Over at Scientific American, David Dobbs has introduced a wonderful new "seminar blog" in which researchers discuss a specific topic or paper. This week's topic is the prevalence of Post Traumatic Stress Disorder (PTSD) among Vietnam veterans. The catalyst is a Science paper by Bruce Dohrenwend published last year which concluded that actual rates of PTSD were roughly 40 percent lower than previous studies had shown.

But that reduction in PTSD - a statistic that the popular media trumpeted - occludes the larger lesson of the study:

The Dohrenwend study provides not a refutation or even a "huge revision" of the NVVRS [PTSD] findings, but rather a rigorous and vital confirmation of the picture those findings painted of war's psychological consequences. It refutes the critics' idea that we've overestimated PTSD or coddled veterans who claim to have it, and it documents that, for most part, the suffering is real. It also shows that the charge of the critics--that veterans are exaggerating or dissembling--is false.

I'm still amazed that some people don't take PTSD seriously. How much evidence do we need? Neuroscience is beginning to understand the etiology of the illness. We can see how people suffering from PTSD have reduced levels of cortisol and a shrunken hippocampus. This fits in with a large body of evidence in other animals which demonstrates that chronic stress is poison for the brain. It not only suppresses neurogenesis, but kills existing brain cells. And nothing is more chronically stressful than war.

Furthermore, we can now see how these neural changes manifest themselves as a set of devastating symptoms. And this doesn't only include the usual suspects of anxiety, depression and violence. According to a paper that appeared in JAMA last summer, "soldiers recently returned from duty in Iraq were highly likely to show subtle lapses in memory and in ability to focus, a deficit that often persisted for more than two months after they arrived home." These findings, of course, make perfect sense, since the hippocampus is essential for learning and memory.

Despite all this evidence, the Army shown signs of still not getting it. According to a very disturbing NPR report from late last year:

Army studies show that at least 20 percent to 25 percent of the soldiers who have served in Iraq display symptoms of serious mental-health problems, including depression, substance abuse and post-traumatic stress disorder (PTSD). Administration officials say there are extensive programs to heal soldiers both at home and in Iraq.

But an NPR investigation at Colorado's Ft. Carson has found that even those who feel desperate can have trouble getting the help they need. In fact, evidence suggests that officers at Ft. Carson punish soldiers who need help, and even kick them out of the Army.

It's as if the Army still subscribes to Cartesian dualism. If you get injured in the body - if a bullet or IED tears into the flesh - then the Army will help you in any way possible. But if you suffer a mental wound, if the chronic stress of war injures your brain, then you not only don't get sufficient treatment, but end up getting punished. When is the Army going to realize that both mental and bodily illness have physical causes? The mind can also be a casualty of war.


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its not "as if" they subscribe to dualism, they do. They may not describe it that way, but most of society looks at the "mind" as if its some ether-like substance.

Respectful of Otters has an interesting piece on some of the factors behind the reluctance to acknowledge PTSD.
Another basis for the visceral reaction against PTSD is its implications under a common and compelling, but deeply flawed, narrative of the dynamics of war. This is the "national Will" concept, the idea that triumph in war is the result of a sufficiently strong will and failure is caused by disloyalty, dissent, and lack of will on the part of the people. This piece has an excellent description of the phenomenon. Under this interpretation of war, PTSD has an almost treasonous air. The condition looks like so much leftist psychobabble invented to serve the political ends of disloyal antiwar elements by coddling cowards in the ranks. Alternatively, PTSD is a real condition; but one caused by defeatist therapists who assume that combat must damage people and by the scorn of a public that refuses to honor its soldiers. While scientifically baseless and terribly dangerous for PTSD patients, this narrative is tremendously convenient and satisfactory to those who hold to the theory of will. PTSD is not a cost of war, it is a simple symptom of personal and cultural cowardice.
See This piece for a good description of the opposition to PTSD.

Unfortunately, the lack of response to PTSD is more than just the error of dualism. There are strong reasons, some flawed but sincere, and some coldly pragmatic, for PTSD to be ignored, denigrated, and denied whenever possible. Just like global climate change or evolution, PTSD suffers from a resistance that goes far beyond ignorance.

