this realm and they have come up with some extraordinarily efficient and mass produce therapies that are getting relief to veterans as we speak. however with respect to prolonged exposure that therapy fits neatly with the ministry of psychology.

it fits neatly into classical learning therapy so it appeals to researchers because it has a very clear lineage, genealogy back to the dawn of psychology and pavlov the russian physiologist. and it does work in many cases. one of my good friends a battle of fallujah veteran who saw far worse things than i did, worked wonders for him however i don't think -- i think there are a lot of side effects that are not being addressed by the va and specifically it's interesting because, in this speaks to the medicalization of ptsd which i think is one of the major problems, we treat it like we treat strep throat. we treated based on the perceptions in the research on the knowledge and the wisdom gained from people in white lab coats, from physicians who have taken us very far in terms of public health. however it's very rare to meet a psychiatrist or clinical psychologist who has been in a

combat zone. i can think of to and those two tend to be rather disinterested and not proponents of prolonged exposure. i think there's a fundamental misunderstanding of the part of the va about the nature of combat trauma. if you talk to iraq or afghanistan veterans, someone who did seven deployments to the middle east anbar in helmand province which i know several marines did seven deployments. in most cases it's not a single ied ambush. it can be excised or treated with antibiotic of the prolonged exposures. it's often dozens of events in living in the shadow of death for literally four months, four months and months and months i think there needs to be a reassessment of that therapy modality in a consideration of how to better conceptualized the idea of combat trauma is an existential event that impacts the entire individual and not

simply a one-time event that can be treated with the antibiotic of prolonged exposure. >> host: the next treatment modality you talked about was cognitive processing therapy and you refer to that as yankee optimism that solves nothing and acknowledge though that the skills and tools help to get out of bed in the morning. as you just mentioned you have some concerns that over medical icing ptsd and focusing on treating the symptoms might go so far as to encourage governments to wage war in silence trauma survivors. i wanted to dig in that a little more deeply because i can definitely understand where you're coming from with that but at the same time i can imagine the interpretation that giving people the tools to manage their symptoms actually enables them to speak so i think for example about a friend of mine who was

assaulted in the military and because of successive therapy is able to get up out of bed in the morning and leave the house and cope with traffic, take the metro and saddam capitol hill and testify before house and senate committees about the experience of military sexual assault. i wonder few which is kind of dig into that peer docs a little bit more. >> guest: you make a good point and with respect to your colleague i think that is an excellent outcome and something you want to encourage. one of the most important things to recognize about ptsd is that it is a moral argument. it has a moral component in that argument is this. war and rape which are both socially generated traumas. human beings acting on other human beings. there are long-term psychological enduring cost to both of those events. as a result we should be more careful in how we wage war.

we should protect women and we need to meet -- think more exhaustive wing clearly about how women are treated in society and do a better job than we are in the military and civilian life to protect women and their safety. there's a moral component to ptsd that is important to recognize. before ptsd was recognize people that you are killed or wounded and afterward he went home and put your uniform in the closet and went on with your life. there is this aspect of ptsd that should echo, should not be minimized in any way. that was one of the arguments that robert j. lifton who was one of the initial architects of ptsd was concerned. he himself was a psychoanalytic comment trained as a psychiatrist but his concern because he was working in the

70s and very politically active person he was very concerned that this moral argument, that ptsd as a moral entity as an objection to the american war-making machinery if that were treated as strictly a technical matter, treated in a medicalized manner in which it is treated today one of his first concerns as they were advocating to get this recognize was that it would be essentially morally neutered by medicine which is largely happen in my opinion. i think it's been for the better. robert lifton was very much a man of the left, an iconic man of the left but i think it would be inaccurate and a distortion to say what you have to be a lefty to get ptsd and if you are republican is not for you. as a result, since ptsd has been medicalized and mainstreamed within psychiatry and has become

treated as a biological disorder which is the tenor of research now, more biological emphasis that it is made more apolitical and made it less of an argument against war and more of a condition that arises from trauma and can be treated. so i think in all of the original architects of ptsd who all grew out of the port -- protests in the 70s mind you they were all very concerned and one of their motivations were advocating for ptsd's recognition was to decrease the likelihood of war, to think about and to step back and ask more questions of the american way of war. i think it's important to recognize that. without the protest movement without the antiwar movement of the 70s without the political context of vietnam created we would not have ptsd. there've been a number of agents in history after world war i and after the holocaust when nations and cultures like the british

