The Politics of PTSD
In World War II, PTSD was called Combat Fatigue and dealt with differently in different armies. Among the Allies, you got R&R leave behind the lines. If you were a Russian soldier who said he had Combat Fatigue, you were shot. Amazingly, there weren't nearly as many cases of Combat Fatigue in the Russian Army (from James Dunnigan's book How to Make War (Fourth Edition) : A Comprehensive Guide to Modern Warfare in the Twenty-first Century).
We no longer deal with PTSD in such a severe way, but is going to the opposite extreme where veterans are told they will never get better the answer?
The Washington Post has an article today on Post-Traumatic Stress Disorder (PTSD)--hat tip to immodestproposals' blog for pointing out the article. Basically, criteria for PTSD are that a person has been exposed to a traumatic event, and has recurrent nightmares, hypervigilance etc. as a result of the trauma. See here for a description of PTSD. While I do believe that some people can experience PTSD, my concern is the growing political debate over soldiers who may or may not have the condition. Here is an excerpt from the Post article that clearly shows the politics involved in the diagnosis of PTSD:
This professor is correct about his assertion that soldiers will remain sick if they are told they will never recover by the PC crowd:
There are some soldiers who truly suffer from PTSD, but many of these can be treated, if they seek help or believe that they have the chance to get better. But as long as these soldiers can be exploited for the political cause of the moment, their working lives will be tragically cut short and they will suffer for that, regardless of the size of their disability check. Or vice versa, those who need help will not get it because of the stigma. Whenever diagnoses are politicized, it is bad for the people involved. Those who have PTSD may not go for help and those who are malingerers have the incentive to rip off the system.
Update: Medpundit has more thoughts on PTSD.
We no longer deal with PTSD in such a severe way, but is going to the opposite extreme where veterans are told they will never get better the answer? The Washington Post has an article today on Post-Traumatic Stress Disorder (PTSD)--hat tip to immodestproposals' blog for pointing out the article. Basically, criteria for PTSD are that a person has been exposed to a traumatic event, and has recurrent nightmares, hypervigilance etc. as a result of the trauma. See here for a description of PTSD. While I do believe that some people can experience PTSD, my concern is the growing political debate over soldiers who may or may not have the condition. Here is an excerpt from the Post article that clearly shows the politics involved in the diagnosis of PTSD:
The growing national debate over the Iraq war has changed the nature of the discussion over PTSD, some participants said. "It has become a pro-war-versus-antiwar issue," said one VA official who spoke on the condition of anonymity because politics is not supposed to enter the debate. "If we show that PTSD is prevalent and severe, that becomes one more little reason we should stop waging war. If, on the other hand, PTSD rates are low . . . that is convenient for the Bush administration."
This professor is correct about his assertion that soldiers will remain sick if they are told they will never recover by the PC crowd:
"We have young men and women coming back from Iraq who are having PTSD and getting the message that this is a disorder they can't be treated for, and they will have to be on disability for the rest of their lives," said Frueh, a professor of public psychiatry at the Medical University of South Carolina. "My concern about the policies is that they create perverse incentives to stay ill. It is very tough to get better when you are trying to demonstrate how ill you are."
There are some soldiers who truly suffer from PTSD, but many of these can be treated, if they seek help or believe that they have the chance to get better. But as long as these soldiers can be exploited for the political cause of the moment, their working lives will be tragically cut short and they will suffer for that, regardless of the size of their disability check. Or vice versa, those who need help will not get it because of the stigma. Whenever diagnoses are politicized, it is bad for the people involved. Those who have PTSD may not go for help and those who are malingerers have the incentive to rip off the system.
Update: Medpundit has more thoughts on PTSD.
posted by Helen at 7:15 AM
64 Comments:
But aren't psychological diagnoses always more or less politicized, reflecting the p.c. narratives of the day?
. . . Penis envy in Freud's day and Attention Deficit Disorder in our own come to mind. I must say the old terms -- Combat Fatigue vs. Post-Traumatic Stress Disorder, for example -- have a poetry missing in today's bloodless terminology.
sissy,
I suppose to some degree but that certainly should not be the goal. It is harmful to tell people they are psychologically sick and will not get better. The DSM is a way for mental health professionals to talk to each other and have a common language. It serves some purpose in treatment--but it is best to stay away from politics in diagnoses, if possible.
