Tuesday, July 20, 2010

WSJ on PTSD

In my latest bit over at BigPeace, Politics, Fraud, and PTSD, I review Dr. Sally Satel's important article in TheWallStreetJournal, The Battle Over Battle Fatigue.

Make sure and read her entire bit. As I said over at BigPeace, if everything is PTSD – then nothing is – and that means that those who actually have real PTSD will find services diluted, funds diverted, and their case lost in a sea of fraud.

On the political side, the Leftist logic train runs like this: if anyone in the military can have PTSD – then all have it. If everyone in the military has PTSD, they are not well. If they are not well, then they are to be pitied. If they are to be pitied, then they are not my peer. If they are not my peer, then their opinion is of no value. If their opinion is of no value, it can be ignored. If they can be ignored, no one will take them seriously. If no one takes them seriously, they have no power. If they have no power – they cannot get in my way.

Quod erat demonstrandum.

55 comments:

AW1 Tim said...

 It's even worse than that, CDR. The left wants to make the military into another victim class. That helps support the meme that military folks don't understand what they are doing, why they are being manipulated by whatever the left's enemy d'jour is, etc.  That supports the idea that only the lower classes, the substabndard intellect, the deficient join the military.

 In the actual near-term, however, having everyone diagnosed with PTSD also helps them to deny firearms, and possibly other weapons to veterans. It could also be argued by them that if folks are suffering from PTSD then they have a serious mental health issue and should not be allowed to vote.

  I agree completely with the whole PTSD fraud situation. It's an easy diagnosis to make, hard to disprove, and gets the veteran into some form of treatment where the VA (and especially the left who is pushing this isue) can be seen to be "doing something".

Salty Gator said...

Sal, I really like how you crystallized your position on this.  Before I was left in a bit of a cloud trying to understand why it appeared-to me-that you were slamming PTSD.  But I agree with you completely now.  The broad brush stroke that the liberal left is attempting to paint the entire military with, especially our combat veterans, exists only to marginalize the uniformed population (obviously not a key democratic demographic).

Sal, great article. 

Mid Mom said...

It's just part of "Support our troops. End the war."

Byron said...

Time for Starship Troopers...

Cdr K said...

If you do your mindfulness excercises, you'll be okay:
http://www.dodlive.mil/index.php/2010/07/medical-monday-staying-cool-and-calm-for-awareness/

11B40 said...

Greetings:

Another aspect that may be in play here, besides the obvious growing of the PTSD industry itself, is the diffusion of what used to be known as "welfare" into myriad other programs that can share the same goal of increasing societal dependency but under less reprehensible cover.

This process has been evolving ever since the Clinton administration "welfare reform" was implemented in the '90s.  The usual bunch of compassionate subversives in our social service industries have been doing their best to undermine the intent of the legislation by creating programmatic screens that make "welfare" look less like direct cash transfers from the taxpayers to those who would prefer to enjoy some subsidized leisure.  

My current favorite is a program out in the San Francisco Bay area where I live that uses radio commercials to encourage enrollment in our area's community colleges to get training.  Financial aid, scholarships or loans, I suppose, is available listeners are told for tuition, fees, books, and possibly "rent".
So, the attendee can borrow some money, which may or may not be actually paid back, from a government loan program to pay for classes taught by government employee education professionals and administrators which in these California days probably included free or subsidized "child care". Oh yeah, that "rent" thingee, can the attendees get rent money to pay their mothers whose homes they're lining in?  Huh, why not?

Alpha Check said...

It could be that if there is doubt about whether someone has PTSD, we should be erring on the side of giving them the resources they may need.

The opposite theory, that because not everyone exposed to a similar situation has PTSD or is affected the same way, only the weak get PTSD and seeking help is a sign of weakness is a recipe for continual problems.  Yeah, best to make the individual prove their case, and get bogged down in paperwork.  That's way more effective.  We wouldn't want to presume that someone with military experience is telling the truth.

Where exactly where you?  Can you prove you were there? Can you get someone to testify that you were shot at?  Exactly how far away was that firefight? Can you prove that the firefight was within 1 mile?  I'm sorry, we lost your records, you'll need to start the process over again.

Alpha Check said...

