American warships could be stationed permanently in Darwin as part of the United States military's strategic plan in the region, but an expert warns that will not sit well with China.
US chief of navy operations, Admiral Jonathan Greenert, said the US was considering having a permanent naval base in Australia.
Admiral Greenert recently visited Darwin to inspect facilities and infrastructure which could allow US warships to be based in the Top End.
At an address in Canberra this week Admiral Greenert said the US was "doing a study together with the Australian Defence Force to see what might be feasible for naval co-operation in and around Australia, which might include basing ships".
Australian National University (ANU) Senior Fellow Peter Dean said such a move would be part of the US plan for Asia and would add to the existing US Marine Corps presence in Darwin.
"That started off small up there in Darwin as part of the US rebalance in the region. And that's slowly increasing the number of US marines based up there in Darwin," Dr Dean said.
"The plan that Admiral Greenert put out for that marine rotational force was to grow it to what he called a marines expeditionary unit.
"That is an all-arms combined force."
China won't like it: expert
Dr Dean said any such move would be sure to ruffle some feathers with China.
"They don't particularly like having a forward US presence in the region," Dr Dean said.
The naval base would be used to refuel and repair ships - and for sailors to have some down-time.
Up to 2,500 US marines will be stationed in Darwin by 2017 under an agreement reached between former prime minister Julia Gillard and US president Barack Obama.
Dr Dean said the US troops would be good for Darwin's economy and for their Australian counterparts.
"It also provides some really good training opportunities for the Australian Defence Force," he said.
In August last year, about 1,500 US marines and Australian soldiers trained in hot and dusty conditions at a former cattle station 600 kilometres south of Darwin.
Chinese troops have trained with Australian and US forces in the NT as recently as 2014.
Indonesia has also expressed concern at US military escalation in the Top End.
Dr Dean said the warships could be based in Darwin within a few years, but the US was still investigating infrastructure requirements.
In December last year, the ADF unveiled its new $125 million joint logistics facility in Darwin, which is expected to be used to support US marines rotating through the Top End.
"My understanding is those who are in charge today see this as a potential site for doing some of that support for the marines," retired Major General Peter Haddad said.
The combination of two photos shows August Schreitmueller's sandstone sculpture "The Goodness" from the Rathausturm (Townhall Tower) overlooking the destroyed city of Dresden, eastern Germany, in 1945, left, and on Feb. 12, 2015 above a parking lot. British and US bombers destroyed Dresden's centuries-old Baroque city center on Feb. 13 and 14, 1945.
DRESDEN, Germany — Soviet troops were pressing into Germany from the east and the other Allies from the west, but for 12-year-old schoolboy Eberhard Renner the war seemed far away.
Dresden had been spared the destruction suffered by other cities like Berlin and Hamburg, and Renner clung to the hope that the Saxon capital would stay off the target list with the war so clearly near its end.
Even as air-raid sirens started screaming 70 years ago Friday, Renner's father dismissed the attack as another reconnaissance mission.
Then the bomb fell into Renner's backyard. It blew the thick oak door off the shelter where the family had taken refuge, slamming him and his mother to the ground. Somebody yelled that the roof was on fire, and they ventured out into the streets as the bombs rained down.
The Allied decision to firebomb Dresden — immortalized in Kurt Vonnegut's novel "Slaughterhouse Five" — has long been a source of controversy.
At the time, the Allies hoped the attack on a city deep in the German heartland would hit hard at civilian morale and help force the Nazis to capitulate. Some historians, however, said the destruction was a tragic waste of human life and cultural patrimony — with little to no effect on the outcome of the war.
The raid left the city littered with corpses, and tens of thousands of Dresden's buildings had been turned to rubble, including its famous opera house and museums in the historic old city. The baroque Church of Our Lady, appeared initially to have survived, but, weakened by the intense heat, it collapsed two days after the bombing under its own weight.
As Renner wandered the streets of Dresden, he saw a dead body for the first time in his life. In the days to come, he would see many more. Renner remembers the streets still being littered with bodies a week after the attack and coming across the corpse of a woman in a square.
"She was burned to a cinder, had become very small, but her hand was held up and on it was her gold wedding band, shining, not blackened at all," said the 82-year-old retired architecture professor. "I will never forget this scene."
