Two branches of the U.S. military are locked in a property battle worthy of Google and Apple.

By D.B. GRADY l The Atlantic Jan.17, 2013

Military combat uniforms have two purposes: to camouflage soldiers, and to hold together in rugged conditions. It stands to reason that there’s only one “best” pattern, and one best stitching and manufacture. It should follow that when such a uniform is developed, the entire military should transition to it.

In 2002, the Marine Corps adopted a digital camouflage pattern called MARPAT. Rigorous field-testing proved that it was more effective than the splotched woodland pattern in use at the time, and the Combat Utility Uniform (of which it was a part) was a striking change for such a conservative institution.

Not to be outdone, the Army drew up digital plans of its own, and in 2005 issued a redesigned combat uniform in a “universal camouflage pattern” (UCP). Three years after the Marines made the change, four years after the invasion of Afghanistan, and two years after the invasion of Iraq, you might think the Army would have been loaded with data on how best to camouflage soldiers in known combat zones. You would be wrong.

In fact, not only did the Army dismiss the requirements of the operating environments, but it also literally chose the poorest performing pattern of its field tests. The “universal” in UCP refers to jungle, desert, and urban environments. In designing a uniform for wear in every environment, it designed a uniform that was effective in none.

As for durability, not long after the Army combat uniform appeared in Iraq, soldiers discovered that the uniform’s crotch seams were prone to ripping open on the battlefield. Rather than fix the problem, however, the Army simply shipped more boxes of defective uniforms to supply sergeants. Stitching techniques were revisited the following year, and in 2007, uniforms already in circulation were tailored to compensate for the frustrating and distracting deficiency.

As it would turn out, MultiCam — a pattern that the Army had originally passed over in favor of the universal pattern — was discovered to work quite well in Afghanistan. The Army began issuing MultiCam combat uniforms to deployed soldiers, but continued (and continues to this day) peddling universal pattern combat uniforms to soldiers stateside — a combat uniform that will never again be used in combat.

Such dysfunction is not unique to the Army. MARPAT was a success not only in function, but also in adding distinction to the Marines wearing it. Naturally the Air Force wanted in on that action, and set about to make its own mark on the camouflage world. It’s first choice? A Vietnam-era blue tiger-stripe pattern. (You know, to blend in with the trees on Pandora.)

After an outcry in the ranks, the leadership settled on a color scheme slightly more subdued. The new uniform did, however, have the benefit of being “winter weight” only, which was just perfect for service in Iraq.

The Marine Corps has remained loyal to the effective MARPAT, and rightfully so. But when the Navy decided to migrate to a digital pattern three years ago, it chose a desert scheme a few shades too close to that of the Marines, and the Corps balked. The Navy has since restricted its digital desert pattern to Special Warfare units. (The Marine Corps has also warned the Army against infringing on its design.) Essentially, the branches of the U.S. military are now engaged in the same intellectual property battle as Google and Apple.

To make matters worse, the new Navy Working Uniform has been found to be highly flammable, and “will burn robustly” if exposed to fire. In fact, it turns into a “sticky molten material.”

Nobody expects the military to make smart financial decisions. While the six-hundred-dollar hammer was a myth, such boondoggles as the F-35 joint strike fighter are very real. And while it is the world’s best jet for fighting Transformers or supporting Iron Man, it is the worst for modern, non-computer-generated battlefields. (The Air Force isn’t exactly flying a lot of sorties against the Taliban fighter jets.)

But everyone should expect and demand that the Defense Department purchase durable combat uniforms printed with the most effective camouflage pattern. Only the galactic stupidity of the Pentagon would allow inferior concealment in the name of public relations and marketing, which is what this uniform arms race amounts to. Each branch wants its members to have a distinct appearance, and there’s nothing wrong with that. Such matters should, however, be confined to dress uniforms. As a matter of camouflage in hostile areas, a standard combat uniform across the branches is the only sane option.

