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Editorial: Paying a Moral Debt

New PTSD Study Raises Hope

The justly famous peroration of Abraham Lincoln’s Second Inaugural Address, which begins with the timeless “With malice toward none; with charity for all,” includes a declaration of the nation’s obligation “to care for him who shall have borne the battle” — a moral debt each new generation of Americans has been called upon to repay.

Since the Civil War, understanding of the nature of that obligation has evolved beyond caring only for physical wounds to also treating psychological ones, which are often equally grievous. With news last week that the National Center for Post-Traumatic Stress Disorder in White River Junction has been awarded $45 million by the federal government for a five-year research project carries promise that even deeper insight will be gained and more effective treatment devised.

Although PTSD was not officially recognized as a disorder until 1980, when the American Psychiatric Association added it to the authoritative Diagnostic and Statistical Manual of Mental Disorders in the wake of the Vietnam War, the condition, or something very like it, was hardly unknown in previous wars. The “shell shock” of World War I and “combat fatigue” of World War II are linear antecedents. Nor is PTSD limited to combat veterans; victims of rape, torture, accidents and natural disasters are also vulnerable.

As staff writer Chris Fleisher reported Saturday, what makes this new project exceptionally noteworthy is that it focuses not only on improving diagnosis and treatment, but also on determining whether PTSD can be cured or even prevented.

“Historically, PTSD has been considered to be a chronic, lifelong disorder that is difficult to treat, particularly in military combat veterans,” according to Dr. Alan Peterson, a professor of psychiatry at the University of Texas who is helping to lead the project. “However, results of studies of PTSD in civilian populations demonstrate that a large percentage of patients have been able to be treated to the point of remission or recovery. Although the term ‘cured’ is rarely used in reference to PTSD, we believe it is possible.” One wonders whether recovery for veterans may be more difficult because of prolonged exposure to traumatic circumstances, as opposed to a single isolated incident. Nevertheless, this research will surely provide hope to thousands upon thousands of veterans who suffer the continuing ill effects of their service.

Equally intriguing is the declaration by Matthew Friedman, executive director of the National Center for PTSD, headquartered at the VA Medical Center in White River Junction, that researchers will also be trying to answer the question of whether the disorder can be prevented.

We suppose that PTSD could certainly be prevented by not going to war any more. But given how unlikely that desirable state is, the idea of trying to use biological traits to predict resiliency to traumatic events could potentially mean diverting vulnerable people out of potentially traumatic circumstances. There is also the real possibility that whatever the researchers learn can be adapted to civilian use, as with so much other military research.

We are mindful that government spending is under heightened scrutiny at all levels these days and that $45 million is a lot of money. But few things we do as a nation have a higher claim on our resources than taking care of those who have borne the brunt of battle, as a compassionate Lincoln articulated almost 150 years ago.