Dexter Filkins, in his moving article on a veteran’s struggle with post-traumatic stress disorder after the killing of civilians in Iraq, illuminates crucial issues that returning veterans face (“Atonement,” October 29th & November 5th). After Lu Lobello, the former marine featured in the article, developed P.T.S.D., he unfortunately received treatment “mostly in the form of antidepressants.” Medications often reduce symptoms, but they rarely yield remission of P.T.S.D. Although they may provide the simplest practical response for an overwhelmed Veterans Administration system, psychotherapy is usually crucial in helping P.T.S.D. patients process their emotional reactions to traumatic events, put the trauma in perspective, and reach out for support. Impressively, Lobello seems to have achieved these ends in his own novel fashion. This reflects his resilience, which might inspire individuals with P.T.S.D. and the clinicians who treat them. I hope that Lobello’s encounter with his victims will help to alleviate his symptoms, but, if not, there are empirically tested psychotherapies that may.
John C. Markowitz, M.D.
New York State Psychiatric Institute
Professor of Clinical Psychiatry
Columbia University College of Physicians & Surgeons
New York City