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Healing the Invisible Wounds of War

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and the therapist keeps watch of the physiological readouts as new cues, like gunshots and mortar explosions, are added incrementally.

Meanwhile, a specialist intermittently asks the patient to gauge his levels of distress. The philosophy is that each experience should progress as quickly or slowly as is medically sound, striking a balance between comfort and anxiety.

Perhaps no piece of Virtual Iraq hardware symbolizes this paradox as well as the replica M-16
control device.

"Some troops said, 'Hey, I'm walking through here but I don't have a gun in my hand. When I'm on patrol, I've got a gun in my hand,'" said Roy, explaining why troops have the choice of a handheld joystick or lifelike assault rifle with built-in controls -- a kind of semi-automatic security blanket.

The vulnerability that lies at the heart of PTSD demands that therapists tread carefully while administering treatment. The disorder occurs in the wake of life-threatening events, from surviving an ambush or car crash, to witnessing a fatal accident. While it's normal for a person affected by trauma to have nightmares or flashbacks of the event, PTSD is defined by symptoms that persist longer than
one month.

In addition to avoidance, hallmark characteristics of the disorder fall under two categories: hypervigilance and, somewhat paradoxically, numbing.

Michael Bradley, a former Army staff sergeant with the Army's 4th Infantry Division, was diagnosed with PTSD after narrowly surviving a roadside bombing and mortar attack in Baqouba, Iraq, last year. His escalated feeling of vigilance became manifest while vacationing at an amusement park after
returning home.

"I went to Disneyland, and the cannons starting firing off the ship," Bradley recalled in an interview. "And here I am low-crawling across the ground, knowing full well that I'm in Disneyland, but my body's reacting.

"My mind is saying, 'Get up, you fool! But my body's saying, 'No. I'm not going to do it.'"

Experts believe the parts of the brain affected by PTSD are the amygdale and anterior cingulate gyrus, sections that regulate aggression and fear, and avoidance and numbing, respectively. Though the understanding of its neural pathways has evolved greatly, records of PTSD trace their roots as far back as Homer's ancient Greek epic poem the Iliad, when

the protagonist Achilles hears about the death of his closest companion, Patroclus.

Despite its various names -- shell shock, battle fatigue -- and the prospect of even better treatment in the future, it seems PTSD is likely to remain part and parcel of human conflict, Roy said.

"No matter how well we prepare our troops, war is not a pleasant thing; it doesn't come naturally to human beings to be faced with killing other human beings," he said. "We're just not wired that way."

But in the meantime, the secret to what could be the next best treatment of PTSD might be inside the last computer in this room. Known around the psychiatric ward as "The Wizard of Oz," this processor controls everything from the sandstorm pelting the soldier's helmet to the body odor he smells.

We've had guys who were avoiding going out in public, not using the Metro, not going shopping, not going to sporting events and the movies. Then they go through this, and suddenly they're able to do those things.

Roy fires up the machine and places his subject in the driver's seat of an armored vehicle ripping down a pitch-black desert highway. Through the troop's night-vision goggles, the landscape glows electric green. With the omnipresence of a deity, this machine transports a soldier through time and space, back into the far recesses of his mind, where memories steeped in translucent neon fog remain tucked away.

Whistles of AK-47 assault rifle rounds sing past the vehicle. One connects with the front of the car and web-like cracks spread across the windshield. A panicked call cracks over the radio as mortars begin erupting along the unlit ground like landmines. A scream cuts through the interior noise, and the troop swivels his helmeted-head to see the slain body of the soldier in his passenger seat.

Though it's counterintuitive that reliving a moment like this could somehow lead to a breakthrough, evidence culled from soldiers in this stuffy room suggests
it does.

"We've had guys who were avoiding going out in public, not using the Metro, not going shopping, not going to sporting events and the movies," Roy said. "Then they go through this, and suddenly they're able to do those things."