Interesting that as I was about to write a long post on the status of Post-Traumatic Stress Disorder (PTSD) as a diagnosis in the
Diagnostic and Statistics Manual of Mental Disorders, fifth edition (DSM-V, new edition now due in 2013), AlterNet posted an article proclaiming the first decade of the 21st Century as
the decade that made the US the PTSD Nation.
Here in the home of the brave, we've endured a decade that shattered nearly every notion of what it meant to be an American, whether you live on the left or the right. And so we shout. Or hide. Or startle too easily.
In America today, it seems we all have a touch of post-traumatic stress disorder, as evidenced by our increasingly vitriolic political environment, where reality is denied and histrionics run riot. Anger, we're told, is the natural reaction to trauma; in people with PTSD, the anger is out of control. By that measure, the millennial decade has brought us 10 years of PTSD politics -- with no end in sight.
From the Tea Party madness, the unwillingness of Republicans in Congress to vote for any piece of legislation drafted by Democrats, the misuse of the filibuster in the Senate to all but break the institution, and the outsized rage on the left toward the Obama administration for simply behaving as politicians do, our national politics have moved beyond the bounds of extreme partisanship into the realm of mental illness.
This breaking of the national psyche was bound to happen; it's been decades in the making. American exceptionalism -- the idea that we are somehow better and more blessed than any other people on the face of the earth by dint of our own hard work, ingenuity, innate goodness and superior democracy -- was bound to fail as our nation, like every other before it, found itself caught in the grinding wheels of history.
Rooted in denial, the doctrine of American exceptionalism edits out of the American story the sins against humanity that created our nation: the genocide of the people who were here before the Europeans came, and the building of the nation on the backs of involuntary laborers who were tortured, abused and even killed for their trouble. Once you ditch that, it becomes easier to look past the other unpleasant realities of our history, be it our neo-colonialism throughout the world, which helped to build our economy, or the enduring practices of racism and sexism. But denial almost invariably leads to trauma, when on one day, or in one decade, the decay that denial fostered summons home the demons set loose through willful ignorance to do their fright dance before one's very eyes.
It's
a long article and worth the read. On the other hand, I wonder if a story like this (which does have its value) serves to confuse people as to the true, horrible nature of living with PTSD.
In Part I of this 2-part series I want to look at the PTSD diagnosis as it has been used (or not used) in the military, focusing on the current wars in Iraq and Afghanistan. Part II will look at possible changes to the diagnosis in the new DSM-V, due out in 2013, and how the disorder develops and might be treated more effectively.
PTSD and the Militry
There are many people who think that PTSD is just a liberal creation to keep soldiers from serving their country, not least among them are Rich Lowry (editor
The National Review) and Brigadier General Rhonda Cornum (the Pentagon's new director of Comprehensive Soldier Fitness). This comes from a recent article at
Huffington Post:
Now comes Rich Lowry, nationally prominent editor of the National Review, who mocks the soldier who plays the victim and indulges in "childish evasions." PTSD, proclaims Lowry, is a liberal media obsession. In the same week the Pentagon's new director of Comprehensive Soldier Fitness gave an interview in which she said that the Army is spending too much time treating PTSD. Talking with the author Gail Sheehy, Brigadier General Rhonda Cornum said we should concentrate on the healthy soldiers and train the fittest to be able to absorb a "kick in the gut" and get back to combat.
American kids are pampered, Cornum told Sheehy. Their parents "bubble wrap" them. "Sometimes," she said, "you gotta package up your feelings and get on with the mission." Like Rich Lowry, the general seemed to think that kids whose brains fill up with images of horror are like computers. They should just push reset and erase the memory.
Clearly, however, there is something serious going on here. The rate of suicide among soldiers is at
an all-time high (2/3 of which are in soldiers who have served in war zones), and has increased over each of the last five years. From
Time Magazine:
The recently released figure for November show that 12 soldiers are suspected of taking their own lives, bringing to 147 the total suicides for 2009, the highest since the Army began keeping track in 1980. Last year the Army had 140 suicides.
* * *
"Soldiers who are suffering from posttraumatic stress are six times more likely to commit suicide than those that are not," General Peter Chiarelli told the House Armed Services Committee on Dec. 10. "The greatest single debilitating injury of soldiers returning from Iraq and Afghanistan is posttraumatic stress." Nearly 1 in 5 soldiers — more than 300,000 — comes home from the wars reporting symptoms of PTSD. Army officials also acknowledge that substance abuse, fueled by repeated combat tours, and a war-created shortage of mental-health professionals, contribute to mental ills that can lead to suicide.
Other researchers (not employees of the military) have warned that the number of PTSD cases the military predicts is too low.