It was not just the bombs dropped by the waves of British and U.S. bombers that wreaked devastation. The fire made superheated air rise rapidly, creating a vacuum at ground level that produced winds strong enough to uproot trees and suck people into the flames. Many Dresden residents died of collapsed lungs.
Renner's family made it safely to the home of one of his dentist father's patients. They were able to stay the night and regroup. After that they moved in with an uncle.
Nazi propaganda from 1945 put the death toll at 200,000 and after the war some scholars estimated as many as 135,000 were killed — more than the combined total of those immediately killed by the nuclear blasts in Hiroshima and Nagasaki.
After neo-Nazis began inflating the figure further, talking of 500,000 to 1 million victims of a "bombing Holocaust," the city established an expert commission to investigate. It concluded in 2008 that closer to 25,000 people were killed in the attack.
Whatever the number, Renner mourns the victims as friends, schoolmates and neighbors. Even if the Allies thought it would shorten the war, he said he thinks the bombing was unjustifiable.
"To sacrifice 25,000 woman and children, innocent people for that? That's a war crime," he said. "We started the war, but it is a war crime."
Published: Thursday, February 12, 2015 at 3:28 p.m.
Last Modified: Thursday, February 12, 2015 at 4:31 p.m.
A group of volunteers looking for clues about a World War II-era bomber that crashed more than 70 years ago in Osteen will soon get some help from the U.S. Navy.
An archaeologist from the Naval History and Heritage Command in Washington, D.C., is scheduled to arrive next week and guide a group of metal-detecting enthusiasts and search-and-rescue dog handlers in a search for more parts of the ill-fated dive bomber — and possibly, the remains of its pilot.
The mystery about the plane started some three years ago, when Osteen resident Rodney Thomas started finding old metal parts in his backyard — items he first thought belonged to an old tractor. But after picking up a metal detector and searching his and his neighbors’ properties, more parts turned up, including an ID plate for an exhaust collector of a Douglas SBD-5 Dauntless.
During WWII, the planes were used to train pilots at the DeLand Naval Air Station.
Late last year, Thomas contacted the DeLand Naval Air Station Museum and found volunteer Scott Storz, a Volusia County Sheriff’s Office intelligence analyst by day.
Since then, Storz said, the search effort has taken on a life of its own. Volunteers from the Central Florida Metal Detecting Club and K-9 Search & Rescue of Orange City have stepped forward to help in the effort. The Navy archaeologist plans to train the volunteers on how to conduct a systematic search of the site. Navy officials are set to be in the area Feb. 18-20. “We’re very interested in being a part of continuing the search for wreckage and whatever’s down there,” said Paul Taylor, an official with the communication and outreach division of the Naval History and Heritage Command. “We’re very grateful that the folks on the ground down there have reached out to us and paused the search, while we help develop a process to more thoroughly search the site.”
Added Storz, “We’re going to have a news conference and a training orientation on our site at the restoration building (at the DeLand Naval Air Station Museum). The Navy is going to make a presentation and do some training for the metal detector people and cadaver (dog) people.”
During the war, Naval Air Station DeLand became a major training base for Navy pilots and gunners. The plane is assumed to have come from DeLand, as its air station was the only facility near the site of the crash where SBDs were used — NAS Daytona Beach and NAS Sanford trained pilots in other aircraft.
“The U.S. Navy in Washington, D.C., has confirmed that there are six (6) SBD-5 Aircraft that took off from the DeLand Naval Air Base in 1943-1944 in the direction of the site discovered, never to be heard from again, and classified as missing,” according to a news release from the DeLand Naval Air Station Museum.
Ken Torbet, who served as flight-line chief at the station from 1942 to 1944, said while he wasn’t familiar with the Osteen crash, he said during his tenure at the base, several aircraft were lost in the area — some near New Smyrna Beach, which hosted an auxiliary field during the war; others over Bunnell, site of a practice bombing target site; and over Lake County.
At the Osteen crash site, the metal detecting club has turned up a slate of various plane parts.
“In this case with the plane search, we went out at Scott’s request and the homeowners’ request,” said Alan James, club president. “I think there were just under 20 of us that day and we found roughly 100 pieces of that plane.” He said the club is trying to find something that can identify the exact plane that crashed to identify its pilot, to see if he walked away from the crash or perished.
