PTSD Lives a Long Life
July 11, 2009 by Michael Leon · 4 Comments
When discussing Post Traumatic Stress Disorder (PTSD), one wishes to be precise and careful in refuting the political forces challenging this diagnosis of a malady that is pervasive in our veterans.
Col. Dan Cedusky, USA (Ret) sends us a piece entitled Valid Diagnosis Who Benefits From Challenging Its Existence from the Psychiatric Times written by Rachel Yehuda, PhD and Alexander C. McFarlane, MD. See below.
So to the neocons and specifically the rightwing VA Inspector General’s offices around the country that are giving our Wisconsin veterans and indeed veterans all over the country such a hard time, let me be precise and careful in my lay-medical advice to you: Go fuck yourselves.
Excerpt below is from the issue of July 9, 2009 Psychiatric Times. Vol. 26 No. 7
Point/CounterpointPTSD Is a Valid Diagnosis: Who Benefits From Challenging Its Existence?
Rachel Yehuda, PhD and Alexander C. McFarlane, MD
… The PTSD construct is valid independent of symptoms of overlapping disorders.5,6 The argument that ’symptom overlap’ calls the PTSD diagnosis into question reflects a fundamental misunderstanding of the purpose of diagnostic categories—which is to organize symptoms around a common cause to effectively provide the needed intervention. Treating specific symptoms outside the framework of a diagnosis is problematic.7 The idea here is that one arguably treats behavioral manifestations of panic attacks that come ‘out of the blue’ differently from similar physiological reactivity provoked by traumatic reminders in PTSD. The PTSD diagnosis implies a failure of homeostatic mechanisms involved in stress recovery.8 In the absence of trauma exposure, some of the same symptoms might reflect a different neurobiological process and treatment intervention.
We agree that the diagnosis of PTSD almost entered a cul-de-sac when it initially postulated—back in the days before functional neuroimaging in psychiatric research—that symptoms resulted from an organic brain change occurring secondary to stress-induced arousal. Fortunately, advances in neuroscience disconfirmed this, while providing the constructs for a more nuanced way of understanding enduring brain effects resulting from environmental perturbations—including gene-environment interactions, epigenetic modifications, and other molecular mechanisms.9-11 These advances have not only explained mechanisms involved in enduring stress effects but have also revealed individual differences that explain why long-term illness develops in only some traumaexposed persons.9 That initial theories about pathophysiology may have been erroneous does not jeopardize the validity of the PTSD construct any more than the concept of schizophrenia was jeopardized when its cause was considered to be the “schizophrenogenic mother.”12
So too, the ‘errors’ that can be made in the diagnosis of PTSD underscore the need for better training. Also, there is every reason to believe that scientific advances will yield PTSD biomarkers that differentiate this condition from others, particularly, those with overlapping symptoms. Progress in this area has already been made, and the yield from the rapid development of methodologies for unbiased genome-wide genotyping, gene expression, and molecular approaches are only beginning to be realized.9-11 Soon it will be more difficult for those who have never seen PTSD clinically to dismiss the “validity” of the PTSD diagnosis.
What is it that really bothers people? Could it be the high price tag of caring for persons disabled with PTSD? Could it be resentment that some persons fake symptoms for secondary gain? ‘Malingerophobia’ is a strong fear for doctors, but being able to fake an illness does not invalidate it as a diagnostic entity.13 Could it be that if we continue to assert that trauma exposure really can result in a mental health syndrome, our society will need to shoulder some of the responsibility for primary prevention and start making the world safer from violence, accidents, and disasters that threaten our citizens? [Emphasis added by all of us.]
The fact that many persons choose not to continue mental health treatment for PTSD after they become service-connected is often used to ‘prove’ that the injury was never really there and that the diagnosis was only a vehicle for compensation. Anyone who works with veterans or civilians battling the courts in an attempt to obtain compensation for PTSD would understand that severity of PTSD would be high during this process. It is stressful to recount explicit details of traumatic material—even with appropriate support, corrective information, and anxiety-reduction techniques in therapy. Imagine needing to do so in the context of an adversarial process in which the veracity of one’s report of trauma or level of distress is questioned. It is unfortunate that some veterans link the experiences of seeking compensation with mental health treatment at the VA and do not return. It is also true that the compensation- seeking process promotes avoidance behavior, accounting for more dropouts. Because there are still barriers to care, it is important not to draw conclusions about the prevalence, severity, or reality of any mental illness based on treatment-seeking behavior. Indeed, only a minority of those with PTSD seek any treatment.14,15 …
Dr Yehuda is director of the PTSD Program at James J. Peters Veterans Affairs Medical Center in the Bronx, and professor of psychiatry at Mount Sinai School of Medicine in New York City. Dr McFarlane is professor of psychiatry and head of CMVH University of Adelaide Node at the Centre for Military and Veterans’ Health at the University of Adelaide, Australia.
