Vet's mental health needs increase!

[CPTAUSRET]

http://www.foxnews.com/story/0,2933,190396,00.html

"He and other critics point to recent Army statistics indicating that 35 percent of soldiers and Marines returning from Iraq sought mental health care and 19 percent were diagnosed with a mental disorder like post traumatic stress disorder, depression or anxiety within a year of coming home."


This is only going to get worse, the VA is pretty much overwhelmed.

Any thoughts?

Terry

[Jack Moroney (RIP)]

[QUOTE=CPTAUSRET
This is only going to get worse, the VA is pretty much overwhelmed.

Any thoughts?

Terry[/QUOTE]

Yep, but you are probably not going to want to hear them. Now I will not claim any expertise in this area, but I have seen a whole gaggle of whiners, losers, quiters, dead-beats, and shitbirds claiming PTSD who came into the service with more mental baggage than they could have ever accumulated in a career in the military. The only place most of the ones I have come across have looked the elephant in the eye was in the zoo. I think I mentioned this one time before, but one of these clowns is so proud of his status he has PTSD on his license plate-sort of like a badge of honor akin to all those psychological testers who sport their Meirs-Briggs label on their desk, lapel pin, or calling card. I can't figure out why they just don't have the damn thing tatooed on their forehead. I know only one person with whom I served over my entire career that even claims to have PTSD and he was 4/10ths wacko at birth. When I was laid up in the VA and they finally let me wander the halls in my wheelchair I used to find some of these "shells of former humanity" sitting around telling of the horrendous experiences that they had. One was talking about a small place in II Corps where he was shelled day and night until the compound was overrun. Come to find out he was talking about my A-Camp at Ben Het at the time I was there-he had the shelling right but everything else wrong. When I introduced my self as the A-Team Commander from "this living hell" he lapsed into a mantra and put on a performance worthy of an Oscar. I was his brother, I must also have the same night sweats, flashbacks, and ghosts because I have washed these events from my psyche, etc, etc, etc. Come to find out, he never was in Vietnam but on a ship off the coast in the Navy. Now I am not saying that some folks haven't been affected by their experiences but from my limited experience what I have been seeing is a feeling of guilt which has them living their experiences vicariously to cover their own personal shortcomings.

Jack Moroney-the insensitive

[CPTAUSRET]

Actually, That's why I posted this article.

I know of very few individuals whom I believe are really PTSD disabled, I think a great many are using it as a crutch...Which eats up monies the VA could better use to help those truly in need.

Nancy's original definition is pretty specific re what qualifies, and what does not.

[CPTAUSRET]

Acute and Delayed Posttraumatic Stress Disorders: A History and Some Issues

Nancy C. Andreasen
This issue of the Journal features stress disorders as its theme. The study of the psychological and emotional consequences of stress has become a burgeoning and important field in psychiatric research and treatment. In fact, the diagnoses of posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) are now so frequently made that one wonders how we once got by without them.

The stress syndromes that we refer to as PTSD and ASD have a very long descriptive history. In general, their early history was closely linked to the experiences that soldiers suffered in combat. Before a diagnosis existed, many features of the syndrome were well-described in literary form in The Red Badge of Courage. The terrible carnage of trench warfare during World War I led many young men to return home deeply traumatized, and this led in turn to systematic descriptions of the syndrome under names such as "shell shock" or "combat fatigue." World War II was, however, the catalytic event that led to the creation of a formal diagnostic category to refer to this syndrome: Gross Stress Reaction. World War II for the first time brought together soldiers, psychiatrists, and other medical personnel from all over the country, giving them an opportunity to discover the many things that they had in common and also to recognize the ways that they differed. Socially, our great melting pot received yet another incentive to continue to melt—and to meld together all the diverse components of our society. (The World War II musical, Oklahoma, celebrated this fact—watch it again some time in the context of our current world situation.) On the medical and psychiatric scene people discovered that they did not always share a common vocabulary with which to discuss the syndromes and diagnoses observed in their patients.