"Support the troops, keep a war going" is better?

MR T's Haircut said...

MR T's Haircut doesnt have time for the Jibba Jabba....

virgil xenophon said...

You NAILED it, Commander! That's EXACTLY
the logic of the left. Discredit the messenger. Forget about principled debate on the merits of the theory or the accuracy of the facts. The publication of the correspondence among lefty journalists participating in "Journolist" as exposed in the D.C. Caller amply confirms/verifies--BY THEIR OWN WORDS--the absolute truth of this viewpoint/analysis.

UltimaRatioRegis said...

Hey AlphaTroll,

How about "Support our Troops, Win the War"? 

Why do you and your Obammunist buddies never mention victory?

"<span>Where exactly where you?  Can you prove you were there? Can you get someone to testify that you were shot at?  Exactly how far away was that firefight? Can you prove that the firefight was within 1 mile?"</span>

Those are pretty reasonable questions for the VA to ask.  They are also reasonable questions for the veteran to answer.  The alternative is just what Sal outlines.  Everybody has PTSD.  Notification of possible deployment?  PTSD.  Closest you got to AFG or Iraq was Fort Pickett?  PTSD.  Hell, volunteer for the Armed Forces knowing that going to war is a possibility?  PTSD from the time you left the recruiter's office. 

I watched many a Vietnam "Vet" play that card for decades, when the closest a number of them got to RVN was Clark AFB.  And they drew the derision and scorn of the two and three-tour guys who saw the bulk of the fighting, because they perpetuated the "crazy Nam vet" profile that Hollywood and the Left are so eager to embrace.

Therapist1 said...

I have to disagree because I know the researchers who are involved and their primary focus is retention, treatment and hopefully prevention.  In the beginning, they were running into a lot of REMF resistance. As the combat deployments increased and the numbers kept increasing, the military started to seek out help because the suicide rates kept rising.

I agree that the parameters can not be to broadly defined.  Conversely, the narrow definition is done for a far more callous reason.  Money.  My experience is having vets brought in to my clinic by police or coming in on their own with PTSD symptoms.  Early on, we contacted the VA for records nd to link to services.  The VA would deny benefits stating that they were not treated prior to discharge and there is no record of PTSD Sxs.  It is later revealed that there was a deliberate attempt to misdiagnose accute stress reactions as adjustment disorders to avoid having to treat them in the future.

Tim, I and those I work with do not want, "victims."  We want to see fully functioning people.  Unfortunately there is a negative view of the military by many in my profession.  However, I would ask that the same broad brush not be used to paint all mental health workers the same way.

Therapist1 said...

It is teaching a lot of psuedo self hypnosis to limit the effects of cortosol on the brain and hopefully to maintain some equalibrium so the individual is not constantly, "switched on."  Being able to downshift is just as improtant as being able to accelerate.

cdrsalamander said...

I have news for you.  Welcome to the 21st Century.  No one in OEF/OIF will every have lost records.  If anyone uses that line, you know they are full of BS.  Everything is archived in multiple places and or cached.

Swing and a miss.  Try again.

UltimaRatioRegis said...

<span>Therapist,</span>

<span>I do have to agree with Tim above.  From comments in a previous post:</span>

<span>"The VA and the medical community at large is still in the dark about most of the subject they wax so authoritative about.  Often they don't know and won't acknowledge the difference between survival behaviors (ducking at the sound of a car backfiring, or in many cases here, checking the sides of roads, tops of buildings, etc.), emotional reactions to trigger stimuli, or true "flashbacks" where someone is unsure or unaware of location and situation.  They lump it all into PTSD, and that is entirely incorrect.  I don't care WHO tries to tell me otherwise.   
 
I guest lectured to the VAQS annual meeting a couple of years ago, spoke for about an hour and then had a general discussion/Q&A period scheduled for 20 minutes.  The session took three hours.  The misconceptions from trained professionals, and some of the attitudes openly expressing returning servicemen and women as "victims" has been indicative of those elsewhere in the medical community.   
 