From a financial perspective, it makes sense as well. Four combat uniforms require distinct accouterments and gear, to say nothing of manufacturing times and transportation overseas. If standards are an issue, I’ll offer a baseline: a pattern that blends into the relevant operating environment; stitching that doesn’t rip at the crotch; material that doesn’t melt onto the skin. And the Pentagon should leave the embarrassing copyright battles to the smartphone industry. I’d like to think the United States military has more pressing things to worry about.

By SCOTT JOHNSON  l  Guernica magazine Aug. 2011

1.
“My country is dying,” my friend, an Iraqi, says and looks at me.

We’re standing in his garden and he is cradling some oily nuts and bolts in his hand. The sprinkler system he set up in our yard is filling the air with a thin mist. He has called his device the mister-mister. Outside the small triangle of relief it provides the air is tight and sharp. The sun is so hot it hurts my skin, which turns feverish and prickly. The leaves wither and grow leathery. The grass, such a feeble and primordial thorn, somehow endures. I look at my friend.

“Mine too,” I say, “I think mine too.”

Luc, the photographer I’m working with, is upstairs sleeping. He arrived this morning from Paris. I haven’t seen him since Nasiriyah. He smiled broadly when we met. His smile is wry, warm. Lines of laughter pull his eyes down at the edges. People call him the Little Prince.

2.
Luc prefers to keep death to himself. When it’s in front of him, dead people scattered about the fields of war, he’ll take his camera out and, click, freeze it. He gets as close as possible. He wanders into it, like an itinerant herdsman looking for grazing pasture, identifying it by the sway of the grass, the dispersion of seeds across the air, the thickness of the soil underfoot. This is it, he will say, this is the right place to be.

Luc once photographed an Afghan as the rounds whistled through the grass around him and hit the sand—thppt, thppt. Many people say Luc photographs death more beautifully than anyone.

After Nasiriyah, I began to have death fugues.

The fugue of the musician: “A contrapuntal composition in which a short melody or phrase (the subject) is introduced by one part and successively taken up by others and developed by interweaving the parts.”

The fugue of the psychiatrist: “A state or period of loss of awareness of one’s identity, often coupled with flight from one’s usual environment, associated with certain forms of hysteria or epilepsy.”

My fugue: I am stopped at a traffic light in Kuwait City. And then this question arises: Am I dead?

I am not sure. I am confused about it.

I run through the events again. I am driving down Highway 8, in southern Iraq. I come to what I believe is a checkpoint. A man with a large gun is standing to the side of the road with his gun pointed at me. Weapons, weapons, they have weapons comes to me over the radio from Luc, who is in another car, ahead of me. The words are in French. The shooting begins. It is directed at me. The bullets puncture the car. They sound like hard rain. Hail. They sound like small hammers, children’s toy hammers. As they pass through the car they suck air out with them. I duck. When I do, I lose control of the car. It flips onto a sidewalk. I skid into a pole. When I come to, I am on my side. I can smell gas. I am sure that any moment a face will appear in front of the window, raise a weapon, and end me.

In Kuwait City, the lights have changed. Cars begin to honk. I am not sure what to do. If I am dead, then presumably I don’t need to do anything urgently. Death absolves one of a certain degree of responsibility it would seem. If, however, I am not dead, I need to act.

After I crashed, and the face did not appear, I began to kick at the windows. I kicked until the window cracked, then webbed, then gave way. I kicked it free, crawled out, away from the truck. The shooting had ended. All I heard were celebratory shouts. I pressed myself into the ground, on a patch of dirt, and then crawled away on my belly. There was a dung beetle underneath me. He was big, black, slow. He was unconcerned in every way. I poured something of myself into him and let him crawl with me, away from the smoldering wreck behind me.

I am not dead, I say, to the uncertainty. I am alive. Dead is something else entirely. I cannot say how it is different. But it is different.

3.
I don’t always say it, but it’s death I’ve come to see. Death, and to a certain extent, destruction.

We sit in a small room on one of the bases in downtown Ramadi. There are no windows. I am on one bunk. Across the room Luc is on another, facing me. We lie like this for hours. Sometimes we talk, sometimes we’re quiet for long stretches. Occasionally one of us will fall asleep. The other will wake him up. We ask each other what time it is. Luc wants to know what music I have on my iPod and when I show him he scrolls through lists of albums, countless songs I have never heard, music I don’t even like. He scrolls quickly, seemingly more fascinated by the technical feat than by the music itself. He hands it back to me.