One of my close friends is a retired US Army general, who did 4 tours in Vietnam, 3 leading troops in combat, and one as a Intelligence officer. After Vietnam he was involved with warfare and combat in various other places where "black operations" took place. I did talk to him about theis whole concept fo PTSD. he said, yes that he did get nightmares now and then. But, according to him, PTSD is what you allow it to be. Kinda like say, a cancer patient. One can either deal with it in the "victim" mode, at which point, PTSd will take over and ruin your life, or one can be a strong person, look at the situation rationally, and deal with some symptoms.
he feels that PTSd has always been a political issue, when during the Vietnam conflict, anti-war mental health professionals diagnosed PTSDin massive numbers to try to prove that war should never be waged, since consequences were so 'bad". It is as if, the effete, oer-educated academic types, refused to realise that not all people were made i n their model, as it were. That there are people out there, who can/could deal with a lot of stress or adversity, without breaking down, crying up a storm, and acting like a weakling. For some reasons, I have noticed, even with my own experiences dealing with brain cancer, that today's mental health professionals cant accept the fact that a person suffering from a serious condition, can get through the situation with out falling apart and essentially behaving like a whiny, cowardly individual. Why do they think that dealing with problems like a stoic is wrong? Why do they expect every person, especially soldiers trained to engage in combat will act like effete, weak individuals who will suffer a mental/psychological breakdown under very stressful situations?
ronin1516,
I guess emotional issues are big business. What would Oprah do for work if emoting every 10 seconds did not prove profitable? I do think people and soldiers can have issues of stress and problems coping--but it should be our job to help people live the best life they can. Victimhood, however, provides many jobs, a good moral stance and a feeling of superiority. I guess some people feel, why give it up?
Except for the part where it is making people sick, weak and desperate to hang onto the goodies they get from being victims (while exploiting and harming others). And it gives the state more reason to intervene and control others. A necessary ingredient for the continuation of the liberal agenda.
B.G. Burkett's book "Stolen Valor : How the Vietnam Generation Was Robbed of Its Heroes and Its History" was a real eye-opener for me in its discussion (with numerous examples and explanations) of how PTSD diagnoses were used as a political tool. If you haven't read the book, it's highly recommended. "The rest of the story," as it were, to someone (me) who, at the time, bought into the left's Vietnam narrative with no reservation... x_dhimmi
anonymous 10:15
Thanks for the book suggestion.
In the few years that I taught in a community college, I had numerous students who were either active military or veterans. I will not rant, here, about those who expected to get by in college by making excuses and whining a lot; I expected better from people who had been trained by our military.
However, I had one male student, a Viet Nam vet' in his 40's, I think, who suffered from PTSD. He claimed he wanted to do well in the class, but he wrote several times of wanting to be granted full and permanent disability. A year or more later, I saw him on campus. He had apparently "proven" that he was too sick to succeed in college, and anticipated getting his wish. Then he planned to work as a counselor for other vets with PTSD. He seemed quite convinced that he could never recover.
That belief, however, and its propagation, is no different from what I heard in a 12-Step setting: We were told we would *always* need to participate in support groups, for the rest of our lives. Some of us--me, for one--who worked in our recovery to the point of being able to handle relationships and situations in healty ways, chose to stop attending. That decision was frowned on. But the basis was the same: victimhood, even though we were encouraged to leave that persona behind and were given tools to do so. I might have bought into the basic belief, if I had not married a man who was healthier than I and who pushed me to become healthier. God bless 'im!
I read that during the Civil War and its aftermath, what is now called PTSD was known as "soldier's heart."
Which seems like a more human way of thinking about it.
As a psychiatrist, I believe PTSD tends to be overdiagnosed in general (and I am not talking about only military personnel). For many who are subjected to a traumatic event, the biological result (assuming they are physiologically vulnerable) is depression. I am not completely convinced that PTSD represents something biologically different than depression. The "flashbacks" and "nightmares" aspect of the diagnosis seem to occur when the trauma is quite severe, but the rest of the syndrome seems far too similar to depression or melancholia. Since I deal with personality disorders primarily, it is not unusual to see PTSD listed as one of the Axis I disorders in addition to the Axis II personality disorder. PTSD is very "in" in psychiatric circles; the same way multiple personality disorder used to be "in". Both--if they really exists as separate biological abnormalities--are probably much rarer than once thought.
As a layman, I cannot add much to this discussion except:
1. I also recommend Burkett's book, Stolen Valor. It is definitely an eye-opener and a rare factual look at Vietnam War vets.
2. I sympathize with sufferers of PTSD - military and others - while at the same time acknowledging that some are too willing to opt-out of responsibility and become victims when faced with difficult situations. Having said that, I am concerned with people who become aggressive after stress, such as military personnel who returned from Iraq and killed their spouses. There are reports implicating vaccines (anthrax?) in these episodes, as well as concerns about PTSD. From a psychological perspective, perhaps there is no difference between people who respond to PTSD with anger vs. those who respond with depression. But I think it matters a great deal to society.
Thanks for the hat tip and the response. Figured it was right up your alley. I'll link back here on my original post, naturally.
David,
Soldier's heart does sound very descriptive but I guess it is not clinical enough for the DSM.
Dr. Sanity,
I agree that our professions tend to overdiagnose PTSD. I deal with cases where therapists diagnose even employees who have disagreements at work and the juries buy into it--sometimes awarding money based on "PTSD." In my experience, many of these "PTSD survivors" were simply personality disordered individuals who were really upset when they lost their jobs for being bad obnoxious employees. That said, I do work with veterans who display the classic symptoms of PTSD--the flashbacks and nightmares but often, they are not the soldiers who have been in combat. They seem to perceive the situation as much more intense or worse than others in the same situation. My guess is, they have a predispostion to depression and trauma seems to push them into a depressive episode. Thanks for your input.
