Jacob Fadley served four years and 12 tours in Iraq and Afghanistan, repeatedly exposed to heart-thumping blasts. “It’s just like an entire force is being pushed through you, something powerful too,” he described. “Your body just kind of stops and goes, ‘What, what is going on?’ And kind of, for me, it felt like it was rebooting itself.”
At the end of it, he was left with no apparent physical injuries. But something was very wrong inside his head. “I came back home from my third deployment. I cried, like, all the time,” he recalls. “I would get drunk, and the night would end with me yelling at somebody … I think, no I knew, I had PTSD, but I never wanted to say that. Because when you say it, then you have to deal with it.”
That was the last thing he wanted to do. So he evaded a diagnosis. It wasn’t hard. Right now there is no objective, concrete test – no X-ray or blood test – to diagnose PTSD. Instead, U.S. Department of Veteran Affairs psychologists do a subjective evaluation of patients based on criteria set by the American Psychiatric Association. With that type of an evaluation, it is difficult to account for veterans like Fadley who are in denial or worried that a diagnosis might stigmatize them or cause them to be reassigned.
To some vets, the current method for diagnosing PTSD feels like a game of 20 questions, which is literally the number asked on the VA’s questionnaire. The exam includes questions like, “In the past month, how much were you bothered by repeated, disturbing, and unwanted memories of the stressful experience?” The answers can be “not at all,” “a little bit,” “moderately,” “quite a bit” or “extremely.” Doctors rely on their experience and the honesty of the subjects to make their diagnosis. They have no way of telling if they’re getting at the truth.
“To some vets, the current method for diagnosing PTSD feels like a game of 20 questions, which is literally the number asked on the VA’s questionnaire.”
Fadley is not the only veteran hoping medicine will find more concrete ways of diagnosing PTSD. On March 29, 30, and 31 on on the PBS NewsHour, I profile several veterans, including Fadley, as part of a series on veterans, PTSD and the brain entitled “War on the Brain.” All of them have struggled with getting a PTSD diagnosis and are looking to medicine for answers. We also look at researchers exploring new ways to potentially diagnose PTSD like blood tests, MRIs, and other tools that might bring quick, inexpensive results. One brain researcher shows us a breakthrough discovery: indications that PTSD might be partly caused by the physical trauma of blasts. We also look at the limits of the current way of diagnosing the disorder.
“PTSD has biological markers, heart rate, certain levels of hormones, certain kinds of brain activity that we’re learning about. But none of those are strong enough to act as a diagnostic test,” said Dr. Harold Kudler, a psychiatrist who is the chief consultant for mental health for the Department of Veterans’ Affairs. “So to diagnose PTSD, we talk to people, we listen to people, and we see if in fact they’ve had those kind of events and have those kinds of symptoms, enough of them severe enough to make the full diagnosis. It is ultimately something you do with a clinician, sitting down with someone to talk about these things.”
That could change. Researchers are working at brain banks around the country to see what is going on inside the heads of veterans like Fadley. They are examining the brains of deceased veterans in hopes of knowing more accurately what effects trauma ― psychological or physical ― has had on the brain. That could someday lead to better diagnostic tests, treatments, clues into where PTSD originates and evolves.
But for the science around PTSD to progress, banks will need many more veterans like Fadley to pledge to give these vital organs to science. Right now brains of veterans for studies are so scarce that the largest brain bank in the U.S., the Harvard Brain Resource Center which houses 3,000 brains, has taken to making public appeals for donations. Most of their existing brains were donated by people with mental health issues, not vets who suffered from Post Traumatic Stress Disorder.
“There are almost no brains of patients with PTSD and TBI (traumatic brain injuries) available for study in the U.S. ― or world for that matter,” said Dr. Kerry Ressler, McLean Hospital’s chief scientific officer. Dr. Ressler believes advancing brain research could lead to “better treatments, interventions, and maybe one day cures.”
Donating a brain is easy. Anyone over the age of 18 can register to give their brain. Brain banks suggest potential donors consult with family members because whoever is closest to the donor will be asked to sign a consent form after the donor’s death. People who are not veterans with PTSD can also help the cause by donating their brains. That gives researchers a baseline from which to compare.
Michael Rodriguez, a former special forces Green Beret, has decided to donate his brain to the Boston University Chronic Traumatic Encephalopathy Center. He is also hoping research will someday lead to a test for PTSD.
“If there was a tangible test, I think it would make is easier on the patient, because it will validate it. And I think it will go more toward decreasing the stigma. You know, like if someone has leukemia, no one ever says, ‘You don’t have leukemia,’” Rodriguez said.
“For the science around PTSD to progress, banks will need many more veterans like Fadley to pledge to give these vital organs to science.”
One of the beneficiaries of donations like those is Dr. Daniel Perl, a neuropathologist at the Uniformed Services University of the Health Sciences. He is comparing the brains of people who have suffered concussions or traumatic brain injuries with those of veterans who were exposed to severe blasts and later developed PTSD. He has discovered that the PTSD brains have a distinct scarring that could be a sign that PTSD is caused, at least in part, by physical damage to the brain.
“I’ve been looking at brain slides for over 40 years, and I had never seen this pattern before,” said Perl, whose research is in its infancy. “We thought this must be something very unique and special to blast exposure.”
Kudler says Perl’s research is promising, but doesn’t yet change things for veterans and active duty military hoping medicine will provide more insights into the brain and PTSD. “There’s nothing written that gets in the way of Dr. Perl making an important and valuable discovery and I hope that he does,” he said. “At this point, the jury’s still out. But that’s science also.”
Rodriquez’s wife, Kelly, a platoon sergeant with the 18th Airborne Corps at Fort Bragg in North Carolina, is counting that science will someday provide more insights on her PTSD, which took years to diagnose.
She had been deployed five times, bombarded with terrible images. One particular incident would haunt her. A female soldier had a husband who was also serving, just like Kelly. She volunteered for a convoy so she could see him before he shipped out. “The convoy was hit by an IED. She was alive when she got to us, and she died,” she remembered. “And her husband was there. I think the reason it was really hard is because if Michael was down range, I would have done the same thing. That could’ve been me.”
The feelings that enveloped her after she got home were painful, but doctors told her she would be fine. “It came down to (me) screaming, ‘Find out if it is PTSD, great. If it’s not, great. Don’t care. I don’t (care) one way or the other, I need something besides you have anxiety and you’re depressed.’ Well, you know, so is half of America,” she said. “I always felt like at the end of the day I didn’t want to hurt myself, I didn’t want to hurt anybody else, so that meant that I was okay.”
Because of that, Kelly Rodriguez is also considering donating her brain in light of the scientific research. It’s a donation that could advance research to the point where one day, there is a way to identify, better treat, and maybe, maybe even cure PTSD.