For the past twenty years, 57-year-old clinical psychologist Michael Telch has seen around ten patients every week, some of them so afflicted by anxiety that they’ve had trouble simply getting to his office. One woman, who’d often spend eighteen hours a day chanting to herself in the shower, had to be physically retrieved for her first session. Another had been scared to leave her bedroom for fifteen years. But while some clinicians might be frustrated by such challenges, Telch doesn’t express the faintest irritation. These are his people.
Telch is the founder and director of the Laboratory for the Study of Anxiety Disorders at the University of Texas at Austin, also known as the Telch Lab. He bears a slight resemblance to Mel Gibson, if Gibson’s face were frozen in an expression of extreme concern. He speaks calmly, a trait one might expect in an anxiety therapist, and moves his hands slowly while he talks, stirring tea if he’s at his office or, if he’s at home, petting one of his springer spaniels, who like to curl up in his lap and snore like a buzz saw.
Much of Telch’s research involves exposure therapy, a potent anxiety-reducing technique that has become prevalent over the past few decades. When I visited his office in January, he explained how it worked. Say a person is afraid of frogs. “In the old days, a psychoanalyst might have assumed the phobia was symbolic of a deeper disturbance,” he said. “The therapist would probe the person’s childhood history, investigate how they were toilet trained, and year after year, hundreds of thousands of dollars later, the phobia still was not gone. Now we can treat patients in a few sessions.”
“Just put a frog on them?” I asked.
“Well, basically, yes,” he said. “But it usually starts with looking at pictures of frogs. I’ve had some serious snake phobics where we had to start by drawing a line on a piece of paper. I’d say, ‘Imagine that’s a snake,’ and the patient would scream, ‘Aahh!’”
Variations of this technique—in conjunction with other methods—are used in most of Telch’s cases. Afraid of flying? He’ll take you on a plane ride. Afraid of heights? Look over the balcony. Claustrophobic? Get in this box. Telch has treated a bewildering variety of ailments—arachnophobia, cynophobia (fear of dogs), obsessive-compulsive disorder, even the fear of fear itself. But until five years ago he hadn’t spent much time researching one devastating condition: post-traumatic stress disorder, the long-term debility caused by exposure to a traumatic event. PTSD victims often suffer from flashbacks, insomnia, and intense anger, among other symptoms.
Telch’s professional focus widened in the spring of 2005, after he was contacted by Brian Baldwin, who was the project manager of UT Austin’s new neuroimaging lab, the Imaging Research Center (IRC). A former Army colonel, Baldwin had once supervised two detachments of psychologists and specialists who helped soldiers cope with combat stress. After the Iraq and Afghanistan wars began, he saw an alarming rise in the number of PTSD victims. Reportedly, between 11 to 20 percent of veterans showed symptoms of PTSD, compared with 2 to 10 percent of veterans of the first Gulf war. Baldwin was surprised. The Army, he believes, has done a great deal to fight PTSD. It has provided psychological care during combat operations and tried to get to the afflicted early. It has also tried to cement the bond between a soldier and his unit, which has been shown to improve the welfare of the soldier when he gets back home. “I thought, ‘Gosh, you know, we’ve done a lot to try to take care of this,’” he said.
But despite such efforts, the nature of combat in the Middle East, in which insurgents are around every corner, is taking a psychological toll. The constant vigilance that serves a soldier well overseas can become an issue when he returns home. The most typical, noticeable effects—relationship problems, for example, or a loss of productivity—are difficult enough. Even more grave is the prevalence of substance abuse, homelessness, and suicide among PTSD victims. According to a recent report, 160 active-duty soldiers killed themselves in 2009, more than in any year since the Army began keeping track of suicides three decades ago (though no conclusive link has been made between these suicides and PTSD).
Baldwin did some research and found that for all that scientists understand about how people develop PTSD, no one has ever definitively determined what predisposes a person to the disorder. Different people, after all, have different responses to traumatic events. But no one is sure why. Is it brain function? A behavioral disposition? Baldwin had an idea: Why not take pictures of soldiers’ brains before they leave for combat, take more pictures when they return, compare the results, and keep track of who does and doesn’t develop PTSD? Baldwin knew he could get some soldiers from nearby Fort Hood on board; all he needed was a scientist to lead the project.
Telch recognized the unique opportunity he was being offered. “For PTSD, too much focus has been on the treatment rather than its causes,” he said. Sufferers can see a psychologist or take drugs such as Zoloft and Paxil, which have been shown to help. But not all the soldiers who need assistance will get it. According to a 2008 RAND Corporation study, only slightly more than half of the soldiers returning from combat in Iraq and Afghanistan with symptoms of PTSD and depression sought treatment, and only half of those received treatment that was considered “minimally adequate.”
Telch wasn’t the first researcher to try to determine what predisposes people to PTSD. But the vast majority of risk assessments had taken place after the patients had been diagnosed, and those reports relied on questionnaires that focused on broad demographics—rank, race, gender. These biographical details offered helpful clues but little more. Telch suggested a far more comprehensive attack that would include genetic and cognitive elements, pre- and post-deployment tests, and