"Having said that, I am concerned with people who become aggressive after stress, such as military personnel who returned from Iraq and killed their spouses."
Not to minimize the seriousness of combat stress, but is a soldier who has returned from combat any more likely than the general population to commit this sort of crime? The articles I see about crimes like this or about soldiers who become ill during or after service invariably lack any sort of comparative data that enable a reader to determine whether the premise that their problems are a result of their military service is valid.
The most interesting biological finding in PTSD is that, in contrast to Major Depression, (the 'stress hormone') cortisol levels are low. Aerni at al. in "Am J Psychiatry"http://ajp.psychiatryonline.org/cgi/content/full/161/8/1488 discuss how low cortisol lends to consolidation of traumatic memories and that 10 mg a day of Cortef for a month may be helpful in halting this. For diagnosis, using the CAPS, the "clinician ..PTSD scale," in an appropriate way drops you past the patients irritabiity defenses, an aspect of PTSD = personality disorder diagnostically. PTSD is like panic in that if there is suspicion and you deny it you may be more likely to have it. An aspect of PTSD is discussed in "my recent blog"irvingpsychiatrist.blogspot.com.
If the only tool you have is a hammer, you tend to see every problem as a nail. Likewise, people in the dysfunctional person business tend to see dysfucntional people everywhere they look.
There appears to be a general consensus in the media (as a layman I can't speak for the therapeutic professions) that any exposure to trauma permanently and adversely affects the individual. Hence, preemptive steps are taken to ensure that everybody recieves counseling, whether they need it or not. The message this sends is that everyone needs it. And if everybody needs it, then everybody is sick and those who don't accept their illness are living in denial.
The PC Left will try to exploit this issue for what it's worth, but unlike in the 1970s, there's a lot more information available to the public about PTSD. As a PTSD sufferer myself (not from combat), I can speak from my own experience and that of some friends I know who fought in Vietnam and the Persian Gulf war.
PTSD is both real and quite treatable, especially in adults suffering from limited adult traumas. It is not just depression, although that's a component. Depending on the circumstances, memories of trauma are not processed and "discharged" like normal memories. Instead, they are "dissociated" -- selectively suppressed (with perception, thought, and feeling fragmented), then intrusive upon triggering, leading the victim to the feeling that the traumatic event hasn't stopped -- the film keeps running over and over. That is the key to PTSD. It's bad conditioning. The cure is reconditioning: arriving at the point where the victim no longer feels "it's still happening" -- i.e., the victim is no longer a victim. Many victims arrive at this state without professional help. However, victims with more severe cases need intensive, specialized techniques.
About this, there is truly nothing new under the sun. Every war since the rise of modern medicine has featured PTSD -- in the Civil War, soldier's heart; in WWI, war or combat hysteria or shell-shock; in WWII and Korea, combat fatigue. In WWI, it was treated with some success using hypnosis; in WWII and Korea, with drugs. In Vietnam, the drugs (barbituates) became cheap and common enough that soldiers began abusing them before and during combat. Contrary to myth, almost all those addicts lost their habits once they left combat. In previous wars, alcohol was the barbituate.
Following late 19th-century psychiatric discoveries, the treatment goal was and is inducing abreaction: leading the victim up to an integrated remembering of the incident(s) that combined feeling, thought, and perception, but with enough preliminary desensitization to prevent the victim from being overwhelmed. Sometimes it was induced too fast, and soldiers came out crazier than before. But mostly, it worked.
The issue of disability and treatment is also in no way new. The British and US after WWI gave generous combat hysteria pensions and treatment plans, leading to a generation of "never-recovered" veterans, some of whom were still lingering in veterans hospitals at the outbreak of WWII. So the policy was changed. After WWII, the British gave time-limited treatment and no disability for PTSD alone, only if combined with a physical injury. The US was somewhat more generous, but not a lot. The opposite policy was followed after Vietnam, leading to a large number of lingering patients, some of whom had real problems, just not combat-related problems.
Before the attempted political exploitation of this starts, remember these figures. In WWI, the psychiatric casualty rate was 1 in 3 for prolonged combat. In WWII and after, it was about 1 in 6. (In WWII, about 1 in 7 in combat were sent home for unsuitability -- makes you think differently about the "greatest generation.") Contrary to myth, Vietnam was not different in the slightest. Civilian awareness was, but that's a different matter. WWII also featured the classic study of men in combat, leading to the conclusion that 9 to 12 months of prolonged combat is the limit for most. (They didn't know that in WWI.) Ergo 6- and 12-month rotations became standard US and British practice during and after WWII. In Vietnam, these were individual rotations; later, unit rotations.
