Philosophy and Combat Stress

An interview with Rotman Institute Doctoral Entrance Scholarship recipient Andrew Peterson

Andrew Peterson is one of two recipients of the 2011/12 Rotman Institute of Philosophy Doctoral Entrance Scholarship. Valued at $10,000, these scholarship assist some of the strongest doctoral candidates entering their study at Western with support for their innovative research in philosophy and science. This year’s other recipient, Yann Benétreau-Dupin will be the subject of a future profile.

Peterson comes to Western from the San Francisco State University, where he was involved with research on the neuroscience of Combat Operational Stress in U.S. military veterans, which he now continues at Western. His general interests in philosophy are in both the theoretical problems inherent to medical science and the ethical issues that arise in clinical and research settings. He has written on the nature of discovery in biomedical research and the normative parameters that constrain our knowledge of the human body. A more detailed profile of Peterson can be found here.

The following interview was conducted with Andrew via email in January and February, 2012.

Q: Tell me about some of the work you’ve been doing since coming to Western in September.

Andrew Peterson: First let me say that the opportunities for innovative research at Western for students like myself are absolutely wonderful. I didn’t quite know what to expect when entering my first term at Western, but I have since been astounded by the quality and quantity of research transpiring here. Moreover, I am very humbled at the enthusiastic invitations extended to me by high level researchers to work with them. Many of these opportunities have been a direct result of the Rotman Institute and the Philosophy Department as a whole. I am very thankful for this.

Of the many opportunities I have been given thus far, working with Dr. Ruth Lanius, the Harris-Woodman Chair in the Department of Psychiatry, has been a highlight. Before coming to Western, I was involved with various research projects at UCSF Medical Center exploring the topic of Combat Operational Stress; a term used by the US Department of Defense to describe the type of posttraumatic stress disorder (PTSD) unique to active duty military personnel and the psychological stress of war. These projects aimed at developing educational strategies for US veterans returning from Iraq and Afghanistan who faced significant psychological reintegration challenges. Apart from the experience being very rewarding, it was also very interesting to see how receptive the young veterans were to learning about the neurophysiology of combat stress. Coming to understand that the reintegration challenges they faced were nothing more than natural, neurophysiological processes was a profound turning point for many of them. It removed a great psychological burden they had been carrying since returning, much of which was shame and guilt for not being as psychologically tough as they thought they should be.

Dr. Lanius’s current research has been instrumental in identifying the neural correlates of PTSD. By identifying these baseline correlates, deciphering empirically verifiable treatments is an easier process. In the coming year, Dr. Lanius and I, along with other members of the Rotman Institute, hope to develop a strong relationship between Western’s Rotman Institute of Philosophy, Western’s PTSD Research Unit, and the Veterans Health Research Institute in San Francisco, California.

Q: What first got you interested in studying Combat Operational Stress?

Peterson: My introduction to the subject is rather serendipitous. In fact, I think it can largely be traced to a birthday gift I gave my father, a former US Marine, several years ago. Not knowing exactly what to give him, nor wanting to gift the predictable tie or shirt, I settled on a book (yes, I know… very original!). Little did I know this choice would profoundly influence my research interests! The book was Nancy Sherman’s The Untold War, and I thought it a perfect choice because it effectively bridged the insights of stoic military culture familiar to dad, and areas of academic philosophy familiar to me. During this time I was also teaching an Introduction to Philosophy class (at SFSU) and ended up inviting my father to guest lecture on the nature of character building in the military, which I analyzed through Sherman’s discussion of stoicism. A psychologist working on Combat Operational Stress at UCSF, also a former Marine, got wind of the lecture. He attended, found it intriguing, and the rest is history.

Q: How does your role as a philosopher affect your approach to these research projects related to Combat Operational Stress? Specifically, how do the philosophical questions that come up in projects like this differ from the questions researchers from other fields (such as Psychiatry or Neuroscience) are asking?

Peterson: The current neuropsychiatric research on Combat Operational Stress is very thought provoking in a variety of philosophical sub-disciplines. Starting with Sherman’s analysis, there is a clear relationship between ancient stoic ethics and the warrior ethos. This is an important facet of the psychiatric phenomenon since soldiers often believe that mental resiliency is a virtue. Having a grasp on stoicism allows health care providers to understand the reactivity many soldiers have to psychiatric therapy – for soldiers, there is nothing wrong, they are always “good-to-go!” In the philosophy of medicine and psychiatry, issues of conventionalism arise when determining the clinical signs of PTSD. The condition is rather controversial in this respect, and will likely see several changes to diagnostic criteria in the new 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). In terms of bioethical issues, determining the neurophysiological correlates of Combat Operationa

l Stress will likely change the way medical benefits are allocated. Giving empirical evidence of psychiatric injury will no longer be a difficult task, and military medical benefits for psychiatric therapy will be distributed more effectively and fairly (in the United States). These are only a few of the philosophical puzzles that arise from the issue. There are, of course, broader implications in the philosophy of science, cognitive sciences, and theories of mind that surface when examining the problem in more detail.

