The Transcendental Meditation Technique as a Proposed Treatment for Vietnam Veterans Suffering from Post-traumatic Stress Disorder

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Abstract

Chapter I

Post-Traumatic Stress Disorder A Large Scale Problem for Vietnam Veterans

Chapter II

Theories of Stress and the Suggested Treatment of Post-Traumatic Stress Disorder through the
Transcendental Meditation Technique ....... p. 17

Reference Notes p. 43

References

CHAPTER I

POST-TRAUMATIC STRESS DISORDER; A LARGE SCALE PROBLEM FOR VIETNAM VETERANS

Post Traumatic Stress Disorder

On the 10th of January, 1982, a plane headed to Florida from Washington, DC, fails to achieve take-off and crashes into a downtown bridge.  The plane breaks in half throwing several passengers into the icy Potomac River.  Only five survive after being pulled from the river.  Most of them owe their lives to one fellow passenger who, by refusing help himself, saved four others before perishing.

These few survivors now all have one thing in common; the experience of an event so intense, so overwhelming, that it would readily "evoke significant symptoms of distress in most people."  Events such as this fall far outside the range of the more "commonplace" experiences of distress caused by business losses, marital conflict, chronic illness and simple bereavement.  These two features that characterize the nature of this kind of intense traumatic event are now recognized as the most essential criterial aspects for what the American Psychological Association Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM III) has designated as "Post-traumatic Stress Disorder."

Post-traumatic Stress Disorder (PTSD) is the result of a psychologically traumatic event, sometimes accompanied by physical harm, that leads to the development of a specific range of symptoms.  It can occur at any age, including early childhood.  The symptoms may begin immediately or, they may not arise for months or years following the trauma.  This recognition of a latency period is very significant.  Without this awareness, the symptoms of PTSD, such as anxiety and depression, can be so severe that if the person was examined only in terms of the manifest symptoms and a severe trauma experienced sometime in the past is overlooked, they might be diagnosed as having an Anxiety or Depressive Disorder,

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There exists indications that a possible "predisposition" to PTSD may exist in individuals with a history of psychopathology.  This can further complicate diagnosis in a victim of PTSD.

The traumatic events, or "stressors", that are recognized as most likely to cause PTSD are divided into three groups.  First are the natural disasters such as floods and earthquakes.  Next, there are "accidental" man-made disasters, such as severe auto crashes, or as we have seen, plane crashes.  Finally, one can experience "deliberate" man-made disasters, including war, bombings, torture, and death camps.

Some of these stressors produce the disorder only occasionally, other produce PTSD frequently; man-made disasters, intentionally carried out, are among those stressors that frequently cause PTSD.  In addition, it is recognized that the disorder is more severe and lasts longer when .the trauma is of "human design."  Rape is an example where an individual experiences the trauma alone.  Military combat is one example where one can be exposed to the trauma while in a group of people.

Ten years after having fought in Vietnam, Charles Heads, while pursuing his wife after an argument, is transformed back into a Marine ready for combat.  Heads, now reliving a war over for many years, shoots his brother-in-law, thinking him to be an enemy.  "It was like I was being controlled," he stated.  "I was on; I could not have stopped."  In a land­mark case, Heads was recognized to be suffering from PTSD--Post-traumatic Stress Disorder, and was unanimously aquitted. Charles Heads' experience is another recognized symptom of PTSD.  He was, at the time of the shooting, in what is known as a "dissociative-like state."  It has been known to last minutes, hours, and even days, in which components of the original trauma are relived.  At such times, the person behaves as though they were actually experiencing the event over again.  Another way the traumatic event is rexperienced is in recurrent, painful intrusive recollections.

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These intrusions may come in the form of recurrent dreams or nightmares in which the event is re-experienced.  These dreams or nightmares can lead to difficulty falling asleep and/or staying asleep, which can in time result in middle or terminal sleep disturbances.

The day-to-day activity of normal life can be affected significantly by one suffering from PTSD. Some individuals display excessive autonomic arousal characterized by hyper-alertness and an exaggerated startle response.

While each victim does not necessarily suffer from all the "symptoms associated with the disorder, each can suffer from a wide range of complications and impairments that it does produce.  Perhaps it is difficulty in concentrating or in completing tasks.  There is often a diminished responsiveness to the external world, which usually begins after the traumatic event.  The person may feel detached or estranged from other people.  The ability to feel emotions of any type, especially those associated with intimacy, tenderness, and sexuality, are significantly reduced; this "psychic numbing," as it is called, can interfere with married and family life.

Particularly characteristic of war veterans is increased irritability that may lead to unpredictable explosions of aggressive behavior.  Impulsive behavior may occur, such as making sudden trips, unexplained absences and changes in residence or lifestyle.

Sometimes, as a result of the physical component, or for war veterans, their wounds, there may now exist an organic mental disorder resulting in headaches, failing memory, and emotional liability.  Often the individual feels he has lost the ability to become interested in previously enjoyed significant activities.  Also, activities or situations that might arouse recollections of the traumatic event may now be avoided as the symptoms of PTSD are often intensified when the individual is exposed to such events.

As a result of all these symptoms, plus for many, the painful guilt they feel for having survived their ordeal when others may not have, or about the things they may have

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had to do to survive; these may lead the person into self-defeating behavior, such as substance abuse and suicidal acts.

The DMS. Ill also makes the following distinctions about this disorder.  The prognosis for one with PTSD is good when the symptoms have begun within six months of the trauma and have not lasted for more than six months.  This is called "acute subtype."

When symptoms develop more than six months after the trauma, it is called "PTSD, delayed."  When the symptoms have lasted six months or more, it is called "PTSD chronic."
Besides Charles Heads, many other Vietnam veterans are recognized as suffering from these symptoms of Post-traumatic Stress Disorder.  Since the war has been over for many years now, the type of PTSD we will be concerned with in these veterans will be of the "delayed, chronic" type.

The Vietnam War was not the first war to provide trauma for the combatants nor was it the first to have such casualties. This next section will review the historical recognition of post-stress disorders recognized in combat troops on the battle­field and in the combat veterans afterwards.

An Historical Review of Post-Stress Disorders That Lead up to Post-traumatic Stress Disorder

"Awareness of the existence of combat stress grew out of the necessity to care for those who were psychological casualties" (Bourne, 1970, p. 8).

The first acknowledgement of the existence of a "combat fatigue" or, as it was then called, "nostalgia," was made during the Civil War.  The first war that specialists in psychiatry were used to treat mental illness in miliary personnel was during the Russo-Japanese War in 1904.  By WWI, planning for psychiatric casualties was considered as part of the overall responsibility of the medical organization. "Combat psychiatry grew out of the need to care for the individuals that, under the stress of combat, suffered psychological disintegration" (Bourne, 1970, p. 9).  For the first time systematic observations were made and theories were generated attempting to explain the cause of this disintegration.  Of

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particular interest was why it would occur in some but not all of the men who were exposed to the same stress.  "Shell shock" was theorized to have an organic origin in damage sustained by the brain as a result of exposure to intense artillery bombardment.  But, for those whose breakdowns could not be linked to such an event, the diagnosis was usually that they were "lacking in moral fiber," or, were just cowards.  Significantly, the symptoms displayed in both groups were the same.

The French divided these cases into two groups:  the "shell shocked" and the "commotional shocked" whose cause was considered to be entirely psychological.

During the post-war period, a great deal of attention was given to the subject of combat stress, or as it was then called, the "traumatic neuroses of war."  Bourne (1970) points out that "although the phenomenology was complete and accurate, the exact etiology and preferred treatment was left obscure" (p. 14).