While the plate from the exhaust collector identifies the plane as an SBD-5, it doesn’t contain a specific tail number.
Thomas, the landowner, said he’s excited by all the developments surrounding the search. He hopes to find out more about the pilot and put a historical marker on the crash site.
“I would like to go as far as to find out what time this guy got up in the morning, what he had for breakfast, what time he flew out of DeLand, if he lived or he died,” he said. “It doesn’t matter if he lived or died, I’d like to see some kind of marker put there. The guy should be recognized. It’s a piece of history.”
For now, the parts are on display at the museum, 910 Biscayne Blvd., near the city’s airport in DeLand. The museum is open Wednesday through Saturday from noon to 4 p.m.
The SBD Dauntless was used extensively in battles in the Pacific Ocean, including the Battle of Midway, where Navy SBDs sunk three Japanese carriers within six minutes, according to the Naval History and Heritage Command. A fourth was sunk several hours later.
The planes were produced by the Douglas Aircraft Co. from 1940 to 1944. The SBD-5 featured a 1,200-horsepower engine, two forward-facing and two rear-facing machine guns, along with up to 2,250 pounds of bombs.
Tracey Loughran delivers a fitting tribute to the men who suffered in the First World War, and in more modern conflicts.
Editor's note: This article is from the forthcoming March edition, published early today to mark 100 years since the publication of Charles Myers' seminal Lancet paper. View our archive for much more on Charles Myers and shell shock.
In 1914 Britain was the only major European power without a system of conscription in place. Over the next two years, the second-largest volunteer army in the history of the nation was raised (Gregory, 2008). Although the First World War is often remembered as a war of conscripts, 2.5 million men from the UK enlisted in the armed forces without any form of legal compulsion.
One hundred years after the outbreak of the First World War, it is difficult to understand what motivated men to fight, and how they possibly withstood the horrors of the trenches. These are complex and contested historical questions, but it is clear that deeply embedded ideas of honourable masculine behaviour guided the actions of many men. Oscar Wilde’s eldest son Cyril was perhaps more worried than most men about how others might judge his ability to live up to masculine ideals, but his explanation of his decision to join up is nonetheless telling. He believed that ‘first and foremost, I must be a man. There was to be no cry of decadent artist, of effeminate aesthete, of weak-kneed degenerate.’ He asked ‘nothing better to end in honourable battle for my King and Country’ (Sinfield, 1994, p.126). He died in May 1915 at Neuve Chappelle.
The success of the voluntary recruitment campaign represented, at least in part, the triumph of Victorian ideals of manly behaviour. But when we think of this war, we also think about those who could not live up to the exacting demands of this ideal, no matter how hard they tried. Only a few months after war broke out, soldiers of several combatant nations began to manifest strange nervous and mental symptoms. Doctors in all countries immediately noted the similarity of these disorders to well-established diagnostic categories such as hysteria, neurasthenia, and traumatic neurosis. They also debated the unknown effects of high explosive artillery on the central nervous system. In all combatant nations, doctors formulated theories that explained soldiers’ symptoms as the result of concussion, or invisible molecular damage to the nervous system caused by exposure to repeated shell blasts. As the war went on, increasingly sophisticated psychological theories were formulated to explain symptoms as the outcome of a conflict between the instinct of self-preservation and the desire to fulfil one’s duty, or as the result of the attempt to repress memories of war experience. Nowadays, ‘shell-shock’ is most often perceived as a form of psychological breakdown, equated in the popular mind with the modern construct of post-traumatic stress disorder (PTSD).
We do not know exactly how many men were diagnosed and treated for ‘shell-shock’ during the war or in its aftermath: the number most often quoted for the British Army is between 80,000 and 200,000 men (Leese, 2002). But even these estimates are based only on those formally diagnosed and treated for ‘shell-shock’. It is likely that many men suffered nightmares, distressing memories of war experience, and other traumatic symptoms, but coped well enough in everyday life to avoid seeing a doctor. These men endured the war, but we do not know how they picked up the threads of their lives. The only indisputable fact is that after 1918, ‘shell-shock’ formed part of a new popular understanding of the potential effects of war on men’s bodies and minds.
