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by Tom Matlack
View “The Reality of War”,
a short exerpt from Michael
Kamber’s essay “Shooting
the Truth”, from The Good
Men Project anthology, now
available: here.
Mark Pollack, MD, is the director of the Home
Base Clinical Program. Home Base is a
partnership between the Red Sox Foundation
and Massachusetts General Hospital dedicated
to improving the lives of veterans who deployed
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and live with deployment- or combat-related stress
and/or traumatic brain injury.
Click the link to learn more about Treating PTSD.
MATLACK: 7KDQN \RX 'U 3ROODFN , FDPH WR
MGH to hear your lecture and heard about how
your brother has served our country and how that
was one part of your motivation to head up the
Home Base program. So maybe we can start with
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are affected at this point, we think?
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there are more men affected than women. There
are more men serving. But it can affect both men
and women.
MATLACK: There’s no evidence to indicate that
men are more inclined to post-traumatic stress
disorder.
POLLACK: No.
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includes both post-traumatic stress and
brain injury, or is it just post-traumatic stress?
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MATLACK: Traumatic brain injury occurs when
soldiers are near explosions that rattle their
brain?
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explosive device, that goes off would be a common
provocation for traumatic brain injury. Sometimes
shock waves, as an explosion would, or if a bomb
or missile or something like that goes off nearby,
that kind of thing.
MATLACK: What are the symptoms of each?
POLLACK: Well, individuals with post-traumatic
stress disorder have experienced a situation or a
trauma that involves a threat of loss of life or severe
bodily harm to themselves, or witnessing such an
event to somebody else. Coupled with that, people
will typically experience a variety of different kinds
of symptoms, from sort of three large categories of
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experiencing symptoms of arousal or anxiety, fear,
if provoked by coming in contact with a situation
that reminds them of the original trauma. So a car
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assaulted in a dark alley, if they walk by a dark
alley, that might start to make them feel aroused
and frightened.
The second major category of symptoms is
withdrawal symptoms, so things like feeling
depressed, feeling a lack of future, a tendency to
kind of withdraw themselves. This is also often very
painful for spouses and children. The individual
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hyperarousal which leads to irritability, anger,
panic attacks, sleep disturbance.
Now, it’s not uncommon after a trauma for people
to have some of these kinds of symptoms normally.
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uncommon to be anxious, aroused, or have sleep
disturbance for days afterwards. But the diagnosis
of PTSD is made when these persist for a month
or more afterwards, with the idea that, for many
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some people these might not occur immediately
after a trauma, but it might occur months or kind of going on constantly, that pushes you to re-
sometimes even years down the road. H[SHULHQFH WKDW E\ EHLQJ LQ WKDW DGUHQDOLQH¿OOHG
environment?
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the symptoms? POLLACK: , WKLQN SHRSOH KDYH DOO VRUWV RI
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POLLACK: For traumatic brain injury, the
clear is that, once people get into those situations
symptoms include things like memory disturbance,
they are very connected and committed to each
dizziness, lightheadedness, a variety of physical
other. There really is a lot of truth to the idea that
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depression, anxiety, irritability, those kinds of things.
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returning veterans talk about the fact that the
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work there felt really meaningful, and that what
the physical force of the blast, but also develop
they do on a day-to-day basis here, while it can
PTSD as a result of having been exposed to a
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near-death experience.
kind of saliency and meaning that the work there
MATLACK: So it seems like one of the biggest ZDV ZKHUH WKH\ ZHUH OLWHUDOO\ ¿JKWLQJ IRU WKHLU
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are suffering to actually come forward. of what’s going on when people stay, and when
they go back. Just last week we were in Walter
POLLACK: The evidence is that probably less
Reed and saw some very impressive men who
than half of people who are suffering with this are
had been badly wounded, and they’re anxious to
seeking any kind of treatment. That may, in large
go back. They certainly have enough injuries that
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they wouldn’t have to go back, but they want to go
may be a desire, in some cases, for people not
back because their guys are still there.
want to call attention to themselves in a way that’s
going to get them pulled out of the situation and MATLACK: $V SDUW RI WKLV *RRG 0DQ 3URMHFW
away from the other soldiers. They don’t want RQHRIWKHJX\VZH¶YHSUR¿OHGLV0LFKDHO.DPEHU
to feel like they’re abandoning them, so they’ll who’s the number-one war photographer for the
PLQLPL]HWKHLUV\PSWRPVIURP7%,DQGHYHQZLWK New York Times.He’s covered twelve wars, and
$QG WKHQ ZKHQ KRPH RIWHQ SHRSOH PD\ DYRLG when he comes back, he’ll say, “Nothing here
seeking treatment, either because VHHPVWRPDWWHU,QHHGWRWDNHSLFWXUHVWKDWDUH
people just want to put the whole thing behind going to show the truth, the real truth, of what’s
them, again because of the stigma, and because going on in the wars that are going on in this world,
of a desire to avoid getting involved in any sort and that’s somehow become this passion, but a
of screening or treatment that might delay their lot more than that.
ability to return home.
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Junger, who writes for Vanity Fair a lot. He spent
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the most dangerous situation choose to be there,
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choose to do that. Do you think once you kind of get
to a point of having experienced so much trauma
that you kind of get into this cycle where it’s kind
of the only thing that you know, and that there’s
some level of post-traumatic stress that’s actually
POLLACK: Many people are searching for
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something that makes sense to them and gives
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put themselves in harm’s way to do it.
MATLACK: So tell me a little bit about Home
Base.