The military number is 20%, as noted above, but in “
A Dynamic Model for Post-traumatic Stress Disorder Among U.S. Troops in Operation Iraqi Freedom,” Michael P. Atkinson of the Naval Postgraduate School and Adam Guetz and Lawrence M. Wein of Stanford University predict as many as
35 percent of returning soldiers could have PTSD.
From
Psych Central:
The authors combine a dynamic mathematical operations research model with deployment data and PTSD data from the Iraq War, and estimate that the PTSD rate among Iraq War veterans will be approximately 35 percent, which is roughly double the rate from the raw survey data.
This doubling is due to the time lag between the PTSD-generating event and the onset of symptoms and to the fact that many surveyed troops will do subsequent deployments.
Consequently, the authors write, the VA system, which is already experiencing significant delays for PTSD treatment provision, urgently needs to ramp up its mental health resource capacity.
It will be hard to know how serious the issue really is. A lot of soldiers will not seek help because to do so is to appear weak in their eyes. There is also still a stigma to being diagnosed with any kind of mental illness, which will also keep soldiers from seeking help. And finally, soldiers returning home are give a brief (30-60 minutes) lecture on not abusing alcohol and not abusing their wives or girlfriends. There is no real, clear information on PTSD and how to know if you have it. [This has been related to me by the wife of a young man with PTSD currently serving his 2nd tour in Afghanistan as a soldier in the Air Force.]
It's all part of a larger pattern. Looking back over the last decade, it's clear that the Bush Administration and their operation of the Veterans Administration sought to not only downplay the PTSD diagnosis, but to deny treatment to soldiers who need help. [The Obama administration has since
reversed this policy, but there is still is not enough funding to adequate address the issue.]
Doctors in the VA systems were asked to diagnose soldiers exhibiting PTSD symptoms as having a pre-existing personality disorder - essentially permanently pathologizing these young people who are exhibiting a perfectly human response to inhuman conditions. Personality disorders are Axis II disorders in the DSM-IV-TR, which means they are more resistant to treatment and more a part of who a person is by nature. On the other hand, PTSD is an Axis I disorder, along with depression, anxiety, and other mostly treatable disorders. To label someone with an Axis II disorder is serious.
This is from 2007 (
written by Phillip Leveque, who has spent his life as a Combat Infantryman, Physician, Toxicologist and Pharmacologist):
PTSD veterans have become the Lepers of the V.A. system. The worst thing is, there is a reasonably, effective treatment for Leprosy. “Psychologic Leprosy” must be forced into the backrooms or better yet cashiered out of the service by denying it exists and forcing the patients out of the service for specious, deceitful reasons.
I don’t know if I must clarify the last statement but ask any veteran who has been in hard combat. We combat veterans were so tired we just didn’t care any more. If that is not a psychosis please straighten me out.
Any battle veteran will tell you combat is crazy. “War is Hell” is often said. Any person to get into a probable death dealing situation must be (a little) crazy. Even Army psychiatric statistics indicate a combat soldier may only last about 200 days before going goofy. That is if he’s still alive.
The latest perversion of the V.A. against PTSD battle veterans is to label them PRE-EXISTING PERSONALITY DISORDERS. I guess that may be correct. We are trained to KILL by any means possible. However, we were trained for that in the Army or Marines. Most of us were quiet, peaceful guys before going “crazy” and volunteering for the service and killing.
I have just heard that the Army/ V.A. have discharged 22 thousand by this perverted deception. We will be faced with tens of thousands of “trigger-happy, short-fused, Army-made sociopaths”. There is no other way to describe them. In their dreams, or even resting quietly, if they think they hear the click of an AK-47 bolt or the ping of stepping on a mine, they are back facing death. We were trained that way.
Another aspect of this scandal is that
they (VA Administrators) asked doctors in the VA system NOT TO DIAGNOSE PTSD at all. This story is from 2008:
There was email was written in March by Norma Perez, Ph.D., a V.A. psychologist who coordinates post-traumatic stress disorder cases. She wrote, "Given that we are having more and more compensation-seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of adjustment disorder."
The email was discovered by accident through a Freedom of Information request by a veterans group.
Such conduct is unfathomable. And yet it gets worse. Rather the discharge or treat soldiers with PTSD, depression, or anxiety, the military is giving them drugs to make them essentially numb and sending them back into combat. From Time Magazine:
For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.
Interestingly, the military does not keep stats on prescription drug use among its soldiers. Among the drugs being prescribed, according to the article, are the antidepressant Zoloft and the antianxiety drug clonazepam.
Klonopin (the trade name of clonazepam) is not a mild drug - here is
a list of side effects:
Clonazepam side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:
* confusion, hallucinations, unusual thoughts or behavior;
* hyperactivity, agitation, hostility;
* unusual or involuntary eye movements;
* weak or shallow breathing;
* depressed mood, thoughts of suicide or hurting yourself;
* chest tightness, fast or pounding heartbeats;
* painful or difficult urination, urinating more or less than usual;
* pale skin, easy bruising or bleeding; or
* new or worsening seizures.