Many historians have argued that the experience of mass breakdown in the First World War led to the reconfiguration of ideals of masculine behaviour. The literary historian Samuel Hynes believes that after 1918, war was imagined in fundamentally new ways. The soldier hero was no longer the main actor in popular conceptions of war; now, he was accompanied by the coward, the frightened boy, and the ‘shell-shock’ victim (Hynes, 1991). For Elaine Showalter, ‘shell-shock’ represented ‘a crisis of masculinity and a trial of the Victorian masculine ideal’; it was an unconscious protest ‘not only against the war but against the concept of “manliness” itself’ (Showalter, 1987, pp.171–2). Other historians have suggested that the acknowledgement that any man could break down under sufficient stress ‘forced western society to take note and modify its views on mental illness, human motivation, and other issues far beyond the immediate problems of disabled soldiers’ (Feudtner, 1993, p.409; see also Bogacz, 1989; Stone, 1985). From this perspective, ‘shell-shock’ revealed the ultimate fragility of the human psyche, and undermined the bombastic stoicism applied to so many areas of social life.
However, I argue that although the experience of 1914–18 did force popular awareness of the potentially traumatic effects of war, it did not completely overturn existing conceptions of ideal masculinity. This is evident in the desire of First World War psychologists to restore soldiers to self-control and manly ‘character’. Doctors used many different forms of treatment for ‘shell-shock’ during the war, and most soldiers were probably treated using conservative therapies. In a few institutions, such as Maghull Military Hospital near Liverpool, and Craiglockhart War Hospital in Edinburgh, some influential doctors developed analytic techniques. It was rare for doctors to employ these kinds of ‘talking cures’, but these treatments show that even the most sophisticated psychological approaches developed to deal with shell-shock’ drew heavily on concepts of self-control, self-reliance, and strength of character.
‘Analytic’ doctors favoured forms of treatment based on analysis and re-education. They believed the prolonged strain of war service exhausted the patient and lowered his self-control, which led him to fixate on an emotional element of his war experience. The role of the doctor was to help the patient understand the ‘true significance’ of his history and condition, and this was achieved through the therapeutic process of re-education (‘the process whereby causal factors, which have been elicited by analysis, are modified or re-arranged, so that they no longer produce morbid effects’: Hart, 1927, p.125). The doctor conducted extended interviews with the patient to ascertain the exact nature of the incident(s) that had led to breakdown. The doctor then helped the patient to understand why the symptoms had occurred, and to guard against their recurrence by imparting understanding of the psychological processes behind them. As the patient gained insight into the nature and origin of his symptoms, both the symptoms and the emotional tone connected with them would disappear.
These doctors displayed considerable empathy for their patients. But they did not waver from the belief that the war must be fought to the finish, and that ‘shell-shocked’ men must, if possible, be returned to some form of service (not necessarily as combatants). Consequently, ‘analytic’ doctors did not reappraise the fundamental tenets of Victorian and Edwardian ideals of masculine character. Instead, they reinforced the importance of living up to the values embodied in this ideal. The psychoanalyst David Eder described a case in which hypnotism failed, and he reverted to persuasion: Eder’s exhortations prompted ‘a flood of tears’ in the patient, who ‘lay awake all that night making up his mind that he would walk, and the next day the sticks were relinquished, he was cured of the paraplegia’ (Eder, 1917, pp.72–3). It is difficult to conceive of a more literal demonstration of the belief that patients must learn to stand on their own two feet.
‘Analytic’ doctors consistently described re-education in the language of a militarised, masculine ethos of honour, stoicism, and self-control. The patient’s effort to gain a ‘proper’ understanding of his war experience was depicted as a confrontation, in which he squared up to his past and mastered it. The doctor had to make the patient see the impossibility of ‘running away’ from troubling memories (Rivers, 1918). Doctors did not see this form of treatment as the imposition of masculine values on subjects who had rejected these standards. They believed they were helping ‘shell-shocked’ men to regain the character and self-control that would allow them to live with themselves after the war. Even the most sophisticated treatments for ‘shell-shock’ depended on the reassertion of masculine values.
