Getting blown up, again and again

U.S. soldiers traumatized by Iraq are combating PTSD with a virtual reality treatment that plunges them back into the war zone.

By Eilene Zimmerman

Read more: Therapy, Politics, Veterans, Virtual Reality, trauma, News, post-traumatic stress disorder, Health Care, Iraq, Army, Iraq War, fallujah

Photo composite of "Virtual Iraq" screen shots. (Inset) A soldier participating in the therapy.

May 16, 2007 | Kevin Smith and his unit have just finished an unsuccessful search for snipers inside a house in Fallujah and are headed back to their base. Smith is behind the wheel of a Humvee, the seat beneath him vibrating from the familiar roaring engine. He makes a left turn and suddenly there is an ear-splitting boom, an explosion right behind him that rocks the vehicle. The sky goes dark and smoky, and Smith senses the piercing pain of shrapnel in his neck and hands. The Humvee's radio crackles with voices asking for information, as his mind races. Will there be more explosions or a hail of bullets from unseen snipers? Are his fellow soldiers hurt? Time seems at once to speed up and slow to a crawl.

Then, just as suddenly, a voice cuts into the nightmare: "What are you thinking right now?"

It is the voice of Maryrose Gerardi, a psychologist at the Emory University School of Medicine and Smith's guide through the world of "Virtual Iraq." Smith isn't actually in Fallujah, where he served as an Army infantry scout in 2004; it is April 2007, and he is in Gerardi's office, wearing a sophisticated headset and sitting in a chair on a vibrating platform. Smith is one of a handful of Iraq veterans involved in the trial of a cutting-edge therapy that uses a high-tech virtual reality system to treat war veterans afflicted by post-traumatic stress disorder.

Smith, Gerardi and the designers of the virtual reality system say the experimental treatment has had such positive results that it may prove to be the most significant advance in years for the treatment of PTSD -- a problem of growing scope among veterans returning from the wars in Iraq and Afghanistan. The treatment's healing power derives from repeated exposure, using vivid simulation, to a veteran's most traumatic memories of war.

For years, experts have considered exposure therapy, also known as talk therapy, to be the most effective treatment for PTSD: Doctors help their patients recall and confront troubling experiences, until the patients are habituated enough to control their emotional response. Virtual reality therapy is like exposure therapy on steroids. It plunges the patient into a direct sensory experience of past events, potentially accelerating the coping process.

As the veteran begins to recall an incident, a clinician introduces elements into the experience: A car bomb suddenly explodes, a building catches fire, insurgent snipers unleash a spray of bullets. "Virtual Iraq" resembles a video game, but it is also a convincing portrayal of the war zone, according to Smith. "It was like I was really sitting in the Humvee," he says. "From behind the steering wheel, everything looked like what it really looked like there. The streets, driving down the road, the desert landscape, the mosques, the people, were realistic enough." Other simulated sights and sounds include wind, a Muslim call to prayer, babies crying, footsteps, helicopters, rockets and gunfire. The veteran walks, stands or sits on the platform, which has a range of motion. The system, still under development, is also starting to incorporate smells, including gasoline, rotting trash, cordite, diesel fuel, spices and gunpowder.

Smith, whose real name has been withheld, recently finished participating in a five-week trial at Emory. He is one of eight Iraq veterans who have undergone the experimental treatment there; a handful of others have participated in virtual reality studies at military bases in California and Hawaii. Smith is the first Iraq veteran who has completed the treatment to speak about it publicly. He agreed to talk with Salon about his experiences both in Iraq and in the virtual reality treatment if his identity was kept private.

Smith was a 20-year-old college student living with his parents in Georgia when he joined the Army. He was deployed to Iraq in January 2004. Serving as an infantry scout meant Smith was either driving a Humvee or gunning -- standing half-exposed in the turret, manning a .50-caliber machine gun. His days were a blur of firefights, of killing and the fear of being killed. He got little sleep, he says, often staying up for days during a mission, and returning to base for some sleep only to be awakened a few hours later for another mission. As Iraq spiraled into deeper chaos, he was constantly on guard against snipers, suicide bombers and roadside explosives.

"How do you feel right now?" Gerardi asks during the pause in the simulated ambush. Some soldiers become so upset or anxious that the therapist may have to shut off the program. "I'm OK," Smith replies. In the beginning, Smith says the explosions and the sound of the radio going off made his heart race and his stress level quickly rise. "I started to get nervous and couldn't really talk. I was mumbling but I didn't even realize it at the time. Dr. Gerardi told me she couldn't hear me."

She asks him to rate his anxiety level on a scale of 1 to 100, a regular way of monitoring his response. Then he's back behind the wheel of the Humvee, doing it all over again.

The goal, according to Gerardi, is to get a veteran to grapple with a selected memory at least twice if not three times in each one-hour virtual reality session. "With every repetition we get more details, and the memory becomes a more complete story. We want a narrative that makes sense and has all the sights and sounds," she says. "But most important are the feelings that were happening at the time. In a survival situation you don't have time to feel terror or grief about what is happening at that moment."

That tends to come weeks, or even months, later. When Smith got back home to the United States in December 2004, he was plagued with nightmares, sleeplessness, irritability, jumpiness and depression. Terrifying thoughts of Iraq could enter his mind at any moment. Driving was difficult. "Bridges startled me," he says. "Leaves blowing over the car. I was always looking for things on the side of the road."

After several unsuccessful attempts to get effective treatment, Smith entered the virtual reality trial, and his fears finally began to diminish. "Every time I told the story, the less it bothered me," Smith says. "For a long while I felt like I had done something wrong in Fallujah. They teach you in basic training that if you get shot, you did something wrong. They want you to be motivated. They tell you that if you die, it's your fault. It was my Humvee and I was in control of it. I felt it was my fault."

"He was very courageous," says Gerardi. "He had some very difficult stuff to think about during the treatment. It was exhausting for him. It's a very hard thing to do."

Yet, despite Smith's progress, some memories from Iraq are still too gruesome for him to confront.

Next page: Seeing a dismembered body for the first time, and two weeks of combat hell in "the cemetery"