Finally: people need to debate war on the merits, not on some bogus psychiatric claims, e.g., that Vietnam or the Iraq war (or whatever war the Left happens to be opposed to) somehow generates more psychiatric casualties than wars the Left supports. This central principle of anti-war psychiatry is totally false. Combat is combat; war is hell. The crack-up rates have not changed since the 1940s.
Classic books on the subject, both British: Ben Shephard's War of Nerves (2001) and William Sargant's Battle for the Mind (1957).
Read history, or read headlines. Your choice.
I have a variety of small bits to add to the discussion.
A lot of PTSD is temporary, and has actually been underdiagnosed for many years. The skills needed to survive in combat -- automatic response, constant vigilance, intolerance of error, for example -- are not so useful in the civilian world. A majority of returning combat veterans have some periods of painful adjustment.
But most do adjust. Chronic symptoms are rarer, and completely disabling symptoms rarer still. PTSD is a continuum, and what you bring to the table for coping skills is as important as your decompression treatment after.
My 3rd and 4th sons grew up in enormously traumatic situations in Romania. Because I work in an acute psychiatric emergency setting, I see the worst that this society has to deal out on my caseload, but few of my patients exceed what I have in my own own home. But trauma is not destiny. Both my sons show considerable resiliance -- they have friends, they have jobs, they do well in school. You can see the attachment and painful memory issues surface at times, but they show more balance than most of their classmates.
Protective factors are enormously important in dealing with trauma. It may be more important for personality development to have good things happen to you than to avoid bad ones. A network of friends, a useful skill, religious faith, physical contact, and general health do more FOR you than most trauma can mount against you.
You're quite right Helen - there are veterans who truly need help with PTSD and others (very likely the majority of others) who would be just fine if someone didn't tell them they'd never recover.
Whenever someone starts throwing out the word "never" I turn and walk away. There are few absolutes in the world and certainly you can't state that someone will "never" recover from this - there is no proof whatsoever that this is the case. And for anyone who claims such a thing - I'd have to say "prove it! beyond a shadow of a doubt" If they can't do that - they can't say "never".
And yes the PTSD diagnosis is the darling of the current TV "experts". I remember after 9/11 there were numerous people who claimed PTSD - they were in California and other places around the country. Now I think you might be able to call it PTTVD (Post Traumatic TV Disorder) but to lump them in with Veterans who have been in a war or someone who was actually in the World Trade Center or Pentagon that day... does a huge disservice to everyone.
But the media has created it's own little psychiatric niche and I don't think they'll give it up easily.
Tell someone they will not get better and very often they will not get better.
Tell someone that they will get better if they put some work into getting better and very often they will put that work into getting better.
Surprise, eh?
As for combat veterans killing their spouse...
There does appear to be a dual spike for recently returned MALE vets. That is, they are both more likely to kill their wife and to be killed by their wife. There does not appear to be a spike for female vets. Why? No idea. How big of a spike? The dataset is too confused to answer the question. Better research is needed.
My own opinion is that the above is true for a few reasons. One, we tend not to listen to males in pain: We do listen to females in pain. Two, females who have taken a lover are more likely to use violence as a tool to "remove" their husband and women whose husbands are off at war are indeed more lilely to take a lover.
The Marines/Navy have a program called OSCAR, which is an acronym of some sorts. Essentially, if someone gets PTSD they are kept as close to their unit as possible, preferrably in it and told that their reaction is normal and they'll be well again shortly.
I saw several of the Marines in my battalion this past year treated in this manner. In all cases that I'm aware of, the Marines were better in short order.
Anonymous 10:15 -
I bought Burkett's book and was glad to see that you found it helpful, as I did, in making sense of why my father could go to war against Japan and come home to marry, raise 5 kids and be a steady guy, but a Vietnam vet is expected to be damaged merchandise and live under a bridge. From that I concluded that most PTSD diagnoses are not helpful to the veteran, and many are actually frauds, not just as PTSD sufferers, but in claiming veteran status.
However, my chiropractor told me recently that after his stint in Korea (he was trained to kill with his bare hands), he enjoyed watching war movies. One night he was awakened by his wife's plaintive cries - he was choking her in his sleep. He said he never watched another war movie, and this behavior stopped. He said he might be able to watch a war movie now (he's 75), but doesn't care to try.
I left an abusive marriage in 1983, and had nightmares for a long time. I could not watch Coal Miner's Daughter without getting panicky and having sweaty hands and a racing heart. It came on TV last night, and I watched a bit of it, but when Doo kicked Loretta down the aisle on the bus, I had call it quits. Been there, done that. 22 years!
The Civil War term I've seen is "jackknifing." Reference was to the person's suddenly crouching to take cover, if you threw a rock behind him to make noise.
Interesting part is that it's not seen early in the war, despite the hells of Shiloh, Antietem, Gettysburg, etc. It's first noticed at Wilderness-Spottsylvania, when conflict became constant. Men who could weather two or three days of pure hell had trouble weathering weeks or months of constant conflict, even if the major fights were interspersed with periods of much lower intensity fighting.
