Monday, November 16, 2009

Tara McKelvey - God, the Army, and PTSD

In the current Boston Review, Tara McKelvey asks if religion is an obstacle to treatment.
In a 2004 study of approximately 1,400 Vietnam veterans, almost 90 percent Christian, researchers at Yale found that nearly one-third said the war had shaken their faith in God and that their religion no longer provided comfort for them.
That is a little surprising to me - I might have thought they could weather experience easier because of their faith. But, they are also more likely to seek treatment, too.

The bottom line, however, is that the military (and conservatives) hate the PTSD diagnosis and not want to pay to treat the soldiers suffering from it.

God, the Army, and PTSD

Is religion an obstacle to treatment?

When Roger Benimoff arrived at the psychiatric building of the Coatesville, Pennsylvania veterans’ hospital, he was greeted by a message carved into a nearby tree stump: “Welcome Home.” It was a reminder that things had not turned out as he had expected.

In Faith Under Fire, a memoir about Benimoff’s life as an Army chaplain in Iraq, Benimoff and co-author Eve Conant describe his return from Iraq to his family in Colorado and subsequent assignment to Walter Reed Army Medical Center. He retreated deep into himself, spending hours on the computer and racking up ten thousand dollars in debt on eBay. Above all, he was angry and jittery, scared even of his young sons, and barely able to make it through the day. He was eventually admitted to Coatesville’s “Psych Ward.” For a while the lock-down facility was his home. He wondered where God was in all of this, and was not alone in that bewilderment and pain.

In a 2004 study of approximately 1,400 Vietnam veterans, almost 90 percent Christian, researchers at Yale found that nearly one-third said the war had shaken their faith in God and that their religion no longer provided comfort for them. The Yale study found that these soldiers were more likely than others to seek mental health treatment through the Department of Veterans Affairs (VA) when they came home. It was not that these veterans had unusually high confidence in government or especially good information about services at VA hospitals. Instead, they had fallen into a spiritual abyss and were desperate to find a way out. The trauma of war seems to be especially acute for men and women whose faith in a benevolent God is challenged by the carnage they have witnessed.

Of course, not all veterans with mental health concerns are led to VA hospitals by a loss of faith: many simply want to get a night’s sleep without being terrorized by nightmares. Whatever kind of assistance they are seeking, it has been in increasingly short supply. The decline in resources for veterans’ mental health services started in the 1980s, as part of a nationwide effort to move psychiatric patients into outpatient treatment. The number of inpatient psychiatric beds fell from 9,000 in the late ’80s to 3,000 by 2008.

During the Iraq war, however, the great difficulty veterans experienced in getting psychiatric care—greater than before—was not a product of cost-cutting, but of conviction: many Bush administration officials believed that soldiers who supported the war would not face psychological problems, and if they did, they would find comfort in faith. In a resigned tone, one prominent researcher who worked for the VA, and asked that he not be identified because he was not authorized to speak to the press, explained that high-ranking officials believed that “Jesus fixes everything.” Benimoff and the others who returned with devastating psychological injuries found a faith-based bureau within the VA. At veterans’ hospitals, chaplains were conducting spirituality assessments of patients.

The story of the mistreatment of returning veterans from Iraq is well known and shocking. But the role of religious ideology in that mistreatment—how, inside the government, it was a potent tool in the betrayal of an overwhelmingly Christian Army—is much less known.

“I couldn’t stand to hear that phrase any longer—‘God was watching over me,’” Benimoff wrote.

He wasn’t watching over the good men I knew in Iraq. Faith was the center of my life yet it failed to explain why I came home and those soldiers did not. The phrase was a Christian nicety, a cliché that when put to the test didn’t fit reality.

• • •

Things had already begun to change dramatically at the VA by early 2005, shortly after Roger Benimoff left for his second deployment to Iraq. Many appointees at the agency were disturbed that so many Iraq veterans showed symptoms of post-traumatic stress disorder (PTSD). In part the concern grew from skepticism about the diagnosis itself, which some believed to be a legacy of the Vietnam-era anti-war movement. Whatever the merits of the diagnosis, it was clearly widespread and, moreover, staggeringly expensive to treat. In 2008 the RAND Corporation put a number on the problem, reporting that one in five veterans of the wars in Iraq and Afghanistan has suffered some form of mental illness, mostly PTSD and depression.

“God doesn’t like ugly,” one political appointee told Paul Sullivan, an analyst in the VA’s Veterans Benefits Administration, in a clumsy attempt to reduce the cost of caring for psychologically traumatized veterans. “You need to make the numbers lower.” Sullivan left the VA in 2006 and became head of Veterans for Common Sense, a group that filed a class-action lawsuit against the secretary of the VA for the shoddy treatment of veterans. It was dismissed in 2008 and is now being appealed.

PTSD, along with its diagnosis and treatment, has been a charged subject in the United States since the term was introduced nearly three decades ago. Studying returning veterans and working with a group of psychiatrists and others in the 1970s, former Air Force psychiatrist Robert Jay Lifton pushed to create an entry for “post-traumatic stress disorder” in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the official manual of the American Psychiatric Association. Lifton and his colleagues believed that the kind of horror induced by the experience of war and other comparably catastrophic shocks needed a special category that would distinguish it from lesser kinds of trauma. A definition appeared in the DSM-III in 1980. The DSM-IV, published in 1994, included revised diagnostic criteria that reduced the severity of the external shock required to induce PTSD. From the start, conservatives charged that the disorder was created by anti-war activists with a political agenda. The debate about it has been marked by passion, rhetoric, politics, and religion, all of which have only made things worse for the individuals who have suffered from the disorder.

Tens of thousands of soldiers, including Benimoff, have been diagnosed with PTSD, which occurs when an individual responds to a traumatic event with “intense fear” and feelings of helplessness. For PTSD sufferers, that experience is followed by horrifying nightmares, hyper-vigilance, sleeplessness, and other potentially debilitating symptoms. Some of those diagnosed with the disorder never recover, and for this reason skeptics say that the DSM definition has turned ordinary men and women into chronic sufferers, dependent on government assistance and relieved of responsibility for their own lives. It is true that some Iraq veterans with full-blown PTSD diagnoses have been granted government benefits—usually between $200 and $2,600 per month—even though they might be able to support themselves. (I have met several of them while traveling across the country.) Nonetheless, far more suffer either with poor care or no care at all.

Read the whole article.

Oh, wait, here is one more quote that needs to be shared - this is our fu*ked government in action, screwing the soldiers they sent to fight for them.
Sullivan was working as an analyst at the Veterans Benefits Administration in Washington in early 2005 when he was called to a meeting with a top political appointee at the VA, Deputy Assistant Secretary for Policy Michael McLendon. McLendon, an intensely focused man in a neatly pressed suit, kept a Bible on his desk at the office. Sullivan explained to McLendon and the other attendees that the rise in benefits claims the VA was noticing was caused partly by Iraq and Afghanistan veterans who were suffering from PTSD. “That’s too many,” McLendon said, then hit his hand on the table. “They are too young” to be filing claims, and they are doing it “too soon.” He hit the table again. The claims, he said, are “costing us too much money,” and if the veterans “believed in God and country . . . they would not come home with PTSD.” At that point, he slammed his palm against the table a final time, making a loud smack. Everyone in the room fell silent.
Effing weasel.

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