I actually had a number of people tell me not once, but several times that battle fatigue and shellshock were synonymous.  Until I explained that battle fatigue was psychological in nature, and shellshock was a physical manifestation of enduring a great number of large concussions much like a boxer taking repeated punches to the head.  In the years following that discussion, much more is being understood by medical authorities about closed-head brain injuries, that are not necessarily caused by being struck by shrapnel or debris of the explosion, but by the shock wave itself."   </span>

Attitudes and condescension as I describe above lead to there being a negative view of your profession by many in the military.  I work with the medical profession, and their politics often get in the way of their medicine.  I don't have reason to believe PTSD will be any different.

劉明倫劉明倫 said...

每日都有新日光,每日都有新希望。..................................................

Alpha Check said...

That's funny, almost as funny as thinking about a SWO getting PTSD.  Ironically, the Navy lost my medical record a couple of times.... this century (and I was OEF/OIF).  Try to make something idiot proof, they just make bigger idiots. At least the DoD and VA computers talk to each other... LOL!

Stop Captain, the ship can't handle a MOBOARD of this magnitude! OMG, I have PTSD.  A SWO would love a circular admin drill, and stand behind the assumption of lying service members.  Gotta keep everyone employed!

Alpha Check said...

Do me a favor, define "Win the War" in concrete measurable definitive terms, just so we'll know when it's won.  The war isn't won when we say, oh look, it's won.

Yeah, the VA should ask those questions, and the presumption should be that the service member is telling the truth.  Why is anyone's VA medical diagnosis any of your business, and why should they have to prove they were in a fire fight.

Vietnam is both inflammatory and a topic change.  You know what to call people that do that.   =-O

UltimaRatioRegis said...

Why don't you have the Commander in Chief and the Secretary of State define "win the war" for you?  I do believe that is in their job descriptions, hot shot.  But neither talks of victory.  Nor do you.

As for the VA trusting the service member, Ronnie Reagan's "trust but verify" works well.

Vietnam is the case study for veterans being marginalized as damaged goods, much as Salamander asserts above.  Pretty germane to the argument.  Get your money back from that on-line law school.

Alpha Check said...

<span>"Why don't you have the Commander in Chief and the Secretary of State define "win the war" for you?"</span>
Because you're the one that used it.  If you don't know what it means, why would you say that?  Oh, that's right... "Support the troops, Keep a war going."

C-dore 14 said...

Alpha Check, Re: your comment about SWOs and PTSD...maybe you need to think harder (or maybe just study your history a little more).  I've known several who have been in fires, collisions, and combat action that could easily result in that diagnosis.  Not just in the 20th century either...several SWOs were in the Pentagon on 9/11 (two of my former shipmates died there) not to mention USS COLE.

I'll chalk your comment off to a lame attempt humor based on ignorance.

UltimaRatioRegis said...

Because I am the one who used the word "win", I should be on the National Security Council? 

Wow.  I will have MOBCOM send my clearance data.  That is probably a good-paying gig.

In case you missed that whole Clausewitz thing, and the US Constitution, "victory" is defined by our National Command Authority.  If they're not up to the task, perhaps we should elect someone else.

So, since you seem to think I love war so much, just what is YOUR combat experience?

Alpha Check said...

C-14,

Wait, I get PTSD from the times the aircraft caught on fire?  I had no idea.  SWOs run ships into things all the time, and things catch on fire.  Yes, I mocked his position, guilty as charged.  Glad you see just how ridiculous it is.

All of the things in your characterization fall into the new definition that is decried by Sal (see below).  As for my position, I side with the service member.  If a SWO thinks he has PTSD because docking was stressful, and the CO yelled at him, fine by me.  His diagnosis is none of my business, and if he/she is having trouble coping with life, spend the money on a counselor, and tell the CNO that he can't hit the Tour de France circuit this year. I'd rather see our servicemen get the support they need, instead of a runaround the rulebook.

Which of your examples is not covered by the new definition?  What is your more appropriate, and more restrictive definition?
<span>The occasion for his remark was a new VA rule allowing veterans to receive disability benefits for PTSD if, as non-combatants, they had good reason to fear hostile activity, such as firefights or explosions.</span><span> </span>

Byron said...

Hey Alpha Troll, you having fun pissing everyone off? About tired of lowering the signal to noise ratio? More to the point, you just showed a lot of disrespect to a fine man who the rest of us have an immense amount of respect towards. I expect your time here will be short, as you've just about exhausted Phib's patience.

