DISTRESS CAN BE a normal
response to pain and loss or
a sign of a psychic wound that is failing to heal. Critics of PTSD diagnostic criteria, including many soldiers, feel that returning veterans’ natural process of adjustment is often mislabeled as a dysfunctional state.
Image: TYLER HICKS New York Times
In Brief
- The syndrome of post-traumatic stress disorder (PTSD) is under fire because its defining criteria are too broad, leading to rampant overdiagnosis.
- The flawed PTSD concept may mistake soldiers' natural process of adjustment to civilian life for dysfunction.
- Misdiagnosed soldiers receive the wrong treatments and risk becoming mired in a Veterans Administration system that encourages chronic disability.
In 2006, soon after returning from military service in Ramadi, Iraq, during the bloodiest period of the war, Captain Matt Stevens of the Vermont National Guard began to have a problem with PTSD, or post-traumatic stress disorder. Stevens's problem was not that he had PTSD. It was that he began to have doubts about PTSD: the condition was real enough, but as a diagnosis he saw it being wildly, even dangerously, overextended.
Stevens led the medics tending an armored brigade of 800 soldiers, and his team patched together GIs and Iraqi citizens almost every day. He saw horrific things. Once home, he said he had his share of "nights where I'd wake up and it would be clear I wasn't going to sleep again."
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98 Comments
Add CommentI am speechless and heartbroken by this article.
Reply | Report Abuse | Link to thisThere is a gain here alright - a gain to eliminate COST.
Too many times over we see this. If money is involved results are
questionable. Lets look at Vaccine Risk - lies and money. Fake claims exposed recently of false pharma reports on drug safety - lies and money. Lets make up anything we want for financial gain - which includes saving money by eliminating or cutting back on compensation for PTSD. Veteran's compensation which may look huge in dollar amounts is "chunk change" compared to other spending programs and bail outs going on right now. Do you realize what a SMALL percentage of Americans actually serve our country? The War in Iraq - more lies and more money.
Questioning PTSD, and its previlence - and stating there is GAIN to be made financially by an individual from the VA in having this diagnosis - undermines so many who suffer, and are afraid to come forward.
Are there scammers - sure. Is it worth it to hurt others by "scrapping the whole system and starting from scratch" - with let me guess a system that would cost less?
You better get real and take a look at these increased and alarming sucide rates. This guy who still has nightmares, and yet "mans" up and states PTSD is way too over diagnosed HE is doing a big diservice - I am glad HE personally sees the nightmares and stuff as just "normal" but different. Maybe down the line when he is older and a few more life traumas have been added on to his war history life won't seem so simple. Maybe he is exceptionally resilant. Good for him. I on the otherhand have lost too many friends that can't take the nighmares anymore. Projecting his opinion on others is just wrong. Good for him, shut up about others.
I am glad someone experienced in trauma study called this "Harvard" expert and lead author liar too. There are psychatrists on the Harvard payroll who have said alien abuductions are real too - oh and that females and blacks are less intelligent. So lets just default to the above reproach professionals most especially if they come from some esteemed unquestionable institution such as HARVARD.
As a stalked for vengence, raped, female veteran of a combat zone - I would trade my VA PTSD compensation any day for having back my "normal" life. Take the damn money and give me my life back.
Now thinking that myself and others face further scrutiny . . . to prove yet again that yes, the PTSD is real for me . . . and others while they fight about the DSM rewrite . . . disgusting. Hurtful.
There might be those who would question PTSD Dx rates in veterans out of a desire to cut the associated health-care and disabiilty-benefit costs. I -- the author of the article -- am not one of them. Rather I'm suggesting another, different disability-benefit structure (and lifetime universal health-care access for combat-theater veterans) that would serve the veterans better -- and might or might not cost more. (It's not clear to me whether it would cost more or less -- though I suspect less, since more vets would recover faster.) Take a look at the sort of disability system and health-care benefits I'm suggesting toward the end of the section "Disabling Conditions." You'll see that a) I'm not suggesting at all that we should leave vets to their own devices and b) that I'm recommending a positive, veteran-friendly restructuring of disability benefits that would enhance treatment and reward healing rather than to undermine treatment and punish recovery -- and honor their sacrifices, even after they recover, with a modest but meaningful lifetime payment much like those received now by vets who suffer lasting physical injury.
Reply | Report Abuse | Link to thisThis is an extremely difficult and touchy subject, and the positions have been staked out and dug in so deeply, and so tainted with politics, that it's sometimes hard to see new ideas clearly and evaluate them without assuming certain motives.
Let me repeat: PTSD exists, and where it exists we must treat it. But the VA's track record of success treating PTSD, despite their use of some therapies that work in civilian populations, suggests that we need to consider not necessarily doing LESS for vets with PTSD, but forging a response that's different -- one that actively encourages recovery in every way, and that provides help for other mental-health and economic readjustment issues as well.
I appreciate your reply and dialog. What I have suggested to my own therapists at the VA is a different look at this issue. They treat us with antidepressants, misdirected therapy approaches. Lets take a better look at the brain - and discover why some of this might happen. I have repeated to my providers I felt as if my brain marinated in stress hormones while deployed in theater, literally as if smoke could be seen coming out of my ears. I did not even smell the same. Ever have a close call and get stinky? Try that for months - One doctor suggested maybe the food . . . no I ate the same stuff as I do at home. IT WAS THE FEAR. Why this gets heated and hostile is because there has been so much waivering as a whole by the VA as well as the DOD in the treatment of sick service members. Bad history. Please read and research Agent Orange. They throw a cocktail of vaccines at you, expose you to chemicals, radiation, and continual fear arrousal. Then they try to treat PTSD with a one size fits all - but the shoe doesn't fit all the new female veterans and our experiences, and the consequences of different hormones. The current medication approaches I believe are part of the sucide problem. I agree it has got to get smarter.
Reply | Report Abuse | Link to thisLets keep it simple - if the pancrease can be injured in ways that result in diabetes (and insulin is a horomone) why is it not possible all that cortisol production causes damage to the amagdyla? We used to used the term chemical imbalance - is not depression treated by "correcting" serotonin issues? Sadly I am glad the new wave is bring home many cases of TBI - because NOW they might really look into this as a brain issue. Yes you are right there has got to be a better answer. Better meds, better treatments.
BUT - It is not just trauma we are exposed too - War is a dirty business.
You may come home seeming reasonably well - with a slowly ticking time bomb inside. So lets go for it. LETS GET REALLY HONEST ABOUT IT, and get real about the toxic exposures too - and come up with plans and treatment protocols that at least return some quality of life to those who have served.
I believe ALL returning veterans should be screened for Brain injury - that should be the start. Then start sorting if you must. Just remember there is no experation date of the development of PTSD or physical illnesses.
I, too, am horrified by the bias and lack of information present in this article. Besides its inaccuracies, it states positions that are 180 degrees the opposite of the larger view. The comments about possible cost-containment by the VA, since it was underfunded during the Bush administration may be true. But many other points made are either untrue, misleading, or false.
Reply | Report Abuse | Link to thisFor instance, the PTSD diagnosis became that after Vietnam vets were affected, but it had long been identified in the literature, sometimes referred to as shell-shock. Historically there have been many efforts to drive trauma and PTSD diagnoses into the background-this slanted opinion piece is another part of that effort. See Herman, Judith, Trauma and Recovery. Also, many of the leading trauma researchers and practitioners conceive of certain types of trauma reactions as going beyond even the DSM-IV-TR criteria; depression can be part of a complex PTSD reaction, dissociation is not necessarily separate from PTSD, etc. Also, it is well-known that exposed to the same traumatic event people will and will not experience PTSD, due to differences between the people before the trauma.
If anything, PTSD/complex trauma is still not recognized enough. Treatment theories vary and more than one type of treatment can work for different people depending on the circumstances. I worked at a VA hospital treating trauma patients myself and there was no question that the ones I saw were experiencing PTSD and its effects; PTSD is not a static thing; because it affects every part of life it evolves in a variety of ways.
It is true that the VA uses particular cognitive treatments in its approach to treating PTSD. There is no assurance that the modality will help everyone, or that another modality could not help someone.
Also, citing Elizabeth Loftus's work without even mentioning all the research contradicting her conclusions is just inexcusable. Generalizing that to say all memory is always unreliable is just irresponsible. See Memory, Trauma Treatment and the Law. It also leaves out all the recent brain research findings, functional MRI studies, etc.
Same with citing Rachel Yehuda without also mentioning that she has published research on intergenerational trauma-certainly misleading.
Finally, it is time that professionals understand trauma and its effects more clearly-including opposing theories, but not to assume it's being overdiagnosed! There are very fine instruments that can assess it, plus much information on what it is and is not.
Trauma therapist and lawyer
"Trauma therapist and lawyer" complains that the article "states positions that are 180 degrees the opposite of the larger view." Well, yes -- that's the point of the article: That a growing number of experts and authorities in trauma studies, epidemiology, and diagnostic science are questioning PTSD's diagnostic construct and its application.
Reply | Report Abuse | Link to thisAs to the PTSD diagnosis's creation in the wake of the Vietnam War, the commenter argues, as many have, that "PTSD" represents an updated version of post-combat reactions categorized previously as shell-shock and other terms in previous wars. This is not quite the case, as the concept of trauma response expressed in the post-Vietnam vision of PTSD differed in fundamental ways from its precursors: In particular, PTSD was seen at first (in its debut in the 1980 DSM-III) as an inevitable response to an overwhelming experience. The idea was that certain traumas are so bad they would give anyone PTSD. There was no recognition of variations in vulnerability.
That has changed somewhat since then, as both the DSM-IV definition and most practitioners recognize that only a subset of people exposed to any given traumatic event will develop PTSD. However, both the culture and some in the clinical world seem to view PTSD as the expected rather than the exceptional response. ("I don't know why they don't all get PTSD," as one acquaintance of mine said about soldiers in combat.) Along with other factors encouraging overdiagnosis, such as the perverse disability structure, this likely helps spur a reflexive view of any distress in combat veterans as PTSD.
Regarding memory: I did not state that memory is "always unreliable." I stated that memory is often unreliable and malleable, which is not a theory but a fact shown in countless studies (including neuroscientific studies), which makes it very easy to attribute distress or other emotions to either the wrong events or even to events that never actually occurred. This wouldn't be a problem if the PTSD Dx was not based on a coherent causal tie in which memory links an event to symptoms that might arise as readily from non-traumatic sources as from trauma.
I am all for professionals understanding trauma and its effects more clearly. This won't happen if the discipline doesn't confront the serious questions being raised about some of the mechanisms and concepts fundamental to the present PTSD construct and its application.
David Dobbs
(the article's author)
http://neuronculture.com
How about starting at the true cause? Insane wars where human potential is utterly wasted, and for nothing.
Reply | Report Abuse | Link to thisUsing a study of treatment seeking rich civilians who can afford to go to McLean Hospital, a private hospital in Boston, to suggest that PTSD is over diagnosed in treatment avoiding military members is hilarious. It is also evidence of a type of denseness prevalent in one faction of psychiatry, apparently the same faction which approved changing the original description of traumatic stressors in DSM III into the mind numbing ritualistic (yes, I do mean a numbing ritual like "It don't mean nothing" used in Vietnam) series of latinate words in DSM IV.
Reply | Report Abuse | Link to thisScientific American is once again in the vanguard of the wrong, just like when they published Elizabeth Loftus' drivel (she only created false memories when she got the parents to lie to the kids about being lost in a shopping mall...it was not easy). The study on Gulf War vets who reported worse things at the 2 year follow up is also evidence of psychiatric nonsense and lack of understanding of human nature. Young soldiers are not going to tell some guy in a white coat just how nuts they feel or just what happened to them when they get back. They lie! They want to be fine. Years later when they can finally admit they are not fine, the truth comes out, and then these brilliant researchers think they are making it up. NO common sense at all!!
Your article is lame and inept and a disservice to all of us
Patience Mason
Actually PTSD does not represent shell shock. Shell shock and combat fatigue etc were critical stress responses (CRS) which happened in the field. People broke down at the time of the trauma. This rarely happened in Vietnam (1.2% as opposed to 26% in WWII) because people can hang on for a year, and they can deal with enough alcohol and drugs.
