During treatment at the naval medical center, Schuring and ten-year-old daughter Carolynn spend time at a computer in one of the rehabilitation rooms. Photograph by Chris Gavin Jones
Schuring arrived at Bethesda’s National Naval Medical Center in the fall of 2008 for more orthopedic surgeries on his injured leg and hip and met neuropsychiatrist David Williamson. As part of a hospital policy, Dr. Williamson’s team routinely consulted with wounded warriors who came to the hospital to determine if they had psychological issues. A man with a warm smile, quick laugh, and firm handshake, Schuring professed to be fine. But as the two men talked, Williamson realized Schuring suffered from PTSD as well as anxiety and depression. He prescribed medications.
That Schuring suffers from an anxiety disorder and depression isn’t surprising, says Williamson: “There is a strong linkage between the two and with PTSD as well. We think all three are biochemically linked in the brain. We also know depression is the mental disorder most associated with anger and violence.”
Schuring at first refused to take antidepressants. “You’ve got to take them,” Lynn Schuring told her husband, “because you’re not the same guy who left for Iraq two years ago.” He relented, and in time his depression lightened, as did his anger and anxiety, but his PTSD didn’t respond as well.
“PTSD is a very misunderstood condition,” says Williamson. “The biochemistry of PTSD is a very old evolutionary phenomenon that is vital for our survival. It allows us to learn from experiences and recognize a dangerous situation if and when we confront it again. Essentially, PTSD is tied into the system in the brain involved in learning and is basically a corruption of something normal that happens in the brain.
“When we confront something that evokes fear in us, a fight-or-flight response triggers a physiological reaction that is anatomically linked to the brain’s memory system. When fully activated—as it is in combat situations—what triggers it is so powerfully imprinted on the mind it becomes almost indelible. These kinds of experiences remain far more vivid and persistent memories than something that happens in the ordinary course of life.”
The brain’s response to extreme stress is a critical part of the imprinting and alters how we record stressful events, Williamson says: “The heightened emotional coloring of events makes for much more ingrained memories.”
That’s why many of us have such vivid recollections of where we were and what we were doing when a traumatic event occurred such as the loss of a loved one, the terrorist attacks of 9/11, or, for those old enough, the assassination of President Kennedy.
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With Schuring and many other combat veterans and servicemembers, these powerfully imprinted memories spring into consciousness from stimuli that might go unnoticed by other people—a loud noise or a scene in a war movie. For some veterans, seeing a plastic garbage bag on the side of the road evokes fearful memories of IED explosions. Many become alarmed driving under a highway overpass. For Schuring and other PTSD sufferers, vivid and disturbing memories, whether in dreams or when fully awake, reengage the fight-or-flight response and emotionally transports them back to the combat theater.
“They sense the same danger and go back to that time and place, and there’s a big arousal of their nervous system and physical changes,” Williamson says. “They begin to breathe rapidly, their heart pounds 150 times a minute, their muscles are tense and tremulous and ready for maximum exertion as epinephrine breaks down carbohydrate stored in the muscles. It activates areas of the brain to allow them to reach peak performance and speed up their reflexes and cognitive process.
“There are changes in the body’s blood-flow patterns,” Williamson says. “No blood goes to the GI tract, because you don’t need to be digesting food when you are about to fight—you need to get the blood to your brain and muscles. [PTSD sufferers] hyperventilate, feel nauseated, and sweat heavily.
“It’s one thing for this to happen in a combat situation, but it’s another when it happens while they’re in their living room holding a two-year-old on their lap or driving in a car with their family. Some people become so gripped by these PTSD episodes and depression that they become social hermits, which is what happened to Lieutenant Colonel Schuring for a while.”