Q: You referred to the  Diagnostic and Statistical Manual of Mental Disorders (DSM), could you briefly describe what DSM is, and the relevance of the upcoming fifth edition?

Peterson: The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a standardized reference tool for clinical psychiatry and psychology. It provides schematized models for every universally accepted psychiatric disorder, discusses etiology, and provides recommendations for treatment.

The DSM is controversial because of its conventional nature. Experts agree on a set of clinical symptoms, lump these under the rubric of a psychopathology, and fix the definition as a clinical guide for all practitioners to follow. The process is not quite this crude, but it is certainly a source of much disagreement.

For example, one very problematic aspect of the PTSD diagnosis articulated in the current version of the DSM is Criterion A. To be diagnosed with PTSD one must display a variety of clinical symptoms. Broadly, these might be intrusive traumatic thoughts, hyper-vigilance, emotional numbness, and loss of normal psychiatric function. A further requirement for diagnosis, however, is that the patient must have actually experienced a traumatic event – this is called “Criterion A.” Criterion A is a very valuable component to the diagnosis, since it distinguishes various comorbid anxiety disorders from trauma induced PTSD. But the conditions that satisfy defining an event as “traumatic” are notoriously unclear. Does the experience of war qualify? Does a car accident qualify? Must the traumatic event be acute or can it also be protracted, leading to chronic exposure? Changes in the DSM 5 are intended to address questions such as these.

Q: Several years ago you worked on a project called the Hands On Philosophy Education Program at the Exploratorium Science Museum of San Francisco. Tell me about this experience, and your opinion about the importance of this kind of educational programming for philosophy as a discipline.

Peterson: Thanks for asking about this one! This experience was very fun, and in fact was the first philosophical public outreach I participated in. For those unfamiliar with The Exploratorium, it is a hallmark of the San Francisco landscape. The museum is filled with elaborate scientific demonstrations and was modeled after Francis Bacon’s vision of Salomon’s House; an institution that  celebrates humanity’s interests and accomplishments in natural philosophy.

We developed a pamphlet on various philosophical thought experiments to compliment the natural science demonstrations. We focused narrowly on problems of visual illusions and philosophy of mind, which was timely since the museum had just opened a ‘Mind’ exhibit on the cognitive sciences.

The project was certainly an eye-opening experience. Not only did I come to realize how relevant philosophy is to other disciplines and institutions, I was also very happy to find how interested others were despite their lack of formal training. It broke down my assumptions that philosophy proper was strictly for halls of the academy.

Q: What are you currently reading in your field?

Peterson: Mostly large collections of philosophical and neuropsychiatric papers. In terms of philosophy papers, I have been giving close attention to various theories of consciousness. I’ve found many papers on this issue to be an informative nexus between neuroscience and contemporary theories of mind.

As for neuropsychiatric papers, I have been focusing on reviews and meta-analyses of the amygdala’s response to traumatic stimuli; this subject is very controversial in current PTSD literature.

Q: What books are you currently reading outside the field of philosophy?

Peterson: Three books that I have recently read for leisure, though are directly relevant to my research are: What it is Like to Go to War (2011) Karl Marlantes; Rule Number Two: Lessons I Learned in a Combat Hospital (2010) Heidi Kraft; and Loon: A Marine Story (2009) Jack McLean.

All three of these books provide striking memoirs of both combat experience in Vietnam and the recent conflict in Iraq. They give a very raw look at soldiers attempting to make sense of their combat experience.

Q: Who working in the field of Philosophy today inspires you?

Peterson: Three people that come to mind immediately are my mentors at San Francisco State University: Isabelle Peschard, Anita Silvers, and Bas van Fraassen. Their passion for philosophy, openness to new philosophical approaches, and just plain curiosity is infectious. They have done a great deal for me, and this inspires me to reciprocate to the philosophical community in any way I can.

Q: Is there someone outside the field of Philosophy who similarly inspires you?

Peterson: Throughout my current studies of Combat Operational Stress, I’ve been fortunate enough to discuss philosophical issues with both retired and active duty military personnel. Their stories and character never cease to amaze me – I find them a great inspiration. I should also mention that my family and partner have given me a great deal of practical inspiration – they always keep me on track. I wouldn’t be here without their support.

Q: Thanks for taking the time to share your insights and experience. Best of luck in your studies.

Peterson: Thanks for the opportunity.

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