I'm intrigued at another possibility: namely, that the Left is trying to "induct" military folk into the "victim" mentality, that is, to co-opt the best and bravest. Victimhood is very tempting.
As to recovering or not, I like "Assistant Village Idiot's" point that it's a continuum. I mean, if I cut myself a little, it usually heals without a scar; if I cut myself more deeply, scars are likely. If I get cut very badly, they may have to amputate, and I *never* recover. The mind is a tricky thing, and there's seldom a visible cut. In particular, I'd be careful of absolutes: some of the folks traumatized by TV coverage of 9/11 may have been in a state of previous injury, after all. (Not that it's likely, mind you, but remember the demographics: LA is full of Liberals. Think "self-inflicted".)
Dr. Helen,
When I returned from Afghanistan, I was diagnosed with PTSD. For severity of symptoms and reactions, it can be equated to ice cream - it comes in many flavors.
Some folks have almost symptoms. Others have flushed their lives, and the lives of their loved ones, down the toilet in their confusion.
That PTSD is happening in Afghanistan and Iraq is no surprise - the nature of the combat is up close, personal, and ordinary things, such as litter (soda cans) are deadly. Quick, easy, and nothing left but the questions of "Why him/her, why not me?"
My observations of the Veterans Administration are mixed. The VA is a political organization: political appointees in charge of government bureaucrats - the heady stuff self importance. On the other hand, the VA staff I've worked with are dedicated, and are doing better, working more aggressively to help OEF/OIF veterans here and now - unlike the Viet Nam era.
There may be no cure for PTSD, but one of your posters was correct - you either control it, or it will control you.
Thank you for this opportunity to post on a subject near and dear to my heart.
V/R, Dave
I think that PTSD is more common in a draftee military. Volunteers may be presumed to have a warrior mentality.
I've been reading my uncle's diary from his service in WWII. He was the Captain of an AA battery on Corregidor until the surrender of the Phillipines and spent the rest of the war in a Japanese POW camp at Cabanatuan. I'm only at the end of the first year of his imprisonment in 1943, but I keep wondering how he could have made it to 1945.
What he wrote about was his concerns about avoiding malnutrition and wanting to get back home. He seemed to have a positive attitude. Even in those horrible circumstances suffering from beriberi, scurvy and ringworm, and various other health problems, he wrote about his being thankful for his life and his family at home. He took an interest in the activities, including slave labor on the camp's prison farm.
He was relieved to be imprisoned after six months out on the rock of Corregidor subjected to near constant bombing and shelling, but he endured as thousands died around him. I think that being engaged in life, such as it was, and having a compelling goal, were what saved him. I don't know whether he had flashbacks at home, but I would be surprised if he did. He would probably have remembered the men he had known and sought to help which would be wrenching, but not the stuff of haunting, as I picture PTSD to be.
I don't but this PTSD thing at all.
Sure anyone can breakdown when subject to stresses beyond their coping mechanisms, but this should happen when subject to the stress not many years later
The reason for the burgeoning PTSD numbers among Vets for "traumas" suffered over thirty years ago?
Easy to diagnose - it is worth money from the VA if you can pull it off.
My Grandfather had nightmares up until almost the day he died from his experiences in WWII in the Pacific as a Naval officer. At his funeral my cousin recalled the time (in the early 1950's) that a plane flew low over the house. My grandmother, god bless her, explained to my counsin that grandfather had dived under the table "ever since he came back from the war".
A Naval chaplain who has studied PTSD tells me that the difference in VIetnan from WWII was that the WWII guys came home and joined the Lodge or VFW or American Legion and then did "group work" every weekend for the next few (or many) years with all the other vets - they just didn't call it that then.
He also says the eye movement therapy (the exact name escapes me) really does work, although no one can explain why.
I should add that grandfather was a very accomplished and high functioning fellow who died at age 99. PTSD may have slowed him down, but I never saw it.
I remember seeing my first PTSD patient in israel while training. funny enough, it didn't have to do with terrorism. it was a young girl who was involved in a car accident where her boyfriend and two other friends were killed. she tried to commit suicide more than once. really hits the point home.
Makes you think of politicians who take advantage of these youth in the light they deserve to be thought of doesn't it?
Internal Medicine Doctor
manfromantiquity / Dave:
Thank you for your service to our country and in support of democracy.
Dr. Helen:
If you can find a copy, you might find the book "365 Days" interesting. It was written during the Viet Nam war, by a doctor at a hospital in Japan. Most of the chapters relate things he'd heard about from patients. One chapter, titled "Gentlemen, It Works," was about combat fatigue. The cure rate was 100%, and no, that's not a typo. It came from recognizing that "combat fatigue" was another name for fear, and that the individual in question would have to get over it.
Apparently, the politics have changed again.
The House of Saud Must Be Destroyed!
"On Killing" is an interesting and has some fine chapters on Vietnam era vet problems and their causes.