“You listen to all that?” he asks.

When I say no, he nods as if this is what he expected.

He pulls out his cell phone. All of his music he carries there. He has only a few artists: Lou Reed, Bob Dylan, the Rolling Stones, Serge Gainsbourg, the Clash. He says this is the real thing. Everything else is background noise. He suggests we play musical trivia. He begins.

An easy one, he says. On which album will you find the song “Tangled Up In Blue”?

Easy, I agree. Blood on the Tracks.

He increases the difficulty immediately, considerably. He plays me two seconds of a song. I must guess the song from the clip. I know the song, that it is Dylan, but I don’t know the title. What year was it recorded, he asks. I have no idea.

1965, he says. He lets the rest of the song play. The chorus reverberates.

Something is happening
But you don’t know what it is
Do you?
Mr. Jones?

Luc smokes little brown cigarettes. I eat. We are waiting for the moment when we can approach death. It is not meant to sound dramatic, though I know it does. It is simply what it is. There is no other point in being here. There is no other story to tell. That fact is not sad, nor is it tawdry or opportunistic. We all approach death from different directions. Sometimes I rush headlong towards it, behind a soldier, say. Sometimes I watch from a great distance with utter boredom. Twelve dead in a plane crash? My fascination with the irrelevant detail makes my contempt for the dead that much more acute: What sort of plane? A storm? Anyone famous? Sometimes, most times, I run away. And then there is this—this waiting, this subtle orchestration of events that will bring me into close proximity to the beast. I want to slow it down, understand it, describe it; I want to be swept up in its swirling currents for a moment. Isn’t that what I want?

Neither Luc nor I ever did military service. I come from a country where it is not required. Luc is French and of a generation that demanded it of its young men. But Luc got himself categorized as a P-4, mentally unstable. Then he spent much of the rest of his life in the company of soldiers. He has been shot, and shot at, more times than he can count. He is thin. Oh thin men of Haddam, I think, whenever I see him, sucking on a beetroot with a Cheshire grin. He never exercises and yet his stomach is a flat six-pack of muscle. He is tight and strong, wired. If he lost control for one second too long I imagine he would begin to twitch with electricity and zing off into outer space. He is here for one thing. L’action.

4.
Consider the expression death is all around.

Luc and I are sitting in one of the bunkers at the governor’s palace downtown. The marines are watching the streets outside the wire. The city around here has been destroyed. The buildings are broken and crumbling. Walls are gone. There are no windows, only holes. Roofs have collapsed and now lie in rubble and wreckage. Other journalists have compared this section of town to Stalingrad, but none of them has ever seen the Stalingrad they imagine, nor felt what life force existed there. Nevertheless, the proximity of death provides parallels. Life, as we might experience it, is here warped by the closeness of death.

For instance, there is an intersection a few hundred meters down the road, guarded by American marines. Now and again men and women scurry from one side to the other. A man on a bicycle rides up and then down again, seemingly oblivious to the armed men who surround him on three sides. Perhaps he is a madman. An old man sits in a chair on one side of the intersection. The marines are trained to believe that any of them could be insurgents, killers, terrorists.

A box appears in the middle of the street. There is no explanation for it. The marines tense up immediately. They squint through their binoculars. A giddy child screams, runs up the street, his lightheartedness improbable and confusing.

“Watch that fucking box,” one marine orders, in case anyone wasn’t already paying attention. Several pairs of binoculars swivel, focus on the box. The lenses on these binoculars are green and shiny, much bigger than your average binoculars, rounder, more like eyes, green alien eyes, flat, all-seeing, pointed in the same direction like mongoose eyes, the world reduced to digits of infinitesimal movement.

“Is that fucking box moving?”

“Could be on a rope.”

“Who’s pulling?”