At the beginning of World War II, it was thought that, with the new mechanical era, traumatic neuroses would no longer arise but that some new, radically different disease would emerge from the battlefield.  It soon became clear that, despite all the differences, the fundamental condition that arose during WWII  was the same only now it was called a "gross stress reaction," or "battle fatigue."

Archiebald and Tuddenham (1963) recount that while the gross stress reaction was being studied intensively, the researchers disagreed as to whether or not the combat fatigue syndrome should be differentiated from psychoneurosis.  However, they did all agree upon viewing it as a transient state.  This is the same conclusion agreed upon by researchers during WWI.

In 1952, the Grey Manual listed five diagnostic criteria ..for the gross stress reaction/battle fatigue:  1) unusual stress; 2) previous normal personality; 3) reversibility; M-V possible progress to one of the neurotic reactions; and

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5) if persistant reaction, "this term is to 'be regarded as a temporary diagnosis to be used only until a more definite diagnosis is established" (p. 40).  No provision or term was given for the persistance of these symptoms.

Archiebald and Tuddenham's research into a group of combat veterans followed up both 15 and 20 years after the war indicated that Many veterans have retained their original combat symptoms of startle reaction, recurrent nightmares, and irritability largely unchanged ...  now ... reason to believe that the symptoms following from severe traumatic stress may persist over very long intervals, if indeed they ever disappear ...  (p. 475).

Kalinowsky (1950) reported about "the unexpected high percentage of chronic cases and their obvious differences from peacetime neuroses" (p. 340). Brill and Beebe (1955) in a psychiatric follow-up five years after the breakdown of a sample of WWII veterans admitted for psychoneurosis, found 8% had a severe disability and 20% more with a moderate disability at follow-up. Futterman and Pumpian-Mindlin reported "even at this late date (1951) we still encounter fresh cases (WWII combat veterans) that have never sought treatment until the present time" (p. 401).

Based on these growing findings, along with their own long-term research, Archiebald and Tuddenham (1965) define what they called a "post-stress syndrome" (p. 477).  While the stressor for this syndrome was usually combat, the same syndrome was also identified in survivors of a severe accidental man-made disaster (Leopold and Dillon, 1963).

This syndrome is chronic, highly persistant over long intervals and resistant to modification ... it is differentiated from the less severe stress response which clears with rest and the removal of the stressor. Disturbing ...  is ...  suggestion that the incidence of the syndrome is increasing as aging makes manifest the symptoms of traumatic stress which have been latent (author's underline) since the war ...  clearly the [/ syndrome following exposure to severe stress does not "just fade away" (Archiebald £ Tuddenham, 1965, p. 477-478).

This recognition of a latency period that can exist between the experience of a trauma and the resultant surfacing

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of symptoms is of particular importance. A person, experiencing a severe trauma, may seem "normal" for days, months, and even years. When symptoms do begin to arise, they may never be associated with their actual cause and blamed on something current.

The idea of a latency period becomes more strongly accepted as research into survivors of traumatic events who, while at first seem to be free of symptoms, begin to display them long after the actual event occurred.

In a study of Norwegian ex-concentration camp prisoners, Stom (1962) emphasized the persistance of the symptoms and their similiary to traumatic war neurosis.  "Ex-prisoners who made a good recovery for several years after the war began to show symptoms of breakdown despite the fact that no new trauma could be detected."  Berger (1977) reported that many symptoms found in survivors of Nazi persecution are consistant with traumatic neuroses. He suggested that a new category—"survivor syndrome" be recognized because in addition to the symptoms of traumatic neurosis, he found several additional symptoms, among which was a latency period that had to be recognized.  In addition, he found that these symptoms were not self-limiting, i.e., they did not diminish with time. Berger also points out that survivors "do not as a rule seek psychotherapy" (p. 242).

In a personal communication between Chodoff and Archiebald in 1963, Chodoff notes the similarity between survivors of concentration camps and veterans with combat stress syndrome.

Particularly striking is the marked startle response in both groups ...  instead of becoming attenuated as time passes ...  seems to get reinforced each time it is activated by a new stress stimulus ... more or less perma­nently conditioned to this kind of reaction ....  As I see it, the differences between concentration camp patients and the combat fatigue group are quantitative rather than qualitative (Archiebald and Tuddenham, 1965, p. 476).

Popkin, Stillner, Hall and Pierce (1978) in a comparison between released prisoners of war and Antarctic monitoring personnel showed that the behavior and cognitive changes in

both groups was remarkably consonant. The' authors viewed the resultant constellation in the two groups as a maximal adaptation to unremitting stressors and have suggested that these observed changes represent a generalized response--"a predictable behavioral final common pathway in situations of protracted stress" (p. 480).

As this brief review points out, there has been a steady growth in the recognition that a person, exposed to a severe stressor, can manifest symptoms that are consistent with those most people would also display if exposed to a similarly severe stressor. Also recognized is that while symptoms can begin immediately, they can also lie dormant and arise months, even years after the event. A latency period can blur the clear diagnosis of the cause of the symptoms and can even re­sult in mistreating the person (Van Putten and Emory, 1973). While most of this research focused on combat troops and veterans, these symptoms have been identified in civilian sur­vivors of intentional man-made disasters such as concentration camps and accidental man-made disasters such as severe accidents.

The syndrome is apparently found in different parts of of the world and among victims of difference kinds of stress, although it may be called by different names (Archiebald and Tuddenham, 1965, p. 481).

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served in a war that has come to be ranked as the most un­popular one this nation has ever fought.  They fought in a war that, as the years went by, didn't seem to have victory in mind.  Finally, by not winning the Vietnam War, somehow the nations' hostility toward the war was transferred to the men and women who served in it.

Of all the elements in the country who were involved with Vietnam ,-fhe (the Vietnam veteran) suffered most. And of all the elements, he has received the least amount of benefit for his suffering . . ; .  (Representative John Paul Hammerschmidt, Note 1).

Despite all these factors, Vietnam veterans still shared the basic experience of combat that all war veterans have had. In addition, they all had to share the same basic readjustment when they returned home to peacetime military service or re-entry to civilian life.

Borus (1973) delineates four aspects of readjustment that combat veterans and particularly Vietnam combat veterans have had to face:  1) miliary issues of adjusting to military mis­sion, group support and leadership; 2) family issues of adjusting to changes in family dynamics and to discrepancies between the fantasized and real homecoming; 3) emotional issues of adjusting to change in temperament; to recurrent thoughts and feelings about the Vietnam (combat) experience and, for some, in drug use patterns.  The fourth and last point is particularly important for the Vietnam veterans, that of the social issues of adjusting to ones' participation in an unpopular war and to increased racial polarization.
Another factor that is present for all veterans is that they, as a result of years of service and for many, months and years of readjustment, suffer from the loss of experience and expertise that their peers, who did not have an interrupted career start, possessed.  This factor is particularly more marked for the Vietnam veteran group.

Fortunately, despite the readjustment and interrupted career start, most of the Vietnam veterans, as do most war veterans, have managed to successfuly reintegrate themselves with their families and their careers.

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One point of interest, especially when contrasted with veterans of earlier conflicts, is noted by Tiffany (1981). He points out that many Vietnam veterans soon found it necessary to conceal the fact they had served in Vietnam in order to avoid the controversy, and in many cases, to get jobs where the employer had taken an "anti-war stand."  To this day, many Vietnam veterans who have made successful transitions into society refuse to admit that they had anything to do with the war.