After the war ended, the Veterans Administration (VA) developed a diagnostic manual, which provided the incentive for the APA to create its own first manual: DSM-I. The manual was very concise, but it included a diagnosis that covered victims of stress: Gross Stress Reaction. During that post-war era and after, psychiatrists also began systematic investigations of the consequences of exposure to death camps and the POW experience, as well as nonmilitary stressors, such as mass catastrophes—fires, earthquakes, or plane crashes (1). However, for reasons that remain obscure but that perhaps reflect the early links between military combat and the diagnosis of stress disorders, Gross Stress Reaction was somehow dropped from DSM-II. That manual was written when our country was not engaged in any major war. However, the scientific study of the consequences of stress continued. In fact, your editor began her early research career by studying the consequences of severe burn injuries in the pre-DSM-III era—identifying symptoms, risk factors for poor outcome, and the prevalence of severe psychiatric consequences (2–5).

DSM-III was crafted in the post-Vietnam era, a time when our country contained yet another wave of young men who had been exposed to the trauma of combat. VA and military psychiatrists had no official diagnosis to give them, as long as DSM-II was the official diagnostic manual. As a member of the DSM-III Task Force, I was assigned to this problem. An active group of advocates were lobbying for the inclusion of a diagnosis of "Post-Vietnam syndrome." The purpose and the concept were correct, but the name and the specificity were not. I pointed out the long history of the syndrome, as well as the fact that it frequently occurred in traumatized civilians as well. A stress syndrome characterized by reliving, indicators of autonomic overarousal, and other such features was simply a final common pathway with many different sites of entry. We worked together to agree on diagnostic criteria, which were rooted in the extensive literature on stress disorders already available at that time, and christened our 100-year-old offspring Post-traumatic Stress Disorder. I wrote the entire text description of the syndrome, which was based on my experience caring for burn patients and the substantial literature available at the time. My burn patients had almost universally experienced this syndrome immediately after their injuries. So we designated an acute form of PTSD. However, many soldiers do not develop stress symptoms until they return home, since a stress reaction in the midst of combat is not adaptive, and so the impact of their traumatic experiences is delayed. Therefore, we also identified a delayed form.

The concept of PTSD took off like a rocket, and in ways that had not initially been anticipated. The DSM-III text struggled with many issues: how severe should the trauma be? What types of trauma could be considered causative? Does it make a difference if the trauma is inflicted by another human being, by an accident, or by a natural disaster? What impact does duration of the stressor have? What impact does premorbid psychiatric status have? And so on. PTSD is a complex concept. The DSM-III formulation emphasized that the stressor should be significant—outside the range of normal human experience. It assumed, but did not explicitly state, that there would be a temporally close juxtaposition between the stressor and the development of symptoms.

Many psychiatrists liked the DSM-III formulation and began to use the diagnosis widely. Its application broadened steadily. For example, it was used for victims of childhood sexual abuse who developed traumatic stress symptoms much later. Dissociation, a component of the original definition but not its core, received increasing emphasis. And the requirement that the stressor be outside the range of normal human experience was sometimes reinterpreted to include less severe stressors. In fact, that stringent requirement was dropped in DSM-III-R and DSM-IV, providing a much broader concept than was originally intended. (In my view, this broadening should be reconsidered. Giving the same diagnosis to death camp survivors and someone who has been in a motor vehicle accident diminishes the magnitude of the stressor and the significance of PTSD.) Acute PTSD, dropped from DSM-III-R, was fortunately added back in DSM-IV with a new name: Acute Stress Disorder.

This issue includes several articles on various forms of PTSD. The literature on this diagnosis is now vast. It goes far beyond the descriptive psychopathology upon which the original DSM-III definition was based. We now have a multitude of papers covering topics such as neural mechanisms as revealed in imaging studies, risk factors, prevalence, comorbidity, symptom patterns, and outcome. The study of PTSD has enriched our conceptualization of memory in both its conscious and unconscious forms. The task of summarizing all this literature—and producing a DSM-V description and definition—will be challenging. Not all the studies converge on the same conclusions.

Why?