“That old man?”

“Watch that kid, where’s the kid?”

“Is it moving?”

“Can’t tell.”

“I want the road closed.”

“Close alpha now.”

“Where’s that fucking kid?”

“You see rope?”

“No.”

“It hasn’t moved.”

“I don’t care, shut it down now.”

For now, death is in this box. All our eyes are locked on it. If we open it, if they shoot it, if someone steps on it, a vehicle drives over it, a dog sideswipes it, destruction will hurl forth. Life dances around it. In the street men and women continue to cross back and forth. The sun is beating down; the box pushes back at the sky. If the sky falls, it will fall down upon all of us. We will be covered in a blue death.

So we focus our eyes on figures in the streets, the old woman’s clothed frame, the crooked nose of the old man and his bony sandaled feet, the whirring of the bicycle wheels. There is no air anymore. The whole world is contained inside this small box. My breath is there. No one can look away.

And then a tall man comes strolling along. He’s lanky, an Iraqi jughead. He swings his arms blithely. In another reality he is whistling. He comes along and, whack, kicks the box and sends it flying down the street.

Read on

By BRYAN ANDERSON

Michael and Annie Mithoefer’s patients come to their clinic in Charleston, South Carolina, as a last resort on a grueling tour of duty. Unable to shake what they’ve experienced, witnessed or carried out, on orders or otherwise, in the suburbs of Baghdad or the valleys of Helmand Province, they’re wracked by the relentless mental sirens of post-traumatic stress. They’ve sought out the husband-wife team because no other therapy has made it all stop. They’re up for anything.

The Mithoefer’s are upfront: should trauma not surface at the patient’s behest, well, then at a certain point they’ll make it surface. The process can be painful, and spans hours, so patients arrive mid-morning. After final “set” preparations each subject is handed one small, curious capsule. It’s 10AM and they’re ingesting ecstasy.

The daylong sessions that follow are part of a small, open-label Phase II study of MDMA-assisted psychotherapy for post-traumatic stress disorder in war veterans. The experiment examines how 3,4-Methylenedioxymethamphetamine, better known as ecstasy, may alleviate the crippling, long-term horrors of “chronic, treatment-resistant, combat-related PTSD” when administered at low doses and in controlled settings.

This is the leading edge of a 10-year, $10 million push by the Multidisciplinary Association for Psychedelic Studies for Food and Drug Administration approval of MDMA as prescription medicine. Rick Doblin, the founder and director of MAPS, envisions a day when ecstasy can be picked up at the corner drug store.

It’s not clear how close that day is, given lingering taboos and stigmas attached to anything that strays too close to the roiling, unchartered waters of the “mind-altering.” For now, the Mithoefer’s will score MDMA from the only licensed dealer in the U.S., a Purdue University chemist. They’re doled 30-, 75-, and 125-mg capsules from the only government-approved batch of ecstasy ever made, in 1985, when the drug was criminalized. (This product is routinely tested for purity, and remains over 99 percent pure MDMA.) This current study is double blind, so no one’s privy to the dosage – 125, 75, or 30, the low-level active placebo – they’re taking from the outset of their trips. Then again, it’s not too difficult to put a finger on just how hard you’re rolling on ecstasy.

Once medicated, patients are encouraged to lay back, to focus inward. Some opt for eyeshades and headphones. Others simply close their eyes, favoring the quiet. Everyone waits.

THE AGONY

What we know as PTSD isn’t anything new. Severe, sustained psychological anguish stemming from harrowing experiences is an ancient phenomenon, though it was only first recognized in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

The symptoms of PTSD are wide ranging. They fall under three broad categories, according to the National Institute of Mental Health. Re-experience symptoms are textbook pangs – vivid flashbacks, dark thoughts and darker dreams. Avoidance behavior includes shying away from “places, events, or objects” linked to the experience, plus emotional numbing, feelings of guilt, depression and anxiety, loss of interest in “activities that were enjoyable in the past,” and even difficulty recalling the event. Hyperarousal sparks short fuses – one is easily startled, feels tense or “on edge,” has difficulty sleeping and has sporadic, angry outbursts.