Reply | Report Abuse | Link to thisYou do know that, until recently, alcohol and drug abuse were considered willful misconduct instead of "efforts to avoid thought and feelings associated with the trauma." And workaholism is still considered "resiliency" instead of a sure sign of PTSD, probably because it is one characteristic psychiatrists and PTSD people share. Talk to their family if you want to know if someone with workaholism is "fine."
I would like to know what other diagnosis causes flashbacks, nightmares of things you've lived through, extremely effective startle responses (NOT exaggerated), the inability to concentrate on anything but survival information (notice I reinterpret the symptoms because they are misunderstood) the inability to fall or stay asleep because you might be killed in your sleep, etc.
PTSD can and does happen years later. If CRS lasts more than a month it becomes PTSD. This is one of the major flaws of Shepherd's book. He can't tell the difference and compares the two as if they were the same thing.
I am a psychiatrist who works at a veterans hospital and I agree with Mr. Dobbs's article. PTSD is a true illness, mostly misdiagnosed, and rarely a chronic one. DSM criteria for PTSD are so vague that they neither gauge the time frame, or the instensity of symptoms. Depression, GAD, panic disorder, and less so Bipolar disorder, and psychosis heavily overlap with this symptomology and the accurate diagnosis takes more than one visit. Most veterans are diagnosed in brief one session interviews. Once diagnosed, veterans are placeed in weekly group therapy. Group therapy is an ironic idea when the criteria for avoidance usually involve fear in crows or in rooms with other people. In my VA, the veteran has to negotiate the city to get to the hospital. If one is able to make it through a busy city, with noise and traffic then criteria for impairment are probably not fulfilled. Cognitive therapy is a scarcely available at a VA or most other hospitals for that matter and most veterans do not engage in individual therapy. There are a large group of veterans who once suffered from PTSD, but adjusted over time, as is the norm. When doctors normalize an acute disease becoming chronic, it becomes that way. VA hospitals also give full and sustained service connection for other mental health problems that usually are compatible with function, bipolar disorder as an example. Many veterans present requesting a PTSD evaluation when they are unemployed and need extra money and the timing can be very suspect. This presents inherent bias in reporting symptoms and means that more clinical judgment and observation should be figured into the mix. Part of the reason PTSD is so difficult to treat is because it is so often misdiagnosed.
Reply | Report Abuse | Link to thisAt least prior to Vietnam, there does not appear to have been a significant incidence of what is now called PTSD. I knew many WWII veterens (as well as many Vietnam veterans, including one of my brothers) and only one of them had PTSD or anything like it. That one was a teacher in High School whom we called "Wimpy" because he had been a tail-gunner in Wellington bombers over Germany. I think PTSD would have been a fair diagnosis for Wimpy.
Reply | Report Abuse | Link to thisSome of them sufferred from depression and nightmares for varying lengths of time, which is hardly surprising, and many of them had trouble adjusting to ordinary life, free of constant danger and excitement as it is.
I think one of the factors for over-diagnosing PTSD is political - a campaign to raise another reason for not deploying the military and for disparaging a government for damaging its citizens in large numbers while at teh same time purporting to honour them - as particularly happens in the US.
There is some worthiness in some of the statements in this article but overall is the suggestion that it cost too much to diagnose a veteran. It smacks of the scheme to change the DSM-4 a few years ago by the VA and the American Enterprise Institute's Dr Salley Sattle when the last administration SUDDENLY realized that following the regulations was going to cost them money. I have no problem telling a veteran they can heal, and I have no problem telling them that they should seek treatment. But I have a big problem with redefining PTSD in the 6th year of the war. If a veteran does not meet the definition of PTSD and they are not incapacitated in any way then they dont get compensation. If they do meet the definition, we care for them and try to make them whole. We encourage them to own the experience , rather than being owned by it and then we set them on a path of healing. Some will recover, some will not.
Reply | Report Abuse | Link to thisIf the government wants to mitigate the effect of wartime trauma then they better start training people before they go to war so they are completely competent in understanding the occupational exposure of war. Additionally, they should stop sending the same service members over and over and over. They should enact a dwell-time policy that really works and most importantly, they should make sure that when we send people to war we dont lie to them about the reason why we send them.
Thank you so much for a lucid, comprehensive, thoughtful article.
Reply | Report Abuse | Link to thisI am a combat veteran and the wife of a combat veteran who sustained a traumatic brain injury and was diagnosed with PTSD and major depressive disorder - so I've learned more than I ever wanted to know about the symptom overlap and comorbidity of those problems. It was extremely scary when my husband was getting his disability rating because his functionality at that time was so low - if he had gotten a low rating, we would have struggled to get by on my salary alone. But once he was discharged from the Army and was on VA disability, getting treatment was virtually impossible - long waits for appointments, overreliance on medication, no use of evidence-based treatments. Getting the disability rating from the VA was also extremely depressing for both of us, because it basically said, "You're getting a 100% disability rating because you are so profoundly messed up that you'll never be able to work or have good personal relationships ever again."
Over time, he has seen a great deal of improvement in his PTSD symptoms - in fact, he is currently doing really well. This has taken years - maybe five years from the date of injury, three years from the date of discharge - and he faced the physical TBI as well as the psychological aftereffects. I profoundly wish that he had gotten more and better care when he needed it.
I currently speak out quite a bit on the importance of getting all veterans access to evidence-based treatment when they need it. But I also struggle with the fear that civilian perception that vets are all crazy may be worsening our unemployment levels (higher than among our civilian peers). And I worry that the pathological-ization of having struggles transitioning back into civilian life, of having some PTSD symptoms, actually discourages help-seeking among those who want to stay in the military.
David, thank you for the obvious thought and care you put into your research and writing. I think the suggestions you made, such as examining the Australian system, should be carefully considered. I'm so sorry that so many people are having a knee-jerk reaction of fearing that "change" means "doing the wrong thing for vets." Getting the right treatment for the right disorder is clearly the best option. And helping those who are able to recover move back into functional lives while providing lifelong total support for the minority who develop profound PTSD seems not only reasonable but preferable.
Thanks for your comments, Kelby, vet, and others. vet, I can understand the worry that a critique of the PTSD diagnosis and the VA's disability system seems to carry "the suggestion that it cost too much to diagnose a veteran." Some have pushed cuts to disability benefits as a response. However, it's important to see that my article proposes actually giving combat vets MORE than they're getting now, and doing so in a way that promotes healing and doesn't make PTSD a sort of unique conduit to care and benefits any ailing vet should get by rights. Those changes are a) giving all combat vets full lifetime access to health care and b) structuring disability benefits, as in the Australian system described in the article, so that "incapacity" benefits (those to replace income while the vet can't work) continue for a significant period after the vet recovers and returns to work.
Reply | Report Abuse | Link to thisPrior critiques of PTSD and the countertherapeutic effect of the VA's disability system have usually proposed limiting the benefits in some way. I'm arguing that the problem is not in how we give the benefits, but in how we end them The solution, then, lies in ending them only after the vet has been at full function for a while, and then ending them only gradually. This turns a countertherapeutic structure into a therapeutic one, with tremendous incentive to heal -- and gives the vet a period of extra income in which s/he can regroup financially.
Reading the above posts and article has been informative and helpful. As an old vet of southeast asia with friends and family members of nearly 100 years of wars this problem is an old friend with a new pycho-babble name. It is good that our newer veterans are getting better help with the transition from the intensitys of military activities to normal life. Nightmares, flashbacks and numbness to regular life is like a computer's firm ware that has been installed in the brain by the military war experience and is hard to rewrite. After 40 years my memories of that time have begun to fade a bit and are not so personal.
Reply | Report Abuse | Link to thisI do think the stress of the military experience is as an important part of this problem as is the war part. High stress and prolonged sleep deprivation cause many of the same problems. Thank you all
Davedobbs - Your specialty is in fish - you should stick to that subject matter.
Reply | Report Abuse | Link to this"I'm arguing that the problem is not in how we give the benefits, but in how we end them."
BLUF: If I had the power I'd let you keep your tax dollars Dave, becasue thats what your underlining aurgument is.
Until you have been in a war time military situation, you and other fish researchers, should stick to helping out the upper class that have the options to be "incapacitated" and still take care of their families. Either way, a $5 or $5,000,000 is not enoguh to cure or replace what veterans lose in their service to our country.
Army Officer/Veteran
I have been watching this "debate" on both sides for some time now, as I have a cousin and two close friends who all get "treatment" for PTSD and i can say that only one has any real psycological trauma, and growing up in Baltimore during Rayfulls drug war and race riots, which some of us were in the middle of, we all have preexisting suceptability to psycological trauma.
Reply | Report Abuse | Link to thiswhen I learned my boy claimed to have PTSD we asked him wat it was about, he said he had it all along and just didnt know it. He told me something that made me think long and hard - Brains on the wall in Baltimore is brains on the wall in Bahgdad- eventually i knew what was going through his head:
when we left B-more most of us made something of ourselves, and he was still the same ol nobody till he came back from Iraq, the only thing having changed was that he belonged to the PTSD crowd. wat was going though his head was that having seen the stuff we seen made him someone important and respectable, and he doesnt have to work either cause of it. dude gets enough to live off of. Hell the church even gives him free food sometimes. I think he needs that culture otherwise he'd just be another g from the streets.
All i know is that he claims to have horrid unimaginable trauma like everyone else and the soldiers with real trauma, thats not all glorified and "unimaginable" get turned down for treatment and i dont even talk to him anymore nor respect him...hes a loaf and a liar.
i think they need to re-evaluate the whole damn program cause every loaf and no-life in america is gonna take advantage.
-peace and love to the real soldiers who fight for something real who really lose somthing real
As a psychiatrist involved with the FDNY for 7 years after September 11th I am apalled that a 'physician's assistant' who is not a board certified psychiatrist, should make such outrageous comments.
Reply | Report Abuse | Link to thisPTSD in firefighters after September 11th was estimated at between 7-15% in the 8,600 personnel we studied. Our article will be published in the American Journal of Public Health in the next few months.
The politics around those who seek psychiatric disability may be a factor here. Some patients seek to exaggerate or feign symptoms to try to get psychiatric disability. He simply isnt trained enough to tell the difference, and instead concludes that there is 'no such thing' as PTSD.
Nice headline, bad science.
K JONES MD
Interesting article. I've been living with PTSD since 1968. Unlike your average sufferer I am way ahead of the curve. I have been telling my therapist and VA psychiatrist this articles topics for years. PTSD is not what the CW contests. PTSD is not a trauma based event. PTSD goes deeper than a traumatic event. PTSD is real but it's dynamics are NOT what people think.People should take note of this well written article.
Reply | Report Abuse | Link to thisInteresting article. I've been living with PTSD since 1968. Unlike your average sufferer I am way ahead of the curve. I have been telling my therapist and VA psychiatrist this articles topics for years. PTSD is not what the CW contests. PTSD is not a trauma based event. PTSD goes deeper than a traumatic event. PTSD is real but it's dynamics are NOT what people think.People should take note of this well written article.
Reply | Report Abuse | Link to thisComments by psychiatrist, veteran, and researcher: The struggle between the pressure to deny a traumatic experience and the need for integration occurs at the individual, system and social level. This cycle has been repeated in the context of the Holocaust, Vietnam, and other mass traumatic exposures that affected large groups. What is missing in the conversation is the simultaneous acknowledgment of resilience process which occurs in response to adversity. Methodologically speaking, there are many challenges to demonstrating causality even in the case of combat trauma because preexisting risk and vulnerability factors play a key role. While the conversation posed in the article and subsequent discussion is necessary, it may violate the principal of 'first do no harm'. Right now, this Nation is trying to prepare for a returning wave of veterans in a manner most consistent with promoting their resilience and reintegration into society. We also want to identify and support the subset of individuals who are experiencing significant posttraumatic symptoms and those with PTSD. This is a challenge as long as people continue to take sides and/or question the validity of PTSD. This approach has not been helpful throughout the history of mental illness in this country, and it runs the risk of harming the most vulnerable, those who we claim to want to protect the most. We need to force ourselves to see the issue as complex, not simple, and to take and article like this as part of the universal struggle with adaptation to life, and let it be an opportunity for discussion and public wrestling with the issues. Let us maintain respect for each other and not be so quick to personalize the debate. Above all ,remind yourself that the soldier is the one who is the subject here. We have a moral responsibility to do our best to get it right, to not pathologize or medicalize war, to treat significant psychic distress and disorder, and at the same time not ignore the individual and group variation in the capacity to thrive.
