The War Against PTSD

How one machine and two Minnesota researchers are forever changing the stigma surrounding Post-Traumatic Stress Disorder

Apostolos Georgopoulos looks like a brain scientist. Animated, friendly, and crowned with a mane of flyaway gray hair, he shakes my hand and ushers me into his office. He immediately offers to make me coffee, then, in the next breath, insists I sit in the throne situated next to the window—a gift he received for being a Regents professor of neuroscience at the University of Minnesota. “Isn’t it something?” he says enthusiastically. “I don’t even know how they got it in here!”

I don’t catch everything he says, and not just because he talks fast: his thick accent (Georgopoulos was born and raised in Patras, Greece) has caught me by surprise. I look to Dr. Brian Engdahl, the Watson to Georgopoulos’s Sherlock, for help, and find instead an amused smile.

The two men form an unlikely team: Georgopoulos, the mustachioed, 100-miles-a-minute director of the Brain Sciences Center; and Engdahl, the soft-spoken, dry-humored counseling psychologist. The two met in 1991 when Georgopoulos came to the Minneapolis Veterans Affairs Medical Center, but it wasn’t until 2010 that they rocked the world of neuroscience: that’s when they published a study in the Journal of Neural Engineering demonstrating that they could prove, with 97 percent accuracy, that Post-Traumatic Stress Disorder isn’t a phantom disease, but a physically traceable condition in victims’ brains.
 

The machine that could forever change the face of PTSD doesn’t look like much. Tucked away in a vault of a room that looks more like a walk-in freezer than a groundbreaking research chamber, the contraption resembles a beauty-salon hair dryer—albeit a gigantic one. But this brain-scanning machine, technically known as the Magnetoencephalography (MEG), is much more than its unassuming exterior advertises: it is, as Georgopoulos and Engdahl discovered, an essential tool for unlocking the mystery of PTSD.

Developed in 1968 by a physicist at the University of Illinois, MEG is most commonly used to study such neurological disorders as epilepsy and Alzheimer’s. It’s an expensive and rare machine (approximately 60 MEGs exist worldwide; only a handful are as high-quality as the one at the Minneapolis VA), but it’s also the most accurate and safest brain scanner in existence. Where an MRI scan can be skewed if a patient so much as wiggles or has any metal in their body, the MEG is a passive scanner that is not inhibited by such restrictions.

Here’s how it works: the subject lies with his or her head inside the helmet portion of the MEG and, for one minute, focuses on a dot. During that minute, 248 hypersensitive sensors detect and record the tiny voltages that occur on the surface of the brain when neurons communicate with each other. The resulting magnetic field provides a snapshot of what a brain affected by PTSD looks like.

The Minneapolis VA received its MEG through a congressional appropriation in the late 1990s. It was installed in 2001, and has since played a critical role in Engdahl and Georgopoulos’s research. In the last four years alone, they’ve scanned more than 700 brains, “more than all the MEG scanners in the world combined,” Engdahl says. Those scans have led to unprecedented insight into many mental illnesses, each identified by its own unique marker.

In 2007, Georgopoulos and Engdahl applied for funding to see if MEG could be used to detect PTSD. Dr. Robert A. Petzel, then the network director of the Veterans Affairs Midwest Health Care Network, now the Under Secretary for Health in the U.S. Department of Veterans Affairs, approved the idea, making way for the groundbreaking research. At the time (and currently), doctors rely on a 17-point questionnaire to diagnose PTSD. But that process has a lot of “gray area,” as Georgopoulos puts it, due to its dependence on patients’ honesty in disclosing their symptoms. The researchers hoped to find a more definitive way to locate the disorder.

But no one could have predicted how drastically the study would deepen researchers’ understanding of PTSD; how it would change the way everyone—scientists, soldiers, victims, society—perceived it. Or how incredibly capable the MEG would be in giving the disorder a face: something Georgopoulos and Engdahl call the “PTSD stamp.”
 

By January 1, 2009, Georgopoulos and Engdahl had gathered 74 veterans diagnosed with varying degrees of PTSD, plus hundreds of control subjects. They scanned each subject, then compared the results, searching for a biomarker that would identify those affected by the disorder. They didn’t have to look hard.  

“We saw clear abnormal network activity in the brain’s right-temporal cortex on the scans of PTSD victims,” Georgopoulos says. “That pattern of hyperactivity is very specific to PTSD, and goes along with observations from neurosurgeons who say that region is tied to experiential memories.”

