By Gretel C. Kovach, UNION-TRIBUNE STAFF WRITER
Saturday, April 10, 2010 at 12:04 a.m.

POST-TRAUMATIC STRESS DISORDER
An anxiety disorder that can occur after a traumatic event, such as military combat, natural disasters, terrorism incidents, serious  accidents or sexual assault.
The National Center for PTSD identified six factors essential to building resilience against those sources of stress:
• Positive outlook
• Spirituality
• Active coping
• Self-confidence
• Learning and making meaning
• Acceptance of limits

When Sgt. Michael Blair awoke from a drug-induced coma four years ago, doctors gave him a choice.

Blair’s legs had been blasted by a roadside bomb in Iraq. The physicians could amputate both limbs, or they could try to save them  through a series of grueling medical procedures. More than 60 surgeries later, the Marine, formerly stationed at Twentynine Palms, still  struggles with chronic pain as he continues his care at Walter Reed Army Medical Center in Washington, D.C.

With the help of a cane, though, Blair walked amid the cherry blossoms at the White House this week with his wife and 4-year-old  daughter. He has piloted his first solo flight, kayaked through the Grand Canyon, used a hand cycle to finish several marathons and  dreamed of opening a therapeutic recreation center for wounded troops.

Blair relies on a strong support network that includes his family, sports organizations and the Marine Corps. But he also may be  genetically predisposed to withstand physical and mental trauma.
“I am just so freakin’ grateful to be alive,” said Blair, 35, who will be a featured speaker next month at the Naval Center for Combat &  Operational Stress Control’s conference in San Diego. Researchers are just starting to understand what gives some service members the mental hardiness, or resilience, to fend off post- traumatic stress disorder. Is it innate, a matter of training or a complex interaction between the two? The answers could help inoculate both combat veterans and civilians against potentially debilitating bouts of trauma-induced  stress.

“It’s a really exciting time. This idea of resilience — we are just starting to scratch the surface,” said Steven Thorp from the Post- traumatic Stress Disorders Clinical Team at the San Diego VA Healthcare System and a research psychologist with the University of  California San Diego.

The new focus on resilience comes as about 17,000 troops from Camp Pendleton and supporting bases are deploying to  Afghanistan between now and fall. As many as one in five veterans of the Iraq and Afghanistan wars suffers from PTSD, according to the Department of Veterans  Affairs’ National Center for PTSD. High suicide rates among service members also are causing deep concern among Pentagon  leaders and commanders at bases nationwide. The number of suicides among combat-experienced Marines doubled from 2006 to  2007, the Navy reported, and a record number of Marines and soldiers took their lives in 2008.

Scientists have developed some treatments for PTSD, which was once called shell shock or battle fatigue. The condition was  recognized as a disorder in 1980, largely because of attention paid to affected Vietnam War veterans. Last year, researchers published one of the first studies — by Robert H. Pietrzak and colleagues — about resilience against PTSD  among Iraq and Afghanistan war veterans. The biggest unknown is “what’s trainable and what’s hard-wired,” said Chris Johnson, a clinical and research psychologist in the  Warfighter Performance Department at the San Diego-based Naval Health Research Center. The center’s staff is using computerized rehabilitation environments and neuro-imaging to study how the brain functions under  stress. It’s also evaluating the mental effects of immersive, or simulation-based, combat training at Camp Pendleton.

“We know a lot about effective treatments, how units function and how important biology and behavior are in terms of responding to  it,” Johnson said. “But there is still a lot of work to be done in terms of prevention.” Thorp focuses on “post-traumatic growth,” the phenomenon where some walk away from a traumatic experience — such as a car  accident or deadly firefight — with better attitudes and behaviors.

“There is a point where just about any of us would get PTSD given a traumatic event,” he said. “But when exposed to combat, some  get PTSD, some don’t, and some have an enhanced life. They value life even more.”

While resilience research gestates, controversy over the use of psychotropic medications to treat combat stress is being debated in  Congress. Bart Billings, a retired military medical officer from Carlsbad and founder of the longest-running combat-stress conference in the  nation, submitted testimony for a Feb. 24 hearing on the issue by the U.S. House Committee on Veterans Affairs. Billings said he was  troubled by “a surge in the number of suicides among service members and their family members that appears to correlate directly with  the increased use of psychiatric medication.”

“Would you want your daughter or son who is carrying a loaded weapon in battle to be given a medication where the first warning on  the label is suicidality?” he asked in an interview.

But Brig. Gen. Loree Sutton, a doctor and director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain  Injury, testified that the Pentagon supports psychopharmacological treatments as a key component of mental health care.

“Scientific evidence over the past several decades points to the role of medications in limiting the severity and duration of illness, as  well as for preventing relapses and recurrences,” she said.

The Marine Corps and Navy will present a new doctrine about combat and operational stress during the Navy conference in San  Diego next month. Commanders have already rolled out the program, which teaches troops to identify signs of stress among their  ranks, intervene before a crisis and reach out to a sailor or Marine overwhelmed with stress, for instance when a fighter under attack  freezes.

The goal is to codify operational stress management, but “this is what a really good leader already does instinctively,” said Capt. Paul  Hammer, a former enlisted Marine and a Navy-trained psychiatrist. He directs the Naval Center for Combat & Operational Stress  Control, which began operating about two years ago at San Diego Naval Medical Center. “I don’t think anybody thinks we are going to completely prevent everybody from getting PTSD,” Hammer said. “But we can minimize  the impact. It is much like how we have better helmets, better surgical procedures.”

Once home from the war, Blair, the wounded sergeant, was buoyed by camaraderie among wounded Marines, the aviation  community, kayakers and many others. He agreed to speak at the upcoming conference because he hopes his experiences will inspire  others nursing physical and mental wounds.

“It is easy for guys to fall through the cracks, but you don’t have to sit around in your room,” he said. “You can get out and do things.” Blair recently took a ride in a vintage Russian propeller plane. The pilot treated him to barrel rolls, half-Cubans and upside-down loop- the-loops.

For someone who still has trouble walking, soaring in the skies was a rush. “It is great for the mind, body and spirit,” Blair said. “It is nice being up there, close to God.”