Acknowledgments: This work was supported by funding from Veterans Affairs, Department of Defense, and NIMH.
1. Yehuda R, McFarlane AC. Conflict between current knowledge
about posttraumatic stress disorder and its original conceptual basis. Am J
Psychiatry. 1995; 152:1705-1713.
2. Weathers FW, Keane TM. The Criterion A
problem revisited: controversies and challenges in defining and measuring
psychological trauma. J Trauma Stress. 2007;20:107-121.
3. Spitzer RL, First
MB, Wakefield JC. Saving PTSD from itself in DSM-V. J Anxiety Disord.
2007;21:233-241.
4. McHugh PR, Treisman G. PTSD: a problematic diagnostic
category. J Anxiety Disord. 2007;21:211-222.
5. North CS, Suris AM, Davis M,
Smith RP. Toward validation of the diagnosis of posttraumatic stress disorder.
Am J Psychiatry. 2009;166:34-41.
6. Elhai JD, Grubaugh AL, Kashdan TB, Frueh
BC. Empirical examination of a proposed refinement to DSM-IV posttraumatic
stress disorder symptom criteria using the National Comorbidity Survey
Replication data [published correction appears in J Clin Psychiatry.
2008;69:1985]. J Clin Psychiatry. 2008;69:597-602.
7. McFarlane AC, Yehuda
R. Clinical treatment of posttraumatic stress disorder: conceptual challenges
raised by recent research. Aust N Z J Psychiatry. 2000;34:940-953.
8. Yehuda
R. Post-traumatic stress disorder. N Engl J Med. 2002;346:108-114.
9. Yehuda
R, LeDoux J. Response variation following trauma: a translational neuroscience
approach to understanding PTSD. Neuron. 2007;56:19-32.
10. Koenen KC, Nugent
NR, Amstadter AB. Geneenvironment interaction in posttraumatic stress disorder:
review, strategy and new directions for future research. Eur Arch Psychiatry
Clin Neurosci. 2008; 258:82-96.
11. Malhi GS, Lagopoulos J. Making sense of
neuroimaging in psychiatry. Acta Psychiatr Scand. 2008; 117:100-117.
12.
Banati R, Hickie IB. Therapeutic signposts: using biomarkers to guide better
treatment of schizophrenia and other psychotic disorders. Med J Aust. 2009;190
(suppl 4):S26-S32.
13. Pilowsky I. Malingerophobia. Med J Aust. 1985;
143:571-572.
14. Kessler RC. Posttraumatic stress disorder: the burden to
the individual and to society. J Clin Psychiatry. 2000;61(suppl 5):4-14.
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Spinazzola J, Blaustein M, van der Kolk BA. Posttraumatic stress disorder
treatment outcome research: the study of unrepresentative samples? J Trauma
Stress. 2005;18:425-436.
[QUOTE] The fact that many persons choose not to continue mental health treatment for PTSD after they become service-connected is often used to ‘prove’ that the injury was never really there and that the diagnosis was only a vehicle for compensation. Anyone who works with veterans or civilians battling the courts in an attempt to obtain compensation for PTSD would understand that severity of PTSD would be high during this process. [END QUOTE]
Leon,
How timely, it seems as if unintentionally Veterans Today writers have begun focusing on the Myths and Realities of PTSD, and you’ve hit on one important aspect that cannot be underestimated and in fact need be DEALT with – THE FISCAL COSTS AND POLITICAL IDEOLOGICAL ASPECTS OF PTSD.
To be honest with you, I was having similar symptoms tied to PTSD, and tied to trauma both combat related and personal, however I went into the VA Claims process knowing full well just how controversial and politically charged the issue of PTSD had become and this was before the Global War on Terror, well just before circa 2000-2001.