Yet, like a ghost of the Vietnam War, the Vietnam vet­erans who have not been so successful in their readjustment ... periodically arise.  When they do, often they make brief headlines--another Vietnam veteran thinking himself surrounded by Viet Cong, is killed in a Shootout with police. Or, as he is portrayed in the movies, usually as a psycho­path who kills indiscriminately.  As the Doonesbury carton (Figure 1) [Editor's note: the carton does not appear online due to copyright restrictions.] attempts to point out, thousands of Vietnam veterans are "healthy," yet many are not so fortunate.

Those who died in Vietnam are estimated to number 57,000 with an additional 303,706 wounded.  These statistics, com­piled by the Vietnam Veterans of America indicated that Vietnam veterans have a suicide rate 25% higher than non-veteran peers. Vietnam veterans have a divorce rate double that of non-veteran peers.  Unemployment rates are twice as high.  Substance abuse is serious and widespread with approximately 70,000 Vietnam veterans in jail and another 200,000 on bail, parole or probation (Note 2).
Why?  Why so much difficulty for the Vietnam veterans when the other veteran groups seem to have readjusted so well?

The early reports from military psychiatrists in Vietnam indicated that the incidence of psychiatric symptoms was much lower than in previous war (Bourne, 1970; Tiffany, 1967).
Strange and Brown (1970), in a survey of Vietnam combat veterans who had developed psychiatric problems, compared his findings with a non-combat group.  He concludes:

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Vietnam veterans seem to be no more likely to act out self-destructive impulses than other servicemen without combat experience, but are more likely to threaten such self-destructive behavior ...  aggressive problems of all types were slightly less frequent than in the non-combat group ...  indicate that the combat veteran may be more likely to talk about violence but no more likely to behave violently (p. 13H).

Studies aimed at attempting to locate some of the causes for this reported large scale ineffective readjustment in a large segment of Vietnam veterans located two possible causes:  1) pre-service factors and 2) traumatic war neurosis, or post-traumatic stress disorder.

"Pre-service factors" refers to a man's social adaptability prior to his time in the service.  Those veterans with poor social adaptability had higher incidences of pre-service arrests, substance abuse and other chronic maladaptive coping response.  Many continued this pattern when in the armed forces.  The following studies indicate that for many of these people, their difficulty in readjusting after Vietnam is just a continuation of the same pattern  (Huffman, 1970). Nace, Meyers, O'Brien, Ream and Kintz (1977) reports pre-service factors are strong indicators and were strongly correlated with those veterans having a high incidence of depression and other problems.  Helzer, Robins, Wish and Hesselbrock (1979) found in a study of depressive syndromes in Vietnam veterans that, after controlling for pre-service factors

...  some evidence that combat as a stressful life event did predict depressive syndromes in Vietnam veterans, but these depressions were short-lived, and the effects of combat as a predictor diminished over time (p. 529).

One compelling feature of ''pre-service factors" is that it puts the focus back on the man rather than the experience. If it can be shown that it is basically the person from a disadvantaged upbringing with a poor educational background who had a hard time adjusting to society long before Vietnam and now continues to have a hard time, then it is hard to blame Vietnam service for this.

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There is a similarity here with the WWI diagnosis of "shell shock" and "commotional shock."  While both groups displayed the same symptoms, one was considered a result of war itself, the other the result of inherit psychological weakness in the man.

At the same time (1970) early reports found a low in­cidence of psychiatric problems in Vietnam troops, Blank (1981) recounts that a group of psychiatrists and psychologists first began to recognize important and persisting emotional stress in veterans who had successfully completed tours in Vietnam.

In 1973, Van Putten and Emory reported that the diagnosis of traumatic neuroses has been frequently overlooked in Vietnam returnees:

... recognition of the syndrome is essential since the therapy of war neurosis is different from the treatment of a character disorder or psychosis ... early recognition and appropriate treatment is crucial, since with the passage of time these neurosis become consolidated and the prognosis becomes progressively poorer (p. 695).

Archiebald and Tuddenham (1962; 1965) pointed out much earlier that "aging makes manifest the symptoms ...  which have been latent since the war."  Again, the idea of latency arises.  This may be the single most complexing part of the whole picture.  Some people, immediately following a trauma, display the symptoms of Post-trauma Stress Disorder. 
Others, seemingly unaffected, can go months and years before symptoms
-manifest.

The veteran himself usually does not understand why he feels and acts the way he does when symptoms manifest.  As we have considered earlier, some of the associated features of PTSD. listed in the DSM III are symptoms of anxiety and depression, which in some cases, are severe enough to be diagnosed as an Anxiety Disorder or a Depressive Disorder. Also  particular to war veterans is the increased irritability and unpredictable outbursts of aggressive behavior that can occur with little or no provocation.  Nash and Walker

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(1981) point out that, as a result of overlooking the latency and other associated features of PTSD, "Vietnam veterans not inclined to talk about their combat experiences remain misdiagnosed, underdiagnosed and mistreated." This, along with Berger's (1977) report that "survivors tend not to seek psychotherapy" has resulted in what Van Putten and Emory (1973) put in this way:  "Vietnam veterans' reticence ... because they reject authority and mistrust institutions, come to the V.A. only out of desperation."

It was estimated that 500,000 Vietnam veterans are presently suffering from Post-traumatic Stress Disorder (D. A. V., Note 3) and, by 1985, this number will increase to 700,000 (Vietnam Veterans of America, Note 2).

Several theories have been advanced attempting to explain such a high incidence of Post-traumatic Stress Disorder in the Vietnam veteran group.  Bourne (1970) points out:

Neuropsychological casualties in combat occur predomi­nantly when lines of battle are static and diminish sharply when troops are on the move ... also accepted ...  that artillery or other bombardment without any effective method of retaliation is more likely to produce psychological casualties than any other combat circumstances (p. 124).

The majority of American troops in Vietnam were confined to base camps where there was very little effective retaliation available to the constant threat of bombardment which could and did happen at any time.  Rockets, mortars, and artillery, at one time or another, struck every base camp, city, town, airstrip and insallation in the country.

Blank (1981) "describes Vietnam as a combat zone, "the whole way through."  He recounts that there was "no safe ground and no safe people.  Every Vietnamese person—man, woman and child, young and old, was potentially the enemy." Blank, who served in Vietnam as a combat psychiatrist also points out that:

The features of guerilla terrorism were added to the mental challenge of combat experiences and have produced in some veterans an especially painful, deep - and abiding kind of paranoid fear which we are now beginning to learn to recognize and treat (p. 9).

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In a letter to a Mr. Poniatoff, Army General Franklin Davis wrote:

Like most military people, I did some time in Vietnam and when I was commanding a brigade there, I realized that the kind of combat we had to fight there was a far greater stress on the individual than did the kind of combat I saw during World War II . . . (p. 4, Note 4).

Yet another theory, one that may turn out to be of major significance, is that the intensity of the event itself may be sufficient stressor to cause Post-trauma Stress Disorder. This would indicate that regardless of the persons' history, the cause of their being traumatized rests in the severity of the stressor itself.  Leopold and Dillon (1963), as a result of their studies, concluded that the nature of the trauma is more significant than the pre-accident personality.

A study titled Legacies of Vietnam: Comparative Adjustment of Veterans and Their Peers (1981) found similar results:

Persistance of stress depends much more on the veterans' exposure to combat than on the emotional stability of his childhood .... In light combat, soldiers from disadvantaged backgrounds did develop more psychological problems than their buddies with more stable upbringings. But in heavy combat, all such differences disappeared (Vol. IV).

