Is there a connection between PTSD and combat blast exposure?

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• JUDY WOODRUFF:

  Tonight, we conclude our series War on the Brain.

  Special correspondent Soledad O'Brien reports on the efforts of researchers to find the cause of post-traumatic stress disorder.

• JACOB FADLEY, U.S. Army Veteran:

  Having PTSD is — it's like being in a room where you have no control and everything's going wrong. There's a lot of anxiety. It's a feeling of dread and hopelessness.

  Triggers are, for me, when I'm in traffic. There's a lot of stuff going on.

• SOLEDAD O’BRIEN:

  Jacob Fadley served 12 years and four tours in Iraq and Afghanistan. He was a combat photographer in the Army. He spent time close to heart-thumping blasts. Yet he came home without a scratch — on the outside.

  Did you think you had post-traumatic stress?

• JACOB FADLEY:

  I think, — no, I knew I had PTSD, but I never wanted to say that, because, when you say it, then you have to deal with it.

  DR. DANIEL PERL, Uniformed Services University of the Health Sciences: She's cutting very, very thin ribbon of sections of this portion of the brain, the specimen. She will put it in the water bath. And it will spread out. Look at that.

• SOLEDAD O’BRIEN:

  Wow.

  Dr. Daniel Perl has a clue as to what's going on inside the heads of veterans like Jacob Fadley. He is a neuropathologist at the Uniformed Services University of the Health Sciences, an entity of the Department of Defense. He is studying how blast exposure impacts the brain.

• DR. DANIEL PERL:

  Now, this is from an individual who had been in an automobile accident.

• SOLEDAD O’BRIEN:

  He is studying the brains of people who suffered traumatic brain injuries, one group, civilians who suffered impacts to the head, another, soldiers exposed to blast shockwaves.

• DR. DANIEL PERL:

  Now let me show you the same procedure in roughly the same area of the brain, same stain.

• SOLEDAD O’BRIEN:

  Oh, wow.

• DR. DANIEL PERL:

  This is somebody who'd been exposed to an IED, to blasts.

• SOLEDAD O’BRIEN:

  And is this — a person clearly has blast exposure. Do they also have post-traumatic stress disorder?

• DR. DANIEL PERL:

  Yes. All of the cases that we looked at had been diagnosed with post-traumatic stress disorder.

• SOLEDAD O’BRIEN:

  While there's growing evidence of a link between traumatic brain injuries and post-traumatic stress disorder, a connection between PTSD and blast waves has remained elusive.

• DR. DANIEL PERL:

  When the explosion goes off, it forms what's called a blast wave, which is a high-pressure pulse that expands out from the blast in all directions at the speed of sound, approximately.

  And so here you have a high — high-pressure pulse blasting through this delicate instrument called the brain.

• SOLEDAD O’BRIEN:

  What does a concussive blast feel like?

• JACOB FADLEY:

  It's just like a an entire force is being pushed through you, something powerful, too. You know it's powerful. You freeze, that your body just kind of stops and goes, what — what is going on? And kind of, for me, it felt like it was rebooting itself.

• SOLEDAD O’BRIEN:

  Dr. Perl believes this brown scarring is a breakthrough discovery, possible evidence that blast exposure may contribute to PTSD.

• DR. DANIEL PERL:

  I have been looking at brain slides for over 40 years, and I had never seen this pattern before. We thought, this must be something very unique and special to blast exposure.

• SOLEDAD O’BRIEN:

  When you look at this picture, do you say this matches someone's reporting on the impact of post-traumatic stress disorder?

• DR. DANIEL PERL:

  Sure. It's widespread damage throughout the cortex. And it's our belief that, in these areas with the scarring, function is compromised.

• SOLEDAD O’BRIEN:

  Fadley left the military in 2014, after his fourth deployment.

• MAN:

  What's another visual component?

• JACOB FADLEY:

  Rhythm.