Reply | Report Abuse | Link to thisAGPSYCHDOC at 04:14 PM on 03/29/09: "...In my VA, the veteran has to negotiate the city to get to the hospital. If one is able to make it through a busy city, with noise and traffic then criteria for impairment are probably not fulfilled. "
Reply | Report Abuse | Link to thisSo in other words if you can get to your facility you aren't impaired, but if you can't then you probably are. Nice logic, reminds me of Joseph Heller's "Catch-22";
"There was only one catch and that was Catch-22, which specified that a concern for one's safety in the face of dangers that were real and immediate was the process of a rational mind. Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn't, but if he was sane he had to fly them. If he flew them he was crazy and didn't have to; but if he didn't want to he was sane and had to."
"Many veterans present requesting a PTSD evaluation when they are unemployed and need extra money and the timing can be very suspect."
So in addition to navigating their way to your facility if they're unemployed then there's a good chance they're faking it? Boy if a vet is grappling with serious post-deployment emotional and mental issues, has trouble with getting along with any employer/co-workers so that he's unemployed but he can find your facility the benefit of the doubt is against him?
PTSD has become a major industry, keeping many in gainful employment and comfort. It'll be hard to give up, even by those diagnosed with it, who've been encouraged to feel helpless and in need of endless therapy and who would have to find another way of gaining so much individual attention, perhaps a more difficult way. Its easy to get hooked on attention!
Reply | Report Abuse | Link to this"Possum at 03:10 PM on 04/14/09"
Reply | Report Abuse | Link to thisIt's tough enough dealing with 21 year old infantrymen who've had two or three tours overseas , been ambushed, seen friends killed in horrid ways, sat through sniper fire and mortaring, etc. and are ready to return into civilian society to rejoin there buddies at the frat or local plant. Now they have yahoo's like yourself and a VA shrink who believes if you can find his clinic you probably don't have PTSD.
There is another, simpler, explanation for why PTSD subjects don't recover with treatment. This is true with much of psychotherapy, and has been known for decades. It is why medications have become so much more used, because they work.
Reply | Report Abuse | Link to thisAnother part of the problem is that many psychotherapists are either not very good, or not well suited to the patient. I'll give you a real world example - verbatim, from a conversation recorded by a PTSD patient. This conversation is a real, I kid you not conversation with a therapist contracted to provide such mental health services to the military.
Patient: Describes a traumatic event in which he almost gets killed. Describes how angry it makes him to be home and going to university and people say things like, "Well, it was your job."
Therapist: Yes. I know what it's like to be angry. The other day I came out and someone had broken the hood ornament off of my new Mercedes. It made me so angry.
Sorry - a little obscure in that first paragraph above. The reason most psychotherapy doesn't work is unclear, but mostly it doesn't. Talk therapy is notorious for spending years with no outcome except more of the same. A huge amount hinges on the skill and intuition, as well as chemistry, between therapist and patient.
Reply | Report Abuse | Link to thisIt's no accident that a lot of guys prefer going to hookers for psychotherapy, or that quite a few hookers are pretty darn good at it. If the guy wants more time to talk, he gets it - no cutoff at "50 minutes".
I'd like to see a study that looked at the relative efficacy of hookers versus psychotherapists for treating PTSD over 5 years.
Also - I have wondered about whether or not the incidence/susceptibility to PTSD was greater in women than in men. I tend to think that it is both from my own anecdotal experience, and because it makes evolutionary sense. Men evolved to hunt and fight. Women evolved to nurture and only to fight in the most extreme circumstances when their families were in danger. So it would make sense that the survival value of longer maintenance of stronger fear and hypervigilance response is greater in women.
Reply | Report Abuse | Link to thisPtsd can never be over diagnosed until thr research shows the particular brain difference that causes the behavior and discomfort.
Reply | Report Abuse | Link to thisFor each case consider the impact on all others in contact with that brain injured survivor. I suggest that AA and Alanon have a better way of diagnosis.
Thus each case needs to be a healing team effort.
I am not denigrating the horrendous experiences of servicemen and women. Its much of the therapy I have no faith in.
Reply | Report Abuse | Link to thisAlthough memory of a specific traumatic event in combat is an important factor, relying only on a traumtic event for understanding the genesis of combat PTSD, is a misunderstanding of what it means to be in a combat zone and to experience the daily pressures, threats, grind and stress of that environment. The generation of combat PTSD is more complex and deep than other forms and often has a different "shape" as well.
Reply | Report Abuse | Link to thisDennis H. Grant, MD
Phoenix, Arizona
(Vietnam Veteran)
Dear Sir,
Reply | Report Abuse | Link to thisThis is a problem anticipated by many of us ( Psychiatrists ). The basic issue her is who is able to diagnose. Only persons adequately qualified in the field should be allowed to make diagnosis. He or she should be accountable for the valid diagnosis. Unfortunately no other medical specialties are encroached from outside as the specialty of Psychiatry. Need further tightening up and 'quality control' to prevent huge mistakes in the future.
Dr.M.D
Spin doctors at work. PTSD is waaaay under diagnosed.. follow the money...it's all about the money. we can afford to send the troops, but can't afford to take care of them when they come home. Remember when all the "Docs" said agent orange wasn't harmful? many still do.. shameful
Reply | Report Abuse | Link to thisSpin doctors at work. PTSD is waaaay under diagnosed.. follow the money...it's all about the money. we can afford to send the troops, but can't afford to take care of them when they come home. Remember when all the "Docs" said agent orange wasn't harmful? many still do.. shameful.
Reply | Report Abuse | Link to thisI have met this Doc, or some like them. I have taken suicidal vets to a VAMC, and later found, they were given antismoking patches, vigra, everything but true mental health treatments.
What this country needs are more experts to add to the statistical data base concerning PTSD. It is too bad that the
Reply | Report Abuse | Link to thisdenoument would be that CBT works best. So sad that none of these experts had the experience in treating traumatic neurosis of war first hand and can attest to there being specific forms of therapy that really do work. We all know that there are many licensed drivers of automobiles but not all of them know how to drive. Thus is the state of psychiatry.
These articles that appear from the so-called experts never address the formulation and dynamic of PTSD treatment. As a veteran myself I get tired of the manufacturing of statistics to solve the problem itself. PTSD has not been treated in the military or at the Department of Veterans Affairs because they don't know how to treat. They are limited to CBT, EMDR, and social chit-chat because they are "cost effective." However, they are not "therapy effective" for actual PTSD in the long run. The military, DOD, and Department of Veterans Affairs do not understand that the treatment of large numbers of assets requires a program for PTSD treatment. In order to be effective in returning soldiers to duty or home life there must be a complete program that does more than symptom cover up. The successful treatment of PTSD enables the individual to integrate the traumatic experience and become master of his/her symptoms without medication or props. Naturally, medication is a different issue and is not sucessfully used as the primary treatment for PTSD. Alcohol and drugs have done that for far too long. Too many experts and not many grunts in the field that know how to treat PTSD.
readers should note that the author of this letter is Dr Ronald Chase, America's foremost expert on PTSD & one of the few psychiatrists who know what he's doing with PTSD -- it's a pity the VA & the military don't listen to him !!
Reply | Report Abuse | Link to thisI am a clinical psychologist working at a VA Medical Center. I read your article with much interest since part of my job involves assessing veterans for mental disorders that they claimed were incurred during their military service. I would like to address some points that were made in your article, however:
Reply | Report Abuse | Link to this1) First, you frequently give voice to clinicians who speak of our "cultural obsession with trauma" and our investment in a PTSD diagnosis because it "absolves us" for "being fooled into supporting a war we later regretted." First of all, I don't know where McNally's assertion about our cultural obsession with trauma comes from. This is certainly not consistent with my personal experience. Examples of how this is the case would have been helpful. Second, I do not follow the reasoning of how acknowledging PTSD absolves us from our responsibility for sending soldiers to war. If anything, it has been my experience from working with numerous soldiers that it is those people who are dismissive of PTSD that are more likely to send an already mentally-scarred soldier to a subsequent combat deployment. Does it not make more sense that by dismissing the presence of PTSD, people are absolving themselves from the responsibility of contributing to the emotional scars of our soldiers?
2) You refer to individual studies by Dohrenwend, McNally, and Smith as evidence that PTSD is being overdiagnosed. What I don't understand is your assumption that the studies by these particular researchers are superior to those of other researchers who found PTSD to be more prevalent. Isn't it possible that those researchers you reference are underestimating PTSD? Perhaps my experience is biased by the nature of being a mental health treatment provider, but Tyler Smith's finding of PTSD in only 4.3% of the troops returning from Iraq and Afghanistan seems very low to me.
3) McNally suggests that many veterans experiencing late-onset PTSD are attributing their depression and anxiety to unconsciously fabricated stories of trauma. His evidence for this is that many of those same veterans neglected to report traumatic events when questioned one month after they returned from their combat deployment. Perhaps that is the case for some, but there are other very understandable reasons why people might neglect reporting their trauma. Many people avoid talking about traumatic experiences in efforts to suppress the intrusion of PTSD symptoms. In fact, that is one of the classic symptoms of PTSD. It is also not uncommon to experience delayed onset of PTSD symptoms. Many of the veterans I see today were able to manage their PTSD symptoms at bay by drinking, using other recreational drugs, or working 12 hour days. Others felt they got better over the years, and then experienced a return of PTSD symptoms after they were confronted by new stories of the current wars.
4) McNally also points out that a major problemswith misdiagnosing depression for PTSD is treatment. This is definitely a problem if you treat based on diagnosis, but most clinicians I know treat the individual. A depressed patient who suffers from recurrent trauma-related nightmares but does not meet diagnostic criteria for PTSD can still get exposure-based therapy if the patient expresses desire to work on the reduction of that symptom. Likewise, a patient who meets diagnostic criteria for PTSD but does not have the motivation or ego-strength to undergo exposure-based therapy will not receive such a treatment. The therapist must first work on building a trusting relationship with the patient or on helping the patient develop internal and external resources.
The article mentions that "false memories are common." Yet, there is little evidence that a false memory of a trauma can be created. Loftus' research has been misapplied to traumatic memory, since her study only discusses non-traumatic memory.
Reply | Report Abuse | Link to thisResearch has shown that traumatic memory may be stored differently than regular memory.
The reality is that recovered memories have fairly high corroboration rates.
Studies that back this include:
http://ritualabuse.us/research/memory-fms/recovered-memory-corroboration-rates/
van der Kolk, BA & R Fisler (1995), Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study , J Traumatic Stress 8: 50525
"Of the 35 subjects with childhood trauma, 15 (43%) had suffered significant, or total amnesia for their trauma at some time of their lives. Twenty seven of the 35 subjects with childhood trauma (77%) reported confirmation of their childhood trauma.
http://www.trauma-pages.com/a/vanderk2.php
Chu, JA; et al. (1999). Memories of childhood abuse: Dissociation, amnesia and corroboration.. Am J Psychiatry 156: 749-55. Childhood abuse, particularly chronic abuse beginning at early ages, is related to the development of high levels of dissociative symptoms including amnesia for abuse memories. This study suggests that psychotherapy usually is not associated with memory recovery and that independent corroboration of recovered memories of abuse is often present.
http://ajp.psychiatryonline.org/cgi/content/full/156/5/749
Williams LM (1994). Recall of childhood trauma: a prospective study of womens memories of child sexual abuse. J Consult Clin Psychol 62: 116776. PMID 7860814.