Has so much really changed today? Rightly or wrongly, the First World War is popularly conceived as one of the major tragedies of the 20th century. It is very tempting to look back and think ‘we’ now know better, and that the legacy of ‘shell-shock’ is an improved understanding of war trauma. Perhaps this is true in some respects. Certainly, although no one has worked out a definitive way either to prevent men breaking down or to cure PTSD, and there are still serious gaps in the provision of psychiatric services for veterans, it is no longer possible for governments, militaries and public to ignore the existence of traumatic responses to combat. Yet when we talk about ‘shell-shock’, we often unwittingly reinforce older ideals of heroism. This is shown by newspaper coverage of the decision, in August 2006, to issue a blanket pardon of the 306 British soldiers executed for desertion, cowardice or other offences (excluding murder) during the First World War. For the most part, this decision was celebrated in the media. Journalists explained that it was now known that many of those executed had been suffering from ‘shell-shock’. In these reports, the psychological injuries suffered justified the pardon. However, coverage also implicitly bolstered traditional ideas of heroism and cowardice.
This is nowhere more evident than in newspaper accounts of the life and death of Private Harry Farr, the test case for the decision to pardon the soldiers. Farr, a scaffolder from London, joined up on the outbreak of war, but developed ‘nervous trouble’ and reported sick with nerves four times between 1915 and 1916. This included five months in hospital, during which time he had an uncontrollable shake so bad he could not hold a pen. In September 1916 he refused to go back to the trenches, stating that he could no longer stand the explosions of artillery. He was reported as trembling and not in a fit state, but was still executed in October 1916 after a peremptory court-martial. Newspaper coverage emphasised that Farr was undoubtedly suffering from ‘shell-shock’, and that this doubtless applied to many other executed soldiers.
The use of Farr’s story in the media is more ambiguous than it first appears. Farr was presented as both victim and hero. As a volunteer, he had proved his courage; he broke down not once, but several times; and he was executed because he refused to return to the front, not for actions that put his comrades immediately in danger. Because Farr suffered so much, his case does not involve confronting our own attitudes towards heroism, cowardice and the demands of war. If Farr is the exemplar of the ‘shell-shocked’ soldier, then ‘we’ can remain convinced modern sensibilities are more alive to such suffering. The truly radical reappraisal of social and cultural expectations of military masculinity will come when it is accepted not just that ‘shell-shocked’ men could be heroes as well as victims, but that heroism does not need to be part of our discussions of ‘shell-shock’ – when we stop holding the dead up to these standards at all. Narratives of progress are consoling, but perhaps our starting point should be not what has changed, but what remains to be done. This is the most fitting tribute to all the men – heroes, victims, cowards, malingerers – who have tried since 1914 to survive war, in whatever ways they could.
Walking Wounded A U.S. paratrooper in the Korengal Valley of Afghanistan in 2008 wears an unofficial patch in English and phonetic Dari spoofing the ‘ISAF’ insignia worn by members of the International Security Assistance Force.PHOTO: TIM HETHERINGTON/MAGNUM PHOTOSÒÒ
Controversy has haunted post-traumatic stress disorder ever since its appearance in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. The diagnosis emerged after the Vietnam War as veterans began experiencing psychological troubles upon returning home. Although military doctors had long known that combat could cause psychiatric symptoms, they believed that such stress reactions dissipated soon after soldiers left the battlefield, at least in previously well-adjusted men. A failure of symptoms to remit, they thought, implied pre-existing vulnerabilities.
Vietnam changed these views. Many veterans were troubled by memories of the war long after leaving the service, and some began suffering symptoms only months or years after coming home. They felt emotionally numb and alienated. Anxious, angry and forever on edge, they startled easily at sudden noises. They did not merely remember the war; they re-experienced it in nightmares, intrusive thoughts and vivid, sensory “flashbacks.”
After listening to veterans tell their stories in informal “rap groups,” the antiwar psychiatrists Chaim Shatan and Robert Lifton became convinced that combat in Vietnam could cause chronic psychological difficulties even in men without any previous problems. Yet no single diagnostic category in DSM-II, the manual’s then-current edition, captured the diversity of their symptoms.