A second nod to LTC Grossman's On Killing. One of the interesting things he discusses in that text is how PTSD is affected by how the returning vet is treated by the public. If treated as a returning hero, the symptoms are greatly mitigated. If treated as our Vietnam vets were, the problems are amplified.
Dr. Helen and Dr. Sanity,
Good points all. When I came back from my rotation, I thought I might be suffering from PTSD - it was not so. I did have quite treatable depression. Big difference, thank goodness. I just hope there are not too many others that get led down the PTSD trail, when it could likely be something temporary and treatable.
If you haven't actually been in a combat situation, you really don't know what you are talking about! It is like a man discussing the experience of giving birth!
I am diagnosed as 80% disabled, 40% for hostile fire wounds and 40% for ptsd. Most of the VN unit that I was on an advisory team for was either killed or wounded the day I was shot. I was not physically injured when I carried a BAR in Korea But the terrible unknown of what might happen at any minute was the same in both wars.
I would like to meet (face to face) with the commenters who used the terms "whining" and "crying". I wonder where they have built up their knowledge about combat.
I think the correct response to Dr Helen's pointed raising of the politics issue of PTSD is this: it depends.
If (as I've found to be true) PTSD requires individual treatment, then (beyond standard supportive mesasures) patients and clients respond best to self-mobilization. How then is over-dependency to be avoided? Institutions are least equiped to make these cutting decisions.
War certainly does politicize medicine whenever mental illness is concerned. As others say, de-politicization is always best. But the mental health establishment has other ideas.
Contrary to Dr. Sanity's comments - that PTSD and PDs are vastly overdiagnosed - the recent research of J. Douglas Bremner reverses this argument. Instead, his research indicates that similar neuroanatomical changes undergird many of the most of these diagnoses.
In fact, Bremner goes so far as to speculate that most anxiety and presonality disorders are trauma related syndromes. He bases this on modern systematic brain imaging studies. This empirical groundwork, mostly done at Yale Emd School, is summarized in "Does Stress Damage the Brain?: Understanding Trauma-Related Disorders from a Neurological Perspective" (2002, and 2005 in paper).
If so, interventions can be devised to target specific psychoneuroendocrine changes involved in PTSD related problems. This sophisticated behavioral, neurological and endocrinolgical perspective, is laid out elsewhere by Bruce S. McEwen in "The End of Stress As We Know It," - This is a seriously mistitled book: it's really a primer to the relevant scientific literature, holding out promise and help but no simple "how to."
I have been misdiagnosed so many times in my life, I've lost count. Yet the psychoneuroendocrine approach has changed my life. Furthermore, Bremner's schematic makes sense of my (certainly exceptional) convoluted psychiatric history. But without both, I wouldn't have the tools I now have for managing PTSD and getting on with having a better life.
Unfortunately, "clinical psychoneuroendocrinology" is too new of a field to have practicioners for those who need it yet. Realizing this is medicine on the frontiers of knowledge, however, it is possible to cooperatively combine praticioners in different fields if you are up to doing sufficient research and find doctors and psychiatrists willing to work with the motivated and well-informed patient. It also greatly helps if you find docs intereested in stretching their own knowledge-base.
I was cured of PTSD after being raped by a violent serial rapist who threatened to kill me, and later stalked me. He's in jail now. I used the Emotional Freedom Technique, a do it yourself accupressure routine that I did on my own and later with a therapist. I had also been able to "tough it out," continuing with my life as usual, but being free of the trauma is definitely better. BTW, the eye-movement thing another poster refers to is EMDR, which I haven't tried but may be similar to EFT, in that it rewires the energy system or whatever. I'm not a shrink, just a very happy and healthy former victim. Check it out, it's free: emofree.com
sid jones: There is a group of people who deeply believe that no male can be "hurt." That is, hurt in any way other than physically.
It is best to speak up. Tell them their beliefs have less than no merit. Tell them their beliefs are a threat to society. They will not believe you ar even hear you: Do it anyway.
The heart and soul of the men's movements is speaking up against such idiocy.
It's not terribly surprising that the anti-war folks are using PTSD as evidence that we should leave Iraq. It's part of the "war is not healthy for children and other living things" hippy-dippy pacifism that marked the sixties and seventies.
War is hell. No one disputes that. The part that the pacifists forget is that there are some things even worse than war right now. Saddam nuking London or New York, planes into building after building, or war fought later under less advantageous circumstances are all worse.
The all-pacifist approach forgets that the trade-off here isn't war vs. no war. It's war now vs. war later. Death, PTSD, amputations, and orphaned children aren't arguments against war. They're evidence that man is flawed, and our best hope is freedom.
There might be a follow-the-money angle: A soldier I talked to on a cross-country flight told me that being diagnosed with PTSD gets you a bump-up in pay. He was mildly annoyed with the people who claim symptoms or exaggerate them, but you can understand why they would.
You don't get a bump in pay for having a disease. That's mallarky.
Quick addendum. A number of people have mentioned Burkett's Stolen Valor. It's a good book correcting the distortions and lies about Vietnam vets you still hear.