Point: I was diagnosed with Major Depression, a slight dementia by a Navy medical doctor who referred me to a Navy Shrink and I was a DON civilian not Sailor. However, that said, it was the medical doctor not shrink who prescribed zolft for me. That was a year or so before filing my VA Claim.
By the time I filed my claim I was seeing an outside shrink via TRICARE as a military retiree. The base Mental Health clinic really didn’t want to touch retirees because by now it was wartime and they could not really control how retirees THINK.
Long story short, I was advised by my civilian shrink that was familiar with VA Claims to not apply for PTSD but bipolar as disagnosed by him and another shrink in office. This was tied to my military records only because I happened to be smart enough to keep my military medical records at home with me instead of at the base hospital that is until the Air Force wised up to the idea that if Vets had immediate access to their military medical records we could more easily file a VA Claim. I assume they caught onto this via interaction with the VA. Anyway, if you are a retiree than you know we are no longer allowed to keep our military medical records at home despite the military no longer using paper records per se but automated computer databases on us. HUM.
Back to your point, see I do have bipolar. I went to the VA Mental Health clinic for a few visits but my attitude and views on the war did not quite fit in with the attitude and views of my VA Shrink a retired Air Force Colonel passionate Bush supporter, and so on.
My point is that Veterans choose not to continue mental health treatment for PTSD at a VA after they become service-connected for many and varied reasons that have everything to do with their mental illness!!!
Example: In addition to the VA shrink being a biased Neocon, at least the Therapist was open minded, but he was disabled too – go figure. I mean mentally unstable. At least I got along with him because we had something in common – mental illness.
Another example: The primary care physcian I had at the VA, an Iranian BTW, referred me to mental health for Anger Management Rap Session. When I showed up for the session my political views had become so common knowledge at the VAMC that the only three people who showed up for the Rap session were another Neocon shrink, and patient affairs talking dog to tell me the Anger Management sessions had been cancilled for political reasons. They actually told me that. In a Rap session that even incarcerted Vets can attend IF under guard, it was cancilled because I was viewed as a politcal threat.
Another example: I tried to attend a Iraq-Afghanistan Vet PTSD Rap session being formed way back in 2005 as the VA was experimenting with it. Ironically over half the members showing up to Rap were Vietnam Vets dissatisfied with their Vietnam War Rap sessions. What really took the cake is that active duty or Guard members subject to recall were the focus NOT Iraq and Afghanistan Veterans in the true sense of the meaning.
Rules of Engagement: You could only be part of any Rap group at the VA if you did not in anyway question the war(s) that you believe contributed to your PTSD. DUMB, DUMB, DUMB.
Hell, if I go out to my listserve and tell the vast number of younger Vets on it that in order to get PTSD treatment at the VA is to only talk about the good things about war, how many young and smarter Vets would go???? Not too many.
In fact, the rap groups was to focus on Gulf War, Iraq and Afghanistan War Vets not active duty or Vietnam Vets who had their own sessions.
I was not impressed by either the active duty Vets who either could not see how their ops tempo had nothing to do with their PTSD, and they were not allowed to talk about it even if it did due to the Hatch Act. The Vietnam Vets must have either been invited to attend by the VA baby sitter, because most of them were Reich wing Vets.
That I could have live with, but you see I have a therapy dog who keeps me from wanting to kill anything or put my fist through a wall or you. When some overweight Vietnam Vet sits in his wheel chair and is telling young Iraq and Afghanistan Vets that he still got a thrill out of killing small birds and squirrils in his backyard.
That was the first and last Rap session for me, because yep I had bipolar for sure, maybe even PTSD, but to sit and listen to this nonsense while some VA admin employee monitoring us tells me not to talk politics is not my idea of PTSD therapy or Rap session.
Hell, PTSD by birth and definition IS ALL ABOUT POLITICS!!!
Anyway, I feel my bipolar and PTSD whatever is under control enough that I don’t want to end my life because of other people’s (politicians and Reich wing nuts) mistakes, I know when to play THE GAME, so I get my Mental Health medication maintenance from an Air Force Base.
