Conflict of Interest

This morning on NPR they aired a comment by an Army physician, "The Army has a system in place which required questions be asked, but no action be taken." He was told people he'd seen PTSD in were "faking it" to go home or get out of the Army. In my opinion, this is because there is a conflict of interest between the goals of the Army, to train people to fight and keep fighting no matter what, and the health of individuals.
The questions are asked about PTSD symptoms so the Army can say they want to prevent or are preventing PTSD, but the fact that there is no requirement for action means that the service member can't trust that if he or she speaks up, help will follow. "Betrayal of what's right," as Jonathan Shay, MD, called it in Achilles in Vietnam, is one of the significant contributors to PTSD. It makes a mockery of the sacrifices of soldiers.
At the International Society for Traumatic Stress Studies conference a couple of years ago, I saw a presentation by doctors from Walter Reed who were dealing with the PTSD ward. One young, rich, stupid, innocent-of-the-realities-of-war MD told us they were diagnosing personality disorders because some of these guys had been in trouble as adolescents, so it couldn’t have been the war…
This of course is utter bullsomething. The fact that they may have been in trouble before the war may mean they had childhood PTSD, and PTSD gets retriggered by further trauma, but they were functioning well enough to get into the military and go to war, and that means their problems are related to their service. The conflict of interest is that, if they have personality disorders, it is a pre-existing condition and they get bad discharges and no VA benefits. This is wrong. Even a personality disorder can be made worse by war.
There is also a conflict of interest in the VA. Limited resources means that there is pressure not to find PTSD. I know several MD’s who no longer do psychiatric exams for the VA because they were pressured not to find PTSD and could not honestly keep working there when their diagnoses were ignored by the compensation officers.
There is also unforgivable and contemptible professional ignorance. Two recent cases at the Gainesville, FL VA: A young woman psychiatrist says to a vet, “I see you were originally diagnosed with anxiety,” The wife says “Look at the date, 1968,” and the shrink replies, “What difference does that make?” “Well, there was no such diagnosis in 1968…” Even though she is doing compensation exams at the VA, she is completely unaware of the history of PTSD, especially the fact that in 1968, the American Psychiatric Association decided with NO EVIDENCE that the diagnosis of “Gross Stress Reaction” (if you have been through a gross, i.e. big, enough stressful situation like combat or a concentration camp, it can affect you!) was discarded and replaced with “transient situational disturbance,” which meant that if any trauma affected you for more than 6 months you had a pre-existing condition, and the trauma hadn’t caused your problems. No one has ever taken responsibility for this lethal decision. The other case was a woman psychiatrist in the course of a compensation exam, saying to a veteran of Hamburger Hill, “I saw the movie. It can’t have been as bad as the movie.” This ended his ability to speak, as well as indicating an unbelievable inability on the part of the psychiatrist to think or empathize: IT IS WORSE WHEN IT’S REAL.
Then there is the lack of resources for PTSD treatment. These are part of the actual costs of war, but no one but veterans and their families want them paid.
Tomorrow I will talk more about treatment, but right now I am so mad I have to get off the computer and go calm down.