We’re all subject to this at any age, science says. But in the United States we’re breeding the disorder within the military at sickening rates. Over 70,000 veterans received PTSD disability support in 2005. One study, as the Economist reported in 2008, “estimated that 12 percent of American veterans from the wars in Iraq and Afghanistan suffer from PTSD.” Last year, the New York Times figured “well over” 300,000 troops had returned with PTSD, depression, traumatic brain injury, “or some combination of those.”

Distressed veterans and active-duty troops can take antidepressants like sertraline (Zoloft) or paroxetine (Paxil), the two FDA-approved SSRI (selective serotonin reuptake inhibitor) medications for adult PTSD. (Under a recent settlement between veterans and the military and stemming from a 2008 class-action lawsuit, more than a thousand Iraq and Afghanistan veterans with the disorder would be given lifetime disability retirement benefits such as military health insurance.) The FDA says these are relatively safe, but warns of unintentional side effects: “worsening depression, suicidal thinking or behavior” and “sleeplessness, agitation, or withdrawal from normal social situations.” (One recent study claims those on antidepressants are “much more” prone to relapse into major depression than the non-medicated.)

Benzodiazepines – relaxation and sleep inducers that may meddle with memory and spur dependency, such as Xanax – “other antidepressants,” like fluoxetine (Prozac) and citalopram (Celexa), or antipsychotics are all other medications the NIMH cites as possible PTSD treatments.

The military’s medical program has over the past decade developed a knack for throwing prescription drugs at the mental health problem – so much so that the Army now limits how many addictive painkillers any soldier can score at any one time. It’s not uncommon, though, that troops be on multiple approved antipsychotics, antidepressants and opiates simultaneously. The risks of overmedicated war machines hoarding drugs and channeling a “national psychosis,” as some have illustrated, can be as unsettling as the original problem. Between 2006 and 2009 over 100 military personnel have died accidentally due to toxic prescription-drug blends. Illicit self-medicating, the default for so many Vietnam-era troops, is falling out of favor among newer veterans. Now, the bottles are in. Vets are five times more likely to abuse pills and alcohol than weed or coke or heroin.

There’s also this: The Government Accountability Office just concluded that the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, created in 2007 when Congress tasked the Pentagon with establishing a program for handling influxes of brain injuries and PTSD among veterans, has no idea what it’s doing (pdf). The DCoE was supposed to be a guiding light when it came to developing techniques for treating so-called invisible wounds. But as Denise Fontane, who headed the audit, told NPR, “[DCoE was] not able to explain to us in any clarity what they’re about, what they intend to do in the future, how much it’s going to cost and what value will come out of that spending.”

It may be unsurprising, then, to learn that suicide rates across the Department of Defense rose by about 50 percent between 2001 and 2008. Nor is it surprising that active-duty suicides topped battlefield casualties in 2009, or that a dozen reserve soldiers killed themselves last March, or even that some experts, according to the Times story, consider exposure therapy (a form of cognitive-behavioral psychotherapy) the “only proven treatment” for PTSD. (To its credit, the U.S. Department of Veterans Affairs requires veterans seeking treatment be given universal access to prolonged exposure or cognitive processing therapies.)

And given the severity of the problem, it’s hardly shocking that there’s actually a waiting list of subjects eager to see about the Mithoefer-MAPS MDMA method.

CHEMICAL WARFARE

MDMA’s effects typically manifest themselves 30-45 minutes after ingestion, so it doesn’t take long for rhythms to develop in Charleston. Sessions at the clinic oscillate between stretches of silent, inward focus, where the patient is left alone to process his trauma, and unfiltered dialogue with the co-therapists. “It’s a very non-directed approach,” Michael Mithoefer told me. This allows subjects to help steer the flow of their trip. They are as much the pilots of this therapy as their overseers. “Once they get the hang of it,” Mithoefer explained, “sometimes people will talk to us for a while and then say, ‘OK, time to go back inside. I’ll come report when I’m ready.’”