One hundred twenty-nine women with previously documented histories of sexual victimization in childhood were interviewed....A large proportion of the women (38%) did not recall the abuse that had been reported 17 years earlier....Long periods with no memory of abuse should not be regarded as evidence that the abuse did not occur.
http://www.hss.caltech.edu/courses/2004-05/winter/psy130/Debate2Williams1.pdf
How often do childrens reports of abuse turn out to be false? Research has consistently shown that false allegations of child sexual abuse by children are rare. (Leadership Council)
http://www.leadershipcouncil.org/1/res/csa-acc.html
More research studies
http://dynamic.uoregon.edu/~jjf/suggestedrefs.html
101 Corroborated Cases of Recovered Memory
http://www.brown.edu/Departments/Taubman_Center/Recovmem/archive.html
Fear, and more fear. I suppose if one reads your article in full which I did as a parent of a soldier, pretending that I do not suffer from what you so easily dismiss, you are right. The sum total of a person brings them to the point of PTSD. That could be said of all mental health conditions and probably most health conditions. I guess I am not understanding why you do not say the truth of the end result. Fear to go to the grocery store, fear to go to the doctor, FEAR. I guess it may be from when I fell off that tree when I was six, or the way my parents treated me, but dammnit man, there is a difference. MMC
Reply | Report Abuse | Link to thisNot again. Something doesn't fit in one situation therefore it is wrong for others, too. The brain wave evidence alone is scientifically demonstrating the presence of the real thing. The FMSF agenda (which is scientifically unsustainable, with reams of evidence to show that) is once again shoving its agenda so those who commit heinous acts can keep on doing them, period. The sheer numbers of people who believe sex with children, for example, is so large that they can literally finance and publicize what they need and attack anyone who disagrees.
Reply | Report Abuse | Link to thisJulaine
I recommend you read a recent article from Houston, Texas, about a vet whose dog was shot by some idiots. He had been trained to kill in special ops in Taliban country, and his training took over. He managed not to kill anyone, but his story graphically illustrates the reality of the after-effects of traumatic experiences. Two people experiencing the same trauma have different outcomes, with a number of variables contributing to the outcomes. Nothing applies to everyone uniformly, except the mind set of people with an agenda to push. The FMSF is the most infamous of these groups, with absolutely zero truly scientific evidence to back it up--it uses benign examples at best. The research to back up true trauma damage is so incredibly solid scientifically, yet we never hear of it in the mainstream media, while the FMSF folks make sure their "side" of the situation receives prominent exposure. Their primary tactic to to attack anyone who disagrees. Something is backwards here, and catch-all thinking is not going to solve anything, but perhaps lets someone vent their angst.
Reply | Report Abuse | Link to thisI found this article a sad reflection of the easier way out of anything unpleasant. It is the "get over it" mentality, that has never healed any one. It may be buried or hidden for years, because it is socially unacceptable not to conform to societal expectations, but it is never gone. And when it pops up inappropriately years or decades later, then it may take a form that is far more serious than if it had been addressed compassionately in the first place.
This whole thing reflects a military mindset, and I grew up in that closed setting. It took real life interactions outside the military to finally realize that any group of people can be made to conform to a certain set of expectations and behaviors, and there are so many other ways of looking at life and its joys and sorrows. To proclaim the beliefs of the writer of this article in a "scientific" journal strikes me as simple propaganda.
Julaine
Not everyone is a Spartan, I watched a History Channel show about a 19 year old German pilot that rammed a B17 during WW2, everyone in both planes survived the war and went on with their lives. Nobody was paying for having a bad day in the 1940s and 1950s, some people shouldn't be soldiers they should stay working at Wal Mart. And yes, I've been carrying a gun for 35 years.
Reply | Report Abuse | Link to thisOk let me comment, first, unless a shrink has been there and done that, then they have zero ability to say crap about the vet presenting with PTSD symptoms. The doc above says he is fine, with a few nightmares...hey bud when they get out of control and you can't sleep with out meds, your smacking your wife around because your wound tighter than a drum from all the stress, meds, lack of sleep, crap VA care, lack of real therapists, not glorified social workers with a one hour class on PTSD. I was mortared just about every day, three and sometimes 4 times a day. I saw men die, saw men wounded, felt helpless when i could not help them. I am emotionally numb, except for rage which is my constant companion. The VA says I am depressed, whatever, i am pissed, get over it....my ass. Battle Mind is what a friend of mine was diagnosed with, what a crock, that is PTSD without the disability payments. The VA is already telling guys they are bi-polar...and they were fine before Iraq, so they became bi-polar or some other crap in county..either way, again no benefits. My family deals with my anger, my lack of compassion, the numbness I have towards everything around me, my co-workers are afraid of me, I hate to drive but have to to go to work, and the butt head that said if you can get here your fine... you sir are a moron.... I can drive anywhere, did many convoys in Iraq, so I can get to yuo..do you want to deal with me when I do, that is if I do not have my wife driving for me that is. Oh and the WV VA...they only have middle eastern psychiatrists...wonder why me and the boys do not want to go see them, I was told I just need to get over that...how about, no, get me a damned American therapist, psychitrist and so on, get me weekly therapy, not once a month, get me counselors that care and are not so overloaded they do no followups and have no clue what is going on with the men they are caring for. Involve the damn families, it affects them too...and when the families call in to say the meds are too much, or the vet is out of control, do not log them as nuts or controlling, take the call as a call for help and get involved, get out to the vet and see them... make a damn effort to help us, not drug us and send us home. Five veterans in WV, and over 81 that my wife has found country wide, have died of being overmedicated on VA PTSD drug Cocktails... look into this someone and save us from the people that are supposed to help us all. Semper Fi and god bless my brothers and sisters in arms..and their families...Geritol Ranger!
Reply | Report Abuse | Link to thisThe term 'expert' itself is confusing in an era when too many self-declare as experts. The successful treatment for any disease is that is replicated and clearly evidence-based.
Reply | Report Abuse | Link to thisWe are mixing two entirely different issues here: (1) Combat persons' reaction and ( 2) the concept of PTSD.
The concept of exposure to adversities and the development of resilience are generally alien to majority of the people of the West / affluent nations; whereas it is the NORM for many of the disadvantaged elsewhere. This particular factor dictates the individual's reaction to and endurance when facing a difficult or unexpected experience. An individual abundant with the ego defence of anticipation is almost resistant to any 'shock experience' as an aftermath. I would conclude that really orientated, well-selected, programed-for-combat individulas are unlikely to suffer from any serious shocks. To put it in plain words " what do you expect to see happen in the front line of a war zone ? Isn't it flying bullets and piercing wounds, fatal attacks and dying and death ? " One who is prepared for the WORST would cope the BEST in those circumstances. I am not implying that one/who should go for war. But if the policy makers decide to go ahead with a war please select and prepare individulas for the normally expected tasks in the war front. Let the soft, feeble-minded and sensitive stay back ( until they gather the necessary skills and courage )! This will save lives as well as money.
For item (2) let it be dealt with by real experts who are accountable for their diagnosis and treatment. When there was some controversy over the use of ECT ( electroconvulsive therapy ) in some countries the diagnosis and treatment needed to be authorised independantly by two different physicians. It works a lot better since then. Please do not apply democratic principles to Medicine. Last but not people wanting to undertake treatment delivery as in gold rush can be counterproductive. Legislations should be maximally stringent so that no one will ever misdiagnose or treat a human being of his/her misery. America need to divorce the practice of medicine from the business of medicine, to see a sea change in this area.
DocD
In my career as apsychiatrist the formost diagnosis demanded by more number of patients is nothing but PTSD !
I am amazed that the VA and Military wastes so much money and time that could be put to better use then "studying" something that you already have many answers to?
Reply | Report Abuse | Link to thisIt is so much easier to blame everyone and everything but what "it" stems from...... truama? You do not have to have a degree to "get it" especially if you live it.
What is tramatic for one person is not always tramatic for another. Could that possibly be related to the vast differences in social values and beliefs that just plain make people different? Each person's limit to "fear" and the ability to "stuff" it is not going to be the same.
Stop wasting so much time on trying to scientifically pin point this problem and possibly more time in actually treating it?
Could we not better address this by spending all this time, energy and money on good THERAPY and COUNSELING?
Better qualified doctors and medical/mental health staff, more sensitive and educated employees, and even educating the public?
You have to questions why giving these men numerous medications appears to be the "standard threatment" yet that is NOT the answer, it just adds to the problem and increased the risks.
How difficult is it to take a look at the past men who fought in WWII and notice one of the current problems might be that we are sending our troops over as a group but tossing them immediatley back into society with no real down time to recover as a group?
Look at the National Guard and Reserves who are being used in a way they never were before in history. Our society as a whole is changed, community is not as close as it was during WWI and WWII, yet we did not dope thse same men up and send them home to family and loved ones to try and pick up the pieces. Have we yet not learned from our past mistakes either?
All you see or read about is alot of pill popping and non therapy with numerous "diagnosis" more medications ad nausium....none of these medications are 100% safe or effective and they only address the symptoms, not the trauma....everything is about the almighty $ and that is a very sad state to be in. Wake up! We are the biggest pill popping for a cure nation out there, the question is why?
GERITOL RANGER you go guy, tell 'em like it really is! Tell them about the quality of care while you are at it. WVa not withstanding the problem is with all the VAMC and DOD because they just don't get it. "Therapy" once a week will never git-r-done especially if the next appointment is six weeks down range.
Reply | Report Abuse | Link to thisGERITOL RANGER check out "PTSD A War Of Memories" on Youtube. Of the original 16 combat veterans filmed in 1984 only three are still living. The others died prematurely, within six years of the filming -- average age was 36. There has been no clarification forthcoming as to causes of those deaths given by the VAMC. Some of those that participated in the film were listed by the VAMC as not being patients or not having served in Vietnam! Talk about your denials and cover ups. Perhaps the government hires incompetents so that they can manipulate anything they desire.---DocPTSD
Reply | Report Abuse | Link to thisAn excellent story but please, it needs some editorial corrections: could you pull it and not put it back before you add some more punctuation please because there was not enough I found it difficult to read it was really irritating in places as a result this is a shame because a serious piece of journalism should not suffer from silly defects I dont see what anyone can possibly have against a comma in, the right place
Reply | Report Abuse | Link to thisI find it puzzeling that Scientific American chose someone who is not trained in pyschotherapy, or even science, to write an article about post traumatic stress disorder. The previous article on primate color vision were experts in there field.
Reply | Report Abuse | Link to thisDOC D, you are so full of it I could scream, your answer is the exact reason why vets will not come forward when having problems. I did my freaking job in Iraq, served my country for 23.5 frigging years, got a chest full of frigging medals to prove it, and a chronic PTSD to beat the band... and you say I am sqeachmish or weak..I would kick your arse but i am sure someone would call the thought police and delete my posting...you sir are a disgrace if you are a doctor, you and your ilk hide behind your degrees while we go fight for your rights...so that you can call us weak when we finnish our wars and come home and look to reclaim our lost lives. You owe all vets and their families an appology punk.
Reply | Report Abuse | Link to thisAs to eddjas... please who cares about punctuation right now, the article deals with PTSD, and how they are now saying it does not really exist, and that we are fakers, and that they know how to cure us...and that is by taking the diagnosis out of the DSM-V, not by actually curing the problem.
We need weekly one on one counseling, from the git go, not 2-3 years later on, when you are set in your ways and PTSD has its hooks in you. Do not drug the hell out of us when we walk in the door of the clinic, send us on our way, then wonder why we are lost, pissed off and confused with what in gods name is going on.
We need the community to at least empathize with us, support us, get rid of the darn yellow ribbons and do something... ribbons and memories of parades fade... give a vet and their families a helping hand in all areas of their lives... we are asking for help, not a hand out, we gave, some till they died, some till they lost control of their minds, or pieces of their bodies....what did you do? where were you when we needed your help????
Semper Fi....... always faithful! Geritol Ranger 82-06
Can not find the movie you mentioned. If you know where to watch it let me know.
Reply | Report Abuse | Link to thisThe fact that you called him "wimpy" perfectly illustrates why less cases of PTSD were reported in WW2 and Vietnam.
