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We can count the dead. We can see physical injuries. But in soldiers returning home, it's hard to see the psychological damage among those who have witnessed the blood, heard the screaming, felt the shattering blast and smelled the burning flesh. Unless they make sense of what they saw and felt under fire, they'll continue to relive the experiences of war. Fortunately, the human brain--which evolved in an environment of constant physical threat--is so resilient that horror is usually contained. Most soldiers do not require professional help. But when coping fails, so does recovery.
In the first three months after a trauma, survivors need to be reassured that they will recover. By talking about their memories with family and friends, soldiers can begin to find meaning in their experience. They discover the pride in their sacrifice and they grieve their losses. Talking should be encouraged, but some veterans prefer not to be pushed, and that wish should usually be respected.
Unfortunately the natural healing process sometimes fails. When survivors become depressed, angry, guilt-ridden or emotionally distant--all possible symptoms of posttraumatic stress disorder--treatment is critical. Drug therapy often includes antidepressants, which can alleviate the core anxiety symptoms of PTSD. Stress can exacerbate almost any mental disorder, so a psychiatrist may also prescribe a mood stabilizer such as lithium or an antipsychotic such as risperidone. Anxiety-muting benzodiazepines such as lorazepam and clonazepam may actually raise the risk of chronic PTSD if taken continuously.
Talk therapy, especially cognitive behavioral therapy, also has a role. A psychotherapist may cautiously encourage the trauma victim to confront ideas and situations, both real and imagined, that trigger symptoms. Treatment may even include virtual-reality devices that re-create the experience of combat. Talk therapists often encourage patients to manage their anxiety with relaxation methods, such as meditation or breathing exercises, and with distraction techniques that shift attention away from distressing thoughts. Ultimately the survivor must come to terms with how the trauma has changed his or her self-concept, relationships and aspirations.
We may never be able to expunge memories selectively from consciousness, but some researchers are investigating ways of helping the brain soothe the pain of recollection. Beta blockers, which blunt the adrenaline response to stress, may reduce the intensity of emotions associated with traumatic memories. And a technique called repetitive transcranial magnetic stimulation seems to activate the prefrontal cortex, a brain region believed to be responsible for putting memories in context.
Still, the best treatment is a successful reintegration into civilian life. Storytelling can help turn traumatic alarm signals into tolerable autobiographical memories. And when the dreadful memories are accompanied--as is likely--by memories of loyal friends loved and honorable tasks completed, emotional distress can be transformed into emotional growth.