Less serious clonazepam side effects may include:
* drowsiness, dizziness, spinning sensation;
* memory problems;
* tired feeling, muscle weakness, lack of balance or coordination;
* slurred speech;
* drooling or dry mouth, sore gums;
* runny or stuffy nose;
* loss of appetite, nausea, diarrhea, constipation;
* blurred vision;
* headache;
* nervousness, sleep problems (insomnia);
* skin rash; or
* weight changes.
This is not a complete list of side effects and others may occur.
Many of these symptoms could aggravate PTSD symptoms - and many are made worse by combining alcohol with this drug, and alcohol is the most popular form of self-medication among soldiers. Even without the side effects, we end up with emotionally numb soldiers who continue to accumulate trauma experiences without any emotional awareness of what it is happening to them.
We send our children to fight in these ill-conceived and poorly conducted wars, and we make them serve multiple tours of duty, witnessing things no human being should have to witness, doing things no human being should have to do, and then when the come home psychologically damaged, which is not only predictable but inevitable, our government does not want to help these young men and women.
Here is part of an article - War Vet: I Served 40 Months in Iraq, After Which I Didn't Want to Go Back Home - written by a Vet with PTSD. He begins with his reasoning, very admirable, for rejoining the Army National Guard:
I joined the Marines in 1977 and served in the infantry until I got out in 1981. I went to work for a major transportation company, eventually rising to a management position. But as I saw the war in Iraq dragging on, I decided in 2005 to re-enlist. I was too old at 46 to get back into the Marine Corps, but with a waiver I was able to join the Army National Guard.
I volunteered for the next unit deploying to Iraq, and reached the combat zone in late 2005. I knew that I was filling a slot, and I hoped that because I had deployed that a soldier who did not want to go to Iraq was able to stay home with his family. I felt that I was contributing more in Iraq than I had during the previous 24 years as a civilian. I truly enjoyed being in Iraq and doing an important and dangerous job.
I volunteered to stay in Iraq for four consecutive tours. I stayed because I felt that I was doing something worthwhile, regardless of the politics of the war. I felt that the younger soldiers deserved experienced leaders. I knew that they needed someone who would stand shoulder-to-shoulder with them by choice, not because he was ordered to. I know that I had a positive impact on the soldiers in all of the units that I served with.
Here is some more - this is what we face with untreated veterans in our community. These people are broken and suffering. They need good psycho-therapeutic treatment and compassionate community support.
And I stayed in Iraq because I adjusted so well to the environment there that I did not want to come home.
This is part of the sickness of PTSD. We become so proficient at operating in combat that we forget how to function effectively in a normal environment. Therapists and readjustment counselors call some of these symptoms “survival skills,” behaviors that keep us safe and alive in a combat environment. Being paranoid and quick to react to movement or sound, and the readiness to use violence are all good things in war. It isn’t easy to come home and turn that off, because when we try to do it we don’t feel safe.
I don’t feel comfortable at home anymore. My threat tolerance and response to perceived threats is so finely tuned that I felt safer in Iraq. Here, every stranger looks like a possible threat. If I am driving near my house and a car pulls in behind me, I will take several extra turns to make sure that I am not being followed. When I am home I feel like I am being watched. At night I leave the lights off in my house and the blinds drawn so no one can see inside. My dog thinks I am an idiot because I am always running into him in the dark.
At least in Iraq I had an armored vehicle and body armor, and I carried and operated several weapon systems. Most importantly, we had skilled soldiers watching each others’ backs. At home, I have none of that. I have no protection and I do not have any authority to tell people to get out of my way or to stop moving. If I had a choice, I would still be in Iraq or in Afghanistan.
People don’t realize how PTSD affects us. They don’t understand why we are hyper-alert and always looking for threats. They don’t understand why we are always angry and want to be in a controlled environment. I have had family members tell me that I should just relax and get myself under control. They think it is just a matter of self-control, and that it should be easy to fix. It isn’t. Do they think we want to be like this? Don’t they understand that if it was that easy we would not need to be in treatment? Then they wonder why we don’t want to talk about it.
This is the reality of PTSD that the government would rather we not know about.
For a whole other view on this issue, see this great article from the Boston Review: God, the Army, and PTSD, Is religion an obstacle to treatment? by Tara McKelvey - here is a sample:
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.
This ends Part I of this two part article.
See Part II here.
Tags:
Psychology, PTSD, trauma, military, government, VA, veteran's administration, Iraq, vets, Afghanistan, DSM-V, religion, Bush Administration, anger, anxiety, depression, violence, suicide, combat, mental health, stigma