When they ask me if I want to be seen by the Air Force shrink now that the war(s) are no longer popular even within the Air Force, I tell the USAF doctor that IF anyone can convince me to blindly support the Iraq or Afghanistan war or occupation I’ll take them up on Mental Health. In fact, I put it this way. "I’m a retired officer, I’m suppose to blindly support Wars, so I must be nuts when I feel smarter than that. I’d love for someone at the base to cure me so that I can passionately support any war the vast majority of American’s don’t or won’t, especially if called upon to fight it beside me."
The response I got from Air Force personnel was quite distinctive than from VA personnel, instead of telling me to not talk politics, I was told that I was an AMERICAN!
Bobby Hanafin
The Mustang Major
[QUOTE] The fact that many persons choose not to continue mental health treatment for PTSD after they become service-connected is often used to ‘prove’ that the injury was never really there and that the diagnosis was only a vehicle for compensation. Anyone who works with veterans or civilians battling the courts in an attempt to obtain compensation for PTSD would understand that severity of PTSD would be high during this process. [END QUOTE]
Leon,
How timely, it seems as if unintentionally Veterans Today writers have begun focusing on the Myths and Realities of PTSD, and you’ve hit on one important aspect that cannot be underestimated and in fact need be DEALT with - THE FISCAL COSTS AND POLITICAL IDEOLOGICAL ASPECTS OF PTSD.
However, I do have but one editorial comment: could you please change f–k you to screw you?
We are attempting to be somewhat a family oriented website, and though my sentiments are definitely with you, screw is a bit more acceptable in mixed company today.
To be honest with you, I was having similar symptoms tied to PTSD, and tied to trauma both combat related and personal, however I went into the VA Claims process knowing full well just how controversial and politically charged the issue of PTSD had become and this was before the Global War on Terror, well just before circa 2000-2001.
Point: I was diagnosed with Major Depression, a slight dementia by a Navy medical doctor who referred me to a Navy Shrink and I was a DON civilian not Sailor. However, that said, it was the medical doctor not shrink who prescribed zolft for me. That was a year or so before filing my VA Claim.
By the time I filed my claim I was seeing an outside shrink via TRICARE as a military retiree. The base Mental Health clinic really didn’t want to touch retirees because by now it was wartime and they could not really control how retirees THINK.
Long story short, I was advised by my civilian shrink that was familiar with VA Claims to not apply for PTSD but bipolar as disagnosed by him and another shrink in office. This was tied to my military records only because I happened to be smart enough to keep my military medical records at home with me instead of at the base hospital that is until the Air Force wised up to the idea that if Vets had immediate access to their military medical records we could more easily file a VA Claim. I assume they caught onto this via interaction with the VA. Anyway, if you are a retiree than you know we are no longer allowed to keep our military medical records at home despite the military no longer using paper records per se but automated computer databases on us. HUM.
Back to your point, see I do have bipolar. I went to the VA Mental Health clinic for a few visits but my attitude and views on the war did not quite fit in with the attitude and views of my VA Shrink a retired Air Force Colonel passionate Bush supporter, and so on.
My point is that Veterans choose not to continue mental health treatment for PTSD at a VA after they become service-connected for many and varied reasons that have everything to do with their mental illness!!!
Example: In addition to the VA shrink being a biased Neocon, at least the Therapist was open minded, but he was disabled too – go figure. I mean mentally unstable. At least I got along with him because we had something in common – mental illness.
Another example: The primary care physcian I had at the VA, an Iranian BTW, referred me to mental health for Anger Management Rap Session. When I showed up for the session my political views had become so common knowledge at the VAMC that the only three people who showed up for the Rap session were another Neocon shrink, and patient affairs talking dog to tell me the Anger Management sessions had been cancilled for political reasons. They actually told me that. In a Rap session that even incarcerted Vets can attend IF under guard, it was cancilled because I was viewed as a politcal threat.
Another example: I tried to attend a Iraq-Afghanistan Vet PTSD Rap session being formed way back in 2005 as the VA was experimenting with it. Ironically over half the members showing up to Rap were Vietnam Vets dissatisfied with their Vietnam War Rap sessions. What really took the cake is that active duty or Guard members subject to recall were the focus NOT Iraq and Afghanistan Veterans in the true sense of the meaning.
Rules of Engagement: You could only be part of any Rap group at the VA if you did not in anyway question the war(s) that you believe contributed to your PTSD. DUMB, DUMB, DUMB.
