We train soldiers for war. Let's train them to come home, too

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
weapons 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 peaceable 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 into 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 have 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 MK-19 automatic grenade launchers

and say, here's a 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
base 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 that 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 has been there.

You don't require training for operations
on the battlefield.

You require training on how to come home.

Now, 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 I have 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 that 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."

And 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 that 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,
that the energy level, that the value

that we place on sending them
off to war is at very least mirrored

in how well we prepare them

to come back home to us.

This much we owe them.

Thank you.

(Applause)