Pre-service factors and Post-traumatic Stress Disorder are both at play in the Vietnam veteran group.  The complexity of this issue is further seen in later studies.  Mintz (1979) studying heroin use in Vietnam veterans found that "in many cases the factors underlying drug abuse are to be found not in Vietnam, but here at home."  Post-traumatic Stress Disorder with its latency period means that problems thought to be here at home may well have had their cause in the trauma of combat in Vietnam.  Nace, O'Brien, Mintz and Ream (1980) suggest that there exists a "complex relationship across time:  pre-service -Vietnam - post-service.

For the purpose of this paper, location of the actual cause of the Vietnam veterans' maladjustment is not a central concern.  This review has been to acknowledge the existence of a serious problem.  Archiebald and Tuddenham wrote the

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following in 1965, yet it is just as valid today:  "We are faced with a human problem.  There is a large and growing number of victims of the war who need help, but whose problems are still not even recognized" (p . 480).

The author would like to postulate that similar proportionate numbers of WWII and Korean veterans are suffering from Post-traumatic Stress Disorder.  It may just have been the unpopular and vocal era of the Vietnam War that is re­sponsible for the recognition of the disorder in so many Vietnam veterans.  The unrecognized influence of a latency period could have masked the cause of symptoms they suffer from just as we have seen happen in Vietnam veterans today.

If this was the case, the number of veterans suffering from Post-traumatic Stress Disorder could number in the millions.  Whether or not this is the case, we know we have a large number of veterans who are in need of assistance. It is a very large scale problem and one that, due to the uniqueness of the Vietnam veterans, may well require investigation into novel modalities of treatment.

One such potential modality of treatment for stress disorders holds great promise.  Not only does it contain a technique that has been widely applied, scientifically researched and shown to be safe and effective; it also contains a theory that, if further research bears out, will revolu­tionize not only the etiology of stress-related disorders, but also how we treat them.

CHAPTER II THEORIES OF STRESS AND THE SUGGESTED TREATMENT
OF POST-TRAUMATIC STRESS DISORDER THROUGH THE TRANSCENDENTAL MEDITATION TECHNIQUE

Psychosomatic and Mental Disorders

Stress and its resultant effects on the body and mind is now being recognized as a basic contributor to not only psychos.omatic illnesses, but mental disorders as well.
"Stress," as Dr. Hans Seyle has defined it, " is the non-specific response of the body to any demand made upon it" (1976, p. 1).

Stress then is not in the environment, but rather, lies in our reaction to the environment.  The first phase of the "non-specific response of the body" is the "alarm" or "fight-flight response" characterized by the adrenal and pituitary hormones flooding the systems, the sympathetic branch of the autonomic nervous system mobilizing the body for defensive action.  Skeletal muscles tense, digestion is restricted along with an increase in breathing and heart rate. 'The system is then in its most excited state, ready to fight or take "flight."
While this innate response of the body has been long accepted as an intricate part of mans' adaptive abilities, it is now seen more as an inappropriate, or maladaptive, response in our civilized society.  Yet the pressure, the demands of contemporary life have continued to evoke this age-old response, resulting in the tendency for many people to become chronically "hyper" aroused.  This high state of 'arousal, maintained for long periods of time, traps the body in this state which resultantly strains the cardiovascular system and damages the digestive organs.  It also wears down the very chemicals needed to trigger the arousal.  This general overall weakening of the system results in reduced defense against real danger and makes the system susceptible to nearly any form of physical ailment or disease (Dates, )

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Psychosomatic medicine accepts the fact that a physical disorder can give rise to a mental disorder and that an aggravated mental state can cause a physical disorder.  This subtle interaction between mind and body has also been acknowledged by E.E. Green in what he calls the "Psychological Principle:"

Every change in the physiological state is accompanied by an appropriate change in the mental-emotional" state, and conversely, every change in the mental-emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state (Green, 1970, p. 3).

Bloomfield, Cain and Jaffe (1975) point out that the alarm reaction developing into a prolonged stress reaction contribute significantly to the development and course of mental illness.  Mental stressors arising out of our psychological and social lives lead to the growth of discontent and anxiety.  Research done by Ilfied (1977) supports this view:

Stressful life events consistently have been found to be related to psychological problems in both normal individuals and identified patients ... current social stressors ... patterned into our everyday roles as marital partners, breadwinners, and parents are equally important in affecting mental status ... that current social stressors are usually present before symptom onset ... supports the contention that such stressors influence symptoms more than they are influenced by them (p. 162).

Stress creates a negative spiral in which stress causes symptoms, which lead to a reduced resistance and thus, more stress Ilfied, 1977, states:

the more common stressors in everyday life ...  are responsible for taking a significant toll in suffering above and beyond fortuitious and traumatic life crises in the past ... (p. 162).

It is this unchecked accumulation of stress that, over "time, leads to the development of a stress disease.  This unchecked accumulation of stress weakens the entire system. Hereditary and constitutional factors, among others, are recognized as determinants as to whether the person would go on to develop a psychosomatic illness or a psychiatric

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disorder.  As we have seen, these factors may'also predis­pose a person to a Post-traumatic Stress Disorder.

In the next section, we will consider the possibility of a state of life that would be diometrically-opposed to the state of life produced by psychosomatic and mental disorders; this proposed state is known as "Enlightenment."

Maharishi Mahesh Yogi's Theory of Human Stress and Its Opposte: Enlightenment

According to Maharishi Mahesh Yogi, 'the goal of human life is the attainment of a permanent state he calls "Enlightenment."  Enlightenment has been operationally defined as:

results[ing] from the full development of consciousness and depends upon the perfect and harmonious functioning of every part of the body ... the state of enlightenment represents the ultimate development of what we ordinarily consider to be the most valuable qualities of human life.  It is something real, natural, and tangible ... develops in a continuous and progressive manner--on the basis of neuro-physiological refine­ment, or purification (Wallace, Note 5).

Maharishi explains that his Transcendental Meditation tech­nique (TM) is an ancient, systematic and totally natural procedure for gaining enlightenment.  The research done on the TM technique has demonstrated measurable improvement in virtually all aspects of mind and body.

These predicted movements in the psycho-physiology are being increasingly substantiated by research findings and are to be viewed, according to Maharishi, as the "milestones" in the growth of an individual from his present level of limited function through increasing activation and utiliza­tion" of his latent abilities up to the requisite "full development of consciousness ... perfect and harmonious functioning of every part of the body" (enlightenment). This may be why "enlightenment" isn't a more commonly known and understood phenomenon ... Such a high state of function may well be rare today.  Another value that Maharishi's theory and the research findings indicate is that the ideal of a state of human enlightenment or "perfection" (which is by no mean - an idea novel to Maharishi) may now be well on

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its way out of the realm of mysticism and uncertainty into a scientifically verifiable reality. Such knowledge would be of immense practical value.

Enlightenment, then, is dependent upon the full develop­ment of consciousness and depends upon the perfect, harmonious function of every part of the body.  If some imperfection exists in the body, or there is a lack in the development in ones' consciousness, then the full expression of ones' total potentiality will be blocked.  These imperfections, these blocks, are what Maharishi refers to as "Stress."  This def­inition of stress will now be constrasted with two other recognized theories of stress; Hans Seyle's and Lazarus'.

'Stress' (as Seyle has already pointed out) is the .... non-specific response of the body to any demand made upon it.  It does not specify whether the demands of the body and their results are pleasant or unpleasant. The stress of anxiety or physical pain causes certain objectively measurable nervous and hormonal reactions which are essentially identical with those induced by the pleasant stress of fulfillment, victory and accomplishment (Bloomfield, Cain and Jaffe, 1975, p. xi).

Stress, according to Lazarus' theory of "Cognitive Appraisal of Stress" is explained:

Thus, the same stimulus may be either a stressor or not, depending upon the nature of the cognitive ap­praisal regarding the significance for him ... :,.;..,..,.... (1966, p. 244).