Coincidentally, the American Psychiatric Association had begun revising its DSM as the problems of Vietnam veterans were becoming apparent. Shatan and Dr. Lifton joined leaders of Vietnam veterans’ organizations, urging the APA to include “Post-Vietnam Syndrome” in its revised manual. Indeed, without an official diagnosis, troubled veterans would be unable to receive treatment or disability compensation from the Veterans Administration. The syndrome’s delayed onset, however, made it especially challenging to show that war was the cause. “Shell shock” in World War I and “combat fatigue” in World War II had erupted on the battlefield, not later, after soldiers had returned to civilian life. Because clinicians seldom saw cases of combat-related breakdown within Vietnam itself, the appearance of so many cases of delayed reactions was truly puzzling.
Leaders of the DSM revision process initially rejected Post-Vietnam Syndrome. They argued that combinations of diagnoses covered the problems of recent veterans. Moreover, they aimed to define disorders by their symptoms, not by unproven etiologies such as those posited by psychoanalysis. Unlike the previous editions, DSM-III was to be purely descriptive, such that clinicians could agree on whether a disorder was present even if they disagreed about what had caused it.
After failing to persuade the DSM task force, advocates for the new syndrome changed their strategy. They made common cause with clinicians who had been working with survivors of rape, disasters and concentration camps. Symptomatic similarities among victims of such stressors produced a consensus that any traumatic event could cause a syndrome hitherto attributed only to the Vietnam War. An influential psychiatrist on the task force agreed, noting that she had seen the same symptoms in survivors of severe burns. Her support clinched the case, and post-traumatic stress disorder became an official diagnosis in 1980.
David J. Morris’s fascinating “The Evil Hours: A Biography of Post-Traumatic Stress Disorder” covers much of the above in tracing how clinicians, scientists, poets and historians have endeavored to understand psychological trauma throughout the ages. Into this history he interweaves an account of his own struggle with post-traumatic stress. Although a former Marine, he experienced the trauma of war only years after he left the service, during his time as a journalist embedded in Iraq.
Mr. Morris joined the Marine Corps after college, serving in the peaceful mid-1990s as a lieutenant. Seeking adventure, he found boredom instead. He resigned his commission and enrolled in graduate school, aspiring to be a writer. After 9/11, he realized that being a war correspondent would enable him to acquire the experiences he missed while serving in the peacetime military. During his time abroad, he repeatedly came under fire, witnessed much carnage and survived a harrowing explosion when a Humvee he was riding in hit a bomb hidden in roadside trash.
After leaving Iraq in 2007, Mr. Morris returned to California. His readjustment to civilian life went reasonably well at first. But troubles began to surface two years later. He reflexively bolted from a movie theater when an explosion occurred on-screen: “My mind had gone dark, but my body was back in Iraq.” Traumatic nightmares began disturbing his sleep. He became increasingly irritable toward people whose smug preoccupation with the trivialities of their world made them blissfully unaware of what was happening in Iraq. “That these two worlds, war and home, could be kept isolated, one living in almost perfect ignorance of the other, was an obscenity surpassed only by the obscenity of the war itself,” he writes. His life took a turn for the worse when his girlfriend suddenly left him without any explanation.
Mr. Morris began to wonder whether he had PTSD. He read voraciously in the clinical and scientific literature. His autodidactic enterprise also spanned war memoirs, poetry, history and anthropology, from Homer to the poets of the Great War. Mr. Morris deftly and accessibly synthesizes all this material. One of the notable strengths of this book is his ability to calmly summarize both sides of controversial debates.
As Mr. Morris observes, the contentious political climate that gave birth to the diagnosis has made some scholars wonder whether PTSD is a socially constructed artifact of the Vietnam War rather than a disease discovered in nature by astute clinicians. In support of this view, historians and medical anthropologists have noted that different wars have produced different psychiatric syndromes. For example, flashbacks are nowhere to be found in the medical records of British shell-shock victims of World War I. Both psychobiology and culture influence the experience of soldiers emotionally damaged by war, yet there are persistent symptomatic themes across time. Nightmares, anxiety, hypervigilance, irritability and emotional disconnection are consistent complaints.