A clue is provided by the articles in this issue. Although the final common pathway (in the psychological and physical/autonomic sense) is the same, there are many different kinds of stressors. As detailed by Verger et al., experiencing a terrorist bombing in a metro—a man-made and unanticipated disaster that produced concomitant physical injuries, facial deformities, and the psychological terror that was intended—is indeed something outside "the normal human range." A PTSD prevalence rate of 31% was observed approximately 2.6 years after the event. If anything, this seems surprisingly low, but the assessments were done via phone interview and could be an underestimate. A companion paper by Fullerton et al. examines both ASD and PTSD in disaster workers at the site of a plane crash. Their stressors are quite different. A plane crash is an accident, and therefore has a different impact than man-made malevolence. Disaster workers have chosen their occupation with foreknowledge of its risks. To say this is not to diminish the enormous value of their work. But the psychological impact is different. And, not surprisingly, the prevalence of PTSD at a 13-month assessment was lower than in the terrorism victims: 16.7%. The studies examine different predictors of outcome and produce different results. These articles are but two examples of the many difficulties in conceptualizing the essence of PTSD and its consequences. A third article by O’Donnell et al. examines the thorny issue of comorbid depression. (The original concept of Gross Stress Reaction specified that it must occur in an otherwise normal individual—which was probably wrong, since stressors do not preferentially occur in normal individuals, and those with other disorders may have fewer adaptive resources remaining.)

As the psychiatrist who was also midwife at the birth of PTSD, I have followed its growth and maturation with great interest. Others have parented it, and generally well. It is of particular interest in the 21st century, when the entire world is filled with the spectre of terrorism—a stressor of great magnitude that can strike any time and anywhere. This is also a time when we again will have many young soldiers returning from yet another war: the treacherous combat experience in Iraq and Afghanistan. Unfortunately, the present world situation is likely to give us many more opportunities to study ASD and PTSD. For this I have regrets, but I am pleased that I helped create a diagnostic category and conceptual framework for this important syndrome, so that its causes and consequences can be examined both clinically and scientifically.

[Jack Moroney (RIP)]

Actually, That's why I posted this article.

.

Well, glad to know that. I often feel like I am way out in left field about this topic. The VA sometimes is their own worst enemy when it comes to this and seems to want to bend over backwards to sift thru the population that they serve to discover any new candidate for PTSD. It certainly seems to be the case up here because White River Junction is the VA center for PTSD. At one point they actually sent me an invitatin to come in and be interviewed to make sure I wasn't "suffering" from PTSD based on a comment I made to an intern who was a 3rd year medical student from Dartmouth Hitchcock Medical Center who was working a rotation thru the VA. I had had a little surgery and was in to have about 40 staples removed from my abdomen and the VA doc was going to let the student remove them. The kid was a little nervous about jerking the staples out so I tried to put his mind at ease by telling him his ability to complete his fourth year in med school was going to be predicated on how much pain he was going to inflict during this staple removal. He turned pale and asked if I wanted a local pain killer and I said I had had sutures removed by tribal witch doctors in a lot worse conditions than this. Then explained I was really talking about the fact that he was about to stick himself with a syringe he had just placed in his pocket without the needle cap on it. Now some how they equated this with some minor abberation in my psyche and thought perhaps I needed to talk with one of their PTSD screeners.

[CPTAUSRET]

COL:

I do not recall the last time I have disagreed with anything you have espoused.

Terry

[Jack Moroney (RIP)]

COL:

I do not recall the last time I have disagreed with anything you have espoused.

Terry


Now that is scarey:D

[CPTAUSRET]

Now that is scarey:D


Nancy would agree with you!

Just sent you a PM.

Terry

[The Reaper]

Just saw the daughter of an alleged VN vet on TV last night claiming that she caught PTSD from her poor father.

My initial reaction was, "You have got to be shitting me."

TR

[CPTAUSRET]

Just saw the daughter of an alleged VN vet on TV last night claiming that she caught PTSD from her poor father.

My initial reaction was, "You have got to be shitting me."

TR

That is the problem...You want the guys who need help to receive it, but it has become a large umbrella, and too many are using it!

Terry