That a "stimulus may be a stressor or not" depending upon the .nature of the cognitive appraisal regarding the significance for him," can be readily contrasted with Seyle:

It is essential to point out that the medical definition of stress does not attribute an intrinsically unpleasant or harmful quality to stressful event situations.  Stress is defined as the non-specific (that is, stereotyped) response of the body to any demand made upon it.  An experience of intense joy ...  can act as a stress pro­ducer or "stressor" just as much as anxiety or physical pain, in both cases, certain ... reactions occur in essentially identical patterns ...  stress is inherit in all human activity ... in life itself ...  what is needed ...  to minimize harmful stress (distress) with its damaging accumulation of "chemical scars" while "if cultivating ...  beneficial effects of pleasant, ful­filling stress (eustress) (Kanellakos and Lucas, 1974, p. 146).

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It may well be in the realm of common experience that we have cognitively appraised an event as threatening and ex­perienced the "distressful" response of the body to the event, and later, with greater knowledge and experience, re-experienced the same event as "positive" and experienced the "eustressful" response of the body to it.  Bloomfield, Gain and Jaffe (1975) point out:

No one specific criterion is sufficient to determine whether or not an event will be a stressor because constitutional factors play an important role in susceptibility to stress.  One person may show a severe stress reaction to a situation which another person experiences with no appreciable effect.  A situation may be termed stressful only with respect to a person whom it taxes sufficiently to induce the stress reaction (p. 50).

So, according to Seyle, it is the non-specific response of the body to any demand made upon it that constitutes stress.  This response of the body is essentially the same, regardless of whether the cause is harmful (distress) or beneficial, 'enjoyable (eustress).  Lazarus points out that it is the individual's perception of the event that determines 'if this response is to be "distressful" or "eustressful."

In Maharishi's theory of stress, stress is defined as the result of a stressor, or the physiological abnormality caused by an overload of experience.  It is not the "stressful exper­ience" or our appraisal of the experience that is paramount; it is rather the resultant "chemical scars" and other damages actually sustained by the body as a consequence of the experience that is of importance.  It is the physical results left behind in the body by any experience that Maharishi refers to by the word "stress."  These stresses or damages done to the body may result in chemical, structural, neuro-muscular or homeostatic imbalances.

Before going on to considering how stress, as Maharishi has defined it, is reduced and eliminated by the regular practice  of" the TM technique, it is important to note here that Maharishi considers stress and the release of stress as a beneficial, but a secondary consideration.

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"The important question does not concern' the way any particular 'stress1 happened to an individual," writes Dates (1975, p. 161).  "The question is how to get rid of it. ' Dissolving stress should lead toward normal, healthy life."

The Transcendental Meditation Technique

The Transcendental Meditation Technique (TM) is unique in its approach and practice.  It is an entirely mechanical process which attains its goal automatically with consistant practice.  Moreover, it requires no faith or belief whatsoever, is associated with no religion or philosophy, and involves no concentration, control or auto-suggestion.  The twice-daily practice of the technique fits in with the regular daily activities, enhancing creativity and increas­ing the energy level needed for an active and fulfilling life.

The practice of the TM technique requires no intellectual analysis; it has been found to be easily learned by people of all socio-economic backgrounds, ages and educations.

In fact, instruction in the technique is so simple that individuals with physical and mental handicaps have learned the TM technique successfully and have measurably benefitted from the practice.  Even with individuals with whom only limited communication is possible, TM can be learned easily and quickly (Eyerman, 1979).

The TM technique affects all aspects of life in a holistic way.  Its approach is not directed at merely treating specific symptoms, but at spontaneously unfolding the full potential of the mind, heart and body by providing deep rest to remove stress.

Instruction in the technique is very specific and is taught by a qualified instructor.  The TM technique is practiced 20 minutes, twice daily, sitting comfortably.  Once instructed, the meditator becomes self-sufficient in his practice, and can continue to enjoy cumulative improvements in ;his well-being for the rest of his life.

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During the practice of the TM technique, the awareness experiences progressively quieter or less excited states of the thinking process until the finest or quietest level of thought is transcended and pure awareness, pure consciousness is experienced.  In this calm quietness, the body is allowed to carry out with exceptional efficiency repairs and adjustments which are not possible during activity or regular deep sleep.  At the end of the meditation period, the alert mind gently re-enters activity refreshed, relaxed and revitalized.

The physiological changes that have been found to accompany the practice of the TM technique confirm this pattern of rest and alertness.  Oxygen consumption, breath rate and heart rate decrease significantly, but all in a natural manner, without any attempts at manipulation (Wallace, 1970).

Benson, Wallace and Wilson (1972) reported, as a result of study that:

(Transcendental) meditation "... produces not a single specific response but a complex of responses that mark a highly relaxed state ... suggests that meditation generates an integrated response ... the hypometabolic state produced by meditation is of course opposite to this ["fight or flight" response of the aroused sympathetic nervous system to a stressor] in almost all respects.  It looks very much like a counterpart of the fight-or-flight reaction (p. 908).

In 1975, based on the findings of the growing number of studies being done on individuals practicing the TM technique, Dr. Seyle remarked that:

TM's physiologic effects ... are exactly opposite to those identified by medicine as being characteristic of the effort to meet the demands of stress.  Similarly, the therapeutic effect of TM on bodily derangements is mostly evident in those conditions known as "diseases of stress" or "diseases of adaptation" (especially mental, cardiovascular, gastrointestinal and hyper-sensitivity ailments) ... caused by inappropriate adaptive responses to the stressors of every day life (Bloomfield, Cain, Jaffe, 1975, p. x).

Over 400 scientific studies have been done to date on the TM technique while another 300 are currently underway. Scientific studies on the TM program have been conducted

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at over 100 independent research institutions throughout the world including:  Harvard Medical School, Princeton University; Stanford Medical School; University of Edinburgh, Scotland; Langley Port Neuropsychiatric Institute; University of Michigan Medical School; University of Cali­fornia, Berkeley; Pritzker School of Medicine; University of Chicago; and the UCLA Medical School.

Many leading scientific journals have published this research including:  Science, American Journal of Physiology, Scientific American, Journal of Psychology, Academy of Management Journal, The Lancet, Electroencephalography and Clinical Neurophysiology, International Journal of Neuroscience, American Journal of Psychiatry, Clinical Research, Perceptual and Motor Skills, Physiology and Behavior, Journal of Special Education, Psychosomatic Medicine, The Physiologist, and Criminal Justice and Behavior.

A number of research studies have focused specifically on the academic and educational benefits of the TM technique. Among the results are increased creativity (MacCallum, 1975; Shecter, 1974; Travis, 1977); improved learning ability (Tjoa, 1975, 1977; Abrams, 1977); increased orderliness of thinking and improved memory (Miskiman, 1973a); improved academic and athletic performance (Collier, 1975; Heaton and Orme-Johnson, 1977; Reddy, 1975); and increased intelligence growth rate (Tjoa, 1975).  Further results include: increased self-esteem (Rosenthal, 1974; Sheeter, 1974); and increased energy level and greater tolerance in high school students (Schecter, 1974).  Jackson (1977) found improved learning ability and greater self-actualization in adolescents with learning problems who began TM.

One growing result of all this research is that several of the theories that Maharishi has postulated are receiving growing support.  One of these theories, Enlightenment as "the result of the elimination of physical impurities along with the full development of consciousness, has already been considered.

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With this knowledge of the TM technique, it is possible to go on to consider the second part of Maharishi's theory of Human Stress; what determines how stress is stored in the body, and how it can be removed from the body.

