This is a revised version of a story originally broadcast in October, 2012.
Every Veterans Day, we talk about the challenges veterans face back home from war. And in recent years, we’ve heard a lot about one challenge in particular: post-traumatic stress disorder.
It’s estimated that 15 percent of soldiers who have returned from conflicts in Iraq and Afghanistan suffer from PTSD. That amounts to—and it’s a conservative estimate—some 250,000 people in the United States who experience PTSD-related symptoms.
Of course, there’s nothing new about PTSD, and what that number leaves out are the veterans of previous wars whose lives have been derailed by the disease to some extent, even decades after they returned from war.
Despite all the attention on PTSD, the disease remains stubbornly hard to treat. That has forced the Department of Veterans Affairs to explore treatments that would have been considered decidedly from-the-fringes a generation ago. Some of that work is taking place at the Menlo Park division of the VA Palo Alto Health Care System.
“My little safe zone”
John Montgomery is a Vietnam vet with a bushy gray mustache and a tattoo of a scorpion on each forearm.
I met him at the Menlo Park VA hospital, where he was being treated for the PTSD that had haunted him ever since he came back from the war.
During his time in the clinic, Montgomery had been thinking a lot about his life before the war. What relaxed him, he said, was to think about his childhood on the family farm.
“We were dirt farmer kids,” he tells me. “It was the summer of 1957. We were irrigating 80 acres of cotton. I was laying back on a haystack at home. My brother was yelling, off in the distance, and I was just laying back.”
Montgomery trails off for a moment, lost in the memory. “Yeah, that’s my little safe zone,” he says.
But when he talks about Vietnam and what he saw there, something in his voice changes. Montgomery speaks louder and more quickly.
“Our society teaches us to go to school, live with our families and stuff, not to blow somebody else up,” he says. The image he can’t shake—even now, nearly four decades after his return—is of Vietnamese children trying to kill him. “They were after you, you know?”
Montgomery hadn’t even heard of PTSD until a few years ago. He sought help after decades of what he calls failed relationships and self-abuse. Part of his treatment is a twice-weekly guided meditation session.
On a bright fall afternoon, four men slouch in armchairs arranged in a circle. One younger vet in board shorts and flip flops lies on the floor. A couple of therapy dogs—golden retrievers named Eldridge and Elaine—settle at their owners’ feet.
Two of the vets served in Vietnam; three younger men served in Iraq.
Leah Weiss, a meditation trainer from Stanford’s Center for Compassion and Altruism Research and Education, begins the session.
“Let’s start with three deep, cleansing breaths,” she says.
An old approach, revisited.
The VA first began exploring meditation as a complementary treatment for PTSD back in the 1970s, says Stephen Xenakis, a retired brigadier general who formerly oversaw the Southeast Army Regional Medical Command.
In the 1970s, Xenakis worked as a psychiatrist with Vietnam vets at the former Letterman Army Medical Center, in San Francisco’s Presidio. He says meditation was one of several Eastern-inspired treatments that he and others were experimenting with.
Even back then, he says, it was clear that meditation could help calm the nervous systems not just of veterans, but also prisoners and other people suffering from trauma.
But getting the VA to integrate meditation into its standard treatment was tough, especially after the late 1980s when drugs like Prozac came on the scene. The drugs were easy to study and prescribe, cheap to administer. For a lot of patients, they were very effective.
“I think in many ways,” he says, “these other options that we had learned were helpful, back in the ‘70s, kind of fell off to the wayside.”
In recent years, it’s become clear that drugs are no panacea. Side effects are common. And for about half of PTSD patients, the drugs don’t work at all. A recent report from the Institute of Medicine concluded that “the evidence is inadequate” to demonstrate that SSRIs like Prozac are generally effective in treating PTSD.
Those limitations have spurred renewed interest in other approaches, such as meditation.
What meditation may do for the brain
Back in the TV room at the Menlo Park VA, Weiss’s voice is calm, almost hypnotic. She tells the men to “bring to mind a stranger, maybe someone you pass by when you’re commuting.”
“Consider,” she instructs them, “that just like me, this person has had ups and downs in his or her life. Just like me, this person has had goals and dreams. Just like me, this person knows what it’s like to be disappointed, or to feel afraid.”
This particular practice, called “compassion meditation,” aims at a specific and widely held hypothesis about what is happening in the brain of someone like Vietnam vet John Montgomery.
The idea is that in combat, a switch—a fight-or-flight survival mode located in a part of the brain called the amygdala—has been turned on, and essentially become stuck. Meanwhile, another part, the frontal cortex, takes the backseat. And that’s critical. Because this part of the brain helps us relate to other people.
“The frontal cortex,” says Stephen Xenakis, “is what allows us to have relationships and families, what gives us a sense that there are rules of society and morality. It’s part of what is different about our brains from even other primates, and clearly other mammals.”
Whether or not this kind of meditation is effective in treating PTSD is, from a scientific standpoint, still unknown. According to a 2012 meta-analysis on the efficacy of different kinds of meditation in treating PTSD, studies have shown that repeated sessions can increase “positive affect” and “social connectedness,” both of which are deficient in PTSD patients.
Meditation in general, wrote the authors, “holds some promise” as a treatment for PTSD.
Advice from an older veteran
After about 20 minutes, Weiss asks the men to open their eyes and to reflect on what the meditation made them feel.
Most of the men have been taking part in these sessions for a couple months now. They’ve been listening to CDs with Weiss’s voice back in their rooms. They say they feel calmer, and more compassionate toward other people.
But one of them, Esteban Brojas, is newer to this. Brojas served during the Iraq invasion in 2003. In some ways, he says, it’s like he’s still there.
Coming back to civilian life has been “a culture shock,” he says. “You’re still with that adrenaline; you’re still hyper-vigilant.”
Brojas’s wife gave birth to their daughter while he was in Iraq. When he came back, he didn’t know how to hold her. “After taking someone’s life? It’s hard,” he says.
As he speaks, Brojas’s voice starts to tremble and speed up. He rubs his hands together quickly as he rocks back and forth in his armchair.
“After the fact that you’re going into a building and there’s a grenade being popped in there and there’s a woman and a child in there? And you’re part of that? That’s hard. And to come home and hold your daughter in your hands?”
Doreen, the therapist steps in. “I would say…” she begins, tentatively.
John Montgomery steps in.
“You’re not there right now, you’re right here,” he tells Brojas, firmly. “You’re in this environment, here. I mean, it’ll take time, it’s like a wave coming. It’ll subside.”
Montgomery’s doing something he thought he had forgotten how to do: feel compassion.
VA officials are now expanding the program and bringing it to women veterans, among others. The hope is to reach more vets sooner than it took John Montgomery to find the help he needs.