The stamp is so distinct, in fact, that Georgopoulos and Engdahl were able to spot it in all but two of the 74 victims’ scans. With an image to validate it, PTSD went from being a largely unrecognized condition (it wasn’t considered a diagnosable disorder by the American Psychiatric Association until 1980) to being a very real problem in need of a solution.

“Before we had the scan, victims felt like they had to hide their symptoms or ignore them, for fear of being perceived as weak,” Georgopoulos says. “Now, we have an extremely objective way to show and measure PTSD.”

“All my patients who see the scans say, ‘I knew it. I know what I went through, and I know how it changed my brain,’” adds Engdahl. “And now you can see it.”

One such patient was Robert Michelsen. Michelsen is a World War II veteran who spent 95 days as a prisoner of war in Tokyo in 1946. He enlisted when he was just 17 years old, and served for two-and-a-half years as a gunner on a B-29 in the Pacific before getting shot down. Of the 11 men on his plane, he was one of eight who survived and were taken into custody.

“We were fortunate to be shot down over Tokyo,” he tells me matter-of-factly from across the table in a conference room at the VA. At 86, he’s a sharp-looking man, with black-rimmed glasses, crisply ironed khaki pants, and white hair that’s neatly parted to one side. “If you were shot down anywhere else, one man would be sent to Tokyo for interrogation, the rest would be eliminated. That I survived was just a matter of luck.”

But that miracle came with a price tag. For Michelsen, it meant years of guilt, nightmares, and a deep fear of dying alone—none of which he shared with anyone once he got home. And if it hadn’t been for two men 55 years later, he might have kept his story to himself forever.

One of those men was Don Patton, a retired U.S. Army colonel and author on military history. In 1999, Patton introduced Michelsen to the “Wednesday club,” a group of Pacific POWs who met once a month to eat lunch and swap stories at the Robbinsdale American Legion. There, Michelsen met the other man who changed his mind about keeping quiet: Irving Silverlieb. “He was a superb person,” Michelsen says. “He brought me to the POW group [led by Dr. Engdahl] here at the VA, and I’ve been here ever since.”

Encouraged by the other veterans’ willingness to share, Michelsen began to unload the many memories that had been haunting him for so long. He even agreed to get scanned in the MEG. Seeing the scan converted him from being “quite the skeptic” into a believer, he says. “This is just the tip of the iceberg.”
 

 

But even with such seemingly irrefutable evidence, not everyone puts PTSD on par with war’s more “traditional” injuries.

The U.S. Department of Defense still refuses to add PTSD to the list of injuries that merit a Purple Heart medal. And many soldiers still think that if they disclose their mental struggles, they won’t be deployed again—or that they’ll be judged by their peers and commanding officers, says staff sergeant Chad McNiesh, a medic in the Minnesota Army National Guard.

“I see a lot of my guys struggling with it, but they don’t want to be stuck at a desk job or perceived as weak,” he says. “So they don’t say anything.”

What they don’t realize, he adds, is that this fear is largely unwarranted.

McNiesh has been deployed three times in the past eight years. After returning home from his second deployment, he began experiencing extreme bouts of anger and paranoia, often triggered by everyday situations. He sought help and was diagnosed with mild PTSD. After a series of counseling sessions and medications, his symptoms subsided enough that he was also allowed to return overseas.

“There’s still a stigma attached to PTSD, but there shouldn’t be,” he says. “It’s bound to happen when you’re constantly exposed to those circumstances. There’s no shame in admitting that.”
 

Armed with their MEG scans and encouraged by veterans’ increasing willingness to participate in their studies, Engdahl and Georgopoulos are already looking ahead to their next project—one that could center around yet another way to spot the PTSD stamp in victims’ brains.

On a recent sunny afternoon, I got a call from Dr. Engdahl. “Apostolos just called me from California,” he said, a buzz of excitement in his voice. “He said that they’ve been comparing functional MRI scans with MEG scans, and have been able to spot PTSD in both!”

He went on to explain the significance of the discovery: “If we can figure out what the PTSD stamp looks like in functional MRI scans, we won’t be limited to using only the MEG to identify the disorder in patients. Almost every hospital has an MRI machine—patients could be scanned and treated anywhere!”

And that, coupled with a recent influx of research money from Washington, D.C., is big news. “These are the silver linings in the dark cloud of war,” says Engdahl. “The future is pretty bright.”
 

Ellen Burkhardt is the assistant editor of Minnesota Monthly.
 

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