Impact and the Release of Stress

In Maharishi's paradigm of stress, the only difference between some minor stress and a traumatic stress that results in a disruption of almost all aspects of ones' life (Post-traumatic Stress Disorder) lies in the degree of intensity and complexity of the damage caused by the stressor.  The actual impact made by the stressor upon the persons' mind and body, influenced by the persons' cognitive appraisal of the event, combine to produce not only a unique overt response to the stressor itself, but a unique covert response in terms of harm sustained-by the stressor.

In Post-traumatic Stress Disorder, the existence of "a recognizable stressor that would evolve significant symptoms of distress in almost everyone" implies the stressor is of a magnitude sufficient to overwhelm "almost everyone," but not everyone.  Due to individual variations and complexities, everyone will have a unique response to a stressor.  Events such as simple bereavement, chronic illness, business losses, and marital conflict, while generally held to be outside the range of magnitude or intensity of the PTSD stressors, do result in the disorder manifesting in some people.

A "traumatic" stressor such as rape, assault, combat or bombings, floods and earthquakes and stress gained from a "minor" stressor such as getting in trouble with the boss, or spraining a finger to a "micro" stressor like forgetting to bring a pen or your shoelace breaks when you are in a rush—the c'hief distinction is, again, only a question of intensity.  The more intense the stressor, the more the overloading to the various aspects of the body and mind.

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The greater the damage, the greater the resultant inhibition is in ones' subsequent activities.  All aspects of ones' physical, mental and emotional functioning are within this range.  So the main difference between an ulcer and the symp­toms of PTSD is that the ulcer is usually the result of many minor and micro stressors accumulated over time, whereas the disorder caused as a result of exposure to a traumatic stress seems to occur as a result of one or a series of intense trau­matic stressors, usually in a brief period of time.

Another example of severity of the stressor being linked with the severity of its' resultant disorder can be seen in the DSM III definition of an "Adjustment Disorder":
The stressor is usually less severe and within the range of common experience ...  characteristic symptoms of Post-traumatic Stress Disorder, such as re-experiencing the trauma, are absent (p. 237).

In Maharishi's paradigm of stress and its' release we find that the chief distinction between stress as it has been defined and thought of by others is a comprehensive approach to facilitating the release of stress and making an individual more resistant to stress. ...... Maharishi explains that the release, or "normalization" of a stress can occur virtually unnoticed while resting for a few moments or in the subsequent activity.  A stronger stress, as it is normalized, may produce more obvious symptoms—a headache, a twitch, a sudden unexpected jolt.  These experiences are common enough during rest, particularly as one begins to fall asleep.  In Post-traumatic Stress Disorder, the release of stress is usually quite obvious.  Due to the intense nature of the stressor and the resultant inhibition and damage sustained, the body's attempt to rid itself of this overload are obvious and frequent:  recurrent memories and nightmares, indirect avoidence of events and situations that may remind one of the original trauma along with diminished interest in significant activities , feeling detached and constricted effects are all results of stress in the more subtle areas of the emotions and feelings.  Hyperalertness and sleep impairment indicate the damage in the more "physical" aspects of the nervous system.

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The TM technique, proven to produce deep rest that becomes deeper with regular practice, allows the body to heal itself, to rid itself of any foreign deposits, to regain more normal function in all areas.  One of these areas of the body benefitting from this is the autonomic nervous system which, when functioning more normally, improves the possibility of reducing the inappropriate triggering of the "alarm" or stress response.  This physical rest also heals and normalizes the more deep, subtle damage done to the areas of deeper mental function and feelings (Torber, Mertsedorf and Hiesel, 1976).  Emotional and affective phases of the individual are enhanced concurrently (Hand-maeher, 1978).
This increased physical refinement then produces even greater mental refinement.  This, along with the repeated experience of the field of pure consciousness, facilitates rapid normalization for body and mind, which in turn promotes normal and harmonious functioning of all aspects of the individual—body, mind, feelings and the emotions. Concurrent to these beneficial changes is the increasingly fuller value of enlivened consciousness.  These normalizing effects are cumulative over time.  Maharishi explains that all deeply imprinted stresses can be eliminated; all mental and physical abnormalities as well as fatigue and tension, etc.  Only irreparable physical damage and genetic defects appear to be beyond this normalization.

Psychiatrists, utilizing the TM technique along with therapy, indicate that repressed traumatic material seem to be very quickly and easily processed during the TM technique resulting in a promotion of patient autonomy while facilitating therapy.  The following section will provide a review of them.

The TM Technique and Psychiatry

It is the recognition of the wide range of damage that can be sustained by an individual resulting from stress that Maharishi takes to its' deepest level to explain how a psychiatric disorder can arise.

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E.E. Green (1970) in his "Psychophysiolbgical Principle" accepted this reciprocity of the body and mind:  a trauma sustained by one will have its' effect on the other.  As we have already noted earlier, psychosomatic medicine accepts that an aggrevated mental state can cause a physical disorder while a physical disorder can give rose to a mental disorder. It is in this area of the intimate interaction between mind and body that the damage sustained by a stressor (stress) can have its affect.  There is an enormous range of diverse potential stressors that could overwhelm the body and leave as a result, an equally diverse range of "scars" in the body. This resultant damage in ones' subsequent psycho-physiological functioning can be equally variable.  Further, Maharishi explains that within this realm of subtle mind/body interactions are located the fine levels of ones' mental, emotional and effective functioning.  Since ones' psychology is so deeply rooted in his physiology (and vice versa), stress in the body has to have its effect on the functioning of the mind.  It is here, where the body and mind constantly and profoundly affect each other that stress accumulate, and depending upon several factors, by interacting and compounding each other, go on to produce a physical or mental disorder.  Mental disorders are, therefore, held to be subtle physical disorders.

When sufficient deep rest is gained to normalize a stress in the body, then there is a corresponding ease of mind, a degree more clarity, and an increase of orderliness on the psychological level.  As the functioning of the body improves, this in turn allows the mind to become even more subtle in its awareness.  The result is a natural momentum of progressive improvement.

Drs. Glueck and Stroebel (1975) conducted a study at the Institute for Living at Hartford, Connecticut to investigate the possible use of the TM technique as an adjunct to the treatment of psychiatric in-patients.  In three years, 237 patients began the TM technique.  They reported that patients with all types of psychiatric illnesses including severely disturbed patients were able to learn the technique easily.

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Drs. Glueck and Stroebel offer the following Theory as to why the TM technique works so well in the area of "mental distress":

Presumably, in sleep, limbic-system activity diminishes, mediated perhaps by the reticular activating system. One of the theories about the appearance of dreams, especially about the ideational content in dreams, has to do with an increasing access to the non-dominant hemisphere where presumably repressed memories are stored.  The weakening of the repression barrier that occurs in sleep and in other altered states of consciousness, such as free association during the process of psychoanalytic therapy, may be produced in a relatively simple fashion during TM meditation.  This would offer an explanation of a phenomenon that has been reported by a number of investigators, and which we have seen repeatedly in our patients.  During meditation, thoughts and ideas may appear that are ordinarily re­pressed .... An impressive aspect of this phenomenon is that, during the meditation, the intense emotional effect that would ordinarily accompany this ideation, e.g., when obtained by free association, seems to be markedly reduced or almost absent.