Everyone else: IGNORE THIS FLAMING ASSHOLE, NO MATTER WHAT HE SAYS.

Alpha Check said...

<span>"Because I am the one who used the word "win", I should be on the National Security Council?"</span>
No, not by a long shot.  You may want to know what the words your using mean.  Just a suggestion, but it is a free country.   :)

C-dore 14 said...

Alpha Check, I used to think that you were someone who liked to be the devil's advocate and stir things up a bit with a counterpoint.  Now I realize, as Byron and URR have, that you're just a troll and an ignorant one at that.

cdrsalamander said...

Byron is Troll Watch Section Leader.

Salty Gator said...

Agreed.  My former skipper was in a boiler explosion on USS To Remain Nameless and led the main space fire response.  Lost a bunch of guys.  Was awarded the Navy and Marine Corps Medal for it. No, Omega, that is not the same thing as a NAM.  The Navy and Marine Corps Medal is the medal you get for heroism not related to combat.

Long story short:  he saved the ship.  Lived to fight another day.  Commanded my ship.  Did a hell of a job.  And now I have the honor of working for him again.

UltimaRatioRegis said...

Byron,

See me ignoring Troll off the port bow....

Notice I didn't even point out that, in admonishing me about my lack of understanding of the language, the Troll said "the words your using".  Making sound like an imbecile Troll.

Notice me ignoring all that, Byron!

UltimaRatioRegis said...

<span>Byron, 
 
See me ignoring Troll off the port bow.... 
 
Notice I didn't even point out that, in admonishing me about my lack of understanding of the language, the Troll said "the words your using".  Making him sound like an imbecile Troll. 
 
Notice me ignoring all that, Byron!</span>

sid said...

Uncle Jimmy (Rodgers for URR's edification) joined the Marines when he was 16 in early 1942.

I remember seeing him one time when I was wee little kid. Dark man, He kinda scared me.

Some time after that mom (they were 1st cousins but like brother and sister)said that Uncle Jimmy had died...that he had "shell shock".

Much later, I found out that he drank himself to death. Also found out that he had been in the thick of things from Cape Gloucester to Pelieu...

Not sure how it fits...but thought I would share.

Alpha Check said...

Byron,

Sir, Thank you for you kind words, and input on the VA's PTSD policy.  I truly appreciate that you stuck to the topic, raised specific concerns, and didn't resort to name calling.  I'm impressed when people don't resort to personal attacks, and simply bounce around the positions and topics.  It's refreshing to see the host keep the blog clean and free of foul language and insults. I'm quite sure he wouldn't tolerate foul language from those he disagrees with. It's good to see that standards aren't based on personal affinity, and are simply good standards of decency for all.

It shows that we're adults, and can disagree without being disagreeable.  Have a fantastic evening!  :)

V/R
Alpha

Redeye80 said...

I guess I need to run down and talk to the VA man.

Few years ago, we ran into our wingman or he to us.  Head on mid-air, both us doing about 525KTS.  We survived, the other guys didn't.  Lost some sleep for awhile. I decided I was doing the job that I loved and I needed to get back on that horse.  It took awhile to get comfortable again but I did.

I used to get a little squirrelly around the anniversary but I got over that as well.

You can either let an event consume your life or you can get it over.  I chose to move on.

Therapist1 said...

Agreed.  It will never happen again.

Therapist1 said...

URR, I am not sure where you quote ended.

As for your definition of "survival techniques," everyone has a startle reflex.  Clap behind a baby and the startle reflex is activated and they cry.  The difference is how debilitating it is and how global the response becomes.  Do they respond that way every time a door slams and then they dissociate, lose track of time, location, etc...as Marcus Luttrel described in "Lone Survivor."

I worked with a former Vietnam Vet who was quite high functioning but eery once in a while would dissociate.  One episode had a UH-1B flying over his apartment complex and as the tell tale whump of the rotor became louder, he dropped and started probing the ground for mines.  Over time much of this stuff begins to fade, for some it does not.

Therapist1 said...