Just over one year ago, I was diagnosed with PTSD stemming from a sexual trauma that happened while I was on active duty in the Navy 25 years ago. I have filed a claim for compensation through the VA, but my modest hope for help is quickly fading.

My VA claim representative told me that there were 60,000 new claims filed over a very short period of time. I do not know what the numbers were before or if the figure is close to being correct, but what I do know is that the Bush Administration noticed and they are already beginning to fight those claims by minimizing the diagnosis of PTSD to the status of malingering. We are lazy and we all just want hand-outs.

What we will soon see is an adapted attitude from the top down that these service men and women are just whiners who need to be reprimanded. They will be dealt with within their command.

Here is how they helped me: I was sent to a padded room for 48 hours because I was suicidal. No other treatment was offered. No one would listen, especially the psychiatrist! The only thing I remember was the feeling that I had done something wrong to them; I had no right to threaten to damage government property. (But they had every right to send me to work with a known sexual predator in order to catch him in the act.)

My heart aches for the men and women who are being mentally wounded by what they are experiencing through this war.

Having PTSD means that you continue to experience the traumatic event long after it is over. Thanks, George, I do feel like I am being fucked again.

I'm a Vietnam Vet who is total and permanent due to combat trauma (PTSD) So let me give a different perspective. On the Army, it is the Army's job to train people who can kill people. Most of us can't do that without training. They do this for the protection of our country. There are probably quite a number of people in the army with some form of PTSD. They don't even realize they have it. It is not disabling. As long as they stay in the military they can deal with their lives for the most part just fine. This is a normal environment for them. For those who are in the military and cannot deal with military life because of combat trauma, they need to get out and get help. They need to get out and go to the VA where they can find help.

We can see how people suffering from PTSD have reduced levels of cortisol and a shrunken hippocampus. This fits in with a large body of evidence in other animals which demonstrates that chronic stress is poison for the brain. It not only suppresses neurogenesis, but kills existing brain cells. And nothing is more chronically stressful than war.

While this is true, it is not true for all who have engaged in combat. There are guys who served in Vietnam, returned home and lived fairly normal lives. The big question for combat trauma is why are some so effected that they become disabled and why some are not. This relates to all PTSD sufferers. For almost every adult trauma there are some who have endured the trauma with no disabling effects and some who are so disabled they can no longer function normally in society. Therefore, it becomes difficult to connect the event with the disability.

I took a look at the last article referenced by JTP and it was another bash job on Bush. I am so tired of these that they hold no interest for me. However, I did extract one line which I wanted to address:

Battlefield damage is minimized while operatives plant stories in the media to trumpet the view that the source of PTSD resides solely within the individual and not with the war itself.

One of the things psychiatry is coming to realize as to why some vets develop disabling combat trauma and other don't is the existence of pre-existing factors (other than combat) that will make them susceptible to combat trauma. This was certainly the case with me and the other vets I know. However, the trigger which leads to full-blown combat trauma is triggered as a result of combat. The VA understands this. The government will not exclude you because of pre-existing factors.

With regards to cutbacks, yes there have been cutbacks but I have not seen it reflected in the VA I deal with. What I have seen is better diagnosing of disabling PTSD so that the funds available are going to those who need it. Remember not all PTSD is disabling PTSD and not all combat veterans have PTSD.

When I finally found myself in the psych ward of a VA hospital I realized I had a problem and that the only person that can help me was myself. The VA offered me tools with which to deal with PTSD but it was I who decided to use them. It was I who began to study PTSD and what it did to me. I was the one who took the effort to go to counseling, to listen to what was said and bring these ideas into my life. I read books on PTSD. I began to learn how the brain works and why PTSD disabled me. But PTSD is not going to define me. I am not a victim of PTSD. I am a survivor and how well I survive depends on me.

To the lady having problems with the VA, work with one of a number of service organizations who are there to help you with the VA.