• MAN:

  Rhythm. Rhythm.

• SOLEDAD O’BRIEN:

  Thirty-three and eligible for the G.I. Bill, he thought studying film at USC would put his life back on track, but just one month into his first semester:

• JACOB FADLEY:

  I didn't see the train signal. I didn't see that at all. I made a left turn exactly as the train was coming. I could feel blood pouring out of me. I knew I was dying.

• SOLEDAD O’BRIEN:

  L.A. news media reported on his brush with death.

• REPORTER:

  It's hard to believe, but the man driving the silver Hyundai with Arizona plates survived the crash that caused this Metro rail train to derail.

• SOLEDAD O’BRIEN:

  Fadley had driven, accidentally, into the path of an oncoming commuter train. To this day, he avoids this intersection.

• JACOB FADLEY:

  It's not comfortable. Yes, it's — yes, it's — it's OK.

  I mean, there's no reason to be upset with this. I'm not — I'm not upset. I'm just anxious.

• SOLEDAD O’BRIEN:

  It was finally enough for him to seek treatment for PTSD.

  That sawdusty, brown pattern that exists across the brain in the slides that you showed me, an MRI doesn't pick that up? A CAT scan doesn't pick that up?

• DR. DANIEL PERL:

  No.

• SOLEDAD O’BRIEN:

  You can't see that in a living person?

• JACOB FADLEY:

  It's not that it isn't there. It just doesn't have the resolution to see it.

  We're going to need to use other means. We're going to have to develop other approaches.

• SOLEDAD O’BRIEN:

  Dr. Perl's research is just in its infancy. If confirmed, it would be evidence that PTSD, a psychological disorder, might partly be the result of physical harm. That could change the way we diagnose and treat the disorder.

  Do you think you will ever be able to not only identify it, but come up with some kind of a solution when you start working in living beings?

• JACOB FADLEY:

  Well, that's, that's the ultimate objective. We need to be able to find a therapy for this. We need to be able to find a way to prevent it.

• SOLEDAD O’BRIEN:

  The Veterans Administration uses the diagnosis of the American Psychiatric Association for PTSD. They call it a mental disorder, to be treated by drugs or therapy. They don't consider it a physical injury.

  DR. HAROLD KUDLER, Chief Consultant for Mental Health Services, Department of Veterans Affairs: A series of problems that happen after you have lived through an overwhelming life event. The problems involve things intruding on you, memories, images, nightmares, flashbacks, where you feel like you're reliving that event.

• SOLEDAD O’BRIEN:

  The VA's chief mental health consultant is Dr. Harold Kudler.

• DR. HAROLD KUDLER:

  I think, no matter what we find in the brain, in the blood, on EEGs, we're still going to have to have these conversations with people and talk about what trauma means to people as part of their recovery.

• SOLEDAD O’BRIEN:

  Fadley's film school thesis is called "Into the Trenches" and focuses on his struggles.

• WOMAN:

  Depression on a scale of one to 10?

• JACOB FADLEY:

  Three.

• WOMAN:

  Anxiety on a scale of one to 10?

• JACOB FADLEY:

  Seven.

• WOMAN:

  Feeling emotionally numb or being unable to have loving feelings for those close to you?

• JACOB FADLEY:

  Quite a bit.

• SOLEDAD O’BRIEN:

  Fadley hopes research will one day give him the comfort of knowing what's going wrong inside his head.

• JACOB FADLEY:

  It makes you feel like you're not crazy. You can point to something to someone else and say, do you see this? This thing did it.

• SOLEDAD O’BRIEN:

  For the PBS NewsHour, I'm Soledad O'Brien in Los Angeles.

• JUDY WOODRUFF:

  There is more reporting on PTSD, including four profiles of military veterans working through the disorder.

  That's at pbs.org/newshour.

  PBS NEWSHOUR "WAR ON THE BRAIN" IS SUPPORTED BY Cohen Veterans Bioscience.