Reply | Report Abuse | Link to thisThe reason for the increase in Vietnam Vets filing for PTSD since 199 and 2004, is that most of them did not understand what emotional wounds they have been carrying around for 40, and how it has affected their lives. I am an accredited service rep with the Vietnam Veterans of America, who has assisted many such warriors. Many of them break down in tears when the lights go on about what is in their psyche, and that someone, even the VA, is now going to understand and help them. The ivory tower assholes who author articles such as this don't have much of a clue. How many of them have been overrun by terrorists trying to kill everything in sight, or seen their brother's brains explode next to them, and splatter all over them? Soldiers bury this horror in their soul when it happens because they can't afford to 'process their emotions' because the next mission is in a few hours, and you can't afford to relax at any time. The government, the VA and academia all need to come to grips with the fact that PTSD is the normal by-product of sending young men into life and death combat. The whole society rejected the Vietnam Vet when he (or she) came home from war. No wonder the emotional carnage stayed buried. The bean counters bitch about Vietnam Vets getting compensation for PTSD after 40 years in the dark. Emotional wounds and scars can often be more disabling than physical stuff, especially when they are not recognized and/or treated. The compensation that a Vietnam Vet gets today, doesn't even begin to rectify the cost to the vet over decades. If we as a society are going to send our kids into war, we need to understand the full cost of doing so and then be gladly willing to foot that bill. Any less of a committment is unworthy of a great and free country, made great by many, but kept free by soldiers, sailors, airmen and marines.
Reply | Report Abuse | Link to thisASKMEIFICARE you make wonderful sense in your previous comment. There is no time for therapy in DOD or DVA. You are so right on when you point to medication are only for symptoms and that is not treatment. It is for those institutions, however. If you are asking about my reference to a film, it would be on YouTube under the title "PTSD A War Of Memories." That was not clear but if you were asking...
Reply | Report Abuse | Link to thisDocPtsd
ASKMEIFICARE you make wonderful sense in your previous comment. There is no time for therapy in DOD or DVA. You are so right on when you point to medication are only for symptoms and that is not treatment. It is for those institutions, however. If you are asking about my reference to a film, it would be on YouTube under the title "PTSD A War Of Memories." That was not clear but if you were asking...
Reply | Report Abuse | Link to thisDocPtsd
ASKMEIFICARE you make wonderful sense in your previous comment. There is no time for therapy in DOD or DVA. You are so right on when you point to medication are only for symptoms and that is not treatment. It is for those institutions, however. If you are asking about my reference to a film, it would be on YouTube under the title "PTSD A War Of Memories." That was not clear but if you were asking...
Reply | Report Abuse | Link to thisDocPtsd
Over diagnosis is not as unusual as many would think - particularly where drug based cures are the norm.
Reply | Report Abuse | Link to thisWhile the watchword in these situations is that it's better to be cautious, one can't help but to wonder if this is to do with the health of patients or healthy profits for those who supply the drugs.
Mr. Dobbs,
Reply | Report Abuse | Link to thisGreat job stirring up the hornets’ nest! Yours is not a coward’s mission, but an earnest investigation into identifying what is NOT working. We owe our veterans no less. Personal attacks and political agendas serve no constructive function in upgrading the care our service members receive.
The disability trap within the V.A benefit system you describe seems no different that what goes on in the civilian disability system. It’s quite nearly impossible for a person on disability to climb out of dependence without being penalized for earnings. Lest the Social Security Department reclaim income, disabled civilians are compelled to vigilantly monitor income lest they lose housing, health coverage and housing.
Finally, there are organizations that offer free mental health services to veterans. These organizations all suffer the same, vexing obstacle: the veterans will not come. Any constructive comments pertinent to overcoming this obstacle will be most welcome.
Thank you, again, for opening this enriching discussion.
Mr. M,
Reply | Report Abuse | Link to thisSuspecting drug companies (surely, NOT my favorite industry) doesn't hold water. The majority of medications are generic. If symptoms of anxiety, panic and rumination are chemically reduced, individuals are better able to tackle ineffective patterns of thinking and behaving that may otherwise be chronically unmanageable. The combination of medication AND effective therapy offer the best hope of improvement.
Been There,
Reply | Report Abuse | Link to thisI agree. Veteran health benefits should not "expire" unless replaced by employer-provided insurance. I've always wondered why Senators and Congressmen aren't on Tricare, the insurance that "covers" our military and their dependents.
Possum,
Reply | Report Abuse | Link to thisAm I wrong in understanding that the greatest challenge is convincing OIF and OEF vets to CONSIDER therapy as an option?
G. Ranger,
Reply | Report Abuse | Link to thisGreat post. Can you help me understand why the free care organizations like "give an hour" and "there and back again" cannot get vets to use their services? These volunteers are, I believe, patriots who, though not "Spartans", desire to serve those who served. The ones I know have full private practices, years of experience and strong hearts. I would sincerely appreciate your wisdom and advice on this question.
Fly on the wall, the reason is that they do not even know about these services is why......
Reply | Report Abuse | Link to thisAllot of the younger vets do not realize they are having problems, or if they are having problems what they may be. Movies make PTSD out to be just nightmares and flashbacks, the other issues such as emotional numbness, inability to bond with family or friends, constant rage, these are the problems the young vets are having, and they do not see them as PTSD, and they do not seek treatment because they are fine right? They are wimps if they come forward, their mariages fall apart, their drinking to stay calm and to sleep, they beat their wives and kids... all the stuff the older vets did, but then again they all did it right? it was all swept under the rug and ignored..now we look out for those families and kids, and we want the vets to get better...but...they have to know what they are facing, they have to want to get help (much like AA and other programs) if they are forced to go, they will not be treatable, they will be more aggressive and less likely to conform to the treatment goals. Then of course there are those that say they are wimps, to suck it up, that they are cowards...Cowards my ass, they went, they did their jobs honorably, and now they are having troubles getting back into life folks...we can deal with them now, or wait and deal with the epidemic it will become in the next 5-10 years. Homeless, drunk, drugged, in jail... is that how we want to treat our vets???? But they won't come in unless they fell they are not threatened or belittled...and that you get the word really out there about the free non-VA based programs!
Reply | Report Abuse | Link to thisSemper FI......Geritol Ranger
I have just reviewed the book Achilles in Vietnam. I refer to pages 183 -194, Healing and Tragedy. I am a Vietnam combat veteran. I have managed to find my way through the depths of PTSD. I have actually recovered my feelings of excitement, silly, fun, angry, sad, love and passion. I can legitimately respond to the question: Is Recovery Possible (Page 184), yes it is possible and it can be done without narrative healing. The statement, Return to normal is not possible, is invalid. I have returned to a healthy emotional life, not the one of my adolescence but the person I am today. The statement, We dont know if recovery is possible, is invalid. I can show you the way to full recovery. The statement, Yes Recovery is possible, describes a limited form of recovery, not full emotional healing. I have completed the path to full recovery and I can take you there. The question, What is the best treatment? explains a partial recovery process. My method of recovery involves; EMDR, limited medications, reprogramming conditioned responses, and reinventing personal self-esteem . I can give a name to their pain, hope for their future and honest reality to their existence. I am sure that there are less than 1% of us that have discovered the pathway to healing
Reply | Report Abuse | Link to thisI have just reviewed the book “Achilles in Vietnam.” I refer to pages 183 -194, Healing and Tragedy. I am a Vietnam combat veteran. I have managed to find my way through the depths of PTSD. I have actually recovered my feelings of excitement, silly, fun, angry, sad, love and passion. I can legitimately respond to the question: Is Recovery Possible (Page 184), yes it is possible and it can be done without narrative healing. The statement, “Return to “normal” is not possible,” is invalid. I have returned to a healthy emotional life, not the one of my adolescence but the person I am today. The statement, “We don’t know if recovery is possible,” is invalid. I can show you the way to full recovery. The statement, “Yes – Recovery is possible,” describes a limited form of recovery, not full emotional healing. I have completed the path to full recovery and I can take you there. The question, “What is the best treatment?” explains a partial recovery process. My method of recovery involves; EMDR, limited medications, reprogramming conditioned responses, and reinventing personal “self-esteem”. I can give a name to their pain, hope for their future and honest reality to their existence. I am sure that there are less than 1% of us that have discovered the pathway to healing
Reply | Report Abuse | Link to this"Australian vets come home to an utterly different support system from ours: theirs is a scaffold they can climb. Ours is a low-hanging "safety net" liable to trap anyone who falls in."
Reply | Report Abuse | Link to thisAs an Australian Soldier with PTSD as a result of service in Iraq, I take particular issue with this assertion. The Australian system is inherently flawed - both on the military side and the Department of Veterans affairs side. It is currently the subject of two separate inquiries led by Professor David Dunt.
For example:
http://www.abc.net.au/news/stories/2009/02/07/2484952.htm
Our system is flawed. Medical staff at many bases lack adequate knowledge of mental health related issues, the chain of command frequently mishandles the welfare of soldiers, and a culture of stigma surrounding mental health makes it difficult for veterans to acknowledge that they may need help.
And that's just the military.
The Department of Veterans affairs system for applying for benefits is so convoluted and confusing that veterans need to enlist the help of especially trained third-party advocates or lawyers to submit a claim. Failure to do this will often see veterans getting minimal benefits.
Ours is not a scaffold to climb, it's a bloody tar pit!
My husband is currently on his 3rd deployment rotation. He went to Iraq in March 2003 and was part of the first invasion of Iraq. That first year was horrendous. He spent much of that year living in real fear for his life, with horrible living conditions to top it off. For those who didn't do that first year, no one can even imagine what it was like. My husband eventually was doing mine hunting in Tikrit and his convoy was attacked when he was coming home on his R&R. He has the diagnosis of PTSD and we firmly believe he has it. I am a graduate student getting my Masters in psychology and while I am thankful he has gotten the help he needs, I must also state that the Army "says" one thing and does another. They "say" they care about the mental health of their soldiers, but I have seen first hand how many in the medical field try to get in the way of treatment that is working. My husband was also diagnosed with ADD (which explained a lot of his issues for years) and every time he deploys he runs into medical personnel that want to change or take away his medication. What is that? That is irresponsibility and frankly it makes me sick to witness it. I had to personally go to the medical clinic here and see the Colonel in charge to let him know that medical personnel (in Afghanistan) were taking away medication prescribed at the home station. So, while your article is interesting and I agree that not everyone will react to combat situations the same, I can say with certainty that there is still a serious breakdown in this system and as long as upper echelon leaders do not enforce a positive standard of care, this will only get worse. My husband doesn't complain, he is not a malingerer, he is a SFC who does his job and does it well. He is 3 years from retirement and hopefully this will be his last deployment (he will be gone until the end of 2009). A good friend of ours CLEARLY has PTSD but is not diagnosed because he feels there is a stigma attached and I worry for the safety of his family when he comes home. He has been 4 times and is a Ranger. He currently is part of the IED team dealing with explosives recovery and was just recommended for a Bronze Star with (v) for an amazing and insane combat with insurgents. He has PTSD and if he isn't diagnosed, he and his family will suffer. Maybe commanders should ensure that when a soldier comes back it is mandatory to be in counseling after such harrowing experiences. I don't know what is right, I just know this isn't working
Reply | Report Abuse | Link to thisPTSD is real and I've seen symptoms as a kid growing up around ww1 and ww11 veterans who turned to alcohol and they lived their lives in hell and their family's suffered, they where arrested and made fin of and this country did not give a damn.
Reply | Report Abuse | Link to thisThe only conclusion is to have these fancy pants arrogant doctors be put on the lines and get a first hand look at what combat service people go through and maybe when they learn how to pucker their a hole from freight maybe they will be able to sit at the level of veterans who where in heavy combat. Also I believe they are in need of a attitude change
Disgusted USMC 1967-1969 2 Tet Offenses Vietnam
"Service connection also makes a vet eligible for monthly disability payments of up to $3,000. That link may explain why most veterans getting PTSD treatment from the VA report worsening symptoms until they are designated 100 percent disabled at which point their use of VA mental health services drops by 82 percent."
Reply | Report Abuse | Link to thisDoes no one else think this statistic is troubling ?