Hell, if I go out to my listserve and tell the vast number of younger Vets on it that in order to get PTSD treatment at the VA is to only talk about the good things about war, how many young and smarter Vets would go???? Not too many.
In fact, the rap groups was to focus on Gulf War, Iraq and Afghanistan War Vets not active duty or Vietnam Vets who had their own sessions.
I was not impressed by either the active duty Vets who either could not see how their ops tempo had nothing to do with their PTSD, and they were not allowed to talk about it even if it did due to the Hatch Act. The Vietnam Vets must have either been invited to attend by the VA baby sitter, because most of them were Reich wing Vets.
That I could have live with, but you see I have a therapy dog who keeps me from wanting to kill anything or put my fist through a wall or you. When some overweight Vietnam Vet sits in his wheel chair and is telling young Iraq and Afghanistan Vets that he still got a thrill out of killing small birds and squirrils in his backyard.
That was the first and last Rap session for me, because yep I had bipolar for sure, maybe even PTSD, but to sit and listen to this nonsense while some VA admin employee monitoring us tells me not to talk politics is not my idea of PTSD therapy or Rap session.
Hell, PTSD by birth and definition IS ALL ABOUT POLITICS!!!
Anyway, I feel my bipolar and PTSD whatever is under control enough that I don’t want to end my life because of other people’s (politicians and Reich wing nuts) mistakes, I know when to play THE GAME, so I get my Mental Health medication maintenance from an Air Force Base.
When they ask me if I want to be seen by the Air Force shrink now that the war(s) are no longer popular even within the Air Force, I tell the USAF doctor that IF anyone can convince me to blindly support the Iraq or Afghanistan war or occupation I’ll take them up on Mental Health. In fact, I put it this way. "I’m a retired officer, I’m suppose to blindly support Wars, so I must be nuts when I feel smarter than that. I’d love for someone at the base to cure me so that I can passionately support any war the vast majority of American’s don’t or won’t, especially if called upon to fight it beside me."
The response I got from Air Force personnel was quite distinctive than from VA personnel, instead of telling me to not talk politics, I was told that I was an AMERICAN!
Bobby Hanafin
The Mustang Major
[QUOTE] The fact that many persons choose not to continue mental health treatment for PTSD after they become service-connected is often used to ‘prove’ that the injury was never really there and that the diagnosis was only a vehicle for compensation. Anyone who works with veterans or civilians battling the courts in an attempt to obtain compensation for PTSD would understand that severity of PTSD would be high during this process. [END QUOTE]
Leon,
How timely, it seems as if unintentionally Veterans Today writers have begun focusing on the Myths and Realities of PTSD, and you’ve hit on one important aspect that cannot be underestimated and in fact need be DEALT with - THE FISCAL COSTS AND POLITICAL IDEOLOGICAL ASPECTS OF PTSD.
However, I do have but one editorial comment: could you please change f–k you to screw you?
We are attempting to be somewhat a family oriented website, and though my sentiments are definitely with you, screw is a bit more acceptable in mixed company today.
To be honest with you, I was having similar symptoms tied to PTSD, and tied to trauma both combat related and personal, however I went into the VA Claims process knowing full well just how controversial and politically charged the issue of PTSD had become and this was before the Global War on Terror, well just before circa 2000-2001.
Point: I was diagnosed with Major Depression, a slight dementia by a Navy medical doctor who referred me to a Navy Shrink and I was a DON civilian not Sailor. However, that said, it was the medical doctor not shrink who prescribed zolft for me. That was a year or so before filing my VA Claim.
By the time I filed my claim I was seeing an outside shrink via TRICARE as a military retiree. The base Mental Health clinic really didn’t want to touch retirees because by now it was wartime and they could not really control how retirees THINK.
Long story short, I was advised by my civilian shrink that was familiar with VA Claims to not apply for PTSD but bipolar as disagnosed by him and another shrink in office. This was tied to my military records only because I happened to be smart enough to keep my military medical records at home with me instead of at the base hospital that is until the Air Force wised up to the idea that if Vets had immediate access to their military medical records we could more easily file a VA Claim. I assume they caught onto this via interaction with the VA. Anyway, if you are a retiree than you know we are no longer allowed to keep our military medical records at home despite the military no longer using paper records per se but automated computer databases on us. HUM.