That said, patients understand that if no traumas emerge, the Mithoefer’s must coax them out. But they’ve never had to. The traumas always emerge, and by now there have been over 60 sessions between an initial, smaller Phase 2 study and the present trials. Horrors are bubbling up naturally, patient after patient.

Vital signs are monitored throughout sessions. Blood pressure and pulse rate are measured every 15 minutes. Body temperature is recorded on the hour, at which point subjects reliving experiences, alone and inside, are checked on. Intense emotions and visuals are commonplace, so preventing freak-outs is critical. (There’s even space at the clinic for patients to spend the night, which they’re required to do.) If the thought of returning to the unthinkable isn’t enough, imagine your most horrific life experience stroked, possibly for the first time, by MDMA. “It’s painful,” Mithoefer admitted. “A few people on the first day have said they don’t know why it’s called ecstasy.”

Psychoactives offer new access to deeper regions of the brain, according to Amanda Feilding of the Beckley Foundation, an Oxford-based charitable trust using modern brain-imaging technology to explore consciousness and its altered states. Experientially, they seem to purge the repression that prevents attention getting to trauma. This reduces treatment length from years to hours, in some cases. Therapeutic psychedelia, Feilding said, “is a great, beautiful orchard filled with ripe fruit for picking.”

From out of this beautiful orchard – replete with LSD and psilocybin, ibogaine and cannabis – MDMA seems especially equipped to enhance psychotherapy. “MDMA has the greatest opportunity of any psychedelic to be integrated into psychiatric practice,” Doblin wrote in “A Clinical Plan for MDMA.”

Ecstasy is brief, for one. Compared with, say, LSD, whose effects can last in excess of 10 hours, MDMA’s roughly four-hour “primary effect” window (and two-hour comedown) is relatively manageable. Ecstasy is also gentle despite its slight toxicity, which can cause depression in the days following trips. Compared to acid, which warps “rational cognition processes” and perception and may also prompt fear and panic, MDMA operates more so on emotions than cognitive function. It subdues the amygdala, the inner-brain “fear center” that sparks heavy negative emotions, while opening serotonin and dopamine brain-messenger floodgates and boosting blood levels of oxytocin and prolactin, two sociable hormones.

In other words, patient-therapist empathy increases. Patients are comfortable, all things considered. They’re willing to enter “the eye of the trauma,” as Feilding put it. In this regard, she argues, MDMA’s not unlike psilocybin in as much as it “removes the filters,” allowing people to consider situations past and present in slightly different ways.

The subjects are in the sweet spot. Mitheofer says so many people are resistant to PTSD treatment because of either under- or over-engagement. He and his wife, a psychiatric nurse, are observing that MDMA shepherds subjects into an optimal arousal zone, or window of tolerance. It’s here that they can connect with their emotions while revisiting trauma and not lose it, so to speak. “Four or five hours in this zone,” he said, “may be what gets them past the obstacle to treatment.”

That doesn’t mean it’s easy. But it’s not overwhelming – or free from all uncertainty.

“I have concerns,” said Charles Hoge, a psychiatrist and senior scientist at the Walter Reed Army Institute of Research. Hoge spent two decades on active duty before signing on at the Office of the Army’s Surgeon General and Walter Reed. And while he hasn’t delved too deeply into the medicinal-psychedelic literature – “I don’t know much about it,” he admitted – Hoge noted that MDA (3,4-Methylenedioxyamphetamine) and its related compounds have significant, immutable biological effects. “They have irreversible bindings on some receptors in the brain,” he explained, “which can potentially result in maybe greater or longer-term side effects for an individual.” SSRIs, he claimed, are reversible.

Whether long-standing regulations can be overturned is another question. The policy push for FDA approval is not easy. It’s overwhelming. “We’re in a dark age at the moment,” Feilding, the Briton, admitted. Yet she believes we’re on the brink of a sort of renaissance in which psychedelia’s medicinal potential is fully realized, accepted by the Old Guard of global-medical politics after decades of staunch resistance.