I am a vietnam vet and vet center counselor. I also believe we need to revamp how we think @ PTSD. However, this article and discussion seems to confuse diagnosis with severity of symptoms. PTSD is a condition that exists or doesn't based on criteria that is well documented and does not require great clinical skill to assess. Post traumatic stress responses should also not be confused with Post Traumatic Stress Disorder. It is PTSDr's that are normal given the experience of any combat vet. I think it is ok to acknowledge and even honor that these Vets may forever "walk in the world" diferently after their experiences. The question is (and it is a seperate question), to what extent have these changes negatively impacted their lives. In other words the problem is not in diagnosis or even "treatment success", but in the disability rating system. There seems to be no standardized "schedule" for various impairment levels. Frankly, I think the rating structure should look more like affirimative action. That is, the door should be wide open on the front end (presumed to be service connected upon confirmed diagnosis and verified service in combat zone), with clear and universal criteria for progressing/advancement (increases only upon careful review of complications/advancing symptoms/documented impairments/complications stemming directly from the symptoms. As it is now, the disability rating has unfortunately come to be viewed by vets as "the degree to which the va believes you". One vet responds,"Is this like I'm 30% pregnant" and another kills himself within a month of hearing the VA somehow scores him 30 on a scale of 1-100.
Reply | Report Abuse | Link to thisGood discussion , but be careful not to throw the baby out with the bath.
I am a vietnam vet and vet center counselor. I also believe we need to revamp how we think @ PTSD. However, this article and discussion seems to confuse diagnosis with severity of symptoms. PTSD is a condition that exists or doesn't based on criteria that is well documented and does not require great clinical skill to assess. Post traumatic stress responses should also not be confused with Post Traumatic Stress Disorder. It is PTSDr's that are normal given the experience of any combat vet. I think it is ok to acknowledge and even honor that these Vets may forever "walk in the world" diferently after their experiences. The question is (and it is a seperate question), to what extent have these changes negatively impacted their lives. In other words the problem is not in diagnosis or even "treatment success", but in the disability rating system. There seems to be no standardized "schedule" for various impairment levels. Frankly, I think the rating structure should look more like affirimative action. That is, the door should be wide open on the front end (presumed to be service connected upon confirmed diagnosis and verified service in combat zone), with clear and universal criteria for progressing/advancement (increases only upon careful review of complications/advancing symptoms/documented impairments/complications stemming directly from the symptoms. As it is now, the disability rating has unfortunately come to be viewed by vets as "the degree to which the va believes you". One vet responds,"Is this like I'm 30% pregnant" and another kills himself within a month of hearing the VA somehow scores him 30 on a scale of 1-100.
Reply | Report Abuse | Link to thisGood discussion , but be careful not to throw the baby out with the bath.
The point is a long time overdue. The diagnosis has crept into the workman's comp and accident liabilty arenas with similar results. Compensation for claims probably needs overhauling on all fronts. The narrative becomes internalized and self propagating.
Reply | Report Abuse | Link to thisR Sine
The point is a long time overdue. The diagnosis has crept into the workman's comp and accident liabilty arenas with similar results. Compensation for claims probably needs overhauling on all fronts. The narrative becomes internalized and self propagating.
Reply | Report Abuse | Link to thisR Sine
The point is a long time overdue. The diagnosis has crept into the workman's comp and accident liabilty arenas with similar results. Compensation for claims probably needs overhauling on all fronts. The narrative becomes internalized and self propagating.
Reply | Report Abuse | Link to thisR Sine
PTSD: My experience returning from Vietnam was hell. You don't hear those stories because, honestly, I feel ashamed. I can express it this way. It truly is a nightmare. The way one feels is like living under a black cloud. The stigma of being labeled a "crazy Vietnam Vet" is still another dark perverted scene. All I can describe is the conflict impacts my life every day. The help I have received from the Veterans Administration is akin to a rat getting poisioned. Until one suffers the exposure to hell, one knows not hell!
Reply | Report Abuse | Link to thisI am referring to the first post that I perused briefly, and I trust the rest are as illustrative, so I quote the young lady: "As a stalked for vengence, raped, female veteran of a combat zone - I would trade my VA PTSD compensation any day for having back my "normal" life. Take the damn money and give me my life back." I too would like to have my life back but that's the point here, I enlisted, I volunteered. I am now 58 years old and two months ago, after the normal four and a half year va processing of my claim I finally got the money. Thanks but no thanks; I too would rather have my life back because the $$ only partially heals. That the va offers nothing other than psycho pills for treatment is a no brainer and it is only the most desperate of vets that end up in treatment at a va facility; ie there is no real treatment. I am not going to waste your time here; those of us with ptsd have been dealing with it and we will continue as warriors to do the best we can, but we really have had enough of the va's ineptness to last a lifetime. You idiots wonder why so many vietnam era vets are surfacing? It is your goddam iraq and afghan killing my marines for nothing that is exciting us and that is the bottom line you seem to miss here.
Reply | Report Abuse | Link to thisRe: The April 09 article entitled, The Post-traumatic Stress Trap by David Dobbs.
Reply | Report Abuse | Link to thisThe DSM IV terminology and the criteria and categories used to identify mental illnesses or disorders are, I think, subject to question and not always well understood or properly applied. Human behavior is never easy to classify and categorize. But the manual is a useful tool that is probably the best thing that psychiatry will have for some time. Unfortunately, however, it appears to me that this article on PTSD has really missed the mark with respect to a couple of highly significant issues, including the diagnosis itself.
Trauma is brought on by and is an individual response to an experience or set of disruptive circumstances which overwhelm a persons capacity for stress. It instills a degree of shock, severe mental stress, or disengagement from full conscious awareness that goes beyond the type and level of reaction one ordinarily has when faced with a mere problem, dilemma, or disturbance. Fear, anxiety, bravado, and feelings of numbness, confusion, or disassociation are all within the range of responses normally present or available to us to protect us from a total breakdown in an emergent situation as a consequence of our evolutionary development. There are typically delayed effects that may linger indefinitely, which vary in severity and duration, depending on a multitude of factors, both current and residual (from past stressful experience).
Therefore, traumatization is a factor not only of the particular events and damages or dangers but also of subjective responses, perceptions, and vulnerabilities related to age, social integration and support, past trauma and success of resolution, personal confidence, etc. It is my contention, for example, that many of the problems of students that are labeled as symptoms of ADHD, or behavior or conduct disorders and the like are actually a direct consequence of physical or emotional abuse, chronic and extreme parental arguments or conflicts within the family, neglect due to drug or alcohol abuse, and the like, all of which may serve to traumatize young children, often with delayed or invisible long-term symptoms and effects. You may have the resources to cope with a horrible experience without major negative life altering effects, while I may faint at the sight of blood and may become a virtual basket case after having an identical horrible experience, thanks to my anxiety-provoking past.
The implication here for soldiers is obvious. Not all are affected the same and not all effects are apparent at any given moment, nor are victims aware of suppressed memories. Indeed, one of the distinguishing features of trauma is that victims they most certainly are victims reactively and nearly universally shut the experience out of their conscious mental processing to the greatest extent possible. It is extremely unpleasant and painful for most victims to recall, relive or re-visualize traumatic events, although that may be essential later for a resolution. In some cases, it is apparently decades before the person is able to process the experience to end the nightmares or other symptoms.
Dobbs and some of the researchers/experts he quotes apparently believe that a low level of early symptoms or self-reports of traumatic events correlates with a typical or normal adjustment process wherein healthy and strong individuals are just working through issues and problems of returning to a safer but now unfamiliar home environment. I wonder how many of these experts have seen actual combat and dealt with death, mayhem and real trauma.
The article seems to overlook the fact that the soldiers reporting symptoms at a later date, despite an initial adjustment and seemingly normal transitioning with its typical period of discomfort and strangeness may in many instances have blocked painful memories or denied their realities and may have disassociated in part or completely from their terrifying experiences in a reflexive attempt to protect their integrity and sanity.
Just because the majority of those who have witnessed horror or received injuries do not believe they are traumatized or fail to immediately display visible PTSD symptoms does not mean they should be given a clean bill of mental health automatically. Likewise, it is a stretch to assume that any sizable number of vets are likely to transfer a trauma narrative onto other more benign problems for some odd reason, or because the system makes them do it. By the way, what is supposed to be proven by the mention that traumatic brain injury produces symptoms similar to PTSD? I see no relevance.
Lastly, the suggestion that we, as a nation have superimposed our need to assuage some residual responsibility or guilt or emotional regrets over the Viet Nam debacle onto the opportunity to objectively evaluate the PTSD controversy is really reaching in my humble opinion. McNally should look into working for the Fox Nuisance channel. Dobbs ideas of cult obsession with trauma and a post-war neurosis are more a figment of the imagination than any claim of PTSD by a vet ever was.
The science is quite logically a bit fuzzy and there is surely some limited amount of inflation in claims. The VA definitely needs an overhaul. Still, the extrapolations from the facts at hand in no way justify Dobbs skewed conclusions. It looks like sloppy science to me, at best.
Having devoted my entire career to treating this real but sometimes hard to grasp disorder, I am amazed that so few professionals really 'get it'. If you get PTSD is devastating, unmistakable and real. If you are an academic looking for simple fixes, magical techniques and check lists you will neither grasp it or be able to treat it. PTSD is a complicated but simple condition that affects all spheres of functioning. It forever alters your view of the world, and may or may not be disabling (a whole monitary and political question). Shephard's book was wretchedly lacking and highly selective. PTSD is real: Rod Serling had and 'got it', yet most people miss the simplicity and power of the condition. It is a complex, contradictory and compelling condition that is simply "a sane reaction to insane conditions". It takes an agile mind and a flexible personality to not get locked into the academic myopia wishing to reduce it to simplistic criteria and pathetically simple techniques. Much more work is needed; articles like this may raise consciousness, not simply anger. Perhaps one day this will be less vexing and confusing an issue. Fortunately, the majority of ordinary folks seem to intuitively 'get it'; perhaps even the experts will eventually learn.
Reply | Report Abuse | Link to thisI agree. I too suffer from PTSD and depression and would give everything I have just to have my life back the way it was. I applaud the gentleman who is able to adapt to his nightmares and accept them as his "just having a normal reaction to an abnormal event". PTSD may be over diagnosed as some have said but lets think back to when it was almost never diagnosed and veteran's from WWI, WWII, Korea, Vietnam and Gulf War I & II were not given the proper diagnosis. I truely believe that with the multiple deployments we are just at the tipping of the ice berg on PTSD as well as TBI's. I think that individuals who agree that it is overdiagnosed have their own personal reasons for believing this. It is a terrible shame to think that the powers that be may take these individuals seriously and rethink about compensating service members who have paid a hefty price for their service.
Reply | Report Abuse | Link to thisBrothers and Sisters... no one gives a rats A$$ about us other than about 52% of the American People.. and they have become irrelevant in today's world..
Reply | Report Abuse | Link to thisJust as you and I have become irrelevant to the same corrupt degenerate leaders.. Both inside the Military at the Flag Officer Level and among our elected and appointed officials..
There are GIs who have spent the last 30 40 years prisoners in their own bodies.. Not mentally ill.. but truly physically disabled.. If the self medication starts some devolve into homeless street people, "Drunks and Drug Abusers". However there are far more who once down crawl and stagger stone sober thru the rest of their lives....and when from time to time it becomes too much, silently, briefly weep where no one sees.. Prisoners of their own broken bodies physically damaged minds..
You young folks better join that VFW and American Legion.. Kick out the National Leaders and use the muscle of those organizations to defend each other.. maybe even a few of your older brothers and sisters as well.
Both Parties take Servicemen and Women for granted because we are too proud to even ask for that which we were promised and entitled to..
Soon even the services provided now.. using in many cases Doctors brought in on B1B Visas who like our leaders could give a rats a$$ what happens to us.. We are "Patients" not wounded and disabled Warriors.. We are crap in their eyes an impediment to them working their investment portfolios.
Let a Public Official or Bureaucrat be so injured as they can no longer do their job. They are offered other positions they can do or they are fully retired..
As GI pieces of Crap we are told "your 10=50% whatever disabled" "Hit the road" Your Compensation? Oh that's based upon that percentage of your "Base Pay".
Food, Clothing, Housing.. Your family does not need those things anymore.. you can work as a Greeter at Wall Mart for the rest (one of the better employers actually).
Like I said.. Take over the Veterans Organizations. Start kicking some political ass.. do not be pleasant or nice.
