Hector Garcia
1,027,071 views • 10:31

Carlos, the Vietnam vet Marine who volunteered for three tours and got shot up in every one. In 1971, he was medically retired because he had so much shrapnel in his body that he was setting off metal detectors. For the next 42 years, he suffered from nightmares, extreme anxiety in public, isolation, depression. He self-medicated with alcohol. He was married and divorced three times. Carlos had post-traumatic stress disorder.

Now, I became a psychologist to help mitigate human suffering, and for the past 10 years, my target has been the suffering caused by PTSD, as experienced by veterans like Carlos. Until recently, the science of PTSD just wasn't there. And so, we didn't know what to do. We put some veterans on heavy drugs. Others we hospitalized and gave generic group therapy, and others still we simply said to them, "Just go home and try to forget about your experiences." More recently, we've tried therapy dogs, wilderness retreats — many things which may temporarily relieve stress, but which don't actually eliminate PTSD symptoms over the long term.

But things have changed. And I am here to tell you that we can now eliminate PTSD, not just manage the symptoms, and in huge numbers of veterans. Because new scientific research has been able to show, objectively, repeatedly, which treatments actually get rid of symptoms and which do not.

Now as it turns out, the best treatments for PTSD use many of the very same training principles that the military uses in preparing its trainees for war.

Now, making war — this is something that we are good at. We humans have been making war since before we were even fully human. And since then, we have gone from using stone and sinew to developing the most sophisticated and devastating weapon systems imaginable. And to enable our warriors to use these weapons, we employ the most cutting-edge training methods. We are good at making war. And we are good at training our warriors to fight.

Yet, when we consider the experience of the modern-day combat veteran, we begin to see that we have not been as good at preparing them to come home. Why is that? Well, our ancestors lived immersed in conflict, and they fought right where they lived. So until only very recently in our evolutionary history, there was hardly a need to learn how to come home from war, because we never really did. But thankfully, today, most of humanity lives in far more peaceful societies, and when there is conflict, we, especially in the United States, now have the technology to put our warriors through advanced training, drop them in to fight anywhere on the globe and when they're done, jet them back to peacetime suburbia.

But just imagine for a moment what this must feel like. I've spoken with veterans who've told me that one day they're in a brutal firefight in Afghanistan where they saw carnage and death, and just three days later, they found themselves toting an ice chest to their kid's soccer game. "Mindfuck" is the most common term.

(Laughter)

It's the most common term I've heard to describe that experience. And that's exactly what that is. Because while our warriors spend countless hours training for war, we've only recently come to understand that many require training on how to return to civilian life.

Now, like any training, the best PTSD treatments require repetition. In the military, we don't simply hand trainees Mark-19 automatic grenade launchers and say, "Here's the trigger, here's some ammo and good luck." No. We train them, on the range and in specific contexts, over and over and over until lifting their weapon and engaging their target is so engrained into muscle memory that it can be performed without even thinking, even under the most stressful conditions you can imagine.

Now, the same holds for training-based treatments. The first of these treatments is cognitive therapy, and this is a kind of mental recalibration. When veterans come home from war, their way of mentally framing the world is calibrated to an immensely more dangerous environment. So when you try to overlay that mind frame onto a peacetime environment, you get problems. You begin drowning in worries about dangers that aren't present. You begin not trusting family or friends. Which is not to say there are no dangers in civilian life; there are. It's just that the probability of encountering them compared to combat is astronomically lower.

So we never advise veterans to turn off caution completely. We do train them, however, to adjust caution according to where they are. If you find yourself in a bad neighborhood, you turn it up. Out to dinner with family? You turn it way down. We train veterans to be fiercely rational, to systematically gauge the actual statistical probability of encountering, say, an IED here in peacetime America. With enough practice, those recalibrations stick.

The next of these treatments is exposure therapy, and this is a kind of field training, and the fastest of the proven effective treatments out there.

You remember Carlos? This was the treatment that he chose. And so we started off by giving him exercises, for him, challenging ones: going to a grocery store, going to a shopping mall, going to a restaurant, sitting with his back to the door. And, critically — staying in these environments. Now, at first he was very anxious. He wanted to sit where he could scan the room, where he could plan escape routes, where he could get his hands on a makeshift weapon. And he wanted to leave, but he didn't. He remembered his training in the Marine Corps, and he pushed through his discomfort. And every time he did this, his anxiety ratcheted down a little bit, and then a little bit more and then a little bit more, until in the end, he had effectively relearned how to sit in a public space and just enjoy himself.

He also listened to recordings of his combat experiences, over and over and over. He listened until those memories no longer generated any anxiety. He processed his memories so much that his brain no longer needed to return to those experiences in his sleep. And when I spoke with him a year after treatment had finished, he told me, "Doc, this is the first time in 43 years that I haven't had nightmares."

Now, this is different than erasing a memory. Veterans will always remember their traumatic experiences, but with enough practice, those memories are no longer as raw or as painful as they once were. They don't feel emotionally like they just happened yesterday, and that is an immensely better place to be.

But it's often difficult. And, like any training, it may not work for everybody. And there are trust issues. Sometimes I'm asked, "If you haven't been there, Doc, how can you help me?" Which is understandable. But at the point of returning to civilian life, you do not require somebody who's been there. You don't require training for operations on the battlefield; you require training on how to come home.

For the past 10 years of my work, I have been exposed to detailed accounts of the worst experiences that you can imagine, daily. And it hasn't always been easy. There have been times where I have just felt my heart break or that I've absorbed too much. But these training-based treatments work so well, that whatever this work takes out of me, it puts back even more, because I see people get better. I see people's lives transform.

Carlos can now enjoy outings with his grandchildren, which is something he couldn't even do with his own children. And what's amazing to me is that after 43 years of suffering, it only took him 10 weeks of intense training to get his life back. And when I spoke with him, he told me, "I know that I can't get those years back. But at least now, whatever days that I have left on this Earth, I can live them in peace." He also said, "I hope that these younger veterans don't wait to get the help they need." And that's my hope, too. Because ... this life is short, and if you are fortunate enough to have survived war or any kind of traumatic experience, you owe it to yourself to live your life well. And you shouldn't wait to get the training you need to make that happen.

Now, the best way of ending human suffering caused by war is to never go to war. But we are just not there yet as a species. Until we are, the mental suffering that we create in our sons and in our daughters when we send them off to fight can be alleviated. But we must ensure that the science, the energy level, the value that we place on sending them off to war is at the very least mirrored in how well we prepare them to come back home to us. This much, we owe them.

Thank you.

(Applause)