Tuesday, May 12, 2015

Peeling Apart PTSD

I have to admit it, four times I avoided reading Sebastian Junger's bit over at Vanity Fair, How PTSD Became a Problem Far Beyond the Battlefield.

It was the title. I have less then zero interest in another hype-hit-bit from the media - Vanity Fair as the venue didn't help either - about the broken vet, etc etc that is recycled over and over. I'm just done with the whole thing. B.G. Burkett warned about it before 911, I hit on it a decade ago - I'm just done with it.

Don't be like me the first four opportunities, take a moment and read it. The title does not do the article justice. 

Yes, there is discussion about PTSD, but not the way we are used to it being flung about. Junger adds nuance and also shows some of the side issues that may or may not be PTSD (I lean to the not) or PTSD related - just coping mechanisms. He also puts some well needed facts on the ground so we can all have a fact-based conversation, and goodness knows, we need more facts and less compassion trolls on the topic.

That is what hooked me. This was not the normal PTSD belly-picking. This is solid, important stuff.
Suicide by combat veterans is often seen as an extreme expression of PTSD, but currently there is no statistical relationship between suicide and combat, according to a study published in April in the Journal of the American Medical Association Psychiatry. Combat veterans are no more likely to kill themselves than veterans who were never under fire. The much-discussed estimated figure of 22 vets a day committing suicide is deceptive: it was only in 2008, for the first time in decades, that the U.S. Army veteran suicide rate, though enormously tragic, surpassed the civilian rate in America. And even so, the majority of veterans who kill themselves are over the age of 50. Generally speaking, the more time that passes after a trauma, the less likely a suicide is to have anything to do with it, according to many studies. Among younger vets, deployment to Iraq or Afghanistan lowers the incidence of suicide because soldiers with obvious mental-health issues are less likely to be deployed with their units, according to an analysis published in Annals of Epidemiology in 2015. The most accurate predictor of post-deployment suicide, as it turns out, isn’t combat or repeated deployments or losing a buddy but suicide attempts before deployment. The single most effective action the U.S. military could take to reduce veteran suicide would be to screen for pre-existing mental disorders.
Amen and thank you. There is more.
Part of the problem is bureaucratic: in an effort to speed up access to benefits, in 2010 the Veterans Administration declared that soldiers no longer have to cite a specific incident—a firefight, a roadside bomb—in order to be eligible for disability compensation. He or she simply has to report being impaired in daily life. As a result, PTSD claims have reportedly risen 60 percent to 150,000 a year. Clearly, this has produced a system that is vulnerable to abuse and bureaucratic error. A recent investigation by the V.A.’s Office of Inspector General found that the higher a veteran’s PTSD disability rating, the more treatment he or she tends to seek until achieving a rating of 100 percent, at which point treatment visits drop by 82 percent and many vets quit completely. In theory, the most traumatized people should be seeking more help, not less. It’s hard to avoid the conclusion that some vets are getting treatment simply to raise their disability rating.

In addition to being an enormous waste of taxpayer money, such fraud, intentional or not, does real harm to the vets who truly need help. One Veterans Administration counselor I spoke with described having to physically protect someone in a PTSD support group because some other vets wanted to beat him up for faking his trauma. This counselor, who asked to remain anonymous, said that many combat veterans actively avoid the V.A. because they worry about losing their temper around patients who are milking the system. “It’s the real deals—the guys who have seen the most—that this tends to bother,” this counselor told me.
Bookmark this article next time you find yourself cornered by someone that likes to wallow in PTSD-by proxy.

This next pull quote hit home.
If we weed out the malingerers on the one hand and the deeply traumatized on the other, we are still left with enormous numbers of veterans who had utterly ordinary wartime experiences and yet feel dangerously alienated back home. Clinically speaking, such alienation is not the same thing as PTSD, but both seem to result from military service abroad, so it’s understandable that vets and even clinicians are prone to conflating them. Either way, it makes one wonder exactly what it is about modern society that is so mortally dispiriting to come home to.
There are a few things in his article I'm not in alignment with, but I think Junger has advanced the conversation - and for that alone it deserves a full read.

Hat tip RC.

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