The current Mithoefer-MAPS trials just enrolled a sixth patient, and will cap at 16. Brad Burge, MAPS’ director of communications, said that’s a low enough figure that the study is manageable, but high enough to yield statistical significance. Burge admitted that it would be better to have 100 subjects – any significant result would then carry some real weight. “But we actually have a lot more than 16 waiting to be interviewed by the research team,” he said, and will “almost certainly” have enough subjects for Phase III. “We’re not terribly concerned about that considering how prevalent PTSD is, and how enthusiastic so many people are about trying these new therapies.”

“This is already mainstream research,” Burge added, given MAPS’ collaboration with governments and universities from around the world. (He may have a point, considering Oprah’s nod.) “We’re already doing this just like a mainstream pharmaceutical company would do it,” he said, so it’s “pretty clear” prescription MDMA for PTSD psychotherapy will be available at the corner store within the next 10 – 15 years. To him, it’s a question of when, rather than if.

So the Mithoefers will roll on. In addition to ongoing trials, they’re following up with participants from the initial Phase II trials, which used inactive placebos. (The researchers noticed a “big improvement” from sessions where patients took placebos to those on ecstasy. These results were the most downloaded article from the Journal of Psychopharmacology in 2010.) Three years later, how are they feeling? Eventually a paper will be published on this, though for now the co-therapists are wary of leaking data. But they told me that average CAPS scores weren’t fluctuating wildly – an encouraging sign. Yet a few people relapsed. “They were having significant symptoms again,” Mithoefer said. “The benefit didn’t last for everyone, but the benefit did last for a majority of people.”

Still, SSRIs are the only Level-A medications to have been shown in randomized trials to be “fairly consistently” effective for treating PTSD, Hoge insisted. He added that a lot of newer-class antipsychotics are being developed with fewer and fewer negative side effects; there are even adjunct medications that may help treat certain PTSD symptoms. Prazosin (Minipress), a blood-pressure medication with no psychotropic effect, has been shown in a few randomized trials to dampen physiological hyperarousal, especially in reducing nightmares, which then encourages improved sleep. But as with MDMA and all other ripe fruits of the great, beautiful orchard – “all those types of things” – until prazosin and various other promising medications are tested more rigorously in randomized trials with double-blind control, “we can’t confirm whether they’re effective or not, whether they have greater side effects or not,” he said. “I think that’s the bottom line.”

Don’t Tell

But the effects and promise of various PTSD drugs mean nothing when many of those most in need of treatment are reluctant to seeking treatment in the first place. Writing in an editorial that ran with a study published last week in the Journal of the American Medical Association, Hoge not only suggested that a whole class of antipsychotics – like Risperdal, Seroquel, Geodon, and Abilify – can’t top placebos. He points to the bigger, more pervasive problem: half of veterans who can’t shut out the mental sirens, and who should seek care, don’t. The quiet stigma of PTSD has helped turn the post-apocalyptic illness into a cross-generation epidemic, and amplified its already devastating effects.

There are many reasons for the “don’t ask don’t tell” approach to PTSD, and not all are unique to the military. Some people fear being shunned by their peers or leaders or potential employers. Others run up against barriers to treatment – it may be difficult to land an appointment, or individuals may choose to prioritize work over getting help. Others simply have the idea that mental care doesn’t work, that it’s a shoddy “last resort,” Hoge told me. And among those who do manage to begin treatment for PTSD with either psychotherapy or medication, he wrote, “a high percentage drop out,” typically between 20 and 40 percent, a figure that can rise “considerably higher” in routine practice.

Meanwhile, Michael Mithoefer and others continue to fight a guerrilla war against PTSD, special forces in the shadows. “We’re encouraged by the results so far, but we have to do a lot more research, and it’ll be interesting to see how it all unfolds,” he said. But progress isn’t just a matter of breaking taboos – and amending regulations – around psychedelics and other edgy treatments. Medicine may not win the war on PTSD until society can break much more basic taboos, around the terrible, invisible traumas of combat. Only then might veterans have a chance to trade the bitter pill of war for one that only tastes bitter.