For some it is that easy, for others the physical changes within the brain caused by repeated actions is irreversible.  For example warriors train like they fight so the motions become gross motor and not fine motor as that deteriorates with increased heart rate.  However, those with repeated combat experience begin to litterally rewire their brain resulting in increased response times and clearer thinking under combat stress.  The more exposure, the less likely one is to be able to reboot and down shift to civilian life.  Combine that with horrible images of friends dying, guilt it is your fault (despite evidence to the contrary) and fear you too will die and the brain begins to replay bits and pieces when out of the traumatic event.  The more trauma th emore likely you are to have this response.  It is no different than any other physical injury.  IF one has a TBI congruently, it makes it even harder because as brain matter, unlike other tissue,  is difficult tissue to heal.

MR T's Haircut said...

Byron, I request to be put on the watchbill...

You are relieved.  I have the Troll Watch....  Hey Alphalfa ... kiss my ass.

C-dore 14 said...

Salty, The ship didn't happen to be DDG 17 did it?

張雅筑張雅筑 said...

令人心動的好文章~~..................................................................

UltimaRatioRegis said...

Therapist,

What I am referring to is much more than a startle reflex.  Much like your Nam Vet patient, those reactions are not "disorders" but necessary survival behaviors.  Sometimes they never fade.  They can be triggered by sounds, sights, and smells, and I am sure other things, too. 

Some years ago, there was a small car fire near where I worked, lost the car, but nobody hurt.  I walked out of my office building to go to lunch, and smelled the burning car.  My companions said I took off in a crouch halfway across the parking lot, scanning the rooftops.  It was only when I turned back and saw them gawking at me that it dawned on me that I was in Hanover NH, and everything was fine. There have been other instances of that kind of thing lasting from a few secons to a few tens of seconds.  It is NOT "post-traumatic stress disorder".  It is a perfectly understandable set of reactions to stimuli, albeit a tad embarrassing, perhaps. 

My quote ends with ...shock wave itself", by the way.  The last paragraph is in response to your above comment.  (Maybe I do have PTSD from 6th Grade English!  I frantically checked to make sure I had closed quotes, otherwise I was afraid Mrs. Lynch would give me a C-minus and make me stay in for recess!)

Alpha Check said...

CDR Sal,  I ran across this today (yes it's old).  It runs pretty counter to your comment that "no one in OEF/OIF will every [sic] have lost records."

http://www.npr.org/templates/story/story.php?storyId=127860466

"But during his time in Taji, in central Iraq, the helicopter mechanic spent 24 hours under suicide watch. That information never made it to his new commander in Fort Hood, Texas."

Seems like if someone was on suicide watch during deployment, that might be a red flag.
Seems like if someone says they think about harming themselves more than half the time, that might be a red flag and should justify something more engaging than a sleep study scheduled at some point in the future.

June was a new peak for Army suicides, and they trend significantly higher than the civilian population.  I won't apologize for supporting a loosening of the language for a PTSD diagnosis that allows people to get care they need without having to prove they need it, or deserve it.  If there is a shortage of counselors in the military or VA, authorize private therapists and have Tricare cover it. The people on this site can insult me all they want.

Salty Gator said...

Look Therapist, I suffered a TBI, not service related.  The symptoms look like PTSD when you are recovering:  irratibility, paranoia, minor depression, reclusiveness, nightmares, etc.  Not to mention a migraine that lasts 9 months.  You can treat TBI with some anti-depressants; however, it is a physical problem.  It even has a name:  post-concussive syndrome.  Not PTSD.  Most people don't get PTSD and TBI.  If we're going to start misdiagnosing TBI with TBI-PTSD, you're not doing anyone any favors.

Fortunately, Navy Medicine understood my TBI was not PTSD.  That's why I got into NROTC, once I demonstrated that I was "fully recovered" and up to my normal academic / physical tricks. 

Anon, Alpha Check, I know what you are thinking:  he was brain damaged?!  that explains so much!  

Salty Gator said...

Sir I can't name the ship because it would completely out him and it would completely out me. 

Salty Gator said...

Therapist, are you a USN or other DoD head shrinker?  I'm sorry if I am coming off a little rough on you, my mother is in fact a head shrinker and I respect your profession.  I, like many, feel that your profession can be absorbed in politics and absent a healthy understanding of military culture your profession's well intentioned efforts can cause more harm than good.