POLLACK: The Red Sox won the World Series, in
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the team docs was in the military, they went to
Walter Reed with the idea that that would be a
nice thing for the soldiers down there, especially
Red Sox fans. Tom Werner and a number of the
owners really were very moved by what they saw
down there, and decided they wanted to make a
commitment to doing something, and eventually
agreed to underwrite, along with MGH, for a
program designed to help take care of soldiers,
returning veterans, and their families.
So Home Base is a program that helps provide
care focused on combat stress-related disorders,
PTSD, depression, anxiety, and traumatic brain
injury, and also helping provide education,
support, and treatment for family members. They
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there for months or sometimes even years. You
can imagine what the impact would be on a kid
[in] these formative years with parents not there
for long stretches of time.
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education to the general public, but we’re going
out to yellow ribbon events for returning veterans,
providing education around family issues,
education on the Web. The truth is that most
returning vets are probably not going to get treated
in a military sense. The majority of these people
will get treated in the general publics, and trying
to increase awareness and expertise among docs
outside of military settings is one of our goals.
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a lot of people still are symptomatic after receiving
standard treatments. So we are looking to learn
more about the disorders and to develop the next
generation of treatments to try and get more people
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that a number of vets, not surprisingly, want to
deal with other veterans. For some people, having
that ongoing vet-to-vet contact is critical.
MATLACK: So my understanding is that there’s
drug treatment and therapeutic treatment.
POLLACK: Psychosocial treatment too. Both
psychosocial treatments or psychological
treatments are effective, and pharmacotherapies
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the two most commonly used and documented
effective are cognitive behavioral therapy and
cognitive processing therapies, which basically
involve having patients expose themselves to the
memories of what happened, and giving them
cognitive and behavioral tools to deal with the
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exposing themselves to those situations, and
managing the feelings that come up over time,
they gain some control over the feelings. Those
are the cognitive behavioral therapies, or cognitive
processing therapies. The other are medication
treatments and also can be effective. Drugs like
antidepressants are commonly used, and then
there are other medications as well.
MATLACK: , ZDV KHDULQJ DERXW LQ WHUPV RI
exposing patients to the actual trauma, that
technology’s being used in that regard.
POLLACK: That’s something that’s been an
active area of research, and we’re starting up a
program here with the idea that, for some people,
remembering what happened to them, or bringing
it back up in their mind and talking about it, and
writing it down, kind of exposing themselves to
the memory, can be inordinately painful, to the realize the anxiety and the arousal will rise, peak,
point that it’s very hard for them to do it. For those but it will end. The more they go that experience
people, using a virtual reality, where in some ways of seeing it arouse, and increase, and then peak,
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avoiding thinking about it, and can be very they have that it’s not going to last forever.There’s
evocative. The idea is to expose the person to what a sense of constantly reminding them that, while
they’re afraid of repeatedly, and again, give them you’re feeling this, while you’re experiencing these
some tools for sort of managing the arousal and memories, in fact, you are in a safe place, and
the anxiety as they go through it. With repeated the fact that you’re feeling your heart racing, and
exposure over time, their fear tends to extinguish. you’re feeling that sense of anticipation, doesn’t
The virtual reality stuff is a way of getting people mean you’re actually in danger. Trying to teach
to expose themselves to these memories and them to distinguish what happened in the past
situations that they’re afraid of. from the present safety.
MATLACK: So at its core, post-traumatic stress
MATLACK: So this is actually a good use of video
really is, in some ways, about the unconscious or
games.
conscious belief that you’re still in that situation.
POLLACK: Well, the main thing is that the
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dysregulations in memory, and at the moment,
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feeling like you’re back in the traumatic situation.
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The distress that you get triggered in certain
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situations makes it hard to distinguish what was
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then from what was now.
about that, and they’ll sort of go through it, and
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their own experiences.
impact. People developed PTSD after September
MATLACK: So they impose their memory on it. ,I\RX¶UHGULYLQJGRZQWKHURDGDQG\RXVHHD
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POLLACK: Yeah, that’s sort of what you would
the road, or somebody really injured, those kinds
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of things can trigger it in an individual. The
to life, that it might inhibit somebody from putting
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in their own kind of experience. But certainly with
to be happening directly to you.
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certain parts of it, so there’s going to be a balance MATLACK: 2QDSHUVRQDOEDVLVKRZGLG\RXJHW
between making it so real that maybe it’ll lose some interested in this kind of work?
of its generalizability, and making it real enough.
Click the link to “See Virtual Iraq”.
MATLACK: So when a veteran is hooked up to
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you’re using to allow them to manage their fear?
POLLACK: Well, in some ways you would do it the
same ways as you do regular behavior therapy,
where they’re exposing themselves to their own
memories, and helping them talk in great detail
about what happened, feel those feelings and

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already in civilian populations. My brother is career
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he would tell, where every day kids would line up,
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important work trying to help some of these people
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their health in some cases, given up years to do
this for us to some extent, and it feels important.
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do some of it, to help give something back, and
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The owners of the Red Sox felt that they wanted
to give something back. Think about what it was
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in uniform, and for many people they tended to
abuse the soldiers and veterans. Now you go from
the airport and the veteran walks by in uniform,
people will spontaneously go up and thank them,
buy them a beer. The airlines will upgrade them
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that they were all extraordinary when they started.
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some calling to do this. But there’s something about
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them, and made many of them do extraordinary
things.
MATLACK: So do you talk to your brother about
this at all, and what does he say?
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general public is kind of paying attention to this.
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the generals, they’ll say that to really be helpful,
it really does need to be a partnership between
the private sector and the military. There are
hundreds of thousands of people, and it really is
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country, not just the military, to help take care of
these people.
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appreciate it.
POLLACK: Well, thank you.

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is that the politics of war, and the individuals that
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good. So whether you support a war or not, as an
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soldiers do.
POLLACK: You meet some of these soldiers, and
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