Back to your point, see I do have bipolar. I went to the VA Mental Health clinic for a few visits but my attitude and views on the war did not quite fit in with the attitude and views of my VA Shrink a retired Air Force Colonel passionate Bush supporter, and so on.
My point is that Veterans choose not to continue mental health treatment for PTSD at a VA after they become service-connected for many and varied reasons that have everything to do with their mental illness!!!
Example: In addition to the VA shrink being a biased Neocon, at least the Therapist was open minded, but he was disabled too – go figure. I mean mentally unstable. At least I got along with him because we had something in common – mental illness.
Another example: The primary care physcian I had at the VA, an Iranian BTW, referred me to mental health for Anger Management Rap Session. When I showed up for the session my political views had become so common knowledge at the VAMC that the only three people who showed up for the Rap session were another Neocon shrink, and patient affairs talking dog to tell me the Anger Management sessions had been cancilled for political reasons. They actually told me that. In a Rap session that even incarcerted Vets can attend IF under guard, it was cancilled because I was viewed as a politcal threat.
Another example: I tried to attend a Iraq-Afghanistan Vet PTSD Rap session being formed way back in 2005 as the VA was experimenting with it. Ironically over half the members showing up to Rap were Vietnam Vets dissatisfied with their Vietnam War Rap sessions. What really took the cake is that active duty or Guard members subject to recall were the focus NOT Iraq and Afghanistan Veterans in the true sense of the meaning.
Rules of Engagement: You could only be part of any Rap group at the VA if you did not in anyway question the war(s) that you believe contributed to your PTSD. DUMB, DUMB, DUMB.
Hell, if I go out to my listserve and tell the vast number of younger Vets on it that in order to get PTSD treatment at the VA is to only talk about the good things about war, how many young and smarter Vets would go???? Not too many.
In fact, the rap groups was to focus on Gulf War, Iraq and Afghanistan War Vets not active duty or Vietnam Vets who had their own sessions.
I was not impressed by either the active duty Vets who either could not see how their ops tempo had nothing to do with their PTSD, and they were not allowed to talk about it even if it did due to the Hatch Act. The Vietnam Vets must have either been invited to attend by the VA baby sitter, because most of them were Reich wing Vets.
That I could have live with, but you see I have a therapy dog who keeps me from wanting to kill anything or put my fist through a wall or you. When some overweight Vietnam Vet sits in his wheel chair and is telling young Iraq and Afghanistan Vets that he still got a thrill out of killing small birds and squirrils in his backyard.
That was the first and last Rap session for me, because yep I had bipolar for sure, maybe even PTSD, but to sit and listen to this nonsense while some VA admin employee monitoring us tells me not to talk politics is not my idea of PTSD therapy or Rap session.
Hell, PTSD by birth and definition IS ALL ABOUT POLITICS!!!
Anyway, I feel my bipolar and PTSD whatever is under control enough that I don’t want to end my life because of other people’s (politicians and Reich wing nuts) mistakes, I know when to play THE GAME, so I get my Mental Health medication maintenance from an Air Force Base.
When they ask me if I want to be seen by the Air Force shrink now that the war(s) are no longer popular even within the Air Force, I tell the USAF doctor that IF anyone can convince me to blindly support the Iraq or Afghanistan war or occupation I’ll take them up on Mental Health. In fact, I put it this way. "I’m a retired officer, I’m suppose to blindly support Wars, so I must be nuts when I feel smarter than that. I’d love for someone at the base to cure me so that I can passionately support any war the vast majority of American’s don’t or won’t, especially if called upon to fight it beside me."
The response I got from Air Force personnel was quite distinctive than from VA personnel, instead of telling me to not talk politics, I was told that I was an AMERICAN!
Bobby Hanafin
The Mustang Major
Okay, first of all I applaud all of the hard work I’m sure was needed for this article. I wonder though who your intended target reader was supposed to be. Was is for other PHD’s such as yourself or the lay person Veteran who needs the help and understanding of what they are experiencing.
If it was for the Veterans, it would be nice if it were written in a user friendly manner. You are not going for a grant, speak to us as if we were your friends or family, lose the ten dollar words. What impresses us is the comfortable information we can understand and use. Knowledge is great but can be a total loss if not able to share correctly of completely. Your reader should not need to feel the need to have a Dictionary at the ready to understand you. Okay, you are smart, get over it. It serves no purpose if you can’t reach and teach.