The citation about how there were fewer Russian cases of PTSD in WWII is worthless. In those days, the Red Army often shot or exiled such soldiers. The Soviet system was built on denial of reality, on top of the Russians' long-standing "Potemkin village" habits, and it's a little strange to see "conservative" bloggers citing it as a model. The only reliable, systematic, and long-term information available on combat trauma in modern warfare comes from the British and American armed forces.
Many classic pieces of war reporting and fiction contain descriptions of combat fatigue, e.g., Stephen Crane's Red Badge of Courage.
A C-SPAN archive of interviews with congressional war veterans can be found here. Most of them describe combat fatigue and trauma, some in detail.
My brother is a phd pyschologist for the VA, and has written numerous papers on PTSD. From my conversations with him, the VA staff are very conscious of people manufacturing claims, and of false positives. On the other hand, PTSD does appear to be a very serious problem. While various folks may seek to make the condition a political issue, the dedicated medical professionals who are dealing with it for the VA (usually for much less than they could make in private practice) are not.
The sound of helicopters and the smell of half-burned diesel still make the short hairs stand up, but an old vet taught me how to beat that black dog: Immediately think of the best memories you have associated with those same things.
Like the time we hovered down in an old bomb crater only to find that we couldn't land -- too many 10-15 foot-tall saplings -- and our decrepit UH-1a didn't have the guts to climb back out of the hole in the trees. So.. I arranged a rendezvous with the pilot, and my senior NCO and I bailed.
Well, let me tell you, what wasn't water was mud and, while we didn't have far to go, we spent a very scary night in fear of missing the meet-up next am. Then the chopper was late..
Turned out they'd stopped off for KFC and beer, figuring we might be a mite hungry, then ran afoul of some prissy prick at the airfield who didn't think they should be flying around with chicken and suds.
Angel's wings couldn't sound any sweeter than that old Huey did coming back and I do believe that was the best meal I've ever had.
So now I feel better than I did before those old black memories showed up, and my wife is wondering why I'm sitting here chuckling.
Cheers!
Pogo,
I am with you--War is hell and what else can it be? In an ideal world, none of us would have to fight each other, but that world is a fantasy land that does not exist. The human mind is such that there will always be people who want to do bad things to others and we have to defend against them. I do not understand all of these rationals for why we should not be at war in Iraq. They are rationals for why we should never be at war, period. If liberals, democrats, etc. really believe we should never defend our country under any circumstances or go to war, they should just say it instead of coming up with one flimsy hypycritical excuse after the next as to why we should not be at war. I suppose this would be too damaging to them politically but at least it would be the truth.
According to this article. The fear reaction in mice (the mouse equivalent of PTSD) decays according to genetics.
What we know is that for some the decay of such memories (PTSD) can last a lifetime.
I have been doing research on this subject since early 2001. My interest is the "drug addiction" aspect. What I have found is that much of what we refer to as addiction is just self medication for such things as PTSD, bipolar, ADD/ADHD etc.
I do believe tthat for some at this time the condition is incurable. Medical science is improving. In two years or so we will have a test for PTSD. That alone should help a lot and will give us a much better view of the prevalence of PTSD in the population.
An interesting article on PTSD in the Civil War. It was the cause of alcoholism. Such alcoholism was considered honorable.
BTW re: PTSD prevalence.
I estimate that PTSD (long term version - every one gets it short term from severe enough trauma) affects about 10% of the population. Genetically about 20% of the population is susceptable.
Now if we really want to get upset about PTSD causes War is not the biggest problem. Child abuse is.
My son was diagnosed with PTSD after he returned from 15 months in Iraq in the Army. He saw many Americans and Iraqi die there in gruesome ways. Today he is depressed, unemployed, prone to binge drinking. He does get counseling from the VA, which is a lifesaver.
Don't tell me PTSD is a myth or exaggerated: I suspect your post is part of a "debate" to create a "controversy" which will cover those despicable people in government who will use it to cut VA funding, to keep those tax cuts in place for the rich.
Many of the (apparently) "conservative" warmongers who posted in comments are already picking this up to say that PTSD is exaggered: of course they have never been shot at.
"Support Our Troops," "Honor Our Veterans" -- what an empty crock that is. Easy to put a $1 magnet on your car, hard to do anything real.
It is quite possible for a real problem to be both overblown and politicized. This is the case with PTSD.
It is real. It does need to be taken seriously. It can kill - I lost a friend to it. He survived the war (which he supported with all his heart). He just couldn't survive what came after, and he couldn't admit he needed help. That was a great tragedy.
It is not helpful for conservatives to get their pantyhose all in a wad by going into denial and pretending it doesn't exist: they don't serve the military well by doing that. That attitude is what keeps people like my friend from seeking help, and then we find them swinging from a rafter somewhere.
And it doesn't help to infantilize people who, by and large, can heal on their own with time by treating them like broken wrecks who are beyond redemption.
There is a happy medium here somewhere.