and the israelis had opportunities to institutionalize something like ptsd and did not. so it's very interesting that we in america we ended up inventing this disorder for lack of a better word that came out of the protest movement of the 1970s. it's interesting. i think there is a large the moral argument of ptsd was one of the most powerfully impacting ideas for me to think about, the idea that veterans can be damaged by war and it's a cost that all of society must bear because we live in a world and you know better than most that only 1% of americans serving the military so there's this tendency to treat soldiers as ammunition and veterans as extended brass. i want ptsd to be taken seriously and i'm glad that the

media covers it with such seriousness because it is important to think about. the va and it should be a nursery of all american foreign policy. we need to think about the cost of war before we wage it. >> let's talk about the portrayal as a component of ptsd. you mentioned prevalence after natural disaster and within word you mentioned friendly fire incidents is. i do you think that's related to that feeling of betrayal and as that link to moral injury? >> guest: indeed it is and that's one of the arguments i make in the book and why i argue that culture is more important than biology. the social realm is more important than the biological realm with respect to ptsd. if you look at who is more likely to get ptsd the most toxic common form of trauma is

rape. around 50% of rape victims tend to develop ptsd in the long term. so take that figure on and then you look at warfare for example iraq and afghanistan vets and the their rates of ptsd diagnosis the best rates hover around 10 to 15% so it's relatively a quarter of what rape victims suffer. you compare that against a the blue survived tsunamis or earthquakes or volcanoes normal natural disasters. ptsd diagnoses they are tends to hover around 45% so you think about that from 50% figure with rape victims than the 5% figure with natural disasters and you compare and what is a significant difference between the two phenomenon. for rape victims is a social this idea of betrayal by the human race by people being essentially predators on other humans. that is also a component of war.

war happens but it's not a naturally occurring phenomenon. it's something that human beings do to other human beings is speaking for myself and this is why their prank on justness of the iraq war and the politics for which no cost has been assessed in the political class of the united states that was one reason for me that was a serious blow to my belief in the united states as a country. it fell to me and a lot of marines felt that from the first battle of fallujah was at the trail that they had victory stolen from them. they had been asked to go and conquer the city and halfway through they are told that it off, not a good idea and they felt betrayed. for me and were a lot of veterans, iraq veterans who are friends of mine it's the lies in the sense of betrayal by the national leadership for which there was accountability after vietnam and there's never been

accountability for the run-up to the iraq war. i know i'm speaking in some sense out of turn because a lot of people a lot of republican members of my family get very upset when i make this argument with them but for me this was one of the very strong convictions and one of the reasons i wanted to write this book. to understand how one conceptualizes politics post-war. how does the idea of the break-in social trust and you feel you have been betrayed by the society that would not protect you and fail to protect you and the man in your life that fail to protect you depending on the circumstances these issues and these vexing questions are what harmed trauma survivors. >> you write about and you quote other veterans expressing concerns about letting go of memories.

i wonder if you think it's possible to work through and release the trauma and the negative reactions associated with memories while still keeping memories? >> guest: the short answer is yes. as we talked about earlier, having retold the story of being blown up a few hundred times it's become less toxic so that's a good thing. it is easier to talk about a lot of the stuff and having written a book, one of the reasons i wrote the book is because i had questions i wanted to answer than i wanted to do it a thorough way that would be satisfying to me. that speaks to why the book turned out the way it did. but there is this aspect of the addiction to trauma and the addiction to the adrenaline the addiction to the extreme experiences and you see this with what marines often call repeat offenders, guys that

can't stop deploying that don't know how to live as civilians. i knew a number of marines when i was serving a deployment would and then they would cross that dimension and bored because they didn't want to go home. there was this feeling even among veterans who would get out and leave the service and live in stateside america of not being able to let go and being so addicted to their memories and not wanting to let them go for a variety of reasons number one because they loved us so much. it was the best moment of their lives and why would they not want to think about it and secondarily you hear a lot of veterans say my nightmares are an honor to my buddies. >> host: that was more the type of memory that i was talking about. >> guest: when think through that that's really heavy. a veteran is so impacted in the speaks to the gravity of ptsd as

it expresses itself in a lot of cases, that this veteran and i've heard people say this veteran was saying my subconscious damage is my way of honoring my buddies. it's a common thing. in some ways but i would argue for myself personally for my own personal experience one thing i realized that ptsd is therapy is helpful in yoga is very helpful and a therapy that i went through in the va was useful. i spoke to a lot of very smart people robert still a row russ karr who is a psychologist at d.a. who have really meditate on these issues and read the philosophy and read the literature and thought through this on a deep level. i discovered they all influence the writing of this book and i discovered for me personally meditating on these issues was very powerful but i also decided

as a matter of post-traumatic growth of wanting to make something positive of that i needed to leave some things behind. some of the things i left behind were they idea up in some ways this book was my saying goodbye to my 30-year-old self my former marine infantry officer self my war correspondents self international man of mystery self this person i wanted to be and letting those go in saying i can't go to afghanistan and spend the next four years of my life working as a reporter there and it will be an extension of what what i have artegon but i need something new. i didn't really want to go to afghanistan because i knew the longer he stayed there it's like lost time. you can't get that time back and every day you spend deployed overseas makes it that much harder in my view to come back and live a full life.