Another controversy covered by Mr. Morris concerns how many military personnel and veterans develop PTSD. Psychiatric epidemiology is ordinarily not an explosive topic, but when it comes to PTSD, passions run high. Anyone who questions a high prevalence estimate will surely be accused of denying the suffering of veterans. The landmark National Vietnam Veterans Readjustment Study, completed in the late 1980s, concluded that 30.9% of male Vietnam veterans had developed PTSD and that 15.2% still had the disorder when the study was done. Military historians later wondered how that many men could have developed PTSD when only about 15% had served in combat roles.
Their questions inspired reanalysis of the data, which yielded prevalence estimates for current (late 1980s) PTSD of 9.1% and 5.4%—substantially less than 15.2%. It turns out that where one sets the threshold for how impairing symptoms must be in order to classify someone as having PTSD matters a great deal. Other epidemiologists have studied the course of PTSD, noting that delayed onset—emergence of the full syndrome more than six months after the trauma—is rare among civilians but not among war veterans. Most cases of PTSD among civilians erupt shortly after the trauma occurs, and one study showed that about two-thirds of these cases recover within one year. Of those who do not remit, about half eventually do so, regardless of treatment.
These issues are arising once again. Although the fact of PTSD among post-9/11 veterans is beyond dispute, it is unclear just how many have the disorder. Estimates vary considerably. One very large study revealed that 4.3% of American military personnel deployed to either Afghanistan or Iraq developed PTSD and that 7.6% of those with combat experience did. Other studies put the overall rate between 13% and 20%. Not all disorders diagnosed in veterans originate during their time in the service, however. A major recent study revealed that about 25% of active-duty Army personnel met criteria for at least one psychiatric disorder. Nearly 30% of those with PTSD developed it before joining the Army. Although deployment to a war zone can certainly exacerbate PTSD and other problems, it appears that a substantial minority of enlistees have undetected or undisclosed disorders when they join the Army.
In dramatic contrast to the post-Vietnam era, the Veterans Administration anticipated an influx of new PTSD patients returning from Iraq and Afghanistan. Accordingly, it requested the Institute of Medicine (IOM) to review the evidential basis for the many therapies claimed to be effective. The IOM concluded that only two psychological treatments, Prolonged Exposure and Cognitive Processing Therapy, qualified as efficacious for PTSD. Although some medications are helpful for certain symptoms, none met the rigorous IOM criteria.
Mr. Morris received Prolonged Exposure as an outpatient at the San Diego VA system. (“Dealing with the VA, I would learn, is basically a patience marathon,” he comments.) PE has two main components: imaginal exposure to memories of trauma and “real-life” exposure to safe activities and situations that trigger the recollection of traumatic memories. Imaginal exposure requires patients to visualize and describe aloud the narrative of their trauma repeatedly until emotional distress subsides. Just as frightening movies lose their evocative power after multiple viewings, so does imaginal exposure typically diminish the distress provoked by recalling trauma.
One study showed that 85% of patients who completed PE no longer met the criteria for PTSD, although typical studies put the recovery figure closer to 65%. Studies on civilians traumatized by rape, other crimes or car accidents outnumber studies on combat veterans. But a recent report involving 1,888 veterans treated with PE found that about 54% recovered from PTSD.
Others patients improve, but do not fully recover, and still others fail to respond much at all. However, persistent adverse reactions are very rare. In fact, one recent study of more than 300 assault victims revealed that 8.1% of patients on the waitlist experienced persistent worsening of their symptoms, whereas none of the patients receiving PE did so. Hence, people with PTSD have a greater risk of their symptoms getting worse if they do not receive PE than if they do.
Sadly, Mr. Morris was among the nonresponders. Never really connecting with his young, relatively inexperienced therapist, he found that his distress failed to diminish during imaginal exposure. The repetitive nature of the therapy felt extreme, inflexible and “excruciating.” He found his anger growing worse, rather than better, and dropped out. He subsequently received Cognitive Processing Therapy, conducted in a group. CPT involves writing narratives of one’s traumatic experiences and hence contains some element of exposure. Mr. Morris found it useful, but it is difficult to tell how much it diminished his PTSD symptoms or whether he still qualifies for the disorder.