Or find yourself too old and too debilitated to do much more in a day than what you read here.
Lie in bed most days a prisoner, only worth money alive because once you die even your percentage of disability is taken from your family.
Fight Now or risk becoming too ill to fight, waiting to die. While the crooks on Wall Street and in Washington DC spend their lives in drunken orgies on the blood, sweat and tears of that 52% while stealing the food from your children's mouths.
Please clarify in detail. My reseach shows different.
Reply | Report Abuse | Link to this"Some studies of stress hormones in groups of PTSD patients show differences from normal subjects, but the overlap between the normal and the PTSD groups is huge, making individual profiles useless for diagnostics."
Nice Post
Reply | Report Abuse | Link to thisNimesh – Perception System
http://www.perceptionsystem.com/
Gabrielcrew
Reply | Report Abuse | Link to thisThe most effective treatment for patients whose symptoms arise from trauma is exposure-based cognitive-behavioral therapy (CBT), which concentrates on altering the response to a specific traumatic memory by repeated, controlled exposure to it. "And it works," McNally says. "If someone with genuine PTSD goes to the people who do this really well, they have a good chance of getting better."
Does CBT work? Here is your chance to find out, if you can find someone to assist you who can CBT really well...
Locker: Shock, Awe, Brilliance
http://online.wsj.com/article/SB10001424052970204621904574249972655817950.html
The Hurt Locker states its case with a prefatory quote from the journalist Chris Hedges War is a drug then makes its case with masterful clarity, mounting intensity and phenomenal force.
Kathryn Bigelows film, which was written by Mark Boal, manages to be many things at oncea first-rate action thriller, a vivid evocation of urban warfare in Iraq, a penetrating study of heroism and a showcase for austere technique, terse writing and a trio of brilliant performances. Most of all, though, its an instant classic that demonstrates, in a brutally hot and dusty laboratory setting, how the drug of war hooks its victims and why they cant kick the habit.
EOD: its the ultimate form of a gamblers high.
I applaud this scientific view into the cultural problem of trauma run amok. Our culture is obsessed with trauma and now tends to think that all bad experiences have to have bad consequences. The data do not support that view en toto and that is a blessing. Traumatic experiences are bad, war is bad, child abuse is bad and it is good that the outcome may not be as bad and some of the bad outcomes have nothing to do with the trauma itself. Great article.
Reply | Report Abuse | Link to thisAs a psychologist in clinical public practice, I applaud this article. Further, the "over-stretching" (a useful if cumbersome phrase) of the PTSD diagnosis has company--most n0tably the diagnosis de jeur of bi-polar disorder. Mental health diagnoses are useful, though dangerous. Providers, such as myself, should be skeptical. The article that we are discussing raises healthy, wise, ethical skepticism.
Reply | Report Abuse | Link to thisIndeed, current criteria for PTSD diagnosis is broad and perhaps even considered complex or inefficient for the effects of military service in war. Leaders in the field of child trauma including Dr. Van Der Kolk, Medical Director and Founder of the Trauma Center at Justice Resource Institute, and Robert Pynoos, M.D., Director of the National Child Traumatic Stress Network (NCTSN) have proposed the introduction of a new diagnosis in the DSM to include the complexity of developmental trauma and its expression over time C-PTSD.
Reply | Report Abuse | Link to thisIts not hard to find evidence that there also needs to be a rethinking of war and long-deployment trauma. There are the obvious exposures to violence and immediate threat of death. There is the prolonged tension of threat (high and low) and the sleeplessness and fatigue. There is also the prolonged physical impact on the spine, base brain and whole nervous system. Combine these with medications that impact the nervous system and preexisting neuro-characteristics and you have a cocktail of possibilities to diagnose.
In addition, there appears to be underlying issues not spoken of in literature. These are the effects of the individuals innate response to the world in this case exacerbated by the trauma of duty. The post-duty trauma of interfacing with family, society and the medical care community can compound what may or may not be diagnosable as war PTSD. If the innate survival instincts of fight/rage, flight/freeze, seek, panic and justice remain activated for an individual returning from duty - as they most often do, the results will not make sense to anyone. And until these instincts can be calmed and understood the results will be compounding and lead to confusion in diagnosis and treatment.
The question should not be whether PTSD exists, or in what intensity it can be qualified as deserving treatment . Our returning military men and women have served their time - be damned what appears to have caused their distress. The questions must be, What are the interruptive micro-expressions the individual is experiencing in the very moment? And what is missing and prohibiting their healthy presence? By noticing and providing an opportunity to experience a new experience the individual can learn create any experience in life they desire. Diagnosis simply imprisons the individual by definition and they will never believe in their possibilities.
Bob Bornt, MFT
www.CGOF.org
Washington Post Staff Writer Steve Vogels Aug 10, 2009 article Study to Seek Clues to Soldier Suicides supports my research on stressed combat soldiers by using saliva and blood samples for genetic and neurobiological studies. As a 60 year old combat veteran with two trauma brain injuries (TBI), I have a lot of mental and health problems after being a workaholic for forty years. I found in my research (to get better), and, pushing my VA councilor for months that two lab tests can show which combat vets are stressors or faker$: neurotransmitter and adrenal hormone values (saliva samples) that the main stream medical profession has always considered as non beneficial snake oil test. Reading books on adrenal stress lead me to a web site where combatants can be lab tested with out going through a doctor/Care Bear: http://www.canaryclub.org/. The one neurotransmitter test requires a practitioner: http://www.sanesco.net/.
Reply | Report Abuse | Link to thisAs Steve wrote, each soldier has their own baggage problems-from family, occupation hazards of the killing fields to dealing with TCNs adverse culture. To us combatants, who use(d) hand weapons to kill our fellow man, with out remorse, therapy sessions by outsiders (non-combatant: Care Bear wimps) are mostly mental torture after a couple of sessions. For combatants who are having problems adjusting there three cures or options; death, become a hermit, or adapt to what I call The Jackson Scale: Six Habits/Elements/Routines for combatants to deal with stressors to be a Centenarian (live to be 100+)
1. Exercise: Physical & Mental
2. Diet/Body Mass Index-BMI
3. Hygiene
4. Sleep
5. Quality of Life: Replace bad thoughts with good; be a victor, avoid victims; resolving the adrenal kick; etc
6. Frequent Sex
Non-compliance with one or more of the above elements is subject to depression and suicide by convenience.
There are a number of books by combat veterans showing the above being valid. Start of with American Hero, The Life and Death of Audie Murphy by Charles Whiting and read pages 178-9.
Also, after living is Saudi Arabia for six-years and Viet Nam for 18 months the term "unjust cause" is taking its effect on many of our deployed military.
I agree with DOBBS title for his article. He also validates to phrases: ignorance is bliss, and, those who can--do, those that cant--teach.
As a veteran of two deployments and now out of the military, I told the meds that everything was fine so I could get home asap and not have my discharge held up with weeks of testing. So I lied then and later realized that some of the combat experiences did in fact have a serious effect on my behavior in certain situations. So now I'm thinking of seeing the VA, but now know that they will assume I am inventing my experience.
Reply | Report Abuse | Link to thisWhether its involves Soldiers’ Fire/ Police/ Emergency Service Personnel Ambulance or People Exposed to Real Life Trauma's & Violence & abuse PTSD is REAL has HUGE personal family career life repercussions that ripple through generations I am from experience inclined to commend some of the strong feedbacks written in reply to this article posted. It is offensive and narrow in its substance and out to encourage laziness and more ignorance about the complexity of people inflicted with PTSD.Linda Ring Horsham West Sussex UK
Reply | Report Abuse | Link to thisDuring a flashback the sufferer actually re-experiences the traumatic event as evidenced by the regions of the brain activated during a flashback.
Reply | Report Abuse | Link to thisFrancine Shapiro, Ph.D originated the concept of EMDR (eye movement desensitization and reprocessing) for treatment of PTSD. It is a remarkably effective form of treatment.
http://www.emdr.com/shapiro.htm
Shapiro's thesis was that symptoms of PTSD were unprocessed traumatic memories -memories that got stuck forcing the patient to relive the experience in the present rather than remembering something that happened in the past.
Her unorthodox treatment seemed to interfere with the patients memories reducing the intensity of the flashbacks.
Recently scientists discovered the biochemical mechanism associated with fear processing.
Scientists have also discovered that when memories are recalled they are vulnerable to change. This opens the door to new and effective treatments -it is also consistent with Dr. Shapiro's successes.
There is a lot of good science regarding learned fear and PTSD
Here are links to abstracts. For the untrained these will be hard to follow. Sadly most psychiatrists are amongst the untrained. The point of adding these references is to demonstrate that a lot is already known. I see no reference to this knowledge in this article.
Nat Neurosci. 2007 Aug;10(8):1012-9. Epub 2007 Jul 15.
A hippocampal Cdk5 pathway regulates extinction of contextual fear.
http://www.ncbi.nlm.nih.gov/pubmed/17632506
Nat Neurosci. 2007 Aug;10(8):1012-9. Epub 2007 Jul 15.
A hippocampal Cdk5 pathway regulates extinction of contextual fear.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2441763/?tool=pubmed
Curr Opin Neurobiol. 2006 Apr;16(2):174-8. Epub 2006 Mar 24.
Reconsolidation: the advantage of being refocused.
http://www.ncbi.nlm.nih.gov/sites/pubmed/16563730
Nature advance online publication 9 December 2009 | doi:10.1038/nature08637;
Preventing the return of fear in humans using reconsolidation update mechanisms
http://www.ncbi.nlm.nih.gov/sites/pubmed/20010606
Neuropsychopharmacology. 2010 Jan;35(1):136-46.
Changing fear: the neurocircuitry of emotion regulation.
http://www.ncbi.nlm.nih.gov/sites/pubmed/19710632
J Neurosci. 2008 Nov 5;28(45):11517-25.
From fear to safety and back: reversal of fear in the human brain.
http://www.ncbi.nlm.nih.gov/pubmed/18987188
Nat Rev Neurosci. 2009 Mar;10(3):224-34.
A single standard for memory: the case for reconsolidation.
http://www.ncbi.nlm.nih.gov/pubmed/1922924
PTSD is quite real, its symptoms are not hard to spot, and it has a high prevalence. The underlying biochemical mechanisms of PTSD are largely understood and effective treatments exist and far more effective treatments are being developed based on rapidly advancing understanding of the physiological causes of the disorder.
Reply | Report Abuse | Link to thisAntidepressants do not address the primary disease mechanism but they do offer some neuroprotection from chronic levels of the stress (fight or flight) response.
PTSD is an extremely common response to rape. Indeed the emdr therapy I mentioned in my preceding note is provided free to rape victims in Canada (where health care is free, universal, and without red tape).
In my experience CBT is not very effective because it is too impersonal. To properly interfere with the re-consolidation of a learned fear memory the patient has to relive the experience. You don't want to do this without the presence of a well trained therapist that understands the human psyche. Psychiatrists no longer receive treatment in dealing with acute emotions. The therapist has to connect with the patient to help contain the extreme fear that can emerge without suppressing it. They help you through the fear and use techniques that interfere with the reconsolidation of the memory so that it is weakened. This is not a simple turning of the crank action. The therapist needs to have real talent and real skill. CBT practitioners are not trained in the dynamics of the human psyche. They are not particularly adept at dealing with acute emotions. They are following a recipe that is too mechanistic and fails to connect with the patient where they are hurting.
CBT is cheap. SSRI's are relatively cheap. Atypical antipsychotics (now deemed to be misnamed given their efficacy in dealing with a multitude of neuropsychiatric disorders) are more expensive but in many cases they are more effective because they interfere with specific neurotransmitter pathways. Flooding your brain with serotonin is not a very sophisticated form of treatment. New treatments will follow in the footsteps of the atypical antipsychotics interfering with the neurotransmitter receptors that are involved in specific neuropathology.
Eventually Cdk5 inhibitors will be developed for human consumption which may be the silver bullet that cures PTSD.
In the meantime there are medications on the market that do interfere with memory reconsolidation and could be prescribed today and taken during flashbacks to weaken the underlying memory so that it is less severe the next time.
this is horrible, soldiers should never have doubts about PTSD. i am heartbroken as well, this is just sad.