i wanted to leave that part of myself behind. >> host: was creating this narrative a form of treatment for you? >> guest: totally and i should say it was helpful to write this book because it was a therapeutic experience. i am not against writing as therapy but i'm against publication as therapy. i think there are a lot of good books. alice seibold's wonderful narrative and she is spoken about this and i have to agree with her that you can use a journal can be an extraordinarily powerful medicine, keeping a journal and recording your feelings in processing your feelings can be extraordinarily healing but books that i'm familiar with that have sort of used the publication process as a way of merely sorting through their own form of therapy i'm opposed to

because i simply, i'm kind of a snob i guess. i like books, i like being in the hands of a writer who knows what they are doing and is not using the book simply as a way of unloading their personal issues on me. i like to have some sort of echo and a writer who has a sense of the view. >> host: what do you think is more important, the therapist or the therapy the particular treatment modality that was chosen? >> guest: to be honest the therapist. there is a lot of research that factors in to my answer to that question but interestingly a researcher in the 70s look at this question and assigned a number of therapists using different therapy mortalities to treat patients, college students. as a control this researcher

also took english professors at the university trained them with supportive therapy techniques and compared and researched the results across-the-board and found the english professors performed as well as the clinical psychology grad students. >> host: when you get a bad anecdote i couldn't help wonder if a bad experience might've been different for the different therapist or if it's the modality itself and how it intersects? >> guest: i think it's a combination of things but i think interestingly anyone who has looked at the randomized clinical trials that have been done on therapy and therapy is incredible. it's a constellation of factors and scientist assigned to zero in on the research and isolate factors but the research has shown that report that occurs between the therapist and the patient is the most important

factor. interestingly the va has minimize back and rolled out these therapies designed to be one-size-fits-all and elaborately mammon -- minimalize the therapy alliance. i do think, and i talked to gary greenberg who is in new york -- new yorker blogger in the smart therapist. this complaint is enacted by a there be officials of a interviewed, that the art of therapy is really one of the most important things. with any art form people say the art of therapy you can't really train for that but if you look at row grahams around the united states and the nea you can institutionalize intangible artistic emotionally smart therapy. it's not impossible and any art form can be institutionalize in a way.

so there is a way out and away to do that but americans as a whole prefer hard science fixes two things and the va to their great credit has rolled out these seven supported treatment which minimize the artistic side of therapy. their rationale which is a good one is they are trying to get as many treatments to as many beds as possible. they are doing that but there needs to be some account made for the artistic softer less tangible, less scientifically provable ideas of the art of therapy. >> host: you talked about shaman as some in your book and you also talk about the concept of post-traumatic growth. i was wondering if you could maybe delve into those concepts a little bit more and see if you

have any thought that either/or both of those can be linked to the use of peer counselors. just go i think what's interesting one of my goals in the book was to delve deeply into research literature and discover what i could about the epidemiology of the etiology and the origins of the disease which largely comes from psychiatry and psychiatric research so that is sort of the weeds but i wanted to step back as far as i could from a problem and still be on the planet earth and think about it to ask the question where of all the disciplines and ranges of human human experiences where does ptsd fit in and if there is a sort of a lego structure of human experiences. what i discovered and it fits into mythology and pre-scientific thought rather neatly trauma has always been with us. we know a lot about it and how it impacts the brain from

science that human beings have had opinions about trauma for a long time. they have just use different names for it. one of the things i discovered that he asked the question how our homecoming and the aftermath of diseases treated? how our heroic journeys treated in mythology and the larger pre-scientific cultures quickly discover is there is a dramatic journey off and the heroic journey is discussed by joseph campbell. the idea and in the hair with a thousand faces just as campbell discusses the journey of the schama -- the shaman. some describe a faith healer or politician someone who is often called to the role of the shamong by a germanic near-death experience by a close call with disease or a close call in the