Salty Gator said...

Alpha Check Fail, any president who says that they are not comfortable with "victory" but who continues to send our fighting men and women into war is unfit to be the Commander in Chief.  Any President who fights on a war until such time that he can withdraw to absorb minimal political fallout is unfit to be Commander in Chief.  Any President who half-heartedly executes a war in order to be able to not lose the momentum to pass his "great society" domestic agenda is unfit to be Commander in Chief.

Johnson. Nixon. Carter. and now Obama.  Unfit for Command.  And you are unfit for service as an Officer of Sailors or Marines if you believe CHT that is coming out of your yap.

Therapist1 said...

"<span>If we're going to start misdiagnosing TBI with TBI-PTSD, you're not doing anyone any favors"  Nor did I say everyone with a TBI will have PTSD.  I said that brain tissue does not heal as easily as other tissue.
</span>

I never said this.  What I said is PTSD compounded by a TBI is much worse.  Also what you seem to be missing is that PTSD is a PHYSICAL INJURY with psychological symptoms.  The brain is an organ.  When we have good pretest post test MRI scans of those with PTSD it shows smaller hippocampal volume.  PET Scans will show less firing in certain areas of the brain with depression and other anxiety disorders.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819093/

http://www.lawandpsychiatry.com/html/hippocampus.htm

What they have yet to be able to prove is whether the individuals al ready had smaller hippocampal volume.  Also they ahve not been able to prove how much is too much for the resilient individual and why they have more resiliency.

Casey Tompkins said...

URR, thanks for the clarification. It reminded me of one of my favorite Hugh Grant movies, The Englishman Who Went Up a Hill But Came Down a Mountain. One of the locals was nicknamed "Johnny Shellshock," home from the trenches in WW1. At one point during a thunderstorm, Johnny pretty much flips out. Ah, here we go, a clip. Please excuse the Greek subtitles.

Now, from what you've said, that's not shellshock, but I am wondering how well it might match up to PTSD? Unless it's just typical Hollywood drivel.

Therapist1 said...

As a risk assessment specialist, asking someone if they want to hurt themselves is not the same as asking if they are suicidal.  Regardless, it appears more could have been done in the assessment phase.

Therapist1 said...

<span>"I, like many, feel that your profession can be absorbed in politics and absent a healthy understanding of military culture your profession's well intentioned efforts can cause more harm than good."</span>

What...my profession?  pleeeaaaaasssseeee!!!!!!  LMAO....  I agree totally.  We can be well intentioned and totally ignorant and dismissive of the culture.

I am not in the military.  I am civilian worker in VA.  However because of the laws in VA and our location, we work quite closely with a few intelligence agencies, military personnel off post, their families and are part of our local Hostage Barricade Negotiators Unit.  My family is military or former civilian DoD.

Therapist1 said...

Thanks for the clarification.

I agree it is not a "disorder".  That is defined by the impact it has on the individual's normal level of functioning.  For example a Sheriff's DEputy I know recently returned from Iraq and the first time the cell dorrs shut, he dove on the floor covered his ears and dropped his jaw.  He explained it sounded just like a round slamming home and going down range from a 155.  Survival behavior is exactly right!!!   Now if this continued and prevented him from carrying out his duties, began to invade and inhibit his sleep, intrude into his thought process and affect his mood; that would begin to define PTSD.  It is becoming a disorder as evidenced by his decreased functioning across multiple spheres.

UltimaRatioRegis said...

Casey,

My non-medical comment would be that Therapist above outlines the behavior from the clip.  If it impinges on a normal level of functioning, it is possibly PTSD. 

I DID stay at a Holiday Inn Express last night... !

THERAPIST1 said...

Nice......I needed that.

Casey Tompkins said...

I see. Hadn't caught Therapist1's comment before my post. His description does seem to describe events in the clip, so maybe Hollywood didn't screw it up this one time. :)

Alpha Check said...

<span>"Hey Alphalfa ... kiss my ass."</span>
Are you that hard up for attention, or are you just so ignorant that you can't discuss the issues?

MR T's Haircut said...

Master at Arms for the porch troll.. nice time late response.. I hope you don' fly ASW missions.. your Datum is seriously down doppler.