Mr. Morris also surveys alternative approaches touted as cures for PTSD, ranging from yoga to cage fighting. Glowing testimonials abound, but properly controlled studies are rare. At one point, he takes a swipe at “evidence-based therapy,” saying that it mostly means that a lot of doctors like an intervention often for reasons of trendiness as much as efficacy, adding that doctors once liked to perform lobotomies to cure PTSD. This is misleading. In fact, as the Institute of Medicine report makes clear, the standards for classifying a treatment as “evidence-based” are very rigorous, and their purpose is precisely to prevent untested and dangerous treatments, such as lobotomy, from proliferating. Mr. Morris is an excellent writer who has written a very good book. My only concern is that people suffering from PTSD will avoid Prolonged Exposure after reading Mr. Morris’s account. Although a minority of people do not benefit from PE, most do, as Mr. Morris acknowledges, and many recover entirely. Nevertheless, researchers need to listen carefully to those who fail to benefit since lessons can be learned that will surely facilitate improvements in our therapies for this serious, but common, disorder.
—Dr. McNally, professor of psychology and director of clinical training at Harvard University, is the author of “Remembering Trauma” and “What Is Mental Illness?”
The Royal Air Force 17 (Reserve) Squadron recently celebrated their centenary Feb. 9, 2015 with a parade and parade review by RAF Chief of the Air Staff, Air Chief Marshal Sir Andrew Pulford. The centenary comes on the cusp of the joint squadron, comprised of Royal Navy and RAF personnel, receiving the United Kingdom’s first F-35B Lightning II, known as BK-1, on Jan. 13 for operational testing and evaluation here at Edwards. (U.S. Air Force photo by Jet Fabara)
2/12/2015 - EDWARDS AIR FORCE BASE, Calif. -- For a squadron with heraldry dating as far back as 1915 and being stationed out of multiple foreign locations during World War I and WWII, the Royal Air Force 17 (Reserve) Squadron recently celebrated their centenary Feb. 9, 2015.
The centenary comes on the cusp of the joint squadron, comprised of Royal Navy and RAF personnel, receiving the United Kingdom's first F-35B Lightning II, known as BK-1, on Jan. 13 for operational testing and evaluation here at Edwards.
"Today is an important day for both the Royal Air Force and the Royal Navy. The start of U.K. operational testing on the Lightning II aircraft is a significant milestone for us; although our relationship with the United States as partners on the Joint Strike Fighter Program remains as strong as ever. Our collaboration with the U.S. Armed Forces on the world's largest and most advanced defense project is a clear demonstration of our enduring close military partnership with the United States," said Chief of the Air Staff, Air Chief Marshal Sir Andrew Pulford. "I am delighted to be here at Edwards Air Force Base today to celebrate the centenary of Number 17 (Reserve) Squadron. Their new role in developing and testing the U.K.'s fifth-generation fighter aircraft will be an exciting new chapter in the squadron's rich and proud history."
Prior to the ceremony's commencement, band members from the 3rd Marine Aircraft Wing were invited to be a part of the centenary parade, which was held in front of the squadron's hangar and those in attendance, which included Air Force Test Center and 412th Test Wing leadership amongst many others, were also able to witness the parade general salute and parade review by the RAF Chief of the Air Staff.
During the ceremony, attendees were treated to a World War II-era Spitfire fly-over and an F-35 fly-over to recognize the squadron's rich flying past and the squadron's current standing up of F-35B operations out of Edwards.
"We're here to mark two things, the 100th anniversary of the 17 Squadron since it was formed, and to mark the fact that the U.K. is now commencing organic operations of the F-35B. We're maintaining it and flying it independently under U.K. regulations with minimum assistance from the U.S. It truly is a two-fold celebration," said Squadron Leader Frankie Buchler, 17 (R) Squadron evaluator pilot for the joint operational test team. "The 17 (R) Squadron has been here for several years now as part of the Joint Operational Test Team. We're working with the U.S. Air Force, U.S. Marine Corps and international partners from the Netherlands and Australia who are also going to participate in operational test here."
According to Buchler, the U.K. aircraft have been at Eglin Air Force Base, Florida, for the last two years, where initial pilot and maintenance crew training was being held. With the arrival of the squadron's first F-35B model, Buchler noted that the squadron will now prepare for future acquisition of two additional F-35B models for test and evaluation within the next year.
To crown the centennial celebration, the squadron was also honored with a designated exhibit inside the Air Force Flight Test museum to recognize and display the squadron's rich history, since it will now become part of Edwards AFB's test history.