wilderness. shamans were people that had survived and been out and come back to the mainstream come back to the tribe the village with the sacred knowledge that they had achieved in that altered state. interestingly when you step back and look at the larger history that's one thing we have exactly reversed in the va today and the medical establishment today. we look towards people that are the most sheltered that is spent most of their lives in academia and have i would argue some of far lesser knowledge of the dramatic universe from personal experience so they tend to look at things from a particular point of view which originally, and near-death experiences were looked upon as a source of wisdom and insight and mystical perception and growth. there was the idea and there is with them this one hindu subset

of that there is this idea of being traumatized as being a positive thing. which completely inverts the modern idea of trauma as a war veteran being damaged goods. the idea of post-traumatic growth as i began looking at looking into the research and experiences of ptsd i discovered and how i came to the conclusion myself personally that we tend to over precise the pathology of the war experience. one good friend of mine and iraq war veteran told me he feels the united states has passed college as the entire veteran experience and over precise the negative parts of it. we tend to address veterans as damaged goods too much. what i discovered is that there are a number of people and i include myself in this subset of people that found the war to be a growth experience in many

ways. there were certainly negative impacts from my wartime experience but i discovered and i interviewed my cousin who took an 80-foot fall in the canadian rockies in 2010 and nearly died. he took that moment of his near-death as an attempt, he took that as an opportunity to recalibrate his life and his words to fix some things in his life that he wanted to change. for him and he didn't really dwell on it. he had nightmares but he didn't blow on the diagnoses, the ptsd idea. he focused on okay i almost died when i was on this ledge in mt. temple. i had these thoughts and i was reflecting on my experience. i have a better perspective on how i want to live my life now and i want to achieve some things that i had not paid enough attention to. as a result he moved to colorado

and started this philanthropic organization and changed the trajectory of his life in many ways. i think a lot of veterans can learn from that experience. you survived the war. that's the craziest while this most extreme of their experience that human beings have engaged in. you have seen history in the first person. what wisdom can you derive from your continued survival and your perseverance in the face of insanely long odds. a lot of the hanoi hilton prisoners of war came away with 60% of the u.s. air force prisoner of war veterans from hanoi hill described it as a positive spiritual experience. so that is a possibility. >> host: i fully agree with that. one of the things when you talked about the hanoi hilton survivors was the social bonds that they had and also the societal recognition of their experience when i got home.

i was wondering what else do you think can be important for facilitating resilience and recovery? >> guest: they hanoi hilton is a unicorn of research literature. they have a strikingly low lifetime ptsd a fraction. very low when you think about john mccain who was imprisoned for five and half years and endured torture at the extreme end of what has ever been measured and yet a lot of those were positive experiences. when you look at those people who are older and have been trained and prepared in many had been to a mock prisoner of war course beforehand so there was preparation that occurred. if you think about it in terms of my perspective as a marine officer, atop the school tends to produce the best soldiers. if you embark on training that

is arduous and not abusive but very arduous and pushes people to their limits within reason you tend to have a person who is more prepared to work stream adversity, deployment stressors and traumas of various kinds. i do find that to be the case. special operations groups and this is somewhat debatable, they tend to have a lower ptsd diagnosis and the reason for that people think it the training is tougher. i have a particular view of what i think helps people but working with a stare strap -- stairstep approach can build resilience. a lot of what researchers examined and what causes ptsd is the concept of surprise or seeing something that you were not prepared for so it surprises you and you feel helpless. that feeling of helplessness of being completely overwhelmed and being completely crashed like a

great -- glacier by your environment are the things that tend to produce drama. if you can contract that feeling and give a personal sense of agency in and a sense of optimism in control of their environment you reduce the likelihood of ptsd. researchers interviewed veterans of the hanoi hilton cohort found that optimism which is really weird but the idea of being optimistic and positive and looking for the upside in your experience is oftentimes what helps build resilience in the long run just the feeling of we are going to make it out of this, we are good by family loves me and i have this great team with me. all those factors help mitigate it. >> host: i'm very pleased we have managed to end the discussion on a difficult topic topic on somewhat of an up note. thank you so much for joining me today. guess we'll thank you for having me.

>> that was "after words" booktv's signature program in which authors of the latest nonfiction books are interviewed by journalists, public policymakers and others familiar with their material. "after words" airs every weekend on booktv at 10:00 p.m. on saturday, 12 and 9:00 p.m. on sunday and 12:00 a.m. on monday. and you can also watch "after words" on line. go to booktv.org and click on "after words" in the booktv series and topics list on the upper right side of the page. >> marc goodman thunder the future crimes in sudan senior adviser to enter paul talks about the criminals corporations and governments are using technology to disrupt the lives of people around the world. it's next on booktv.