Our speculation ...  during meditation, the limbic-system activities are diminished sufficiently to permit the regulatory mechanisms for transmission of signals between the hemispheres, via the commissures and corpus callosum, to respond to this more muted, tranquil state of the limbic system by opening up the pathways ... allows a freer interchange of information between the hemispheres that ordinarily does not occur during the fully alert waking state when attention is directed at sensory input.  In our experience and that of other therapists, this seems to allow significant repressed material to come into conscious awareness relatively rapidly and comfortably, material that might otherwise not be available, or might take long period of intensive psychotherapy to reach.  The apparent splitting of ideation and affect that meditational state produces, we feel, may be primarily responsible for this.  This phenomenon has been used to advantage by a number of our therapists to assist the psychotherapeutic process has permitted a much more rapid recovery of significant repressed material than might otherwise have been the case. 

This has also been reported in detail by Carrington and Ephron, who have been using TM as a specific adjunct to the treatment of their psychotherapeutic and psychoanalytic patients (Glueck and Stroebel, 1975, p. 315-316).

Maharishi, in a private communication to Dr. Kanellakos, explained this phenomenon:

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Diagnostic Criteria of the Post-Traumatic Stress Disorder and Related Research Findings on the Transcendental Meditation Technique

As we have seen, Maharishi Mahesh Yogi's theory of Human Stress, along with a very well documented body of re­search conducted on practitioners of his Transcendental Meditation technique, shows not only an insightful view of'the human dynamics as they are influenced by events in life, but also offers great promise in enabling man to recover from the deleterious effects of these events.  This section will relate some of the most applicable findings on the TM technique to the Diagnostic Criteria for the Post-traumatic Stress Disorder listed in the DSM III (p. 238).

A.  Existence of a recognizable stressor that would evoke significant symptoms of distress in almost everyone. Lahr (1974) found that, in both beginners and experienced meditators, a more efficient adaption to changes in their lives than was found in non-meditators.  Meditators wereshown to have a greater recovery than controls to a stress­
ing condition and were lower on both trait and state anxiety (Goleman and Schwartz, 1976).  Karinetti (1976) found a significant reduction of perceptual illusion that indicated improved perceptual awareness in meditators.

B.   Re-experiencing of the trauma as evidenced by at least one of the following: 1) recurrent and intrusive recollections of the event.  Daniels (1976) showed that meditators have greater autonomic stability and greater ability to process information at speed than controls and practitioners of other relaxation procedures.  Johansson (1978) found that deep-rooted stresses, which are only measurable by using tests that show changes in the subliminal perception are found to resolve through six months of the practice of the TM technique.  This study is of particular importance for the entire phenomenon of PTSD.

2)  Recurrent dreams of the event.  Fuson (1976) found im­proved quality of sleep and dreams in meditators. Candelent and Candelent (1975) showed increased mind-body coordination

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and stability of the nervous system, indicating increased normalizing in the bodily cycles.  3)  Sudden acting or feeling as if the traumatic event were recurring because of an association with an environmental or ideational stimulus. Wilcox showed an increased autonomic stability and effective interaction with the environment (1977).  Jevnings  and Wilson (1977) showed a reduction in blood lactate.  In 1978, Jevnings, Wilson and Davidson found a reduction of cortisol in long-term practitioners of the TM technique.  Lactate has been associated with anxiety and high cortisol levels with stress. Again, Martinetti's (1976) and Johannsson's (1978) findings of improved perceptual awareness and dissolution of deep-rooted stresses are very applicable in this consideration.

C.  Numbing of responsiveness; reduced involvement with the external world, beginning some time after the trauma, as shown by at least one of the following:  1) markedly diminished interest in one or more significant activities.  Willis (1974) found a greater degree of adjustment along with an in­creased self-concept in meditators.  A decrease in hostility, anxiety and depression was found in a study by Halen and Whalen (1974).  Hanley and Spates (1978) showed improved social and psychological attitudes.  2)  Feelings of detach­ment or estrangement from others.  Dillbeck (1976) showed decreased perceptual rigidity and increased perceptual performance.  He attributed these gains to a growth of "unbonded awareness" in the meditators.  Schwartz, in 1979, showed an increase in sensitivity and flexibility of the nervous system.  3)  Constricted affect.  In a study carried out by Handmacher (1978), he found that TM practitioners scored lower on several measures of anxiety and depression. In addition, they showed themselves to be affectionate and tolerant  in personal relationships, with less need to be accepted or to have superficial social contacts than the non-meditating controls.

D.  At least two of the following symptoms that were no-fe present before the trauma:  1)  Hyperalertness.  Several studies have been done on the biochemical indicators of

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stress.  Jevning, Wilson and Davidson (1978) found a signifi­cant decrease in coritsol, indicating reduced stress and an improved resistance to disease.  Bujatti and Riederer (1976) found higher serotonin metabolite  levels (indicating a more orderly brainfunction) along with lower levels of noradrenaline metabolite (which indicates lower physiological arousal) than in the non-meditating controls.  2)  Sleep disturbance. Miskiman (1972b) showed faster recovery from sleep deprivation and relief from insomnia in meditators.  Fuson (1976) had already showed an improvement in the quality of sleeping and dreaming, indicating greater stability in biological rhythms. 3)  Guilt about surviving when others have not, or about behavior required for survival.  Torber, Mertesdorf and Hiesel (1976) found increased emotional stability and psychological integration in meditators.  In particular, they located decreased depression, anxiety, nervousness, anger, fatigue and dreaminess along with increased relaxation, actuation and elation as compared to controls.  Long-term positive effects of the TM technique on mood and body sensations indicating permanent improvement were also indicated.  4)  Memory impairment or trouble concentrating.  Pelletier (1974) showed meditators had broader comprehension and an improved ability to focus attention.  Miskiman (1977) found increased orderliness of thinking along with improved memory.  Berrettini (1976) showed an improvement in memory among the meditating groups.  Nataraja and Radhamani (1975) found improved concen­tration along with improved comprehension and memory in the meditating students.  5)  Avoidance of activities that arouse recollections of the traumatic event, and 6) intensification of symptoms by exposure to events that symbolize or resemble the traumatic event.  Several studies indicating possible improvement in this area include increased adaption and dis­crimination of the central nervous system (McEvoy and Franklin, 1980); an increase response of the brain to environmental stimuli; indicating a more effective interaction with the environment (Wandhoffer, Kobal and Platting, 1977), and an increase in adaptability, equanimity and self-sufficiency independent of external circumstances (Donner, 1976).

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As it has already been pointed out, the goal of the Transcendental Meditation program is the full and integrated development of the individual.  This evolutionary growth, naturally brought about through the expansion of consciousness, is the direct result of the regular practice of the Transcendental Meditation technique.  With this regular practice, an individual acquires, in a natural and effortless way, all the positive attributes that are associated with physiological and psychological well-being. The TM program is a means for global self-development.  It holistically strengthens the individual, physiologically and psychologically, which results in a decrease in psychological problems and anti-social traits.

The purpose of this paper has been to show that a strong possibility exists that the symptoms characterizing Post-traumatic Stress Disorder may be alleviated by the regular practice of the TM technique.  Further, it has been shown in Maharishi Mahesh Yogi's paradigm of stress and its release that it may be possible to eliminate some or all of the damage caused by the stress resulting in a cessation of the Post-traumatic Stress Disorder.  Scientific research indicating these events may already be occurring have been reviewed.

Therefore, it is hypothesized that in Vietnam veterans diagnosed as suffering from the symptoms associated with Post-traumatic Stress Disorder, an experimental group taught and regularly practicing the TM technique, will show greater improvement characterized by the lessening of the severity of symptoms than a matched control group participating in a .time-balanced, traditional individual and group counseling program.

It is further hypothesized that the experimental group, when measured for long-term effects (six and 12 months) will continue to show a continual improvement measured by lessened symptoms as well as significantly greater improvement

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psychologically, physiologically and effectively, when compared to the control group.