By the way, the military is treating PTSD with virtual reality - WIRED mag did a great story on this. The program has been very successful in the more extreme cases. It allows the guys to gradually desensitize themselves to the sights and sounds of war. They work with a psychiatrist to pace themselves so they don't get overwhelmed, but they are in control.
Self-help - as a conservative, I've gotta love it. A manly way to treat PTSD - with war games.
A link to the WIRED article on using virtual reality to treat PTSD.
Sorry, but I think this is incredibly important. Maybe this will help someone:
http://www.wired.com/news/technology/0,1282,68575,00.html?tw=wn_tophead_1
For John, in memoriam.
I'm one of those right wingers. I know PTSD is real and that we as a society have yet to take it seriously.
My husband's co-worker with PTSD from Vietnam reports that Zoloft is far more useful than other antidepressants for him. My husband, who may have PTSD or a related condition (not from combat) found that his tendency to "play the film" of traumatic events over and over again almost stopped when his treatment was switched to Zoloft from other antidepressants.
Now, he does not start going over the traumatic events in his mind as soon as he goes to bed. He can now sleep without the sounds of a movie playing in the room as a distraction and a fan running on high speed.
drj - thank you very much!
This has been great to re-read, and I'm going to take folks up on some of their suggestions.
I see there are comparisons between Viet Nam and OEF/OIF. I feel very fortunate by way of the increase in interest in PTSD by the medical and psychological communities, and the American people. Personally I thank my VN vet friends - they pioneered modern PTSD treatments (borrowing from WWII vets' communities: VFW, DAV, AL) where the federal government could not recognise this issue.
Given the numbers of veterans and increasing numbers of new veterans, debate should center on just what capabilities does the American public want from its vets? Does this need to go to the level of Constitutional debate (does my right to pursue happiness as a disabled vet trump a non-veteran's right to the same through increased taxation? for example).
There is resentment (at best) to anger (at worst) in the veterans' community at the policies and funding of veterans programs. Regardless of the program, the argument boils down to money. It is a realistic if crass argument, better term is insulting.
So - what capabilities do the People want in their veterans? How will we work to provide what it takes for veterans to integrate these capabilities into themselves and live lives as productive, law-abiding citizens? Then we should resourcing - money and other things.
I don't agree with folks co-opting PTSD as an argument for surrender and appeasement - nor an entitlement; but transparent discussion, planning, and action commensurate with our gratitude to our fellow citizens-in-uniform (and non-citizens) shouldn't be dismissed.
Again Dr. Helen - thank you for the opportunity to post!
I am an OIF 2 vet who has PTSD. I am pretty sure this is never going to end until I am dead. All of this physco-babble on this sight is a bunch of junk. I am on Zanax, Lithium, Welbutron, and Hydoxyzine, and still have all of my symptoms. I don't want to be stigmatized as being crazy or a coward especially the latter. I received a Bronze Star for courage under fire during the Sadr uprising in 2004, and I am still am in the Army, probably going to be deployed again. I think there are two seperate disorders with PTSD, some people become afraid and others can't get out of fight mode, I am pretty sure everybody who has seen actual combat has some form of PTSD, everyone I was in actual combat with (bullets flying) are having problems, some of them self medicate with alchohol and others pretemd they don't have a problem. It would be nice to find all of the slugs who milk off of the VA but since that is impossible lets keep our little comments about veterans to ourselves, go pick on people on welfare or something, 99.9% percent of them don't deserve a penny the get.
Fascinating discussion and viewpoints. I believe that there is value in all of them. As one of the commenters said, if the word 'never' is used, than I turn away. There is a balance to be used for sure and politics needs to be taken out of the picture. As an anti-war person, I recognize ptsd,BUT..do think that it is something that can be overcome when truly afflicted. Aside from the horror of combat, the fact (stepping up on my soap box for a minute) that Americans have never been occupied, have had battles with other nations, have had to be in the resistance and endured loss and suffering in the non military environment (i.e. civillian casualties), I think psychologically (and if I'm using the wrong lingo, let me know) Americans have no real concept of 'trauma'. This is such a sanitized, entertainment, shallow driven society (the intelligent discussions notwithstanding), expectations are the things that must be a factor in all of this. Yes, you're going to see some and experience horrific things, what did you expect? Real combat is not like a computer game. I've had to endure a lot of stresses in my life and if you've always had a cushioned life with the expectation that 'life owes you' (kids grow up affluent having the expectation that it's easy to acquire material goods), if anything bad happens that'll ruin your psyche if you can't handle any knocks.
Off my soapbox (was born and raised in the NL, lived in different countries) and back to ptsd.. I am developing some idea in my head for veterans support. However, aside from the ideas that I have been mulling over, I know one thing for sure: no politician is going to be involved in this.
This is not about pro or anti war. This is about plain and simple, people support. I do believe that with most traumas, one can survive and come out on top emotionally. It's all in the tools and the support..
Ingrid
希望大家都會非常非常幸福~
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