Reply | Report Abuse | Link to thisFirst of all the majority of military members do not have PTSD, it is still a minority of members who have PTSD, and PTSD is chronic problems lasting more than 6 months. I was an Infantry Staff Sergeant and I did not believe in PTSD while in the Army, Vietnam - 1982 and then Army National Guard 88-92 activated for GW1 in Nov 1990-May 1991.
Reply | Report Abuse | Link to thisI was one of the platoon sergeants/squad leaders that told men to "suck it up" "drive on, be a man" "real men don't cry" for christsakes WW2 veterans on Omaha Beach or the battle of the Bulge had it worse than we do, my own step father was on a flight crew of a B-17 that flew from England to bomb Germany 3-5 times a week for months, he saw a lot of his friends shot down, and himself he was terrified of flak. He once tried to watch the movie "Memhis Belle" as the plane was in his wing, he knew all of those men personally. He got to the first scene with flak in it, he tore the arms off his easy chair his face almost as white as his hair and never said a word and walked into the kitchen and poured a very stiff scotch. We threw the chair pieces out and mom bought him a new chair. Did he have PTSD I would bet my last dollar on it.
WW2 vets came home and went to work, they belonged to the vet clubs where they spent many nights telling war stories with men who had "been there" and came home and poured themselves into bed. Dale worked at the Post Office as many WW2 veterans did, he worked with a vet from the Arizona, one from Guadacanal, another Ira Purser who had survived the Bataan death March, none of these men thought of themselves as "hero's" they felt guilty for surviving, when so many of their friends didn't. They also did not admit to having bad thoughts or nightmares of the war, but as kids we all felt their anger, their lashing out at us with fists or belts, our moms with black eyes from walking into doors. There was always one or 2 town drunks that were never "right" after coming back from the war, everyone just said they were mentally weak to start with and should never have gone off to war.
I coped my way thru life, 4 ex wives, problems with my bosses, my kids, the DUI's suspended from work, busted in the Army a few times still made it to the promotion list for Sergeant First Class. My kids will not allow me to see my grand kids due to my behavior towards them as they were growing up, my ex wives would all agree I have "mental issues" I blamed everyone for everything except me, it was not until I crashed and burned after my 7th heart attack and congestive heart failure.
I was a patient at a VAMC when my primary care doctor suggested I see a VA psychiatrist for my "issues" we had a few exchanges when he set me up with the PTSD diagnosis team, the VAMC where I go does not allow a single doctor to make this diagnosis, it is made by a 3 member team who does nothing but interview, test and they decide who is and is not diagnosed with PTSD after 4 months of many tests and interviews with a psychiatrist and a psychologist they informed myself and my treating mental health doc that they concluded I have severe PTSD and it is more likely than not that I had been surpressing it since 1975, 7 fellow soldiers robbed me and beat me unconcious and left me in a snowbank at 20 below zero, they were caught and 4 of them were given general court martials for attemptedmurder and robbery and received sentences of 15 years in Leavenworth Prison, the other 3 who turned govt witnesses were given Field Grade Article 15s reduced to PV1 and given Bad Conduct Discharges, the Army sent me to Korea to get me off Fort Lewis and away from the 7 mens friends, I was stationed on the DMZ where I was present for many border incidents the most infamous of these was Operation Paul Bunyan caused by the murders of Captain Bonifas and the 1LT that was with him that tragic day in August 1976.
Reply | Report Abuse | Link to thisI saw many sights I wish I had not seen while in the Army, but that comes with service stuff happens, on Super Bowl Sunday 1982 after spending a day back on Fort Irwin the battalion command decided tomove the units tanks and othe rtrack vehicles into formation at 2000 hours to be readt for the mornings battle, I saw a young private get caught between 2 Sheridans that had been mocked up to be russian BMPs the fiberglass fenders caught him under his chin and seperated his head like someone popping a grape off his body, that is a sight that no drugs will ever wipe from my brain. The men were drunk, the vehicles should not have been moved, it was nothing more than command failure, fromthe squad leaders to the Battalion Commander, they all knew the men had been drinking hard that day while watching the game.
Is PTSD real yes my life is a textbook example of it, I would give anything to change it.
In response to Patience Mason's comments
Reply | Report Abuse | Link to this"You do know that, until recently, alcohol and drug abuse were considered willful misconduct instead of "efforts to avoid thought and feelings associated with the trauma." And workaholism is still considered "resiliency" instead of a sure sign of PTSD, probably because it is one characteristic psychiatrists and PTSD people share. Talk to their family if you want to know if someone with workaholism is "fine."
I would like to know what other diagnosis causes flashbacks, nightmares of things you've lived through, extremely effective startle responses (NOT exaggerated), the inability to concentrate on anything but survival information (notice I reinterpret the symptoms because they are misunderstood) the inability to fall or stay asleep because you might be killed in your sleep, etc."
Factualy, drug and alcohol abuse are NOT "efforts to avoid thoughts and feelings associated with the trauma." Science proves beyond a reasonable doubt that ptsd physically injures the opioid system, and drug and alcohol abuse are biological, not psycho-logical. Stressed mice even self administer drugs when they let them.
Factualy,"the inability to fall asleep because you might get killed in your sleep" is another psycho-illogical explination for a physio-logical injury called ptsd. Fact, the inability to sleep is due to high levels of stress hormones due to autonomic nervous system arousal. Not everyone with ptsd had to afraid to fall asleep because they might get killed. That psycho analysis works for war veterans. I prefer to outline the very real physiological injuries of ptsd. The "mental health proffessionals" don't know what ptsd even is, let alone how to correctly diagnose it. In fact, ptsd is under diagnosed, and misdiagnosed as bipolar, personality disorder, generalized anxiety disorder, depression, ADHD,ADD, etc etc. If you've been given other diagnosis' in addition to ptsd, it's a wrong diagnosis. PTSD doesn't co occur with drug or alcohol abuse, it's a symptom of the same dis-ease. PTSD does not co occur with depression, it's a symptom of the same disease. The "mental health proffessionals" don't even know that anxiety doesn't co occur with ptsd. PTSD IS AN ANXIETY DISORDER. The only people with a mental illness in my book, are the people who diagnose ptsd as one. And those who perpetuate the big fat psycho-illogical lie. Fact, ptsd is a neurobiological injury, pass it on!
In response to philipderoot
Reply | Report Abuse | Link to this"Antidepressants do not address the primary disease mechanism but they do offer some neuroprotection from chronic levels of the stress (fight or flight) response. "
That's incorrect information. Antidepressants raise the levels of noradrenaline. People with ptsd already have high levels of noradrenaline. Antidepressants can cause anxiety, suicide, and racing thoughs due to their effect on stress hormones. If you don't know what system is broken, don't play trial and error attempting to fix it. It's pretty insane to recommend drugs for ptsd that comes witha black box warning that this drug causes suicide.
"CBT is cheap. SSRI's are relatively cheap. Atypical antipsychotics (now deemed to be misnamed given their efficacy in dealing with a multitude of neuropsychiatric disorders) are more expensive but in many cases they are more effective because they interfere with specific neurotransmitter pathways. "PTSD causes neurological injury. These drugs are deadly and dangerous. The manufacturer warns "These drugs should be taken as a last resort, when nothing else worked, in the smallest possible dose, for the shortest amount of time." They are called neuroleptics. Side effects are permanent neurological injury called neuroleptic malignant syndrome, tartive diskenesia, diabetes, serotonin syndrome, death, which makes taking these drugs a traumatic STRESSOR. They might be effective for causing mental illness. Research shows they cause the problem behavior. If you read the side effects, they are worse than the dis-ease itself. I'd love to see anyone who perscribes or recommends these drugs for ptsd take them first before being allowed to give them to innocent, mentally healthy people who have suffered a stress injury/syndrome we call ptsd.
"Flooding your brain with serotonin is not a very sophisticated form of treatment. New treatments will follow in the footsteps of the atypical antipsychotics interfering with the neurotransmitter receptors that are involved in specific neuropathology."
Since stress affects every bodily system, I seriously doubt they can create a drug/pill that repairs the neurological injury caused by life threatening stress. The problem ptsd sufferers face is that mental health believers are misinforming the public as to the real nature and symptoms of ptsd.
Trying to fix a physiological injury by treating peoples psyche doesn't work naturally. In my book, you'd have to be insane to take the drugs they perscribe for ptsd.
I am not a doctor, or a veteran, but I do have complex PTSD. When I tell someone I have it, they immediately ask where I served... because I am young and I have something more commonly known in veterans. That being said, I am here to tell you my own experience when receiving treatment and the attitudes I have been given over the years.
Reply | Report Abuse | Link to thisMy ptsd, as far as we can tell, began when I was still young, five years old, watching your father get shot for his religion will do that to you... I hold a scar of my own from that day, he himself served and came home only to be killed trying to give me more time to escape so they would kill me just for being their... disgraceful place we live in that lets these things happen. His murderers were never brought to justice(whole other slew of issues isn't it?).
OK... I can tell you my mother kept me mostly protected, however some things were inevitable(she was also a veteran)although it was after her death that the problems began with HER mother.
I am going to be blunt without going into much more detail, as it is too numerous, and most people don't have the stomach for it anyway. I have been beaten, raped(in more than one way), sold off, medically abused(and not all the doc knew but shame on the ones who even suspected a little and did nothing!), and literally tortured... seriously, when I child thinks grandma's "water punishment"(later found to be 'Chinese water torchure') is "normal" their is a serious issue... an even bigger one when you go to school bloody and bruised and you slip through the cracks.
I have had much worse happen, some I have come to enough terms to talk about and some not, only recently did I even begin to talk about the mild mutilation my grandmother inflicted upon me.
I have a shorter list of things that don't trigger me, than I do of things that do... thankfully some more cope-able than others.
I have nightmares and wake up knowing I will not fall back asleep, I often freeze in place and tense during a particularly vivid flashback because I fear I will lash out. I have never enjoyed hurting anyone and I didn't enjoy the things that I wasn't always able to stop from happening during a flashback. I have found that sometimes my own fears caused by this are my own trigger at times... so I have worked very hard to be where I am now.
I have found that since children were not the cause, they are the exception to many rules, and as such have found solace and peace with my little family... however I am protective of them, more so because as I say every day "I know what waits behind those dark corners, and I know what goes bump in the night." you know... I don't think knowing makes it less scary for me... more like I fear those things every day, I have nightmares(more recently) evolving from fears, I have two small boys, so you can imagine the things that I fear for them... because those things happened to me.
Reply | Report Abuse | Link to thisWhen you have PTSD, even when you get to the point where you can work with minimal "barriers" (mine being you cannot touch me from behind), they don't want you... like your weak and faulty, like your broken, a doll that isn't new enough. I was screamed at as a child, BY people who were supposed to be helping me, because I could not forget. I was accused of fixating and not "forgiving" not being able to let go... but that wasn't the case. talking about it helped me... they just didn't want to be reminded that shit happened and that I didn't have the luxury of ignoring it like they did.
When the people who did it(anything that has become part of my ptsd) yelled I have come to believe that it is because if they admit I am haunted they have to admit they did something horrible and to be honest, my grandmother was so screwed in the head, she tried to convince me I did it to myself... some wounds cannot be caused by your own hand, however at one point, I half believed her... even WANTED to believe her. The grandmother I knew was dead to me when she "took me in", because that was when she stopped being kind(though knowing she did these things to my mother, I wonder not only the sanity of the courts after my mothers death, but also if she ever was truly that person she showed me...).
Their is a stigma to PTSD, and as a woman who survives with the memories haunting me, I was told, that I was to be treated as if I was a child who grew up in a war zone... and I have more trouble existing when someone isn't trying to kill me, than if they are... because of how much I have suffered.
In my experience, medications only suppresses the things until they bubble up. It is, to me either a tool to help temporarily, or something that should not be touched at all regarding this. what helps me the most is finding something "the little things" and holding on to that, with all my might.
I know at least one person will object to the validity of my post, because I am saying many things nobody wants to hear, or admit. The real problem here, beyond ptsd, is that those who have this need help coming to terms with the things that happened... it never goes away, and the memories will never cease haunting anyone who has them... but... people want it to.
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