A brief proposal follows this thesis in Appendix A. It contains an outline for an experimental study that can test this theses.

APPENDIX  A

A Proposed Study to Determine the Value of the Transcendental Meditation Technique with Vietnam Veterans Suffering from Post-traumatic Stress Disorder

I think that before very long we will see more and more proof of the value of TM in dealing with all kinds of stress and strain and ...  in application it may have for the stress of combat and the great burdens this places on the individual soldier ...  the military has got to study this, so we can take better care of the young people entrusted to our care and so collectively, we can perform better in the kind of fighting we have to be ready to do in the future (General Davis, Interchange, 1972).

In 1974, the U.S. Army did authorize a study on the TM technique.  It was titled An Experimental Evaluation of the Effects of Meditation and Karate.  The authors, Myers and Eisner (1974) reported:

The present experiment ... had the power to establish whether involvement with TM significantly alters drug use ... and it appears that this is the case ... virtually all meditators felt that they had gained something of value in their knowledge of TM and were grateful for their free training ... (p. 41, 44, Note 6).

In the study Legacies of Vietnam:  Comparative Adjust­ment of Veterans and their Peers, conducted  by the Center for Policy Research (1981), one of the recommendations it makes regarding assistance to Vietnam veterans suffering from difficulty in readjustment and PTSD is:

Support on-going basic research and professional devel­opment to deepen the knowledge and expertise available on human responses to massive trauma (Vol. IV).

It has been hypothesized that in Vietnam veterans diag­nosed as suffering from the symptoms associated with Post-traumatic Stress Disorder, a group taught and regularly practicing the TM technique will show greater improvement characterized by the lessening of severity of symptoms than a control group undergoing traditional individual and group counseling programs (time-balanced to match the twice daily practice of the TM technique).

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It was further hypotheszied that the experimental group, when measured' for long-term effects (six and 12 months) will continue to show increasing reduction in symptoms as well as significantly greater improvement in the physical, psychological and effective areas of their lives than the control groups.

This grant proposal is submitted in the aim of accomplishing two goals:  first, to test the hypothesis, which if it was to be supported would indicate that further research is clearly warranted.  Also, this would lend support to Maharishi Mahesh Yogi's theory of Human Stress.  Second, and more urgent, is to assist the large number of Vietnam veterans who are presently, or in the near future, suffering from Post-traumatic Stress Disorder.

Whatever the reason for the veterans' difficulties, be it his background or his severe combat trauma, experience gained from teaching over 2 million people in the world sup­port the claim that the TM technique can be learned by vir­tually anyone.  Age, previous experience, educational background are not significant barriers to learning and benefitting from the practice.

The following quotes were taken from the Executive Sum­mary of the study Legacies of Vietnam: Comparative Adjustment and their Peers (1981).  They raise important points that any potential modality of treatment to be used with Vietnam vet­erans must address:

Reaching out to assist Vietnam veterans may be more difficult than is often assumed ...  those who might be more readily aided, the great majority of Vietnam veterans with unresolved war experiences are much less likely to accept the role of counselee or patient

1. ...Efforts to assist Vietnam veterans would do well to be informed by "what works" among men who have achieve a high level of post-war adjustment
2. Programs undertaken to encourage and assist veterans in working through their experiences will not duplicate the impact of the incentives provided for higher educa­tion under the G.I. Bill.  Working through is not an intellectual procedure,
3. and policy-makers should not assume that the current G.I. Bill or existing structure of higher education, with its emphasis on vocational and intellectual skills, will address veterans' need for personal development.

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These points can be responded to as follows:  1)  learning and practicing the TM technique is in terms of self-improvement.  This self-improvement is explained as a means to better personal and family life, as well as helping to create a more ideal society which can contribute to estab­lishing world peace.  The vast majority of TM practitioners are stable, successful and effective members of society. The TM program does not counsel and practitioners are re­ferred to as meditators.  It is interesting to note that the novelty and curiosity many people still have about the TM program may actually enhance the viability of application of the TM program to a group that is reportedly suspicious of"more traditional treatments.  2)  The TM technique has already "worked" in hundreds of cases in assisting already-meditating veterans to achieve higher levels of post-war adjustment.  3)  The TM technique, as has been shown by a review of some of the scientific studies (Chapter II), produce a constellation of beneficial changes both during and after the practice.  Further, these beneficial changes grow more strong, more demonstrable through time.  The results show growth on all levels of the individual:  mental, physi­cal, psychological and social.  It has been referred to as a technology that enhances personal development while pro­moting intellectual growth.

Subjects

Qualified VA personnel will interview and diagnose the veterans for Post-traumatic Stress Disorder.  At least four of the symptoms must be present to take part in the study. These veterans will be drawn from as wide an area as pos­sible, and as randomly as possible.

Method

One hundred veterans, diagnosed as having Post-traumatic Stress Disorder, will be randomly assigned to control and experimental groups.  Four groups, two experimental and two control, are formed.  One control and one experimental group are; pre-tested; the other groups are not.

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The experimental groups are instructed in the TM technique.  The control groups begin counseling.  To balance the time, all groups will have the same number of meetings or the same lengths of time with their counselor and instructors.  To balance the twice daily TM practice time, the control group will be given a meaningful task for 20 minutes twice a day; e.g. directed writing in a diary as part of their counseling program.  To further test the hypothesis, the control groups can be instructed in the TM technique, one at three or six months, the other at six or nine months.

Appropriate statistical techniques will be utilized.

Post-test Schedule and Designs

The design				suggested is t
					1M
1.	R	0	xl	TMt -	0
2-	R	0	X2	Diary	0
3.	R	-	Xl	TMt	0
4.	R	-	X2	Diary	0
Assessment

Assessment is recommended on three levels:  1) subjective; self-reports and inventories, 2) objective; pencil and paper tests, and 3) chemical; evaluation of stress levels using urine analysis of 17-hydroxycorticosteroid levels.  This particular measure has been utilized and is felt to be a reliable chemical indicator of stress levels (Bourne, 1970). To test the long-term effects of the second hypothesis, instruments used in the pre-test will be chosen for their long-term value.

Budget

1.  Salaries.  Two qualified teachers of the TM program would be hired and paid in accordance with the prevailing VA guidelines for hiring outside consultants.  Two qualified counselors already in the employment of the VA would also be assigned to the study.

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2.  Instruction in the TM technique will be $500 per man.

1. Assessment instruments utilized, lab fees and other related items and service could use the existing VA structures to minimize costs.  The actual cost cannot be determined at this time.
2. Transportation would be budgeted in accordance with the present VA guidelines.

Location

To be determined.  A site with access to a large number of Vietnam veterans and to VA resources is a prime consideration.

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REFERENCES

Abrams, A.I.  The effect of meditation on elementary school students.  Scientific Research on the Transcendental Meditation Program; Collected Papers, Vol. II, in press.
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (Third Edition).  Washington, DC.:  American Psychiatric Association, 1980, p. 236-238.
Archiebald, H.C., Long, D.M., Miller, C., £ Tuddenham, R.
Gross stress reaction in combat - a 15 year follow-up. American Journal of Psychiatry, 1962, 119 , 317-322.
Archiebald, H.C., £ Tuddenham, R.D.  A 20-year follow-up. Archives General Psychiatry, 1965, 12, 475-481.
Benson, H., Wallace, K., £ Wilson, A.  The physiology of
meditation.  Scientific American, 226, 2, 1972, 84-90.
Berger, D.  The survivor syndrome:  a problem of nosology and treatment.  American Journal of Psychotherapy, 1977, 2, April 31, p. 238-251.
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